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Avatar MSO 2023 Quarterly Release 2023.04 Details

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Product Requirements and Recommendations

Avatar MSO required
RADplus required

  • Avatar MSO 2023 is Installed
    Installation will upgrade to the 2023 version. This will not change any current functionality.
Included Updates
None
Product Update Description
Avatar MSO 2022 is updated to Avatar MSO 2023
Topics
• Upgrade
  • 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 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 'Claims Adjudication Rules Definition' Form
    An issue is resolved in the 'Claims Adjudication Rules Definition' form to ensure that Limit Rules using Procedure Code/Revenue Code/Procedure Code Group values including dashes (-) are correctly filed.
  • Avatar MSO 'Performing Provider Registration' form
    The 'Performing Provider Registration' form is updated to not allow registration date to be modified to a later date if the Performing Provider is associated to a Contracting Provider.
  • Avatar MSO 'Claims Adjudication Rules Definition' Form
    An issue is resolved in the 'Claims Adjudication Rules Definition' form to ensure that Limit Rules including Diagnosis Code value may be removed via the 'Remove Selected Rule' button/action.
Included Updates
None
Product Update Description
The following modifications are made: 1) Resolves issues in the 'Claims Adjudication Rules Definition' form where the form fails to file limit rules for procedure/revenue codes with dashes, and also fails to return when attempting to remove a limit rule with a diagnosis code. 2) The 'Performing Provider Registration' form is modified to not allow registration date to be modified to a later date if the performing provider is associated to a contracting provider.
Topics
• Claims Processing • NX • Performing Provider
  • 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 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
  • Avatar MSO Automated Claim Processing and Service Adjudication
    An issue is resolved to ensure that services are correctly adjudicated (Approved/Denied) when 837 files are posted via Avatar MSO Import/Export File Configuration and Claim Processing Automation functionality.
  • Avatar MSO 'Create Voucher' Form/Function
    An issue is resolved to ensure that the 'Create Voucher' form does not allow multiple voucher creation processes to run at same time for same claims/services.
  • Avatar MSO '835 Healthcare Claim Payment/Advice' Information
    An issue is resolved to ensure that 835 files produced via the Avatar MSO '835 Health Care Claim Payment/Advice' form include CAS-2110 Claim Adjustment Reason Code/Remark Code values for services denied with 'Missing valid primary CPT Code' adjudication reason.
Included Updates
None
Product Update Description
The following issues are resolved: 1) Services are incorrectly approved when automated 837 files are posted. 2) 'Create Voucher' form is allowing multiple voucher processes to run at same time. 3) The 835 file produced via the '835 Health Care Claim Payment/Advice' form is not producing the CAS-2110 segment for services denied with 'Missing valid primary CPT Code'.
Topics
• 837 Health Care Claim Professional • Claims Processing • 837 Health Care Claim Institutional • Create Voucher • NX • 835 Health Care Claim Payment/Advice
  • Provider Fee Definition Upload Process
    An issue has been resolved to ensure that the 'Provider Fee Definition Upload Process' loads successfully.
Included Updates
None
Product Update Description
An issue is resolve where "[UNDEFINED]ClassStorageUp+53^MSOFEE" error is produced when importing files via Provider Fee Definition form.
Topics
• Provider Fee Definition
  • Avatar MSO 'Enable Authorize and Adjudicate on Per Stay Basis' Registry Setting
    The 'Enable Authorize and Adjudicate on Per Stay Basis' Registry Setting is added to Avatar MSO.
    The Avatar MSO 'Enable Authorize and Adjudicate on Per Stay Basis' Registry Setting adds the 'Authorize and Adjudicate on Per Stay Basis' field to the 'Service Authorization' form. This allows for claims/services to be adjudicated on a per-stay basis - the first service associated to Service Authorization will be approved at the per-stay rate and all other services associated to same Service Authorization will be approved for zero dollars.
Included Updates
None
Product Update Description
The 'Enable Authorize and Adjudicate on Per Stay Basis' registry setting is added.
Topics
• Registry Settings • NX • Service Authorizations • 837 Health Care Claim Professional • Claims Processing • 837 Health Care Claim Institutional • File Import • Retro Claim Adjudication
  • Avatar MSO 'Create EOB' Form/Function
    An issue is resolved to ensure that Retro Claim Adjudication entries are placed in an EOB for the corresponding fiscal year when Avatar MSO Registry Settings 'Include In EOB Retros For Replaced Services Not On EOB' and 'Create EOB By Fiscal Year' Registry Settings are enabled.
