Outside Provider Cal-OMS Annual Update - Annual Update Date
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Cal-OMS Admission
- Outside Providers
- Outside Provider Cal-OMS Admission
- Outside Provider Cal-OMS Annual Update
- Dictionary Update
- Associate User ID With Outside Providers
Scenario 1: Outside Provider Cal-OMS Annual Update - Annual update date is more than one year from the admission date - 'Enforce Annual Update Date Rule' registry setting is enabled
Specific Setup:
- Registry Setting:
- The 'Enable LA County Reporting Requirements' registry setting is set to 'Y'.
- Dictionary Update:
- A Cal-OMS Outside Provider must be defined in the Dictionary Update form. This dictionary code has an extended dictionary data element Cal-OMS Type Of Service. Note the dictionary code/values, Extended dictionary codes/values.
- File – CalOMS File
- Dictionary – 70701 Outside Provider
- Dictionary Code - 221001
- Dictionary value - desired value
- Extended Dictionary Data Element - Cal-OMS Type of Service
- Extended Dictionary Value - desired value
- Program Maintenance:
- Create a new Cal-OMS program or identify an existing program to update.
- The 'Provider ID (CalOMS)' field contains the Dictionary (70701) value defined for the program (221001).
- The 'Cal-OMS Type of Service' field contains the same value as Dictionary 70701's Extended Dictionary Value for the Outside Provider created.
- Note the program code/name.
- Admission:
- A new client is admitted in the program defined above.
- Associate User ID With Outside Providers:
- The user must be granted access to Cal-OMS outside provider.
- Outside Provider Cal-OMS admission:
- The 'Outside Provider Cal-OMS admission' is submitted for the client. Please note the admission date is same as the admission date of the client.
Steps
- Open the 'Outside Provider Cal-OMS Annual Update' form.
- Select desired Cal-OMS outside provider in the 'Provider' field.
- In the 'Program' field, select the Cal-OMS program. Programs must be associated with the same Cal-OMS Type of Service as the provider (Program Maintenance form, Cal-OMS Type of Service field).
- In the 'Cal-OMS Type of Service' field, select the Cal-OMS type of service associated with the program.
- In the Provider's Participant ID field, enter the provider’s participant ID.
- This number is used to identify the client. In order to access an outside provider Cal-OMS admission, this number must be re-entered exactly.
- Select 'New' in the 'Submission Type' field.
- Select the serial number in the 'Select Serial Number' field.
- Enter the form serial number in the 'Form Serial Number' field.
- In the Current First Name field, enter the client’s first name if different from the birth name.
- In the Current Last Name field, enter the client’s last name if different from the birth name.
- In the Sex field, select the client's sex.
- In the Social Security Number field, enter the client’s social security number.
- In the Date Of Birth field, enter the client’s date of birth.
- In the Admission Date field, enter date of admission. Note the admission date.
- In the Annual Update Date field, enter the date of the Cal-OMS annual update. Please note the 'Cal-OMS annual update' date is more than one year after admission date.
- In the Annual Update Number field, enter the annual update number.
- In the Birth First Name field, enter the client's first name at birth.
- In the Birth Last Name field, enter the client's last name at birth.
- In the ZIP Code At Current Residence field, enter the client's ZIP code.
- In the Place of Birth - County field, select the county from the list. Choose Other if the client was born outside California.
- In the Place of Birth - State field, select the client's place of birth.
- In the Driver's License Number field, enter the client’s driver’s license.
- In the Mother's First Name field, enter the client’s mother’s first name.
- In the Disability field, select the client disability.
- In the Consent field, select Yes if the client has given consent to be contacted in the future.
- Enter/select values for all other fields as desired/as required by form.
- When finished, click Submit.
- Verify the form submits successfully.
Scenario 2: Outside Provider Cal-OMS Annual Update - Annual update date is more than or equal to 60 days earlier than one year from the admission date
Specific Setup:
- Registry Setting:
- The 'Enable LA County Reporting Requirements' registry setting is set to 'Y'.
- Dictionary Update:
- A Cal-OMS Outside Provider must be defined in the Dictionary Update form. This dictionary code has an extended dictionary data element Cal-OMS Type Of Service. Note the dictionary code/values, Extended dictionary codes/values.
- File – CalOMS File
- Dictionary – 70701 Outside Provider
- Dictionary Code - 221001
- Dictionary value - desired value
- Extended Dictionary Data Element - Cal-OMS Type of Service
- Extended Dictionary Value - desired value
- Program Maintenance:
- Create a new Cal-OMS program or identify an existing program to update.
- The 'Provider ID (CalOMS)' field contains the Dictionary (70701) value defined for the program (221001).
- The 'Cal-OMS Type of Service' field contains the same value as Dictionary 70701's Extended Dictionary Value for the Outside Provider created.
- Note the program code/name.
- Admission:
- A new client is admitted in the program defined above.
- Associate User ID With Outside Providers:
- The user must be granted access to Cal-OMS outside provider.
- Outside Provider Cal-OMS admission:
- The 'Outside Provider Cal-OMS admission' is submitted for the client. Please note the admission date is same as the admission date of the client.
Steps
- Open the 'Outside Provider Cal-OMS Annual Update' form.
- Select desired Cal-OMS outside provider in the 'Provider' field.
- In the 'Program' field, select the Cal-OMS program. Programs must be associated with the same Cal-OMS Type of Service as the provider (Program Maintenance form, Cal-OMS Type of Service field).
- In the 'Cal-OMS Type of Service' field, select the Cal-OMS type of service associated with the program.
- In the Provider's Participant ID field, enter the provider’s participant ID.
- This number is used to identify the client. In order to access an outside provider Cal-OMS admission, this number must be re-entered exactly.
- Select 'New' in the 'Submission Type' field.
- Select the serial number in the 'Select Serial Number' field.
- Enter the form serial number in the 'Form Serial Number' field.
