Skip to main content

Avatar Cal-PM 2024 Monthly Release 2024.01.00 Acceptance Tests

  1. Last updated
  2. Save as PDF
Update 3 Summary | Details
Cal-OMS Submission - Cal-OMS Annual Update
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Cal-OMS Submission
  • Cal-OMS Annual Update
Scenario 1: Cal-OMS Submission - Annual update.
Specific Setup:
  • Registry Setting:
  • The 'Allow Multiple Cal-OMS Admissions Per Avatar Episode' is set to 'Y'.
  • The 'Enforce Annual Update Date Rule' registry setting is set to 'Y'
  • The 'Enable LA County Reporting Requirements' registry setting is set to 'N'.
  • The 'Enforce Monthly Reporting' registry setting is set to 'N'.
  • Program Maintenance:
  • Create a new Cal-OMS program or identify an existing program for use.
  • The 'Substance Abuse Program (Cal-OMS)' field should be selected as 'Yes (Reportable)'.
  • The 'Provider ID (CalOMS)' field should contain a value. (Not more than 6 digits).
  • Note the program code/name.
  • Admission:
  • A new client is admitted to the program defined above. Note the client's id/name.
  • Client A.
  • Cal-Oms Admission:
  • The 'Cal-OMS Admission' is created with all the required data using the 'Cal-OMS Admission' form for Client A.
Steps
  1. Open the 'Cal-OMS Submission' form.
  2. Set the 'Option' field to 'Compile' and enter the 'Through Date' value which will include Cal-OMS Admission record(s).
  3. Click the 'Submit' button for Cal-OMS Submission file compilation.
  4. Ensure that file compilation is completed successfully.
  5. Set the 'Option' field to 'Print' and select compiled Cal-OMS Submission file.
  6. In Cal-OMS Submission compiled data/records (opened using the 'Print Selected File Error(s)' button), ensure that compiled Cal-OMS admission data for 'Client A' is shown.
  7. Close the report.
  8. Set the 'Option' field to 'Submit (Create File)'.
  9. Select the compiled Cal-OMS Submission file from the 'Select File To Print/Submit' field.
  10. Select 'Review' for the 'Create File' field.
  11. Click the 'Submit' button for Cal-OMS Submission file creation.
  12. Validate that upon the successful submission, the text file(s) with the suffix "R" is generated.
  13. Click [OK].
  14. Click [No].
  15. Ensure that Cal-OMS Submission files are created on the server in the designated output directory.
  16. Validate that the Text Files generated have the suffix "R".
  17. Open the .txt files and validate that the details for Cal-OMS admission show up for 'Client A'.
  18. Open the 'Cal-OMS Submission' form.
  19. Set the 'Option' field to 'Submit (Create File)'.
  20. Select the compiled Cal-OMS Submission file from the 'Select File To Print/Submit' field.
  21. Select 'Final' for the 'Create File' field.
  22. Click the 'Submit' button for Cal-OMS Submission file creation.
  23. Validate that upon the successful submission, the text file(s) with the suffix "F" is generated.
  24. Click [OK].
  25. Click [No].
  26. Ensure that Cal-OMS Submission files are created on the server in the designated output directory.
  27. Validate that the Text Files generated have the suffix "F".
  28. Open the .txt files and validate that the details for Cal-OMS admission show up for 'Client A'.
  29. Open the 'Cal-OMS Annual Update' form.
  30. Select 'Client A' and select the respective Episode and the Cal-OMS Admission records in the pre-display.
  31. Validate that the form opens with the relevant data successfully.
  32. Fill out the form with all the required data.
  33. Click [Submit].
  34. Navigate back to the 'Cal-OMS Annual Update' form.
  35. Validate that all the filed data displays properly.
  36. Click [Discard].
  37. Click [Yes].
Topics
• Cal-Oms Admission • Cal-OMS • NX
Update 5 Summary | Details
Compile/Edit/Post/Unpost Roll-Up Services Worklist
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Compile/Edit/Post/Unpost Roll-Up Services Worklist
Scenario 1: Unpost Roll-Up worklist - Validating the 'Unpost Selected Roll-Up Services' workflow
Specific Setup:
  • Clients are admitted and the diagnosis record(s) are created,
  • Client A
  • Client B
  • Financial Eligibility is added to the clients as below,
  • Client A - Guarantor 1.
  • Client B - Guarantor 2.
  • Rollup services and the respective component services are created using the 'Service Codes' form and set up with the fee using the 'Service Fee/Cross Reference Maintenance' form.
  • Rollup 1
  • Component 1(a)
  • Component 1(b)
  • Component 1(c)
  • Rollup 2
  • Component 2(a)
  • Component 2(b)
  • Component 2(c)
  • Rollup 3
  • Component 3(a)
  • Component 3(b)
  • Component 3(c)
  • Using the 'Client Charge Input' form, enter a few component services on different dates for the client(s).
  • Multiple Roll-Up Services Definitions are created that include the above roll-up/ component services.
  • Rollup Definition 1
  • Rollup Definition 2
  • Rollup Definition 3
  • Using the 'Compile Roll-Up Services Worklist' form compile the roll-up Worklist(s).
  • Post the roll-up compiles and use 'Client Ledger' to spot check the roll-up services have been created and the component services have been adjusted appropriately.
  • User Definition:
  • User Definition gives the tester access to the below database table:
  • "rollup_services_unpost"
Steps
  1. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’.
  2. Select 'Unpost Selected Roll-Up Services'.
  3. Validate that the 'Roll-Up Worklists' field is empty.
  4. Click [Select Roll-Ups to Unpost].
  5. Validate the received message says, "Missing required fields.".
  6. Click [OK].
  7. Click [Unpost Roll-Ups].
  8. Validate the received message says, "Please select at least one roll-up service to unpost.".
  9. Click [OK].
  10. Click 'Roll-Up Posting Date' in the 'Select By Posting Date or Date of Service' field.
  11. Enter appropriate 'From' and 'To' date(s), that include the roll-ups.
  12. Click 'All Clients' in the 'All or Individual Client' field.
  13. Validate that the 'Roll-Up Worklists' field shows all the roll-up(s) available to unpost with the selected date range.
  14. Validate that the 'Client' search input field is disabled.
  15. Click 'Individual Client' -in the 'All or Individual Client' field.
  16. Validate that the 'Roll-Up Worklists' field is cleared up and empty.
  17. Validate that the 'Client' search input field is now enabled.
  18. Enter 'Client A' in the 'Client search' field and select from the results.
  19. Validate that the 'Roll-Up Worklists' shows with the data that involves 'Client A'.
  20. Select 'All' in the ''Roll-Up Worklists' field.
  21. Click [Select Roll-Ups to Unpost].
  22. Validate that the 'Select Roll-Up Services To Unpost' window opens up with the below filter options with data to select and the grid that has the service details.
  23. Service Code.
  24. Guarantor.
  25. Location.
  26. Practitioner.
  27. In the 'Select Roll-Up Services To Unpost' form, Validate that the Grid shows data that only involves 'Client A'.
  28. Click [Close/Cancel].
  29. Enter 'Client B' in the 'Client search' field and select from the results.
  30. Validate that the 'Roll-Up Worklists' shows with the data that involves 'Client B'.
  31. Select 'All' in the ''Roll-Up Worklists' field.
  32. Click [Select Roll-Ups to Unpost].
  33. Validate that the 'Select Roll-Up Services To Unpost' window opens up with the below filter options with data to select and the grid that has the service details.
  34. Service Code.
  35. Guarantor.
  36. Location.
  37. Practitioner.
  38. In the 'Select Roll-Up Services To Unpost' form, Validate that the Grid shows data that only involves 'Client B'.
  39. Click [Close/Cancel].
  40. Click 'All Clients' -in the 'All or Individual Client' field.
  41. Validate that the 'Client' search input field is disabled.
  42. Validate that the 'Roll-Up Worklists' field now shows all the roll-up(s) available to unpost with the selected date range.
  43. Select 'All' in the ''Roll-Up Worklists' field.
  44. Click [Select Roll-Ups to Unpost].
  45. Validate that the 'Select Roll-Up Services To Unpost' window opens up with the below filter options with data to select and the grid that has the service details.
  46. Service Code.
  47. Guarantor.
  48. Location.
  49. Practitioner.
  50. In the 'Select Roll-Up Services To Unpost' form, Validate that the Grid shows data that involves both 'Client A' and 'Client B'.
  51. Validate that the grid is sorted by the client's last name.
  52. Select and deselect the data from the four selection fields at the top of the screen.
  53. Verify that when checking/ unchecking any of the values in the above four fields, the grid rows are updated with the appropriate roll-up services that match the selection.
  54. Click [Save].
  55. Click [Yes].
  56. Click [Unpost Roll-Ups].
  57. Validate the received message says, "Roll-up unposting complete."
  58. Click [OK].
  59. Validate that the Report Viewer opens up.
  60. Verify that the report contains all the roll-up data that are successfully unposted.
  61. Close the Report.
  62. Query the below tables and verify that the posted roll-up data is displayed correctly:
  63. "rollup_services_unpost"
  64. Close the SQL Querying window.
Scenario 2: Unpost Roll-Up worklist - 'Unpost Selected Roll-Up Services' Grid/ Additional Error validation.
Specific Setup:
  • Clients are admitted and the diagnosis record(s) are created,
  • Client A
  • Client B
  • Financial Eligibility is added to the clients as below,
  • Client A - Guarantor 1.
  • Client B - Guarantor 2.
  • Rollup services and the respective component services are created using the 'Service Codes' form and set up with the fee using the 'Service Fee/Cross Reference Maintenance' form.
  • Rollup 1
  • Component 1(a)
  • Component 1(b)
  • Component 1(c)
  • Rollup 2
  • Component 2(a)
  • Component 2(b)
  • Component 2(c)
  • Rollup 3
  • Component 3(a)
  • Component 3(b)
  • Component 3(c)
  • Using the 'Client Charge Input' form, enter a few component services on different dates for the client(s).
  • Multiple Roll-Up Services Definitions are created that include the above roll-up/ component services.
  • Rollup Definition 1
  • Rollup Definition 2
  • Rollup Definition 3
  • Using the 'Compile Roll-Up Services Worklist' form compile the roll-up Worklist(s).
  • Post the roll-up compiles and use 'Client Ledger' to spot check the roll-up services have been created and the component services have been adjusted appropriately.
  • Roll-Up already claimed:
  • Using the 'Electronic Billing' form, create claims for some roll-up services that have already been compiled and posted.
  • Roll_Up has a payment, adjustment, or transfer posted:
  • Post a payment, adjustment, or transfer against some existing roll-up services.
  • User Definition:
  • User should be added permissions for the below database table,
  • "rollup_unpost_errors"
Steps
  1. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’.
  2. Select 'Unpost Selected Roll-Up Services'.
  3. Click 'Roll-Up Posting Date' in the 'Select By Posting Date or Date of Service' field.
  4. Enter appropriate 'From' and 'To' date(s), that include our roll-ups.
  5. Click 'Individual Client' -in the 'All or Individual Client' field.
  6. Enter 'Client A' in the 'Client search' field and select from the results.
  7. Validate that the 'Roll-Up Worklists' shows with the data that involves 'Client A'.
  8. Select the roll-ups that have Payments/ Adjustments/ Transfers for the services.
  9. Click [Select Roll-Ups to Unpost].
  10. Validate that the 'Select Roll-Up Services To Unpost' window opens up with the below filter options with data to select and the grid that has the service details.
  11. Service Code.
  12. Guarantor.
  13. Location.
  14. Practitioner.
  15. In the 'Select Roll-Up Services To Unpost' form, Validate that the 'Pmt/Adj' column fields show a "Y" for the services that have Payments/ Adjustments/Transfers.
  16. Select the service row for which the 'Pmt/Adj' fields show a "Y".
  17. Click [Save].
  18. Click [Yes].
  19. Click [Unpost Roll-Ups].
  20. Validate that the received message says "Roll-up unposting complete. Errors found."
  21. Click [OK].
  22. Validate that the Report Viewer opens up.
  23. Verify that the report contains 'No Data Found For Report' with the 'Roll-Up Services Unpost Errors' link.
  24. Click the 'Roll-Up Services Unpost Errors' link.
  25. Validate that the 'Roll-Up Services Unpost Errors' have the error detail concerning the payment/ Adjustment/ transfer posted to the roll-up service.
  26. Close the Report.
  27. Repeat steps 3 to 7 for 'Client B'.
  28. Select the roll-ups that have Claims for the services.
  29. Click [Select Roll-Ups to Unpost].
  30. Validate that the 'Select Roll-Up Services To Unpost' window opens up with the below filter options with data to select and the grid that has the service details.
  31. Service Code.
  32. Guarantor.
  33. Location.
  34. Practitioner.
  35. In the 'Select Roll-Up Services To Unpost' form, Validate that the 'Claim #' column fields show the Claim number for the services that are already claimed.
  36. Select the service row for which the 'Claim #' column fields have the Claim number.
  37. Click [Save].
  38. Click [Yes].
  39. Click [Unpost Roll-Ups].
  40. Validate that the received message says "Roll-up unposting complete. Errors found."
  41. Click [OK].
  42. Validate that the Report Viewer opens up.
  43. Verify that the report contains 'No Data Found For Report' with the 'Roll-Up Services Unpost Errors' link.
  44. Click the 'Roll-Up Services Unpost Errors' link.
  45. Validate that the 'Roll-Up Services Unpost Errors' have the error detail concerning the roll-up service that has been claimed along with the claim number(s).
  46. Close the Report.
  47. Query the below tables and verify that the error details are captured and shown correctly,
  48. "rollup_unpost_errors"
  49. Close the SQL Querying window.
Roll-Up Services Definition - Roll-Up Add-On Codes If Present
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Roll-Up Services Definition
  • Compile/Edit/Post/Unpost Roll-Up Services Worklist
Scenario 1: Roll-Up Services Definition - Validating the form with the new field 'Roll-Up Add-On Codes If Present'
Specific Setup:
  • Rollup services and the respective component services are created using the 'Service Codes' form and set up with the fee using the 'Service Fee/Cross Reference Maintenance' form.
  • Rollup 1
  • Component 1(a)
  • Component 1(b)
  • Component 1(c)
Steps
  1. Open ‘Roll-Up Services Definition’.
  2. Validate that the new field 'Roll-Up Add-On Codes If Present' exists with the below options,
  3. Yes.
  4. No.
  5. Validate that by default no options are selected.
  6. Click 'Add' in 'Add/Edit/Delete Roll-Up Service Definition'.
  7. Set any desired value to the 'Roll-Up Description' field.
  8. Rollup Definition 1.
  9. Select 'Rollup 1' from the Roll-Up Service field.
  10. Select the below services in the 'Component Services' field.
  11. Component 1(a).
  12. Component 1(b).
  13. Component 1(c).
  14. Fill in all the required fields.
  15. Select 'Yes' in 'Roll-Up Add-On Codes If Present'.
  16. Click [Submit].
  17. Validate a message is received stating "Roll-Up Services Definition has completed. Do you wish to return to form?".
  18. Click [No].
  19. Open ‘Roll-Up Services Definition’.
  20. Click 'Edit' in 'Add/Edit/Delete Roll-Up Service Definition'.
  21. Select 'Rollup Definition 1' from 'Existing Roll-Up Definition'.
  22. Validate that the field 'Roll-Up Add-On Codes If Present' is retained with the value 'Yes'.
  23. Click [Discard].
  24. Click [Yes].
  25. Query the below table and validate that the columns 'roll_up_add_on_code' and 'roll_up_add_on_value' are shown with the values 'Y' and 'Yes' respectively for 'Rollup Definition 1'.
