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Avatar MSO 2022 Update 18

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Product Update Form Description

The issue is resolved where the error "[SUBSCRIPT]zGetOHCData+44^SYSTEM.msoservicecob.1" is produced when compiling an 837 5010 Professional or Institutional file via the 'Electronic Billing' form that includes MSO OHC services.

Included Updates

12

Required Updates

Avatar MSO 2022 Update 12
Details
NEW0 CHANGED0 FIXED1
Fixed (1)
'Electronic Billing' Support for Services Originating in Avatar MSO
An issue is resolved to ensure that 837 5010 Professional and Institutional files are produced without system error via the Avatar Cal-PM 'Electronic Billing' form for services originating in Avatar MSO when the Avatar Cal-PM 'Support MSO Other Healthcare Coverage' Registry Setting is enabled.
Topics
• Claims Processing • Electronic Billing • NX
 
Acceptance Tests
AV-81003 Summary | Details
'Electronic Billing' Support for Services Originating in Avatar MSO
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Professional
  • Electronic Billing
  • 837 Health Care Claim Institutional
  • Client Other Healthcare Coverage
  • Registry Settings (PM)
Scenario 1: 'Electronic Billing' - Verification of 'Support MSO Other Healthcare Coverage' Registry Setting (Services Originating in Avatar MSO With Incomplete OHC Information)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar Cal-PM Registry Setting 'Include Service Level Adjudication Info' must be enabled (and 'Include Service Level Adjudication Information (2430)' field set to 'Yes' via 'Guarantor/Program Billing Defaults' form '837 Professional' and/or '837 Institutional' section for applicable Guarantor/Program)
  • Avatar Cal-PM Registry Setting 'Include Patient Remaining Liability' must be enabled (and 'Select Type Of Information To Include In Patient Remaining Liability' field defined via 'Guarantor/Program Billing Defaults' form '837 Professional' and/or '837 Institutional' section for applicable Guarantor/Program)
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional/837 Institutional file inclusion (via 'Electronic Billing' form) originating in Avatar MSO and including incomplete Third Party Payment/Adjustment 'Other Healthcare Coverage' information
  • Example: Service-level Third Party Payment/Adjustments entered for service in Avatar MSO but with no value for 'Payer Identifier'
Steps
  1. Open Avatar PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.)
  2. Select 837 Professional or 837 Institutional in 'Billing Form' field.
  3. Enter/select 837 file sorting criteria, using values which will include service(s) originating in Avatar MSO.
  4. Click 'Process' button to sort/generate 837 Professional or 837 Institutional file.
  5. Ensure 837 generation process is completed and user is presented with 'Compile Complete' dialog message.
  6. Select 'Run Report' in the 'Billing Options' field.
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional/837 Institutional file sorted which includes services originating in Avatar MSO, and click 'Print 837 Report' button to display 837 outbound file report.
  9. In 'Electronic Billing' 837 Professional and/or 837 Institutional report display, ensure that 837 compilation errors are present for services originating in Avatar MSO and including incomplete Third Party Payment/Adjustment 'Other Healthcare Coverage' information; Errors can be reviewed under the 'Required Data Missing: Patient Claim Data', 'Required Data Missing: Patient Service Data' and/or 'Required Data Missing: Other Data' sub-reports/sections.
  10. 837 Electronic Billing Error Examples:
  11. Missing Field/Invalid Format: Name Last Or Org. Name (Loop: 2330A Segment: NM1 Iteration: 1)
  12. Unable To Create Segment: NM1 (Loop: 2330A) / Unable To Create Loop: 2330A
  13. Missing Field/Invalid Format: Name Last Or Org. Name (Loop: 2330B Segment: NM1 Iteration: 1)
  14. Unable To Create Segment: NM1 (Loop: 2330B) / Unable To Create Loop: 2330B
  15. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  16. Select 'Print' in the 'Print Or Delete Report' field.
  17. Select 837 Professional/837 Institutional file sorted which includes services originating in Avatar MSO, and click 'Process' button to display 837 outbound file data.
  18. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file data - for services originating via Avatar MSO manual entry and including incomplete Service-Level Third Party Payment/Adjustment 'Other Healthcare Coverage' information as noted above, ensure that claims are successfully created (without incomplete/missing data loops from 837 error reports where non-required elements).
