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@@ -1,297 +1,367 @@
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-@if($pro->pro_type === 'ADMIN')
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-<div class="p-3 border-bottom screen-only" data-non-segment-section="Payments">
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- <div>
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- <h2 class="d-inline-block font-weight-bold text-secondary">Payments Received</h2>
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- <div moe class="ml-1 d-inline-block">
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- <a class="text-danger" href="" show start><i class="fa fa-plus"></i> Add payment received</a>
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- <form url="/api/receivedPayment/createForNote">
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- <input type="hidden" name="noteUid" value="{{$note->uid}}">
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Service Code</label>
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- <input type="text" name="serviceCode" placeholder="Service code"
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- class="form-control form-control-sm"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Modifier</label>
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- <input type="text" name="modifier" placeholder="Modifier"
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- class="form-control form-control-sm"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Charged Amount</label>
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- <input type="number" step=".01" name="chargedAmount" placeholder="Charged Amount"
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- class="form-control form-control-sm"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Charged Amount Status</label>
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- <select type="text" name="chargedAmountStatus" placeholder="Charged Amount Status"
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- class="form-control form-control-sm">
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- <option value="NEW">New</option>
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- <option value="PENDING">Pending</option>
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- <option value="SUBMITTED">Submitted</option>
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- </select>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Allowed Amount</label>
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- <input type="number" step=".01" name="allowedAmount" placeholder="Allowed Amount"
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- class="form-control form-control-sm"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Primary Insurance</label>
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- <input type="number" step=".01" name="primaryInsuranceAmount" placeholder="Primary Insurance"
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- class="form-control form-control-sm"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Primary Insurance Payment Status</label>
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- <select type="text" name="primaryAmountStatus" placeholder="Primary Insurance Payment Status"
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- class="form-control form-control-sm">
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- <option value="PAID">Paid</option>
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- <option value="DENIED">Denied</option>
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- <option value="APPEALED">Appealed</option>
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- <option value="REJECTED">Rejected</option>
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- <option value="PAYMENT_RECEIVED">Payment Received</option>
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- <option value="WAIVED">Waived</option>
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- </select>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Secondary Insurance</label>
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- <input type="number" step=".01" name="secondaryInsuranceAmount" placeholder="Secondary Insurance"
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- class="form-control form-control-sm"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Secondary Insurance Payment Status</label>
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- <select type="text" name="secondaryAmountStatus" placeholder="Secondary Insurance Payment Status"
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- class="form-control form-control-sm">
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- <option value="PAID">Paid</option>
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- <option value="DENIED">Denied</option>
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- <option value="APPEALED">Appealed</option>
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- <option value="REJECTED">Rejected</option>
