Avatar Cal-PM 2022 Quarterly Release 2022.03 Acceptance Tests

• Registry Setting: ‘Enable Co-Practitioner Services From Progress Notes’ has a value of ‘Y’.
• Service Code A:
• Service can be billed on the 837 Professional and has a fee defined in ‘Service Fee/Cross Reference Maintenance. Note the fee.
• Client A:
• Note the client’s admission date and program.
• Financial Eligibility is assigned to a Med-Cal guarantor that allows customization of the plan. The plan is customized to set the ‘Insurance Dollar Limit Per Day’ to the amount of the fee noted above. The client has no other guarantors assigned.
• A progress note has been created for Client A, Service Code A, has a duration, a practitioner, a co-practitioner, and a co-practitioner duration. Note the date of service.
• Client Ledger has been used to verify that the practitioner service distributed to the Med-Cal guarantor and that the co- practitioner service distributed to the default guarantor (99999).
• Close Charges has been used to close the charge.
• Create Interim Billing Batch File has been used to create a batch for the service. Note the batch number.

1. Open ‘Electronic Billing’.
2. Select ‘837-Professional’ in ‘Billing Form’.
3. Select ‘Medi-Cal’ in ‘Type Of Bill’.
4. Select ‘All’ in ‘Individual Or All Guarantors’.
5. Select ‘Outpatient’ in ‘Billing Type’.
6. Select ‘Sort File’ in ‘Billing Options’.
7. Set ‘File Description/Name’ to desired value’.
8. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
9. Select the desired ‘Interim Batch Number’.
10. Select desired value in ‘Create Claims’.
11. Enter the desired values in required date fields.
12. Select desired value in ‘Include Primary and/or Secondary Billing’.
13. Click Process.
14. Validate that an error message is received stating: ‘No Valid Information Found. Please Check The Error Report’.
15. Select ‘Run Report’ in ‘Billing Options’.
16. Select ‘Print’ in ‘Print Or Delete Report’.
17. Select the ‘File Description/Name’ from above in ‘File’.
18. Click [Print 837 Report].
19. Click the ‘Required Data Missing: Patient Service Data’ link.
20. Validate that the error message states: ‘ A parent service can only be billed if all the co-practitioner services are also on the bill’ and provides the service date and service code.
21. Close the report.
22. Close the form.

• Registry Setting: ‘Enable Co-Practitioner Services From Progress Notes’ has a value of ‘Y’.
• Service Code A:
• Service can be billed on the 837 Institutional and has a fee defined in ‘Service Fee/Cross Reference Maintenance. Note the fee.
• Client A:
• Note the client’s admission date and program.
• Financial Eligibility is assigned to a Med-Cal guarantor that allows customization of the plan. The plan is customized to set the ‘Insurance Dollar Limit Per Day’ to the amount of the fee noted above. The client has no other guarantors assigned.,
• A progress note has been created for Client A, Service Code A, has a duration, a practitioner, a co-practitioner, and a co-practitioner duration. Note the date of service.
• Client Ledger has been used to verify that the practitioner service distributed to the Med-Cal guarantor and that the co- practitioner service distributed to the default guarantor (99999).
• Close Charges has been used to close the charge.
• Create Interim Billing Batch File has been used to create a batch for the service. Note the batch number.

1. Open ‘Electronic Billing’.
2. Select ‘837-Institutional’ in ‘Billing Form’.
3. Select ‘Medi-Cal’ in ‘Type Of Bill’.
4. Select ‘All’ in ‘Individual Or All Guarantors’.
5. Select ‘Outpatient’ in ‘Billing Type’.
6. Select ‘Sort File’ in ‘Billing Options’.
7. Set ‘File Description/Name’ to desired value’.
8. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
9. Select the desired ‘Interim Batch Number’.
10. Select desired value in ‘Create Claims’.
11. Enter the desired values in required date fields.
12. Select desired value in ‘Include Primary and/or Secondary Billing’.
13. Click Process.
14. Validate that an error message is received stating: ‘No Valid Information Found. Please Check The Error Report’.
15. Select ‘Run Report’ in ‘Billing Options’.
16. Select ‘Print’ in ‘Print Or Delete Report’.
17. Select the ‘File Description/Name’ from above in ‘File’.
18. Click [Print 837 Report].
19. Click the ‘Required Data Missing: Patient Service Data’ link.
20. Validate that the error message states: ‘ A parent service can only be billed if all the co-practitioner services are also on the bill’ and provides the service date and service code.
21. Close the report.
22. Close the form.

• Registry Setting: ‘Enable Co-Practitioner Services From Progress Notes’ has a value of ‘Y’.
• Service Code A:
• Service can be billed on the 837 Professional and has a fee defined in ‘Service Fee/Cross Reference Maintenance. Note the fee.
• Client A:
• Note the client’s admission date and program.
• Financial Eligibility is assigned to a Med-Cal guarantor that allows customization of the plan. The plan is customized to set the ‘Insurance Dollar Limit Per Day’ to the amount of the fee noted above. The client has no other guarantors assigned.
• A progress note has been created for Client A, Service Code A, has a duration, a practitioner, a co-practitioner, and a co-practitioner duration. Note the date of service.
• Client Ledger has been used to verify that the practitioner service distributed to the Med-Cal guarantor and that the co- practitioner service distributed to the default guarantor (99999).
• Quick Billing Rule Definition’ has been used to create a definition that includes the program and guarantor.

