Avatar MSO 2023 Monthly Release 2023.02.02 Summary

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NEW4 CHANGED0 FIXED4

New (4)

Update 8 Details \| User Acceptance Tests 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. Value Added: Adds 'Enable Authorize and Adjudicate on Per Stay Basis' Registry Setting and functions to Avatar MSO	Topics • Registry Settings • NX • Service Authorizations • 837 Health Care Claim Professional • Claims Processing • 837 Health Care Claim Institutional • File Import • Retro Claim Adjudication

Update 18 Details \| User Acceptance Tests 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. Value Added: Updates Avatar MSO 837 Professional/837 Institutional Health Care Claim Processing 'Funding Source' determination	Topics • Registry Settings • 837 Health Care Claim Professional • NX • 837 Health Care Claim Institutional

Update 26 Details \| User Acceptance Tests 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 . Value Added: Increased flexibility in the Service Authorization form. Service Authorization The ability to display the 'Benefit Plan' has been added to the Service Authorization pre-display. Value Added: More information available in the pre-display.	Topics • Service Authorizations • NX

Update 30 Details \| User Acceptance Tests 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. Value Added: Adds the ability to send services to PM based on the date of service.	Topics • MSO To Parent System Integration Mapping • NX

Fixed (4)

Update 14 Details \| User Acceptance Tests 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.	Topics • Claims Processing • NX

Update 20 Details \| User Acceptance Tests 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'.	Topics • Contracting Provider Registration • NX • Claims Processing

Update 27 Details \| User Acceptance Tests 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.	Topics • Claims Processing • NX

Update 29 Details \| User Acceptance Tests 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 (DTP435) 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.	Topics • 837 Health Care Claim Institutional • Claim Acknowledgement (277CA)

Avatar_MSO_2023_Monthly_Release_2023.02.02_Details.csv