- In the Current First Name field, enter the client’s first name if different from the birth name.
- In the Current Last Name field, enter the client’s last name if different from the birth name.
- In the Sex field, select the client's sex.
- In the Social Security Number field, enter the client’s social security number.
- In the Date Of Birth field, enter the client’s date of birth.
- In the Admission Date field, enter date of admission. Note the admission date.
- In the Annual Update Date field, enter the date of the Cal-OMS annual update. Please note the 'Cal-OMS annual update' date is more than 60 days earlier than one year after admission date.
- In the Annual Update Number field, enter the annual update number.
- In the Birth First Name field, enter the client's first name at birth.
- In the Birth Last Name field, enter the client's last name at birth.
- In the ZIP Code At Current Residence field, enter the client's ZIP code.
- In the Place of Birth - County field, select the county from the list. Choose Other if the client was born outside California.
- In the Place of Birth - State field, select the client's place of birth.
- In the Driver's License Number field, enter the client’s driver’s license.
- In the Mother's First Name field, enter the client’s mother’s first name.
- In the Disability field, select the client disability.
- In the Consent field, select Yes if the client has given consent to be contacted in the future.
- Enter/select values for all other fields as desired/as required by form.
- When finished, click Submit.
- Verify a 'Annual Update Date: Annual Update Date must be at most 60 days earlier than one year after admission date.' error message.
- Click [Return to the form].
- In the 'Annual Update Date' field, enter the date of the Cal-OMS annual update. Please note the 'Cal-OMS annual update' date is exactly 60 days earlier than one year after admission date.
- Click [Submit].
- Verify the form submits successfully.
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Topics
• Cal-OMS
• NX
• Outside Provider Cal-OMS Annual Update
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837 Professional Rendering Provider (2310B/2420A) Information
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- File Import
- File Import - Compile/Post Report
- Practitioner Numbers By Guarantor and Program
- Practitioner Enrollment
- Electronic Billing
Scenario 1: 'File Import' - Verification of 'Guarantor/Program Billing Defaults Template' Import (Avatar Cal-PM)
Specific Setup:
- Avatar Cal-PM 'Guarantor/Program Billing Defaults' Import File containing one or more valid import rows for 837 Professional information
- Crystal Reports or other SQL reporting tool
Steps
- Open Avatar Cal-PM 'File Import' form.
- Select File Type 'Guarantor/Program Billing Defaults'.
- Select 'Upload New File' in 'Action' field and Click 'Process Action' button.
- Select Avatar Cal-PM 'Guarantor/Program Billing Defaults' import file including value for one or more of the following 837 Professional fields/segments and click 'Open' button:
- 'Rendering Provider Entity Type Qualifier (2310B/2420A-NM1-02)' field/segment 127
- 'Rendering Provider Last Or Organization Name (2310B/2420A-NM1-03)' field/segment 128
- 'Rendering Provider First Name (2310B/2420A-NM1-04)' field/segment 129
- 'Rendering Provider Middle Name (2310B/2420A-NM1-05)' field/segment 130
- 'Rendering Provider Name Suffix (2310B/2420A-NM1-07)' field/segment 131
- 'Rendering Provider Identification Code Qualifier (2310B/2420A-NM1-08)' field/segment 132
- 'Rendering Provider Identification Code (2310B/2420A-NM1-09)' field/segment 133
- 'Rendering Provider Taxonomy Code (2310B/2420A-PRV-03)' field/segment 134
- 'Rendering Provider Reference Identification Qualifier (2310B/2420A-REF-01)' field/segment 135
- 'Rendering Provider Reference Identification (2310B/2420A-REF-01)' field/segment 136
- 'Rendering Provider Reference Identification Qualifier-2 (2310B/2420A-REF-01)' field/segment 137
- 'Rendering Provider Identification Code-2 (2310B/2420A-REF-02)' field/segment 138
- 'Specify How Rendering Provider Information Should Be Populated' field/segment 139
- Select 'Compile/Validate File' in 'Action' field.
- Select loaded 'Guarantor/Program Billing Defaults' import file and click 'Process Action' button.
- Ensure that 'Compile/Validate File' action completes, and message 'Compiled' or '(File Name) contains one or more errors. These errors can be reviewed using 'Print Errors' action' is displayed.
- Click 'OK' button.
- Select 'Print File' in 'Action' field to view successfully compiled import data; Select compiled import file and click 'Process Action' button.
- In 'Guarantor/Program Billing Defaults' File Import Report, ensure that all valid import row(s) are included in report with segment/value details.
- Select 'Post File' in 'Action' field to post successfully compiled import data; Select compiled import file and click 'Process Action' button.
- Ensure that 'Compile/Validate File' action completes, and message 'Posted' and/or 'The selected file contains one or more lines with compilation errors. Only those lines without compilation errors will be posted' is displayed.
- Open Avatar Cal-PM 'Guarantor/Program Billing Defaults' form.
- Select 'Edit Template' in 'Action' field and select imported Guarantor/Program Billing Defaults template for review/edit.
- Navigate to '837 Professional' section of form.
- Ensure that imported values for 837 Professional Rendering Provider (2310B/2420A) fields noted above are present for selected template.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar Cal-PM SQL table 'SYSTEM.file_import_gpbd_p837', ensure that new row is filed in table for each successfully compiled/posted import row, including values for following fields:
- 'rendering_entity_code'/'rendering_entity_value'
- 'rendering_first_name'
- 'rendering_last_org_name'
- 'rendering_middle_name'
- 'rendering_suffix'
- 'rendering_id_qual_code'/'rendering_id_qual_value'
- 'rendering_id'
- 'rendering_taxonomy'
- 'rendering_ref_qual_code'/'rendering_ref_qual_value'
- 'rendering_ref_id'
- 'rendering_ref_qual2_code'/'rendering_ref_qual2_value'
- 'rendering_ref_id2'
- 'use_rnd_if_notfound_code'/'use_rnd_if_notfound_value'
For Avatar Cal-PM 'Guarantor/Program Billing Defaults - 837 Professional' format/layout, please refer to 'Avatar_Cal-PM_File_Import_Record_Layouts.xls' document included with update.