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- <option value="PAYMENT_RECEIVED">Payment Received</option>
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- <option value="WAIVED">Waived</option>
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- </select>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Patient Responsibility</label>
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- <input type="number" step=".01" name="patientResponsibilityAmount" placeholder="Patient Responsibility Amount"
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- class="form-control form-control-sm"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Patient Responsibility Payment Status</label>
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- <select type="text" name="patientResponsibilityAmountStatus" placeholder="Patient Responsibility Payment Status"
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- class="form-control form-control-sm">
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- <option value="PAID">Paid</option>
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- <option value="DENIED">Denied</option>
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- <option value="APPEALED">Appealed</option>
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- <option value="REJECTED">Rejected</option>
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- <option value="PAYMENT_RECEIVED">Payment Received</option>
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- <option value="WAIVED">Waived</option>
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- </select>
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- </div>
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- <div class="mb-0">
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- <button class="btn btn-primary btn-sm" submit>Submit</button>
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- <button class="btn btn-default border btn-sm" cancel>Cancel</button>
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- </div>
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- </form>
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- </div>
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- <div class="d-flex justify-content-center align-items-start">
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- <table class="mr-2 w-75 flex-grow-1 table-bordered table-condensed table-sm table-striped">
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- <thead>
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- <tr>
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- <th>Service Code</th>
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- <th>Charged Amount</th>
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- <th>Allowed Amount</th>
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- <th>Adjustment</th>
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- <th>Primary Insurance</th>
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- <th>Secondary Insurance</th>
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- <th>Patient Responsiblity</th>
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- <th>Balance</th>
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- <th></th>
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- </tr>
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- </thead>
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- <tbody>
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- @foreach($note->receivedPayments as $rp)
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- <tr>
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- <td class="text-secondary">
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- {{$rp->service_code}}({{$rp->modifier}})
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- </td>
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- <td>{{friendly_money($rp->charged_amount)}} ({{$rp->charged_amount_status}})</td>
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- <td>${{friendly_money($rp->allowed_amount)}}</td>
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- <td>${{friendly_money($rp->adjustment)}}</td>
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- <td>{{friendly_money($rp->primary_insurance_amount)}} ({{$rp->primary_amount_status}})</td>
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- <td>{{friendly_money($rp->secondary_insurance_amount)}} ({{$rp->secondary_amount_status}})</td>
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- <td>{{friendly_money($rp->patient_responsibility_amount)}} ({{$rp->patient_responsibility_amount_status}})</td>
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- <td>{{friendly_money($rp->balance)}}</td>
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- <td>
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- @if($rp->is_active)
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- <i class="fa fa-check"></i>
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- <div moe class="ml-1 d-inline-block">
