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Avatar MSO 2022 Monthly Release 2022.01.02 Acceptance Tests

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Update 2 Summary | Details
Site Specific Section Modeling - Fast Service Entry Submission
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Admission (Outpatient)
  • Diagnosis
  • Dynamic Form - Pre-Display Confirmation
  • Financial Eligibility
  • CPT Code Definition (PM)
  • CPT Code Definition (MSO)
  • Revenue Code Definition (PM)
  • Revenue Code Definition (MSO)
  • Service Codes
  • Plan Definition
  • Funding Source Registration
  • Applying Contracting Provider
  • Provider Fee Definition
  • Registry Settings (PM)
  • MSO to Parent System Integration Mapping
  • Claim Processing (CMS 1500)
  • Close Batch
  • Dynamic Form - Site Specific Section Modeling (CWS)
  • Site Specific Section Modeling (MSO)
  • Fast Service Entry
Scenario 1: 'Claim Processing...' forms and functions - Verification of 'Explanation Of Coverage' value for 'Pended' Service Authorization, and verifying new batch not created when batch is closed
Specific Setup:
  • Client record with Service Authorization(s) where 'Current Authorization Status' value is 'Pending'
  • One or more claim(s)/service(s) for adjudication where 'Pending' status Service Authorization is selected/associated to service
Steps
  1. Open Avatar MSO 'Claim Processing...' form ('Claim Processing (CMS 1500)', 'Claim Processing (UB-04)' and/or 'Fast Service Entry' forms).
  2. Select claims processing batch for service entry/edit.
  3. Open existing claim or create new claim for service entry/edit.
  4. Set value for 'Member Name or ID' and 'Provider' in claim level section (if adding new claim/services).
  5. Navigate to 'Service Detail' section of form.
  6. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button).
  7. Enter/select 'Date of Service', 'Procedure Code', 'Total Charge' and 'Service Units' field values.
  8. Click 'Display Valid Authorizations' button and select Service Authorization (or directly enter value in 'Authorization Number' field).
  9. In case where 'Current Authorization Status' value is 'Pending' for selected/associated Service Authorization record - ensure that 'Claim Status' value is set to 'Pending' for service.
  10. In case where 'Current Authorization Status' value is 'Pending' for selected/associated Service Authorization record - ensure that 'Explanation Of Coverage' field for service includes value 'The service was pended for the following reason: Authorization is pending'.
  11. Click [Enter Third Party Adjudication Data].
  12. Create a new row with desired data, and if desired click [View] and create a new row with desired data. Save the rows.
  13. Click [Submit].
  14. Close the batch and validate that a new pended batch is created.
  15. Repeat steps 1-12 and validate that the ‘Third Party Adjudication Data’ was copied forward.
  16. Click [Submit].
  17. Close the batch and validate that a new pended batch is created.
  18. Repeat steps 1-12 and validate that the ‘Third Party Adjudication Data’ was copied forward.
Scenario 2: Avatar MSO 'Site Specific Section Modeling' - 'Fast Service Entry Submission' - opening prompt section.
Specific Setup:
  • Site Specific Section Modeling for MSO:
  • Select the ‘MSOBAT185SUBMISSION (Fast Service Entry Submission) Fast Service Detail’ item in the dropdown list.
  • Click [OK].
  • Select ‘Prompt Definition’ section.
  • If desired, add a new prompt and customize the label or customize the label of an existing prompt.
  • Click [Submit].
  • Refresh the forms.
