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Avatar Cal-PM 2024 Monthly Release 2024.00.01 Acceptance Tests

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Update 2 Summary | Details
CPT Code Definition
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CPT Code Definition (PM)
Scenario 1: CPT Codes: Annual code update
Steps
  1. Open Avatar PM 'CPT Code Definition' form.
  2. Click [Print CPT Codes].
  3. A list of the current CPT Codes will display.
  4. Review the list to assure new codes have been added.
  5. Click [Close].
Topics
• CPT Codes • NX
Update 7 Summary | Details
RADPlus - Family Entity Modeling
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Change MR#
  • Family Registration
  • Delete Last Movement
  • Table Definition (PM)
  • High Utilizier
  • Delete Family
Scenario 1: Change MR# - "Family" Entity Data validations
Specific Setup:
  • Have an active test client on the system [ClientA], note their current PATID# [OrigPATID#].
  • In form "Family Registration" have a family created [FamilyA], with [ClientA] added as a family member in "Family Members" section of the form.
  • Have a user modeled form [FormA] created based on the "Family" entity database that's enabled for document routing.
  • A row has been filed in [FormA] for [FamilyA], selecting [ClientA] in the "Family Members" field and the document created during submission has been routed and approved.
  • Have a report [ReportA], to display data in the "SYSTEM.user_modelled_fam_members" table.
Steps
  1. Run [ReportA] to display data in the "SYSTEM.user_modelled_fam_members" table.
  2. Validate there is a row displayed for [FamilyA] and [ClientA].
  3. Open "Change MR#" form in Avatar PM.
  4. Select [ClientA] in the "Client ID" field and note their current PATID [OrigPATID#].
  5. Click [Assign MR#].
  6. Note the new PATID# assigned, [NewPATID#].
  7. Click [Submit].
  8. Validate the form files successfully.
  9. At the home view, search for the [OrigPATID#] noted in step 3a.
  10. Validate there are no results.
  11. Now search for the [NewPATID#] noted in step 3b.
  12. Validate the [NewPATID#] is found and the associated client is [ClientA].
  13. Run [ReportA], to display data in the "SYSTEM.user_modelled_fam_members" table.
  14. Validate there is a row displayed for [FamilyA] and with new PATID# [NewPATID#] displayed for [ClientA].
Scenario 2: Client Delete - "Family" Entity Data validations
Specific Setup:
  • Have an active test client on the system [ClientA].
  • In form "Family Registration", have a family created [FamilyA] with [ClientA] added as a family member in "Family Members" section of the form.
  • Have a user modeled form [FormA] created based on the "Family" entity database that's enabled for document routing.
  • A row has been filed in [FormA] for [FamilyA], selecting [ClientA] in the "Family Members" field and the document created during submission has been routed and approved.
  • Have a report [ReportA] created to display data in the "SYSTEM.user_modelled_fam_members" table.
  • User has launched [ReportA] and has logged into the system.
Steps
  1. Run [ReportA] to display data in the "SYSTEM.user_modelled_fam_members" table.
  2. Validate there is a row displayed for [FamilyA] and [ClientA].
  3. Open "Client Delete" form.
  4. Select [ClientA] in the "Client ID" field.
  5. Validate an error message is received "Client Must Be Removed From All Families Before Client Can Be Deleted."
  6. Click [OK].
  7. Close the form.
  8. Open form "Family Registration".
  9. Select [FamilyA].
  10. Click the "Family Members" section.
  11. Select the row for [ClientA].
  12. Click [Delete].
  13. Validate the client is removed as a family member.
  14. Submit the form.
  15. Open form "Delete Last Movement".
  16. Select [ClientA].
  17. Select the admission episode from the "Episode Number" field.
  18. Click [Submit].
  19. Click [Yes] to continue.
  20. Validate the form submits successfully.
  21. Open "Client Delete" form.
  22. Select [ClientA] in the "Client ID" field.
  23. Click [Submit].
  24. Validate the form submits successfully.
  25. At the home view, search for [ClientA].
  26. Validate there are no results.
  27. Run [ReportA] to display data in the "SYSTEM.user_modelled_fam_members" table.
  28. Validate there is no longer a row displayed for [FamilyA] and [ClientA].
Scenario 3: "Family" Entity User Modeled Form - Create a new form
Specific Setup:
  • In form "Family Registration" have a family created [FamilyA] with one or more clients added as family member's in "Family Members" section of the form.
Steps
  1. Open form "Envelope Definition".
  2. Click [New Avatar Envelope].
  3. Set the "Envelope Description" field to the desired name [EnvelopeA], for the envelope.
  4. Select "Family" in the "Entity Database" field.
  5. Click the "Yes - Is Envelope Eligible for Export" field.
  6. Click the "Yes - Always Allow Export" field.
  7. Click [Submit].
  8. Validate the form files successfully.
  9. Open form "Table Definition".
  10. At the "Select Avatar Table" prompt enter the desired table name [TableA].
  11. Click [New Avatar Table].
  12. From the "Envelope" dialog field, select [EnvelopeA].
  13. Populate the "Table Name" field with the desired table name [TableA].
  14. Populate the "Table Description" field with the desired description of the table.
  15. Select the "Column Definition" section.
  16. Click [Add New Item].
  17. Select "Family Member(s)" column from the "Type of Column" field.
  18. Populate the "Column Name" field.
  19. Populate the "Column Description" field.
  20. Populate the "Column Label" field.
  21. Validate the "Column Definition" grid contains a row with values just populated.
  22. Click [Add New Item].
  23. Select "Draft/Final (Document Routing)" column from the "Type of Column" field.
  24. Populate the "Column Name" field.
  25. Populate the "Column Description" field.
  26. Populate the "Column Label" field.
  27. Validate the "Column Definition" grid contains a row with values just populated.
  28. Repeat step 4 for any other desired prompts to be added from the "Type of Column" field.
  29. Validate results are as expected.
  30. Click [Submit].
  31. Validate the form files successfully.
  32. Open form "Form Definition".
  33. At the "Select Avatar Table" prompt enter the desired form name [FormA]
  34. Click [New Avatar Form].
  35. From the "Envelope" dialog, select [EnvelopeA].
  36. Populate the "Table Name" field with the desired table name [TableA].
  37. Populate the "Table Description" field with the desired description of the table.
  38. Select a menu location for the form from the "Menu to Place Form Under" field.
  39. Populate the "Form Name" field [FormA].
  40. In the "Primary Table" field, select [TableA].
  41. Click the "Pre-display" section.
  42. Select one or more pre-display columns from the "Primary Table Pre-display" column prompts.
  43. Click the "Section Definition" section.
  44. Click [Add New Item] and populate the "Section Description" field.
  45. Click the "Object Definition" section.
  46. Click [Add New Item].
  47. From the "Table Column" field, select the "Family Member's" column.
  48. Validate the "Object Definition" grid reflect the column added.
  49. From the "Table Column" field, select the "Draft/Final" column.
  50. Validate the "Object Definition" grid reflect the column added.
  51. Repeat step b adding any other columns desired from the "Table Column" field.
  52. Validate the "Object Definition" grid reflect the columns added.
  53. Click [Submit].
  54. Validate the form files successfully.
  55. Open [FormA].
  56. At the "Select Family" prompt, select [FamilyA].
  57. Validate the form loads successfully.
  58. Verify the "Family Member's" field is present and contains each client added as a family member in the set up, along with a check box next to their name.
  59. Verify the "Draft/Final" field is present on the form.
  60. Verify any other fields added during "Form Definition" are present on the form, as expected.
  61. Select values for any desired fields on the form.
  62. Submit the form.
  63. Validate the form files successfully.
Scenario 4: "Family" Entity User Modeled Form - Form submission and Document Routing Validations
Specific Setup:
  • The "Document Management Defaults" form has "Family - User Defined Family" selected in the field "Select Entity Types Allowed".
  • The "Document Management Definition" form has been submitted with a "Form Name" [FName] associated to the "Family" entity in the "Entity Database" field.
  • In form "Family Registration" have a family created [Family] with family members added in "Family Members" section of the form. For the test [ClientA] and [ClientB].
  • Have a user modeled form [Form] created based on the "Family - User Defined Family" entity database.
  • [Form] contains fields from [Table] that include a "Family Member(s)" column type, a field using a "Draft/Final" column type and any other desired field types.
  • [Form] is enabled for document routing with form name [FName] selected in the "Select Type" field.
  • [User] is a staff member who has access to [Form] and [Table].
  • [User] has the "My To do's" widget on their home view.
  • Have a report [Report], set to display data in the "SYSTEM.user_modelled_fam_members" table.
  • Log in as [User].
Steps
  1. Access [Form].
  2. In the "Select Family" prompt, select [Family].
  3. Validate the "Family Member's" prompt has selections for members [ClientA] and [ClientB].
  4. Click "All", to select all members.
  5. Populate any other desired fields on the form.
  6. Select "Draft" in the 'Draft/Final' field.
  7. Click [Submit].
  8. Validate the form files successfully.
  9. Run [Report] to display data in the "SYSTEM.user_modelled_fam_members" table.
  10. Validate there is a row displayed for [Family] and [ClientA].
  11. Validate there is a row displayed for [Family] and [ClientB].
  12. Access [Form].
  13. In the "Select Family" prompt, select [Family].
  14. In the pre-display screen, click [Edit] to select the row filed in step 1.
  15. Validate all fields are populated, as expected.
  16. Close the form.
  17. Access [Form].
  18. In the "Select Family" prompt, select [Family].
  19. In the pre-display screen, select the row filed in step 1.
  20. Click [Delete].
  21. Validate the row is removed from the pre-display.
  22. Run [Report] to display data in the "SYSTEM.user_modelled_fam_members" table.
  23. Validate the row field for [Family] and [ClientA], has been deleted.
  24. Validate the row field for [Family] and [ClientB], has been deleted.
  25. Access [Form].
  26. In the "Select Family" prompt, select [Family].
  27. Validate the "Family Member's" prompt has selections for members [ClientA] and [ClientB].
  28. Click "All", to select all members.
  29. Populate any other desired fields on the form.
  30. Select "Final in the 'Draft/Final' field.
  31. Click [Submit] and then [OK].
  32. Validate the "Confirm Document" screen displays all data submitted, including clients [ClientA] and [ClientB] listed in the "Family Member's field.
  33. Click [Accept and Route].
  34. Enter the password for the user in the 'Password' field and click [OK].
  35. At the "Route Document to" dialog, add [User] as an approver.
  36. Click [Submit].
  37. Run [Report] to display data in the "SYSTEM.user_modelled_fam_members" table.
  38. Validate there is a row displayed for [Family] and [ClientA].
  39. Validate there is a row displayed for [Family] and [ClientB].
  40. Navigate to the "My To Do's" widget.
  41. Click the "New" tab.
  42. Validate the To Do for [Form] is present in the list.
  43. Validate the "Client" column indicates [Family].
  44. Click [Approve Document].
  45. Validate the document displays all data submitted, including clients [ClientA] and [ClientB] in the "Family Member's" field.
  46. Click [Accept].
  47. Validate the To Do is removed the widget, as expected.
Scenario 5: Delete Family - Form (Submission and Validations)
Specific Setup:
  • Have an active test client on the system [ClientA].
  • In form "Family Registration" have a family created [FamilyA], with [ClientA] added as a family member in "Family Members" section of the form.
  • Have a user modeled form [FormA] created based on the "Family" entity database that's enabled for document routing.
  • File a row for [FamilyA], selecting [ClientA] selected in the "Family Members" field and routing the document to [UserA] to create To do.
  • [UserA] has the "My To do's" widget on their home view.
  • Have a report [ReportA] created to display data in the "SYSTEM.user_modelled_fam_members" table.
  • [UserA] has launched [ReportA] and has logged into the system.
Steps
  1. Run [ReportA], to display data in the "SYSTEM.user_modelled_fam_members" table.
  2. Verify a data row is displayed for the row filed in the set up for [FamilyA] that includes [ClientA].
  3. On the home view, validate a To do exists in the "My To do's" widget for the row filed in [FormA] in the set up.
  4. Open form "Delete Family".
  5. Select [FamilyA].
  6. Validate an error message is displayed stating "The Family has members on file. You must delete all family members in the Family Registration form prior to deleting the family".
  7. Click [OK].
  8. Open form "Family Registration".
  9. Select [FamilyA].
  10. Click the "Family Members" section.
  11. Select each family member row and click delete to remove the row.
  12. Submit the form.
  13. Open form "Delete Family".
  14. Select [FamilyA].
  15. Click [Submit].
  16. At the "Delete Family" dialog, click [Yes].
  17. Validate the message "Family has been Deleted" displays.
  18. Click [OK].
  19. Open form "Delete Family".
  20. Search for [FamilyA].
  21. Validate [FamilyA] is not found.
  22. Return to the "My To Do's" widget.
  23. Validate a To do is no longer present for [FormA] for [ClientA].
  24. Run [ReportA], to display data in the "SYSTEM.user_modelled_fam_members" table.
  25. Verify there are no rows displayed for [FamilyA].
Topics
• Modeling • Change MR# • Family Registration
Update 9 Summary | Details
Eligibility Response (271) - Compile Eligibility Inquiry (270) Request
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Eligibility Response (271)
  • Eligibility Inquiry and Response (270/271) Report
Scenario 1: Eligibility Response (271) - Compile 271 eligibility response file based on 270 request.
