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Avatar MSO 2022 Quarterly Release 2022.01 Acceptance Tests

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Update 1 Summary | Details
Avatar MSO 2022 is Installed
Scenario 1: Validate Upgrading Avatar MSO 2021 to 2022 is successful when 2021.04.00 is loaded
Specific Setup:
  • Latest Monthly Release is installed.
Steps
  1. Open the "Product Updates" form.
  2. Select the appropriate [Namespace] from the Application dropdown list
  3. Click [Select Update/Customization Pack].
  4. Browse to the location for the updates and select the Update 1.
  5. Click [OK] on the "File Upload Complete" window.
  6. Click [Review Update/Customization Pack Contents].
  7. Verify Update 1 is included.
  8. Click [Install Update/Customization Pack].
  9. Click [OK] when the install completes.
  10. Click [Close Form].
Topics
• NX • Upgrade
Update 3 Summary | Details
'Claim PreAdjudication' Web Service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Claim Pre-Adjudication Web Service
Scenario 1: 'Claim Pre-Adjudication' Web Service - Receipt and processing of claim/service data from ProviderConnect
Specific Setup:
  1. Client record eligible for Claim/Service entry in Avatar MSO and Netsmart ProviderConnect
  2. Netsmart ProviderConnect (or other application utilizing the Avatar MSO 'Claim Pre-Adjudication' web service)
  3. 'Crystal Reports' or other SQL reporting tool
Steps
  1. Enter one or more services via Netsmart ProviderConnect 'Treatment' service entry.
  2. Navigate to ProviderConnect 'Billing' menu.
  3. Click 'Generate Bill' button for selected criteria.
  4. Click 'Click 'Submit Bill for Pre-adjudication' button for ProviderConnect billing transaction (or via other application utilizing the Avatar MSO 'Claim Pre-Adjudication' web service).
  5. Within 'Unsubmitted Bills' section of ProviderConnect 'Billing' menu, navigate to bill created above which was submitted for Pre-Adjudication.
  6. Click 'View Pre-adjudication Results' button for unsubmitted bill.
  7. For all services in bill submitted for Pre-Adjudication but not yet processed by Avatar MSO, ensure 'Status' value is 'Queued'.
  8. The Avatar MSO Pre-Adjudication processing will be performed by a system background process automatically, starting every 30 minutes and processing any new/previously unprocessed services; accordingly, wait for sufficient time frame for Pre-Adjudication to be performed by Avatar MSO.
  9. Click the 'Refresh Bill Pre-adjudication Results' button.
  10. Following Avatar MSO Pre-Adjudication processing of services, ensure that 'Status' value in ProviderConnect is updated from 'Queued' to either 'Passed Edit' or 'Failed Edit'. ('Passed Edit' or 'Failed Edit' Pre-Adjudication status for each service will be determined by Avatar MSO using the same configurations/criteria/logic as standard Claim Processing service adjudication for 'Approved' and 'Denied'/'Pending' claim status (respectively).)
  11. Following Avatar MSO Pre-Adjudication processing of services, ensure that services with 'Status' value of 'Failed Edit' also include data for 'Pre-Adjudication Edit Failed Reason' in ProviderConnect display. ('Pre-Adjudication Edit Failed Reason values for 'Failed Edit' services will be determined by Avatar MSO using the same configurations/criteria/logic as standard Claim Processing service adjudication for the 'Explanation of Coverage' detailed message.)
  12. Open 'Crystal Reports' or other SQL reporting tool.
  13. In Avatar MSO SQL table 'SYSTEM.claims_pre_adj table' - ensure new single row is present for each service submitted/processed by Claim Pre-Adjudication web service/background process.
  14. In Avatar MSO SQL table 'SYSTEM.claims_pre_adj table' - for each service submitted/processed, confirm 'Queued', 'Passed Edit' or 'Failed Edit' status in field 'status' (value 'Q', '1' or '0', respectively).
  15. In Avatar MSO SQL table 'SYSTEM.claims_pre_adj table' - for each service submitted/processed with 'Failed Edit' status, confirm 'Pre-Adjudication Edit Failed Reason' values in field 'pre_adj_edit_failed_reason'.
