Avatar MSO 2022 Quarterly Release 2022.03 Acceptance Tests

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Update 11 Summary \| Details Avatar MSO 'Performing Provider Association' form Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Contracting Provider Registration Performing Provider Association Scenario 1: 'Contracting Provider Registration' - Form Verification Specific Setup: One or more Avatar MSO Contracting Provider entries eligible for Contracting Provider Registration entry/edit One or more Avatar MSO Performing Provider Registration entries eligible for Contracting Provider assignment Crystal Reports or other SQL reporting tool Steps Open Avatar MSO 'Contracting Provider Registration' form. Enter/select Contracting Provider for Contracting Provider Registration entry/edit. Click 'Add' button to create new Contracting Provider Registration (or select existing Contracting Provider Registration record for edit). Enter/select values for all required/desired fields in main/first section of 'Contracting Provider Registration' form. Navigate to 'Performing Provider's Information' section of form. Click 'Add New Item' button to create new Performing Provider association entry (or select existing Performing Provider association record for edit). Ensure that the following fields are present in the 'Contracting Provider Registration' form, 'Performing Provider's Information' section: 'Performing Provider's Office Telephone (1)' 'Performing Provider's Office Telephone (2)' 'Performing Provider's Cellular Telephone' 'Performing Provider's Fax' 'Secondary Provider Identification Number' On addition of new Performing Provider association entry in 'Contracting Provider Registration' form, ensure that values for 'Performing Provider's Office Telephone (1)', 'Performing Provider's Office Telephone (2)', 'Performing Provider's Cellular Telephone', 'Performing Provider's Fax' and/or 'Secondary Provider Identification Number' fields are defaulted from 'Performing Provider Registration' information for selected Performing Provider record where defined. Enter/edit value(s) in 'Performing Provider's Office Telephone (1)', 'Performing Provider's Office Telephone (2)', 'Performing Provider's Cellular Telephone', 'Performing Provider's Fax' and/or 'Secondary Provider Identification Number' fields (and any other Performing Provider's Information data fields as required/desired). Click 'Submit' button to file 'Contracting Provider Registration' form. Open Avatar MSO 'Contracting Provider Registration' form. Enter/select previously filed Contracting Provider Registration record. Navigate to 'Performing Provider's Information' section of form. Select previously entered Performing Provider association record for edit. Ensure that previously entered/filed values are present in 'Performing Provider's Office Telephone (1)', 'Performing Provider's Office Telephone (2)', 'Performing Provider's Cellular Telephone', 'Performing Provider's Fax' and/or 'Secondary Provider Identification Number' fields. Open Crystal Reports or other SQL reporting tool. In Avatar MSO SQL table 'SYSTEM.provider_performing_data', ensure that the following fields are present and reflect values entered/filed via 'Contracting Provider Registration' form for fields noted above (respectively): 'perf_prov_office_phone_1' 'perf_prov_office_phone_2' 'perf_prov_cellular_telephone' 'perf_prov_fax' 'sec_prov_ident_num' Scenario 2: 'Performing Provider Registration' - Form Verification Specific Setup: Crystal Reports or other SQL reporting tool Steps Open Avatar MSO 'Performing Provider Registration' form. Click 'New Performing Provider' button to create new Performing Provider Registration (or search/select existing Performing Provider Registration record for edit). Enter/select values in 'Name' and 'Registration Start Date' fields. Ensure that the following fields are present in the 'Performing Provider Registration' form: 'Performing Provider's Office Telephone (1)' 'Performing Provider's Office Telephone (2)' 'Performing Provider's Cellular Telephone' 'Performing Provider's Fax' 'Secondary Provider Identification Number' Enter value(s) in 'Performing Provider's Office Telephone (1)', 'Performing Provider's Office Telephone (2)', 'Performing Provider's Cellular Telephone', 'Performing Provider's Fax' and/or 'Secondary Provider Identification Number' fields (and any other Provider data fields as required/desired). Select one or more values in 'Primary License Type for Claims' field. Select 'Create New' from the 'Primary License Type Effective Dates' field. Enter/select values for 'Effective Start Date', 'Primary License Type for Claims' fields. Click 'File Primary License Type Effective Date' button. Click 'Submit' button to file 'Performing Provider Registration' form. Open Avatar MSO 'Performing Provider Registration' form. Enter/select previously filed Performing Provider Registration record. Ensure that previously entered/filed values are present in 'Performing Provider's Office Telephone (1)', 'Performing Provider's Office Telephone (2)', 'Performing Provider's Cellular Telephone', 'Performing Provider's Fax' and/or 'Secondary Provider Identification Number' fields. Open Crystal Reports or other SQL reporting tool. In Avatar MSO SQL table 'SYSTEM.performing_provider_data', ensure that the following fields are present and reflect values entered/filed via 'Performing Provider Registration' form for fields noted above (respectively): 'perf_prov_office_phone_1' 'perf_prov_office_phone_2' 'perf_prov_cellular_telephone' 'perf_prov_fax' 'sec_prov_ident_num' Scenario 3: 'Performing Provider Association' - Form Verification Specific Setup: One or more Avatar MSO Contracting Provider Registration entries eligible for Performing Provider association entry One or more Avatar MSO Performing Provider Registration entries eligible for Contracting Provider assignment Steps Open Avatar MSO 'Performing Provider Association' form. Enter/select Contracting Provider for Performing Provider Association entry. In 'Performing Provider Association' form, ensure the following fields exist: 'Contracting Provider Registration' Dropdown selection field containing all Contracting Provider Registration entries for selected Contracting Provider 'Performing Provider' Lookup/selection field for selection of Performing Provider to be associated/assigned to selected Contracting Provider Registration 'Performing Provider Registration' Dropdown selection field for selection of Performing Provider Registration record to be associated/assigned to selected Contracting Provider Registration (if more than one Performing Provider Registration record exists for selected Performing Provider) 'Effective Start Date' / 'Effective End Date' Used to enter begin/end date for Performing Provider association/assignment; Value defaulted from row selected in 'Performing Provider Registration' field 'Registration Start Date' / 'Registration End Date' Populated from row selected in 'Performing Provider Registration' field 'Primary License Type Effective Dates' Dropdown selection field for Primary License Type rows/entries, including 'Create New' selection; populated with all Primary License Type rows/entries defined via 'Performing Provider Registration' form