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- <a class="text-danger" href="" show start> Deactivate</a>
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- <form url="/api/receivedPayment/deactivate">
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- <input type="hidden" name="uid" value="{{$rp->uid}}">
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Memo</label>
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- <textarea type="text" name="memo" placeholder="Source memo"
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- class="form-control form-control-sm"></textarea>
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- </div>
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- <div class="mb-0">
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- <button class="btn btn-primary btn-sm" submit>Submit</button>
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- <button class="btn btn-default border btn-sm" cancel>Cancel</button>
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- </div>
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- </form>
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- </div>
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-
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- <i class="fa fa-check"></i>
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- <div moe class="ml-1 d-inline-block">
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- <a class="text-danger" href="" show start> Update</a>
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- <form url="/api/receivedPayment/deactivate">
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- <input type="hidden" name="uid" value="{{$rp->uid}}">
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Service Code</label>
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- <input type="text" name="serviceCode" placeholder="Service code"
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- class="form-control form-control-sm" value="{{$rp->service_code}}"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Modifier</label>
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- <input type="text" name="modifier" placeholder="Modifier"
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- class="form-control form-control-sm" value="{{$rp->modifier}}"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Charged Amount</label>
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- <input type="number" step=".01" name="chargedAmount" placeholder="Charged Amount"
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- class="form-control form-control-sm" value="{{$rp->charged_amount}}"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Charged Amount Status</label>
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- <select type="text" name="chargedAmountStatus" placeholder="Charged Amount Status"
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- class="form-control form-control-sm">
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- <option {{$rp->charged_amount_status == 'NEW'? 'checked':'' }} value="NEW">New</option>
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- <option {{$rp->charged_amount_status == 'PENDING'? 'checked':'' }} value="PENDING">Pending</option>
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- <option {{$rp->charged_amount_status == 'SUBMITTED'? 'checked':'' }} value="SUBMITTED">Submitted</option>
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- </select>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Allowed Amount</label>
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- <input type="number" step=".01" name="allowedAmount" placeholder="Allowed Amount"
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- class="form-control form-control-sm" value="{{$rp->allowed_amount}}"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Primary Insurance</label>
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- <input type="number" step=".01" name="primaryInsuranceAmount" placeholder="Primary Insurance"
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- class="form-control form-control-sm" value="{{$rp->primary_insurance_amount}}"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Primary Insurance Payment Status</label>
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- <select type="text" name="primaryAmountStatus" placeholder="Primary Insurance Payment Status"
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- class="form-control form-control-sm">
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- <option {{$rp->primary_amount_status == 'PAID'? 'checked' : ''}} value="PAID">Paid</option>
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- <option {{$rp->primary_amount_status == 'DENIED'? 'checked' : ''}} value="DENIED">Denied</option>
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- <option {{$rp->primary_amount_status == 'APPEALED'? 'checked' : ''}} value="APPEALED">Appealed</option>
