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Avatar Cal-PM 2022 Quarterly Release 2022.01 Acceptance Tests

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Update 1 Summary | Details
Avatar AM 2021 is Installed
Scenario 1: Validate Upgrading Avatar Cal-PM 2021 to 2022 is successful when 2021.04.00 is loaded
Specific Setup:
  • Latest Monthly Release is installed.
Steps
  1. Open the "Product Updates" form.
  2. Select the appropriate [Namespace] from the Application dropdown list
  3. Click [Select Update/Customization Pack].
  4. Browse to the location for the updates and select the Update 1.
  5. Click [OK] on the "File Upload Complete" window.
  6. Click [Review Update/Customization Pack Contents].
  7. Verify Update 1 is included.
  8. Click [Install Update/Customization Pack].
  9. Click [OK] when the install completes.
  10. Click [Close Form].
Topics
• Upgrade
Update 2 Summary | Details
Avatar Cal-PM 'Support MSO Other Healthcare Coverage' Registry Setting
Scenario 1: Avatar Cal-PM Registry Settings - Verification of 'Support MSO Other Healthcare Coverage' Registry Setting
Steps
  1. Open 'Registry Settings' form.
  2. Enter search value 'Support MSO Other Healthcare Coverage' and click 'View Registry Settings' button.
  3. Ensure Registry Setting ' is returned (under 'Avatar PM -> Billing -> Electronic Billing -> All 837 Submissions -> Support MSO Other Healthcare Coverage' path).
  4. Ensure 'Registry Setting Details' field contains the following explanation text:

"When this registry setting is set to "Y", MSO will no longer send payments over with services into PM. Instead, it will take the information from the 837 file and echo that information on the bill out of PM with the corresponding service. An asterisk will be added to the service row in the 'Client Ledger' form to denote that there is Other Healthcare Coverage in MSO for that service. Avatar MSO 2016 Update 21 must be installed for this functionality to work. Selecting "N" will enable default functionality.

In order to enable this setting, the registry setting "Enable Fee Override in PM" must be set to either '1', '2', or '3'."
Topics
• Registry Settings • NX
Update 3 Summary | Details
'Electronic Billing' - 837 Professional 2400-SV1 Service Information
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 8 Summary | Details
'Quick Billing Rule Definition' Form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Quick Billing Rule Definition
Scenario 1: 'Quick Billing Rule Definition' - Form Verification
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable New Quick Billing Format' must be enabled
Steps
  1. Open Avatar Cal-PM 'Quick Billing Rule Definition' form.
  2. Select 'Add New' or 'Edit Existing' in the 'Add New Or Edit Existing Rule Definition' field.
  3. Select value in 'Billing Form' field.
  4. Ensure that if '837 Institutional' or '837 Professional' is selected in the 'Billing Form' field, 'Include Primary and/or Secondary Billing' field is enabled and required.
Topics
• Quick Billing • NX
Update 9 Summary | Details
Avatar Cal-PM 'Payor Based Authorizations'
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Payor Based Authorizations
  • Payor Based Authorizations Report
  • Client Charge Input (Charge Fee Access)
  • Managed Care Authorizations
  • Client Charge Input With Diagnosis Entry
  • Recurring Client Charge Input (Diagnosis Entry)
  • Client Charge Input (Charge Fee Access and Diagnosis Entry)
  • Scheduling Calendar
Scenario 1: Avatar Cal-PM Registry Settings - Verification of 'Enable Payor Based Authorizations' Registry Setting
Steps
  1. Open 'Registry Settings' form.
  2. Enter search value 'Enable Payor Based Authorizations' and click 'View Registry Settings' button.
  3. Ensure Registry Setting 'Enable Payor Based Authorizations' is returned (under 'Avatar PM -> Services -> Payor Based Authorizations' path).
  4. Ensure 'Registry Setting Details' field contains the following explanation text:

"Selecting 'Y' adds the form 'Payor Based Authorizations' to the menu. This form allows the user to file authorizations for a particular guarantor and service combination. These authorizations will be used for all clients that do not have an authorization specified for that particular guarantor and service in the 'Managed Care Authorizations' form. Selecting 'N' will remove the form from the menu.

Please Note: This functionality is only applicable to 837 electronic billing."

Scenario 2: Avatar Cal-PM Registry Settings - Verification of 'Enable CPT Based Payor Authorizations' Registry Setting
Steps
  1. Open 'Registry Settings' form.
  2. Enter search value 'Enable CPT Based Payor Authorizations' and click 'View Registry Settings' button.
  3. Ensure Registry Setting 'Enable CPT Based Payor Authorizations' is returned (under 'Avatar PM -> Services -> Payor Based Authorizations' path).
  4. Ensure 'Registry Setting Details' field contains the following explanation text:

"Selecting 'Y' will remove 'Service Code' or 'Service Code(s)' field from the 'Payor Based Authorizations' form and replace it with the 'Select CPT Codes' button, which will allow users to define payor-based authorizations based on a service's relevant CPT code as defined in 'Service Fee/Cross Reference Maintenance'.

Selecting 'N' will revert back to service code based payor authorizations."

Scenario 3: 'Payor Based Authorizations' - Form Verification
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Payor Based Authorizations' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' may optionally be enabled/disabled
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar Cal-PM 'Payor Based Authorizations' form (under 'Avatar PM / System Maintenance / System Definition' menu).
  2. Select 'Add' action in 'Add/Edit/Delete' field (or select 'Edit' action and click 'Select Authorizations To Edit/Delete' button to view/update existing Payor Based Authorization record/entry).
  3. Ensure the following fields are present in the 'Payor Based Authorizations' form:
  4. 'Guarantor'
  5. 'Service Code' (Not available when Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled)
  6. 'Effective Date'
  7. 'Expiration Date'
  8. 'Authorization Number'
  9. 'Display Authorizations' Button
  10. 'Select Authorizations To Edit/Delete' Button
  11. 'Select CPT Codes' Button (Available only when Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled)
  12. 'All CPT Codes' (Available only when Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled)
  13. Enter/select values for all required/desired fields for Payor Based Authorization record/entry.
  14. Where Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled - Click 'Select CPT Codes' button and enter one or more code selections in the multi-iteration grid displayed (or set 'All CPT Codes' field to 'Yes').
  15. Click 'Submit' button to file 'Payor Based Authorizations' form/record.
  16. Select 'Edit' action in 'Add/Edit/Delete' field and click 'Select Authorizations To Edit/Delete' button to view/update previously entered Payor Based Authorization record/entry.
  17. Ensure all field values are present in 'Payor Based Authorizations' form/record as previously entered/filed.
  18. Click 'Display Authorizations' button to display the Payor Based Authorizations report/information.
  19. In Payor Based Authorizations report display/results, ensure that all Payor Based Authorization entries/records for selected 'Guarantor' value are displayed, including the following fields:
  20. 'Guarantor'
  21. 'Service Code' or 'CPT Code' (Dependent on Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations')
  22. 'Program' (To be employed by future Avatar Cal-PM update - Will display 'All Programs (NONE)' in report information)
  23. 'Practitioner Category' (To be employed by future Avatar Cal-PM update - Will display 'All Practitioner Categories (NONE)' in report information)
  24. 'Effective Date'
  25. Expiration Date'
  26. 'Authorization Number'
  27. Open Crystal Reports or other SQL reporting tool.
  28. Where Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is disabled - In Avatar Cal-PM SQL table 'SYSTEM.table_payor_auths', ensure that data row(s) are added/updated on filing of 'Payor Based Authorizations' form and contain values/information filed via form for all applicable fields.
  29. Where Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled - In Avatar Cal-PM SQL table 'SYSTEM.table_payor_auths_cpt', ensure that data row(s) are added/updated on filing of 'Payor Based Authorizations' form and contain values/information filed via form for all applicable fields.
Scenario 4: 'Client Charge Input' - Verification of Payor Based Authorization Requirements (Service Code Based Authorizations)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Payor Based Authorizations' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' must be disabled
  • One or more Guarantor(s) where values are selected/defined for 'Verify Services and Appointments Against Available Authorizations' and 'Verification Level For Authorizations For Client Charge Input' fields (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  • Client record eligible for 'Client Charge Input' form service entry where applicable Guarantor(s) is/are assigned via client Financial Eligibility record
Steps
  1. Open Avatar Cal-PM 'Client Charge Input' form.
  2. Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Client Charge Input (Charge Fee Access)', 'Client Charge Input With Diagnosis Entry', 'Client Charge Input (Charge Fee Access And Diagnosis Entry)', 'Recurring Client Charge Input', 'Recurring Client Charge Input (Charge Fee Access)', 'Recurring Client Charge Input With Diagnosis Entry' and/or 'Recurring Client Charge Input (Charge Fee Access And Diagnosis Entry)' forms
  3. Enter value for 'Date of Service'.
  4. Enter/select values for 'Client ID', 'Episode Number', 'Program', 'Service Code' and 'Practitioner' fields (and any other fields as desired/required).
