Undistrbuted funds after uploading an ERA


(Daniel) #1

I am currently researching the reasons for consistent undistributed funds after uploading an ERA to OpenEMR. It seems that smaller files generally don’t leave funds undistributed but when a large ERA file is uploaded the payer shows the adjustments but when loaded to OpenEMR adjustments aren’t reflected.

After going through the code I found some depreciated code using sqlQ() in the sl_eob_process.php file on 3 lines.


My customer is using OpenEMR500 but after checking openEMR501 I see the same mistakes. Since this code is depreciated and most folks are using PHP7.0 and above, could this code be the root of some of the issues?

If someone has some general insight the the causes of undistributed funds, that would be great.


(Daniel) #2

Right now I am looking at the edi file viewer and searching the edit payment screen to see if maybe they differ or if the ERA has extra characters that the file ignores.


(Stephen Waite) #3

are you posting the ERA through Fees->Posting?


(Daniel) #4

They are posting by Fees-> Batch Payments, then selecting ERA Posting

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(Stephen Waite) #5

ok, pretty sure that points to the same script, if you could post an example of what adjustments are missing and the slice of the 835 that contains those adjustments that aren’t getting posted it would help.


(albanyeye) #6

I have the same issue with undistributed funds but the funds are actually distributed an the patients accounts are in balance.
Are your balance out of whack?
Maybe I need to scrutinize more.


(Daniel) #7

When I was searching for the Edi file I did a grep to find the check number. I uploaded the EDI file to the viewer:

Upon further inspection it looks like there are two encounters associated with this payment, but when I look at the Edit payment screen I only see one.

The other caveat is that both encounters have the same exact charges since they have the exact same CPT code.

One of the patients shows a balance of zero for this encounter and one of the patients shows they owe $20 for this encounter.

but…

image

The other thing that has been happening is the adjustments are reported by the insurance company but the adjustments aren’t being uploaded to OpenEMR.


(Stephen Waite) #8

if the ins co puts a modifier on a charge that wasn’t in the outgoing file it will cause problems, this can happen with the 51 modifier for multiple surgeries for example


(Daniel) #9

I’ll look for modifiers. Is there a reason why the insurance company would add a modifier?


(Stephen Waite) #10

so they can process the 2nd procedure at half the price :slight_smile:


(Daniel) #11

Is the solution to strip the modifier from the ERA then?


(Kevin Mc Cormick) #13

Check whether there is a “PLB” segment in the ERA file. This is a provider level balance and is where penalties and adjustments are reported at the provider level. As I recall, the ERA payment script did not handle that field, leaving an unresolved ERA balance. Another thing to try is to check the “Report” button on the EDI History | EDI File tab. I believe the script that creates the report checks whether the ERA is in balance and indicates that in the first few lines. There will be more detail in the “report” because this is a formatting of the EDI file in more human readable form. I personally would advise against modifying the EDI file. The code should correctly read the file and interpret everything there. If not, then perhaps the file format has changed and updates are needed.


(Stephen Waite) #14

thanks for the info @kevmccor, noticed this in the report
Balanced: Fee 150 Pmt 58.97 ClpAdj 0 SvcAdj 66.03 PtRsp 25 (svcPtRsp 25) PlbAdj 0 indicating that this EDI file was balanced and did not contain a PLB.


(Daniel) #15

I’m showing that there is a balance of zero, unless I am misreading the file:

I took one of the charges that were displaying as Undistributed. I chose one file that only had two claims because I thought it would be easier to troubleshoot.

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When I run the report I see the following at the top of the report

270 - pmt - svcAdj - ptRsp = 0

Is it possible that the error isn’t in how the ERA is being processed but how the report is presenting the information?


(Daniel) #16

Here is a screenshot of the ar_session with some of the private checknumbers blanked out

There seems to be one encounter that was listed on 2 ERA’s, but one of the ERA’s had a rejection code. So it looks like it was sent again and accepted by the clearing house / insurance company.


(Stephen Waite) #17

it looks like the same ERA was in the EDI file 3 times for encounter 170690 which makes the Unapplied line look reasonable


(Daniel) #18

I’m only seeing one ERA in the one EDI. Can you explain a little more about what you mean?


(Stephen Waite) #19

for that encounter and pid 8015, it looks like there are three entries for the same check dated 1-24 with the same post time


(Daniel) #20

Maybe there is something I am missing. Where is the adj_amount fitting into the picture? It looks like when a payment is posted it is logged as three different transactions. I’m trying to see how the Undistributed is getting summed to 41.80. How is this behavior differing from the other payments?

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It looks like the charge is twice as much as the other encounters with the same code.


(Daniel) #21

The other thing i’m wondering is why one payment for a patient says 41.80 and the other patient it says 83.60 even though its for the same CPT code and from the same insurance company.