Avatar Cal-PM 2023 Monthly Release 2023.03.01 Acceptance Tests

• Registry setting:
• Set Import File Delimiter = desired vale, noting the value.
• File Import:
• A 'CPT Code Description' file type is added to the File Import.
• Import a file to add new CPT code.
• Import a file to edit above CPT code.

1. Open the "File Import" form.
2. Select the "CPT Code Description" in the 'File Type' field.
3. Select "Upload New File" in the 'Action' field.
4. Click [Process Action].
5. Select the "File A".
6. Select "Compile/Validate File" in the 'Action' field.
7. Select the "File A" in the 'Files(s)' field.
8. Click [Process Action].
9. Validate an Information message is displayed stating: Compiled
10. Click [OK].
11. Select "Print File" in the 'Action' field.
12. Select the "File A" in the 'Files(s)' field.
13. Click [Process Action].
14. Validate the Report Viewer displays the contents of the file.
15. Click [Close Report].
16. Select "Post File" in the 'Action' field.
17. Click [Process Action].
18. Select the "File A".
19. Validate an Information message is displayed stating: Posted.
20. Click [OK] and close the form.
21. Open the "CPT Code Definition" form.
22. Click [Edit].
23. Validate the form is filed with the data based on the uploaded file.
24. Close the form.
25. Follow steps 1-24 for Edit CPT Code File Import.

1. Client is admitted and has no 'Fast Financial Eligibility', 'Family Financial Eligibility', 'Financial Eligibility', or 'Cross Episode Financial Eligibility' records.
2. An active 'Guarantors/Payors' exists.

1. Open 'Fast Financial Eligibility'.
2. Add the eligibility record and submit the form.
3. Open 'Fast Financial Eligibility'.
4. Edit the eligibility record and submit the form.
5. Open 'Fast Financial Eligibility'.
6. Verify that the edited information displays correctly.

• Registry Setting:
• Set Add Policy Number Override = Y.
• Allow Policy Number By Date Sort = Y.
• Enable MHSA/DIG Data Collection Fields = Y.
• Guarantor/Program Billing Defaults:
• Set Override Policy Number With CIN # = Y in 837P and 837I sections.
• Client A:
• Financial Eligibility:
• Enter the 'Subscriber Policy number in the 'Guarantor Selection' section. Note the value.
• Enter 'Subscriber Client Index Number' in the 'Guarantor Selection' section. Note the value.
• Enter 'Subscriber Client Index Number' in the 'Policy Number Override' section. Note the value.
• Enter 'Policy Number' in the 'Policy Number Override' section. Note the value.
• Has unclaimed services, for different/same service codes, that can be billed on the 837 Professional.
• Use 'Client Ledger' to note the service codes, dates of service, financial class, and guarantor.
• Client has an active diagnosis record.
• Create Interim Batch.
• Close the charges using 'Close Charges'.
• Client B:
• Financial Eligibility:
• Enter the 'Subscriber Policy number in the 'Guarantor Selection' section. Note the value.
• Enter 'Subscriber Client Index Number' in the 'Guarantor Selection' section. Note the value.
• Enter 'Subscriber Client Index Number' in the 'Policy Number Override' section. Note the value.
• Enter 'Policy Number' in the 'Policy Number Override' section. Note the value.
• Has unclaimed services, for different/same service codes, that can be billed on the 837 Institutional.
• Use 'Client Ledger' to note the service codes, dates of service, financial class, and guarantor.
• Client has an active diagnosis record.
• Create Interim Batch.
• Close the charges using 'Close Charges'.

1. Open 'Electronic Billing'.
2. Create an 837 Professional for Client A.
3. Review the dump file to verify.
4. Open dump file and validate the subscriber client index number contains the value in the 'Policy Number 'Override' section.
5. Close the report.
6. Create an 837 Institutional for Client B.
7. Review the dump file to verify.
8. Open dump file and validate the subscriber client index number contains the value in the 'Policy Number 'Override' section.
9. Close the report.
10. Close the form.

• Client A:
• Has unbilled, closed, services for a two-month date range. Tester knows the date range, guarantor, financial class of the guarantor and the program.
• The 'Guarantor/Program Billing Defaults' template used to bill the services has a value of 'Yes' in 'Sort Claims by Month' in the 837 Professional and/or 837 Institutional sections.

