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Avatar CareFabric 2024 Update 11.1

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Product Requirements and Recommendations

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

Recommended Update Level

Avatar Cal-PM 2024 Monthly Release 2024.00.01
Avatar CareFabric 2024 Monthly Release 2024.00.01
Avatar CareFabric 2024 Update 11
Avatar PM 2024 Monthly Release 2024.00.01
RADplus 2024 Monthly Release 2024.00.01

Product Update Description

Avatar CareFabric is updated to support the Explanation of Benefits data from Avatar MSO and Avatar PM.

Required Updates

Avatar CareFabric 2024 Update 11

Included Updates

11

Details
NEW3 CHANGED0 FIXED0
New (3)
'Explanation Of Benefits' CareFabric Support - Inpatient
Avatar CareFabric is enhanced to support actions and events for Inpatient Explanation Of Benefits data to be available via Fhir.
Avatar CareFabric is updated to support the 'ListExplanationOfBenefitResource' and 'GetExplanationOfBenefitResource' actions for Avatar PM/Cal-PM and Avatar MSO Explanation Of Benefits information to be available via Fhir/APIs for Inpatient claims/services.

Note - Avatar MSO 2024 Update 6 is required for full support of this functionality.

Value Added: Adds API/Fhir support for Avatar PM/Cal-PM and Avatar MSO Explanation Of Benefits Information
Topics
• CareFabric
 
'Explanation Of Benefits' CareFabric Support - Outpatient
Avatar CareFabric is enhanced to support actions and events for Outpatient Explanation Of Benefits data to be available via Fhir.
Avatar CareFabric is updated to support the 'ListExplanationOfBenefitResource' and 'GetExplanationOfBenefitResource' actions for Avatar PM/Cal-PM and Avatar MSO Explanation Of Benefits information to be available via Fhir/APIs for Outpatient claims/services.

Note - Avatar MSO 2024 Update 6 is required for full support of this functionality.

Value Added: Adds API/Fhir support for Avatar PM/Cal-PM and Avatar MSO Explanation Of Benefits Information
Topics
• CareFabric
 
'Explanation Of Benefits' CareFabric Support
Avatar CareFabric is enhanced to support actions and events for Explanation Of Benefits data to be available via Fhir.
The Avatar PM/Cal-PM and Avatar MSO '835 Health Care Claim Payment/Advice' forms are updated to support filing of Explanation Of Benefits information to be available via Fhir/APIs (via the 'BulkDataStoreUpdate' CareFabric Action).

Note - Avatar MSO 2024 Update 6 is required for full support of this functionality.

Value Added: Adds API/Fhir support for Avatar PM/Cal-PM and Avatar MSO Explanation Of Benefits Information
Topics
• 835 Health Care Claim Payment/Advice • CareFabric
 
