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Avatar Cal-PM 2022 Update 40

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Product Requirements / Recommendations

Avatar Cal-PM required
RADplus required

Product Update Form Description

The following is included: 1) Avatar Cal-PM is updated with the AMA provided list of CPT codes for 2021. Any CPT codes that already exist within Avatar Cal-PM will remain unchanged. 2) CPT trademark/copyright labels are added to the following forms: 'CPT Code Definition', 'Service Fee/Cross Reference Maintenance' (tabs 'Service Fee Maintenance' and 'Guarantor Definitions'), 'Program Maintenance', 'Modifiers By Practitioner Categories', 'Payor Based Authorizations', 'Eligibility Inquiry (270) Request','Real-Time Inquiry (270) Request' and 'Eligibility Inquiry and Response (270/271) Report'. 3) Start Date and End Date fields are added to the 'CPT Code Definition' form. 4) 'CPT License Count Report' is added to list active Avatar Users and Practitioners that have used CPT Codes in Avatar Cal-PM. The report needs to be run for each facility.

Included Updates

9, 19

Required Updates

None

Details
NEW0 CHANGED4 FIXED0
Changed (4)
A new report: 'CPT License Count Report' is added to Avatar PM.
A new report called 'CPT License Count Report' is added to list active Avatar Users and Practitioners that have used CPT Codes in Avatar PM. The report needs to be run for each facility in the system. Inactive User and Providers are not included.
Value Added: Ability to track CPT usage by User and Provider.
Topics
• CPT License Count Report • NX
 
Copyright notice is added to forms where CPT content is displayed.
Per the AMA, all forms will contain a copyright notice. The notice: "CPT copyright 2021 American Medical Association. All rights reserved." will be added to the bottom of forms via a display only text field. The trademark symbol will be displayed following the first appearance of 'CPT' in each form section.
The following forms will display the copyright notice:
* Program Maintenance
* Single Program Maintenance
* Modifiers By Practitioner Categories
* Payor Based Authorizations
* Eligibility Inquiry (270) Request
* Real-Time Inquiry (270) Request
* Eligibility Inquiry and Response (270/271) Report
Value Added: AMA License copyright notice is added to all CPT content.
Topics
• Eligibility Inquiry (270) Request • Eligibility Response (271) • NX • Program Maintenance • Service Authorizations
 
CPT Code copyright notice is added to Avatar forms.
The AMA copyright notice: "CPT copyright 2021 American Medical Association. All rights reserved." will be added to the bottom of the following forms via a display only text field.
* CPT Code Definition
* CPT Place of Service Override
* Service Fee/Cross Reference Maintenance
* Service Fee/Cross Reference Maintenance (Guarantor Definitions)
Value Added: Added copyright notice for CPT content to select forms.
Topics
• NX • Service Fee/Cross Reference Maintenance
 
Avatar PM is enhanced with updated CPT codes.
Avatar PM is updated with the AMA provided list of CPT codes for 2021. Only codes that do not already exist in the system will be added. Existing CPT Codes will not be overridden. No start or end dates are added. Any CPT codes that already exist within Avatar PM will remain unchanged.
Value Added: CPT codes are updated with current AMA CPT Code content.
Topics
• CPT Codes • NX
 