Scenario 2: 'Guarantor/Program Billing Defaults' - Verification of Rendering Provider (2310B/2420A) Fields
Specific Setup:
- Crystal Reports or other SQL reporting tool
Steps
- Open Avatar Cal-PM 'Guarantor/Program Billing Defaults' form.
- Select 'Add Template' in 'Action field (or 'Edit Template' and select existing Guarantor/Program Billing Defaults template for review/edit).
- Navigate to '837 Professional' section of form.
- Ensure the following fields related to 837 Professional Rendering Provider (2310B/2420A) information are present in 'Guarantor/Program Billing Defaults' form:
- 'Rendering Provider Entity Type Qualifier (2310B/2420A-NM1-02)'
- 'Rendering Provider Last Or Organization Name (2310B/2420A-NM1-03)'
- 'Rendering Provider First Name (2310B/2420A-NM1-04)'
- 'Rendering Provider Middle Name (2310B/2420A-NM1-05)'
- 'Rendering Provider Name Suffix (2310B/2420A-NM1-07)'
- 'Rendering Provider Identification Code Qualifier (2310B/2420A-NM1-08)'
- 'Rendering Provider Identification Code (2310B/2420A-NM1-09)'
- 'Rendering Provider Taxonomy Code (2310B/2420A-PRV-03)'
- 'Rendering Provider Reference Identification Qualifier (2310B/2420A-REF-01)'
- 'Rendering Provider Reference Identification (2310B/2420A-REF-01)'
- 'Rendering Provider Reference Identification Qualifier-2 (2310B/2420A-REF-01)'
- 'Rendering Provider Identification Code-2 (2310B/2420A-REF-02)'
- 'Specify How Rendering Provider Information Should Be Populated'
- Enter/select values for fields noted above (and any other fields/sections as desired).
- Click 'Submit' button to file Guarantor/Program Billing Defaults template.
- Select 'Edit Template' in 'Action field and select previously filed Guarantor/Program Billing Defaults template for review/edit.
- Navigate to '837 Professional' section of form.
- Ensure that previously entered/filed values for 837 Professional Rendering Provider (2310B/2420A) fields noted above are present for selected template.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar Cal-PM SQL table 'SYSTEM.table_837_p_facility_prov_num', ensure that Guarantor/Program Billing Defaults template entries/records are present, including values for the following fields:
- 'rendering_entity_code'/'rendering_entity_value'
- 'rendering_first_name'
- 'rendering_last_org_name'
- 'rendering_middle_name'
- 'rendering_suffix'
- 'rendering_id_qual_code'/'rendering_id_qual_value'
- 'rendering_id'
- 'rendering_taxonomy'
- 'rendering_ref_qual_code'/'rendering_ref_qual_value'
- 'rendering_ref_id'
- 'rendering_ref_qual2_code'/'rendering_ref_qual2_value'
- 'rendering_ref_id2'
- 'use_rnd_if_notfound_code'/'use_rnd_if_notfound_value'
Scenario 3: 'Electronic Billing' - Verification of Rendering Provider (2310B/2420A) Information
Specific Setup:
- Avatar Cal-PM Registry Setting 'Rendering Provider Name (Loop 2310B)' must be enabled
- 'Rendering Provider' must be selected in 'Select Type Of Information To Include In Rendering Provider Name (2310B)' field for applicable 'Guarantor/Program Billing Defaults' template
- One or more service(s) eligible for Avatar Cal-PM 837 Professional file inclusion (via 'Electronic Billing' form)
Steps
- Open Avatar Cal-PM 'Electronic Billing' form.
- Note - Acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.
- Select '837 Professional' in the 'Billing Form' field.
- Select 'Sort File' in the 'Billing Options' field.
- Enter/select 837 Professional file sorting criteria.
- Click 'Process' button to sort/generate 837 Professional file.
- Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
- Select 'Print' in the 'Print Or Delete Report' field.
- Select 837 Professional file sorted which includes services and click 'Process' button to display 837 Professional outbound file data.