Specific Setup:
  • System must be setup to create a 270 request for the client/service.
  • Registry Setting:
  • The 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Enable 270/271 Transaction Sets' registry setting is set to 'Y'.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. All the required information for the eligibility inquiry and response are populated correctly on the '270 / 271 / 834' section of the form. Note the guarantor's code/name.
  • Guarantor/Program Billing Defaults:
  • All the fields required to compile 270 request and 271 response data are populated correctly for the template that contains desired program and the guarantor.
  • Service codes:
  • An existing service code is identified to be used. The 'Service Type Code (270)' is set up with the desired value. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing client is identified, or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
  • Client Charge Input:
  • A service is rendered to the client using the service code identified above. Note service date, service code.
  • Client Ledger:
  • A service distributed correctly to the assigned guarantor.
  • Close the charges.
  • Eligibility Inquiry (270) Request:
  • An Eligibility Inquiry (270) request is created for a client.
  • A 271 eligibility response file is created based on the information found on the Eligibility Inquiry (270) Submission. Note the path of the location where the 271 response file is located.
Steps
  1. Open the 'Eligibility Response (271)' form.
  2. Load the 271 eligibility response file created in the setup section.
  3. Verify the file loads successfully.
  4. Compile the loaded 271 eligibility response file.
  5. Verify the file compiles successfully.
  6. Select 'Response Data' option from the report.
  7. Verify the system displays data correctly.
  8. Post the compiled 271 eligibility response file.
  9. Verify the file posts successfully.
  10. Open the 'Crystal report' or any other SQL Data Viewer.
  11. Query the billing_271_sub_elig and billing_271_dep_elig tables.
  12. Verify that the data_entry_utc field is present in the table.
Scenario 2: Eligibility Inquiry and Response (270/271) Report field validation
Steps
  1. Open 'Eligibility Inquiry and Response (270/271) Report'.
  2. Enter the 'Client ID' for the client that will not be rejected.
  3. Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT-4 Code' field.
  4. Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
  5. Close the form.
Topics
• Eligibility Response (271) • NX
Update 12 Summary | Details
Client Lookup - Sub-System Codes
Scenario 1: Registry Setting - Exclude Non-Episodic Clients From Sub-System Code Client Lookup
Specific Setup:
  • The test system has multiple system codes.
  • Note the 'Root' system code.
  • Note a 'Sub-System' code'.
  • Note a user that can log into both system codes.
  • Tester is logged in to the 'Root' system code.
  • A non-episodic client exists in the 'Root' system code only. Note the client ID. If needed, a non-episodic client can be created in the 'Call Intake' form.
  • Registry Setting: 'Exclude Non-Episodic Clients From Sub-System Code Client Lookup' = 'Y'.
  • Validate that the client ID can be found in 'Client Search'.
  • Validate that the following forms open: 'Pre Admit', 'Admission' and 'Admission (Outpatient)'.
  • On each form, a message displays stating: 'Client has not been assigned a permanent Medical Record number. Clients with temporary numbers cannot be admitted. Would you like to assign a permanent MR# now?' 'Click [No].
  • A new message displays stating: 'Client has not been assigned a permanent Medical Record number. Clients with temporary numbers cannot be admitted. To assign an ID # use the Assign Permanent MR # form. Click [OK].
  • Logout of the 'Root' system code.
  • Sign into the 'Sub-System' code.
Steps
  1. Search for the non-episodic client and verify that no search results are returned.
  2. Log out of the 'Sub-System' code.
  3. Log into the 'Root' system code.
  4. Open 'Registry Settings'.
  5. Change the value of ' 'Exclude Non-Episodic Clients From Sub-System Code Client Lookup' to 'Y'.
  6. Validate that the Client Search returns the non-episodic client.
  7. Log out of the 'Root' system code.
  8. Log into the 'Sub-System' code.
  9. Validate that the Client Search returns the non-episodic client.
  10. Validate that the following forms open: 'Pre Admit', 'Admission' and 'Admission (Outpatient)' and that each form contains the same two messages from 'Setup'.
Topics
• Sub-System Code • NX
Update 17 Summary | Details
274 Provider Directory Submission
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 274 - Provider Directory Defaults
  • 274 - Provider Directory Definition
  • 274 - Provider Directory Submission
Scenario 1: 274 - worklflow (274 - Provider Directory Defaults, 274 - Provider Directory Definition, 274 - Provider Directory Submission)
Specific Setup:
  • Tester has been given access to the following forms in 'User Definition' under ‘Avatar PM / System Maintenance / System Definition / Health Care Provider Directory (274)’:
  • 274 - Provider Directory Defaults.
  • 274 - Provider Directory Definition.
  • 274 - Provider Directory Submission.
Steps
  1. Open '274 - Provider Directory Defaults'.
  2. Validate that the 'Plan Type' field is required.
  3. Select desired value in 'Plan Type' and validate that the 'Healthcare Plan Code' field becomes required.
  4. Enter desired data for each field.
  5. Submit the form.
  6. Open '274 - Provider Directory Defaults'.
  7. Validate that the submitted data was retained.
  8. Open ‘274 - Provider Directory Definition’.
  9. Validate that the form opened to the ‘Group Definition’ section.
  10. Validate that the 'Plan Type' field is required.
  11. Select desired value in 'Plan Type' and validate that the 'Add or Edit Group' field is required.
  12. Select 'Add' in 'Add or Edit Group'.
  13. Validate that the 'Active' and 'Provider Group Name (2100CA-NM1-03)' fields are required.
  14. Enter desired data for each field.
  15. Click [File Group Details].
  16. Select 'Edit' in 'Add or Edit Group'.
  17. Select the group added above and validate that the submitted data was retained.
  18. Select the 'Site Definition' section.
  19. Validate that the 'Plan Type' field is required.
  20. Select desired value in 'Plan Type' and validate that the 'Add or Edit Site' field is required.
  21. Select 'Add' in 'Add or Edit Site'.
  22. Validate that 'Site or Location of Service Name (2100DA-NM1-03)', 'Provider Group', and 'Active' fields are required.
  23. Validate that the field label 'Site or Location Address (2100DA-N3-01)' has been replaced with 'Site or Location Address (2110DA-N3-01)'.
  24. Validate that the field label 'Site or Location Address 2 (2100DA-N3-02)' has been replaced with 'Site or Location Address 2 (2110DA-N3-02)'.
  25. Enter desired data for each field, which would include nine digit zip codes with a hyphen.
  26. Click [Site Work Schedule (2100DA-WS)].
  27. Enter desired data.
  28. Click [Save].
  29. Click [Yes].
  30. Click [Foreign Languages Spoken At This Site (2100DA-LUI)].
  31. Enter desired data.
  32. Click [Save].
  33. Click [Yes].
  34. Click [Affiliated Entities (2100DB)].
  35. Enter desired data.
  36. Click [Save].
  37. Click [Yes].
  38. Click [File Site Details].
  39. Click [OK].
  40. Select 'Edit' in 'Add or Edit Site'.
  41. Select the 'Provider Site' that was added above and validate that the submitted data was retained.
  42. Select the 'Provider Definition' section.
  43. Validate that the 'Plan Type' field is required.
  44. Select desired value in 'Plan Type' and validate that the 'Provider' field is required.
  45. Select a 'Provider'.
  46. Validate that 'Associated Site' and 'Active' became required.
  47. Enter desired data for each field. Note:
  48. To meet California regulations, when there is data in these fields, 'Additional Provider Name (2100EA-N2-01)' and 'Provider Doing Business As or Trade Name (2100EA-N2-02)', that data is output in the submission file.
  49. If those fields are left blank, the data from the 'Percentage of FTE Serving Children (2100EA-N2-01)' and 'Percentage of FTE Serving Adults (2100EA-N2-01)' fields will be output in the submission file.
  50. When the 'Plan Type' equals 'Mental Health Plan', the value of the field will contain three characters and be zero filled for values less than three digits. A value of '27' is output as '027'.
  51. When the 'Plan Type' equals 'Drug Medi-Cal Organized Delivery System, can contain three characters and be null filled for values less than three digits. A value of '40' is output as '40'.
  52. Click [File Provider Details].
  53. Click [OK].
  54. Select the same 'Provider'.
  55. Select the 'Associated Site' selected above.
  56. Validate that the submitted data was retained.
  57. Close the form.
  58. Open '274 - Provider Directory Submission'.
  59. Validate that the 'Plan Type' field is required.
  60. Select desired value in 'Plan Type' and validate that the
  61. Select 'Compile File' in 'Options'.
  62. Enter the desired value in 'Reporting Period (MM/YY)'.
  63. Enter desired 'File Description'.
  64. Click [Process File].
  65. Validate that the report display and that the zip code fields do not contain a hyphen.
  66. Validate the report data.
  67. Close the report.
  68. Close the form.
Topics
• NX • 274 - Provider Directory
Update 23 Summary | Details
837 Professional bill - Re-Bill Claims - Discharge Date Segment
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Financial Eligibility
  • Client Ledger
  • Discharge
  • Electronic Billing
  • Electronic Re-Billing Service Assignment
Scenario 1: Validating re-bill claim claimed via 'Electronic Billing' in the 'SYSTEM.billing_rebill_tx_assign' SQL table.
Specific Setup:
  • Registry Setting:
  • The 'Specify Loops/Segments To Suppress/Include' is set 1.
  • Guarantor/Program Billing Defaults:
  • The 'Discharge Date (2300-DTP-096)' is selected in the 'Select Segments To Suppress' field.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor's code/name.
  • Service codes:
  • An existing service code is identified to be used where the 'Does This Service Have a professional Component' is set to 'Yes'. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing inpatient client is identified, or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
  • Client Charge Input:
  • A service is rendered to the client on the admission date. Note service date, service code.
  • Client Ledger:
  • A service distributed correctly to the assigned guarantor.
  • Diagnosis:
  • A diagnosis record is created for the client.
  • Close Charges:
  • The charges distributed to the guarantor are closed.
  • Create Interim Billing Batch File:
  • An interim billing batch is created for the client that includes an identified client and services. Note the batch number/name.
  • Discharge:
  • Client is discharged after 30 days from the admission date. Note the discharge date.
  • Electronic Billing:
  • The bill is created, and the services are claimed. Note the claim number.
  • Electronic Re-billing Service Assignment:
  • The claim is flagged for the re-bill.
Steps
  1. Open the 'Electronic Billing' form.
  2. Create an 837-Institutional/professional claim for the services assigned for the re-billing.
  3. Verify the bill compiles successfully.
  4. Close the form.
  5. Open the 'Crystal Reports' or any other SQL reporting tool.
  6. Query the SYSTEM.billing_rebill_tx_assign table.
  7. Verify the SYSTEM.billing_rebill_tx_assign table does not contain the flagged claim.
  8. Close the crystal report.
Scenario 2: Cal-PM - 837 Professional Bill - Validating 2300-DTP segment for the date of discharge - Re-bill services
Specific Setup:
  • Registry Setting:
  • The 'Specify Loops/Segments To Suppress/Include' is set 1.
  • Guarantor/Program Billing Defaults:
  • The 'Discharge Date (2300-DTP-096)' is selected in the 'Select Segments To Suppress' field.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor's code/name.
  • Service codes:
  • An existing service code is identified to be used where the 'Does This Service Havs a professional Component' is set to 'Yes'. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing inpatient client is identified, or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
  • Client Charge Input:
  • A service is rendered to the client on the admission date. Note service date, service code.
  • Client Ledger:
  • A service distributed correctly to the assigned guarantor.
  • Diagnosis:
  • A diagnosis record is created for the client.
  • Close Charges:
  • The charges distributed to the guarantor are closed.
  • Create Interim Billing Batch File:
  • An interim billing batch is created for the client that includes an identified client and services. Note the batch number/name.
  • Discharge:
  • Client is discharged after 30 days from the admission date. Note the discharge date.
Steps
  1. Open the 'Electronic Billing' form.
  2. Create an 837-Professional claim for the services.
  3. Verify the bill compiles successfully.
  4. Dump the 837 professional file.
  5. Verify the dump file does not contain DTP*096 segment to the bill to include the date of discharge. Note the claim number.