for row selected in 'Performing Provider Registration' field 'Primary License Type For Claims' / 'Effective Start Date' / 'Effective End Date' Used to enter/edit selected Primary License Type row/entry if desired; 'File Primary License Type Effective Date', 'Delete...' and 'Display...' buttons also present in form for Primary License Type row/entry functions Performing Provider Demographic information fields (all fields from Avatar MSO 'Performing Provider Registration' form / Avatar MSO 'Contracting Provider Registration' form 'Performing Provider's Information' section), including but not limited to the following fields: 'Performing Provider's Name' 'Performing Provider's Birthdate' 'Performing Provider's Social Security Number' 'Performing Provider's E-mail Address' 'Performing Provider's Address Street 1', '...Street 2', '...City', '...State' 'Medicaid Provider #' 'Provider ID' / 'Provider ID Qualifier' 'Performing Provider's Office Telephone (1)' 'Performing Provider's Office Telephone (2)' 'Performing Provider's Cellular Telephone' 'Performing Provider's Fax' 'Secondary Provider Identification Number' Select Contracting Provider Registration for Performing Provider association/assignment in the 'Contracting Provider Registration' field. Enter/select Performing Provider for association/assignment in the 'Performing Provider' field (and select row/entry in 'Performing Provider Registration' field if more than one entry exists/different row is desired). On selection of 'Performing Provider' and 'Performing Provider Registration' values, ensure that Performing Provider Demographic information fields are populated with values defined via Avatar MSO 'Performing Provider Registration' form for selected record ('Performing Provider's Name', 'Performing Provider's Social Security Number', 'Provider ID', 'Secondary Provider Identification Number', etc.). Enter/edit Performing Provider Demographic information field values (if desired). On selection of 'Performing Provider' and 'Performing Provider Registration' values, ensure that 'Primary License Type Effective Dates' selection field is populated with all Primary License Type rows/entries defined via 'Performing Provider Registration' form for selected Performing Provider Registration. Enter/edit Performing Provider Primary License Type row/entry information (if desired; Selection of existing Primary License Type row or 'Create New', entry/edit of 'Primary License Type For Claims' / 'Effective Start Date' / 'Effective End Date' fields and use of 'File Primary License Type Effective Date' / 'Delete Primary License Type Effective Date' buttons). Click 'Submit' button to file 'Performing Provider Association' form and create or update Contracting Provider/Performing Provider association/assignment. Ensure user is presented with a confirmation dialog noting 'Performing Provider Association Successfully Filed'; Click 'OK' button and ensure 'Performing Provider Association' form is closed. Open Avatar MSO 'Contracting Provider Registration' form Enter/select Contracting Provider/Contracting Provider Registration record for review (selecting same Contracting Provider Registration record as updated via 'Performing Provider Association' form). Navigate to 'Performing Provider's Information' section of form. Confirm Performing Provider association/assignment row created/updated via 'Performing Provider Association' form is present in multi-row selection grid. Select Performing Provider association/assignment row created/updated via 'Performing Provider Association' form and click 'Edit Selected Item' button. On selection/view of Performing Provider association/assignment row, ensure that all field values filed via 'Performing Provider Association' form are present (including Primary License Type Effective Date rows/entries). Ensure that subsequent filing of 'Performing Provider Association' form for same Contracting Provider Registration/Performing Provider combination results in updating of existing Performing Provider association/assignment row in 'Contracting Provider Registration' form/record. Avatar MSO 'Fast Service Entry Submission' Form Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Fast Service Entry Submission Scenario 1: 'Fast Service Entry Submission' - Verification of form filing Specific Setup: One or more client records eligible for Fast Service Entry Steps Open Avatar MSO 'Fast Service Entry Submission' form (under 'Avatar MSO / Claims Processing' menu). In 'Fast Service Entry Submission' form, ensure that 'Close Batches' field is set to 'No' and is read-only/disabled for any system user which does not also have access to Avatar MSO 'Close Batch form (via 'User Definition' and/or 'User Role Definition' forms). Ensure that 'Close Batches' field is set to 'No' by default but value may be changed to 'Yes' for any system user which also has access to Avatar MSO 'Close Batch form (via 'User Definition' and/or 'User Role Definition' forms). Ensure that 'Date Claims Received' field is set to current date by default; ensure that 'Date Claims Received' field is disabled/read-only and date value may not be edited. Navigate to 'Fast Service Detail' section of form. Click 'Add New Item' button to enter new service. Enter/select client for service entry in 'Member Name or ID' field. Ensure that 'Funding Source' field contains only selections applicable to Contracting Provider Registration; enter/select value in 'Funding Source' field. Enter/select value in 'Provider' field. Ensure that 'Performing Provider' field contains only selections applicable to Contracting Provider Registration; select value in 'Performing Provider' field if desired. Enter value in 'Begin Date Of Authorization' and 'End Date Of Authorization' field. Select value in 'Date Of Service' field. Enter/select value in 'Procedure Code' field. Enter value in 'Total Charge' and 'Service Units' field. Enter value in 'Authorization Number' field, or click 'Display Valid Authorizations' button and select Service Authorization applicable to service entry. Ensure that 'Claim Status' field (Approved/Denied/Pending) is populated with value determined by Avatar MSO claim/service adjudication rules and requirements. Ensure that 'Claim Status' field is disabled/read-only, and that 'Claim Status' value/status may not be manually edited following entry of service detail values and/or selection of Service Authorization. Ensure that 'Expected Disbursement' and 'Approved Units' fields are populated with value determined by Avatar MSO claim/service adjudication rules and requirements in conjunction with 'Claim Status'. Enter/select values in any other fields as required/desired. Click 'Add New Item' button to enter additional service(s) as desired; when all desired services have been entered in 'Fast Service Detail' section of form, navigate to 'Fast Service Entry Summary' section of form. Click 'Submit Fast Service Entry' form to file service(s) and create Avatar MSO claims processing batch(es). Claims processing batch(es) created via the 'Fast Service Entry Submission' form where 'Close Batches' field is set to 'No' must be further adjudicated/finalized/closed via Avatar MSO 'Close Batch' form (or 'Close Multiple Batches' form). Avatar MSO 'Fast