Steps
  1. Open ‘Fast Service Entry’.
  2. Select the ‘Fast Service Detail’ section.
  3. Validate that the prompt that was added or changed exists on the form.
  4. Close the form.
  5. Open ‘Site Specific Section Modeling’ for MSO.
  6. Select the ‘MSOBAT185OVERRIDE (Fast Service Entry) Fast Service Detail’ item in the dropdown list.
  7. Click [OK].
  8. Select ‘Prompt Definition’ section.
  9. Validate that the prompt added or changed in Setup displays in the table.
  10. Select the prompt and click [Delete Selected Item].
  11. Click [Yes] on the ‘Confirm’ message.
  12. Click [Submit].
  13. Refresh the forms.
  14. Open ‘Fast Service Entry’.
  15. Select the ‘Fast Service Detail’ section.
  16. Validate that the prompt does not exist.
Claim Processing - Third Party Adjudication Data
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Admission (Outpatient)
  • Diagnosis
  • Dynamic Form - Pre-Display Confirmation
  • Financial Eligibility
  • CPT Code Definition (PM)
  • CPT Code Definition (MSO)
  • Revenue Code Definition (PM)
  • Revenue Code Definition (MSO)
  • Service Codes
  • Plan Definition
  • Funding Source Registration
  • Applying Contracting Provider
  • Provider Fee Definition
  • Registry Settings (PM)
  • MSO to Parent System Integration Mapping
  • Claim Processing (CMS 1500)
  • Close Batch
  • Dynamic Form - Site Specific Section Modeling (CWS)
  • Site Specific Section Modeling (MSO)
  • Fast Service Entry
Scenario 1: 'Claim Processing...' forms and functions - Verification of 'Explanation Of Coverage' value for 'Pended' Service Authorization, and verifying new batch not created when batch is closed
Specific Setup:
  • Client record with Service Authorization(s) where 'Current Authorization Status' value is 'Pending'
  • One or more claim(s)/service(s) for adjudication where 'Pending' status Service Authorization is selected/associated to service
Steps
  1. Open Avatar MSO 'Claim Processing...' form ('Claim Processing (CMS 1500)', 'Claim Processing (UB-04)' and/or 'Fast Service Entry' forms).
  2. Select claims processing batch for service entry/edit.
  3. Open existing claim or create new claim for service entry/edit.
  4. Set value for 'Member Name or ID' and 'Provider' in claim level section (if adding new claim/services).
  5. Navigate to 'Service Detail' section of form.
  6. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button).
  7. Enter/select 'Date of Service', 'Procedure Code', 'Total Charge' and 'Service Units' field values.
  8. Click 'Display Valid Authorizations' button and select Service Authorization (or directly enter value in 'Authorization Number' field).
  9. In case where 'Current Authorization Status' value is 'Pending' for selected/associated Service Authorization record - ensure that 'Claim Status' value is set to 'Pending' for service.
  10. In case where 'Current Authorization Status' value is 'Pending' for selected/associated Service Authorization record - ensure that 'Explanation Of Coverage' field for service includes value 'The service was pended for the following reason: Authorization is pending'.
  11. Click [Enter Third Party Adjudication Data].
  12. Create a new row with desired data, and if desired click [View] and create a new row with desired data. Save the rows.
  13. Click [Submit].
  14. Close the batch and validate that a new pended batch is created.
  15. Repeat steps 1-12 and validate that the ‘Third Party Adjudication Data’ was copied forward.
  16. Click [Submit].
  17. Close the batch and validate that a new pended batch is created.
  18. Repeat steps 1-12 and validate that the ‘Third Party Adjudication Data’ was copied forward.
Scenario 2: Avatar MSO 'Site Specific Section Modeling' - 'Fast Service Entry Submission' - opening prompt section.
Specific Setup:
  • Site Specific Section Modeling for MSO:
  • Select the ‘MSOBAT185SUBMISSION (Fast Service Entry Submission) Fast Service Detail’ item in the dropdown list.
  • Click [OK].
  • Select ‘Prompt Definition’ section.
  • If desired, add a new prompt and customize the label or customize the label of an existing prompt.
  • Click [Submit].
  • Refresh the forms.
