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Avatar MSO 2022 Update 4

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Product Requirements / Recommendations

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Product Update Form Description

The following issues are resolved: 1) The error "[UNDEFINED]FileClaimForm+5^MSOCLAIMFORMFile" produced on 837 automated posting. 2) The error "[UNDEFINED]Save997toClass+60^MSOEACK997Compile" produced on load of an 837 Professional or Institutional file and the error "[MAXNUMBER]Save997toClass+38^MSOEACK997Compile" produced on compile of an 837 Professional or Institutional file. 3) The 'SYSTEM.table_eob_core' table is not updated when an existing check date, check number, or check amount is removed via the 'Other EOB Information' form.

Included Updates

None

Required Updates

None

Details
NEW0 CHANGED0 FIXED3
Fixed (3)
Avatar MSO 'Claim Processing Automation' form.
An issue is resolved to ensure files are correctly loaded/compiled/posted via Avatar MSO Claim Processing Automation functions.
Topics
• 837 Health Care Claim Institutional • 837 Health Care Claim Professional • Claims Processing
 
'837 Health Care Claim Professional' Form / '837 Health Care Claim Institutional' Form
An issue is resolved to ensure that user-friendly error messaged are produced on attempted loading of an invalid format 837 Professional or Institutional file. KB0068585 v0.01
Topics
• 837 Health Care Claim Institutional • 837 Health Care Claim Professional • NX
 
Avatar MSO 'Other EOB Information' form
An issue is resolved to ensure that Avatar MSO SQL table 'SYSTEM.table_eob_core' data is updated when an existing check date, check number, or check amount is removed via the 'Other EOB Information' form.

KB0068586 v0.01
Topics
• Create EOB • NX
 
Acceptance Tests
AV-77277 Summary | Details
Avatar MSO 'Claim Processing Automation' form.
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
  • Claim Processing Automation
Scenario 1: Automated 837 Inbound Processing/Claim Processing Automation - Verification of 837 Processing
Specific Setup:
  • Avatar MSO Automated Claim Processing functionality must be enabled and configured for system (via 'Import/Export File Configuration' form)
  • Avatar MSO Automated Claim Processing functionality 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 Claims Processing Automation (as defined in the 'Import/Export File Configuration' form).
  2. Ensure Avatar MSO Automated Claims Processing function for 837 Professional and Institutional files loads, compiles and posts each 837 inbound file in 'Processing' directories.
  3. Ensure for all Claims Processing batches created via inbound 837 automated processing are closed automatically (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
AV-77465 Summary | Details
'837 Health Care Claim Professional' Form / '837 Health Care Claim Institutional' Form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Professional
  • 837 Health Care Claim Institutional
Scenario 1: '837 Health Care Claim Professional' - Verification of File Format Validation
Specific Setup:
  • Inbound 837 Professional format file where 'Functional Group Header - Application Sender's Code/Receiver's Code (GS-02/GS-03) and/or 'Transaction Set Control Number' (ST-02) values are not included
Steps
  1. Open '837 Health Care Claim Professional' form.
  2. Select 'Load File' in the 'Options' field.
  3. Enter file path for inbound 837 Professional format file and click 'Process' button.
  4. Ensure user is presented with error dialog noting 'Missing Required Field / Invalid Format: APPLICATION SENDERS CODE = (Segment: GS - segment name Loop: 0)' / '...APPLICATION RECEIVERS CODE...' or 'Missing Required Field / Invalid Format: TRANSACTION SET CONTROL NUMBER = (Segment: ST - Transaction Set Loop: 0)' and the file is not successfully loaded.
  5. If Functional Acknowledgement (999) file is generated following 837 load attempt, ensure that file is reported as 'Rejected' (R) with Syntax Error Code 'One or More Segments in Error' (5) in 999 Functional Acknowledgement data (loop/segment 2110-IK5-01 'Transaction Set Acknowledgement Code' = 'R' and 'Syntax Error Code' = '5'; Example: IK5*R*5~AK9*R*1*1*0~).
Scenario 2: '837 Health Care Claim Institutional' - Verification of File Format Validation
Specific Setup:
  • Inbound 837 Institutional format file where 'Functional Group Header - Application Sender's Code/Receiver's Code (GS-02/GS-03) and/or 'Transaction Set Control Number' (ST-02) values are not included
Steps
  1. Open '837 Health Care Claim Institutional' form.
  2. Select 'Load File' in the 'Options' field.
  3. Enter file path for inbound 837 Institutional format file and click 'Process' button.
  4. Ensure user is presented with error dialog noting 'Missing Required Field / Invalid Format: APPLICATION SENDERS CODE = (Segment: GS - segment name Loop: 0)' / '...APPLICATION RECEIVERS CODE...' or 'Missing Required Field / Invalid Format: TRANSACTION SET CONTROL NUMBER = (Segment: ST - Transaction Set Loop: 0)' and the file is not successfully loaded.
  5. If Functional Acknowledgement (999) file is generated following 837 load attempt, ensure that file is reported as 'Rejected' (R) with Syntax Error Code 'One or More Segments in Error' (5) in 999 Functional Acknowledgement data (loop/segment 2110-IK5-01 'Transaction Set Acknowledgement Code' = 'R' and 'Syntax Error Code' = '5'; Example: IK5*R*5~AK9*R*1*1*0~).
Topics
• 837 Health Care Claim Institutional • 837 Health Care Claim Professional • NX
AV-77966 Summary | Details
Avatar MSO 'Other EOB Information' form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Other EOB Information
Scenario 1: 'Other EOB Information' - Form Verification
Specific Setup:
  • One or more existing EOB(s) to use in filing or importing 'Other EOB Information' data
  • Avatar MSO 'Other EOB Information' import file
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open 'Other EOB Information' form.
  2. For manual entry of 'Other EOB Information', select existing EOB and enter or clear 'Check/EFT Date', 'Check/EFT Number' and/or 'Check/EFT Amount' field values.
  3. Click 'Submit' button to file/save Other EOB Information.
  4. Select same existing EOB in 'Other EOB Information' form, and ensure that previously entered/filed field values are present, including values for 'Check/EFT Date', 'Check/EFT Number' and/or 'Check/EFT Amount' fields where added/updated or cleared.
  5. For import of 'Other EOB Information', navigate to 'Import Other EOB Information' section of form.
  6. Click 'Select Data Import File' button.
  7. Select 'Other EOB Information' import file containing valid EOB Info import data.
  8. Click 'Import Other EOB Information' button.
  9. For import of 'Other EOB Information' data, ensure that file import is completed in timely manner and confirmation dialog is presented on import filing completion.
  10. Open Crystal Reports or Other SQL tool.
  11. In Avatar MSO SQL table 'SYSTEM.table_eob_core', ensure that values in fields 'eob_check_date', 'eob_check_number' and/or 'eob_check_amount' (for 'Check/EFT Date', 'Check/EFT Number' and/or 'Check/EFT Amount' form fields, respectively) are updated/reflect most recent information from 'Other EOB Information' manual entry or import.
Topics
• Create EOB • NX

 

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