  26. "rollup_services_def".
  27. Close the SQL query viewer and return to the NX application window.
  28. Open ‘Roll-Up Services Definition’.
  29. Click 'Edit' in 'Add/Edit/Delete Roll-Up Service Definition'.
  30. Select 'Rollup Definition 1' from 'Existing Roll-Up Definition'.
  31. Select 'No' in 'Roll-Up Add-On Codes If Present'.
  32. Click [Submit].
  33. Click [No].
  34. Query the below table and validate that the columns 'roll_up_add_on_code' and 'roll_up_add_on_value' are shown with the values 'N' and 'No' respectively for 'Rollup Definition 1'.
  35. "rollup_services_def".
  36. Close the SQL query viewer and return to the NX application window.
  37. Open ‘Roll-Up Services Definition’.
  38. Click 'Edit' in 'Add/Edit/Delete Roll-Up Service Definition'.
  39. Select 'Rollup Definition 1' from 'Existing Roll-Up Definition'.
  40. Clear the current selection in 'Roll-Up Add-On Codes If Present' by selecting the option and pressing the 'F5' key.
  41. Click [Submit].
  42. Click [No].
  43. Query the below table and validate that the columns 'roll_up_add_on_code' and 'roll_up_add_on_value' are shown with the values '[NULL]' and 'No Entry' respectively for 'Rollup Definition 1'.
  44. "rollup_services_def".
  45. Close the SQL query viewer and return to the NX application window.
Scenario 2: Roll-Up Services Definition - Validating the Roll-Up process with the new field 'Roll-Up Add-On Codes If Present'
Specific Setup:
  • A client got admitted and the diagnosis record(s) were created,
  • Client A
  • Financial Eligibility is added to the clients as below,
  • Client A - Guarantor 1.
  • Rollup service, component service, and add-on services are created using the 'Service Codes' form and set up with the fee using the 'Service Fee/Cross Reference Maintenance' form.
  • Rollup 1 (Roll up code)
  • Component 1 (Component code)
  • AddOn 1 (select 'Add-On Code' for the 'Service Code Category' and Select 'Evaluation Management' for the 'Service Code Type').
  • AddOn 2 (select 'Interactive Complexity' for the 'Service Code Category').
  • Roll-Up Services Definition:
  • Roll-Up Services Definition is created that includes the above roll-up/component services.
  • Rollup Definition 1
  • Do not include the service codes of the add-on services in the list of component services.
  • In the new field- 'Roll-Up Add-On Codes If Present' field, select 'Yes'.
Steps
  1. Open 'Client Charge Input'.
  2. For 'Client A' create charges with the component service(s) of the roll-up as below
  3. Date 1 - Component 1(a)
  4. Select AddOn 1 and AddOn 2 in the 'Additional Information'.
  5. Set any desired value in the 'Psychotherapy Add-On Duration' field, such as 15 or 30 minutes.
  6. Date 2 - Component 1(a), Component 1(b)
  7. Select AddOn 1 and AddOn 2 in the 'Additional Information'.
  8. Set any desired value in the 'Psychotherapy Add-On Duration' field, such as 15 or 30 minutes.
  9. Close the 'Client Charge Input' form.
  10. Open 'Client Ledger'.
  11. Select 'Client A'.
  12. Click 'All Episodes'.
  13. Click 'Simple'.
  14. Click [Process].
  15. Validate that the ledger shows all the component services along with the service add-ons for the respective dates.
  16. Close the report.
  17. Click [No].
  18. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  19. Set the 'From' and 'To' date that covers the services created in Step 2.
  20. Select 'Rollup Definition 1' from 'Roll-Up Definitions'.
  21. Click [Compile Worklist].
  22. Validate a message is received stating "Compile complete.".
  23. Click [OK].
  24. Click [Run Report].
  25. Validate that the primary service('Component 1') and both of its add-on services(AddOn 1 and AddOn 2) are included in the Worklist.
  26. Close the report.
  27. Click 'Post Roll-Up Services Worklist'.
  28. Select the compiled Roll-up Worklist in the 'Through Date' field.
  29. Select any desired posting code from the 'Write Off Posting Code' dropdown.
  30. Click [Post Worklist].
  31. Validate a message is received stating "Post complete.".
  32. Click [OK].
  33. Click [Discard].
  34. Click [Yes].
  35. Open 'Client Ledger'.
  36. Select 'Client A'.
  37. Click 'All Episodes'.
  38. Click 'Simple'.
  39. Click [Process].
  40. Validate that the roll-up service was created and that the primary service and two add-on services are marked as "RollUp" and have been written off.
  41. Close the report.
  42. Click [No].
  43. Open ‘Roll-Up Services Definition’.
  44. Select 'Edit' from the 'Add/Edit/Delete Roll-Up Service Definition' field.
  45. Select 'Rollup Definition 1' from the 'Existing Roll-Up Definition' dropdown list.
  46. Validate that all the fields are populated with the data for the 'Rollup Definition 1'.
  47. Select 'No' for 'Roll-Up Add-On Codes If Present'.
  48. Click [Submit].
  49. Click [No].
  50. Repeat Steps 1 to 18 for some different date(s).
  51. Validate that the add-on services are not included in the Worklist report.
  52. Close the report.
  53. Click 'Post Roll-Up Services Worklist'.
  54. Select the compiled Roll-up Worklist in the 'Through Date' field.
  55. Select any desired posting code from the 'Write Off Posting Code' dropdown.
  56. Click [Post Worklist].
  57. Validate a message is received stating "Post complete.".
  58. Click [OK].
  59. Click [Discard].
  60. Click [Yes].
  61. Open 'Client Ledger'.
  62. Select 'Client A'.
  63. Click 'All Episodes'.
  64. Click 'Simple'.
  65. Click [Process].
  66. Validate that the add-on services are not included during the roll-up and not adjusted off.
  67. Close the report.
  68. Click [No].
  69. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  70. Select 'Unpost Last Roll-Up Services Worklist'.
  71. Select the posted roll-up Worklist from the 'Through Date' dropdown.
  72. Click [Unpost Worklist].
  73. Validate a message is received stating "Unpost complete.".
  74. Click [OK].
  75. Click [Discard].
  76. Click [Yes].
  77. Open 'Client Ledger'.
  78. Select 'Client A'.
  79. Click 'All Episodes'.
  80. Click 'Simple'.
  81. Click [Process].
  82. Validate that the roll-up service is removed and that the adjustments are removed from the component service and the two add-on services.
  83. Close the report.
  84. Click [No].
Roll-Up Services Definition
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Roll-Up Services Definition
  • Compile/Edit/Post/Unpost Roll-Up Services Worklist
Scenario 1: Roll-Up Services Definition - Validating the New Registry Setting 'Prevent Roll-Up From Happening If There Is Only One Component Service'
Specific Setup:
  • Rollup services and the respective component services are created using the 'Service Codes' form and set up with the fee using the 'Service Fee/Cross Reference Maintenance' form.
  • Rollup 1
  • Component 1(a)
  • Component 1(b)
  • Component 1(c)
  • Roll-Up Services Definition is created that includes the above roll-up/component services.
  • Rollup Definition 1
Steps
  1. Open ‘Registry Settings’.
  2. Search for the 'Prevent Roll-Up From Happening If There Is Only One Component Service' setting and select it.
  3. Validate that initially the Registry Setting Value text is defaulted to "N".
  4. Try to enter a value that is more than one character in the 'Registry Setting Value' field and exit the field.
  5. Validate the error message displays saying, "The selected value is not valid in the current system code for the following reason: More than 1 character".
  6. Click [OK].
  7. Try to enter a value that is one character anything other than 'Y' or 'N' in the 'Registry Setting Value' field and exit the field.
  8. Validate the error message displays saying, "The selected value is not valid in the current system code for the following reason: Response must be 'Y' or 'N'".
  9. Click [OK].
  10. Click [Submit].
  11. Click [OK].
  12. Click [No].
  13. Open ‘Roll-Up Services Definition’.
  14. Validate that the new field 'Prevent Roll-Up From Happening If There Is Only One Component Service' does not exist in the form.
  15. Click [Discard].
  16. Open ‘Registry Settings’.
  17. Search for the 'Prevent Roll-Up From Happening If There Is Only One Component Service' setting and select it.
  18. Set the 'Registry Setting Value' field value to "Y".
  19. Click [Submit].
  20. Click [OK].
  21. Click [No].
  22. Open ‘Roll-Up Services Definition’.
  23. Select 'Edit' from the 'Add/Edit/Delete Roll-Up Service Definition' field.
  24. Select 'Rollup Definition 1' from the 'Existing Roll-Up Definition' dropdown list.
  25. Validate that all the fields are populated with the data for the 'Rollup Definition 1'.
  26. Validate that the new field 'Prevent Roll-Up From Happening For A Client If There Is Only One Component Service' exists with the below options:
  27. Yes
  28. No
  29. Validate that no option is selected by default.
  30. Click [Submit].
  31. Click [No].
  32. Query the below table and validate that Columns 'prevent_if_single_code' and 'prevent_if_single_value' have the following values respectively, '[NULL]' and '[NULL]'.
  33. "rollup_services_def"
  34. Close the query window and return to the Avatar NX window.
  35. Open ‘Roll-Up Services Definition’.
  36. Select 'Edit' from the 'Add/Edit/Delete Roll-Up Service Definition' field.
  37. Select 'Rollup Definition 1' from the 'Existing Roll-Up Definition' dropdown list.
  38. Validate that all the fields are populated with the data for the 'Rollup Definition 1'.
  39. Select 'No' for 'Prevent Roll-Up From Happening For A Client If There Is Only One Component Service'.
  40. Click [Submit].
  41. Click [No].
  42. Query the below table and validate that Columns 'prevent_if_single_code' and 'prevent_if_single_value' have the following values respectively, 'N' and 'No'.
  43. "rollup_services_def"
  44. Close the query window and return to the Avatar NX window.
  45. Open ‘Roll-Up Services Definition’.
  46. Select 'Edit' from the 'Add/Edit/Delete Roll-Up Service Definition' field.
  47. Select 'Rollup Definition 1' from the 'Existing Roll-Up Definition' dropdown list.
  48. Validate that all the fields are populated with the data for the 'Rollup Definition 1'.
  49. Validate that the 'Prevent Roll-Up From Happening For A Client If There Is Only One Component Service' field is showing the value filed in Step-36.
  50. Select 'Yes' for 'Prevent Roll-Up From Happening For A Client If There Is Only One Component Service'.
  51. Click [Submit].
  52. Click [No].
  53. Query the below table and validate that Columns 'prevent_if_single_code' and 'prevent_if_single_value' have the following values respectively, 'Y' and 'Yes'.
  54. "rollup_services_def"
  55. Close the SQL Querying window.
Scenario 2: Compile/Post Roll-Up Services Definition - with the New Registry Setting 'Prevent Roll-Up From Happening If There Is Only One Component Service'
Specific Setup:
  • Registry Settings:
  • 'Prevent Roll-Up From Happening For A Client If There Is Only One Component Service' is set to 'Y'.
  • Clients: Client A is admitted and has an active diagnosis and financial eligibility records. The eligibility guarantor is guarantor 1.
  • Rollup services and the respective component services are created using the 'Service Codes' form and set up with the fee using the 'Service Fee/Cross Reference Maintenance' form.
  • Rollup 1
  • Component 1(a)
  • Component 1(b)
  • Roll-Up Services Definition is created that includes the above roll-up/component services.
  • Rollup Definition 1
Steps
  1. Open ‘Roll-Up Services Definition’.
  2. Select 'Edit' from the 'Add/Edit/Delete Roll-Up Service Definition' field.
  3. Select 'Rollup Definition 1' from the 'Existing Roll-Up Definition' dropdown list.
  4. Validate that all the fields are populated with the data for the 'Rollup Definition 1'.
  5. Select desired value in 'Component Service Date Rules'.
  6. Select 'Yes' for 'Prevent Roll-Up From Happening For A Client If There Is Only One Component Service'.
  7. Click [Submit].
  8. Click [No].
  9. Open 'Client Charge Input'.
  10. For 'Client A' create charges with the component service(s) of the roll-up as below
  11. Date 1 - Component 1(a)
  12. Date 2 - Component 1(a), Component 1(b)
  13. Close the 'Client Charge Input' form.
  14. Open 'Client Ledger'.
  15. Select 'Client A'.
  16. Click 'All Episodes'.
  17. Click 'Simple'.
  18. Click [Process].
  19. Validate that the ledger shows the component services for the respective dates.
  20. Close the report.
  21. Click [No].
  22. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  23. Set the 'From' and 'To' dates to cover the services created in Step 10.
  24. Select 'Rollup Definition 1' from 'Roll-Up Definitions'.
  25. Click [Compile Worklist].
  26. Validate that received message says, "Compile complete.".
  27. Click [OK].
  28. Click [Run Report].
  29. Validate that no roll-up was created for the date(s) where there was only one component service entered for 'Client A'.
  30. Validate that a roll-up was created for the date(s) where there are multiple component services.
  31. Close the report.
  32. Click [Discard].
  33. Click [Yes].
  34. Open ‘Roll-Up Services Definition’.
  35. Select 'Edit' from the 'Add/Edit/Delete Roll-Up Service Definition' field.
  36. Select 'Rollup Definition 1' from the 'Existing Roll-Up Definition' dropdown list.
  37. Select 'No' for 'Prevent Roll-Up From Happening For A Client If There Is Only One Component Service'.
  38. Click [Submit].
  39. Click [No].
  40. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  41. Set the 'From' and 'To' dates to cover the services created in Step 10.
  42. Select 'Rollup Definition 1' from 'Roll-Up Definitions'.
  43. Click [Compile Worklist].
  44. Validate that the received message says, "Compile complete.".
  45. Click [OK].
  46. Click [Run Report].
  47. Validate that a roll-up service was created for each component service date, even if there is only one component service on that date for 'Client A'.
  48. Close the report.
  49. Click [Discard].
  50. Click [Yes].
  51. Open ‘Roll-Up Services Definition’.
  52. Select 'Edit' from the 'Add/Edit/Delete Roll-Up Service Definition' field.
  53. Select 'Rollup Definition 1' from the 'Existing Roll-Up Definition' dropdown list.
  54. Validate that all the fields are populated with the data for the 'Rollup Definition 1'.
  55. Select 'Yes' for 'Prevent Roll-Up From Happening For A Client If There Is Only One Component Service'.
  56. Click [Submit].
  57. Click [No].
  58. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  59. Set the 'From' and 'To' dates to cover the services created in Step 10.
  60. Select 'Rollup Definition 1' from 'Roll-Up Definitions'.
  61. Click [Compile Worklist].
  62. Validate that the received message says, "Compile complete.".
  63. Click [OK].
  64. Click [Run Report].
  65. Validate that no roll-up was created for the date(s) where there was only one component service entered for 'Client A'.
