Skip to main content

Avatar MSO 2022 Update 31

  1. Last updated
  2. Save as PDF

Product Requirements / Recommendations

Avatar MSO required
RADplus required

Product Update Form Description

The following updates are included: 1) The duplicate file check for MSO 837 Professional and Institutional files are updated to use file names and ignore file paths. 2) MSO Background job checks are updated. 3)An issue is resolved where the error "RADPlusException: [Illegal Value]Compile1+464^EB837ICompile" would occur when an invalid admission date is specified in an 837 Institutional file.

Included Updates

2

Required Updates

None

Details
NEW0 CHANGED2 FIXED1
Changed (2)
Avatar MSO Automated 837 Health Care Claim Processing
Automated 837 Health Care Claim processing is updated to use file names and ignore file paths.
Avatar MSO inbound 837 Professional and Institutional Health Care Claim file processing duplicate file validation will consider duplicate files by file names alone, to ensure that distinct files with same file name are not processed more than once in case where inbound processing directory is updated.
Value Added: Updates Avatar MSO Automated 837 file processing to use file names only
Topics
• 837 Health Care Claim Institutional • 837 Health Care Claim Professional • Claims Processing
 
Avatar MSO Background Task Processing
Performance improvements have been made in Avatar MSO background task processing; No visible changes to system users will be reflected in this update.
Value Added: Updates Avatar MSO background system processes for performance
Topics
• 837 Health Care Claim Institutional • 837 Health Care Claim Professional • Claims Processing • Widgets
 
Fixed (1)
'837 Health Care Claim Institutional' Invalid Data Handling
An issue is resolved to ensure that 837 Institutional inbound files/claims containing an invalid 2300 DTP Admission Date value are compiled without a system error and display invalid segment/value information.
Topics
• 837 Health Care Claim Institutional
 