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- <option {{$rp->primary_amount_status == 'REJECTED'? 'checked' : ''}} value="REJECTED">Rejected</option>
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- <option {{$rp->primary_amount_status == 'PAYMENT_RECEIVED'? 'checked' : ''}} value="PAYMENT_RECEIVED">Payment Received</option>
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- <option {{$rp->primary_amount_status == 'WAIVED'? 'checked' : ''}} value="WAIVED">Waived</option>
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- </select>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Secondary Insurance</label>
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- <input type="number" step=".01" name="secondaryInsuranceAmount" placeholder="Secondary Insurance"
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- class="form-control form-control-sm" value="{{$rp->secondary_insurance_amount}}"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Secondary Insurance Payment Status</label>
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- <select type="text" name="secondaryAmountStatus" placeholder="Secondary Insurance Payment Status"
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- class="form-control form-control-sm">
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- <option {{$rp->secondary_amount_status == 'PAID' ? 'checked': ''}} value="PAID">Paid</option>
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- <option {{$rp->secondary_amount_status == 'DENIED' ? 'checked': ''}} value="DENIED">Denied</option>
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- <option {{$rp->secondary_amount_status == 'APPEALED' ? 'checked': ''}} value="APPEALED">Appealed</option>
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- <option {{$rp->secondary_amount_status == 'REJECTED' ? 'checked': ''}} value="REJECTED">Rejected</option>
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- <option {{$rp->secondary_amount_status == 'PAYMENT_RECEIVED' ? 'checked': ''}} value="PAYMENT_RECEIVED">Payment Received</option>
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- <option {{$rp->secondary_amount_status == 'WAIVED' ? 'checked': ''}} value="WAIVED">Waived</option>
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- </select>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Patient Responsibility</label>
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- <input type="number" step=".01" name="patientResponsibilityAmount" placeholder="Patient Responsibility Amount"
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- class="form-control form-control-sm" value="{{$rp->patient_responsibility_amount}}"></input>
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- </div>
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- <div class="mb-2">
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- <label class="mb-1 text-secondary">Patient Responsibility Payment Status</label>
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- <select type="text" name="patientResponsibilityAmountStatus" placeholder="Patient Responsibility Payment Status"
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- class="form-control form-control-sm">
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- <option {{$rp->patient_responsibility_status == 'PAID' ? 'checked': ''}} value="PAID">Paid</option>
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- <option {{$rp->patient_responsibility_status == 'DENIED' ? 'checked': ''}} value="DENIED">Denied</option>
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- <option {{$rp->patient_responsibility_status == 'APPEALED' ? 'checked': ''}} value="APPEALED">Appealed</option>
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- <option {{$rp->patient_responsibility_status == 'REJECTED' ? 'checked': ''}} value="REJECTED">Rejected</option>
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- <option {{$rp->patient_responsibility_status == 'PAYMENT_RECEIVED' ? 'checked': ''}} value="PAYMENT_RECEIVED">Payment Received</option>
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- <option {{$rp->patient_responsibility_status == 'WAIVED' ? 'checked': ''}} value="WAIVED">Waived</option>
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- </select>
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- </div>
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- <div class="mb-0">
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- <button class="btn btn-primary btn-sm" submit>Submit</button>
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- <button class="btn btn-default border btn-sm" cancel>Cancel</button>
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- </div>
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- </form>
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- </div>
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+@if ($pro->pro_type === 'ADMIN')
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+ <div class="p-3 border-bottom screen-only" data-non-segment-section="Payments">
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+ <div>
