phongtrang wrote on Monday, January 23, 2012:
Hello all,
We use openemr 4.1 with all the patches install. However, our test X12 is rejected by the clearing house as below:
1. Facility is 00
2. the pay-to address is the same as the billing address
Need help figuring out how to address the above issues.
Thank you in advance.
hadrins wrote on Tuesday, January 24, 2012:
That sounds like a Clearing house rejection and not so much a openemr error. I would check with the clearing house and see why a Facility 00 would be reject. Maybe they are expecting a 1 or 01. Also, I would ask why the addresses can’t match. Keep in mind that with the new 5010 ruling you have to use an address and not a P.O. BOX. Also the zip must be the zip+4.
Depending on the clearing house you may have a portal to log into and see the errors and have a chance to change them and retest. That is always a good place to start.
aethelwulffe wrote on Tuesday, January 24, 2012:
Actually, it sounds like an OpenEMR issue…primarily a set-up and configuration issue.
1. Do you have facilities set up? Do those facilities have Place of Service codes assigned to them? Looks like they do not. Either that, or you did not select a facility in the encounter form.
Next, the pay to address is the same as the billing address because both are blank…in all likelyhood.
You must set up the insurance company properly and put in the insurance companies address. You must also set up your facilities, like “Office, POS code 11”, and the address of that facility (likeyour office). He is right that YOUR address (Facility address) must not be a po box. You must also enter your zip code as nine digits, but it must be like 123456789 or 12345-6789, and not a + etc… Best just to leave the hyphen out, as the code looks to strip out hyphens (specifically) and does not simply strip out all non-numeric characters.
You must also pick the facility that is the billing (pay-to) facility, and indicate that in the set-up (“this is a billing facility”)
You must also properly select the facillity and billing facility in the encounter form when creating the billing. You might only have one facility (such as Office) and it is used for both, and you never have to worry about this….but most folks have at least two (Office: 11, Hospital: 21).
aethelwulffe wrote on Tuesday, January 24, 2012:
BTW, 00 is not a valid POS code.
You can find a fairly comprehensive (but NOT complete!) list here:
http://www.findacode.com/cms1500-claim-form/cms1500-place-of-service-codes.html
hadrins wrote on Tuesday, January 24, 2012:
Sorry, you did a lot better explaining that than me. Just that I would have started with the clearing house and worked back to the software setups. And I agree with you on the zip code.
Thanks Love that website.
phongtrang wrote on Wednesday, January 25, 2012:
Thank you all for your help. I had to select version 510 for X12 configuration. Using latest patch 6 for vesion 4.1 to have it working properly. The X12 now is passing.
I notice the CMS ID field in Insurance. Don’t know what I should put there. We leave them blank and it seems we don’t have any issue. The youtube setup facility told me I have to get it from Clearing House, but when we ask, they don’t know what that number suppose to be.
In any case, I think my original problem is solved. Will have to submit a real claim to find out.
voipbound wrote on Wednesday, January 25, 2012:
I updated to 4.1 v6 and use Office Ally. My x12 is not passing. My set up is similar to yours and I finally placed the last 4 numbers to my zip without the dash. I got several errors.
1. ISA16 Component Element Separator is > (greater) but : (colon) used
2. GS Segment Not Found but GS segment is definitely there. I discovered that maybe one of my Tax ID wasn’t repeated after the first one. Once, I manually put it in, I got the above error.
It’s been a month since I updated an haven’t been able to bill, please help
voipbound wrote on Wednesday, January 25, 2012:
3. for some reason after I upgraded, I getting 30 instead of ZZ and I can’t find out why. Can you post on your gen_x12 file so I can compare. I pretty downloaded the latest one from Git but am still having the problem
gutiersa wrote on Wednesday, January 25, 2012:
I had a problem in the past also with office ally and generating x12 files.
See this thread, but ignore code changes, none are required:
https://sourceforge.net/projects/openemr/forums/forum/202505/topic/4832396
the following need to be configured in Admin->practice->x12 Parners->OfficeAlly:
(if office ally is not in the list, it needs to be added)
My officeally info looks like this:
Partner Name Office Ally
ID Number (ETIN) 330897513 Office Ally Tax ID number
Receiver ID Qualifier (ISA07) Mutually Defined
Receiver ID (ISA08) 330897513
Sender ID Qualifier (ISA05) Mutually Defined
Sender ID (ISA06) XXXXXXXXX this is my tax id number
Acknowledgment Requested (ISA14) Yes or no, it works either way for me. Office ally sends acknowledgments anyway
Usage Indicator (ISA15) Production
Application Sender Code (GS02) ZZ
Submitter EDI Access Number (PER06) ZZ
Version 004010X098A1 or 005010X222A1 (it does not matter with office ally. All 4010 claims they receive get automatically converted to 5010.
