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Manage financial eligibility - PM

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Manage how financial liability is distributed to a client's guarantors for all service codes rendered. myAvatar PM allows you to define episode-based, cross episode and family-based financial eligibility information.

The guarantor assignment provides myAvatar with the guarantor's address, bill/claim sorting, and effective insurance dates and billing data.

Note: A guarantor is the party responsible for payment of services.

Prerequisites:

  • For clients with multiple financial eligibility records:
  • Financial Eligibility or Fast Financial Eligibility guarantor information replaces Cross Episode Financial Eligibility guarantor information.
  • Family Financial Eligibility guarantors must be contained in other financial eligibility records (Financial Eligibility, Fast Financial Eligibility, Cross Episode Financial Eligibility).

How Financial Eligibility Works

  1. Go to: Avatar PM > Client Management > Account Management > Financial Eligibility
  2. In the Select Client screen, enter the client name or ID, and select.
    If the client has multiple episodes, the Episode Information pre-display shows. Select the episode and click OK.
  3. In the Default Information From Different Episode field:
  • Select Yes to copy guarantor information from another episode.
  • Select No to create a new guarantor record for the episode.
  1. In the Episode to Default From field, select the client episode.
  2. The Admission Date field shows the client's admission date (Admission form).
  3. The Social Security Number field shows the client’s social security number (Admission form).
    Note: Access to the Social Security Number field is defined in the User Definition, and User Role Definition forms (Social Security Number Access field). This is defined by a system administrator. The user may be able to:
  • Enter new data for a client, edit and view data.
  • Enter new data for a client, and view data.
  • Enter new data for a client.
  1. The Financial Investigation Medicaid Number and Financial Investigation Medicare Number fields are populated with the values entered in the same fields on the Financial Investigation form.
    Note: These fields do not populate the Subscriber Medicare and Medicaid fields on the Guarantor Selection section.
  2. In the Coverage Comments field, enter comments associated with guarantor coverage.
  3. Click Clear Previous Guarantor Order to clear the guarantor order.
  4. In the 'Guarantor' fields, select the guarantors in the liability distribution order.
  5. Click Review Financial Eligibility to launch an eligibility information report.
    Note: This button display is controlled via the Enable 270/271 Submission on Financial Eligibility registry setting (if 270/271 web services are available).
  6. When finished, click Submit.
► Additional Sections
► Registry Settings
  • Add Detailed Client Name
  • Add Policy Number Override
  • Allow Additional Release Of Information HIPAA Codes (2300-CLM-09 and 2320-OI-06)
  • Allow Inquiry Program Override
  • Assignment Of Benefits
  • Benefit Plan Start/Stop Date Defaults
  • Client Demographics - Additional Fields
  • Customize Plan Description
  • Default Benefit Plan Level
  • Default Subscriber Secondary ID
  • Eligibility Codes (EB01)
  • Enable 270/271 Submission on 834/820 Update
  • Enable 270/271 Submission on Cross Episode Financial Eligibility
  • Enable 270/271 Submission on Financial Eligibility
  • Enable 270/271 Submission on Liability Update
  • Enable 270/271 Transaction Sets
  • Enable Contract Information
  • Enable Default Guarantor Assignment
  • Enable Member Level Detail (2000-INS)
  • Enable Popup Warnings
  • Enable Percentage of Coverage Based on Gross Charge
  • Enable Real-Time 270/271 Submission
  • Enable Subscriber Additional Id (2100C)
  • Enable Subscriber Policy Number Override
  • Enable Variable Plan Limitations
  • Include 'Per Diem Percentage Applies To'
  • Include Enhanced Limits
  • Include Notes
  • Include Subscriber Secondary ID Info
  • Include Title XX Information
  • Make 'Per Diem Rate' Not Required
  • Make 'Subscriber Social Security Number' field Not Required
  • Other Subscriber Secondary ID Suffix
  • Specify Insurance Plan Name Or Program Name At Client Level
  • Specify Patient Signature Source Code (2300-CLM-10 and 2320-OI-04)
  • Specify Subscriber/Dependent Date (2100C/2100D-DTP and 2110C/2110D-DTP)
  • Subscriber Additional Identifier
  • Subscriber Information
  • Support Foreign Address
  • Support Foreign Address For Subscriber
  • Support Pseudo Social Security Numbers
  • Update Financial Eligibility Data
  • Use Billing Guarantor To Determine Provider Accept Assignment Code
  • Use Calendar Month For Monthly Variable Plan Limitations
     
► SQL Tables
  • SYSTEM.billing_guar_comments
  • SYSTEM.billing_guar_data
  • SYSTEM.billing_guar_emp_data
  • SYSTEM.billing_guar_order_cur_ep
  • SYSTEM.billing_guar_subs_data
  • SYSTEM.billing_no_financial_elig
  • SYSTEM.billing_plan_assigned
  • SYSTEM.billing_policy_override
  • SYSTEM.patient_current_demographics