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Avatar Cal-PM 2023 Monthly Release 2023.03.00 Acceptance Tests

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Update 33 Summary | Details
Inhibit Billing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Ledger
  • Inhibit Billing By Service
  • Inhibit Billing By Reason
  • Registry Settings (PM)
  • Financial Eligibility
  • Diagnosis
  • File Import
  • Create Interim Billing Batch File
  • Electronic Billing
  • Inhibited Services For Billing Report
  • Service Fee/Cross Reference Maintenance
  • Program Maintenance
  • Dictionary Update (PM)
  • Guarantors/Payors
  • Practitioner Numbers By Guarantor and Program
Scenario 1: 'Inhibit Billing By Service' - Verification of form filing
Specific Setup:
  • Client with one or more service(s) eligible for 'Inhibit Billing By Service' filing.
  • Crystal Reports or other SQL reporting tool.
Steps
  1. Open the Avatar Cal-PM 'Inhibit Billing By Service' form.
  2. Enter/select values for 'Rendering Practitioner', 'Client ID'/'Episode Number', 'Program Where Service Was Rendered', 'Search Start Date'/'Search End Date' and/or 'Liable Guarantor' filter fields to populate/limit service(s) for selection.
  3. Select one or more service(s) in the 'Select Service(s) To Mark Billing-Inhibited' field (or deselect to remove Inhibit Billing information for service).
  4. Click 'Submit' button to file form/Inhibit Billing entries for selected service(s).
  5. Ensure that 'Please Review Your Selection' dialog is presented and displays service(s) from 'Inhibit Billing By Service' form; confirm selected/deselected service(s) are correctly noted in 'Inhibit' column.
  6. Click 'OK' button in the 'Please Review Your Selection' dialog to accept selections and continue to form/information filing.
  7. If any service is deselected to remove Inhibit Billing entry and service also has one or more 'Inhibit Billing By Reason' entries, ensure that user is presented with alert message noting 'At least one selected service is inhibited by one or more reasons. If you continue the services will be uninhibited for all reasons.'
  8. Click 'Yes' button in the 'Continue filing?' dialog to file Inhibit Billing information.
  9. Re-open/return to 'Inhibit Billing By Service' form.
  10. Enter/select values for filter fields to populate/limit service(s) for selection, using same criteria/selections as in Inhibit Billing filing.
  11. In the 'Select Service(s) To Mark Billing-Inhibited' field, ensure that services with Inhibit Billing entry previously filed/removed are marked as selected or deselected (respectively).
  12. Open Crystal Reports or other SQL reporting tool.
  13. In Avatar Cal-PM SQL table 'SYSTEM.inhibit_billing', ensure that data rows are added/deleted from table based on 'Inhibit Billing By Service' form filing and that field values reflect client/service information selected in form.


Scenario 2: 'Inhibit Billing By Reason' - Verification of form filing, 'All Open Services' selection
Specific Setup:
  • Dictionary codes/values must be defined for Avatar Cal-PM 'Billing' file Data Element 'Reason for Inhibit' (20520).
  • Client with one or more open charge service(s) eligible for 'Inhibit Billing By Reason' filing.
  • Crystal Reports or other SQL reporting tool.
Steps
  1. Open the Avatar Cal-PM 'Inhibit Billing By Reason' form (under 'Avatar PM / Billing / Bill Production' menu).
  2. Select value in 'Reason for Inhibit' field to add/remove Inhibit Billing entries under 'Reason For Inhibit' code. Selection of value in 'Reason for Inhibit' field is required prior to Inhibit Billing By Reason entry/review/removal in form since services may have Inhibit Billing By Reason entries filed under multiple 'Reason for Inhibit' values.
  3. Enter/select values for service search/selection criteria in 'Rendering Practitioner', 'Client ID', 'Episode Number', 'Liable Guarantor', 'Program Where Service Was Rendered', 'Search Start Date' and/or 'Search End Date' fields. ('Client ID' must be specified for 'All Open Services For Client' service selection.)
  4. Select 'Uninhibited' in the 'Services to Display' selection field.
  5. Ensure 'All Open Services For Client' selection is included in 'Services' field. Selecting 'All Open Services For Client' will file an 'Inhibit Billing By Reason' entry under the selected 'Reason for Inhibit' for all existing open charge service(s) for client, and will automatically file an 'Inhibit Billing By Reason' entry under the selected 'Reason for Inhibit' for each new open charge service added for client while the 'All Open Services For Client' selection is in place.