- In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 2310B Rendering Provider Name loop/segment values (and 2420A Rendering Provider Name if included) reflect information from service practitioner or 'Guarantor/Program Billing Defaults' template values according to 'Specify How Rendering Provider Information Should Be Populated' field as follows:
- If 'Do Not Use Information From The Guarantor/Program Level' is selected (or if no value is selected):
- 2310B/2420A Rendering Provider Name loop/segments for all claims/services will be populated with information from service practitioner reporting values defined (via Avatar Cal-PM 'Practitioner Numbers By Guarantor and Program' or 'Practitioner Enrollment' forms)
- If practitioner is not defined for service or if service practitioner reporting values are not defined, 2310B/2420A Rendering Provider Name information will not be included
- If 'Always Use Information From The Guarantor/Program Level For Both Name And Identification' is selected:
- 2310B/2420A Rendering Provider Name loop/segments for all claims/services will be populated with information from 'Rendering Provider...' fields in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template
- If 'Rendering Provider...' field values in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template are not defined, 2310B/2420A Rendering Provider Name information will not be included
- If 'Use Information From The Guarantor/Program Level For Both Name And Identification If No Practitioner Found' is selected:
- 2310B/2420A Rendering Provider Name loop/segments will be populated with information from service practitioner reporting values defined where practitioner is defined for service; 2310B/2420A Rendering Provider Name loop/segments will be populated with information from 'Rendering Provider...' fields in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template where practitioner is not defined for service
- If practitioner is defined for service but service practitioner reporting values are not defined, 2310B/2420A Rendering Provider Name information will not be included
- If practitioner is not defined for service and 'Rendering Provider...' field values in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template are not defined, 2310B/2420A Rendering Provider Name information will not be included
- If 'Use Information From The Guarantor/Program Level For Identification Only But Just When A Practitioner Is Found Who Lacks Identification Information' is selected:
- 2310B/2420A Rendering Provider Name loop/segments will be populated with identification information (2310B/2420A NM1-08/09, 2310B/2420A PRV, 2310B/2420A REF) from service practitioner reporting values if defined; 2310B/2420A Rendering Provider Name loop/segments will be populated with identification information (2310B/2420A NM1-08/09, 2310B/2420A PRV, 2310B/2420A REF) from 'Rendering Provider...' fields in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template where practitioner is defined for service but service practitioner reporting values are not defined
- If practitioner is defined for service but service practitioner reporting values are not defined and 'Rendering Provider...' field values in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template are not defined, 2310B/2420A Rendering Provider Name information will not be included
- If practitioner is not defined for service, 2310B/2420A Rendering Provider Name information will not be included
- In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 2310B Rendering Provider Individual or Organizational Name (NM) values (and 2420A Rendering Provider Name if included) reflect information from service practitioner reporting values defined (via Avatar Cal-PM 'Practitioner Numbers By Guarantor and Program' or 'Practitioner Enrollment' forms) or from the following 'Guarantor/Program Billing Defaults' template fields where applicable:
- 'Rendering Provider Entity Type Qualifier (2310B/2420A-NM1-02)'
- 'Rendering Provider Last Or Organization Name (2310B/2420A-NM1-03)'
- 'Rendering Provider First Name (2310B/2420A-NM1-04)'
- 'Rendering Provider Middle Name (2310B/2420A-NM1-05)'
- 'Rendering Provider Name Suffix (2310B/2420A-NM1-07)'
- 'Rendering Provider Identification Code Qualifier (2310B/2420A-NM1-08)'
- 'Rendering Provider Identification Code (2310B/2420A-NM1-09)'
- Examples:
- NM1*82*1*RENDERINGLASTNAME*RENDERINGFIRSTNAME****XX*1245319599~
- NM1*82*1*RENDERINGLASTNAME*RENDERINGFIRSTNAME*RENDERMIDDLE**SR~
- NM1*82*2*RENDERINGORGNAME*****XX*1245319599~
- NM1*82*2*RENDERINGORGNAME~
- In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 2310B Rendering Provider Specialty Information/Taxonomy Code (PRV) value reflects information from service practitioner reporting values defined (via Avatar Cal-PM 'Practitioner Numbers By Guarantor and Program' or 'Practitioner Enrollment' forms) or from the following 'Guarantor/Program Billing Defaults' template field where applicable:
- 'Rendering Provider Taxonomy Code (2310B/2420A-PRV-03)'
- Example:
- PRV*PE*PXC*1223G0001X~
- In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 2310B Rendering Provider Secondary Identification (REF) values reflect information from service practitioner reporting values defined (via Avatar Cal-PM 'Practitioner Numbers By Guarantor and Program' or 'Practitioner Enrollment' forms) or from the following 'Guarantor/Program Billing Defaults' template fields where applicable:
- 'Rendering Provider Reference Identification Qualifier (2310B/2420A-REF-01)'
- 'Rendering Provider Reference Identification (2310B/2420A-REF-01)'
- 'Rendering Provider Reference Identification Qualifier-2 (2310B/2420A-REF-01)'
- 'Rendering Provider Identification Code-2 (2310B/2420A-REF-02)'
- Example:
- REF*1G*X99999~
- Note - If 'Health Care Financing Administration National Provider Identifier' (NPI) is selected/included in Rendering Provider Identification Code Qualifier/Code (2310 NM1-08/NM1-09), 2310B-REF/2420A-REF loops/segments will not be included in 837 Professional claim
- In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 2420A Rendering Provider Individual or Organizational Name (NM), 2420A Rendering Provider Specialty Information/Taxonomy Code (PRV) and 2420A Rendering Provider Secondary Identification (REF) loop/segments reflect information from service practitioner or 'Guarantor/Program Billing Defaults' template values as configured/detailed above where 2420A Rendering Provider Name Information is included in 837 Professional claims.
- Note - 2420A Rendering Provider Name loop/segments may be excluded from 837 Professional claims in case where 'If The Loop/Segment Information At The Service Level Is The Same As The Loop/Segment Information At The Claim Level (e.g. Service Facility Location Loop), Do You Want The Loop/Segment At The Service Level To Be Skipped?' is set to 'Yes' for applicable 'Guarantor/Program Billing Defaults' template
- Note - If 'Health Care Financing Administration National Provider Identifier' (NPI) is selected/included in Rendering Provider Identification Code Qualifier/Code (2420A NM1-08/NM1-09), 2420A-REF loops/segments will not be included in 837 Professional claim
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Topics
• Electronic Billing
• File Import
• Guarantor/Program Billing Defaults
• NX
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File Import - Client Charge Input
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Site Specific Section Modeling (PM)
- File Import
- Client Ledger
Scenario 1: File Import - Client Charge Input - 'SS Treatment ICD-10 Code' and 'SS Treatment Integer' fields.
Specific Setup:
- Site Specific Section Modeling has been used to add the following fields, at a minimum, to the ‘Client Charge Input’ and ‘Edit Service Information’ forms. Use the ‘Product Custom Logic Definition’ field to assign the values for 'SS Treatment Integer 1’ - 'SS Treatment Integer 9’.
- 'SS Treatment Integer 1’ - Use As First Field To Calculate Duration.
- 'SS Treatment Integer 2’ - Use As Second Field To Calculate Duration.
- 'SS Treatment Integer 3’ - Use As Third Field To Calculate Duration.
- 'SS Treatment Integer 4’ - Use As First Field To Calculate Co-Practitioner Duration.
- 'SS Treatment Integer 5’ - Use As Second Field To Calculate Co-Practitioner Duration.
- 'SS Treatment Integer 6’ - Use As Second Field To Calculate Co-Practitioner Duration.
