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Avatar MSO 2022 Quarterly Release 2022.04 Acceptance Tests

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Update 23 Summary | Details
Avatar MSO 'Claim Acknowledgement (277CA) File' Service Line Information
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Claim Acknowledgement (277CA) File
  • Claim Acknowledgement (277CA) File - Report
Scenario 1: 'Claim Acknowledgement (277CA) File' - Verification of Claim Acknowledgement File Creation
Specific Setup:
  • File path for 277CA Claim Acknowledgement file creation must be defined in the 'Output Directory' field for system (via Avatar MSO 'Set System Defaults' or 'Import/Export File Configuration' form)
  • 277CA Claim Acknowledgment file may optionally be enabled for automatic generation (via Avatar MSO 'Import/Export File Configuration' form)
  • 837 Professional and/or Institutional format inbound file(s) for compilation/posting
Steps
  1. Using Avatar MSO '837 Health Care Claim Professional' and/or '837 Health Care Claim Institutional' forms (or via Avatar MSO automated 837 file processing), load/compile/post inbound 837 file(s).
  2. Open the Avatar MSO 'Claim Acknowledgement (277CA) File' form.
  3. 277CA file generation/content review may also be confirmed directly in system output directory where automatic 277CA file generation is enabled
  4. Select 'Create File On Server' in 'Options' field.
  5. Select 'Submission Type' field value ('Institutional' or 'Professional').
  6. Select 837 file for Claim Acknowledgement (277CA) file creation.
  7. Click 'Process' button.
  8. Ensure that for selected 837 file, Claim Acknowledgement (277CA) file is created on server in defined directory.
  9. This may be confirmed via the 'Claim Acknowledgement (277CA) File' form 'Run Report' or 'Dump File' options, and/or by reviewing files in 277CA output directory
  10. Select 'Dump File' in 'Options' field.
  11. Select 'Submission Type' field value ('Institutional' or 'Professional').
  12. Select 837 file for Claim Acknowledgement (277CA) file review.
  13. Click 'Process' button.
  14. 277CA file content review may also be confirmed directly in system output directory by opening/reviewing file(s)
  15. In 277CA Claim Acknowledgement file(s) for successfully processed 837 Professional and/or Institutional inbound files, ensure that Submitter/Provider acceptance levels (2200B/2200C Status Information) are reported with accepted/rejected status.
  16. Examples:
  17. STC*A1:19:40*20221005*WQ*2000~
  18. STC*A7:478*20221005*U*1500~
  19. In 277CA Claim Acknowledgement file(s) for successfully processed 837 Professional and/or Institutional inbound files, ensure that Accepted Amount (2200B/2200C Total Accepted Amount) is reported with total amount for successfully compiled/posted claims/service(s).
  20. Example:
  21. AMT*YU*700~
  22. In 277CA Claim Acknowledgement file(s) for successfully processed 837 Professional and/or Institutional inbound files, ensure that Rejected Amount (2200B/2200C Total Rejected Amount) is reported with total amount for rejected claims/service(s).
  23. Example:
  24. AMT*YY*1300~
  25. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims, ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Accepted', 'Rejected' or 'Acknowledged' status.
  26. Examples:
  27. STC*A2:20**WQ*180~
  28. STC*A2:20*20220516*WQ*60~
  29. STC*A7:0**U~
  30. STC*A5:0*20221005*U*500~
Scenario 2: 'Claim Acknowledgement (277CA) File' - Verification of Claim Acknowledgement File Service Line Information
Specific Setup:
  • File path for 277CA Claim Acknowledgement file creation must be defined in the 'Output Directory' field for system (via Avatar MSO 'Set System Defaults' or 'Import/Export File Configuration' form)
  • 277CA Claim Acknowledgment file may optionally be enabled for automatic generation (via Avatar MSO 'Import/Export File Configuration' form)
  • 837 Professional and/or Institutional format inbound file(s) for compilation/posting
  • Crystal Reports or other SQL reporting tool
Steps
  1. Using Avatar MSO '837 Health Care Claim Professional' and/or '837 Health Care Claim Institutional' forms (or via Avatar MSO automated 837 file processing), load/compile/post inbound 837 file(s).
