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Avatar Cal-PM 2022 Update 64

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Product Requirements / Recommendations

Avatar Cal-PM required
RADplus required

Recommended Update Level

Avatar Cal-PM 2022 Update 9

Product Update Form Description

An issue where the form 'Payor Based Authorizations' will not allow valid service codes to be selected if the registry setting 'Activate Program/Service Code Filter' is set to "Y" is resolved.

Included Updates

9, 10, 14, 15, 19, 21, 25, 28, 30, 37, 38, 40, 48, 56, 58, 59, 62

Required Updates

Avatar Cal-PM 2022 Update 9
Details
NEW0 CHANGED0 FIXED1
Fixed (1)
'Payor Based Authorizations' Form 'Service Code' Field
An issue to ensure that the 'Payor Based Authorizations' form allows valid service codes to be selected where Avatar Cal-PM Registry Setting 'Activate Program/Service Code Filter' is enabled. KB0071947 v0.01
Topics
• Registry Settings • Service Authorizations
 
Acceptance Tests
AV-79677 Summary | Details
'Payor Based Authorizations' Form 'Service Code' Field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Payor Based Authorizations
  • Payor Based Authorizations Report
  • Registry Settings (PM)
Scenario 1: 'Payor Based Authorizations' - Form Verification
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Payor Based Authorizations' must be enabled
  • Avatar Cal-PM Registry Setting 'Require Authorizations At Guarantors/Payors Level' may optionally be enabled/disabled
  • Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' may optionally be enabled/disabled
  • Avatar Cal-PM Registry Setting 'Enable Program/Service Code Filter' 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. 'Program'
  6. Available only where Avatar Cal-PM Registry Setting 'Require Authorizations At Guarantors/Payors Level' is enabled
  7. 'Practitioner Category'
  8. Available only where Avatar Cal-PM Registry Setting 'Require Authorizations At Guarantors/Payors Level' is enabled
  9. 'Effective Date'
  10. 'Expiration Date'
  11. Not a required field where Avatar Cal-PM Registry Setting 'Require Authorizations At Guarantors/Payors Level' is enabled
  12. 'Authorization Number'
  13. 'Service Code' / 'Service Code(s)'
  14. All service codes will be available for search/selection regardless of whether Avatar Cal-PM Registry Setting 'Enable Program/Service Code Filter' is enabled
  15. Not available where Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled
  16. 'Service Code' is a single code search/select field where Avatar Cal-PM Registry Setting 'Require Authorizations At Guarantors/Payors Level' is disabled
  17. 'Service Code(s)' is a multiple selection field (including 'All Service Codes' selection) where Avatar Cal-PM Registry Setting 'Require Authorizations At Guarantors/Payors Level' is enabled
  18. 'Authorization Group'
  19. Available only where Avatar Cal-PM Registry Setting 'Require Authorizations At Guarantors/Payors Level' is enabled
  20. 'Select CPT ® Codes' button
  21. Available only where Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled
  22. 'All CPT Codes'
  23. Available only where Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations' is enabled
  24. 'Display Authorizations' button
  25. 'Select Authorizations To Edit/Delete' button
  26. Enter/select values in 'Effective Date' and 'Expiration Date' fields.
  27. Where Avatar Cal-PM Registry Setting 'Require Authorizations At Guarantors/Payors Level' is enabled - select one or more values in 'Program' and/or 'Practitioner Category' multiple selection fields if desired.
  28. Where Avatar Cal-PM Registry Setting 'Require Authorizations At Guarantors/Payors Level' is enabled - select one or more codes or 'All Service Codes' in 'Service Code(s)' multiple selection field, or select grouping in 'Authorization Group' field and ensure that codes in group are selected in 'Service Codes' field (and limited to only codes specified for group).
  29. 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').
  30. Enter 'Authorization Number' field value.
  31. Click 'Submit' button to file 'Payor Based Authorizations' form/record.
  32. 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.
  33. Ensure all field values are present in 'Payor Based Authorizations' form/record as previously entered/filed.
  34. Click 'Display Authorizations' button to display the Payor Based Authorizations report/information.
  35. 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:
  36. 'Guarantor'
  37. 'Service Code' or 'CPT Code'
  38. Dependent on Avatar Cal-PM Registry Setting 'Enable CPT Based Payor Authorizations'
  39. 'Program'
  40. 'Practitioner Category'
  41. 'Effective Date'
  42. Expiration Date'
  43. 'Authorization Number'
  44. Open Crystal Reports or other SQL reporting tool.
  45. 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 (including 'Program' and 'Practitioner Category' values where entered).
  46. 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 (including 'Program' and 'Practitioner Category' values where entered).
Topics
• Registry Settings • Service Authorizations