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Avatar MSO 2023 Monthly Release 2023.03.02 Details

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Avatar MSO required
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  • Avatar MSO 'CPT Code Definition' and 'Revenue Code Definition' Coverage Period Support
    The Avatar MSO 'CPT Code Definition' and 'Revenue Code Definition' Forms are updated to support the 'Enable Coverage Effective Period' Registry Setting.
    Where enabled, the Avatar MSO 'Enable Coverage Effective Period' Registry Setting will add/update the following in the 'CPT Code Definition' and 'Revenue Code Definition' Forms: - 'Coverage Period' selection field added, with existing Coverage Periods and 'Create New' selections available - 'Coverage Effective Date' and 'Coverage Expiration Date' fields added - 'File Coverage Period', and 'Delete Coverage Period' buttons added - The following 'CPT Code Definition' and 'Revenue Code Definition' form fields are updated to be filed/stored by Coverage Period (and will be disabled by default in form, pending selection of existing Coverage Period or 'Create New' option): - 'Maximum Units Per Day' - 'Minimum Duration' - 'Maximum Duration' - 'Duration Per Unit' - 'Limit License Type(s) Allowed' - 'Measurement Code' - 'Place of Service' - On enabling the Avatar MSO 'Enable Coverage Effective Period' Registry Setting, default Coverage Period entries will be created for all existing CPT Codes and Revenue Codes, using '01/01/1900' as 'Coverage Effective Date', no value for 'Coverage Expiration Date' (open-ended) and with existing/current values for all CPT Code Definition/Revenue Code Definition fields detailed above. In addition, the following Avatar MSO SQL tables are added/updated: - 'SYSTEM.table_cpt_rev_cov_period' - 'SYSTEM.table_cpt_service_codes' - 'SYSTEM.table_revenue_codes'
  • Avatar MSO CPT Code Definition/Revenue Code Definition Import Coverage Period Support
    The Avatar MSO 'CPT Code Definition' and 'Revenue Code Definition' Imports are updated to support the 'Enable Coverage Effective Period' Registry Setting.
    Where enabled, the Avatar MSO 'Enable Coverage Effective Period' Registry Setting will update the 'CPT Code Definition' and 'Revenue Code Definition' Imports to support entry/update of one or more Coverage Periods for each code with the following information included: - 'Coverage Effective Date' - 'Coverage Expiration Date' - 'Maximum Units Per Day' - 'Minimum Duration' - 'Maximum Duration' - 'Duration Per Unit' - 'Limit License Type(s) Allowed' - 'Measurement Code' - 'Place of Service' Please refer to 'Avatar_MSO_2023_File_Import_Record_Layouts.xls' document included with Avatar MSO 2023 Update 37 for updated import format/definition
  • 'MSO To Parent System Integration Mapping' Form Coverage Period Support
    The Avatar MSO 'MSO To Parent System Integration Mapping' Form is updated to support the 'Enable Coverage Effective Period' Registry Setting.
    Where enabled, the Avatar MSO 'Enable Coverage Effective Period' Registry Setting will add/update the following in the 'MSO To Parent System Integration Mapping' Form: - 'Coverage Period'/'Revenue Coverage Period' selection fields added, with existing Coverage Periods for selected CPT/Revenue Code - The Avatar MSO CPT Code to Avatar PM/Cal-PM Service Code mappings are updated to be filed/stored by CPT Code Coverage Period - The Avatar MSO Revenue Code to Avatar PM/Cal-PM Service Code mappings are updated to be filed/stored by Revenue Code Coverage Period - On enabling the Avatar MSO 'Enable Coverage Effective Period' Registry Setting, default MSO CPT Code/Revenue Code and Coverage Period to PM/Cal-PM Service Code mapping entries will be created for all existing CPT Codes and Revenue Code to Service Code mappings, using the default '01/01/1900' Effective Date Coverage Period entry created for all CPT Codes/Revenue Codes, with existing/current Service Code In addition, the following Avatar MSO SQL tables are added/updated: - 'SYSTEM.table_parentmap_cpt_cov' - 'SYSTEM.table_parentmap_cpt' - 'SYSTEM.table_parent_map_rev_cov' - 'SYSTEM.table_parent_map_rev'
  • Avatar MSO To Parent System Integration Mapping Upload/Import Coverage Period Support
    The Avatar MSO To Parent System Integration Mapping Upload/Import is updated to support the 'Enable Coverage Effective Period' Registry Setting.
    Where enabled, the Avatar MSO 'Enable Coverage Effective Period' Registry Setting will update the 'MSO To Parent System Integration Mapping' CPT Code/Revenue Code to Service Code Uploads/Imports to support entry of Avatar MSO CPT Code/Revenue Code and Coverage Period for mapping to Avatar PM/Cal-PM Service Code. Please refer to 'Avatar_MSO_2023_File_Import_Record_Layouts.xls' document included with Avatar MSO 2023 Update 37 for updated import format/definition
  • Avatar MSO Claim Processing Coverage Period Support
    Avatar MSO Claim Processing/Service Adjudication is updated to support the 'Enable Coverage Effective Period' Registry Setting.
