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Avatar MSO 2023 Quarterly Release 2023.01 Acceptance Tests

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Update 1 Summary | Details
Avatar MSO 2023 is Installed
Scenario 1: Validate Upgrading Avatar MSO 2022 to 2023 is successful when 2022.04.00 is loaded
Specific Setup:
  • Latest Monthly Release is installed.
Steps
  1. Open the "Product Updates" form.
  2. Select the appropriate [Namespace] from the Application dropdown list
  3. Click [Select Update/Customization Pack].
  4. Browse to the location for the updates and select the Update 1.
  5. Click [OK] on the "File Upload Complete" window.
  6. Click [Review Update/Customization Pack Contents].
  7. Verify Update 1 is included.
  8. Click [Install Update/Customization Pack].
  9. Click [OK] when the install completes.
  10. Click [Close Form].
Topics
• Upgrade
Update 3 Summary | Details
Avatar MSO 'Claims Adjudication Rules Definition' Form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Claims Adjudication Rules Definition
Scenario 1: 'Claims Adjudication Rules Definition' - Verification of Limit Rule Filing
Specific Setup:
  • CPT Code Definition and/or Revenue Code Definition where dash character ('-') is used in code (Ex: 'H0004-A')
Steps
  1. Open Avatar MSO 'Claims Adjudication Rules Definition' form.
  2. Select 'Add' in 'Action' field (or 'Edit' to select/view/edit existing rule).
  3. Enter/select values for Rule Definition fields 'Rule ID', 'Rule Description', 'Status', 'Status Reason', 'Funding Source' (and 'From Date'/'Through Date' if desired).
  4. Select 'Limit' in 'Rule Type' field.
  5. Enter/select values for Limit Rule Definition fields - selecting CPT Code/Revenue Code where dash character ('-') is used in code (Ex: 'H0004-A') or Procedure Code Group including one or more such codes/characters.
  6. Click 'Add Rule' button to save Limit Rule Definition information.
  7. Ensure Limit Rule Definition information is displayed in 'Business Rule Viewer' field, including CPT Code/Revenue Code where dash character ('-') is used in code.
  8. Click 'Submit' button to file 'Claims Adjudication Rules Definition' form/rule.
  9. Ensure confirmation dialog noting 'Claims Adjudication Rules Definition has completed. Do you wish to return to form?' is presented; click 'Yes' button to return to form.
  10. Select 'Edit' in 'Action' field and select previously entered/filed 'Limit' Type Claims Adjudication Rule for review.
  11. Ensure previously entered/filed Limit Rule Definition information is displayed in 'Business Rule Viewer' field, including CPT Code/Revenue Code where dash character ('-') is used in code.
Avatar MSO 'Performing Provider Registration' form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Performing Provider Registration
Scenario 1: 'Performing Provider Registration' - Form Verification
Specific Setup:
  • Performing Provider Registration record(s) assigned to one or more Contracting Provider Registration
Steps
  1. Open Avatar MSO 'Performing Provider Registration' form.
  2. Click 'New Performing Provider' button to create new Performing Provider Registration (or search/select existing Performing Provider Registration record for edit).
  3. Enter/select values in 'Name' and 'Registration Start Date' fields (and 'Registration End Date' if desired).
  4. Select one or more values in 'Primary License Type for Claims' field.
  5. Select 'Create New' from the 'Primary License Type Effective Dates' field.
  6. Enter/select values for 'Effective Start Date', 'Primary License Type for Claims' fields.
  7. Click 'File Primary License Type Effective Date' button.
  8. Enter/select values for any other Performing Provider Registration fields as required/desired.
  9. Click 'Submit' button to file 'Performing Provider Registration' form.
  10. Open Avatar MSO 'Contracting Provider Registration' form.
  11. Search/select Contracting Provider/Registration record for update/Performing Provider assignment and click 'Edit' button.
  12. Navigate to 'Performing Provider's Information' form section.
  13. Click 'Add New Item' button to add new Performing Provider assignment row.
  14. Search/select Performing Provider Registration filed above.
  15. Ensure that 'Effective Start Date' and 'Effective End Date' fields are populated with values filed via 'Performing Provider Registration' form 'Registration Start Date'/'Registration End Date' fields.
  16. Click 'Submit' button to file 'Contracting Provider Registration' form with Performing Provider assignment included; repeat as desired for additional Contracting Provider Registration records.
  17. Open Avatar MSO 'Performing Provider Registration' form.
  18. Enter/select previously filed Performing Provider Registration record currently assigned to one or more Contracting Provider Registrations.
  19. Ensure that if 'Registration Start Date' value is updated to date later/more recent than current field value, user is presented with error dialog noting 'Registration Start Date cannot be changed to a later date, registration already associated to a contracting provider' and the entry is disallowed.
  20. Note - If Performing Provider is assigned to one or more Contracting Provider Registration records, 'Registration Start Date' may be updated to date earlier than current field date value; 'Registration Start Date' may be updated to date earlier than or later than current field date value only in case where Performing Provider is not assigned to any existing Contracting Provider Registration records,
Avatar MSO 'Claims Adjudication Rules Definition' Form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Claims Adjudication Rules Definition
Scenario 1: 'Claims Adjudication Rules Definition' - Verification of Limit Rule Removal
Steps
  1. Open Avatar MSO 'Claims Adjudication Rules Definition' form.
  2. Select 'Add' in 'Action' field (or 'Edit' to select/view/edit existing rule).
  3. Enter/select values for Rule Definition fields 'Rule ID', 'Rule Description', 'Status', 'Status Reason', 'Funding Source' (and 'From Date'/'Through Date' if desired).
  4. Select 'Limit' in 'Rule Type' field.
  5. Enter/select values for Limit Rule Definition fields - including value for ICD-10 Diagnosis Code in 'For Diagnosis' field (if entering new rule).
  6. Click 'Add Rule' button to save Limit Rule Definition information (if entering new rule).
  7. Ensure entered/existing Limit Rule Definition information is displayed in 'Business Rule Viewer' field, including 'For Diagnosis' value/code.
  8. Click 'Remove Selected Item' button to open rule removal selection dialog.
  9. Select Limit Rule Definition row for removal, and click 'OK' button.
  10. Ensure Limit Rule Definition is removed from rule and is not displayed in 'Business Rule Viewer' field.
Topics
• Claims Processing • NX • Performing Provider
Update 7 Summary | Details
Provider Fee Definition Upload Process
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (MSO)
  • Provider Fee Definition
  • Avatar NX Report Viewer
Scenario 1: 'Provider Fee Definition' - Verification of Provider Fee Definition Upload
Specific Setup:
  • File containing Provider Fee Definitions to be uploaded
Steps
  1. Open the 'Provider Fee Definition' form.
  2. Go to the "Provider Fee Definition Upload" section.
  3. Select the file to be uploaded.
  4. Process the selected file.
  5. Submit the form to upload the fees.
  6. Open the 'Provider Fee Definition' form.
  7. Select ‘Edit’ in ‘Enter New Or Edit Existing Fee Definition’.
  8. Click [CPT Service Code - Procedure Code Type Or Group Fee Definition].
  9. Select the ‘Provider’.
  10. Select the ‘CPT Service Code’.
  11. Click [Select Fee Definition To Edit].
  12. Validate that the definition contains the values from the import files.
  13. Close the form.
Topics
• Provider Fee Definition
2022 Update 22 Summary | Details
Registry Setting - Enable Contracting Provider Specific File Folder Structure
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (MSO)
  • Guarantors/Payors
  • Registry Settings (PM)
  • Financial Eligibility
  • Program Maintenance
  • CPT Code Definition (PM)
  • 837 Health Care Claim Professional
  • Avatar NX Report Viewer
  • Provider Fee Definition
  • Crystal Report Viewer
  • Create EOB
  • 835 Health Care Claim Payment/Advice (MSO)
  • Contracting Provider Termination
Scenario 1: Registry Setting - Enable Contracting Provider Specific File Folder Structure
Specific Setup:
  • A directory has been created on the server that will contain the specific file folders for contracting providers if the following registry setting is enabled.
