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Avatar MSO 2022 Monthly Release 2022.02.02 Acceptance Tests

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Update 15 Summary | Details
'Provider Activity Invoice' Forms
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Provider Activity Invoice
  • Provider Activity Invoice with Override
Scenario 1: 'Provider Activity Invoice' - Form Verification
Specific Setup:
  • Avatar MSO Contracting Provider(s) with Provider Activity Authorization record(s) valid for Provider Activity Invoice entry
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open the Avatar MSO 'Provider Activity Invoice' form.
  2. Select Contracting Provider for Provider Activity Invoice entry/review.
  3. Select existing Provider Activity Invoice for review/edit, or click 'Add' button for new Provider Activity Invoice entry.
  4. Enter/select values for 'Invoice/Name Description', 'Invoice Date' and 'Provider Invoice Identifier' fields.
  5. Navigate to 'Provider Activity Invoice Details' section of form.
  6. Click 'Add New Item' button for new Provider Activity entry, or select existing Provider Activity entry/row and click 'Edit Selected Item' button.
  7. Select value in 'Funding Source' field.
  8. Ensure 'From Date' and 'Through Date' fields are present in 'Provider Activity Invoice' form.
  9. 'From Date' field replaces previously existing 'Activity Date' field
  10. 'Through Date' field is not required for Provider Activity row/entry
  11. Enter/select value for 'From Date' field (and 'Through Date' field if desired).
  12. Ensure that on entry of 'From Date' and/or 'Through Date' value which is later than 'Invoice Date' for Provider Activity Invoice, user is presented with error dialog noting 'Activity From Date cannot be past the Invoice Date' or 'Activity Through Date cannot be past the Invoice Date' and the entry/edit is disallowed.
  13. Ensure that on entry of 'Through Date' value which is earlier than 'From Date' value for Provider Activity entry/row, user is presented with error dialog noting 'Activity To Date cannot be before Activity From Date' and the entry/edit is disallowed.
  14. Enter/select values for 'Activity Type', 'Activity Unit' and 'Activity Amount' fields (as well as 'Performing Provider' and 'Contracting Provider Program' and fields if desired).
  15. Click 'Display Valid Authorizations' button to display/select associated Provider Activity Authorization.
  16. Ensure Provider Activity Authorization(s) valid for Provider Activity association are displayed for selection (based on 'From Date' and 'Through Date' values entered for Provider Activity compared to 'Start Date'/'End Date' values for Provider Activity Authorization records).
  17. If no applicable Provider Activity Authorization exists, ensure user is presented with dialog noting 'No authorizations are on file which match the entered criteria.'
  18. Select Provider Activity Authorization record/row and click 'OK' button.
  19. Ensure 'Activity Status' field value is determined by Avatar MSO on entry/selection of Provider Activity detail field values (and 'Explanation Of Coverage' field is populated with reason/information for 'Pended' or 'Denied' status services).
  20. 'Explanation Of Coverage' examples:
  21. 'Invalid authorization'
  22. 'Activity From Date is before the authorization start date'
  23. 'Activity Through Date is after the authorization end date'
  24. Select 'Activity Status Reason' field value if desired.
  25. Repeat Provider Activity entry/update steps as desired.
  26. Click 'Submit' button to file 'Provider Activity Invoice' form with Provider Activity entries.
  27. Re-open the Avatar MSO 'Provider Activity Invoice' form (selecting same Contracting Provider/Provider Activity Invoice for review).
  28. Navigate to 'Provider Activity Invoice Details' section of form.
  29. Select previously entered/updated Provider Activity entry/row and click 'Edit Selected Item' button.
  30. Ensure 'From Date' and 'Through Date' field values for selected Provider Activity entry/row (as well as all other field values for selected row).
  31. Open Crystal Reports or other SQL reporting tool.
  32. In Avatar MSO SQL table 'SYSTEM.prov_act_inv_detail', ensure that 'From Date' and 'Through Date' values filed via 'Provider Activity Invoice' form are present in fields 'activity_date' and 'activity_to_date' (respectively).
Scenario 2: 'Provider Activity Invoice With Override' - Form Verification
Specific Setup:
  • Avatar MSO Contracting Provider(s) with Provider Activity Authorization record(s) valid for Provider Activity Invoice entry
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open the Avatar MSO 'Provider Activity Invoice With Override' form.
  2. Select Contracting Provider for Provider Activity Invoice entry/review.
  3. Select existing Provider Activity Invoice for review/edit, or click 'Add' button for new Provider Activity Invoice entry.
  4. Enter/select values for 'Invoice/Name Description', 'Invoice Date' and 'Provider Invoice Identifier' fields.
  5. Navigate to 'Provider Activity Invoice Details' section of form.
  6. Click 'Add New Item' button for new Provider Activity entry, or select existing Provider Activity entry/row and click 'Edit Selected Item' button.
  7. Select value in 'Funding Source' field.
  8. Ensure 'From Date' and 'Through Date' fields are present in 'Provider Activity Invoice With Override' form.
  9. 'From Date' field replaces previously existing 'Activity Date' field.
  10. 'Through Date' field is not required for Provider Activity row/entry.
  11. Enter/select value for 'From Date' field (and 'Through Date' field if desired).
  12. Ensure that on entry of 'From Date' and/or 'Through Date' value which is later than 'Invoice Date' for Provider Activity Invoice, user is presented with error dialog noting 'Activity From Date cannot be past the Invoice Date' or 'Activity Through Date cannot be past the Invoice Date' and the entry/edit is disallowed.
  13. Ensure that on entry of 'Through Date' value which is earlier than 'From Date' value for Provider Activity entry/row, user is presented with error dialog noting 'Activity To Date cannot be before Activity From Date' and the entry/edit is disallowed.
  14. Enter/select values for 'Activity Type', 'Activity Unit' and 'Activity Amount' fields (as well as 'Performing Provider' and 'Contracting Provider Program' and fields if desired).
  15. Click 'Display Valid Authorizations' button to display/select associated Provider Activity Authorization.
  16. Ensure Provider Activity Authorization(s) valid for Provider Activity association are displayed for selection (based on 'From Date' and 'Through Date' values entered for Provider Activity compared to 'Start Date'/'End Date' values for Provider Activity Authorization records).
  17. If no applicable Provider Activity Authorization exists, ensure user is presented with dialog noting 'No authorizations are on file which match the entered criteria.'
  18. Select Provider Activity Authorization record/row and click 'OK' button.
  19. Ensure 'Activity Status' field value is determined by Avatar MSO on entry/selection of Provider Activity detail field values (and 'Explanation Of Coverage' field is populated with reason/information for 'Pended' or 'Denied' status services).
  20. 'Explanation Of Coverage' examples:
  21. 'Invalid authorization'
  22. 'Activity From Date is before the authorization start date'
  23. 'Activity Through Date is after the authorization end date'
  24. 'Activity Status' field value may be manually selected/set in the 'Provider Activity Invoice With Override' form.
  25. Select 'Activity Status Reason' field value if desired.
  26. Repeat Provider Activity entry/update steps as desired.
  27. Click 'Submit' button to file 'Provider Activity Invoice With Override' form with Provider Activity entries.
  28. Re-open the Avatar MSO 'Provider Activity Invoice With Override' form (selecting same Contracting Provider/Provider Activity Invoice for review).
  29. Navigate to 'Provider Activity Invoice Details' section of form.
  30. Select previously entered/updated Provider Activity entry/row and click 'Edit Selected Item' button.
  31. Ensure 'From Date' and 'Through Date' field values for selected Provider Activity entry/row (as well as all other field values for selected row).
  32. Open Crystal Reports or other SQL reporting tool.
  33. In Avatar MSO SQL table 'SYSTEM.prov_act_inv_detail', ensure that 'From Date' and 'Through Date' values filed via 'Provider Activity Invoice With Override' form are present in fields 'activity_date' and 'activity_to_date' (respectively).
Topics
• NX • Provider Activity
Update 20 Summary | Details
American Medical Association Copyright Notice Display
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CPT Code Definition (MSO)
  • CPT Code Cross Reference
Scenario 1: 'CPT Code Definition' - Verification of American Medical Association Trademark/Copyright Notice Display
Steps
  1. Open Avatar MSO 'CPT Code Definition' form.
  2. Verify the 'CPT Service Code' field in form contains the AMA Trademark 'CPT® Codes' label.
  3. Verify the following AMA copyright notice is displayed at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'
  4. Note - location of AMA copyright form field/labels may be affected by any Form Designer changes present for form
