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Avatar Cal-PM 2022 Update 68

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Product Requirements / Recommendations

Avatar Cal-PM required
RADplus required

Product Update Form Description

Support of 'Place Of Service' overrides is added to the system via new registry setting 'Allow CPT Place Of Service Override'.

Included Updates

3, 9, 10, 14, 15, 19, 21, 25, 28, 30, 37, 38, 40, 43, 48, 58, 59, 65

Required Updates

Avatar Cal-PM 2022 Update 40
Avatar Cal-PM 2022 Update 58
Details
NEW1 CHANGED0 FIXED0
New (1)
CPT Place of Service Override
The ability to override the 'CPT Place of Service' has been added to the 837 Professional (2300 loop-CLM05; 2400 loop-SV105) and the paper HCFA (form locator 24-B).
Set the following registry setting to 'Y' to enable the functionality: Avatar PM->System Maintenance->Service Code Maintenance->->->Allow CPT Place Of Service Override.
The following tables are added: 'table_cpt_place_override' and 'table_cpt_pos_template_def'.
Value Added: User is able to change the Place of Service Location by CPT Code.
Topics
• 837 Professional • Database Management • File Import • NX • Print Bill
 
Acceptance Tests
AV-81217 Summary | Details
CPT Place of Service Override
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Client Charge Input
  • CPT Place Of Service Override
  • Create Interim Billing Batch File
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
  • Print Bill
  • Program Maintenance
  • Registry Settings (PM)
  • User Definition
  • Dictionary Update (PM)
  • File Import
  • Guarantors/Payors
Scenario 1: Cal-PM - CPT Place of Service Override - Billing
Specific Setup:
  • Registry Settings: Avatar PM->System Maintenance->Service Code Maintenance->->->Allow CPT Place Of Service Override = 'Y'.
  • User Definition is used to give the tester access to the form 'CPT Place Of Service Override' and the tables 'table_cpt_place_override' and 'table_cpt_pos_template_def'.
  • CPT Code Definition: Identify two codes that are associated to two different service codes in ‘Service Fee/Cross Reference Maintenance’.
  • Service Codes:
  • Service Code 1: Is associated to CPT Code 1.
  • Service Code 2: Is associated to CPT Code 2.
  • Client: Select an outpatient client.
  • Note the program.
  • Ensure that the client has an active Diagnosis record.
  • Ensure the client has an active Financial Eligibility record. Note the guarantor.
  • Program Maintenance is used to note the ‘Location’.
  • Client Charge Input: Create a service for each of the service codes. Note the date(s) of service.
  • Client Ledger: Verify that the services distributed to the guarantor noted above.
  • Close Charges is used to close the charges.
  • Create Interim Billing Batch File is used to create a batch specific to the guarantor, program, and client.
  • Print Bill is used to create an unclaimed bill for the interim batch.
  • Print the report for further comparison. The service line will contain the service date, location code, CPT Code, and other details.
  • Electronic Billing is used to create an unclaimed bill for the interim batch.
  • Print the dump file for further comparison. The ‘CLM’ segment will contain the location in field 5 (CLM05). The ‘SV1’ will contain the location in field 5 (SV105).
Steps
  1. Open ‘CPT Place Of Service Override’.
  2. Select ‘Add’ in ‘Action’.
  3. Enter desired value in ‘Template Name’.
  4. Select the client’s guarantor in ‘Guarantor’.
  5. Select the client’s program in ‘Program’.
  6. Select ‘Individual’ in ‘All or Individual Service Code’.
  7. Enter ‘Service Code 1’ in ‘Select Service’.
  8. Validate that the service is saved in ‘Selected Service(s)’.
  9. Select ‘Individual’ in ‘All or Individual CPT Code’.
  10. Enter ‘CPT Code 1’ in ‘Select CPT’.
  11. Validate that the code is saved in ‘Selected CPT(s)’.
  12. Select desired value in ‘All or Individual Location’.
  13. Enter ‘Modifiers’, if desired.
  14. Select a location value that differs from the ‘Print Bill’ location in ‘Place Of Service (HCFA 24-B)’.