  5. In case where no Managed Care Authorization record exists for selected client applicable to service criteria/entry values and no Payor Based Authorization record exists in system applicable to service criteria/entry values - Ensure that user is presented with Error/Warning message noting 'No valid authorizations found on file.'
  6. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service' entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
  7. Note - Service entry via 'Client Charge Input' forms may be disallowed or allowed following error/warning message, dependent on 'Verification Level For Authorizations For Client Charge Input' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  8. In case where Managed Care Authorization record exists for selected client applicable to service criteria/entry values but is exhausted/cannot be used for additional services (due to Available Dollars/Available Units/Available Visits limitations), and no Payor Based Authorization record exists in system applicable to service criteria/entry values - Ensure that user is presented with Error/Warning message noting 'Authorization On File For Guarantor Will Be Exhausted With Requested Services.'
  9. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service' entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
  10. Note - Service entry via 'Client Charge Input' forms may be disallowed or allowed following error/warning message, dependent on 'Verification Level For Authorizations For Client Charge Input' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  11. In case where no Managed Care Authorization record exists for selected client applicable to service criteria/entry values (or Managed Care Authorization record exists but is exhausted/cannot be used for additional services) but Payor Based Authorization record exists in system applicable to service criteria/entry values - Ensure that user is not presented with Error/Warning message and Service entry is allowed due to coverage by Payor Based Authorization record(s).
  12. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service' entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
Scenario 5: 'Client Charge Input' - Verification of Payor Based Authorization Requirements (CPT Code Based Authorizations)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Payor Based Authorizations' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' must be enabled
  • One or more Service Codes where 'CPT-4/HCPCS Code' value is defined for Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form)
  • One or more Guarantor(s) where values are selected/defined for 'Verify Services and Appointments Against Available Authorizations' and 'Verification Level For Authorizations For Client Charge Input' fields (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  • Client record eligible for 'Client Charge Input' form service entry where applicable Guarantor(s) is/are assigned via client Financial Eligibility record
Steps
  1. Open Avatar Cal-PM 'Client Charge Input' form.
  2. Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Client Charge Input (Charge Fee Access)', 'Client Charge Input With Diagnosis Entry', 'Client Charge Input (Charge Fee Access And Diagnosis Entry)', 'Recurring Client Charge Input', 'Recurring Client Charge Input (Charge Fee Access)', 'Recurring Client Charge Input With Diagnosis Entry' and/or 'Recurring Client Charge Input (Charge Fee Access And Diagnosis Entry)' forms
  3. Enter value for 'Date of Service'.
  4. Enter/select values for 'Client ID', 'Episode Number', 'Program', 'Service Code' and 'Practitioner' fields (and any other fields as desired/required).
  5. In case where no Managed Care Authorization record exists for selected client applicable to service criteria/entry values and no Payor Based Authorization record exists in system applicable to service criteria/entry values - Ensure that user is presented with Error/Warning message noting 'No valid authorizations found on file.'
  6. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service' entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
  7. For CPT Based Payor Authorizations - Records/Authorizations applicable to service criteria/entry values will be determined by the selected Service Code for Client Charge Input and the 'CPT-4/HCPCS Code' value assigned to this Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form) where CPT Code is also included/authorized in the 'Select CPT Codes' section of Payor Based Authorization record, and/or Payor Based Authorization records where 'All CPT Codes' field is set to 'Yes'
  8. Note - Service entry via 'Client Charge Input' forms may be disallowed or allowed following error/warning message, dependent on 'Verification Level For Authorizations For Client Charge Input' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  9. In case where Managed Care Authorization record exists for selected client applicable to service criteria/entry values but is exhausted/cannot be used for additional services (due to Available Dollars/Available Units/Available Visits limitations), and no Payor Based Authorization record exists in system applicable to service criteria/entry values - Ensure that user is presented with Error/Warning message noting 'Authorization On File For Guarantor Will Be Exhausted With Requested Services.'
  10. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service' entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
  11. For CPT Based Payor Authorizations - Records/Authorizations applicable to service criteria/entry values will be determined by the selected Service Code for Client Charge Input and the 'CPT-4/HCPCS Code' value assigned to this Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form) where CPT Code is also included/authorized in the 'Select CPT Codes' section of Payor Based Authorization record, and/or Payor Based Authorization records where 'All CPT Codes' field is set to 'Yes'
  12. Note - Service entry via 'Client Charge Input' forms may be disallowed or allowed following error/warning message, dependent on 'Verification Level For Authorizations For Client Charge Input' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  13. In case where no Managed Care Authorization record exists for selected client applicable to service criteria/entry values (or Managed Care Authorization record exists but is exhausted/cannot be used for additional services) but Payor Based Authorization record exists in system applicable to service criteria/entry values - Ensure that user is not presented with Error/Warning message and Service entry is allowed due to coverage by Payor Based Authorization record(s).
  14. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service' entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
  15. For CPT Based Payor Authorizations - Records/Authorizations applicable to service criteria/entry values will be determined by the selected Service Code for Client Charge Input and the 'CPT-4/HCPCS Code' value assigned to this Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form) where CPT Code is also included/authorized in the 'Select CPT Codes' section of Payor Based Authorization record, and/or Payor Based Authorization records where 'All CPT Codes' field is set to 'Yes'
Scenario 6: 'Electronic Billing' - Verification of Payor Based Authorization Requirements (Service Code Based Authorizations)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Payor Based Authorizations' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' must be disabled
  • One or more Guarantor(s) where values are selected/defined for 'Verify Services and Appointments Against Available Authorizations' and 'Verification Level For Authorizations For 837 Electronic Billing' fields (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional or 837 Institutional file inclusion under applicable Guarantor(s) (via 'Electronic Billing' form)
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' or '837 Institutional' in the 'Billing Form' field.
  3. Select 'Sort File' in the 'Billing Options' field.
  4. Enter/select 837 Professional/837 Institutional file sorting criteria.
  5. Click 'Process' button to sort/generate 837 Professional/837 Institutional file.
  6. Select 'Run Report' in the 'Billing Options' field.
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional/837 Institutional file sorted which includes services(s), and click 'Process' button to display 837 Professional/837 Institutional outbound file report.
  9. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file report: In case where no Managed Care Authorization record exists for client/service(s) to be included in 837 file and no Payor Based Authorization record exists for service(s) to be included in 837 file - Ensure that error is reported/included for service(s) in 'Required Data Missing: Patient Service Data' (837 Professional) or 'Required Data Missing: Patient Claim Data' (837 Institutional) section of report.
  10. Error Message Examples:
  11. 'Authorizations On File For Guarantor Are Exhausted For Service Code: (CODE INFO) On Service Date: (DATE)'
  12. 'Service Code (CODE) Is Missing An Authorization Number For Guarantor (GUARANTOR) For Date Of Service (DATE). No More Claims Processing Will Be Done For The Episode'
  13. Note - Service(s) may be excluded or included in 837 Professional/837 Institutional file where error is present, dependent on 'Verification Level For Authorizations For 837 Electronic Billing' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  14. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file report: In case where Managed Care Authorization record exists for client/service(s) to be included in 837 file but is exhausted/cannot be used for services (due to Available Dollars/Available Units/Available Visits limitations) and no Payor Based Authorization record exists for service(s) to be included in 837 file - Ensure that error is reported/included for service(s) in 'Required Data Missing: Patient Service Data' (837 Professional) or 'Required Data Missing: Patient Claim Data' (837 Institutional) section of report.
  15. Note - Service(s) may be excluded or included in 837 Professional/837 Institutional file where error is present, dependent on 'Verification Level For Authorizations For 837 Electronic Billing' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  16. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file report: In case where no Managed Care Authorization record exists for client/service(s) to be included in 837 file but Payor Based Authorization record exists for service(s) to be included in 837 file - Ensure that Authorization-related error is not reported/included for service(s) in 'Required Data Missing: Patient Service Data' (837 Professional) or 'Required Data Missing: Patient Claim Data' (837 Institutional) section of report, and service(s) is/are included in 837 file information as expected (subject to all other 837 sorting criteria/requirements).
Scenario 7: 'Electronic Billing' - Verification of Payor Based Authorization Requirements (CPT Code Based Authorizations)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Payor Based Authorizations' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' must be enabled
  • One or more Service Codes where 'CPT-4/HCPCS Code' value is defined for Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form)
  • One or more Guarantor(s) where values are selected/defined for 'Verify Services and Appointments Against Available Authorizations' and 'Verification Level For Authorizations For 837 Electronic Billing' fields (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional or 837 Institutional file inclusion under applicable Guarantor(s) (via 'Electronic Billing' form)
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' or '837 Institutional' in the 'Billing Form' field.