Topics
• Claims Processing
2021 Update 27 Summary | Details
Registry Setting - Claims Processing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (MSO)
  • 837 Health Care Claim Professional
  • Dynamic Form - Registry Settings - Registry Editor Filing
  • Client Ledger
  • Dynamic Form - Admission - Client
  • Admission (Outpatient)
  • Diagnosis
  • Financial Eligibility
  • Funding Source Registration
  • CPT Code Definition (PM)
  • CPT Code Definition (MSO)
  • Provider Fee Definition
  • Member Specific Information
  • Service Authorization
  • MSO to Parent System Integration Mapping
  • Approve/Pend/Deny Rules Definition
  • Plan Definition
  • Dynamic Form - Retro Rate Adjudication Process
  • Registry Settings (PM)
  • App Dashboard
  • Managed Care Authorizations
  • Claim Processing Automation
Scenario 1: Include In EOB Retros For Replaced Services Not On EOB
Specific Setup:
  • The ’Avatar MSO->Claims Processing->Include In EOB Retros For Replaced Services Not On EOB' registry setting has a value of ‘N’.
Steps
  1. Using the '837 Health Care Claim Professional' form, load, compile and post an inbound 837P that has multiple services per claim.
  2. Create EOB for all the services in the claim.
  3. Using the '837 Health Care Claim Professional' form, load, compile and post an inbound 837P that will replace one of the services in the claim.
  4. Create EOB for the replacement service.
  5. Using the '837 Health Care Claim Professional' form, load, compile and post an inbound 837P that will replace ANOTHER one of the services in the claim.
  6. Create EOB for that replacement service.
  7. Verify the SYSTEM.retro_claim_adjudications for the original batch that there is a non processed 0 dollar retro filed against the first replaced service.
  8. Using‘Registry Settings’ and set ‘'Avatar MSO->Claims Processing->Include In EOB Retros For Replaced Services Not On EOB'’ to ‘Y’.
  9. Create EOB again and verify the retro is processed.
File Import - Service Authorizations
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Dynamic Form - Site Specific Section Modeling (CWS)
  • Site Specific Section Modeling (MSO)
  • Registry Settings (PM)
  • Dynamic Form - Registry Settings - Registry Editor Filing
  • Dynamic Form - Admission - Client
  • Admission (Outpatient)
  • CPT Code Definition (PM)
  • CPT Code Definition (MSO)
  • Funding Source Registration
  • Plan Definition
  • Provider Fee Definition
  • Dynamic Form - Edit Provider Fee Definition
  • Financial Eligibility
  • Member Specific Information
  • MSO to Parent System Integration Mapping
  • File Import
  • Service Authorization
  • Select Provider
  • Contracting Provider Service Authorization
Scenario 1: File Import - [Avatar MSO] Service Authorization - Member - Add / Edit
Specific Setup:
  • Client:
  • Has a Financial Eligibility record
  • Has a Member Enrollment or Member Specific Information record.
  • File Import:
  • The File_Import_Record_Layouts Excel document will be included in the update zip file.
  • Locate the 'Member Service Authorization' section.
  • A 'Member Service Authorization' file is created.
Steps
  1. Open 'File Import'.
  2. Select '[Avatar MSO] Service Authorization - Member' in 'File Type'.
  3. Select 'Upload New File' in 'Action'.
  4. Click [Process Action].
  5. Select the file.
  6. Click [Open].
  7. Select 'Compile/Validate File' in 'Action'.
  8. Select the file in 'File(s)'.
  9. Click [Process Action].
  10. Click [OK].
  11. Select 'Print File' in 'Action'.
  12. Select the file in 'File(s)'.
  13. Click [Process Action].
  14. Validate the report data.
  15. Close the report.
  16. Select 'Post File' in 'Action'.
  17. Select the file in 'File(s)'.
  18. Click [Process Action].
  19. Click [OK].
  20. Open 'Service Authorization' for the member.
  21. Validate the data.
  22. Click [Cancel].
  23. Close the form.
  24. Copy the data and edit at least one item.
  25. Post the edited file through 'File Import', '[Avatar MSO] Service Authorization - Member'.
  26. Open 'Service Authorization' for the member.
  27. Validate the updated data.
  28. Click [Cancel].
  29. Close the form.
Scenario 2: File Import - [Avatar MSO] Service Authorization - Contracting Provider - Add / Edit
Specific Setup:
  • File Import:
  • The File_Import_Record_Layouts Excel document will be included in the update zip file.
  • Create a 'Contracting Provider Service Authorization' for an existing 'Contracting Provider'.
