X12 generator failing with Availity?

Not sure if this is the right place to post, but I figure billers might look here…

Originally the OpenEMR was v 6.0 (3) but has been upgraded to 6.1.0-dev. With the the ‘Generate X-12 Based On Insurance Company’ (AKA, ‘Direct to insco’) was turned off we had some fails in the x-12 generator where it would say the x12 claim had data missing when the data was in fact present in the pt record and the x12 file. And with the Direct to Insco turned on, claims were accepted by Availity but never made it to the payers, for unknown reasons. Now with openemr 6.1 and ‘Direct to insco’ on, the x12 files are missing whole segments, such as payer name. Turned it off and the error logs complain of errors that are not actually present in the claim file.

I realize this is pretty random sounding. I suppose I’m asking if others have had problems with ‘Direct to insco’ creating inaccurate error reports or bad x12 files, either in OpenEMR 6.0 or 6.1-dev?

Hi @htuck, if claims are accepted by a clearinghouse then the clearinghouse will report on the payer rejections.

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Thanks for the advice-- yes, usually they do. Come to find out after even more dev- digging, in this case it was some code mutations prevented x12 files from being written correctly.

We are now getting login error when submitting claims through Availity. Not sure if this has to do with the x12 files, but claims are still not going through.

14 posts were split to a new topic: Claimrev clearinghouse