- 'SS Treatment Integer 7’ - Use As First Field To Calculate Co-Practitioner 2 Duration.
- 'SS Treatment Integer 8’ - Use As Second Field To Calculate Co-Practitioner 2 Duration.
- 'SS Treatment Integer 9’ - Use As Third Field To Calculate Co-Practitioner 2.
- 'SS Treatment Integer 10’.
- 'SS Treatment ICD-10 Code 1’.
- 'SS Treatment ICD-10 Code 2’.
- 'SS Treatment ICD-10 Code 3’.
- 'SS Treatment ICD-10 Code 4’.
- 'SS Treatment ICD-10 Code 5’.
- File Import – Client Charge Input:
- A test file has been created which includes the fields above and all required fields. Note the information in the file.
- The update zip file contains the ‘Avatar_Cal-PM_File_Import_Record_Layouts’ spreadsheet for guidance.
Steps
- Open ‘File Import’.
- Select ‘Client Charge Input’ in ‘File Type’.
- Validate that ‘Upload New File’ is selected in ‘Action’.
- Click [Process Action] and select the file from setup.
- Click [Open].
- Select ‘Compile/Validate File’ in ‘Action’.
- Select the file from setup.
- Click [Process Action].
- Click [OK] on the compile message.
- Select ‘Post’ in ‘Action’.
- Select the file from setup.
- Click [Process Action].
- Click [OK] on the posted message.
- Close the form.
- Open ‘Edit Service Information’.
- Enter the ‘Client ID’ and select the client.
- Click [Select Service(s) To Edit].
- Select the desired service in the ‘Select Services(s) To Edit’ checklist.
- Click [OK].
- Validate that the ‘Duration (Minutes)’, ‘Co-Practitioner Duration (Minutes)’, and ‘Second Co Staff Duration (Minutes)’ fields contain the sum of the three fields for each practitioner’s duration.
- Also, validate that the other service information matches the information in the imported file.
- Close the form.
- If desired, open ‘Client Ledger’.
- Select the ‘Client ID’ from the import file.
- Select ‘All Episodes’ in ‘Claim/Episode/All Episodes’.
- Select the desired ‘From Date’.
- Select the desired ‘To Date’.
- Select ‘Simple’ in ‘Ledger Type’.
- Click [Process].
- Validate that the report contains the service information in the import file.
- Close the report.
- Close the form.
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Topics
• Client Charge Input
• Site Specific Section Modeling
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Reports - 'Bed Availability Report' and 'Official Census Report'
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Bed Availability Report
- Official Census Report
Scenario 1: Bed Availability Report - Validating bed availability after 'Bed Assignment'
Specific Setup:
- Inpatient client assigned to a room and bed (Client A).
Steps
- Select "Client A" and access the 'Bed Assignment' form.
- Assign a 'Unit', 'Room' and 'Date/Time of Bed Assignment'.
- Click [Submit].
- Access the 'Bed Availability Report' form.
- Select "Individual" in the 'For Individual Unit Or All' field.
- Select "Room/Bed" in the 'Sort By Room/Bed Or Alpha' field.
- Select the unit for "Client A" in the 'For Unit' field.
- Click [Process].
- Validate the 'Bed Availability Report' is displayed as expected.
- Validate the 'Client Name' field contains "Client A" for the unit/room selected in the previous steps.
- Click [Dismiss] and close the form.
Scenario 2: Validate the 'Official Census Report'
Steps
- Access the 'Official Census Report' form.
- Enter the desired date in the 'Date' field.
- Select the desired value in the 'Treatment Setting' field.
- Click [Process].
- Validate the 'Official Census Report' is displayed as expected.
- Click [Dismiss] and close the form.
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Topics
• Bed Assignment
• Bed Availability Report
• Official Census Report
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CPT Place of Service Override
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- User Definition
- Financial Eligibility
- Print Bill
- Electronic Billing
- CPT Place Of Service Override
- Guarantors/Payors
- File Import
Scenario 1: Cal-PM - CPT Place of Service Override - Billing
Specific Setup:
- Registry Settings: Avatar PM->System Maintenance->Service Code Maintenance->->->Allow CPT Place Of Service Override = 'Y'.
- User Definition is used to give the tester access to the form 'CPT Place Of Service Override' and the tables 'table_cpt_place_override' and 'table_cpt_pos_template_def'.
- CPT Code Definition: Identify two codes that are associated to two different service codes in ‘Service Fee/Cross Reference Maintenance’.
- Service Codes:
- Service Code 1: Is associated to CPT Code 1.
- Service Code 2: Is associated to CPT Code 2.
- Client: Select an outpatient client.
- Note the program.
- Ensure that the client has an active Diagnosis record.
- Ensure the client has an active Financial Eligibility record. Note the guarantor.
- Program Maintenance is used to note the ‘Location’.
- Client Charge Input: Create a service for each of the service codes. Note the date(s) of service.
- Client Ledger: Verify that the services distributed to the guarantor noted above.
- Close Charges is used to close the charges.
- Create Interim Billing Batch File is used to create a batch specific to the guarantor, program, and client.
- Print Bill is used to create an unclaimed bill for the interim batch.
- Print the report for further comparison. The service line will contain the service date, location code, CPT Code, and other details.
- Electronic Billing is used to create an unclaimed bill for the interim batch.
- Print the dump file for further comparison. The ‘CLM’ segment will contain the location in field 5 (CLM05). The ‘SV1’ will contain the location in field 5 (SV105).
Steps
- Open ‘CPT Place Of Service Override’.
- Select ‘Add’ in ‘Action’.
- Enter desired value in ‘Template Name’.
- Select the client’s guarantor in ‘Guarantor’.
- Select the client’s program in ‘Program’.
- Select ‘Individual’ in ‘All or Individual Service Code’.
- Enter ‘Service Code 1’ in ‘Select Service’.