  3. Select 'Sort File' in the 'Billing Options' field.
  4. Enter/select 837 Professional/837 Institutional file sorting criteria.
  5. Click 'Process' button to sort/generate 837 Professional/837 Institutional file.
  6. Select 'Run Report' in the 'Billing Options' field.
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional/837 Institutional file sorted which includes services(s), and click 'Process' button to display 837 Professional/837 Institutional outbound file report.
  9. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file report: In case where no Managed Care Authorization record exists for client/service(s) to be included in 837 file and no Payor Based Authorization record exists for service(s) to be included in 837 file - Ensure that error is reported/included for service(s) in 'Required Data Missing: Patient Service Data' (837 Professional) or 'Required Data Missing: Patient Claim Data' (837 Institutional) section of report.
  10. Error Message Examples:
  11. 'Authorizations On File For Guarantor Are Exhausted For Service Code: (CODE INFO) On Service Date: (DATE)'
  12. 'Service Code (CODE) Is Missing An Authorization Number For Guarantor (GUARANTOR) For Date Of Service (DATE). No More Claims Processing Will Be Done For The Episode'
  13. For CPT Based Payor Authorizations - Records/Authorizations applicable to service(s) to be included in 837 file will be determined by the Service Code and the 'CPT-4/HCPCS Code' value assigned to this Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form) where CPT Code is also included/authorized in the 'Select CPT Codes' section of Payor Based Authorization record, and/or Payor Based Authorization records where 'All CPT Codes' field is set to 'Yes'
  14. Note - Service(s) may be excluded or included in 837 Professional/837 Institutional file where error is present, dependent on 'Verification Level For Authorizations For 837 Electronic Billing' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  15. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file report: In case where Managed Care Authorization record exists for client/service(s) to be included in 837 file but is exhausted/cannot be used for services (due to Available Dollars/Available Units/Available Visits limitations) and no Payor Based Authorization record exists for service(s) to be included in 837 file - Ensure that error is reported/included for service(s) in 'Required Data Missing: Patient Service Data' (837 Professional) or 'Required Data Missing: Patient Claim Data' (837 Institutional) section of report.
  16. For CPT Based Payor Authorizations - Records/Authorizations applicable to service(s) to be included in 837 file will be determined by the Service Code and the 'CPT-4/HCPCS Code' value assigned to this Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form) where CPT Code is also included/authorized in the 'Select CPT Codes' section of Payor Based Authorization record, and/or Payor Based Authorization records where 'All CPT Codes' field is set to 'Yes'
  17. Note - Service(s) may be excluded or included in 837 Professional/837 Institutional file where error is present, dependent on 'Verification Level For Authorizations For 837 Electronic Billing' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  18. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file report: In case where no Managed Care Authorization record exists for client/service(s) to be included in 837 file but Payor Based Authorization record exists for service(s) to be included in 837 file - Ensure that Authorization-related error is not reported/included for service(s) in 'Required Data Missing: Patient Service Data' (837 Professional) or 'Required Data Missing: Patient Claim Data' (837 Institutional) section of report, and service(s) is/are included in 837 file information as expected (subject to all other 837 sorting criteria/requirements).
  19. For CPT Based Payor Authorizations - Records/Authorizations applicable to service(s) to be included in 837 file will be determined by the Service Code and the 'CPT-4/HCPCS Code' value assigned to this Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form) where CPT Code is also included/authorized in the 'Select CPT Codes' section of Payor Based Authorization record, and/or Payor Based Authorization records where 'All CPT Codes' field is set to 'Yes'
Scenario 8: 'Scheduling Calendar' - Verification of Payor Based Authorization Requirements (Service Code Based Authorizations)
Specific Setup:
  • Avatar Appointment Scheduling must be installed
  • Avatar Cal-PM Registry Setting 'Enable Payor Based Authorizations' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' must be disabled
  • One or more Guarantor(s) where values are selected/defined for 'Verify Services and Appointments Against Available Authorizations' and 'Verification Level For Authorizations For Appointment Scheduling' fields (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  • Client record eligible for Scheduling Calendar/Appointment Scheduling service entry where applicable Guarantor(s) is/are assigned via client Financial Eligibility record
Steps
  1. Open Avatar Cal-PM 'Scheduling Calendar' form.
  2. Select date and Practitioner for Appointment Scheduling entry; right click and select 'Add Appointment' action.
  3. Enter/select values for 'Appointment Site', 'Appointment Date', 'Appointment Start Time', 'Duration', 'Appointment End Time', 'Service Code', 'Client' and 'Practitioner' fields.
  4. In case where no Managed Care Authorization record exists for selected client applicable to Appointment/service criteria/entry values and no Payor Based Authorization record exists in system applicable to Appointment/service criteria/entry values - Ensure that user is presented with Error/Warning message noting 'No valid authorizations found on file.'
  5. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service'/Appointment Date entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
  6. Note - Appointment/service entry via 'Scheduling Calendar' form may be disallowed or allowed following error/warning message, dependent on 'Verification Level For Authorizations For Appointment Scheduling' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  7. In case where Managed Care Authorization record exists for selected client applicable to Appointment/service criteria/entry values but is exhausted/cannot be used for additional services (due to Available Dollars/Available Units/Available Visits limitations), and no Payor Based Authorization record exists in system applicable to Appointment/service criteria/entry values - Ensure that user is presented with Error/Warning message noting 'Authorization On File For Guarantor Will Be Exhausted With Requested Services.'
  8. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service'/Appointment Date entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
  9. Note - Appointment/service entry via 'Scheduling Calendar' form may be disallowed or allowed following error/warning message, dependent on 'Verification Level For Authorizations For Appointment Scheduling' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  10. In case where no Managed Care Authorization record exists for selected client applicable to Appointment/service criteria/entry values (or Managed Care Authorization record exists but is exhausted/cannot be used for additional services) but Payor Based Authorization record exists in system applicable to Appointment/service criteria/entry values - Ensure that user is not presented with Error/Warning message and Appointment/service entry is allowed due to coverage by Payor Based Authorization record(s).
  11. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service'/Appointment Date entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
Scenario 9: 'Scheduling Calendar' - Verification of Payor Based Authorization Requirements (CPT Code Based Authorizations)
Specific Setup:
  • Avatar Appointment Scheduling must be installed
  • Avatar Cal-PM Registry Setting 'Enable Payor Based Authorizations' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' must be enabled
  • One or more Service Codes where 'CPT-4/HCPCS Code' value is defined for Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form)
  • One or more Guarantor(s) where values are selected/defined for 'Verify Services and Appointments Against Available Authorizations' and 'Verification Level For Authorizations For Appointment Scheduling' fields (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  • Client record eligible for Scheduling Calendar/Appointment Scheduling service entry where applicable Guarantor(s) is/are assigned via client Financial Eligibility record
Steps
  1. Open Avatar Cal-PM 'Scheduling Calendar' form.
  2. Select date and Practitioner for Appointment Scheduling entry; right click and select 'Add Appointment' action.
  3. Enter/select values for 'Appointment Site', 'Appointment Date', 'Appointment Start Time', 'Duration', 'Appointment End Time', 'Service Code', 'Client' and 'Practitioner' fields.
  4. In case where no Managed Care Authorization record exists for selected client applicable to Appointment/service criteria/entry values and no Payor Based Authorization record exists in system applicable to Appointment/service criteria/entry values - Ensure that user is presented with Error/Warning message noting 'No valid authorizations found on file.'
  5. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service'/Appointment Date entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
  6. For CPT Based Payor Authorizations - Records/Authorizations applicable to Appointment/service criteria/entry values will be determined by the selected Service Code for Appointment/service and the 'CPT-4/HCPCS Code' value assigned to this Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form) where CPT Code is also included/authorized in the 'Select CPT Codes' section of Payor Based Authorization record, and/or Payor Based Authorization records where 'All CPT Codes' field is set to 'Yes'
  7. Note - Appointment/service entry via 'Scheduling Calendar' form may be disallowed or allowed following error/warning message, dependent on 'Verification Level For Authorizations For Appointment Scheduling' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  8. In case where Managed Care Authorization record exists for selected client applicable to Appointment/service criteria/entry values but is exhausted/cannot be used for additional services (due to Available Dollars/Available Units/Available Visits limitations), and no Payor Based Authorization record exists in system applicable to Appointment/service criteria/entry values - Ensure that user is presented with Error/Warning message noting 'Authorization On File For Guarantor Will Be Exhausted With Requested Services.'