1. Open 'Electronic Billing'.
2. Create a bill for the services entering both months of service in the billing date range.
3. Review the dump file.
4. Validate that the client has two CLM segments.
5. Validate that the service DTP segments after the first CLM segment are for the first month of service.
6. Validate that the service DTP segments after the second CLM segment are for the second month of service.
7. Click [X].
8. Click [X].

• Client A:
• Has unbilled, closed, services for a two-month date range. Tester knows the date range, guarantor, financial class of the guarantor and the program.
• The 'Guarantor/Program Billing Defaults' template used to bill the services has a value of 'Yes' in 'Sort Claims by Month' in the 837 Professional and/or 837 Institutional section.

1. Open 'Electronic Billing'.
2. Create a bill for the services entering both months of service in the billing date range.
3. Review the dump file.
4. Validate that the client has only one CLM segment.
5. Validate that the service DTP segments after the first CLM segment are for both months of service.
6. Click [X].
7. Click [X].

• Avatar Cal-PM 'Guarantor/Program Billing Defaults' Import File containing one or more valid import rows for 837 Professional information:
• 'Rendering Provider Entity Type Qualifier (2310B/2420A-NM1-02)' field/segment 127
• 'Rendering Provider Last Or Organization Name (2310B/2420A-NM1-03)' field/segment 128
• 'Rendering Provider First Name (2310B/2420A-NM1-04)' field/segment 129
• 'Rendering Provider Middle Name (2310B/2420A-NM1-05)' field/segment 130
• 'Rendering Provider Name Suffix (2310B/2420A-NM1-07)' field/segment 131
• 'Rendering Provider Identification Code Qualifier (2310B/2420A-NM1-08)' field/segment 132
• 'Rendering Provider Identification Code (2310B/2420A-NM1-09)' field/segment 133
• 'Rendering Provider Taxonomy Code (2310B/2420A-PRV-03)' field/segment 134
• 'Rendering Provider Reference Identification Qualifier (2310B/2420A-REF-01)' field/segment 135
• 'Rendering Provider Reference Identification (2310B/2420A-REF-01)' field/segment 136
• 'Rendering Provider Reference Identification Qualifier-2 (2310B/2420A-REF-01)' field/segment 137
• 'Rendering Provider Identification Code-2 (2310B/2420A-REF-02)' field/segment 138
• 'Specify How Rendering Provider Information Should Be Populated' field/segment 139
• Crystal Reports or other SQL reporting tool

1. Open Avatar Cal-PM 'File Import' form.
2. Select File Type 'Guarantor/Program Billing Defaults'.
3. Select 'Upload New File' in 'Action' field and Click 'Process Action' button.
4. Select Avatar Cal-PM 'Guarantor/Program Billing Defaults' import file including value for one or more of the following 837 Professional fields/segments and click 'Open' button:
5. Select 'Compile/Validate File' in 'Action' field.
6. Select loaded 'Guarantor/Program Billing Defaults' import file and click 'Process Action' button.
7. Ensure that 'Compile/Validate File' action completes, and message 'Compiled' or '(File Name) contains one or more errors. These errors can be reviewed using 'Print Errors' action' is displayed.
8. Click 'OK' button.
9. Select 'Print File' in 'Action' field to view successfully compiled import data; Select compiled import file and click 'Process Action' button.
10. In 'Guarantor/Program Billing Defaults' File Import Report, ensure that all valid import row(s) are included in report with segment/value details.
11. Select 'Post File' in 'Action' field to post successfully compiled import data; Select compiled import file and click 'Process Action' button.
12. Ensure that 'Compile/Validate File' action completes, and message 'Posted' and/or 'The selected file contains one or more lines with compilation errors. Only those lines without compilation errors will be posted' is displayed.
13. Open Avatar Cal-PM 'Guarantor/Program Billing Defaults' form.
14. Select 'Edit Template' in 'Action' field and select imported Guarantor/Program Billing Defaults template for review/edit.
15. Navigate to '837 Professional' section of form.
16. Ensure that imported values for 837 Professional Rendering Provider (2310B/2420A) fields noted above are present for selected template.
17. Open Crystal Reports or other SQL reporting tool.
18. In Avatar Cal-PM SQL table 'SYSTEM.file_import_gpbd_p837', ensure that new row is filed in table for each successfully compiled/posted import row, including values for following fields:
19. 'rendering_entity_code'/'rendering_entity_value'
20. 'rendering_first_name'
21. 'rendering_last_org_name'
22. 'rendering_middle_name'
23. 'rendering_suffix'
24. 'rendering_id_qual_code'/'rendering_id_qual_value'
25. 'rendering_id'
26. 'rendering_taxonomy'
27. 'rendering_ref_qual_code'/'rendering_ref_qual_value'
28. 'rendering_ref_id'
29. 'rendering_ref_qual2_code'/'rendering_ref_qual2_value'
30. 'rendering_ref_id2'
31. 'use_rnd_if_notfound_code'/'use_rnd_if_notfound_value'

