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.
Value Added: Adds 'Require Exact Authorization Number (Institutional)' control field to 'Contracting Provider Registration' form and 837 Institutional file processing
Avatar MSO Claim Processing Batch Naming Convention
The 'Set Batch File Naming Convention' Registry Setting is added to Avatar MSO.
Value Added: Adds 'Set Batch File Naming Convention' Registry Setting to Avatar MSO
Avatar MSO 'Provider EOB Report'
The 'Provider EOB Report' form/report is added.
Value Added: Adds 'Provider EOB Report' form/report to Avatar MSO
Avatar MSO 'Service Authorization Request' Form
The 'Service Authorization Request' form is updated to default additional field values when an Authorization Grouping is selected.
Value Added: Adds 'Requested Units' and 'Units Authorized' defaulting in 'Service Authorization Request' form
Avatar MSO 837 Health Care Claim Forms
The 837 Health Care Claim forms are updated to filter loaded files by Contracting Provider.
Value Added: Filters/restricts files available in 837 Health Care Claim forms by Contracting Provider
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.
Value Added: Updates 'Does This Service Represent An Admission' field to be non-required in Claim Processing forms
Avatar ProviderConnect NX Additional Support
Avatar MSO is updated for additional support of Avatar ProviderConnect NX.
Value Added: Updates Avatar MSO forms for Avatar ProviderConnect NX support.
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Topics
• Contracting Provider Registration
• NX
• 837 Health Care Claim Institutional
• Registry Settings
• Claims Processing
• 837 Health Care Claim Professional
• Reports
• Service Authorizations
• 837 Professional
• 837 Institutional
• Retro Claim Adjudication
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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.
Value Added: Updates Avatar MSO 'Enable Fee Override in PM' Registry Setting to support user defined Type Of Override based on service date
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Topics
• Close Batch
• MSO To Parent System Integration Mapping
• NX
• Registry Settings
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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.
Value Added: Adds 'Enable Authorize and Adjudicate on Per Stay Basis' Registry Setting and functions to Avatar MSO
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Topics
• Registry Settings
• NX
• Service Authorizations
• 837 Health Care Claim Professional
• Claims Processing
• 837 Health Care Claim Institutional
• File Import
• Retro Claim Adjudication
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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.
Value Added: Updates Avatar MSO 'Additional Checking' Registry Settings to support Date of Birth validation for only month and year
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Topics
• Registry Settings
• 837 Health Care Claim Professional
• NX
• 837 Health Care Claim Institutional
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MSO Approve/Pend/Deny Rule – 837 Health Care Claim Professional
The A/P/D rule has been updated to count the service as one service when a primary service has add-on add/or interactive complexity services.
Value Added: Enables agencies to submit the add-on and add/or interactive complexity services in the same claims as the primary service.
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.
Value Added: Enables agencies to submit the add-on and add/or interactive complexity services in the same claims as the primary service.
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Topics
• 837 Health Care Claim Professional
• Claims Processing
• NX
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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.
Value Added: Allows reporting of additional values from the ‘Limit License Type(s) Allowed’ field in the ‘CPT Code Definition’ form.
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Topics
• CPT Code Definition
• NX
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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.
Value Added: Updates Avatar MSO 837 Professional/837 Institutional Health Care Claim Processing 'Funding Source' determination
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Topics
• Registry Settings
• 837 Health Care Claim Professional
• NX
• 837 Health Care Claim Institutional
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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.
Value Added: Updates 'Enable Fee Override in PM' Registry Setting for services with Other Healthcare Coverage information
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Topics
• Registry Settings
• MSO To Parent System Integration Mapping
• Claims Processing
• NX
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Avatar MSO 'Plan Definition' form
The 'Plan Coverage Level Name' field is added to the 'Plan Definition' form.
Value Added: Adds 'Plan Coverage Level Name' field to 'Plan Definition' form
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Topics
• Plan Definition
• NX
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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 .
Value Added: Increased flexibility in the Service Authorization form.
Service Authorization
The ability to display the 'Benefit Plan' has been added to the Service Authorization pre-display.
Value Added: More information available in the pre-display.
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Topics
• Service Authorizations
• NX
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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.
Value Added: Adds support for linking Primary Service to Add-On/Interactive Complexity services when filing to Avatar PM/Cal-PM
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Topics
• MSO To Parent System Integration Mapping
• CPT Code Definition
• 837 Professional
• Claims Processing
• NX
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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.
Value Added: Adds the ability to send services to PM based on the date of service.
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Topics
• MSO To Parent System Integration Mapping
• NX
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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.
Value Added: Adds 'Set Up Co-Pay Based On Avatar PM 834' Registry Setting/Form/Claim Processing 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.
Value Added: Adds 'Enable APD Rule for Missing TPL/COB/OHC' Registry Setting And Claim Processing 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.
Value Added: Enhances 'Allow Provider Fee Definition By Age' Registry Setting to support additional 'Age At Admission' control field
Avatar MSO 'Claim Processing Blackout' Form and Functionality
The 'Enable Additional Fields' (Claim Processing Blackout) Registry Setting is added to Avatar MSO.
