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Avatar Cal-PM 2023 Update 47

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Product Requirements and Recommendations

Avatar Cal-PM required
RADplus required

Recommended Update Level

Avatar Cal-PM 2023 Monthly Release 2023.03.00
RADplus 2023 Monthly Release 2023.03.00

Product Update Description

1) A new field called 'Subscriber Client Index Number' is added to the 'Financial Eligibility' form (Policy Number Override section) that will allow users to specify a Subscriber Client Index Number based on a date range. 2) A new field called 'Sort Claims by Month' is added to the 'Guarantor/Program Billing Defaults ' form (837 Professional/Institutional section) that will allow users to sort claims by date of service months.

Required Updates

None

Included Updates

3, 5, 7, 8, 11, 16, 17, 21, 24, 26, 28, 32, 39, 43, 45

Details
NEW2 CHANGED0 FIXED0
New (2)
Financial Eligibility - Policy Number Override section
A new field, 'Subscriber Client Index Number', is added, and allows output based on a date range.
Value Added: Allows additional reporting options.
Topics
• Financial Eligibility • NX
 
Guarantor/Program Billing Defaults
A new field, 'Sort Claims by Month', is added to the 837 Professional and 837 Institutional sections of the Guarantor/Program Billing Defaults template.
Value Added: Allows for the 837 Billing files to sort the claims by month of service.
Topics
• 837 Institutional • 837 Professional • File Import • Guarantor/Program Billing Defaults
 
Acceptance Tests
AV-80717 Summary | Details
Financial Eligibility - Policy Number Override section
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Diagnosis
  • Fast Financial Eligibility
  • Admission
  • App Dashboard
  • Client Charge Input
  • Client Ledger
  • Create Interim Billing Batch File
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Registry Settings (PM)
Scenario 1: Fast Financial Eligibility - Add/Edit record
Specific Setup:
  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.
Steps
  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.
Scenario 2: Cal-PM - Financial Eligibility - Policy Number Override - Subscriber Client Index Number
Specific Setup:
  • 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'.
Steps
  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.
Topics
• Financial Eligibility • NX
AV-85848 Summary | Details
Guarantor/Program Billing Defaults
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Client Charge Input
  • Client Ledger
  • Create Interim Billing Batch File
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
  • Crystal Report Viewer
  • File Import
  • File Import - Compile/Post Report
Scenario 1: Validate 'Guarantor Program Billing Defaults', 'Sort Claims by Month' = Yes.
Specific Setup:
  • 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.
Steps
  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].
Scenario 2: Validate 'Guarantor Program Billing Defaults', 'Sort Claims by Month' = No.
Specific Setup:
  • 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.
Steps
  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].
Scenario 3: 'File Import' - Verification of 'Guarantor/Program Billing Defaults Template' Import (Avatar Cal-PM)
Specific Setup:
  • 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
Steps
  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.
Topics
• 837 Institutional • 837 Professional • File Import • Guarantor/Program Billing Defaults
Table Changes
Table Column Change
billing_policy_override subscriber_client_index_number_override ADD
billing_policy_override data_entry_utc ADD
billing_policy_override data_entry_timezone_info_all ADD
billing_policy_override data_entry_time_j ADD
billing_policy_override data_entry_offset ADD
billing_policy_override data_entry_timezone_short ADD
table_837_p_facility_prov_num sort_clms_by_month_code ADD
table_837_p_facility_prov_num sort_clms_by_month_value ADD
file_import_gpbdt_p837 sort_clms_by_month_code ADD
file_import_gpbdt_p837 sort_clms_by_month_value ADD
table_837_i_facility_prov_num sort_clms_by_month_code ADD
table_837_i_facility_prov_num sort_clms_by_month_value ADD
file_import_gpbdt_i837 sort_clms_by_month_code ADD
file_import_gpbdt_i837 sort_clms_by_month_value ADD