Scenario 2: 'CPT Code Cross Reference' - Verification of American Medical Association Copyright Notice Display
Steps
  1. Open Avatar MSO 'CPT Code Cross Reference' form.
  2. Verify the 'CPT Service Code' field in form contains the AMA Trademark 'CPT® Codes' label.
  3. Verify the following AMA copyright notice is displayed at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'
  4. Note - location of AMA copyright form field/labels may be affected by any Form Designer changes present for form
Claims Processing/Service Entry 'Client And Counselor Groups' Support
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CPT Code Definition (MSO)
  • Revenue Code Definition (MSO)
  • Claim Processing (CMS 1500)
  • Claim Processing with Override (CMS 1500)
  • Claim Processing (UB-04)
  • Claim Processing with Override (UB-04)
  • Fast Service Entry
  • Fast Service Entry Submission
Scenario 1: 'CPT Code Definition' - Verification of Group Service Entry Limit Fields
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Group Services' must be enabled
  • Avatar MSO Registry Setting 'Enable Client and Counselor Groups In Service Entry' must be enabled
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar MSO 'CPT Code Definition' form.
  2. Select 'Add' or 'Edit' action in 'Add/Edit/Delete CPT Code' field.
  3. Enter (or search/select) CPT Code Definition to be added (or updated).
  4. Ensure the following fields are present in form:
  5. 'Minimum Number of Clients in Group'
  6. 'Maximum Number of Clients in Group'
  7. 'Documentation Time Limit' (dropdown list selection field, including 'Create New' selection)
  8. 'Documentation Time Limit' - 'Number of Clients in Group'
  9. 'Documentation Time Limit' - 'Maximum Documentation Time (minutes)'
  10. 'Documentation Time Limit' - Maximum Travel Time (minutes)'
  11. 'File Documentation Time Limit' Button
  12. 'Delete Documentation Time Limit' Button
  13. 'Use ODS Group Service Calculation' (Yes/No)
  14. Ensure fields above are disabled when 'Type of Service' field is set to 'Individual' (or is not defined).
  15. Set 'Type of Service' field value to 'Group'.
  16. Enter values for 'Minimum Number of Clients in Group' and 'Maximum Number of Clients in Group' fields.
  17. The value entered for 'Minimum Number of Clients in Group' and 'Maximum Number of Clients in Group' will be used to limit user entry values in the 'Number of Clients In Group' field in Avatar MSO Claims Processing forms for the selected CPT service code. If no value is entered for 'Minimum...' and/or 'Maximum...' fields, no limitation on 'Number of Clients in Group' entry value will be enforced.
  18. Set 'Documentation Time Limit' field value to 'Create New'.
  19. Enter values for 'Number of Clients in Group', 'Maximum Documentation Time (minutes)' and 'Maximum Travel Time (minutes)' fields.
  20. The entries filed for 'Number of Clients in Group', 'Maximum Documentation Time' and 'Maximum Travel Time (minutes)' fields will be used to limit minimum/maximum user entry values in the 'Documentation Time' and 'Travel Time' fields in Avatar MSO Claims Processing forms for the selected CPT service code based on the 'Number of Clients in Group' value for service. If no entry is applicable to the ‘Number of Clients in Group’ value for service, no limitation on 'Documentation Time'/'Travel Time' entry values will be enforced.
  21. Click 'File Documentation Time Limit' button.
  22. Ensure Documentation Time Limit entry filed is available under 'Documentation Time Limit' dropdown list selection field.
  23. Repeat Documentation Time Limit entry process as desired for selected CPT Code, ensuring new entries are saved (and/or deleted via 'Delete Documentation Time Limit' button).
  24. Select value for 'Use ODS Group Service Calculation' field.
  25. The value selected for 'Use ODS Group Service Calculation' field will be used to determine whether the ODS Group Service Calculation for Client and Counselor Groups will be used in the Avatar MSO Claims Processing forms for the selected CPT Code (for services with 'Date Of Service' value on or after the date specified in Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'')
  26. Click 'File CPT Service Code' button when code entry/edit has been completed.
  27. Ensure 'CPT Code Successfully Filed' message dialog is present, and click 'OK' button.
  28. Select 'Edit' and open same CPT Service Code record for review.
  29. Ensure values filed for 'Minimum Number of Clients in Group' and 'Maximum Number of Clients In Group' fields are present.
  30. Ensure Documentation Time Limit entries added/deleted are present/reflected and available for selection in the 'Documentation Time Limit' dropdown list selection field.
  31. Ensure value selected/filed for 'Use ODS Group Service Calculation' field is present.
  32. Open Crystal Reports or other SQL reporting tool.
  33. In Avatar MSO SQL table 'SYSTEM.'table_cpt_service_codes', ensure fields 'ods_group_svc_calc_code'/'ods_group_svc_calc_value' contain value filed via the 'CPT Code Definition' form for 'Use ODS Group Service Calculation' field.
  34. In Avatar MSO SQL table 'SYSTEM.table_grp_doc_time_limits', ensure row(s) are present for each Documentation Time Limit entry filed via the 'CPT Code Definition' form, including the following properties/fields:
  35. group_service_code_type ('C')
  36. group_service_code (CPT Code)
  37. number_of_clients ('Number of Clients in Group')
  38. max_doc_time ('Maximum Documentation Time (minutes)')
  39. max_travel_time ('Maximum Travel Time (minutes)')
Scenario 2: 'Revenue Code Definition' - Verification of Group Service Entry Limit Fields
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Group Services' must be enabled
  • Avatar MSO Registry Setting 'Enable Client and Counselor Groups In Service Entry' must be enabled
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar MSO 'Revenue Code Definition' form.
  2. Select 'Add' or 'Edit' action in 'Add/Edit/Delete Revenue Code' field.
  3. Enter (or search/select) Revenue Code Definition to be added (or updated).
  4. Ensure the following fields are present in form:
  5. 'Minimum Number of Clients in Group'
  6. 'Maximum Number of Clients in Group'
  7. 'Documentation Time Limit' (dropdown list selection field, including 'Create New' selection)
  8. 'Documentation Time Limit' - 'Number of Clients in Group'
  9. 'Documentation Time Limit' - 'Maximum Documentation Time (minutes)'
  10. 'Documentation Time Limit' - Maximum Travel Time (minutes)'
  11. 'File Documentation Time Limit' Button
  12. 'Delete Documentation Time Limit' Button
  13. 'Use ODS Group Service Calculation' (Yes/No)
  14. Ensure fields above are disabled when 'Type of Service' field is set to 'Individual' (or is not defined).
  15. Set 'Type of Service' field value to 'Group'.
  16. Enter values for 'Minimum Number of Clients in Group' and 'Maximum Number of Clients in Group' fields.
  17. The value entered for 'Minimum Number of Clients in Group' and 'Maximum Number of Clients in Group' will be used to limit user entry values in the 'Number of Clients In Group' field in Avatar MSO Claims Processing forms for the selected Revenue service code. If no value is entered for 'Minimum...' and/or 'Maximum...' fields, no limitation on 'Number of Clients in Group' entry value will be enforced.
  18. Set 'Documentation Time Limit' field value to 'Create New'.
  19. Enter values for 'Number of Clients in Group', 'Maximum Documentation Time (minutes)' and 'Maximum Travel Time (minutes)' fields.
  20. The entries filed for 'Number of Clients in Group', 'Maximum Documentation Time' and 'Maximum Travel Time (minutes)' fields will be used to limit minimum/maximum user entry values in the 'Documentation Time' and 'Travel Time' fields in Avatar MSO Claims Processing forms for the selected Revenue service code based on the 'Number of Clients in Group' value for service. If no entry is applicable to the ‘Number of Clients in Group’ value for service, no limitation on 'Documentation Time'/'Travel Time' entry values will be enforced.
  21. Click 'File Documentation Time Limit' button.
  22. Ensure Documentation Time Limit entry filed is available under 'Documentation Time Limit' dropdown list selection field.
  23. Repeat Documentation Time Limit entry process as desired for selected Revenue Code, ensuring new entries are saved (and/or deleted via 'Delete Documentation Time Limit' button).
  24. Select value for 'Use ODS Group Service Calculation' field.
  25. The value selected for 'Use ODS Group Service Calculation' field will be used to determine whether the ODS Group Service Calculation for Client and Counselor Groups will be used in the Avatar MSO Claims Processing forms for the selected Revenue Code (for services with 'Date Of Service' value on or after the date specified in Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'')
  26. Click 'File Revenue Code' button when code entry/edit has been completed.
  27. Ensure 'Revenue Code Successfully Filed' message dialog is present, and click 'OK' button.
  28. Select 'Edit' and open same Revenue Service Code record for review.
  29. Ensure values filed for new 'Minimum Number of Clients in Group' and 'Maximum Number of Clients In Group' fields are present/correct.
