{% extends 'base.html' %} {% load static %} {% block title %}Bill {{ bill.bill_number }} - Billing{% endblock %} {% block content %}

Medical Bill {{ bill.bill_number }}

{{ bill.patient.get_full_name }} - MRN: {{ bill.patient.mrn }}

Back to Bills {% if bill.status == 'DRAFT' %}
{% csrf_token %}
{% endif %}
Bill Information
Bill Number: {{ bill.bill_number }}
Bill Type: {{ bill.get_bill_type_display }}
Bill Date: {{ bill.bill_date|date:"M d, Y" }}
Due Date: {{ bill.due_date|date:"M d, Y" }} {% if bill.is_overdue %} Overdue {% endif %}
Service Period: {{ bill.service_date_from|date:"M d, Y" }} - {{ bill.service_date_to|date:"M d, Y" }}
Payment Terms: {{ bill.get_payment_terms_display }}
{% if bill.encounter %} {% endif %} {% if bill.admission %} {% endif %}
Status: {% if bill.status == 'DRAFT' %} Draft {% elif bill.status == 'PENDING' %} Pending {% elif bill.status == 'SUBMITTED' %} Submitted {% elif bill.status == 'PARTIAL_PAID' %} Partially Paid {% elif bill.status == 'PAID' %} Paid {% elif bill.status == 'OVERDUE' %} Overdue {% elif bill.status == 'COLLECTIONS' %} Collections {% elif bill.status == 'WRITTEN_OFF' %} Written Off {% elif bill.status == 'CANCELLED' %} Cancelled {% endif %}
Attending Provider: {{ bill.attending_provider.get_full_name|default:"Not assigned" }}
Billing Provider: {{ bill.billing_provider.get_full_name|default:"Not assigned" }}
Encounter: {{ bill.encounter.encounter_number }}
Admission: {{ bill.admission.admission_number }}
Days Outstanding: {{ bill.days_outstanding }} days
{% if bill.notes %}
Notes:

{{ bill.notes }}

{% endif %}
Line Items
{% for item in line_items %} {% empty %} {% endfor %}
Line Service Date Service Code Description Category Qty Unit Price Total Status
{{ item.line_number }} {{ item.service_date|date:"M d, Y" }} {{ item.service_code }} {{ item.service_description }} {{ item.get_service_category_display }} {{ item.quantity }} ${{ item.unit_price|floatformat:2 }} ${{ item.total_price|floatformat:2 }} {% if item.status == 'ACTIVE' %} Active {% elif item.status == 'DENIED' %} Denied {% elif item.status == 'ADJUSTED' %} Adjusted {% elif item.status == 'VOIDED' %} Voided {% endif %}

No line items found.
Payments
{% for payment in payments %} {% empty %} {% endfor %}
Payment Number Date Amount Method Source Status Received By
{{ payment.payment_number }} {{ payment.payment_date|date:"M d, Y" }} ${{ payment.payment_amount|floatformat:2 }} {{ payment.get_payment_method_display }} {{ payment.get_payment_source_display }} {% if payment.status == 'PENDING' %} Pending {% elif payment.status == 'PROCESSED' %} Processed {% elif payment.status == 'CLEARED' %} Cleared {% elif payment.status == 'BOUNCED' %} Bounced {% elif payment.status == 'REVERSED' %} Reversed {% elif payment.status == 'REFUNDED' %} Refunded {% endif %} {{ payment.received_by.get_full_name|default:"System" }}

No payments recorded.
Insurance Claims
{% if bill.primary_insurance %}
{% csrf_token %}
{% endif %} {% if bill.secondary_insurance %}
{% csrf_token %}
{% endif %}
{% for claim in insurance_claims %} {% empty %} {% endfor %}
Claim Number Type Insurance Submission Date Billed Amount Paid Amount Patient Responsibility Status
{{ claim.claim_number }} {{ claim.get_claim_type_display }} {{ claim.insurance_info.insurance_company }} {{ claim.submission_date|date:"M d, Y" }} ${{ claim.billed_amount|floatformat:2 }} ${{ claim.paid_amount|floatformat:2 }} ${{ claim.patient_responsibility|floatformat:2 }} {% if claim.status == 'DRAFT' %} Draft {% elif claim.status == 'SUBMITTED' %} Submitted {% elif claim.status == 'PENDING' %} Pending {% elif claim.status == 'PROCESSING' %} Processing {% elif claim.status == 'PAID' %} Paid {% elif claim.status == 'DENIED' %} Denied {% elif claim.status == 'REJECTED' %} Rejected {% elif claim.status == 'APPEALED' %} Appealed {% elif claim.status == 'VOIDED' %} Voided {% endif %}

No insurance claims submitted.
Financial Summary
Subtotal: ${{ bill.subtotal|floatformat:2 }}
Tax Amount: ${{ bill.tax_amount|floatformat:2 }}
Discount: -${{ bill.discount_amount|floatformat:2 }}
Adjustment: ${{ bill.adjustment_amount|floatformat:2 }}
Total Amount: ${{ bill.total_amount|floatformat:2 }}
Paid Amount: ${{ bill.paid_amount|floatformat:2 }}
Balance Due: ${{ bill.balance_amount|floatformat:2 }}
{% if bill.balance_amount > 0 %}
{{ bill.payment_percentage }}% Paid
{% endif %}
Payment Summary
Total Payments: ${{ payment_summary.total_payments|floatformat:2 }}
Insurance Payments: ${{ payment_summary.insurance_payments|floatformat:2 }}
Patient Payments: ${{ payment_summary.patient_payments|floatformat:2 }}
{% if bill.primary_insurance or bill.secondary_insurance %}
Insurance Information
{% if bill.primary_insurance %}
Primary Insurance

{{ bill.primary_insurance.insurance_company }}

Policy: {{ bill.primary_insurance.policy_number }}

Group: {{ bill.primary_insurance.group_number|default:"N/A" }}

{% endif %} {% if bill.secondary_insurance %}
Secondary Insurance

{{ bill.secondary_insurance.insurance_company }}

Policy: {{ bill.secondary_insurance.policy_number }}

Group: {{ bill.secondary_insurance.group_number|default:"N/A" }}

{% endif %}
{% endif %}
{% endblock %}