  • Registry Setting: Enable Contracting Provider Specific File Folder Structure = Y.
  • Validate that a file folder has been created on the server for the facility and for each contracting provider within the facility folder.
  • Import/Export File Configuration:
  • 277 Claim Acknowledgement: Select Yes in ‘Automatically Generate a 277 Claim Acknowledgement File’.
  • 999 Functional Acknowledgement: Select Yes in ‘Automatically Generate a 999 Functional Acknowledgement File’.
  • Automated Claim Processing Output: The directory created above is placed in ‘Automated Claim Processing Output File Path’.
  • 837 Professional and 837 Institutional are defined as desired.
  • A file to use in '837 Health Care Claim Professional' or '837 Health Care Claim Institutional’ is available. Note the contracting provider.
Steps
  1. Open ‘Applying Contracting Provider’ and create a record.
  2. Open ‘Contracting Provider Registration’, selecting the ‘Applying Contracting Provider’ record.
  3. Complete the ‘Contracting Provider Registration’ as desired.
  4. Validate that a new folder was created for the ‘Contracting Provider’ within the facility folder.
  5. Open ‘Contracting Provider Termination’ and terminate the contracting provider.
  6. Validate that the folder now contains ‘Inactive’.
  7. Open '837 Health Care Claim Professional' or '837 Health Care Claim Institutional’ and load, compile and post the file. Note the batch number in the posted report.
  8. Open ‘Close Batch’ and close the batch.
  9. Open ‘Create Voucher’ and create the voucher for the contracting provider.
  10. Open ‘Create EOB’ and create the EOB for the contracting provider.
  11. Create and post the 835 file in '835 Health Care Claim Payment/Advice'.
  12. Validate that the folder for the contracting provider contains a new file in the ‘277’, ‘835’ and ‘999’ folders.
Topics
• Registry Settings • Contracting Provider Registration • NX
2022 Update 30 Summary | Details
Avatar MSO/Avatar PM 'Additional Claim Follow-Up' Filing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • Provider Fee Definition
  • Create EOB
  • Client Ledger
  • Retro Claim Adjudication
Scenario 1: 'Retro Claim Adjudication' - Verification of Claim Follow-Up Filing in Avatar PM/Cal-PM With Multiple/Partial 'Take Back Amount' Entries
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Claim Follow-Up' must be enabled
  • Avatar Cal-PM Registry Setting 'Support Additional Claim Follow-Up Functionality' must be enabled
  • Avatar MSO Registry Setting 'Enable Fee Override in PM' must be enabled (and override in use for service CPT/Revenue Code via 'Provider Fee Definition' form 'Fee Override In PM' section)
  • One or more services in 'Closed' status Claim Processing batch(es) eligible for Retro Claim Adjudication entry, where services have also been pushed to Avatar Cal-PM parent system and included in Cal-PM 837 outbound bill/claim
Steps
  1. Open Avatar MSO 'Retro Claim Adjudication' form.
  2. Select 'Add' in the 'Add/Edit/Delete Claim Adjudication' field.
  3. Select 'Claim' and 'Date of Service/Procedure' values for Retro Claim Adjudication entry/update, selecting service which has been pushed to Avatar PM parent system and included in Cal-PM 837 outbound bill/claim.
  4. Enter value for 'Updated Approved Units' and calculate or directly update 'Updated Disbursement Amount' field to value less than 'Total Charge'/'Original Disbursement Amount' for service but greater than zero (so that Retro Claim Adjudication entry is partial and not full service takeback/Void entry).
  5. Allow system-calculation of updated values or directly enter value for 'Take Back Amount' - ensuring that 'Take Back Amount' is less than 'Total Charge'/'Original Disbursement Amount' for service but greater than zero (so that Retro Claim Adjudication entry is partial and not full service takeback/Void entry).
  6. Select value for 'Adjustment Code' field if not defaulted automatically.
  7. Click 'Update Claim Adjudication' button in 'Retro Claim Adjudication' form to file entry/update.
  8. Open Avatar Cal-PM 'Client Ledger' form.
  9. Enter/select values for 'Client ID', 'Claim/Episode/All Episodes', 'From Date', 'To Date' and 'Ledger Type' values, and click 'Process' button to view Client Ledger information.
  10. For services originating in Avatar MSO and included in Cal-PM 837 outbound bill/claim - ensure that no Claim Follow-Up 'Void' entry is present for service(s) with partial takeback 'Retro Claim Adjudication' entry (as denoted by 'Claim Number' not including 'V' Void marker in Client Ledger information).
  11. Open Avatar Cal-PM 'Claim Follow-Up' form and select client.
  12. Ensure that no Claim Follow-Up entry is filed for partial takeback 'Retro Claim Adjudication' entry for service(s).
  13. Open Avatar MSO 'Create EOB' form.
  14. Enter/select values for 'All or Individual Providers', including Contracting Provider where partial takeback 'Retro Claim Adjudication' entry is present.
  15. Click 'Submit' to file form/create EOB, allowing second/subsequent Retro Claim Adjudication entry for same claim/service(s).
  16. Open Avatar MSO 'Retro Claim Adjudication' form.
  17. Select 'Add' in the 'Add/Edit/Delete Claim Adjudication' field.
  18. Select 'Claim' and 'Date of Service/Procedure' values for Retro Claim Adjudication entry/update, selecting service which has been pushed to Avatar PM parent system and included in Cal-PM 837 outbound bill/claim, where previous Retro Claim Adjudication entry with partial takeback exists.
  19. Enter value for 'Updated Approved Units' field and calculate or directly update 'Updated Disbursement Amount' field to zero (so that Retro Claim Adjudication second/subsequent entry is full service takeback/Void entry in conjunction with previously entered 'Take Back Amount' values).
  20. Allow system-calculation of updated values or directly enter value for 'Take Back Amount' - ensuring that 'Take Back Amount' is equal to the difference between the previous Retro Claim Adjudication 'Take Back Amount' entry/entries and 'Total Charge'/'Original Disbursement Amount' for the service (so that Retro Claim Adjudication second/subsequent entry is full service takeback/Void entry in conjunction with previously entered 'Take Back Amount' values).
