Funding Source Registration

Define member health care coverage and provider reimbursement.

Avatar MSO > Funding Source Management > Funding Source Registration

1. In the Funding Source field, enter the funding source name, click Select Funding Name.
2. If a funding source is found, select the funding source, click Ok.

• If a funding source is not found, click New.
• The Auto Assign dialog displays.
• Click Yes to generate a funding source ID.
• Click No to display the ID Number dialog and enter an ID.

3. In the Funding Source Name field, enter the funding source name.

4. In the Funding Source Effective Date field, enter the first date members assigned to the funding source are eligible for coverage.

5. In the Funding Source Type field, select the type of funding source.

6. In the Member Authorizations Contain Unit Limitations field, select Yes to deny services for service authorizations that do not have units specified.

7. In the Member Authorizations Contain Dollar Limitations field, select Yes if the authorizations contain dollar limitations.

8. In the Member Authorizations Contain Unit Limitations field, select Yes if the authorizations contain unit limitations.

9. In the Contracting Provider Authorizations Contain Dollar Limitations field, select Yes if the authorizations contain dollar limitations.

10. In the Contracting Provider Authorizations Contain Unit Limitations field, select Yes if the authorizations contain unit limitations.

11. In the Funding Source Authorizations Contain Unit Limitations field, select Yes if the authorizations contain unit limitations.

12. In the Perform Eligibility Check field, select Yes to check member eligibility.

• There must be a connection to eligibility files to perform an eligibility check.
• This field applies to facilities running myAvatar MSO, with myAvatar Cal-PM as the parent application.

13. In the Eligibility Check Type field, select the eligibility check type.

14. In the Funding Source demographic fields, enter demographic information as appropriate.

15. In the Funding Source County field, select the county.

16. In the Select Authorization Types to Enable Monthly Max Percentage to Disburse field, select the authorization types that should calculate a percentage reduction to be applied against the expected disbursement of all approved claims.

• Services/activities that are otherwise approved against an authorization of any of the selected types will be subjected to an additional level of adjudication. Sometimes called the 'One Twelfth Rule', this level of adjudication ensures that the dollars distributed for an authorization per month do not exceed a percentage equal to one divided by the number of months in the authorization date range. In the example, that means an authorization lasting one year will only be allowed to distribute 1/12 of its total dollars per month.
• If the approval of a service/activity would cause the monthly amount to exceed this calculation, that service/activity will instead be assigned a Claim Status or Activity Status of "Pended" with a reason of: "Provider monthly dollar max has insufficient remaining funds for service." When a batch or invoice is closed, all services/activities pended due to monthly max will be placed in a separate batch/invoice, where they will remain until a future point when more dollars become available. At that point, a field on the Create EOB form called Readjudicate Services Previously Pended Due to Depleted Monthly Max (or Readjudicate Invoices Previously Pended Due to Depleted Monthly Max on Provider Activity Payment) allows you to approve those services/activities using newly available dollars.
• If all dollars have been exhausted for the associated authorization and no new dollars will be made available in the final month, the pended services/activities will need to be denied through Claim Processing or Provider Activity Invoice and the batch/invoice closed.

17. In the Funding Source Registration Notes field, enter information associated with the funding source.

The following fields populate associated fields in the Admission form (Avatar PM), for members that are associated with the funding source. These fields are the minimum data required to enroll a member, or terminate a member enrollment.

18. In the Program field, select the treatment program.

19. In the Unit field, select the unit.

20. In the Room field, select the room.

21. In the Room and Board Billing Code field, select the code.

22. In the Type of Admission field, select the admission type.

23. In the Source of Admission field, select the admission source.

24. In the Admitting Practitioner field, enter the staff name, and select.

25. In the Attending Practitioner field, enter the staff member name, and select.

26. In the Practitioner Type field, select the practitioner type.

27. In the Type of Discharge field, select the discharge type.

28. In the Discharge Practitioner field, enter the staff member name, and select.
    Changes to dictionaries that are mapped in myAvatar PM will updated the associated dictionary in myAvatar MSO.

29. When finished, click Submit.