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Avatar Cal-PM 2022 Monthly Release 2022.00.01 Acceptance Tests

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Update 3 Summary | Details
'Electronic Billing' - 837 Professional 2400-SV1 Service Information
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Electronic Billing
Scenario 1: 'Electronic Billing' - Verification of 837 Professional 2400-SV1 Service Information
Specific Setup:
  • One or more 837 Professional /HCFA1500 service(s) eligible for Electronic Billing inclusion where applicable Guarantor Definition Override exists with 'Service Unit Of Measurement Code' and 'Quantity' values defined (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form, 'Guarantor Definition' section)
Steps
  1. Open Avatar Cal-PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar PM 'Quick Billing' form/functionality.)
  2. Select '837 Professional' in the 'Billing Form' field.
  3. Select 'Sort File' in the 'Billing Options' field.
  4. Enter/select 837 Professional file sorting criteria.
  5. Click 'Process' button to sort/generate 837 Professional file.
  6. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional file sorted which includes services(s), and click 'Process' button to display 837 Professional outbound file data.
  9. In Avatar PM 837 Professional format outbound electronic billing file data - If applicable Guarantor Definition Override exists with 'Service Unit Of Measurement Code' and 'Quantity' values defined, ensure that values for Unit of Measurement and Quantity are reflected in 2400-SV1 Service Line Number service information (2400-SV1-03 and 2400-SV1-04 segments/values, respectively).
  10. Examples:
  11. SV1*HC:90804*125.50*UN*10*11**1~
  12. SV1*HC:90804*125.50*MJ*60*11**1~
  13. SV1*HC:90804*125.50*DA*1*11**1~
Topics
• Service Fee/Cross Reference Maintenance • Electronic Billing • NX
Update 15 Summary | Details
'Electronic Billing' Support for Services Originating in Avatar MSO
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Electronic Billing
Scenario 1: 'Electronic Billing' - Verification of 2320 AMT Values in 837 Professional (Services Originating in Avatar MSO)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar Cal-PM Registry Setting 'Include Service Level Adjudication Info' must be enabled (and 'Include Service Level Adjudication Information (2430)' field set to 'Yes' via 'Guarantor/Program Billing Defaults' form '837 Professional' section for applicable Guarantor/Program)
  • Avatar Cal-PM Registry Setting 'Include Patient Remaining Liability' must be enabled (and 'Select Type Of Information To Include In Patient Remaining Liability' field defined via 'Guarantor/Program Billing Defaults' form '837 Professional' section for applicable Guarantor/Program)
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional file inclusion (via 'Electronic Billing' form) originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
Steps
  1. Open Avatar Cal-PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.)
  2. Select '837 Professional' in the 'Billing Form' field.
  3. Select 'Sort File' in the 'Billing Options' field.
  4. Enter/select 837 Professional file sorting criteria.
  5. Click 'Process' button to sort/generate 837 Professional file.
  6. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional file sorted which includes services(s), and click 'Process' button to display 837 Professional outbound file data.
  9. In Avatar PM 837 Professional format outbound electronic billing file data - for services originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information where 'Patient Responsibility' (PR) payments/adjustment(s) are present, ensure that 2320-AMT Coordination Of Benefits (COB) Payer Paid Amount loop/segment value is present and reflects Avatar MSO 'Other Healthcare Coverage' values.
  10. Example: AMT*D*2~
  11. In Avatar PM 837 Professional format outbound electronic billing file data - for services originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information, ensure that 2320-AMT Remaining Patient Liability Amount loop/segment is present and reflects value for total claim charge minus any payments received from Avatar MSO 'Other Healthcare Coverage' values.
