Avatar MSO 2023 Monthly Release 2023.02.01 Details
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Product Requirements and Recommendations
Avatar MSO
required
RADplus
required
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Avatar MSO Automated Claim Processing and Service Adjudication
An issue is resolved to ensure that services are correctly adjudicated (Approved/Denied) when 837 files are posted via Avatar MSO Import/Export File Configuration and Claim Processing Automation functionality.
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Avatar MSO 'Create Voucher' Form/Function
An issue is resolved to ensure that the 'Create Voucher' form does not allow multiple voucher creation processes to run at same time for same claims/services.
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Avatar MSO '835 Healthcare Claim Payment/Advice' Information
An issue is resolved to ensure that 835 files produced via the Avatar MSO '835 Health Care Claim Payment/Advice' form include CAS-2110 Claim Adjustment Reason Code/Remark Code values for services denied with 'Missing valid primary CPT Code' adjudication reason.
Included Updates
None
Product Update Description
The following issues are resolved: 1) Services are incorrectly approved when automated 837 files are posted. 2) 'Create Voucher' form is allowing multiple voucher processes to run at same time. 3) The 835 file produced via the '835 Health Care Claim Payment/Advice' form is not producing the CAS-2110 segment for services denied with 'Missing valid primary CPT Code'.
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Topics
• 837 Health Care Claim Professional
• Claims Processing
• 837 Health Care Claim Institutional
• Create Voucher
• NX
• 835 Health Care Claim Payment/Advice
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Avatar MSO 'Create EOB' Form/Function
An issue is resolved to ensure that Retro Claim Adjudication entries are placed in an EOB for the corresponding fiscal year when Avatar MSO Registry Settings 'Include In EOB Retros For Replaced Services Not On EOB' and 'Create EOB By Fiscal Year' Registry Settings are enabled.
Included Updates
None
Product Update Description
The issue is resolved where when 'Include In EOB Retros For Replaced Services Not On EOB' and 'Create EOB By Fiscal Year' registries are enabled, retros are placed in an EOB for the incorrect fiscal year.
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Topics
• Registry Settings
• Retro Claim Adjudication
• NX
• myAvatar/myAvatar NX
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Avatar MSO 'Enable Fee Override in PM' Registry Setting
The Avatar MSO To Cal-PM Parent service push process is updated to support the 'Enable Fee Override in PM' Registry Setting for Other Healthcare Coverage information.
The Avatar MSO To Cal-PM Parent service push process is updated to support the Avatar MSO 'Enable Fee Override in PM' Registry Setting for 837-originated services with Other Healthcare Coverage information. In addition, the service push process will no longer default the Avatar MSO expected disbursement value as cost of service for services without Other Healthcare Coverage information if the Avatar Cal-PM 'Support MSO Other Healthcare Coverage' Registry Setting is enabled.
Included Updates
4
Product Update Description
The Avatar MSO To Parent service push process is updated to support the 'Enable Fee Override in PM' registry setting for 837 originated services with Other Healthcare Coverage. In addition, the process will no longer default the expected disbursement if the 'Support MSO Other Healthcare Coverage' registry setting is enabled.
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Topics
• Registry Settings
• MSO To Parent System Integration Mapping
• Claims Processing
• NX
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Avatar MSO 'Plan Definition' form
The 'Plan Coverage Level Name' field is added to the 'Plan Definition' form.
The 'Plan Coverage Level Name' field is added to the Avatar MSO 'Plan Definition' form ('Plan Coverage Definition' section). Avatar MSO SQL table 'SYSTEM.plan_covered_services' is updated accordingly.
Included Updates
None
Product Update Description
The 'Plan Coverage Level Name' field is added to 'Plan Definition' (Plan Coverage Definition).
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Topics
• Plan Definition
• NX
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Included Updates
None
Product Update Description
An issue is resolved to correctly spell "Maximum" in the 'Maximum field warning' dialog that is received in the 'MSO Case Default' form, when a value is selected in the 'MSO Case Default Fields' field that contains more than 4 fields.
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Topics
• Forms
• NX
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Avatar MSO 'Service Authorization Request' Form
An issue is resolved to ensure that the 'Contracting Provider Program' field in the 'Service Authorization Request' form is populated with selection values if the 'Provider To Be Authorized' field/value is defaulted in form for Avatar ProviderConnect NX users.
Included Updates
None
Product Update Description
An issue is resolved where the 'Contracting Provider Program' field in the 'Service Authorization Request' form would not populate if the 'Provider To Be Authorized' field was defaulted for ProviderConnect NX users.
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Topics
• Service Authorizations
• NX
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Avatar MSO to Avatar PM/Cal-PM Service Filing
Avatar MSO is updated to add support for linking Add-On services with the associated Primary Service when transferring services to Avatar PM/Cal-PM.
Avatar MSO is updated to add support for linking Add-On (and Interactive Complexity) services entered in MSO with the associated Primary Service when transferring services from Avatar MSO to Avatar PM/Cal-PM when batches are closed for original claims/services. This will allow Primary/Add-On/Interactive Complexity services from Avatar MSO original claims to be included in same Avatar PM/Cal-PM 837 Professional outbound claim regardless of the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' setting in Avatar PM/Cal-PM 'Guarantor/Program Billing Defaults' form.
Included Updates
4, 19
Product Update Description
Avatar MSO is updated to add support for linking Add-On services entered in MSO with the associated Primary Service when transferring services from MSO to PM/CAL-PM when batches are closed for original claims/services.
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Topics
• MSO To Parent System Integration Mapping
• CPT Code Definition
• 837 Professional
• Claims Processing
• NX
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Avatar_MSO_2023_Monthly_Release_2023.02.01_Details.csv