  21. Select value for 'Adjustment Code' field if not defaulted automatically.
  22. Click 'Update Claim Adjudication' button in 'Retro Claim Adjudication' form to file entry/update.
  23. Open Avatar Cal-PM 'Client Ledger' form.
  24. Enter/select values for 'Client ID', 'Claim/Episode/All Episodes', 'From Date', 'To Date' and 'Ledger Type' values, and click 'Process' button to view Client Ledger information.
  25. For services originating in Avatar MSO and included in Cal-PM 837 outbound bill/claim - ensure that Claim Follow-Up 'Void' entry is present for service(s) with multiple partial takeback 'Retro Claim Adjudication' entries totaling to a full takeback/'Void' entry in Avatar MSO (as denoted by 'Claim Number' including 'V' Void marker in Client Ledger information).
  26. Note - The Avatar MSO-generated Claim Follow-Up 'Void' will be in 'Pended' status, and 'V' Void marker not yet present in Client Ledger information if 835 Health Care Claim Remittance/Advice payment/adjustment information has not yet been posted for original Cal-PM Electronic Billing 837 claim(s); this will be updated following 835 payment/adjustment posting for original 837 claim(s).
  27. Open Avatar Cal-PM 'Claim Follow-Up' form and select client.
  28. Select 'Edit' in 'Add, Edit or Delete Claim Follow-Up' field, and select Claim Follow Up Entry for review.
  29. Ensure that Claim Follow-Up entry exists for service(s) with multiple partial takeback 'Retro Claim Adjudication' entries totaling to a full takeback/'Void' entry in Avatar MSO.
  30. Note - The Avatar MSO-generated Claim Follow-Up entry will be in 'Pended' status if 835 Health Care Claim Remittance/Advice payment/adjustment information has not yet been posted for original Cal-PM Electronic Billing 837 claim(s); this will be updated following 835 payment/adjustment posting for original 837 claim(s).
Topics
• Retro Claim Adjudication • NX
2022 Update 31 Summary | Details
Avatar MSO Automated 837 Health Care Claim Processing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Professional Automated Processing
  • 837 Health Care Claim Institutional Automated Processing
Scenario 1: Automated 837 Inbound Processing - Verification of Duplicate 837 Inbound File Handling
Specific Setup:
  • Avatar MSO Automated 837 Health Care Claim Processing must be enabled and configured for system (via 'Import/Export File Configuration' form)
  • Inbound 837 Professional and/or Institutional format files for automated processing
Steps
  1. Place 837 Professional and/or Institutional inbound file(s) in 'Processing' directories for Avatar MSO Automated inbound 837 Health Care Claim processing (as defined via 'Import/Export File Configuration' form).
  2. Ensure Avatar MSO Automated inbound process for 837 Professional and Institutional files loads/compiles/posts each 837 inbound file in 'Processing' directories (according to behavior defined via 'Import/Export File Configuration' form).
  3. Ensure that inbound 837 automated processing completes for valid 837 inbound files placed in 'Processing' directories, and that valid files are correctly moved to 'Processed' directories.
  4. Place one or more 837 Professional and/or Institutional inbound file(s) with same/duplicate file name in 'Processing' directories for Avatar MSO Automated inbound 837 Health Care Claim processing
  5. Ensure Avatar MSO Automated inbound process for 837 Professional and Institutional files does not compile/post inbound 837 file(s) with same/duplicate file name as previously processed file; ensure that file extension is changed to .INVALID in 'Processing' directory.
  6. Ensure that in 'Error' file path directory, new error is recorded for duplicate/already processed files, noting '(Date/Time) - (File Path/Name) - The file '(File Path/Name)' has already been previously processed.'
  7. Example:
  8. '12/02/2022 11:51:13 - E:\INBOUND\AVPM_AUTOPROF\837InboundProf_AVMSO_DUPLICATECHECK.txt - The file 'E:\INBOUND\AVPM_AUTOPROF\837InboundProf_AVMSO_DUPLICATECHECK.txt' has already been previously processed.'
  9. Open Avatar MSO 'Import/Export File Configuration' form.
  10. Enter new value for 837 Professional 'Process File Path' and/or 837 Institutional 'Process File Path' configuration fields.
  11. Click 'Submit' button to file updated 'Import/Export File Configuration' values.
  12. Place one or more 837 Professional and/or Institutional inbound file(s) with same/duplicate file name in updated 'Processing' directories for Avatar MSO Automated inbound 837 Health Care Claim processing
  13. Ensure Avatar MSO Automated inbound process for 837 Professional and Institutional files does not compile/post inbound 837 file(s) with same/duplicate file name as previously processed file regardless of file path; ensure that file extension is changed to .INVALID in 'Processing' directory.
  14. Ensure that in 'Error' file path directory, new error is recorded for duplicate/already processed files, noting '(Date/Time) - (File Path/Name) - The file '(File Path/Name)' has already been previously processed.'
  15. Example:
  16. '12/02/2022 11:51:13 - E:\INBOUND\AVPM_AUTOPROF\NEW_PATH\837InboundProf_AVMSO_DUPLICATECHECK.txt - The file 'E:\INBOUND\AVPM_AUTOPROF\NEW_PATH\837InboundProf_AVMSO_DUPLICATECHECK.txt' has already been previously processed.'
'837 Health Care Claim Institutional' Invalid Data Handling
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Institutional
  • 837 Health Care Claim Institutional - Error Report
  • 837 Health Care Claim Institutional - Compile Report
Scenario 1: '837 Health Care Claim Institutional' - Validation of 2300 DTP Admission Date Format
Specific Setup:
  • 837 Health Care Claim Institutional file with one or more claims containing invalid 2300 DTP Admission Date value
  • Example: DTP*435*DT*2022101~
Steps
  1. Open '837 Health Care Claim Institutional' form.
  2. Note - Acceptance testing may also be confirmed via Avatar MSO Automated inbound 837 inbound file processing functionality
  3. Select 'Load File' in the 'Options' field.
  4. Enter file path for inbound 837 Institutional format file and click 'Process' button.
  5. Select 'Compile File' in the 'Options' field, and select loaded 837 Institutional file.
  6. Click 'Process' button.
  7. In 837 Institutional Compile Report - in case where one or more claim(s) include an invalid 2300 DTP Admission Date value, ensure that claim/service(s) are not successfully compiled (and are not included in 837 compile report).
  8. Select 'Run Error Report' in the 'Options' field, and select compiled 837 Institutional file.
  9. In 837 Institutional Error Report - in case where one or more claim(s) include an invalid 2300 DTP Admission Date value, ensure that claim is included in 837 error report with Error Type 'Critical Error' and Error Message 'Invalid admission date for claim.'
  10. Select 'Post File' in the 'Options' field, and select compiled 837 Institutional file.
  11. Click 'Process' button.
  12. In 837 Institutional Post Report - in case where one or more claim(s) include an invalid 2300 DTP Admission Date value, ensure that claim/service(s) are not successfully posted (and are not included in 837 post report).