  9. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service'/Appointment Date entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
  10. For CPT Based Payor Authorizations - Records/Authorizations applicable to Appointment/service criteria/entry values will be determined by the selected Service Code for Appointment/service and the 'CPT-4/HCPCS Code' value assigned to this Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form) where CPT Code is also included/authorized in the 'Select CPT Codes' section of Payor Based Authorization record, and/or Payor Based Authorization records where 'All CPT Codes' field is set to 'Yes'
  11. Note - Appointment/service entry via 'Scheduling Calendar' form may be disallowed or allowed following error/warning message, dependent on 'Verification Level For Authorizations For Appointment Scheduling' configuration for applicable Guarantor (via Avatar Cal-PM 'Guarantors/Payors' form, 'Authorization Information' section)
  12. In case where no Managed Care Authorization record exists for selected client applicable to Appointment/service criteria/entry values (or Managed Care Authorization record exists but is exhausted/cannot be used for additional services) but Payor Based Authorization record exists in system applicable to Appointment/service criteria/entry values - Ensure that user is not presented with Error/Warning message and Appointment/service entry is allowed due to coverage by Payor Based Authorization record(s).
  13. For Payor Based Authorizations - Records/Authorizations applicable to 'Date Of Service'/Appointment Date entry/value will be those where 'Date of Service' is on or after 'Effective Date' and before 'Expiration Date' (not including records where 'Date of Service' is same as 'Expiration Date')
  14. For CPT Based Payor Authorizations - Records/Authorizations applicable to Appointment/service criteria/entry values will be determined by the selected Service Code for Appointment/service and the 'CPT-4/HCPCS Code' value assigned to this Service Code (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form) where CPT Code is also included/authorized in the 'Select CPT Codes' section of Payor Based Authorization record, and/or Payor Based Authorization records where 'All CPT Codes' field is set to 'Yes'
Topics
• Registry Settings • Service Authorizations • NX • Client Charge Input • Electronic Billing • Scheduling Calendar
Update 10 Summary | Details
'Women's Health History' form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Women's Health History
Scenario 1: Women's Health History - Gender validations
Specific Setup:
  • The following clients are enrolled in existing episodes:
  • A client with "Male" selected in the 'Sex' field (Client A).
  • A client with "Transgender (M to F)" selected in the 'Sex' field (Client B).
  • A client with "Other" selected in the 'Sex' field (Client C).
  • A client with "Unknown" selected in the 'Sex' field (Client D).
  • A client with "Transgender (F to M)" selected in the 'Sex' field (Client E).
  • A client with "Female" selected in the 'Sex' field (Client F).
Steps
  1. Access the 'Women's Health History' form.
  2. Select "Add" in the 'Add, Edit, or Delete a Record' field.
  3. Select "Client A" in the 'Client ID' field.
  4. Validate an error message is displayed stating: Only female clients may be selected.
  5. Click [OK].
  6. Select "Client B" in the 'Client ID' field.
  7. Validate an error message is displayed stating: Only female clients may be selected.
  8. Click [OK].
  9. Select "Client C" in the 'Client ID' field.
  10. Validate an error message is displayed stating: Only female clients may be selected.
  11. Click [OK].
  12. Select "Client D" in the 'Client ID' field.
  13. Validate an error message is displayed stating: Only female clients may be selected.
  14. Click [OK].
  15. Select "Client E" in the 'Client ID' field.
  16. Validate no error is displayed.
  17. Populate all required and desired fields.
  18. Click [Submit] and [Yes] to return to form.
  19. Select "Add" in the 'Add, Edit, or Delete a Record' field.
  20. Select "Client F" in the 'Client ID' field.
  21. Validate no error is displayed.
  22. Populate all required and desired fields.
  23. Click [Submit] and [No] to exit the form.
Scenario 2: ProviderConnect Enterprise - Validate the 'PutPregnancy' 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 defined for a valid managing organization.
  • A female client must be enrolled in an existing episode that is mapped to the defined managing organization in the 'ProviderConnect Enterprise Identifiers' section of the 'Admission' form (Client A).
Steps
  1. Access the 'Women's Health History' form.
  2. Select "Add" in the 'Add, Edit, or Delete a Record' field.
  3. Enter "Client A" in the 'Client ID' field.
  4. Select the episode mapped to the managing organization in the 'Episode Number' field.
  5. Enter the desired date in the 'Assessment Date' field.
  6. Enter the desired date in the 'Pregnancy Start Date' field.
  7. Enter the desired date in the 'Pregnancy End Date' field.
  8. Click [Submit].
  9. Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
  10. Click [No].
  11. Access the 'ProviderConnect Enterprise Action Log' form.
  12. Enter the desired dates in the 'From Date' and 'Through Date' fields.
  13. Enter the desired times in the 'From Time' and 'Through Time' fields.
  14. Select the desired organization in the 'Managing Organization' field.
  15. Select "PutPregnancy" in the 'Action Name' field.
  16. Click [View Action Log].
  17. Validate the 'ProviderConnect Enterprise Action Log' Report is displayed.
  18. Validate the 'ProviderConnect Enterprise Action Log' Report contains the 'PutPregnancy' action that was triggered from the 'Women's Health History' form with a "Success" result.
  19. Close the report and the form.
'CSI Admission' web service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CSI Admission
  • SOAPUI - CSIAdmission - AddCSIAdmission
Scenario 1: ProviderConnect Enterprise - CSI Admission - Validate the 'PutEhrAssessment' action
Specific Setup:
  • Avatar CareFabric->ProviderConnect Enterprise->Contracting Providers->->->Enable External Connections' must be set to "Y".
  • The 'Managing Organization Definition' form must be defined for a valid managing organization.
  • A client must be enrolled in an existing episode and be mapped to the defined managing organization in the 'ProviderConnect Enterprise Identifiers' section of the 'Admission' form (Client A).
  • Client A's episode must be in a program that has "Yes" selected in the 'Mental Health Program (CSI)' field in the 'Program Maintenance' form.
Steps
  1. Select "Client A" and access the 'CSI Admission' form.
  2. Select the desired episode in the Pre-Display and click [OK].
  3. Populate all required and desired fields.
  4. Click [Submit].
  5. Access the 'ProviderConnect Enterprise Action Log'.
  6. Enter the desired dates in the 'From Date' and 'Through Date' fields.
  7. Enter the desired times in the 'From Time' and 'Through Time' fields.
  8. Select the desired organization in the 'Managing Organization' field.
  9. Select "PutEhrAssessment" in the 'Action Name' field.
  10. Click [View Action Log].
  11. Validate the 'ProviderConnect Enterprise Action Log' Report is displayed.
  12. Validate the 'ProviderConnect Enterprise Action Log' Report contains the 'PutEhrAssessment' action that was triggered from the 'CSI Admission' form with a "Success" result.
  13. Close the report and the form.
Scenario 2: 'WEBSVC.CSIAdmission' - 'AddCSIAdmission' web service
Specific Setup:
  • A client must be enrolled in a program that has "Yes" selected in the 'Mental Health Program (CSI)' field in the 'Program Maintenance' form (Client A).
Steps
  1. Access SoapUI for the 'CSIAdmission' - 'AddCSIAdmission' 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. Do not enter a value in the 'BirthNameMiddle' field.
  7. Enter "Client A" in the 'ClientID' field.
  8. Enter "1" in the 'EpisodeNumber' field.
  9. Click [Run].
  10. Validate the 'Message' field contains: CSI Admission web service has been filed successfully.
  11. Select "Client A" and access the 'CSI Admission' form.
  12. Validate all populated fields are displayed as expected.
  13. Validate the 'Birth Name (Middle)' field does not contain a value.
  14. Close the form.
Topics
• Women's Heath History • Pregnancy • Csi Admission • Web Services
Update 12 Summary | Details
274 - Provider Directory Definition - inactive provider
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • User Definition
  • 274 - Provider Directory Submission
  • 274 - Provider Directory Definition
  • Site Specific Section Modeling (PM)
Scenario 1: 274 - Provider Directory Submission - form validation
Specific Setup:
  • An output directory has been defined in ‘Facility Defaults’ field ‘Output Path On Server For State Reporting Files’.
Steps
  1. Open ‘274 - Provider Directory Submission’.
  2. Validate that the ‘Options’, ‘Reporting Period (MM/YY)’, and ‘File Description’ fields are required.
  3. Select ‘Compile File’ in ‘Options’.
  4. Enter the desired value in ‘Reporting Period (MM/YY)’.
  5. Enter the desired value in ‘File Description’.
  6. Click [Process File].
  7. The ‘Health Care Provider Directory’ report will open. The report can contain the following links: ‘274 Submission’, ‘Required Data Missing/Invalid - Directory Defaults’, ‘Required Data Missing/Invalid - Group’, ‘Required Data Missing/Invalid – Site’, ‘‘Required Data Missing/Invalid – Provider’, and ‘‘Required Data Missing/Invalid – Other’.