  6. Select 'All Open Services For Client' in 'Services' field for Inhibit Billing By Reason entry.
  7. Click 'Inhibit' button to file Inhibit Billing By Reason entry under selected Reason for Inhibit for all existing open charge service(s) for selected client.
  8. Ensure user is presented with confirmation dialog noting 'Are you sure you want to inhibit billing for all open services for the selected client/reason?', with 'Yes' and 'No' buttons included; click 'Yes' button to continue with Inhibit Billing By Reason filing.
  9. Ensure user is presented with filing confirmation dialog noting 'Inhibit Billing By Reason filed successfully.'
  10. Ensure that where Inhibit Billing By Reason entry for 'All Open Services For Client' has been filed under selected 'Reason for Inhibit', 'All Open Services For Client' selection is not displayed/included in the 'Services' selection field when 'Uninhibited' is selected in the 'Services to Display' field.
  11. Select 'Inhibited' in the 'Services to Display' selection field.
  12. Ensure that where Inhibit Billing By Reason entry for 'All Open Services For Client' has been filed under selected 'Reason for Inhibit', 'All Open Services For Client' selection is displayed/included in the 'Services' selection field when 'Inhibited' is selected in the 'Services to Display' field.
  13. Ensure that where Inhibit Billing By Reason entry for 'All Open Services For Client' has been filed under selected 'Reason for Inhibit', 'Services' selection field also includes/displays all open charge service(s) for selected search/selection criteria. This allows for selection of individual service(s) for 'Uninhibit'/removal action where 'All Open Services For Client' Inhibit Billing By Reason entry exists for client.
  14. Select 'All Open Services For Client' in 'Services' field for Inhibit Billing By Reason 'Uninhibit'/removal action.
  15. Click 'Uninhibit' button to remove Inhibit Billing By Reason entry under selected Reason for Inhibit for all open charge services for client.
  16. Ensure user is presented with confirmation dialog noting 'Are you sure you want to uninhibit billing all open services for the selected client/reason?', with 'Yes' and 'No' buttons included; click 'Yes' button to continue with removal of Inhibit Billing By Reason entry/'Uninhibit' action.
  17. Ensure user is presented with filing confirmation dialog noting 'Inhibit Billing By Reason filed successfully.'
  18. Ensure that open charge service(s) where Inhibit Billing By Reason entry has been removed/'Uninhibited' under selected 'Reason for Inhibit' are not displayed/included in the 'Services' selection field when 'Inhibited' is selected in the 'Services to Display' field.
  19. Using client where Inhibit Billing By Reason entry for 'All Open Services For Client' has been filed/exists, enter one or more new open charge services. (New open charge services may originate via Avatar Cal-PM and/or Avatar MSO.)
  20. On creation of new open charge services for client where Inhibit Billing By Reason entry for 'All Open Services For Client' has been filed/exists, ensure that Inhibit Billing By Reason entry under selected 'Reason for Inhibit' is automatically filed for services.
  21. Open Crystal Reports or other SQL reporting tool.
  22. In Avatar Cal-PM SQL table 'SYSTEM.inhibit_billing', ensure that one row is included in table for each distinct open charge service with Inhibit Billing By Reason entry using 'All Open Services For Client'; ensure that service row is removed from 'SYSTEM.inhibit_billing' table only if/when all Inhibit Billing By Reason entries for service are Uninhibited (including use of 'All Open Services For Client' selection).
  23. In Avatar Cal-PM SQL table 'SYSTEM.inhibit_billing_reason', ensure that one row is included in table for each Inhibit Reason per open charge service with Inhibit Billing By Reason entry using 'All Open Services For Client'; ensure that Inhibit Reason/service combination row is removed from 'SYSTEM.inhibit_billing_reason' table when Inhibit Billing By Reason entries for Inhibit Reason/service combination are Uninhibited (including use of 'All Open Services For Client' selection).
  24. In Avatar Cal-PM SQL table 'SYSTEM.inhibit_reason_global', ensure that one row is included in table for each Inhibit Reason per client where Inhibit Billing By Reason entry exists using 'All Open Services For Client'; ensure that Inhibit Reason/client combination row is removed from 'SYSTEM.inhibit_reason_global' table when Inhibit Billing By Reason entry for Inhibit Reason/client combination are Uninhibited using 'All Open Services For Client' selection.
