Saving X12 claims?

[Daniel Fielder]

I'm with a software developer who has a customer using the OpenDental software for their dental practice. We're looking at sending claims directly to TMHP (Texas Medicaid & Healthcare Partnership) - they accept the X12 format. Is there any way to print the claims to a local file on the PC in the X12 format, or does OpenDental only generate the X12 format when sending e-claims? This may be a silly question, since we're just learning about the software, but hopefully someone can either answer it or give me tips on what kind of questions I should actually be asking.

[jordansparks]

Yes, very easy. Add a clearinghouse
http://www.opendental.com/manual/clearinghouses.html
When setting up the clearinghouse, you will specify the folder where the X12 files are to be created. Then, other software can automatically grab the files, upload them, and delete them. Or, the user can do this manually if uploading through some sort of web interface.

Now there may be more than one clearinghouse. If you just want the TMHP claims to go to one folder (clearinghouse), and all the regular claims to go to a different clearinghouse, then leave the other one set as the default. In the new TMHP clearinghouse that you created, specify the Payor ID in the box at the bottom. That will cause all claims with that payor id to automatically go to TMHP.

[Daniel Fielder]

Awesome, thanks - this sounds exactly like what we were looking for.

[Daniel Fielder]

I'm trying to validate the X-12 format that OD outputs against the Texas Medicare & Healthcare Partnership (TMHP) - I've got it mostly working, except for the error at the end of this message. The referenced section is this:

REF*0B*TX12345~ (this is what I have as the provider's state license #)
REF*1D*1234567~ (this is what I have as the Medicaid ID)
REF*SY*123456789~ (this is what I have as the provider SSN)

TMHP doesn't like the "OB", which is the line that contains the provider's state license number. That is what the error text below refers to. Any ideas what would be causing this? Is the OB value hard-coded somewhere? I tried not including the state license # in the provider definition with OD to see if that would prevent this line from being included, but if I do that then OD complains when I try to send the claim, saying that that number needs to be filled in.

Here is what the TMHP says are valid codes for the REF lines:

1D - Medicaid provider number (OD does this correctly)
EI - employer's identification #
SY - social security # (OD does this as well)

So, it sounds like TMHP doesn't need the state license # - how do we exclude that from the X-12 claim that gets written out?

REF segment could not be validated due to unrecognized data being used in element REF01. The valid codes for this element are: 1D, EI, SY, 06, 8U, EM, IJ, LU, RB, ST, TT. The last known Segment was N4 at guideline position 030. This error was detected at: Segment Count: 14 Characters: 420 through 434 REF*0B*TX12117 1 Normal
2 Element REF01 (Reference Identification Qualifier) does not contain a valid identification code: '0B' is not allowed. Segment REF is defined in the guideline at position 271. This error was detected at: Segment Count: 30 Element Count: 1 Characters: 790 through 792