  6. Close the form.
  7. Open the 'Electronic Re-Billing Service Assignment' form.
  8. Mark the claim from the recent 837 compile to re-bill.
  9. Close the form.
  10. Open the 'Electronic Billing' form.
  11. Compile an 837-Professional bill for the services assigned for the re-billing.
  12. Verify the bill compiles successfully.
  13. Dump the 837 professional file.
  14. Verify the dump file does not contain DTP*096 segment to the bill to include the date of discharge.
  15. Close the form.
  16. Open the 'Guarantor/Program Billing Defaults' form.
  17. The 'Discharge Date (2300-DTP-096)' option is not selected in the 'Select Segments To Suppress' field.
  18. Submit the form.
  19. Open the 'Electronic Billing' form.
  20. Compile an 837-Professional bill for the services assigned for the re-billing.
  21. Verify the bill compiles successfully.
  22. Verify the dump file contains DTP*096 segment to the bill to include the date of discharge.
  23. Close the form.
Topics
• 837 Institutional • Re-Bill • Electronic Re-billing Service Assignment
Update 31 Summary | Details
Quick Billing - Workscreen
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Practitioner Numbers By Guarantor and Program
  • Quick Billing Rule Definition
  • Admission (Outpatient)
  • Financial Eligibility
  • Quick Billing
  • Client Ledger
Scenario 1: 'Quick Billing' - Verification of workscreen row deletion
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable New Quick Billing Format' must be enabled
  • One or more Quick Billing batch(es) must be present for edit via 'Quick Billing' form workscreen
Steps
  1. Open 'Quick Billing' form.
  2. In the 'Add New Or Edit Existing Quick Billing Batch' field, select 'Edit Existing'.
  3. In the 'File' drop-down selection field, select existing Quick Billing batch for edit.
  4. Click the 'Launch Workscreen' button.
  5. In 'Quick Billing' form work screen, select one or more rows for deletion, and click 'Delete Row' button.
  6. Ensure that 'Confirm Delete' dialog is presented; click 'Yes' button to confirm work screen row deletion.
  7. Repeat row selection and 'Delete Row' action for further rows as desired in the 'Quick Billing' form work screen.
  8. When edits/deletions are complete, click the 'Save' button to save work screen data for selected Quick Billing batch.
  9. Ensure that 'Exit Grid' dialog is presented, noting 'Save Successful'.
  10. In 'Quick Billing' form, select same batch for edit and click 'Launch Work screen' button.
  11. Ensure that the deleted rows from the Quick Billing batch are not present in work screen grid on re-entry of work screen for same batch.
  12. Ensure that the deleted rows from the Quick Billing batch are not re-added to same batch on re-run/submission of 'Quick Billing' form for existing batch.
  13. Ensure that in case where all rows are deleted from Quick Billing batch, the Quick Billing/Interim Billing batch is deleted from system on saving of work screen data/submission of 'Quick Billing' form.
Scenario 2: Quick Billing - Validating work screen and 837 report through 'Edit Existing' quick billing batch
Specific Setup:
  • Registry Setting:
  • The 'Enable New Quick Billing Format' registry setting is enabled.
  • Please note: This is a one-time, system-wide registry setting and the associated functionality cannot be disabled once the registry setting is enabled. Once this setting has been enabled, it will no longer be able to be viewed in the 'Registry Settings' form.
  • Admission:
  • Two outpatient clients are identified. Please note the admission programs of the clients.
  • Guarantors/Payor:
  • An existing guarantor is identified.
  • Financial Eligibility:
  • Guarantor identified above is assigned to the clients.
  • Client Charge Input:
  • 1-2 days of professional charges are rendered to the clients. Please note the service codes used during rendering services.
  • Client Ledger:
  • The charges are distributed to the guarantors assigned to the clients.
  • Quick Billing Rule Definition:
  • A new quick billing rule is created as follows:
  • The admission programs are selected in the 'Program' field.
  • '837 Professional' is selected in the 'Billing Form' field.
  • The guarantor assigned to the clients in their financial eligibility is selected in the 'Guarantors' field.
  • All required fields are populated.
  • The 'Create Interim Billing Batch' field is set to 'Yes'.
Steps
  1. Open the 'Quick Billing' form.
  2. Process a new quick billing batch using the rule created in the setup section.
  3. Use a date range spanning services entered.
  4. Select 'Create Batch', 'Close Charges', and 'Generate Bills' in the 'Quick Billing Tasks To Execute' field.
  5. Submit the form.
  6. Verify that compile completes and the prompt states 'Compile Complete'. A Quick Billing Batch and an Interim Billing Batch will be created.
  7. Select [Yes] and return to the form.
  8. Select the 'Add New' option.
  9. Enter the same parameters used in Steps 2 to 4 again, and click [Submit]
  10. Verify that 'Compile Complete' dialog contains the quick billing batch description followed by 'No Information Found'. A Quick Billing Batch and an Interim Billing Batch will be created, instead of the message "No Information Found" without the Quick Billing Rule description.
  11. Select [Yes] and return to the form.
  12. Select the 'Edit Existing' option.
  13. Select the quick bill that was created in the previous step.
  14. Click [Print 837 Report].
  15. Verify the report launched successfully.
  16. Close the report.
  17. Click [Launch Workscreen].
  18. Verify the work screen contains all the clients included in the batch.
  19. Deselect one client from the 'Client' filter at the top of the work screen.
  20. Verify the grid does not display the services of that client.
  21. Select the same client again from the 'Client' filter at the top of the work screen.
  22. Verify the grid includes the services for that client selected in the 'Client' filter.
  23. Select, Deselect and Re select clients, services codes, and practitioners in the 'Client', 'Service Code' and 'Practitioner' filters.
  24. Verify the grid includes/excludes items from the grid based on the selection made in the filters at the top of the work screen.
  25. Save the grid.
  26. Verify the grid saves successfully.
  27. Close the form.
Topics
• Quick Billing • NX
2023 Update 75 Summary | Details
Registry Setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Financial Eligibility
  • Client Ledger
  • Electronic Billing
  • Discharge
  • File Import
Scenario 1: 837I Compile - With '837I-Dates To Populate 2300 DTP' RS 1
Specific Setup:
  • Guarantor:
  • An active guarantor is identified or created - "Guarantor 1".
  • Guarantor/Program Billing Defaults Template:
  • An active 'Guarantor/Program Billing Defaults' template is identified or created that includes "Guarantor 1" - "Template 1".
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' text input box to "837I-Dates To Populate 2300 DTP".
  3. Select 'Yes' in 'Include Hidden Registry Settings'.
  4. Click [View Registry Settings].
  5. Validate that the registry setting exists and show the respective values.
  6. Set the 'Registry Setting Value' field to '1'.
  7. Click [Submit].
  8. Click [OK].
  9. Click [No].
  10. Open the 'Guarantor/Program Billing Defaults' form.
  11. Select 'Edit Template'.
  12. Select "Template 1" from the 'Select Template' dropdown.
  13. Select '837 Institutional'.
  14. Validate that the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' is shown with the following options, (none selected by default):
  15. Yes (Inpatient/Outpatient)
  16. Yes (Outpatient Only)
  17. Yes (Inpatient Only)
  18. No (Inpatient/Outpatient)
  19. Click [Submit].
  20. Click [No].
  21. Open the 'Admission' form.
  22. Admit an Inpatient client - "Client 1".
  23. Using the 'Diagnosis' form, File an active diagnosis record for "Client 1".
  24. File the 'Financial Eligibility' form for "Client 1", with "Guarantor 1".
  25. Specify the 'Coverage Effective Date' and 'Coverage Expiration Date' in the financial eligibility.
  26. Create charges for "Client 1" for more than one date, with the dates between the dates saved in step 21.
  27. Create a new Interim Billing Batch File, "Batch 1", which covers the services created for "Client 1" in step 22.
  28. Close the charges using the Interim Billing Batch File, "Batch 1".
  29. Open 'Client Ledger'.
  30. Select "Client 1" and the respective Episode.
  31. Validate that all the services are closed.
  32. Open 'Electronic Billing'.
  33. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  34. Set 'First Date Of Service To Include' with a date before the 'Coverage Effective Date' filed in step 21.
  35. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  36. Click [Process].
  37. Validate that the compile completes successfully.
  38. Click [OK].
  39. Select 'Dump File' from 'Billing Options'.
  40. Select 'Print' from 'Print Or Delete Report'.
  41. Select the file compiled in step 31.
  42. Click [Process].
  43. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  44. Close the report.
  45. Click [No].
  46. Open 'Discharge' form.
  47. Set the 'Date Of Discharge' field to a date that is the day after the last day of service.
  48. Fill in all the required fields and select [Submit].
  49. Open 'Electronic Billing'.
  50. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  51. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  52. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  53. Click [Process].
  54. Validate that the compile completes successfully.
  55. Click [OK].
  56. Select 'Dump File' from 'Billing Options'.
  57. Select 'Print' from 'Print Or Delete Report'.
  58. Select the file compiled in step 46.
  59. Click [Process].
  60. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  61. Close the report.
  62. Click [No].
  63. Open the 'Guarantor/Program Billing Defaults' form.
  64. Select 'Edit Template'.
  65. Select "Template 1" from the 'Select Template' dropdown.
  66. Select '837 Institutional'.
  67. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient/Outpatient)'.
  68. Click [Submit].
  69. Click [No].
  70. Open 'Electronic Billing'.
  71. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  72. Set 'First Date Of Service To Include' a date before the 'Coverage Effective Date' filed in step 21.
  73. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  74. Click [Process].
  75. Validate that the compile completes successfully.
  76. Click [OK].
  77. Select 'Dump File' from 'Billing Options'.
  78. Select 'Print' from 'Print Or Delete Report'.
  79. Select the file compiled in step 65.
  80. Click [Process].
  81. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  82. Close the report.
  83. Click [No].
  84. Open the 'Guarantor/Program Billing Defaults' form.
  85. Select 'Edit Template'.
  86. Select "Template 1" from the 'Select Template' dropdown.
  87. Select '837 Institutional'.
  88. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient Only)'.
  89. Click [Submit].
  90. Click [No].
  91. Open 'Electronic Billing'.
  92. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  93. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  94. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  95. Click [Process].
  96. Validate that the compile completes successfully.
  97. Click [OK].
  98. Select 'Dump File' from 'Billing Options'.
  99. Select 'Print' from 'Print Or Delete Report'.
  100. Select the file compiled in step 85.
  101. Click [Process].
  102. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  103. Close the report.
  104. Click [No].
  105. Open the 'Guarantor/Program Billing Defaults' form.
  106. Select 'Edit Template'.
  107. Select "Template 1" from the 'Select Template' dropdown.
  108. Select '837 Institutional'.
  109. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient Only)'.
  110. Click [Submit].
  111. Click [No].
  112. Open 'Electronic Billing'.
  113. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  114. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  115. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  116. Click [Process].
  117. Validate that the compile completes successfully.
  118. Click [OK].
  119. Select 'Dump File' from 'Billing Options'.
  120. Select 'Print' from 'Print Or Delete Report'.
  121. Select the file compiled in step 105.
  122. Click [Process].
  123. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  124. Close the report.
  125. Click [No].
  126. Open the 'Guarantor/Program Billing Defaults' form.
  127. Select 'Edit Template'.
  128. Select "Template 1" from the 'Select Template' dropdown.
  129. Select '837 Institutional'.
  130. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'No (Inpatient/Outpatient)'.
  131. Click [Submit].
  132. Click [No].
  133. Open 'Electronic Billing'.
  134. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  135. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  136. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  137. Click [Process].
  138. Validate that the compile completes successfully.
  139. Click [OK].
  140. Select 'Dump File' from 'Billing Options'.
  141. Select 'Print' from 'Print Or Delete Report'.
  142. Select the file compiled in step 105.
  143. Click [Process].
  144. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  145. Close the report.
  146. Click [No].
  147. Query the tables below and validate that the new columns 'inc_dis_dt_2300_dtp_code' and 'inc_dis_dt_2300_dtp_value' are shown with the field 'Include Discharge Date In Statement To Date (2300-DTP)' value,
  148. SYSTEM.file_import_gpbdt_i837
  149. SYSTEM.table_837_i_facility_prov_num
  150. Close the SQL query window.
Scenario 2: File Import - Guarantor Program Billing Defaults - New field validations
Specific Setup:
  • At least one 'Guarantor/Program Billing Defaults' template exists, "Template 1", and the 837 Professional and Institutional sections contain data.
  • Files can be saved to the local desktop, "File A", edited, and imported back into Avatar through 'File Import'.
  • Registry setting '837I-Dates To Populate 2300 DTP' value set as '1'.
Steps
  1. Open 'Guarantor/Program Billing Defaults'.
  2. Edit the ‘837 Institutional’ section of "Template 1".
  3. Validate that the new field has no values selected.
  4. Click [Submit].
  5. Export the template in 'Edit' mode, saving it to the desktop with a unique name "File A".
  6. Edit the 'Edit' mode template to have a value defined for piece 130- 'Include Discharge Date In Statement To Date (2300-DTP)' and save it.
  7. Open 'File Import'.
  8. Import/Compile/Post the 'Edit' mode template "File A" in the 'Guarantor/Program Billing Defaults Template' file type.
  9. Select 'Print File'.
  10. Print the file posted in step 8 by selecting it and clicking 'Process Action'.
  11. Validate that the Crystal report is included with the new field 'Include Discharge Date In Statement To Date (2300-DTP)' and it's value we selected in step 6 for file import for 837 Institutional.
  12. Open 'Guarantor/Program Billing Defaults'.
  13. Select 'Edit Template'.
  14. Select the 'Edit mode template', "Template 1".
  15. Select the ‘837 Professional’ section. The field, 'Include Discharge Date In Statement To Date (2300-DTP)' will have the value used in step 6.
  16. Click [Submit].
  17. Click [No].
Scenario 3: 837I Compile - With '837I-Dates To Populate 2300 DTP' RS 2
Specific Setup:
  • Guarantor:
  • An active guarantor is identified or created - "Guarantor 1".