- Validate that the service is saved in ‘Selected Service(s)’.
- Select ‘Individual’ in ‘All or Individual CPT Code’.
- Enter ‘CPT Code 1’ in ‘Select CPT’.
- Validate that the code is saved in ‘Selected CPT(s)’.
- Select desired value in ‘All or Individual Location’.
- Enter ‘Modifiers’, if desired.
- Select a location value that differs from the ‘Print Bill’ location in ‘Place Of Service (HCFA 24-B)’.
- Select a location value that differs from the ‘Electronic Billing’ location in ‘Place Of Service (837 Professional)’.
- Click [Submit].
- Close the form.
- Open ‘Print Bill’ and print an unclaimed bill for the interim batch.
- Validate that the location for Service Code 1 now contains the value selected in ‘Place Of Service (HCFA 24-B)’.
- Validate that the location for Service Code 2 contains the value that was in bill printed during Setup.
- Close the report.
- Close the form.
- Open ‘Electronic Billing’ and create an unclaimed bill for the interim batch.
- Validate that the ‘CLM’ LOCATION now contains the value selected in ‘Place Of Service (837 Professional)’.
- Validate that the ‘SV1’ location for Service Code 1 now contains the value selected in ‘Place Of Service (837 Professional)’.
- Validate that the ‘SV1’ location for Service Code 2 contains the value that was in the dump file printed during Setup.
- Close the report.
- Close the form.
Scenario 2: File Import - CPT Place of Service Override
Specific Setup:
- The 'Avatar_Cal-PM_File_Import_Record_Layouts' is included in the update zip file to aid in creating the test files for File Import.
- Registry Settings:
- Note the value of the 'Avatar PM->System Maintenance->File Import->->->Import File Delimiter' setting to determine how to build the test files for File Import.
- Avatar PM->System Maintenance->Service Code Maintenance->->->Allow CPT Place Of Service Override = 'Y'.
- User Definition is used to give the tester access to the form 'CPT Place Of Service Override' and the tables 'table_cpt_place_override' and 'table_cpt_pos_template_def'.
- Service Codes: Select one or more for the File Import test files.
- Guarantors/Payors: Select one or more for the File Import test files.
- Program Maintenance: Select one or more for the File Import test files.
- CPT Code Definition: Select one or more for the File Import test files.
- Dictionary Update:
- Client:
- Print dictionary '(578) Place Of Service (HCFA 24-B)' to select a value for the File Import test files.
- Print dictionary '(579) Place Of Service (837 Professional)' to select a value for the File Import test files.
- Print dictionary '(10006) Location' to select values for the File Import test files.
- Other Tabled Files:
- Print dictionary '(556) Action' to select values for the File Import test files.
- Create a file import item with an 'Action' of '1' which will 'add' the 'CPT Place Of Service Override Template' when posted. There will be no value in the 'Template ID' field.
- Copy the 'add' file and edit the 'Action' to be '2' to make it an 'edit' file. Edit at least one thing in the file, such as the 'Modifier' field.
- After the 'Add' file is posted, the 'Template ID' will need to be added to this file.
- Copy the 'edit' file and edit the 'Action' to be '3' to make it a 'delete' file.
- After the 'Add' file is posted, the 'Template ID' will need to be added to this file.
Steps
- Open ‘File Import’.
- Select ‘CPT Place Of Service Override’ in ‘File Type’.
- Upload, compile, print, and post the file that will add the template.
- Close the form.
- Open ‘CPT Place Of Service Override’.
- Click [Display CPT Place Of Service Overrides].
- Validate that the ‘CPT Place Of Service Override Report’ opens.
- Validate that the report contains the data that was submitted in the posted file.
- Close the report.
- Select ‘Edit’ in ‘Action’.
- Select the imported template in ‘Select Template’.
- Validate the template data.
- Close the form.
- Open ‘File Import’.
- Select ‘CPT Place Of Service Override’ in ‘File Type’.
- Upload, compile, print, and post the file that will edit the template.
- Close the form.
- Open ‘CPT Place Of Service Override’.
- Click [Display CPT Place Of Service Overrides].
- Validate that the ‘CPT Place Of Service Override Report’ opens.
- Validate that the report contains the edited data that was submitted in the posted file.
- Close the report.
- Select ‘Edit’ in ‘Action’.
- Select the imported template in ‘Select Template’.
- Validate the edited template data.
- Close the form.
- Open ‘File Import’.
- Select ‘CPT Place Of Service Override’ in ‘File Type’.
- Upload, compile, print, and post the file that will delete the template.
- Close the form.
- Open ‘CPT Place Of Service Override’.
- Click [Display CPT Place Of Service Overrides].
- Validate that the ‘CPT Place Of Service Override Report’ opens.
- Validate that the report does not contain the template.
- Close the report.
- Select ‘Edit’ in ‘Action’.
- Validate that the template is not available in ‘Select Template’.
- Close the form.
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Topics
• 837 Professional
• Database Management
• File Import
• NX
• Print Bill
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Diagnosis - 'Add To Problem List' functionality
Scenario 1: Diagnosis - Add new / Add to Problem List
Specific Setup:
- A client must be enrolled in an existing episode (Client A).
Steps
- Select "Client A" and access the 'Diagnosis' form.
- Click [Add] if present.
- Select any value for the 'Type of Diagnosis' field.
- Enter the desired values for the 'Date of Diagnosis' and 'Time of Diagnosis' fields.
- Click [New Row].
- Enter any value in the 'Diagnosis Search' field and press the 'Enter' key.
- Validate "Powered By IMO Terminology" displays under the search results.
- Select a diagnosis that has an associated SNOMED code.
- Populate any desired and required fields.
- Select "Yes" in the 'Add to Problem List' field.
- Submit the form.
- Access the 'Problem List' form.
- Click [Enter Problems].
- Validate the new diagnosis is included.
- Click [View - DSM/IDC Code].
- Validate a dialog opens with the DSM/IDC code data for the problem.
