Avatar Cal-PM 2024 Update 30

Last updated
Save as PDF

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 issue is resolved where the primary and add-on services might not be included in the same claim on an 837 Professional bill.

Required Updates

None

Included Updates

None

Details

NEW0 CHANGED0 FIXED1

Fixed (1)

AV-95189 Details \| User Acceptance Tests 837 Billing - Primary / Add-On Services The 837 bills are modified to always include primary and associated add-on services in the same claim. KB0076185 v0.01	Topics • 837 Professional • NX

Acceptance Tests

AV-95189 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:

Admission (Outpatient)
Client Charge Input
Client Ledger
Create Interim Billing Batch File
Diagnosis
Dictionary Update (PM)
Electronic Billing
Financial Eligibility
Program Maintenance
Registry Settings (PM)
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

Open ‘Electronic Billing’.
Select ‘837-Professional’ in ‘Billing Form’.
Select the primary guarantor ‘Financial Class in ‘Type Of Bill’.
Select ‘Individual’ in ‘Individual Or All Guarantors’.
Select the primary guarantor in ‘Guarantor’.
Select ‘Outpatient’ in ‘Billing Type’.
Select ‘Sort File’ in ‘Billing Options’.
Enter the desired value in ‘File Description/Name’.
Select ‘Interim Billing Batch’ in ‘All Clients Or Interim Billing Batch’.
Select desired interim billing batch file from the 'Interim Billing Batch' drop down field.
Select desired value in ‘Program(s)’.
Select ‘No’ in ‘Create Claims’.
Enter the desired value in ‘First Date Of Service To Include’.
Enter the desired value in ‘Last Date Of Service To Include’.
Select ‘All in ‘Include Primary and/or Secondary Billing.
Click [Process].
Validate the ‘Processing Report’ message contains ‘Compile Complete’.
Click [OK].
Select ‘Dump File’ in ‘Billing Options’.
Select ‘Print’ in ‘Print Or Delete Report’.
Select the desired report in ‘File’.
Click [Process].
Validate that there is one ‘CLM’ segment per service for the services which are not primary or add-on services.
Validate that the primary and associated add-on services are included under the same CLM segment.
Close the report.
Select ‘Yes’ in ‘Create Claims’.
Enter desired date in the 'Date Of Claim'.
Click [Process].
Validate the ‘Processing Report’ message contains ‘Compile Complete’.
Click [OK].
Close the form.
Open the 'Client ledger' form.
Select desired client from the 'Client' field.
Enter desired dates in the 'Service Start Date' and 'Service End date' fields.
Select 'Simple' from the 'Ledger Type' field.
Click [Process].
Verify the client ledger contains the primary and associated add-on services on the same claim.
Close the report.
Close the form.
Open the 'Registry Setting' form.
Set the 'Include Delay Reason Code' registry setting to 'N'.
Set the 'Select REF Segments To Include Registry Setting Value' to 2.
Submit the form.
Open the 'Guarantor/Program Billing Defaults'.
Select 'Edit Template' option in the 'Actions' field.
Select desired template from the 'Select Template' drop down list.
Click the '837 Professional' or '837 Institutional' section.
Set the 'Demonstration Project Identifier (2300-REF-02)' field to desired value.
Submit the form.
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