Avatar MSO 2022 Update 23

• 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)
• 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

1. 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).
2. Open the Avatar MSO 'Claim Acknowledgement (277CA) File' form.
3. 277CA file generation/content review may also be confirmed directly in system output directory where automatic 277CA file generation is enabled
4. Select 'Create File On Server' in 'Options' field.
5. Select 'Submission Type' field value ('Institutional' or 'Professional').
6. Select 837 file for Claim Acknowledgement (277CA) file creation.
7. Click 'Process' button.
8. Ensure that for selected 837 file, Claim Acknowledgement (277CA) file is created on server in defined directory.
9. 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
10. Select 'Dump File' in 'Options' field.
11. Select 'Submission Type' field value ('Institutional' or 'Professional').
12. Select 837 file for Claim Acknowledgement (277CA) file review.
13. Click 'Process' button.
14. 277CA file content review may also be confirmed directly in system output directory by opening/reviewing file(s)
15. In 277CA Claim Acknowledgement file(s) for successfully processed 837 Professional and/or Institutional inbound files, ensure that Submitter/Provider acceptance levels (2200B/2200C Status Information) are reported with accepted/rejected status.
16. Examples:
17. STC*A1:19:40*20221005*WQ*2000~
18. STC*A7:478*20221005*U*1500~
19. In 277CA Claim Acknowledgement file(s) for successfully processed 837 Professional and/or Institutional inbound files, ensure that Accepted Amount (2200B/2200C Total Accepted Amount) is reported with total amount for successfully compiled/posted claims/service(s).
20. Example:
21. AMT*YU*700~
22. In 277CA Claim Acknowledgement file(s) for successfully processed 837 Professional and/or Institutional inbound files, ensure that Rejected Amount (2200B/2200C Total Rejected Amount) is reported with total amount for rejected claims/service(s).
23. Example:
24. AMT*YY*1300~
25. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims, ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Accepted', 'Rejected' or 'Acknowledged' status.
26. Examples:
27. STC*A2:20**WQ*180~
28. STC*A2:20*20220516*WQ*60~
29. STC*A7:0**U~
30. STC*A5:0*20221005*U*500~

• 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)
• 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
• Crystal Reports or other SQL reporting tool

1. 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).
2. Open the Avatar MSO 'Claim Acknowledgement (277CA) File' form.
3. 277CA file generation/content review may also be confirmed directly in system output directory where automatic 277CA file generation is enabled
4. Select 'Create File On Server' in 'Options' field.
5. Select 'Submission Type' field value ('Institutional' or 'Professional').
6. Select 837 file for Claim Acknowledgement (277CA) file creation.
7. Click 'Process' button.
8. Ensure that for selected 837 file, Claim Acknowledgement (277CA) file is created on server in defined directory.
9. 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
10. Select 'Dump File' in 'Options' field.
11. Select 'Submission Type' field value ('Institutional' or 'Professional').
12. Select 837 file for Claim Acknowledgement (277CA) file review.
13. Click 'Process' button.
14. 277CA file content review may also be confirmed directly in system output directory by opening/reviewing file(s).
15. Note - Claim/Service Detail information detailed below applies to 277CA files processed subsequent to installation of Avatar MSO 2022 Update 23
16. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all services within claim are accepted by Avatar MSO, ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Accepted' status (A2).
17. Example:
18. STC*A2:20*20221005*WQ*500~
19. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all services within claim are rejected by Avatar MSO, ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Rejected' status (A7).
20. Example:
21. STC*A7:21*20221005*U*500******A7:454~
22. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where services within claim are both accepted and rejected by Avatar MSO (split claims), ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Acknowledged' status (A5).
23. Example:
24. STC*A5:0*20221005*U*500~
25. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all services within claim are accepted by Avatar MSO, ensure that Service level acceptance information (2220D Service Line Information/Service Line Level Status Information/Service Line Item Identification/Service Line Date) is not included/reported.
26. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Information (2220D SVC) is included/reported for each individual service line within claim (for all services, accepted and rejected).
27. Examples:
28. SVC*HC:H0004*100*****210~
29. SVC*NU:910*54*****8~
30. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Level Status Information (2220D STC) is included/reported with 'Accepted' or 'Rejected' status (A2/A7) for individual service line (for all services, accepted and rejected).
31. Examples:
32. STC*A2:20**WQ~
33. STC*A7:21**U*******A7:455~
34. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Item Identification (2220D REF) is included/reported for individual service line.
35. If 2400 Service Line Item Reference Number (2400 REF) is included in inbound 837 Professional/Institutional claim/service information, this reference number will be reported in 277CA file 2220D REF Service Line Item Identification segment.
36. If 2400 Service Line Item Reference Number (2400 REF) is not included in inbound 837 Professional/Institutional claim/service information, the line sequence number (2400 LX) for the service line within claim will be reported in 277CA file 2220D REF Service Line Item Identification segment
37. Examples:
38. REF*FJ*CX74X66110.003~
39. REF*FJ*3~
40. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Date (2220D DTP) is included/reported for individual service line.
41. Examples:
42. DTP*472*D8*20220915~
43. DTP*472*RD8*20220915-20220920~
44. Open Crystal Reports or other SQL reporting tool.
45. In Avatar MSO SQL table 'SYSTEM.clm_status_provider', ensure provider level claim information is present for processed 837 inbound files.
46. In Avatar MSO SQL table 'SYSTEM.clm_status_receiver', ensure receiver/submitter level claim information is present for processed 837 inbound files.
47. In Avatar MSO SQL table 'SYSTEM.svc_status_resp', ensure claim/service level information is present for processed 837 inbound files.

