Avatar Cal-PM 2024 Update 85

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Product Requirements and Recommendations

Avatar Cal-PM required
RADplus required

Recommended Update Level

Avatar Cal-PM 2024 Monthly Release 2024.01.02
RADplus 2024 Monthly Release 2024.01.02

Product Update Description

The registry setting 'Include Guarantors with Self Pay System Financial Class' is added for the 'Self Pay Payment Redistribution' process.

Required Updates

None

Included Updates

None

Details

NEW1 CHANGED0 FIXED0

New (1)

AV-97459 Details | User Acceptance Tests

Self Pay Payment Redistribution

The registry setting 'Include Guarantors with Self Pay System Financial Class' is added to the 'Self Pay Payment Redistribution' process.

'Dictionary Update', 'Payor' file, dictionary 'Financial Class (1000)' will allow agencies to select 'Self-Pay' in the 'Extended Dictionary Element', 'System Financial Class (1500)'.

Value Added: The new registry setting will be included when processing the 'Self Pay Payment Redistribution' functionality.

Topics

• Self Pay Payment Redistribution

Acceptance Tests

AV-97459 Summary | Details

Self Pay Payment Redistribution

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
Deposit Entry
Diagnosis
Dictionary Update (PM)
Financial Eligibility
Guarantors/Payors
Posting/Adjustment Codes Definition
Registry Settings (PM)
Self Pay Payment Redistribution
Service Codes

Scenario 1: Cal-PM Self Pay Payment Redistribution

Specific Setup:

Service Codes:
Identify an existing 'prepayment' service code or create a new service code.
Posting/Adjustment Codes Definition:
An existing payment posting code (credit) is identified. Select 'Yes' for the 'Include in Self Pay Redistribution Payment Process' field.
An existing payment reversal posting code (debit) is identified and is the reversal for the above code. Select 'Yes' for the 'Include in Self Pay Redistribution Payment Process' field.
Registry Settings:
'Pre Payment Service Code' = the above 'Service Code'.
'Self Pay Payment Redistribution Posting Code' = the above credit 'Posting/Adjustment Code'.
'Include Guarantors with Self Pay System Financial Class' = N.
Dictionary Update: Identify an existing, or create a new financial class with the following:
File - Payor
Data Element - (1000) Financial Class
Dictionary Code - The dictionary code for the financial class of the guarantor identified above to be used as secondary guarantor.
Extended Dictionary Data Element - (1500) System Financial Class
Extended Dictionary Value - Self Pay.
Guarantors/Payors:
Identify a guarantor with the standard 'Self Pay' financial class.
Identify or create a new guarantor with the new financial class added through dictionary update.
Identify a primary guarantor.
Admission:
Two new clients are admitted, or existing clients are identified. Note the client id, admission date and admission program.
Financial Eligibility:
Client 1:
Assigned a primary guarantor where the benefit plan includes a co-pay amount.
Assigned self-pay guarantor defined above with the standard 'Self Pay' financial class, as the secondary guarantor.
Client 2:
Assigned a primary third party guarantor where the benefit plan includes a co-pay amount.
Assigned the guarantor defined above with the new self pay financial class added through dictionary update. This is the secondary guarantor.
Client Charge Input:
Services are rendered to the clients. Note the service date and service code.
Client Ledger is used to review the report data for each client, and to note the self pay balance due for each client.
Deposit Entry:
Client 1: Create a payment for the standard self-pay guarantor. Note the date and amount.
Client 2: Create a payment for the new self pay financial class. Note the date and amount.
Self Pay Payment Redistribution
Run the process by 'Individual' for 'Client 1'.
Run the process by 'Individual' for 'Client 2'.
Client Ledger
Client 1: Process the report and validate that the payment made through 'Deposit Entry' was applied to the co-pay portion of the services distributed to the self-pay guarantor.
Client 2: Process the report and validate that the payment made through 'Deposit Entry' was not applied to the co-pay portion of the services distributed to the self-pay guarantor.

Steps

Open the “Registry Settings” form.
Set the 'Limit Registry Settings' to 'Self Pay Payment Redistribution'.
Click [Yes] in 'Include Hidden Registry Settings'.
Click [View Registry Settings].
Select 'Include Guarantors with Self Pay System Financial Class Registry Setting Value: N' item.
Validate the message displays: 'When set to 'Y', the 'Self Pay Payment Redistribution' process will consider guarantors that have a Financial Class value where the System Financial Class is set to Self Pay. When 'N' is selected, only text contains 'When set to 'Y', the 'Self Pay Payment Redistribution' process will consider guarantors that have a Financial Class value where the System Financial Class is set to Self Pay. When 'N' is selected, only guarantors with a base Financial Class of Self Pay will be considered during the 'Self Pay Payment Redistribution' process. This is the default behavior of the system'.
Click [OK].
Set the 'Registry Setting Value' to 'Y'.
Click [Submit].
Click [OK].
Click [No].
Open the “Self Pay Payment Redistribution” form.
Click [Individual] in 'All Or Individual Client'.
Enter 'Client 2' in 'Client ID'.
Click [Run Self Pay Payment Redistribution].
Validates the message displays: 'The process is complete for Client 2'.
Click [OK].
Click [Discard].
Click [Yes].
Open the "Client Ledger" form.
Enter 'Client 2' in 'Client ID'.
Click [All Episodes] in 'Claim/Episode/All Episodes'.
Click [Simple] in 'Ledger Type'.
Click [Process].
Validate that the payment made through 'Deposit Entry' was applied to the co-pay portion of the services distributed to the self-pay guarantor.
Click [X].
Click [No].

Topics

• Self Pay Payment Redistribution