Avatar Cal-PM 2023 Update 39

1. Open 'Registry Settings' form.
2. Enter search value 'Enable CalAIM BH Payment Reforms' and click 'View Registry Settings' button.
3. Ensure Registry Setting 'Enable CalAIM BH Payment Reforms' is returned (under 'Avatar PM -> Billing -> Services' path).
4. Ensure 'Registry Setting Details' field contains the following explanation text:

"Setting a date allows for the logic enabled through the 'Use the Medi-Cal Fee as The Usual & Customary Fee' and 'Enable SD/MC Minute to Unit Override' Registry Settings to no longer be evaluated for dates of service on or after the date specified.

This will allow the Registry Settings noted above (and related fields) to be enabled for billing/services with dates of service prior to the date specified; Defining of date in this Registry Setting will allow for billing/services with dates of service on or after specified date to be processed as if the Registry Settings noted above are disabled (and as if the 'Use Medi-Cal Rules For Fee Calculations' and 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' fields are set to 'No' in the 'Guarantor/Payors' forms). The 'Bill Cal Billing Units' field within the 'Guarantor/Payors' form will behave as defined for billing/services with dates of service prior to the date specified in this Registry Setting but will be regarded as 'No' for dates of service on or after the date specified. The 'Is this an ODS Group Service' field within the 'Service Codes' form will behave as defined for billing/services with dates of service prior to the date specified in this Registry Setting but will be regarded as 'No' for dates of service on or after the date specified."

• Avatar Cal-PM Registry Setting 'Enable CalAIM BH Payment Reforms' must be enabled (payment reform effective date set)
• Avatar Cal-PM Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' may optionally be enabled/disabled
• If Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' is disabled, 'Use Medi-Cal Rules For Fee Calculations' field in 'Guarantors/Payors' form must be set to 'Yes' for applicable Guarantor(s)
• One or more Service Codes where 'Type Of Service' value is set to 'Group' and 'Is this an ODS Group Service?' value is set to 'Yes' (via Avatar Cal-PM 'Service Codes' form)
• Applicable Group Service Fee/Override value calculation may be determined by 'Apply Multiple Practitioner Calculations To This Service Using' field in 'Service Codes' form is defined/applicable to service
• Client record eligible for 'Client Charge Input' form service entry where applicable Guarantor(s) is/are assigned via client Financial Eligibility record

1. Open Avatar Cal-PM 'Client Charge Input' form.
2. Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Client Charge Input (Charge Fee Access)', 'Client Charge Input With Diagnosis Entry', 'Client Charge Input (Charge Fee Access And Diagnosis Entry)', 'Recurring Client Charge Input', 'Recurring Client Charge Input (Charge Fee Access)', 'Recurring Client Charge Input With Diagnosis Entry' and/or 'Recurring Client Charge Input (Charge Fee Access And Diagnosis Entry)' forms
3. Enter value for 'Date of Service'.
4. Enter/select values for 'Client ID', 'Episode Number', 'Program', 'Service Code' and 'Practitioner' fields, using Service Code defined as ODS Group Service and entering value for the 'Enter The Number Of Clients In The Group' dialog/prompt.
5. Enter value for 'Co-Practitioner' and 'Co-Practitioner 2' fields for ODS Group Service if desired (as well as detailed Duration fields 'Face-to-Face Time', 'Documentation and Travel Time', etc if present/configured in form).
6. Enter/select values for any other service entry fields as desired/required.
7. Click 'Submit' button to file form/service.
8. Open Avatar Cal-PM 'Client Ledger' form.
9. Select 'Client ID' value for client where ODS Group Service(s) entered.
10. Select 'Claim/Episode/All Episodes' value (and enter/edit 'From Date'/'To Date' values if desired).
11. Select 'Ledger Type' value.
12. Click 'Process' button.
13. In Client Ledger information/report data for ODS Group Services filed in system - ensure that 'Total Charge' and/or 'Guarantor Liability' values for services are determined as follows:
14. For service dates prior to date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that ODS Group Service total charge/liability is set according to the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form) and 'Is this an ODS Group Service' field for selected Service Code.
15. For service dates on or after date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that service total charge/liability is set without ODS Group Service calculations under the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form is regarded as 'No') and the 'Is this an ODS Group Service' field for selected Service Code is regarded as 'No'.