Steps
  1. Open 'File Import'.
  2. Select '[Avatar MSO] Service Authorization - Contracting Provider' in 'File Type'.
  3. Select 'Upload New File' in 'Action'.
  4. Click [Process Action].
  5. Select the file.
  6. Click [Open].
  7. Select 'Compile/Validate File' in 'Action'.
  8. Select the file in 'File(s)'.
  9. Click [Process Action].
  10. Click [OK].
  11. Select 'Print File' in 'Action'.
  12. Select the file in 'File(s)'.
  13. Click [Process Action].
  14. Validate the report data.
  15. Close the report.
  16. Select 'Post File' in 'Action'.
  17. Select the file in 'File(s)'.
  18. Click [Process Action].
  19. Click [OK].
  20. Open 'Service Authorization' for the member.
  21. Validate the data.
  22. Click [Cancel].
  23. Close the form.
  24. Copy the data and edit at least one item.
  25. Post the edited file through 'File Import', '[Avatar MSO] Service Authorization - Contracting Provider'.
  26. Open 'Service Authorization' for the member.
  27. Validate the updated data.
  28. Click [Cancel].
  29. Close the form.
Topics
• Retro Claim Adjudication • NX • myAvatar/myAvatar NX • File Import
2021 Update 30 Summary | Details
'Budget Tracking Account Setup' Form
Scenario 1: 'Budget Tracking Account Setup' - Form Verification
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Budget Tracking' must be enabled
Steps
  1. Open Avatar MSO 'Budget Tracking Account Setup' form.
  2. Select 'Account' value for existing Budget Tracking Account view/update (or select 'Create New' for new Budget Tracking Account entry).
  3. On selection of Budget Tracking Account value, ensure all fields in 'Account Budget Management' section of form are populated with/display existing values.
  4. Select the 'Account Level' value for existing Budget Tracking Account Level view/update (or select 'Create New' for new Budget Tracking Account Level entry).
  5. On selection of Budget Tracking Account Level value, ensure all fields in 'Account Levels' sub-section of form are populated with/display existing values.
  6. Navigate to 'Contracting Provider Service Authorization' section of 'Budget Tracking Account Setup' form.
  7. Enter/select value for 'Contracting Provider' field.
  8. Select 'Authorization' value for existing Contracting Provider Service Authorization view/update (or select 'Create New' for new Contracting Provider Service Authorization entry).
  9. On selection of Authorization value, ensure all fields in 'Contracting Provider Service Authorization' section of form are populated with/display existing values.
  10. Navigate/return to 'Account Budget Management' section of form.
  11. Ensure previous 'Account'/'Account Level' selections/values are present in display, and all fields in 'Account Budget Management' section/'Account Levels' sub-section of form are populated with/display existing values.
  12. Navigate/return to 'Contracting Provider Service Authorization' section of form.
  13. Ensure previous 'Contracting Provider'/'Authorization' selections/values are present in display, and all fields in 'Contracting Provider Service Authorization' section of form are populated with/display existing values.
Topics
• NX • Budget Tracking
2021 Update 32 Summary | Details
837 Health Care Claim - Performing Provider
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CPT Code Definition (PM)
  • CPT Code Definition (MSO)
  • Funding Source Registration
  • Plan Definition
  • Performing Provider Registration
  • Dynamic Form - Pre-Display Confirmation
  • Provider Fee Definition
  • MSO to Parent System Integration Mapping
  • App Dashboard
  • Practitioner Enrollment
  • Admission (Outpatient)
  • Financial Eligibility
  • Member Specific Information
  • Service Authorization
  • Diagnosis
  • Claim Processing Automation
  • 837 Health Care Claim Professional
  • Contracting Provider Termination
  • Revenue Code Definition (PM)
  • Revenue Code Definition (MSO)
  • Admission
  • 837 Health Care Claim Institutional
Scenario 1: Validate 837 Health Care Claim Professional when Performing Provider is not in the Contracting Provider's first registration record.
Specific Setup:
  • Performing Provider Registration exists.
  • Contracting Provider Registration exists with the Performing Provider included.
  • Contracting Provider Termination is used to terminate the Contracting Provider Registration.
  • Contracting Provider Registration is used to register the same Contracting Provider again and include the Performing Provider.
  • File exists for the Contracting Provider / Performing Provider to post in the 837 Health Care Claim Professional.
Steps
  1. Open ‘837 Health Care Claim Professional’.
  2. Load and compile the file.
  3. Validate that the Contracting Provider or Performing Provider forms populate successfully.
  4. Post the file if desired.
Scenario 2: Validate 837 Health Care Claim Institutional when Performing Provider is not in the Contracting Provider's first registration record.
Specific Setup:
  • Performing Provider Registration exists.
  • Contracting Provider Registration exists with the Performing Provider included.
  • Contracting Provider Termination is used to terminate the Contracting Provider Registration.
  • Contracting Provider Registration is used to register the same Contracting Provider again and include the Performing Provider.
  • File exists for the Contracting Provider / Performing Provider to post in the 837 Health Care Claim Institutional.
Steps
  1. Open ‘837 Health Care Claim Institutional’.
  2. Load and compile the file.
  3. Validate that the Contracting Provider or Performing Provider forms populate successfully.
  4. Post the file if desired.
Topics
• Performing Provider • Contracting Provider Registration • 837 Health Care Claim Institutional