Acceptance Tests
AV-79782 Summary | Details
A new report: 'CPT License Count Report' is added to Avatar PM.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CPT License Count Report
Scenario 1: CPT License Count Report
Steps
  1. Open the 'CPT License Count Report'.
  2. Set the Start Date input box to any date.
  3. Set the End Date input box to any date.
  4. Click [Process].
  5. Validate the 'Date Range' item contains the Date range as entered on the selection screen.
  6. Validate the '#' column contains a numeric value for each listed line item.
  7. Validate the 'User Name' column contains only active Users.
  8. Validate the 'User ID' column contains only active User IDs.
  9. Validate the 'Provider Name' column contains only active Providers
  10. Validate the 'Provider ID' column contains only active Provider IDs.
  11. Validate the 'Provider Category' column contains the Provider Category associated to the Provider.
  12. Click [Close Report]
  13. Click [Close Form].
Topics
• CPT License Count Report • NX
AV-79783 Summary | Details
Copyright notice is added to forms where CPT content is displayed.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Eligibility Inquiry (270) Request
  • Real Time Inquiry (270 Request)
  • Eligibility Inquiry and Response (270/271) Report
  • Program Maintenance
  • App Dashboard
  • Avatar NX Report Viewer
  • Confirm Compile Completed
  • Payor Based Authorizations
  • Payor Based Authorizations Report
  • Registry Settings (PM)
Scenario 1: Process 'Real Time Inquiry (270) Request' with a value of 'Request Inquiry' in 'Eligibility Inquiry (270) Status'.
Specific Setup:
  • Agency uses 'Real Time Inquiry (270) Request' functionality.
  • Avatar PM 2018 Update 187 is installed.
  • At least one 'Guarantors/Payors' has a value of 'Yes' in 'Support 270/271 Transaction Sets'. Note the guarantor.
  • Selecting any client with the above 'Guarantors/Payors', update the 'Financial Eligibility' record to have a value of 'Request Inquiry' in 'Eligibility Inquiry (270) Status'. Note the client and the episode.
  • If the 'Request Type' is 'Specific', a 'Service Code' with a value in 'Service Type Code (270)' must exist.
Steps
  1. Open 'Real Time Inquiry (270) Request'.
  2. Select the client.
  3. Select the episode.
  4. Select the guarantor.
  5. Select any value in 'Request Type'.
  6. Select the 'Service Code' if 'Specific' was selected above.
  7. Verify the AMA trademark 'CPT® Codes' is displayed above the 'CPT-4 Code' field.
  8. Verify the AMA Copyright Notice 'CPT copyright 2021 American Medical Association. All rights reserved.' is displayed at the bottom of the form.
  9. Click [Process Request].
  10. Validate that submission is successful.
  11. If a system error message is received, review the 'Eligibility Inquiry and Response (270/271) Report' to correct client or setup issues.
Scenario 2: Eligibility Inquiry and Response (270/271) Report field validation
Steps
  1. Open 'Eligibility Inquiry and Response (270/271) Report'.
  2. Enter the 'Client ID' for the client that is not rejected.
  3. Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT-4 Code' field.
  4. Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
  5. Close the form.
Scenario 3: 'Program Maintenance' - Field Validation
Steps
  1. Access the 'Program Maintenance' form.
  2. Navigate to the 'Encounter CPT Code' field.
  3. Verify that the AMA CPT Code Trademark 'CPT® Codes' is displayed.
  4. Scroll to the bottom of the form.
  5. Verify that 'CPT copyright 2021 American Medical Association. All rights reserved.' is displayed.
  6. Close the form.
Scenario 4: Modifiers by Practitioner Category - Validation
Steps
  1. Open 'Modifiers by Practitioner Categories' form.
  2. Validate the CPT Code selection box contains 'CPT® Code'.
  3. Validate the AMA copyright notice displays at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
  4. Close the form.
Scenario 5: Eligibility Inquiry (270) Request field validation
Specific Setup:
  • The following registry setting is enabled: 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Enable 270/271 Transaction Sets'.
Steps
  1. Open 'Eligibility Inquiry (270) Request'.
  2. Verify the 'CPT-4 Code' field contains the AMA Trademark 'CPT® Codes'.
  3. Verify the AMA copyright notice is displayed at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'
Scenario 6: 'Payor Based Authorizations' - Form Verification
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Payor Based Authorizations' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' may optionally be enabled/disabled
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar Cal-PM 'Payor Based Authorizations' form (under 'Avatar PM / System Maintenance / System Definition' menu).
  2. Select 'Add' action in 'Add/Edit/Delete' field (or select 'Edit' action and click 'Select Authorizations To Edit/Delete' button to view/update existing Payor Based Authorization record/entry).
  3. Ensure the following fields are present in the 'Payor Based Authorizations' form:
  4. 'Guarantor'
  5. 'Service Code' (Not available when Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled)
  6. 'Effective Date'
  7. 'Expiration Date'
  8. 'Authorization Number'
  9. 'Display Authorizations' Button
  10. 'Select Authorizations To Edit/Delete' Button
  11. 'Select CPT ® Codes' Button (Available only when Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled)
  12. 'All CPT Codes' (Available only when Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled)
  13. Validate "CPT copyright 2021 American Medical Association. All rights reserved." Displays at the bottom of the form
  14. Enter/select values for all required/desired fields for Payor Based Authorization record/entry.
  15. Where Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled - Click 'Select CPT Codes' button and enter one or more code selections in the multi-iteration grid displayed (or set 'All CPT Codes' field to 'Yes').
  16. Click 'Submit' button to file 'Payor Based Authorizations' form/record.
  17. Select 'Edit' action in 'Add/Edit/Delete' field and click 'Select Authorizations To Edit/Delete' button to view/update previously entered Payor Based Authorization record/entry.
  18. Ensure all field values are present in 'Payor Based Authorizations' form/record as previously entered/filed.
  19. Click 'Display Authorizations' button to display the Payor Based Authorizations report/information.
  20. In Payor Based Authorizations report display/results, ensure that all Payor Based Authorization entries/records for selected 'Guarantor' value are displayed, including the following fields:
  21. 'Guarantor'
  22. 'Service Code' or 'CPT Code' (Dependent on Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations')
  23. 'Program' (To be employed by future Avatar Cal-PM update - Will display 'All Programs (NONE)' in report information)
  24. 'Practitioner Category' (To be employed by future Avatar Cal-PM update - Will display 'All Practitioner Categories (NONE)' in report information)
  25. 'Effective Date'
  26. Expiration Date'
  27. 'Authorization Number'
  28. Open Crystal Reports or other SQL reporting tool.
  29. Where Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is disabled - In Avatar Cal-PM SQL table 'SYSTEM.table_payor_auths', ensure that data row(s) are added/updated on filing of 'Payor Based Authorizations' form and contain values/information filed via form for all applicable fields.
  30. Where Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled - In Avatar Cal-PM SQL table 'SYSTEM.table_payor_auths_cpt', ensure that data row(s) are added/updated on filing of 'Payor Based Authorizations' form and contain values/information filed via form for all applicable fields.
Topics
• Eligibility Inquiry (270) Request • Eligibility Response (271) • NX • Program Maintenance • Service Authorizations
AV-79784 Summary | Details
CPT Code copyright notice is added to Avatar forms.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CPT Code Definition (PM)
Scenario 1: Service Fee/Cross Reference Maintenance - field validations
Steps
  1. Access the 'Service Fee/Cross Reference Maintenance' form.
  2. Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT Code' field.
  3. Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
  4. Close the form.
Topics
• NX • Service Fee/Cross Reference Maintenance
AV-79785 Summary | Details
Avatar PM is enhanced with updated CPT codes.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CPT Code Definition (PM)
Scenario 1: CPT Codes: Annual code update
Steps
  1. Open Avatar PM 'CPT Code Definition' form.
  2. Click [Print CPT Codes].
  3. A list of the current CPT Codes will display.
  4. Review the list to assure new codes have been added.
  5. Click [Close].
Topics
• CPT Codes • NX