- Close out of the dialog.
- Click [View - System Notes].
- Validate the dialog displays the user information for the problem.
- Close out of the dialog.
- Click [Close/Cancel].
- Close the form.
Scenario 2: Diagnosis / Add to Problem List
Specific Setup:
- A client is enrolled in an existing episode (Client A).
Steps
- Select "Client A" and access the 'Diagnosis' form.
- Add a diagnosis.
- Select the desired practitioner in the 'Diagnosing Practitioner' field.
- Do not select a value in the 'Add To Problem List' field.
- Click [Submit] and close the form.
- Select "Client A" and access the 'Problem List' form.
- Click [View/Enter Problems].
- Validate the 'Problem List' grid does not contain the problem added via the 'Diagnosis' form.
- Close the form.
- Select "Client A" and access the 'Diagnosis' form.
- Edit the previously filed diagnosis.
- Select "Yes" in the 'Add To Problem List' field.
- Click [Submit] and close the form.
- Select "Client A" and access the 'Problem List' form.
- Click [View/Enter Problems].
- Validate the 'Problem List' grid contains the problem added via the 'Diagnosis' form.
- Close the form.
Scenario 3: Diagnosis - Add new / Add to Problem List
Specific Setup:
- A client must be enrolled in an existing episode (Client A).
Steps
- Select "Client A" and access the 'Diagnosis' form.
- Click [Add] if present.
- Select any value for the 'Type of Diagnosis' field.
- Enter the desired values for the 'Date of Diagnosis' and 'Time of Diagnosis' fields.
- Click [New Row].
- Enter any value in the 'Diagnosis Search' field and press the 'Enter' key.
- Validate "Powered By IMO Terminology" displays under the search results.
- Select a diagnosis that has an associated SNOMED code.
- Populate any desired and required fields.
- Select "Yes" in the 'Add to Problem List' field.
- Submit the form.
- Access the 'Problem List' form.
- Click [Enter Problems].
- Validate the new diagnosis is included.
- Click [View - DSM/IDC Code].
- Validate a dialog opens with the DSM/IDC code data for the problem.
- Close out of the dialog.
- Click [View - System Notes].
- Validate the dialog displays the user information for the problem.
- Close out of the dialog.
- Click [Close/Cancel].
- Close the form.
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Topics
• Diagnosis
• Problem List
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Diagnosis - 'Problem Classification' field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: Diagnosis - Add new / Add to Problem List
Specific Setup:
- A client must be enrolled in an existing episode (Client A).
Steps
- Select "Client A" and access the 'Diagnosis' form.
- Click [Add] if present.
- Select any value for the 'Type of Diagnosis' field.
- Enter the desired values for the 'Date of Diagnosis' and 'Time of Diagnosis' fields.
- Click [New Row].
- Enter any value in the 'Diagnosis Search' field and press the 'Enter' key.
- Validate "Powered By IMO Terminology" displays under the search results.
- Select a diagnosis that has an associated SNOMED code.
- Populate any desired and required fields.
- Select "Yes" in the 'Add to Problem List' field.
- Submit the form.
- Access the 'Problem List' form.
- Click [Enter Problems].
- Validate the new diagnosis is included.
- Click [View - DSM/IDC Code].
- Validate a dialog opens with the DSM/IDC code data for the problem.
- Close out of the dialog.
- Click [View - System Notes].
- Validate the dialog displays the user information for the problem.
- Close out of the dialog.
- Click [Close/Cancel].
- Close the form.
Scenario 2: Diagnosis - Add new / Add to Problem List
Specific Setup:
- A client must be enrolled in an existing episode (Client A).
Steps
- Select "Client A" and access the 'Diagnosis' form.
- Click [Add] if present.
- Select any value for the 'Type of Diagnosis' field.
- Enter the desired values for the 'Date of Diagnosis' and 'Time of Diagnosis' fields.
- Click [New Row].
- Enter any value in the 'Diagnosis Search' field and press the 'Enter' key.
- Validate "Powered By IMO Terminology" displays under the search results.
- Select a diagnosis that has an associated SNOMED code.
- Populate any desired and required fields.
- Select "Yes" in the 'Add to Problem List' field.
- Submit the form.
- Access the 'Problem List' form.
- Click [Enter Problems].
- Validate the new diagnosis is included.
- Click [View - DSM/IDC Code].
- Validate a dialog opens with the DSM/IDC code data for the problem.
- Close out of the dialog.
- Click [View - System Notes].
- Validate the dialog displays the user information for the problem.
- Close out of the dialog.
- Click [Close/Cancel].
- Close the form.
Scenario 3: 'Diagnosis' form 'Problem Classification' field validation when defaulting diagnosis from a previous episode
Specific Setup:
- The 'Avatar CWS->Problem List->->->->Problem Classification Required' registry setting is set to "Y".
- A new code has been added to the Avatar CWS 'Dictionary Update' file 'Problem Classification'. This is in field 16250.
Steps
- Access the 'Diagnosis' form for any client.
- Add a new diagnosis for the client. Note the episode selected as it will be used in later steps.
- Complete required fields as needed.
- Select 'Y' in the 'Add to Problem List' field.
- Do not populate the 'Problem Classification' field at this time.
- Click [Submit].
- Access the 'Diagnosis' form again for the same client.
- Select 'Add' on the pre-display. Do not select the existing diagnosis.
- Select the episode used in the above steps in the 'Select Episode To Default Diagnosis Information From' field.
- Select the diagnosis entered in the above steps in the 'Select Diagnosis To Default Information From' field.
- Click on the existing diagnosis row to populate the detail fields.
- Click on the 'Problem Classification' field. Verify that all codes for selection display in the drop down list, including the newly added code (see Setup section).
- Select a code from the drop down list.
- Click [Submit] and close the form.
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Topics
• Diagnosis
• Problem List
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Avatar Cal-PM is updated to capture additional information
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: 'Facility Defaults' form - field validations
Steps
- Access the 'Facility Defaults' form.
