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Avatar MSO 2022 Update 2

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Product Requirements / Recommendations

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Product Update Form Description

The following issues are resolved: 1) The error "[UNDEFINED]Predisplay1+68^GUISSTabModeling" produced when selecting 'Fast Service Entry Submission' in the 'Site Specific Section Modeling' form. 2) When a batch is closed via the 'Close Batch' form, COB/Third Party Liability grid data for pended services are not being copied to the pended batch. 3) User definitions are being copied when a new system code is created.

Included Updates

None

Required Updates

None

Details
NEW0 CHANGED0 FIXED2
Fixed (2)
Site Specific Section Modeling - Fast Service Entry Submission
Site Specific Section Modeling is updated to resolve an error when '
MSOBAT185SUBMISSION (Fast Service Entry Submission) Fast Service Detail' is selected.

KB0069721 v0.01
Topics
• Claims Processing • NX • Service Authorizations • Site Specific Section Modeling
 
Claim Processing - Third Party Adjudication Data
The 'Third Party Adjudication Data' functionality has been updated to retain the data for pended claims and to copy it to the service when a new pended batch is created.
Topics
• Claims Processing • NX • Service Authorizations • Site Specific Section Modeling
 
Acceptance Tests
AV-76145 Summary | Details
Site Specific Section Modeling - Fast Service Entry Submission
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • App Dashboard
  • Applying Contracting Provider
  • Claim Processing (CMS 1500)
  • Close Batch
  • CPT Code Definition (MSO)
  • CPT Code Definition (PM)
  • Diagnosis
  • Dynamic Form - Admission - Client
  • Dynamic Form - Pre-Display Confirmation
  • Financial Eligibility
  • Funding Source Registration
  • Guarantors/Payors
  • Member Specific Information
  • MSO to Parent System Integration Mapping
  • Plan Definition
  • Provider Fee Definition
  • Registry Settings (PM)
  • Revenue Code Definition (MSO)
  • Revenue Code Definition (PM)
  • Service Codes
  • Dynamic Form - Site Specific Section Modeling (CWS)
  • Fast Service Entry
  • Site Specific Section Modeling (MSO)
Scenario 1: 'Claim Processing...' forms and functions - Verification of 'Explanation Of Coverage' value for 'Pended' Service Authorization, and verifying new batch not created when batch is closed
Specific Setup:
  • Client record with Service Authorization(s) where 'Current Authorization Status' value is 'Pending'
  • One or more claim(s)/service(s) for adjudication where 'Pending' status Service Authorization is selected/associated to service
Steps
  1. Open Avatar MSO 'Claim Processing...' form ('Claim Processing (CMS 1500)', 'Claim Processing (UB-04)' and/or 'Fast Service Entry' forms).
  2. Select claims processing batch for service entry/edit.
  3. Open existing claim or create new claim for service entry/edit.
  4. Set value for 'Member Name or ID' and 'Provider' in claim level section (if adding new claim/services).
  5. Navigate to 'Service Detail' section of form.
  6. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button).
  7. Enter/select 'Date of Service', 'Procedure Code', 'Total Charge' and 'Service Units' field values.
  8. Click 'Display Valid Authorizations' button and select Service Authorization (or directly enter value in 'Authorization Number' field).
  9. In case where 'Current Authorization Status' value is 'Pending' for selected/associated Service Authorization record - ensure that 'Claim Status' value is set to 'Pending' for service.
  10. In case where 'Current Authorization Status' value is 'Pending' for selected/associated Service Authorization record - ensure that 'Explanation Of Coverage' field for service includes value 'The service was pended for the following reason: Authorization is pending'.
  11. Click [Enter Third Party Adjudication Data].
  12. Create a new row with desired data, and if desired click [View] and create a new row with desired data. Save the rows.
  13. Click [Submit].
  14. Close the batch and validate that a new pended batch is created.
  15. Repeat steps 1-12 and validate that the ‘Third Party Adjudication Data’ was copied forward.
  16. Click [Submit].
  17. Close the batch and validate that a new pended batch is created.
  18. Repeat steps 1-12 and validate that the ‘Third Party Adjudication Data’ was copied forward.
Scenario 2: Avatar MSO 'Site Specific Section Modeling' - 'Fast Service Entry Submission' - opening prompt section.
Specific Setup:
  • Site Specific Section Modeling for MSO:
  • Select the ‘MSOBAT185SUBMISSION (Fast Service Entry Submission) Fast Service Detail’ item in the dropdown list.
  • Click [OK].
  • Select ‘Prompt Definition’ section.
  • If desired, add a new prompt and customize the label or customize the label of an existing prompt.
  • Click [Submit].
  • Refresh the forms.
Steps
  1. Open ‘Fast Service Entry’.
  2. Select the ‘Fast Service Detail’ section.
  3. Validate that the prompt that was added or changed exists on the form.