  30. Ensure Documentation Time Limit entries added/deleted are present/reflected and available for selection in the 'Documentation Time Limit' dropdown list selection field.
  31. Ensure value selected/filed for 'Use ODS Group Service Calculation' field is present.
  32. Open Crystal Reports or other SQL reporting tool.
  33. In Avatar MSO SQL table 'SYSTEM.'table_revenue_codes', ensure fields 'ods_group_svc_calc_code'/'ods_group_svc_calc_value' contain value filed via the 'Revenue Code Definition' form for 'Use ODS Group Service Calculation' field.
  34. In Avatar MSO SQL table 'SYSTEM.table_grp_doc_time_limits', ensure rows are present for each Documentation Time Limit entry filed via the 'Revenue Code Definition' form, including the following properties/fields:
  35. group_service_code_type ('R')
  36. group_service_code (Revenue Code)
  37. number_of_clients ('Number of Clients in Group')
  38. max_doc_time ('Maximum Documentation Time (minutes)')
  39. max_travel_time ('Maximum Travel Time (minutes)')
Scenario 3: 'Revenue Code Definition' Import - Verification of Group Service Entry Limit Fields
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Group Services' must be enabled
  • Avatar MSO Registry Setting 'Enable Client and Counselor Groups In Service Entry' must be enabled
  • Avatar MSO 'Revenue Code Definition' Import file containing one or more valid import row(s) where 'Type of Service (segment/field 5) is 'G' (Group) with values included for one or more of the following fields/segments:
  • 'Minimum Number of Clients in Group' (segment/field 39)
  • 'Maximum Number of Clients in Group' (segment/field 40)
  • 'Documentation Time Limit' (segment/field 41 - ampersand delimited list of 'Number of Clients in Group'~'Maximum Documentation Time (minutes)'~'Maximum Travel Time (minutes)' combinations. Example: 5~15~30&7~30&10~45~60)
  • 'Use ODS Group Service Calculation' (segment/field 47)
Steps
  1. Open Avatar MSO 'Revenue Code Definition' form.
  2. Navigate to 'Import Codes' section of form.
  3. Click 'Select Data Import File' button.
  4. Select Revenue Code Import file containing one or more code(s) with 'Group Or Individual' value of 'Group and with 'Minimum Number of Clients in Group', 'Maximum Number of Clients in Group', and 'Documentation Time Limit' segments defined.
  5. Click 'Import Codes' button.
  6. Navigate to 'Revenue Code Setup' section of form.
  7. Set 'Add/Edit/Delete Revenue Code' field to 'Edit'.
  8. Select Revenue Code defined in processed import file.
  9. Ensure value for 'Minimum Number of Clients in Group' and 'Maximum Number of Clients in Group' fields are correct/same values as in import file.
  10. Ensure value for 'Use ODS Group Service Calculation' field is correct/same value as in import file.
  11. Ensure 'Documentation Time Limit' dropdown list field contains row(s) for each/all Documentation Time Limit combinations defined in import file.
  12. Select Documentation Time Limit entry.
  13. Ensure value for 'Number of Clients in Group', 'Maximum Documentation Time (minutes)' and 'Maximum Travel Time (minutes)' fields for selected Documentation Time Limit entry are correct/same values as defined in import file.
Scenario 4: 'CPT Code Definition' Import - Verification of Group Service Entry Limit Fields
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Group Services' must be enabled
  • Avatar MSO Registry Setting 'Enable Client and Counselor Groups In Service Entry' must be enabled
  • Avatar MSO 'CPT Code Definition' Import file containing one or more valid import row(s) where 'Type of Service (segment/field 5) is 'G' (Group) with values included for one or more of the following fields/segments:
  • 'Minimum Number of Clients in Group' (segment/field 39)
  • 'Maximum Number of Clients in Group' (segment/field 40)
  • 'Documentation Time Limit' (segment/field 41 - ampersand delimited list of 'Number of Clients in Group'~'Maximum Documentation Time (minutes)'~'Maximum Travel Time (minutes)' combinations. Example: 5~15~30&7~30&10~45~60)
  • 'Use ODS Group Service Calculation' (segment/field 47)
Steps
  1. Open Avatar MSO 'CPT Code Definition' form.
  2. Navigate to 'Import Codes' section of form.
  3. Click 'Select Data Import File' button.
  4. Select CPT Code Import file containing one or more code(s) with 'Group Or Individual' value of 'Group and with 'Minimum Number of Clients in Group', 'Maximum Number of Clients in Group', 'Documentation Time Limit' and 'Use ODS Group Service Calculation' segments defined.
  5. Click 'Import Codes' button.
  6. Navigate to 'CPT Service Code' section of form.
  7. Set 'Add/Edit/Delete CPT Code' field to 'Edit'.
  8. Select CPT Code defined in processed import file.
  9. Ensure value for 'Minimum Number of Clients in Group' and 'Maximum Number of Clients in Group' fields are correct/same values as in import file.
  10. Ensure value for 'Use ODS Group Service Calculation' field is correct/same value as in import file.
  11. Ensure 'Documentation Time Limit' dropdown list field contains row(s) for each/all Documentation Time Limit combinations defined in import file.
  12. Select Documentation Time Limit entry.
  13. Ensure value for 'Number of Clients in Group', 'Maximum Documentation Time (minutes)' and 'Maximum Travel Time (minutes)' fields for selected Documentation Time Limit entry are correct/same values as defined in import file.
Scenario 5: 'Claim Processing (CMS 1500)' - Enforcing of Group Service Entry Limits
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Group Services' must be enabled
  • Avatar MSO Registry Setting 'Enable Client and Counselor Groups In Service Entry' must be enabled
  • Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'' must be enabled (Start Date defined)
  • CPT Service Code Definition where 'Minimum Number of Clients in Group'/'Maximum Number of Clients in Group' values and 'Documentation/Travel Time Limit' entries are defined (via Avatar MSO 'CPT Code Definition' form)
  • Client with eligible Service Authorization record(s) valid for Service Entry/Claim Processing
Steps
  1. Open Avatar MSO 'Claim Processing (CMS 1500)' form (or 'Claim Processing (CMS 1500) With Override' form).
  2. Select claims processing batch for service entry/edit.
  3. Open existing claim or create new claim for service entry/edit.
  4. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form.
  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' field value.
  8. Enter/select 'Procedure Code' field value.
  9. Enter or edit 'Number Of Clients In Group' field value.
  10. Ensure that if 'Number Of Clients In Group' field value entered is less than the 'Minimum Number of Clients in Group' value defined for CPT Code (via 'CPT Code Definition' form), user is presented with an error dialog noting 'Number of clients in a group cannot be smaller than minimum number of clients defined in 'CPT Code Definition'' and the entry is disallowed.
  11. Ensure that if 'Number Of Clients In Group' field value entered is greater than the 'Maximum Number of Clients in Group' value defined for CPT Code (via 'CPT Code Definition' form), user is presented with an error dialog noting 'Number of clients in group cannot be greater than maximum number of clients defined in 'CPT Code Definition'' and the entry is disallowed.
  12. Ensure that if 'Number Of Clients In Group' field value entered is equal to/greater than the 'Minimum Number of Clients in Group' value and also equal to/less than the 'Maximum Number of Clients in Group' value defined for CPT Code (or no Minimum/Maximum '...Number Of Clients In Group' values are defined for CPT Code), no error message is displayed and the entry is allowed.
  13. Enter or edit 'Client Documentation Time' field value.
  14. Ensure that if 'Client Documentation Time' field value entered is greater than the 'Maximum Documentation Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the CPT Code (via 'CPT Code Definition' form), user is presented with an error dialog noting 'Documentation Time does not fall within the Documentation Time Limits defined in 'CPT Code Definition'' and the entry is disallowed.
  15. Ensure that if 'Client Documentation Time' field value entered is equal to/less than the 'Maximum Documentation Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the CPT Code (via 'CPT Code Definition' form) (or no Documentation/Travel Time Limit entries are defined for CPT Code applicable to the 'Number Of Clients In Group'), no error message is displayed and the entry is allowed.
  16. Enter or edit 'Travel Time' field value.
  17. Ensure that if 'Travel Time' field value entered is greater than the 'Maximum Travel Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the CPT Code (via 'CPT Code Definition' form), user is presented with an error dialog noting 'Travel Time does not fall within the Travel Time Limits defined in 'CPT Code Definition'' and the entry is disallowed.
  18. Ensure that if 'Travel Time' field value entered is equal to/less than the 'Maximum Travel Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the CPT Code (via 'CPT Code Definition' form) (or no Documentation/Travel Time Limit entries are defined for CPT Code applicable to the 'Number Of Clients In Group'), no error message is displayed and the entry is allowed.