  • Guarantor/Program Billing Defaults Template:
  • An active 'Guarantor/Program Billing Defaults' template is identified or created that includes "Guarantor 1" - "Template 1".
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' text input box to "837I-Dates To Populate 2300 DTP".
  3. Select 'Yes' in 'Include Hidden Registry Settings'.
  4. Click [View Registry Settings].
  5. Validate that the registry setting exists and show the respective values.
  6. Set the 'Registry Setting Value' field to '2'.
  7. Click [Submit].
  8. Click [OK].
  9. Click [No].
  10. Open the 'Guarantor/Program Billing Defaults' form.
  11. Select 'Edit Template'.
  12. Select "Template 1" from the 'Select Template' dropdown.
  13. Select '837 Institutional'.
  14. Validate that the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' is not shown.
  15. Click [Submit].
  16. Click [No].
  17. Open the 'Admission' form.
  18. Admit an Inpatient client - "Client 1".
  19. Using the 'Diagnosis' form, File an active diagnosis record for "Client 1".
  20. File the 'Financial Eligibility' form for "Client 1", with "Guarantor 1".
  21. Specify the 'Coverage Effective Date' and 'Coverage Expiration Date' in the financial eligibility.
  22. Create charges for "Client 1" for more than one date(s), that fall between the dates saved in step 21.
  23. Create a new Interim Billing Batch File "Batch 1" which covers the services created for "Client 1" in step 22.
  24. Close the charges using the Interim Billing Batch File "Batch 1".
  25. Open 'Client Ledger'.
  26. Select "Client 1" and the respective Episode.
  27. Validate that all the services are closed.
  28. Open 'Electronic Billing'.
  29. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  30. Set 'First Date Of Service To Include' with the date earlier than the 'Coverage Effective Date' filed in step 21.
  31. Set 'Last Date Of Service To Include' with a date later than the 'Coverage Expiration Date' filed in step 21.
  32. Click [Process].
  33. Validate that the compile completes successfully.
  34. Click [OK].
  35. Select 'Dump File' from 'Billing Options'.
  36. Select 'Print' from 'Print Or Delete Report'.
  37. Select the file compiled in step 31.
  38. Click [Process].
  39. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the 'Coverage Effective date' filed in step 21 and the 'Last Date Of Service To Include' selected in step 29(b).
  40. Close the report.
  41. Click [No].
  42. Open 'Discharge' form.
  43. Set the 'Date Of Discharge' field to a date that is greater than the 'Coverage Expiration Date' filed in step 21.
  44. Fill in all the required fields and select [Submit].
  45. Open 'Electronic Billing'.
  46. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  47. Set 'First Date Of Service To Include' with the date earlier than the 'Coverage Effective Date' filed in step 21.
  48. Set 'Last Date Of Service To Include' with a date later than the 'Coverage Expiration Date' filed in step 21.
  49. Click [Process].
  50. Validate that the compile completes successfully.
  51. Click [OK].
  52. Select 'Dump File' from 'Billing Options'.
  53. Select 'Print' from 'Print Or Delete Report'.
  54. Select the file compiled in step 46.
  55. Click [Process].
  56. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the 'Coverage Effective Date' and 'Coverage Expiration Date' filed in step 21.
  57. Close the report.
  58. Click [No].
  59. Open 'Electronic Billing'.
  60. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  61. Set 'First Date Of Service To Include' with the date later than the 'Coverage Effective Date' filed in step 21.
  62. Set 'Last Date Of Service To Include' with a date earlier than the 'Coverage Expiration Date' filed in step 21.
  63. Click [Process].
  64. Validate that the compile completes successfully.
  65. Click [OK].
  66. Select 'Dump File' from 'Billing Options'.
  67. Select 'Print' from 'Print Or Delete Report'.
  68. Select the file compiled in step 46.
  69. Click [Process].
  70. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the First Date Of Service To Include' and 'Last Date Of Service To Include' dates used in the step 57(a, b).
  71. Close the report.
  72. Click [No].
Scenario 4: "Restrict Coverage Effective Date Edits to Prior Dates Only" registry setting functionality
Specific Setup:
  • Client: The client should be admitted and have an active episode - "Client A".
  • Financial Eligibility: "Client A" should have an already existing Financial Eligibility record with both Coverage Effective and Expiration dates.
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' to 'Restrict Coverage Effective Date Edits to Prior Dates Only'.
  3. Click [View Registry Settings].
  4. Validate that the respective registry setting shows up.
  5. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to a value other than 'Y' or 'N'.
  6. Verify an error message displays that the valid choices are 'Y or N' only.
  7. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to 'Y' and then submit to save.
  8. Open the 'Financial Eligibility' form.
  9. Search and select "Client A".
  10. Select the Episode from the grid.
  11. Select 'Guarantor Selection'.
  12. Check if the 'Coverage Effective Date' field is already showing the date in the file.
  13. Try to enter a date that is after the date that is already in the file and move away from the field.
  14. Validate that an error message appears when updating the 'Coverage Effective Date' field to a date that is later than the previously filed date.
  15. Validate the error text - 'The Coverage Effective Date cannot be updated to be later than the previously filed date.'.
  16. Click [OK].
  17. Validate that the 'Coverage Effective Date' field is restored with the last value saved.
  18. Set 'Coverage Effective Date' with a date that is before the date that is already in the file and move away from the field.
  19. Validate that there are no errors shown.
  20. Click [Submit].
  21. Open the 'Financial Eligibility' form.
  22. Search and select "Client A".
  23. Select the Episode from the grid.
  24. Select 'Guarantor Selection'.
  25. Check if the 'Coverage Effective Date' field is showing with the date we save in step 18.
  26. Click [Discard].
  27. Click [Yes].
  28. Open the 'Registry Settings' form.
  29. Set the 'Limit Registry Settings to the Following Search Criteria' to 'Restrict Coverage Effective Date Edits to Prior Dates Only'.
  30. Click [View Registry Settings].
  31. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to 'N' and then submit to save.
  32. Open the 'Financial Eligibility' form.
  33. Search and select "Client A".
  34. Select the Episode from the grid.
  35. Select 'Guarantor Selection'.
  36. Check if the 'Coverage Effective Date' field is showing with the date we save in step 18.
  37. Try to enter a date that is after the date that is already in the file and move away from the field.
  38. Validate that there are no errors shown.
  39. Click [Submit].
  40. Open the 'Financial Eligibility' form.
  41. Search and select "Client A".
  42. Select the Episode from the grid.
  43. Select 'Guarantor Selection'.
  44. Check if the 'Coverage Effective Date' field is showing with the date we save in step 37.
  45. Click [Discard].
  46. Click [Yes].
Scenario 5: Update Financial Eligibility - 'Coverage Effective Date' - Webservice
Specific Setup:
  • Client: The client should be admitted and have an active episode - "Client A"
  • Financial Eligibility: "Client A" should have an already existing Financial Eligibility record with both Coverage Effective and Expiration dates.
  • Registry Setting: Set the 'Restrict Coverage Effective Date Edits to Prior Dates Only' setting value as 'Y'.
Steps
  1. Open SoapUI or any other web service testing tool.
  2. Create a web service request to update the Financial Eligibility information.
  3. Enter the same value in the "SYSTEMCODE" which is used to sign into Avatar.
  4. Enter the same value in the "USERNAME" which is used to sign into Avatar.
  5. Set the value for 'CoverageEffectiveDate' with a date that is after the date already in the file for "Client A".
  6. Enter values for all other required fields.
  7. Submit the request.
  8. Verify that the service failed to post with the error message: "The Coverage Effective Date cannot be updated to be later than the previously filed date."
  9. Set the value for 'CoverageEffectiveDate' with a date that is before the date already in the file for "Client A".
  10. Submit the request.
  11. Verify that the service was posted successfully with the message: "Financial Eligibility web service has been filed successfully."
  12. Open 'Financial Eligibility' for the "Client A".
  13. Select 'Guarantor Selection'.
  14. Validate that the 'Coverage Effective Date' is showing the value that we posted in step 9.
  15. Click [Discard].
  16. Click [Yes].
Registry Setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Financial Eligibility
  • Client Ledger
  • Electronic Billing
  • Discharge
  • File Import
Scenario 1: 837I Compile - With '837I-Dates To Populate 2300 DTP' RS 1
Specific Setup:
  • Guarantor:
  • An active guarantor is identified or created - "Guarantor 1".
  • Guarantor/Program Billing Defaults Template:
  • An active 'Guarantor/Program Billing Defaults' template is identified or created that includes "Guarantor 1" - "Template 1".
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' text input box to "837I-Dates To Populate 2300 DTP".
  3. Select 'Yes' in 'Include Hidden Registry Settings'.
  4. Click [View Registry Settings].
  5. Validate that the registry setting exists and show the respective values.
  6. Set the 'Registry Setting Value' field to '1'.
  7. Click [Submit].
  8. Click [OK].
  9. Click [No].
  10. Open the 'Guarantor/Program Billing Defaults' form.
  11. Select 'Edit Template'.
  12. Select "Template 1" from the 'Select Template' dropdown.
  13. Select '837 Institutional'.
  14. Validate that the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' is shown with the following options, (none selected by default):
  15. Yes (Inpatient/Outpatient)
  16. Yes (Outpatient Only)
  17. Yes (Inpatient Only)
  18. No (Inpatient/Outpatient)
  19. Click [Submit].
  20. Click [No].
  21. Open the 'Admission' form.
  22. Admit an Inpatient client - "Client 1".
  23. Using the 'Diagnosis' form, File an active diagnosis record for "Client 1".
  24. File the 'Financial Eligibility' form for "Client 1", with "Guarantor 1".
  25. Specify the 'Coverage Effective Date' and 'Coverage Expiration Date' in the financial eligibility.
  26. Create charges for "Client 1" for more than one date, with the dates between the dates saved in step 21.
  27. Create a new Interim Billing Batch File, "Batch 1", which covers the services created for "Client 1" in step 22.
  28. Close the charges using the Interim Billing Batch File, "Batch 1".
  29. Open 'Client Ledger'.
  30. Select "Client 1" and the respective Episode.
  31. Validate that all the services are closed.
  32. Open 'Electronic Billing'.
  33. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  34. Set 'First Date Of Service To Include' with a date before the 'Coverage Effective Date' filed in step 21.
  35. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  36. Click [Process].
  37. Validate that the compile completes successfully.
  38. Click [OK].
  39. Select 'Dump File' from 'Billing Options'.
  40. Select 'Print' from 'Print Or Delete Report'.
  41. Select the file compiled in step 31.
  42. Click [Process].
  43. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  44. Close the report.
  45. Click [No].
  46. Open 'Discharge' form.
  47. Set the 'Date Of Discharge' field to a date that is the day after the last day of service.
  48. Fill in all the required fields and select [Submit].
  49. Open 'Electronic Billing'.
  50. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  51. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  52. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  53. Click [Process].
  54. Validate that the compile completes successfully.
  55. Click [OK].
  56. Select 'Dump File' from 'Billing Options'.
  57. Select 'Print' from 'Print Or Delete Report'.
  58. Select the file compiled in step 46.
  59. Click [Process].
  60. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  61. Close the report.
  62. Click [No].
  63. Open the 'Guarantor/Program Billing Defaults' form.
  64. Select 'Edit Template'.
  65. Select "Template 1" from the 'Select Template' dropdown.
  66. Select '837 Institutional'.
  67. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient/Outpatient)'.
  68. Click [Submit].
  69. Click [No].
  70. Open 'Electronic Billing'.
  71. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  72. Set 'First Date Of Service To Include' a date before the 'Coverage Effective Date' filed in step 21.
  73. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  74. Click [Process].
  75. Validate that the compile completes successfully.
  76. Click [OK].
  77. Select 'Dump File' from 'Billing Options'.
  78. Select 'Print' from 'Print Or Delete Report'.
  79. Select the file compiled in step 65.
  80. Click [Process].
  81. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  82. Close the report.
  83. Click [No].
  84. Open the 'Guarantor/Program Billing Defaults' form.
  85. Select 'Edit Template'.
  86. Select "Template 1" from the 'Select Template' dropdown.
  87. Select '837 Institutional'.
  88. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient Only)'.
  89. Click [Submit].
  90. Click [No].
  91. Open 'Electronic Billing'.
  92. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  93. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  94. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  95. Click [Process].
  96. Validate that the compile completes successfully.
  97. Click [OK].
  98. Select 'Dump File' from 'Billing Options'.
  99. Select 'Print' from 'Print Or Delete Report'.
  100. Select the file compiled in step 85.
  101. Click [Process].
  102. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  103. Close the report.
  104. Click [No].
  105. Open the 'Guarantor/Program Billing Defaults' form.
  106. Select 'Edit Template'.
  107. Select "Template 1" from the 'Select Template' dropdown.
  108. Select '837 Institutional'.
  109. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient Only)'.
  110. Click [Submit].
  111. Click [No].
  112. Open 'Electronic Billing'.
  113. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  114. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  115. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  116. Click [Process].
