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Avatar MSO 2023 Quarterly Release 2023.02 Details

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Product Requirements / Recommendations

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  • Avatar MSO 837 Institutional Health Care Claim Processing
    The 'Contracting Provider Registration' form (837 Defaults section) is updated to support the 'Require Exact Authorization Number (Institutional)' field.
    The 'Require Exact Authorization Number (Institutional)' field is added to the '837 Defaults' section of the Avatar MSO 'Contracting Provider Registration' form. When set to 'Yes', the 'Require Exact Authorization Number (Institutional)' will only populate Authorization Number for compiled/posted services with value included in 2300-REF Prior Authorization Number information for inbound 837 Health Care Claim Institutional claims.
  • Avatar MSO Claim Processing Batch Naming Convention
    The 'Set Batch File Naming Convention' Registry Setting is added to Avatar MSO.
    The 'Set Batch File Naming Convention' Registry Setting allows for optional configuration of Avatar MSO Claim Processing Batch naming formats for batches created via inbound 837 Health Care Claim file posting and 'Fast Service Entry' filing.
  • Avatar MSO 'Provider EOB Report'
    The 'Provider EOB Report' form/report is added.
    The Avatar MSO 'Provider EOB Report' form/report allows for display of Remittance Information/Claim Adjudication and Adjustment Information for selected EOB, with EOBs available for selection filtered/restricted by Contracting Provider.
  • Avatar MSO Service Authorization Widgets
    An issue is resolved to ensure that the Avatar MSO 'Pending Service Authorization' and 'Service Authorization Information' Widgets display Authorization Number values in case where user does not have access to the 'Service Authorization' form.
  • Avatar MSO 'Service Authorization Request' Form
    The 'Service Authorization Request' form is updated to default additional field values when an Authorization Grouping is selected.
    The Avatar MSO 'Service Authorization Request' form is updated to default in the 'Requested Units' and 'Units Authorized' field values when an Authorization Grouping is selected (based on 'Authorization Grouping Definition' Units value for codes).
  • Avatar MSO 837 Health Care Claim Forms
    The 837 Health Care Claim forms are updated to filter loaded files by Contracting Provider.
    The 'Select File' field in the Avatar MSO '837 Health Care Claim Professional' and '837 Health Care Claim Institutional' forms is updated to filter/restrict files available by Contracting Provider in form.
  • Avatar MSO Claim Processing Forms
    The 'Does This Service Represent An Admission' field is updated to no longer be required in all Claim Processing forms.
    The 'Does This Service Represent An Admission' field is updated to no longer be required in the following Avatar MSO forms: * 'Claim Processing (CMS 1500)' * 'Claim Processing With Override (CMS 1500)' * 'Claim Processing (UB-04)' * 'Claim Processing With Override (UB-04)' * 'Fast Service Entry' * 'Fast Service Entry Submission'
  • Avatar ProviderConnect NX Additional Support
    Avatar MSO is updated for additional support of Avatar ProviderConnect NX.
    The 'Void Claim Assignment' and 'Authorization Hardcopy' forms are updated for use with Avatar ProviderConnect NX. In addition, the 'Fast Service Entry Submission' form is updated to ensure that the 'Close Batches' and 'Date Claims Received' field values and state are defaulted following form submission/return to form.
Included Updates
None
Product Update Form Description
