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Avatar CareFabric 2023 Update 2

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Product Requirements / Recommendations

Avatar CareFabric required
Avatar PM required
RADplus required
Avatar Cal-PM

Product Update Form Description

Avatar CareFabric is updated to send additional data for ProviderConnect Enterprise actions.

Included Updates

None

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Avatar CareFabric - support for ProviderConnect Enterprise
Avatar CareFabric is updated to send additional 'Service Authorization' data in order to support ProviderConnect Enterprise.
Value Added: Support for ProviderConnect Enterprise
Topics
• ProviderConnect Enterprise • Service Authorizations
 
Acceptance Tests
AV-81696 Summary | Details
Avatar CareFabric - support for ProviderConnect Enterprise
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CareFabric Monitor
  • Service Authorization Request
  • Service Authorization
Scenario 1: Service Authorization Request - Validate the 'ServiceAuthorizationRequestCreated' and 'ServiceAuthorizationRequestUpdated' events
Specific Setup:
  • A member must be defined in the 'Member Enrollment' form (Client A).
  • CPT Codes and Revenue Codes must be defined in Avatar MSO.
  • Please note: this scenario is for Avatar Cal-PM systems only.
Steps
  1. Select "Client A" and access the 'Service Authorization Request' form.
  2. Select the desired provider in the 'Provider To Be Authorized' field.
  3. Validate the 'Current Authorization Status' field is set to "Pending".
  4. Select the desired value in the 'Current Authorization Status Reason' field.
  5. Enter the desired date in the 'Begin Date Of Authorization' field.
  6. Enter the desired date in the 'End Date Of Authorization' field.
  7. Select "Individual" in the 'Authorization Grouping or Individual Authorizations' field.
  8. Select "CPT Code" in the 'Procedure Code Type (1)' field.
  9. Enter the desired CPT Code in the 'Code Authorized (1)' field.
  10. Enter the desired value in the 'Requested Units (1)' field.
  11. Select "Revenue Code" in the 'Procedure Code Type (1)' field.
  12. Enter the desired Revenue Code in the 'Code Authorized (1)' field.
  13. Enter the desired value in the 'Requested Units (1)' field.
  14. Select the "Care Manager" section.
  15. Enter the desired care manager in the 'Care Manager Assigned' field.
  16. Enter the desired date in the 'Date Care Manager Assigned' field.
  17. Select the "Comments" section.
  18. Enter the desired value in the 'Comments On Authorization' field.
  19. Click [Submit] and [No] to exit the form.
  20. Access the 'CareFabric Monitor' form.
  21. Enter the current date in the 'From Date' and 'Through Date' fields.
  22. Enter "Client A" in the 'Client ID' field.
  23. Enter "ServiceAuthorizationRequestCreated" in the 'Event/Action Search' field.
  24. Click [View Activity Log].
  25. Validate the 'CareFabric Monitor Report' contains the "ServiceAuthorizationRequestCreated" record.
  26. Click [Click to View Record].
  27. Validate the 'assignedCareManagerDate' field contains the date entered in the previous steps.
  28. Validate the 'assignedCareManagerID' - 'id' field contains care manager ID selected in the previous steps.
  29. Validate the 'benefitPlanCode' 'id' field contains the benefit plan ID for the client.
  30. Validate the 'benefitPlanCode' 'displayName' field contains the benefit plan for the client.
  31. Validate the 'clientID' - 'id' field contains the client ID.
  32. Validate the 'comment' field contains the authorization comments entered in the previous steps.
  33. Validate the 'createdDate' field contains the authorization created date.
  34. Validate the 'endDate' field contains the authorization end date entered in the previous steps.
  35. Validate the 'fundingSourceCode' - 'code' field contains the funding source code for the client.
  36. Validate the 'fundingSourceCode' - 'displayName' field contains the funding source for the client.
  37. Validate the 'providerID' - 'id' field contains the provider ID selected.
  38. Validate the 'requestedItems' - 'unit' field contains "CPT".
  39. Validate the 'requestedItems' - 'unitCode' - 'code' field contains the CPT code selected.
  40. Validate the 'requestedItems' - 'unitCode' - 'displayName' field contains the value of the CPT code selected.
