Avatar Cal-PM 2022 Update 28

Last updated
Save as PDF

Product Requirements / Recommendations

Avatar Cal-PM required
RADplus required

Product Update Form Description

The issue is resolved where the 837 5010 Professional and Institutional files produced via the 'Electronic Billing' form is not producing the 2320-AMT(EAF) segment for MSO OHC services.

Included Updates

14, 15

Required Updates

Avatar Cal-PM 2022 Update 15

Avatar Cal-PM 2022 Update 14

Details

NEW0 CHANGED0 FIXED1

Fixed (1)

AV-80138 Details \| User Acceptance Tests 'Electronic Billing' Support for Services Originating in Avatar MSO An issue is resolved to ensure that 837 5010 Professional and Institutional files produced via the 'Electronic Billing' form produce the 2320-AMT (EAF) Remaining Patient Liability segment for Avatar MSO OHC (Other Healthcare Coverage) services where included in original claim.	Topics • 837 Institutional • 837 Professional • Electronic Billing

Acceptance Tests

AV-80138 Summary | Details

'Electronic Billing' Support for Services Originating in Avatar MSO

Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:

837 Health Care Claim Professional
Electronic Billing
837 Health Care Claim Institutional

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 inbound 837 file processing and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information

Steps

Open Avatar Cal-PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.)
Select '837 Professional' in the 'Billing Form' field.
Select 'Sort File' in the 'Billing Options' field.
Enter/select 837 Professional file sorting criteria.
Click 'Process' button to sort/generate 837 Professional file.
Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
Select 'Print' in the 'Print Or Delete Report' field.
Select 837 Professional file sorted which includes services(s) originating via Avatar MSO inbound 837 claim(s), and click 'Process' button to display 837 Professional outbound file data.
In Avatar PM 837 Professional format outbound electronic billing file data - for services originating via Avatar MSO inbound 837 file claims including 'Other Healthcare Coverage' information where 2320-AMT Coordination Of Benefits (COB) Payer Paid Amount value is present in original inbound 837 claim, ensure that 2320-AMT Coordination Of Benefits (COB) Payer Paid Amount loop/segment value is present and reflects same/original Avatar MSO 'Other Healthcare Coverage' inbound 837 claim value.
Example: AMT*D*2~
In Avatar PM 837 Professional format outbound electronic billing file data - for services originating via Avatar MSO inbound 837 file claims including 'Other Healthcare Coverage' information where 2320-AMT Remaining Patient Liability Amount value is present in original inbound 837 claim, ensure that 2320-AMT Remaining Patient Liability Amount loop/segment is present and reflects same/original Avatar MSO 'Other Healthcare Coverage' inbound 837 claim value.
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 inbound 837 file processing and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information

Steps

Open Avatar Cal-PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.)
Select '837 Institutional' in the 'Billing Form' field.
Select 'Sort File' in the 'Billing Options' field.
Enter/select 837 Institutional file sorting criteria.
Click 'Process' button to sort/generate 837 Institutional file.
Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
Select 'Print' in the 'Print Or Delete Report' field.
Select 837 Institutional file sorted which includes services(s) originating via Avatar MSO inbound 837 claim(s), and click 'Process' button to display 837 Institutional outbound file data.
In Avatar PM 837 Institutional format outbound electronic billing file data - for services originating via Avatar MSO inbound 837 file claims including 'Other Healthcare Coverage' information where 2320-AMT Coordination Of Benefits (COB) Payer Paid Amount value is present in original inbound 837 claim, ensure that 2320-AMT Coordination Of Benefits (COB) Payer Paid Amount loop/segment value is present and reflects same/original Avatar MSO 'Other Healthcare Coverage' inbound 837 claim value.
Example: AMT*D*2~
In Avatar PM 837 Institutional format outbound electronic billing file data - for services originating via Avatar MSO inbound 837 file claims including 'Other Healthcare Coverage' information where 2320-AMT Remaining Patient Liability Amount value is present in original inbound 837 claim, ensure that 2320-AMT Remaining Patient Liability Amount loop/segment is present and reflects same/original Avatar MSO 'Other Healthcare Coverage' inbound 837 claim value.
Example: AMT*EAF*58~

Topics

• 837 Institutional • 837 Professional • Electronic Billing