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+ <h2 class="d-inline-block font-weight-bold text-secondary">Payments Received</h2>
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+ <div moe class="ml-1 d-inline-block">
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+ <a class="text-danger" href="" show start><i class="fa fa-plus"></i> Add payment received</a>
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+ <form url="/api/receivedPayment/createForNote" style="min-width: 500px;">
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+ <input type="hidden" name="noteUid" value="{{ $note->uid }}">
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+ <div class="row">
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Service Code</label>
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+ <input type="text" name="serviceCode" placeholder="Service code"
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+ class="form-control form-control-sm"></input>
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+ </div>
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Modifier</label>
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+ <input type="text" name="modifier" placeholder="Modifier"
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+ class="form-control form-control-sm"></input>
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+ </div>
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Charged Amount</label>
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+ <input type="number" step=".01" name="chargedAmount" placeholder="Charged Amount"
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+ class="form-control form-control-sm"></input>
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+ </div>
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Charged Amount Status</label>
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+ <select type="text" name="chargedAmountStatus" placeholder="Charged Amount Status"
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+ class="form-control form-control-sm">
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+ <option value="NEW">New</option>
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+ <option value="PENDING">Pending</option>
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+ <option value="SUBMITTED">Submitted</option>
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+ </select>
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+ </div>
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Allowed Amount</label>
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+ <input type="number" step=".01" name="allowedAmount" placeholder="Allowed Amount"
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+ class="form-control form-control-sm"></input>
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+ </div>
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Primary Insurance</label>
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+ <input type="number" step=".01" name="primaryInsuranceAmount"
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+ placeholder="Primary Insurance" class="form-control form-control-sm"></input>
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+ </div>
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Primary Insurance Payment Status</label>
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+ <select type="text" name="primaryAmountStatus"
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+ placeholder="Primary Insurance Payment Status" class="form-control form-control-sm">
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+ <option value="PAID">Paid</option>
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+ <option value="DENIED">Denied</option>
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+ <option value="APPEALED">Appealed</option>
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+ <option value="REJECTED">Rejected</option>
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+ <option value="PAYMENT_RECEIVED">Payment Received</option>
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+ <option value="WAIVED">Waived</option>
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+ </select>
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+ </div>
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Secondary Insurance</label>
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+ <input type="number" step=".01" name="secondaryInsuranceAmount"
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+ placeholder="Secondary Insurance" class="form-control form-control-sm"></input>
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+ </div>
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Secondary Insurance Payment Status</label>
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+ <select type="text" name="secondaryAmountStatus"
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+ placeholder="Secondary Insurance Payment Status" class="form-control form-control-sm">
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+ <option value="PAID">Paid</option>
