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Avatar Cal-PM 2024 Update 72

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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
Avatar Cal-PM 2024 Update 32
RADplus 2024 Monthly Release 2024.01.01

Product Update Description

The issue is resolved where the "Missing HCPCS Code For Service..." is incorrectly displayed on an 837 bill.

Required Updates

None

Included Updates

3, 5, 7, 10, 21, 23, 25, 28, 32, 33, 39, 49, 52, 60, 62

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Service/Fee Cross Reference Maintenance - Guarantor Definition
Issue is resolved where there was a missing HCPCS Code error received for the service on the 837 bill when the HCPCS/CPT-4 code is present in the 'Guarantor Definition' but not in the 'Service Fee Definition'. KB0076748 v0.01
Topics
• Service Fee/Cross Reference Maintenance
 
Acceptance Tests
AV-98414 Summary | Details
Service/Fee Cross Reference Maintenance - Guarantor Definition
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
  • Crystal Report Viewer
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
  • Service Fee/Cross Reference Maintenance
Scenario 1: Service Fee/Cross Reference Maintenance - Service Fee/Guarantor Definition Report
Specific Setup:
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor's code/name.
  • Site Specific Section modeling:
  • Add-On service, Save Add-On, Add-On Duration, Co-Practitioner, Co-Practitioner Duration fields are added to the Progress Note form if they are not available on the form.
  • Dictionary Update:
  • File= 'Other Tabled File':
  • Data Element: 291 - Service Code Type
  • Dictionary Code = 1
  • Dictionary Value = Evaluation Management
  • Extended dictionary 'Allow Multiple Add-On Code' = Yes
  • Service Codes:
  • A primary service code is created to have desired number of add-on with the following:
  • Service Code Category = Primary Code
  • Service Code Type = desired value
  • Type of Fee = Evaluation Management
  • 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 = Evaluation Management
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = No
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • Service Fee/Cross Reference Maintenance:
  • A fee definition is created for the primary and Add-On service codes.
  • There is no HCPCS code defined for the primary and add-on service in the 'Service Fee Maintenance' section.
  • The only applicable HCPCS code is defined in the 'Guarantor Definitions' section for the guarantor that is assigned to the client. 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.
  • Client Charge Input:
  • A primary service is rendered to the client and the Add-On service code is attached to the primary while rendering the service. Note service date, service code.
  • Client Ledger:
  • The primary and Add-On services are distributed correctly to the assigned guarantor.
  • Close Charges:
  • The charges are closed.
  • Create Interim Billing Batch:
  • An interim billing batch is created to cover client, services rendered to the client and the guarantor. Note the batch number.
Steps
  1. Open the 'Electronic Billing' form.
  2. Select “837-Professional” in 'Billing Form' and “Blue Cross” in 'Type Of Bill'.
  3. Select desired guarantor in 'Guarantor'.
  4. Click [Outpatient] in 'Billing Type'.
  5. Click [Sort File] in 'Billing Options' and [Interim Batch] in 'All Clients Or Interim Billing Batch'.
  6. Select desired interim billing batch in 'Interim Batch Number'.
  7. Click [No] in 'Create Claims'.
  8. Set both 'First Date Of Service To Include' and 'Last Date Of Service To Include' to desired dates.
  9. Click [Version 5010] in "HIPAA Transaction Version",
  10. Verify the bill compiles successfully.
  11. Click [Run Report] in 'Billing Options'.
  12. Click [Print] in 'Print Or Delete Report'.
  13. Select the most recent compiled file in 'File'.
  14. Click [Print 837 Report].
  15. Verify that the report does not contain an error regarding 'Missing HCPCS code' and displays primary and add-on services correctly.
  16. Click [X].
  17. Click [Discard].
Topics
• Service Fee/Cross Reference Maintenance