The following modifications are made: 1) The 'Contracting Provider Registration' form (837 Defaults section) is updated to support the 'Require Exact Authorization Number (Institutional)' field. 2) The 'Provider EOB Report' form is added to Avatar MSO. 3) The 'Set Batch File Naming Convention' registry setting is added. This registry setting will control how batches will be named when claims were created via 837 files or Fast Service Entry forms. 4) An issue is resolved where the 'Pending Service Authorization' and 'Service Authorization Information' widget would not display the authorization number if the user did not have access to the 'Service Authorization' form. 5) The '837 Health Care Claim Professional' and '837 Health Care Claim Institutional' forms are updated to sort Loaded files by Contracting Provider. 6) The 'Does This Service Represent An Admission' field is updated to no longer be required in all MSO Claim Processing and Fast Service Entry forms. 7) The 'Service Authorization Request' form is updated to default in the 'Requested Units' and 'Units Authorized' fields when an Authorization Grouping is selected. 8) The 'Void Claim Assignment' and 'Authorization Hardcopy' forms are updated to support ProviderConnect NX functionality. 9) An issue is resolved where the 'Date Claims Received' field in the 'Fast Service Entry Submission' form would not default the current date upon re-entering the form after filing.
Topics
• Contracting Provider Registration • NX • 837 Health Care Claim Institutional • Registry Settings • Claims Processing • 837 Health Care Claim Professional • Reports • Widgets • Service Authorizations • 837 Professional • 837 Institutional • Retro Claim Adjudication
  • Avatar MSO 'Enable Fee Override in PM' Registry Setting
    The Avatar MSO 'Enable Fee Override in PM' Registry Setting is updated to support an additional setting that will allow user-defined Type Of Override entries based on the date of service.
    The 'Enable Fee Override in PM' Registry Setting is updated to support an additional/new value of '4'; this will allow definition of Fee Override Type by date ranges/service dates, via an additional 'MSO to Parent System Integration Mapping' form 'Enable Fee Override In PM' sub-section.
Included Updates
None
Product Update Form Description
The 'Enable Fee Override in PM' Registry Setting is updated to support an additional setting that will let users define the type of override based on the date of service.
Topics
• Close Batch • MSO To Parent System Integration Mapping • NX • Registry Settings
  • Contracting Provider Registration
    The functionality for 'Contracting Provider Registration' has been updated to allow the successful deletion of an existing record.
Included Updates
2
Product Update Form Description
An issue is resolved where an user cannot delete a row in the 'Contracting Provider Registration' form.
Topics
• Contracting Provider Registration • NX
  • Avatar MSO 'Additional Checking' Registry Settings
    The Avatar MSO 'Additional Checking' Registry Settings are updated to support Date of Birth validation for only month and year values.
    The 'Additional Checking' Registry Settings (837 Institutional and 837 Professional) are updated to support a new value of '3'; this will allow validation for only the month and year when comparing subscriber DOB to client demographic DOB contained in the inbound 837I/P file (2010BA-DMG-DMG02) during 837 Institutional and Professional compile/process.
Included Updates
2, 11
Product Update Form Description
Avatar MSO Registry Settings 'Additional Checking' (837 Institutional/837 Professional) are updated to support a new value of '3'. This will allow validation for only the month and year when comparing subscriber DOB to client demographic DOB contained in the inbound 837I/P file during 837 Institutional and Professional compile/process.
Topics
• Registry Settings • 837 Health Care Claim Professional • NX • 837 Health Care Claim Institutional
  • 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 add/or interactive complexity services.
  • MSO Approve/Pend/Deny Rule - Claim Processing Forms
    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.
Included Updates
2, 11, 12
Product Update Form Description
Updated the 837 Healthcare Claim Professional Compile and Post logic to skip the Number of Services Allowed Per Claim APD rule for CPT codes that are defined as Add-On or Interactive Complexity.
Topics
• 837 Health Care Claim Professional • Claims Processing • NX
  • MSO - CPT Code Definition - Limit License Type(s) Allowed
    The ''limit_lic_type_code' field' field in the 'SYSTEM.table_cpt_service_codes' has been increased to a length of 500 characters.
Included Updates
None
Product Update Form Description
The property 'limit_lic_type_code' in the 'SYSTEM.table_cpt_service_codes' table has had its maximum length increased to 500.
Topics
• CPT Code Definition • NX
 

Avatar_MSO_2023_Quarterly_Release_2023.02_Details.csv