Avatar MSO Background Task Processing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • View Definition
  • NX View Definition
  • 837 Health Care Claim Professional Automated Processing
  • 837 Health Care Claim Institutional Automated Processing
  • Claim Processing Automation
  • Claim Pre-Adjudication Web Service
Scenario 1: Automated 837 Professional/Institutional Process Status Widgets - Verification of Widget Data Display
Specific Setup:
  • Avatar MSO Automated 837 Health Care Claim Processing must be enabled and configured for system (via 'Import/Export File Configuration' form)
  • Avatar MSO Automated 837 Health Care Claim Processing may optionally be configured to automatically close batch(es) after 837 posting, create Vouchers and/or create EOBs (via 'Claim Processing Automation' form)
  • 'Automated MSO 837 Professional Process Status' and/or 'Automated MSO 837 Institutional Process Status' Widget must be assigned to user Home/myDay/Dashboard view (via RADplus 'View Definition'/'NX View Definition' form)
  • Inbound 837 Professional and/or Institutional format files for automated processing
Steps
  1. Place multiple 837 Professional and/or Institutional inbound files in 'Processing' directories for Avatar MSO Automated inbound 837 Health Care Claim processing (as defined via 'Import/Export File Configuration' form).
  2. Refresh the 'Automated MSO 837 Professional Process Status' and/or 'Automated MSO 837 Institutional Process Status' Widget within user's Home View/myDay View/Dashboard View.
  3. Ensure that 'Automated MSO 837 Professional Process Status' / 'Automated MSO 837 Institutional Process Status' Widgets display current/correct information for inbound 837 files processing/to be processed in the 'Status' and 'File Name' widget columns.
  4. Ensure Automated 837 file process loads/compiles/posts each 837 inbound file in 'Processing' directories as expected (according to behavior defined via 'Import/Export File Configuration' form).
  5. During/following additional Avatar MSO Automated inbound 837 file processing actions, refresh the 'Automated MSO 837 Professional Process Status' and/or 'Automated MSO 837 Professional Process Status' Widget within user's Home View/myDay View/Dashboard View, ensuring that display is updated with current/correct information for inbound 837 files processing/to be processed in the 'Status' and 'File Name' widget columns.
Scenario 2: Automated 837 Inbound Processing/Claim Processing Automation - Verification of 837 Processing
Specific Setup:
  • Avatar MSO Automated 837 Health Care Claim Processing must be enabled and configured for system (via 'Import/Export File Configuration' form)
  • Avatar MSO Automated 837 Health Care Claim Processing may optionally be configured to automatically close batch(es) after 837 posting, create Vouchers and/or create EOBs (via 'Claim Processing Automation' form)
  • Inbound 837 Professional and/or Institutional format files for automated processing containing one or more valid claims/services
Steps
  1. Place multiple 837 Professional and/or Institutional inbound files in 'Processing' directories for Avatar MSO Automated inbound 837 Health Care Claim processing (as defined via 'Import/Export File Configuration' form).
  2. Ensure Avatar MSO Automated inbound process for 837 Professional and Institutional files loads/compiles/posts each 837 inbound file in 'Processing' directories (according to behavior defined via 'Import/Export File Configuration' form).
  3. Ensure for all Claims Processing batches created via inbound 837 automated processing are closed automatically if configured (as defined in the 'Claim Processing Automation' form). This can be confirmed via 'Close Batch' form, the 'Open Batches' Widget and/or by reviewing data in Avatar MSO SQL table 'SYSTEM.batch_current_data.'
  4. Ensure that inbound 837 automated processing completes for all 837 inbound files placed in 'Processing' directories, and that files are correctly moved to 'Processed' directories.
  5. Ensure that no system errors are recorded in the 'Error' file directory .txt file (as defined in the 'Import/Export File Configuration' form) for processed 837 inbound files.
  6. If 999 Functional Acknowledgement response files are configured for generation on 837 file automated processing - ensure that on inbound 837 file processing, 999 Functional Acknowledgement response file(s) are automatically generated on server in directory specified for 999 file creation in the 'Import/Export File Configuration' form.
  7. If 277CA Claim Acknowledgement response files are configured for generation on 837 file automated processing - ensure that on inbound 837 file processing, 277CA Claim Acknowledgement response file(s) are automatically generated on server in directory specified for 277CA file creation in the 'Import/Export File Configuration' form.
  8. If 835 Health Care Claim Payment/Advice response files are configured for generation on EOB creation - ensure that on EOB creation (manually via 'Create EOB' form or via automated claims processing functionality including scheduled EOB creation), 835 Health Care Claim Acknowledgement response file(s) are automatically generated on server in directory specified for 835 file creation in the 'Claim Processing Automation' form.
Scenario 3: 'Claim Pre-Adjudication' Web Service - Receipt and processing of claim/service data from ProviderConnect
Specific Setup:
  1. Client record eligible for Claim/Service entry in Avatar MSO and Netsmart ProviderConnect
  2. Netsmart ProviderConnect (or other application utilizing the Avatar MSO 'Claim Pre-Adjudication' web service)
  3. 'Crystal Reports' or other SQL reporting tool
Steps
  1. Enter one or more services via Netsmart ProviderConnect 'Treatment' service entry.
  2. Navigate to ProviderConnect 'Billing' menu.
  3. Click 'Generate Bill' button for selected criteria.
  4. Click 'Click 'Submit Bill for Pre-adjudication' button for ProviderConnect billing transaction (or via other application utilizing the Avatar MSO 'Claim Pre-Adjudication' web service).
  5. Within 'Unsubmitted Bills' section of ProviderConnect 'Billing' menu, navigate to bill created above which was submitted for Pre-Adjudication.
  6. Click 'View Pre-adjudication Results' button for unsubmitted bill.
  7. For all services in bill submitted for Pre-Adjudication but not yet processed by Avatar MSO, ensure 'Status' value is 'Queued'.
  8. The Avatar MSO Pre-Adjudication processing will be performed by a system background process automatically, starting every 30 minutes and processing any new/previously unprocessed services; accordingly, wait for sufficient time frame for Pre-Adjudication to be performed by Avatar MSO.
  9. Click the 'Refresh Bill Pre-adjudication Results' button.
  10. Following Avatar MSO Pre-Adjudication processing of services, ensure that 'Status' value in ProviderConnect is updated from 'Queued' to either 'Passed Edit' or 'Failed Edit'. ('Passed Edit' or 'Failed Edit' Pre-Adjudication status for each service will be determined by Avatar MSO using the same configurations/criteria/logic as standard Claim Processing service adjudication for 'Approved' and 'Denied'/'Pending' claim status (respectively).)
  11. Following Avatar MSO Pre-Adjudication processing of services, ensure that services with 'Status' value of 'Failed Edit' also include data for 'Pre-Adjudication Edit Failed Reason' in ProviderConnect display. ('Pre-Adjudication Edit Failed Reason values for 'Failed Edit' services will be determined by Avatar MSO using the same configurations/criteria/logic as standard Claim Processing service adjudication for the 'Explanation of Coverage' detailed message.)
  12. Open 'Crystal Reports' or other SQL reporting tool.
  13. In Avatar MSO SQL table 'SYSTEM.claims_pre_adj table' - ensure new single row is present for each service submitted/processed by Claim Pre-Adjudication web service/background process.