  117. Validate that the compile completes successfully.
  118. Click [OK].
  119. Select 'Dump File' from 'Billing Options'.
  120. Select 'Print' from 'Print Or Delete Report'.
  121. Select the file compiled in step 105.
  122. Click [Process].
  123. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  124. Close the report.
  125. Click [No].
  126. Open the 'Guarantor/Program Billing Defaults' form.
  127. Select 'Edit Template'.
  128. Select "Template 1" from the 'Select Template' dropdown.
  129. Select '837 Institutional'.
  130. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'No (Inpatient/Outpatient)'.
  131. Click [Submit].
  132. Click [No].
  133. Open 'Electronic Billing'.
  134. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  135. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  136. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  137. Click [Process].
  138. Validate that the compile completes successfully.
  139. Click [OK].
  140. Select 'Dump File' from 'Billing Options'.
  141. Select 'Print' from 'Print Or Delete Report'.
  142. Select the file compiled in step 105.
  143. Click [Process].
  144. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  145. Close the report.
  146. Click [No].
  147. Query the tables below and validate that the new columns 'inc_dis_dt_2300_dtp_code' and 'inc_dis_dt_2300_dtp_value' are shown with the field 'Include Discharge Date In Statement To Date (2300-DTP)' value,
  148. SYSTEM.file_import_gpbdt_i837
  149. SYSTEM.table_837_i_facility_prov_num
  150. Close the SQL query window.
Scenario 2: File Import - Guarantor Program Billing Defaults - New field validations
Specific Setup:
  • At least one 'Guarantor/Program Billing Defaults' template exists, "Template 1", and the 837 Professional and Institutional sections contain data.
  • Files can be saved to the local desktop, "File A", edited, and imported back into Avatar through 'File Import'.
  • Registry setting '837I-Dates To Populate 2300 DTP' value set as '1'.
Steps
  1. Open 'Guarantor/Program Billing Defaults'.
  2. Edit the ‘837 Institutional’ section of "Template 1".
  3. Validate that the new field has no values selected.
  4. Click [Submit].
  5. Export the template in 'Edit' mode, saving it to the desktop with a unique name "File A".
  6. Edit the 'Edit' mode template to have a value defined for piece 130- 'Include Discharge Date In Statement To Date (2300-DTP)' and save it.
  7. Open 'File Import'.
  8. Import/Compile/Post the 'Edit' mode template "File A" in the 'Guarantor/Program Billing Defaults Template' file type.
  9. Select 'Print File'.
  10. Print the file posted in step 8 by selecting it and clicking 'Process Action'.
  11. Validate that the Crystal report is included with the new field 'Include Discharge Date In Statement To Date (2300-DTP)' and it's value we selected in step 6 for file import for 837 Institutional.
  12. Open 'Guarantor/Program Billing Defaults'.
  13. Select 'Edit Template'.
  14. Select the 'Edit mode template', "Template 1".
  15. Select the ‘837 Professional’ section. The field, 'Include Discharge Date In Statement To Date (2300-DTP)' will have the value used in step 6.
  16. Click [Submit].
  17. Click [No].
Scenario 3: 837I Compile - With '837I-Dates To Populate 2300 DTP' RS 2
Specific Setup:
  • Guarantor:
  • An active guarantor is identified or created - "Guarantor 1".
  • Guarantor/Program Billing Defaults Template:
  • An active 'Guarantor/Program Billing Defaults' template is identified or created that includes "Guarantor 1" - "Template 1".
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' text input box to "837I-Dates To Populate 2300 DTP".
  3. Select 'Yes' in 'Include Hidden Registry Settings'.
  4. Click [View Registry Settings].
  5. Validate that the registry setting exists and show the respective values.
  6. Set the 'Registry Setting Value' field to '2'.
  7. Click [Submit].
  8. Click [OK].
  9. Click [No].
  10. Open the 'Guarantor/Program Billing Defaults' form.
  11. Select 'Edit Template'.
  12. Select "Template 1" from the 'Select Template' dropdown.
  13. Select '837 Institutional'.
  14. Validate that the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' is not shown.
  15. Click [Submit].
  16. Click [No].
  17. Open the 'Admission' form.
  18. Admit an Inpatient client - "Client 1".
  19. Using the 'Diagnosis' form, File an active diagnosis record for "Client 1".
  20. File the 'Financial Eligibility' form for "Client 1", with "Guarantor 1".
  21. Specify the 'Coverage Effective Date' and 'Coverage Expiration Date' in the financial eligibility.
  22. Create charges for "Client 1" for more than one date(s), that fall between the dates saved in step 21.
  23. Create a new Interim Billing Batch File "Batch 1" which covers the services created for "Client 1" in step 22.
  24. Close the charges using the Interim Billing Batch File "Batch 1".
  25. Open 'Client Ledger'.
  26. Select "Client 1" and the respective Episode.
  27. Validate that all the services are closed.
  28. Open 'Electronic Billing'.
  29. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  30. Set 'First Date Of Service To Include' with the date earlier than the 'Coverage Effective Date' filed in step 21.
  31. Set 'Last Date Of Service To Include' with a date later than the 'Coverage Expiration Date' filed in step 21.
  32. Click [Process].
  33. Validate that the compile completes successfully.
  34. Click [OK].
  35. Select 'Dump File' from 'Billing Options'.
  36. Select 'Print' from 'Print Or Delete Report'.
  37. Select the file compiled in step 31.
  38. Click [Process].
  39. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the 'Coverage Effective date' filed in step 21 and the 'Last Date Of Service To Include' selected in step 29(b).
  40. Close the report.
  41. Click [No].
  42. Open 'Discharge' form.
  43. Set the 'Date Of Discharge' field to a date that is greater than the 'Coverage Expiration Date' filed in step 21.
  44. Fill in all the required fields and select [Submit].
  45. Open 'Electronic Billing'.
  46. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  47. Set 'First Date Of Service To Include' with the date earlier than the 'Coverage Effective Date' filed in step 21.
  48. Set 'Last Date Of Service To Include' with a date later than the 'Coverage Expiration Date' filed in step 21.
  49. Click [Process].
  50. Validate that the compile completes successfully.
  51. Click [OK].
  52. Select 'Dump File' from 'Billing Options'.
  53. Select 'Print' from 'Print Or Delete Report'.
  54. Select the file compiled in step 46.
  55. Click [Process].
  56. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the 'Coverage Effective Date' and 'Coverage Expiration Date' filed in step 21.
  57. Close the report.
  58. Click [No].
  59. Open 'Electronic Billing'.
  60. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  61. Set 'First Date Of Service To Include' with the date later than the 'Coverage Effective Date' filed in step 21.
  62. Set 'Last Date Of Service To Include' with a date earlier than the 'Coverage Expiration Date' filed in step 21.
  63. Click [Process].
  64. Validate that the compile completes successfully.
  65. Click [OK].
  66. Select 'Dump File' from 'Billing Options'.
  67. Select 'Print' from 'Print Or Delete Report'.
  68. Select the file compiled in step 46.
  69. Click [Process].
  70. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the First Date Of Service To Include' and 'Last Date Of Service To Include' dates used in the step 57(a, b).
  71. Close the report.
  72. Click [No].
Scenario 4: "Restrict Coverage Effective Date Edits to Prior Dates Only" registry setting functionality
Specific Setup:
  • Client: The client should be admitted and have an active episode - "Client A".
  • Financial Eligibility: "Client A" should have an already existing Financial Eligibility record with both Coverage Effective and Expiration dates.
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' to 'Restrict Coverage Effective Date Edits to Prior Dates Only'.
  3. Click [View Registry Settings].
  4. Validate that the respective registry setting shows up.
  5. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to a value other than 'Y' or 'N'.
  6. Verify an error message displays that the valid choices are 'Y or N' only.
  7. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to 'Y' and then submit to save.
  8. Open the 'Financial Eligibility' form.
  9. Search and select "Client A".
  10. Select the Episode from the grid.
  11. Select 'Guarantor Selection'.
  12. Check if the 'Coverage Effective Date' field is already showing the date in the file.
  13. Try to enter a date that is after the date that is already in the file and move away from the field.
  14. Validate that an error message appears when updating the 'Coverage Effective Date' field to a date that is later than the previously filed date.
  15. Validate the error text - 'The Coverage Effective Date cannot be updated to be later than the previously filed date.'.
  16. Click [OK].
  17. Validate that the 'Coverage Effective Date' field is restored with the last value saved.
  18. Set 'Coverage Effective Date' with a date that is before the date that is already in the file and move away from the field.
  19. Validate that there are no errors shown.
  20. Click [Submit].
  21. Open the 'Financial Eligibility' form.
  22. Search and select "Client A".
  23. Select the Episode from the grid.
  24. Select 'Guarantor Selection'.
  25. Check if the 'Coverage Effective Date' field is showing with the date we save in step 18.
  26. Click [Discard].
  27. Click [Yes].
  28. Open the 'Registry Settings' form.
  29. Set the 'Limit Registry Settings to the Following Search Criteria' to 'Restrict Coverage Effective Date Edits to Prior Dates Only'.
  30. Click [View Registry Settings].
  31. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to 'N' and then submit to save.
  32. Open the 'Financial Eligibility' form.
  33. Search and select "Client A".
  34. Select the Episode from the grid.
  35. Select 'Guarantor Selection'.
  36. Check if the 'Coverage Effective Date' field is showing with the date we save in step 18.
  37. Try to enter a date that is after the date that is already in the file and move away from the field.
  38. Validate that there are no errors shown.
  39. Click [Submit].
  40. Open the 'Financial Eligibility' form.
  41. Search and select "Client A".
  42. Select the Episode from the grid.
  43. Select 'Guarantor Selection'.
  44. Check if the 'Coverage Effective Date' field is showing with the date we save in step 37.
  45. Click [Discard].
  46. Click [Yes].
Registry Setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Financial Eligibility
  • Client Ledger
  • Electronic Billing
  • Discharge
  • File Import
Scenario 1: 837I Compile - With '837I-Dates To Populate 2300 DTP' RS 1
Specific Setup:
  • Guarantor:
  • An active guarantor is identified or created - "Guarantor 1".
  • Guarantor/Program Billing Defaults Template:
  • An active 'Guarantor/Program Billing Defaults' template is identified or created that includes "Guarantor 1" - "Template 1".
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' text input box to "837I-Dates To Populate 2300 DTP".
  3. Select 'Yes' in 'Include Hidden Registry Settings'.
  4. Click [View Registry Settings].
  5. Validate that the registry setting exists and show the respective values.
  6. Set the 'Registry Setting Value' field to '1'.
  7. Click [Submit].
  8. Click [OK].
  9. Click [No].
  10. Open the 'Guarantor/Program Billing Defaults' form.
  11. Select 'Edit Template'.
  12. Select "Template 1" from the 'Select Template' dropdown.
  13. Select '837 Institutional'.
  14. Validate that the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' is shown with the following options, (none selected by default):
  15. Yes (Inpatient/Outpatient)
  16. Yes (Outpatient Only)
  17. Yes (Inpatient Only)
  18. No (Inpatient/Outpatient)
  19. Click [Submit].
  20. Click [No].
  21. Open the 'Admission' form.
  22. Admit an Inpatient client - "Client 1".
  23. Using the 'Diagnosis' form, File an active diagnosis record for "Client 1".
  24. File the 'Financial Eligibility' form for "Client 1", with "Guarantor 1".
  25. Specify the 'Coverage Effective Date' and 'Coverage Expiration Date' in the financial eligibility.
  26. Create charges for "Client 1" for more than one date, with the dates between the dates saved in step 21.
  27. Create a new Interim Billing Batch File, "Batch 1", which covers the services created for "Client 1" in step 22.
  28. Close the charges using the Interim Billing Batch File, "Batch 1".
  29. Open 'Client Ledger'.
  30. Select "Client 1" and the respective Episode.
  31. Validate that all the services are closed.
  32. Open 'Electronic Billing'.
  33. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  34. Set 'First Date Of Service To Include' with a date before the 'Coverage Effective Date' filed in step 21.
  35. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  36. Click [Process].
  37. Validate that the compile completes successfully.
  38. Click [OK].
  39. Select 'Dump File' from 'Billing Options'.
  40. Select 'Print' from 'Print Or Delete Report'.
  41. Select the file compiled in step 31.
  42. Click [Process].
  43. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  44. Close the report.
  45. Click [No].
  46. Open 'Discharge' form.
  47. Set the 'Date Of Discharge' field to a date that is the day after the last day of service.
  48. Fill in all the required fields and select [Submit].
  49. Open 'Electronic Billing'.
  50. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  51. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  52. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  53. Click [Process].
  54. Validate that the compile completes successfully.
  55. Click [OK].
  56. Select 'Dump File' from 'Billing Options'.
  57. Select 'Print' from 'Print Or Delete Report'.
  58. Select the file compiled in step 46.
  59. Click [Process].
  60. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  61. Close the report.
  62. Click [No].
  63. Open the 'Guarantor/Program Billing Defaults' form.
  64. Select 'Edit Template'.
  65. Select "Template 1" from the 'Select Template' dropdown.
  66. Select '837 Institutional'.
  67. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient/Outpatient)'.