    Where enabled, the Avatar MSO 'Enable Coverage Effective Period' Registry Setting will update the Claim Processing/Service Adjudication functionality to determine values for the following Approve/Pend/Deny Rule service information field allowances (where defined) according to Coverage Period for related CPT Code/Revenue Code and date of service (for all 837 inbound and manually entered claims/services): - 'Maximum Units Per Day' - For 'Maximum Units Per Day Exceeded' Approve/Pend/Deny Rule - 'Minimum Duration'/'Maximum Duration' - For 'Specified Duration is not valid for Procedure Code' Approve/Pend/Deny Rule - 'Duration Per Unit' - For 'Duration Per Unit For Procedure Code Is Incorrect' Approve/Pend/Deny Rule, as well as ODS Group Service Units calculation - 'Limit License Type(s) Allowed' - For Allowable Performing Provider License Type Approve/Pend/Deny Rule - 'Measurement Code' - For 'Invalid Measurement Code for Procedure Code' Approve/Pend/Deny Rule - 'Place of Service' - For 'Invalid Place Of Service For Procedure Code' Approve/Pend/Deny Rule
  • Avatar MSO to Parent System Service Filing Coverage Period Support
    The Avatar MSO to Avatar PM/Cal-PM Parent System service push/service filing process is updated to support the 'Enable Coverage Effective Period' Registry Setting.
    Where enabled, the Avatar MSO 'Enable Coverage Effective Period' Registry Setting will update the MSO to PM/Cal-PM Parent System service push/filing to determine Avatar PM/Cal-PM Service Code values from 'MSO To Parent System Integration Mapping' entries according to Coverage Period for related Avatar MSO CPT Code/Revenue Code and date of service.
  • Avatar MSO 'Enable Coverage Effective Period' Registry Setting
    The 'Enable Coverage Effective Period' Registry Setting is added to Avatar MSO.
    Where enabled, the Avatar MSO 'Enable Coverage Effective Period' Registry Setting adds the ability to define multiple Coverage Effective Periods within the 'CPT Code Definition' and 'Revenue Code Definition' forms for date-sensitive Claim Processing/Service Adjudication and Avatar PM/Cal-PM parent system service filing of single CPT Codes/Revenue Codes. NOTE: This Registry Setting is a ONE WAY registry setting that can only be enabled. Once enabled, this Registry Setting cannot be disabled.
  • Avatar MSO to Parent System Service Filing, Void/Replacement Claims
    An issue is resolved to ensure that services in claims with multiple services are correctly filed in the Avatar MSO to Avatar PM/Cal-PM Parent System service push/service filing process (and Claim Follow Up/Electronic Re-Billing Assignment filing if enabled).
Included Updates
2, 3, 4, 7, 8, 11, 12, 13, 17, 19, 20, 27, 28, 29, 30, 31, 33, 34, 36
Product Update Description
The following modifications are made: 1) 'Enable Coverage Effective Period' registry setting is added to Avatar MSO. 2) An issue is resolved where replacements and voids in claims with multiple services would not get pushed over to PM from MSO.
Topics
• CPT Code Definition • Revenue Code Definition • Registry Settings • MSO To Parent System Integration Mapping • 837 Health Care Claim Professional • Claims Processing • 837 Health Care Claim Institutional • Close Batch
  • Service Authorization
    Performance improvements in Service Authorization and Service Authorization Request forms.
Included Updates
2, 3, 4, 7, 8, 11, 12, 13, 17, 19, 20, 25, 26, 27, 28, 29, 30, 31, 33, 34, 36, 37
Product Update Description
Performance improvements are made to the 'Service Authorization' and 'Service Authorization Request' forms.
Topics
• Service Authorizations • NX
  • File Import - [Avatar MSO] Service Authorization - Member
    The Comments On Authorization' and 'Internal Comments' fields have been modified to allow 5000 characters.
    Note: The 'Avatar_MSO_2021_File_Import_Record_Layouts.xls' document has not changed but is being included in the update zip file as a courtesy.
  • File Import - MSO - Budget Tracking Account Level
    The 'Comments' field has been modified to allow a maximum of 5000 characters.
    Note: The 'Avatar_MSO_2021_File_Import_Record_Layouts.xls' document has not changed but is being included in the update zip file as a courtesy.
  • Provider Fee Definition & Retro Claim Adjudication
    An issue is resolved where the Retro Claim Adjudication process could be ran for a funding source/contracting provider that was not updated when a funding source for the same code was updated.
  • 'Provider Fee Definition - Allow Duplicate Services on the Same Day?
    Resolves an issue for 'Procedure Code Groups' that was not respecting the value of the 'Allow Duplicate Services on the Same Day?' field.
  • Provider Fee Definition - Expiration Date
    An issue has been resolved to allow users to add an 'Expiration Date' to a record.
  • Set Associated Codes & Associated Code Upload process
    Resolves an issue where codes that were manually added to the 'Set Associated Codes' form might lose data when the same code is added through the 'Associated Code Upload' process.
Included Updates
2, 3, 4, 7, 8, 11, 12, 13, 17, 19, 20, 25, 26, 27, 28, 29, 30, 31, 33, 34, 36, 37, 38
Required Updates
Avatar MSO 2023 Update 34
Product Update Description
The maximum lengths of Service Authorization file import fields 'Comments On Authorization' and 'Internal Comments' are increased to 5000 characters. Also, the maximum length of Budget Tracking Account Level field 'Comments' is increased to 5000 characters. In addition, the following issues are resolved: 1) Provider fee changes for a specific funding source filed via the 'Provider Fee Definition' form creates retro claim adjudications for services not associated to that funding source. 2) 'Allow Duplicate Services on the Same Day?' in the 'Provider Fee Definition' form is not recognized for Procedure Code Groups. 3) In the 'Provider Fee Definition' form, invalid overlap error prevents expiration date to be added to an existing fee. 4) When associated codes are uploaded via the 'Set Associated Codes' form, existing association's 'Determine Fee Table Amount By Code Authorized or Code Claimed' values are not preserved.
Topics
• File Import • Budget Tracking • Retro Claim Adjudication • Claims Processing • Data Import
 

Avatar_MSO_2023_Monthly_Release_2023.03.02_Details.csv