1. Open ‘Quick Billing’.
2. Select ‘Add New’ in ‘Add New or Edit Existing Quick Billing Batch’.
3. Enter desired value required dates.
4. Select the desired rule definition in ‘Billing Rule To Execute’.
5. Select desired values in ‘Quick Billing Tasks to Execute’
6. Enter desired ‘Date of ‘Claim’.
7. Click [Submit].
8. Validate that an error message is received stating ‘No Information Found Errors found’ and contains information specific to the batch.
9. Click [OK].
10. Click [Yes].
11. Select ‘Edit Existing’ in ‘Add New Or Edit Existing Quick Billing Batch’.
12. Select the desired ‘File’.
13. Click [Print 837 Report].
14. Click the ‘Required Data Missing: Patient Service Data’ link.
15. Validate the error message states: ‘ A parent service can only be billed if all the co-practitioner services are also on the bill’ and provides the service date and service code.
16. Close the report.
17. Close the form.

• Registry Setting: ‘Enable Co-Practitioner Services From Progress Notes’ has a value of ‘Y’.
• Service Code A:
• Service can be billed on the 837 Institutional and has a fee defined in ‘Service Fee/Cross Reference Maintenance. Note the fee.
• Client A:
• Note the client’s admission date and program.
• Financial Eligibility is assigned to a Med-Cal guarantor that allows customization of the plan. The plan is customized to set the ‘Insurance Dollar Limit Per Day’ to the amount of the fee noted above. The client has no other guarantors assigned.
• A progress note has been created for Client A, Service Code A, has a duration, a practitioner, a co-practitioner, and a co-practitioner duration. Note the date of service.
• Client Ledger has been used to verify that the practitioner service distributed to the Med-Cal guarantor and that the co- practitioner service distributed to the default guarantor (99999).
• Quick Billing Rule Definition’ has been used to create a definition that includes the program and guarantor.

1. Open ‘Quick Billing’.
2. Select ‘Add New’ in ‘Add New or Edit Existing Quick Billing Batch’.
3. Enter desired value required dates.
4. Select the desired rule definition in ‘Billing Rule To Execute’.
5. Select desired values in ‘Quick Billing Tasks to Execute’
6. Enter desired ‘Date of ‘Claim’.
7. Click [Submit].
8. Validate that an error message is received stating ‘No Information Found Errors found’ and contains information specific to the batch.
9. Click [OK].
10. Click [Yes].
11. Select ‘Edit Existing’ in ‘Add New Or Edit Existing Quick Billing Batch’.
12. Select the desired ‘File’.
13. Click [Print 837 Report].
14. Click the ‘Required Data Missing: Patient Service Data’ link.
15. Validate the error message states: ‘ A parent service can only be billed if all the co-practitioner services are also on the bill’ and provides the service date and service code.
16. Close the report.
17. Close the form.

• Dictionary codes/values must be defined for Avatar Cal-PM 'Billing' file Data Element 'Reason for Inhibit' (20520).
• Client with 50 or more open service(s) eligible for 'Inhibit Billing By Reason' filing.