  12. Example: AMT*EAF*58~
Scenario 2: 'Electronic Billing' - Verification of 2320 AMT Values in 837 Institutional (Services Originating in Avatar MSO)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar Cal-PM Registry Setting 'Include Service Level Adjudication Info' must be enabled (and 'Include Service Level Adjudication Information (2430)' field set to 'Yes' via 'Guarantor/Program Billing Defaults' form '837 Institutional' section for applicable Guarantor/Program)
  • Avatar Cal-PM Registry Setting 'Include Patient Remaining Liability' must be enabled (and 'Select Type Of Information To Include In Patient Remaining Liability' field defined via 'Guarantor/Program Billing Defaults' form '837 Institutional' section for applicable Guarantor/Program)
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • One or more service(s) eligible for Avatar Cal-PM 837 Institutional file inclusion (via 'Electronic Billing' form) originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
Steps
  1. Open Avatar Cal-PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.)
  2. Select '837 Institutional' in the 'Billing Form' field.
  3. Select 'Sort File' in the 'Billing Options' field.
  4. Enter/select 837 Institutional file sorting criteria.
  5. Click 'Process' button to sort/generate 837 Institutional file.
  6. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Institutional file sorted which includes services(s), and click 'Process' button to display 837 Institutional outbound file data.
  9. In Avatar PM 837 Institutional format outbound electronic billing file data - for services originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information where 'Patient Responsibility' (PR) payments/adjustment(s) are present, ensure that 2320-AMT Coordination Of Benefits (COB) Payer Paid Amount loop/segment value is present and reflects Avatar MSO 'Other Healthcare Coverage' values.
  10. Example: AMT*D*2~
  11. In Avatar PM 837 Institutional format outbound electronic billing file data - for services originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information, ensure that 2320-AMT Remaining Patient Liability Amount loop/segment is present and reflects value for total claim charge minus any payments received from Avatar MSO 'Other Healthcare Coverage' values.
  12. Example: AMT*EAF*58~
Topics
• Electronic Billing
2021 Update 22 Summary | Details
Electronic Billing - SBR segment
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Posting/Adjustment Codes Definition
  • Guarantors/Payors
  • Admission (Outpatient)
  • Electronic Billing
  • Individual Cash Posting (PM)
  • Dynamic Form - Individual Cash Posting - Information
  • Managed Care Authorizations
  • Program Maintenance
  • Practitioner Numbers By Guarantor and Program
Scenario 1: Validate 837P when 'Posting/Adjustment Codes Definition' = 'Bill Charge Created from this Transfer Code As Primary'.
Specific Setup:
  • Posting Code 1: A 'Posting/Adjustment Codes Definition' is defined as a ‘Transfer’:
  • Contains 'Credit' in 'Credit or Debit.
  • Contains ‘Yes’ in 'Bill Charge Created from this Transfer Code As Primary'. Note the ‘Posting Code’.
  • Posting Code 2: A 'Posting/Adjustment Codes Definition' is defined as a ‘Transfer’:
  • Contains 'Credit' in 'Credit or Debit.
  • Contains ‘No’ in 'Bill Charge Created from this Transfer Code As Primary'. Note the ‘Posting Code’.
  • Posting Code 3: A 'Posting/Adjustment Codes Definition' is defined as a ‘Payment':
  • Contains 'Credit' in 'Credit or Debit.
  • Guarantors/Payors 1:
  • Note the guarantor and financial class.
  • This is the only guarantor assigned to the clients in pre-conditions.
  • Client enrolled in one episode:
  • Note the program.
  • Guarantors/Payors 1 is assigned in the ‘Financial Eligibility’ record.
  • Two claims, with one service each, billed to 'Guarantors/Payors' 1.
  • Note the date of service and claim number for Claim 1.
  • Note the date of service and claim number for Claim 2.
  • Guarantors/Payors 2:
  • Note the guarantor. Note the 'Financial Class'.
  • This is the guarantor that will be added to the ‘Financial Eligibility’ record during testing.