Service Entry Submission' Form Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Fast Service Entry Submission Scenario 1: 'Fast Service Entry Submission' - Verification of form filing Specific Setup: One or more client records eligible for Fast Service Entry Steps Open Avatar MSO 'Fast Service Entry Submission' form (under 'Avatar MSO / Claims Processing' menu). In 'Fast Service Entry Submission' form, ensure that 'Close Batches' field is set to 'No' and is read-only/disabled for any system user which does not also have access to Avatar MSO 'Close Batch form (via 'User Definition' and/or 'User Role Definition' forms). Ensure that 'Close Batches' field is set to 'No' by default but value may be changed to 'Yes' for any system user which also has access to Avatar MSO 'Close Batch form (via 'User Definition' and/or 'User Role Definition' forms). Ensure that 'Date Claims Received' field is set to current date by default; ensure that 'Date Claims Received' field is disabled/read-only and date value may not be edited. Navigate to 'Fast Service Detail' section of form. Click 'Add New Item' button to enter new service. Enter/select client for service entry in 'Member Name or ID' field. Ensure that 'Funding Source' field contains only selections applicable to Contracting Provider Registration; enter/select value in 'Funding Source' field. Enter/select value in 'Provider' field. Ensure that 'Performing Provider' field contains only selections applicable to Contracting Provider Registration; select value in 'Performing Provider' field if desired. Enter value in 'Begin Date Of Authorization' and 'End Date Of Authorization' field. Select value in 'Date Of Service' field. Enter/select value in 'Procedure Code' field. Enter value in 'Total Charge' and 'Service Units' field. Enter value in 'Authorization Number' field, or click 'Display Valid Authorizations' button and select Service Authorization applicable to service entry. Ensure that 'Claim Status' field (Approved/Denied/Pending) is populated with value determined by Avatar MSO claim/service adjudication rules and requirements. Ensure that 'Claim Status' field is disabled/read-only, and that 'Claim Status' value/status may not be manually edited following entry of service detail values and/or selection of Service Authorization. Ensure that 'Expected Disbursement' and 'Approved Units' fields are populated with value determined by Avatar MSO claim/service adjudication rules and requirements in conjunction with 'Claim Status'. Enter/select values in any other fields as required/desired. Click 'Add New Item' button to enter additional service(s) as desired; when all desired services have been entered in 'Fast Service Detail' section of form, navigate to 'Fast Service Entry Summary' section of form. Click 'Submit Fast Service Entry' form to file service(s) and create Avatar MSO claims processing batch(es). Claims processing batch(es) created via the 'Fast Service Entry Submission' form where 'Close Batches' field is set to 'No' must be further adjudicated/finalized/closed via Avatar MSO 'Close Batch' form (or 'Close Multiple Batches' form).	Topics • Contracting Provider Registration • NX • Performing Provider • Claims Processing
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 Open the Avatar MSO 'Provider Activity Invoice' form. Select Contracting Provider for Provider Activity Invoice entry/review. Select existing Provider Activity Invoice for review/edit, or click 'Add' button for new Provider Activity Invoice entry. Enter/select values for 'Invoice/Name Description', 'Invoice Date' and 'Provider Invoice Identifier' fields. Navigate to 'Provider Activity Invoice Details' section of form. Click 'Add New Item' button for new Provider Activity entry, or select existing Provider Activity entry/row and click 'Edit Selected Item' button. Select value in 'Funding Source' field. Ensure 'From Date' and 'Through Date' fields are present in 'Provider Activity Invoice' form. 'From Date' field replaces previously existing 'Activity Date' field 'Through Date' field is not required for Provider Activity row/entry Enter/select value for 'From Date' field (and 'Through Date' field if desired). 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. 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. 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). Click 'Display Valid Authorizations' button to display/select associated Provider Activity Authorization. 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). If no applicable Provider Activity Authorization exists, ensure user is presented with dialog noting 'No authorizations are on file which match the entered criteria.' Select Provider Activity Authorization record/row and click 'OK' button. 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). 'Explanation Of Coverage' examples: 'Invalid authorization' 'Activity From Date is before the authorization start date' 'Activity Through Date is after the authorization end date' Select 'Activity Status Reason' field value if desired. Repeat Provider Activity entry/update steps as desired. Click 'Submit' button to file 'Provider Activity Invoice' form with Provider Activity entries. Re-open the Avatar MSO 'Provider Activity Invoice' form (selecting same Contracting Provider/Provider Activity Invoice for review). Navigate to 'Provider Activity Invoice Details' section of form. Select previously entered/updated Provider Activity entry/row and click 'Edit Selected Item' button. Ensure 'From Date' and 'Through Date' field values for selected Provider Activity entry/row (as well as all other field values for selected row). Open Crystal Reports or other SQL reporting tool. 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 Open the Avatar MSO 'Provider Activity Invoice With Override' form. Select Contracting Provider for Provider Activity Invoice entry/review. Select existing Provider Activity Invoice for review/edit, or click 'Add' button for new Provider Activity Invoice entry. Enter/select values for 'Invoice/Name Description', 'Invoice Date' and 'Provider Invoice Identifier' fields. Navigate to 'Provider Activity Invoice Details' section of form. Click 'Add New Item' button for new Provider Activity entry, or select existing Provider Activity entry/row and click 'Edit Selected Item' button. Select value in 'Funding Source' field. Ensure 'From Date' and 'Through Date' fields are present in 'Provider Activity Invoice With Override' form. 'From Date' field replaces previously existing 'Activity Date' field. 'Through Date' field is not required for Provider Activity row/entry. Enter/select value for 'From Date' field (and 'Through Date' field if desired). 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. 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. 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). Click 'Display Valid Authorizations' button to display/select associated Provider Activity Authorization. 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). If no applicable Provider Activity Authorization exists, ensure user is presented with dialog noting 'No authorizations are on file which match the entered criteria.' Select Provider Activity Authorization record/row and click 'OK' button. 