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Avatar MSO 2022 Update 17

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Product Requirements / Recommendations

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Product Update Form Description

The issue is resolved where retro take back amounts are not added back to the remaining amount in the budget account.

Included Updates

None

Required Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Avatar MSO Budget Tracking
The 'Budget Tracking Account Setup' form and Avatar MSO Budget Tracking functionality are updated to ensure that Retro Claim Adjudication 'Take Back Amount' values (as well as any deleted services) are correctly reflected/added back to Budget Tracking Account/Account Level 'Remaining Amount' calculations.
Topics
• Budget Tracking • NX • Retro Claim Adjudication
 
Acceptance Tests
AV-80621 Summary | Details
Avatar MSO Budget Tracking
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Budget Tracking Account Setup
  • Retro Claim Adjudication
  • Delete Services
Scenario 1: 'Budget Tracking Account Setup' - Verification of Retro Claim Adjudication Entries
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Budget Tracking' must be enabled (Setting 'YC')
  • One or more Budget Tracking Account/Account Level entries for Authorization/service association
  • Client with 'Closed' status claim(s)/service(s) eligible for Retro Claim Adjudication entry in Avatar MSO, associated to existing Budget Tracking Account/Account Level entry
Steps
  1. Open Avatar MSO 'Budget Tracking Account Setup' form.
  2. Select 'Account' value for existing Budget Tracking Account view/update.
  3. On selection of existing Budget Tracking Account, ensure 'Summary' field in 'Account Levels' sub-section of form is populated with/displays existing values for all defined Account Levels, including 'Claimed' amount and 'Amount Remaining' values for existing 'Approved' status services associated to Account Levels (from service 'Expected Disbursement' values).
  4. Select the 'Account Level' value for existing Budget Tracking Account Level view/update.
  5. On selection of Budget Tracking Account Level, ensure 'Summary' field in 'Account Levels' sub-section of form is populated with/displays existing values for selected Account Level, including 'Claimed' amount and 'Amount Remaining' values for existing 'Approved' status services associated to Account Level (from service 'Expected Disbursement' values).
  6. Close (or submit/file) 'Budget Tracking Account Setup' form.
  7. Open Avatar MSO 'Retro Claim Adjudication' form.
  8. Note, Retro Claim Adjudication entry may also be created/confirmed via 837 Health Care Claim Professional/Institutional 'Void' and/or 'Replacement' claim posting.
  9. Select 'Add' in the 'Add/Edit/Delete Claim Adjudication' field (or 'Edit' to update existing Retro Claim Adjudication entry).
  10. Select 'Claim' and 'Date of Service/Procedure' value for Retro Claim Adjudication entry/update, selecting claim/service associated to Budget Tracking Account/Account Level.
  11. Enter value(s) for 'Updated Approved Units' and/or 'Updated Duration' fields, and calculate or directly update 'Updated Disbursement Amount' field.
  12. Allow system-calculation of updated values or directly enter values for 'Take Back Amount', 'Take Back Units' and/or 'Take Back Duration' fields.
  13. Select value for 'Adjustment Code' field if not defaulted automatically.
  14. Enter value in 'Comments' field for service/Retro Claim Adjudication entry.
  15. Click 'Update Claim Adjudication' button in 'Retro Claim Adjudication' form to file entry/update.
  16. Close 'Retro Claim Adjudication' form (or repeat/file additional Retro Claim Adjudication entries as desired).
  17. Open Avatar MSO 'Budget Tracking Account Setup' form.
  18. Select 'Account' value for existing Budget Tracking Account view/update (selecting Account Level with associated service(s) where Retro Claim Adjudication entries exist).
  19. On selection of existing Budget Tracking Account, ensure 'Summary' field in 'Account Levels' sub-section of form is populated with/displays existing values for all defined Account Levels, including 'Claimed' amount and 'Amount Remaining' values for existing 'Approved' status services associated to Account Levels (from service 'Expected Disbursement' values).
  20. Ensure that 'Summary' field 'Amount Remaining' values for selected Budget Tracking Account reflect 'Take Back Amount' values filed for Retro Claim Adjudication entries.
  21. Example:
  22. Budget Tracking Account Level 'Amount' value = $1000
  23. Two services claimed/associated to Account Level; Expected Disbursement for each service = $250 ($500 total for two services)