Scenario 3: File Import - 'Client Charge Input' file type - Render a service to the client that is marked as a billing non inhibited
Specific Setup:
  • Registry Settings:
  • The registry setting 'Import File Delimiter' is set to desired value.
  • Program Maintenance:
  • Identify an existing program code / name. Note the program code.
  • Admission:
  • An existing client is identified. Note the client's id/name, admission date, admission program code/name.
  • A 'Client Charge Input' import file is created to render a service to the client and mark that service billing non inhibited. The predefined client, episode number, practitioner id, service code, admission program and cost of the service are entered in the file.
Steps
  1. Open the 'File Import' form.
  2. Select the 'Client Charge Input' from the 'File Type' field.
  3. Upload the file Import file created in the setup section to mark a service as a billing inhibited.
  4. Compile the file.
  5. Verify that the file compiles successfully.
  6. Select the 'Print File' option.
  7. Review the information on compile report.
  8. Verify that all the information entered through the 'File Import' file displayed correctly in the specific field.
  9. Post the compiled file.
  10. Verify that the file posted successfully.
  11. Open the 'Crystal Report' or any other SQL data viewer.
  12. Run the query against SYSTEM.billing_tx_history SQL table.
  13. Verify the 'billable_code' code column is blank for the service.
  14. Run the query against SYSTEM.inhibit_billing SQL table.
  15. Verify the table does not contain the non inhibited service record of the client.
  16. Close the Crystal Report or the SQL Data Viewer.
  17. Locate to the 'CLIENT INHIBITED SERVICES (SERVICE DATE LESS THAN 1 YEAR OLD)' WIDGET.
  18. Verify the 'Client Name' and 'Episode' column does not display the client's name and episode for the client for whom the non inhibited service is rendered through file import.
  19. Open the 'Inhibited Services For Billing Report' form.
  20. Enter desired date in the 'Start Date' field.
  21. Enter desired date in the 'End Date' field.
  22. Select desired client in the 'Client' field.
  23. Click [Process Report].
  24. Verify the non inhibited service record does not display in the report.
  25. Close the report.
Scenario 4: Cal-PM - File Import - 'Client Charge Input' file type - Render a service to the client that is marked as a billing inhibited
Specific Setup:
  • Registry Settings:
  • The registry setting 'Import File Delimiter' is set to desired value.
  • Program Maintenance:
  • Identify an existing program code / name. Note the program code.
  • Admission:
  • An existing client is identified. Note the client's id/name, admission date, admission program code/name.
  • A 'Client Charge Input' import file is created to render a service to the client and mark that service billing inhibited. The predefined client, episode number, practitioner id, service code, admission program and cost of the service are entered in the file. Note the file location.
Steps
  1. Open the 'File Import' form.
  2. Select the 'Client Charge Input' from the 'File Type' field.
  3. Upload the file Import file created in the setup section to mark a service as a billing inhibited.
  4. Compile the file.
  5. Verify that the file compiles successfully.
  6. Select the 'Print File' option.
  7. Review the information on compile report.
  8. Verify that all the information entered through the 'File Import' file displayed correctly in the specific field.
  9. Post the compiled file.
  10. Verify that the file posted successfully.
  11. Open the 'Crystal Report' or any other SQL data viewer.
  12. Run the query against SYSTEM.billing_tx_history table.
  13. Verify the 'billable_code' displays 'X'.
  14. Close the Crystal Report or the SQL Data Viewer.
  15. Open the 'Close Charges' form.
  16. Close the charges rendered to the client.
  17. Click [Submit].
  18. Verify the form submits successfully.
  19. Open the 'Client Ledger' form.
  20. Verify the service is not closed and still in 'Open' status as it is marked as billing inhibited.
Topics
• Inhibit Billing • File Import
Update 42 Summary | Details
Facility Defaults - CarePathways Configuration
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
Scenario 1: 'Facility Defaults' form - field validations
Steps
  1. Open the 'Registry Setting' form.
  2. Set the 'Enable CarePathways Benchmarking and Analytics' to 'Y'.
  3. Submit the form.
  4. Open the 'Facility Defaults' form.
  5. Verify the 'CarePathways Configuration' section is available on the form.
  6. Click on the 'CarePathways Configuration' tab.
  7. Verify system navigates user to the 'CarePathways Configuration' section correctly.
  8. Populate required fields as needed.
  9. Click [Submit].
  10. Open the 'Registry Setting' form.
  11. Set the 'Enable CarePathways Benchmarking and Analytics' to 'N'.
  12. Submit the form.
  13. Open the 'Facility Defaults' form.
  14. Verify the 'CarePathways Configuration' section is not available on the form.
  15. Populate any desired fields.
  16. Validate the 'Provider Country' field is displayed.
  17. Select the desired value in the 'Provider Country' field. Note: this field is populated based off the dictionary values under the 'Client' file, '(150) Country Of Origin' data element in 'Dictionary Update'.