1. Open the Avatar Cal-PM 'Inhibit Billing By Reason' form (under 'Avatar PM / Billing / Bill Production' menu).
2. Ensure that the following service criteria selection/entry fields are present in form:
3. 'Reason For Inhibit' (dropdown selection field)
4. 'Rendering Practitioner'
5. 'Client ID' / 'Episode Number'
6. 'Liable Guarantor'
7. 'Program Where Service Was Rendered' (dropdown selection field)
8. 'Search Start Date' (with 'Today' and 'Yesterday' entry buttons)
9. 'Search End Date' (with 'Today' and 'Yesterday' entry buttons)
10. 'Services to Display' ('Inhibited' or 'Uninhibited' radio selection buttons)
11. Ensure that on opening 'Inhibit Billing By Reason' form, only the 'Reason for Inhibit' field is enabled. Selection of value in 'Reason for Inhibit' field is required prior to Inhibit Billing By Reason entry/review/removal in form since a single service may have Inhibit Billing By Reason entries filed under multiple 'Reason for Inhibit' values.
12. Select value in 'Reason for Inhibit' field to add/remove Inhibit Billing entries under 'Reason For Inhibit' code.
13. Ensure that all fields in form are enabled following selection of 'Reason for Inhibit' field value.
14. Enter/select values for service search/selection criteria in 'Rendering Practitioner', 'Client ID', 'Episode Number', 'Liable Guarantor', 'Program Where Service Was Rendered', 'Search Start Date' and/or 'Search End Date' fields. ('Rendering Practitioner' and/or 'Client ID' must be specified for service selection.)
15. Select 'Uninhibited' in the 'Services to Display' selection field.
16. Ensure that 'Services' selection field displays all service(s) for selected search/selection criteria which do not currently have an Inhibit Billing By Reason entry for selected 'Reason for Inhibit' value (if more than 50 services meet selected search/selection criteria entered, first 50 services meeting criteria are displayed initially).
17. Click 'Next 50 Services' button to navigate through displayed services; click 'Prev 50 Services' to navigate backward through same displayed services.
18. Ensure that if one or more service(s) is selected and 'Inhibit' button (or 'Uninhibit' button) is not used to file selections prior to use of 'Next 50 Services'/'Prev 50 Services' navigation button, user is presented with an error dialog noting 'Selections have been made. Please either click Inhibit or Uninhibit or clear the selections.'
19. Ensure that if one or more service(s) are not selected and 'Inhibit' button (or 'Uninhibit' button) is clicked, user is presented with an error dialog noting 'No information found to file.'
20. Select one or more individual service(s) for Inhibit Billing By Reason entry.
21. Click 'Inhibit' button to file Inhibit Billing By Reason entry under selected Reason for Inhibit for selected service(s).
22. Ensure user is presented with confirmation dialog noting 'Are you sure you want to inhibit billing for the selected services/reason?', with 'Yes' and 'No' buttons included; click 'Yes' button to continue with Inhibit Billing By Reason filing.
23. Ensure user is presented with filing confirmation dialog noting 'Inhibit Billing By Reason filed successfully.'
24. Ensure that service(s) where Inhibit Billing By Reason entry has been filed under selected 'Reason for Inhibit' are not displayed/included in the 'Services' selection field when 'Uninhibited' is selected in the 'Services to Display' field.
25. Select 'Inhibited' in the 'Services to Display' selection field.
26. Ensure that 'Services' selection field displays all service(s) for selected search/selection criteria which have an Inhibit Billing By Reason entry for selected 'Reason for Inhibit' value (if more than 50 services with Inhibit Billing By Reason entry meet selected search/selection criteria entered, first 50 services meeting criteria are displayed initially).
27. Select one or more individual service(s) for Inhibit Billing By Reason 'Uninhibit'/removal action.
28. Click 'Uninhibit' button to remove Inhibit Billing By Reason entry under selected Reason for Inhibit for selected service(s).
29. Ensure user is presented with confirmation dialog noting 'Are you sure you want to uninhibit billing for the selected services/reason?', with 'Yes' and 'No' buttons included; click 'Yes' button to continue with removal of Inhibit Billing By Reason entry/'Uninhibit' action.
30. Ensure user is presented with filing confirmation dialog noting 'Inhibit Billing By Reason filed successfully.'
31. Ensure that service(s) where Inhibit Billing By Reason entry has been removed/'Uninhibited' under selected 'Reason for Inhibit' are not displayed/included in the 'Services' selection field when 'Inhibited' is selected in the 'Services to Display' field.
32. Change value/select different value in 'Reason for Inhibit' field.
33. Ensure that 'Services' selection field (following service search/selection criteria entry) includes only services with/without Inhibit Billing by Reason entries under selected 'Reason for Inhibit' value, and does not include Inhibit Billing by Reason entries for service(s) under any other code/reason (since a single service may have Inhibit Billing By Reason entries filed under multiple 'Reason for Inhibit' values).
34. Open Crystal Reports or other SQL reporting tool.
35. In Avatar Cal-PM SQL table 'SYSTEM.inhibit_billing', ensure that one row is included in table for each distinct service with Inhibit Billing By Reason entry; ensure that service row is removed from 'SYSTEM.inhibit_billing' table only if/when all Inhibit Billing By Reason entries for service are Uninhibited.
36. In Avatar Cal-PM SQL table 'SYSTEM.inhibit_billing_reason', ensure that one row is included in table for each Inhibit Reason per service with Inhibit Billing By Reason entry; ensure that Inhibit Reason/service combination row is removed from 'SYSTEM.inhibit_billing_reason' table when Inhibit Billing By Reason entries for Inhibit Reason/service combination are Uninhibited.
37. Open ‘Inhibit Billing By Reason' form.
38. Select desired value in ‘Reason for Inhibit’.
39. Enter the desired ‘Client ID’.
40. Select desired ‘Episode Number’.
41. If desired, enters dates ‘Search Start Date’ and ‘Search End Date’.
42. Select ‘Uninhibited in ‘Service to Display’.
43. Select desired service(s) to inhibit.
44. Click [Inhibit].
45. Click [Yes].
46. Click [OK].
47. Close the form.
48. Open ‘Edit Service Information’.
49. Select the inhibited service and change the service code.
50. Click [Submit].
51. Click [No].
52. Open ‘Inhibit Billing By Reason' form.
53. Select desired value in ‘Reason for Inhibit’.
54. Enter the desired ‘Client ID’.
55. Select desired ‘Episode Number’.
56. Select ‘Inhibited in ‘Service to Display’.
57. Validate that the previously inhibited service is still inhibited and displays the edited service code.
58. Close the form.

• 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.

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 ‘Edit Service Information’ form.
12. Edit the service code.
13. Submit the form.
14. Open the 'Inhibit Billing By Service' form.
15. Validate that the service is still inhibited and displays the edited service code.
16. Open the 'Close Charges' form.
17. Enter all required information to close the service.
18. Click [SUBMIT].
19. Open the 'Client Ledger' form.
20. Verify the service is in 'Open' status.
21. Open the 'Crystal report' or any other SQL data viewer.
22. Query the 'SYSTEM.billing_tx_history' table.
23. Verify the 'billable_code' field displays 'X'.
24. Close the report.