Included Updates
None
Product Update Description
The issue is resolved where when 'Include In EOB Retros For Replaced Services Not On EOB' and 'Create EOB By Fiscal Year' registries are enabled, retros are placed in an EOB for the incorrect fiscal year.
Topics
• Registry Settings • Retro Claim Adjudication • NX • myAvatar/myAvatar NX
  • 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 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 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 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
  • Plan Definition - Annual dollar limit
    Resolves an issue to ensure that the services do not approve over the annual dollar limit filed for the plan.
  • Claim Processing (CMS 1500) - Third Party Adjudication Data section
    Resolves an issue to ensure that the subsequent third party adjudication data grid in the 'Claim Processing (CMS 1500)' form saves information correctly when there is an existing entry and more entries are added to the grid through 'Edit' option.
  • Import/Export File Configuration - Process MSO 837P files
    Resolves an issue to ensure that 837 Professional files in cloud are processing correctly.
Included Updates
None
Product Update Description
The following issues are resolved: 1) Services are being approved over the annual dollar limit filed in the 'Plan Definition' form. 2) COB Adjustment Data goes missing after adding a subsequent TPL grid entry in the claim processing forms. 3) Automated 837 processing fails to process multiple threads.
Topics
• 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 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 837 Professional/837 Institutional Health Care Claim Processing
    The '837 Health Care Claim Professional' and '837 Health Care Claim Institutional' are modified to determine 'Funding Source' based on Avatar PM eligibility tables.
    Avatar MSO '837 Health Care Claim Professional' and '837 Health Care Claim Institutional' compilation/posting are modified to determine 'Funding Source' for claims/services based on Avatar PM eligibility table information if Funding Source cannot be determined via MSO. This will only occur when Registry Settings 'Determine Funding Source By Policy Number' and 'Enable Eligibility Check' are enabled.
Included Updates
None
Product Update Description
The '837 Health Care Claim Professional' and '837 Health Care Claim Institutional' are modified to determine 'Funding Source' based on Avatar PM eligibility tables if Funding Source cannot be determined. This will only occur when the 'Determine Funding Source By Policy Number' and 'Enable Eligibility Check' registry settings are enabled.
Topics
• Registry Settings • 837 Health Care Claim Professional • NX • 837 Health Care Claim Institutional
  • Avatar MSO 'Enable Fee Override in PM' Registry Setting
    The Avatar MSO To Cal-PM Parent service push process is updated to support the 'Enable Fee Override in PM' Registry Setting for Other Healthcare Coverage information.
    The Avatar MSO To Cal-PM Parent service push process is updated to support the Avatar MSO 'Enable Fee Override in PM' Registry Setting for 837-originated services with Other Healthcare Coverage information. In addition, the service push process will no longer default the Avatar MSO expected disbursement value as cost of service for services without Other Healthcare Coverage information if the Avatar Cal-PM 'Support MSO Other Healthcare Coverage' Registry Setting is enabled.
Included Updates
4
Product Update Description
The Avatar MSO To Parent service push process is updated to support the 'Enable Fee Override in PM' registry setting for 837 originated services with Other Healthcare Coverage. In addition, the process will no longer default the expected disbursement if the 'Support MSO Other Healthcare Coverage' registry setting is enabled.
Topics
• Registry Settings • MSO To Parent System Integration Mapping • Claims Processing • NX
  • Contracting Provider Registration - Edit a performing provider.
    Resolves an issue to ensure that the performing provider information can be updated successfully within the 'Contracting Provider Registration' form for the performing providers that have multiple registrations with at least 1 license record on file.
  • Claim Processing (CMS 1500) - Registry setting 'Require Performing Provider'=Y.
    Resolves an issue to ensure that the claim processing (CMS 1500) process the claim successfully when the registry setting 'Require Performing Provider' is set to 'Y'.
Included Updates
2, 3, 11, 12, 13
Required Updates
Avatar MSO 2023 Update 3
Avatar MSO 2023 Update 11
Product Update Description
The following issues are resolved: 1) "Historic group is not a child of current screen." error produced when attempting to edit a performing provider within the 'Contracting Provider Registration' form. 2) The claim processing forms incorrectly denies a previously approved service with "Performing Provider is blank" when the total charge is modified and performing provider is required.
Topics
• Contracting Provider Registration • NX • Claims Processing
  • Avatar MSO 'Plan Definition' form
    The 'Plan Coverage Level Name' field is added to the 'Plan Definition' form.