Acceptance Tests
AV-54625 Summary | Details
Avatar MSO Automated 837 Health Care Claim Processing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Institutional Automated Processing
  • 837 Health Care Claim Professional Automated Processing
  • Import/Export File Configuration
Scenario 1: Automated 837 Inbound Processing - Verification of Duplicate 837 Inbound File Handling
Specific Setup:
  • Avatar MSO Automated 837 Health Care Claim Processing must be enabled and configured for system (via 'Import/Export File Configuration' form)
  • Inbound 837 Professional and/or Institutional format files for automated processing
Steps
  1. Place 837 Professional and/or Institutional inbound file(s) in 'Processing' directories for Avatar MSO Automated inbound 837 Health Care Claim processing (as defined via 'Import/Export File Configuration' form).
  2. Ensure Avatar MSO Automated inbound process for 837 Professional and Institutional files loads/compiles/posts each 837 inbound file in 'Processing' directories (according to behavior defined via 'Import/Export File Configuration' form).
  3. Ensure that inbound 837 automated processing completes for valid 837 inbound files placed in 'Processing' directories, and that valid files are correctly moved to 'Processed' directories.
  4. Place one or more 837 Professional and/or Institutional inbound file(s) with same/duplicate file name in 'Processing' directories for Avatar MSO Automated inbound 837 Health Care Claim processing
  5. Ensure Avatar MSO Automated inbound process for 837 Professional and Institutional files does not compile/post inbound 837 file(s) with same/duplicate file name as previously processed file; ensure that file extension is changed to .INVALID in 'Processing' directory.
  6. Ensure that in 'Error' file path directory, new error is recorded for duplicate/already processed files, noting '(Date/Time) - (File Path/Name) - The file '(File Path/Name)' has already been previously processed.'
  7. Example:
  8. '12/02/2022 11:51:13 - E:\INBOUND\AVPM_AUTOPROF\837InboundProf_AVMSO_DUPLICATECHECK.txt - The file 'E:\INBOUND\AVPM_AUTOPROF\837InboundProf_AVMSO_DUPLICATECHECK.txt' has already been previously processed.'
  9. Open Avatar MSO 'Import/Export File Configuration' form.
  10. Enter new value for 837 Professional 'Process File Path' and/or 837 Institutional 'Process File Path' configuration fields.
  11. Click 'Submit' button to file updated 'Import/Export File Configuration' values.
  12. Place one or more 837 Professional and/or Institutional inbound file(s) with same/duplicate file name in updated 'Processing' directories for Avatar MSO Automated inbound 837 Health Care Claim processing
  13. Ensure Avatar MSO Automated inbound process for 837 Professional and Institutional files does not compile/post inbound 837 file(s) with same/duplicate file name as previously processed file regardless of file path; ensure that file extension is changed to .INVALID in 'Processing' directory.
  14. Ensure that in 'Error' file path directory, new error is recorded for duplicate/already processed files, noting '(Date/Time) - (File Path/Name) - The file '(File Path/Name)' has already been previously processed.'
  15. Example:
  16. '12/02/2022 11:51:13 - E:\INBOUND\AVPM_AUTOPROF\NEW_PATH\837InboundProf_AVMSO_DUPLICATECHECK.txt - The file 'E:\INBOUND\AVPM_AUTOPROF\NEW_PATH\837InboundProf_AVMSO_DUPLICATECHECK.txt' has already been previously processed.'
Topics
• 837 Health Care Claim Institutional • 837 Health Care Claim Professional • Claims Processing
AV-64113 Summary | Details
'837 Health Care Claim Institutional' Invalid Data Handling
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Institutional
  • 837 Health Care Claim Institutional - Compile Report
  • 837 Health Care Claim Institutional - Error Report
Scenario 1: '837 Health Care Claim Institutional' - Validation of 2300 DTP Admission Date Format
Specific Setup:
  • 837 Health Care Claim Institutional file with one or more claims containing invalid 2300 DTP Admission Date value
  • Example: DTP*435*DT*2022101~
Steps
  1. Open '837 Health Care Claim Institutional' form.
  2. Note - Acceptance testing may also be confirmed via Avatar MSO Automated inbound 837 inbound file processing functionality
  3. Select 'Load File' in the 'Options' field.
  4. Enter file path for inbound 837 Institutional format file and click 'Process' button.
  5. Select 'Compile File' in the 'Options' field, and select loaded 837 Institutional file.
  6. Click 'Process' button.
  7. In 837 Institutional Compile Report - in case where one or more claim(s) include an invalid 2300 DTP Admission Date value, ensure that claim/service(s) are not successfully compiled (and are not included in 837 compile report).
  8. Select 'Run Error Report' in the 'Options' field, and select compiled 837 Institutional file.
  9. In 837 Institutional Error Report - in case where one or more claim(s) include an invalid 2300 DTP Admission Date value, ensure that claim is included in 837 error report with Error Type 'Critical Error' and Error Message 'Invalid admission date for claim.'
  10. Select 'Post File' in the 'Options' field, and select compiled 837 Institutional file.
  11. Click 'Process' button.
  12. In 837 Institutional Post Report - in case where one or more claim(s) include an invalid 2300 DTP Admission Date value, ensure that claim/service(s) are not successfully posted (and are not included in 837 post report).
Topics
• 837 Health Care Claim Institutional
AV-75469 Summary | Details
Avatar MSO Background Task Processing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Institutional Automated Processing
  • 837 Health Care Claim Professional Automated Processing
  • NX View Definition
  • View Definition
  • Claim Pre-Adjudication Web Service
  • Claim Processing Automation
Scenario 1: Automated 837 Professional/Institutional Process Status Widgets - Verification of Widget Data Display
Specific Setup:
  • Avatar MSO Automated 837 Health Care Claim Processing must be enabled and configured for system (via 'Import/Export File Configuration' form)
  • Avatar MSO Automated 837 Health Care Claim Processing may optionally be configured to automatically close batch(es) after 837 posting, create Vouchers and/or create EOBs (via 'Claim Processing Automation' form)
  • 'Automated MSO 837 Professional Process Status' and/or 'Automated MSO 837 Institutional Process Status' Widget must be assigned to user Home/myDay/Dashboard view (via RADplus 'View Definition'/'NX View Definition' form)
  • Inbound 837 Professional and/or Institutional format files for automated processing
Steps
  1. Place multiple 837 Professional and/or Institutional inbound files in 'Processing' directories for Avatar MSO Automated inbound 837 Health Care Claim processing (as defined via 'Import/Export File Configuration' form).
  2. Refresh the 'Automated MSO 837 Professional Process Status' and/or 'Automated MSO 837 Institutional Process Status' Widget within user's Home View/myDay View/Dashboard View.