  8. Click on the link for any ‘Required Data Missing/Invalid’ links and review the data in the sub report. Correct the data as desired.
  9. Click on the link for ‘274 Submission’ and review the data in the report. Providers will not display for the sites in which they are inactive.
  10. Close the report.
  11. Select ‘Dump File’ in ‘Options’.
  12. Validate that ‘Select File’ in now required.
  13. Select the file compiled above in ‘Select File’.
  14. Click [Process File].
  15. The ‘Health Care Provider Directory’ report will open and display the data that will be included in the dump file.
  16. Close the report.
  17. Select ‘Create File On Server For Submission’ in ‘Options’.
  18. Select the file compiled above in ‘Select File’.
  19. Click [Process File].
  20. The ‘Create File’ item is received with the message ‘Process Completed’.
  21. Click [OK].
  22. Select ‘Run Report’ Select ‘Create File On Server For Submission’ in ‘Options’.
  23. Select the file compiled above in ‘Select File’.
  24. Click [Process File].
  25. The ‘Health Care Provider Directory’ report will open and contain the same links the previously opened.
  26. Close the report.
  27. ‘Options’ contains ‘Delete File’. If deleting a file is desired, select ‘Delete File’.
  28. Select the file compiled above in ‘Select File’.
  29. Click [Process File].
  30. Close the form.
Scenario 2: 274 - Provider Directory Definition - Provider Definition
Specific Setup:
  • Tester has been given access to the ‘274 - Provider Directory Definition’ form in ‘User Definition’ under ‘Avatar PM / System Maintenance / System Definition / Health Care Provider Directory (274)’.
Steps
  1. Open ‘274 - Provider Directory Definition’.
  2. Validate that the form opened to the ‘Group Definition’ section.
  3. Select the ‘Provider Definition’ section.
  4. Validate that ‘Provider’ is the only required field on the form.
  5. Select a ‘Provider’.
  6. Validate that ‘Associated Site’ and ‘Active’ are now required fields.
  7. Click [X].
  8. Open 'Site Specific Section Modeling' for Avatar PM.
  9. Select 'TABLE27400 (274 = Provider Directory Definition) Provider Definition’ in 'Site Specific Selection'.
  10. Click [OK].
  11. Select ‘Site Specific Section’ option.
  12. Click on row ‘84’ in ‘Prompt Order’.
  13. Click [Edit Selected Item].
  14. Validate that ‘Label’ is disabled and contains ‘Provider Identifier - Secondary (2140EA-REF-02)’.
  15. Validate that ‘Initially Enabled’ = ‘Yes’.
  16. Validate that ‘Initially Required’ = 'No'.
  17. Select ‘Yes’ in ‘Initially Required’.
  18. As desired, set other ‘Prompt Order’ rows to a value of ‘Yes’ in ‘Initially Required’. Note the values of the other fields, specifically the ‘Label’.
  19. Click [Submit].
  20. Click ‘Refresh Forms’ icon.
  21. Open ‘274 - Provider Directory Definition’.
  22. Select the ‘Provider Definition’ section.
  23. Validate that ‘Provider Identifier - Secondary (2140EA-REF-02)’ is now required.
  24. Validate that all other rows that were updated to be required display as required. The 'Label' that was noted is the field name.
  25. Add desired data to the form.
  26. Click [File Provider Details].
  27. Select the ‘Provider’ that was submitted in ‘Provider’.
  28. Select a new value in ‘Associated Site’.
  29. Validate that a ‘Provider-Site Records On File’ items displays the message ‘Record to default Information From’ and contains a drop down list of ‘Sites’.
  30. Select a site and click [OK].
  31. Validate that the data defaulted into the fields.
  32. Click [File Provider Details].
  33. Create additional desired ‘Provider Definitions’ for the same provider for another site and then inactivate the provider in one of the three sites. The provider will not display in the submission for the inactive site.
  34. Create additional desired ‘Provider Definitions’.
  35. Click [X].
Topics
• 274 - Provider Directory
Update 15 Summary | Details
'Electronic Billing' Support for Services Originating in Avatar MSO
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
Update 16 Summary | Details
Admission - "ProviderConnect Enterprise" section
Scenario 1: Admission - "ProviderConnect Enterprise" section
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.
  • 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. Select the desired value in the 'Type Of Admission' field.
  15. Select "Practitioner A" in the 'Admitting Practitioner' field.
  16. Select the "ProviderConnect Enterprise Identifiers" section.
  17. Click [Add New Item].
  18. Select the defined managing organization in the 'External Organization' field.
  19. Click [Search].
  20. Select the matching client record in the 'Select Matching Client Record' dialog.
  21. Click [OK].
  22. Validate the 'External ID' field is disabled contains the client ID for the client in the managing organization's system.
  23. Click [Update Demographics].
  24. Validate an "Information" message is displayed stating: Client Demographics Information Updated.
  25. Click [OK].
  26. Select the "Demographics" section.
  27. Validate demographic fields have been updated to match the managing organization's record.
  28. Click [Submit].
  29. Select the client admitted in the previous steps and access the 'Admission' form.
  30. Select the "ProviderConnect Enterprise Identifiers" section.
  31. Select the mapping filed in the previous steps and click [Edit Selected Item].
  32. Validate the 'External Organization' field is disabled.
  33. Validate the 'External ID' field is disabled.
  34. Validate the 'Search' button is disabled.
  35. Click [Delete Selected Item].
  36. Validate an "Error" message is displayed stating: This mapping has already been created and cannot be deleted here. Please use the 'Delete ProviderConnect Enterprise Client Mapping' form to remove existing mappings.
  37. Click [OK] and close the form.
  38. Access Crystal Reports or other SQL Reporting Tool.
  39. Select the PM namespace.
  40. Create a report using the 'SYSTEM.pce_client_mapping' table.
  41. Validate a row is displayed for the client mapping created in the previous steps.
  42. Validate the 'ID' field contains a unique identifier (ex. 1||3||1).
  43. Validate the 'FACILITY' field contains the facility (ex. 1).
  44. Validate the 'external_PATID' field contains the ID of the client in the managing organization (ex. 16).
  45. Validate the 'local_PATID' field contains the ID of the client (ex. 3).
  46. Validate the 'managing_organization_ID' field contains the ID of the managing organization the client is mapped to (ex. 1).
  47. Close the report.
Topics
• Admission • ProviderConnect Enterprise • Admission (Outpatient)
Update 17 Summary | Details
'Client Ledger' Re-Billed Service Display
Scenario 1: 'Client Ledger' - Verification of Service Display for Client Ledger Sorting by Claim
Specific Setup:
  • Client record with Client record with re-billed services included in claim(s)
Steps
  1. Open the Avatar PM/Cal-PM 'Client Ledger' form.
  2. Enter/select 'Client ID' value for Client Ledger display.
  3. Select 'Claim' in the 'Claim/Episode/All Episodes' field for limiting Client Ledger display/results to a single claim.
  4. Select desired claim number for Client Ledger display in 'Claim Number' field, where claim includes re-billed services.
  5. Select 'Simple' in the 'Ledger Type' field.
  6. Click 'Process' button.
  7. In Client Ledger results/display, ensure that re-billed service(s) related to/included in the selected claim are included in display.
Topics
• Client Ledger
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
  • 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 47 Summary | Details
Eligibility Inquiry (270) Request - exclude client with expired coverage
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Diagnosis (CAL)
  • Scheduling Calendar
  • Eligibility Inquiry (270) Request
  • Eligibility Inquiry (270) Submission
  • Dynamic Form Sort File
  • Eligibility Inquiry (270) Submission Report
  • System Task Scheduler
  • User Definition
  • Update Demographics
Scenario 1: Batch Eligibility Inquiry (270) Request - Exclude Clients With Expired Coverage For Selected Guarantor
Specific Setup:
  • The following registry setting is enabled: Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Enable 270/271 Transaction Sets.
  • Service Code 1: Has been defined with a value in 'Service Type Code (270)'. Note the value.
  • Guarantors/Payors 1: has a value of ‘Yes’ in ‘Support 270/271 Transaction Sets’ in the ‘270 / 271 / 834’ section. The ‘270’ section has data filed.
  • Client 1:
  • Is assigned Guarantors/Payors 1 in Financial Eligibility.
  • Coverage Effective date is 30 days before current date.
  • Coverage Expiration Date is 15 days before current date.
  • Client 2:
  • Is assigned Guarantors/Payors 1 in Financial Eligibility.