    The 'Plan Coverage Level Name' field is added to the Avatar MSO 'Plan Definition' form ('Plan Coverage Definition' section). Avatar MSO SQL table 'SYSTEM.plan_covered_services' is updated accordingly.
Included Updates
None
Product Update Description
The 'Plan Coverage Level Name' field is added to 'Plan Definition' (Plan Coverage Definition).
Topics
• Plan Definition • NX
  • MSO Case Default
    An issue has been corrected for a misspelled word in the 'Maximum field warning' dialog
Included Updates
None
Product Update Description
An issue is resolved to correctly spell "Maximum" in the 'Maximum field warning' dialog that is received in the 'MSO Case Default' form, when a value is selected in the 'MSO Case Default Fields' field that contains more than 4 fields.
Topics
• Forms • NX
  • Avatar MSO 'Service Authorization Request' Form
    An issue is resolved to ensure that the 'Contracting Provider Program' field in the 'Service Authorization Request' form is populated with selection values if the 'Provider To Be Authorized' field/value is defaulted in form for Avatar ProviderConnect NX users.
Included Updates
None
Product Update Description
An issue is resolved where the 'Contracting Provider Program' field in the 'Service Authorization Request' form would not populate if the 'Provider To Be Authorized' field was defaulted for ProviderConnect NX users.
Topics
• Service Authorizations • NX
  • Service Authorization
    A registry setting it added, 'Require Current Authorization Status Reason'. the setting allows users to make the 'Current Authorization Status Reason' required or optional .
  • Service Authorization
    The ability to display the 'Benefit Plan' has been added to the Service Authorization pre-display.
Included Updates
25
Product Update Description
The following modifications are made: 1) A new registry setting 'Require Current Authorization Status Reason' is added to Avatar MSO. This registry setting will allow users to make the field 'Current Authorization Status Reason' required or optional in the 'Service Authorization Request' form. 2) The registry setting 'Set Service Authorization Pre-Display' is updated to account for the option to include the "Benefit Plan" field in the pre-display for Service Authorization forms.
Topics
• Service Authorizations • NX
  • Fast Service Entry
    An issue is resolved to ensure that claim status over-rides are being applied when services are re-adjudicated.
  • Claims Adjudication Rules Definition
    An issue has been resolved to ensure that definitions for procedure code groupings that contain CPT/Revenue codes with colon(s) are correctly adjudicated.
Included Updates
2, 11, 12, 13
Required Updates
Avatar MSO 2023 Update 2
Product Update Description
The following issues are resolved: 1) 'Fast Service Entry' claim status over-rides are not being recognized when services are re-adjudicated. 2) 'Claims Adjudication Rules Definition' are not correctly adjudicated for procedure code groupings that contain CPT/Revenue codes with colon(s).
Topics
• Claims Processing • NX
  • Avatar MSO to Avatar PM/Cal-PM Service Filing
    Avatar MSO is updated to add support for linking Add-On services with the associated Primary Service when transferring services to Avatar PM/Cal-PM.
    Avatar MSO is updated to add support for linking Add-On (and Interactive Complexity) services entered in MSO with the associated Primary Service when transferring services from Avatar MSO to Avatar PM/Cal-PM when batches are closed for original claims/services. This will allow Primary/Add-On/Interactive Complexity services from Avatar MSO original claims to be included in same Avatar PM/Cal-PM 837 Professional outbound claim regardless of the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' setting in Avatar PM/Cal-PM 'Guarantor/Program Billing Defaults' form.
Included Updates
4, 19
Product Update Description
Avatar MSO is updated to add support for linking Add-On services entered in MSO with the associated Primary Service when transferring services from MSO to PM/CAL-PM when batches are closed for original claims/services.
Topics
• MSO To Parent System Integration Mapping • CPT Code Definition • 837 Professional • Claims Processing • NX
  • Avatar MSO '837 Health Care Claim Institutional'
    An issue is resolved to ensure that when compiling an 837 Institutional file via the '837 Health Care Claim Institutional' form, claims without an admission segment (DTP*435) are not rejected with incorrect critical error "Invalid admission date for claim ()".
  • Avatar MSO 'Claim Acknowledgement (277CA) File'
    An issue is resolved to ensure that the 277CA file produced via the 'Claim Acknowledgement (277CA) File' form does not add 'rejected' status records in the 'SYSTEM.clm_status_resp' SQL table for zero dollar claims that are accepted by Avatar MSO.
