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Avatar MSO 2022 Update 16

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Product Requirements / Recommendations

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Product Update Form Description

The following issues are resolved: 1) When the 'Sort File' option in the '835 Healthcare Claim Payment/Advice' form is selected and the 'Process' button clicked once, the system creates multiple identical files that are available to be selected. 2) Service Authorization file import is incorrectly rejecting records with invalid 'Type Of Authorization'.

Included Updates

None

Required Updates

None

Details
NEW0 CHANGED0 FIXED2
Fixed (2)
Avatar MSO - 835 Healthcare Claim Payment/Advice
The '835 Healthcare Claim Payment/Advice' functionality has been updated in the following way: If 'Sort' is selected in 'Options' and the selected file has previously been sorted, a dialog box displays the message: Previously sorted 835 contains the same EOB(s). Continue sort? KB0070037 v0.01
The dialog box allows the user to select 'No' to cancel the selection.
The dialog box allows the user to select 'Yes' to continue to sort the file and will produce a file with same information as the previous file, except for the envelope information.
Topics
• 835 Health Care Claim Payment/Advice
 
[Avatar MSO] Service Authorization - Member
The '[Avatar MSO] Service Authorization - Member' functionality has been updated to prevent an error for 'Type Of Authorization' field, when editing the file import to include the authorization number and posting it again as an edit. KB0069961 v0.01
Topics
• File Import
 
Acceptance Tests
AV-78502 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
  1. Open '835 Health Care Claim Payment/Advice' form.
  2. In 'Options' field, select 'Sort File'.
  3. Select the 'Contracting Provider'.
  4. Select 'Yes' in 'Exclude EOB(s) On Previous 835'.
  5. Click 'Process' button.
  6. Verify that the 835 outbound file sorting for EOB completes.
  7. Click 'Process' button again.
  8. Verify that a message is received stating: Previously sorted 835 contains the same EOB(s). Continue sort?
  9. Click 'No'.
  10. Verify that a message is received stating: Cancelled.
  11. Click [OK].
  12. Verify that a message is received stating: Previously sorted 835 contains the same EOB(s). Continue sort?
  13. Click 'Yes'.
  14. Verify that the 835 outbound file sorting for EOB completes.
Topics
• 835 Health Care Claim Payment/Advice
AV-80309 Summary | Details
[Avatar MSO] Service Authorization - Member
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • App Dashboard
  • Contracting Provider Registration
  • CPT Code Definition (MSO)
  • CPT Code Definition (PM)
  • File Import
  • Financial Eligibility
  • Funding Source Registration
  • Member Specific Information
  • MSO to Parent System Integration Mapping
  • Plan Definition
  • Provider Fee Definition
  • Registry Settings (PM)
  • Service Authorization
  • Service Codes
  • Site Specific Section Modeling (MSO)
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
  1. Open 'File Import'.
  2. Select '[Avatar MSO] Service Authorization - Member' in 'File Type'.
  3. Select 'Upload New File' in 'Action'.
  4. Click [Process Action].
  5. Select the file.
  6. Click [Open].
  7. Select 'Compile/Validate File' in 'Action'.
  8. Select the file in 'File(s)'.
  9. Click [Process Action].
  10. Click [OK].
  11. Select 'Print File' in 'Action'.
  12. Select the file in 'File(s)'.
  13. Click [Process Action].
  14. Validate the report data.
  15. Close the report.
  16. Select 'Post File' in 'Action'.
  17. Select the file in 'File(s)'.
  18. Click [Process Action].
  19. Click [OK].
  20. Open 'Service Authorization' for the Client A.
  21. Validate the data, noting the authorization number.
  22. Click [Cancel].
  23. Close the form.
  24. Open 'Service Authorization' for the Client B.
  25. Validate the data, noting the authorization number.
  26. Click [Cancel].
  27. Close the form.
  28. Create a new batch for one service for the Client A.
  29. Using a 'Claims Processing' forms, create a service that will use the imported authorization.
  30. Open the 'Member Service Authorization' file and edit the file to include the authorization number for Client A and Client B.
  31. Post the edited file through 'File Import', '[Avatar MSO] Service Authorization - Member'.
  32. Close the form.
  33. Open 'Service Authorization' for the Client A.
  34. Validate the data.
  35. Click [Cancel].
  36. Close the form.
  37. Open 'Service Authorization' for the Client B.
  38. Validate the data.
  39. Click [Cancel].
  40. Close the form.
Topics
• File Import

 

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