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 Post subject: Problem with BC BS of SC
PostPosted: Mon Mar 20, 2017 8:28 am 
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I am trying to submit directly to BC BS of SC (I submitted years ago without a problem). The issue is this. Per their specs, they want 00 in the ISA03 field but they want the ISA04 blank.

However, with using the Outbound MS 19 5010 Claims - Standard Guide, the guide is placing my TP number in the ISA04 segment, even though I have the ISA04 field empty when configuring the receiving in RM. This is clearly a flaw with the Guide.

I am not sure if the guide has to be revised with some SQL language that if ISA04 is blank, then the ISA04 should be blank.

Also, the file rejected on a TA1 (not a 999), but when running reports in RM it could not read the TA1 report for some reason.

Thanks,
Steve

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Steven Zats
Medical Billing Professionals


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PostPosted: Mon Mar 20, 2017 8:57 am 
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Location: Springfield, MO
Hi Steve, in Revenue Management, edit the receiver record you setup for BC of SC. Click the Header Info field. Enter 00 in the ISA03 field and make sure the ISA04 field is blank.

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Gavin Walker
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PostPosted: Mon Mar 20, 2017 9:43 am 
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I do have the ISA04 field blank (and 00 in ISA03) but still my TP ID is coming through in the ISA04 field. That leads me to believe the IGuide is flawed and needs to be corrected.

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Steven Zats
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PostPosted: Mon Mar 20, 2017 1:54 pm 
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In the Receiver Name, do you have RELAYHEALTH? If so, change it to something else like BC of SC.


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PostPosted: Mon Mar 20, 2017 1:57 pm 
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No, it is not RelayHealth. The Receiver Name is Blue Cross Blue Shield.

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Steven Zats
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PostPosted: Mon Mar 20, 2017 2:42 pm 
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Below is the info from the IGuide. I definitely do not have RELAYHEALTH as the Receiver Name so not sure what is wrong with the below.

If not string.isnullorempty( :Header_Receiver_InterchangeAuthorization ) then
Result = :Header_Receiver_InterchangeAuthorization
Else
If LEFT(UCASE( REPLACE(:Header_Receiver_Name, CHR(32),"")),11) = "RELAYHEALTH" Then
Result = "CYCTRANS"
End IF
End If

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Steven Zats
Medical Billing Professionals


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PostPosted: Tue Mar 21, 2017 9:54 am 
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Hey, Gavin:

Just checking back to see if there can be a fix for this problem with the ISA04. It appears there is a flaw with the logic for the standard 5010 guide.

Thanks,
Steve

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Steven Zats
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PostPosted: Tue Mar 21, 2017 10:44 am 
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Location: Springfield, MO
You are using the iGuide labeled Outbound Claims (837P MS19 5010 Claims - Standard) right?

I can't duplicate your issue. I entered 00 in ISA03 and left ISA04 blank.

When I generate claims and go to Tech View and click the Raw Text tab, this is what I get on the ISA segment:

ISA*00* *00* *ZZ*2XHT*ZZ*

What are you getting?


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PostPosted: Tue Mar 21, 2017 10:51 am 
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Yes, that is the guide I am using. See attached screenshot and you see that the ISA04 is definitely blank. Is it possible that at some point something happened that corrupted the guide? I know a year or so ago your guys made a modification to my guide for some other issue so not sure if maybe that affected anything.

Is there a way for me to take the IGuide you are using and import it and see if it works (that might indicate if something is corrupted with my IGuide--the standard one)?

Otherwise, I guess I can manually delete the ISA04 each time...but do I leave a space in between the 00* and the *ZZ?

Steve


Attachments:
BCBSGuide.png
BCBSGuide.png [ 123.92 KiB | Viewed 1112 times ]

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Steven Zats
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PostPosted: Tue Mar 21, 2017 1:32 pm 
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The ISA fields must have the exact number of spaces that are defined. When you go to Tech View and look at the Raw Text, what are you getting?


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PostPosted: Tue Mar 21, 2017 1:43 pm 
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My TP number is in the ISA04 of the Raw Text, even though I do not have it in the setup for the Receiver. See below for the raw text:

ISA*03*CGW0445PA2*00*CGW0445PA2*ZZ*CGW0445PA2*30*570287419*170321*0241*^*00501*000000001*0*P*:

So, RM is populating the ISA04 field even though I have it blank in the setup for the receiver, which is why I think something might be wrong with the logic in the IGuide.

Steve

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Steven Zats
Medical Billing Professionals


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PostPosted: Wed Mar 22, 2017 8:19 am 
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Hey, Gavin, I think I figured out the problem...The IGuide does not have correct mapping. If you look below at what the Mapping is for ISA04 field for the Standard 5010 guide, it says if the Interchange Authorization field is null or empty to use the Interchange Authorization. But the Interchange Authorization is the ISA02 (which is populated per the payer's specs with my Trading Partner number), which is why my TP # is appearing in the ISA04. What the below SHOULD have is for the InterchangeSecurity, not the Interchange Authorization. And I do not know how to correct the mapping for the guide.

If not string.isnullorempty( :Header_Receiver_InterchangeAuthorization ) then
Result = :Header_Receiver_InterchangeAuthorization
Else
If LEFT(UCASE( REPLACE(:Header_Receiver_Name, CHR(32),"")),11) = "RELAYHEALTH" Then
Result = "CYCTRANS"
End IF
End If

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Steven Zats
Medical Billing Professionals


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PostPosted: Thu Mar 23, 2017 8:23 am 
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Location: Springfield, MO
I see what you mean. My test worked because what I had in ISA02 was also blank. To figure out the correct field name, look under the Data Elements Tab under Header -> Receiver and then you can drag the field over to the mapping area.

This here should be the correction:

If not string.isnullorempty(:Header_Receiver_InterchangeSecurity) then
Result = :Header_Receiver_InterchangeSecurity
Else
If LEFT(UCASE( REPLACE(:Header_Receiver_Name, CHR(32),"")),11) = "RELAYHEALTH" Then
Result = "CYCTRANS"
End IF
End If

Keep in mind, the next time eMDs pushes a new mapping for the Standard iGuide, your changes will be wiped unless you copy off the iGuide under a new name.


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PostPosted: Thu Mar 23, 2017 9:06 am 
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Thanks...I fixed the guide...Can you let eMDs know so they can fix the Guide for future releases (and I understand that in the meantime I either have to fix the guide when I upgrade to V21).

Steve

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Steven Zats
Medical Billing Professionals


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PostPosted: Thu Mar 23, 2017 3:16 pm 
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Location: Springfield, MO
eMDs wrote up defect #195385 on this one. Since this doesn't affect any clearinghouse they officially support, this is definitely going to be a low priority defect. I am trying to get this in on the next major revision to the iGuides. We'll see.


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