  66. Validate that a roll-up was created for the date(s) where there are multiple component services.
  67. Close the report.
  68. Click 'Post Roll-Up Services Worklist'.
  69. Select the compiled Roll-up Worklist in the 'Through Date' field.
  70. Select any desired posting code from the 'Write Off Posting Code' dropdown.
  71. Click [Post Worklist].
  72. Validate the received message says, "Post complete.".
  73. Click [OK].
  74. Click [Discard].
  75. Click [Yes].
  76. Open 'Client Ledger'.
  77. Select 'Client A'.
  78. Click 'All Episodes'.
  79. Click 'Simple'.
  80. Click [Process].
  81. Validate that the ledger shows the component services marked as 'Roll-Up', along with the newly created Roll-Up service as 'Open' only for the dates that have multiple component services.
  82. Validate that the component services are not rolled up and that no Roll-Up service is created for the dates that have only one component service.
  83. Close the report.
  84. Click [No].
Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist • NX • Roll-Up Service Definition • Registry Settings
Update 10 Summary | Details
Avatar Cal-PM 'Electronic Billing' 837 Professional
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Dictionary Update (PM)
  • Electronic Billing
Scenario 1: 'Guarantor/Program Billing Defaults' - Verification of 'Service Facility Location 2310D/2420C' Registry Setting
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Service Facility Location 2310D/2420C' must be enabled
Steps
  1. Open Avatar Cal-PM 'Guarantor/Program Billing Defaults' form.
  2. Select 'Add Template' in 'Action field (or 'Edit Template' and select existing Guarantor/Program Billing Defaults template for review/edit).
  3. Navigate to '837 Professional' section of form.
  4. Ensure the 'Select Type Of Information To Include In Service Facility Location (2310D/2420C)' field is present in 'Guarantor/Program Billing Defaults' form '837 Professional' section.
  5. Ensure 'Select Type Of Information To Include In Service Facility Location (2310D/2420C)' field includes the following selections/options:
  6. 'Suppress 2310C/2310D (Only if Facility Type Code is NOT '12 - Home' or '10-Telehealth-Patient in Home')'
  7. 'Suppress 2420C (Only if Place Of Service is NOT '12 - Home' or '10-Telehealth-Patient in Home')'
  8. Select values for 'Select Type Of Information To Include In Service Facility Location (2310D/2420C)' field (and any other fields/sections as desired).
  9. Click 'Submit' button to file Guarantor/Program Billing Defaults template.
  10. Select 'Edit Template' in 'Action field and select previously filed Guarantor/Program Billing Defaults template for review/edit.
  11. Navigate to '837 Professional' section of form.
  12. Ensure that previously selected/filed values for 'Select Type Of Information To Include In Service Facility Location (2310D/2420C)' field are present for selected template.
Scenario 2: 'Electronic Billing' - 837 Professional, Verification of Service Facility Location 2310D/2420C Suppression
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Service Facility Location 2310D/2420C' must be enabled
  • One or more 'Location' Dictionary Codes ('Client' Indirect, Data Element 10006) with Extended Dictionary Data Element '(579) Place Of Service (837 Professional)' value must be defined (via 'Dictionary Update' form)
  • One or more values selected for 'Select Type Of Information To Include In Service Facility Location (2310D/2420C)' field for applicable Guarantor/Program for 837 Professional service billing (via 'Guarantor/Program Billing Defaults' form '837 Professional' section)
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 in 'Billing Form' field.
  4. Enter/select 837 file sorting criteria, using values which will include service(s) with 'Location' value defined (for Admission program and/or service).
  5. Click 'Process' button to sort/generate 837 Professional 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 file sorted which includes services with 'Location' value defined, and click 'Process' button to display 837 outbound file data.
  9. In Avatar Cal-PM 837 Professional format outbound electronic billing file data - for claims including service(s) with 'Location' value defined, ensure that the Service Facility Location 2310D/2420C loops/segments are included or not included/suppressed according to selections in 'Select Type Of Information To Include In Service Facility Location (2310D/2420C)' Guarantor/Program Billing Defaults field (based on 'Place Of Service (837 Professional)' Extended Dictionary value for 'Location' code):
  10. Examples:
  11. If 'Suppress 2310C/2310D (Only if Facility Type Code is NOT '12 - Home' or '10-Telehealth-Patient in Home')' and/or 'Suppress 2420C (Only if Place Of Service is NOT '12 - Home' or '10-Telehealth-Patient in Home')' are selected for 'Select Type Of Information To Include In Service Facility Location (2310D/2420C)' field...
  12. Ensure that Service Facility Location 2310D and/or 2420C loops (respectively) are not included in 837 Professional claims where 'Place Of Service (837 Professional)' Extended Dictionary value for 'Location' is any value other than '12 - Home' or '10-Telehealth-Patient in Home'
  13. Ensure that Service Facility Location 2310D and/or 2420C loops (respectively) are included in 837 Professional claims where 'Place Of Service (837 Professional)' Extended Dictionary value for 'Location' is value '12 - Home' or '10-Telehealth-Patient in Home'
  14. If 'Suppress 2310C/2310D (Only if Facility Type Code is '12 - Home')' and/or 'Suppress 2420C (Only if Place Of Service Is '12 - Home')' are selected for 'Select Type Of Information To Include In Service Facility Location (2310D/2420C)' field...
  15. Ensure that Service Facility Location 2310D and/or 2420C loops (respectively) are not included in 837 Professional claims where 'Place Of Service (837 Professional)' Extended Dictionary value for 'Location' is value '12 - Home'
  16. Ensure that Service Facility Location 2310D and/or 2420C loops (respectively) are included in 837 Professional claims where 'Place Of Service (837 Professional)' Extended Dictionary value for 'Location' is any value other than '12 - Home'
Topics
• Registry Settings • Guarantor/Program Billing Defaults • Electronic Billing • 837 Professional
Update 20 Summary | Details
Web Service - Cal-OMS Admission
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • SOAPUI - CalOMSAdmissionSoap - FileCalOMSAdmission
  • SOAPUI - CalOMSAdmissionSoap - FileCalOMSDischarge
Scenario 1: WEBSVC.CalOMSAdmission - Verification of Web Service Filing - Enable LA County Reporting Requirements=YC
Specific Setup:
  • Registry Setting:
  • Avatar Cal-PM Registry Setting 'Enable LA County Reporting Requirements' must be enabled (set to 'YC').
  • Avatar Cal-PM Registry Setting 'Enable Non LA County Requirements' must be enabled (set to 'Y').
  • Admission:
  • A new client is admitted or an existing client is identified. Note the client id, admission program, admission program code to be used as a location of admission.
  • Crystal Reports or other SQL reporting tool.
Steps
  1. Create a SoapUI project for Avatar Cal-PM 'Cal-OMS Admission' web service.
  2. Populate all the required/desired fields to create a Cal-OMS admission record for the client identified. Note all the data defined while creating web service request.
  3. Using the 'Cal-OMS Admission' web service (and/or 'Cal-OMS Admission V2' web service), submit request to 'FileCalOMSAdmission' method to create or update Cal-OMS Admission record.
  4. Confirm 'Cal-OMS Admission' web service responds with confirmation data/ID on successful filing of 'FileCalOMSAdmission' method. Example:"<Confirmation>ClientID:305||EP:1||UniqueID:OMA.001</Confirmation>"
  5. Confirm 'Cal-OMS Admission' web service responds with confirmation message on successful filing of 'FileCalOMSAdmission' method. Example:"<Message>Cal-OMS Admission web service has been filed successfully.</Message>"
  6. Confirm 'Cal-OMS Admission' web service responds with successful status value on successful filing of 'FileCalOMSAdmission' method. Example:"<Status>1</Status>"
  7. Open Avatar Cal-PM 'Cal-OMS Admission' form and select client/episode/Cal-OMS Admission record filed via web service for view/update.
  8. Confirm Cal-OMS Admission record is created/updated in Avatar Cal-PM, with values/data submitted via web service, including the following fields: 'Record To Be Submitted', 'Ethnicity', 'What is your Principal Source of Referral?', 'Primary Drug Route of Administration', 'Secondary Drug Route of Administration', 'Which of the following medication is prescribed as part of treatment?', 'Current Living Arrangements', 'Race 1', 'Race 2', 'Race 3', 'Race 4', 'Race 5'.
  9. Open Crystal Reports or other SQL reporting tool.
  10. In Avatar Cal-PM SQL table 'SYSTEM.cal_oms_admission', ensure data values are filed/present for all fields as filed via web service, including LA-Specific field values noted above.
Scenario 2: WEBSVC.CalOMSDischarge - Verification of Web Service Filing - Enable LA County Reporting Requirements=YC
Specific Setup:
  • Registry Setting:
  • Avatar Cal-PM Registry Setting 'Enable LA County Reporting Requirements' must be enabled (set to 'YC').
  • Avatar Cal-PM Registry Setting 'Enable Non LA County Requirements' must be enabled (set to 'Y').
  • Admission:
  • A new client is admitted or an existing client is identified. Note the client id, admission program, admission program code to be used as a location of admission.
  • Crystal Reports or other SQL reporting tool.
  • Cal-OMS admission is filed for the client and 'GUID' value received from the SYSTEM.cal_oms_admission table to be used in Associated CalOMS admission. Note the value.
Steps
  1. Using the 'Cal-OMS Discharge' web service (and/or 'Cal-OMS Discharge V2' web service), submit request to 'FileCalOMSDischarge' method to create or update Cal-OMS Discharge record.
  2. Confirm 'Cal-OMS Discharge' web service responds with confirmation data/ID on successful filing of 'FileCalOMSDischarge' method. Example <Confirmation>ClientID:305||EP:1||UniqueID:OMD.001</Confirmation>"
  3. Confirm 'Cal-OMS Discharge' web service responds with confirmation message on successful filing of 'FileCalOMSDischarge' method. Example:"<Message>Cal-OMS Discharge web service has been filed successfully.</Message>".
  4. Confirm 'Cal-OMS Discharge' web service responds with successful status value on successful filing of 'FileCalOMSDischarge' method. Example:"<Status>1</Status>".
  5. Open Avatar Cal-PM 'Cal-OMS Discharge' form and select client/episode/Cal-OMS Discharge record filed via web service for view/update.
  6. Confirm Cal-OMS Discharge record is created/updated in Avatar Cal-PM, with values/data submitted via web service.
Scenario 3: WEBSVC.CalOMSAdmission and WEBSVC.CalOMSDischarge - Enable LA County Reporting Requirements=N
Specific Setup:
  • The registry setting 'Enable LA County Reporting Requirements' is set to 'N'.
  • Admission:
  • A new client is admitted or an existing client is identified. Note the client id, admission program, admission program code to be used as a location of admission.
  • Crystal Reports or other SQL reporting tool.

  • The 'Cal-OMS Admission' is submitted for the client with populating data in each field.
  • The GUID value is selected from the 'SYSTEM'.cal_oms_admission table for the client ID.
Steps
  1. Open the SoapUI or any other web service testing tool.
  2. Create a SoapUI project for Avatar Cal-PM 'Cal-OMS Admission' web service.
  3. Create Cal-OMS Admission web service request for the client identified in the setup section with all the fields EXCEPT for the following tags/fields:
  4. *<MedsAsPartOfTreatment>/'Medication Prescribed As Part Of Treatment' = empty
  5. <PregnantAtAdmission>/'Pregnant At Admission' = empty
  6. SecondaryDrugCode = 0
  7. SecondaryDrugFrequency = empty
  8. SecondaryDrugRoute = file empty
  9. SecondaryDrugAgeFirstUse = empty
  10. Using the 'Cal-OMS Admission' web service (and/or 'Cal-OMS Admission V2' web service), submit request to 'FileCalOMSAdmission' method to create or update Cal-OMS Admission record.
  11. Confirm 'Cal-OMS Admission' web service responds with confirmation data/ID on successful filing of 'FileCalOMSAdmission' method. Example:"<Confirmation>ClientID:305||EP:1||UniqueID:OMA.001</Confirmation>".
  12. Confirm 'Cal-OMS Admission' web service responds with confirmation message on successful filing of 'FileCalOMSAdmission' method. Example:"<Message>Cal-OMS Admission web service has been filed successfully.</Message>"
  13. Confirm 'Cal-OMS Admission' web service responds with successful status value on successful filing of 'FileCalOMSAdmission' method. Example:"<Status>1</Status>".
  14. Open Crystal Reports or other SQL reporting tool
  15. Query 'SELECT GUID.* FROM SYSTEM.cal_oms_admission WHERE PATID= [ClientID].
  16. Verify 'GUID' field populates correctly with the unique value. Note this GUID to be used at the time of editing 'WEBSVC.CalOMSDischarge' web service if needed.
  17. Verify the 'meds_part_treatment_code' field defaults to NULL.
  18. Verify the 'meds_part_treatment_value' field defaults to NULL
  19. Verify the 'pregnant_code' field defaults to 0.
  20. Verify the 'pregnant_value' field defaults to No.
  21. Verify the 'sec_drug_code' field defaults to 0.
  22. Verify the 'sec_drug_value' field defaults to None.
  23. Verify the 'sec_drug_first_use' field defaults to 99902
  24. Verify the 'sec_drug_route_code' field defaults to 99902.
  25. Verify the 'sec_drug_route_value' field defaults to None or Not Applicable.
  26. Verify the 'sec_drug_freq' field defaults to 99902.
  27. Close the SQL data viewer tool.
  28. Go back to SoapUI or any other web service testing tool.
  29. Create Cal-OMS Discharge web service request for the client identified in the setup section with all the fields EXCEPT for the following tags/fields:
  30. PregnantDuringTreatment = empty.
  31. SecondaryDrugCode = 0.
  32. SecondaryDrugFrequency = empty.
  33. SecondaryDrugRoute = file empty.
  34. SecondaryDrugAgeFirstUse = empty.
  35. Enter the client ID used above during Cal-OMS admission, episode number, discharge date and status, GUID value in the property 'AssociatedCalOMSAdmission'.
  36. Submit the web service request.
  37. Confirm 'Cal-OMS Admission' web service responds with confirmation data/ID on successful filing of 'FileCalOMSDischarge' method. Example:"<Confirmation>ClientID:305||EP:1||UniqueID:OMD.001</Confirmation>".
  38. Confirm 'Cal-OMS Admission' web service responds with confirmation message on successful filing of 'FileCalOMSDischarge' method. Example:"<Message>Cal-OMS Discharge web service has been filed successfully.</Message>".
  39. Confirm 'Cal-OMS Admission' web service responds with successful status value on successful filing of 'FileCalOMSDischarge' method. Example:"<Status>1</Status>".
  40. Open Crystal Reports or other SQL reporting tool.
  41. Create a Query against 'SYSTEM.cal_oms_discharge' table.
  42. Run the query for the client used in the above step.
  43. Verify 'GUID' field populate correctly with the unique value.
  44. Verify the 'pregnant_code' field defaults to 0.
  45. Verify the 'pregnant_value' field defaults to No.
  46. Verify the 'sec_drug_code' field defaults to 0.
  47. Verify the 'sec_drug_value' field defaults to None.
  48. Verify the 'sec_drug_route_code' field defaults to 99902.
  49. Verify the 'sec_drug_route_value' field defaults to None or Not Applicable.
  50. Verify the 'sec_drug_freq' field defaults to 99902.
  51. Close the SQL data viewer tool.
Web Service - Cal-OMS Discharge
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • SOAPUI - CalOMSAdmissionSoap - FileCalOMSDischarge
  • SOAPUI - CalOMSAdmissionSoap - FileCalOMSAdmission
Scenario 1: WEBSVC.CalOMSDischarge - Verification of Web Service Filing - Enable LA County Reporting Requirements=YC
Specific Setup:
  • Registry Setting:
  • Avatar Cal-PM Registry Setting 'Enable LA County Reporting Requirements' must be enabled (set to 'YC').
