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Avatar Cal-PM 2022 Update 58

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Product Requirements / Recommendations

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Product Update Form Description

Added the fields 'Requirement Start Date' and 'Requirement End Date' to the tab 'Treatment Plan Requirements' within the form 'Guarantor/Payors'. This will check whether or not to exclude client services from requiring a Treatment Plan for billing.

Included Updates

9, 10, 14, 15, 19, 21, 25, 28, 30, 37, 38, 40, 48

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
'Guarantors/Payors' Form 'Treatment Plan Requirements' Fields
The 'Requirement Start Date' and 'Requirement End Date' fields are added to the Avatar Cal-PM 'Guarantors/Payors' form 'Treatment Plan Requirements' section.
The 'Requirement Start Date' and 'Requirement End Date' fields in the Avatar Cal-PM 'Guarantors/Payors' form 'Treatment Plan Requirements' section may be used to limit the date range for which Electronic Billing requires a Treatment Plan for services to be billed (in conjunction with other 'Treatment Plan Requirements' fields and according to the 'Exclude Services If No Treatment Plan' Registry Setting).
Value Added: Adds Start Date/End Date for Guarantors/Payors 'Treatment Plan Requirements' settings
Topics
• Electronic Billing • File Import • Guarantor • NX • Registry Settings • Treatment Plan
 