Steps
  1. Open ‘Fast Service Entry’.
  2. Select the ‘Fast Service Detail’ section.
  3. Validate that the prompt that was added or changed exists on the form.
  4. Close the form.
  5. Open ‘Site Specific Section Modeling’ for MSO.
  6. Select the ‘MSOBAT185OVERRIDE (Fast Service Entry) Fast Service Detail’ item in the dropdown list.
  7. Click [OK].
  8. Select ‘Prompt Definition’ section.
  9. Validate that the prompt added or changed in Setup displays in the table.
  10. Select the prompt and click [Delete Selected Item].
  11. Click [Yes] on the ‘Confirm’ message.
  12. Click [Submit].
  13. Refresh the forms.
  14. Open ‘Fast Service Entry’.
  15. Select the ‘Fast Service Detail’ section.
  16. Validate that the prompt does not exist.
Topics
• Claims Processing • Service Authorizations • Site Specific Section Modeling • NX
Update 10 Summary | Details
'Provider File Attach' Form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Provider File Attach
Scenario 1: 'Provider File Attach' - Form Verification
Specific Setup:
  • Document Management Configuration must be defined for Cache Server or Perceptive (via Avatar PM / RADplus Utilities 'Document Management Defaults' form)
  • Dictionary Codes may optionally be defined for 'Other Tabled Files' Data Element '(70007) Document Type' (via Avatar MSO 'Dictionary Update' form)
  • One or more .PDF (Adobe Portable Document Format) and/or .TIF (Tagged Image File Format) files for Provider File Attach upload/storage
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar MSO 'Provider File Attach' form (under 'Avatar MSO / Provider Management' menu).
  2. Enter/select 'Member ID' value.
  3. Enter/select 'Provider' value.
  4. In 'File Type' field, ensure the following selections are available:
  5. 'Authorization' (will link File Attachment to a specific Avatar MSO Service Authorization record for selected Provider)
  6. 'Provider' (will link File Attachment to selected Provider)
  7. 'Other' (will link File Attachment to selected Provider)
  8. Select 'File Type' value.
  9. If 'Authorization' is selected in 'File Type' field, ensure that 'Authorization' selection field is enabled, and includes only Avatar MSO Service Authorization records for selected Provider; select 'Authorization' field if applicable.
  10. Select 'Document Type' value (optional field).
  11. Enter 'Comments' value if desired (optional field).
  12. Click 'Upload File' button, and select file for Provider Attachment upload/storage.
  13. On completion of File Attachment upload, ensure 'File Name' field is populated with uploaded file name.
  14. Click 'Store File' field to store File Attachment in Avatar MSO; ensure user is presented with confirmation dialog noting 'File successfully created'.
  15. Click 'OK' button to return to 'Provider File Attach' form.
  16. Select 'File Type' value for previously uploaded/stored File Attachment.
  17. Ensure uploaded/stored File Attachment files are listed/available for selection in the 'Existing Files' field; select file in 'Existing Files' field.
  18. Ensure that 'Comment History' field displays entered/updated 'Comments' field entries for selected file (with username and date/timestamp associated to each 'Comments' entry).
  19. Example:
  20. "Comment 1 AVATAR USERNAME 1 2022-04-21 04:19PM"
  21. Enter additional/new 'Comments' field data for selected File Attachment.
  22. Click 'Update Comments' button to store additional/new 'Comments' field data for selected File Attachment; ensure user is presented with confirmation dialog noting 'Comments Successfully updated'.
  23. Click 'OK' button to return to 'Provider File Attach' form.
  24. Select 'File Type' value for previously uploaded/stored File Attachment.
  25. Select uploaded/stored File Attachment in 'Existing Files' field.
  26. Ensure that 'Comment History' field displays all previously entered/updated 'Comments' field entries for selected file (with username and date/timestamp associated to each 'Comments' entry).
  27. Example:
  28. "Comment 2 AVATAR USERNAME 2 2022-04-22 01:35PM / Comment 1 AVATAR USERNAME 1 2022-04-21 04:19PM"
  29. Select 'File Type' value.
  30. Click 'Upload File' button, and select file for Provider Attachment upload/storage - selecting file with same name as previously uploaded/stored File Attachment.
  31. If file with same name as previously uploaded/stored File Attachment (for same Member ID/client) is selected, ensure user is presented with error dialog noting 'File already exists on the server' on clicking 'Store File' button (and File Attachment is disallowed).
  32. Select 'File Type' value for previously uploaded/stored File Attachment.
  33. Select uploaded/stored File Attachment file in 'Existing Files' field.
  34. Click 'Delete File' button to delete File Attachment.
  35. Ensure user is presented with Delete File confirmation dialog noting 'Are you sure you want to delete this file?'; click 'Yes' button to confirm file deletion.