  • Avatar Cal-PM Registry Setting 'Enable Non LA County Requirements' must be enabled (set to 'Y').
  • Admission:
  • A new client is admitted or an existing client is identified. Note the client id, admission program, admission program code to be used as a location of admission.
  • Crystal Reports or other SQL reporting tool.
  • Cal-OMS admission is filed for the client and 'GUID' value received from the SYSTEM.cal_oms_admission table to be used in Associated CalOMS admission. Note the value.
Steps
  1. Using the 'Cal-OMS Discharge' web service (and/or 'Cal-OMS Discharge V2' web service), submit request to 'FileCalOMSDischarge' method to create or update Cal-OMS Discharge record.
  2. Confirm 'Cal-OMS Discharge' web service responds with confirmation data/ID on successful filing of 'FileCalOMSDischarge' method. Example <Confirmation>ClientID:305||EP:1||UniqueID:OMD.001</Confirmation>"
  3. Confirm 'Cal-OMS Discharge' web service responds with confirmation message on successful filing of 'FileCalOMSDischarge' method. Example:"<Message>Cal-OMS Discharge web service has been filed successfully.</Message>".
  4. Confirm 'Cal-OMS Discharge' web service responds with successful status value on successful filing of 'FileCalOMSDischarge' method. Example:"<Status>1</Status>".
  5. Open Avatar Cal-PM 'Cal-OMS Discharge' form and select client/episode/Cal-OMS Discharge record filed via web service for view/update.
  6. Confirm Cal-OMS Discharge record is created/updated in Avatar Cal-PM, with values/data submitted via web service.
Scenario 2: WEBSVC.CalOMSAdmission and WEBSVC.CalOMSDischarge - Enable LA County Reporting Requirements=N
Specific Setup:
  • The registry setting 'Enable LA County Reporting Requirements' is set to 'N'.
  • Admission:
  • A new client is admitted or an existing client is identified. Note the client id, admission program, admission program code to be used as a location of admission.
  • Crystal Reports or other SQL reporting tool.

  • The 'Cal-OMS Admission' is submitted for the client with populating data in each field.
  • The GUID value is selected from the 'SYSTEM'.cal_oms_admission table for the client ID.
Steps
  1. Open the SoapUI or any other web service testing tool.
  2. Create a SoapUI project for Avatar Cal-PM 'Cal-OMS Admission' web service.
  3. Create Cal-OMS Admission web service request for the client identified in the setup section with all the fields EXCEPT for the following tags/fields:
  4. *<MedsAsPartOfTreatment>/'Medication Prescribed As Part Of Treatment' = empty
  5. <PregnantAtAdmission>/'Pregnant At Admission' = empty
  6. SecondaryDrugCode = 0
  7. SecondaryDrugFrequency = empty
  8. SecondaryDrugRoute = file empty
  9. SecondaryDrugAgeFirstUse = empty
  10. Using the 'Cal-OMS Admission' web service (and/or 'Cal-OMS Admission V2' web service), submit request to 'FileCalOMSAdmission' method to create or update Cal-OMS Admission record.
  11. Confirm 'Cal-OMS Admission' web service responds with confirmation data/ID on successful filing of 'FileCalOMSAdmission' method. Example:"<Confirmation>ClientID:305||EP:1||UniqueID:OMA.001</Confirmation>".
  12. Confirm 'Cal-OMS Admission' web service responds with confirmation message on successful filing of 'FileCalOMSAdmission' method. Example:"<Message>Cal-OMS Admission web service has been filed successfully.</Message>"
  13. Confirm 'Cal-OMS Admission' web service responds with successful status value on successful filing of 'FileCalOMSAdmission' method. Example:"<Status>1</Status>".
  14. Open Crystal Reports or other SQL reporting tool
  15. Query 'SELECT GUID.* FROM SYSTEM.cal_oms_admission WHERE PATID= [ClientID].
  16. Verify 'GUID' field populates correctly with the unique value. Note this GUID to be used at the time of editing 'WEBSVC.CalOMSDischarge' web service if needed.
  17. Verify the 'meds_part_treatment_code' field defaults to NULL.
  18. Verify the 'meds_part_treatment_value' field defaults to NULL
  19. Verify the 'pregnant_code' field defaults to 0.
  20. Verify the 'pregnant_value' field defaults to No.
  21. Verify the 'sec_drug_code' field defaults to 0.
  22. Verify the 'sec_drug_value' field defaults to None.
  23. Verify the 'sec_drug_first_use' field defaults to 99902
  24. Verify the 'sec_drug_route_code' field defaults to 99902.
  25. Verify the 'sec_drug_route_value' field defaults to None or Not Applicable.
  26. Verify the 'sec_drug_freq' field defaults to 99902.
  27. Close the SQL data viewer tool.
  28. Go back to SoapUI or any other web service testing tool.
  29. Create Cal-OMS Discharge web service request for the client identified in the setup section with all the fields EXCEPT for the following tags/fields:
  30. PregnantDuringTreatment = empty.
  31. SecondaryDrugCode = 0.
  32. SecondaryDrugFrequency = empty.
  33. SecondaryDrugRoute = file empty.
  34. SecondaryDrugAgeFirstUse = empty.
  35. Enter the client ID used above during Cal-OMS admission, episode number, discharge date and status, GUID value in the property 'AssociatedCalOMSAdmission'.
  36. Submit the web service request.
  37. Confirm 'Cal-OMS Admission' web service responds with confirmation data/ID on successful filing of 'FileCalOMSDischarge' method. Example:"<Confirmation>ClientID:305||EP:1||UniqueID:OMD.001</Confirmation>".
  38. Confirm 'Cal-OMS Admission' web service responds with confirmation message on successful filing of 'FileCalOMSDischarge' method. Example:"<Message>Cal-OMS Discharge web service has been filed successfully.</Message>".
  39. Confirm 'Cal-OMS Admission' web service responds with successful status value on successful filing of 'FileCalOMSDischarge' method. Example:"<Status>1</Status>".
  40. Open Crystal Reports or other SQL reporting tool.
  41. Create a Query against 'SYSTEM.cal_oms_discharge' table.
  42. Run the query for the client used in the above step.
  43. Verify 'GUID' field populate correctly with the unique value.
  44. Verify the 'pregnant_code' field defaults to 0.
  45. Verify the 'pregnant_value' field defaults to No.
  46. Verify the 'sec_drug_code' field defaults to 0.
  47. Verify the 'sec_drug_value' field defaults to None.
  48. Verify the 'sec_drug_route_code' field defaults to 99902.
  49. Verify the 'sec_drug_route_value' field defaults to None or Not Applicable.
  50. Verify the 'sec_drug_freq' field defaults to 99902.
  51. Close the SQL data viewer tool.
Topics
• Cal-Oms Admission • Web Services • Cal-OMS
Update 25 Summary | Details
Enable Co-Practitioner Services From Progress Notes - Edit Service Information
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Progress Notes (Group and Individual)
  • Delete Service
  • Program Maintenance
  • Site Specific Section Modeling (CWS)
  • Dictionary Update (PM)
  • Admission (Outpatient)
  • Financial Eligibility
  • Service Fee/Cross Reference Maintenance
  • Electronic Billing
Scenario 1: Enable Co-Practitioner Services From Progress Notes - Delete Service functionality
Specific Setup:
  • Registry Setting:
  • The 'Enable Co-Practitioner Services From Progress Notes' registry setting is set to 'Y'.
  • Program Maintenance:
  • Identify an existing program to be used for client's admission. Note the program code/value and associated 'Service Programs'.
  • The 'Create Co-Practitioner Services From Progress Notes' field is set to 'Yes' for the above program.
  • Site Specific Section modeling:
  • Add-On service, Save Add-On, Add-On Duration, Co-Practitioner, Co-Practitioner Duration fields are added to the Progress Note form if they are not available on the form.
  • Dictionary Update:
  • File= 'Other Tabled File,
  • Data Element -291, Service Code Type'
  • Dictionary Code = desired code
  • Dictionary Value = Desired value
  • Extended Dictionary = 'Allow Multiple Add-On Code Definition'
  • Extended Dictionary Value (Single Dictionary) = Yes
  • Service Codes:
  • A primary service code is created to have desired number of add-on with the following:
  • Service Code Category = Primary Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • A primary add-on service code is created with the following:
  • Service Code Category = Primary Add-On Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = No
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • Another add-on service code is created with the following:
  • Service Code Category = Add-On Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = Yes
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • An interactive complexity add-on service code is created with the following:
  • Service Code Category =Interactive Complexity code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = NULL
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • Service Fee/Cross Reference Maintenance:
  • A fee definition is created for all the service codes. Note the fee for each service code.
  • An active practitioner is identified. Note the practitioner ID.
  • Admission:
  • An active client is identified, or a new client is created. Note the client id, name.
  • Diagnosis:
  • The client has an active diagnosis record. Note the diagnosis codes.
  • Financial Eligibility:
  • The client has an active financial eligibility record. Note the financial class of the guarantor. Note the client ID. Note the episode and program.
Steps
  1. Select desired client from the 'My Clients' widget.
  2. Open the 'Progress Notes (Group and Individual)' form.
  3. Validate the 'Select Client' field contains the client selected from the 'My Clients' widget.’.
  4. Select desired episode from the 'Select Episode' field.
  5. Select ‘New Service’ from the 'Progress Notes For' field.
  6. Select desired value from the 'Note Type' field.
  7. Enter desired value in the 'Notes Field' field.
  8. Enter desired date in the 'Date Of Service' field.
  9. Enter primary service code in the 'Service Charge Code' field.
  10. Validate the 'Service Program' field contains the program associated to the selected episode.
  11. Select desired practitioner from the 'Practitioner' field.
  12. Enter desired duration in the 'Service Duration' field.
  13. Select desired co-practitioner from the 'Co-Practitioner' field.
  14. Enter desired duration in the 'Co-Practitioner Duration (Minutes)'.
  15. Select desired codes from the 'Add-On Services'.
  16. Enter desired value in the 'Add-On Duration'.
  17. Click [Save Add-On Service].
  18. Verify the add-on service displays in the 'Selected Add-On Services' text area.
  19. Repeat steps from 15 through 18 if more than one add-on code needs to be added to the primary code.
  20. Select ‘Final’ from the 'Draft/Final' field.
  21. Click [File Note].
  22. Validate a message is displayed stating: 'Note Filed'.
  23. Click [OK].
  24. Close the form.
  25. Open the 'Client Ledger' for the client.
  26. Verify the client ledger contains primary and add-on services created for all the co-practitioner listed in the progress note if the field 'Should Add-On Services Generate for Co-Practitioners for this Service Code?' is set to 'Yes' or Null for the add-on service code in the 'Service Code' form.
  27. Close the form.
  28. Open the ‘Delete Service’ form.
  29. Select the client in the 'Client Id' field.
  30. Enter 'Start Date' and 'End Date' such that it covers the services rendered to the selected client.
  31. Click [Display Client].
  32. Verify the message box displays only the service of the main practitioner within the date range previously specified.
  33. Select desired service to be deleted.
  34. Click [OK].
  35. Click [Delete].
  36. Verify 'The following services will be deleted' dialog displays the service selected to be deleted.
  37. Click [OK].
  38. Click [Yes].
  39. Verify the 'Information' message contains 'Deleted'.
  40. Close the form.
  41. Open the ‘Client Ledger’ for the client.
  42. Verify the previously selected service and all of its associated co-practitioner services are deleted.
  43. Close the form.
Scenario 2: Enable Co-Practitioner Services From Progress Notes – Edit service Information functionality
Specific Setup:
  • Registry Setting:
  • The 'Enable Co-Practitioner Services From Progress Notes' registry setting is set to 'Y'.
  • Program Maintenance:
  • Identify an existing program to be used for client's admission. Note the program code/value, and the associated service programs.
  • The 'Create Co-Practitioner Services From Progress Notes' field is set to 'Yes' for the above program.
  • Site Specific Section modeling:
  • Add-On service, Save Add-On, Add-On Duration, Co-Practitioner, Co-Practitioner Duration fields are added to the Progress Note form if they are not available on the form.
  • Dictionary Update:
  • File= 'Other Tabled File,
  • Data Element -291, Service Code Type'
  • Dictionary Code = desired code
  • Dictionary Value = desired value
  • Extended Dictionary = 'Allow Multiple Add-On Code Definition'
  • Extended Dictionary Value (Single Dictionary) = Yes
  • Service Codes:
  • A primary service code is created to have desired number of add-on with the following:
  • Service Code Category = Primary Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • A primary add-on service code is created with the following:
  • Service Code Category = Primary Add-On Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = No
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • Another add-on service code is created with the following:
  • Service Code Category = Add-On Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = Yes
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • An interactive complexity add-on service code is created with the following:
  • Service Code Category =Interactive Complexity code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = NULL
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • Service Fee/Cross Reference Maintenance:
  • A fee definition is created for all the service codes. Note the fee for each service code.
  • An active practitioner is identified. Note the practitioner ID.
  • Admission:
  • An active client is identified, or a new client is created. Note the client's id, name.
  • Diagnosis:
  • The client has an active diagnosis record. Note the diagnosis codes.
  • Financial Eligibility:
  • The client has an active financial eligibility record. Note the financial class of the guarantor. Note the client ID. Note the episode and program.
Steps
  1. Select desired client from the 'My Clients' widget.
  2. Open the 'Progress Notes (Group and Individual)' form.
  3. Validate the 'Select Client' field contains the client selected from the 'My Clients' widget.’.
  4. Select desired episode from the 'Select Episode' field.
  5. Select ‘New Service’ from the 'Progress Notes For' field.
  6. Select desired value from the 'Note Type' field.
  7. Enter desired value in the 'Notes Field' field.
  8. Enter desired date in the 'Date Of Service' field.
  9. Enter primary service code in the 'Service Charge Code' field.
  10. Validate the 'Service Program' field contains the program associated to the selected episode.
  11. Select desired practitioner from the 'Practitioner' field.
  12. Enter desired duration in the 'Service Duration' field.
  13. Select desired co-practitioner from the 'Co-Practitioner' field.
  14. Select desired duration in the 'Co-Practitioner Duration (Minutes)'.
  15. Select ‘Final’ from the 'Draft/Final' field.
  16. Click [File Note].
  17. Validate a message is displayed stating: 'Note Filed'.
  18. Click [OK].
  19. Close the form.
  20. Open the 'Client Ledger' for the client.
  21. Verify the client ledger contains primary and add-on services created for all the co-practitioner listed in the progress note if the field 'Should Add-On Services Generate for Co-Practitioners for this Service Code?' is set to 'Yes' or Null for the add-on service code in the 'Service Code' form.
  22. Close the form.
  23. Open the ‘Edit service Information’ form.
  24. Select the same client from the above step 'Client ID' field.
  25. Click [Select Service(s) to Edit].
  26. Select a service for the practitioner to edit.
  27. Verify the Service Code, Program, Office, all Practitioner fields, and their duration are editable.
  28. Enter a new value in the Duration, Co-Practitioner Duration (Minutes) and Second Co Staff (Minutes).
  29. Click [Submit].
  30. Open the ‘Client Ledger’ form.
  31. Verify the practitioner and co-practitioner services reflect the duration change and new charges are calculated based on the new value specified for the duration.