  15. Select a location value that differs from the ‘Electronic Billing’ location in ‘Place Of Service (837 Professional)’.
  16. Click [Submit].
  17. Close the form.
  18. Open ‘Print Bill’ and print an unclaimed bill for the interim batch.
  19. Validate that the location for Service Code 1 now contains the value selected in ‘Place Of Service (HCFA 24-B)’.
  20. Validate that the location for Service Code 2 contains the value that was in bill printed during Setup.
  21. Close the report.
  22. Close the form.
  23. Open ‘Electronic Billing’ and create an unclaimed bill for the interim batch.
  24. Validate that the ‘CLM’ LOCATION now contains the value selected in ‘Place Of Service (837 Professional)’.
  25. Validate that the ‘SV1’ location for Service Code 1 now contains the value selected in ‘Place Of Service (837 Professional)’.
  26. Validate that the ‘SV1’ location for Service Code 2 contains the value that was in the dump file printed during Setup.
  27. Close the report.
  28. Close the form.
Scenario 2: File Import - CPT Place of Service Override
Specific Setup:
  • The 'Avatar_Cal-PM_File_Import_Record_Layouts' is included in the update zip file to aid in creating the test files for File Import.
  • Registry Settings:
  • Note the value of the 'Avatar PM->System Maintenance->File Import->->->Import File Delimiter' setting to determine how to build the test files for File Import.
  • Avatar PM->System Maintenance->Service Code Maintenance->->->Allow CPT Place Of Service Override = 'Y'.
  • User Definition is used to give the tester access to the form 'CPT Place Of Service Override' and the tables 'table_cpt_place_override' and 'table_cpt_pos_template_def'.
  • Service Codes: Select one or more for the File Import test files.
  • Guarantors/Payors: Select one or more for the File Import test files.
  • Program Maintenance: Select one or more for the File Import test files.
  • CPT Code Definition: Select one or more for the File Import test files.
  • Dictionary Update:
  • Client:
  • Print dictionary '(578) Place Of Service (HCFA 24-B)' to select a value for the File Import test files.
  • Print dictionary '(579) Place Of Service (837 Professional)' to select a value for the File Import test files.
  • Print dictionary '(10006) Location' to select values for the File Import test files.
  • Other Tabled Files:
  • Print dictionary '(556) Action' to select values for the File Import test files.
  • Create a file import item with an 'Action' of '1' which will 'add' the 'CPT Place Of Service Override Template' when posted. There will be no value in the 'Template ID' field.
  • Copy the 'add' file and edit the 'Action' to be '2' to make it an 'edit' file. Edit at least one thing in the file, such as the 'Modifier' field.
  • After the 'Add' file is posted, the 'Template ID' will need to be added to this file.
  • Copy the 'edit' file and edit the 'Action' to be '3' to make it a 'delete' file.
  • After the 'Add' file is posted, the 'Template ID' will need to be added to this file.
Steps
  1. Open ‘File Import’.
  2. Select ‘CPT Place Of Service Override’ in ‘File Type’.
  3. Upload, compile, print, and post the file that will add the template.
  4. Close the form.
  5. Open ‘CPT Place Of Service Override’.
  6. Click [Display CPT Place Of Service Overrides].
  7. Validate that the ‘CPT Place Of Service Override Report’ opens.
  8. Validate that the report contains the data that was submitted in the posted file.
  9. Close the report.
  10. Select ‘Edit’ in ‘Action’.
  11. Select the imported template in ‘Select Template’.
  12. Validate the template data.
  13. Close the form.
  14. Open ‘File Import’.
  15. Select ‘CPT Place Of Service Override’ in ‘File Type’.
  16. Upload, compile, print, and post the file that will edit the template.
  17. Close the form.
  18. Open ‘CPT Place Of Service Override’.
  19. Click [Display CPT Place Of Service Overrides].
  20. Validate that the ‘CPT Place Of Service Override Report’ opens.
  21. Validate that the report contains the edited data that was submitted in the posted file.