  68. Click [Submit].
  69. Click [No].
  70. Open 'Electronic Billing'.
  71. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  72. Set 'First Date Of Service To Include' a date before the 'Coverage Effective Date' filed in step 21.
  73. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  74. Click [Process].
  75. Validate that the compile completes successfully.
  76. Click [OK].
  77. Select 'Dump File' from 'Billing Options'.
  78. Select 'Print' from 'Print Or Delete Report'.
  79. Select the file compiled in step 65.
  80. Click [Process].
  81. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  82. Close the report.
  83. Click [No].
  84. Open the 'Guarantor/Program Billing Defaults' form.
  85. Select 'Edit Template'.
  86. Select "Template 1" from the 'Select Template' dropdown.
  87. Select '837 Institutional'.
  88. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient Only)'.
  89. Click [Submit].
  90. Click [No].
  91. Open 'Electronic Billing'.
  92. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  93. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  94. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  95. Click [Process].
  96. Validate that the compile completes successfully.
  97. Click [OK].
  98. Select 'Dump File' from 'Billing Options'.
  99. Select 'Print' from 'Print Or Delete Report'.
  100. Select the file compiled in step 85.
  101. Click [Process].
  102. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  103. Close the report.
  104. Click [No].
  105. Open the 'Guarantor/Program Billing Defaults' form.
  106. Select 'Edit Template'.
  107. Select "Template 1" from the 'Select Template' dropdown.
  108. Select '837 Institutional'.
  109. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient Only)'.
  110. Click [Submit].
  111. Click [No].
  112. Open 'Electronic Billing'.
  113. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  114. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  115. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  116. Click [Process].
  117. Validate that the compile completes successfully.
  118. Click [OK].
  119. Select 'Dump File' from 'Billing Options'.
  120. Select 'Print' from 'Print Or Delete Report'.
  121. Select the file compiled in step 105.
  122. Click [Process].
  123. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  124. Close the report.
  125. Click [No].
  126. Open the 'Guarantor/Program Billing Defaults' form.
  127. Select 'Edit Template'.
  128. Select "Template 1" from the 'Select Template' dropdown.
  129. Select '837 Institutional'.
  130. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'No (Inpatient/Outpatient)'.
  131. Click [Submit].
  132. Click [No].
  133. Open 'Electronic Billing'.
  134. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  135. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  136. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  137. Click [Process].
  138. Validate that the compile completes successfully.
  139. Click [OK].
  140. Select 'Dump File' from 'Billing Options'.
  141. Select 'Print' from 'Print Or Delete Report'.
  142. Select the file compiled in step 105.
  143. Click [Process].
  144. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  145. Close the report.
  146. Click [No].
  147. Query the tables below and validate that the new columns 'inc_dis_dt_2300_dtp_code' and 'inc_dis_dt_2300_dtp_value' are shown with the field 'Include Discharge Date In Statement To Date (2300-DTP)' value,
  148. SYSTEM.file_import_gpbdt_i837
  149. SYSTEM.table_837_i_facility_prov_num
  150. Close the SQL query window.
Scenario 2: File Import - Guarantor Program Billing Defaults - New field validations
Specific Setup:
  • At least one 'Guarantor/Program Billing Defaults' template exists, "Template 1", and the 837 Professional and Institutional sections contain data.
  • Files can be saved to the local desktop, "File A", edited, and imported back into Avatar through 'File Import'.
  • Registry setting '837I-Dates To Populate 2300 DTP' value set as '1'.
Steps
  1. Open 'Guarantor/Program Billing Defaults'.
  2. Edit the ‘837 Institutional’ section of "Template 1".
  3. Validate that the new field has no values selected.
  4. Click [Submit].
  5. Export the template in 'Edit' mode, saving it to the desktop with a unique name "File A".
  6. Edit the 'Edit' mode template to have a value defined for piece 130- 'Include Discharge Date In Statement To Date (2300-DTP)' and save it.
  7. Open 'File Import'.
  8. Import/Compile/Post the 'Edit' mode template "File A" in the 'Guarantor/Program Billing Defaults Template' file type.
  9. Select 'Print File'.
  10. Print the file posted in step 8 by selecting it and clicking 'Process Action'.
  11. Validate that the Crystal report is included with the new field 'Include Discharge Date In Statement To Date (2300-DTP)' and it's value we selected in step 6 for file import for 837 Institutional.
  12. Open 'Guarantor/Program Billing Defaults'.
  13. Select 'Edit Template'.
  14. Select the 'Edit mode template', "Template 1".
  15. Select the ‘837 Professional’ section. The field, 'Include Discharge Date In Statement To Date (2300-DTP)' will have the value used in step 6.
  16. Click [Submit].
  17. Click [No].
Scenario 3: 837I Compile - With '837I-Dates To Populate 2300 DTP' RS 2
Specific Setup:
  • Guarantor:
  • An active guarantor is identified or created - "Guarantor 1".
  • Guarantor/Program Billing Defaults Template:
  • An active 'Guarantor/Program Billing Defaults' template is identified or created that includes "Guarantor 1" - "Template 1".
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' text input box to "837I-Dates To Populate 2300 DTP".
  3. Select 'Yes' in 'Include Hidden Registry Settings'.
  4. Click [View Registry Settings].
  5. Validate that the registry setting exists and show the respective values.
  6. Set the 'Registry Setting Value' field to '2'.
  7. Click [Submit].
  8. Click [OK].
  9. Click [No].
  10. Open the 'Guarantor/Program Billing Defaults' form.
  11. Select 'Edit Template'.
  12. Select "Template 1" from the 'Select Template' dropdown.
  13. Select '837 Institutional'.
  14. Validate that the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' is not shown.
  15. Click [Submit].
  16. Click [No].
  17. Open the 'Admission' form.
  18. Admit an Inpatient client - "Client 1".
  19. Using the 'Diagnosis' form, File an active diagnosis record for "Client 1".
  20. File the 'Financial Eligibility' form for "Client 1", with "Guarantor 1".
  21. Specify the 'Coverage Effective Date' and 'Coverage Expiration Date' in the financial eligibility.
  22. Create charges for "Client 1" for more than one date(s), that fall between the dates saved in step 21.
  23. Create a new Interim Billing Batch File "Batch 1" which covers the services created for "Client 1" in step 22.
  24. Close the charges using the Interim Billing Batch File "Batch 1".
  25. Open 'Client Ledger'.
  26. Select "Client 1" and the respective Episode.
  27. Validate that all the services are closed.
  28. Open 'Electronic Billing'.
  29. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  30. Set 'First Date Of Service To Include' with the date earlier than the 'Coverage Effective Date' filed in step 21.
  31. Set 'Last Date Of Service To Include' with a date later than the 'Coverage Expiration Date' filed in step 21.
  32. Click [Process].
  33. Validate that the compile completes successfully.
  34. Click [OK].
  35. Select 'Dump File' from 'Billing Options'.
  36. Select 'Print' from 'Print Or Delete Report'.
  37. Select the file compiled in step 31.
  38. Click [Process].
  39. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the 'Coverage Effective date' filed in step 21 and the 'Last Date Of Service To Include' selected in step 29(b).
  40. Close the report.
  41. Click [No].
  42. Open 'Discharge' form.
  43. Set the 'Date Of Discharge' field to a date that is greater than the 'Coverage Expiration Date' filed in step 21.
  44. Fill in all the required fields and select [Submit].
  45. Open 'Electronic Billing'.
  46. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  47. Set 'First Date Of Service To Include' with the date earlier than the 'Coverage Effective Date' filed in step 21.
  48. Set 'Last Date Of Service To Include' with a date later than the 'Coverage Expiration Date' filed in step 21.
  49. Click [Process].
  50. Validate that the compile completes successfully.
  51. Click [OK].
  52. Select 'Dump File' from 'Billing Options'.
  53. Select 'Print' from 'Print Or Delete Report'.
  54. Select the file compiled in step 46.
  55. Click [Process].
  56. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the 'Coverage Effective Date' and 'Coverage Expiration Date' filed in step 21.
  57. Close the report.
  58. Click [No].
  59. Open 'Electronic Billing'.
  60. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  61. Set 'First Date Of Service To Include' with the date later than the 'Coverage Effective Date' filed in step 21.
  62. Set 'Last Date Of Service To Include' with a date earlier than the 'Coverage Expiration Date' filed in step 21.
  63. Click [Process].
  64. Validate that the compile completes successfully.
  65. Click [OK].
  66. Select 'Dump File' from 'Billing Options'.
  67. Select 'Print' from 'Print Or Delete Report'.
  68. Select the file compiled in step 46.
  69. Click [Process].
  70. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the First Date Of Service To Include' and 'Last Date Of Service To Include' dates used in the step 57(a, b).
  71. Close the report.
  72. Click [No].
Scenario 4: "Restrict Coverage Effective Date Edits to Prior Dates Only" registry setting functionality
Specific Setup:
  • Client: The client should be admitted and have an active episode - "Client A".
  • Financial Eligibility: "Client A" should have an already existing Financial Eligibility record with both Coverage Effective and Expiration dates.
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' to 'Restrict Coverage Effective Date Edits to Prior Dates Only'.
  3. Click [View Registry Settings].
  4. Validate that the respective registry setting shows up.
  5. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to a value other than 'Y' or 'N'.
  6. Verify an error message displays that the valid choices are 'Y or N' only.
  7. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to 'Y' and then submit to save.
  8. Open the 'Financial Eligibility' form.
  9. Search and select "Client A".
  10. Select the Episode from the grid.
  11. Select 'Guarantor Selection'.
  12. Check if the 'Coverage Effective Date' field is already showing the date in the file.
  13. Try to enter a date that is after the date that is already in the file and move away from the field.
  14. Validate that an error message appears when updating the 'Coverage Effective Date' field to a date that is later than the previously filed date.
  15. Validate the error text - 'The Coverage Effective Date cannot be updated to be later than the previously filed date.'.
  16. Click [OK].
  17. Validate that the 'Coverage Effective Date' field is restored with the last value saved.
  18. Set 'Coverage Effective Date' with a date that is before the date that is already in the file and move away from the field.
  19. Validate that there are no errors shown.
  20. Click [Submit].
  21. Open the 'Financial Eligibility' form.
  22. Search and select "Client A".
  23. Select the Episode from the grid.
  24. Select 'Guarantor Selection'.
  25. Check if the 'Coverage Effective Date' field is showing with the date we save in step 18.
  26. Click [Discard].
  27. Click [Yes].
  28. Open the 'Registry Settings' form.
  29. Set the 'Limit Registry Settings to the Following Search Criteria' to 'Restrict Coverage Effective Date Edits to Prior Dates Only'.
  30. Click [View Registry Settings].
  31. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to 'N' and then submit to save.
  32. Open the 'Financial Eligibility' form.
  33. Search and select "Client A".
  34. Select the Episode from the grid.
  35. Select 'Guarantor Selection'.
  36. Check if the 'Coverage Effective Date' field is showing with the date we save in step 18.
  37. Try to enter a date that is after the date that is already in the file and move away from the field.
  38. Validate that there are no errors shown.
  39. Click [Submit].
  40. Open the 'Financial Eligibility' form.
  41. Search and select "Client A".
  42. Select the Episode from the grid.
  43. Select 'Guarantor Selection'.
  44. Check if the 'Coverage Effective Date' field is showing with the date we save in step 37.
  45. Click [Discard].
  46. Click [Yes].
Registry Setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Financial Eligibility
  • Client Ledger
  • Electronic Billing
  • Discharge
  • File Import
Scenario 1: 837I Compile - With '837I-Dates To Populate 2300 DTP' RS 1
Specific Setup:
  • Guarantor:
  • An active guarantor is identified or created - "Guarantor 1".
  • Guarantor/Program Billing Defaults Template:
  • An active 'Guarantor/Program Billing Defaults' template is identified or created that includes "Guarantor 1" - "Template 1".
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' text input box to "837I-Dates To Populate 2300 DTP".
  3. Select 'Yes' in 'Include Hidden Registry Settings'.
  4. Click [View Registry Settings].
  5. Validate that the registry setting exists and show the respective values.
  6. Set the 'Registry Setting Value' field to '1'.
  7. Click [Submit].
  8. Click [OK].
  9. Click [No].
  10. Open the 'Guarantor/Program Billing Defaults' form.
  11. Select 'Edit Template'.
  12. Select "Template 1" from the 'Select Template' dropdown.
  13. Select '837 Institutional'.
  14. Validate that the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' is shown with the following options, (none selected by default):
  15. Yes (Inpatient/Outpatient)
  16. Yes (Outpatient Only)
  17. Yes (Inpatient Only)
  18. No (Inpatient/Outpatient)
  19. Click [Submit].
  20. Click [No].
  21. Open the 'Admission' form.
  22. Admit an Inpatient client - "Client 1".
  23. Using the 'Diagnosis' form, File an active diagnosis record for "Client 1".
  24. File the 'Financial Eligibility' form for "Client 1", with "Guarantor 1".
  25. Specify the 'Coverage Effective Date' and 'Coverage Expiration Date' in the financial eligibility.
  26. Create charges for "Client 1" for more than one date, with the dates between the dates saved in step 21.
  27. Create a new Interim Billing Batch File, "Batch 1", which covers the services created for "Client 1" in step 22.
  28. Close the charges using the Interim Billing Batch File, "Batch 1".
  29. Open 'Client Ledger'.
  30. Select "Client 1" and the respective Episode.
  31. Validate that all the services are closed.
  32. Open 'Electronic Billing'.
  33. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  34. Set 'First Date Of Service To Include' with a date before the 'Coverage Effective Date' filed in step 21.
