Avatar MSO 'Claim Acknowledgement (277CA) File' Form/Function
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- 837 Health Care Claim Institutional
- 837 Health Care Claim Professional
- Claim Acknowledgement (277CA) File
- Claim Processing Automation
- Import/Export File Configuration
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)
- Avatar MSO Claims Processing Batch(es) may optionally be set to automatically close following 837 posting (via Avatar 'Claim Processing Automation' 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, including one or more 'Pending' Claim Status service(s)
Steps
- 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) containing one or more valid claim(s) where Claim Status for one or more service(s) is 'Pending'.
- Avatar MSO Claims Processing batch(es) created via inbound 837 file posting may be 'Open' or 'Closed' status, including batches closed automatically via 'Claim Processing Automation' functionality.
- Open the Avatar MSO 'Claim Acknowledgement (277CA) File' form.
- 277CA file generation/content review may also be confirmed directly in system output directory where automatic 277CA file generation is enabled.
- Select 'Create File On Server' in 'Options' field.
- Select 'Submission Type' field value ('Institutional' or 'Professional').
- Select 837 file for Claim Acknowledgement (277CA) file creation.
- Click 'Process' button.
- Ensure that for selected 837 file, Claim Acknowledgement (277CA) file is created on server in defined directory.
- 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.
- Select 'Dump File' in 'Options' field.
- Select 'Submission Type' field value ('Institutional' or 'Professional').
- Select 837 file for Claim Acknowledgement (277CA) file review.
- Click 'Process' button.
- In 277CA Claim Acknowledgement file(s) for successfully posted 837 Professional and/or Institutional inbound claims including one or more 'Pending' Claim Status service(s), ensure that claim/service(s) is/are reported with 'Accepted' status (including case where 837 Claims Processing batch containing 'Pending' status service is automatically closed following 837 posting).
- Examples:
- 'STC*A2:20**WQ*180~'
- 'STC*A2:20*20220516*WQ*60~'
- 277CA file content review may also be confirmed directly in system output directory by opening/reviewing file(s).
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Topics
• 837 Health Care Claim Institutional
• 837 Health Care Claim Professional
• Claims Processing
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