I dug into the code to see where the data should be coming from and what I found is this.
// 30. Balance Due
// For secondary payers this reflects primary "contracted rate" adjustments,
// so in general box 30 will not equal box 28 minus box 29.
if (!hcfa_1500_version_02_12()) { // Box 30 Reserved for NUCC Use in 02/12
put_hcfa(56, 71, 8, str_replace('.', ' ', sprintf(
'%8.2f',
$clm_total_charges - $clm_amount_paid - $clm_amount_adjusted
)));
}
These three variables are set to equal 0.
Then I followed $claim->patientPaidAmount(); And this is still zero. @stephenwaite@sjpadgett
Plus I think if a pre-payment hasn’t been applied/posted then it will just carry forward as a patient balance. Also it seems reasonable this is an insurance claim so if a patient payment hasn’t been applied against the insurance balance then will not been reflected in box 29.
That sounds good for the US. But in other parts of the world, the payer would like to see the amount that the patient has paid and it is required to be in that box.
Yes but, how were the payments applied? Were they applied to insurance balances or just applied as a payment against patient balance? I’ll take a look at code for ya and see how that is calculated…That should tell the story.
Seem if posting to Primary then only copay is calculated. I’m having a hard time wrapping my head around this. Is there an item in ar_activity reflecting the payment and if not see if there is anything in payments.
I understand that is why I like talking these things out. If you go in the system and create an encounter and fill out the fee sheet for that encounter and then take a prepayment for the patient. The prepayment does not show in the Payment Record at all because it is not against anything is my guess as to how the system is designed.
This is the ar_session table where the prepayment is held in limbo.
Okay i’m satisfied I know where the problem is but i’m always leery messing with billing code. I need to step through code and figure out best way to bypass posting to Primary for this type of payment(only copay is calc’ed). Code will not touch patient payments unless as a secondary posting. Don’t know why yet.
Now, I have another issue. The screenshots that I posted. The $150.00 payment shows on the hcfa.
This is my demo system where the payment shows on the hcfa. Now I have to go try to figure out where the two systems are different. Production does not work but the dev works. @!@#%^&
UPDATE:
This was a misunderstanding of how the data is populated. If there is no primary insurance the amount prepaid shows up. @stephenwaite could you please step in and help me with getting this to work for prepayments in the system. Because the change we made below fills this box for everyone and caused a lot of problems. I humbly ask.
Apparently you can’t post a patient payment against Primary payer. Only copay.
re: Best I clarify. It looks like it is not expected that a patient payment would be made against Primary except copay.
Start here for the code that is offending you:)
L124 if ($this->payerSequence() != ‘P’) {
of library/billing/src/Claim.php
There are several conditionals testing if payor is Primary before patient payments are returned. Evidently Billing expects patient payments against secondary payor’s rather than Primary.
A thought may be to add a flag(Global) to the conditional to allow all patient payments to be summed and reported. This worked for me however, some due diligence should be paid to if this may blow up later in billing. My first inkling is no.
if ($this->payerSequence() != ‘P’ || $GLOBALS[‘allow_this’]) {