  • Coverage Effective date is 30 days before current date.
  • Scheduling Calendar has been used to create appointments for Client 1 and Client 2, using Service Code 1, 10 days before current date.
Steps
  1. Open 'Eligibility Inquiry (270) Request'.
  2. Select the 'Batch Eligibility (270) Request' section.
  3. Create a batch for appointments for Guarantors/Payors 1.
  4. Select 'No' in 'Exclude Clients With Expired Coverage For Selected Guarantor(s)'.
  5. Click [File].
  6. Open 'Eligibility Inquiry (270) Submission'.
  7. Select 'Compile File' in 'Options'.
  8. Select 'Yes' in 'Batch Request'.
  9. Select the batch created above in 'Select Batch'.
  10. Click [Process File].
  11. Validate that Client 1 and Client 2 are output to the report.
  12. Close the report.
  13. Delete the file.
  14. Close the form.
  15. Open 'Eligibility Inquiry (270) Request'.
  16. Select the 'Batch Eligibility (270) Request' section.
  17. Create a batch for appointments for Guarantors/Payors 1.
  18. Select 'Yes' in 'Exclude Clients With Expired Coverage For Selected Guarantor(s)'.
  19. Click [File].
  20. Open 'Eligibility Inquiry (270) Submission'.
  21. Select 'Compile File' in 'Options'.
  22. Select 'Yes' in 'Batch Request'.
  23. Select the batch created above in 'Select Batch'.
  24. Click [Process File].
  25. Validate that only Client 2 is output to the report.
  26. Close the report.
  27. Delete the file.
  28. Close the form.
Eligibility Inquiry (270) - Request and Submission
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Diagnosis (CAL)
  • Eligibility Inquiry (270) Request
  • Update Demographics
  • Dictionary Update (PM)
  • Scheduling Calendar
  • User Definition
  • Eligibility Inquiry (270) Submission
Scenario 1: 270/271 batch processing - 'Guarantors/Payors' field validations
Specific Setup:
  • The registry setting 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Enable 270/271 Transaction Sets' is enabled.
  • The registry setting ‘Specify Subscriber/Dependent Date (2100C/2100D-DTP and 2110C/2110D-DTP)’ is enabled.
  • At least one ‘Guarantors/Payors’ has a value of ‘Yes’ in ‘Support 270/271 Transaction Sets’ in the ‘270 / 271 / 834’ section.
  • A client has a service or appointment that can be used to create a 270 request.
Steps
  1. Open 'Guarantors/Payors’
  2. Select the guarantor to 'Edit'.
  3. Select the '270 / 271 / 834' segment.
  4. Note each value entered or selected for comparison after submission.
  5. Select any value in 'Date To Display (2100C/2100D-DTP:102-Issue)'.
  6. Select 'Submission Through Date' in 'Date To Display (2100C/2100D-DTP:472-Service)'.
  7. Select 'Submission Through Date' in 'Date To Display (2110C/2110D-DTP:472-Service)'.
  8. Select all desired values in 'Always Display The Following DTP Segment(s) In D8 (CCYYMMDD) Format'.
  9. Select any value in 'Information Source Entity Identifier Code (2100A-NM1-01)'.
  10. Select any value in 'Information Source Entity Type Qualifier (2100-NM1-02)'.
  11. Enter any value in 'Information Source Last Or Organization Name (2100A-NM1—03)'.
  12. Select any value in 'Information Source Identification Code Qualifier (2100A-NM1-08)'.
  13. Enter any value in 'Information Source Primary Identifier (2100A-NM1-09)'.
  14. Select all desired values in 'Minimum Search Options'.
  15. Select all desired values in 'Search Options for Other Guarantor Coverage Requests'.
  16. Select any value in 'Single Date or Date Range for Subscriber Date'.
  17. Select any value in 'Date Range Specifications'.
  18. Select all desired values in 'Allowable Values for Subscriber Date'.
  19. Select the 'Guarantors/Payors' segment.
  20. Click [File].
  21. Select 'Edit' and the same guarantor.
  22. Validate that the data was correctly saved.
  23. Change at least one value from steps 5-18.
  24. Select the 'Guarantors/Payors' segment.
  25. Click [File].
  26. Select 'Edit' and the same guarantor.
  27. Validate that the changed value saved correctly.
  28. Open ‘Eligibility Inquiry (270) Request’.
  29. Enter desired ‘Client ID’.
  30. Select desired ‘Guarantor’.
  31. Select the ‘Batch Eligibility Inquiry (270) Request’ section.
  32. Select ‘Create’ in ‘Create, Edit or Delete Batch’.
  33. Enter desired value in ‘Batch Description’.
  34. Select desired ‘Date Range Type’
  35. Enter desired ‘From Date’ and ‘Through Date’.
  36. Select desired value in ‘Services/Appointments to Include’.
  37. Validate that the ‘Guarantor(s)’ field does not contain any selected values.
  38. Select desired values in ‘Guarantor(s)’.
  39. Select desired values in ‘Program(s)’.
  40. Select desired values in ‘Request Type’.
  41. Select desired values in ‘Service Type Code’.
  42. Select desired values in Split Files By Payer’.
  43. Select desired value in ‘Guarantor to Send Request’.
  44. Select desired value in ‘Exclude Clients With Expired Coverage For Selected Guarantor(s).
  45. Click [File].
Scenario 2: Validating 'Eligibility Inquiry (270) Submission' for batch processing with data submitted from the 'Guarantor/Program Billing Defaults' form.
Specific Setup:
  • The following registry settings are enabled:
  • 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Enable 270/271 Transaction Sets'.
  • 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Specify Segments To Require'.
  • 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Specify Segments To Suppress'.
  • Dictionary Update: Other Tabled Files:
  • Add desired values to # 270085 - Segments To Require.
  • Add desired values to # 270175 - Segments To Suppress.
  • 'Guarantors/Payors’ form contains values for the following fields:
  • 'Support 270/271 Transaction Sets' = Yes.
  • Data in all other fields is based on agency preference.
  • Note that data placed in the following fields will be overwritten by data placed in the ''Guarantor/Program Billing Defaults'' template:
  • 'Information Source Entity Identifier Code (2100A-NM1-01)'.
  • 'Information Source Entity Type Qualifier (2100-NM1-02)'.
  • 'Information Source Last Or Organization Name (2100A-NM1-03)'.
  • 'Information Source Identification Code Qualifier (2100A-NM1-08)'.
  • 'Information Source Primary Identifier (2100A-NM1-09)'.
  • 'Guarantor/Program Billing Defaults', 'Eligibility Inquiry (270)' template exists that allows the 270 to be prepared. Values entered in the following fields allow the values from ''Guarantor/Program Billing Defaults'' to be output instead of the 'Guarantors/Payors’ form:
  • 'Information Source Entity Identifier Code (2100A-NM1-01)'.
  • 'Information Source Entity Type Qualifier (2100-NM1-02)'.
  • 'Information Source Last Or Organization Name (2100A-NM1-03)'.
  • 'Information Source Identification Code Qualifier (2100A-NM1-08)'.
  • 'Information Source Primary Identifier (2100A-NM1-09)'.
  • If desired, select segments to require and segments to suppress.
  • Client has an active financial eligibility record, with a policy number for the guarantor.
  • One service and one appointment exist for the client in the date range specified in the batch created in 'Eligibility inquiry (270) Request'.
  • A batch has been created for the guarantor in 'Eligibility Inquiry (270) Request' for ‘Services Dates’ and/or Appointment Dates’.
Steps
  1. Open 'Eligibility Inquiry (270) Submission'.
  2. Select 'Compile File' in 'Options'.
  3. Select 'Yes' in 'Batch Request'.
  4. Select desired 'Batch Eligibility Inquiry (270) Request' from pre-conditions in 'Select Batch'.
  5. Click [Process File].
  6. Click [OK].
  7. Click ‘Submission Data’ link.
  8. Review the report for accuracy.
  9. Close the report.
  10. Click [Process File].
  11. Click [OK].
  12. Click ‘Submission Data’ link.
  13. Review the report for accuracy and to verify that the entry is not duplicated.
  14. Close the report.
  15. Set 'Options' to 'Dump File'.
  16. Select desired file in ‘Select File’.
  17. Click [Process File].
  18. Review the 'Dump File' to validate that the following fields contain the data from the 'Guarantor/Program Billing Defaults' form:
  19. 'Information Source Entity Identifier Code (2100A-NM1-01)'.
  20. 'Information Source Entity Type Qualifier (2100-NM1-02)'.
  21. 'Information Source Last Or Organization Name (2100A-NM1-03)'.
  22. 'Information Source Identification Code Qualifier (2100A-NM1-08)'.
  23. 'Information Source Primary Identifier (2100A-NM1-09)'.