  32. Close the form.
  33. Open the ‘Edit service Information’ form.
  34. Select the same client from the above step 'Client ID' field.
  35. Click [Select Service(s) to Edit].
  36. Select a service for the practitioner to edit.
  37. Verify the Service Code, Program, Office, all Practitioner fields, and their duration are editable.
  38. Select desired add-on service from the 'Add-On Service' codes to attach to the primary service code.
  39. Click [Submit].
  40. Open the ‘Client Ledger’ form.
  41. Verify that the primary and add-on services are created for the practitioner and co-practitioners.
  42. Close the form.
  43. Open the ‘Edit service Information’ form.
  44. Select the same client from the above step 'Client ID' field.
  45. Click [Select Service(s) to Edit].
  46. Select a service for the practitioner to edit.
  47. Remove one of the add-on service codes added to the primary service code of the practitioner service.
  48. Click [Submit].
  49. Open the ‘Client Ledger’ form.
  50. Verify that the desired add-on service code is deleted for the practitioner and co-practitioners.
  51. Close the form.
Scenario 3: Validating co-practitioner services - 'Should Add-On Services Generate for Co-Practitioners for this Service Code?' = Y, N or Null and 'Create Co-Practitioner Services From Progress Notes' = Y
Specific Setup:
  • Registry Setting:
  • The 'Enable Co-Practitioner Services From Progress Notes' registry setting is set to 'Y'.
  • Program Maintenance:
  • Identify an existing program to be used for client's admission. Note the program code/value, and associated service programs.
  • The 'Create Co-Practitioner Services From Progress Notes' field is set to 'Yes' for the above program.
  • Site Specific Section modeling:
  • Add-On service, Save Add-On, Add-On Duration, Co-Practitioner, Co-Practitioner Duration fields are added to the Progress Note form if they are not available on the form.
  • Dictionary Update:
  • File= 'Other Tabled File,
  • Data Element -291, Service Code Type'
  • Dictionary Code = Desired code
  • Dictionary Value = Desired value
  • Extended Dictionary = 'Allow Multiple Add-On Code Definition'
  • Extended Dictionary Value (Single Dictionary) = Yes
  • Service Codes:
  • A primary service code is created to have desired number of add-on with the following:
  • Service Code Category = Primary Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • A primary add-on service code is created with the following:
  • Service Code Category = Primary Add-On Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = No
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • Another add-on service code is created with the following:
  • Service Code Category = Add-On Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = Yes
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • An interactive complexity add-on service code is created with the following:
  • Service Code Category =Interactive Complexity code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = NULL
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • Service Fee/Cross Reference Maintenance:
  • A fee definition is created for all the service codes. Note the fee for each service code.
  • An active practitioner is identified. Note the practitioner's ID.
  • Admission:
  • An active client is identified, or a new client is created. Note the client's id, name.
  • Diagnosis:
  • The client has an active diagnosis record. Note the diagnosis codes.
  • Financial Eligibility:
  • The client has an active financial eligibility record. Note the financial class of the guarantor. Note the client ID. Note the episode and program.
Steps
  1. Select desired client from the 'My Clients' widget.
  2. Open the 'Progress Notes (Group and Individual)' form.
  3. Validate the 'Select Client' field contains the client selected from the 'My Clients' widget.’.
  4. Select desired episode from the 'Select Episode' field.
  5. Select ‘New Service’ from the 'Progress Notes For' field.
  6. Select any value from the 'Note Type' field.
  7. Enter any value in the 'Notes Field' field.
  8. Enter the desired date in the 'Date Of Service' field.
  9. Enter primary service code in the 'Service Charge Code' field.
  10. Validate the 'Service Program' field contains the Service Program associated to selected episode.
  11. Select desired practitioner from the 'Practitioner' field.
  12. Enter desired duration in the 'Service Duration' field.
  13. Select desired co-practitioner from the 'Co-Practitioner' field.
  14. Enter desired duration in the 'Co-Practitioner Duration (Minutes)'.
  15. Select desired codes from the 'Add-On Services'.
  16. Select desired value in the 'Add-On Duration'.
  17. Click [Save Add-On Service].
  18. Verify the add-on service displayed in the 'Selected Add-On Services' text area.
  19. Repeat steps from 15 through 18 if more than one add-on code needs to be added to the primary code.
  20. Select ‘Final’ from the 'Draft/Final' field.
  21. Click [File Note].
  22. Validate a message is displayed stating: 'Note Filed'.
  23. Click [OK].
  24. Close the form.
  25. Open the 'Client Ledger' for the client.
  26. Verify the client ledger contains primary and add-on services created for all the co-practitioner listed in the progress note if the field 'Should Add-On Services Generate for Co-Practitioners for this Service Code?' is set to 'Yes' or Null for the add-on service code in the 'Service Code' form.
  27. Close the form.
  28. Open the 'Close Charges' form.
  29. Close all the charges distributed to the guarantor.
  30. Close the form.
  31. Open the 'Create Interim Billing Batch File' form.
  32. Create an interim billing batch that covers the client, guarantor and services rendered to the client. Note the batch number.
  33. Close the form.
  34. Open the 'Electronic Billing' form.
  35. Compile an 837 bill for the client.
  36. Verify the bill compiles successfully.
  37. Select 'Dump File' option from the billing options.
  38. Select the recently compiled 837 file.
  39. Review the file.
  40. Verify the primary and add-on services are created for all the co-practitioner listed in the progress note if the field 'Should Add-On Services Generate for Co-Practitioners for this Service Code?' is set to 'Yes' or Null for the add-on service code in the 'Service Code' form.
  41. Close the report.
  42. Close the form.
Topics
• Progress Notes • Delete Service • Edit Service Information • Service Codes
Update 28 Summary | Details
Client Demographic forms - 'Address Type' field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Discharge
  • Pre Admit
  • Client Alternate Addresses
  • SoapUI - ClientDemographics
  • SoapUI - UpdateAdmission
  • Admission (Outpatient)
  • Pre Admit Discharge
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 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  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 that the 'Address Type' 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 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  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 that the 'Address Type' 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 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  9. Select the desired value in the 'Do you have family members that are agricultural workers?' field.
  10. Select the desired value in the 'Are you an aged and disabled former migratory agricultural worker?' field.
  11. Click [Submit].
  12. Select "Client A" and access the 'Discharge' form.
  13. Select the discharged episode and click [Edit].
  14. Validate all previously filed data is displayed.
  15. Select the "Demographics" section.
  16. Validate the 'Address Type' field contains the value filed in the previous steps.
  17. Validate the 'Do you have family members that are agricultural workers?' field contains the value filed in the previous steps.
  18. Validate the 'Are you an aged and disabled former migratory agricultural worker?' field contains the value filed in the previous steps.
  19. Close the form.
  20. Access Crystal Reports or other SQL Reporting Tool.
  21. Create a report using the 'SYSTEM.patient_current_demographics' and 'SYSTEM.patient_demographic_history' SQL tables.
  22. Validate a row is displayed for "Client A".
  23. Validate the 'address_type_code' and 'address_type_value' fields contain the code/value filed in the previous steps.
  24. Validate the 'fam_agric_worker_code' and 'fam_agric_worker_value' fields contain the code/value filed in the previous steps.
  25. Validate the 'former_agric_worker_code' and 'former_agric_worker_value' fields contain the code/value filed in the previous steps.
  26. Close the reports.
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 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  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 'Address Type' 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 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  5. Click [Submit].
  6. Select "Client A" and access the 'Call Intake' form.
  7. Select the existing call intake record and click [Edit].
  8. Validate the 'Address Type' field contains the value selected in the previous steps.
  9. Close the form.
Scenario 6: Client Alternate Addresses - Form Validations
Specific Setup:
  • The 'Enable Client Alternate Addresses' registry setting must be set to "Y".
  • A client is admitted in an existing episode (Client A).
Steps
  1. Access the 'Client Alternate Addresses' form.
  2. Select "Client A" in the 'Client' field.
  3. Select "Add" in the 'Add/Edit' field.
  4. Enter the desired value in the 'Description' field.
  5. Enter the desired date in the 'Address Start Date' field.
  6. Enter the desired date in the 'Address End Date' field.
  7. Enter the desired value in the 'Address Line 1' field.
  8. Enter the desired value in the 'Address Line 2' field.
  9. Enter the desired value in the 'Zip' field.
  10. Enter the desired value in the 'City' field.
  11. Select the desired value in the 'State' field.
  12. Enter the desired value in the 'Contact Name field.
  13. Enter the desired value in the 'Contact Phone' field.
  14. Enter the desired value in the 'Address Notes' field.
  15. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  16. Select "Yes" in the 'Enabled' field.
  17. Click [File].
  18. Validate a message is displayed stating: Saved.
  19. Click [OK].
  20. Validate the 'Client' field contains "Client A".
  21. Select "Edit" in the 'Add/Edit' field.
  22. Validate the 'Select Existing Address' field contains the alternate address filed in the previous steps with the 'Address Start Date', 'Address End Date', and 'Description'.
  23. Select the address filed in the previous steps in the 'Select Existing Address' field.
  24. Validate all previously filed data is displayed.
  25. Close the form.
  26. Access Crystal Reports or other SQL Reporting Tool.
  27. Select the PM namespace.
  28. Create a report using the 'SYSTEM.client_alternate_address' SQL table.
  29. Validate there is a row for "Client A" will all previously filed data.
  30. Validate the 'addr_type_code' and 'addr_type_value' fields contain the code/value filed in the previous steps.
  31. Close the report.
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 'AddresType' 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 'Address Type' 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 'AddressType' 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 'Address Type' 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 'AddressType' 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 'Address Type' 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 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  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 'Address Type' 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 'Address Type' 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 'Address Type' field contains the value selected in the previous steps.
  15. Close the form.
Topics
• Admission • Update Client Data • Discharge • Pre Admit • Call Intake • Web Services • Admission (Outpatient) • Pre Admit Discharge
Update 30 Summary | Details
837 Billing - Primary / Add-On Services
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Dictionary Update (PM)
  • Admission (Outpatient)
  • Financial Eligibility
  • Electronic Billing
  • Program Maintenance
  • Service Fee/Cross Reference Maintenance
Scenario 1: Cal-PM -Validating primary and associated add-on services in the same claim
Specific Setup:
  • Registry Setting:
  • Set the 'Include Delay Reason Code' registry setting to 'Y'.
  • Guarantors/Payors:
  • Guarantor 1: Note the ‘Financial Class’. This will be the client’s primary guarantor.
  • Guarantor/Program Billing Defaults:
  • The ‘Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = 1.
  • Program Maintenance:
  • Identify an existing program to be used for client's admission. Note the program code/value.
  • Dictionary Update:
  • File= 'Other Tabled File,
  • Data Element -291, Service Code Type'
  • Dictionary Code = Desired code
  • Dictionary Value = Desired value
  • Extended Dictionary = 'Allow Multiple Add-On Code Definition'
  • Extended Dictionary Value (Single Dictionary) = Yes
  • Service Codes:
  • A primary service code is created to have desired number of add-on service codes with the following:
  • Service Code Category = Primary Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • A primary add-on service code is created with the following:
  • Service Code Category = Primary Add-On Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • Another add-on service code is created with the following:
  • Service Code Category = Add-On Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • An interactive complexity add-on service code is created with the following:
  • Service Code Category =Interactive Complexity code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • Service Fee/Cross Reference Maintenance:
  • A fee definition is created for all the service codes. Note the fee for each service code.
  • An active practitioner is identified. Note the practitioner's ID.
  • Admission:
  • An active client is identified, or a new client is created. Note the client's id, name.
  • Diagnosis:
  • The client has an active diagnosis record. Note the diagnosis codes.
  • Financial Eligibility:
  • The client has an active financial eligibility record. Note the financial class of the guarantor. Note the client ID. Note the episode and program.
  • Recurring Client Charge Input:
  • Render 9 services to the client that are not add-on services. It could be any service. Once those services are filed, services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
  • Create Interim Billing Batch File:
  • An interim billing batch is created to cover the services rendered to the client and distributed to the guarantor. Note the interim billing batch number.
Steps
  1. Open ‘Electronic Billing’.
  2. Select ‘837-Professional’ in ‘Billing Form’.
  3. Select the primary guarantor ‘Financial Class in ‘Type Of Bill’.
  4. Select ‘Individual’ in ‘Individual Or All Guarantors’.
  5. Select the primary guarantor in ‘Guarantor’.
  6. Select ‘Outpatient’ in ‘Billing Type’.
  7. Select ‘Sort File’ in ‘Billing Options’.
  8. Enter the desired value in ‘File Description/Name’.
  9. Select ‘Interim Billing Batch’ in ‘All Clients Or Interim Billing Batch’.
  10. Select desired interim billing batch file from the 'Interim Billing Batch' drop down field.
  11. Select desired value in ‘Program(s)’.
  12. Select ‘No’ in ‘Create Claims’.
  13. Enter the desired value in ‘First Date Of Service To Include’.
  14. Enter the desired value in ‘Last Date Of Service To Include’.
  15. Select ‘All in ‘Include Primary and/or Secondary Billing.
  16. Click [Process].
  17. Validate the ‘Processing Report’ message contains ‘Compile Complete’.
  18. Click [OK].
  19. Select ‘Dump File’ in ‘Billing Options’.
  20. Select ‘Print’ in ‘Print Or Delete Report’.
  21. Select the desired report in ‘File’.
  22. Click [Process].
  23. Validate that there is one ‘CLM’ segment per service for the services which are not primary or add-on services.
  24. Validate that the primary and associated add-on services are included under the same CLM segment.
  25. Close the report.
  26. Select ‘Yes’ in ‘Create Claims’.
  27. Enter desired date in the 'Date Of Claim'.
  28. Click [Process].
  29. Validate the ‘Processing Report’ message contains ‘Compile Complete’.
  30. Click [OK].
  31. Close the form.
  32. Open the 'Client ledger' form.
  33. Select desired client from the 'Client' field.
  34. Enter desired dates in the 'Service Start Date' and 'Service End date' fields.
  35. Select 'Simple' from the 'Ledger Type' field.
  36. Click [Process].
  37. Verify the client ledger contains the primary and associated add-on services on the same claim.
  38. Close the report.
  39. Close the form.
  40. Open the 'Registry Setting' form.
  41. Set the 'Include Delay Reason Code' registry setting to 'N'.
  42. Set the 'Select REF Segments To Include Registry Setting Value' to 2.
  43. Submit the form.
  44. Open the 'Guarantor/Program Billing Defaults'.
  45. Select 'Edit Template' option in the 'Actions' field.
  46. Select desired template from the 'Select Template' drop down list.
  47. Click the '837 Professional' or '837 Institutional' section.
  48. Set the 'Demonstration Project Identifier (2300-REF-02)' field to desired value.
  49. Submit the form.
  50. Repeat the steps from 1 through 39 for different dates of primary/add-on services and verify the primary and add-on are included in the same claim.
Topics
• 837 Professional • NX
Update 32 Summary | Details
File Import - Service Guarantor Definitions
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Service Fee/Cross Reference and Guarantor Definition Export
  • File Import
  • Service Fee/Cross Reference Maintenance
Scenario 1: File Import: Service Guarantor Definitions - Registry Setting = Disable Full Table Backups Prior To File Import
Specific Setup:
  • Registry Settings: 'Disable Full Table Backups Prior To File Import' contains no value.