• Avatar CWS Progress Note form(s) configured for Avatar Cal-PM group service entry/creation
• Avatar Cal-PM Registry Setting 'Enable CalAIM BH Payment Reforms' must be enabled (payment reform effective date set)
• Avatar Cal-PM Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' may optionally be enabled/disabled
• If Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' is disabled, 'Use Medi-Cal Rules For Fee Calculations' field in 'Guarantors/Payors' form must be set to 'Yes' for applicable Guarantor(s)
• One or more Service Codes where 'Type Of Service' value is set to 'Group' and 'Is this an ODS Group Service?' value is set to 'Yes' (via Avatar Cal-PM 'Service Codes' form)
• Applicable Group Service Fee/Override value calculation may be determined by 'Apply Multiple Practitioner Calculations To This Service Using' field in 'Service Codes' form is defined/applicable to service
• Service Group must be defined for Progress Note/group service entry (via Avatar Cal-PM 'Group Registration' form)
• Service Group/client records eligible for Progress Note/group service entry where applicable Guarantor(s) is/are assigned via client Financial Eligibility record

1. Open Avatar CWS Progress Note form for group progress note/group service entry.
2. Navigate to 'Group Default Notes' section of form for Group Service entry.
3. Enter/select values for 'Date Of Group', 'Practitioner', 'Progress Note For', 'Note Type', 'Service Program', 'Service Charge Code' and 'Service Duration' fields, using Service Code defined as ODS Group Service.
4. Enter value for 'Co-Practitioner' and 'Co-Practitioner 2' fields for ODS Group Service if desired (as well as detailed Duration fields 'Face-to-Face Time', 'Documentation and Travel Time', etc if present/configured in form).
5. Enter/select values for any other progress note/group service entry fields as desired/required.
6. Click 'Submit' button to file form/group progress note/group service entry.
7. Finalize Progress Note entry for one or more clients included in selected Service Group so that one or more ODS Group Services associated to finalized Progress Note entries are created.
8. Open Avatar Cal-PM 'Client Ledger' form.
9. Select 'Client ID' value for client where Progress Note/ODS Group Service(s) entered.
10. Select 'Claim/Episode/All Episodes' value (and enter/edit 'From Date'/'To Date' values if desired).
11. Select 'Ledger Type' value.
12. Click 'Process' button.
13. In Client Ledger information/report data for ODS Group Services filed in system via Progress Note entry - ensure that 'Total Charge' and/or 'Guarantor Liability' values for services are determined as follows:
14. For service dates prior to date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that ODS Group Service total charge/liability is set according to the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form) and 'Is this an ODS Group Service' field for selected Service Code.
15. For service dates on or after date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that service total charge/liability is set without ODS Group Service calculations under the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form is regarded as 'No') and the 'Is this an ODS Group Service' field for selected Service Code is regarded as 'No'.

• Avatar Appointment Scheduling must be installed
• Avatar Cal-PM Registry Setting 'Enable CalAIM BH Payment Reforms' must be enabled (payment reform effective date set)
• Avatar Cal-PM Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' may optionally be enabled/disabled
• If Registry Setting 'Use The Medi-Cal Fee As The Usual & Customary Fee' is disabled, 'Use Medi-Cal Rules For Fee Calculations' field in 'Guarantors/Payors' form must be set to 'Yes' for applicable Guarantor(s)
• One or more Service Codes where 'Type Of Service' value is set to 'Group' and 'Is this an ODS Group Service?' value is set to 'Yes' (via Avatar Cal-PM 'Service Codes' form)
• Applicable Group Service Fee/Override value calculation may be determined by 'Apply Multiple Practitioner Calculations To This Service Using' field in 'Service Codes' form is defined/applicable to service
• Service Group must be defined for Appointment/group service entry (via Avatar Cal-PM 'Group Registration' form)
• Service Group/client records eligible for Scheduling Calendar/Appointment Scheduling group service entry where applicable Guarantor(s) is/are assigned via client Financial Eligibility record

1. Open Avatar Cal-PM 'Scheduling Calendar' form.
2. Select date and Practitioner for Appointment Scheduling entry; right click and select 'Add Appointment' action.
3. Enter/select values for 'Appointment Site', 'Appointment Date', 'Appointment Start Time', 'Duration', 'Appointment End Time', 'Appointment Status', 'Recurrence Schedule', 'Service Code', 'Program', 'Location', 'Group' and 'Practitioner' fields, using Service Code defined as ODS Group Service.
4. Enter value for 'Co-Practitioner' and 'Co-Practitioner 2' fields for ODS Group Service if desired (as well as detailed Duration fields 'Face-to-Face Time', 'Documentation and Travel Time', etc if present/configured in form).
5. Enter/select values for any other Scheduling Calendar entry fields as desired/required.
6. Click 'Submit' button to file form/appointments/group service entries.
7. Verify Appointment for one or more staff members where Appointment/group service entered (via Avatar Cal-PM 'Verify Staff Member Appointments' form).
8. Post Appointment for one or more staff members where Appointment/group service entered (via Avatar Cal-PM 'Post Staff Member Schedule' form) so that one or more ODS Group Services associated to Appointment Scheduling entries are created for clients included in selected Service Group.
9. Open Avatar Cal-PM 'Client Ledger' form.
10. Select 'Client ID' value for client where ODS Group Service(s) entered.
11. Select 'Claim/Episode/All Episodes' value (and enter/edit 'From Date'/'To Date' values if desired).
12. Select 'Ledger Type' value.
13. Click 'Process' button.
14. In Client Ledger information/report data for ODS Group Services filed in system via Appointment Scheduling/Scheduling Calendar entries - ensure that 'Total Charge' and/or 'Guarantor Liability' values for services are determined as follows:
15. For service dates prior to date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that ODS Group Service total charge/liability is set according to the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form) and 'Is this an ODS Group Service' field for selected Service Code.
16. For service dates on or after date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that service total charge/liability is set without ODS Group Service calculations under the 'Use the Medi-Cal Fee as The Usual & Customary Fee' Registry Setting (and 'Use Medi-Cal Rules For Fee Calculations' field if enabled in 'Guarantors/Payors' form is regarded as 'No') and the 'Is this an ODS Group Service' field for selected Service Code is regarded as 'No'.

