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Avatar Cal-PM 2023 Monthly Release 2023.02.01 Acceptance Tests

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Update 32 Summary | Details
Service Fee/Cross Reference Maintenance - Practitioner Category
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Service Fee/Cross Reference Maintenance
  • Dictionary Update (PM)
Scenario 1: 'Service Fee/Cross Reference Maintenance' - Form Validation (Avatar Cal-PM)
Specific Setup:
  • Crystal Reports or other SQL reporting tool
  • Dictionary Update - Staff File - Practitioner Category (79): Note a dictionary code that has more than five characters, not how many characters there are.
Steps
  1. Open Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form.
  2. Select 'Enter New' or 'Edit Existing' in the 'Enter New Or Edit Existing Fee/Cross Reference' field.
  3. Enter/select values for 'Service Code' and 'From Date' fields (and select Service Fee/Cross Reference entry for edit if applicable).
  4. Enter/select values for 'Practitioner Category', 'Location', 'Practitioner' and/or 'Program' Service Fee/Cross Reference entry criteria if desired.
  5. Ensure that 'Fixed Fee Unit' and 'User Defined Fee Unit' fields are present in form.
  6. In case where selected Service Code is defined as 'User Defined' (via Avatar Cal-PM 'Service Codes' form 'Type Of Fee' field) - ensure that the 'Fixed Fee Unit' field is disabled (as field only applies to Fixed Fee Service Codes).
  7. In case where selected Service Code is defined as 'Fixed Fee' (via Avatar Cal-PM 'Service Codes' form 'Type Of Fee' field) - ensure that the 'User Defined Fee Unit' field is disabled (as field only applies to User Defined Fee Service Codes).
  8. Ensure user help message is present in form for 'User Defined Fee Unit' field (lightbulb icon), containing the following information:
  9. "A value entered in this field will make the 'Duration Range' field required. The Unit Quantity amount and gross charge amount generated for the service will be based on the integer entered in this field."
  10. Ensure that if value is entered for 'User Defined Fee Unit' field, the 'Duration Range' fee criteria field is required.
  11. Enter/select values for 'Duration Range', 'Fee', 'Fixed Fee Unit' and/or 'User Defined Fee Unit' fields (and any other Service Fee/Cross Reference definition fields as desired/required).
  12. Click 'Submit' button to file 'Service Fee/Cross Reference Maintenance' form/entry; ensure user is presented with filing confirmation dialog noting 'Service Fee/Cross Reference Maintenance has completed. Do you wish to return to form?'; Click 'Yes' button to return to form.
  13. Select 'Edit Existing' in the 'Enter New Or Edit Existing Fee/Cross Reference' field.
  14. Enter/select values for 'Service Code' and 'From Date' fields, using same code/date as previously filed Service Fee/Cross Reference entry, and select previously entered/filed Service Fee/Cross Reference entry for view/edit.
  15. Ensure previously entered/filed values are present in all form fields for selected Service Fee/Cross Reference entry (including values for 'Fixed Fee Unit' and 'User Defined Fee Unit' fields where applicable).
  16. Click 'Service Fee/Cross Reference Definition Report' button to launch report displaying all defined Service Fee/Cross Reference entries.
  17. In Service Fee/Cross Reference Definition Report, ensure that existing Service Fee/Cross Reference entries are present, including values for 'Units' field where value defined.
  18. Note, 'Units' field in Service Fee/Cross Reference Definition Report will display value of 'Fixed Fee Unit' if present for Fixed Fee Service Codes, and will display value of 'User Defined Fee Unit' if present for User Defined Fee Service Codes
  19. Open Crystal Reports or other SQL reporting tool.
  20. In Avatar Cal-PM SQL table 'SYSTEM.billing_tx_master_fee_table' (and 'SYSTEM.billing_tx_master_fee_audit' for deleted entries), ensure that data rows are present for all Service Fee/Cross Reference entries filed/updated in system, including values for 'fixed_fee_units' and 'user_defined_fee_units' fields.
  21. Click the 'Guarantor Definitions' section.
  22. Select 'Enter New' or 'Edit Existing' in the 'Enter New Or Edit Existing Fee/Cross Reference' field.
  23. Enter/select values for 'Service Code' and 'From Date' fields (and select Service Fee/Cross Reference entry for edit if applicable).
