Avatar MSO 2022 Update 7

Last updated
Save as PDF

Product Requirements / Recommendations

Avatar MSO required
RADplus required

Product Update Form Description

The following updates are included: 1) An issue is resolved where the Avatar MSO 'Claim Entry' web service may not correctly file claim/service data. 2) An issue is resolved where using the 'File' or 'Delete' fields in the 'Service Filling' section of the 'MSO to Parent System Integration Mapping' form while claims are being filed from MSO to PM may result in claims incorrectly validating for EOB and EOB check numbers before filing.

Included Updates

None

Required Updates

None

Details

NEW0 CHANGED0 FIXED2

Fixed (2)

AV-76687 Details \| User Acceptance Tests Avatar MSO to Avatar PM Service Filing An issue is resolved to ensure that using the 'File' or 'Delete' fields in the 'Service Filling' section of the 'MSO to Parent System Integration Mapping' form while claims are being filed from MSO to PM correctly validates for EOB/EOB check numbers before filing.	Topics • MSO To Parent System Integration Mapping • NX

AV-77902 Details \| User Acceptance Tests 'Claim Entry' Web Service An issue is resolved to ensure that the Avatar MSO 'Claim Entry' Web Service correctly files data where Batch ID to be created exceeds 6 digits in length.	Topics • Web Services

Acceptance Tests

AV-76687 Summary | Details

Avatar MSO to Avatar PM Service Filing

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

Client Ledger
Close Batch
Create EOB
MSO to Parent System Integration Mapping
Other EOB Information

Scenario 1: Avatar MSO to PM Parent System Service Filing - Verification of Service Filing With 'Service Filing Inhibit Rule' Defined

Specific Setup:

'File Services On Closing Of Batch Or Creation Of EOB' must be set to 'Yes' (via 'MSO to Parent System Integration Mapping' form)
Service Filing Inhibit Rule for 'Check Number For EOB' and/or 'EOB Creation' must be defined for Avatar MSO Contracting Provider (via 'MSO to Parent System Integration Mapping' form)
Client record with Avatar PM/Cal-PM episode(s) eligible for service filing
Client record with service(s) originating in Avatar MSO eligible for service filing to Avatar PM/Cal-PM

Steps

Open Avatar MSO 'Close Batch' or 'Close Multiple Batches' form.
Note - Acceptance Testing may also be confirmed via Avatar MSO 'Claim Processing Automation' functionality for automatic posting/closing 837 file batches
Select Claims Processing batch(es) to be closed.
Set 'Close Batch' field to 'Yes' and submit form to close batch(es).
For clients with 'Approved' status services eligible for service filing to Avatar PM/Cal-PM and where 'Service Filing Inhibit Rule' is defined for Contracting Provider(s), ensure that service(s) are not filed/not present in Avatar PM/Cal-PM following 'Close Batch' action, pending EOB Creation and/or 'Check/EFT Number' entry for inclusive EOB.
Service Filing Inhibition may be confirmed by service(s) not being included in Avatar PM/Cal-PM 'Client Ledger' display
Service Filing Inhibition may also be confirmed via Avatar MSO SQL table 'SYSTEM.mso_to_pm_service_failed', with a row present for Claims Processing Batch ID/Service ID and error message 'Service will be held from filing into PM until it is placed on an EOB' or 'Service will be held from filing into PM due to lack of a check number'
On inclusion of service(s) in Avatar MSO EOB and/or 'Check/EFT Number' entry for inclusive EOB, ensure that eligible service(s) are successfully filed to Avatar PM/Cal-PM.
Service Filing may be confirmed by service(s) being included in Avatar PM/Cal-PM 'Client Ledger' display
Service Filing may also be confirmed via Avatar MSO SQL table 'SYSTEM.mso_to_pm_service_failed', with a rows deleted for Claims Processing Batch ID/Service IDs previously filed due to Service Filing Inhibition

Topics

• MSO To Parent System Integration Mapping • NX

AV-77902 Summary | Details

'Claim Entry' Web Service

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

Claim Entry Web Service

Scenario 1: 'Claim Entry' Web Service - Verification of Claim/Service Filing

Specific Setup:

Client record eligible for Claim/Service entry in Avatar MSO and Netsmart ProviderConnect
Netsmart ProviderConnect (or other application utilizing the Avatar MSO 'Claim Entry' web service)

Steps

Enter service(s) via Netsmart ProviderConnect 'Treatment' service entry.
Navigate to ProviderConnect 'Billing' menu.
Click 'Generate Bill' button for selected criteria.
Click 'Submit Bill' button for ProviderConnect billing transaction (or file via other application utilizing the Avatar MSO 'Claim Entry' web service).
In Avatar MSO, ensure that claims processing batch(es) are created/updated via the 'Claim Entry' web service/receipt of services from Netsmart ProviderConnect (this can be confirmed via 'Batch Creation' form and/or 'Open Batches' Widget).
In Avatar MSO 'Claim Processing (CMS 1500)' and/or 'Claim Processing (UB04)' form, open created claims processing batch.
Ensure that all claims/services are present/filed from ProviderConnect submitted 'Billing' data (or filed/confirmed via other application utilizing the Avatar MSO 'Claim Entry' web service).

Topics

• Web Services