• Tester can access the cache Management Portal and has opened 'Usage by Process' in 'License Usage'. This will display the current processes.
• Registry setting "RADplus->Database Management->Episode Predisplay->Sort Episodes by Admission Date".
• Services:
• Create new services or select existing services for distinct clients on the same date where there are 27 or more clients.

1. Open the "Spreadsheet Edit Service Information" form.
2. Select ‘All’ in ‘Individual Or All Programs’.
3. Select ‘All’ in ‘All - Individual Or All Clients’.
4. Select ‘No’ in ‘Only Show Services That Require A Diagnosis Or Are Primary Medical Program Services’.
5. Select desired values in ‘Only Load Services With This Status’.
6. Enter the service date in ‘Begin Date of Service’ and ‘End Date of Service’.
7. Click [Edit Service Information].
8. Edit at least one column for every row in the grid.
9. Click [Save] and review the 'Usage by Process' in the Management Portal.
10. Note that the 'Usage by Process' does not create a new process for each row in the spreadsheet.
11. Click [Save].
12. Click [Yes].
13. Click [OK].
14. Close the form.

• Registry Settings:
• Prior to installing the update, the following registry setting has a value of ‘Y or ‘YC’: 'Avatar PM->California Required EDI->CAL OMS Reporting->->->Enable LA County Reporting Requirements’. Note the value.
• Program Maintenance is used to validate that the 'Cal-OMS Provider No Activity Submission Status' field is not on the form.

1. Open ‘Registry Settings’.
2. Set ‘Limit Registry Settings to the Following Search Criteria’ to ‘Avatar PM->California Required EDI->CAL OMS Reporting->->->Enable LA County Reporting Requirements’.
3. Click [View Registry Settings].
4. Set the ‘Registry Setting Value’ to’ Y’.
5. Click [Submit].
6. Close the form.
7. Open ‘Program Maintenance’ for desired program. Validate that the 'Cal-OMS Provider No Activity Submission Status' field is not on the form.
8. Close the form.
9. Open ‘Registry Settings’.
10. Set ‘Limit Registry Settings to the Following Search Criteria’ to ‘Avatar PM->California Required EDI->CAL OMS Reporting->->->Enable LA County Reporting Requirements’.
11. Click [View Registry Settings].
12. Set the ‘Registry Setting Value’ to ‘YC’.
13. Click [Submit].
14. Close the form.
15. Open ‘Program Maintenance’ for desired program. Validate that the 'Cal-OMS Provider No Activity Submission Status' field is on the form. Set the value to the desired value and file the form.
16. Reenter the same program and validate that the filed value was retained.
17. Close the form.

• Eligibility Inquiry (270) Submission
• More than 5000 files exist for selection in the form.

1. Open 'Eligibility Inquiry (270) Submission'.
2. Select 'Run Report' in 'Options'.
3. Enter a date range that contains more than 5000 files in the 'File From Date' and 'File Through Date' fields.
4. Validate that an error message displays: More than 5000 entries found. Please refine your search.
5. Click [OK].
6. Change the date range to fewer days so that 5000 files or fewer display in 'Select File'.
7. Validate that the files display in 'Select Files'.
8. Repeat steps 3 - 7 for the following 'Options': 'Dump File'; 'Create File On Server For Submission'; and 'Delete File'.
9. Close the form.

• Tester has been given access to the following forms in 'User Definition' under ‘Avatar PM / System Maintenance / System Definition / Health Care Provider Directory (274)’:
• 274 - Provider Directory Defaults.
• 274 - Provider Directory Definition.
• 274 - Provider Directory Submission.

1. Open '274 - Provider Directory Defaults'.
2. Validate that there are no required fields.
3. Enter desired data for each field.
4. Submit the form.
5. Open '274 - Provider Directory Defaults'.
6. Validate that the submitted data was retained.
7. Open ‘274 - Provider Directory Definition’.
8. Validate that the form opened to the ‘Group Definition’ section.
9. Validate that 'Add or Edit Group' is the only required field.
10. Select 'Add' in 'Add or Edit Group'.
11. Validate that 'Active' and 'Provider Group Name (2100CA-NM1-03)' became required.
12. Enter desired data for each field.
13. Click [File Group Details].
14. Select 'Edit' in 'Add or Edit Group'.
15. Validate that the submitted data was retained.
16. Select the 'Site Definition' section.
17. Validate that 'Add or Edit Site' is the only required field.
18. Select 'Add' in 'Add or Edit Site'.
19. Validate that 'Site or Location of Service Name (2100DA-NM1-03)', 'Provider Group', and 'Active' became required.
20. Validate that the field label 'Site or Location Address (2100DA-N3-01)' has been replaced with 'Site or Location Address (2110DA-N3-01)'.
21. Validate that the field label 'Site or Location Address 2 (2100DA-N3-02)' has been replaced with 'Site or Location Address 2 (2110DA-N3-02)'.
22. Enter desired data for each field, which would include nine digit zip codes with a hyphen.
23. Click [Site Work Schedule (2100DA-WS)].
24. Enter desired data.
25. Click [Save].
26. Click [Yes].
27. Click [Foreign Languages Spoken At This Site (2100DA-LUI)].
28. Enter desired data.
29. Click [Save].
30. Click [Yes].
31. Click [Affiliated Entities (2100DB)].
32. Enter desired data.
33. Click [Save].
34. Click [Yes].
35. Click [File Site Details].
36. Click [OK].
37. Select 'Edit' in 'Add or Edit Site'.
38. Validate that the submitted data was retained.
39. Select the 'Provider Definition' section.
40. Validate that 'Provider' is the only required field.
41. Select a 'Provider'.
42. Validate that 'Associated Site' and 'Active' became required.
43. Enter desired data for each field.
44. Click [File Provider Details].
45. Click [OK].
46. Select the same 'Provider'.
47. Select the 'Associated Site' selected above.
48. Validate that the submitted data was retained.
49. Close the form.
50. Open '274 - Provider Directory Submission'.
51. Select 'Compile File' in 'Options'.
52. Enter the desired value in 'Reporting Period (MM/YY)'.
53. Enter desired 'File Description'.
54. Click [Process File].
55. Validate that the report display and that the zip code fields do not contain a hyphen.
56. Validate the report data.
57. Close the report.
58. Close the form.