  24. Budget Tracking Account Level 'Amount Remaining' value = $500
  25. Retro Claim Adjudication entered for one claimed/associated service; Retro Claim Adjudication 'Take Back Amount' = $250
  26. Budget Tracking Account Level 'Amount Remaining' value = $750
  27. Select the 'Account Level' value for existing Budget Tracking Account Level view/update (selecting Account Level with associated service(s) where Retro Claim Adjudication entries exist).
  28. On selection of Budget Tracking Account Level, ensure 'Summary' field in 'Account Levels' sub-section of form is populated with/displays existing values for selected Account Level, including 'Claimed' amount and 'Amount Remaining' values for existing 'Approved' status services associated to Account Level.
  29. Ensure that 'Summary' field 'Amount Remaining' value for selected Budget Tracking Account Level reflects 'Take Back Amount' values filed for Retro Claim Adjudication entries.
  30. Close (or submit/file) 'Budget Tracking Account Setup' form.
Scenario 2: 'Budget Tracking Account Setup' - Verification of Deleted Services
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Budget Tracking' must be enabled (Setting 'YC')
  • One or more Budget Tracking Account/Account Level entries for Authorization/service association
  • Client with 'Closed' status claim(s)/service(s) eligible for service deletion in Avatar MSO
Steps
  1. Open Avatar MSO 'Budget Tracking Account Setup' form.
  2. Select 'Account' value for existing Budget Tracking Account view/update.
  3. On selection of existing Budget Tracking Account, ensure 'Summary' field in 'Account Levels' sub-section of form is populated with/displays existing values for all defined Account Levels, including 'Claimed' amount and 'Amount Remaining' values for existing 'Approved' status services associated to Account Levels (from service 'Expected Disbursement' values).
  4. Select the 'Account Level' value for existing Budget Tracking Account Level view/update.
  5. On selection of Budget Tracking Account Level value, ensure 'Summary' field in 'Account Levels' sub-section of form is populated with/displays existing values for selected Account Level, including 'Claimed' amount and 'Amount Remaining' values for existing 'Approved' status services associated to Account Level (from service 'Expected Disbursement' values).
  6. Close (or submit/file) 'Budget Tracking Account Setup' form.
  7. Open Avatar MSO 'Delete Services' form.
  8. Enter/select client for service deletion in the 'Select Member' field.
  9. Select service for deletion in 'Select Service To Delete' field.
  10. Submit 'Delete Services' form to delete selected service.
  11. Open Avatar MSO 'Budget Tracking Account Setup' form.
  12. Select 'Account' value for existing Budget Tracking Account view/update (selecting Account with previously associated service(s) that have been deleted).
  13. On selection of existing Budget Tracking Account, ensure 'Summary' field in 'Account Levels' sub-section of form is populated with/displays existing values for all defined Account Levels, including 'Claimed' amount and 'Amount Remaining' values for existing 'Approved' status services associated to Account Levels (from service 'Expected Disbursement' values).
  14. Ensure that 'Summary' field 'Amount Remaining' value for selected Budget Tracking Account reflects any deleted services previously associated to Account Levels.
  15. Example:
  16. Budget Tracking Account Level 'Amount' value = $1000
  17. Two services claimed/associated to Account Level; Expected Disbursement value for each service = $250 ($500 total for two services)
  18. Budget Tracking Account Level 'Amount Remaining' value = $500
  19. One claimed/associated service deleted; deleted Expected Disbursement value = $250
  20. Budget Tracking Account Level 'Amount Remaining' value = $750
  21. Select the 'Account Level' value for existing Budget Tracking Account Level view/update (selecting Account Level with previously associated service(s) that have been deleted).
  22. On selection of Budget Tracking Account Level value, ensure 'Summary' field in 'Account Levels' sub-section of form is populated with/displays existing values for selected Account Level, including 'Claimed' amount and 'Amount Remaining' values for existing 'Approved' status services associated to Account Level.
  23. Ensure that 'Summary' field 'Amount Remaining' value for selected Budget Tracking Account Level reflects any deleted services previously associated to Account Level.
  24. Close (or submit/file) 'Budget Tracking Account Setup' form.
Topics
• Budget Tracking • NX • Retro Claim Adjudication

 

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