  14. In Avatar MSO SQL table 'SYSTEM.claims_pre_adj table' - for each service submitted/processed, confirm 'Queued', 'Passed Edit' or 'Failed Edit' status in field 'status' (value 'Q', '1' or '0', respectively).
  15. In Avatar MSO SQL table 'SYSTEM.claims_pre_adj table' - for each service submitted/processed with 'Failed Edit' status, confirm 'Pre-Adjudication Edit Failed Reason' values in field 'pre_adj_edit_failed_reason'.
Topics
• 837 Health Care Claim Professional • Claims Processing • 837 Health Care Claim Institutional • Widgets
2022 Update 36 Summary | Details
Avatar MSO 'Enable Multiple Service Date Entry' Registry Setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • Fast Service Entry Submission
  • Claim Processing (CMS 1500)
  • Claim Processing with Override (CMS 1500)
  • Claim Processing (UB-04)
  • Claim Processing with Override (UB-04)
  • Foster Care Service Entry
Scenario 1: Avatar MSO Registry Settings - Verification of 'Enable Multiple Service Date Entry' Registry Setting
Steps
  1. Open 'Registry Settings' form.
  2. Enter search value 'Enable Multiple Service Date Entry' and click 'View Registry Settings' button.
  3. Ensure Registry Setting 'Enable Multiple Service Date Entry' is returned (under 'Avatar MSO -> Claims Processing' path).
  4. Ensure Registry Setting 'Enable Multiple Service Date Entry' is set to 'N' (disabled) by default on update installation.
  5. Ensure 'Registry Setting Details' field contains the following explanation text:

"Setting this registry setting to 'Y' will add support for multiple service date entry to MSO.

The fields 'Select Dates Option', 'From Date', 'Through Date', 'Exclude Weekends' and 'Select Dates' will be added to the Avatar MSO forms for Fast Service Entry, Fast Service Entry Submission, Claim Processing (CMS-1500), Claim Processing with Override (CMS-1500), Claim Processing (UB-04), Claim Processing with Override (UB-04) and Foster Care Service Entry.

Selecting 'N' removes these fields from the forms and disables the related functionality."

Scenario 2: 'Fast Service Entry' - Verification Of Multiple Service Date Entry
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Multiple Service Date Entry' must be enabled
  • Note - Multiple service date entry fields will be added to end of Fast Service Entry forms 'Fast Service Detail' section by default; Fields may be relocated/repositioned within form as desired via Avatar MSO 'Form Designer'
  • Client record(s) eligible for claim/service entry
Steps
  1. Open Avatar MSO 'Fast Service Entry' or 'Fast Service Entry Submission' form.
  2. Enter/select value for 'Date Claims Received' (and 'Close Batches' if allowed/applicable).
  3. Navigate to 'Fast Service Detail' section of form.
  4. Click 'Add New Item' button to enter new service row(s).
  5. Ensure the following fields are present in the Avatar MSO 'Fast Service Entry' or 'Fast Service Entry Submission' form, 'Fast Service Detail' section:
  6. 'Select Dates Option'
  7. Radio button selection field with 'Single Date' and 'Multiple Dates' selections
  8. Set to 'Single Date' by default
  9. 'From Date'
  10. Begin date filtering/criteria field for 'Select Dates' multiple date service entry
  11. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  12. 'Through Date'
  13. End date filtering/criteria field for 'Select Dates' multiple date service entry
  14. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  15. 'Exclude Weekends'
  16. Radio button filtering/criteria field with 'Yes' and 'No' selections for 'Select Dates' multiple date service entry
  17. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  18. 'Select Dates'
  19. Date selection field for multiple date service entry
  20. Populated with service dates on or between 'From Date'/'Through Date' criteria fields
  21. Weekend dates (Saturday/Sunday) included or excluded in 'Select Dates' field via 'Exclude Weekends' criteria field
  22. A maximum of 31 services/service dates may be selected for entry
  23. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  24. 'Create Service(s) For Selected Dates' button
  25. Used to create/add multiple date service row(s) in form following service information entry and date selection
  26. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  27. Ensure 'Select Dates Option' field is set to 'Single Date' by default on new service entry (and 'Date of Service' date entry field is enabled for single service date entry where 'Single Date' is selected for 'Select Dates Option' field).
  28. Select 'Multiple Dates' in 'Select Dates Option' field.
  29. Ensure 'From Date', 'Through Date', 'Exclude Weekends' and 'Select Dates' fields are enabled where 'Multiple Dates' is selected in 'Select Dates Option' field.
  30. Enter/select values for 'From Date' and 'Through Date' filtering/criteria fields.
  31. If date range for 'From Date' and 'Through Date' fields is greater than 31 days, ensure user is presented with an error dialog noting 'The Date Range cannot exceed 31 days' and the entry is disallowed.
  32. Select value for 'Exclude Weekends' filtering/criteria field.
  33. Ensure 'Select Dates' field is populated with service dates on or between 'From Date'/'Through Date' criteria fields (with weekend dates included or excluded based on 'Exclude Weekends' selection).
  34. Select two or more dates for service entry/creation in the 'Select Dates' field.
  35. Ensure 'Date of Service' date entry field is disabled in form for service entry where 'Multiple Dates' is selected for 'Select Dates Option'; ensure 'Date of Service' field is populated with earliest selected date in 'Select Dates' field.
  36. Enter/select values for 'Member Name Or ID', 'Funding Source' and 'Provider' fields.
  37. Enter/select values for 'Procedure Code', 'Total Charge' and 'Service Units' fields.
  38. Click 'Display Valid Authorizations' button for Service Authorization selection.
  39. Ensure Authorization Listing display includes authorization record(s) applicable to service dates selected/service detail information (or 'No authorizations are on file which match the entered criteria' message is displayed if no applicable authorization record found).
  40. Select Authorization record/row for service entry (or directly enter value in 'Authorization Number' field).
  41. Enter/select values for any other service detail fields as required/desired.
  42. Click the 'Create Service(s) For Selected Dates' button to add services for each/all dates selected in the 'Select Dates' multiple service entry field.
  43. In case where any required field(s) is/are not completed - On clicking 'Create Service(s) For Selected Dates' button, ensure that user is presented with error dialog noting incomplete required fields (and multiple date service rows are not added in form).
  44. Following use of the 'Create Service(s) For Selected Dates' button, ensure user is presented with confirmation dialog noting services/service rows which will be added in form; click 'OK' button to close dialog/continue.
  45. Example: "Services will be added for Dates: 2023-02-02 - Thursday 2023-02-03 - Friday 2023-02-15 - Wednesday 2023-02-16 - Thursday"
  46. In case where 'Authorization Number' entered in Service Detail does not fully cover all specified service dates/rows for approval - Following use of the 'Create Service(s) For Selected Dates' button/date confirmation dialog, ensure user is presented with an alert dialog noting 'Some or all of the services entered are denied due to invalid authorization information'; click 'OK' button to close dialog/continue.
  47. Ensure one service row is added for each selected date in form (visible in the 'Fast Service Entry Summary' tabular data entry grid at top of 'Fast Service Detail' section of form), with all services using same service detail information/values as entered/selected in form.
