Avatar MSO 2022 Update 33

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Recommended Update Level

Avatar MSO 2022 Update 20

Product Update Form Description

The "[PROPERTY DOES NOT EXIST]ProcessFields+23^MSOWebServiceClaimEntryAPI *TravelTime,SYSTEM.ClaimEntryServiceObject" error which could occur during the ProviderConnect pre-adjudication process is resolved.

Included Updates

None

Required Updates

None

Details

NEW0 CHANGED0 FIXED1

Fixed (1)

AV-83119 Details \| User Acceptance Tests Avatar MSO/ProviderConnect Claims Pre-Adjudication An issue is resolved to ensure that Avatar MSO Claims Pre-Adjudication processing of information/entries from ProviderConnect is completed.	Topics • Claims Processing

Acceptance Tests

AV-83119 Summary | Details

Avatar MSO/ProviderConnect Claims Pre-Adjudication

Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:

Billing - Bill Generation section
Billing - Unsubmitted Bill
View Bill Pre-adjudication Results

Scenario 1: Avatar MSO 'Claims Pre-Adjudication' - Processing/Transmission of Pre-Adjudication Information to ProviderConnect

Specific Setup:

Netsmart ProviderConnect (or other application utilizing the Avatar MSO 'Claim Pre-Adjudication' web service/process)
Client record eligible for Claim/Service entry in Avatar MSO and Netsmart ProviderConnect
Claims Pre-Adjudication Submission data submitted via Netsmart ProviderConnect to be Pre-Adjudicated automatically by Avatar MSO background process

Steps

Enter one or more services via Netsmart ProviderConnect 'Treatment' service entry.
Navigate to ProviderConnect 'Billing' menu.
Click 'Generate Bill' button for selected criteria.
Click 'Click 'Submit Bill for Pre-adjudication' button for ProviderConnect billing transaction.
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.
Within 'Unsubmitted Bills' section of ProviderConnect 'Billing' menu, navigate to bill created above which was submitted for Pre-Adjudication.
Click 'View Pre-adjudication Results' button for unsubmitted bill.
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).)
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.)

Topics

• Claims Processing

Table Changes

Table	Column	Change
SYSTEM.ClaimEntryServiceObject	TravelTime	new
SYSTEM.ClaimEntryServiceObject	GroupSeviceUnitsPerDay	new