• Avatar Cal-PM Registry Setting 'Enable CalAIM BH Payment Reforms' must be enabled (payment reform effective date set)
• Avatar Cal-PM Registry Setting 'Enable SD/MC Minute to Unit Override' may optionally be enabled/disabled
• If Registry Setting 'Enable SD/MC Minute to Unit Override' is enabled, 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' field in 'Guarantor/Program Billing Defaults' form must be set to 'Yes' for applicable Program/Guarantor template
• 'Bill Cal Billing Units' field in 'Guarantors/Payors' form must be set to 'Yes' for applicable Guarantor
• One or more Service Codes where 'Type Of Service' value is set to 'Group' and 'Is this an ODS Group Service?' value is set to 'Yes' (via Avatar Cal-PM 'Service Codes' form)
• One or more ODS Group Service(s) eligible for Avatar Cal-PM 837 Professional/837 Institutional file inclusion

1. Open Avatar Cal-PM 'Electronic Billing' form.
2. Note, 'Quick Billing' form/functions may also be used for 837 generation/validation.
3. Select 837 Professional or 837 Institutional in 'Billing Form' field.
4. Select values for 837 bill generation in the 'Type of Bill', 'Individual or All Guarantors' and 'Billing Type' fields.
5. Select 'Sort File' in the 'Billing Options' field.
6. Select/enter values for service inclusion in 'All Clients or Interim Billing Batch' and 'Program(s)' fields.
7. Select/enter values for 'Create Claims' (and 'Date of Claim' if 'Yes'), 'First Date of Service to Include' and 'Last Date of Service to Include' fields.
8. Select/enter values for any other bill sorting criteria fields as required/desired.
9. Click 'Process' button in form to sort bill.
10. Select 'Run Report' in the 'Billing Options' field
11. Select 'Print' in the 'Print Or Delete Report' field.
12. Select 837 Professional/837 Institutional file sorted which includes one or more Cal Billing Unit/ODS Group Services and click 'Process' button to display 837 Electronic Billing Report.
13. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file report information including Cal Billing Unit/ODS Group Services - ensure that Service Cost/Liability ('Amount') and Service Units ('Unit') values for services are determined as follows:
14. For service dates prior to date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that ODS Group Service total charge/liability and service units are set according to the 'Bill Cal Billing Units' field/setting for applicable Guarantor (and 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' field if enabled in 'Guarantor/Program Billing Defaults' form/template).
15. For service dates on or after date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that service total charge/liability and service units are set without Cal Billing Units calculations under the 'Bill Cal Billing Units' field/setting for applicable Guarantor (and the 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' field is regarded as 'No' if enabled in 'Guarantor/Program Billing Defaults' form/template).
16. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
17. Select 'Print' in the 'Print Or Delete Report' field.
18. Select 837 Professional/837 Institutional file sorted which includes one or more Cal Billing Unit/ODS Group Services and click 'Process' button to display 837 outbound file data.
19. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file data including Cal Billing Unit/ODS Group Services - ensure that Service Cost/Liability and Service Units (2400-SV1/SV2 Quantity/Monetary Amount) values for services are determined as follows:
20. For service dates prior to date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that ODS Group Service total charge/liability and service units are set according to the 'Bill Cal Billing Units' field/setting for applicable Guarantor (and 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' field if enabled in 'Guarantor/Program Billing Defaults' form/template).
21. For service dates on or after date defined for 'Enable CalAIM BH Payment Reforms' Registry Setting, ensure that service total charge/liability and service units are set without Cal Billing Units calculations under the 'Bill Cal Billing Units' field/setting for applicable Guarantor (and the 'If Short-Doyle Medi-Cal, Override The Minute-Based Treatment Units?' field is regarded as 'No' if enabled in 'Guarantor/Program Billing Defaults' form/template).