  24. Validate the data within the dump file. Verify that the required segments are present, and the suppressed segments are not present.
  25. Close the dump file.
  26. Close the form.
270 - Segments to Suppress
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Update Demographics
  • Dictionary Update (PM)
  • Diagnosis (CAL)
  • Scheduling Calendar
  • User Definition
  • Eligibility Inquiry (270) Request
  • Eligibility Inquiry (270) Submission
Scenario 1: Validating 'Eligibility Inquiry (270) Submission' for batch processing with data submitted from the 'Guarantor/Program Billing Defaults' form.
Specific Setup:
  • The following registry settings are enabled:
  • 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Enable 270/271 Transaction Sets'.
  • 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Specify Segments To Require'.
  • 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Specify Segments To Suppress'.
  • Dictionary Update: Other Tabled Files:
  • Add desired values to # 270085 - Segments To Require.
  • Add desired values to # 270175 - Segments To Suppress.
  • 'Guarantors/Payors’ form contains values for the following fields:
  • 'Support 270/271 Transaction Sets' = Yes.
  • Data in all other fields is based on agency preference.
  • Note that data placed in the following fields will be overwritten by data placed in the ''Guarantor/Program Billing Defaults'' template:
  • 'Information Source Entity Identifier Code (2100A-NM1-01)'.
  • 'Information Source Entity Type Qualifier (2100-NM1-02)'.
  • 'Information Source Last Or Organization Name (2100A-NM1-03)'.
  • 'Information Source Identification Code Qualifier (2100A-NM1-08)'.
  • 'Information Source Primary Identifier (2100A-NM1-09)'.
  • 'Guarantor/Program Billing Defaults', 'Eligibility Inquiry (270)' template exists that allows the 270 to be prepared. Values entered in the following fields allow the values from ''Guarantor/Program Billing Defaults'' to be output instead of the 'Guarantors/Payors’ form:
  • 'Information Source Entity Identifier Code (2100A-NM1-01)'.
  • 'Information Source Entity Type Qualifier (2100-NM1-02)'.
  • 'Information Source Last Or Organization Name (2100A-NM1-03)'.
  • 'Information Source Identification Code Qualifier (2100A-NM1-08)'.
  • 'Information Source Primary Identifier (2100A-NM1-09)'.
  • If desired, select segments to require and segments to suppress.
  • Client has an active financial eligibility record, with a policy number for the guarantor.
  • One service and one appointment exist for the client in the date range specified in the batch created in 'Eligibility inquiry (270) Request'.
  • A batch has been created for the guarantor in 'Eligibility Inquiry (270) Request' for ‘Services Dates’ and/or Appointment Dates’.
Steps
  1. Open 'Eligibility Inquiry (270) Submission'.
  2. Select 'Compile File' in 'Options'.
  3. Select 'Yes' in 'Batch Request'.
  4. Select desired 'Batch Eligibility Inquiry (270) Request' from pre-conditions in 'Select Batch'.
  5. Click [Process File].
  6. Click [OK].
  7. Click ‘Submission Data’ link.
  8. Review the report for accuracy.
  9. Close the report.
  10. Click [Process File].
  11. Click [OK].
  12. Click ‘Submission Data’ link.
  13. Review the report for accuracy and to verify that the entry is not duplicated.
  14. Close the report.
  15. Set 'Options' to 'Dump File'.
  16. Select desired file in ‘Select File’.
  17. Click [Process File].
  18. Review the 'Dump File' to validate that the following fields contain the data from the 'Guarantor/Program Billing Defaults' form:
  19. 'Information Source Entity Identifier Code (2100A-NM1-01)'.
  20. 'Information Source Entity Type Qualifier (2100-NM1-02)'.
  21. 'Information Source Last Or Organization Name (2100A-NM1-03)'.
  22. 'Information Source Identification Code Qualifier (2100A-NM1-08)'.
  23. 'Information Source Primary Identifier (2100A-NM1-09)'.
  24. Validate the data within the dump file. Verify that the required segments are present, and the suppressed segments are not present.
  25. Close the dump file.
  26. Close the form.
Topics
• Eligibility Inquiry (270) Request • Eligibility Inquiry (270) Submission • NX
2021 Update 54 Summary | Details
File Import - Client Charge Input - Inhibit Billing By Service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Program Maintenance
  • Dictionary Update (PM)
  • Practitioner Numbers By Guarantor and Program
  • File Import
  • Inhibit Billing By Service
  • Dynamic Form - File Service Inhibit Information
  • Avatar_PM_Fil_Import_Tx.rpt
  • Service Codes
Scenario 1: Cal-PM - File Import - 'Client Charge Input' file type - Render a service to the client that is marked as a billing inhibited
Specific Setup:
  • Registry Settings:
  • The registry setting 'Import File Delimiter' is set to desired value.
  • Program Maintenance:
  • Identify an existing program code / name. Note the program code.
  • Admission:
  • An existing client is identified. Note the client id/name, admission date, admission program code/name.
  • A 'Client Charge Input' import file is created to render a service to the client and mark that service billing inhibited. The predefined client, episode number, practitioner id, service code, admission program and cost of the service are entered in the file. Note the file location.
Steps
  1. Open the 'File Import' form.
  2. Select the 'Client Charge Input' from the 'File Type' field.
  3. Upload the file Import file created in the setup section to mark a service as a billing inhibited.
  4. Compile the file.
  5. Verify that the file compiles successfully.
  6. Select the 'Print File' option.
  7. Review the information on compile report.
  8. Verify that all the information entered through the 'File Import' file displayed correctly in the specific field.
  9. Post the compiled file.
  10. Verify that the file posted successfully.
  11. Open the 'Crystal Report' or any other SQL data viewer.
  12. Run the query against SYSTEM.billing_tx_history table.
  13. Verify the 'billable_code' displays 'X'.
  14. Close the Crystal Report or the SQL Data Viewer.
  15. Open the 'Close Charges' form.
  16. Close the charges rendered to the client.
  17. Click [Submit].
  18. Verify the form submits successfully.
  19. Open the 'Client Ledger' form.
  20. Verify the service is not closed and still in 'Open' status as it is marked as billing inhibited.
Scenario 2: Cal-PM- Inhibit Billing By Service - Validating the service that is marked as billing inhibited
Specific Setup:
  • A practitioner must be associated to the user that is logged into the application (Practitioner A).
  • Practitioner A must be associated to services that exist for an existing client.
Steps
  1. Access the 'Inhibit Billing By Service' form.
  2. Enter the practitioner associated to the logged in user in the 'Rendering Practitioner' field.
  3. Select any value from the 'Select Service(s) To Mark Billing-Inhibited' field.
  4. Click [Submit].
  5. Validate a "Please review your selections" dialog is displayed.
  6. Click [OK].
  7. Validate a "File Service Inhibit Information" dialog is displayed stating: Continue Filing?
  8. Click [Yes].
  9. Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
  10. Click [No].
  11. Open the 'Close Charges' form.
  12. Enter all required information to close the service.
  13. Click [SUBMIT].
  14. Open the 'Client Ledger' form.
  15. Verify the service is in 'Open' status.
  16. Open the 'Crystal report' or any other SQL data viewer.
  17. Query the 'SYSTEM.billing_tx_history' table.
  18. Verify the 'billable_code' field displays 'X'.
  19. Close the report.
Scenario 3: File Import - 'Client Charge Input' file type - Render a service to the client that is marked as a billing non inhibited
Specific Setup:
  • Registry Settings:
  • The registry setting 'Import File Delimiter' is set to desired value.
  • Program Maintenance:
  • Identify an existing program code / name. Note the program code.
  • Admission:
  • An existing client is identified. Note the client id/name, admission date, admission program code/name.
  • A 'Client Charge Input' import file is created to render a service to the client and mark that service billing non inhibited. The predefined client, episode number, practitioner id, service code, admission program and cost of the service are entered in the file.