  48. Select added service detail row in 'Fast Service Entry Summary' tabular data entry grid at top of 'Fast Service Detail' section and click 'Edit Selected Item' button to review service detail information.
  49. Ensure all service detail fields contain information/values as entered/selected in form for multiple date service entry.
  50. Repeat single date or multiple date service entry as desired for same or different client/provider.
  51. When all desired services have been entered in 'Fast Service Detail' section of form, navigate to 'Fast Service Entry Summary' section of form.
  52. Click 'Submit Fast Service Entry' button to file service(s) and create Avatar MSO claims processing batch(es).
  53. Re-open claim(s) created via 'Fast Service Entry'/'Fast Service Entry Submission' form for review (via Avatar MSO 'Claim Processing (CMS 1500)' form, selecting Fast Service Entry batch/claim).
  54. Navigate to 'Service Detail' section of form.
  55. Ensure all previously filed services/service detail rows are present in 'Claim Service Detail History' tabular data entry grid at top of 'Service Detail' section (with all services using service detail information/values as previously entered via 'Fast Service Entry'/'Fast Service Entry Submission' form).
Scenario 3: 'Claim Processing (CMS 1500)' - Verification of Multiple Service Date Entry
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Multiple Service Date Entry' must be enabled
  • Note - Multiple service date entry fields will be added to end of Claim Processing forms 'Service Detail' section by default; Fields may be relocated/repositioned within form as desired via Avatar MSO 'Form Designer'
  • Client record(s) eligible for claim/service entry
Steps
  1. Open Avatar MSO 'Claim Processing (CMS 1500)' or 'Claim Processing With Override (CMS 1500)' form.
  2. Select claims processing batch for claim/service entry.
  3. Create new claim for service entry (or open existing claim for new service entry).
  4. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form (as well as any other required/desired fields in claim level section).
  5. Navigate to 'Service Detail' section of form.
  6. Click 'Add New Item' button to enter new service row(s).
  7. Ensure the following fields are present in the Avatar MSO 'Claim Processing (CMS 1500)' or 'Claim Processing With Override (CMS 1500)' form, 'Service Detail' section:
  8. 'Select Dates Option'
  9. Radio button selection field with 'Single Date' and 'Multiple Dates' selections
  10. Set to 'Single Date' by default
  11. 'From Date'
  12. Begin date filtering/criteria field for 'Select Dates' multiple date service entry
  13. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  14. 'Through Date'
  15. End date filtering/criteria field for 'Select Dates' multiple date service entry
  16. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  17. 'Exclude Weekends'
  18. Radio button filtering/criteria field with 'Yes' and 'No' selections for 'Select Dates' multiple date service entry
  19. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  20. 'Select Dates'
  21. Date selection field for multiple date service entry
  22. Populated with service dates on or between 'From Date'/'Through Date' criteria fields
  23. Weekend dates (Saturday/Sunday) included or excluded in 'Select Dates' field via 'Exclude Weekends' criteria field
  24. A maximum of 31 services/service dates may be selected for entry
  25. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  26. 'Create Service(s) For Selected Dates' button
  27. Used to create/add multiple date service row(s) in form following service information entry and date selection
  28. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  29. Ensure 'Select Dates Option' field is set to 'Single Date' by default on new service entry (and 'Date of Service' date entry field is enabled for single service date entry where 'Single Date' is selected for 'Select Dates Option' field).
  30. Select 'Multiple Dates' in 'Select Dates Option' field.
  31. Ensure 'From Date', 'Through Date', 'Exclude Weekends' and 'Select Dates' fields are enabled where 'Multiple Dates' is selected in 'Select Dates Option' field.
  32. Enter/select values for 'From Date' and 'Through Date' filtering/criteria fields.
  33. If date range for 'From Date' and 'Through Date' fields is greater than 31 days, ensure user is presented with an error dialog noting 'The Date Range cannot exceed 31 days' and the entry is disallowed.
  34. Select value for 'Exclude Weekends' filtering/criteria field.
  35. Ensure 'Select Dates' field is populated with service dates on or between 'From Date'/'Through Date' criteria fields (with weekend dates included or excluded based on 'Exclude Weekends' selection).
  36. Select two or more dates for service entry/creation in the 'Select Dates' field.
  37. Ensure 'Date of Service' date entry field is disabled in form for service entry where 'Multiple Dates' is selected for 'Select Dates Option'; ensure 'Date of Service' field is populated with earliest selected date in 'Select Dates' field.
  38. Enter/select values for 'Procedure Code', 'Total Charge' and 'Service Units' fields.
  39. Click 'Display Valid Authorizations' button for Service Authorization selection.
  40. Ensure Authorization Listing display includes authorization record(s) applicable to service dates selected/service detail information (or 'No authorizations are on file which match the entered criteria' message is displayed if no applicable authorization record found).
  41. Select Authorization record/row for service entry (or directly enter value in 'Authorization Number' field).
  42. Enter/select values for any other service detail fields as required/desired.
  43. Click the 'Create Service(s) For Selected Dates' button to add services for each/all dates selected in the 'Select Dates' multiple service entry field.
  44. In case where any required field(s) is/are not completed - On clicking 'Create Service(s) For Selected Dates' button, ensure that user is presented with error dialog noting incomplete required fields (and multiple date service rows are not added in form).
  45. Following use of the 'Create Service(s) For Selected Dates' button, ensure user is presented with confirmation dialog noting services/service rows which will be added in form; click 'OK' button to close dialog/continue.
  46. Example: "Services will be added for Dates: 2023-02-02 - Thursday 2023-02-03 - Friday 2023-02-15 - Wednesday 2023-02-16 - Thursday"
  47. In case where 'Authorization Number' entered in Service Detail does not fully cover all specified service dates/rows for approval - Following use of the 'Create Service(s) For Selected Dates' button/date confirmation dialog, ensure user is presented with an alert dialog noting 'Some or all of the services entered are denied due to invalid authorization information'; click 'OK' button to close dialog/continue.
  48. Ensure one service row is added for each selected date in form (visible in the 'Claim Service Detail History' tabular data entry grid at top of 'Service Detail' section of form), with all services using same service detail information/values as entered/selected in form.
  49. Select added service detail row in 'Claim Service Detail History' tabular data entry grid at top of 'Service Detail' section and click 'Edit Selected Item' button to review service detail information.
  50. Ensure all service detail fields contain information/values as entered/selected in form for multiple date service entry.
  51. Repeat single date or multiple date service entry as desired for client/provider/claim.
  52. Click 'Submit' button to file form/save claim and service entries.
  53. Re-open same claim for review (via 'Return to Pre-Display' dialog for Claim Processing form or by re-opening Claim Processing form and selecting same batch/claim).
  54. Navigate to 'Service Detail' section of form.
  55. Ensure all previously filed services/service detail rows are present in 'Claim Service Detail History' tabular data entry grid at top of 'Service Detail' section (with all services using service detail information/values as previously entered).
