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Avatar Cal-PM 2024 Update 61

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Product Requirements and Recommendations

Avatar Cal-PM required
RADplus required

Recommended Update Level

Avatar Cal-PM 2020 Update 29
Avatar Cal-PM 2024 Monthly Release 2024.01.02
RADplus 2024 Monthly Release 2024.01.02

Product Update Description

An issue is resolved where incorrect data or no data would display in the 'Monthly 835 Denial Trends Report'. In addition, the report query is modified for improved efficiency.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Monthly 835 Denial Trends Report - Data validation
An issue is resolved where incorrect data or no data would display in the ‘Monthly 835 Denial Trends Report’.
Topics
• 835 Health Care Claim Payment/Advice • 837 Professional
 
Acceptance Tests
AV-74429 Summary | Details
Monthly 835 Denial Trends Report - Data validation
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Monthly 835 Denial Trends Report
Scenario 1: 'Monthly 835 Denial Trends Report' - One Guarantor - multiple claims/clients - same service date
Specific Setup:
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor's code/name.
  • Guarantor/Program Billing Defaults:
  • The 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field does not contain any value.
  • Service codes:
  • An existing service code is identified to be used. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • 5-6 existing clients are identified, or new clients are admitted. Note client ids, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to all the clients as a primary guarantor.
  • Recurring Client Charge Input:
  • 2-3 services are rendered to all the client on the same dates. (i.e. Select a month and the same days of that month to create services for all the clients, using the same service codes and same dates of service for each client.). Note service dates.
  • Client Ledger:
  • All the services are distributed to the assigned guarantor.
  • Claim Adjustment Group/Reason Code Definitions:
  • 2-3 group/reason codes are created/identified. Note the definitions.
  • Close Charges:
  • All the services distributed to the identified guarantor are closed.
  • Create Interim Billing Batch:
  • An interim billing batch is created to include all the services rendered to all the clients. Note the batch number.
  • Electronic Billing:
  • Claims are created for all the clients and services. Note the claim numbers.
  • An 835 Healthcare Claim Payment/Advice file is created to deny at least two of the services for each of your test clients. Note the file name/path.
  • The Claim Adjustment Group/Reason Code Definitions used for the denials are the same for every client in the 835.
  • 835 Healthcare Claim Payment/Advice:
  • Load/compile/post the 835 Healthcare Claim Payment/Advice file. Note the posting date.
Steps
  1. Open 'Monthly 835 Denial Trends Report'.
  2. Set 'By Financial Class or Guarantor(s)' to 'Guarantor(s)'.
  3. Enter the claims 'Start Date'.
  4. Enter the claims 'End Date'.
  5. Click [Process].
  6. Review the report, 'MONTHLY 835 DENIAL TRENDS BY GUARANTOR REPORT'.
  7. The 'CLAIM DATE' displays the dates entered in 'Start Date' and 'End Date'.
  8. The 'GUARANTOR' column displays the guarantor’s name.
  9. The 'DENIALS' column displays the denial 'Reason Codes' defined in 'Claim Adjustment Group/Reason Code Definition'.
  10. The distinctive months will display a count by reason code.
  11. Validate that the 'Total Denials For Month' values are correct.
  12. Close the report.
  13. Set 'By Financial Class or Guarantor(s)' to 'Financial Class'.
  14. Enter the claims 'Start Date'.
  15. Enter the claims 'End Date'.
  16. Click [Process].
  17. Review the report, 'MONTHLY 835 DENIAL TRENDS BY FINANCIAL CLASS REPORT'.
  18. The 'FINANCIAL CLASS' displays the financial class.
  19. The 'DENIALS' column displays the denial 'Reason Codes' defined in 'Claim Adjustment Group/Reason Code Definition'.
  20. The distinctive months will display a count by reason code.
  21. Validate that the 'Total Denials For Month' values are correct.
  22. Close the report.
  23. Close the form.
Topics
• 835 Health Care Claim Payment/Advice • 837 Professional