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). 'Explanation Of Coverage' examples: 'Invalid authorization' 'Activity From Date is before the authorization start date' 'Activity Through Date is after the authorization end date' 'Activity Status' field value may be manually selected/set in the 'Provider Activity Invoice With Override' form. Select 'Activity Status Reason' field value if desired. Repeat Provider Activity entry/update steps as desired. Click 'Submit' button to file 'Provider Activity Invoice With Override' form with Provider Activity entries. Re-open the Avatar MSO 'Provider Activity Invoice With Override' form (selecting same Contracting Provider/Provider Activity Invoice for review). Navigate to 'Provider Activity Invoice Details' section of form. Select previously entered/updated Provider Activity entry/row and click 'Edit Selected Item' button. Ensure 'From Date' and 'Through Date' field values for selected Provider Activity entry/row (as well as all other field values for selected row). Open Crystal Reports or other SQL reporting tool. 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 16 Summary \| Details Avatar MSO - 835 Healthcare Claim Payment/Advice Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: 835 Health Care Claim Payment/Advice (MSO) Scenario 1: '835 Health Care Claim Payment/Advice' - file sorting Specific Setup: An EOB File exists. Note the contracting provider. Steps Open '835 Health Care Claim Payment/Advice' form. In 'Options' field, select 'Sort File'. Select the 'Contracting Provider'. Select 'Yes' in 'Exclude EOB(s) On Previous 835'. Click 'Process' button. Verify that the 835 outbound file sorting for EOB completes. Click 'Process' button again. Verify that a message is received stating: Previously sorted 835 contains the same EOB(s). Continue sort? Click 'No'. Verify that a message is received stating: Cancelled. Click [OK]. Verify that a message is received stating: Previously sorted 835 contains the same EOB(s). Continue sort? Click 'Yes'. Verify that the 835 outbound file sorting for EOB completes. [Avatar MSO] Service Authorization - Member Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Site Specific Section Modeling (MSO) Admission (Outpatient) CPT Code Definition (MSO) Funding Source Registration Contracting Provider Registration File Import CPT Code Definition (PM) Financial Eligibility Service Codes Scenario 1: File Import - [Avatar MSO] Service Authorization - Member - Add / Edit Specific Setup: Client A: Has a Member Enrollment or Member Specific Information record. Client B: 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 to add a service authorization for both clients, and the 'Type Of Authorization' is not the same for both clients. Steps Open 'File Import'. Select '[Avatar MSO] Service Authorization - Member' in 'File Type'. Select 'Upload New File' in 'Action'. Click [Process Action]. Select the file. Click [Open]. Select 'Compile/Validate File' in 'Action'. Select the file in 'File(s)'. Click [Process Action]. Click [OK]. Select 'Print File' in 'Action'. Select the file in 'File(s)'. Click [Process Action]. Validate the report data. Close the report. Select 'Post File' in 'Action'. Select the file in 'File(s)'. Click [Process Action]. Click [OK]. Open 'Service Authorization' for the Client A. Validate the data, noting the authorization number. Click [Cancel]. Close the form. Open 'Service Authorization' for the Client B. Validate the data, noting the authorization number. Click [Cancel]. Close the form. Create a new batch for one service for the Client A. Using a 'Claims Processing' forms, create a service that will use the imported authorization. Open the 'Member Service Authorization' file and edit the file to include the authorization number for Client A and Client B. Post the edited file through 'File Import', '[Avatar MSO] Service Authorization - Member'. Close the form. Open 'Service Authorization' for the Client A. Validate the data. Click [Cancel]. Close the form. Open 'Service Authorization' for the Client B. Validate the data. Click [Cancel]. Close the form.	Topics • 835 Health Care Claim Payment/Advice • File Import
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 Open Avatar MSO 'CPT Code Definition' form. Verify the 'CPT Service Code' field in form contains the AMA Trademark 'CPT® Codes' label. Verify the following AMA copyright notice is displayed at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.' 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 Open Avatar MSO 'CPT Code Cross Reference' form. Verify the 'CPT Service Code' field in form contains the AMA Trademark 'CPT® Codes' label. Verify the following AMA copyright notice is displayed at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.' 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 Open Avatar MSO 'CPT Code Definition' form. Select 'Add' or 'Edit' action in 'Add/Edit/Delete CPT Code' field. Enter (or search/select) CPT Code Definition to be added (or updated). Ensure the following fields are present in form: 'Minimum Number of Clients in Group' 'Maximum Number of Clients in Group' 'Documentation Time Limit' (dropdown list selection field, including 'Create New' selection) 'Documentation Time Limit' - 'Number of Clients in Group' 'Documentation Time Limit' - 'Maximum Documentation Time (minutes)' 'Documentation Time Limit' - Maximum Travel Time (minutes)' 'File Documentation Time Limit' Button 'Delete Documentation Time Limit' Button 'Use ODS Group Service Calculation' (Yes/No) Ensure fields above are disabled when 'Type of Service' field is set to 'Individual' (or is not defined). Set 'Type of Service' field value to 'Group'. Enter values for 'Minimum Number of Clients in Group' and 'Maximum Number of Clients in Group' fields. 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. Set 'Documentation Time Limit' field value to 'Create New'. Enter values for 'Number of Clients in Group', 'Maximum Documentation Time (minutes)' and 'Maximum Travel Time (minutes)' fields. 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. Click 'File Documentation Time Limit' button. Ensure Documentation Time Limit entry filed is available under 'Documentation Time Limit' dropdown list selection field. 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). Select value for 'Use ODS Group Service Calculation' field. 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'') Click 'File CPT Service Code' button when code entry/edit has been completed. Ensure 'CPT Code Successfully Filed' message dialog is present, and click 'OK' button. Select 'Edit' and open same CPT Service Code record for review. Ensure values filed for 'Minimum Number of Clients in Group' and 'Maximum Number of Clients In Group' fields are present. Ensure Documentation Time Limit entries added/deleted are present/reflected and available for selection in the 'Documentation Time Limit' dropdown list selection field. Ensure value selected/filed for 'Use ODS Group Service Calculation' field is present. Open Crystal Reports or other SQL reporting tool. 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. 