  24. Select values for 'Location', 'Practitioner' and/or 'Program' Service Fee/Cross Reference entry criteria if desired.
  25. Select the dictionary code that has more than five characters, and one more category in 'Practitioner Category'.
  26. Fill out other fields as desired.
  27. Click [Submit].
  28. Return to the form and edit the Guarantor Definition that was submitted.
  29. Validate that all fields contain the correct data.
  30. Close the form.
Financial Eligibility - Guarantor Selection
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Financial Eligibility
Scenario 1: 'Financial Eligibility' - file financial eligibility for a client
Specific Setup:
  • Guarantors/Payors: Two guarantors, A & B, are identified that each have a 'Default Guarantor Plan' and the 'Associated Plans' only has the value of the 'Default Guarantor Plan' selected. Ensure that the guarantors have different values in 'Default Guarantor Plan' and 'Associated Plans'
  • A client must be enrolled in an existing episode (Client A).
Steps
  1. Select "Client A" and access the 'Financial Eligibility' form.
  2. Select the 'Guarantor Selection' section.
  3. Click [Add New Item].
  4. Enter guarantor A in 'Guarantor #' field.
  5. Validate an "Information" message is displayed stating: Selecting This Guarantor Will Over-Write Any Previous Plan Information. The Master Plan Information Will Default.
  6. Click [OK].
  7. Validate that the correct plan displays in ‘Guarantor Plan.
  8. Select "Yes" in the 'Eligibility Verified' field.
  9. Enter desired date in the 'Coverage Effective Date' field.
  10. Select any value in the 'Client's Relationship To Subscriber' field.
  11. Enter any value in the format of LASTNAME,FIRSTNAME in the 'Subscriber's Name' field.
  12. Enter any value in the 'Subscriber Address - Street Line 1' field.
  13. Enter any value in the 'Subscriber's Address - Zip' field.
  14. Enter any value in the 'Subscriber's Social Security #' field.
  15. Select any value in the 'Subscriber Sex' field.
  16. Select any value in the 'Subscriber Release Of Info' field.
  17. Select "Yes" in the 'Subscriber Assignment of Benefits' field.
  18. Repeat steps 3 – 17 for guarantor B.
  19. Click [Edit] in ‘Guarantor Information’ for guarantor A.
  20. Validate that the correct information displays for all fields.
  21. Click [Edit] in ‘Guarantor Information’ for guarantor B.
  22. Validate that the correct information displays for all fields.
  23. Select the 'Financial Eligibility' tab.
  24. Select guarantor A in the 'Guarantor #1' field.
  25. Select guarantor B in the 'Guarantor #2' field.
  26. Click [Submit].
  27. Open the 'Financial Eligibility' form for Client A.
  28. Select the 'Guarantor Selection' section.
  29. Click [Edit Selected Item] for guarantor A.
  30. Validate that all data is correct.
  31. Click [Edit Selected Item] for guarantor B.
  32. Validate that all data is correct.
  33. Close the form.
Topics
• Service Fee/Cross Reference Maintenance • NX • Financial Eligibility
Update 34 Summary | Details
AR Console - Claim Follow-Up Entry
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • View Definition
  • NX View Definition
  • AR Console Configuration
  • AR Console User Defaults Setup
  • System Task Scheduler
Scenario 1: AR Console - Validating follow-up entry and services tables for the client/claim selected
Specific Setup:
  • Note the tester's 'User Definition', 'User Description'.
  • Registry Setting:
  • Set the 'Avatar PM->Billing->Accounts Receivable Management->->->Enable Accounts Receivable Management Functionality' registry setting to "Yes".
  • Accounts Receivable functionality has been defined.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor code/name.
  • Service codes:
  • An existing service code is identified to be used. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing client is identified or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
  • Recurring Client Charge Input:
  • 3-5 services are rendered to the client. Note service date, service code.
  • Client Ledger:
  • The service distributed correctly to the assigned guarantor.
  • Electronic Billing:
  • All the services are claimed. Note the claim numbers.
  • Use ‘AR Console User Defaults’ to give the tester access to the following:
  • First initial of the client's last name.
  • Admission program
  • Guarantor the claim liability distributed to.
  • Use ‘System Task Scheduler’ to process the ‘Auto AR Batch’ after the claims were created.
  • AR Console:
  • A claim follow up note is created for the first service of the client. Note the information of the claim follow-up note.
