Skip to main content

Avatar Cal-PM 2024 Update 19

  1. Last updated
  2. Save as PDF

Product Requirements and Recommendations

Avatar Cal-PM required
RADplus required

Recommended Update Level

Avatar Cal-PM 2023 Update 47

Product Update Description

An issue is resolved where SBR segments would not generate for MSO originated services if the 'Add Policy Number Override' registry setting is enabled.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
'Electronic Billing' Support for Services Originating in Avatar MSO
An issue is resolved in the Avatar Cal-PM Electronic Billing 837 compile process to ensure that 2320/2330 SBR information is included in claims where present for services originating in Avatar MSO with Other Healthcare Coverage information where Avatar Cal-PM Registry Setting 'Add Policy Number Override' is enabled.
Topics
• Claims Processing • Electronic Billing
 
Acceptance Tests
AV-95433 Summary | Details
'Electronic Billing' Support for Services Originating in Avatar MSO
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Electronic Billing
  • Registry Settings (PM)
Scenario 1: 'Electronic Billing' - Verification of 'Support MSO Other Healthcare Coverage' Registry Setting (Services Originating in Avatar MSO)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Add Policy Number Override' must be enabled
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar Cal-PM Registry Setting 'Include Service Level Adjudication Info' must be enabled (and 'Include Service Level Adjudication Information (2430)' field set to 'Yes' via 'Guarantor/Program Billing Defaults' form '837 Professional' and/or '837 Institutional' section for applicable Guarantor/Program)
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional/837 Institutional file inclusion (via 'Electronic Billing' form) originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
Steps
  1. Open Avatar Cal-PM 'Electronic Billing' form.
  2. Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality
  3. Select 837 Professional or 837 Institutional in 'Billing Form' field.
  4. Enter/select 837 file sorting criteria, using values which will include service(s) originating in Avatar MSO.
  5. Click 'Process' button to sort/generate 837 Professional or 837 Institutional file.
  6. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional/837 Institutional file sorted which includes services originating in Avatar MSO, and click 'Process' button to display 837 outbound file data.
  9. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file data - for services originating via Avatar MSO inbound 837 file posting and including Service-Level Third Party Payment/Adjustment 'Other Healthcare Coverage' information, ensure that the following 837 Loop/Segments are included with values from original Avatar MSO inbound 837 claim/service Other Healthcare Coverage information:
  10. Other Subscriber Information (2320)
  11. Other Insurance Coverage Information (2320)
  12. Other Subscriber Name (2330A)
  13. Other Payer Name (2330B)
Topics
• Claims Processing • Electronic Billing