Avatar Cal-PM 2022 Update 14

1. Open 'Registry Settings' form.
2. Enter search value 'Add Support For Client Other Healthcare Coverage' and click 'View Registry Settings' button.
3. Ensure Registry Setting 'Add Support For Client Other Healthcare Coverage' is returned (under 'Avatar PM-> Billing' path).
4. Ensure 'Registry Setting Details' field contains the following explanation text:

"Selecting 'Y' adds the form 'Client Other Healthcare Coverage' to the system.

This allows an end user to capture subscriber and guarantor information for guarantors that process claims and need to be reported in an outbound 837 Institutional or Professional File in loops 2320 and 2330B.

Please note that any records input in this form will not impact liability distribution.

This form should only be used to collect a client's Other Healthcare Coverage information if Avatar MSO is installed and the registry setting, 'Add Support For The Input Of Third Party Payer Amounts' is set to either 1 or 2.

Selecting 'N' will not enable the 'Client Other Healthcare Coverage' form."

• Avatar Cal-PM Registry Setting 'Add Support For Client Other Healthcare Coverage' must be enabled
• Crystal Reports or other SQL reporting tool

1. Open Avatar Cal-PM 'Client Other Healthcare Coverage' form (under 'Avatar PM / Client Management' menu path).
2. Select client (and episode if multiple episodes exist) for 'Client Other Healthcare Coverage' record entry/view.
3. Ensure the following fields are present in the 'Client Other Healthcare Coverage' form:
4. 'Create or Edit Coverage Period'
5. Allows selection of existing Other Healthcare Coverage row/entry for client, as well as 'Create New' selection for new Other Healthcare Coverage row entry
6. 'Guarantor #'
7. Allows selection of Avatar Cal-PM Guarantor/Payor for Other Healthcare Coverage row/entry
8. 'Guarantor Name'
9. Value defaulted from Avatar Cal-PM Guarantor/Payor definition, may be edited
10. 'Effective Date'
11. Including 'Today' and 'Yesterday' selection buttons
12. 'Expiration Date'
13. Including 'Today' and 'Yesterday' selection buttons
14. 'Client's Relationship To Subscriber'
15. 'Subscriber's Name'
16. Value defaulted from Avatar Cal-PM Demographic data for selected client where 'Client's Relationship To Subscriber' = 'Self'
17. 'Subscriber Address - Street Line 1'
18. Value defaulted from Avatar Cal-PM Demographic data for selected client where 'Client's Relationship To Subscriber' = 'Self'
19. 'Subscriber Address - Street Line 2'
20. Value defaulted from Avatar Cal-PM Demographic data for selected client where 'Client's Relationship To Subscriber' = 'Self'
21. 'Subscriber Address - City'
22. Value defaulted from Avatar Cal-PM Demographic data for selected client where 'Client's Relationship To Subscriber' = 'Self'
23. 'Subscriber Address - State'
24. Value defaulted from Avatar Cal-PM Demographic data for selected client where 'Client's Relationship To Subscriber' = 'Self'
25. 'Subscriber Address - Zip'
26. Value defaulted from Avatar Cal-PM Demographic data for selected client where 'Client's Relationship To Subscriber' = 'Self'
27. 'Subscriber Policy #'
28. 'Subscriber Group Name'
29. 'Subscriber Assignment Of Benefits'
30. 'Subscriber Release Of Info'
31. 'Guarantor Payer Identifier'
32. To have third party adjudication data reported on an 837 Institutional or Professional file, the Guarantor Payer Identifier entered here must match the Payer Identifier entered for the service in the 'Enter Third Party Adjudication Data' section in the Avatar MSO Claim Processing and Fast Service Entry forms
33. 'Insurance Type Code (2320-SBR-05)'
34. Value defaulted from Avatar Cal-PM Guarantor/Payor definition, may be edited
35. 'Claim Filing Indicator Code (2320-SBR-09)'
36. Value defaulted from Avatar Cal-PM Guarantor/Payor definition, may be edited
37. In 'Create or Edit Coverage Period' field, select 'Create New' for new Other Healthcare Coverage row entry.
38. Enter/select values for all fields as required/desired.
39. Click 'Submit' button to file Client Other Healthcare Coverage row/entry.
40. Ensure user is presented with confirmation dialog noting 'Submitting has completed. Do you wish to return to form?' with 'Yes'/'No' buttons.
41. Click 'Yes' button to return to 'Client Other Healthcare Coverage' form.
42. In 'Create or Edit Coverage Period' field, select existing Other Healthcare Coverage row/entry.
43. Ensure all field values are present in 'Client Other Healthcare Coverage' form/record as previously entered/filed.
44. On entry or filing of Other Healthcare Coverage for same Guarantor and Coverage Period as an existing Other Healthcare Coverage entry ('Effective Date' through 'Expiration Date' if specified), ensure that user is presented with error dialog noting 'The Coverage date range for the current Coverage Period overlaps an existing entry. (Dates ##/##/#### - ##/##/####)' and the overlapping Other Healthcare Coverage entry is disallowed.
45. Open Crystal Reports or other SQL reporting tool.
46. In Avatar Cal-PM SQL table 'SYSTEM.other_healthcare_coverage', ensure that data row(s) are added/updated on filing of 'Client Other Healthcare Coverage' form and contain values/information filed via form for all applicable fields.

