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Avatar Cal-PM 2022 Update 21

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Product Requirements / Recommendations

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Product Update Form Description

The following issues are resolved: 1) The error "[UNDEFINED]SvcIncluded+7^EB837Utils04" produced when sorting the 837 5010 Professional or Institutional files via the 'Electronic Billing' form. 2) When an open service is edited via the 'Edit Service Information' form, inhibit billing records are not retained.

Included Updates

14

Required Updates

None

Details
NEW0 CHANGED0 FIXED2
Fixed (2)
Electronic Billing / Quick Billing
Functionality for Electronic Billing and Quick Billing has been modified to prevent the following error when billing a service that has a co-practitioner, and the co-practitioner service falls to the default guarantor:
"[UNDEFINED]SvcIncluded+7^EB837Utils04" KB0069509 v0.01
Neither service will be billable until the co-practitioner service can also be billed on the claim.
Topics
• 837 Institutional • 837 Professional • NX • Progress Notes • Quick Billing • Quick Billing Rule Definition
 
Edit Service Information - Inhibited Billing services
Modifications have been made to functionality to ensure that the inhibit billing records are retained when an open service is edited in the 'Edit Service Information' form. KB0069547 v0.01
Topics
• Inhibit Billing
 
Acceptance Tests
AV-73269 Summary | Details
Electronic Billing / Quick Billing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Ambulatory Progress Notes
  • App Dashboard
  • Client Ledger
  • Diagnosis
  • Dynamic Form - Admission - Client
  • Dynamic Form - document routing - sign
  • Dynamic Form Address Validation
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Practitioner Enrollment
  • Practitioner Numbers By Guarantor and Program
  • Program Maintenance
  • Registry Settings (PM)
  • Admission
  • Quick Billing
  • Quick Billing Rule Definition
Scenario 1: Cal-PM - 837 Professional - Validate processing when progress note has a practitioner and a co-practitioner
Specific Setup:
  • 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.
Steps
  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.
Scenario 2: Cal-PM - 837 Institutional - Validate processing when progress note has a practitioner and a co-practitioner
Specific Setup:
  • 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.
Steps
  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.
Scenario 3: Cal-PM - Quick Billing - 837 Professional - Validate processing when progress note has a practitioner and a co-practitioner
Specific Setup:
  • 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.
Steps
  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.
Scenario 4: Cal-PM - Quick Billing - 837 Institutional - Validate processing when progress note has a practitioner and a co-practitioner
Specific Setup:
  • 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.
Steps
  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.
Topics
• 837 Institutional • 837 Professional • NX • Progress Notes • Quick Billing • Quick Billing Rule Definition
AV-76013 Summary | Details
Edit Service Information - Inhibited Billing services
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • App Dashboard
  • Client Charge Input
  • Diagnosis
  • Dynamic Form - Admission - Client
  • Dynamic Form - Inhibit Billing By Reason
  • Dynamic Form Address Validation
  • Financial Eligibility
  • Guarantors/Payors
  • Inhibit Billing By Reason
  • Inhibit Billing By Service
  • Practitioner Enrollment
  • Practitioner Numbers By Guarantor and Program
  • Program Maintenance
  • Admission
  • Dynamic Form - File Service Inhibit Information
Scenario 1: 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 ‘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.
Scenario 2: Cal-PM - 'Inhibit Billing By Reason' - Verification of form filing, single services selection
Specific Setup:
  • 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.
Steps
  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.
Topics
• Inhibit Billing