Included Updates
2, 3, 11, 12, 13, 20, 27
Required Updates
Avatar MSO 2023 Update 12
Product Update Description
The following issues are resolved: 1) When compiling an 837 Institutional file via the '837 Health Care Claim Institutional' form, claims without an admission segment (DTP*435) are rejected with critical error "Invalid admission date for claim ()". 2) The 277 file produced via the 'Claim Acknowledgement (277CA) File' form is incorrectly adding a rejected record in the SYSTEM.clmstatusresp table for 0 dollar claims that are accepted.
Topics
• 837 Health Care Claim Institutional • Claim Acknowledgement (277CA)
  • Registry Setting - Send units to Avatar PM
    The registry setting is updated to include a new value of '1'. When '1' is selected the 'Service Filing' section of the 'MSO to Parent System Integration Mapping' form allow the user to configure a 'Send Units' definition by an effective date range.
    New fields added to 'service_unit_override' table.
Included Updates
4, 19, 28
Product Update Description
The registry setting 'Send units to Avatar PM' is updated to accept a new value '1'. This will update the 'Service Filing' tab in the 'MSO to Parent System Integration Mapping' form to now include the ability to configure a 'Send Units' definition by an effective date range.
Topics
• MSO To Parent System Integration Mapping • NX
  • Automated Processing - 837 Professional
    Functionality for Automated Processing has been modified to ensure that processing completes before the validation process begins.
Included Updates
None
Product Update Description
An issue is resolved where the automated MSO 837 validation process was incorrectly validating files while they were still being processed.
Topics
• Claims Processing
  • Avatar MSO 'Claims Adjudication Rule Definition'
    An issue is resolved to ensure that 'Limit' rules defined via the 'Claims Adjudication Rules Definition' form correctly identify when defined rule limits are exceeded for Avatar MSO Claim Processing/Service Adjudication.
Included Updates
2, 3, 11, 12, 13, 20, 27, 29
Required Updates
Avatar MSO 2023 Update 27
Product Update Description
The issue is resolved where 'Limit' rules defined via the 'Claim Adjudication Rules Definition' form fails to recognize when the limit is exceeded.
Topics
• Claims Processing • NX • Claims Adjudication Rule Definition
  • Avatar MSO 'Set Up Co-Pay Based On Avatar PM 834' Registry Setting
    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.
  • Avatar MSO 'Enable APD Rule for Missing TPL/COB/OHC' Registry Setting
    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.
  • Avatar MSO 'Allow Provider Fee Definition By Age' Registry Setting
    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).
  • Avatar MSO 'Claim Processing Blackout' Form and Functionality
    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.
  • Avatar MSO 'Service Authorization' Filing
    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.
Included Updates
2, 3, 4, 7, 8, 11, 12, 13, 17, 19, 20, 27, 28, 29, 30
Product Update Description
The 'Determine Inpatient Co-Pay Based on Avatar PM 834 Data', 'Enable APD Rule for Missing TPL/COB/OHC' and 'Enable Additional Fields' registry settings are added. The 'Allow Provider Fee Definition By Age' registry setting is updated to also add 'Age on Admission' to 'Provider Fee Definition'. The issue where claims may be denied when there is a valid authorization is resolved. Note: Avatar PM 2023 Update 58 is required for the functionality enabled by the 'Determine Inpatient Co-Pay Based on Avatar PM 834 Data' and 'Enable APD Rule for Missing TPL/COB/OHC' registry settings.
Topics
• Registry Settings • NX • Claims Processing • 837 Health Care Claim Institutional • Contracting Provider Registration • CPT Code Definition • Financial Eligibility • 837 Health Care Claim Professional • Provider Fee Definition • Claim Processing Blackout • Service Authorizations
  • Registry Setting - Beginning Of Fiscal Year For A Batch
    Functionality has been updated to create separate batches for different fiscal years.
Included Updates
2, 3, 4, 7, 8, 11, 12, 13, 17, 19, 20, 27, 28, 29, 30, 33, 34
Product Update Description
The issue is resolved where "Beginning Of Fiscal Year For A Batch" registry setting is not creating separate batches.
Topics
• 837 Health Care Claim Professional • Claims Processing • 837 Health Care Claim Institutional
  • 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
  • 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.
  • 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.
Topics
• 837 Health Care Claim Professional • Claims Processing • 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
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
Topics
• CPT Code Definition • Claims Processing • Database Management
 

Avatar_MSO_2023_Quarterly_Release_2023.04_Details.csv