  • Click the 'Refresh Forms' icon.
  • Service Fee/Cross Reference Maintenance: The 'Restore Definitions' section contains the 'Restore Definitions That Existed Prior to Last Import' and Restore Maximum Liability Assignment Definitions That Existed Prior to Last Import' buttons.
  • Service Fee/Cross Reference and Guarantor Definition Export:
  • Select 'Guarantor Definition' in 'Record Type(s) to Export'.
  • Select 'Export Guarantor Definition to File and save the file locally.
  • Select 'Export to Crystal Report' and save the report locally.
  • File Import: Copy the exported file and edit it to change at least one 'Service Guarantor Definitions' - 'File A'.
  • Make a copy of 'File A' to edit and use when setting the above registry setting to 'F' - 'File B'.
  • Make a copy of 'File A' to edit and use when setting the above registry setting to 'G' - 'File C'.
  • Make a copy of 'File A' to edit and use when setting the above registry setting to 'null' - 'File D'.
Steps
  1. Open 'Registry Settings'.
  2. Set 'Limit Registry Settings to the Following Search Criteria' to 'Disable Full Table Backups'.
  3. Verify that 'Registry Setting' contains 'Avatar PM->System Maintenance->File Import->Service Fee/Guarantor Definitions->->Disable Full Table Backups Prior To File Import'
  4. Validate that the 'Registry Setting Value' is null.
  5. Close the form.
  6. Open 'Service Fee/Cross Reference Maintenance'.
  7. Click [Restore Definitions].
  8. Validate that the buttons are 'Restore Fee Definitions That Existed Prior To The Last File Import' and 'Restore Maximum Liability Assignment Definitions That Existed Prior To The Last File Import'.
  9. Click [Discard].
  10. Open 'File Import'.
  11. Select 'Service Guarantor Definitions' in 'File Type'.
  12. Upload, compile & post 'File A'
  13. Close the form.
  14. Open 'Service Fee/Cross Reference and Guarantor Definition Export'.
  15. Select 'Guarantor Definition' in 'Record Type(s) to Export'.
  16. Select either option to compare to the 'SETUP' version and validate that the data was changed as edited in the posted file, 'File A': 'Export to Crystal Report' or 'Export Guarantor Definition to File'.
  17. Close the form.
  18. Open 'Registry Settings'.
  19. Set 'Limit Registry Settings to the Following Search Criteria' to 'Disable Full Table Backups'.
  20. Verify that 'Registry Setting' contains 'Avatar PM->System Maintenance->File Import->Service Fee/Guarantor Definitions->->Disable Full Table Backups Prior To File Import'
  21. Set the 'Registry Setting Value' to 'F'.
  22. Click [Submit].
  23. Click [OK].
  24. Click [No].
  25. Click [Refresh Forms] icon.
  26. Open 'Service Fee/Cross Reference Maintenance'.
  27. Click [Restore Definitions].
  28. Validate that the only button is: 'Restore Maximum Liability Assignment Definitions That Existed Prior To The Last File Import'.
  29. Click [Discard].
  30. Open 'File Import'.
  31. Select 'Service Guarantor Definitions' in 'File Type'.
  32. Upload, compile & post 'File B'
  33. Close the form.
  34. Open 'Service Fee/Cross Reference and Guarantor Definition Export'.
  35. Select 'Guarantor Definition' in 'Record Type(s) to Export'.
  36. Select either option to compare the last version and validate that the data was changed as edited in the posted file, 'File B': 'Export to Crystal Report' or 'Export Guarantor Definition to File'.
  37. Close the form.
  38. Open 'Registry Settings'.
  39. Set 'Limit Registry Settings to the Following Search Criteria' to 'Disable Full Table Backups'.
  40. Verify that 'Registry Setting' contains 'Avatar PM->System Maintenance->File Import->Service Fee/Guarantor Definitions->->Disable Full Table Backups Prior To File Import'
  41. Set the 'Registry Setting Value' to 'G'.
  42. Click [Submit].
  43. Click [OK].
  44. Click [No].
  45. Click [Refresh Forms] icon.
  46. Open 'Service Fee/Cross Reference Maintenance'.
  47. Click [Restore Definitions].
  48. Validate that the only button is: 'Restore Fee Definitions That Existed Prior To The Last File Import'.
  49. Click [Discard].
  50. Open 'File Import'.
  51. Select 'Service Guarantor Definitions' in 'File Type'.
  52. Upload, compile & post 'File C'.
  53. Close the form.
  54. Open 'Service Fee/Cross Reference and Guarantor Definition Export'.
  55. Select 'Guarantor Definition' in 'Record Type(s) to Export'.
  56. Select either option to compare the last version and validate that the data was changed as edited in the posted file, 'File C': 'Export to Crystal Report' or 'Export Guarantor Definition to File'.
  57. Close the form.
  58. Open 'Registry Settings'.
  59. Set 'Limit Registry Settings to the Following Search Criteria' to 'Disable Full Table Backups'.
  60. Verify that 'Registry Setting' contains 'Avatar PM->System Maintenance->File Import->Service Fee/Guarantor Definitions->->Disable Full Table Backups Prior To File Import'
  61. Set the 'Registry Setting Value' to be blank.
  62. Click [Submit].
  63. Click [OK].
  64. Click [No].
  65. Click [Refresh Forms] icon.
  66. Open 'Service Fee/Cross Reference Maintenance'.
  67. Click [Restore Definitions].
  68. Validate that the buttons are 'Restore Fee Definitions That Existed Prior To The Last File Import' and 'Restore Maximum Liability Assignment Definitions That Existed Prior To The Last File Import'.
  69. Click [Discard].
  70. Open 'File Import'.
  71. Select 'Service Guarantor Definitions' in 'File Type'.
  72. Upload, compile & post 'File D'.
  73. Close the form.
  74. Open 'Service Fee/Cross Reference and Guarantor Definition Export'.
  75. Select 'Guarantor Definition' in 'Record Type(s) to Export'.
  76. Select either option to compare the last version and validate that the data was changed as edited in the posted file, 'File D': 'Export to Crystal Report' or 'Export Guarantor Definition to File'.
  77. Close the form.
  78. Open 'Service Fee/Cross Reference Maintenance'.
  79. Click [Restore Definitions].
  80. Click [Restore Maximum Liability Assignment Definitions That Existed Prior To The Last File Import].
  81. Click [Yes].
  82. Click [OK].
  83. Click [Restore Fee Definitions That Existed Prior To The Last File Import].
  84. Click [Yes].
  85. Click [OK].
  86. Click [Service Fee/Cross Reference Maintenance].
  87. Click [Guarantor Definitions].
  88. Validate that the report contains the definitions from 'File C'.
  89. Close the report.
  90. Close the form.
Topics
• Service Fee/Cross Reference Maintenance • File Import • NX
Update 33 Summary | Details
Avatar Cal-PM Registry Settings
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
Scenario 1: Avatar Cal-PM Registry Settings - Verification of 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting
Steps
  1. Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' may only be accessed/enabled by Netsmart; please contact Netsmart representative/associate for more information.

"When this registry setting is set to "Y", when a batch is closed in Avatar MSO, each service in the batch that contains Other Healthcare Coverage and is pushed to Avatar Cal-PM will use the parent system service fee table to determine the Fee.


This also gives an end user the ability to override service charge and line adjustments within an 837I and 837P submission for MSO originating services that contain COB. This is accomplished by adding the field 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' to the 'Guarantor/Program Billing Defaults' form.


Entering "N" removes the Avatar MSO logic and the field from the form and disables Enable Override MSO Coordination of Benefits Service Charges and Line Adjustments logic in 837I and 837P submissions.


Upon product installation, the default setting will be "N"."

Scenario 2: File Import - Verification of 'Guarantor/Program Billing Defaults' File Type Import, 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting (Avatar Cal-PM)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' may only be accessed/enabled by Netsmart; please contact Netsmart representative/associate for more information
  • Avatar Cal-PM 'Guarantor/Program Billing Defaults Template' File Import file containing one or valid import rows for 837 Professional and/or 837 Institutional Defaults including 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field value ('Y' or 'N' value)
  • Segment 141 for '837 Professional' defaults
  • Segment 131 for '837 Institutional' defaults
  • Updated import file layout document 'Avatar_Cal-PM_File_Import_Record_Layouts.xls' included with update package
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar Cal-PM 'File Import' form.
  2. Select File Type 'Guarantor/Program Billing Defaults'.
  3. Select 'Upload New File' in 'Action' field and Click 'Process Action' button.
  4. Select Avatar Cal-PM 'Guarantor/Program Billing Defaults' import file including one or more 837 Professional and/or 837 Institutional Defaults import rows and click 'Open' button.
  5. Select 'Compile/Validate File' in 'Action' field.
  6. Select loaded 'Guarantor/Program Billing Defaults' import file and click 'Process Action' button.
  7. Ensure that 'Compile/Validate File' action completes, and message 'Compiled' or '(File Name) contains one or more errors. These errors can be reviewed using 'Print Errors' action' is displayed.
  8. Click 'OK' button.
  9. Select 'Print File' in 'Action' field to view successfully compiled import data; Select compiled import file and click 'Process Action' button.
  10. In 'Guarantor/Program Billing Defaults' File Import Report, ensure that all valid import row(s) are included in report with segment/value details, including 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' fields.
  11. Select 'Post File' in 'Action' field to post successfully compiled import data; Select compiled import file and click 'Process Action' button.
  12. Ensure that 'Compile/Validate File' action completes, and message 'Posted' and/or 'The selected file contains one or more lines with compilation errors. Only those lines without compilation errors will be posted' is displayed.
  13. Open Avatar Cal-PM 'Guarantor/Program Billing Defaults' form.
  14. Select 'Edit Template' in 'Action' field and select imported Guarantor/Program Billing Defaults template for review/edit.
  15. Navigate to '837 Professional' section of form.
  16. Ensure that imported value for 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field is present for selected template.
  17. Navigate to '837 Institutional' section of form.
  18. Ensure that imported value for 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field is present for selected template.
  19. Open Crystal Reports or other SQL reporting tool.
  20. In Avatar Cal-PM SQL table 'SYSTEM.file_import_gpbdt_p837', ensure that value filed via import for 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field is present in 'ovd_mso_cob_chg_adj_code' / 'ovd_mso_cob_chg_adj_value' SQL table fields.
  21. In Avatar Cal-PM SQL table 'SYSTEM.file_import_gpbdt_i837', ensure that value filed via import for 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field is present in 'ovd_mso_cob_chg_adj_code' / 'ovd_mso_cob_chg_adj_value' SQL table fields.
Scenario 3: 'Guarantor/Program Billing Defaults' - Verification of 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting (Avatar Cal-PM)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' may only be accessed/enabled by Netsmart; please contact Netsmart representative/associate for more information
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar Cal-PM 'Guarantor/Program Billing Defaults' form.
  2. Select 'Add Template' in 'Action field (or 'Edit Template' and select existing Guarantor/Program Billing Defaults template for review/edit).
  3. Navigate to '837 Professional' section of form.
  4. Ensure 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field is present in '837 Professional' section of form; ensure User Help information (lightbulb icon) is included for field, containing the following information:
  5. "When "Yes" is selected, the Cal-PM Service Fee associated with the service will post as the Service Line Item Charge Amount. To balance the claim, the system will identify the difference and insert either an OA*23 or OA*94 claim line adjustment segment."
  6. Select value for 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field (and any other fields/sections as desired).
  7. Navigate to '837 Institutional' section of form.
  8. Ensure 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field is present in '837 Institutional' section of form; ensure User Help information (lightbulb icon) is included for field, containing the following information:
  9. "When "Yes" is selected, the Cal-PM Service Fee associated with the service will post as the Service Line Item Charge Amount. To balance the claim, the system will identify the difference and insert either an OA*23 or OA*94 claim line adjustment segment."
  10. Select value for 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field (and any other fields/sections as desired).
  11. Click 'Submit' button to file Guarantor/Program Billing Defaults template.
  12. Select 'Edit Template' in 'Action field and select previously filed Guarantor/Program Billing Defaults template for review/edit.
  13. Navigate to '837 Professional' section of form.
  14. Ensure that previously selected/filed value for 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field is present in '837 Professional' section for selected template.
  15. Navigate to '837 Institutional' section of form.
  16. Ensure that previously selected/filed value for 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field is present in '837 Institutional' section for selected template.
  17. Open Crystal Reports or other SQL reporting tool.
  18. In Avatar Cal-PM SQL table 'SYSTEM.table_837_p_facility_prov_num', ensure that value filed for 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field is present in 'ovd_mso_cob_chg_adj_code' / 'ovd_mso_cob_chg_adj_value' SQL table fields.
  19. In Avatar Cal-PM SQL table 'SYSTEM.table_837_i_facility_prov_num', ensure that value filed for 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field is present in 'ovd_mso_cob_chg_adj_code' / 'ovd_mso_cob_chg_adj_value' SQL table fields.
Scenario 4: 'Close Batch' - Avatar MSO to Cal-PM Parent System Service Filing, Verification of 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' may only be accessed/enabled by Netsmart; please contact Netsmart representative/associate for more information
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • Avatar MSO Registry Setting 'Enable Fee Override in PM' must be set to use Parent System Service Fee Table (set to '0' or '4')
  • If Avatar MSO Registry Setting 'Enable Fee Override in PM' is set to '4', 'Fee Override in PM' date/override type entry for service date(s) must be defined to use 'Parent System Service Fee Table' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section, 'Enable Fee Override in PM' sub-section)
  • 'File Services On Closing Of Batch Or Creation of EOB?' must be set to 'Yes' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section)
  • One or more 'Approved' status Avatar MSO services eligible for filing to parent Avatar Cal-PM system and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar MSO 'Close Batch' form.
  2. Note - Acceptance Testing may also be confirmed on service filing to parent Avatar Cal-PM system via Avatar MSO 'Create EOB' or 'Other EOB Information' entry/filing where 'Inhibit Service Filing' restrictions are defined via 'MSO to Parent System Integration Mapping' form 'Service Filing' section
  3. Select Avatar MSO Claims Processing batch containing one or more 'Approved' status services eligible for filing to parent Avatar Cal-PM system.
  4. Set 'Close Batch' field to 'Yes' (and click 'OK' button to close warning message dialog).
  5. Click 'Submit' button to close batch/file services to parent Avatar Cal-PM system.
  6. Open 'Client Ledger' form in parent Avatar Cal-PM system.
  7. Select 'Client ID' value for client where services are present in Avatar MSO closed status Claims Processing batch.
  8. Select 'Claim/Episode/All Episodes' value.
  9. Select 'Ledger Type' value.
  10. Click 'Process' button.
  11. In Client Ledger data, ensure that 'Approved' status services originating in Avatar MSO are present in Avatar Cal-PM system following 'Close Batch' filing (where services are valid for filing to parent system).