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+ <option value="DENIED">Denied</option>
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+ <option value="APPEALED">Appealed</option>
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+ <option value="REJECTED">Rejected</option>
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+ <option value="PAYMENT_RECEIVED">Payment Received</option>
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+ <option value="WAIVED">Waived</option>
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+ </select>
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+ </div>
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Patient Responsibility</label>
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+ <input type="number" step=".01" name="patientResponsibilityAmount"
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+ placeholder="Patient Responsibility Amount"
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+ class="form-control form-control-sm"></input>
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+ </div>
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+ <div class="col-md-6 mb-2">
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+ <label class="mb-1 text-secondary">Patient Responsibility Payment Status</label>
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|
+ <select type="text" name="patientResponsibilityAmountStatus"
|
|
|
+ placeholder="Patient Responsibility Payment Status"
|
|
|
+ class="form-control form-control-sm">
|
|
|
+ <option value="PAID">Paid</option>
|
|
|
+ <option value="DENIED">Denied</option>
|
|
|
+ <option value="APPEALED">Appealed</option>
|
|
|
+ <option value="REJECTED">Rejected</option>
|
|
|
+ <option value="PAYMENT_RECEIVED">Payment Received</option>
|
|
|
+ <option value="WAIVED">Waived</option>
|
|
|
+ </select>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ <div class="mb-0">
|
|
|
+ <button class="btn btn-primary btn-sm" submit>Submit</button>
|
|
|
+ <button class="btn btn-default border btn-sm" cancel>Cancel</button>
|
|
|
+ </div>
|
|
|
+ </form>
|
|
|
+ </div>
|
|
|
+ <div class="d-flex justify-content-center align-items-start">
|
|
|
+ <table class="mr-2 w-75 flex-grow-1 table-bordered table-condensed table-sm table-striped">
|
|
|
+ <thead>
|
|
|
+ <tr>
|
|
|
+ <th>Service Code</th>
|
|
|
+ <th>Charged Amount</th>
|
|
|
+ <th>Allowed Amount</th>
|
|
|
+ <th>Adjustment</th>
|
|
|
+ <th>Primary Insurance</th>
|
|
|
+ <th>Secondary Insurance</th>
|
|
|
+ <th>Patient Responsiblity</th>
|
|
|
+ <th>Balance</th>
|
|
|
+ <th></th>
|
|
|
+ </tr>
|
|
|
+ </thead>
|
|
|
+ <tbody>
|
|
|
+ @foreach ($note->receivedPayments as $rp)
|
|
|
+ <tr>
|
|
|
+ <td class="text-secondary">
|
|
|
+ {{ $rp->service_code }}({{ $rp->modifier }})
|
|
|
+ </td>
|
|
|
+ <td>{{ friendly_money($rp->charged_amount) }} ({{ $rp->charged_amount_status }})</td>
|
|
|
+ <td>${{ friendly_money($rp->allowed_amount) }}</td>
|
|
|
+ <td>${{ friendly_money($rp->adjustment) }}</td>
|
|
|
+ <td>{{ friendly_money($rp->primary_insurance_amount) }}
|
|
|
+ ({{ $rp->primary_amount_status }})</td>
|
|
|
+ <td>{{ friendly_money($rp->secondary_insurance_amount) }}
|
|
|
+ ({{ $rp->secondary_amount_status }})</td>
|
|
|
+ <td>{{ friendly_money($rp->patient_responsibility_amount) }}
|
|
|
+ ({{ $rp->patient_responsibility_amount_status }})</td>
|
|
|
+ <td>{{ friendly_money($rp->balance) }}</td>
|
|
|
+ <td>
|
|
|
+ @if ($rp->is_active)
|
|
|
+ <i class="fa fa-check"></i>
|
|
|
+ <div moe class="ml-1 d-inline-block">
|
|
|
+ <a class="text-danger" href="" show start> Deactivate</a>
|
|
|
+ <form url="/api/receivedPayment/deactivate">
|
|
|
+ <input type="hidden" name="uid" value="{{ $rp->uid }}">
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Memo</label>
|
|
|
+ <textarea type="text" name="memo" placeholder="Source memo" class="form-control form-control-sm"></textarea>
|
|
|
+ </div>
|
|
|
+ <div class="mb-0">
|
|
|
+ <button class="btn btn-primary btn-sm" submit>Submit</button>
|
|
|
+ <button class="btn btn-default border btn-sm"
|
|
|
+ cancel>Cancel</button>
|
|
|
+ </div>
|
|
|
+ </form>
|
|
|
+ </div>
|
|
|
|
|
|
- @else
|
|
|
- <i class="fa fa-cancel"></i>
|
|
|
- <div moe class="ml-1 d-inline-block">
|
|
|
- <a class="text-danger" href="" show start> Reactivate</a>
|
|
|
- <form url="/api/receivedPayment/reactivate">
|
|
|
- <input type="hidden" name="uid" value="{{$rp->uid}}">
|
|
|
- <div class="mb-2">
|
|
|
- <label class="mb-1 text-secondary">Memo</label>
|
|
|
- <textarea type="text" name="memo" placeholder="Source memo"
|
|
|
- class="form-control form-control-sm"></textarea>
|
|
|
- </div>
|
|
|
- <div class="mb-0">
|
|
|
- <button class="btn btn-primary btn-sm" submit>Submit</button>
|
|
|
- <button class="btn btn-default border btn-sm" cancel>Cancel</button>
|
|
|
- </div>
|
|
|
- </form>
|
|
|
- </div>
|
|
|
+ <i class="fa fa-check"></i>
|
|
|
+ <div moe class="ml-1 d-inline-block">
|
|
|
+ <a class="text-danger" href="" show start> Update</a>
|
|
|