  2. Open the Avatar MSO 'Claim Acknowledgement (277CA) File' form.
  3. 277CA file generation/content review may also be confirmed directly in system output directory where automatic 277CA file generation is enabled
  4. Select 'Create File On Server' in 'Options' field.
  5. Select 'Submission Type' field value ('Institutional' or 'Professional').
  6. Select 837 file for Claim Acknowledgement (277CA) file creation.
  7. Click 'Process' button.
  8. Ensure that for selected 837 file, Claim Acknowledgement (277CA) file is created on server in defined directory.
  9. This may be confirmed via the 'Claim Acknowledgement (277CA) File' form 'Run Report' or 'Dump File' options, and/or by reviewing files in 277CA output directory
  10. Select 'Dump File' in 'Options' field.
  11. Select 'Submission Type' field value ('Institutional' or 'Professional').
  12. Select 837 file for Claim Acknowledgement (277CA) file review.
  13. Click 'Process' button.
  14. 277CA file content review may also be confirmed directly in system output directory by opening/reviewing file(s).
  15. Note - Claim/Service Detail information detailed below applies to 277CA files processed subsequent to installation of Avatar MSO 2022 Update 23
  16. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all services within claim are accepted by Avatar MSO, ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Accepted' status (A2).
  17. Example:
  18. STC*A2:20*20221005*WQ*500~
  19. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all services within claim are rejected by Avatar MSO, ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Rejected' status (A7).
  20. Example:
  21. STC*A7:21*20221005*U*500******A7:454~
  22. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where services within claim are both accepted and rejected by Avatar MSO (split claims), ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Acknowledged' status (A5).
  23. Example:
  24. STC*A5:0*20221005*U*500~
  25. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all services within claim are accepted by Avatar MSO, ensure that Service level acceptance information (2220D Service Line Information/Service Line Level Status Information/Service Line Item Identification/Service Line Date) is not included/reported.
  26. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Information (2220D SVC) is included/reported for each individual service line within claim (for all services, accepted and rejected).
  27. Examples:
  28. SVC*HC:H0004*100*****210~
  29. SVC*NU:910*54*****8~
  30. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Level Status Information (2220D STC) is included/reported with 'Accepted' or 'Rejected' status (A2/A7) for individual service line (for all services, accepted and rejected).
  31. Examples:
  32. STC*A2:20**WQ~
  33. STC*A7:21**U*******A7:455~
  34. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Item Identification (2220D REF) is included/reported for individual service line.
  35. If 2400 Service Line Item Reference Number (2400 REF) is included in inbound 837 Professional/Institutional claim/service information, this reference number will be reported in 277CA file 2220D REF Service Line Item Identification segment.
  36. If 2400 Service Line Item Reference Number (2400 REF) is not included in inbound 837 Professional/Institutional claim/service information, the line sequence number (2400 LX) for the service line within claim will be reported in 277CA file 2220D REF Service Line Item Identification segment
  37. Examples:
  38. REF*FJ*CX74X66110.003~
  39. REF*FJ*3~
  40. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Date (2220D DTP) is included/reported for individual service line.
  41. Examples:
  42. DTP*472*D8*20220915~
  43. DTP*472*RD8*20220915-20220920~
  44. Open Crystal Reports or other SQL reporting tool.
  45. In Avatar MSO SQL table 'SYSTEM.clm_status_provider', ensure provider level claim information is present for processed 837 inbound files.
  46. In Avatar MSO SQL table 'SYSTEM.clm_status_receiver', ensure receiver/submitter level claim information is present for processed 837 inbound files.
  47. In Avatar MSO SQL table 'SYSTEM.svc_status_resp', ensure claim/service level information is present for processed 837 inbound files.

For more information on 277CA Acceptance/Acknowledgement/Rejection information and values, please refer to Avatar_MSO_277CA_Mapping_v5010_102022.xls document

Avatar MSO 'Claim Acknowledgement (277CA) File' Report
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Claim Acknowledgement (277CA) File
  • Claim Acknowledgement (277CA) File - Report
Scenario 1: 'Claim Acknowledgement (277CA) File' - 277CA File Report Verification
Specific Setup:
  • Compiled and/or Posted 837 Professional and/or Institutional format inbound file(s)
  • 277CA Claim Acknowledgment file may optionally be enabled for automatic generation (via Avatar MSO 'Import/Export File Configuration' form)
Steps
  1. Using Avatar MSO '837 Health Care Claim Professional' and/or '837 Health Care Claim Institutional' forms (or via Avatar MSO automated 837 file processing), load/compile/post inbound 837 file(s).