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: group_service_code_type ('C') group_service_code (CPT Code) number_of_clients ('Number of Clients in Group') max_doc_time ('Maximum Documentation Time (minutes)') 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 Open Avatar MSO 'Revenue Code Definition' form. Select 'Add' or 'Edit' action in 'Add/Edit/Delete Revenue Code' field. Enter (or search/select) Revenue Code Definition to be added (or updated). Ensure the following fields are present in form: 'Minimum Number of Clients in Group' 'Maximum Number of Clients in Group' 'Documentation Time Limit' (dropdown list selection field, including 'Create New' selection) 'Documentation Time Limit' - 'Number of Clients in Group' 'Documentation Time Limit' - 'Maximum Documentation Time (minutes)' 'Documentation Time Limit' - Maximum Travel Time (minutes)' 'File Documentation Time Limit' Button 'Delete Documentation Time Limit' Button 'Use ODS Group Service Calculation' (Yes/No) Ensure fields above are disabled when 'Type of Service' field is set to 'Individual' (or is not defined). Set 'Type of Service' field value to 'Group'. Enter values for 'Minimum Number of Clients in Group' and 'Maximum Number of Clients in Group' fields. 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. Set 'Documentation Time Limit' field value to 'Create New'. Enter values for 'Number of Clients in Group', 'Maximum Documentation Time (minutes)' and 'Maximum Travel Time (minutes)' fields. 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. Click 'File Documentation Time Limit' button. Ensure Documentation Time Limit entry filed is available under 'Documentation Time Limit' dropdown list selection field. 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). Select value for 'Use ODS Group Service Calculation' field. 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'') Click 'File Revenue Code' button when code entry/edit has been completed. Ensure 'Revenue Code Successfully Filed' message dialog is present, and click 'OK' button. Select 'Edit' and open same Revenue Service Code record for review. Ensure values filed for new 'Minimum Number of Clients in Group' and 'Maximum Number of Clients In Group' fields are present/correct. Ensure Documentation Time Limit entries added/deleted are present/reflected and available for selection in the 'Documentation Time Limit' dropdown list selection field. Ensure value selected/filed for 'Use ODS Group Service Calculation' field is present. Open Crystal Reports or other SQL reporting tool. 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. 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: group_service_code_type ('R') group_service_code (Revenue Code) number_of_clients ('Number of Clients in Group') max_doc_time ('Maximum Documentation Time (minutes)') 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 Open Avatar MSO 'Revenue Code Definition' form. Navigate to 'Import Codes' section of form. Click 'Select Data Import File' button. 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. Click 'Import Codes' button. Navigate to 'Revenue Code Setup' section of form. Set 'Add/Edit/Delete Revenue Code' field to 'Edit'. Select Revenue Code defined in processed import file. 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. Ensure value for 'Use ODS Group Service Calculation' field is correct/same value as in import file. Ensure 'Documentation Time Limit' dropdown list field contains row(s) for each/all Documentation Time Limit combinations defined in import file. Select Documentation Time Limit entry. 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 Open Avatar MSO 'CPT Code Definition' form. Navigate to 'Import Codes' section of form. Click 'Select Data Import File' button. 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. Click 'Import Codes' button. Navigate to 'CPT Service Code' section of form. Set 'Add/Edit/Delete CPT Code' field to 'Edit'. Select CPT Code defined in processed import file. 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. Ensure value for 'Use ODS Group Service Calculation' field is correct/same value as in import file. Ensure 'Documentation Time Limit' dropdown list field contains row(s) for each/all Documentation Time Limit combinations defined in import file. Select Documentation Time Limit entry. 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 Open Avatar MSO 'Claim Processing (CMS 1500)' form (or 'Claim Processing (CMS 1500) With Override' form). Select claims processing batch for service entry/edit. Open existing claim or create new claim for service entry/edit. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form. Navigate to 'Service Detail' section of form. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button). Enter/select 'Date of Service' field value. Enter/select 'Procedure Code' field value. Enter or edit 'Number Of Clients In Group' field value. 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. 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. 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. Enter or edit 'Client Documentation Time' field value. 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. 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. Enter or edit 'Travel Time' field value. 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. 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 Open Avatar MSO 'Claim Processing (UB-04)' form (or 'Claim Processing (CMS UB-04) With Override' form). Select claims processing batch for service entry/edit. Open existing claim or create new claim for service entry/edit. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form. Navigate to 'Service Detail' section of form. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button). Enter/select 'Date of Service' field value. Enter/select 'Revenue Code' field value. Enter or edit 'Number Of Clients In Group' field value. 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. 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. 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. Enter or edit 'Client Documentation Time' field value. 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. 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. Enter or edit 'Travel Time' field value. 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. 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 Open Avatar MSO 'Fast Service Entry' form (or 'Fast Service Entry Submission' form). Navigate to 'Fast Service Detail' section of form. Click 'Add New Item' button to enter new service. Enter/select value for 'Member Name or ID', 'Provider' and 'Funding Source' fields. Enter/select 'Date of Service' field value. Enter/select 'Procedure Code' field value. Enter 'Number In Group' field value. 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. 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. 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. Enter 'Client Documentation Time' value. 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. 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. Enter or edit 'Travel Time' field value. 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. 