  3. Ensure that 'Automated MSO 837 Professional Process Status' / 'Automated MSO 837 Institutional Process Status' Widgets display current/correct information for inbound 837 files processing/to be processed in the 'Status' and 'File Name' widget columns.
  4. Ensure Automated 837 file process loads/compiles/posts each 837 inbound file in 'Processing' directories as expected (according to behavior defined via 'Import/Export File Configuration' form).
  5. During/following additional Avatar MSO Automated inbound 837 file processing actions, refresh the 'Automated MSO 837 Professional Process Status' and/or 'Automated MSO 837 Professional Process Status' Widget within user's Home View/myDay View/Dashboard View, ensuring that display is updated with current/correct information for inbound 837 files processing/to be processed in the 'Status' and 'File Name' widget columns.
Scenario 2: 'Claim Pre-Adjudication' Web Service - Receipt and processing of claim/service data from ProviderConnect
Specific Setup:
  1. Client record eligible for Claim/Service entry in Avatar MSO and Netsmart ProviderConnect
  2. Netsmart ProviderConnect (or other application utilizing the Avatar MSO 'Claim Pre-Adjudication' web service)
  3. 'Crystal Reports' or other SQL reporting tool
Steps
  1. Enter one or more services via Netsmart ProviderConnect 'Treatment' service entry.
  2. Navigate to ProviderConnect 'Billing' menu.
  3. Click 'Generate Bill' button for selected criteria.
  4. Click 'Click 'Submit Bill for Pre-adjudication' button for ProviderConnect billing transaction (or via other application utilizing the Avatar MSO 'Claim Pre-Adjudication' web service).
  5. Within 'Unsubmitted Bills' section of ProviderConnect 'Billing' menu, navigate to bill created above which was submitted for Pre-Adjudication.
  6. Click 'View Pre-adjudication Results' button for unsubmitted bill.
  7. For all services in bill submitted for Pre-Adjudication but not yet processed by Avatar MSO, ensure 'Status' value is 'Queued'.
  8. The Avatar MSO Pre-Adjudication processing will be performed by a system background process automatically, starting every 30 minutes and processing any new/previously unprocessed services; accordingly, wait for sufficient time frame for Pre-Adjudication to be performed by Avatar MSO.
  9. Click the 'Refresh Bill Pre-adjudication Results' button.
  10. Following Avatar MSO Pre-Adjudication processing of services, ensure that 'Status' value in ProviderConnect is updated from 'Queued' to either 'Passed Edit' or 'Failed Edit'. ('Passed Edit' or 'Failed Edit' Pre-Adjudication status for each service will be determined by Avatar MSO using the same configurations/criteria/logic as standard Claim Processing service adjudication for 'Approved' and 'Denied'/'Pending' claim status (respectively).)
  11. Following Avatar MSO Pre-Adjudication processing of services, ensure that services with 'Status' value of 'Failed Edit' also include data for 'Pre-Adjudication Edit Failed Reason' in ProviderConnect display. ('Pre-Adjudication Edit Failed Reason values for 'Failed Edit' services will be determined by Avatar MSO using the same configurations/criteria/logic as standard Claim Processing service adjudication for the 'Explanation of Coverage' detailed message.)
  12. Open 'Crystal Reports' or other SQL reporting tool.
  13. In Avatar MSO SQL table 'SYSTEM.claims_pre_adj table' - ensure new single row is present for each service submitted/processed by Claim Pre-Adjudication web service/background process.
  14. In Avatar MSO SQL table 'SYSTEM.claims_pre_adj table' - for each service submitted/processed, confirm 'Queued', 'Passed Edit' or 'Failed Edit' status in field 'status' (value 'Q', '1' or '0', respectively).
  15. In Avatar MSO SQL table 'SYSTEM.claims_pre_adj table' - for each service submitted/processed with 'Failed Edit' status, confirm 'Pre-Adjudication Edit Failed Reason' values in field 'pre_adj_edit_failed_reason'.
Scenario 3: Automated 837 Inbound Processing/Claim Processing Automation - Verification of 837 Processing
Specific Setup:
  • Avatar MSO Automated 837 Health Care Claim Processing must be enabled and configured for system (via 'Import/Export File Configuration' form)
  • Avatar MSO Automated 837 Health Care Claim Processing may optionally be configured to automatically close batch(es) after 837 posting, create Vouchers and/or create EOBs (via 'Claim Processing Automation' form)
  • Inbound 837 Professional and/or Institutional format files for automated processing containing one or more valid claims/services
Steps
  1. Place multiple 837 Professional and/or Institutional inbound files in 'Processing' directories for Avatar MSO Automated inbound 837 Health Care Claim processing (as defined via 'Import/Export File Configuration' form).
  2. Ensure Avatar MSO Automated inbound process for 837 Professional and Institutional files loads/compiles/posts each 837 inbound file in 'Processing' directories (according to behavior defined via 'Import/Export File Configuration' form).
  3. Ensure for all Claims Processing batches created via inbound 837 automated processing are closed automatically if configured (as defined in the 'Claim Processing Automation' form). This can be confirmed via 'Close Batch' form, the 'Open Batches' Widget and/or by reviewing data in Avatar MSO SQL table 'SYSTEM.batch_current_data.'
  4. Ensure that inbound 837 automated processing completes for all 837 inbound files placed in 'Processing' directories, and that files are correctly moved to 'Processed' directories.
  5. Ensure that no system errors are recorded in the 'Error' file directory .txt file (as defined in the 'Import/Export File Configuration' form) for processed 837 inbound files.
  6. If 999 Functional Acknowledgement response files are configured for generation on 837 file automated processing - ensure that on inbound 837 file processing, 999 Functional Acknowledgement response file(s) are automatically generated on server in directory specified for 999 file creation in the 'Import/Export File Configuration' form.
  7. If 277CA Claim Acknowledgement response files are configured for generation on 837 file automated processing - ensure that on inbound 837 file processing, 277CA Claim Acknowledgement response file(s) are automatically generated on server in directory specified for 277CA file creation in the 'Import/Export File Configuration' form.
  8. If 835 Health Care Claim Payment/Advice response files are configured for generation on EOB creation - ensure that on EOB creation (manually via 'Create EOB' form or via automated claims processing functionality including scheduled EOB creation), 835 Health Care Claim Acknowledgement response file(s) are automatically generated on server in directory specified for 835 file creation in the 'Claim Processing Automation' form.
Topics
• 837 Health Care Claim Institutional • 837 Health Care Claim Professional • Claims Processing • Widgets

 

  1. Back to top
  • Was this article helpful?

Recommended articles

  1. Page type
    Reference
  2. Tags
    1. content:release
    2. llm-no-index
    3. role:sysadmin
    4. search:ready