• Avatar Cal-PM Registry Setting 'Add Support For Client Other Healthcare Coverage' must be enabled
• Client record(s) where one or more 'Client Other Healthcare Coverage' entry/record exists

1. Open Avatar Cal-PM 'Admission' or 'Update Client Data' form for existing client/episode.
2. Navigate to 'Demographics' section of form.
3. Enter or update values for any or all of the following Client Demographic record fields in form:
4. 'Client First Name' / 'Client Last Name' ('Client Name')
5. 'Client's Address -Street' (and 'Client's Address - Street 2' if applicable)
6. 'Client's Address - Zipcode'
7. 'Client's Address - City'
8. 'Client's Address - State'
9. Click 'Submit' Button to file 'Admission'/'Update Client Data' form and Client Demographic record updates.
10. Open Avatar Cal-PM 'Client Other Healthcare Coverage' form for client where Demographic record/fields updated.
11. In 'Create or Edit Coverage Period' field, select existing Other Healthcare Coverage row/entry.
12. For all Client Other Healthcare Coverage rows/entries where 'Client's Relationship To Subscriber' value is set to 'Self', ensure that the following Client Demographic field values are updated according to 'Admission' and/or 'Update Client Data' information entries:
13. 'Subscriber's Name'
14. 'Subscriber Address - Street Line 1'
15. 'Subscriber Address - Street Line 2'
16. 'Subscriber Address - City'
17. 'Subscriber Address - State'
18. 'Subscriber Address - Zip'
19. For all Client Other Healthcare Coverage rows/entries where 'Client's Relationship To Subscriber' value is not set to/defined as 'Self', ensure that Client Demographic field values are not updated following 'Admission' and/or 'Update Client Data' information entries.

• 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' and/or '837 Institutional' section for applicable Guarantor/Program)
• Avatar Cal-PM Registry Setting 'Add Support For Client Other Healthcare Coverage' must be enabled
• Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
• 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/837 Institutional file inclusion (via 'Electronic Billing' form) originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information

1. Open Avatar 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 'Billing Form' field.
3. Enter/select 837 file sorting criteria, using values which will include service(s) originating in Avatar MSO.
4. Click 'Process' button to sort/generate 837 Professional or 837 Institutional file.
5. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
6. Select 'Print' in the 'Print Or Delete Report' field.
7. Select 837 Professional/837 Institutional file sorted which includes services originating in Avatar MSO, and click 'Process' button to display 837 outbound file data.
8. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file data - for services originating via Avatar MSO manual entry and including Service-Level Third Party Payment/Adjustment 'Other Healthcare Coverage' information (but where Claim-Level Other Healthcare Coverage/Third Party Payer Information was not entered), ensure that the following 837 Loop/Segments are included with values defined in Avatar Cal-PM 'Client Other Healthcare Coverage' record(s) for client/episode:
9. Other Subscriber Information (2320)
10. From 'Client Other Healthcare Coverage' form 'Subscriber Group Name', 'Insurance Type Code' and 'Claim Filing Indicator Code' fields
11. Other Insurance Coverage Information (2320)
12. From 'Client Other Healthcare Coverage' form 'Subscriber Assignment Of Benefits' and 'Subscriber Release Of Info' fields
13. Other Subscriber Name (2330A)
14. From 'Client Other Healthcare Coverage' form 'Subscriber's Name' and 'Subscriber Policy #' fields
15. Other Payer Name (2330B)
16. From 'Client Other Healthcare Coverage' form 'Guarantor Name' and 'Guarantor Payer Identifier' fields
17. Notes:
18. The Avatar Cal-PM 'Client Other Healthcare Coverage' record applicable to claims/services originating via Avatar MSO manual entry will be determined by 'Payer Identifier' value entered for MSO Service-Level Third Party Payment/Adjustment 'Other Healthcare Coverage' service information - this value must match the 'Guarantor Payer Identifier' value entered in 'Client Other Healthcare Coverage' record for the above 837 segments/information to be included in 837 claims
19. The Avatar Cal-PM 'Client Other Healthcare Coverage' record applicable to claim/services originating via Avatar MSO manual entry will be determined by service date(s) compared to 'Effective Date' / 'Expiration Date' values entered in 'Client Other Healthcare Coverage' record
20. If no Avatar Cal-PM 'Client Other Healthcare Coverage' record is found applicable to claim/service originating via Avatar MSO manual entry (based on 'Guarantor Payer Identifier' and 'Effective Date'/'Expiration Date' values) the 2320/2330A/2330B loops/segments noted above will not be included in Avatar Cal-PM 837 Professional/Institutional claim
21. Other Subscriber Address 2330A segments are suppressed when Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' is enabled and the claim/service being included in 837 file through 'Electronic Billing' is using Other Healthcare Coverage from MSO