Note:

The Documentation/Travel Time Limit (from 'CPT Code Definition') applicable to the service will be determined by the 'Number Of Clients In Group' value entered for service; the 'Maximum Documentation Time (minutes)' and 'Maximum Travel Time (minutes)' limit applicable/enforced will be entry where 'Number Of Clients In Group' value for service is equal to or less than Documentation/Travel Time Limit 'Number of Clients In Group' value without being equal to or less than another defined Documentation/Travel Time Limit 'Number of Clients In Group' value.


Example:

If the following Documentation/Travel Time Limit entries are defined for the CPT Service Code:

  • 'Number of Clients In Group' = 5; 'Maximum Documentation Time (minutes)' = 15 and 'Maximum Travel Time (minutes)' = 30
  • 'Number of Clients In Group' = 10; 'Maximum Documentation Time (minutes)' = 30 and 'Maximum Travel Time (minutes)' = 45
  • 'Number of Clients In Group' = 15; 'Maximum Documentation Time (minutes)' = 45 and 'Maximum Travel Time (minutes)' = 60


'Client Documentation Time' and 'Travel Time' field entry values will be restricted as follows:

  • 'Number Of Clients In Group' for service = '1', '2', '3', '4' or '5' then 'Client Documentation Time' maximum value of '15' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '1', '2', '3', '4' or '5' then 'Travel Time' maximum value of '30' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '6', '7', '8', '9' or '10' then 'Client Documentation Time' maximum value of '30' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '6', '7', '8', '9' or '10' then 'Travel Time' maximum value of '45' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '11', '12', '13', '14' or '15' then 'Client Documentation Time' maximum value of '45' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '11', '12', '13', '14' or '15' then 'Travel Time' maximum value of '60' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '16' or higher then no 'Client Documentation Time' maximum value enforced in service entry forms (due to no applicable 'Documentation/Travel Time Limit' entry defined)
  • 'Number Of Clients In Group' for service = '16' or higher then no 'Travel Time' maximum value enforced in service entry forms (due to no applicable 'Documentation/Travel Time Limit' entry defined)
Scenario 6: 'Claim Processing (UB-04)' - Enforcing of Group Service Entry Limits
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Group Services' must be enabled
  • Avatar MSO Registry Setting 'Enable Client and Counselor Groups In Service Entry' must be enabled
  • Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'' must be enabled (Start Date defined)
  • Revenue Service Code Definition where 'Minimum Number of Clients in Group'/'Maximum Number of Clients in Group' values and 'Documentation/Travel Time Limit' entries are defined (via Avatar MSO 'Revenue Code Definition' form)
  • Client with eligible Service Authorization record(s) valid for Service Entry/Claim Processing
Steps
  1. Open Avatar MSO 'Claim Processing (UB-04)' form (or 'Claim Processing (CMS UB-04) With Override' form).
  2. Select claims processing batch for service entry/edit.
  3. Open existing claim or create new claim for service entry/edit.
  4. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form.
  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' field value.
  8. Enter/select 'Revenue Code' field value.
  9. Enter or edit 'Number Of Clients In Group' field value.
  10. Ensure that if 'Number Of Clients In Group' field value entered is less than the 'Minimum Number of Clients in Group' value defined for Revenue Code (via 'Revenue Code Definition' form), user is presented with an error dialog noting 'Number of clients in a group cannot be smaller than minimum number of clients defined in 'Revenue Code Definition'' and the entry is disallowed.
  11. Ensure that if 'Number Of Clients In Group' field value entered is greater than the 'Maximum Number of Clients in Group' value defined for Revenue Code (via 'Revenue Code Definition' form), user is presented with an error dialog noting 'Number of clients in group cannot be greater than maximum number of clients defined in 'Revenue Code Definition'' and the entry is disallowed.
  12. Ensure that if 'Number Of Clients In Group' field value entered is equal to/greater than the 'Minimum Number of Clients in Group' value and also equal to/less than the 'Maximum Number of Clients in Group' value defined for Revenue Code (or no Minimum/Maximum '...Number Of Clients In Group' values are defined for Revenue Code), no error message is displayed and the entry is allowed.
  13. Enter or edit 'Client Documentation Time' field value.
  14. Ensure that if 'Client Documentation Time' field value entered is greater than the 'Maximum Documentation Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the Revenue Code (via 'Revenue Code Definition' form), user is presented with an error dialog noting 'Documentation Time does not fall within the Documentation Time Limits defined in 'Revenue Code Definition'' and the entry is disallowed.
  15. Ensure that if 'Client Documentation Time' field value entered is equal to/less than the 'Maximum Documentation Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the Revenue Code (via 'Revenue Code Definition' form) (or no Documentation/Travel Time Limit entries are defined for Revenue Code applicable to the 'Number Of Clients In Group'), no error message is displayed and the entry is allowed.
  16. Enter or edit 'Travel Time' field value.
  17. Ensure that if 'Travel Time' field value entered is greater than the 'Maximum Travel Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the Revenue Code (via 'Revenue Code Definition' form), user is presented with an error dialog noting 'Travel Time does not fall within the Travel Time Limits defined in 'Revenue Code Definition'' and the entry is disallowed.
  18. Ensure that if 'Travel Time' field value entered is equal to/less than the 'Maximum Travel Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the Revenue Code (via 'Revenue Code Definition' form) (or no Documentation/Travel Time Limit entries are defined for Revenue Code applicable to the 'Number Of Clients In Group'), no error message is displayed and the entry is allowed.


Note:

The Documentation/Travel Time Limit (from 'Revenue Code Definition') applicable to the service will be determined by the 'Number Of Clients In Group' value entered for service; the 'Maximum Documentation Time (minutes)' and 'Maximum Travel Time (minutes)' limit applicable/enforced will be entry where 'Number Of Clients In Group' value for service is equal to or less than Documentation/Travel Time Limit 'Number of Clients In Group' value without being equal to or less than another defined Documentation/Travel Time Limit 'Number of Clients In Group' value.


Example:

If the following Documentation/Travel Time Limit entries are defined for the Revenue Service Code:

  • 'Number of Clients In Group' = 5; 'Maximum Documentation Time (minutes)' = 15 and 'Maximum Travel Time (minutes)' = 30
  • 'Number of Clients In Group' = 10; 'Maximum Documentation Time (minutes)' = 30 and 'Maximum Travel Time (minutes)' = 45
  • 'Number of Clients In Group' = 15; 'Maximum Documentation Time (minutes)' = 45 and 'Maximum Travel Time (minutes)' = 60


'Client Documentation Time' and 'Travel Time' field entry values will be restricted as follows:

