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Avatar MSO 2022 Update 12

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Product Requirements / Recommendations

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Product Update Form Description

The issue is resolved where after an 837 5010 Professional or Institutional inbound file is posted and automatically re-adjudicated, OHC claim adjustment data in the SYSTEM.mso_claim_adjustments table is not retained, causing claim adjustment segments to not produce in the 837 generated in the parent PM system.

Included Updates

None

Required Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
837 Health Care Claim Adjustment Posting
An issue is resolved to ensure that after an 837 5010 Professional or Institutional inbound file is posted and automatically re-adjudicated, OHC claim adjustment data in the SYSTEM.mso_claim_adjustments table is retained, to ensure that claim adjustment segments are produced in the 837 generated in the parent PM system.
Topics
• 837 Health Care Claim Professional • Claims Processing • NX
 
Acceptance Tests
AV-79459 Summary | Details
837 Health Care Claim Adjustment Posting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Professional
  • Registry Settings (PM)
  • 837 Health Care Claim Institutional
Scenario 1: '837 Health Care Claim Professional' - Verification of Claim/Service Adjustment Filing
Specific Setup:
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled (set to '2')
  • Avatar MSO Registry Setting 'Adjudicate Batches' must be enabled (set to '2')
  • 'Crystal Reports' or other SQL reporting tool
  • 837 Professional format inbound file for compilation and posting including one or more valid claims/services with adjustment information included
Steps
  1. Open '837 Health Care Claim Professional' form.
  2. Select 'Load File' in the 'Options' field.
  3. Enter file path for inbound 837 Professional format file and click 'Process' button.
  4. Select 'Compile File' in the 'Options' field, and select loaded 837 Professional file.
  5. Click 'Process' button.
  6. In 837 Professional Compile Report, ensure that claim/services are successfully compiled.
  7. Select 'Post File' in the 'Options' field, and select compiled 837 Professional file.
  8. Click 'Process' button.
  9. In 837 Professional Post Report, ensure that claim/services are successfully posted.
  10. Open 'Claim Processing (CMS 1500)' form.
  11. Select claims processing batch created via 837 Professional inbound posting.
  12. Navigate to 'Service Detail' section of form.
  13. Select service row and click 'Edit Service Information' to view service detail.
  14. Click the 'Enter Third Party Adjudication Data' button to view Third Party Payment/Other Healthcare Coverage information for selected service.
  15. Within Third Party Payment/Other Healthcare Coverage information display, click 'View' button to display/view Service Adjustment entries for selected service/Third Party Payment information.
  16. Confirm that service adjustment (CAS) values from 837 Professional inbound claim/service are displayed and present for selected service.
  17. Open 'Crystal Reports' or other SQL reporting tool.
  18. In Avatar MSO SQL table 'SYSTEM.mso_claim_adjustments', ensure that service adjustment(s) for posted 837 Professional claims/services is/are present in SQL table data.
Scenario 2: '837 Health Care Claim Institutional' - Verification of Claim/Service Adjustment Filing
Specific Setup:
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled (set to '2')
  • Avatar MSO Registry Setting 'Adjudicate Batches' must be enabled (set to '2')
  • 'Crystal Reports' or other SQL reporting tool
  • 837 Institutional format inbound file for compilation and posting including one or more valid claims/services with adjustment information included
Steps
  1. Open '837 Health Care Claim Institutional ' form.
  2. Select 'Load File' in the 'Options' field.
  3. Enter file path for inbound 837 Institutional format file and click 'Process' button.
  4. Select 'Compile File' in the 'Options' field, and select loaded 837 Institutional file.
  5. Click 'Process' button.
  6. In 837 Institutional Compile Report, ensure that claim/services are successfully compiled.
  7. Select 'Post File' in the 'Options' field, and select compiled 837 Institutional file.
  8. Click 'Process' button.
  9. In 837 Institutional Post Report, ensure that claim/services are successfully posted.
  10. Open 'Claim Processing (UB-04)' form.
  11. Select claims processing batch created via 837 Institutional inbound posting.
  12. Navigate to 'Service Detail' section of form.
  13. Select service row and click 'Edit Service Information' to view service detail.
  14. Click the 'Enter Third Party Adjudication Data' button to view Third Party Payment/Other Healthcare Coverage information for selected service.
  15. Within Third Party Payment/Other Healthcare Coverage information display, click 'View' button to display/view Service Adjustment entries for selected service/Third Party Payment information.
  16. Confirm that service adjustment (CAS) values from 837 Institutional inbound claim/service are displayed and present for selected service.
  17. Open 'Crystal Reports' or other SQL reporting tool.
  18. In Avatar MSO SQL table 'SYSTEM.mso_claim_adjustments', ensure that service adjustment(s) for posted 837 Institutional claims/services is/are present in SQL table data.
Topics
• 837 Health Care Claim Professional • Claims Processing • NX

 

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