  2. Open the Avatar MSO 'Claim Acknowledgement (277CA) File' form.
  3. Select 'Run Report' in 'Options' field.
  4. Select 'Submission Type' field value ('Institutional' or 'Professional').
  5. Select 837 file for Claim Acknowledgement (277CA) Report review.
  6. Click 'Process' button.
  7. Click 'Claim Status Details' link to view 277CA Claim Acknowledgement Report information.
  8. Note - Claim/Service Detail report information detailed below applies to 277CA files processed subsequent to installation of Avatar MSO 2022 Update 23
  9. In 277CA Claim Acknowledgement Report for successfully processed 837 Professional and/or Institutional inbound files, ensure that Submitter ID/Provider ID 'Status' fields display 'ACCEPTED', 'REJECTED' or 'ACKNOWLEDGED' status for submitter/provider level.
  10. 'ACCEPTED' will be reported for Submitter ID/Provider ID accepted/successfully processed, where all claims/services are fully accepted/fully rejected by Avatar MSO
  11. 'REJECTED' (or rejection Status Category Code/Status Code) will be reported for Submitter ID/Provider ID rejected by Avatar MSO (and no claims accepted/processed)
  12. 'ACKNOWLEDGED' will be reported for Submitter ID/Provider ID accepted/successfully processed, where claims include services both accepted and rejected by Avatar MSO
  13. In 277CA Claim Acknowledgement Report for successfully processed 837 Professional and/or Institutional inbound files, ensure that the following 'Claims...' count fields display values for Submitter ID/Provider ID claims processed:
  14. 'Claims Accepted'
  15. Count of 837 Professional and/or Institutional inbound claims where all services within claim are accepted by Avatar MSO
  16. 'Claims Rejected'
  17. Count of 837 Professional and/or Institutional inbound claims where all services within claim are rejected by Avatar MSO
  18. 'Claims Split'
  19. Count of 837 Professional and/or Institutional inbound claims where services within claim are both accepted and rejected by Avatar MSO
  20. In 277CA Claim Acknowledgement Report for successfully processed 837 Professional and/or Institutional inbound files, ensure that 'Total Accepted Charges' field displays sum of charges for 837 Professional and/or Institutional inbound services accepted by Avatar MSO.
  21. In 277CA Claim Acknowledgement Report for successfully processed 837 Professional and/or Institutional inbound files, ensure that 'Total Rejected Charges' field displays sum of charges for 837 Professional and/or Institutional inbound services rejected by Avatar MSO.
  22. Ensure service details section of 277CA Claim Acknowledgement Report 'Claim Status Details' display includes all successfully processed Accepted/Rejected/Acknowledged (split claim) services, with the following information:
  23. 'Policy Number'
  24. 'Patient Name'
  25. 'Service Date (From-Thru)'
  26. 'Charges'
  27. 'Status' (Status Category Code/Status Code)
  28. Ensure final page in 277CA Claim Acknowledgement Report 'Claim Status Details' display includes listing of all Claim Acknowledgement Status Code values and descriptions related to claims/services in report information.
Topics
• 837 Health Care Claim Professional • Claims Processing • 837 Health Care Claim Institutional • Claim Acknowledgement (277CA) • Reports
Update 24 Summary | Details
Avatar MSO 'Functional Acknowledgement File' Deletion
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Functional Acknowledgement File
Scenario 1: 'Functional Acknowledgement File' (999) - Verification of 837/999 File Deletion
Specific Setup:
  • File path for Functional Acknowledgement 999 file creation must be defined in the 'Output Directory' field for system (via Avatar MSO 'Set System Defaults' or 'Import/Export File Configuration' form)
  • Functional Acknowledgment 999 file may optionally be enabled for automatic generation (via Avatar MSO 'Import/Export File Configuration' form)
  • 837 Professional and/or Institutional format inbound file(s) for loading/compilation