  • 'Number Of Clients In Group' for service = '1', '2', '3', '4' or '5' then 'Client Documentation Time' maximum value of '15' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '1', '2', '3', '4' or '5' then 'Travel Time' maximum value of '30' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '6', '7', '8', '9' or '10' then 'Client Documentation Time' maximum value of '30' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '6', '7', '8', '9' or '10' then 'Travel Time' maximum value of '45' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '11', '12', '13', '14' or '15' then 'Client Documentation Time' maximum value of '45' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '11', '12', '13', '14' or '15' then 'Travel Time' maximum value of '60' allowed in service entry forms
  • 'Number Of Clients In Group' for service = '16' or higher then no 'Client Documentation Time' maximum value enforced in service entry forms (due to no applicable 'Documentation/Travel Time Limit' entry defined)
  • 'Number Of Clients In Group' for service = '16' or higher then no 'Travel Time' maximum value enforced in service entry forms (due to no applicable 'Documentation/Travel Time Limit' entry defined)
Scenario 7: 'Fast Service Entry' - Enforcing of Group Service Entry Limits
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Group Services' must be enabled
  • Avatar MSO Registry Setting 'Enable Client and Counselor Groups In Service Entry' must be enabled
  • Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'' must be enabled (Start Date defined)
  • CPT Service Code Definition where 'Minimum Number of Clients in Group'/'Maximum Number of Clients in Group' values and 'Documentation/Travel Time Limit' entries are defined (via Avatar MSO 'CPT Code Definition' form)
  • Client with eligible Service Authorization record(s) valid for Service Entry/Claim Processing
Steps
  1. Open Avatar MSO 'Fast Service Entry' form (or 'Fast Service Entry Submission' form).
  2. Navigate to 'Fast Service Detail' section of form.
  3. Click 'Add New Item' button to enter new service.
  4. Enter/select value for 'Member Name or ID', 'Provider' and 'Funding Source' fields.
  5. Enter/select 'Date of Service' field value.
  6. Enter/select 'Procedure Code' field value.
  7. Enter 'Number In Group' field value.
  8. Ensure that if 'Number In Group' field value entered is less than the 'Minimum Number of Clients in Group' value defined for CPT Code (via 'CPT Code Definition' form), user is presented with an error dialog noting 'Number of clients in a group cannot be smaller than minimum number of clients defined in 'CPT Code Definition'' and the entry is disallowed.
  9. Ensure that if 'Number In Group' field value entered is greater than the 'Maximum Number of Clients in Group' value defined for CPT Code (via 'CPT Code Definition' form), user is presented with an error dialog noting 'Number of clients in group cannot be greater than maximum number of clients defined in 'CPT Code Definition'' and the entry is disallowed.
  10. Ensure that if 'Number In Group' field value entered is equal to/greater than the 'Minimum Number of Clients in Group' value and also equal to/less than the 'Maximum Number of Clients in Group' value defined for CPT Code (or no Minimum/Maximum '...Number Of Clients In Group' values are defined for CPT Code), no error message is displayed and the entry is allowed.
  11. Enter 'Client Documentation Time' value.
  12. Ensure that if 'Client Documentation Time' field value entered is greater than the 'Maximum Documentation Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the CPT Code (via 'CPT Code Definition' form), user is presented with an error dialog noting 'Documentation Time does not fall within the Documentation Time Limits defined in 'CPT Code Definition'' and the entry is disallowed.
  13. Ensure that if 'Client Documentation Time' field value entered is equal to/less than the 'Maximum Documentation Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the CPT Code (via 'CPT Code Definition' form) (or no Documentation/Travel Time Limit entries are defined for CPT Code applicable to the 'Number In Group'), no error message is displayed and the entry is allowed.
  14. Enter or edit 'Travel Time' field value.
  15. Ensure that if 'Travel Time' field value entered is greater than the 'Maximum Travel Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the CPT Code (via 'CPT Code Definition' form), user is presented with an error dialog noting 'Travel Time does not fall within the Travel Time Limits defined in 'CPT Code Definition'' and the entry is disallowed.
  16. Ensure that if 'Travel Time' field value entered is equal to/less than the 'Maximum Travel Time (minutes)'/'Number of Clients in Group' Documentation/Travel Time Limit defined for the CPT Code (via 'CPT Code Definition' form) (or no Documentation/Travel Time Limit entries are defined for CPT Code applicable to the 'Number In Group'), no error message is displayed and the entry is allowed.


Note:

The Documentation/Travel Time Limit (from 'CPT Code Definition') applicable to the service will be determined by the 'Number In Group' value entered for service; the 'Maximum Documentation Time (minutes)' and 'Maximum Travel Time (minutes)' limit applicable/enforced will be entry where 'Number In Group' value for service is equal to or less than Documentation/Travel Time Limit 'Number In Group' value without being equal to or less than another defined Documentation/Travel Time Limit 'Number of In Group' value.


Example:

If the following Documentation/Travel Time Limit entries are defined for the CPT Service Code:

  • 'Number of Clients In Group' = 5; 'Maximum Documentation Time (minutes)' = 15 and 'Maximum Travel Time (minutes)' = 30
  • 'Number of Clients In Group' = 10; 'Maximum Documentation Time (minutes)' = 30 and 'Maximum Travel Time (minutes)' = 45
  • 'Number of Clients In Group' = 15; 'Maximum Documentation Time (minutes)' = 45 and 'Maximum Travel Time (minutes)' = 60


'Client Documentation Time' and 'Travel Time' field entry values will be restricted as follows:

  • 'Number In Group' for service = '1', '2', '3', '4' or '5' then 'Client Documentation Time' maximum value of '15' allowed in 'Fast Service Entry' form
  • 'Number In Group' for service = '1', '2', '3', '4' or '5' then 'Travel Time' maximum value of '30' allowed in 'Fast Service Entry' form
  • 'Number In Group' for service = '6', '7', '8', '9' or '10' then 'Client Documentation Time' maximum value of '30' allowed in 'Fast Service Entry' form
  • 'Number In Group' for service = '6', '7', '8', '9' or '10' then 'Travel Time' maximum value of '45' allowed in 'Fast Service Entry' form
  • 'Number In Group' for service = '11', '12', '13', '14' or '15' then 'Client Documentation Time' maximum value of '45' allowed in 'Fast Service Entry' form
  • 'Number In Group' for service = '11', '12', '13', '14' or '15' then 'Travel Time' maximum value of '60' allowed in 'Fast Service Entry' form
  • 'Number In Group' for service = '16' or higher then no 'Client Documentation Time' maximum value enforced in 'Fast Service Entry' form (due to no applicable 'Documentation/Travel Time Limit' entry defined)
  • 'Number In Group' for service = '16' or higher then no 'Travel Time' maximum value enforced in 'Fast Service Entry' form (due to no applicable 'Documentation/Travel Time Limit' entry defined)
Scenario 8: Avatar MSO Registry Settings - Verification of 'Start Date for 'Use ODS Group Service Calculation'' Registry Setting
Steps
  1. Open 'Registry Settings' form.
  2. Enter search value 'ODS Group Service' and click 'View Registry Settings' button.
  3. Ensure Registry Setting 'Start Date for 'Use ODS Group Service Calculation'' is returned (under 'Avatar MSO-> Claims Processing' path).
  4. Ensure Registry Setting 'Start Date for 'Use ODS Group Service Calculation' is blank/not defined by default on update installation.
  5. Ensure 'Registry Setting Details' field contains the following explanation text:


"The 'Use ODS Group Service Calculation' field is added to the 'CPT Code Definition' and 'Revenue Code Definition' forms via the 'Enable Client and Counselor Groups in Service Entry' registry setting.

The "ODS Group Service Calculation" will be used for those services where "Y" is selected in the 'Use ODS Group Service Calculation' field for the 'Procedure Code' and have a 'Date Of Service' on or after the date entered in this registry setting."