• Registry Setting: Avatar PM->Client Information->Client Demographics->->->Update Financial Eligibility Data = Y.
• Dictionary Update:
• Client Dictionary – (3) Sex – Every value has an extended dictionary value for ‘Gender (837 Professional/Institutional)’. Note the extended dictionary values.
• Client Dictionary - (837 Professional/Institutional) contains values of Female, Male, and Unknown.
• Client Dictionary - (247) Client's Relationship To Subscriber:
• Dictionary Value = Self contains desired extended values. Note the extended dictionary values.
• Dictionary Value = Any other dictionary value contains desired extended values. Note the extended dictionary values.
• Client: ‘Sex’ contains either ‘Transgender (F to M)’ or ‘Transgender (M to F)’. Note the value.
• Update ‘Financial Eligibility to 'Self' in 'Client's Relationship To Subscriber' and desired value in ‘Subscriber Sex’. Note the value.

1. Open ‘Update Client Data’.
2. Validate that ‘Sex’ contains the value noted in setup.
3. Submit the form.
4. Open ‘Financial Eligibility’.
5. Select the ‘Guarantor Selection’ section.
6. Validate that ‘Subscriber Sex’ contains the dictionary values of ‘Female’, ‘Male’, and ‘Unknown’.
7. Validate that 'Client's Relationship To Subscriber' contains ‘Self’ and that the ‘Subscriber Sex’ contains the ‘Gender (837 Professional/Institutional)’ extended dictionary value from ‘Client Dictionary – (3) Sex’ for the ‘Sex’ field value in ‘Update Client Data’.
8. Change the ‘Subscriber Sex’ to a different value.
9. Submit the form.
10. Open ‘Update Client Data’.
11. Validate that ‘Sex’ contains the value noted in setup.
12. Submit the form.
13. Open ‘Financial Eligibility’.
14. Select the ‘Guarantor Selection’ section.
15. Validate that 'Client's Relationship To Subscriber' contains ‘Self’ and that the ‘Subscriber Sex’ contains the ‘Gender (837 Professional/Institutional)’ extended dictionary value from ‘Client Dictionary – (3) Sex’ for the ‘Sex’ field value in ‘Update Client Data’.
16. Select the ‘Subscriber Sex’ value that has not been previously selected.
17. Submit the form.
18. Open ‘Update Client Data’.
19. Validate that ‘Sex’ contains the value noted in setup.
20. Submit the form.
21. Open ‘Financial Eligibility’.
22. Select the ‘Guarantor Selection’ section.
23. Validate that 'Client's Relationship To Subscriber' contains ‘Self’ and that the ‘Subscriber Sex’ contains the ‘Gender (837 Professional/Institutional)’ extended dictionary value from ‘Client Dictionary – (3) Sex’ for the ‘Sex’ field value in ‘Update Client Data’.
24. Close the form.
25. Open ‘Update Client Data’.
26. Change ‘Sex’ to a non-transgender value. Note the value.
27. Submit the form.
28. Open ‘Financial Eligibility’.
29. Select the ‘Guarantor Selection’ section.
30. Validate that 'Client's Relationship To Subscriber' contains ‘Self’ and that the ‘Subscriber Sex’ contains the ‘Gender (837 Professional/Institutional)’ extended dictionary value from ‘Client Dictionary – (3) Sex’ for the ‘Sex’ field value in ‘Update Client Data’.
31. Submit the form.
32. Open ‘Update Client Data’.
33. Validate that ‘Sex’ contains the changed value.
34. Submit the form.
35. Open ‘Financial Eligibility’.
36. Select the ‘Guarantor Selection’ section.
37. Validate that 'Client's Relationship To Subscriber' contains ‘Self’ and that the ‘Subscriber Sex’ contains the ‘Gender (837 Professional/Institutional)’ extended dictionary value from ‘Client Dictionary – (3) Sex’ for the ‘Sex’ field value in ‘Update Client Data’.
38. Change the 'Client's Relationship To Subscriber' to the other dictionary value from setup.
39. Set ‘Subscriber Sex’ to a value that contradicts the ‘Sex’ field value in ‘Update Client Data’.
40. Submit the form.
41. Open ‘Update Client Data’.
42. Validate that ‘Sex’ contains the changed value.
43. Submit the form.
44. Open ‘Financial Eligibility’.
45. Select the ‘Guarantor Selection’ section.
46. Validate that 'Client's Relationship To Subscriber' contains the changed value and that the ‘Subscriber Sex’ contains the value that contradicts the ‘Sex’ field value in ‘Update Client Data’.
47. Select the ‘Subscriber Sex’ value that has not been previously selected.
48. Submit the form.
49. Open ‘Update Client Data’.
50. Validate that ‘Sex’ contains the value noted in setup.
51. Submit the form.
52. Open ‘Financial Eligibility’.
53. Select the ‘Guarantor Selection’ section.
54. Validate that 'Client's Relationship To Subscriber' contains the changed value and that the ‘Subscriber Sex’ contains the value the changed value.
55. Close the form.

