Avatar MSO 2022 Update 37

Product Requirements / Recommendations

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RADplus required

Product Update Form Description

Performance improvements have been made to the query process for 'SYSTEM.retro_claim_adjudications' table.

Included Updates

Required Updates

None

Details

NEW0 CHANGED1 FIXED0

Changed (1)

AV-58155 Details \| User Acceptance Tests Avatar MSO 'Create EOB' Form/Function Performance improvements have been made in the Avatar MSO 'Create EOB' form/function for inclusion of information from the 'SYSTEM.retro_claim_adjudications' SQL table. Value Added: Improves 'Create EOB' query performance for 'Retro Claim Adjudication' SQL Table	Topics • Create EOB

Acceptance Tests

AV-58155 Summary | Details

Avatar MSO 'Create EOB' Form/Function

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

Scenario 1: 'Create EOB' form - Verification of EOB Creation With 'Retro Claim Adjudication' Entries Included

Specific Setup:

One or more claims/services in 'Closed' status Claims Processing Batch(es), included on Voucher and not yet included on EOB
One or more Retro Claim Adjudication entries not yet included on an EOB (and where 'Withhold Payment' is filed as 'Yes')
Crystal Reports or other SQL reporting tool

Steps

Open 'Create EOB' form.
Note - Acceptance testing may also be confirmed via Avatar MSO Claims Processing Automation EOB creation
Select 'All' or 'Individual Providers' for EOB creation.
Click 'Submit' button.
Ensure EOB creation confirmation message is displayed on process completion.
In EOB creation confirmation message, ensure that 'Total Amount of EOB(s) Created' value reflects/includes sum of all service 'Expected Disbursement' amounts and Retro Claim Adjudication entry/entries 'Take Back Amount' included in EOB(s) generated.
In EOB creation confirmation message, ensure that 'Total Number of EOB(s) Created' value reflects total number of EOB(s) created.
Open Crystal Reports or other SQL reporting tool.
In Avatar MSO SQL table 'SYSTEM.table_eob', ensure that row(s) are present in table for all services and/or Retro Claim Adjudication entries included in EOB(s).
In Avatar MSO SQL table 'SYSTEM.retro_claim_adjudications', ensure that 'EOBID' value is updated to newly created EOB number for all Retro Claim Adjudication entries included in EOB(s).

Topics

• Create EOB