Steps
  1. Access the ‘AR Console’.
  2. Enter desired client in the ‘Client' search box.
  3. Select a client identified in the setup section.
  4. Click [Search].
  5. Validate all the claims for the client are displayed in the ‘Claims with Outstanding Receivables’ grid.
  6. Select one claim row, noting the claim number.
  7. Validate the 'Claim Service Information' table displays all the services of the client / claim selected.
  8. Click [Add Claim Follow-Up/Notes].
  9. Validate the user is navigated to the 'Claim Follow-Up Entry' tab.
  10. Validate the 'Client' drop down field is populated with the selected client.
  11. Validate that ‘Claim Follow-Up’ drop down field contains the selected claim number.
  12. Validate the 'Services' table displays all the services attached to the client/claim selected.
  13. Validate the 'Follow-Up Notes' table contains any follow-up note created for the client/claim selected.
  14. Click [New row].
  15. Add another follow-up note for the client/claim.
  16. Click [File Updates].
  17. Go back to 'AR List' tab.
  18. Click [Reset Defaults].
  19. Enter desired client in the ‘Client' search box.
  20. Select a client identified in the setup section.
  21. Click [Search].
  22. Validate all the claims for the client are displayed in the ‘Claims with Outstanding Receivables’ grid.
  23. Select one claim row, noting the claim number.
  24. Validate the 'Claim Service Information' table displays all the services of the client / claim selected.
  25. Click [Add Claim Follow-Up/Notes].
  26. Validate the user is navigated to the 'Claim Follow-Up Entry' tab.
  27. Validate the 'Client' drop down field is populated with the selected client.
  28. Validate that ‘Claim Follow-Up’ drop down field contains the selected claim number.
  29. Validate the 'Services' table displays all the services attached to the client/claim selected.
  30. Validate the 'Follow-Up Notes' table contains all the follow-up notes created for the client/claim selected.
Topics
• Accounts Receivable Management • NX
Update 36 Summary | Details
'Electronic Billing' Support for Services Originating in Avatar MSO
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • Electronic Billing
Scenario 1: 'Electronic Billing' - Verification of 'Support MSO Other Healthcare Coverage' Registry Setting (Services Originating in Avatar MSO)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar Cal-PM Registry Setting 'Include Service Level Adjudication Info' must be enabled (and 'Include Service Level Adjudication Information (2430)' field set to 'Yes' via 'Guarantor/Program Billing Defaults' form '837 Professional' and/or '837 Institutional' section for applicable Guarantor/Program)
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional/837 Institutional file inclusion (via 'Electronic Billing' form) originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
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 'Billing Form' field.
  4. Enter/select 837 file sorting criteria, using values which will include service(s) originating in Avatar MSO.
  5. Click 'Process' button to sort/generate 837 Professional or 837 Institutional file.
  6. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional/837 Institutional file sorted which includes services originating in Avatar MSO, and click 'Process' button to display 837 outbound file data.
  9. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file data - for services originating via Avatar MSO and including Service-Level Third Party Payment/Adjustment 'Other Healthcare Coverage' information, ensure that 2430-SVD-03 Service Line Adjudication Product/Service ID in Avatar Cal-PM 837 file contains 2430-SVD-03 Service Code value from original Avatar MSO inbound claim/service Other Healthcare Coverage information.
  10. Example: SVD*87755XX*7.5*HC:90806:HA**11~
'Client Ledger' Support for Services Originating in Avatar MSO
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
Scenario 1: 'Client Ledger' - Verification of 'Support MSO Other Healthcare Coverage' Registry Setting
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • Clinical Data Repository (CDL) link must be enabled for Avatar Cal-PM/Avatar MSO namespace connection (via 'Connect/Disconnect Application Namespace' form)
  • One or more service(s) originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
Steps
  1. Open Avatar Cal-PM 'Client Ledger' form.
  2. Select 'Client ID' value for client where services originating in Avatar MSO and including Other Healthcare Coverage information exist.
  3. Select 'Claim/Episode/All Episodes' value (and enter/edit 'From Date'/'To Date' values if desired).
  4. Select 'Ledger Type' value.
  5. Click 'Process' button.
  6. Where 'Simple' is selected for 'Ledger Type' - In 'Client Ledger' form display data, ensure that services originating in Avatar MSO and including Other Healthcare Coverage information are denoted with an asterisk (*) character in the 'Charge' column, and that the 'Charge' ('CHG') value for service(s) reflects the 'Allowed Amount' value from Avatar MSO Other Healthcare Coverage information for service(s).
  7. Note - 'Client Ledger' form 'Guarantor Liability' and 'Line Balance' value(s) for service(s) originating in Avatar MSO with Other Healthcare Coverage information will reflect the 'Cost of Service' value for service filed to Avatar Cal-PM
  8. Where 'Crystal' is selected for 'Ledger Type' - In Client Ledger Report data, ensure that for services originating in Avatar MSO and including Other Healthcare Coverage information, the 'Full Charge' value for service(s) reflects the 'Allowed Amount' value from Avatar MSO Other Healthcare Coverage information for service(s).
