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Avatar Cal-PM 2024 Update 10

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Product Requirements and Recommendations

Avatar Cal-PM required
RADplus required

Recommended Update Level

Avatar Cal-PM 2024 Monthly Release 2024.00.01
RADplus 2024 Monthly Release 2024.00.01

Product Update Description

The Electronic Billing 837 Professional is updated to support the Place of Service value of '10' when suppressing 2310C/2310D and 2420C as it would when Place of Service's value is '12'.

Required Updates

None

Included Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Avatar Cal-PM 'Electronic Billing' 837 Professional
Avatar Cal-PM 837 Professional optional suppression of 2310C/2310D and 2420C loops is updated.
The Avatar Cal-PM 'Electronic Billing' 837 Professional is updated to support the Place of Service value of '10' ('Telehealth – Patient in Home') when optionally suppressing 2310C/2310D and 2420C as it would when Place of Service's value is '12' ('Home') in conjunction with Registry Setting 'Service Facility Location 2310D/2420C'.
Value Added: Updates 837 Professional suppression of 2310C/2310D and 2420C loops
Topics
• 837 Professional • Electronic Billing • Guarantor/Program Billing Defaults • Registry Settings
 
Acceptance Tests
AV-94965 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:
  • Registry Settings (PM)
  • 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
• 837 Professional • Electronic Billing • Guarantor/Program Billing Defaults • Registry Settings