Steps
  1. Open ‘Financial Eligibility’ for the client.
  2. Add 'Guarantors/Payors 2' with an effective date on or before the first service date.
  3. Set 'Guarantors/Payors 2' as ‘Guarantor #1.
  4. Set 'Guarantors/Payors 1' as ‘Guarantor # 2.
  5. Click [Submit].
  6. Open 'Individual Cash Posting'.
  7. Select the 'Client'.
  8. Select 'All Episodes' in 'Post By'.
  9. Enter the first date of service in 'Start Date'.
  10. Enter the last date of service 'Stop Date'.
  11. Click [Select Item(s) to Post Against].
  12. Select Claim 1.
  13. Click [OK].
  14. Click [OK].
  15. Enter the desired 'Posting Date'.
  16. Enter the desired 'Date of Receipt'.
  17. Enter ‘0.00’ in ‘Dollar Amount To Be Posted’.
  18. Set the ‘Posting Code’ to ‘Posting Code 3’.
  19. Select ‘Transfer’ in ‘Action For Remaining Balance If Applicable’.
  20. Select ‘Posting Code 1’ in ‘Transfer Posting Code’.
  21. Select 'Guarantors/Payors 2' in ‘Guarantor To Transfer Remaining Balance To’.
  22. Click [Update Temporary File].
  23. Click [OK].
  24. Click [Select Item(s) to Post Against].
  25. Select Claim 2.
  26. Click [OK].
  27. Click [OK].
  28. Enter the desired 'Posting Date'.
  29. Enter the desired 'Date of Receipt'.
  30. Enter ‘0.00’ in ‘Dollar Amount To Be Posted’.
  31. Set the ‘Posting Code’ to ‘Posting Code 3’.
  32. Select ‘Transfer’ in ‘Action For Remaining Balance If Applicable’.
  33. Select ‘Posting Code 2’ in ‘Transfer Posting Code’.
  34. Select 'Guarantors/Payors 2' in ‘Guarantor To Transfer Remaining Balance To’.
  35. Click [Update Temporary File].
  36. Click [OK].
  37. Click [Submit].
  38. Click [Yes].
  39. Click [No].
  40. Open ‘Electronic Billing.
  41. Select ‘837-Professional’ in ‘Billing Form’.
  42. Create a bill for the service date for Claim 1 for 'Guarantors/Payors 2'.
  43. Review the ‘Dump File’.
  44. Verify that the ‘SBR’ segment contains a ‘P’ after ‘SBR*’. This indicates that the guarantor is the primary guarantor.
  45. Create a bill for the service date for Claim 2 for 'Guarantors/Payors 2'.
  46. Review the ‘Dump File’.
  47. Verify that the ‘SBR’ segment contains a ‘P’ after ‘SBR*’. This indicates that the guarantor is t the primary guarantor.
Scenario 2: Validate 837I when 'Posting/Adjustment Codes Definition' = 'Bill Charge Created from this Transfer Code As Primary'.
Specific Setup:
  • Posting Code 1: A 'Posting/Adjustment Codes Definition' is defined as a ‘Transfer’:
  • Contains 'Credit' in 'Credit or Debit.
  • Contains ‘Yes’ in 'Bill Charge Created from this Transfer Code As Primary'. Note the ‘Posting Code’.
  • Posting Code 2: A 'Posting/Adjustment Codes Definition' is defined as a ‘Transfer’:
  • Contains 'Credit' in 'Credit or Debit.
  • Contains ‘No’ in 'Bill Charge Created from this Transfer Code As Primary'. Note the ‘Posting Code’.
  • Posting Code 3: A 'Posting/Adjustment Codes Definition' is defined as a ‘Payment':
  • Contains 'Credit' in 'Credit or Debit.
  • Guarantors/Payors 1:
  • Note the guarantor and financial class.
  • This is the only guarantor assigned to the clients in pre-conditions.
  • Client enrolled in one episode:
  • Note the program.
  • Guarantors/Payors 1 is assigned in the ‘Financial Eligibility’ record.
  • Two claims, with one service each, billed to 'Guarantors/Payors' 1.
  • Note the date of service and claim number for Claim 1.
  • Note the date of service and claim number for Claim 2.
  • Guarantors/Payors 2:
  • Note the guarantor. Note the 'Financial Class'.
  • This is the guarantor that will be added to the ‘Financial Eligibility’ record during testing.