• Registry Setting: ‘Exclude Services If No Treatment Plan’.
• Note: For our testing purposes, we will start with a value of ‘Y’.
• 'Y' adds the 'Exclude Service From Bill If No Final Treatment Plan In Effect For Service Date In Question' field to the 'Guarantors/Payors' form. It also adds the fields 'Treatment Plan Required' and 'Number Of Days After Admission That Treatment Plan Is Required' to the 'Program Maintenance' form.
• 'P' adds or retains the 'Exclude Service From Bill If No Final Treatment Plan In Effect For Service Date In Question' field on the 'Guarantors/Payors' form and adds and a new section, 'Treatment Plan Requirements' to the form.
• N’ removes all fields/sections from the 'Program Maintenance' and the 'Guarantors/Payors' forms.
• Program Maintenance: Select a program and add a value of ‘Y’ to 'Treatment Plan Required' and if desired, a value to and 'Number Of Days After Admission That Treatment Plan Is Required'.
• 'Guarantors/Payors':
• Select a guarantor and add a value of ‘Yes’ in 'Exclude Service From Bill If No Final Treatment Plan In Effect For Service Date In Question'. Note the ‘Financial Class’.
• Client A:
• Is enrolled in the program selected above.
• Is assigned the above 'Guarantors/Payors' in ‘Financial Eligibility’.
• Does not have a Treatment Plan.
• Has unclaimed closed services, noting the service dates and service codes.
• Create Interim Billing Batch File has been used to create a batch for the guarantor, program, and client.

1. Open ‘Electronic Billing’.
2. Select ‘837-Professional in ‘Billing Form’.
3. Select desired ‘Financial Class’ in ‘Type of Bill’.
4. Select ‘Individual in ‘Individual Or All Guarantors’.
5. Select the desired ‘Guarantor’.
6. Select ‘Outpatient’ in ‘Billing Type’
7. Select ‘Sort File’ in ‘Sort File’.
8. Enter desired ‘File Description/Name’.
9. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
10. Select desired value in ’Create Claims’.
11. Enter ‘Date Of Claim’ if ‘Yes’ selected in ’Create Claims’.
12. Enter ‘First Date Of Service To Include’ and ‘Last Date Of Service To Include’. Suggest one date for both fields.
13. Select desired value in ‘Include Primary and/or Secondary Billing’.
14. Click [Process].
15. Validate that the ‘No Valid Information Found. Please Check The Error Report’ message displays.
16. Click [OK].
17. Select ‘Run Report’ in ‘Sort File’.
18. Select ‘Print’ in ‘Print Or Delete Report’.
19. Select the desired ‘File’.
20. Click [Print 837 Report].
21. Click the ‘Required Data Missing: Patient Service Data’ link.
22. Validate the message indicates ‘No Final Treatment Plan In Effect For Service’.
23. Close the report.
24. Close the form.
25. Open 'Guarantors/Payors'.
26. Edit the guarantor from setup.
27. Select 'No' in 'Exclude Service From Bill If No Final Treatment Plan In Effect For Service Date In Question'.
28. Click [File].
29. Close the form.
30. Open ‘Program Maintenance’.
31. Edit the program from setup.
32. Set 'Treatment Plan Required' to ‘N’.
33. Click [File].
34. Close the form.
35. Open ‘Electronic Billing’.
36. Repeat ‘Electronic Billing’ steps for one service date.
37. Validate ‘Compile Complete’ message is received after [Process] is clicked.
38. If desired, review the dump file.
39. Close the report.
40. Close the form.
41. If desired, continue additional testing with ‘Exclude Services If No Treatment Plan’ registry setting value set to 'Y'.
42. Open 'Registry Settings'.
43. Change the value of ‘Exclude Services If No Treatment Plan’ to 'P'.
44. Submit the form.
45. Close the form.
46. Open ‘Program Maintenance’.
47. Edit the program from setup.
48. Validate that the 'Treatment Plan Required' and 'Number Of Days After Admission That Treatment Plan Is Required' fields are no longer on the form.
49. Close the form.
50. Open 'Guarantors/Payors'.
51. Edit the guarantor from setup.
52. Validate that the 'Exclude Service From Bill If No Final Treatment Plan In Effect For Service Date In Question' field retained the previously filed value. Set the value to ‘Yes’.
53. Validate that the 'Treatment Plan Requirements' section has been added to the form.
54. Select the section.
55. Select program from setup in ‘Select Programs’.
56. Select services codes from setup in ‘Select Services’.
57. Select ‘No’ in ‘Treatment Plan Required’.
58. If desired, add values to ‘Remaining Services To Generate To Do’, ‘Default Treatment Plan Coverage (Days)’ and ‘Day/Service Count Rule For Final Treatment Plan’.
59. Click [Update].
60. Select the ‘Guarantors/Payors’ section.
61. Click [File].
62. Close the form.
63. Open ‘Electronic Billing’.
64. Repeat ‘Electronic Billing’ steps for one service date.
65. Validate ‘Compile Complete’ message is received after [Process] is clicked.
66. If desired, review the dump file.
67. Close the report.
68. Close the form.
69. Edit the guarantor from setup.
70. Validate that the 'Exclude Service From Bill If No Final Treatment Plan In Effect For Service Date In Question' field is set to ‘Yes’.
71. Select the ‘'Treatment Plan Requirements' section’.
72. Select the previously submitted plan in ‘Select Treatment Plan Requirements’.
73. Change ‘Treatment Plan Required’ to ‘Yes’.
74. Click [Update].
75. Select the ‘Guarantors/Payors’ section.
76. Click [File].
77. Close the form.
78. Open ‘Electronic Billing’.
79. Repeat ‘Electronic Billing’ steps for one service date.
80. Click [Process].
81. Validate that the ‘No Valid Information Found. Please Check The Error Report’ message displays.
82. Click [OK].
83. Select ‘Run Report’ in ‘Sort File’.
84. Select ‘Print’ in ‘Print Or Delete Report’.
85. Select the desired ‘File’.
86. Click [Print 837 Report].
87. Click the ‘Required Data Missing: Patient Service Data’ link.
88. Validate the message indicates ‘No Final Treatment Plan In Effect For Service’.
89. Close the report.
90. Close the form.
91. If desired, continue additional testing with ‘Exclude Services If No Treatment Plan’ registry setting value set to 'P'.
92. Open 'Registry Settings'.
93. Change the value of ‘Exclude Services If No Treatment Plan’ to ‘N’.
94. Submit the form.
95. Close the form.
96. Validate that the 'Exclude Service From Bill If No Final Treatment Plan In Effect For Service Date In Question' field does not exist.
97. Validate that the 'Treatment Plan Requirements' section does not exist.
98. Open ‘Electronic Billing’.
99. Repeat ‘Electronic Billing’ steps for one service date.
100. Validate ‘Compile Complete’ message is received after [Process] is clicked.
101. If desired, review the dump file.
102. Close the report.
103. Close the form.