  22. Close the report.
  23. Select ‘Edit’ in ‘Action’.
  24. Select the imported template in ‘Select Template’.
  25. Validate the edited template data.
  26. Close the form.
  27. Open ‘File Import’.
  28. Select ‘CPT Place Of Service Override’ in ‘File Type’.
  29. Upload, compile, print, and post the file that will delete the template.
  30. Close the form.
  31. Open ‘CPT Place Of Service Override’.
  32. Click [Display CPT Place Of Service Overrides].
  33. Validate that the ‘CPT Place Of Service Override Report’ opens.
  34. Validate that the report does not contain the template.
  35. Close the report.
  36. Select ‘Edit’ in ‘Action’.
  37. Validate that the template is not available in ‘Select Template’.
  38. Close the form.
Topics
• 837 Professional • Database Management • File Import • NX • Print Bill
Table Changes
Table Column Change
SYSTEM.table_cpt_place_override FACILITY ADD
SYSTEM.table_cpt_place_override GUARANTOR_ID ADD
SYSTEM.table_cpt_place_override ID ADD
SYSTEM.table_cpt_place_override SERVICE_CODE ADD
SYSTEM.table_cpt_place_override cpt_code ADD
SYSTEM.table_cpt_place_override cpt_value ADD
SYSTEM.table_cpt_place_override guarantor_name ADD
SYSTEM.table_cpt_place_override hcfa_place_of_svc_code ADD
SYSTEM.table_cpt_place_override hcfa_place_of_svc_value ADD
SYSTEM.table_cpt_place_override location_code ADD
SYSTEM.table_cpt_place_override location_value ADD
SYSTEM.table_cpt_place_override modifiers ADD
SYSTEM.table_cpt_place_override p837_place_of_svc_code ADD
SYSTEM.table_cpt_place_override p837_place_of_svc_value ADD
SYSTEM.table_cpt_place_override program_code ADD
SYSTEM.table_cpt_place_override program_value ADD
SYSTEM.table_cpt_place_override template_definition_id ADD
SYSTEM.table_cpt_place_override template_name ADD
SYSTEM.table_cpt_place_override v_service_value ADD
SYSTEM.table_cpt_pos_template_def FACILITY ADD
SYSTEM.table_cpt_pos_template_def GUARANTOR_ID ADD
SYSTEM.table_cpt_pos_template_def ID ADD
SYSTEM.table_cpt_pos_template_def SERVICE_CODE ADD
SYSTEM.table_cpt_pos_template_def action_code ADD
SYSTEM.table_cpt_pos_template_def action_value ADD
SYSTEM.table_cpt_pos_template_def cpt_all_or_ind_code ADD
SYSTEM.table_cpt_pos_template_def cpt_code ADD
SYSTEM.table_cpt_pos_template_def cpt_shvalue ADD
SYSTEM.table_cpt_pos_template_def cpt_value ADD
SYSTEM.table_cpt_pos_template_def data_entry_by ADD
SYSTEM.table_cpt_pos_template_def data_entry_by_option ADD
SYSTEM.table_cpt_pos_template_def data_entry_date ADD
SYSTEM.table_cpt_pos_template_def data_entry_offset ADD
SYSTEM.table_cpt_pos_template_def data_entry_source ADD
SYSTEM.table_cpt_pos_template_def data_entry_time ADD
SYSTEM.table_cpt_pos_template_def data_entry_time_j ADD
SYSTEM.table_cpt_pos_template_def data_entry_timezone_info_all ADD
SYSTEM.table_cpt_pos_template_def data_entry_timezone_short ADD
SYSTEM.table_cpt_pos_template_def data_entry_user_id ADD
SYSTEM.table_cpt_pos_template_def data_entry_user_name ADD
SYSTEM.table_cpt_pos_template_def data_entry_utc ADD
SYSTEM.table_cpt_pos_template_def guarantor_name ADD
SYSTEM.table_cpt_pos_template_def guarantor_shname ADD
SYSTEM.table_cpt_pos_template_def hcfa_place_of_svc_code ADD
SYSTEM.table_cpt_pos_template_def hcfa_place_of_svc_value ADD
SYSTEM.table_cpt_pos_template_def loc_all_or_ind_code ADD
SYSTEM.table_cpt_pos_template_def location_code ADD
SYSTEM.table_cpt_pos_template_def location_shvalue ADD
SYSTEM.table_cpt_pos_template_def location_value ADD
SYSTEM.table_cpt_pos_template_def modifiers ADD
SYSTEM.table_cpt_pos_template_def p837_place_of_svc_code ADD
SYSTEM.table_cpt_pos_template_def p837_place_of_svc_value ADD
SYSTEM.table_cpt_pos_template_def program_code ADD
SYSTEM.table_cpt_pos_template_def program_shvalue ADD
SYSTEM.table_cpt_pos_template_def program_value ADD
SYSTEM.table_cpt_pos_template_def svc_all_or_ind_code ADD
SYSTEM.table_cpt_pos_template_def template_definition_id ADD
SYSTEM.table_cpt_pos_template_def template_name ADD
SYSTEM.table_cpt_pos_template_def v_service_shvalue ADD
SYSTEM.table_cpt_pos_template_def v_service_value ADD