  9. Note - Client Ledger Report 'Guarantor Liability' and 'Line Balance' value(s) for service(s) originating in Avatar MSO with Other Healthcare Coverage information will reflect the 'Cost of Service' value for service filed to Avatar Cal-PM
Topics
• Electronic Billing • Claims Processing • NX • Client Ledger
Update 37 Summary | Details
CPT Code Definition
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 Code Definition' - Verification of American Medical Association-Provided CPT Code Values
Steps
  1. Open 'CPT Code Definition' form.
  2. Select 'Edit' action in 'Add/Edit/Delete CPT Code' field.
  3. In 'CPT Service Code' field, enter search term using CPT Code Description (AMA 'Consumer Descriptor' term) or CPT Code.
  4. Ensure 'CPT Service Code' field search results include American Medical Association-provided CPT Service Code(s) for search term/code entered.
  5. Select CPT Code from 'CPT Service Code' search results.
  6. Confirm value in 'CPT Code Description' field for selected CPT Service Code (from AMA 'Consumer Descriptor' term).
  7. Note - location of AMA copyright form field/labels may be affected by any Form Designer changes present for form
Scenario 2: 'CPT Code Definition' - Verification of American Medical Association Trademark/Copyright Notice Display
Steps
  1. Open 'CPT Code Definition' form.
  2. Verify the 'CPT Service Code' field in form contains the AMA Trademark 'CPT® Codes' label.
  3. Verify the following AMA copyright notice is displayed at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'
  4. Note - location of AMA copyright form field/labels may be affected by any Form Designer changes present for form
Topics
• CPT Codes
Update 39 Summary | Details
Avatar Cal-PM 'Enable CalAIM BH Payment Reforms' Registry Setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Electronic Billing
  • Registry Settings (PM)
  • Guarantors/Payors
  • Program Maintenance
  • Client Charge Input (Charge Fee Access)
  • Client Charge Input With Diagnosis Entry
  • Recurring Client Charge Input (Charge Fee Access)
  • Recurring Client Charge Input (Diagnosis Entry)
  • Progress Notes (Group and Individual)
  • Verify Staff Member Appointments
  • Post Staff Member Schedule
Scenario 1: 'Electronic Billing' - Verification of 'Enable CalAIM BH Payment Reforms' Registry Setting
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable CalAIM BH Payment Reforms' must be enabled (payment reform effective date set)
  • Avatar Cal-PM Registry Setting 'Enable SD/MC Minute to Unit Override' may optionally be enabled/disabled
  • If Registry Setting 'Enable SD/MC Minute to Unit Override' is enabled, 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' field in 'Guarantor/Program Billing Defaults' form must be set to 'Yes' for applicable Program/Guarantor template
  • 'Bill Cal Billing Units' field in 'Guarantors/Payors' form must be set to 'Yes' for applicable Guarantor
  • One or more Service Codes where 'Type Of Service' value is set to 'Group' and 'Is this an ODS Group Service?' value is set to 'Yes' (via Avatar Cal-PM 'Service Codes' form)
  • One or more ODS Group Service(s) eligible for Avatar Cal-PM 837 Professional/837 Institutional file inclusion
Steps
  1. Open Avatar Cal-PM 'Electronic Billing' form.
  2. Note, 'Quick Billing' form/functions may also be used for 837 generation/validation.
  3. Select 837 Professional or 837 Institutional in 'Billing Form' field.
  4. Select values for 837 bill generation in the 'Type of Bill', 'Individual or All Guarantors' and 'Billing Type' fields.
  5. Select 'Sort File' in the 'Billing Options' field.
  6. Select/enter values for service inclusion in 'All Clients or Interim Billing Batch' and 'Program(s)' fields.
  7. Select/enter values for 'Create Claims' (and 'Date of Claim' if 'Yes'), 'First Date of Service to Include' and 'Last Date of Service to Include' fields.
  8. Select/enter values for any other bill sorting criteria fields as required/desired.
  9. Click 'Process' button in form to sort bill.
  10. Select 'Run Report' in the 'Billing Options' field
  11. Select 'Print' in the 'Print Or Delete Report' field.
  12. Select 837 Professional/837 Institutional file sorted which includes one or more Cal Billing Unit/ODS Group Services and click 'Process' button to display 837 Electronic Billing Report.