  12. For services originating via Avatar MSO and filed to Avatar Cal-PM parent system (where Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' is enabled):
  13. Services including Third Party Payment/Adjustment 'Other Healthcare Coverage' information - Ensure that Avatar Cal-PM Client Ledger 'Charge' value for service(s) reflects the applicable Cal-PM Service Fee Table Amount for service(s)
  14. Note - Avatar Cal-PM 'Cost of Service'/'Guarantor Liability' value for service(s) originating in Avatar MSO with Other Healthcare Coverage information will reflect full Cal-PM Service Fee Table Amount, not including 'Other Healthcare Coverage' Third Party Payment amounts for service filed to Avatar Cal-PM
  15. Note - Third Party Payment/Adjustment 'Other Healthcare Coverage' information from Avatar MSO will be stored with Cal-PM parent service to ensure correctly balanced Avatar Cal-PM outbound 837 claim information where Other Healthcare Coverage information is included in original claim/service (via SQL tables noted below)
  16. Services not including Third Party Payment/Adjustment 'Other Healthcare Coverage' information - Ensure that Avatar Cal-PM 'Charge'/'Cost Of Service' (as well as 'Guarantor Liability') value for service(s) in Avatar Cal-PM reflects the applicable Cal-PM Service Fee Table Amount
  17. Open Crystal Reports or other SQL reporting tool.
  18. In Avatar Cal-PM SQL table 'SYSTEM.mso_service_cob', ensure that claim/service Third Party Payer 'Other Healthcare Coverage' filed with service via Avatar MSO is present.
  19. Note - Avatar Cal-PM instance of SQL table 'SYSTEM.mso_service_cob' will on be populated with data where Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' is enabled
  20. In Avatar Cal-PM SQL table 'SYSTEM.mso_claim_adjustments', ensure that claim/service Third Party Adjustment 'Other Healthcare Coverage' filed with service via Avatar MSO is present.
  21. Note - Avatar Cal-PM instance of SQL table 'SYSTEM.mso_claim_adjustments' will on be populated with data where Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' is enabled
Scenario 5: 'Client Ledger' - Verification of 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting (Cal-PM)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' may only be accessed/enabled by Netsmart; please contact Netsmart representative/associate for more information
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • Avatar MSO Registry Setting 'Enable Fee Override in PM' must be set to use Parent System Service Fee Table (set to '0' or '4')
  • If Avatar MSO Registry Setting 'Enable Fee Override in PM' is set to '4', 'Fee Override in PM' date/override type entry for service date(s) must be defined to use 'Parent System Service Fee Table' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section, 'Enable Fee Override in PM' sub-section)
  • 'File Services On Closing Of Batch Or Creation of EOB?' must be set to 'Yes' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section)
  • One or more services originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
Steps
  1. Open Avatar Cal-PM 'Client Ledger' form.
  2. Select 'Client ID' value for client where services originating in Avatar MSO and including Other Healthcare Coverage information exist.
  3. Select 'Claim/Episode/All Episodes' value (and enter/edit 'From Date'/'To Date' values if desired).
  4. Select 'Ledger Type' value.
  5. Click 'Process' button.
  6. Where 'Simple' is selected for 'Ledger Type' - In 'Client Ledger' form display data, ensure that services originating in Avatar MSO and including Other Healthcare Coverage information reflect full Cal-PM Service Fee Table Amount, not including 'Other Healthcare Coverage' Third Party Payment amounts for service filed to Avatar Cal-PM.
  7. Where 'Crystal' is selected for 'Ledger Type' - ensure that new/specific version of Client Ledger report is launched. ('Avatar_Cal_PM_Client_Ledger_Screen_Imbed_OHC_Chg_Adj', used only where Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' is enabled)
  8. In Client Ledger Crystal Report data, ensure that for services originating in Avatar MSO and including Other Healthcare Coverage information, the 'Full Charge' value for service(s) full Cal-PM Service Fee Table Amount, not including 'Other Healthcare Coverage' Third Party Payment amounts for service filed to Avatar Cal-PM.
  9. In Client Ledger Crystal Report data, click on 'Date of Service' to expand service information sub-report.
  10. In Client Ledger Crystal Report data, ensure that for services originating in Avatar MSO and including Other Healthcare Coverage information, including the following fields (information from Avatar Cal-PM SQL tables 'SYSTEM.mso_service_cob' / 'SYSTEM.mso_claim_adjustments'):
  11. 'Third Party Payer Name'
  12. 'Third Party Payer Claim Amount'
  13. 'Third Party Payer Paid Amount'
  14. 'Third Party Payer Adjustment'
  15. 'Third Party Remittance Date'
Avatar Cal-PM 'Electronic Billing' for Avatar MSO Services
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Electronic Billing
Scenario 1: 'Electronic Billing' - 837 Professional, Verification of 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting (Cal-PM)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' may only be accessed/enabled by Netsmart; please contact Netsmart representative/associate for more information
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar Cal-PM Registry Setting 'Add Support For Client Other Healthcare Coverage' may optionally be enabled (for 837 reporting of manually entered Avatar MSO services with Service-Level Third Party Payment/Adjustment 'Other Healthcare Coverage' information)
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • Avatar MSO Registry Setting 'Enable Fee Override in PM' must be set to use Parent System Service Fee Table (set to '0' or '4')
  • If Avatar MSO Registry Setting 'Enable Fee Override in PM' is set to '4', 'Fee Override in PM' date/override type entry for service date(s) must be defined to use 'Parent System Service Fee Table' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section, 'Enable Fee Override in PM' sub-section)
  • 'Include Service Level Adjudication Information (2430)' field must be set to 'Yes' in Avatar Cal-PM 'Guarantor/Program Billing Defaults' form ('837 Professional' section) for applicable Guarantor/Program
  • 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field must be set to 'Yes' in Avatar Cal-PM 'Guarantor/Program Billing Defaults' form ('837 Professional' section) for applicable Guarantor/Program
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional 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 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 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 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 format outbound electronic billing file data - for services originating via Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information:
  10. Ensure that 2300-CLM Total Claim Charge Amount reflects the sum of Cal-PM Service Fee Table Amounts for all service(s) included in claim
  11. Ensure that the following claim information payer loops reflect Third Party Payor 'Other Healthcare Coverage' information from originating Avatar MSO inbound claim (or Avatar Cal-PM 'Client Other Healthcare Coverage' form information for manually entered Avatar MSO services):
  12. Other Subscriber Information (2320)
  13. Other Insurance Coverage Information (2320)
  14. Other Subscriber Name (2330A)
  15. Other Payer Name (2330B)
  16. Ensure that 2400-SV1 Line Item Charge Amount reflects the Cal-PM Service Fee Table Amount for service(s) included in claim
  17. Ensure that 2430-SVD Line Adjudication Information/Service Line Paid Amount reflects Third Party Payment 'Other Healthcare Coverage' information from originating Avatar MSO inbound claim or manual entry
  18. Ensure that 2430-CAS Line Adjustment entries reflect Third Party Adjustment 'Other Healthcare Coverage' information from originating Avatar MSO inbound claim or manual entry (Claim Adjustment Group Code/Claim Adjustment Reason Code/Adjustment Amount)
  19. In case where there is a difference between 2400-SV1 Line Item Charge Amount for claim and sum of 2430-SVD Paid Amount/2430-CAS Line Adjustment Amounts, ensure that an additional 2430-CAS Line Adjustment entry is inserted by Avatar Cal-PM system to ensure claim total balancing and allow 837 inclusion
  20. In case where this difference is positive, ensure that system-generated 2430-CAS Line Adjustment entry includes Claim Adjustment Group Code 'OA' and Claim Adjustment Reason Code '23' (with claim charge amount difference as Adjustment Amount; Example: 'CAS*OA*23*10~')
  21. In case where this difference is negative, ensure that system-generated 2430-CAS Line Adjustment entry includes Claim Adjustment Group Code 'OA' and Claim Adjustment Reason Code '94' (with claim charge amount difference as Adjustment Amount; Example: 'CAS*OA*94*-10~')
Scenario 2: 'Electronic Billing' - 837 Institutional, Verification of 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting (Cal-PM)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' may only be accessed/enabled by Netsmart; please contact Netsmart representative/associate for more information
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar Cal-PM Registry Setting 'Add Support For Client Other Healthcare Coverage' may optionally be enabled (for 837 reporting of manually entered Avatar MSO services with Service-Level Third Party Payment/Adjustment 'Other Healthcare Coverage' information)
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • Avatar MSO Registry Setting 'Enable Fee Override in PM' must be set to use Parent System Service Fee Table (set to '0' or '4')
  • If Avatar MSO Registry Setting 'Enable Fee Override in PM' is set to '4', 'Fee Override in PM' date/override type entry for service date(s) must be defined to use 'Parent System Service Fee Table' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section, 'Enable Fee Override in PM' sub-section)
  • 'Include Service Level Adjudication Information (2430)' field must be set to 'Yes' in Avatar Cal-PM 'Guarantor/Program Billing Defaults' form ('837 Institutional' section) for applicable Guarantor/Program
  • 'Override MSO Coordination of Benefits Service Charges and Line Adjustments' field must be set to 'Yes' in Avatar Cal-PM 'Guarantor/Program Billing Defaults' form ('837 Institutional' section) for applicable Guarantor/Program
  • One or more service(s) eligible for Avatar Cal-PM 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 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 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 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 Institutional format outbound electronic billing file data - for services originating via Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information:
  10. Ensure that 2300-CLM Total Claim Charge Amount reflects the sum of Cal-PM Service Fee Table Amounts for all service(s) included in claim
  11. Ensure that the following claim information payer loops reflect Third Party Payor 'Other Healthcare Coverage' information from originating Avatar MSO inbound claim (or Avatar Cal-PM 'Client Other Healthcare Coverage' form information for manually entered Avatar MSO services):
  12. Other Subscriber Information (2320)
  13. Other Insurance Coverage Information (2320)
  14. Other Subscriber Name (2330A)
  15. Other Payer Name (2330B)
  16. Ensure that 2400-SV2 Line Item Charge Amount reflects the Cal-PM Service Fee Table Amount for service(s) included in claim
  17. Ensure that 2430-SVD Line Adjudication Information/Service Line Paid Amount reflects Third Party Payment 'Other Healthcare Coverage' information from originating Avatar MSO inbound claim or manual entry
  18. Ensure that 2430-CAS Line Adjustment entries reflect Third Party Adjustment 'Other Healthcare Coverage' information from originating Avatar MSO inbound claim or manual entry (Claim Adjustment Group Code/Claim Adjustment Reason Code/Adjustment Amount)
  19. In case where there is a difference between 2400-SV2 Line Item Charge Amount for claim and sum of 2430-SVD Paid Amount/2430-CAS Line Adjustment Amounts, ensure that an additional 2430-CAS Line Adjustment entry is inserted by Avatar Cal-PM system to ensure claim total balancing and allow 837 inclusion
  20. In case where this difference is positive, ensure that system-generated 2430-CAS Line Adjustment entry includes Claim Adjustment Group Code 'OA' and Claim Adjustment Reason Code '23' (with claim charge amount difference as Adjustment Amount; Example: 'CAS*OA*23*10~')
  21. In case where this difference is negative, ensure that system-generated 2430-CAS Line Adjustment entry includes Claim Adjustment Group Code 'OA' and Claim Adjustment Reason Code '94' (with claim charge amount difference as Adjustment Amount; Example: 'CAS*OA*94*-10~')
Topics
• Registry Settings • Guarantor/Program Billing Defaults • File Import • Electronic Billing • Client Ledger • Claims Processing • 837 Professional • 837 Institutional
Update 37 Summary | Details
California Required EDI - CSI
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CSI Submission
Scenario 1: CSI Assessment (Call Intake) - Registry Setting: Require Referral Source
Specific Setup:
  • Registry Settings: 'Avatar PM->California Required EDI->CSI->->->Require Referral Source' = desired value. Note the value and expected result.
  • Client: 'Client A' is admitted to a program that contains 'Call-Intake' in 'Program Type' and 'Yes' in 'Mental Health Program (CSI) '.
Steps
  1. Open the 'CSI Assessment (Call Intake)' form for 'Client A'.
  2. Verify that the 'Referral Source' field is required or not required, based on the value in the 'Require Referral Source' registry setting.
  3. Enter data in all required fields and desired optional fields.
  4. Click [Submit].
  5. If desired, change the value of the 'Require Referral Source' registry setting to get a different result.
  6. Open the 'CSI Assessment (Call Intake)' form for 'Client A'.
  7. Verify that the 'Referral Source' field is required or not required, based on the value in the 'Require Referral Source' registry setting.
  8. Close the form.
  9. If desired, submit the data in the 'CSI Submission' form.
  10. Select 'Compile' in 'Options'.
  11. Enter the desired date range.
  12. Click [Submit].
  13. Click [OK].
  14. Select 'Print' in 'Options'.
  15. Select desired file in 'Select File To Print/Submit'.
  16. Click [Print Selected File Information].
  17. Validate the data for 'Client A', including the 'Referral Source'.
  18. If desired, submit the file.
Scenario 2: CSI Assessment - Registry Setting: Require Referral Source
Specific Setup:
  • Registry Settings: 'Avatar PM->California Required EDI->CSI->->->Require Referral Source' = desired value. Note the value and expected result.
  • Client: 'Client A' is admitted to a program that contains 'Admit' in 'Program Type' and 'Yes' in 'Mental Health Program (CSI)'.
Steps
  1. Open the 'CSI Assessment form for 'Client A'.
  2. Verify that the 'Referral Source' field is required or not required, based on the value in the 'Require Referral Source' registry setting.
  3. Enter data in all required fields and desired optional fields.
  4. Click [Submit].
  5. If desired, change the value of the 'Require Referral Source' registry setting to get a different result.
  6. Open the 'CSI Assessment' form for 'Client A'.
  7. Verify that the 'Referral Source' field is required or not required, based on the value in the 'Require Referral Source' registry setting.
  8. Close the form.
  9. If desired, submit the data in the 'CSI Submission' form.
  10. Select 'Compile' in 'Options'.
  11. Enter the desired date range.
  12. Click [Submit].
  13. Click [OK].
  14. Select 'Print' in 'Options'.
  15. Select desired file in 'Select File To Print/Submit'.
  16. Click [Print Selected File Information].
  17. Validate the data for 'Client A', including the 'Referral Source'.
  18. If desired, submit the file.
California Required EDI - CSI
Scenario 1: CSI Assessment - Registry Setting: Require Referral Source
Specific Setup:
  • Registry Settings: 'Avatar PM->California Required EDI->CSI->->->Require Referral Source' = desired value. Note the value and expected result.
  • Client: 'Client A' is admitted to a program that contains 'Admit' in 'Program Type' and 'Yes' in 'Mental Health Program (CSI)'.
Steps
  1. Open the 'CSI Assessment form for 'Client A'.
  2. Verify that the 'Referral Source' field is required or not required, based on the value in the 'Require Referral Source' registry setting.
  3. Enter data in all required fields and desired optional fields.
  4. Click [Submit].
  5. If desired, change the value of the 'Require Referral Source' registry setting to get a different result.
  6. Open the 'CSI Assessment' form for 'Client A'.
  7. Verify that the 'Referral Source' field is required or not required, based on the value in the 'Require Referral Source' registry setting.
  8. Close the form.
  9. If desired, submit the data in the 'CSI Submission' form.
  10. Select 'Compile' in 'Options'.
  11. Enter the desired date range.
  12. Click [Submit].
  13. Click [OK].
  14. Select 'Print' in 'Options'.
  15. Select desired file in 'Select File To Print/Submit'.
  16. Click [Print Selected File Information].
  17. Validate the data for 'Client A', including the 'Referral Source'.
  18. If desired, submit the file.
California Required EDI -CSI
Scenario 1: CSI Assessment - Registry Setting: Require Referral Source
Specific Setup:
  • Registry Settings: 'Avatar PM->California Required EDI->CSI->->->Require Referral Source' = desired value. Note the value and expected result.
