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MSO Approve/Pend/Deny Rule – 837 Health Care Claim Professional
The A/P/D rule has been updated to count the service as one service when a primary service has add-on or interactive complexity services.
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Claim Processing (CMS 1500) - Create the claim and service details
The A/P/D rule has been updated to count the service as one service when a primary service has add-on add/or interactive complexity services.
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 13
Product Update Description
The following issues have been resolved: 1) The 837 Healthcare Claim Professional Compile and Post logic would not recognize some associated Add-On codes for a Primary Service, which caused the primary service to deny with the message "Number of services per claim allowed exceeded". 2) The issue where the hard error '[SUBSCRIPT]zCheckNumSvcPerClm+51^SYSTEM.batchclmutils.1 ^MSOCPT(1,"")' occurs when trying to manually create the claim and service details via CMS 1500 form for batch.
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Topics
• 837 Health Care Claim Professional
• Claims Processing
• NX
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CPT Code Definition - Import Codes
Resolves an issue to ensure that the 'CPT Code Definition' form rejects the invalid 'Interactive Complexity CPT Code' with correct validation error.
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Fast Service Entry Submission - Maximum Unites Per day Adjudication rule
Resolves an issue to ensure that the 'Fast Service Entry Submission' form approves the service for the different member rendered on the same date when the 'Approve/Pend/Deny Rule Definition' is set up to deny duplicate services and 'Member ID' is checked in the 'Duplicate Service Parameters' field.
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Claims Processing Override 1500 - Field verification
Resolves an issue to ensure that the 'Does This Service Represent An Admission' field is not a required field in the 'Claim Processing With Override (CMS 1500)' form.
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Fast Service Entry - Explanation Of Coverage
Resolves an issue to ensure that the 'Fast Service Entry' form displays correct Denial message when the CPT code is not covered by the plan.
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SQL Table validation - MSO Authorization Tables
Resolves an issue to ensure that user can access 'SYSTEM.history_member_auths_proc', 'SYSTEM.service_auth_detail', and 'SYSTEM.service_auth_svc' SQL tables successfully in a timely manner.
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, 39, 40
Required Updates
Avatar MSO 2023 Update 34
Avatar MSO 2023 Update 37
Product Update Description
The following issues are resolved: 1) The file import process in the 'CPT Code Definition' form is not validating the interactive complexity code. 2) Services entered through the 'Fast Service Entry Submission' form is incorrectly denying with "Maximum Number Of Units Of Procedure Code Per Day Exhausted". 3) Claim processing override forms are not enabling override fields if 'Does This Service Represent An Admission' is not answered. 4) Member and Contracting Provider authorizations defined as "All" codes are loaded for selection in the claim processing forms when the plan does not cover the procedure code. 5) Queries accessing the 'SYSTEM.history_member_auths_proc', 'SYSTEM.service_auth_detail', and 'SYSTEM.service_auth_svc' tables are taking a long time to complete.
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Topics
• CPT Code Definition
• Claims Processing
• Database Management
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