  36. Ensure user is presented with Delete File confirmation dialog noting 'File deleted successfully'; click 'OK' button to return to 'Provider File Attach' form.
  37. Select 'File Type' value for previously uploaded/stored File Attachment.
  38. Ensure deleted File Attachment files are not listed/not available for selection in the 'Existing Files' field.
  39. Open Crystal Reports or other SQL reporting tool.
  40. In Avatar MSO SQL table 'SYSTEM.file_attach_object', ensure that all uploaded/stored File Attachment files are present in SQL table data (one row per File Attachment).
  41. In Avatar MSO SQL table 'SYSTEM.file_attach_comments', ensure that all entered/updated 'Comments' field entries for File Attachment are present in SQL table data (one row per 'Comments' entry for File Attachment).
Avatar MSO 'Provider File Attach' Widget
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • View Definition
  • NX View Definition
  • Provider File Attach
  • Provider File Attach Widget
Scenario 1: 'Provider File Attach' Widget - Widget Display Verification
Specific Setup:
  • Document Management Configuration must be defined for Cache Server or Perceptive (via Avatar PM / RADplus Utilities 'Document Management Defaults' form)
  • 'Provider File Attach' Widget must be assigned to Chart View Definition/Home View Definition/Client Dashboard View assigned to user (via 'View Definition' form / 'NX View Definition' form)
  • One or more .PDF (Adobe Portable Document Format) and/or .TIF (Tagged Image File Format) files uploaded/stored via Avatar MSO 'Provider File Attach' form
Steps
  1. Open 'View Definition' form (under 'Avatar PM / RADplus Utilities / Widget Management' menu).
  2. Click 'Select View' button and select View Definition for update (or select 'Add New View' for new View Definition entry).
  3. Click 'Launch View Designer' button.
  4. In 'View Definition' form View Designer, ensure that Avatar MSO 'Provider File Attach' Widget is available for assignment (under 'Client' category).
  5. Select/add Avatar MSO 'Provider File Attach' Widget to View; click 'Submit' button to save View Designer layout, and click 'Submit' button to file 'View Definition' form.
  6. Navigate/select Home View, Chart View or Client Dashboard View where Avatar MSO 'Provider File Attach' Widget is assigned/present.
  7. Ensure that the 'Provider File Attach' Widget displays all uploaded/stored File Attachment files for selected/currently active Member ID/Client (one row in Widget display per File Attachment).
  8. Ensure that the 'Provider File Attach' Widget includes the following columns/information for each File Attachment row for selected/currently active Member ID/Client:
  9. 'View' button
  10. This button will open the selected .PDF or .TIF File Attachment file in the Console Widget Viewer
  11. 'Provider' display
  12. 'Document Name' display
  13. 'Date' display
  14. 'Authorization Number' display
  15. If applicable/value present, otherwise blank
  16. 'Document Type' display
  17. If applicable/value present, otherwise 'No Entry'
Scenario 2: 'Provider File Attach' Widget - Verification of File Attachment Display in 'Console Widget Viewer'
Specific Setup:
  • Avatar PM/RADplus Registry Setting 'Enable Console Widgets/Views' must be enabled
  • Document Management Configuration must be defined for Cache Server or Perceptive (via Avatar PM / RADplus Utilities 'Document Management Defaults' form)
  • Avatar MSO 'Provider File Attach' Widget must be assigned to Chart View Definition/Home View Definition/Client Dashboard View assigned to user (via 'View Definition' form / 'NX View Definition' form)
  • Avatar NX/myAvatar 'Console Widget Viewer' must be assigned to Chart View Definition/Home View Definition/Client Dashboard View assigned to user (via 'View Definition' form / 'NX View Definition' form)
  • One or more .PDF (Adobe Portable Document Format) and/or .TIF (Tagged Image File Format) files uploaded/stored via Avatar MSO 'Provider File Attach' form
Steps
  1. Navigate/select Home View, Chart View or Client Dashboard View where Avatar MSO 'Provider File Attach' Widget and Avatar NX/myAvatar 'Console Widget Viewer' are assigned/present.