Steps
  1. Open the 'File Import' form.
  2. Select the 'Client Charge Input' from the 'File Type' field.
  3. Upload the file Import file created in the setup section to mark a service as a billing inhibited.
  4. Compile the file.
  5. Verify that the file compiles successfully.
  6. Select the 'Print File' option.
  7. Review the information on compile report.
  8. Verify that all the information entered through the 'File Import' file displayed correctly in the specific field.
  9. Post the compiled file.
  10. Verify that the file posted successfully.
  11. Open the 'Crystal Report' or any other SQL data viewer.
  12. Run the query against SYSTEM.billing_tx_history table.
  13. Verify the 'billable_code' code column is blank for the service.
  14. Close the Crystal Report or the SQL Data Viewer.
Topics
• Inhibit Billing • NX • Client Charge Input • File Import
2021 Update 73 Summary | Details
"SYSTEM.billing_plan_table_levels" table - field length's
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Form and Table Documentation (PM)
Scenario 1: Data Warehouse - Field data and property validations
Specific Setup:
  • Have a system that is configured to run "Avatar Data Warehouse" processes and write data to an external database server, for example an "SQL" server
  • Have the "SYSTEM.billing_plan_table_levels" table marked to be processed for "Data Warehouse"
  • Have a program that can query the "SYSTEM.billing_plan_table_levels' table database table on SQL server. For example program the "Dbeaver Enterprise" program
  • Have a Crystal report created that can be run to query data in the "SYSTEM.billing_plan_table_levels" table, on the "Cache" server
  • In form "Dictionary Update" in the 'Client' file, have twenty or more dictionary codes field for data element '(10021) Covered Charge Category
  • In form "Dictionary Update" in the 'Staff file, have twenty or more dictionary codes field for data element '(70) Practitioner Categories For Coverage'
  • Have the 'Benefit Plans' form submitted [PlanA] with all the dictionary values selected in the "Covered Charge Categories"and the 'Practitioner Categories Necessary For Coverage' field
  • The "Data Warehouse" background journal process has been run
  • The "Data Warehouse" Middleware process to push and create the data warehouse tables on the data warehouse server has been executed
Steps
  1. Run the crystal report to query on the "Cache Server" database for table "SYSTEM.billing_plan_table_levels", displaying all the columns and their values
  2. Locate the "covered_charge_cat_all" field in the "Field Explorer" list on the right side panel
  3. Right click on the field and click "Show Field Type"
  4. Validate the field length number value displayed in parentheses after the field name is "[255]"
  5. Validate the row displayed for [PlanA] contains all the dictionary values selected in "Covered Charge Categories" field in the setup and without truncation
  6. Locate the "pract_cat_for_cov_all" field
  7. Right click on the field and click "Show Field Type"
  8. Validate the field length number value displayed in parentheses after the field name is "[255]"
  9. Validate the row displayed for [PlanA] contains all the dictionary values selected in ''Practitioner Categories Necessary For Coverage'' field in the setup and without truncation
  10. Open the program that will be used to query the "Data Warehouse" SQL server. (For this example: "Dbeaver Enterprise" database program is used),
  11. Connect to the "Data Warehouse" middleware server database, and display all the tables
  12. Search for table "SYSTEM.billing_plan_table_levels" and right click on the "Columns" and click "View Columns" to display all the fields
  13. Click the "Properties" tab and locate the "covered_charge_cat_all" field
  14. Validate the value in the "Length" column is "255
  15. Click the "Data" column and locate the "covered_charge_cat_all" field
  16. Validate all the dictionary values selected in 'Covered Charge Categories' field in the setup for [PlanA], are populated and displayed without truncation
  17. Click the "Properties" tab and locate the locate the ''pract_cat_for_cov_all'" field
  18. Validate the value in the "Length" column is "255
  19. Click the "Data" column and locate the ''pract_cat_for_cov_all'" field
  20. Validate all the dictionary values selected in "Practitioner Categories Necessary For Coverage" in the setup for [PlanA], are populated and displayed without truncation
Scenario 2: SYSTEM.billing_plan_table_levels' table - field property validations
Specific Setup:
  • Have access to the "Form and Table Documentation" form
Steps
  1. Open form "Form and Table Documentation" form
  2. Select "Table" in the "Type of Documentation" field
  3. In the "Tables to be Documented" field, select the "SYSTEM.billing_plan_table_levels' table
  4. Click [Process]
  5. In the report results, locate the 'covered_charge_cat_all" field
  6. Validate the value in the "Max Length" column for the table, indicates "255"
  7. n the report results, locate the ''pract_cat_for_cov_all' field
  8. Validate the value in the "Max Length" column for the table, indicates "255"
Topics
• Data Warehouse • Database Management • NX
2021 Update 77 Summary | Details
CSI Assessment - Site Specific fields
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CSI Assessment
  • Dictionary Update (PM)
  • Site Specific Section Modeling (PM)
  • Program Maintenance
  • CSI Admission
Scenario 1: CSI Assessment with Site Specific Secion Modeling fields
Specific Setup:
  • Dictionary Update - Add desired values to desired site specific CSI dictionary elements. The following are elements in the 'Client' file.
  • 73018.1 - SS CSI Assessment Single Select Dictionary 1
  • 73018.2 - SS CSI Assessment Single Select Dictionary 2
  • 73018.3 - SS CSI Assessment Single Select Dictionary 3
  • 73018.4 - SS CSI Assessment Single Select Dictionary 4
  • 73018.5 - SS CSI Assessment Single Select Dictionary 5
  • 73019.1 - SS CSI Assessment Multiple Select Dictionary 1
  • 73019.2 - SS CSI Assessment Multiple Select Dictionary 2
  • 73019.3 - SS CSI Assessment Multiple Select Dictionary 3
  • 73019.4 - SS CSI Assessment Multiple Select Dictionary 4
  • 73019.5 - SS CSI Assessment Multiple Select Dictionary 5
  • Site Specific Section Modeling has been used to add the following fields to 'PATIENT73000' (CSI Admission) CSI Admission. Make at least on field a required field.
  • SS CSI Assessment Single Select Dictionary 1
  • SS CSI Assessment Single Select Dictionary 2
  • SS CSI Assessment Single Select Dictionary 3
  • SS CSI Assessment Single Select Dictionary 4
  • SS CSI Assessment Single Select Dictionary 5
  • SS CSI Assessment Multiple Select Dictionary 1
  • SS CSI Assessment Multiple Select Dictionary 2
  • SS CSI Assessment Multiple Select Dictionary 3
  • SS CSI Assessment Multiple Select Dictionary 4
  • SS CSI Assessment Multiple Select Dictionary 5
  • Refresh Forms item has been clicked to add the site specific fields to the 'CSA Assessment'.
  • The 'CSI Admission' is completed for an existing client. Note the client for ID for testing purposes/
Steps
  1. Open the 'CSI Assessment' form for the client from Setup.
  2. Validate that the required site specific field displays in red, indicating that it is a required field.
  3. Enter desired information to create an assessment record for the client, including the site specific fields. Note the values entered.
  4. Submit the form.
  5. Open the 'CSI Assessment' form for the client.
  6. Verify that the information is populated correctly.
  7. Open 'Crystal Report' or any other SQL Data Viewer.
  8. Verify that the information displays correctly in the 'assessment_ca_csi_data' table.
  9. Verify that the site specific information displays correctly in the 'assessment_ca_csi_ss_data' table.
Topics
• CSI Assessment
2021 Update 79 Summary | Details
Share of Cost - Quick Billing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Service Codes
  • Share Of Cost Management
  • Quick Billing Rule Definition
  • Quick Billing
  • Dynamic Form Compile Complete
  • Dynamic Form - Select Service
Scenario 1: Share of Cost - Quick Billing
Specific Setup:
  • Registry Setting: 'Avatar PM->Billing->Quick Billing->->->Enable New Quick Billing Format' is set to Y.
  • Guarantors/Payors: A guarantor with a 'Medi-Cal' Financial Class exists.
  • Client A:
  • Client is active and is assigned the above Guarantors/Payors.
  • Client has one or more services in the same month.
  • Client has an unmet share of cost.
  • Client B:
  • Client is active and is assigned the above Guarantors/Payors.
  • Client has one or more services in the same month.
  • Client has a met share of cost.
  • Create Interim Billing Batch File has been used to create a batch for the above services.
  • Close Charges has been used to attempt to close the charges for the clients individually. The expected result is that the services remain open.
  • Close Charges has been used to attempt to close the charges for the Interim Billing Batch File. The expected result is The expected result is that the services remain open.
  • Quick Billing Rule Definition has been used to create a rule that will include the clients, guarantor, and services.
Steps
  1. Open 'Quick Billing'.
  2. Select 'Add New' in 'Add New or Edit Existing'.
  3. Enter the 'First Date Of Service To Include'.
  4. Enter the 'Last Date Of Service To Include'.
  5. Select the 'Billing Rule To Execute'.
  6. Select 'Create Batch', 'Close Charges', 'Generate Bills' and 'Create Claims' in 'Quick Billing Task To Execute'.
  7. Enter the 'Date of Claim'.
  8. Click [Submit].
  9. Click [OK].
  10. Open ‘Client Ledger' for 'Client A' and validate that the service has a value of 'UNBILL' in 'CLAIM NUMBER'.
  11. Open ‘Client Ledger' for 'Client B' and validate that the service has a claim number in 'CLAIM NUMBER'.
Topics
• Quick Billing • Share of Cost Management
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:
  • 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