  35. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  36. Click [Process].
  37. Validate that the compile completes successfully.
  38. Click [OK].
  39. Select 'Dump File' from 'Billing Options'.
  40. Select 'Print' from 'Print Or Delete Report'.
  41. Select the file compiled in step 31.
  42. Click [Process].
  43. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  44. Close the report.
  45. Click [No].
  46. Open 'Discharge' form.
  47. Set the 'Date Of Discharge' field to a date that is the day after the last day of service.
  48. Fill in all the required fields and select [Submit].
  49. Open 'Electronic Billing'.
  50. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  51. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  52. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  53. Click [Process].
  54. Validate that the compile completes successfully.
  55. Click [OK].
  56. Select 'Dump File' from 'Billing Options'.
  57. Select 'Print' from 'Print Or Delete Report'.
  58. Select the file compiled in step 46.
  59. Click [Process].
  60. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  61. Close the report.
  62. Click [No].
  63. Open the 'Guarantor/Program Billing Defaults' form.
  64. Select 'Edit Template'.
  65. Select "Template 1" from the 'Select Template' dropdown.
  66. Select '837 Institutional'.
  67. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient/Outpatient)'.
  68. Click [Submit].
  69. Click [No].
  70. Open 'Electronic Billing'.
  71. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  72. Set 'First Date Of Service To Include' a date before the 'Coverage Effective Date' filed in step 21.
  73. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  74. Click [Process].
  75. Validate that the compile completes successfully.
  76. Click [OK].
  77. Select 'Dump File' from 'Billing Options'.
  78. Select 'Print' from 'Print Or Delete Report'.
  79. Select the file compiled in step 65.
  80. Click [Process].
  81. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  82. Close the report.
  83. Click [No].
  84. Open the 'Guarantor/Program Billing Defaults' form.
  85. Select 'Edit Template'.
  86. Select "Template 1" from the 'Select Template' dropdown.
  87. Select '837 Institutional'.
  88. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient Only)'.
  89. Click [Submit].
  90. Click [No].
  91. Open 'Electronic Billing'.
  92. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  93. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  94. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  95. Click [Process].
  96. Validate that the compile completes successfully.
  97. Click [OK].
  98. Select 'Dump File' from 'Billing Options'.
  99. Select 'Print' from 'Print Or Delete Report'.
  100. Select the file compiled in step 85.
  101. Click [Process].
  102. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first date of the service being billed and the discharge date file in step 41.
  103. Close the report.
  104. Click [No].
  105. Open the 'Guarantor/Program Billing Defaults' form.
  106. Select 'Edit Template'.
  107. Select "Template 1" from the 'Select Template' dropdown.
  108. Select '837 Institutional'.
  109. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'Yes (Inpatient Only)'.
  110. Click [Submit].
  111. Click [No].
  112. Open 'Electronic Billing'.
  113. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  114. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  115. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  116. Click [Process].
  117. Validate that the compile completes successfully.
  118. Click [OK].
  119. Select 'Dump File' from 'Billing Options'.
  120. Select 'Print' from 'Print Or Delete Report'.
  121. Select the file compiled in step 105.
  122. Click [Process].
  123. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  124. Close the report.
  125. Click [No].
  126. Open the 'Guarantor/Program Billing Defaults' form.
  127. Select 'Edit Template'.
  128. Select "Template 1" from the 'Select Template' dropdown.
  129. Select '837 Institutional'.
  130. Set the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' to 'No (Inpatient/Outpatient)'.
  131. Click [Submit].
  132. Click [No].
  133. Open 'Electronic Billing'.
  134. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  135. Set 'First Date Of Service To Include' with the date before the 'Coverage Effective Date' filed in step 21.
  136. Set ' Last Date Of Service To Include' with a date after the 'Coverage Expiration Date' filed in step 21.
  137. Click [Process].
  138. Validate that the compile completes successfully.
  139. Click [OK].
  140. Select 'Dump File' from 'Billing Options'.
  141. Select 'Print' from 'Print Or Delete Report'.
  142. Select the file compiled in step 105.
  143. Click [Process].
  144. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the first and last dates of the services being billed.
  145. Close the report.
  146. Click [No].
  147. Query the tables below and validate that the new columns 'inc_dis_dt_2300_dtp_code' and 'inc_dis_dt_2300_dtp_value' are shown with the field 'Include Discharge Date In Statement To Date (2300-DTP)' value,
  148. SYSTEM.file_import_gpbdt_i837
  149. SYSTEM.table_837_i_facility_prov_num
  150. Close the SQL query window.
Scenario 2: File Import - Guarantor Program Billing Defaults - New field validations
Specific Setup:
  • At least one 'Guarantor/Program Billing Defaults' template exists, "Template 1", and the 837 Professional and Institutional sections contain data.
  • Files can be saved to the local desktop, "File A", edited, and imported back into Avatar through 'File Import'.
  • Registry setting '837I-Dates To Populate 2300 DTP' value set as '1'.
Steps
  1. Open 'Guarantor/Program Billing Defaults'.
  2. Edit the ‘837 Institutional’ section of "Template 1".
  3. Validate that the new field has no values selected.
  4. Click [Submit].
  5. Export the template in 'Edit' mode, saving it to the desktop with a unique name "File A".
  6. Edit the 'Edit' mode template to have a value defined for piece 130- 'Include Discharge Date In Statement To Date (2300-DTP)' and save it.
  7. Open 'File Import'.
  8. Import/Compile/Post the 'Edit' mode template "File A" in the 'Guarantor/Program Billing Defaults Template' file type.
  9. Select 'Print File'.
  10. Print the file posted in step 8 by selecting it and clicking 'Process Action'.
  11. Validate that the Crystal report is included with the new field 'Include Discharge Date In Statement To Date (2300-DTP)' and it's value we selected in step 6 for file import for 837 Institutional.
  12. Open 'Guarantor/Program Billing Defaults'.
  13. Select 'Edit Template'.
  14. Select the 'Edit mode template', "Template 1".
  15. Select the ‘837 Professional’ section. The field, 'Include Discharge Date In Statement To Date (2300-DTP)' will have the value used in step 6.
  16. Click [Submit].
  17. Click [No].
Scenario 3: 837I Compile - With '837I-Dates To Populate 2300 DTP' RS 2
Specific Setup:
  • Guarantor:
  • An active guarantor is identified or created - "Guarantor 1".
  • Guarantor/Program Billing Defaults Template:
  • An active 'Guarantor/Program Billing Defaults' template is identified or created that includes "Guarantor 1" - "Template 1".
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' text input box to "837I-Dates To Populate 2300 DTP".
  3. Select 'Yes' in 'Include Hidden Registry Settings'.
  4. Click [View Registry Settings].
  5. Validate that the registry setting exists and show the respective values.
  6. Set the 'Registry Setting Value' field to '2'.
  7. Click [Submit].
  8. Click [OK].
  9. Click [No].
  10. Open the 'Guarantor/Program Billing Defaults' form.
  11. Select 'Edit Template'.
  12. Select "Template 1" from the 'Select Template' dropdown.
  13. Select '837 Institutional'.
  14. Validate that the new field, 'Include Discharge Date In Statement To Date (2300-DTP)' is not shown.
  15. Click [Submit].
  16. Click [No].
  17. Open the 'Admission' form.
  18. Admit an Inpatient client - "Client 1".
  19. Using the 'Diagnosis' form, File an active diagnosis record for "Client 1".
  20. File the 'Financial Eligibility' form for "Client 1", with "Guarantor 1".
  21. Specify the 'Coverage Effective Date' and 'Coverage Expiration Date' in the financial eligibility.
  22. Create charges for "Client 1" for more than one date(s), that fall between the dates saved in step 21.
  23. Create a new Interim Billing Batch File "Batch 1" which covers the services created for "Client 1" in step 22.
  24. Close the charges using the Interim Billing Batch File "Batch 1".
  25. Open 'Client Ledger'.
  26. Select "Client 1" and the respective Episode.
  27. Validate that all the services are closed.
  28. Open 'Electronic Billing'.
  29. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  30. Set 'First Date Of Service To Include' with the date earlier than the 'Coverage Effective Date' filed in step 21.
  31. Set 'Last Date Of Service To Include' with a date later than the 'Coverage Expiration Date' filed in step 21.
  32. Click [Process].
  33. Validate that the compile completes successfully.
  34. Click [OK].
  35. Select 'Dump File' from 'Billing Options'.
  36. Select 'Print' from 'Print Or Delete Report'.
  37. Select the file compiled in step 31.
  38. Click [Process].
  39. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the 'Coverage Effective date' filed in step 21 and the 'Last Date Of Service To Include' selected in step 29(b).
  40. Close the report.
  41. Click [No].
  42. Open 'Discharge' form.
  43. Set the 'Date Of Discharge' field to a date that is greater than the 'Coverage Expiration Date' filed in step 21.
  44. Fill in all the required fields and select [Submit].
  45. Open 'Electronic Billing'.
  46. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  47. Set 'First Date Of Service To Include' with the date earlier than the 'Coverage Effective Date' filed in step 21.
  48. Set 'Last Date Of Service To Include' with a date later than the 'Coverage Expiration Date' filed in step 21.
  49. Click [Process].
  50. Validate that the compile completes successfully.
  51. Click [OK].
  52. Select 'Dump File' from 'Billing Options'.
  53. Select 'Print' from 'Print Or Delete Report'.
  54. Select the file compiled in step 46.
  55. Click [Process].
  56. Validate that the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the 'Coverage Effective Date' and 'Coverage Expiration Date' filed in step 21.
  57. Close the report.
  58. Click [No].
  59. Open 'Electronic Billing'.
  60. Run the '837-Institutional' bill for the Interim Billing "Batch 1", for "Guarantor 1".
  61. Set 'First Date Of Service To Include' with the date later than the 'Coverage Effective Date' filed in step 21.
  62. Set 'Last Date Of Service To Include' with a date earlier than the 'Coverage Expiration Date' filed in step 21.
  63. Click [Process].
  64. Validate that the compile completes successfully.
  65. Click [OK].
  66. Select 'Dump File' from 'Billing Options'.
  67. Select 'Print' from 'Print Or Delete Report'.
  68. Select the file compiled in step 46.
  69. Click [Process].
  70. Validate that the discharge date is not included instead, the Statement From and To Date in the 2300-DTP-03 segment of the 837 Institutional file is overridden by the First Date Of Service To Include' and 'Last Date Of Service To Include' dates used in the step 57(a, b).
  71. Close the report.
  72. Click [No].
Scenario 4: "Restrict Coverage Effective Date Edits to Prior Dates Only" registry setting functionality
Specific Setup:
  • Client: The client should be admitted and have an active episode - "Client A".
  • Financial Eligibility: "Client A" should have an already existing Financial Eligibility record with both Coverage Effective and Expiration dates.
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' to 'Restrict Coverage Effective Date Edits to Prior Dates Only'.
  3. Click [View Registry Settings].
  4. Validate that the respective registry setting shows up.
  5. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to a value other than 'Y' or 'N'.
  6. Verify an error message displays that the valid choices are 'Y or N' only.
  7. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to 'Y' and then submit to save.
  8. Open the 'Financial Eligibility' form.
  9. Search and select "Client A".
  10. Select the Episode from the grid.
  11. Select 'Guarantor Selection'.
  12. Check if the 'Coverage Effective Date' field is already showing the date in the file.
  13. Try to enter a date that is after the date that is already in the file and move away from the field.
  14. Validate that an error message appears when updating the 'Coverage Effective Date' field to a date that is later than the previously filed date.
  15. Validate the error text - 'The Coverage Effective Date cannot be updated to be later than the previously filed date.'.
  16. Click [OK].
  17. Validate that the 'Coverage Effective Date' field is restored with the last value saved.
  18. Set 'Coverage Effective Date' with a date that is before the date that is already in the file and move away from the field.
  19. Validate that there are no errors shown.
  20. Click [Submit].
  21. Open the 'Financial Eligibility' form.
  22. Search and select "Client A".
  23. Select the Episode from the grid.
  24. Select 'Guarantor Selection'.
  25. Check if the 'Coverage Effective Date' field is showing with the date we save in step 18.
  26. Click [Discard].
  27. Click [Yes].
  28. Open the 'Registry Settings' form.
  29. Set the 'Limit Registry Settings to the Following Search Criteria' to 'Restrict Coverage Effective Date Edits to Prior Dates Only'.
  30. Click [View Registry Settings].
  31. Set the 'Avatar PM->Billing->Financial Eligibility->->->Restrict Coverage Effective Date Edits to Prior Dates Only' registry setting to 'N' and then submit to save.