Scenario 9: 'Claim Processing (CMS 1500)' - Verification Of Client And Counselor Group Calculations
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Group Services' must be enabled
  • Avatar MSO Registry Setting 'Enable Client and Counselor Groups In Service Entry' must be enabled
  • Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'' must be enabled (Start Date defined)
  • CPT Service Code Definition where 'Type of Service' is defined as 'Group' and 'Duration Per Unit' is defined (via Avatar MSO 'CPT Code Definition' form)
  • CPT Service Code Definition where 'Use ODS Group Service Calculation' is set to 'Yes' (via Avatar MSO 'CPT Code Definition' form)
  • Client with eligible Service Authorization record(s) valid for Service Entry/Claim Processing
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar MSO 'Claim Processing (CMS 1500)' form (or 'Claim Processing (CMS 1500) With Override' form).
  2. Select claims processing batch for service entry/edit.
  3. Open existing claim or create new claim for service entry/edit.
  4. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form.
  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' field value.
  8. Enter/select 'Procedure Code' field value.
  9. Enter 'Units' and 'Duration' field values.
  10. Ensure that the following Client and Counselor Groups Service Entry fields are enabled when the 'Type of Service' value for selected CPT/Procedure Code is defined as 'Group':
  11. 'Number of Clients In Group'
  12. 'Number of Counselors In Group'
  13. 'Client Documentation Time'
  14. 'Travel Time' (conditionally enabled - see information below)
  15. Enter or edit 'Number Of Clients In Group' field value.
  16. Enter or edit 'Number of Counselors In Group' field value.
  17. Enter or edit 'Client Documentation Time' field value.
  18. Ensure 'Travel Time' field is disabled where 'Use ODS Group Service Calculation' is set to 'No' for selected CPT/Procedure Code (via Avatar MSO 'CPT Code Definition' form).
  19. Ensure 'Travel Time' field is disabled where 'Use ODS Group Service Calculation' is set to 'Yes' for selected CPT/Procedure Code but 'Date of Service' is prior to value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation''.
  20. Ensure 'Travel Time' field is enabled where 'Use ODS Group Service Calculation' is set to 'Yes' for selected CPT/Procedure Code and 'Date of Service' is on or after value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation''.
  21. Enter or edit 'Travel Time' field value (if field enabled).
  22. For services where 'Use ODS Group Service Calculation' is set to 'No' for selected CPT/Procedure Code, or where 'Use ODS Group Service Calculation' is set to 'Yes' for selected CPT/Procedure Code but 'Date of Service' is prior to value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'', ensure that 'Group Service Units' and 'Total Charge' values are calculated according to the following formula (and 'Group Service Units Per Day' is not calculated/populated):
  23. 'Group Service Units' = ((('Duration Per Unit' from CPT Code Definition x 'Service Units' entered for service) + 'Client Documentation Time' entered for service) / 'Number Of Clients In Group' entered for service) / 'Duration Per Unit' from CPT Code Definition
  24. 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value)
  25. Example:
  26. 'Duration Per Unit' from CPT Code Definition = '1'
  27. 'Service Units' entered for service = '90' (representing a 90 minute service)
  28. 'Number Of Clients In Group' entered for service = '10'
  29. 'Client Documentation Time' entered for service = '30'
  30. Service Fee Amount from Provider Fee Definition = '50'
  31. (((1 x 90) + 30) / 10 ) / 1 = 12
  32. 'Group Service Units' = 12
  33. (12) x (50) = 600
  34. 'Total Charge' = 600
  35. For services where 'Use ODS Group Service Calculation' is set to 'Yes' for selected CPT/Procedure Code and 'Date of Service' is on or after to value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'', ensure that 'Group Service Units', 'Group Service Units Per Day' and 'Total Charge' values are calculated according to the following formula:
  36. 'Group Service Units' = (((('Duration Per Unit' from CPT Code Definition x 'Service Units' entered for service) + ('Travel Time' entered for service)) / 'Number Of Clients In Group' entered for service) + 'Client Documentation Time' entered for service) / 'Duration Per Unit' from CPT Code Definition
  37. 'Group Service Units Per Day' = ((('Duration Per Unit' from CPT Code Definition x 'Service Units' entered for service) + ('Travel Time' entered for service)) / 'Number Of Clients In Group' entered for service) / 'Duration Per Unit' from CPT Code Definition
  38. 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value)
  39. Example:
  40. 'Duration Per Unit' from CPT Code Definition = '1'
  41. 'Service Units' entered for service = '90' (representing a 90 minute service)
  42. 'Number Of Clients In Group' entered for service = '10'
  43. 'Client Documentation Time' entered for service = '10'
  44. 'Travel Time' entered for service = '25'
  45. Service Fee Amount from Provider Fee Definition = '50'
  46. (((1 x 90) + 25) / 10) + 10) / 1 = 21.5
  47. 'Group Service Units' = 21.5
  48. (((1 x 90) + 25) / 10) / 1 = 11.5
  49. 'Group Service Units Per Day' = 11.5
  50. (21.5) x (50) = 1075
  51. 'Total Charge' = 1,075
  52. Enter/select any other Claim/Service field values as required/desired.
  53. Click 'Submit' button to file 'Claim Processing (CMS 1500)' form (or 'Claim Processing (CMS 1500) With Override' form).
  54. Open Crystal Reports or other SQL reporting tool.
  55. In Avatar MSO SQL table 'SYSTEM.batch_clm_svc_detail', ensure that the following fields are present and reflect values filed via 'Claim Processing (CMS 1500)' form (or 'Claim Processing (CMS 1500) With Override' form):
  56. 'number_in_group' ('Number of Clients In Group')
  57. 'num_counselor_in_group' ('Number of Counselors In Group')
  58. 'documentation_time' ('Client Documentation Time')
  59. 'travel_time' ('Travel Time')
  60. 'group_service_units' ('Group Service Units')
  61. 'group_service_units_day' ('Group Service Units Per Day')
Scenario 10: 'Claim Processing (UB-04)' - Verification Of Client And Counselor Group Calculations
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Group Services' must be enabled
  • Avatar MSO Registry Setting 'Enable Client and Counselor Groups In Service Entry' must be enabled
  • Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'' must be enabled (Start Date defined)
  • Revenue Code Definition where 'Type of Service' is defined as 'Group' and 'Duration Per Unit' is defined (via Avatar MSO 'Revenue Code Definition' form)
  • Revenue Code Definition where 'Use ODS Group Service Calculation' is set to 'Yes' (via Avatar MSO 'Revenue Code Definition' form)
  • Client with eligible Service Authorization record(s) valid for Service Entry/Claim Processing
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar MSO 'Claim Processing (UB-04)' form (or 'Claim Processing (UB-04) With Override' form).
  2. Select claims processing batch for service entry/edit.
  3. Open existing claim or create new claim for service entry/edit.
  4. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form.
  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' field value.
  8. Enter/select 'Procedure Code' field value.
  9. Enter 'Units' and 'Duration' field values.
  10. Enter or edit 'Number Of Clients In Group' field value.
  11. Ensure that the following Client and Counselor Groups Service Entry fields are enabled when the 'Type of Service' value for selected Revenue/Procedure Code is defined as 'Group':
  12. 'Number of Clients In Group'
  13. 'Number of Counselors In Group'
  14. 'Client Documentation Time'
  15. 'Travel Time' (conditionally enabled - see information below)
  16. Enter or edit 'Number Of Clients In Group' field value.
  17. Enter or edit 'Number of Counselors In Group' field value.
  18. Enter or edit 'Client Documentation Time' field value.
  19. Ensure 'Travel Time' field is disabled where 'Use ODS Group Service Calculation' is set to 'No' for selected Revenue/Procedure Code (via Avatar MSO 'Revenue Code Definition' form).
  20. Ensure 'Travel Time' field is disabled where 'Use ODS Group Service Calculation' is set to 'Yes' for selected Revenue/Procedure Code but 'Date of Service' is prior to value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation''.
  21. Ensure 'Travel Time' field is enabled where 'Use ODS Group Service Calculation' is set to 'Yes' for selected Revenue/Procedure Code and 'Date of Service' is on or after value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation''.
  22. Enter or edit 'Travel Time' field value (if field enabled).
  23. For services where 'Use ODS Group Service Calculation' is set to 'No' for selected Revenue/Procedure Code, or where 'Use ODS Group Service Calculation' is set to 'Yes' for selected Revenue/Procedure Code but 'Date of Service' is prior to value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'', ensure that 'Group Service Units' and 'Total Charge' values are calculated according to the following formula (and 'Group Service Units Per Day' is not calculated/populated):
  24. 'Group Service Units' = ((('Duration Per Unit' from Revenue Code Definition x 'Service Units' entered for service) + 'Client Documentation Time' entered for service) / 'Number Of Clients In Group' entered for service) / 'Duration Per Unit' from Revenue Code Definition
  25. 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value)
  26. Example:
  27. 'Duration Per Unit' from Revenue Code Definition = '1'