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 Open 'Registry Settings' form. Enter search value 'ODS Group Service' and click 'View Registry Settings' button. Ensure Registry Setting 'Start Date for 'Use ODS Group Service Calculation'' is returned (under 'Avatar MSO-> Claims Processing' path). Ensure Registry Setting 'Start Date for 'Use ODS Group Service Calculation' is blank/not defined by default on update installation. 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 Open Avatar MSO 'Claim Processing (CMS 1500)' form (or 'Claim Processing (CMS 1500) With Override' form). Select claims processing batch for service entry/edit. Open existing claim or create new claim for service entry/edit. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form. Navigate to 'Service Detail' section of form. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button). Enter/select 'Date of Service' field value. Enter/select 'Procedure Code' field value. Enter 'Units' and 'Duration' field values. 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': 'Number of Clients In Group' 'Number of Counselors In Group' 'Client Documentation Time' 'Travel Time' (conditionally enabled - see information below) Enter or edit 'Number Of Clients In Group' field value. Enter or edit 'Number of Counselors In Group' field value. Enter or edit 'Client Documentation Time' field value. 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). 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''. 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''. Enter or edit 'Travel Time' field value (if field enabled). 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): '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 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value) Example: 'Duration Per Unit' from CPT Code Definition = '1' 'Service Units' entered for service = '90' (representing a 90 minute service) 'Number Of Clients In Group' entered for service = '10' 'Client Documentation Time' entered for service = '30' Service Fee Amount from Provider Fee Definition = '50' (((1 x 90) + 30) / 10 ) / 1 = 12 'Group Service Units' = 12 (12) x (50) = 600 'Total Charge' = 600 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: '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 '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 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value) Example: 'Duration Per Unit' from CPT Code Definition = '1' 'Service Units' entered for service = '90' (representing a 90 minute service) 'Number Of Clients In Group' entered for service = '10' 'Client Documentation Time' entered for service = '10' 'Travel Time' entered for service = '25' Service Fee Amount from Provider Fee Definition = '50' (((1 x 90) + 25) / 10) + 10) / 1 = 21.5 'Group Service Units' = 21.5 (((1 x 90) + 25) / 10) / 1 = 11.5 'Group Service Units Per Day' = 11.5 (21.5) x (50) = 1075 'Total Charge' = 1,075 Enter/select any other Claim/Service field values as required/desired. Click 'Submit' button to file 'Claim Processing (CMS 1500)' form (or 'Claim Processing (CMS 1500) With Override' form). Open Crystal Reports or other SQL reporting tool. 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): 'number_in_group' ('Number of Clients In Group') 'num_counselor_in_group' ('Number of Counselors In Group') 'documentation_time' ('Client Documentation Time') 'travel_time' ('Travel Time') 'group_service_units' ('Group Service Units') '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 Open Avatar MSO 'Claim Processing (UB-04)' form (or 'Claim Processing (UB-04) With Override' form). Select claims processing batch for service entry/edit. Open existing claim or create new claim for service entry/edit. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form. Navigate to 'Service Detail' section of form. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button). Enter/select 'Date of Service' field value. Enter/select 'Procedure Code' field value. Enter 'Units' and 'Duration' field values. Enter or edit 'Number Of Clients In Group' field value. 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': 'Number of Clients In Group' 'Number of Counselors In Group' 'Client Documentation Time' 'Travel Time' (conditionally enabled - see information below) Enter or edit 'Number Of Clients In Group' field value. Enter or edit 'Number of Counselors In Group' field value. Enter or edit 'Client Documentation Time' field value. 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). 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''. 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''. Enter or edit 'Travel Time' field value (if field enabled). 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): '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 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value) Example: 'Duration Per Unit' from Revenue Code Definition = '1' 'Service Units' entered for service = '90' (representing a 90 minute service) 'Number Of Clients In Group' entered for service = '10' 'Client Documentation Time' entered for service = '30' Service Fee Amount from Provider Fee Definition = '50' (((1 x 90) + 30) / 10 ) / 1 = 12 'Group Service Units' = 12 (12) x (50) = 600 'Total Charge' = 600 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: '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 '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 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value) Example: 'Duration Per Unit' from Revenue Code Definition = '1' 'Service Units' entered for service = '90' (representing a 90 minute service) 'Number Of Clients In Group' entered for service = '10' 'Client Documentation Time' entered for service = '10' 'Travel Time' entered for service = '25' Service Fee Amount from Provider Fee Definition = '50' (((1 x 90) + 25) / 10) + 10) / 1 = 21.5 'Group Service Units' = 21.5 (((1 x 90) + 25) / 10) / 1 = 11.5 'Group Service Units Per Day' = 11.5 (21.5) x (50) = 1075 'Total Charge' = 1,075 Enter/select any other Claim/Service field values as required/desired. Click 'Submit' button to file 'Claim Processing (UB-04)' form (or 'Claim Processing (UB-04) With Override' form). Open Crystal Reports or other SQL reporting tool. 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): 'number_in_group' ('Number of Clients In Group') 'num_counselor_in_group' ('Number of Counselors In Group') 'documentation_time' ('Client Documentation Time') 'travel_time' ('Travel Time') 'group_service_units' ('Group Service Units') '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 Open Avatar MSO 'Fast Service Entry' form (or 'Fast Service Entry Submission' form). Navigate to 'Fast Service Detail' section of form. Click 'Add New Item' button to enter new service. Enter/select value for 'Member Name or ID', 'Provider' and 'Funding Source' fields. Enter/select 'Date of Service' field value. Enter/select 'Procedure Code' field value. Enter 'Units' and 'Duration' field values. 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': 'Number of Clients In Group' 'Number of Counselors In Group' 'Client Documentation Time' 'Travel Time' (conditionally enabled - see information below) Enter or edit 'Number Of Clients In Group' field value. Enter or edit 'Number of Counselors In Group' field value. Enter or edit 'Client Documentation Time' field value. 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). 