Avatar Cal-PM 2022 Update 56

• Crystal Reports or other SQL reporting tool

1. Open Avatar Cal-PM 'Guarantor/Program Billing Defaults' form.
2. Select 'Add Template' in 'Action field (or 'Edit Template' and select existing Guarantor/Program Billing Defaults template for review/edit).
3. Navigate to '837 Professional' section of form.
4. Ensure the following fields related to 837 Professional Rendering Provider (2310B/2420A) information are present in 'Guarantor/Program Billing Defaults' form:
5. 'Rendering Provider Entity Type Qualifier (2310B/2420A-NM1-02)'
6. 'Rendering Provider Last Or Organization Name (2310B/2420A-NM1-03)'
7. 'Rendering Provider First Name (2310B/2420A-NM1-04)'
8. 'Rendering Provider Middle Name (2310B/2420A-NM1-05)'
9. 'Rendering Provider Name Suffix (2310B/2420A-NM1-07)'
10. 'Rendering Provider Identification Code Qualifier (2310B/2420A-NM1-08)'
11. 'Rendering Provider Identification Code (2310B/2420A-NM1-09)'
12. 'Rendering Provider Taxonomy Code (2310B/2420A-PRV-03)'
13. 'Rendering Provider Reference Identification Qualifier (2310B/2420A-REF-01)'
14. 'Rendering Provider Reference Identification (2310B/2420A-REF-01)'
15. 'Rendering Provider Reference Identification Qualifier-2 (2310B/2420A-REF-01)'
16. 'Rendering Provider Identification Code-2 (2310B/2420A-REF-02)'
17. 'Specify How Rendering Provider Information Should Be Populated'
18. Enter/select values for fields noted above (and any other fields/sections as desired).
19. Click 'Submit' button to file Guarantor/Program Billing Defaults template.
20. Select 'Edit Template' in 'Action field and select previously filed Guarantor/Program Billing Defaults template for review/edit.
21. Navigate to '837 Professional' section of form.
22. Ensure that previously entered/filed values for 837 Professional Rendering Provider (2310B/2420A) fields noted above are present for selected template.
23. Open Crystal Reports or other SQL reporting tool.
24. In Avatar Cal-PM SQL table 'SYSTEM.table_837_p_facility_prov_num', ensure that Guarantor/Program Billing Defaults template entries/records are present, including values for the following fields:
25. 'rendering_entity_code'/'rendering_entity_value'
26. 'rendering_first_name'
27. 'rendering_last_org_name'
28. 'rendering_middle_name'
29. 'rendering_suffix'
30. 'rendering_id_qual_code'/'rendering_id_qual_value'
31. 'rendering_id'
32. 'rendering_taxonomy'
33. 'rendering_ref_qual_code'/'rendering_ref_qual_value'
34. 'rendering_ref_id'
35. 'rendering_ref_qual2_code'/'rendering_ref_qual2_value'
36. 'rendering_ref_id2'
37. 'use_rnd_if_notfound_code'/'use_rnd_if_notfound_value'

• Avatar Cal-PM 'Guarantor/Program Billing Defaults' Import File containing one or more valid import rows for 837 Professional information
• Crystal Reports or other SQL reporting tool

