Skip to main content

Avatar Cal-PM 2022 Update 25

  1. Last updated
  2. Save as PDF

Product Requirements / Recommendations

Avatar Cal-PM required
RADplus required

Product Update Form Description

The following issues are resolved: 1) Required field checking is not enforced for fields on the Site Specific Enrollment section of 'Practitioner Enrollment' form. 2) Editing a service in the 'Edit Service Information' form can take longer in a system that has a lot of data in the SYSTEM.RADplus_workflow_to_do table. Additionally, the logic associated with the Principal Diagnosis (2300-HI) segment has been updated to use the Statement Dates (2300-DTP) segment through date when populating applicable diagnosis for discharge claim (Claim Frequency Code 1 or 4).

Included Updates

9, 15, 19

Required Updates

None

Details
NEW1 CHANGED0 FIXED2
New (1)
837 Institutional - Resolved diagnosis for discharge claims
The 837 Institutional claims evaluates the principal diagnosis segment (2300-HI) based on the claim statement date (2300-DTP). KB0070080 v0.01
The 837 Institutional logic is updated to evaluate resolved diagnosis based on the claim statement date.
Value Added: Logic associated with diagnosis population on the 837 Institutional bill is updated to use the claim statement through date for discharge claims.
Topics
• 837 Institutional • Diagnosis • NX
 
Fixed (2)
Site Specific Section Modeling - Practitioner Enrollment
Resolves an issue to ensure that the system prevents the submission of the 'Practitioner Enrollment' form when 'Site Specific Section Modeling' has been used to require a field, and the field contains no data. KB0067363 v1.0
Topics
• NX • Practitioner
 
Edit Service Information - Validating To-Do's after editing 'Open' service
Resolves an issue to ensure that the open service can be modified successfully using 'Edit Service Information' form. KB0069873 v0.01
The SYSTEM.RADplus_workflow_to_do table displays a to-do in the table that is specific to the service stating it has been edited.
Topics
• Edit Service Information • NX
 