Steps
  1. Open Avatar MSO '837 Health Care Claim Professional' and/or '837 Health Care Claim Institutional' form.
  2. Acceptance testing may also be confirmed via Avatar MSO automated 837 file processing
  3. Select 'Load File' in 'Options' field, and enter 'File Path\Name' value for file to be loaded.
  4. Click 'Process' button to load 837 Professional/837 Institutional file.
  5. Optionally, select 'Compile File' in 'Options' field, and select loaded 837 file to be compiled.
  6. Click 'Process' button to compile 837 Professional/837 Institutional file.
  7. Open Avatar MSO 'Functional Acknowledgement File' form.
  8. Functional Acknowledgement 999 file generation review may also be confirmed directly in system output directory where automatic 999 file generation is enabled
  9. Select 'Create File On Server' in 'Options' field.
  10. Select 'Submission Type' field value ('Institutional' or 'Professional').
  11. Select 837 file for Functional Acknowledgement 999 file creation in 'Select 837 File' field.
  12. Click 'Process' button.
  13. Ensure that for selected 837 file, Functional Acknowledgement 999 file is created on server in defined directory.
  14. This may be confirmed via the 'Functional Acknowledgement File' form 'Run Report' or 'Dump File' options, and/or by reviewing files in 999 output directory
  15. Open Avatar MSO '837 Health Care Claim Professional' and/or '837 Health Care Claim Institutional' form.
  16. Select 'Delete Loaded/Compiled File' in 'Options' field, and select loaded/compiled 837 file to be deleted.
  17. Click 'Process' button to delete 837 Professional/837 Institutional file.
  18. Open Avatar MSO 'Functional Acknowledgement File' form.
  19. Select 'Create File On Server' in 'Options' field.
  20. Select 'Submission Type' field value ('Institutional' or 'Professional').
  21. Ensure that loaded/compiled and subsequently deleted 837 files are not present in 'Select 837 File' field for Functional Acknowledgement 999 file creation.
  22. Select 'Delete File' in 'Options' field.
  23. Select 'Submission Type' field value ('Institutional' or 'Professional').
  24. Select loaded/compiled 837 file for Functional Acknowledgement 999 file deletion in 'Select 837 File' field.
  25. Click 'Process' button.
  26. Select 'Create File On Server' in 'Options' field.
  27. Select 'Submission Type' field value ('Institutional' or 'Professional').
  28. Ensure that loaded/compiled 837 files where Functional Acknowledgement 999 file is directly deleted via 'Functional Acknowledgement File' form are not present in 'Select 837 File' field for file creation.
Topics
• 837 Health Care Claim Professional • Functional Acknowledgement (999) File • 837 Health Care Claim Institutional
Update 26 Summary | Details
Avatar MSO 'Enable Service Times' Registry Setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CPT Code Definition (MSO)
  • Claim Processing (CMS 1500)
  • Claim Processing with Override (CMS 1500)
  • Claim Processing (UB-04)
  • Claim Processing with Override (UB-04)
  • Revenue Code Definition (MSO)
  • Fast Service Entry Submission
  • Fast Service Entry
Scenario 1: 'Claim Processing (CMS 1500)' - Verification Of Service Time Fields
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Service Times' must be enabled
  • CPT Code Definition where 'Require Service Time' is set to 'Yes' (via Avatar MSO 'CPT Code Definition' form)
  • Client record(s) valid for Service Entry/Claim Processing
Steps
  1. Open Avatar MSO 'Claim Processing (CMS 1500)' form (or 'Claim Processing (CMS 1500) With Override' form).
  2. Select claims processing batch for service entry/edit.
  3. Open existing claim or create new claim for service entry/edit.
  4. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form.
  5. Navigate to 'Service Detail' section of form.
  6. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button).
  7. Enter/select 'Date of Service' field value.
  8. Enter/select 'Procedure Code' field value.
  9. If 'Require Service Time' is set to 'Yes' for CPT Code entered/selected in 'Procedure Code' field, ensure that 'Service Start Time' and 'Service End Time' fields are enabled and required in form.
  10. If 'Require Service Time' is set to 'No' for CPT Code entered/selected in 'Procedure Code' field (or no value is defined), ensure that 'Service Start Time' and 'Service End Time' fields are disabled (and not required in form).
  11. Enter/select values for all required/desired fields in form (including 'Service Start Time' and 'Service End Time' fields if applicable).
  12. Click 'Submit' button to file 'Claim Processing (CMS 1500)' form (or 'Claim Processing (CMS 1500) With Override' form).
Scenario 2: 'Claim Processing (UB-04)' - Verification Of Service Time Fields
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Service Times' must be enabled
  • Revenue Code Definition where 'Require Service Time' is set to 'Yes' (via Avatar MSO 'Revenue Code Definition' form)
  • Client record(s) valid for Service Entry/Claim Processing
Steps
  1. Open Avatar MSO 'Claim Processing (UB-04)' form (or 'Claim Processing (UB-04) With Override' form).
  2. Select claims processing batch for service entry/edit.
  3. Open existing claim or create new claim for service entry/edit.
  4. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form.