  13. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file report information including Cal Billing Unit/ODS Group Services - ensure that Service Cost/Liability ('Amount') and Service Units ('Unit') values for services are determined as follows:
  14. For service dates prior to date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that ODS Group Service total charge/liability and service units are set according to the 'Bill Cal Billing Units' field/setting for applicable Guarantor (and 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' field if enabled in 'Guarantor/Program Billing Defaults' form/template).
  15. For service dates on or after date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that service total charge/liability and service units are set without Cal Billing Units calculations under the 'Bill Cal Billing Units' field/setting for applicable Guarantor (and the 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' field is regarded as 'No' if enabled in 'Guarantor/Program Billing Defaults' form/template).
  16. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  17. Select 'Print' in the 'Print Or Delete Report' field.
  18. Select 837 Professional/837 Institutional file sorted which includes one or more Cal Billing Unit/ODS Group Services and click 'Process' button to display 837 outbound file data.
  19. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file data including Cal Billing Unit/ODS Group Services - ensure that Service Cost/Liability and Service Units (2400-SV1/SV2 Quantity/Monetary Amount) values for services are determined as follows:
  20. For service dates prior to date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that ODS Group Service total charge/liability and service units are set according to the 'Bill Cal Billing Units' field/setting for applicable Guarantor (and 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' field if enabled in 'Guarantor/Program Billing Defaults' form/template).
  21. For service dates on or after date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that service total charge/liability and service units are set without Cal Billing Units calculations under the 'Bill Cal Billing Units' field/setting for applicable Guarantor (and the 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' field is regarded as 'No' if enabled in 'Guarantor/Program Billing Defaults' form/template).
Scenario 2: 'Client Charge Input' - Verification of 'Enable CalAIM BH Payment Reforms' Registry Setting
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable CalAIM BH Payment Reforms' must be enabled (payment reform effective date set)
  • Avatar Cal-PM Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' may optionally be enabled/disabled
  • If Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' is disabled, 'Use Medi-Cal Rules For Fee Calculations' field in 'Guarantors/Payors' form must be set to 'Yes' for applicable Guarantor(s)
  • One or more Service Codes where 'Type Of Service' value is set to 'Group' and 'Is this an ODS Group Service?' value is set to 'Yes' (via Avatar Cal-PM 'Service Codes' form)
  • Applicable Group Service Fee/Override value calculation may be determined by 'Apply Multiple Practitioner Calculations To This Service Using' field in 'Service Codes' form is defined/applicable to service
  • Client record eligible for 'Client Charge Input' form service entry where applicable Guarantor(s) is/are assigned via client Financial Eligibility record
Steps
  1. Open Avatar Cal-PM 'Client Charge Input' form.
  2. Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Client Charge Input (Charge Fee Access)', 'Client Charge Input With Diagnosis Entry', 'Client Charge Input (Charge Fee Access And Diagnosis Entry)', 'Recurring Client Charge Input', 'Recurring Client Charge Input (Charge Fee Access)', 'Recurring Client Charge Input With Diagnosis Entry' and/or 'Recurring Client Charge Input (Charge Fee Access And Diagnosis Entry)' forms
  3. Enter value for 'Date of Service'.
  4. Enter/select values for 'Client ID', 'Episode Number', 'Program', 'Service Code' and 'Practitioner' fields, using Service Code defined as ODS Group Service and entering value for the 'Enter The Number Of Clients In The Group' dialog/prompt.
  5. Enter value for 'Co-Practitioner' and 'Co-Practitioner 2' fields for ODS Group Service if desired (as well as detailed Duration fields 'Face-to-Face Time', 'Documentation and Travel Time', etc if present/configured in form).
  6. Enter/select values for any other service entry fields as desired/required.
  7. Click 'Submit' button to file form/service.
  8. Open Avatar Cal-PM 'Client Ledger' form.
  9. Select 'Client ID' value for client where ODS Group Service(s) entered.
  10. Select 'Claim/Episode/All Episodes' value (and enter/edit 'From Date'/'To Date' values if desired).
  11. Select 'Ledger Type' value.
  12. Click 'Process' button.
  13. In Client Ledger information/report data for ODS Group Services filed in system - ensure that 'Total Charge' and/or 'Guarantor Liability' values for services are determined as follows:
  14. For service dates prior to date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that ODS Group Service total charge/liability is set according to the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form) and 'Is this an ODS Group Service' field for selected Service Code.