Value Added: Adds new criteria fields and ordering options to Avatar MSO Claim Processing Blackout form and functionality
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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
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Avatar MSO 'CPT Code Definition' and 'Revenue Code Definition' Coverage Period Support
The Avatar MSO 'CPT Code Definition' and 'Revenue Code Definition' Forms are updated to support the 'Enable Coverage Effective Period' Registry Setting.
Value Added: Adds support for 'Enable Coverage Effective Period' Registry Setting in 'CPT Code Definition' and 'Revenue Code Definition' forms
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.
Value Added: Adds support for 'Enable Coverage Effective Period' Registry Setting in CPT Code Definition/Revenue Code Definition Import
'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.
Value Added: Adds support for 'Enable Coverage Effective Period' Registry Setting in 'MSO To Parent System Integration Mapping' form
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.
Value Added: Adds support for 'Enable Coverage Effective Period' Registry Setting in Avatar MSO To Parent System Integration Mapping Import
Avatar MSO Claim Processing Coverage Period Support
Avatar MSO Claim Processing/Service Adjudication is updated to support the 'Enable Coverage Effective Period' Registry Setting.
Value Added: Adds support for 'Enable Coverage Effective Period' Registry Setting in Avatar MSO Claim Processing/Service Adjudication
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.
Value Added: Adds support for 'Enable Coverage Effective Period' Registry Setting in Avatar MSO to Parent System Service Filing
Avatar MSO 'Enable Coverage Effective Period' Registry Setting
The 'Enable Coverage Effective Period' Registry Setting is added to Avatar MSO.
Value Added: Adds 'Enable Coverage Effective Period' Registry Setting to Avatar MSO
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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
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Service Authorization
Performance improvements in Service Authorization and Service Authorization Request forms.
Value Added: Service Authorization and Service Authorization Request forms are updated to improve performance upon loading
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Topics
• Service Authorizations
• NX
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File Import - [Avatar MSO] Service Authorization - Member
The Comments On Authorization' and 'Internal Comments' fields have been modified to allow 5000 characters.
Value Added: Allows users to import more data in the two comments fields.
File Import - MSO - Budget Tracking Account Level
The 'Comments' field has been modified to allow a maximum of 5000 characters.
Value Added: Allows users to add more data to the Budget Tracking Account Level Comments field.
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Topics
• File Import
• Budget Tracking
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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.
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Topics
• Widgets
• Service Authorizations
• NX
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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.
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Topics
• Claims Processing
• NX
• Performing Provider
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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.
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Topics
• 837 Health Care Claim Professional
• Claims Processing
• 837 Health Care Claim Institutional
• Create Voucher
• NX
• 835 Health Care Claim Payment/Advice
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Provider Fee Definition Upload Process
An issue has been resolved to ensure that the 'Provider Fee Definition Upload Process' loads successfully.
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Topics
• Provider Fee Definition
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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.
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Topics
• Registry Settings
• Retro Claim Adjudication
• NX
• myAvatar/myAvatar NX
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Contracting Provider Registration
The functionality for 'Contracting Provider Registration' has been updated to allow the successful deletion of an existing record.
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Topics
• Contracting Provider Registration
• NX
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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.
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Topics
• Claims Processing
• NX
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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'.
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Topics
• Contracting Provider Registration
• NX
• Claims Processing
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MSO Case Default
An issue has been corrected for a misspelled word in the 'Maximum field warning' dialog
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Topics
• Forms
• NX
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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.
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Topics
• Service Authorizations
• NX
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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.
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Topics
• Claims Processing
• NX
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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.
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Topics
• 837 Health Care Claim Institutional
• Claim Acknowledgement (277CA)
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Automated Processing - 837 Professional
Functionality for Automated Processing has been modified to ensure that processing completes before the validation process begins.
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Topics
• Claims Processing
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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.
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Topics
• Claims Processing
• NX
• Claims Adjudication Rule Definition
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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.
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Topics
• Service Authorizations
• NX
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Registry Setting - Beginning Of Fiscal Year For A Batch
Functionality has been updated to create separate batches for different fiscal years.
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Topics
• 837 Health Care Claim Professional
• Claims Processing
• 837 Health Care Claim Institutional
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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).
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Topics
• 837 Health Care Claim Professional
• Close Batch
• MSO To Parent System Integration Mapping
• 837 Health Care Claim Institutional
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MSO Approve/Pend/Deny Rule – 837 Health Care Claim Professional
The A/P/D rule has been updated to count the service as one service when a primary service has add-on or interactive complexity services.
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.
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Topics
• 837 Health Care Claim Professional
• Claims Processing
• NX
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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.
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Topics
• Retro Claim Adjudication
• Claims Processing
• Data Import
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CPT Code Definition - Import Codes
Resolves an issue to ensure that the 'CPT Code Definition' form rejects the invalid 'Interactive Complexity CPT Code' with correct validation error.
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.
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Topics
• CPT Code Definition
• Claims Processing
• Database Management
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