Medicare "No Claims." Office...

2012-10-24
2013-04-06
  • Sarah Roach

    Sarah Roach - 2012-10-24

    Hello,

    I'm currently learning how to submit X12's to Office Ally. All the claims are going through except for Medicare. Every Medicare claim I send comes up with a "No Claims" status. I'm not sure what this means. I've compared OpenEMR's CMS 1500  to my client's old system's form the only 2 boxes of information that are different are:  23 (it's blank instead of containing the CLIA) and the group number has moved from box 33b to 32b.

    I'd appreciate any insight or instruction. Thanks!

    S_Roach

     
  • CVerk

    CVerk - 2012-10-25

    Like all things involving the government, you probably have to do all the paperwork first. Under office ally resource center/payer enrollment forms for your state you probably have to submit that stuff before medicare claims will fly. They also take their sweet time processing them, because if a medicare carrier gets to be efficient, they usually get replaced. I also don't think medicare pays officeally for claims processing, so they do them just to get your other claims business. But that also means they aren't going to take care of that paperwork stuff for you like they obviously do for private insurance.

     
  • Nerik Cavalier

    Nerik Cavalier - 2012-10-27

    You need to contact OfficeAly customer support for mapping your medicare claims, and send claims  by Text file not X12

     
  • CVerk

    CVerk - 2012-10-27

    Office Ally takes X12 fine,and the current version of openemr makes x12 files fine, but you do have to work with customer support to send them some sample files first.  You also have to have all your Medicare paperwork in to and accepted by your Medicare carrier. They can be a pain about the paperwork, at one point sending me a letter addressed to me by name address and medicare number telling me I had to resubmitt all my paperwork because they couldn't locate my address and then again because they didn't have my medicare number, even though both were printed on both letters. Medicare doesn't send back EOB's through Office Ally though, and at least for me, insist on sending them on paper even though they deposit the checks electronically. So now that they have finally gotten this far, they are in the process of changing the Medicare carrier here and in many states starting this whole mess all over.

     
  • Sarah Roach

    Sarah Roach - 2012-10-29

    Problem solved. After reviewing past SourceForage threads I found the problem. I had incomplete fields (PI, N3 & N4) in the X12 code - Medicare is a stickler. I sent off the new txt files to Office Ally with no problem. It was complete oversight by me in the Insurance Companies section of OpenEMR.

    Thank you all for your help and support.

    S_Roach

     

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