  15. For service dates on or after date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that service total charge/liability is set without ODS Group Service calculations under the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form is regarded as 'No') and the 'Is this an ODS Group Service' field for selected Service Code is regarded as 'No'.
Scenario 3: 'Progress Notes (Group and Individual)' - Verification of 'Enable CalAIM BH Payment Reforms' Registry Setting
Specific Setup:
  • Avatar CWS Progress Note form(s) configured for Avatar Cal-PM group service entry/creation
  • Avatar Cal-PM Registry Setting 'Enable CalAIM BH Payment Reforms' must be enabled (payment reform effective date set)
  • Avatar Cal-PM Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' may optionally be enabled/disabled
  • If Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' is disabled, 'Use Medi-Cal Rules For Fee Calculations' field in 'Guarantors/Payors' form must be set to 'Yes' for applicable Guarantor(s)
  • One or more Service Codes where 'Type Of Service' value is set to 'Group' and 'Is this an ODS Group Service?' value is set to 'Yes' (via Avatar Cal-PM 'Service Codes' form)
  • Applicable Group Service Fee/Override value calculation may be determined by 'Apply Multiple Practitioner Calculations To This Service Using' field in 'Service Codes' form is defined/applicable to service
  • Service Group must be defined for Progress Note/group service entry (via Avatar Cal-PM 'Group Registration' form)
  • Service Group/client records eligible for Progress Note/group service entry where applicable Guarantor(s) is/are assigned via client Financial Eligibility record
Steps
  1. Open Avatar CWS Progress Note form for group progress note/group service entry.
  2. Navigate to 'Group Default Notes' section of form for Group Service entry.
  3. Enter/select values for 'Date Of Group', 'Practitioner', 'Progress Note For', 'Note Type', 'Service Program', 'Service Charge Code' and 'Service Duration' fields, using Service Code defined as ODS Group Service.
  4. Enter value for 'Co-Practitioner' and 'Co-Practitioner 2' fields for ODS Group Service if desired (as well as detailed Duration fields 'Face-to-Face Time', 'Documentation and Travel Time', etc if present/configured in form).
  5. Enter/select values for any other progress note/group service entry fields as desired/required.
  6. Click 'Submit' button to file form/group progress note/group service entry.
  7. Finalize Progress Note entry for one or more clients included in selected Service Group so that one or more ODS Group Services associated to finalized Progress Note entries are created.
  8. Open Avatar Cal-PM 'Client Ledger' form.
  9. Select 'Client ID' value for client where Progress Note/ODS Group Service(s) entered.
  10. Select 'Claim/Episode/All Episodes' value (and enter/edit 'From Date'/'To Date' values if desired).
  11. Select 'Ledger Type' value.
  12. Click 'Process' button.
  13. In Client Ledger information/report data for ODS Group Services filed in system via Progress Note entry - ensure that 'Total Charge' and/or 'Guarantor Liability' values for services are determined as follows:
  14. For service dates prior to date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that ODS Group Service total charge/liability is set according to the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form) and 'Is this an ODS Group Service' field for selected Service Code.
  15. For service dates on or after date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that service total charge/liability is set without ODS Group Service calculations under the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form is regarded as 'No') and the 'Is this an ODS Group Service' field for selected Service Code is regarded as 'No'.
Scenario 4: 'Scheduling Calendar' - Verification of 'Enable CalAIM BH Payment Reforms' Registry Setting
Specific Setup:
  • Avatar Appointment Scheduling must be installed
  • Avatar Cal-PM Registry Setting 'Enable CalAIM BH Payment Reforms' must be enabled (payment reform effective date set)
  • Avatar Cal-PM Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' may optionally be enabled/disabled
  • If Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' is disabled, 'Use Medi-Cal Rules For Fee Calculations' field in 'Guarantors/Payors' form must be set to 'Yes' for applicable Guarantor(s)
  • One or more Service Codes where 'Type Of Service' value is set to 'Group' and 'Is this an ODS Group Service?' value is set to 'Yes' (via Avatar Cal-PM 'Service Codes' form)
  • Applicable Group Service Fee/Override value calculation may be determined by 'Apply Multiple Practitioner Calculations To This Service Using' field in 'Service Codes' form is defined/applicable to service
  • Service Group must be defined for Appointment/group service entry (via Avatar Cal-PM 'Group Registration' form)
  • Service Group/client records eligible for Scheduling Calendar/Appointment Scheduling group service entry where applicable Guarantor(s) is/are assigned via client Financial Eligibility record
Steps
  1. Open Avatar Cal-PM 'Scheduling Calendar' form.
  2. Select date and Practitioner for Appointment Scheduling entry; right click and select 'Add Appointment' action.
  3. Enter/select values for 'Appointment Site', 'Appointment Date', 'Appointment Start Time', 'Duration', 'Appointment End Time', 'Appointment Status', 'Recurrence Schedule', 'Service Code', 'Program', 'Location', 'Group' and 'Practitioner' fields, using Service Code defined as ODS Group Service.