Scenario 4: 'Claim Processing (UB-04)' - Verification of Multiple Service Date Entry
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Multiple Service Date Entry' must be enabled
  • Note - Multiple service date entry fields will be added to end of Claim Processing forms 'Service Detail' section by default; Fields may be relocated/repositioned within form as desired via Avatar MSO 'Form Designer'
  • Client record(s) eligible for claim/service entry
Steps
  1. Open Avatar MSO 'Claim Processing (UB-04)' or 'Claim Processing With Override (UB-04)' form.
  2. Select claims processing batch for claim/service entry.
  3. Create new claim for service entry (or open existing claim for new service entry).
  4. Enter/select value for 'Member Name or ID' and 'Provider' fields in claim level section of form (as well as any other required/desired fields in claim level section).
  5. Navigate to 'Service Detail' section of form.
  6. Click 'Add New Item' button to enter new service row(s).
  7. Ensure the following fields are present in the Avatar MSO 'Claim Processing (UB-04)' or 'Claim Processing With Override (UB-04)' form, 'Service Detail' section:
  8. 'Select Dates Option'
  9. Radio button selection field with 'Single Date' and 'Multiple Dates' selections
  10. Set to 'Single Date' by default
  11. 'From Date'
  12. Begin date filtering/criteria field for 'Select Dates' multiple date service entry
  13. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  14. 'Through Date'
  15. End date filtering/criteria field for 'Select Dates' multiple date service entry
  16. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  17. 'Exclude Weekends'
  18. Radio button filtering/criteria field with 'Yes' and 'No' selections for 'Select Dates' multiple date service entry
  19. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  20. 'Select Dates'
  21. Date selection field for multiple date service entry
  22. Populated with service dates on or between 'From Date'/'Through Date' criteria fields
  23. Weekend dates (Saturday/Sunday) included or excluded in 'Select Dates' field via 'Exclude Weekends' criteria field
  24. A maximum of 31 services/service dates may be selected for entry
  25. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  26. 'Create Service(s) For Selected Dates' button
  27. Used to create/add multiple date service row(s) in form following service information entry and date selection
  28. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  29. Ensure 'Select Dates Option' field is set to 'Single Date' by default on new service entry (and 'Date of Service' date entry field is enabled for single service date entry where 'Single Date' is selected for 'Select Dates Option' field).
  30. Select 'Multiple Dates' in 'Select Dates Option' field.
  31. Ensure 'From Date', 'Through Date', 'Exclude Weekends' and 'Select Dates' fields are enabled where 'Multiple Dates' is selected in 'Select Dates Option' field.
  32. Enter/select values for 'From Date' and 'Through Date' filtering/criteria fields.
  33. If date range for 'From Date' and 'Through Date' fields is greater than 31 days, ensure user is presented with an error dialog noting 'The Date Range cannot exceed 31 days' and the entry is disallowed.
  34. Select value for 'Exclude Weekends' filtering/criteria field.
  35. Ensure 'Select Dates' field is populated with service dates on or between 'From Date'/'Through Date' criteria fields (with weekend dates included or excluded based on 'Exclude Weekends' selection).
  36. Select two or more dates for service entry/creation in the 'Select Dates' field.
  37. Ensure 'Date of Service' date entry field is disabled in form for service entry where 'Multiple Dates' is selected for 'Select Dates Option'; ensure 'Date of Service' field is populated with earliest selected date in 'Select Dates' field.
  38. Enter/select values for 'Revenue Code', 'Total Charge' and 'Service Units' fields.
  39. Click 'Display Valid Authorizations' button for Service Authorization selection.
  40. Ensure Authorization Listing display includes authorization record(s) applicable to service dates selected/service detail information (or 'No authorizations are on file which match the entered criteria' message is displayed if no applicable authorization record found).
  41. Select Authorization record/row for service entry (or directly enter value in 'Authorization Number' field).
  42. Enter/select values for any other service detail fields as required/desired.
  43. Click the 'Create Service(s) For Selected Dates' button to add services for each/all dates selected in the 'Select Dates' multiple service entry field.
  44. In case where any required field(s) is/are not completed - On clicking 'Create Service(s) For Selected Dates' button, ensure that user is presented with error dialog noting incomplete required fields (and multiple date service rows are not added in form).
  45. Following use of the 'Create Service(s) For Selected Dates' button, ensure user is presented with confirmation dialog noting services/service rows which will be added in form; click 'OK' button to close dialog/continue.
  46. Example: "Services will be added for Dates: 2023-02-02 - Thursday 2023-02-03 - Friday 2023-02-15 - Wednesday 2023-02-16 - Thursday"
  47. In case where 'Authorization Number' entered in Service Detail does not fully cover all specified service dates/rows for approval - Following use of the 'Create Service(s) For Selected Dates' button/date confirmation dialog, ensure user is presented with an alert dialog noting 'Some or all of the services entered are denied due to invalid authorization information'; click 'OK' button to close dialog/continue.
  48. Ensure one service row is added for each selected date in form (visible in the 'Claim Service Detail History' tabular data entry grid at top of 'Service Detail' section of form), with all services using same service detail information/values as entered/selected in form.
  49. Select added service detail row in 'Claim Service Detail History' tabular data entry grid at top of 'Service Detail' section and click 'Edit Selected Item' button to review service detail information.
  50. Ensure all service detail fields contain information/values as entered/selected in form for multiple date service entry.
  51. Repeat single date or multiple date service entry as desired for client/provider/claim.
  52. Click 'Submit' button to file form/save claim and service entries.
  53. Re-open same claim for review (via 'Return to Pre-Display' dialog for Claim Processing form or by re-opening Claim Processing form and selecting same batch/claim).
  54. Navigate to 'Service Detail' section of form.
  55. Ensure all previously filed services/service detail rows are present in 'Claim Service Detail History' tabular data entry grid at top of 'Service Detail' section (with all services using service detail information/values as previously entered).
Scenario 5: 'Foster Care Service Entry' - Verification of Multiple Service Date Entry
Specific Setup:
  • Avatar Foster Care solution must be installed
  • Avatar MSO Registry Setting 'Enable Multiple Service Date Entry' must be enabled
  • Note - Multiple service date entry fields will be added to end of Foster Care Service Entry form 'Foster Care Service Detail' section by default; Fields may be relocated/repositioned within form as desired via Avatar MSO 'Form Designer'
  • Client record(s) eligible for Foster Care claim/service entry
Steps
  1. Open Avatar MSO 'Foster Care Service Entry' form.
  2. Enter/select value for 'Date Claims Received' (and 'Close Batches' if allowed/applicable).
  3. Navigate to 'Foster Care Service Detail' section of form.
  4. Click 'Add New Item' button to enter new service row(s).
  5. Ensure the following fields are present in the Avatar MSO 'Foster Care Service Entry' form, 'Foster Care Service Detail' section:
  6. 'Select Dates Option'
  7. Radio button selection field with 'Single Date' and 'Multiple Dates' selections
  8. Set to 'Single Date' by default
  9. 'From Date'
  10. Begin date filtering/criteria field for 'Select Dates' multiple date service entry
  11. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  12. 'Through Date'
  13. End date filtering/criteria field for 'Select Dates' multiple date service entry
  14. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  15. 'Exclude Weekends'
  16. Radio button filtering/criteria field with 'Yes' and 'No' selections for 'Select Dates' multiple date service entry
  17. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  18. 'Select Dates'
  19. Date selection field for multiple date service entry
  20. Populated with service dates on or between 'From Date'/'Through Date' criteria fields
  21. Weekend dates (Saturday/Sunday) included or excluded in 'Select Dates' field via 'Exclude Weekends' criteria field
  22. A maximum of 31 services/service dates may be selected for entry
  23. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  24. 'Create Service(s) For Selected Dates' button
  25. Used to create/add multiple date service row(s) in form following service information entry and date selection
  26. Only enabled where 'Multiple Dates' is selected in 'Select Dates Option' field
  27. Ensure 'Select Dates Option' field is set to 'Single Date' by default on new service entry (and 'Date of Service' date entry field is enabled for single service date entry where 'Single Date' is selected for 'Select Dates Option' field).