Steps
  1. Open ‘Financial Eligibility’ for the client.
  2. Add 'Guarantors/Payors 2' with an effective date on or before the first service date.
  3. Set 'Guarantors/Payors 2' as ‘Guarantor #1.
  4. Set 'Guarantors/Payors 1' as ‘Guarantor # 2.
  5. Click [Submit].
  6. Open 'Individual Cash Posting'.
  7. Select the 'Client'.
  8. Select 'All Episodes' in 'Post By'.
  9. Enter the first date of service in 'Start Date'.
  10. Enter the last date of service 'Stop Date'.
  11. Click [Select Item(s) to Post Against].
  12. Select Claim 1.
  13. Click [OK].
  14. Click [OK].
  15. Enter the desired 'Posting Date'.
  16. Enter the desired 'Date of Receipt'.
  17. Enter ‘0.00’ in ‘Dollar Amount To Be Posted'.
  18. Set the ‘Posting Code’ to ‘Posting Code 3’.
  19. Select ‘Transfer’ in ‘Action For Remaining Balance If Applicable’.
  20. Select ‘Posting Code 1’ in ‘Transfer Posting Code’.
  21. Select 'Guarantors/Payors 2' in ‘Guarantor To Transfer Remaining Balance To’.
  22. Click [Update Temporary File].
  23. Click [OK].
  24. Click [Select Item(s) to Post Against].
  25. Select Claim 2.
  26. Click [OK].
  27. Click [OK].
  28. Enter the desired 'Posting Date'.
  29. Enter the desired 'Date of Receipt'.
  30. Enter ‘0.00’ in ‘Dollar Amount To Be Posted'.
  31. Set the ‘Posting Code’ to ‘Posting Code 3’.
  32. Select ‘Transfer’ in ‘Action For Remaining Balance If Applicable’.
  33. Select ‘Posting Code 2’ in ‘Transfer Posting Code’.
  34. Select 'Guarantors/Payors 2' in ‘Guarantor To Transfer Remaining Balance To’.
  35. Click [Update Temporary File].
  36. Click [OK].
  37. Click [Submit].
  38. Click [Yes].
  39. Click [No].
  40. Open ‘Electronic Billing.
  41. Select ‘837-Institutional’ in ‘Billing Form’.
  42. Create a bill for the service date for Claim 1 for 'Guarantors/Payors 2'.
  43. Review the ‘Dump File’.
  44. Verify that the ‘SBR’ segment contains a ‘P’ after ‘SBR*’. This indicates that the guarantor is the primary guarantor.
  45. Create a bill for the service date for Claim 2 for 'Guarantors/Payors 2'.
  46. Review the ‘Dump File’.
  47. Verify that the ‘SBR’ segment contains a ‘P’ after ‘SBR*’. This indicates that the guarantor is t the primary guarantor.
Topics
• myAvatar/myAvatar NX • Posting/Adjustment Codes
2021 Update 80 Summary | Details
'Client Admission' web service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • ProviderConnect Enterprise Action Log
  • SOAPUI - ClientAdmission
Scenario 1: ProviderConnect Enterprise- Validate the 'PutProgramAdmission' action
Specific Setup:
  • The 'Avatar CareFabric->ProviderConnect Enterprise->Contracting Providers->->->Enable External Connections' must be set to "Y".
  • The 'Managing Organization Definition' form must be configured for a valid managing organization.
  • A client must exist in the configured managing organization's system with a DOB and SSN on file (Client A).
  • A practitioner must have a NPI that is mapped to a matching practitioner in the managing organization's system (Practitioner A).
Steps
  1. Access the 'Admission' form.
  2. Verify the 'Select Client' dialog is displayed.
  3. Enter the last name of the client that exists in the managing organization's system in the 'Last Name' field.
  4. Enter the first name of the client that exists in the managing organization's system in the 'First Name' field.
  5. Enter the sex of the client that exists in the managing organization's system in the 'Sex' field.
  6. Click [Search].
  7. Validate a "Search Results" message is displayed stating: No matches found.
  8. Click [OK] and [New Client].
  9. Validate a "Client" message is displayed stating: Auto Assign Next ID Number?
  10. Click [Yes].
  11. Enter the desired date in the 'Preadmit/Admission Date' field.
  12. Enter the desired time in the 'Preadmit/Admission Time' field.
  13. Select any program that is selected in the 'Associated Admission Programs' field in the 'Managing Organization Definition' form in the 'Program' field.