• Service Codes: Create two new service codes ( Service Code 1 & Service Code 2).
• Use Service Fee/Cross Reference Maintenance to add a fee to Service Code 1.
• Create a 'File Import' file for 'Service Fee/Cross Reference' for Service Code 2. Note the service code, from date, and fee.
• The 'File Import' spreadsheet will be included in the update zip file.

1. Open' File Import'.
2. Load the file created in setup.
3. Compile the file.
4. If necessary correct errors, delete the existing file, load and compile again.
5. Post the compiled file.
6. Open 'Service Fee/Cross Reference Maintenance'.
7. Select 'Edit Existing' in 'Enter New Or Edit Existing Fee/Cross Reference'
8. Enter 'Service Code 2'.
9. Enter the 'From Date'.
10. Click [Select Fee/Cross Ref To Edit/Default From Existing].
11. Select the desired row in the 'Edit Service Fee Definition' grid,
12. Click [OK].
13. Validate the data that was submitted in 'File Import' was saved.

• Prior to the update being installed, use Crystal Reports or other SQL reporting tool to process a query of the SYSTEM.billing_tx_xref_table. Save the results.

1. After installation of the update, use Crystal Reports or other SQL reporting tool to process a query of the SYSTEM.billing_tx_xref_table. Save the results.
2. Compare the results of the two queries to verify that the data is the same.

• Registry Setting: Note the value of 'Avatar PM->California Required EDI->Cal OMS Reporting->->->Annual Update Number'.
• A value of 'N' excludes the 'Annual Update Number' field on the 'Cal-OMS Annual Update' form.
• A value of 'D' includes the 'Annual Update Number' field on the 'Cal-OMS Annual Update' form as a display only field and will contain the previously submitted 'Annual Update Number'
• A value of 'E' includes the 'Annual Update Number' field on the 'Cal-OMS Annual Update' form as an enabled field. The user can override an existing value, or add a value if blank, if the entry is an integer. If a value is removed and left blank, the standard logic will apply the next time the 'Cal-OMS Annual Update' is processed.
• Client: Select a client that has a submitted 'Cal-OMS Admission' and is due for the 'Cal-OMS Annual Update'.

1. Open 'Cal-OMS Annual Update' for desired client.
2. Add Data for all required field and desired optional fields. Note the date of entry.
3. Click [Submit].
4. Open 'Cal-OMS Submission'.
5. Select 'Compile' in 'Option'.
6. Enter a 'Through Date' that includes the date of entry.
7. Click [Yes].
8. Select 'Print' in 'Option'.
9. Select desired file in 'Select File To Print/Submit'.
10. Click [Print Selected File Annual Update Information].
11. Validate that the selected client is included in the report.
12. Close the report.
13. Close the form.

• All Cal-OMS setup is complete.
• Client 1: Is age 17 or younger and has a Cal-OMS admission in a Detox program. The admission has been submitted as a ‘Final’ submission.
• Client 2: Is age 18 or older and has a Cal-OMS admission. The admission has been submitted as a ‘Final’ submission.

