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Avatar Cal-PM 2022 Update 37

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Product Requirements / Recommendations

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Product Update Form Description

The following issues are resolved: 1) Filing the 'Update Client Data' form for a patient might result in the 'Subscriber Sex' field being cleared on the 'Financial Eligibility' form. 2) Changing the value of 'Exclude Services If No Treatment Plan' registry setting from "Y" to "P" will not remove the 'Treatment Plan Required?' and 'Number Of Days After Admission That Treatment Plan Is Required' fields on the 'Program Maintenance' form.

Included Updates

9, 14, 15, 19, 21, 28

Required Updates

None

Details
NEW0 CHANGED0 FIXED2
Fixed (2)
Financial Eligibility - Subscriber Sex
The issue is resolved when the 'Subscriber Sex' field may be cleared on the 'Financial Eligibility' form. KB0069973 v0.01
When the registry setting 'Update Financial Eligibility Data' = Y, the 'Subscriber Sex' field will contain the extended dictionary value from ‘Gender (837 Professional/Institutional)’ in the Client 'Sex' dictionary, #3.
Topics
• Financial Eligibility • NX • Update Client Data
 
Registry Setting - Exclude Services If No Treatment Plan
The functionality for the 'Exclude Services If No Treatment Plan' registry setting is updated to remove fields/sections from forms when the registry setting value is modified.
The registry setting value of '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. If the value is changed from 'Y' to 'P' or 'N' the fields will be removed from the 'Program Maintenance' form.

The registry setting value of 'P' adds '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.

The registry setting value of ‘N’ removes all fields/sections from the 'Program Maintenance' and the 'Guarantors/Payors' forms.
Topics
• Treatment Plan
 
Acceptance Tests
AV-75147 Summary | Details
Financial Eligibility - Subscriber Sex
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Dictionary Update (PM)
  • Financial Eligibility
  • Registry Settings (PM)
  • Update Client Data
Scenario 1: Cal-PM - 'Client's Relationship To Subscriber' - Update Client Data 'Sex' field / Financial Eligibility 'Subscriber Sex' field
Specific Setup:
  • 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.
Steps
  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.
Topics
• Financial Eligibility • NX • Update Client Data
AV-80253 Summary | Details
Registry Setting - Exclude Services If No Treatment Plan
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Client Charge Input
  • Client Ledger
  • Create Interim Billing Batch File
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Program Maintenance
  • Registry Settings (PM)
Scenario 1: 837 Professional - 'Exclude Services If No Treatment Plan'
Specific Setup:
  • 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.
Steps
  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.
Topics
• Treatment Plan