Bill Creation Overview

An overview of the billing process in ProviderConnect and Avatar MSO.

A service authorization must be filed in the Service Authorization form (Avatar MSO). The service authorization can be accessed by the agency in the 'Provider To Be Authorized' field. Additional service authorizations can be created.
CPT codes must have been created in the CPT Code Definition form (Avatar MSO).
Revenue codes must have been created in the Revenue Code Definition form (Avatar MSO).
CPT codes or revenue codes must have been associated with a provider and provider fee definition (Avatar MSO, Provider Fee Definition form).

Details

The initial service authorization is created in Avatar MSO (Service Authorization form).
Additional service authorization requests can be created in ProviderConnect, additional service authorizations can be created in Avatar MSO.

Treatment services must have been created for the client.
The service and treatment dates must be covered by service authorizations (service authorization requests filed in ProviderConnect, and service authorizations filed in the Service Authorization form, Avatar MSO).
The provider must be registered in Avatar MSO (Contracting Provider Registration form, Performing Provider's Information section).
Treatment services must not be billed (treatment status and billing date are blank).

Claims are collected into a new batch.
ProviderConnect service batches are named using the naming convention: "Service Entry Web Service", the funding source, the date services were compiled into a batch, and the batch ID. For example: "Service Entry Web Service Medicaid 04/08/2008 (000001)".
Additional claims can be added to an open batch (Avatar MSO, claims processing forms)
Claims pending in Avatar MSO are associated with a batch and can be included in a new batch. MSO batches created by services from ProviderConnect cannot cover multiple service dates.
The batch is closed. The batch cannot be changed.
A voucher is created.
An EOB is created.
Creating a voucher and EOB sends adjudication details for services contained in the batch to ProviderConnect.
Generate the Audit Log Report to view records sent between ProviderConnect and Avatar MSO.
For more information on claims processing refer to the Avatar MSO online documentation.