  41. Validate the 'requestedItems' - 'value' field contains the amount of requested units.
  42. Validate the second 'requestedUnits' - 'unit' field contains "Revenue".
  43. Validate the second 'requestedUnits' - 'unitCode' - 'code' field contains the revenue code selected.
  44. Validate the second 'requestedUnits' - 'unitCode' - 'displayName' field contains the value of the revenue code selected.
  45. Validate the second 'requestedUnits' - 'value' contains the amount of requested units.
  46. Validate the 'serviceAuthorizationRequestID' - 'id' field contains a unique id for the request (ex. 87||||1).
  47. Validate the 'serviceAuthorizationRequestID' - 'scopeID' field contains the scope being used.
  48. Validate the 'startDate' field contains the authorization start date entered in the previous steps.
  49. Validate the 'statusCode' - 'id' field contains "P".
  50. Validate the 'statusCode' - 'displayName' field contains "Pending".
  51. Close the report and the form.
  52. Select "Client A" and access the 'Service Authorization Request' form.
  53. Select the service authorization request filed in the previous steps and click [Edit].
  54. Enter any new value in the 'Requested Units (1)' field.
  55. Enter any new value in the 'Requested Units (2)' field.
  56. Select the "Comments" section.
  57. Enter any new value in the 'Comments On Authorization' field.
  58. Click [Submit] and [No] to exit the form.
  59. Access the 'CareFabric Monitor' form.
  60. Enter the current date in the 'From Date' and 'Through Date' fields.
  61. Enter "Client A" in the 'Client ID' field.
  62. Enter "ServiceAuthorizationRequestUpdated" in the 'Event/Action Search' field.
  63. Click [View Activity Log].
  64. Validate the 'CareFabric Monitor Report' contains the "ServiceAuthorizationRequestUpdated" record.
  65. Click [Click to View Record].
  66. Validate the 'comments' field contains the new value entered.
  67. Validate the 'requestedItems' - 'value' field contains new requested value.
  68. Validate the second 'requestedItems' - 'value' field contains new requested value.
  69. Validate the 'serviceAuthorizationRequestID' - 'id' field contains a unique id for the request (ex. 87||||1).
  70. Validate the 'serviceAuthorizationRequestID' - 'scopeID' field contains the scope being used.
  71. Close the report and the form.
Scenario 2: Service Authorization - Validate the 'ServiceAuthorizationResponseCreated' and 'ServiceAuthorizationResponseUpdated' events
Specific Setup:
  • A member must be defined in the 'Member Enrollment' form (Client A).
  • CPT Codes and Revenue Codes must be defined in Avatar MSO.
  • Please note: this scenario is for Avatar Cal-PM systems only.
Steps
  1. Select "Client A" and access the 'Service Authorization' form.
  2. Select the desired provider in the 'Provider To Be Authorized' field.
  3. Select "Approved" in the 'Current Authorization Status' field.
  4. Enter the desired date in the 'Begin Date Of Authorization' field.
  5. Enter the desired date in the 'End Date Of Authorization' field.
  6. Select "Individual" in the 'Authorization Grouping or Individual Authorizations' field.
  7. Select "CPT Code" in the 'Procedure Code Type (1)' field.
  8. Enter the desired CPT Code in the 'Code Authorized (1)' field.
  9. Enter the desired value in the 'Requested Units (1)' field.
  10. Enter the desired value in the 'Units Authorized (1)' field.
  11. Select "Revenue Code" in the 'Procedure Code Type (1)' field.
  12. Enter the desired Revenue Code in the 'Code Authorized (1)' field.
  13. Enter the desired value in the 'Requested Units (1)' field.
  14. Enter the desired value in the 'Units Authorized (1)' field.
  15. Select the "Care Manager" section.
  16. Enter the desired care manager in the 'Care Manager Assigned' field.
  17. Enter the desired date in the 'Date Care Manager Assigned' field.
  18. Select the "Comments" section.
  19. Enter the desired value in the 'Comments On Authorization' field.
  20. Click [Submit] and [No] to exit the form.
  21. Access the 'CareFabric Monitor' form.
  22. Enter the current date in the 'From Date' and 'Through Date' fields.
  23. Enter "Client A" in the 'Client ID' field.
  24. Enter "ServiceAuthorizationResponseCreated" in the 'Event/Action Search' field.
  25. Click [View Activity Log].
  26. Validate the 'CareFabric Monitor Report' contains the "ServiceAuthorizationResponseCreated" record.