- Populate any desired fields.
- Click [Submit].
- Access Crystal Reports or other SQL Reporting tool.
- Create a report using the 'SYSTEM.table_facility_defaults' SQL table.
- Validate a row is displayed for the data on file.
- Validate the following audit fields are displayed and are populated accordingly:
- data_entry_by
- data_entry_by_option
- data_entry_date
- data_entry_time
- data_entry_user_id
- data_entry_user_name
- option_id
- option_desc
- The following audit fields will only be populated in a UTC enabled system:
- data_entry_utc
- data_entry_timezone_info_all
- data_entry_time_j
- data_entry_offset
- data_entry_timezone_short
- Close the report.
Scenario 2: 'ClinicianServicesV2' Web Service - Verification Of 'putClinicianCreation' Filing
Steps
- Using the 'ClinicianServicesV2' web service, submit a request using the 'putClinicianCreation' method to create new 'Practitioner Enrollment' record (and optionally Avatar MSO Performing Provider Registration record), including a value for the 'ClinicianOfficeAddressDate' field/segment.
- Confirm the 'ClinicianServicesV2' web service responds with confirmation data on successful filing of 'putClinicianCreation' method.
- Example: "<Confirmation>Practitioner ID:000017||||First Name:FIRSTNAME||Last Name:LASTNAME||Registration Date:01/01/2022||NPI:123456789</Confirmation>"
- Confirm the 'ClinicianServicesV2' web service responds with confirmation message on successful filing of 'putClinicianCreation' method.
- Example: "<Message>Clinician Services web service has been filed successfully.</Message>"
- Confirm the 'ClinicianServicesV2' web service responds with successful status value on successful filing of 'putClinicianCreation' method.
- Example: " <Status>1</Status>"
- Access the 'Practitioner Enrollment' form and select the 'Practitioner Enrollment' record filed via web service for view/update.
- Confirm new 'Practitioner Enrollment' record is created with values/data submitted via web service including the 'Office Address - Start Date' field value (as well as values assigned for Avatar MSO 'Performing Provider' and 'Performing Provider Registration' practitioner association/link fields if enabled).
Scenario 3: 'ClinicianServicesV2' Web Service - Verification Of 'putClinicianUpdate' Filing
Steps
- Using the 'ClinicianServicesV2' web service, submit a request using the 'putClinicianUpdate' method to edit/update a 'Practitioner Enrollment' record (and optionally Avatar MSO Performing Provider Registration record if linked), including a value for the 'ClinicianOfficeAddressDate' field/segment.
- Confirm the 'ClinicianServicesV2' web service responds with confirmation data on successful filing of 'putClinicianUpdate' method.
- Example: "<Confirmation>Practitioner ID:000017||||First Name:FIRSTNAME||Last Name:LASTNAME||Registration Date:01/01/2022||NPI:123456789</Confirmation>"
- Confirm the 'ClinicianServicesV2' web service responds with confirmation message on successful filing of 'putClinicianUpdate' method.
- Example: "<Message>Clinician Services web service has been filed successfully.</Message>"
- Confirm the 'ClinicianServicesV2' web service responds with successful status value on successful filing of 'putClinicianUpdate' method.
- Example: " <Status>1</Status>"
- Access the 'Practitioner Enrollment' form and select the 'Practitioner Enrollment' record filed via web service for view/update.
- Confirm the 'Practitioner Enrollment' record is updated with values/data submitted via web service including the 'Office Address - Start Date' field value.
Scenario 4: 'Practitioner Enrollment' - Form Verification
Specific Setup:
- Crystal Reports or other SQL Reporting Tool.
Steps
- Access the 'Practitioner Enrollment' form.
- Select any existing practitioner for view/update.
- Validate the 'Office Address - Start Date' field is displayed.
- Enter any value in the 'Office Address - Start Date' field.
- Populate any other required and desired fields.
- Click [Submit].
- Access the 'Practitioner Enrollment' form.
- Select the same practitioner from the previous steps.
- Validate the 'Office Address - Start Date' field contains the value filed in the previous steps.
- Validate any other previously field data is displayed.
- Close the form.
- Access Crystal Reports or other SQL Reporting Tool.
- Create a report using the 'SYSTEM.staff_enrollment_history' SQL table.
- Navigate to the row for the practitioner used in the previous steps.
- Validate the 'office_add_date' field contains the value field in the previous steps.
- Close the report.
- Create a report using the 'SYSTEM.staff_current_demographics' SQL table.
- Navigate to the row for the practitioner used in the previous steps.
- Validate the 'office_add_date' field contains the value field in the previous steps.
- Close the report.
Scenario 5: Dictionary Update - Validate the 'Treatment Service' dictionary
Steps
- Access the 'Dictionary Update' form.
- Select "Client" in the 'File' field.
- Select "(101) Treatment Service" in the 'Data Element' field.
- Enter an existing code in the 'Dictionary Code' field.
- Validate the 'Dictionary Value' field populates accordingly.
- Validate the 'Extended Dictionary Data Element' field contains "(742) Encounter Code (FHIR)".
- Select "(742) Encounter Code (FHIR)" in the 'Extended Dictionary Data Element' field.
- Select the desired value in the 'Extended Dictionary Value (Single Dictionary)' field.
- Click [Apply Changes].
- Validate a message is displayed stating: Filed!
- Click [OK].
- Select the "Print Dictionary" section.
- Select "Client" in the 'File' field.
- Select "Individual Data Element" in the 'Individual or All Data Elements' field.
- Select "(101) Treatment Service" in the 'Data Element' field.
- Click [Print Dictionary].
- Validate the report displays the updated dictionary with the "Encounter Code (FHIR)" extended dictionary value populated.
- Close the report and the form.
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Topics
• Dictionary
• Facility Defaults
• Practitioner
• Query/Reporting
• Web Services
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