For more information on 277CA Acceptance/Acknowledgement/Rejection information and values, please refer to Avatar_MSO_277CA_Mapping_v5010_102022.xls document

• Compiled and/or Posted 837 Professional and/or Institutional format inbound file(s)
• 277CA Claim Acknowledgment file may optionally be enabled for automatic generation (via Avatar MSO 'Import/Export File Configuration' form)

1. 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).
2. Open the Avatar MSO 'Claim Acknowledgement (277CA) File' form.
3. Select 'Run Report' in 'Options' field.
4. Select 'Submission Type' field value ('Institutional' or 'Professional').
5. Select 837 file for Claim Acknowledgement (277CA) Report review.
6. Click 'Process' button.
7. Click 'Claim Status Details' link to view 277CA Claim Acknowledgement Report information.
8. Note - Claim/Service Detail report information detailed below applies to 277CA files processed subsequent to installation of Avatar MSO 2022 Update 23
9. In 277CA Claim Acknowledgement Report for successfully processed 837 Professional and/or Institutional inbound files, ensure that Submitter ID/Provider ID 'Status' fields display 'ACCEPTED', 'REJECTED' or 'ACKNOWLEDGED' status for submitter/provider level.
10. 'ACCEPTED' will be reported for Submitter ID/Provider ID accepted/successfully processed, where all claims/services are fully accepted/fully rejected by Avatar MSO
11. 'REJECTED' (or rejection Status Category Code/Status Code) will be reported for Submitter ID/Provider ID rejected by Avatar MSO (and no claims accepted/processed)
12. 'ACKNOWLEDGED' will be reported for Submitter ID/Provider ID accepted/successfully processed, where claims include services both accepted and rejected by Avatar MSO
13. In 277CA Claim Acknowledgement Report for successfully processed 837 Professional and/or Institutional inbound files, ensure that the following 'Claims...' count fields display values for Submitter ID/Provider ID claims processed:
14. 'Claims Accepted'
15. Count of 837 Professional and/or Institutional inbound claims where all services within claim are accepted by Avatar MSO
16. 'Claims Rejected'
17. Count of 837 Professional and/or Institutional inbound claims where all services within claim are rejected by Avatar MSO
18. 'Claims Split'
19. Count of 837 Professional and/or Institutional inbound claims where services within claim are both accepted and rejected by Avatar MSO
20. In 277CA Claim Acknowledgement Report for successfully processed 837 Professional and/or Institutional inbound files, ensure that 'Total Accepted Charges' field displays sum of charges for 837 Professional and/or Institutional inbound services accepted by Avatar MSO.
21. In 277CA Claim Acknowledgement Report for successfully processed 837 Professional and/or Institutional inbound files, ensure that 'Total Rejected Charges' field displays sum of charges for 837 Professional and/or Institutional inbound services rejected by Avatar MSO.
22. Ensure service details section of 277CA Claim Acknowledgement Report 'Claim Status Details' display includes all successfully processed Accepted/Rejected/Acknowledged (split claim) services, with the following information:
23. 'Policy Number'
24. 'Patient Name'
25. 'Service Date (From-Thru)'
26. 'Charges'
27. 'Status' (Status Category Code/Status Code)
28. Ensure final page in 277CA Claim Acknowledgement Report 'Claim Status Details' display includes listing of all Claim Acknowledgement Status Code values and descriptions related to claims/services in report information.