Acceptance Tests
AV-75575 Summary | Details
Site Specific Section Modeling - Practitioner Enrollment
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Dynamic Form - Site Specific Section Modeling (CWS)
  • Dynamic Form - staff auto assign
  • Practitioner Enrollment
  • Registry Settings (PM)
  • Site Specific Section Modeling (PM)
Scenario 1: Practitioner Enrollment - Validating required site specific field - Adding a new practitioner
Specific Setup:
  • Site Specific Section Modeling:
  • The Site Specific Enrollment section on the Practitioner Enrollment form is enabled via the 'Site Specific Section Modeling' form.
  • At least one required and one optional field are added on the Site Specific section screen. Note the names of the field.
Steps
  1. Open the 'Practitioner Enrollment' form.
  2. Set the 'Select Staff' field to desired value.
  3. Click [New Staff].
  4. Validate the Staff dialog contains "Auto Assign Next ID Number?".
  5. Click [Yes].
  6. Set the 'Name' field to desired name.
  7. Select desired value in the 'Sex' field.
  8. Set the 'Date Of Birth' field to desired date.
  9. Set the 'Registration Date' field to desired date.
  10. Set the 'Office Address - Street field to desired value.
  11. Set the 'Office Address - Zip Code' field to desired value.
  12. Validate the 'Office Address - City' field auto populated.
  13. Set the 'Office Telephone (1)' field to desired value.
  14. Click the 'Categories/Taxonomy' item.
  15. Select "Create New" from the Category/Taxonomy dropdown list.
  16. Set the Effective Date field to the same date as 'Registration Date'.
  17. Select desired value from the 'Practitioner Category' dropdown list.
  18. Select desired value from the 'Discipline' dropdown list.
  19. Select desired value from the 'Practitioner Category For Coverage' checklist.
  20. Click [Add Practitioner Categories].
  21. Validate the 'Confirm Saved' message contains 'Please note: The changes will take effect when you submit the form.'
  22. Click [OK].
  23. Click the 'Site Specific Enrollment' item.
  24. Leave the required field empty.
  25. Click [Submit].
  26. Validate the missing required field error.
  27. Enter desired value to the required field.
  28. Make sure the optional field is empty.
  29. Click [Submit].
  30. Validate the form files without any error.
Scenario 2: Practitioner Enrollment - Validating required and optional site specific fields - Editing an existing practitioner
Specific Setup:
  • Registry Setting:
  • The 'Avatar PM->Practitioner->->->->Enable Practitioners link to Performing Providers' registry setting is set to "N".
  • Site Specific Section Modeling:
  • The Site Specific Enrollment section on the Practitioner Enrollment form is enabled via the 'Site Specific Section Modeling' form.
  • At least one required and one optional field are added on the Site Specific section screen. Note the names of the field.
  • An existing active practitioner is identified. Note the practitioner id/name.
Steps
  1. Open the 'Practitioner Enrollment' form for the practitioner identified above.
  2. Set the 'Select Staff' field to the practitioner identified above.
  3. Select the practitioner from the results list.
  4. Validate that all the required/ desired fields are populated correctly.
  5. Click the 'Site Specific Enrollment' item.
  6. Leave the required and optional fields empty.
  7. Click [Submit].
  8. Validate the error about missing required fields.
  9. Enter desired value to the required fields.
  10. Leave the optional field is empty.
  11. Click [Submit].
  12. Validate the form files without any error.
Topics
• NX • Practitioner
AV-77488 Summary | Details
837 Institutional - Resolved diagnosis for discharge claims
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission
  • Client Ledger
  • Create Interim Billing Batch File
  • Diagnosis
  • Discharge
  • Electronic Billing
  • Financial Eligibility
  • Program Maintenance
Scenario 1: 837 Institutional - Validating diagnosis segment (2300-HI) for the discharge claim - Running through last date of the service / Discharge date
Specific Setup:
  • Admission:
  • A new client is admitted into an inpatient program or an existing inpatient client is identified. Note the Client id/name. Admission date/program.
  • Financial Eligibility:
  • An existing guarantor is assigned to the client. Note the guarantor code/name.
  • Service Codes:
  • A new room and board service code is created or an existing room and board service code is identified. Note the service code.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified.
  • Client Charge Input:
  • The Room & Board services are rendered to the client for 5 days starting from the admission date.
  • Discharge:
  • The client is discharged after last date of the service.
  • Client Ledger:
  • All the charges are distributed to the primary guarantor of the client.
  • Close Charges:
  • The charges are closed.
  • An interim billing batch is created to include client, services and guarantor to the bill.
Steps
  1. Open an 'Electronic Billing' form.
  2. Compile an institutional bill for the primary guarantor using the interim billing batch created in the setup section.
  3. Verify the bill compile successfully.
  4. Run the report.
  5. Verify the report launched successfully.
  6. Review the report.
  7. Verify that the report displays the service rendered to the client.
  8. Launch the Dump file.
  9. Verify the bill contains HI segment of the resolved diagnosis.
Topics
• 837 Institutional • Diagnosis • NX
AV-78003 Summary | Details
Edit Service Information - Validating To-Do's after editing 'Open' service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Crystal Report Viewer
  • Dynamic Form - Edit Service Fee Definition
  • Edit Service Information -
  • Admission (Outpatient)
  • Client Charge Input
  • Client Ledger
  • Delete Service
  • Dynamic form- Social Security Number
  • Financial Eligibility
  • Set System Defaults (CWS)
  • User Definition
Scenario 1: Edit Service Information - Editing an open service - the service code is not configured for the work-flow
Specific Setup:
  • Service Codes:
  • A new service code is created or an existing service code is identified. Note the service code.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • A new client is created or an existing client is identified. Note the Client id/Name, Admission date / program.
  • Client Charge Input:
  • A service rendered to the client using the service code identified above.
  • Client Ledger:
  • The service is in 'Open' status.
Steps
  1. Open the 'Edit Service Information' form.
  2. Select the desired client in the 'Client ID' field.
  3. Select desired episode from the 'Episode Number' field.
  4. Click [Select Service(s) To Edit].
  5. Verify the 'Select Service(s) To Edit' dialog is displayed.
  6. Select desired service from the 'Select Service(s) To Edit' dialog.
  7. Enter a different value in the 'Duration (Minutes)' field.
  8. Select a new service code in the 'Service Code' field.
  9. Click [OK].
  10. Submit the form.
  11. Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
  12. Click [No].
  13. Query the 'SYSTEM.billing_tx_history' SQL table.
  14. Validate the 'PATID' column is equal to the correct client id identified in the setup.
  15. Validate the 'date_of_service' column is equal to correct date of service rendered to the client.
  16. Validate the 'duration' column is equal to the correct duration added in the 'Edit Service Information' form.
  17. Validate the 'Service Code' column contains correct service code submitted in the 'Edit Service Information' form.
  18. Validate the 'option_desc' column contains 'Edit Service Information'.
  19. Close the crystal report.
Scenario 2: Edit Service Information - Editing/Deleting an open service -the service code is configured for the work-flow
Specific Setup:
  • User Definition:
  • The logged in user (e.g. SYSADM) has a practitioner assigned.
  • Service Codes:
  • A new service code is created or an existing service code is identified. Note the service code.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Set System Defaults (CWS):
  • The service code identified above is configured for work-flow in the 'Workflow Service Setup' section of the form.
  • The 'Service Provider' is selected in the 'Send To Do Item To Which Staff Member' field.
  • Admission:
  • A new client is created or an existing client is identified. Note the Client id/Name, Admission date / program.
  • Client Charge Input:
  • A service rendered to the client using the service code identified above.
  • Client Ledger:
  • The service is in 'Open' status.
Steps
  1. Open the 'Edit Service Information' form.
  2. Select the desired client in the 'Client ID' field.
  3. Select desired episode from the 'Episode Number' field.
  4. Click [Select Service(s) To Edit].
  5. Verify the 'Select Service(s) To Edit' dialog is displayed.
  6. Select desired service from the 'Select Service(s) To Edit' dialog.
  7. Enter a different value in the 'Duration (Minutes)' field.
  8. Click [OK].
  9. Submit the form.
  10. Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
  11. Click [No].
  12. Query the 'SYSTEM.RADplus_workflow_to_do' SQL table.
  13. Validate the 'ENTITY_ID' column is equal to the correct client id identified in the setup.
  14. Validate the 'sending_user_desc' column is equal to the correct user associated with the rendering practitioner.
  15. Validate the 'outgoing_comments ' column contains correct comments for the specific service stating that it has been edited.
  16. Open the 'Delete Service' form.
  17. Select desired client from the 'Client ID' field.
  18. Set the Start Date input box to desired date.
  19. Set the End Date input box to desired date.
  20. Click [Display Client].
  21. Select desired service from the 'Service Delete' checklist.
  22. Click [OK].
  23. Click [Delete].
  24. Review the message about the services going to be deleted.
  25. Click [OK].
  26. Validate the WARNING! dialog contains "Continue Filing?"
  27. Click [Yes].
  28. Validate the 'Confirm' dialog contains "Deleted".
  29. Click [OK].
  30. Close the form.
  31. Query the 'SYSTEM.RADplus_workflow_to_do' SQL table.
  32. Validate the row is removed from the table.
Topics
• Edit Service Information • NX