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Avatar Cal-PM 2023 Update 64

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Product Requirements and Recommendations

Avatar Cal-PM required
RADplus required

Recommended Update Level

Avatar Cal-PM 2023 Monthly Release 2023.02.01
RADplus 2023 Monthly Release 2023.02.01

Product Update Description

An issue is resolved in the Electronic Billing 837 compile process where the 2430-SVD-03 segment would not display the correct MSO service code.

Required Updates

None

Included Updates

36

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
'Electronic Billing' Support for Services Originating in Avatar MSO
An issue is resolved in the Avatar Cal-PM Electronic Billing 837 compile process to ensure that the 2430-SVD-03 segment includes the correct service code for services originating in Avatar MSO with Other Healthcare Coverage information. KB0074959 v0.01
Topics
• Claims Processing • Electronic Billing • NX
 
Acceptance Tests
AV-91944 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)
  • Service Fee/Cross Reference Maintenance
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
  1. Open Avatar Cal-PM 'Electronic Billing' form.
  2. Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality
  3. Select 837 Professional or 837 Institutional in 'Billing Form' field.
  4. Enter/select 837 file sorting criteria, using values which will include service(s) originating in Avatar MSO.
  5. Click 'Process' button to sort/generate 837 Professional or 837 Institutional file.
  6. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional/837 Institutional file sorted which includes services originating in Avatar MSO, and click 'Process' button to display 837 outbound file data.
  9. 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 with any modifiers if/where present.
  10. Examples:
  11. SVD*87755XX*7.5*HC:90806**11~
  12. SVD*87755XX*7.5*HC:90806:HA**11~
  13. SVD*87755XX*7.5*HC:90806:HA:HE**11~
  14. SVD*87755XX*7.5*HC:90806:HA:HE:HF**11~
  15. SVD*87755XX*7.5*HC:90806:HA:HE:HF:ZZ**11~
Topics
• Claims Processing • Electronic Billing • NX