Acceptance Tests
AV-88113 Summary | Details
'Explanation Of Benefits' CareFabric Support - Inpatient
Scenario 1: Verification of 'GetExplanationOfBenefitResource' Action for Avatar MSO 837 Institutional/835 EOB Information
Steps
  • Internal testing only.
Scenario 2: Verification of 'GetExplanationOfBenefitResource' Action for Avatar PM/Cal-PM Inpatient 835 EOB Information
Steps
  • Internal testing only.
Scenario 3: Verification of 'ListExplanationOfBenefitResource' Action for Avatar MSO 837 Institutional/835 EOB Information
Steps
  • Internal testing only.
Scenario 4: Verification of 'ListExplanationOfBenefitResource' Action for Avatar PM/Cal-PM Inpatient 835 EOB Information
Steps
  • Internal testing only.
Topics
• CareFabric
AV-88114 Summary | Details
'Explanation Of Benefits' CareFabric Support - Outpatient
Scenario 1: Verification of 'GetExplanationOfBenefitResource' Action for Avatar MSO 837 Professional/835 EOB Information
Steps
  • Internal testing only.
Scenario 2: Verification of 'GetExplanationOfBenefitResource' Action for Avatar PM/Cal-PM Outpatient 835 EOB Information
Steps
  • Internal testing only.
Scenario 3: Verification of 'ListExplanationOfBenefitResource' Action for Avatar MSO 837 Professional/835 EOB Information
Steps
  • Internal testing only.
Scenario 4: Verification of 'ListExplanationOfBenefitResource' Action for Avatar PM/Cal-PM Outpatient 835 EOB Information
Steps
  • Internal testing only.
Topics
• CareFabric
AV-88120 Summary | Details
'Explanation Of Benefits' CareFabric Support
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 835 Health Care Claim Payment/Advice (PM)
  • CareFabric Monitor
  • 835 Health Care Claim Payment/Advice (MSO)
Scenario 1: Verification of 'BulkDataStoreUpdate - Explanation Of Benefits' CareFabric Filing via Avatar PM/Cal-PM 835 Posting
Specific Setup:
  • 'BulkDataStoreUpdate' action must be enabled in Avatar system (via 'CareFabric Management' form)
  • Inbound 835 Health Care Claim Payment/Advice file containing one or more successfully compiled entries for Avatar PM/Cal-PM claims/services
Steps
  1. Open Avatar PM/Cal-PM '835 Health Care Claim Payment/Advice' form.
  2. Select 'Load File' in the 'Options' field.
  3. Enter 'File Path/Name' value for 835 inbound file to be loaded and click 'Process File' button.
  4. Ensure 835 file is successfully loaded.
  5. Select 'Compile File' in the 'Options' field.
  6. Select loaded inbound 835 file in the 'Select File' field and click 'Process File' button.
  7. In 835 Compile Report - ensure that payments/adjustments are successfully compiled for one or more Avatar PM/Cal-PM claims/services.
  8. Select 'Post File' in the 'Options' field.
  9. Select compiled inbound 835 file in the 'Select File' field, enter values for 'Posting Date' and 'Date of Receipt' fields (as well as any other fields as required/desired), and click 'Process File' button.
  10. In 835 Posting Report - ensure that payments/adjustments are successfully posted for one or more Avatar PM/Cal-PM claims/services.
  11. Open Avatar PM/Cal-PM 'CareFabric Monitor' form.
  12. Enter values for 'From Date' and 'Through Date' fields (using dates which include 274 Provider Directory Provider Definition entry/edit).
  13. Enter/select values for any other CareFabric Monitor fields as desired.
  14. Click 'View Activity Log' button to display CareFabric Monitor report results.
  15. In CareFabric Monitor report results - ensure that 'BulkDataStoreUpdate' Action/Out Activity is present for all Explanation Of Benefits/835 information posted via the Avatar PM/Cal-PM '835 Health Care Claim Payment/Advice' form (activity is per claim with 835 remittance advice posted).
Scenario 2: Verification of 'BulkDataStoreUpdate - Explanation Of Benefits' CareFabric Filing via Avatar MSO 835 Generation
Specific Setup:
  • 'BulkDataStoreUpdate' action must be enabled in Avatar system (via 'CareFabric Management' form)
  • EOB record(s) eligible for 835 outbound file inclusion including one or more claims/services originating via Avatar MSO 837 inbound processing
Steps
  1. Open Avatar MSO '835 Health Care Claim Payment/Advice' form.
  2. Note - Acceptance testing may also be confirmed in 835 files created via Avatar MSO Claim Processing Automation functions
  3. Select 'Sort File' in the 'Options' field.
  4. Select 'Contracting Provider' value.
  5. Select EOB(s) for 835 outbound file inclusion in the 'Select EOB(s)' field.
  6. Click 'Process' button.
  7. Ensure that '835 Health Care Claim Payment/Advice Report' is displayed following 835 sorting completion (and includes one or more successfully sorted claims/services for 835 file creation).
  8. Open Avatar PM/Cal-PM 'CareFabric Monitor' form.
  9. Enter values for 'From Date' and 'Through Date' fields (using dates which include 274 Provider Directory Provider Definition entry/edit).
  10. Enter/select values for any other CareFabric Monitor fields as desired.
  11. Click 'View Activity Log' button to display CareFabric Monitor report results.
  12. In CareFabric Monitor report results - ensure that 'BulkDataStoreUpdate' Action/Out Activity is present for all Explanation Of Benefits information/835s generated in the Avatar MSO '835 Health Care Claim Payment/Advice' form for claims/services originating via Avatar MSO 837 inbound processing (activity is per claim with 835 remittance advice generated).
Topics
• 835 Health Care Claim Payment/Advice • CareFabric