+ <form url="/api/receivedPayment/deactivate">
|
|
|
+ <input type="hidden" name="uid" value="{{ $rp->uid }}">
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Service Code</label>
|
|
|
+ <input type="text" name="serviceCode"
|
|
|
+ placeholder="Service code"
|
|
|
+ class="form-control form-control-sm"
|
|
|
+ value="{{ $rp->service_code }}"></input>
|
|
|
+ </div>
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Modifier</label>
|
|
|
+ <input type="text" name="modifier" placeholder="Modifier"
|
|
|
+ class="form-control form-control-sm"
|
|
|
+ value="{{ $rp->modifier }}"></input>
|
|
|
+ </div>
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Charged Amount</label>
|
|
|
+ <input type="number" step=".01" name="chargedAmount"
|
|
|
+ placeholder="Charged Amount"
|
|
|
+ class="form-control form-control-sm"
|
|
|
+ value="{{ $rp->charged_amount }}"></input>
|
|
|
+ </div>
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Charged Amount Status</label>
|
|
|
+ <select type="text" name="chargedAmountStatus"
|
|
|
+ placeholder="Charged Amount Status"
|
|
|
+ class="form-control form-control-sm">
|
|
|
+ <option {{ $rp->charged_amount_status == 'NEW' ? 'checked' : '' }}
|
|
|
+ value="NEW">New</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->charged_amount_status == 'PENDING' ? 'checked' : '' }}
|
|
|
+ value="PENDING">Pending</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->charged_amount_status == 'SUBMITTED' ? 'checked' : '' }}
|
|
|
+ value="SUBMITTED">Submitted</option>
|
|
|
+ </select>
|
|
|
+ </div>
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Allowed Amount</label>
|
|
|
+ <input type="number" step=".01" name="allowedAmount"
|
|
|
+ placeholder="Allowed Amount"
|
|
|
+ class="form-control form-control-sm"
|
|
|
+ value="{{ $rp->allowed_amount }}"></input>
|
|
|
+ </div>
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Primary Insurance</label>
|
|
|
+ <input type="number" step=".01"
|
|
|
+ name="primaryInsuranceAmount" placeholder="Primary Insurance"
|
|
|
+ class="form-control form-control-sm"
|
|
|
+ value="{{ $rp->primary_insurance_amount }}"></input>
|
|
|
+ </div>
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Primary Insurance Payment
|
|
|
+ Status</label>
|
|
|
+ <select type="text" name="primaryAmountStatus"
|
|
|
+ placeholder="Primary Insurance Payment Status"
|
|
|
+ class="form-control form-control-sm">
|
|
|
+ <option
|
|
|
+ {{ $rp->primary_amount_status == 'PAID' ? 'checked' : '' }}
|
|
|
+ value="PAID">Paid</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->primary_amount_status == 'DENIED' ? 'checked' : '' }}
|
|
|
+ value="DENIED">Denied</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->primary_amount_status == 'APPEALED' ? 'checked' : '' }}
|
|
|
+ value="APPEALED">Appealed</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->primary_amount_status == 'REJECTED' ? 'checked' : '' }}
|
|
|
+ value="REJECTED">Rejected</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->primary_amount_status == 'PAYMENT_RECEIVED' ? 'checked' : '' }}
|
|
|
+ value="PAYMENT_RECEIVED">Payment Received</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->primary_amount_status == 'WAIVED' ? 'checked' : '' }}
|
|
|
+ value="WAIVED">Waived</option>
|
|
|
+ </select>
|
|
|
+ </div>
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Secondary Insurance</label>
|
|
|
+ <input type="number" step=".01"
|
|
|
+ name="secondaryInsuranceAmount"
|
|
|
+ placeholder="Secondary Insurance"
|
|
|
+ class="form-control form-control-sm"
|
|
|
+ value="{{ $rp->secondary_insurance_amount }}"></input>
|
|
|
+ </div>
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Secondary Insurance Payment
|
|
|
+ Status</label>
|
|
|
+ <select type="text" name="secondaryAmountStatus"
|
|
|
+ placeholder="Secondary Insurance Payment Status"
|
|
|
+ class="form-control form-control-sm">
|
|
|
+ <option
|
|
|
+ {{ $rp->secondary_amount_status == 'PAID' ? 'checked' : '' }}
|
|
|
+ value="PAID">Paid</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->secondary_amount_status == 'DENIED' ? 'checked' : '' }}
|
|
|
+ value="DENIED">Denied</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->secondary_amount_status == 'APPEALED' ? 'checked' : '' }}
|
|
|
+ value="APPEALED">Appealed</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->secondary_amount_status == 'REJECTED' ? 'checked' : '' }}
|
|
|
+ value="REJECTED">Rejected</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->secondary_amount_status == 'PAYMENT_RECEIVED' ? 'checked' : '' }}
|
|
|
+ value="PAYMENT_RECEIVED">Payment Received</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->secondary_amount_status == 'WAIVED' ? 'checked' : '' }}
|
|
|
+ value="WAIVED">Waived</option>
|
|
|
+ </select>
|
|
|
+ </div>
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Patient Responsibility</label>
|
|
|
+ <input type="number" step=".01"
|
|
|
+ name="patientResponsibilityAmount"
|
|
|
+ placeholder="Patient Responsibility Amount"
|
|
|
+ class="form-control form-control-sm"
|
|
|