  18. Click [Submit].
  19. Access Crystal Reports or other SQL Reporting tool.
  20. Create a report using the 'SYSTEM.table_facility_defaults' SQL table.
  21. Validate a row is displayed for the data on file.
  22. Validate the 'provider_country_code' field contains the code associated to the 'Provider Country' selected.
  23. Validate the 'provider_country_value' field contains the value associated to the 'Provider Country' selected.
  24. Close the report.
Topics
• Facility Defaults
Update 49 Summary | Details
'External Documents' widget
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CareConnect HIE Configuration
  • Consent For Access
  • External Documents
  • Form and Table Documentation (PM)
  • Dictionary Update (PM)
Scenario 1: 'External Documents' widget - Validation when 'Carequality' is enabled and 'Consent Model' is "Opt Out"
Specific Setup:
  • Carequality is enabled in the 'CareConnect HIE Configuration' form.
  • One or more organizations are defined as favorites in the 'Organization: Exceptions and Favorites' field.
  • "Query" is selected in the 'Consent Model' field in the 'CareConnect HIE Configuration' form.
  • A client is enrolled in an active episode with consent granted to a network and an organization in 'Consent For Access' (Client A).
  • The logged in user must have a view configured with the 'External Documents' widget and the 'Console Widget Viewer'.
Steps
  1. Select "Client A" and navigate to the 'External Documents' widget.
  2. Click [Search].
  3. Validate the 'External Documents' widget contains CCDs from:
  4. Any organization(s) defined as "Favorite" in the 'Carequality Configuration' section of the 'CareConnect HIE Configuration' form
  5. Any organization with consent granted in 'Consent for Access'
  6. All networks in the Network List
  7. Click [View] for any CCD.
  8. Validate the CCD displays in the 'Console Widget Viewer',
  9. Click [Close All].
Scenario 2: 'External Documents' widget - Validation when 'Carequality' is enabled and 'Consent Model' is "Query"
Specific Setup:
  • Carequality is enabled in the 'CareConnect HIE Configuration' form.
  • One or more organizations are defined as favorites in the 'Organization: Exceptions and Favorites' field.
  • "Query" is selected in the 'Consent Model' field in the 'CareConnect HIE Configuration' form.
  • A client is enrolled in an active episode with consent granted to a network and an organization in 'Consent For Access' (Client A).
  • The logged in user must have a view configured with the 'External Documents' widget and the 'Console Widget Viewer'.
Steps
  1. Select "Client A" and navigate to the 'External Documents' widget.
  2. Click [Search].
  3. Validate the 'External Documents' widget contains CCDs from:
  4. Any organization(s) defined as "Favorite" in the 'Carequality Configuration' section of the 'CareConnect HIE Configuration' form
  5. Any organization with consent granted in 'Consent for Access'
  6. All networks in the Network List
  7. Click [View] for any CCD.
  8. Validate the CCD displays in the 'Console Widget Viewer',
  9. Click [Close All].
Scenario 3: 'External Documents' widget - Validation when 'Carequality' is disabled and 'Consent Model' is "Opt In"
Specific Setup:
  • Carequality is disabled in the 'CareConnect HIE Configuration' form.
  • "Opt In" is selected in the 'Consent Model' field in the 'CareConnect HIE Configuration' form.
  • A client is enrolled in an active episode with consent granted to a network (Network A) in 'Consent For Access' (Client A).
  • The logged in user must have a view configured with the 'External Documents' widget and the 'Console Widget Viewer'.
Steps
  1. Select "Client A" and navigate to the 'External Documents' widget.
  2. Click [Search].
  3. Validate the 'External Documents' widget contains a CCD from "Network A".
  4. Click [View].
  5. Validate the CCD displays in the 'Console Widget Viewer',
  6. Click [Close All].
Scenario 4: 'External Documents' widget - Validation when 'Carequality' is enabled and 'Consent Model' is "Opt In"
Specific Setup:
  • Carequality is enabled in the 'CareConnect HIE Configuration' form.
