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Avatar Cal-PM 2024 Update 70

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Product Requirements and Recommendations

Avatar Cal-PM required
RADplus required

Recommended Update Level

Avatar Cal-PM 2024 Monthly Release 2024.01.01
RADplus 2024 Monthly Release 2024.01.01

Product Update Description

The error '[UNDEFINED]FILE+80^EB837RSVCSEL *ERROR' has been corrected when processing an MSO 837 file.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Avatar MSO to Cal-PM Parent System Service Filing
An issue is resolved to ensure successful posting of inbound Avatar MSO 837 Health Care Claim files including one or more 'replacement' and/or 'void' claims.
Topics
• Claims Processing • Electronic Billing
 
Acceptance Tests
AV-95113 Summary | Details
Avatar MSO to Cal-PM Parent System Service Filing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Institutional
  • 837 Health Care Claim Professional
  • Client Ledger
  • Close Batch
  • Registry Settings (PM)
Scenario 1: 'Close Batch' - Avatar MSO to Cal-PM Parent System Service Filing, Verification of Void/Replacement Claim and Service Filing
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Support Additional Claim Follow-Up Functionality' may optionally be enabled
  • '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 'Void' and/or 'Replacement' claim for single or multiple service claims eligible for filing to parent Avatar Cal-PM system
Steps
  1. Open Avatar MSO 'Close Batch' form.
  2. Select Avatar MSO Claims Processing batch containing one or more 'Approved' status 'Replacement' claim/services eligible for filing to parent Avatar Cal-PM system.
  3. Note - Retro Claim Adjudication entries from Avatar MSO 'Void' 837 Professional/837 Institutional claims are pushed/filed to Avatar Cal-PM parent system on posting in MSO, as no Avatar MSO Claims Processing Batch is created; Retro Claim Adjudication entries from Avatar MSO 'Replacement' 837 Professional/837 Institutional claims are pushed/filed to Avatar Cal-PM parent system on closing of Claims Processing Batch for Replacement Claims/Services in MSO
  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. In Client Ledger data - ensure that 'Approved' status original claim 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).
  11. In Client Ledger data - ensure that services originating in Avatar MSO where 'Void' claim has subsequently been processed in Avatar MSO (resulting in Retro Claim Adjudication service takeback entries) are updated in Avatar Cal-PM parent system as follows:
  12. Original services in 'Open' charge status will be deleted in Avatar Cal-PM parent system
  13. Original services in 'Closed' and 'Unbilled' charge status (not claimed) will have service deletion reversal code ('DELETE') filed in Avatar Cal-PM parent system
  14. Original services which have been included in 837 Electronic Billing outbound claim in Avatar Cal-PM parent system (claimed) will remain in Client Ledger as originally filed, and 'Electronic Re-Billing Service Assignment' entries will be created in Avatar Cal-PM for original claims/services where enabled (with 'Void/Cancel of Prior Claim' Claim Submission Reason Code)
  15. In Avatar Cal-PM parent systems where Avatar Cal-PM Registry Setting 'Support Additional Claim Follow-Up Functionality' is enabled:
  16. 'Claim Follow-Up' entries will be created for original Avatar Cal-PM claims/services on filing of 'Void' claim in Avatar MSO
  17. 'Electronic Re-Billing Service Assignment' entries will only be created in Avatar Cal-PM for original claims and services where/when 835 Remittance Advice with 'Approval' status has been received/posted for original Avatar Cal-PM claim
  18. In Client Ledger data - ensure that services originating in Avatar MSO where 'Replacement' claim has subsequently been processed in Avatar MSO (resulting in Retro Claim Adjudication service takeback entries and new services) are updated in Avatar Cal-PM parent system as follows:
  19. Original services in 'Open' charge status will be deleted in Avatar Cal-PM parent system, and new/replacement services will be filed/present in Avatar Cal-PM system following 'Close Batch' filing (if 'Approved' status and where replacement services are valid for filing to parent system)
  20. Original services in 'Closed' and 'Unbilled' charge status (not claimed) will have service deletion reversal code ('DELETE') filed in Avatar Cal-PM parent system, and new/replacement services will be filed/present in Avatar Cal-PM system following 'Close Batch' filing (if 'Approved' status and where replacement services are valid for filing to parent system)
  21. Original services which have been included in 837 Electronic Billing outbound claim in Avatar Cal-PM parent system (claimed)will remain in Client Ledger as originally filed, and 'Electronic Re-Billing Service Assignment' entries will be created in Avatar Cal-PM for original claims/services where enabled (with 'Replacement of Prior Claim' Claim Submission Reason Code)
  22. In Avatar Cal-PM parent systems where Avatar Cal-PM Registry Setting 'Support Additional Claim Follow-Up Functionality' is enabled:
  23. 'Claim Follow-Up' entries will be created for original Avatar Cal-PM claims/services on filing of 'Replacement' claim in Avatar MSO
  24. 'Electronic Re-Billing Service Assignment' entries will only be created in Avatar Cal-PM for original claims and services where/when 835 Remittance Advice has been received/posted for original Avatar Cal-PM claim
Topics
• Claims Processing • Electronic Billing