  28. 'Service Units' entered for service = '90' (representing a 90 minute service)
  29. 'Number Of Clients In Group' entered for service = '10'
  30. 'Client Documentation Time' entered for service = '30'
  31. Service Fee Amount from Provider Fee Definition = '50'
  32. (((1 x 90) + 30) / 10 ) / 1 = 12
  33. 'Group Service Units' = 12
  34. (12) x (50) = 600
  35. 'Total Charge' = 600
  36. For services where 'Use ODS Group Service Calculation' is set to 'Yes' for selected Revenue/Procedure Code and 'Date of Service' is on or after to value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'', ensure that 'Group Service Units', 'Group Service Units Per Day' and 'Total Charge' values are calculated according to the following formula:
  37. 'Group Service Units' = (((('Duration Per Unit' from Revenue Code Definition x 'Service Units' entered for service) + ('Travel Time' entered for service)) / 'Number Of Clients In Group' entered for service) + 'Client Documentation Time' entered for service) / 'Duration Per Unit' from Revenue Code Definition
  38. 'Group Service Units Per Day' = ((('Duration Per Unit' from Revenue Code Definition x 'Service Units' entered for service) + ('Travel Time' entered for service)) / 'Number Of Clients In Group' entered for service) / 'Duration Per Unit' from Revenue Code Definition
  39. 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value)
  40. Example:
  41. 'Duration Per Unit' from Revenue Code Definition = '1'
  42. 'Service Units' entered for service = '90' (representing a 90 minute service)
  43. 'Number Of Clients In Group' entered for service = '10'
  44. 'Client Documentation Time' entered for service = '10'
  45. 'Travel Time' entered for service = '25'
  46. Service Fee Amount from Provider Fee Definition = '50'
  47. (((1 x 90) + 25) / 10) + 10) / 1 = 21.5
  48. 'Group Service Units' = 21.5
  49. (((1 x 90) + 25) / 10) / 1 = 11.5
  50. 'Group Service Units Per Day' = 11.5
  51. (21.5) x (50) = 1075
  52. 'Total Charge' = 1,075
  53. Enter/select any other Claim/Service field values as required/desired.
  54. Click 'Submit' button to file 'Claim Processing (UB-04)' form (or 'Claim Processing (UB-04) With Override' form).
  55. Open Crystal Reports or other SQL reporting tool.
  56. In Avatar MSO SQL table 'SYSTEM.batch_clm_svc_detail', ensure that the following fields are present and reflect values filed via 'Claim Processing (UB-04)' form (or 'Claim Processing (UB-04) With Override' form):
  57. 'number_in_group' ('Number of Clients In Group')
  58. 'num_counselor_in_group' ('Number of Counselors In Group')
  59. 'documentation_time' ('Client Documentation Time')
  60. 'travel_time' ('Travel Time')
  61. 'group_service_units' ('Group Service Units')
  62. 'group_service_units_day' ('Group Service Units Per Day')
Scenario 11: 'Fast Service Entry' - Verification Of Client And Counselor Group Calculations
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Group Services' must be enabled
  • Avatar MSO Registry Setting 'Enable Client and Counselor Groups In Service Entry' must be enabled
  • Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'' must be enabled (Start Date defined)
  • CPT Service Code Definition where 'Type of Service' is defined as 'Group' and 'Duration Per Unit' is defined (via Avatar MSO 'CPT Code Definition' form)
  • CPT Service Code Definition where 'Use ODS Group Service Calculation' is set to 'Yes' (via Avatar MSO 'CPT Code Definition' form)
  • Client with eligible Service Authorization record(s) valid for Service Entry/Claim Processing
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar MSO 'Fast Service Entry' form (or 'Fast Service Entry Submission' form).
  2. Navigate to 'Fast Service Detail' section of form.
  3. Click 'Add New Item' button to enter new service.
  4. Enter/select value for 'Member Name or ID', 'Provider' and 'Funding Source' fields.
  5. Enter/select 'Date of Service' field value.
  6. Enter/select 'Procedure Code' field value.
  7. Enter 'Units' and 'Duration' field values.
  8. Ensure that the following Client and Counselor Groups Service Entry fields are enabled when the 'Type of Service' value for selected CPT/Procedure Code is defined as 'Group':
  9. 'Number of Clients In Group'
  10. 'Number of Counselors In Group'
  11. 'Client Documentation Time'
  12. 'Travel Time' (conditionally enabled - see information below)
  13. Enter or edit 'Number Of Clients In Group' field value.
  14. Enter or edit 'Number of Counselors In Group' field value.
  15. Enter or edit 'Client Documentation Time' field value.
  16. Ensure 'Travel Time' field is disabled where 'Use ODS Group Service Calculation' is set to 'No' for selected CPT/Procedure Code (via Avatar MSO 'CPT Code Definition' form).
  17. Ensure 'Travel Time' field is disabled where 'Use ODS Group Service Calculation' is set to 'Yes' for selected CPT/Procedure Code but 'Date of Service' is prior to value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation''.
  18. Ensure 'Travel Time' field is enabled where 'Use ODS Group Service Calculation' is set to 'Yes' for selected CPT/Procedure Code and 'Date of Service' is on or after value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation''.
  19. Enter or edit 'Travel Time' field value (if field enabled).
  20. or services where 'Use ODS Group Service Calculation' is set to 'No' for selected CPT/Procedure Code, or where 'Use ODS Group Service Calculation' is set to 'Yes' for selected CPT/Procedure Code but 'Date of Service' is prior to value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'', ensure that 'Group Service Units' and 'Total Charge' values are calculated according to the following formula (and 'Group Service Units Per Day' is not calculated/populated):
  21. 'Group Service Units' = ((('Duration Per Unit' from CPT Code Definition x 'Service Units' entered for service) + 'Client Documentation Time' entered for service) / 'Number Of Clients In Group' entered for service) / 'Duration Per Unit' from CPT Code Definition
  22. 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value)
  23. Example:
  24. 'Duration Per Unit' from CPT Code Definition = '1'
  25. 'Service Units' entered for service = '90' (representing a 90 minute service)
  26. 'Number Of Clients In Group' entered for service = '10'
  27. 'Client Documentation Time' entered for service = '30'
  28. Service Fee Amount from Provider Fee Definition = '50'
  29. (((1 x 90) + 30) / 10 ) / 1 = 12
  30. 'Group Service Units' = 12
  31. (12) x (50) = 600
  32. 'Total Charge' = 600
  33. For services where 'Use ODS Group Service Calculation' is set to 'Yes' for selected CPT/Procedure Code and 'Date of Service' is on or after to value/date defined for Avatar MSO Registry Setting 'Start Date for 'Use ODS Group Service Calculation'', ensure that 'Group Service Units', 'Group Service Units Per Day' and 'Total Charge' values are calculated according to the following formula:
  34. 'Group Service Units' = (((('Duration Per Unit' from CPT Code Definition x 'Service Units' entered for service) + ('Travel Time' entered for service)) / 'Number Of Clients In Group' entered for service) + 'Client Documentation Time' entered for service) / 'Duration Per Unit' from CPT Code Definition
  35. 'Group Service Units Per Day' = ((('Duration Per Unit' from CPT Code Definition x 'Service Units' entered for service) + ('Travel Time' entered for service)) / 'Number Of Clients In Group' entered for service) / 'Duration Per Unit' from CPT Code Definition
  36. 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value)
  37. Example:
  38. 'Duration Per Unit' from CPT Code Definition = '1'
  39. 'Service Units' entered for service = '90' (representing a 90 minute service)
  40. 'Number Of Clients In Group' entered for service = '10'
  41. 'Client Documentation Time' entered for service = '10'
  42. 'Travel Time' entered for service = '25'
  43. Service Fee Amount from Provider Fee Definition = '50'
  44. (((1 x 90) + 25) / 10) + 10) / 1 = 21.5
  45. 'Group Service Units' = 21.5
  46. (((1 x 90) + 25) / 10) / 1 = 11.5
  47. 'Group Service Units Per Day' = 11.5
  48. (21.5) x (50) = 1075
  49. 'Total Charge' = 1,075
  50. Enter/select any other Claim/Service field values as required/desired.
  51. Repeat service entry steps for additional services as desired.
  52. Navigate to 'Fast Service Entry Summary' section of form (main section).
  53. Click 'Submit Fast Service Entry' button to file 'Fast Service Entry' form (or 'Fast Service Entry Submission' form).
  54. Open Crystal Reports or other SQL reporting tool.
  55. In Avatar MSO SQL table 'SYSTEM.batch_clm_svc_detail', ensure that the following fields are present and reflect values filed via 'Claim Processing (CMS 1500)' form (or 'Claim Processing (CMS 1500) With Override' form):
  56. 'number_in_group' ('Number of Clients In Group')
  57. 'num_counselor_in_group' ('Number of Counselors In Group')
  58. 'documentation_time' ('Client Documentation Time')
  59. 'travel_time' ('Travel Time')
  60. 'group_service_units' ('Group Service Units')
  61. 'group_service_units_day' ('Group Service Units Per Day')
Scenario 12: Avatar MSO Registry Settings - Verification of 'Enable Client and Counselor Groups in Service Entry' Registry Setting
Steps
  1. Open 'Registry Settings' form.
  2. Enter search value 'Client And Counselor Groups' and click 'View Registry Settings' button.
  3. Ensure Registry Setting 'Enable Client and Counselor Groups In Service Entry' is returned (under 'Avatar MSO-> Claims Processing' path).
  4. Ensure 'Registry Setting Details' field contains the following explanation text:

"Selecting 'Y' will add the following fields to the 'Fast Service Entry', 'Claim Processing (CMS-1500)', 'Claim Processing with Override (CMS-1500)', 'Claim Processing (UB-04)' and 'Claim Processing with Override (UB-04)' forms: 'Number Of Counselors In Group', 'Client Documentation Time', 'Group Service Units', 'Group Service Unit Per Day', 'Travel Time'.


The 'Group Service Units' will be calculated using this formula: Group Service Units=(((Duration Per Unit * Service Units) + Documentation Time) / Number Of Clients In Group) / Duration Per Unit.

The 'Total Charge' will be calculated using this formula: Total Charge=((((Duration Per Unit * Service Units) + Documentation Time) / Number Of Clients In Group) / Duration Per Unit) * Provider Fee Definition.


Additionally, the following fields will be added to the 'CPT Code Definition' and 'Revenue Code Definition' forms: 'Use ODS Group Service Calculation', 'Documentation Time Limit', 'Number of Clients in Group', 'Maximum Documentation Time (minutes)', 'Maximum Travel Time (minutes), 'File Documentation Time Limit' and 'Delete Documentation Time Limit'.


If the 'Use ODS Group Service Calculations' field is set to "Yes" the 'Group Service Units Per Day' will be calculated using this formula:

Group Service Units Per Day=(((Duration Per Unit * Service Units) + Travel Time) / Number of Clients In Group) / Duration Per Unit

and the 'Group Service Units' will be calculated using this formula:

Group Service Units=((((Duration Per Unit * Service Units) + Travel Time) / Number Of Clients In Group) + Client Documentation Time) / Duration Per Unit

and the 'Total Charge' will be calculated using this formula:

Total Charge=(((((Duration Per Unit * Service Units) + Travel Time) / Number Of Clients In Group) + Client Documentation Time) / Duration Per Unit) * Provider Fee Definition.


Note: The "ODS Group Service Calculation" will be used only if there is a date entered in the 'Start Date for 'Use ODS Group Service Calculation'' registry setting. Please see that registry setting for more information."

American Medical Association Copyright Notice Display
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Copy Provider Fee Definition
  • Contracting Provider Service Authorization
  • Funding Source Service Authorization
  • Automatic Authorization Approval Setup
  • Set Associated Codes
  • Fast Service Entry
  • Claim Processing (CMS 1500)
  • Claim Processing with Override (CMS 1500)
  • Contracting Provider Registration
  • Claim Processing (UB-04)
  • Claim Processing with Override (UB-04)
Scenario 1: Avatar MSO CPT Code Form Fields - Verification of American Medical Association Trademark/Copyright Notice Display
Steps
  1. Open one or more of the following Avatar MSO forms:
  2. 'Provider Fee Definition'
  3. 'Copy Provider Fee Definition'
  4. 'Service Authorization'
  5. 'Contracting Provider Service Authorization'
  6. 'Funding Source Service Authorization'
  7. 'Automatic Authorization Approval Setup'
  8. 'MSO to Parent System Integration Mapping'
  9. 'Set Associated Codes' ('CPT Codes' section)
  10. 'Contracting Provider Registration' ('837 Defaults' section)
  11. 'Plan Definition' ('Plan Coverage Definition' section)
  12. 'Claim Processing (CMS 1500)' ('Service Detail' section)
  13. 'Claim Processing with Override(CMS 1500)' ('Service Detail' section)
  14. 'Claim Processing (UB04)' ('Service Detail' section)
  15. 'Claim Processing with Override (UB04)' ('Service Detail' section)
  16. 'Fast Service Entry' ('Fast Service Detail' section)
  17. 'Fast Service Entry Submission' ('Fast Service Detail' section)
  18. Verify the first instance of 'CPT Service Code'/'CPT Code' field in form contains the AMA Trademark 'CPT® Codes' label.
  19. Verify the following AMA copyright notice is displayed at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'
  20. Note - location of AMA copyright form field/labels may be affected by any Form Designer changes present for form
Topics
• CPT Code Definition • NX • Claims Processing • Registry Settings • Revenue Code Definition
Update 21 Summary | Details
MSO Service Authorization
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • All Documents Widget Definition
  • Service Authorization Request
Scenario 1: Display service authorization forms in NX All Document widget
Specific Setup:
  • Registry Setting: Avatar MSO->Care Management->Service Authorization->->->Require Care Manager Assignment = Y
  • All Documents Widget Definition has been used to assign the following forms to desired tab:
  • Service Authorization Request
  • Service Authorization
  • Assign MSO Care Manager.
  • Signed in tester has access to the 'All Documents' widget.
  • Client A:
  • Has one 'Service Authorization Request' record, which includes 'Care Manager' data.
  • Has one 'Service Authorization' record.
  • Client B:
  • Has no 'Service Authorization Request' record.
  • Has no 'Service Authorization' record.
Steps
  1. Open the 'All Documents' widget for Client A.
  2. Select the 'Assign MSO Care Manager' form.
  3. Validate that the 'Form Description' is 'Assign MSO Care Manager'.
  4. Validate that there is one row.
  5. Select the 'Service Authorization Request' form.
  6. Validate that there zero rows.
  7. Select the 'Service Authorization' form.
  8. Validate that the 'Form Description' is 'Service Authorization'.
  9. Validate that there is one row.
  10. Return to homeview.
  11. Open 'Registry Settings'.
  12. Set 'Avatar MSO->Care Management->Service Authorization->->->Require Care Manager Assignment' to 'N',
  13. Click [Submit].
  14. Click [No].
  15. Select Client B.
  16. Open 'Service Authorization Request'.
  17. Create a request record with no 'Care Manager' data'.
  18. Submit the form.
  19. Close the form.
  20. Open 'Service Authorization'.
  21. Edit the 'Service Authorization Request' created above.
  22. Select 'Approved' in 'Current Authorization Status'.
  23. Enter the number of 'Units Authorized'.
  24. Validate the 'Estimated Liability' contains a value.
  25. Validate that there is no 'Care Manager' data.
  26. Submit the form.
  27. Close the form.
  28. Open the 'All Documents' widget for Client B.
  29. Select the 'Assign MSO Care Manager' form.
  30. Validate that there are no rows.
  31. Select the 'Service Authorization Request' form.
  32. Validate that there are no rows.
  33. Select the 'Service Authorization' form.
  34. Validate that the 'Form Description' is 'Service Authorization'.
  35. Validate that there is one row.
  36. Return to homeview.
Topics
• Service Authorizations • Widgets
Update 27 Summary | Details
MSO SYSTEM.placement_disruption table
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • User Definition
  • CPT Code Definition (PM)
  • CPT Code Definition (MSO)
  • Service Codes
  • Foster Home Registration
  • Foster Home Members
  • Adjustment Code Definition
  • Program Maintenance
  • Funding Source Registration
  • Performing Provider Registration
  • Contracting Provider Registration
  • Admission (Outpatient)
  • Financial Eligibility
  • Foster Child Behaviors
  • Foster Care Defaults
  • Foster Child Placement
  • Dictionary Update (MSO)
  • Placement Disruption
Scenario 1: Placement Disruption - form & table
Specific Setup:
  • The 'Foster Care' module is installed in Avatar MSO.
  • Client: Is in an active 'Foster Child Placement'.
Steps
  1. Open 'Placement Disruption' for the client.
  2. Enter a date in 'Disruption Start Date'.
  3. Select desired value in 'Reason For Disruption'.
  4. Optionally enter value in non-required fields.
  5. Click [Submit].
  6. Query the SYSTEM.placement_disruption table in the MSO namespace and validate the data submitted in the 'Placement Disruption' form.
  7. Query the SYSTEM.placement_disruption table in the Cal-PM namespace and validate the data submitted in the 'Placement Disruption' form.
  8. Open 'Placement Disruption' for the client.
  9. Edit the record to add a ''Disruption End Date' and any other desired optional fields.
  10. Click [Submit].
  11. Query the SYSTEM.placement_disruption table in the MSO namespace and validate the edited data submitted in the 'Placement Disruption' form.
  12. Query the SYSTEM.placement_disruption table in the Cal-PM namespace and validate the edited data submitted in the 'Placement Disruption' form.
Topics
• Foster Care • NX