  • One or more organizations are defined as favorites in the 'Organization: Exceptions and Favorites' field.
  • "Opt In" is selected in the 'Consent Model' field in the 'CareConnect HIE Configuration' form.
  • A client is enrolled in an active episode with consent granted to a network and an organization in 'Consent For Access' (Client A).
  • The logged in user must have a view configured with the 'External Documents' widget and the 'Console Widget Viewer'.
Steps
  1. Select "Client A" and navigate to the 'External Documents' widget.
  2. Click [Search].
  3. Validate the 'External Documents' widget contains CCDs from:
  4. Any organization(s) defined as "Favorite" in the 'Carequality Configuration' section of the 'CareConnect HIE Configuration' form
  5. Any organization with consent granted in 'Consent for Access'
  6. Any network with consent granted in 'Consent for Access'
  7. Click [View] for any CCD.
  8. Validate the CCD displays in the 'Console Widget Viewer',
  9. Click [Close All].
Scenario 5: Form and Table Documentation - Validate the 'SYSTEM.external_documents' table
Specific Setup:
  • Crystal Reports or other SQL reporting tool is required.
Steps
  1. Access the 'Form and Table Documentation' PM form.
  2. Select "Table" in the 'Type of Documentation' field.
  3. Select "SYSTEM.external_documents" in the 'Table(s) to be Documented' field.
  4. Click [Process].
  5. Validate the 'SQL Table Documentation' window is displayed for the 'SYSTEM.external_documents' SQL table.
  6. Validate the 'organization' column has a max length of "4096".
  7. Click [Dismiss] and close the form.
Scenario 6: Dictionary Update - Validate the 'Network' dictionary
Specific Setup:
  • The 'CareConnect HIE Configuration' form must be configured to upload CCDs to a Health Information Exchange.
Steps
  1. Access the 'Dictionary Update' PM form.
  2. Select the "Print Dictionary" section.
  3. Select "Client" in the 'File' field.
  4. Select "Individual Data Element" in the 'Individual or All Data Elements' field.
  5. Select "(36020) Network" in the 'Data Element' field.
  6. Click [Print Dictionary].
  7. Validate the report displays all configured networks.
  8. Close the report and the form.
Diagnosis - 'Default 'Add To Problem List' to "Yes" on New Diagnosis' registry setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Diagnosis
Scenario 1: Diagnosis - Validate the 'Default 'Add To Problem List' to "Yes" on New Diagnosis' registry setting
Specific Setup:
  • The 'Default 'Add To Problem List' to "Yes" on New Diagnosis' registry setting is set to "Y".
  • A client is enrolled in an existing episode (Client A).
Steps
  1. Select "Client A" and access the 'Diagnosis' form.
  2. Select the desired value in the 'Type Of Diagnosis' field.
  3. Enter the desired date in the 'Date Of Diagnosis' field.
  4. Enter the desired time in the 'Time Of Diagnosis' field.
  5. Click [New Row].
  6. Search for and select the desired diagnosis in the 'Diagnosis Search' field.
  7. Select "Active" in the 'Status' field.
  8. Validate the 'Add To Problem List' field contains "Yes" by default.
  9. Select the desired practitioner in the 'Diagnosing Practitioner' field.
  10. Click [New Row].
  11. Search for and select the desired new diagnosis in the 'Diagnosis Search' field.
  12. Select "Rule-out" in the 'Status' field.
  13. Validate the 'Add To Problem List' field is disabled and does not contain a value.
  14. Select the desired practitioner in the 'Diagnosing Practitioner' field.
  15. Click [Submit].
  16. Select "Client A" and access the 'Problem List' form.
  17. Click [View/Enter Problems].
  18. Validate only the active diagnosis filed in the previous steps displays in the 'Problem List'.
  19. Close the form.
  20. Access Crystal Reports or other SQL Reporting Tool.
  21. Create a report using the 'SYSTEM.client_diagnosis_entry' SQL table.
  22. Validate two rows are displayed for the diagnosis records added in the previous steps.
  23. Validate that the active diagnosis has "Yes" in the 'add_prob_list_value' field.
  24. Validate the ruled-out diagnosis has "No Entry" in the 'add_prob_list_value' field.
  25. Close the report.
Topics
• Carequality • External Document Widget • Query/Reporting • Registry Settings • Diagnosis • Problem List
Update 56 Summary | Details
File Import - Service Guarantor Definition
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Registry Settings (PM)
  • Service Fee/Cross Reference Maintenance
  • Service Fee/Cross Reference and Guarantor Definition Export
  • File Import
Scenario 1: File Import - Service Guarantor Definitions
Specific Setup:
  • Note: This functionality is for any service code type, including CCBHC service codes.