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''. 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''. Enter or edit 'Travel Time' field value (if field enabled). 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): '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 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value) Example: 'Duration Per Unit' from CPT Code Definition = '1' 'Service Units' entered for service = '90' (representing a 90 minute service) 'Number Of Clients In Group' entered for service = '10' 'Client Documentation Time' entered for service = '30' Service Fee Amount from Provider Fee Definition = '50' (((1 x 90) + 30) / 10 ) / 1 = 12 'Group Service Units' = 12 (12) x (50) = 600 'Total Charge' = 600 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: '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 '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 'Total Charge' = ('Group Service Units' calculated value) x (Applicable Provider Fee Definition 'Amount' value) Example: 'Duration Per Unit' from CPT Code Definition = '1' 'Service Units' entered for service = '90' (representing a 90 minute service) 'Number Of Clients In Group' entered for service = '10' 'Client Documentation Time' entered for service = '10' 'Travel Time' entered for service = '25' Service Fee Amount from Provider Fee Definition = '50' (((1 x 90) + 25) / 10) + 10) / 1 = 21.5 'Group Service Units' = 21.5 (((1 x 90) + 25) / 10) / 1 = 11.5 'Group Service Units Per Day' = 11.5 (21.5) x (50) = 1075 'Total Charge' = 1,075 Enter/select any other Claim/Service field values as required/desired. Repeat service entry steps for additional services as desired. Navigate to 'Fast Service Entry Summary' section of form (main section). Click 'Submit Fast Service Entry' button to file 'Fast Service Entry' form (or 'Fast Service Entry Submission' form). Open Crystal Reports or other SQL reporting tool. 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): 'number_in_group' ('Number of Clients In Group') 'num_counselor_in_group' ('Number of Counselors In Group') 'documentation_time' ('Client Documentation Time') 'travel_time' ('Travel Time') 'group_service_units' ('Group Service Units') '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 Open 'Registry Settings' form. Enter search value 'Client And Counselor Groups' and click 'View Registry Settings' button. Ensure Registry Setting 'Enable Client and Counselor Groups In Service Entry' is returned (under 'Avatar MSO-> Claims Processing' path). 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 Open one or more of the following Avatar MSO forms: 'Provider Fee Definition' 'Copy Provider Fee Definition' 'Service Authorization' 'Contracting Provider Service Authorization' 'Funding Source Service Authorization' 'Automatic Authorization Approval Setup' 'MSO to Parent System Integration Mapping' 'Set Associated Codes' ('CPT Codes' section) 'Contracting Provider Registration' ('837 Defaults' section) 'Plan Definition' ('Plan Coverage Definition' section) 'Claim Processing (CMS 1500)' ('Service Detail' section) 'Claim Processing with Override(CMS 1500)' ('Service Detail' section) 'Claim Processing (UB04)' ('Service Detail' section) 'Claim Processing with Override (UB04)' ('Service Detail' section) 'Fast Service Entry' ('Fast Service Detail' section) 'Fast Service Entry Submission' ('Fast Service Detail' section) Verify the first instance of 'CPT Service Code'/'CPT Code' field in form contains the AMA Trademark 'CPT® Codes' label. Verify the following AMA copyright notice is displayed at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.' 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 Open the 'All Documents' widget for Client A. Select the 'Assign MSO Care Manager' form. Validate that the 'Form Description' is 'Assign MSO Care Manager'. Validate that there is one row. Select the 'Service Authorization Request' form. Validate that there zero rows. Select the 'Service Authorization' form. Validate that the 'Form Description' is 'Service Authorization'. Validate that there is one row. Return to homeview. Open 'Registry Settings'. Set 'Avatar MSO->Care Management->Service Authorization->->->Require Care Manager Assignment' to 'N', Click [Submit]. Click [No]. Select Client B. Open 'Service Authorization Request'. Create a request record with no 'Care Manager' data'. Submit the form. Close the form. Open 'Service Authorization'. Edit the 'Service Authorization Request' created above. Select 'Approved' in 'Current Authorization Status'. Enter the number of 'Units Authorized'. Validate the 'Estimated Liability' contains a value. Validate that there is no 'Care Manager' data. Submit the form. Close the form. Open the 'All Documents' widget for Client B. Select the 'Assign MSO Care Manager' form. Validate that there are no rows. Select the 'Service Authorization Request' form. Validate that there are no rows. Select the 'Service Authorization' form. Validate that the 'Form Description' is 'Service Authorization'. Validate that there is one row. Return to homeview.	Topics • Service Authorizations • Widgets
Update 25 Summary \| Details Client Merge - Service Authorization - AUTuniqueid Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Admission (Outpatient) Financial Eligibility Scenario 1: Client Merge - With Service Authorization Records - Verify 'AUTuniqueid' Specific Setup: Two clients exist in programs that can be merged: Client A & Client B. The admission dates are not the same. The programs are not the same. Both clients have ‘Service Authorization’ records that begin/end on different dates. Note the authorization numbers and the authorization status. Registry Settings: Avatar MSO->Care Management->Service Authorization->->->Enable Eligibility Check This setting, along with, 'Funding Source/Guarantor Mapping' can affect the 'Current Authorization Status' of the 'Service Authorization' record after the merge. Steps Open ‘Client Merge’. Select Client A as the ‘Source Client’. Select Client B as the ‘Target Client’. Select ‘Yes’ in Merge All Client Data Through Single Filling. Click [File]. Click [Yes]. Click [OK]. Close the form. Open ‘Service Authorization’ for Client B’. Validate that the previously noted authorization numbers exist on the pre-display form. Note the ‘Authorization Status’. If the status is not the same as in Setup, review 'Funding Source/Guarantor Mapping' for the funding source to verify that the status is correct. If desired, click [Edit] on desired rows and review the data. Create an SQL query of the ‘SYSTEM.service_auth_svc' table for Client B. Create an SQL query of the 'SYSTEM.service_auth_detail' table for Client B. Compare the values of the two tables to validate that they match after the merge. Foster Home Registration Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Contracting Provider Registration Foster Home Registration Dictionary Update (MSO) Contracting Provider Termination Scenario 1: 'Foster Home Registration' - Form Verification Specific Setup: Avatar Foster Care Module must be installed in the Avatar MSO system. Contracting Provider with no 'Foster Home Registration' exists. Steps Open the 'Foster Home Registration' form. Enter the Contracting Provider in the search field. Select the