Scenario 2: 'Electronic Billing' - Verification of 2320 AMT Values in 837 Professional (Services Originating in Avatar MSO)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar Cal-PM Registry Setting 'Include Service Level Adjudication Info' must be enabled (and 'Include Service Level Adjudication Information (2430)' field set to 'Yes' via 'Guarantor/Program Billing Defaults' form '837 Professional' section for applicable Guarantor/Program)
  • Avatar Cal-PM Registry Setting 'Include Patient Remaining Liability' must be enabled (and 'Select Type Of Information To Include In Patient Remaining Liability' field defined via 'Guarantor/Program Billing Defaults' form '837 Professional' section for applicable Guarantor/Program)
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional file inclusion (via 'Electronic Billing' form) originating in Avatar MSO inbound 837 file processing and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
Steps
  1. Open Avatar Cal-PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.)
  2. Select '837 Professional' in the 'Billing Form' field.
  3. Select 'Sort File' in the 'Billing Options' field.
  4. Enter/select 837 Professional file sorting criteria.
  5. Click 'Process' button to sort/generate 837 Professional file.
  6. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional file sorted which includes services(s) originating via Avatar MSO inbound 837 claim(s), and click 'Process' button to display 837 Professional outbound file data.
  9. In Avatar PM 837 Professional format outbound electronic billing file data - for services originating via Avatar MSO inbound 837 file claims including 'Other Healthcare Coverage' information where 2320-AMT Coordination Of Benefits (COB) Payer Paid Amount value is present in original inbound 837 claim, ensure that 2320-AMT Coordination Of Benefits (COB) Payer Paid Amount loop/segment value is present and reflects same/original Avatar MSO 'Other Healthcare Coverage' inbound 837 claim value.
  10. Example: AMT*D*2~
  11. In Avatar PM 837 Professional format outbound electronic billing file data - for services originating via Avatar MSO inbound 837 file claims including 'Other Healthcare Coverage' information where 2320-AMT Remaining Patient Liability Amount value is present in original inbound 837 claim, ensure that 2320-AMT Remaining Patient Liability Amount loop/segment is present and reflects same/original Avatar MSO 'Other Healthcare Coverage' inbound 837 claim value.
  12. Example: AMT*EAF*58~
Scenario 3: 'Electronic Billing' - Verification of 2320 AMT Values in 837 Institutional (Services Originating in Avatar MSO)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar Cal-PM Registry Setting 'Include Service Level Adjudication Info' must be enabled (and 'Include Service Level Adjudication Information (2430)' field set to 'Yes' via 'Guarantor/Program Billing Defaults' form '837 Institutional' section for applicable Guarantor/Program)
  • Avatar Cal-PM Registry Setting 'Include Patient Remaining Liability' must be enabled (and 'Select Type Of Information To Include In Patient Remaining Liability' field defined via 'Guarantor/Program Billing Defaults' form '837 Institutional' section for applicable Guarantor/Program)
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • One or more service(s) eligible for Avatar Cal-PM 837 Institutional file inclusion (via 'Electronic Billing' form) originating in Avatar MSO inbound 837 file processing and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
Steps
  1. Open Avatar Cal-PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.)
  2. Select '837 Institutional' in the 'Billing Form' field.
  3. Select 'Sort File' in the 'Billing Options' field.
  4. Enter/select 837 Institutional file sorting criteria.
  5. Click 'Process' button to sort/generate 837 Institutional file.
  6. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Institutional file sorted which includes services(s) originating via Avatar MSO inbound 837 claim(s), and click 'Process' button to display 837 Institutional outbound file data.
  9. In Avatar PM 837 Institutional format outbound electronic billing file data - for services originating via Avatar MSO inbound 837 file claims including 'Other Healthcare Coverage' information where 2320-AMT Coordination Of Benefits (COB) Payer Paid Amount value is present in original inbound 837 claim, ensure that 2320-AMT Coordination Of Benefits (COB) Payer Paid Amount loop/segment value is present and reflects same/original Avatar MSO 'Other Healthcare Coverage' inbound 837 claim value.