  2. Ensure that the 'Provider File Attach' Widget displays all uploaded/stored File Attachment files for selected/currently active Member ID/Client (one row in Widget display per File Attachment).
  3. Click 'View' button in 'Provider File Attach' Widget to view selected File Attachment.
  4. Ensure that selected .PDF or .TIF File Attachment image is opened for display in Avatar NX/myAvatar 'Console Widget Viewer'.
  5. Ensure multiple File Attachments may be opened/displayed in Avatar NX/myAvatar 'Console Widget Viewer' from 'Provider File Attach' Widget simultaneously.
  6. Ensure File Attachment images may be closed within Avatar NX/myAvatar 'Console Widget Viewer' (by closing individual files/tabs within viewer, or use of the 'Close All' button).
Topics
• NX • Provider File Attach • Widgets • Console Widget
Update 13 Summary | Details
Avatar MSO 'Claim Acknowledgement (277CA) File' Form/Function
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Claim Acknowledgement (277CA) File
  • Import/Export File Configuration
  • Claim Processing Automation
  • 837 Health Care Claim Professional
  • 837 Health Care Claim Institutional
Scenario 1: 'Claim Acknowledgement (277CA) File' - Verification of Claim Acknowledgement File Creation
Specific Setup:
  • File path for 277CA Claim Acknowledgement file creation must be defined in the 'Output Directory' field for system (via Avatar MSO 'Set System Defaults' or 'Import/Export File Configuration' form)
  • Avatar MSO Claims Processing Batch(es) may optionally be set to automatically close following 837 posting (via Avatar 'Claim Processing Automation' form)
  • 277CA Claim Acknowledgment file may optionally be enabled for automatic generation (via Avatar MSO 'Import/Export File Configuration' form)
  • 837 Professional and/or Institutional format inbound file(s) for compilation/posting, including one or more 'Pending' Claim Status service(s)
Steps
  1. Using Avatar MSO '837 Health Care Claim Professional' and/or '837 Health Care Claim Institutional' forms (or via Avatar MSO automated 837 file processing), load/compile/post inbound 837 file(s) containing one or more valid claim(s) where Claim Status for one or more service(s) is 'Pending'.
  2. Avatar MSO Claims Processing batch(es) created via inbound 837 file posting may be 'Open' or 'Closed' status, including batches closed automatically via 'Claim Processing Automation' functionality.
  3. Open the Avatar MSO 'Claim Acknowledgement (277CA) File' form.
  4. 277CA file generation/content review may also be confirmed directly in system output directory where automatic 277CA file generation is enabled.
  5. Select 'Create File On Server' in 'Options' field.
  6. Select 'Submission Type' field value ('Institutional' or 'Professional').
  7. Select 837 file for Claim Acknowledgement (277CA) file creation.
  8. Click 'Process' button.
  9. Ensure that for selected 837 file, Claim Acknowledgement (277CA) file is created on server in defined directory.
  10. This may be confirmed via the 'Claim Acknowledgement (277CA) File' form 'Run Report' or 'Dump File' options, and/or by reviewing files in 277CA output directory.
  11. Select 'Dump File' in 'Options' field.
  12. Select 'Submission Type' field value ('Institutional' or 'Professional').
  13. Select 837 file for Claim Acknowledgement (277CA) file review.
  14. Click 'Process' button.
  15. In 277CA Claim Acknowledgement file(s) for successfully posted 837 Professional and/or Institutional inbound claims including one or more 'Pending' Claim Status service(s), ensure that claim/service(s) is/are reported with 'Accepted' status (including case where 837 Claims Processing batch containing 'Pending' status service is automatically closed following 837 posting).
  16. Examples:
  17. 'STC*A2:20**WQ*180~'
  18. 'STC*A2:20*20220516*WQ*60~'
  19. 277CA file content review may also be confirmed directly in system output directory by opening/reviewing file(s).
Topics
• 837 Health Care Claim Professional • Claims Processing • 837 Health Care Claim Institutional