  5. Navigate to 'Service Detail' section of form.
  6. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button).
  7. Enter/select 'Date of Service' field value.
  8. Enter/select 'Revenue Code' field value.
  9. If 'Require Service Time' is set to 'Yes' for Revenue Code entered/selected in 'Revenue Code' field, ensure that 'Service Start Time' and 'Service End Time' fields are enabled and required in form.
  10. If 'Require Service Time' is set to 'No' for Revenue Code entered/selected in 'Revenue Code' field (or no value is defined), ensure that 'Service Start Time' and 'Service End Time' fields are disabled (and not required in form).
  11. Enter/select values for all required/desired fields in form (including 'Service Start Time' and 'Service End Time' fields if applicable).
  12. Click 'Submit' button to file 'Claim Processing (UB-04)' form (or 'Claim Processing (UB-04) With Override' form).
Scenario 3: 'Fast Service Entry' - Verification Of Service Time Fields
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Service Times' must be enabled
  • CPT Code Definition where 'Require Service Time' is set to 'Yes' (via Avatar MSO 'CPT Code Definition' form)
  • Client record(s) valid for Service Entry/Claim Processing
Steps
  1. Open Avatar MSO 'Fast Service Entry' form (or 'Fast Service Entry Submission' form).
  2. Enter/select value in 'Date Claims Received' and 'Close Batches' fields (if applicable).
  3. Navigate to 'Fast Service Detail' section of form.
  4. Click 'Add New Item' button to enter new service.
  5. Enter/select client for service entry in 'Member Name or ID', field.
  6. Enter/Select value in 'Funding Source' field.
  7. Enter/select value in 'Provider' field.
  8. Enter/select 'Date of Service' field value.
  9. Enter/select 'Procedure Code' field value.
  10. If 'Require Service Time' is set to 'Yes' for CPT Code entered/selected in 'Procedure Code' field, ensure that 'Service Start Time' and 'Service End Time' fields are enabled and required in form.
  11. If 'Require Service Time' is set to 'No' for CPT Code entered/selected in 'Procedure Code' field (or no value is defined), ensure that 'Service Start Time' and 'Service End Time' fields are disabled (and not required in form).
  12. Enter/select values for all required/desired fields in form (including 'Service Start Time' and 'Service End Time' fields if applicable).
  13. Click 'Submit' button to file 'Fast Service Entry' form (or 'Fast Service Entry Submission' form).
Topics
• Registry Settings • CPT Code Definition • Claims Processing • NX • Revenue Code Definition
Update 34 Summary | Details
Approve/Pend/Deny Rules Definition
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • CPT Code Definition (PM)
  • CPT Code Definition (MSO)
  • Admission (Outpatient)
  • Diagnosis
  • Financial Eligibility
  • Revenue Code Definition (PM)
  • Revenue Code Definition (MSO)
  • Program Maintenance
  • Guarantors/Payors
  • Funding Source Registration
  • Plan Definition
  • Provider Fee Definition
  • MSO to Parent System Integration Mapping
  • Funding Source 837 Defaults
  • Approve/Pend/Deny Rules Definition
  • Claim Processing (CMS 1500)
  • Manual Batch Adjudication
  • Claim Processing (UB-04)
Scenario 1: Claim Processing - Verification of 'Claim Submitter ID Already Successfully Processed' Approve/Pend/Deny Rule
Specific Setup:
  • Two or more 837 Professional and/or 837 Institutional format inbound files for compilation and posting, including valid claims/services and where Claim Submitter ID' value (CLM-01) is repeated for two or more claims for same/single Contracting Provider
Steps
  1. Open Avatar MSO 'Approve/Pend/Deny Rules Definition' form.
  2. Set adjudication status value (approve, pend or deny) for 'Claim Submitter ID Already Successfully Processed' rule, and submit 'Approve/Pend/Deny Rules Definition' form.
  3. Load and compile/post 837 inbound file (via '837 Health Care Claim Professional' and/or '837 Health Care Claim Institutional' forms, or via import/export automatic file processing) where 'Claim Submitter ID' value (CLM-01) has already been used in a previously posted claim for the Contracting Provider (and is thus repeated for two or more claims with the current 837 inbound file). This claims processing rule will check against 'Claim Submitter ID' value for previously posted claims/services for same Contracting Provider regardless of approved/denied claim status.