desired search result. Click [Add]. Enter desired values in all required fields. Optionally, enter desired values in all non-required fields. Select the ‘Requirements’ section. Click [Add New Item]. Enter desired values in desired fields. Click [Submit]. Click [No] on ‘Pre-Display Confirmation’. Open the 'Foster Home Registration' form. Enter the Contracting Provider in the search field. Select the desired search result. Select the record. Click [Edit]. Edit any desired field(s). Click [Submit]. Click [Yes] on ‘Pre-Display Confirmation’. Select the record. Click [Edit]. Validate the edited data. Close the form. Scenario 2: 'Foster Home Registration' - Verification of Multiple Registration Date/Record Entries Specific Setup: Avatar Foster Care Module must be installed in the Avatar MSO system. Contracting Provider with no 'Foster Home Registration' exists. Steps Open the 'Foster Home Registration' form. Enter the Contracting Provider in the search field. Select the desired search result. Click [Add]. Enter desired values in all required fields. Optionally, enter desired values in all non-required fields. Select the ‘Requirements’ section. Click [Add New Item]. Enter desired values in desired fields. Click [Submit]. Click [No] on ‘Pre-Display Confirmation’. Open the 'Foster Home Registration' form. Enter the Contracting Provider in the search field. Select the desired search result. Select the record. Click [Edit]. Edit any desired field(s). Click [Submit]. Click [Yes] on ‘Pre-Display Confirmation’. Select the record. Click [Edit]. Validate the edited data. Close the form. Terminate the record in 'Contracting Provider Termination', noting the termination date. Open the 'Foster Home Registration' form. Enter the Contracting Provider in the search field. Select the desired search result. Click [Add]. Enter desired values in all required fields. Click [Submit]. Click [Yes] on ‘Pre-Display Confirmation’. Validate there are two records, and the first one has the termination date in ‘Termination’. Select the first record. Click [Cancel]. Verify that the form closed. Open the 'Foster Home Registration' form. Enter the Contracting Provider in the search field. Select the desired search result. Select the first record. Click [Delete]. Click [No] in ‘Confirm Close’. Validate that ‘Confirm Close’ clears. Click [Delete]. Click [Yes] in ‘Confirm Close’. Validate that ‘Provider Registration Deletion’ displays. Click [Cancel]. Validate ‘Pre-Display’ displays. Click [OK]. Click [Delete]. Click [Yes] in ‘Confirm Close’. Validate that ‘Provider Registration Deletion’ displays. Click [OK]. Validate that the row record was deleted. Close the form.	Topics • Client Merge • NX • Service Authorizations • Foster Care
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 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 Open 'Placement Disruption' for the client. Enter a date in 'Disruption Start Date'. Select desired value in 'Reason For Disruption'. Optionally enter value in non-required fields. Click [Submit]. Query the SYSTEM.placement_disruption table in the MSO namespace and validate the data submitted in the 'Placement Disruption' form. Query the SYSTEM.placement_disruption table in the Cal-PM namespace and validate the data submitted in the 'Placement Disruption' form. Open 'Placement Disruption' for the client. Edit the record to add a ''Disruption End Date' and any other desired optional fields. Click [Submit]. Query the SYSTEM.placement_disruption table in the MSO namespace and validate the edited data submitted in the 'Placement Disruption' form. 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
Update 32 Summary \| Details Claim Processing Blackout Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Admission (Outpatient) Claim Processing Blackout Claim Processing (CMS 1500) Scenario 1: Claim Processing Blackout Specific Setup: Client: Identify a client that has a valid Service Authorization record. Note the Client, Provider, Funding Source, and Authorization Number. Claim Processing Blackout: Add a blackout entry, noting the value selected in the following fields (if used): Blackout Start Date, Blackout End Date, Client, Provider, Funding Source, and Authorization. Batch Creation is used to create a new batch, Note the number. Claim Processing (CMS 1500) or Claim Processing (UB-04) is used to create a date of service that is within the Blackout Start Date and Blackout End Date. Validate that the claim is denied due to the blackout. Close Batch is used to close the batch. Steps Open ‘Claim Processing Blackout’. Select ‘Add’ in ‘Add/Edit/Delete’. Create an entry that will overlap the entry created in setup. Validate that following message is displayed: Blackout cannot be filed because it overlaps with an existing blackout record for the same entities. Click [OK]. Change the entries so that there is no overlap. Click [Submit]. Click [Yes] to remain in the form. Select ‘Edit’ in ‘Add/Edit/Delete’. Select the ‘Blackout Record’ that was just created. Edit any field. Click [Submit]. Click [Yes] to remain in the form. Select ‘Edit’ in ‘Add/Edit/Delete’. Select the ‘Blackout Record’ that was just edited. Validate that the data that was changed was retained. Select ‘Delete’ in ‘Add/Edit/Delete’. Select the ‘Blackout Record’ that was created in setup. Validate that the claim that was denied displays in ‘Previously Denied Services For Retro Adjudication’. Select the claim. Select the desired ‘Adjustment Code’. Click [Submit]. Validate that following message is displayed: There are services selected for retro adjudication. Are you sure you want to continue? Click [Yes]. Click [Yes] to remain in the form. Select ‘Edit’ in ‘Add/Edit/Delete’. Validate that the deleted ‘Blackout Record’ is no longer displayed in the ‘Blackout Record’ field. Close the form.	Topics • Claims Processing • NX
Update 33 Summary \| Details Avatar MSO/ProviderConnect Claims Pre-Adjudication Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Billing - Bill Generation section Billing - Unsubmitted Bill View Bill Pre-adjudication Results Scenario 1: Avatar MSO 'Claims Pre-Adjudication' - Processing/Transmission of Pre-Adjudication Information to ProviderConnect Specific Setup: Netsmart ProviderConnect (or other application utilizing the Avatar MSO 'Claim Pre-Adjudication' web service/process) Client record eligible for Claim/Service entry in Avatar MSO and Netsmart ProviderConnect Claims Pre-Adjudication Submission data submitted via Netsmart ProviderConnect to be Pre-Adjudicated automatically by Avatar MSO background process Steps Enter one or more services via Netsmart ProviderConnect 'Treatment' service entry. Navigate to ProviderConnect 'Billing' menu. Click 'Generate Bill' button for selected criteria. Click 'Click 'Submit Bill for Pre-adjudication' button for ProviderConnect billing transaction. 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. Within 'Unsubmitted Bills' section of ProviderConnect 'Billing' menu, navigate to bill created above which was submitted for Pre-Adjudication. Click 'View Pre-adjudication Results' button for unsubmitted bill. 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).) 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.)	Topics • Claims Processing