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Avatar MSO 2023 Monthly Release 2023.02.02 Details

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Product Requirements and Recommendations

Avatar MSO required
RADplus required

  • Avatar MSO 'Enable Authorize and Adjudicate on Per Stay Basis' Registry Setting
    The 'Enable Authorize and Adjudicate on Per Stay Basis' Registry Setting is added to Avatar MSO.
    The Avatar MSO 'Enable Authorize and Adjudicate on Per Stay Basis' Registry Setting adds the 'Authorize and Adjudicate on Per Stay Basis' field to the 'Service Authorization' form. This allows for claims/services to be adjudicated on a per-stay basis - the first service associated to Service Authorization will be approved at the per-stay rate and all other services associated to same Service Authorization will be approved for zero dollars.
Included Updates
None
Product Update Description
The 'Enable Authorize and Adjudicate on Per Stay Basis' registry setting is added.
Topics
• Registry Settings • NX • Service Authorizations • 837 Health Care Claim Professional • Claims Processing • 837 Health Care Claim Institutional • File Import • Retro Claim Adjudication
  • Plan Definition - Annual dollar limit
    Resolves an issue to ensure that the services do not approve over the annual dollar limit filed for the plan.
  • Claim Processing (CMS 1500) - Third Party Adjudication Data section
    Resolves an issue to ensure that the subsequent third party adjudication data grid in the 'Claim Processing (CMS 1500)' form saves information correctly when there is an existing entry and more entries are added to the grid through 'Edit' option.
  • Import/Export File Configuration - Process MSO 837P files
    Resolves an issue to ensure that 837 Professional files in cloud are processing correctly.
Included Updates
None
Product Update Description
The following issues are resolved: 1) Services are being approved over the annual dollar limit filed in the 'Plan Definition' form. 2) COB Adjustment Data goes missing after adding a subsequent TPL grid entry in the claim processing forms. 3) Automated 837 processing fails to process multiple threads.
Topics
• Claims Processing • NX
  • Avatar MSO 837 Professional/837 Institutional Health Care Claim Processing
    The '837 Health Care Claim Professional' and '837 Health Care Claim Institutional' are modified to determine 'Funding Source' based on Avatar PM eligibility tables.
    Avatar MSO '837 Health Care Claim Professional' and '837 Health Care Claim Institutional' compilation/posting are modified to determine 'Funding Source' for claims/services based on Avatar PM eligibility table information if Funding Source cannot be determined via MSO. This will only occur when Registry Settings 'Determine Funding Source By Policy Number' and 'Enable Eligibility Check' are enabled.
Included Updates
None
Product Update Description
The '837 Health Care Claim Professional' and '837 Health Care Claim Institutional' are modified to determine 'Funding Source' based on Avatar PM eligibility tables if Funding Source cannot be determined. This will only occur when the 'Determine Funding Source By Policy Number' and 'Enable Eligibility Check' registry settings are enabled.
Topics
• Registry Settings • 837 Health Care Claim Professional • NX • 837 Health Care Claim Institutional
  • Contracting Provider Registration - Edit a performing provider.
    Resolves an issue to ensure that the performing provider information can be updated successfully within the 'Contracting Provider Registration' form for the performing providers that have multiple registrations with at least 1 license record on file.
  • Claim Processing (CMS 1500) - Registry setting 'Require Performing Provider'=Y.
    Resolves an issue to ensure that the claim processing (CMS 1500) process the claim successfully when the registry setting 'Require Performing Provider' is set to 'Y'.
Included Updates
2, 3, 11, 12, 13
Required Updates
Avatar MSO 2023 Update 3
Avatar MSO 2023 Update 11
Product Update Description
The following issues are resolved: 1) "Historic group is not a child of current screen." error produced when attempting to edit a performing provider within the 'Contracting Provider Registration' form. 2) The claim processing forms incorrectly denies a previously approved service with "Performing Provider is blank" when the total charge is modified and performing provider is required.
Topics
• Contracting Provider Registration • NX • Claims Processing
  • Service Authorization
    A registry setting it added, 'Require Current Authorization Status Reason'. the setting allows users to make the 'Current Authorization Status Reason' required or optional .
  • Service Authorization
    The ability to display the 'Benefit Plan' has been added to the Service Authorization pre-display.
Included Updates
25
Product Update Description
The following modifications are made: 1) A new registry setting 'Require Current Authorization Status Reason' is added to Avatar MSO. This registry setting will allow users to make the field 'Current Authorization Status Reason' required or optional in the 'Service Authorization Request' form. 2) The registry setting 'Set Service Authorization Pre-Display' is updated to account for the option to include the "Benefit Plan" field in the pre-display for Service Authorization forms.
Topics
• Service Authorizations • NX
  • Fast Service Entry
    An issue is resolved to ensure that claim status over-rides are being applied when services are re-adjudicated.
  • Claims Adjudication Rules Definition
    An issue has been resolved to ensure that definitions for procedure code groupings that contain CPT/Revenue codes with colon(s) are correctly adjudicated.
Included Updates
2, 11, 12, 13
Required Updates
Avatar MSO 2023 Update 2
Product Update Description
The following issues are resolved: 1) 'Fast Service Entry' claim status over-rides are not being recognized when services are re-adjudicated. 2) 'Claims Adjudication Rules Definition' are not correctly adjudicated for procedure code groupings that contain CPT/Revenue codes with colon(s).
Topics
• Claims Processing • NX
  • Avatar MSO '837 Health Care Claim Institutional'
    An issue is resolved to ensure that when compiling an 837 Institutional file via the '837 Health Care Claim Institutional' form, claims without an admission segment (DTP*435) are not rejected with incorrect critical error "Invalid admission date for claim ()".
  • Avatar MSO 'Claim Acknowledgement (277CA) File'
    An issue is resolved to ensure that the 277CA file produced via the 'Claim Acknowledgement (277CA) File' form does not add 'rejected' status records in the 'SYSTEM.clm_status_resp' SQL table for zero dollar claims that are accepted by Avatar MSO.
Included Updates
2, 3, 11, 12, 13, 20, 27
Required Updates
Avatar MSO 2023 Update 12
Product Update Description
The following issues are resolved: 1) When compiling an 837 Institutional file via the '837 Health Care Claim Institutional' form, claims without an admission segment (DTP*435) are rejected with critical error "Invalid admission date for claim ()". 2) The 277 file produced via the 'Claim Acknowledgement (277CA) File' form is incorrectly adding a rejected record in the SYSTEM.clmstatusresp table for 0 dollar claims that are accepted.
Topics
• 837 Health Care Claim Institutional • Claim Acknowledgement (277CA)
  • Registry Setting - Send units to Avatar PM
    The registry setting is updated to include a new value of '1'. When '1' is selected the 'Service Filing' section of the 'MSO to Parent System Integration Mapping' form allow the user to configure a 'Send Units' definition by an effective date range.
    New fields added to 'service_unit_override' table.
Included Updates
4, 19, 28
Product Update Description
The registry setting 'Send units to Avatar PM' is updated to accept a new value '1'. This will update the 'Service Filing' tab in the 'MSO to Parent System Integration Mapping' form to now include the ability to configure a 'Send Units' definition by an effective date range.
Topics
• MSO To Parent System Integration Mapping • NX
 

Avatar_MSO_2023_Monthly_Release_2023.02.02_Details.csv