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Avatar Cal-PM 2023 Update 33

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Product Requirements and Recommendations

Avatar Cal-PM required
RADplus required

Recommended Update Level

Avatar Cal-PM 2023 Monthly Release 2023.02.02
RADplus 2023 Monthly Release 2023.02.02

Product Update Description

An issue is resolved where filing the 'Inhibit Billing By Service' form when selecting an 'Inhibit Reason', or filing 'File Import: Client Charge Input' when using the 'Billable (Inhibit Billing)' field to inhibit, may fail to file successfully or encounter an error during processing.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Inhibit Billing
An issue is resolved to ensure that the 'Inhibit Billing By Reason' and 'File Import - Client Charge Input' forms file successfully upon submission.
Topics
• File Import • Inhibit Billing
 
Acceptance Tests
AV-89639 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
  • Admission (Outpatient)
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Diagnosis
  • Electronic Billing
  • File Import
  • Financial Eligibility
  • Inhibited Services For Billing Report
  • Registry Settings (PM)
  • Service Fee/Cross Reference Maintenance
  • Dictionary Update (PM)
  • Guarantors/Payors
  • Practitioner Numbers By Guarantor and Program
  • Program Maintenance
Scenario 1: 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 2: 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.
Scenario 3: '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 4: '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.
Topics
• File Import • Inhibit Billing