Skip to main content

Avatar Cal-PM 2023 Update 32

  1. Last updated
  2. Save as PDF

Product Requirements / Recommendations

Avatar Cal-PM required
RADplus required

Product Update Form Description

The following issues are resolved: 1) Avatar is cutting off the Practitioner Category code in 'Service Fee/Cross Reference Maintenance' form at 5 digits. Any existing fee entries filed with an invalid practitioner category code is deleted. 2) Subsequent Guarantor Plan is removed in the 'Financial Eligibility' form (Guarantor Selection section) after selecting a guarantor.

Included Updates

3, 11, 16, 17, 21, 26, 28

Required Updates

Avatar Cal-PM 2023 Update 17
Details
NEW0 CHANGED0 FIXED2
Fixed (2)
Service Fee/Cross Reference Maintenance - Practitioner Category
An issue is resolved to ensure that Practitioner Category codes that contain more than five characters can be selected and processed correctly, and previously filed Practitioner Category codes are retained. KB0072336 v0.01
Topics
• NX • Service Fee/Cross Reference Maintenance
 
Financial Eligibility - Guarantor Selection
An issue is resolved to ensure that the subsequent Guarantor Plan is not removed in the 'Financial Eligibility' form (Guarantor Selection section) after selecting a guarantor.
Topics
• Financial Eligibility • NX
 
Acceptance Tests
AV-87021 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:
  • Dictionary Update (PM)
  • Service Fee/Cross Reference Maintenance
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.
Topics
• NX • Service Fee/Cross Reference Maintenance
AV-88767 Summary | Details
Financial Eligibility - Guarantor Selection
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Financial Eligibility
  • Guarantors/Payors
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
• Financial Eligibility • NX
Table Changes
Table Column Change
SYSTEM.BillingTxAmtToDistAudit practitioner_category_code Changed max length from 5 to 50
SYSTEM.BillingTxAmtToDistDef practitioner_category_code Changed max length from 5 to 50
SYSTEM.BillingTxMasterFeeAudit practitioner_category_code Changed max length from 5 to 50
SYSTEM.BillingTxMasterFeeDef practitioner_category_code Changed max length from 5 to 50