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Avatar LA Provider Integration 2022 Update 2

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Product Requirements / Recommendations

Avatar Cal-PM required
Avatar LA Provider Integration required
RADplus required

Product Update Form Description

Draft/Final functionality is added to the 'LA Community Outreach Service Entry' form. Also, the 837 5010 professional file produced via the 'Electronic Billing' form is modified to support wraparound requirements for Community Outreach Services.

Included Updates

None

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
LA Community Outreach Service Entry and 837 Professional
Draft/Final functionality is added to the 'LA Community Outreach Service Entry' form. In addition, the 837 Professional is updated to support the wraparound requirements for Community Outreach Services.
Value Added: Draft/Final ability is added to 'LA Community Outreach Service Entry' and the 837 Professional is updated to support the wraparound requirements for Community Outreach Services.
Topics
• 837 Professional • LA Community Outreach Service Entry
 
Acceptance Tests
AV-76526 Summary | Details
LA Community Outreach Service Entry and 837 Professional
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Ledger
  • LA Community Outreach Service Entry
  • Electronic Billing
Scenario 1: LA Community Outreach Service Entry - Enter Service
Specific Setup:
  • Guarantors/Payors: Note a guarantor that contains a value in ‘LA County Guarantor’.
  • Program Maintenance: Note a program that has a value in ‘LA County Program’. Note the 'Location'.
  • Guarantor/Program Billing Defaults: A template exists for the above Guarantors/Payors/ Program Maintenance combination.
  • Service Code is selected for use.
  • Practitioner is selected for use. Note the 'Practitioner Categories For Coverage'.
  • Client A: Client is enrolled in the above program and is assigned the above Guarantors/Payors in Financial Eligibility.
  • LA 837 Setup has been used to set the client up for Community Outreach Services.
  • Client B: Client is enrolled in the above program and is assigned the above Guarantors/Payors in Financial Eligibility.
Steps
  1. Open "LA Community Outreach Service Entry" form.
  2. Validate the 'Community Outreach Service Client ID' defaults to 'Client A'.
  3. Select 'Draft' in "Draft/Final".
  4. Set "Date Of Service" to any date.
  5. Select any value in the "Episode Number" field.
  6. Select any value in the "Program" field.
  7. Select any value in the "Service Code" field.
  8. Select any staff member in the "Practitioner" field.
  9. Select any value in the "Location" field.
  10. Select 'Client B' in Client ID'.
  11. Select any value in the "Service Type" field.
  12. Select any value in the "Ethnicity" field.
  13. Select any value in the "Primary Language".
  14. Select any value in the "Age Category" field.
  15. Select any value in the "Service Recipient Type" field.
  16. Set "Number of Persons Contacted" to any numeric value.
  17. Click [Submit].
  18. Open 'Client Ledger' for 'Client A' and verify the service does not exist.
  19. Open 'Client Ledger' for 'Client B' and verify the service does not exist.
  20. Open "LA Community Outreach Service Entry".
  21. Select the service in 'Draft Entry To Edit'.
  22. Change 'Draft' to 'Final' in "Draft/Final".
  23. Click [Submit].
  24. Open "LA Community Outreach Service Entry".
  25. Validate that the 'Final' service does not display in the form.
  26. Open 'Client Ledger' for 'Client A' and verify the service does exist.
  27. Open 'Client Ledger' for 'Client B' and verify the service does not exist.
  28. Open "LA Community Outreach Service Entry" form.
  29. Validate the 'Community Outreach Service Client ID' defaults to 'Client A'.
  30. Select 'Draft' in "Draft/Final".
  31. Set "Date Of Service" to any date.
  32. Select any value in the "Episode Number" field.
  33. Select any value in the "Program" field.
  34. Select any value in the "Service Code" field.
  35. Select any staff member in the "Practitioner" field.
  36. Select any value in the "Location" field.
  37. Select 'Client B' in Client ID'.
  38. Select any value in the "Service Type" field.
  39. Select any value in the "Ethnicity" field.
  40. Select any value in the "Primary Language".
  41. Select any value in the "Age Category" field.
  42. Select any value in the "Service Recipient Type" field.
  43. Set "Number of Persons Contacted" to any numeric value.
  44. Click [Submit].
  45. Open "LA Community Outreach Service Entry" form for any test client.
  46. Select the service in 'Draft Entry To Edit'.
  47. Click [Delete Draft Entry].
  48. Validate 'LA COS Services Entry' message displays: Are you sure you want to delete this draft entry?
  49. Click [No].
  50. Validate the 'LA COS Services Entry' message closes.
  51. Click [Delete Draft Entry].
  52. Click [Yes].
  53. Validate 'LA COS Services Entry' message displays: Draft entry deleted.
  54. Click [X].
  55. Validate 'Confirm Close' message displays: Are you sure you want to Close without submitting?
  56. Click [Yes].
Scenario 2: LA Community Outreach Service Entry - 837 Professional - NTE segment
Specific Setup:
  • Guarantors/Payors: Note a guarantor that contains a value in ‘LA County Guarantor’.
  • Program Maintenance: Note a program that has a value in ‘LA County Program’. Note the 'Location'.
  • Guarantor/Program Billing Defaults: A template exists for the above Guarantors/Payors/ Program Maintenance combination. 'Display NTE Segment at Service Level' = Y.
  • Service Code is selected for use.
  • Practitioner is selected for use. Note the 'Practitioner Categories For Coverage'.
  • Client: Client is enrolled in the above program and is assigned the above Guarantors/Payors in Financial Eligibility.
  • LA Community Outreach Service Entry is used to create finalized service(s) that contain an entry in 'Client ID'. The client selected in the 'Client ID' does not have an active diagnosis record.
  • Close Charges has been used to close charge(s).
Steps
  1. Open 'Electronic Billing'.
  2. Create an 837 Professional bill for the client, guarantor, and service dates.
  3. Validate that the service(s) errors because of the missing diagnosis. This is because the error is produced on the 'Client ID', not the 'Community Outreach Service' client.
  4. Close the report.
  5. Close the form
  6. For the client from the 'Client ID', add a diagnosis record or add a diagnosis to the service in 'Edit Service Information'.
  7. Open 'Electronic Billing'.
  8. Create an 837 Professional bill for the client, guarantor, and service dates.
  9. Validate that the 'Compile Complete' message is received.
  10. Validate that the dump file 'NTE' segment contains 'NTE*DCP*99~'.
  11. Close the report.
  12. Close the form.
Topics
• 837 Professional • LA Community Outreach Service Entry