  4. Close the form.
  5. Open ‘Site Specific Section Modeling’ for MSO.
  6. Select the ‘MSOBAT185OVERRIDE (Fast Service Entry) Fast Service Detail’ item in the dropdown list.
  7. Click [OK].
  8. Select ‘Prompt Definition’ section.
  9. Validate that the prompt added or changed in Setup displays in the table.
  10. Select the prompt and click [Delete Selected Item].
  11. Click [Yes] on the ‘Confirm’ message.
  12. Click [Submit].
  13. Refresh the forms.
  14. Open ‘Fast Service Entry’.
  15. Select the ‘Fast Service Detail’ section.
  16. Validate that the prompt does not exist.
Topics
• Claims Processing • NX • Service Authorizations • Site Specific Section Modeling
AV-76983 Summary | Details
Claim Processing - Third Party Adjudication Data
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • App Dashboard
  • Applying Contracting Provider
  • Claim Processing (CMS 1500)
  • Close Batch
  • CPT Code Definition (MSO)
  • CPT Code Definition (PM)
  • Diagnosis
  • Dynamic Form - Admission - Client
  • Dynamic Form - Pre-Display Confirmation
  • Financial Eligibility
  • Funding Source Registration
  • Guarantors/Payors
  • Member Specific Information
  • MSO to Parent System Integration Mapping
  • Plan Definition
  • Provider Fee Definition
  • Registry Settings (PM)
  • Revenue Code Definition (MSO)
  • Revenue Code Definition (PM)
  • Service Codes
  • Dynamic Form - Site Specific Section Modeling (CWS)
  • Fast Service Entry
  • Site Specific Section Modeling (MSO)
Scenario 1: 'Claim Processing...' forms and functions - Verification of 'Explanation Of Coverage' value for 'Pended' Service Authorization, and verifying new batch not created when batch is closed
Specific Setup:
  • Client record with Service Authorization(s) where 'Current Authorization Status' value is 'Pending'
  • One or more claim(s)/service(s) for adjudication where 'Pending' status Service Authorization is selected/associated to service
Steps
  1. Open Avatar MSO 'Claim Processing...' form ('Claim Processing (CMS 1500)', 'Claim Processing (UB-04)' and/or 'Fast Service Entry' forms).
  2. Select claims processing batch for service entry/edit.
  3. Open existing claim or create new claim for service entry/edit.
  4. Set value for 'Member Name or ID' and 'Provider' in claim level section (if adding new claim/services).
  5. Navigate to 'Service Detail' section of form.
  6. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button).
  7. Enter/select 'Date of Service', 'Procedure Code', 'Total Charge' and 'Service Units' field values.
  8. Click 'Display Valid Authorizations' button and select Service Authorization (or directly enter value in 'Authorization Number' field).
  9. In case where 'Current Authorization Status' value is 'Pending' for selected/associated Service Authorization record - ensure that 'Claim Status' value is set to 'Pending' for service.
  10. In case where 'Current Authorization Status' value is 'Pending' for selected/associated Service Authorization record - ensure that 'Explanation Of Coverage' field for service includes value 'The service was pended for the following reason: Authorization is pending'.
  11. Click [Enter Third Party Adjudication Data].
  12. Create a new row with desired data, and if desired click [View] and create a new row with desired data. Save the rows.
  13. Click [Submit].
  14. Close the batch and validate that a new pended batch is created.
  15. Repeat steps 1-12 and validate that the ‘Third Party Adjudication Data’ was copied forward.
  16. Click [Submit].
  17. Close the batch and validate that a new pended batch is created.
  18. Repeat steps 1-12 and validate that the ‘Third Party Adjudication Data’ was copied forward.
Scenario 2: Avatar MSO 'Site Specific Section Modeling' - 'Fast Service Entry Submission' - opening prompt section.
Specific Setup:
  • Site Specific Section Modeling for MSO:
  • Select the ‘MSOBAT185SUBMISSION (Fast Service Entry Submission) Fast Service Detail’ item in the dropdown list.
  • Click [OK].
  • Select ‘Prompt Definition’ section.
  • If desired, add a new prompt and customize the label or customize the label of an existing prompt.
  • Click [Submit].
  • Refresh the forms.
Steps
  1. Open ‘Fast Service Entry’.
  2. Select the ‘Fast Service Detail’ section.
  3. Validate that the prompt that was added or changed exists on the form.
  4. Close the form.
  5. Open ‘Site Specific Section Modeling’ for MSO.
  6. Select the ‘MSOBAT185OVERRIDE (Fast Service Entry) Fast Service Detail’ item in the dropdown list.
  7. Click [OK].
  8. Select ‘Prompt Definition’ section.
  9. Validate that the prompt added or changed in Setup displays in the table.
  10. Select the prompt and click [Delete Selected Item].
  11. Click [Yes] on the ‘Confirm’ message.
  12. Click [Submit].
  13. Refresh the forms.
  14. Open ‘Fast Service Entry’.
  15. Select the ‘Fast Service Detail’ section.
  16. Validate that the prompt does not exist.
Topics
• Claims Processing • NX • Service Authorizations • Site Specific Section Modeling

 

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