  4. Adjudicate 837 inbound claims/services following posting (via 'Claims Processing...' and/or 'Manual Batch Adjudication' forms, or via automatic system adjudication process).
  5. Open claims/services for review via 'Claim Processing (CMS 1500)' and/or 'Claim Processing (UB-04)' forms.
  6. Navigate to 'Service Detail' section of form.
  7. Select service row and click 'Edit Selected Item'.
  8. For services in claims where 'Claim Submitter ID' value has not been used in any previously posted claim for the same Contracting Provider, ensure that 'Claim Status' field is set to 'Approved' (subject to all other applicable Approve/Pend/Deny Rules/conditions).
  9. For services in claims where 'Claim Submitter ID' value has already been used in a previously posted claim for the same Contracting Provider, ensure that 'Claim Status' field is set to status defined for the 'Claim Submitter ID Already Successfully Processed' Approve/Pend/Deny Rule.
  10. For services in claims where 'Claim Submitter ID' value has already been used in a previously posted claim for the same Contracting Provider, ensure that 'Explanation of Coverage' includes reason value 'Claim Submitter ID Already Successfully Processed'. (Example: "The service was denied for the following reason: Claim Submitter ID Already Successfully Processed")
Performing Provider Registration
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Performing Provider Registration
Scenario 1: Performing Provider Registration
Specific Setup:
  • A 'Performing Provider Registration' exists that has data filed for all required fields and includes a value in the optional field, 'Registration End Date'.
Steps
  1. Open 'Performing Provider Registration'.
  2. Select the 'Performing Provider Registration' from SETUP.
  3. Edit the value in the 'Registration End Date' field, noting the new value.
  4. Click [Submit].
  5. Click [Yes] on 'Pre-Display Confirmation' message.
  6. Click [Edit].
  7. Validate that the 'Registration End Date' field contains the new value.
  8. Delete the value in 'Registration End Date'
  9. Click [Submit].
  10. Click [No] on 'Pre-Display Confirmation' message.
  11. Open 'Performing Provider Registration'.
  12. Select the 'Performing Provider Registration' from SETUP.
  13. Click [Edit].
  14. Validate that the 'Registration End Date' field is blank.
  15. Enter the same value in 'Registration End Date' that was entered in step 3.
  16. Click [Submit].
  17. Click [Yes] on 'Pre-Display Confirmation' message.
  18. Click [Edit].
  19. Click [T] 'Registration End Date'.
  20. Click [Submit].
  21. 21. Click [Yes] on 'Pre-Display Confirmation' message.
  22. 22. Validate that the 'Registration End Date' is today’s date.
  23. 23. Close the form.
Topics
• Claims Processing • Performing Provider
Update 37 Summary | Details
Avatar MSO 'Create EOB' Form/Function
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Retro Claim Adjudication
Scenario 1: 'Create EOB' form - Verification of EOB Creation With 'Retro Claim Adjudication' Entries Included
Specific Setup:
  • One or more claims/services in 'Closed' status Claims Processing Batch(es), included on Voucher and not yet included on EOB
  • One or more Retro Claim Adjudication entries not yet included on an EOB (and where 'Withhold Payment' is filed as 'Yes')
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open 'Create EOB' form.
  2. Note - Acceptance testing may also be confirmed via Avatar MSO Claims Processing Automation EOB creation
  3. Select 'All' or 'Individual Providers' for EOB creation.
  4. Click 'Submit' button.
  5. Ensure EOB creation confirmation message is displayed on process completion.
  6. In EOB creation confirmation message, ensure that 'Total Amount of EOB(s) Created' value reflects/includes sum of all service 'Expected Disbursement' amounts and Retro Claim Adjudication entry/entries 'Take Back Amount' included in EOB(s) generated.
  7. In EOB creation confirmation message, ensure that 'Total Number of EOB(s) Created' value reflects total number of EOB(s) created.
  8. Open Crystal Reports or other SQL reporting tool.
  9. In Avatar MSO SQL table 'SYSTEM.table_eob', ensure that row(s) are present in table for all services and/or Retro Claim Adjudication entries included in EOB(s).
  10. In Avatar MSO SQL table 'SYSTEM.retro_claim_adjudications', ensure that 'EOBID' value is updated to newly created EOB number for all Retro Claim Adjudication entries included in EOB(s).
Topics
• Create EOB