  4. Enter value for 'Co-Practitioner' and 'Co-Practitioner 2' fields for ODS Group Service if desired (as well as detailed Duration fields 'Face-to-Face Time', 'Documentation and Travel Time', etc if present/configured in form).
  5. Enter/select values for any other Scheduling Calendar entry fields as desired/required.
  6. Click 'Submit' button to file form/appointments/group service entries.
  7. Verify Appointment for one or more staff members where Appointment/group service entered (via Avatar Cal-PM 'Verify Staff Member Appointments' form).
  8. Post Appointment for one or more staff members where Appointment/group service entered (via Avatar Cal-PM 'Post Staff Member Schedule' form) so that one or more ODS Group Services associated to Appointment Scheduling entries are created for clients included in selected Service Group.
  9. Open Avatar Cal-PM 'Client Ledger' form.
  10. Select 'Client ID' value for client where ODS Group Service(s) entered.
  11. Select 'Claim/Episode/All Episodes' value (and enter/edit 'From Date'/'To Date' values if desired).
  12. Select 'Ledger Type' value.
  13. Click 'Process' button.
  14. In Client Ledger information/report data for ODS Group Services filed in system via Appointment Scheduling/Scheduling Calendar entries - ensure that 'Total Charge' and/or 'Guarantor Liability' values for services are determined as follows:
  15. For service dates prior to date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that ODS Group Service total charge/liability is set according to the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form) and 'Is this an ODS Group Service' field for selected Service Code.
  16. For service dates on or after date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that service total charge/liability is set without ODS Group Service calculations under the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form is regarded as 'No') and the 'Is this an ODS Group Service' field for selected Service Code is regarded as 'No'.
Scenario 5: Avatar Cal-PM Registry Settings - Verification of 'Enable CalAIM BH Payment Reforms' Registry Setting
Steps
  1. Open 'Registry Settings' form.
  2. Enter search value 'Enable CalAIM BH Payment Reforms' and click 'View Registry Settings' button.
  3. Ensure Registry Setting 'Enable CalAIM BH Payment Reforms' is returned (under 'Avatar PM -> Billing -> Services' path).
  4. Ensure 'Registry Setting Details' field contains the following explanation text:

"Setting a date allows for the logic enabled through the 'Use the Medi-Cal Fee as The Usual & Customary Fee' and 'Enable SD/MC Minute to Unit Override' Registry Settings to no longer be evaluated for dates of service on or after the date specified.

This will allow the Registry Settings noted above (and related fields) to be enabled for billing/services with dates of service prior to the date specified; Defining of date in this Registry Setting will allow for billing/services with dates of service on or after specified date to be processed as if the Registry Settings noted above are disabled (and as if the 'Use Medi-Cal Rules For Fee Calculations' and 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' fields are set to 'No' in the 'Guarantor/Payors' forms). The 'Bill Cal Billing Units' field within the 'Guarantor/Payors' form will behave as defined for billing/services with dates of service prior to the date specified in this Registry Setting but will be regarded as 'No' for dates of service on or after the date specified. The 'Is this an ODS Group Service' field within the 'Service Codes' form will behave as defined for billing/services with dates of service prior to the date specified in this Registry Setting but will be regarded as 'No' for dates of service on or after the date specified."
Topics
• Registry Settings • Electronic Billing • NX • CalAIM Billing • Client Charge Input • Progress Notes • Scheduling Calendar
Update 45 Summary | Details
Avatar Cal-PM - Support for Mobile CareGiver+
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • Client Alternate Addresses
  • Dictionary Update (PM)
Scenario 1: Client Alternate Addresses - Form Validations
Specific Setup:
  • The 'Enable Client Alternate Addresses' registry setting must be set to "Y".
  • A client is admitted in an existing episode (Client A).
