Avatar MSO Retro Claim Adjudication File Import
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- File Import
- File Import - Error Report
- Retro Claim Adjudication
Scenario 1: 'File Import' - Verification of '[Avatar MSO] Retro Claim Adjudication' Import
Specific Setup:
- Client with claim(s)/services eligible for Retro Claim Adjudication entry/import in Avatar MSO, where two or more services exist in same/single claim
- Avatar MSO 'Retro Claim Adjudication' Import File containing one or more valid import rows
Steps
- Open 'File Import' form in Avatar PM.
- Select File Type '[Avatar MSO] Retro Claim Adjudication'.
- Select 'Upload New File' in 'Action' field and Click 'Process Action' button.
- Select Avatar MSO 'Retro Claim Adjudication' import file and click 'Open' button.
- Select 'Compile/Validate File' in 'Action' field.
- Select loaded Retro Claim Adjudication import file and click 'Process Action' button.
- Ensure that 'Compile/Validate File' action completes, and message 'Compiled' or '(File Name) contains one or more errors. These errors can be reviewed using 'Print Errors' action' is displayed.
- Click 'OK' button.
- Select 'Print File' in 'Action' field.
- Select compiled Retro Claim Adjudication import file and click 'Process Action' button to view report.
- In File Import 'Print File' report, ensure that valid Retro Claim Adjudication entries are successfully compiled/included in report, including case where 'Add' Retro Claim Adjudication entries are included for same claim but different/multiple services in single import file.
- Select 'Print Errors' in 'Action' field.
- Select compiled Retro Claim Adjudication import file and click 'Process Action' button to view report.
- In File Import 'Print Errors' report, ensure that invalid Retro Claim Adjudication entries are displayed with error message/detail, including case where duplicate/multiple 'Add' Retro Claim Adjudication entries exist for same claim/service in single import file.
- Note - Duplicate/multiple Retro Claim Adjudication 'Add' entries for same claim/service in single import file are invalid and will be reported with error condition "Duplicate add record for same batch/claim/service disallowed. This line will be skipped."
- Select 'Post File' in 'Action' field.
- Select compiled Retro Claim Adjudication import file and click 'Process Action' button.
- Ensure that 'Post' action completes, and message 'Posted' and/or 'The selected file contains one or more lines with compilation errors. Only those lines without compilation errors will be posted' is displayed.
- Open Avatar MSO 'Retro Claim Adjudication' form.
- Select 'Edit' in the 'Add/Edit/Delete Claim Adjudication' field to view imported Retro Claim Adjudication entries.
- Select 'Claim' and 'Date of Service/Procedure' value for imported Retro Claim Adjudication review.
- Ensure that Retro Claim Adjudication field values ('Take Back Amount', 'Take Back Units', 'Updated Disbursement Amount', 'Adjustment Code', etc.) reflect information filed via 'File Import' form, including case where 'Add' Retro Claim Adjudication entries were imported/posted for same claim but different/multiple services in single import file.
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Topics
• File Import
• Retro Claim Adjudication
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