  • Please contact your Netsmart representative to enable CCBHC Billing functionality, if desired.
  • CCBHC setup has been completed.
  • The 'Avatar_PM_File_Import_Record_Layouts' spreadsheet is included in the update zip file to assist in creating the 'Service Guarantor Definitions' file to import.
  • Identify an existing service code.
  • Create a 'File Import' for the 'Service Guarantor Definition' file type that contains the service code. Note the value of each field included in the file.
Steps
  1. Open 'File Import'.
  2. Select Service Guarantor Definitions’ in 'File Type'.
  3. Load, compile and post the file.
  4. Open 'Service Fee/Cross Reference Maintenance', 'Guarantor Definitions', and review the imported record in edit mode.
  5. Validate that all values equal the values in the imported file.
  6. Click [Guarantor Definitions Report].
  7. Validate that guarantor information is correct for the service code.
  8. Close the report.
  9. Close the form.
Topics
• File Import
Update 58 Summary | Details
'Task Scheduler Status' widget
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • System Task Scheduler
  • Task Scheduler Status
Scenario 1: Validate the 'Task Scheduler Status' widget
Specific Setup:
  • In the 'System Task Scheduler', a minimum of two active tasks and one inactive task should be filed.
  • 'View Definition' form has been used to add the ‘Task Scheduler Status’ widget to HomeView for the logged in user.
Steps
  1. Access the ‘Task Scheduler Status’ widget on the Home View.
  2. Validate that the widget can be undocked, refreshed, and either minimized (Non NX View) or removed (NX View).
  3. Validate that the widget contains the following columns: ‘Application’, ‘Task’. ‘Inactive’, ‘Recur’, ‘Start Date’, ‘End Date’, ‘Last Run Start Date’, ‘Last Run Start Time’, ‘Last Run End Date’, ‘Last Run End Time’, and ‘Last Run Status’.
  4. Validate the data in each column is accurate. Note that for any task which errors, the error will display in the 'Last Run Status' column.
Topics
• Widgets • System Task Scheduler
Update 59 Summary | Details
Electronic Billing - Error Report
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Program Maintenance
  • Service Fee/Cross Reference Maintenance
  • Financial Eligibility
  • Client Ledger
  • Create Interim Billing Batch File
  • Electronic Billing
Scenario 1: 'Electronic Billing' report - validate data in error report.
Specific Setup:
  • Client A:
  • Note the client’s program.
  • Has closed, unclaimed services that can be billed on the 837 Institutional. Note the guarantor the liability distribute to.
  • The client does not have an active diagnosis record. This will cause an error report to generate in electronic billing.
  • If desired, create an interim billing batch to use in electronic billing.
  • Client B:
  • Note the client’s program.
  • Has closed, unbilled services that can be billed on the 837 Professional. Note the guarantor the liability distribute to.
  • The client does not have an active diagnosis record. This will cause an error report to generate in electronic billing.
  • If desired, create an interim billing batch to use in electronic billing.
Steps
  1. Open 'Electronic Billing' form.
  2. Compile an unclaimed bill for Client A.
  3. Validate that a message is received stating: No Valid Information Found. Please Check The Error Report.
  4. Click [OK].
  5. Select 'Run Report' in 'Billing Options'.
  6. Select 'Print' in 'Print Or Delete Report'.
  7. Select the 'File'.
  8. Click [Print 837 Report].
  9. Validate that the report launches and contains a link to 'Required Data Missing: Patient Claim Data'.
  10. Click the link.
  11. Verify that the error is that the diagnosis is missing and that the listing does not contain a program that the client is not enrolled in.