1. Open Avatar Cal-PM 'File Import' form.
2. Select File Type 'Guarantor/Program Billing Defaults'.
3. Select 'Upload New File' in 'Action' field and Click 'Process Action' button.
4. Select Avatar Cal-PM 'Guarantor/Program Billing Defaults' import file including value for one or more of the following 837 Professional fields/segments and click 'Open' button:
5. 'Rendering Provider Entity Type Qualifier (2310B/2420A-NM1-02)' field/segment 127
6. 'Rendering Provider Last Or Organization Name (2310B/2420A-NM1-03)' field/segment 128
7. 'Rendering Provider First Name (2310B/2420A-NM1-04)' field/segment 129
8. 'Rendering Provider Middle Name (2310B/2420A-NM1-05)' field/segment 130
9. 'Rendering Provider Name Suffix (2310B/2420A-NM1-07)' field/segment 131
10. 'Rendering Provider Identification Code Qualifier (2310B/2420A-NM1-08)' field/segment 132
11. 'Rendering Provider Identification Code (2310B/2420A-NM1-09)' field/segment 133
12. 'Rendering Provider Taxonomy Code (2310B/2420A-PRV-03)' field/segment 134
13. 'Rendering Provider Reference Identification Qualifier (2310B/2420A-REF-01)' field/segment 135
14. 'Rendering Provider Reference Identification (2310B/2420A-REF-01)' field/segment 136
15. 'Rendering Provider Reference Identification Qualifier-2 (2310B/2420A-REF-01)' field/segment 137
16. 'Rendering Provider Identification Code-2 (2310B/2420A-REF-02)' field/segment 138
17. 'Specify How Rendering Provider Information Should Be Populated' field/segment 139
18. Select 'Compile/Validate File' in 'Action' field.
19. Select loaded 'Guarantor/Program Billing Defaults' import file and click 'Process Action' button.
20. Ensure that 'Compile/Validate File' action completes, and message 'Compiled' or '(File Name) contains one or more errors. These errors can be reviewed using 'Print Errors' action' is displayed.
21. Click 'OK' button.
22. Select 'Print File' in 'Action' field to view successfully compiled import data; Select compiled import file and click 'Process Action' button.
23. In 'Guarantor/Program Billing Defaults' File Import Report, ensure that all valid import row(s) are included in report with segment/value details.
24. Select 'Post File' in 'Action' field to post successfully compiled import data; Select compiled import file and click 'Process Action' button.
25. Ensure that 'Compile/Validate File' action completes, and message 'Posted' and/or 'The selected file contains one or more lines with compilation errors. Only those lines without compilation errors will be posted' is displayed.
26. Open Avatar Cal-PM 'Guarantor/Program Billing Defaults' form.
27. Select 'Edit Template' in 'Action' field and select imported Guarantor/Program Billing Defaults template for review/edit.
28. Navigate to '837 Professional' section of form.
29. Ensure that imported values for 837 Professional Rendering Provider (2310B/2420A) fields noted above are present for selected template.
30. Open Crystal Reports or other SQL reporting tool.
31. In Avatar Cal-PM SQL table 'SYSTEM.file_import_gpbd_p837', ensure that new row is filed in table for each successfully compiled/posted import row, including values for following fields:
32. 'rendering_entity_code'/'rendering_entity_value'
33. 'rendering_first_name'
34. 'rendering_last_org_name'
35. 'rendering_middle_name'
36. 'rendering_suffix'
37. 'rendering_id_qual_code'/'rendering_id_qual_value'
38. 'rendering_id'
39. 'rendering_taxonomy'
40. 'rendering_ref_qual_code'/'rendering_ref_qual_value'
41. 'rendering_ref_id'
42. 'rendering_ref_qual2_code'/'rendering_ref_qual2_value'
43. 'rendering_ref_id2'
44. 'use_rnd_if_notfound_code'/'use_rnd_if_notfound_value'

For Avatar Cal-PM 'Guarantor/Program Billing Defaults - 837 Professional' format/layout, please refer to 'Avatar_Cal-PM_File_Import_Record_Layouts.xls' document included with update.

• Avatar Cal-PM Registry Setting 'Rendering Provider Name (Loop 2310B)' must be enabled
• 'Rendering Provider' must be selected in 'Select Type Of Information To Include In Rendering Provider Name (2310B)' field for applicable 'Guarantor/Program Billing Defaults' template
• One or more service(s) eligible for Avatar Cal-PM 837 Professional file inclusion (via 'Electronic Billing' form)