  • Client: 'Client A' is admitted to a program that contains 'Admit' in 'Program Type' and 'Yes' in 'Mental Health Program (CSI)'.
Steps
  1. Open the 'CSI Assessment form for 'Client A'.
  2. Verify that the 'Referral Source' field is required or not required, based on the value in the 'Require Referral Source' registry setting.
  3. Enter data in all required fields and desired optional fields.
  4. Click [Submit].
  5. If desired, change the value of the 'Require Referral Source' registry setting to get a different result.
  6. Open the 'CSI Assessment' form for 'Client A'.
  7. Verify that the 'Referral Source' field is required or not required, based on the value in the 'Require Referral Source' registry setting.
  8. Close the form.
  9. If desired, submit the data in the 'CSI Submission' form.
  10. Select 'Compile' in 'Options'.
  11. Enter the desired date range.
  12. Click [Submit].
  13. Click [OK].
  14. Select 'Print' in 'Options'.
  15. Select desired file in 'Select File To Print/Submit'.
  16. Click [Print Selected File Information].
  17. Validate the data for 'Client A', including the 'Referral Source'.
  18. If desired, submit the file.
California Required EDI -CSI
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • SoapUI - CSIAssessment
Scenario 1: 'CSIAssessment' web service - Add & Update CSI Assessment
Specific Setup:
  • Registry Settings: 'Avatar PM->California Required EDI->CSI->->->Require Referral Source' = desired value. Note the value and expected result.
  • Client: 'Client A' is admitted to a program that contains 'Yes' in 'Mental Health Program (CSI)'.
Steps
  1. Access SoapUI for the 'CSIAssessment' - 'AddCSIAssessment' web service.
  2. Fill out all required and desired fields.
  3. Click [Run].
  4. Validate the 'AddCSIAssessmentResponse' field is populated with data.
  5. Validate the 'Confirmation' field contains a value such as:ClientID:273||EP:1||UniqueID:CSS65274.001.
  6. Validate the 'Message' field contains: CSI Assessment web service has been filed successfully.
  7. Select 'Client A' and access the 'CSI Assessment' form.
  8. Select the desired episode from the Pre-Display and click [OK].
  9. Click [Edit].
  10. Validate the submitted data displays.
  11. Discard the form.
  12. Access SoapUI for the 'CSIAssessment' - 'UpdateCSIAssessment' web service.
  13. Edit at least one field. Note the edits.
  14. Click [Run].
  15. Validate the 'UpdateCSIAssessmentResponse' field is populated with data.
  16. Validate the 'Confirmation' field contains a value such as: ClientID:273||EP:1||UniqueID:CSS65274.001.
  17. Validate the 'Message' field contains: CSI Assessment web service has been filed successfully.
  18. Select 'Client A' and access the 'CSI Assessment' form.
  19. Select the desired episode from the Pre-Display and click [OK].
  20. Click [Edit].
  21. Validate the edited data displays.
  22. Discard the form.
Topics
• NX • CSI Assessment (Call Intake) • CSI Assessment • Web Services
Update 39 Summary | Details
'Client's Email Address' validations
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Discharge
  • Pre Admit
  • SoapUI - ClientDemographics
  • SoapUI - UpdateAdmission
  • Admission (Outpatient)
  • Pre Admit Discharge
Scenario 1: The 'ClientAdmission' - 'AddAdmission' web service: Admission of a new client
Specific Setup:
  • The user has access to a Web services tool.
Steps
  1. Access the Web services tool and select the WSDL for the 'ClientAdmission' - 'AddAdmission' 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 'AdmissionDate' field.
  6. Enter the desired time in the 'AdmissionTime' field.
  7. Enter the desired practitioner in the 'AdmittingPractitioner' field.
  8. Enter the desired value in the 'ClientFirstName' field.
  9. Enter the desired value in the 'ClientLastName' field.
  10. Enter the desired value in the 'ClientMiddleName' field.
  11. Enter the corresponding name in the 'ClientName' field.
  12. Enter the desired value in the 'ESignatureConsentOnFile' field. Note: "Y" and "N" are accepted values.
  13. Enter the desired value in the 'Program' field.
  14. Enter the desired value in the 'Sex' field.
  15. Enter the desired value in the "Time Zone for Appointment Reminders" field.
  16. Set the "PreferredAppointmentSite" to the desired site.
  17. Populate any other required and desired fields.
  18. Enter the desired value in the 'Address Type' field.
  19. Enter "test@gmailcom" in the 'ClientEmailAddress' field.
  20. Click [Run].
  21. Validate a message is displayed stating: Please enter a valid email address.
  22. Enter "test@gmail.com" in the 'ClientEmailAddress' field.
  23. Click [Run].
  24. Validate the 'Confirmation' field contains a value such as: "Client Unique ID: # Unique ID: #".
  25. Validate the 'Message' field contains: "Client Admission web service has been filed successfully".
  26. Select the client filed in the previous steps and access the 'Admission' form.
  27. Select the record filed in the previous steps and click [Edit].
  28. Validate all populated fields are displayed.
  29. Select the "Demographics" section.
  30. Validate the 'Client Last Name' field contains the value filed in the previous steps.
  31. Validate the 'Client First Name' field contains the value filed in the previous steps.
  32. Validate the 'Client Middle Name' field contains the value filed in the previous steps.
  33. Validate the 'Consent On File For Use of Integrated eSignature' field contains the value filed in the previous steps.
  34. Validate 'Time Zone for Appointment Reminders' field contains the value filed in the previous steps.
  35. Validate the 'Preferred Appointment Site' field contains the value filed in the previous steps.
  36. Validate the 'Address Type' field contains the value filed in the previous steps.
  37. Validate the 'Client's Email Address' field contains "test@gmail.com".
  38. Close the form.
Scenario 2: 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. Enter "testgmailcom" in the 'Client's Email Address' field.
  6. Validate a message is displayed stating: Please enter a valid email address.
  7. Click [OK].
  8. Enter "testgmail.com" in the 'Client's Email Address' field.
  9. Validate a message is displayed stating: Please enter a valid email address.
  10. Click [OK].
  11. Enter "testgmail@com" in the 'Client's Email Address' field.
  12. Validate a message is displayed stating: Please enter a valid email address.
  13. Click [OK].
  14. Enter "test@gmail.com" in the 'Client's Email Address' field.
  15. Please note: a valid email address should contain '@' that separates the name and address. The name should be the first piece and the address should be the second piece. The address must have a '.' which separates the domain name.
  16. Click [Submit].
  17. Access the 'Admission' form for the client admitted in the previous steps.
  18. Click [Edit] for the episode added in the previous steps.
  19. Validate the previously filed data is displayed.
  20. Select the "Demographics" section.
  21. Validate the 'Client's Email Address' field contains "test@gmail.com".
  22. Close the form.
Scenario 3: '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. Enter "testgmailcom" in the 'Client's Email Address' field.
  3. Validate a message is displayed stating: Please enter a valid email address.
  4. Click [OK].
  5. Enter "testgmail.com" in the 'Client's Email Address' field.
  6. Validate a message is displayed stating: Please enter a valid email address.
  7. Click [OK].
  8. Enter "testgmail@com" in the 'Client's Email Address' field.
  9. Validate a message is displayed stating: Please enter a valid email address.
  10. Click [OK].
  11. Enter "test@gmail.com" in the 'Client's Email Address' field.
  12. Please note: a valid email address should contain '@' that separates the name and address. The name should be the first piece and the address should be the second piece. The address must have a '.' which separates the domain name.
  13. Click [Submit].
  14. Select "Client A" and access the 'Update Client Data' form.
  15. Validate the previously filed data is displayed.
  16. Validate the 'Client's Email Address' field contains "test@gmail.com".
  17. Close the form.
Scenario 4: '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. Enter "testgmailcom" in the 'Client's Email Address' field.
  9. Validate a message is displayed stating: Please enter a valid email address.
  10. Click [OK].
  11. Enter "testgmail.com" in the 'Client's Email Address' field.
  12. Validate a message is displayed stating: Please enter a valid email address.
  13. Click [OK].
  14. Enter "testgmail@com" in the 'Client's Email Address' field.
  15. Validate a message is displayed stating: Please enter a valid email address.
  16. Click [OK].
  17. Enter "test@gmail.com" in the 'Client's Email Address' field.
  18. Please note: a valid email address should contain '@' that separates the name and address. The name should be the first piece and the address should be the second piece. The address must have a '.' which separates the domain name.
  19. Click [Submit].
  20. Select "Client A" and access the 'Discharge' form.
  21. Select the discharged episode and click [Edit].
  22. Validate all previously filed data is displayed.
  23. Select the "Demographics" section.
  24. Validate the 'Client's Email Address' field contains "test@gmail.com".
  25. Close the form.
Scenario 5: '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. Enter "testgmailcom" in the 'Client's Email Address' field.
  5. Validate a message is displayed stating: Please enter a valid email address.
  6. Click [OK].
  7. Enter "testgmail.com" in the 'Client's Email Address' field.
  8. Validate a message is displayed stating: Please enter a valid email address.
  9. Click [OK].
  10. Enter "testgmail@com" in the 'Client's Email Address' field.
  11. Validate a message is displayed stating: Please enter a valid email address.
  12. Click [OK].
  13. Enter "test@gmail.com" in the 'Client's Email Address' field.
  14. Please note: a valid email address should contain '@' that separates the name and address. The name should be the first piece and the address should be the second piece. The address must have a '.' which separates the domain name.
  15. Click [Submit].
  16. Select "Client A" and access the 'Pre Admit' form.
  17. Select an existing episode and click [Edit].
  18. Select the "Demographics" section.
  19. Validate the 'Client's Email Address' field contains "test@gmail.com".
  20. Close the form.
Scenario 6: '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. Enter "testgmailcom" in the 'Client's Email Address' field.
  5. Validate a message is displayed stating: Please enter a valid email address.
  6. Click [OK].
  7. Enter "testgmail.com" in the 'Client's Email Address' field.
  8. Validate a message is displayed stating: Please enter a valid email address.
  9. Click [OK].
  10. Enter "testgmail@com" in the 'Client's Email Address' field.
  11. Validate a message is displayed stating: Please enter a valid email address.
  12. Click [OK].
  13. Enter "test@gmail.com" in the 'Client's Email Address' field.
  14. Please note: a valid email address should contain '@' that separates the name and address. The name should be the first piece and the address should be the second piece. The address must have a '.' which separates the domain name.
  15. Click [Submit].
  16. Select "Client A" and access the 'Call Intake' form.
  17. Select the existing call intake record and click [Edit].
  18. Validate the 'Client's Email Address' field contains "test@gmail.com".
  19. 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 'AddresType' field.
  10. Enter "Client A" in the 'ClientID' field.
  11. Enter the episode number to be discharged in the 'EpisodeNumber' field.
  12. Enter "test.gmailcom" in the 'ClientEmailAddress' field.
  13. Click [Run].
  14. Validate a message is displayed stating: Please enter a valid email address.
  15. Enter "test@gmail.com" in the 'ClientEmailAddress' field.
  16. Click [Run].
  17. Validate the 'Message' field contains: Client Discharge web service has been filed successfully.
  18. Select "Client A" and access the 'Discharge' form.
  19. Validate all populated fields are displayed as entered in the web service.
  20. Select the "Demographics" section.
  21. Validate the 'Client's Email Address' field contains "test@gmail.com".
  22. 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. Populate any other desired fields.
  6. Enter "Client A" in the 'ClientID' field.
  7. Enter "test@gmailcom" in the 'ClientEmailAddress' field.
  8. Click [Run].
  9. Validate a message is displayed stating: Please enter a valid email address.
  10. Enter "test@gmail.com" in the 'ClientEmailAddress' field.
  11. Click [Run].
  12. Validate the 'Message' field contains: Client Demographics web service has been filed successfully.
  13. Select "Client A" and access the 'Update Client Data' form.
  14. Validate all populated fields are displayed.
  15. Validate the 'Address Type' field contains the value entered via web service.
  16. Validate the 'Client's Email Address' field contains "test@gmail.com".
  17. 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 "Client A" in the 'ClientID' field.
  7. Enter "Client A's" episode in the 'Episode' field.
  8. Enter "test@gmailcom" in the 'ClientEmailAddress' field.
  9. Click [Run].
  10. Validate a message is displayed stating: Please enter a valid email address.
  11. Enter "test@gmail.com" in the 'ClientEmailAddress' field.
  12. Click [Run].
  13. Validate the 'Confirmation' field contains a value such as: "Client Unique ID: # Unique ID: #".
  14. Validate the 'Message' field contains: "Client Admission web service has been filed successfully".
  15. Select "Client A" and access the 'Admission' form.
  16. Select the admission updated in the previous steps and click [Edit].
  17. Validate all populated fields are displayed.
  18. Validate the 'Client's Email Address' field contains "test@gmail.com".
  19. 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. Enter "testgmailcom" in the 'Client's Email Address' field.
  6. Validate a message is displayed stating: Please enter a valid email address.
  7. Click [OK].
  8. Enter "testgmail.com" in the 'Client's Email Address' field.
  9. Validate a message is displayed stating: Please enter a valid email address.
  10. Click [OK].
  11. Enter "testgmail@com" in the 'Client's Email Address' field.
  12. Validate a message is displayed stating: Please enter a valid email address.
  13. Click [OK].
  14. Enter "test@gmail.com" in the 'Client's Email Address' field.
  15. Please note: a valid email address should contain '@' that separates the name and address. The name should be the first piece and the address should be the second piece. The address must have a '.' which separates the domain name.
  16. Click [Submit].
  17. Access the 'Admission (Outpatient)' form for the client admitted in the previous steps.
  18. Click [Edit] for the episode added in the previous steps.
  19. Validate the previously filed data is displayed.
  20. Select the "Demographics" section.
  21. Validate the 'Client's Email Address' field contains "test@gmail.com".
  22. 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. Enter "testgmailcom" in the 'Client's Email Address' field.
  9. Validate a message is displayed stating: Please enter a valid email address.
  10. Click [OK].
  11. Enter "testgmail.com" in the 'Client's Email Address' field.
  12. Validate a message is displayed stating: Please enter a valid email address.
  13. Click [OK].
  14. Enter "testgmail@com" in the 'Client's Email Address' field.
  15. Validate a message is displayed stating: Please enter a valid email address.
  16. Click [OK].
  17. Enter "test@gmail.com" in the 'Client's Email Address' field.
  18. Please note: a valid email address should contain '@' that separates the name and address. The name should be the first piece and the address should be the second piece. The address must have a '.' which separates the domain name.
  19. Click [Submit].
  20. Select "Client A" and access the 'Pre Admit Discharge' form.
  21. Select the discharged episode and click [OK].
  22. Validate the previously filed data is displayed.
  23. Select the "Demographics" section.
  24. Validate the 'Client's Email Address' field contains "test@gmail.com".
  25. Close the form.
Topics
• Admission • Update Client Data • Discharge • Pre Admit • Call Intake • Admission (Outpatient) • Pre Admit Discharge
 

Avatar_Cal-PM_2024_Monthly_Release_2024.01.00_Details.csv