Avatar MSO 2023 Monthly Release 2023.03.00 Details

The 'Set Up Co-Pay Based On Avatar PM 834' Registry Setting is added to Avatar MSO.

Where enabled, the Avatar MSO 'Set Up Co-Pay Based On Avatar PM 834' Registry Setting adds the 'Set Up Co-Pay Based On Avatar PM 834' form to Avatar MSO. This form allows setup of claim/service Co-Pay Indicator/Assignment determinations based on Avatar PM 834 eligibility data for clients. Avatar MSO 837 Health Care Claim Institutional file processing and UB-04 claim/service adjudication are updated to assign Co-Pay or Private Pay amounts to first service within claims based on 'Set Up Co-Pay Based On Avatar PM 834' entries and Avatar PM 834 eligibility data. Note, Avatar PM 2023 Update 58 is required for support of the 'Set Up Co-Pay Based On Avatar PM 834' Registry Setting/functionality.

The 'Enable APD Rule for Missing TPL/COB/OHC' Registry Setting is added to Avatar MSO.

Where enabled, the Avatar MSO 'Enable APD Rule for Missing TPL/COB/OHC' Registry Setting adds the following: * The 'Maximum Number of Days Prior to 'Date Claims Received' Date of Service is Permitted for TPL/COB/OHC' and 'Days Prior to 'Date Claims Received' Exceeded for Claims with TPL/COB/OHC' fields are added to the 'Approve/Pend/Deny Rules Definition' form * The 'Medicare Paneled Provider' field is added to the 'Contracting Provider Registration' form * The 'Medicare Allowable Procedure Code' field is added to the 'CPT Code Definition' form (and File Import) Avatar MSO Claim Processing forms and functions will evaluate whether COB (Third Party Payment Information) must be present/entered for service to be Approved, based on Contracting Provider, CPT Code and Date of Service (compared to Date Claims Received and allowance defined in 'Maximum Number of Days Prior to 'Date Claims Received' Date of Service is Permitted for TPL/COB/OHC' Approve/Pend/Deny Rule). Note, Avatar PM 2023 Update 58 is required for support of the 'Enable APD Rule for Missing TPL/COB/OHC' Registry Setting/functionality.

The Avatar MSO 'Allow Provider Fee Definition By Age' Registry Setting is updated to add 'Age on Admission' field to the 'Provider Fee Definition' form.

Where enabled, the Avatar MSO 'Allow Provider Fee Definition By Age' Registry Setting adds the following fields to the 'Provider Fee Definition' form (as well as Provider Fee Definition Upload and Copy Provider Fee Definition Processes): * 'Minimum Age' * 'Maximum Age' * 'Age on Admission' The 'Age on Admission' field may be used to specify that the client age on the Admission Date of associated episode should be used to determine Provider Fee Table Amount for services rather than the client age on the Date of Service (in conjunction with the 'Minimum Age' and 'Maximum Age' Provider Fee Definition criteria fields, as compared to 'Date of Birth' value for client).

The 'Enable Additional Fields' (Claim Processing Blackout) Registry Setting is added to Avatar MSO.

Where enabled, the Avatar MSO 'Enable Additional Fields' Registry Setting adds the following fields to the 'Claim Processing Blackout' form: - 'Rule ID' - 'Rule Description' - 'Funding Source' (changed to multi-select field type) - 'Performing Provider' - 'Performing Provider Primary License Type' - 'CPT Codes' - 'Revenue Codes' - 'Diagnosis Codes' - 'Blackout Group' - 'Blackout Group Order Definition' section/fields Avatar MSO Claim Processing forms/functions are updated to support the additional Claim Processing Blackout criteria fields and ordering.

An issue is resolved to ensure that the Avatar MSO 'Service Authorization' and 'Service Authorization Request' forms file complete data so claims are not incorrectly denied where a valid authorization exists.