Steps
  1. Access the 'Client Alternate Addresses' form.
  2. Select "Client A" in the 'Client' field.
  3. Select "Add" in the 'Add/Edit' field.
  4. Enter the desired value in the 'Description' field.
  5. Enter the desired date in the 'Address Start Date' field.
  6. Enter the desired date in the 'Address End Date' field.
  7. Enter the desired value in the 'Address Line 1' field.
  8. Enter the desired value in the 'Address Line 2' field.
  9. Enter the desired value in the 'Zip' field.
  10. Enter the desired value in the 'City' field.
  11. Select the desired value in the 'State' field.
  12. Enter the desired value in the 'Contact Name field.
  13. Enter the desired value in the 'Contact Phone' field.
  14. Enter the desired value in the 'Address Notes' field.
  15. Select "Yes" in the 'Enabled' field.
  16. Click [File].
  17. Validate a message is displayed stating: Saved.
  18. Click [OK].
  19. Validate the 'Client' field contains "Client A".
  20. Select "Edit" in the 'Add/Edit' field.
  21. Validate the 'Select Existing Address' field contains the alternate address filed in the previous steps with the 'Address Start Date', 'Address End Date', and 'Description'.
  22. Select the address filed in the previous steps in the 'Select Existing Address' field.
  23. Validate all previously filed data is displayed.
  24. Close the form.
  25. Access Crystal Reports or other SQL Reporting Tool.
  26. Select the PM namespace.
  27. Create a report using the 'SYSTEM.client_alternate_address' SQL table.
  28. Validate there is a row for "Client A" will all previously filed data.
  29. Close the report.
Scenario 2: Validate the 'Enable Alternate Client Addresses' registry setting
Steps
  1. Access the 'Registry Settings' form.
  2. Enter "Client Alternate Addresses" in the 'Limit Registry Settings to the Following Search Criteria' field.
  3. Click [View Registry Settings].
  4. Validate the 'Registry Setting' field contains "Avatar PM->Client Management->Client Information->->->Enable Client Alternate Addresses".
  5. Validate the 'Registry Setting Detail' field contains "Selecting 'Y' will add the 'Client Alternate Addresses' form to the menu. Selecting 'N' will remove the form from the menu."
  6. Validate the 'Registry Setting Value' field contains "N" by default.
  7. Enter "Y" in the 'Registry Setting Value' field.
  8. Click [Submit] and close the form.
  9. Access the 'User Definition' form.
  10. Select the logged in user in the 'Select User' field.
  11. Select the "Forms and Tables" section.
  12. Click [Select Forms for User Access].
  13. Validate the 'Client Alternate Addresses' form is available for selection under "Avatar PM".
  14. Select read/write permissions for the form.
  15. Click [OK] and [Submit].
  16. Refresh forms.
  17. Access the 'Client Alternate Addresses' form.
  18. Validate the form displays as expected.
  19. Close the form.
  20. Access the 'Registry Settings' form.
  21. Enter "Client Alternate Addresses" in the 'Limit Registry Settings to the Following Search Criteria' field.
  22. Click [View Registry Settings].
  23. Validate the 'Registry Setting' field contains "Avatar PM->Client Management->Client Information->->->Enable Client Alternate Addresses".
  24. Enter "N" in the 'Registry Setting Value' field.
  25. Click [Submit] and close the form.
  26. Refresh forms.
  27. Validate the 'Search Forms' search no longer returns the 'Client Alternate Addresses' form since disabling the registry setting removes the form from the menu.
Scenario 3: Dictionary Update - Validate the 'Location' dictionary
Steps
  1. Access the 'Dictionary Update' form.
  2. Select "Client" in the 'File' field.
  3. Select "Data Element Number" in the 'Data Element' field.
  4. Select "(10006) Location" in the 'Data Element' field.
  5. Enter the desired value in the 'Dictionary Code' field.
  6. Enter the desired value in the 'Dictionary Value' field.
  7. Validate the 'Extended Dictionary Data Element' field contains "(587) Place Of Service (Mobile CareGiver+)".
  8. Select "(587) Place Of Service (Mobile CareGiver+)" in the 'Extended Dictionary Data Element' field.
  9. Select the desired value in the 'Extended Dictionary Value (Single Dictionary)' field.
  10. Click [Apply Changes] & Click [OK].
  11. Select the "Print Dictionary" section.
  12. Select "Client" in the 'File' field.
  13. Select "Data Element Number" in the 'Data Element' field.
  14. Select "(587) Place Of Service (Mobile CareGiver+)" in the 'Data Element' field.
  15. Click [Print Dictionary].
  16. Validate the location dictionary is displayed with the place of service filed in the previous steps.
  17. Click [Close] and close the form.
Topics
• Registry Settings • Client Alternate Addresses • Dictionary
 

Avatar_Cal-PM_2023_Monthly_Release_2023.02.01_Details.csv