For Avatar Cal-PM 'Guarantor/Program Billing Defaults - 837 Professional' format/layout, please refer to 'Avatar_Cal-PM_File_Import_Record_Layouts.xls' document included with update.

• Have a modeled form [FormA], contained in [EnvelopeA], that will be used to make form designer changes

1. Open the 'Form Designer' form.
2. Select [FormA] from the 'Forms' field.
3. Make any type of form designer change in the section [FDchange1]. For example, a field is moved to different location.
4. Save the changes and exit the form.
5. Navigate to form "Envelope Export".
6. Select [EnvelopeA].
7. In the "Include Form Design Changes? field, select "Yes".
8. Click [Begin Export].
9. Validate export is completed successfully. [ExportA].
10. Open the 'Form Designer' form.
11. Select [FormA] from the 'Forms' field.
12. Make another form designer change in the section [FDchange2].
13. Save the changes and exit the form.
14. Open [FormA].
15. Validate [FDchange1] and [FDchange2] are both present in the form.
16. Open form "Envelope Import".
17. Click [Select Envelope For Import].
18. Navigate the location of [ExportA].
19. Select the file.
20. Select radio button "Overwrite Existing".
21. In the "Include Form Design Changes? field, select "Yes". [Note: "Yes" implies that any form designer changes contained in the import file, 'will' be imported and/or overwrite any existing changes already made on the form].
22. Click [Begin Import Scan].
23. Validate there are no errors/warnings found within the import file scan results.
24. Click [Begin Import].
25. Validate import is completed successfully.
26. Open [FormA].
27. Select [SectionA].
28. Validate [FDchange1] is present on the form.
29. Validate [FDchange2] is not present on the form.

• Registry Setting:
• The 'Enable New Quick Billing Format' registry setting is enabled.
• Please note: This is a one-time, system-wide registry setting and the associated functionality cannot be disabled once the registry setting is enabled. Once this setting has been enabled, it will no longer be able to be viewed in the 'Registry Settings' form.
• Admission:
• Two outpatient clients are identified. Please note the admission program of the clients.
• Guarantors/Payor:
• An existing guarantor is identified.
• Financial Eligibility:
• Guarantor identified above is assigned to the clients.
• Client Charge Input:
• 1-2 days of professional charges are rendered to the clients. Please note the service codes used during rendering services.
• Client Ledger:
• The charges are distributed to the guarantors assigned to the clients.
• Quick Billing Rule Definition:
• A new quick billing rule is created as follows:
• The admission programs are selected in the 'Program' field.
• An '837 Professional' is selected in the 'Billing Form' field.
• The guarantors assigned to the clients in their financial eligibility are selected in the 'Guarantors' field.
• All required fields are populated.
• The 'Create Interim Billing Batch' field is set to 'Yes'.

1. Open the 'Quick Billing' form.
2. Run a new quick billing batch using the rule created in the setup section.
3. Use a date range spanning services entered.
4. Select 'Create Batch', 'Close Charges', and 'Generate Bills' in the 'Quick Billing Tasks To Execute' field.
5. Submit the form.
6. Verify that compile completes and the prompt states 'Compile Complete'. A Quick Billing Batch and an Interim Billing Batch will be created.
7. Select the 'Edit Existing' option.
8. Select the quick bill that was created in previous step.
9. Submit the form again.
10. Click [OK].
11. Select the 'Edit Existing' option.
12. Select the quick bill that was created in previous step.
13. Click [Print 837 Report].
14. Verify the report launched successfully.
15. Close the report.
16. Click [Launch Workscreen].
17. Verify the work screen contains all the clients included in the batch.
18. Deselect one client from the 'Client' filter at the top of the work screen.
19. Verify the grid does not display the services of that client.
20. Select the same client again from the 'Client' filter at the top of the work screen.
21. Verify the grid displays the services of that client.
22. Save the grid.
23. Verify the grid saves successfully.
24. Close the form.

• 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.

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.

• 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.

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.