1. Open Avatar Cal-PM 'Electronic Billing' form.
2. Note - Acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.
3. Select '837 Professional' in the 'Billing Form' field.
4. Select 'Sort File' in the 'Billing Options' field.
5. Enter/select 837 Professional file sorting criteria.
6. Click 'Process' button to sort/generate 837 Professional file.
7. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
8. Select 'Print' in the 'Print Or Delete Report' field.
9. Select 837 Professional file sorted which includes services and click 'Process' button to display 837 Professional outbound file data.
10. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 2310B Rendering Provider Name loop/segment values (and 2420A Rendering Provider Name if included) reflect information from service practitioner or 'Guarantor/Program Billing Defaults' template values according to 'Specify How Rendering Provider Information Should Be Populated' field as follows:
11. If 'Do Not Use Information From The Guarantor/Program Level' is selected (or if no value is selected):
12. 2310B/2420A Rendering Provider Name loop/segments for all claims/services will be populated with information from service practitioner reporting values defined (via Avatar Cal-PM 'Practitioner Numbers By Guarantor and Program' or 'Practitioner Enrollment' forms)
13. If practitioner is not defined for service or if service practitioner reporting values are not defined, 2310B/2420A Rendering Provider Name information will not be included
14. If 'Always Use Information From The Guarantor/Program Level For Both Name And Identification' is selected:
15. 2310B/2420A Rendering Provider Name loop/segments for all claims/services will be populated with information from 'Rendering Provider...' fields in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template
16. If 'Rendering Provider...' field values in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template are not defined, 2310B/2420A Rendering Provider Name information will not be included
17. If 'Use Information From The Guarantor/Program Level For Both Name And Identification If No Practitioner Found' is selected:
18. 2310B/2420A Rendering Provider Name loop/segments will be populated with information from service practitioner reporting values defined where practitioner is defined for service; 2310B/2420A Rendering Provider Name loop/segments will be populated with information from 'Rendering Provider...' fields in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template where practitioner is not defined for service
19. If practitioner is defined for service but service practitioner reporting values are not defined, 2310B/2420A Rendering Provider Name information will not be included
20. If practitioner is not defined for service and 'Rendering Provider...' field values in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template are not defined, 2310B/2420A Rendering Provider Name information will not be included
21. If 'Use Information From The Guarantor/Program Level For Identification Only But Just When A Practitioner Is Found Who Lacks Identification Information' is selected:
22. 2310B/2420A Rendering Provider Name loop/segments will be populated with identification information (2310B/2420A NM1-08/09, 2310B/2420A PRV, 2310B/2420A REF) from service practitioner reporting values if defined; 2310B/2420A Rendering Provider Name loop/segments will be populated with identification information (2310B/2420A NM1-08/09, 2310B/2420A PRV, 2310B/2420A REF) from 'Rendering Provider...' fields in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template where practitioner is defined for service but service practitioner reporting values are not defined
23. If practitioner is defined for service but service practitioner reporting values are not defined and 'Rendering Provider...' field values in applicable Avatar Cal-PM 'Guarantor/Program Billing Defaults' form/template are not defined, 2310B/2420A Rendering Provider Name information will not be included
24. If practitioner is not defined for service, 2310B/2420A Rendering Provider Name information will not be included
25. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 2310B Rendering Provider Individual or Organizational Name (NM) values (and 2420A Rendering Provider Name if included) reflect information from service practitioner reporting values defined (via Avatar Cal-PM 'Practitioner Numbers By Guarantor and Program' or 'Practitioner Enrollment' forms) or from the following 'Guarantor/Program Billing Defaults' template fields where applicable:
26. 'Rendering Provider Entity Type Qualifier (2310B/2420A-NM1-02)'
27. 'Rendering Provider Last Or Organization Name (2310B/2420A-NM1-03)'
28. 'Rendering Provider First Name (2310B/2420A-NM1-04)'
29. 'Rendering Provider Middle Name (2310B/2420A-NM1-05)'
30. 'Rendering Provider Name Suffix (2310B/2420A-NM1-07)'
31. 'Rendering Provider Identification Code Qualifier (2310B/2420A-NM1-08)'
32. 'Rendering Provider Identification Code (2310B/2420A-NM1-09)'
33. Examples:
34. NM1*82*1*RENDERINGLASTNAME*RENDERINGFIRSTNAME****XX*1245319599~
35. NM1*82*1*RENDERINGLASTNAME*RENDERINGFIRSTNAME*RENDERMIDDLE**SR~
36. NM1*82*2*RENDERINGORGNAME*****XX*1245319599~
37. NM1*82*2*RENDERINGORGNAME~
38. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 2310B Rendering Provider Specialty Information/Taxonomy Code (PRV) value reflects information from service practitioner reporting values defined (via Avatar Cal-PM 'Practitioner Numbers By Guarantor and Program' or 'Practitioner Enrollment' forms) or from the following 'Guarantor/Program Billing Defaults' template field where applicable:
39. 'Rendering Provider Taxonomy Code (2310B/2420A-PRV-03)'
40. Example:
41. PRV*PE*PXC*1223G0001X~
42. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 2310B Rendering Provider Secondary Identification (REF) values reflect information from service practitioner reporting values defined (via Avatar Cal-PM 'Practitioner Numbers By Guarantor and Program' or 'Practitioner Enrollment' forms) or from the following 'Guarantor/Program Billing Defaults' template fields where applicable:
43. 'Rendering Provider Reference Identification Qualifier (2310B/2420A-REF-01)'
44. 'Rendering Provider Reference Identification (2310B/2420A-REF-01)'
45. 'Rendering Provider Reference Identification Qualifier-2 (2310B/2420A-REF-01)'
46. 'Rendering Provider Identification Code-2 (2310B/2420A-REF-02)'
47. Example:
48. REF*1G*X99999~
49. Note - If 'Health Care Financing Administration National Provider Identifier' (NPI) is selected/included in Rendering Provider Identification Code Qualifier/Code (2310 NM1-08/NM1-09), 2310B-REF/2420A-REF loops/segments will not be included in 837 Professional claim
50. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 2420A Rendering Provider Individual or Organizational Name (NM), 2420A Rendering Provider Specialty Information/Taxonomy Code (PRV) and 2420A Rendering Provider Secondary Identification (REF) loop/segments reflect information from service practitioner or 'Guarantor/Program Billing Defaults' template values as configured/detailed above where 2420A Rendering Provider Name Information is included in 837 Professional claims.
51. Note - 2420A Rendering Provider Name loop/segments may be excluded from 837 Professional claims in case where 'If The Loop/Segment Information At The Service Level Is The Same As The Loop/Segment Information At The Claim Level (e.g. Service Facility Location Loop), Do You Want The Loop/Segment At The Service Level To Be Skipped?' is set to 'Yes' for applicable 'Guarantor/Program Billing Defaults' template
52. Note - If 'Health Care Financing Administration National Provider Identifier' (NPI) is selected/included in Rendering Provider Identification Code Qualifier/Code (2420A NM1-08/NM1-09), 2420A-REF loops/segments will not be included in 837 Professional claim