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Avatar MSO 2022 Monthly Release 2022.00.01 Acceptance Tests

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2021 Update 32 Summary | Details
837 Health Care Claim - Performing Provider
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CPT Code Definition (PM)
  • CPT Code Definition (MSO)
  • Service Codes
  • Funding Source Registration
  • Plan Definition
  • Performing Provider Registration
  • Dynamic Form - Pre-Display Confirmation
  • Provider Fee Definition
  • MSO to Parent System Integration Mapping
  • App Dashboard
  • Practitioner Enrollment
  • Admission (Outpatient)
  • Financial Eligibility
  • Member Specific Information
  • Service Authorization
  • Diagnosis
  • Claim Processing Automation
  • 837 Health Care Claim Professional
  • Contracting Provider Termination
  • Revenue Code Definition (PM)
  • Revenue Code Definition (MSO)
  • Admission
  • 837 Health Care Claim Institutional
Scenario 1: Validate 837 Health Care Claim Professional when Performing Provider is not in the Contracting Provider's first registration record.
Specific Setup:
  • Performing Provider Registration exists.
  • Contracting Provider Registration exists with the Performing Provider included.
  • Contracting Provider Termination is used to terminate the Contracting Provider Registration.
  • Contracting Provider Registration is used to register the same Contracting Provider again and include the Performing Provider.
  • File exists for the Contracting Provider / Performing Provider to post in the 837 Health Care Claim Professional.
Steps
  1. Open ‘837 Health Care Claim Professional’.
  2. Load and compile the file.
  3. Validate that the Contracting Provider or Performing Provider forms populate successfully.
  4. Post the file if desired.
Scenario 2: Validate 837 Health Care Claim Institutional when Performing Provider is not in the Contracting Provider's first registration record.
Specific Setup:
  • Performing Provider Registration exists.
  • Contracting Provider Registration exists with the Performing Provider included.
  • Contracting Provider Termination is used to terminate the Contracting Provider Registration.
  • Contracting Provider Registration is used to register the same Contracting Provider again and include the Performing Provider.
  • File exists for the Contracting Provider / Performing Provider to post in the 837 Health Care Claim Institutional.
Steps
  1. Open ‘837 Health Care Claim Institutional’.
  2. Load and compile the file.
  3. Validate that the Contracting Provider or Performing Provider forms populate successfully.
  4. Post the file if desired.
Topics
• Performing Provider • Contracting Provider Registration • 837 Health Care Claim Institutional