Avatar Cal-PM 2023 Update 36

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Product Requirements / Recommendations

Avatar Cal-PM required
RADplus required

Product Update Form Description

The following modifications are made: 1) The Client Ledger report is updated to show the MSO Allowed Amount for services originating from MSO with Other Healthcare Coverage. 2) The Electronic Billing 837 compile process is updated to include the MSO service code in the 2430-SVD-03 segment.

Included Updates

None

Required Updates

None

Details

NEW2 CHANGED0 FIXED0

New (2)

AV-89770 Details \| User Acceptance Tests 'Electronic Billing' Support for Services Originating in Avatar MSO The Avatar Cal-PM Electronic Billing 837 compile process is updated to include the MSO service code in the 2430-SVD-03 segment for services originating in Avatar MSO with Other Healthcare Coverage information. Value Added: Updates 'Electronic Billing' 837 2430-SVD values for Avatar MSO services with Other Healthcare Coverage	Topics • Claims Processing • Electronic Billing • NX

AV-89771 Details \| User Acceptance Tests 'Client Ledger' Support for Services Originating in Avatar MSO The Avatar Cal-PM 'Client Ledger' form and report are updated to display the Avatar MSO 'Allowed Amount' as cost of service for services originating in Avatar MSO with Other Healthcare Coverage information. Value Added: Updates 'Client Ledger' cost of service values for Avatar MSO services with Other Healthcare Coverage	Topics • Client Ledger • NX

Acceptance Tests

AV-89770 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:

Electronic Billing
Registry Settings (PM)

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

Open Avatar Cal-PM 'Electronic Billing' form.
Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality
Select 837 Professional or 837 Institutional in 'Billing Form' field.
Enter/select 837 file sorting criteria, using values which will include service(s) originating in Avatar MSO.
Click 'Process' button to sort/generate 837 Professional or 837 Institutional file.
Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
Select 'Print' in the 'Print Or Delete Report' field.
Select 837 Professional/837 Institutional file sorted which includes services originating in Avatar MSO, and click 'Process' button to display 837 outbound file data.
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.
Example: SVD*87755XX*7.5*HC:90806:HA**11~

Topics

• Claims Processing • Electronic Billing • NX

AV-89771 Summary | Details

'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:

Client Ledger
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

Open Avatar Cal-PM 'Client Ledger' form.
Select 'Client ID' value for client where services originating in Avatar MSO and including Other Healthcare Coverage information exist.
Select 'Claim/Episode/All Episodes' value (and enter/edit 'From Date'/'To Date' values if desired).
Select 'Ledger Type' value.
Click 'Process' button.
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).
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
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).
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

• Client Ledger • NX