Member Enrollment

Enroll a member in a funding source, assign a contracting provider, and enter member information.

Prerequisites:

• A member must be entered in myAvatar MSO to authorize care and process claims for that member.
• See the Require Member Enrollment registry setting.
• When a member enrollment is submitted, that member's demographics are also filed in myAvatar PM.
• If a member has been entered in myAvatar PM, the member's demographics populate the MSO Member Enrollment Demographics section.

1. Go to Avatar MSO > Membership Management > Member Enrollment.
2. In the Select Client screen search for and select the client by name or ID.
3. If a client is found and has not been enrolled:
   • The Create an initial enrollment message displays.
   • Click Yes to create an enrollment.
4. If a client is not found, click New.
   • The Auto Assign dialog displays.
   • Click Yes to generate a medical record number.
   • Click No to display the ID Number dialog and enter an ID number.
5. In the Name field, enter the member name using the format LAST,FIRST.
6. In the Gender field, select the member's gender.
7. In the Date Of Birth field, enter the member's birth date.
8. In the Effective Date of Enrollment field, enter the date the member is eligible for coverage. 
9. Services claimed before this date are denied authorization unless Yes is selected in the Member Ineligible on Date of Service field of the Approve/Pend/Deny Rules Definition form.
10. In the Primary Contracting Provider field, enter the provider name or ID, and select.
    • This field is for information only.
    • The provider populates the Provider to be Authorized field in the Service Authorization form.
11. In the Funding Source field, select the funding source by name or ID.
12. In the Plan field, select the plan. Plans associated with the funding source are available.
13. In the Funding Source Policy Number, enter the funding source ID for verifying eligibility.
14. In the Member Type, select Dependant of Enrollee or Primary Enrollee.
15. In the Primary Enrollee ID field, enter the member name, and select. The member is designated as a dependent of the primary enrollee.
16. Click Review Previous Enrollments to generate the report, that details:
    • Client supplemental diagnosis information (Supplemental Diagnosis Information form).
    • Service authorization information for the client.

► Additional Sections

• Member Demographics
• Enrollment Comments

► Registry Settings

• Confine Client Lookups To Current Sub-System Code
• Default Demographic Information From Eligibility File
• Default Member State
• Enable Additional Demographic Fields
• Enable ZIP Code Lookup
• Number Of Matches Required To Default Demographics
• Require Member Enrollment
• Security Level Required To Delete Member Enrollment From Pre Display
• Use MSO Dictionaries For Enrollment Fields