Acceptance Tests
AV-82460 Summary | Details
'Guarantors/Payors' Form 'Treatment Plan Requirements' Fields
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Registry Settings (PM)
  • File Import - Compile/Post Report
  • File Import - Guarantors/Payors Treatment Plan Requirements
  • Electronic Billing
  • Electronic Billing - Electronic Billing report
  • Treatment Plan
Scenario 1: 'Guarantors/Payors' - Verification of 'Treatment Plan Requirement' Form Section/Fields
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Exclude Services If No Treatment Plan' must be enabled (set to 'P')
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar Cal-PM 'Guarantors/Payors' form.
  2. Select Add or Edit action in 'Add New or Edit Existing Guarantor' field.
  3. Enter new (or select existing) Guarantor Code.
  4. Complete all required/desired fields in main section of 'Guarantors/Payors' form.
  5. Navigate to 'Treatment Plan Requirements' section of 'Guarantors/Payors' form.
  6. Ensure that the 'Requirement Start Date' and 'Requirement End Date' fields are available in form.
  7. If the date of service falls outside of the Requirement Start/End Date Range it will not be included in the Treatment Plan Requirements definition/check
  8. 'Requirement Start Date' and 'Requirement End Date' fields are not required; if no value entered, the Treatment Plan Requirement definition/check will apply to all dates
  9. If value is entered for either 'Requirement Start Date' or 'Requirement End Date' field, value must be entered for both fields
  10. Enter value for 'Requirement Start Date' and 'Requirement End Date' fields (and any other required/desired fields in 'Treatment Plan Requirements' section of form).
  11. Click 'Update' button to save Treatment Plan Requirement entry; repeat entry for additional Treatment Plan Requirements if desired.
  12. Navigate to main section of 'Guarantors/Payors' form.
  13. Click 'File' button to save/file Guarantor/Payor definition information.
  14. Select 'Edit' action and select previously filed Guarantor Code.
  15. Navigate to 'Treatment Plan Requirements' section of 'Guarantors/Payors' form.
  16. Select previously entered/filed Treatment Plan Requirement in 'Select Treatment Plan Requirements' field.
  17. Ensure that previously entered/filed values for 'Requirement Start Date' and 'Requirement End Date' fields are present in form (as well as values for all other fields in 'Treatment Plan Requirements' section of form).
  18. Open Crystal Reports or other SQL reporting tool.
  19. In Avatar Cal-PM SQL table 'SYSTEM.billing_guar_table_tpreq', ensure that fields 'requirement_start_date' and 'requirement_end_date' are present, and reflect values filed via 'Guarantors/Payors' form for 'Requirement Start Date' and 'Requirement End Date' fields (respectively).
Scenario 2: 'File Import' - Verification of 'Guarantors/Payors - Treatment Plan Requirements' Import
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Exclude Services If No Treatment Plan' must be enabled (set to 'P')
  • Avatar Cal-PM 'Guarantors/Payors - Treatment Plan Requirements' import file containing one or more valid import data rows, including values for 'Requirement Start Date' and 'Requirement End Date' segments/fields
  • Updated import file layout document 'Avatar_Cal-PM_File_Import_Record_Layouts.xls' included with update package
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar Cal-PM 'File Import' form.
  2. Select File Type 'Guarantors/Payors - Treatment Plan Requirements'.
  3. Select 'Upload New File' in 'Action' field and Click 'Process Action' button.
  4. Select Avatar Cal-PM 'Guarantors/Payors - Treatment Plan Requirements' import file and click 'Open' button.
  5. Select 'Compile/Validate File' in 'Action' field.
  6. Select loaded import file and click 'Process Action' button.
  7. 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.
  8. Click 'OK' button.
  9. Select 'Print Errors' in 'Action' field if errors encountered in compile; Select compiled import file with errors and click 'Process Action' button.
  10. In 'Guarantors/Payors - Treatment Plan Requirements' File Import Error Report, ensure that all invalid/errored import row(s) are included in report with segment/value reference and error message detail.
  11. Examples of 'Guarantors/Payors - Treatment Plan Requirements' File Import errors related to 'Requirement Start Date' and 'Requirement End Date' segments/fields:
  12. 'Invalid date or format'
  13. 'End Date is prior to Start Date'
  14. 'Missing start date'
  15. 'Missing end date'
  16. Select 'Print File' in 'Action' field to view successfully compiled import data; Select compiled import file and click 'Process Action' button.
  17. In 'Guarantors/Payors - Treatment Plan Requirements' File Import Report, ensure that all valid import row(s) are included in report with segment/value details, including 'Requirement Start Date' and 'Requirement End Date' segments/fields.
  18. Select 'Post File' in 'Action' field to post successfully compiled import data; Select compiled import file and click 'Process Action' button.
  19. 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.
  20. Open Avatar Cal-PM 'Guarantors/Payors' form.
  21. Select Edit action in 'Add New or Edit Existing Guarantor' field, and select Guarantor where Treatment Plan Requirement entry was created/updated via File Import filing.
  22. Navigate to 'Treatment Plan Requirements' section of 'Guarantors/Payors' form.
  23. Select Treatment Plan Requirement entry filed via File Import in 'Select Treatment Plan Requirements' field.
  24. Ensure that values for 'Requirement Start Date' and 'Requirement End Date' fields filed via File Import are present in form (as well as values for all other fields in 'Treatment Plan Requirements' section of form according to File Import data).
  25. Open Crystal Reports or other SQL reporting tool.
  26. In Avatar Cal-PM SQL table 'SYSTEM.file_import_guar_tp_req', ensure that fields 'requirement_start_date' and 'requirement_end_date' are present, and reflect values filed via File Import for 'Requirement Start Date' and 'Requirement End Date' fields (respectively).
Scenario 3: 'Electronic Billing' - Verification of 'Treatment Plan Requirement' Restrictions
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Exclude Services If No Treatment Plan' must be enabled (set to 'P')
  • One or more Guarantor(s) where values are selected/defined for 'Requirement Start Date' and 'Requirement End Date' fields (via Avatar Cal-PM 'Guarantors/Payors' form, 'Treatment Plan Requirements' section)
  • Avatar CWS Treatment Plan form (including Draft/Final Status field)
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional or 837 Institutional file inclusion under applicable Guarantor(s) (via 'Electronic Billing' form)
Steps
  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' or '837 Institutional' in the 'Billing Form' field.
  4. Select 'Sort File' in the 'Billing Options' field.
  5. Enter/select 837 Professional/837 Institutional file sorting criteria.
  6. Click 'Process' button to sort/generate 837 Professional/837 Institutional file.
  7. Select 'Run Report' in the 'Billing Options' field.
  8. Select 'Print' in the 'Print Or Delete Report' field.
  9. Select 837 Professional/837 Institutional file sorted which includes services(s), and click 'Process' button to display 837 Professional/837 Institutional outbound file report.
  10. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file report:
  11. In case where 'Final' status 'Treatment Plan' record does not exist applicable to client/service(s) to be included in 837 file and no 'Requirement Start Date'/'Requirement End Date' values are defined for applicable Guarantor/Treatment Plan Requirements - Ensure that error is reported/included for service(s) in 'Required Data Missing: Patient Service Data' section of report (and service is not included in 837 file claim/service information).
  12. Error Message Example:
  13. 'No Final Treatment Plan In Effect For Service: [Service Code] - Service Date: [Service Date]'
  14. In case where 'Final' status 'Treatment Plan' record does not exist applicable to client/service(s) to be included in 837 file and service date is within 'Requirement Start Date'/'Requirement End Date' values defined for applicable Guarantor/Treatment Plan Requirements - Ensure that error is reported/included for service(s) in 'Required Data Missing: Patient Service Data' section of report (and service is not included in 837 file claim/service information).
  15. Error Message Example:
  16. 'No Final Treatment Plan In Effect For Service: [Service Code] - Service Date: [Service Date]'
  17. In case where 'Final' status 'Treatment Plan' record does not exist applicable to client/service(s) to be included in 837 file and service date is outside of 'Requirement Start Date'/'Requirement End Date' values defined for applicable Guarantor/Treatment Plan Requirements - Ensure that Treatment Plan-related error is not reported/included for service(s) in 'Required Data Missing: Patient Service Data' section of report and service(s) is/are included in 837 file information as expected (subject to all other 837 sorting criteria/requirements).
  18. In case where 'Final' status 'Treatment Plan' record exists applicable to client/service(s) to be included in 837 file (regardless of 'Requirement Start Date'/'Requirement End Date' values defined for applicable Guarantor/Treatment Plan Requirements) - Ensure that Treatment Plan-related error is not reported/included for service(s) in 'Required Data Missing: Patient Service Data' section of report and service(s) is/are included in 837 file information as expected (subject to all other 837 sorting criteria/requirements).
  19. Select 'Create File On Server' in the 'Billing Options' field.
  20. Select 837 Professional/837 Institutional file sorted which includes services(s), and click 'Process' button to create 837 Professional/837 Institutional outbound file on server.
Topics
• Electronic Billing • File Import • Guarantor • NX • Registry Settings • Treatment Plan