  28. Select 'Multiple Dates' in 'Select Dates Option' field.
  29. Ensure 'From Date', 'Through Date', 'Exclude Weekends' and 'Select Dates' fields are enabled where 'Multiple Dates' is selected in 'Select Dates Option' field.
  30. Enter/select values for 'From Date' and 'Through Date' filtering/criteria fields.
  31. If date range for 'From Date' and 'Through Date' fields is greater than 31 days, ensure user is presented with an error dialog noting 'The Date Range cannot exceed 31 days' and the entry is disallowed.
  32. Select value for 'Exclude Weekends' filtering/criteria field.
  33. Ensure 'Select Dates' field is populated with service dates on or between 'From Date'/'Through Date' criteria fields (with weekend dates included or excluded based on 'Exclude Weekends' selection).
  34. Select two or more dates for service entry/creation in the 'Select Dates' field.
  35. Ensure 'Date of Service' date entry field is disabled in form for service entry where 'Multiple Dates' is selected for 'Select Dates Option'; ensure 'Date of Service' field is populated with earliest selected date in 'Select Dates' field.
  36. Enter/select values for 'Foster Child Name Or ID', 'Funding Source' and 'Provider' fields.
  37. Enter/select values for 'Procedure Code (Service Provided)', 'Total Charge' and 'Service Units' fields.
  38. Click 'Display Valid Authorizations' button for Service Authorization selection.
  39. Ensure Authorization Listing display includes authorization record(s) applicable to service dates selected/service detail information (or 'No authorizations are on file which match the entered criteria' message is displayed if no applicable authorization record found).
  40. Select Authorization record/row for service entry (or directly enter value in 'Authorization Number' field).
  41. Enter/select values for any other service detail fields as required/desired.
  42. Click the 'Create Service(s) For Selected Dates' button to add services for each/all dates selected in the 'Select Dates' multiple service entry field.
  43. In case where any required field(s) is/are not completed - On clicking 'Create Service(s) For Selected Dates' button, ensure that user is presented with error dialog noting incomplete required fields (and multiple date service rows are not added in form).
  44. Following use of the 'Create Service(s) For Selected Dates' button, ensure user is presented with confirmation dialog noting services/service rows which will be added in form; click 'OK' button to close dialog/continue.
  45. Example: "Services will be added for Dates: 2023-02-02 - Thursday 2023-02-03 - Friday 2023-02-15 - Wednesday 2023-02-16 - Thursday"
  46. In case where 'Authorization Number' entered in Service Detail does not fully cover all specified service dates/rows for approval - Following use of the 'Create Service(s) For Selected Dates' button/date confirmation dialog, ensure user is presented with an alert dialog noting 'Some or all of the services entered are denied due to invalid authorization information'; click 'OK' button to close dialog/continue.
  47. Ensure one service row is added for each selected date in form (visible in the 'Fast Service Entry Summary' tabular data entry grid at top of 'Foster Care Service Detail' section of form), with all services using same service detail information/values as entered/selected in form.
  48. Select added service detail row in 'Fast Service Entry Summary' tabular data entry grid at top of 'Foster Care Service Detail' section and click 'Edit Selected Item' button to review service detail information.
  49. Ensure all service detail fields contain information/values as entered/selected in form for multiple date service entry.
  50. Repeat single date or multiple date service entry as desired for same or different client/provider.
  51. When all desired services have been entered in 'Foster Care Service Detail' section of form, navigate to 'Foster Care Service Entry Summary' section of form.
  52. Click 'Submit Fast Service Entry' button to file service(s) and create Avatar MSO claims processing batch(es).
  53. Re-open claim(s) created via 'Foster Care Service Entry' form for review (via Avatar MSO 'Claim Processing (CMS 1500)' form, selecting Foster Care Service Entry batch/claim).
  54. Navigate to 'Service Detail' section of form.
  55. Ensure all previously filed services/service detail rows are present in 'Claim Service Detail History' tabular data entry grid at top of 'Service Detail' section (with all services using service detail information/values as previously entered via 'Foster Care Service Entry' form).
Topics
• Registry Settings • Claims Processing • NX • Foster Care
2022 Update 38 Summary | Details
Avatar MSO 'Service Authorization' Form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • Procedure Code Group Definition
  • Provider Fee Definition
Scenario 1: 'Service Authorization' - Verification of 'Restrict Code Authorized By Provider' Registry Setting
Specific Setup:
  • Avatar MSO Registry Setting 'Restrict Code Authorized By Provider' must be enabled
  • One or more Procedure Code Group(s) including CPT Codes must be defined (via Avatar MSO 'Procedure Code Group Definition' form)
  • Provider Fee Definition(s) must be defined by Procedure Code Group for Contracting Provider (via Avatar MSO 'Provider Fee Definition' form)
Steps
  1. Open Avatar MSO 'Service Authorization' form.
  2. Select Client ID for 'Service Authorization' entry.
  3. Click 'Add' button in 'Service Authorization' form pre-display to enter a new record, or select existing row/record and click 'Edit' button to view/update existing record.
  4. Enter/select values for 'Funding Source Authorization Is For', 'Benefit Plan', 'Provider To Be Authorized', 'Begin Date Of Authorization', 'End Date Of Authorization' and 'Current Authorization Status' fields.
  5. Select 'Individual' in the 'Authorization Grouping Or Individual Authorizations' field.
  6. Select 'CPT Code' in the 'Procedure Code Type' field.
  7. Enter search term for CPT Code in 'Code Authorized' field.
  8. In 'Code Authorized' field search results - ensure that only CPT Codes where Provider Fee Definition for selected 'Provider To Be Authorized' are included/available for selection, including CPT Codes where applicable Provider Fee Definition is defined by Procedure Code Group for Contracting Provider.
  9. In 'Code Authorized' field search results - ensure that CPT Codes where no Provider Fee Definition exists for selected 'Provider To Be Authorized' are not included/not available for selection.
  10. Select search result/CPT Code in the 'Code Authorized' field and enter value for corresponding 'Units Authorized' field; if enabled, ensure that 'Estimated Liability Code' field value is populated based on Provider Fee Definition for selected 'Code Authorized'/'Units Authorized' field entries where applicable Provider Fee Definition is defined by Procedure Code Group for Contracting Provider.
  11. Enter/select values for any other fields in form as required/desired.
  12. Click 'Submit' button to file 'Service Authorization' form/record.
Topics
• Registry Settings • Service Authorizations • NX