  32. Open the 'Financial Eligibility' form.
  33. Search and select "Client A".
  34. Select the Episode from the grid.
  35. Select 'Guarantor Selection'.
  36. Check if the 'Coverage Effective Date' field is showing with the date we save in step 18.
  37. Try to enter a date that is after the date that is already in the file and move away from the field.
  38. Validate that there are no errors shown.
  39. Click [Submit].
  40. Open the 'Financial Eligibility' form.
  41. Search and select "Client A".
  42. Select the Episode from the grid.
  43. Select 'Guarantor Selection'.
  44. Check if the 'Coverage Effective Date' field is showing with the date we save in step 37.
  45. Click [Discard].
  46. Click [Yes].
Topics
• Electronic Billing • Guarantor/Program Billing Defaults • File Import • Registry Settings • Financial Eligibility • Web Services
2023 Update 93 Summary | Details
Cal-OMS Admission
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Cal-OMS Admission
Scenario 1: CalOMSAdmission - Validation
Specific Setup:
  • The registry setting "Enable LA County Reporting Requirements" is set to "Y".
  • A new client (OP) is created or an existing one is identified to perform Cal-OMS admission.
  • 'Client A'.
  • The 'Cal-OMS Admission' is submitted for 'Client A' with populating data in each field.
Steps
  1. Open the 'Cal-OMS Admission' form.
  2. Search for 'Client A' and select from the results.
  3. Select the episode from the grid.
  4. Select the Cal-OMS Admission record from the grid.
  5. Select the 'Admission Data' section.
  6. Validate that the field "What is your Principal Source of Referral?" is populated with the filed value.
  7. Clear the field by clicking the 'x' button on it.
  8. Validate the field is cleared successfully.
  9. Fill out or modify all the needed fields and select [Submit].
  10. Select [Continue Filing].
  11. Open the 'Cal-OMS Admission' form.
  12. Select the episode from the grid.
  13. Select the Cal-OMS Admission record from the grid.
  14. Select the 'Admission Data' section.
  15. Validate that the field "What is your Principal Source of Referral?" is populated with the recently filed value.
  16. Select [Discard].
Topics
• Cal-Oms Admission • NX
2023 Update 94 Summary | Details
Client Demographic forms - 'Time Zone for Appointment Reminders' field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Discharge
  • Pre Admit
  • Pre Admit Discharge
  • SoapUI - ClientDemographics
  • SoapUI - UpdateAdmission
  • Admission (Outpatient)
Scenario 1: Validate the 'Admission' form for a new client
Steps
  1. Access the 'Admission' form.
  2. Admit a new client into any episode.
  3. Populate all required and desired fields.
  4. Select the "Demographics" section.
  5. Select the desired value in the 'Time Zone For Appointment Reminders' field.
  6. Click [Submit].
  7. Access the 'Admission' form for the client admitted in the previous steps.
  8. Click [Edit] for the episode added in the previous steps.
  9. Validate the previously filed data is displayed.
  10. Select the "Demographics" section.
  11. Validate the 'Time Zone For Appointment Reminders' field contains the value selected in the previous steps.
  12. Close the form.
Scenario 2: 'Update Client Data' - Verification of form filing
Specific Setup:
  • A client is enrolled in an existing episode (Client A).
Steps
  1. Select "Client A" and access the 'Update Client Data' form.
  2. Select the desired value in the 'Time Zone For Appointment Reminders' field.
  3. Populate any other desired fields.
  4. Click [Submit].
  5. Select "Client A" and access the 'Update Client Data' form.
  6. Validate the previously filed data is displayed.
  7. Validate the 'Time Zone For Appointment Reminders' field contains the value selected in the previous steps.
  8. Close the form.
Scenario 3: 'Discharge' form - Field Validation
Specific Setup:
  • A client is enrolled in an existing episode (Client A).
Steps
  1. Select "Client A" and access the 'Discharge' form.
  2. Select an existing episode and click [Edit].
  3. Enter the desired date in the 'Date Of Discharge' field.
  4. Enter the desired time in the 'Discharge Time' field.
  5. Select the desired value in the 'Type Of Discharge' field.
  6. Select the desired practitioner in the 'Discharge Practitioner' field.
  7. Select the "Demographics" section.
  8. Select the desired value in the 'Time Zone For Appointment Reminders' field.
  9. Click [Submit].
  10. Select "Client A" and access the 'Discharge' form.
  11. Select the discharged episode and click [Edit].
  12. Validate all previously filed data is displayed.
  13. Select the "Demographics" section.
  14. Validate the 'Time Zone For Appointment Reminders' field contains the value filed in the previous steps.
  15. Close the form.
Scenario 4: 'Pre Admit' form - Field Validation
Specific Setup:
  • A client is enrolled in an existing Pre Admit episode (Client A).
Steps
  1. Select "Client A" and access the 'Pre Admit' form.
  2. Select an existing episode and click [Edit].
  3. Select the "Demographics" section.
  4. Select the desired value in the 'Time Zone For Appointment Reminders' field.
  5. Click [Submit].
  6. Select "Client A" and access the 'Pre Admit' form.
  7. Select an existing episode and click [Edit].
  8. Select the "Demographics" section.
  9. Validate the 'Time Zone For Appointment Reminders' field contains the value selected in the previous steps.
  10. Close the form.
Scenario 5: 'Call Intake' form - Field Validation
Specific Setup:
  • The 'Add Demographics To Call Intake' registry setting must be set to "Y".
  • A client is enrolled in an existing Call Intake program (Client A).
Steps
  1. Select "Client A" and access the 'Call Intake' form.
  2. Select the existing call intake record and click [Edit].
  3. Select the "Demographics" section.
  4. Select the desired value in the 'Time Zone For Appointment Reminders' field.
  5. Click [Submit].
  6. Select "Client A" and access the 'Call Intake' form.
  7. Select the existing call intake record and click [Edit].
  8. Select the "Demographics" section.
  9. Validate the 'Time Zone For Appointment Reminders' field contains the value selected in the previous steps.
  10. Close the form.
Scenario 6: Pre Admit Discharge web service validation
Specific Setup:
  • A client is enrolled in an existing Pre Admit episode (Client A).
Steps
  1. Access SoapUI for the 'ClientPreAdmitDischarge' - 'PreAdmitDischargeClient' web service.
  2. Enter the system code that will be used to log into Avatar in the 'SystemCode' field.
  3. Enter the user name that will be used to log into Avatar in the 'UserName' field.
  4. Enter the password that will be used to log into Avatar in the 'Password' field.
  5. Enter the desired date in the 'DateOfDischarge' field.
  6. Enter the desired practitioner in the 'DischargePractitioner' field.
  7. Enter the desired time in the 'DischargeTime' field.
  8. Enter the desired value in the 'TypeOfDischarge' field.
  9. Enter the desired value in the 'TimeZoneForAppointmentReminders' field.
  10. Enter "Client A" in the 'ClientID' field.
  11. Enter the episode number to be discharged in the 'EpisodeNumber' field.
  12. Click [Run].
  13. Validate the 'Message' field contains: Client Pre-Admit Discharge web service has been filed successfully.
  14. Select "Client A" and access the 'Pre Admit Discharge' form.
  15. Validate all populated fields are displayed as entered in the web service.
  16. Select the "Demographics" section.
  17. Validate the 'Time Zone For Appointment Reminders' field contains the value entered via web service.
  18. Close the form.
Scenario 7: Discharge a client via the 'ClientDischarge' web service
Specific Setup:
  • A client is enrolled in an existing episode (Client A).
Steps
  1. Access SoapUI for the 'ClientDischarge' - 'DischargeClient' web service.
  2. Enter the system code that will be used to log into Avatar in the 'SystemCode' field.
  3. Enter the user name that will be used to log into Avatar in the 'UserName' field.
  4. Enter the password that will be used to log into Avatar in the 'Password' field.
  5. Enter the desired date in the 'DateOfDischarge' field.
  6. Enter the desired practitioner in the 'DischargePractitioner' field.
  7. Enter the desired time in the 'DischargeTime' field.
  8. Enter the desired value in the 'TypeOfDischarge' field.
  9. Enter the desired value in the 'TimeZoneForAppointmentReminders' field.
  10. Enter "Client A" in the 'ClientID' field.
  11. Enter the episode number to be discharged in the 'EpisodeNumber' field.
  12. Click [Run].
  13. Validate the 'Message' field contains: Client Discharge web service has been filed successfully.
  14. Select "Client A" and access the 'Discharge' form.
  15. Validate all populated fields are displayed as entered in the web service.
  16. Select the "Demographics" section.
  17. Validate the 'Time Zone For Appointment Reminders' field contains the value entered via web service.
  18. Close the form.
Scenario 8: Client Demographic Web Service validation
Specific Setup:
  • A client is enrolled in an existing episode (Client A).
Steps
  1. Access SoapUI for the 'ClientDemographics' - 'UpdateClientDemographics' web service.
  2. Enter the system code that will be used to log into Avatar in the 'SystemCode' field.
  3. Enter the user name that will be used to log into Avatar in the 'UserName' field.
  4. Enter the password that will be used to log into Avatar in the 'Password' field.
  5. Enter the desired value in the 'TimeZoneForAppointmentReminders' field.
  6. Populate any other desired fields.
  7. Enter "Client A" in the 'ClientID' field.
  8. Click [Run].
  9. Validate the 'Message' field contains: Client Demographics web service has been filed successfully.
  10. Select "Client A" and access the 'Update Client Data' form.
  11. Validate all populated fields are displayed.
  12. Validate the 'Time Zone For Appointment Reminders' field contains the value entered via web service.
  13. Close the form.
Scenario 9: The 'ClientAdmission' - 'UpdateAdmission' web service: Update Admission for an existing client
Specific Setup:
  • A client must be enrolled in an existing episode (Client A).
Steps
  1. Access SoapUI for the 'ClientAdmission' - 'UpdateAdmission' web service.
  2. Enter the system code that will be used to log into Avatar in the 'SystemCode' field.
  3. Enter the user name that will be used to log into Avatar in the 'UserName' field.
  4. Enter the password that will be used to log into Avatar in the 'Password' field.
  5. Populate all required and desired fields.
  6. Enter the desired value in the 'TimeZoneForAppointmentReminders' field.
  7. Enter "Client A" in the 'ClientID' field.
  8. Enter "Client A's" episode in the 'Episode' field.
  9. Click [Run].
  10. Validate the 'Confirmation' field contains a value such as: "Client Unique ID: # Unique ID: #".
  11. Validate the 'Message' field contains: "Client Admission web service has been filed successfully".
  12. Select "Client A" and access the 'Admission' form.
  13. Select the admission updated in the previous steps and click [Edit].
  14. Validate all populated fields are displayed.
  15. Validate the 'Time Zone For Appointment Reminders' field contains the value entered via web service.
  16. Close the form.
Scenario 10: 'Admission (Outpatient)' - Verification of form filing
Steps
  1. Access the 'Admission (Outpatient)' form.
  2. Admit a new client.
  3. Populate all required and desired fields.
  4. Select the "Demographics" section.
  5. Select the desired value in the 'Time Zone For Appointment Reminders' field.
  6. Click [Submit].
  7. Access the 'Admission (Outpatient)' form for the client admitted in the previous steps.
  8. Click [Edit] for the episode added in the previous steps.
  9. Validate the previously filed data is displayed.
  10. Select the "Demographics" section.
  11. Validate the 'Time Zone For Appointment Reminders' field contains the value selected in the previous steps.
  12. Close the form.
Scenario 11: 'Pre Admit Discharge' - Verification of form filing
Specific Setup:
  • A client is enrolled in an existing Pre Admit episode(Client A).
Steps
  1. Select "Client A" and access the 'Pre Admit Discharge' form.
  2. Select an existing episode and click [OK].
  3. Enter the desired date in the 'Date Of Discharge' field.
  4. Enter the desired time in the 'Time Of Discharge' field.
  5. Select the desired value in the 'Type Of Discharge' field.
  6. Select the desired practitioner in the 'Discharge Practitioner' field.
  7. Select the "Demographics" section.
  8. Select the desired value in the 'Time Zone For Appointment Reminders' field.
  9. Click [Submit].
  10. Select "Client A" and access the 'Pre Admit Discharge' form.
  11. Select the discharged episode and click [OK].
  12. Validate the previously filed data is displayed.
  13. Select the "Demographics" section.
  14. Validate the 'Time Zone For Appointment Reminders' field contains the value selected in the previous steps.
  15. Close the form.
Topics
• Admission • Update Client Data • Discharge • Pre Admit • Call Intake • Pre Admit Discharge • Web Services • Admission (Outpatient)
Update 19 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
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 'Add Policy Number Override' must be enabled
  • 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 inbound 837 file posting and including Service-Level Third Party Payment/Adjustment 'Other Healthcare Coverage' information, ensure that the following 837 Loop/Segments are included with values from original Avatar MSO inbound 837 claim/service Other Healthcare Coverage information:
  10. Other Subscriber Information (2320)
  11. Other Insurance Coverage Information (2320)
  12. Other Subscriber Name (2330A)
  13. Other Payer Name (2330B)
Topics
• Electronic Billing • Claims Processing
 

Avatar_Cal-PM_2024_Monthly_Release_2024.00.01_Details.csv