  12. Repeat steps above for Client B.
Topics
• Electronic Billing • NX
Update 65 Summary | Details
File Import - Client Charge Input
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
  • Client Ledger
  • Registry Settings (PM)
  • Dictionary Update (PM)
  • Dynamic Form - Dictionary Update - Locked Dictionary
  • Service Fee/Cross Reference Maintenance
  • Client Charge Input
  • Create Interim Billing Batch File
  • Electronic Billing
Scenario 1: File Import - Render service to the client using multiple add-on codes
Specific Setup:
  • The following registry setting has a value of 'Y': Avatar PM->System Maintenance->Service Code Maintenance->->->Enable Multiple Add-On Code Per Primary Code Functionality.
  • Dictionary Update has been used to update 'Other Tabled File, 291, Service Code Type' to have a value of 'Yes' in the extended dictionary 'Allow Multiple Add-On Code Definition' for all dictionary codes.
  • A 'Service Code' identified with a 'Service Code Category' of 'Primary Code' has at least two values selected in 'Select Multiple Add-On Code'.
  • An outpatient client is identified. Note the program. The client has an active diagnosis record, and an active financial eligibility record, noting the financial class.
  • A 'Client Charge Input', 'File Import' file has been created import the primary service and add-on services.
Steps
  1. Open the 'File Import' form.
  2. Select the 'Client Charge Input' from the 'File Type' field.
  3. Upload the 'Multiple Add-Ons' file created in the setup section.
  4. Compile the file.
  5. Verify the information message : 'Compiled'.
  6. Click [OK].
  7. Post the file.
  8. Verify the file posted successfully.
  9. Close the form.
  10. Open the Client Ledger.
  11. Validate the Primary service code display with Multiple Add-on codes.
Scenario 2: 837 Professional billilng when 'Enable Multiple Add-On Code Per Primary Code Functionality' = Y.
Specific Setup:
  • The following registry setting has a value of 'Y': Avatar PM->System Maintenance->Service Code Maintenance->->->Enable Multiple Add-On Code Per Primary Code Functionality.
  • Dictionary Update has been used to update 'Other Tabled File, 291, Service Code Type' to have a value of 'Yes' in the extended dictionary 'Allow Multiple Add-On Code Definition' for all dictionary codes.
  • A 'Service Code' identified with a 'Service Code Category' of 'Primary Code' has at least two values selected in 'Select Multiple Add-On Code'.
  • An outpatient client is identified. Note the program. The client has an active diagnosis record, and an active financial eligibility record, noting the financial class.
  • A service has been created for the above 'Service Code'. Note the date of service. The service has been closed.
  • Use 'Client Ledger' to note the fee for the 'Service Code' and for each 'Add-On Code'. Note the total fee.
Steps
  1. Open 'Electronic Billing'.
  2. Create an '837 Professional' bill for the service.
  3. Review the dump file to validate that the amount in the 'CLM' is equal to the total fee and that the amounts in the 'SV1' segments is equal to the total fee.
  4. Close the dump file.
  5. Close the form.
  6. Query the SYSTEM.billing_tx_master table. Locate the 'Service Code' selected in Setup.
  7. Validate that the 'multi_addon_svc_code' displays all add-on service code numbers selected in the primary service code.
  8. Validate that the 'multi_addon_svc_value' displays all add-on service code descriptions selected in the primary service code.
Topics
• Client Charge Input • File Import • NX • 837 Professional
Update 67 Summary | Details
SQL Table Validation - SYSTEM.view_episode_summary_admit table
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Pre Admit
Scenario 1: SQL table validation - SYSTEM.view_episode_summary_admit - Outpatient Client Admission on the cache system
Specific Setup:
  • Admission:
  • Create a new client and do not enter date of birth of the client. Note the client id.
Steps
  1. Open the 'Crystal report' or any other SQL data viewer.
  2. Query the 'Select * from SYSTEM.view_episode_summary_admit' table.
  3. Verify the client without a date of birth have a blank value in the 'c_date_of_birth' field.
  4. Open the 'Admission (Outpatient)' form for the client.
  5. Edit an existing admission record.
  6. Enter desired date of birth.
  7. Open the 'Crystal report' or any other SQL data viewer.
  8. Query the 'Select * from SYSTEM.view_episode_summary_admit' table for the client.
  9. Verify the client updated with a date of birth have correct date in the 'c_date_of_birth' field.
Topics
• Admission • Admission (Outpatient) • Database Tables • NX
 

Avatar_Cal-PM_2023_Monthly_Release_2023.03.00_Details.csv