1. Open ‘Cal-OMS Youth/Detox Discharge’ for Client 1. Note the date of discharge.
2. Complete all the fields on the form, noting that some fields are disabled based on values in other fields.
3. Submit the form.
4. Open ‘Cal-OMS Discharge’ for Client 2. Note the date of discharge.
5. Complete all the fields, in all sections, of the form, noting that some fields are disabled based on values in other fields.
6. Submit the form.
7. Open ‘Cal-OMS Submission’.
8. Select ‘Compile’ in ‘Option’.
9. Enter a ‘Through Date’ that included the above dates of discharge.
10. Click [Submit].
11. Select 'Print' in 'Option'
12. Select the compiled file in 'Select File To Print/Submit'.
13. Click [Print Selected File Discharge Information].
14. Validate that both clients are in the report and contain no errors.
15. Close the report.
16. Close the form.
17. Open ‘Cal-OMS Youth/Detox Discharge’ for Client 1.
18. Select 'Discharge Delete' in 'Record to be Submitted'.
19. Click Submit.
20. Open ‘Cal-OMS Discharge’ for Client 2
21. Select 'Discharge Delete' in 'Record to be Submitted'.
22. Click Submit.
23. Open ‘Cal-OMS Submission’.
24. Select ‘Compile’ in ‘Option’.
25. Enter a ‘Through Date’ that included the above dates of discharge.
26. Click [Submit].
27. Select 'Print' in 'Option'
28. Select the compiled file in 'Select File To Print/Submit'.
29. Click [Print Selected File Discharge Information].
30. Validate that both clients are in the report and contain no errors.
31. Close the report.
32. Close the form.

Cal-OMS setup exists.

Program Maintenance:

Program 1: Contains a value of ‘Yes (Reportable)’ in ‘Substance Abuse Program (Cal-OMS)’.

Program 2: : Contains a value of ‘Yes (Not Reportable)’ in ‘Substance Abuse Program (Cal-OMS)’.

Client 1: Is enrolled in Program 1.

Client 2: Is enrolled in Program 2.

1. Open 'Cal-OMS Admission for Client 1.
2. Enter data for all required and desired non-required fields. Note the admission date.
3. Click [Submit].
4. Open 'Cal-OMS Admission for Client 2.
5. Validate the error message contains: Client does not have any Inpatient/Outpatient/Partial(Day) episodes within the current system code'.
6. Open 'Cal-OMS Submission'.
7. Select 'Compile' in 'Option'.
8. Enter a 'Through Date' that includes the admission date for Client 1.
9. Click [Submit].
10. Click [Yes].
11. Select 'Print' in 'Option'.
12. Selected desired file in 'Select File To Print/Submit'.
13. Click [Print Selected File Admission Information].
14. Review the report to verify the data for Client 1.
15. If desired, submit the file in review or final mode.
16. Review the data in the submitted file.
17. Close the form.

Cal-OMS setup exists.

Program Maintenance:

Program 1: Contains a value of ‘Yes (Reportable)’ in ‘Substance Abuse Program (Cal-OMS)’.

Program 2: Contains a value of ‘Yes (Not Reportable)’ in ‘Substance Abuse Program (Cal-OMS)’.

Client 1:

Is enrolled in Program 1.

Has financial eligibility and diagnosis records.

Has closed, unclaimed services. Note the date range and the guarantor.

If necessary, review the Guarantors/Payors form to note the 'Financial Class' of the guarantor.

Create Interim Billing Batch File has been used to create a batch specific to Client 1.

Client 2:

Is enrolled in Program 2.

Has financial eligibility and diagnosis records.

Has closed, unclaimed services. Note the date range and the guarantor.

If necessary, review the Guarantors/Payors form to note the 'Financial Class' of the guarantor.

Create Interim Billing Batch File has been used to create a batch specific to Client 2.

1. Open ‘Electronic Billing’.
2. Select ‘837 Professional’ in ‘Billing Form’.
3. Select the desired ‘HIPAA Transaction Version’.
4. Select the ‘Financial Class’ in ‘Type Of Bill’. This is for Client 1.
5. Select ‘Individual’ in ‘Individual Or All Guarantors’.
6. Select the desired ‘Guarantor’.
7. Select ‘Outpatient’ in ‘Billing Type’.
8. Select ‘Sort File’ in ‘ Billing Options’.
9. Enter desired ‘File Description/Name’.
10. Select ‘Interim Batch’ in ‘All Clients or Interim Billing Batch’.
11. Select desired ‘Interim Batch Number’.
12. Select desired value in ‘Create Claims’. If yes, enter a value on ‘Date of Claim’.
13. Enter desired value in ‘First Date Of Service To Include’.
14. Enter desired value in ‘Last Date Of Service To Include’.
15. Select ‘All’ in ‘Include Primary and/or Secondary Billing’.
16. Click [Process].
17. Click [OK].
18. Select ‘Dump File’ in ‘Billing Options’.
19. Select ‘Print’ in ’Print Or Delete Report’.
20. Select the desired ‘File’.
21. Click [Process].
22. Validate the date within the file to ensure expected services are output with expected data.
23. Close the report.
24. Close the form.