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.
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.
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.
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.
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.
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
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.
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.
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.
When I run the report I see the following at the top of the report
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.
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?
It looks like the charge is twice as much as the other encounters with the same code.
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.