Processing Format Standard
Openemr pretty much does everything else for you (well at least for me).
My problem back then was actually an upgrade error.
At some point in the database upgrades the x12 partners table was altered by adding additional fields. That particular upgrade failed in my system (due to mysql table type issues and the like). I kept trying to save the information above in openemr, but after saving the page the fields were still blank. Turns out my database x12 table was missing those new fields. Openemr had no place to save the data to. Be sure your database table is complete and that you see the data above.
CREATE TABLE IF NOT EXISTS `x12_partners` (
`id` int(11) NOT NULL DEFAULT ‘0’,
`name` varchar(255) DEFAULT NULL,
`id_number` varchar(255) DEFAULT NULL,
`x12_sender_id` varchar(255) DEFAULT NULL,
`x12_receiver_id` varchar(255) DEFAULT NULL,
`x12_version` varchar(255) DEFAULT NULL,
`processing_format` enum(‘standard’,‘medi-cal’,‘cms’,‘proxymed’) DEFAULT NULL,
`x12_isa05` char(2) DEFAULT NULL,
`x12_isa07` char(2) DEFAULT NULL,
`x12_isa14` char(1) DEFAULT NULL,
`x12_isa15` char(1) DEFAULT NULL,
`x12_gs02` varchar(15) DEFAULT NULL,
`x12_per06` varchar(80) DEFAULT NULL,
PRIMARY KEY (`id`)
) ENGINE=MyISAM DEFAULT CHARSET=utf8;
Finally as mentioned before, all providers and facilities need to be configured appropriately. NPI’s, Taxonomy, tax id numbers, facility type, 9 digit zipcodes for all facility addresses.
Example if patient seen at hospital, then the hospital has to be entered in openemr as a facility with POS code of 21 (hospital location), with full street address, 9 digit zip code, no hyphens, and an NPI number). The hospital needs to be also assigned to the particular encounter, and of course the billing address is where the payment would be sent to, usually the practice main/business address.
aethelwulffe wrote on Wednesday, January 25, 2012:
phongtrang,
CMS ID is the payer id of the insurance company. Here is the list of identifiers for a nice pile of companies that Availity works with:
http://availity.com/documents/technology_companies_list.pdf
gutiersa:
ETIN is supposed to be YOUR tax ID number, not Office Ally’s or anyone else. This goes to the insurance company or to medciaid or wherever, and that is the number to which payments are reported.
Application Sender code is a name or code that (typically) you pick, or is given to you by the clearing house. As far as I know, it is not typically your ETIN
You can find others.
When you say
gutiersa wrote on Wednesday, January 25, 2012:
My TIN is already used as sender ID, and is found associated with the billing provider (in Admin->users) and the billing/service facility in (admin->facilities).
First two lines of dialog above refer to x12 Partner NAME, and partner TIN.
These are also the instructions I received from office ally on the phone when I first started using them maybe 2 or 3 years ago.
Re:
“Application Sender code is a name or code that…is given to you by the clearing house.”
Yes this was also part of their instructions.
At any rate, the best thing is probably to get on the phone with them and do the set up with a x12 rep.
gutiersa wrote on Wednesday, January 25, 2012:
BTW the cms id number is also found in the back of the patient’s insurance card:
electronic biller ID
NEIC payor id or code
medical payor id
electronic billing id
also found under “send claims to:”
aethelwulffe wrote on Wednesday, January 25, 2012:
You can’t really match up everything in the standard x12 set-up with what the clearinghouse thinks it is.
The x12 partner edit is out of order, poorly worded etc… You generally have to look at the code, figure out what header element translates to what, then ask “what do I put in for GS06?” FAR better is to get the clearinghouse’s 837 companion guide, and READ what the elements are supposed to be.
Find Office Ally’s companion guide HERE:
http://www.officeally.com/files/OA_Companion_Guide_837p_Revised_10152010.pdf
BTW, OpenEMR has an application sender code. It is posted on the forum of OEMR.org