+ value="{{ $rp->patient_responsibility_amount }}"></input>
|
|
|
+ </div>
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Patient Responsibility Payment
|
|
|
+ Status</label>
|
|
|
+ <select type="text" name="patientResponsibilityAmountStatus"
|
|
|
+ placeholder="Patient Responsibility Payment Status"
|
|
|
+ class="form-control form-control-sm">
|
|
|
+ <option
|
|
|
+ {{ $rp->patient_responsibility_status == 'PAID' ? 'checked' : '' }}
|
|
|
+ value="PAID">Paid</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->patient_responsibility_status == 'DENIED' ? 'checked' : '' }}
|
|
|
+ value="DENIED">Denied</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->patient_responsibility_status == 'APPEALED' ? 'checked' : '' }}
|
|
|
+ value="APPEALED">Appealed</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->patient_responsibility_status == 'REJECTED' ? 'checked' : '' }}
|
|
|
+ value="REJECTED">Rejected</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->patient_responsibility_status == 'PAYMENT_RECEIVED' ? 'checked' : '' }}
|
|
|
+ value="PAYMENT_RECEIVED">Payment Received</option>
|
|
|
+ <option
|
|
|
+ {{ $rp->patient_responsibility_status == 'WAIVED' ? 'checked' : '' }}
|
|
|
+ value="WAIVED">Waived</option>
|
|
|
+ </select>
|
|
|
+ </div>
|
|
|
+ <div class="mb-0">
|
|
|
+ <button class="btn btn-primary btn-sm" submit>Submit</button>
|
|
|
+ <button class="btn btn-default border btn-sm"
|
|
|
+ cancel>Cancel</button>
|
|
|
+ </div>
|
|
|
+ </form>
|
|
|
+ </div>
|
|
|
+ @else
|
|
|
+ <i class="fa fa-cancel"></i>
|
|
|
+ <div moe class="ml-1 d-inline-block">
|
|
|
+ <a class="text-danger" href="" show start> Reactivate</a>
|
|
|
+ <form url="/api/receivedPayment/reactivate">
|
|
|
+ <input type="hidden" name="uid" value="{{ $rp->uid }}">
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1 text-secondary">Memo</label>
|
|
|
+ <textarea type="text" name="memo" placeholder="Source memo" class="form-control form-control-sm"></textarea>
|
|
|
+ </div>
|
|
|
+ <div class="mb-0">
|
|
|
+ <button class="btn btn-primary btn-sm" submit>Submit</button>
|
|
|
+ <button class="btn btn-default border btn-sm"
|
|
|
+ cancel>Cancel</button>
|
|
|
+ </div>
|
|
|
+ </form>
|
|
|
+ </div>
|
|
|
+ @endif
|
|
|
+ </td>
|
|
|
+ </tr>
|
|
|
+ @endforeach
|
|
|
+ @if (!count($note->receivedPayments))
|
|
|
+ <tr>
|
|
|
+ <td colspan="9">No records found!</td>
|
|
|
+ </tr>
|
|
|
@endif
|
|
|
- </td>
|
|
|
- </tr>
|
|
|
- @endforeach
|
|
|
- @if(!count($note->receivedPayments))
|
|
|
- <tr>
|
|
|
- <td colspan="9">No records found!</td>
|
|
|
- </tr>
|
|
|
- @endif
|
|
|
- </tbody>
|
|
|
- </table>
|
|
|
- <table class="w-25 flex-grow-1 table-bordered table-condensed table-sm table-striped">
|
|
|
- <tbody>
|
|
|
- <tr>
|
|
|
- <td class="text-secondary">Bill Total Exp.</td>
|
|
|
- <td>${{friendly_money($note->bill_total_expected)}}</td>
|
|
|
- </tr>
|
|
|
- <tr>
|
|
|
- <td class="text-secondary">Is Billing Closed</td>
|
|
|
- <td>{{$note->is_bill_closed ? 'Yes' : 'No'}}</td>
|
|
|
- </tr>
|
|
|
- <tr>
|
|
|
- <td class="text-secondary">Bill Summary</td>
|
|
|
- <td>{{$note->bill_summary ? $note->bill_summary : '-'}}</td>
|
|
|
- </tr>
|
|
|
- <tr>
|
|
|
- <td class="text-secondary">Bill Total Paid</td>
|
|
|
- <td>${{friendly_money($note->bill_total_paid)}}</td>
|
|
|
- </tr>
|
|
|
- <tr>
|
|
|
- <td class="text-secondary">Billing Closed At</td>
|
|
|
- <td>{{friendlier_date_time($note->bill_closed_at)}}</td>
|
|
|
- </tr>
|
|
|
- <tr>
|
|
|
- <td class="text-secondary">Payments Received Total</td>
|
|
|
- <td>{{friendly_money($note->received_payments_total)}}</td>
|
|
|
- </tr>
|
|
|
- <tr>
|
|
|
- <td class="text-secondary">Gross margin</td>
|
|
|
- <td>{{friendly_money($note->gross_margin)}}</td>
|
|
|
- </tr>
|
|
|
- </tbody>
|
|
|
- </table>
|
|
|
+ </tbody>
|
|
|
+ </table>
|
|
|
+ <table class="w-25 flex-grow-1 table-bordered table-condensed table-sm table-striped">
|
|
|
+ <tbody>
|
|
|
+ <tr>
|
|
|
+ <td class="text-secondary">Bill Total Exp.</td>
|
|
|
+ <td>${{ friendly_money($note->bill_total_expected) }}</td>
|
|
|
+ </tr>
|
|
|
+ <tr>
|
|
|
+ <td class="text-secondary">Is Billing Closed</td>
|
|
|
+ <td>{{ $note->is_bill_closed ? 'Yes' : 'No' }}</td>
|
|
|
+ </tr>
|
|
|
+ <tr>
|
|
|
+ <td class="text-secondary">Bill Summary</td>
|
|
|
+ <td>{{ $note->bill_summary ? $note->bill_summary : '-' }}</td>
|
|
|
+ </tr>
|
|
|
+ <tr>
|
|
|
+ <td class="text-secondary">Bill Total Paid</td>
|
|
|
+ <td>${{ friendly_money($note->bill_total_paid) }}</td>
|
|
|
+ </tr>
|
|
|
+ <tr>
|
|
|
+ <td class="text-secondary">Billing Closed At</td>
|
|
|
+ <td>{{ friendlier_date_time($note->bill_closed_at) }}</td>
|
|
|
+ </tr>
|
|
|
+ <tr>
|
|
|
+ <td class="text-secondary">Payments Received Total</td>
|
|
|
+ <td>{{ friendly_money($note->received_payments_total) }}</td>
|
|
|
+ </tr>
|
|
|
+ <tr>
|
|
|
+ <td class="text-secondary">Gross margin</td>
|
|
|
+ <td>{{ friendly_money($note->gross_margin) }}</td>
|
|
|
+ </tr>
|
|
|
+ </tbody>
|
|
|
+ </table>
|
|
|
+ </div>
|
|
|
</div>
|
|
|
</div>
|
|
|
-</div>
|
|
|
@endif
|