  10. Example: AMT*D*2~
  11. In Avatar PM 837 Institutional format outbound electronic billing file data - for services originating via Avatar MSO inbound 837 file claims including 'Other Healthcare Coverage' information where 2320-AMT Remaining Patient Liability Amount value is present in original inbound 837 claim, ensure that 2320-AMT Remaining Patient Liability Amount loop/segment is present and reflects same/original Avatar MSO 'Other Healthcare Coverage' inbound 837 claim value.
  12. Example: AMT*EAF*58~
Scenario 4: 'Electronic Billing' - Verification of 'Add Support For Client Other Healthcare Coverage' Registry Setting (Services Originating in Avatar MSO)
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Include Service Level Adjudication Info' must be enabled (and 'Include Service Level Adjudication Information (2430)' field set to 'Yes' via 'Guarantor/Program Billing Defaults' form '837 Professional' and/or '837 Institutional' section for applicable Guarantor/Program)
  • Avatar Cal-PM Registry Setting 'Add Support For Client Other Healthcare Coverage' must be enabled
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional/837 Institutional file inclusion (via 'Electronic Billing' form) originating in Avatar MSO and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
Steps
  1. Open Avatar PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.)
  2. Select 837 Professional or 837 Institutional in 'Billing Form' field.
  3. Enter/select 837 file sorting criteria, using values which will include service(s) originating in Avatar MSO.
  4. Click 'Process' button to sort/generate 837 Professional or 837 Institutional file.
  5. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  6. Select 'Print' in the 'Print Or Delete Report' field.
  7. Select 837 Professional/837 Institutional file sorted which includes services originating in Avatar MSO, and click 'Process' button to display 837 outbound file data.
  8. In Avatar Cal-PM 837 Professional/837 Institutional format outbound electronic billing file data - for services originating via Avatar MSO manual entry and including Service-Level Third Party Payment/Adjustment 'Other Healthcare Coverage' information (but where Claim-Level Other Healthcare Coverage/Third Party Payer Information was not entered), ensure that the following 837 Loop/Segments are included with values defined in Avatar Cal-PM 'Client Other Healthcare Coverage' record(s) for client/episode:
  9. Other Subscriber Information (2320)
  10. From 'Client Other Healthcare Coverage' form 'Subscriber Group Name', 'Insurance Type Code' and 'Claim Filing Indicator Code' fields
  11. Other Insurance Coverage Information (2320)
  12. From 'Client Other Healthcare Coverage' form 'Subscriber Assignment Of Benefits' and 'Subscriber Release Of Info' fields
  13. Other Subscriber Name (2330A)
  14. From 'Client Other Healthcare Coverage' form 'Subscriber's Name' and 'Subscriber Policy #' fields
  15. Other Payer Name (2330B)
  16. From 'Client Other Healthcare Coverage' form 'Guarantor Name' and 'Guarantor Payer Identifier' fields
  17. Notes:
  18. The Avatar Cal-PM 'Client Other Healthcare Coverage' record applicable to claims/services originating via Avatar MSO manual entry will be determined by 'Payer Identifier' value entered for MSO Service-Level Third Party Payment/Adjustment 'Other Healthcare Coverage' service information - this value must match the 'Guarantor Payer Identifier' value entered in 'Client Other Healthcare Coverage' record for the above 837 segments/information to be included in 837 claims
  19. The Avatar Cal-PM 'Client Other Healthcare Coverage' record applicable to claim/services originating via Avatar MSO manual entry will be determined by service date(s) compared to 'Effective Date' / 'Expiration Date' values entered in 'Client Other Healthcare Coverage' record
  20. If no Avatar Cal-PM 'Client Other Healthcare Coverage' record is found applicable to claim/service originating via Avatar MSO manual entry (based on 'Guarantor Payer Identifier' and 'Effective Date'/'Expiration Date' values) the 2320/2330A/2330B loops/segments noted above will not be included in Avatar Cal-PM 837 Professional/Institutional claim
  21. Other Subscriber Address 2330A segments are suppressed when Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' is enabled and the claim/service being included in 837 file through 'Electronic Billing' is using Other Healthcare Coverage from MSO
Topics
• Claims Processing • Electronic Billing • NX

 

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