  27. Click [Click to View Record].
  28. Validate the 'assignedCareManagerDate' field contains the date entered in the previous steps.
  29. Validate the 'assignedCareManagerID' - 'id' field contains care manager ID selected in the previous steps.
  30. Validate the 'benefitPlanCode' 'id' field contains the benefit plan ID for the client.
  31. Validate the 'benefitPlanCode' 'displayName' field contains the benefit plan for the client.
  32. Validate the 'clientID' - 'id' field contains the client ID.
  33. Validate the 'comment' field contains the authorization comments entered in the previous steps.
  34. Validate the 'createdDate' field contains the authorization created date.
  35. Validate the 'endDate' field contains the authorization end date entered in the previous steps.
  36. Validate the 'fundingSourceCode' - 'code' field contains the funding source code for the client.
  37. Validate the 'fundingSourceCode' - 'displayName' field contains the funding source for the client.
  38. Validate the 'providerID' - 'id' field contains the provider ID selected.
  39. Validate the 'requestedItems' - 'unit' field contains "CPT".
  40. Validate the 'requestedItems' - 'unitCode' - 'code' field contains the CPT code selected.
  41. Validate the 'requestedItems' - 'unitCode' - 'displayName' field contains the value of the CPT code selected.
  42. Validate the 'requestedItems' - 'value' field contains the amount of authorized units.
  43. Validate the second 'requestedUnits' - 'unit' field contains "Revenue".
  44. Validate the second 'requestedUnits' - 'unitCode' - 'code' field contains the revenue code selected.
  45. Validate the second 'requestedUnits' - 'unitCode' - 'displayName' field contains the value of the revenue code selected.
  46. Validate the second 'requestedUnits' - 'value' contains the amount of authorized units.
  47. Validate the 'serviceAuthorizationRequestID' - 'id' field contains a unique id for the request (ex. 87||||1).
  48. Validate the 'serviceAuthorizationRequestID' - 'scopeID' field contains the scope being used.
  49. Validate the 'serviceAuthorizationResponseID' - 'id' field contains a unique id for the response (ex. 87||||1).
  50. Validate the 'serviceAuthorizationResponseID' - 'scopeID' field contains the scope being used.
  51. Validate the 'startDate' field contains the authorization start date entered in the previous steps.
  52. Validate the 'statusCode' - 'id' field contains "A".
  53. Validate the 'statusCode' - 'displayName' field contains "Approved".
  54. Close the report and the form.
  55. Select "Client A" and access the 'Service Authorization Request' form.
  56. Select the service authorization request filed in the previous steps and click [Edit].
  57. Select "Denied" in the 'Current Authorization Status' field.
  58. Enter "0" in the 'Units Authorized (1)' field.
  59. Enter "0" in the 'Units Authorized (2)' field.
  60. Select the "Comments" section.
  61. Enter any new value in the 'Comments On Authorization' field.
  62. Click [Submit] and [No] to exit the form.
  63. Access the 'CareFabric Monitor' form.
  64. Enter the current date in the 'From Date' and 'Through Date' fields.
  65. Enter "Client A" in the 'Client ID' field.
  66. Enter "ServiceAuthorizationResponseUpdated" in the 'Event/Action Search' field.
  67. Click [View Activity Log].
  68. Validate the 'CareFabric Monitor Report' contains the "ServiceAuthorizationResponseUpdated" record.
  69. Click [Click to View Record].
  70. Validate the 'comments' field contains the new value entered.
  71. Validate the 'requestedItems' - 'value' field contains "0".
  72. Validate the second 'requestedItems' - 'value' field contains "0".
  73. Validate the 'serviceAuthorizationRequestID' - 'id' field contains a unique id for the request (ex. 87||||1).
  74. Validate the 'serviceAuthorizationRequestID' - 'scopeID' field contains the scope being used.
  75. Validate the 'serviceAuthorizationResponseID' - 'id' field contains a unique id for the response (ex. 87||||1).
  76. Validate the 'serviceAuthorizationResponseID' - 'scopeID' field contains the scope being used.
  77. Validate the 'statusCode' - 'code' field contains "D".
  78. Validate the 'statusCode' - 'displayName' field contains "Denied".
  79. Close the report and the form.
Topics
• ProviderConnect Enterprise • Service Authorizations