  14. Enter "Client A's" date of birth in the 'Date Of Birth' field.
  15. Enter "Cleint A's" social security number in the 'Social Security Number' field.
  16. Select the desired value in the 'Type Of Admission' field.
  17. Select desired value in the 'Source Of Admission' field.
  18. Enter "Practitioner A" in the 'Admitting Practitioner' field.
  19. Select the "ProviderConnect Enterprise Identifiers" section.
  20. Click [Add New Item].
  21. Select the defined managing organization in the 'External Organization' field.
  22. Click [Search].
  23. Select the matching client record in the 'Select Matching Client Record' dialog.
  24. Click [OK].
  25. Validate the 'External ID' field contains the client ID for the client in the managing organization's system.
  26. Click [Update Demographics].
  27. Validate an "Information" message is displayed stating: Client Demographics Information Updated.
  28. Click [OK].
  29. Select the "Demographics" section.
  30. Validate demographic fields have been updated to match the managing organizations record.
  31. Click [Submit].
  32. Access the 'ProviderConnect Enterprise Action Log'.
  33. Enter the desired date in the 'From Date' and 'Through Date' fields.
  34. Enter the desired time in the 'From Time' and 'Through Time' fields.
  35. Select the desired organization in the 'Managing Organization' field.
  36. Select "PutProgramAdmission" in the 'Action Name' field.
  37. Click [View Action Log].
  38. Verify the 'ProviderConnect Enterprise Action Log' Report is displayed.
  39. Validate the 'ProviderConnect Enterprise Action Log' Report contains a row for the 'PutProgramAdmission' action that was triggered from the 'Admission' form with a result of "Success".
  40. Close the report and the form.
Scenario 2: The 'ClientAdmission' - 'AddAdmission' web service: Admission of an existing client into a new episode
Specific Setup:

A client is enrolled in an existing episode (Client A)

  • First name: Web Service
  • Last Name: Test
Steps
  1. Access SoapUI for the 'ClientAdmission' - 'AddAdmission' web service.
  2. Enter the system code that will be used to log into Avatar in the 'SystemCode' field.
  3. Enter the user name that will be used to log into Avatar in the 'UserName' field.
  4. Enter the password that will be used to log into Avatar in the 'Password' field.
  5. Populate all required and desired fields.
  6. Enter "2" in the 'EpisodeNumber' field.
  7. Enter "Client A" in the 'ClientID' field.
  8. Click [Run].
  9. Validate the 'Message' field contains: "Client Admission web service has been filed successfully".
  10. Select "Client A" and access the 'Admission' form.
  11. Select episode 2 and click [Edit].
  12. Validate all populated fields are displayed.
  13. Select the "Demographics" section.
  14. Validate the 'Client Last Name' field contains "TEST".
  15. Validate the 'Client First Name' field contains "WEB SERVICE".
  16. Close the form.
Scenario 3: The 'ClientAdmission' - 'AddAdmission' web service: Admission of a new client
Steps
  1. Access SoapUI for the 'ClientAdmission' - 'AddAdmission' web service.
  2. Enter the system code that will be used to log into Avatar in the 'SystemCode' field.
  3. Enter the user name that will be used to log into Avatar in the 'UserName' field.
  4. Enter the password that will be used to log into Avatar in the 'Password' field.
  5. Populate all required and desired fields.
  6. Enter "TEST,WEB SERVICE" in the 'ClientName' field.
  7. Click [Run].
  8. Validate the 'Confirmation' field contains a value such as: "Client Unique ID: # Unique ID: #".
  9. Validate the 'Message' field contains: "Client Admission web service has been filed successfully".
  10. Select the client filed in the previous steps and access the 'Admission' form.
  11. Select the record filed in the previous steps and click [Edit].
  12. Validate all populated fields are displayed.
  13. Select the "Demographics" section.
  14. Validate the 'Client Last Name' field contains "TEST".
  15. Validate the 'Client First Name' field contains "WEB SERVICE".
  16. Close the form.
Topics
• Admission • NX • Web Services