Avatar MSO 2023 Update 12

1. Open 'Registry Settings' form.
2. Enter search value 'Additional Checking' and click 'View Registry Settings' button.
3. Ensure Registry Setting 'Additional Checking' is returned (under 'Avatar MSO-> Claims Processing -> HIPAA Health Care Claims -> 837 Professional -> Inbound' path).
4. Ensure 'Registry Setting Details' field contains the following explanation text:

Selecting '1' will verify social security numbers, when processing an 837 Professional file. If the social security number contained in

(2010BA-REF-REF02) does not match the member's social security number in Avatar.

Selecting '2' will verify date of birth, when processing an 837 Professional file. If the date of birth contained in (2010BA-DMG DMG02) does not match the member's date of birth in Avatar.

Selecting '3' will verify only the Month and Year of the subscriber DOB contained in the inbound 837 Professional file matches the Month and Year of the client demographic DOB. If the date of birth contained in (2010BA-DMG-DMG02) does not match the member's date of birth in Avatar.

Selecting '0' will preserve the current verification process, no additional checks, when processing an 837 Professional file.

If multiple checks are desired, add each checks corresponding number separated by a comma.

Example - If the social security number and date of birth checks are desired, the proper format would be "1,2".

1. Open 'Registry Settings' form.
2. Enter search value 'Additional Checking' and click 'View Registry Settings' button.
3. Ensure Registry Setting 'Additional Checking' is returned (under 'Avatar MSO-> Claims Processing -> HIPAA Health Care Claims -> 837 Institutional -> Inbound' path).
4. Ensure 'Registry Setting Details' field contains the following explanation text:

Selecting '1' will verify social security numbers, when processing an 837 Institutional file. If the social security number contained in (2010BA-REF-REF02) does not match the member's social security number in Avatar.

Selecting '2' will verify date of birth, when processing an 837 Institutional file. If the date of birth contained in (2010BA-DMG-DMG02) does not match the member's date of birth in Avatar.

Selecting '3' will verify only the Month and Year of the subscriber DOB contained in the inbound 837 Institutional file matches the Month and Year of the client demographic DOB. If the date of birth contained in (2010BA-DMG-DMG02) does not match the member's date of birth in Avatar.

Selecting '0' will preserve the current verification process, no additional checks, when processing an 837 Institutional file.

If multiple checks are desired, add each checks corresponding number separated by a comma.

Example - If the social security number and date of birth checks are desired, the proper format would be "1,2".

• Avatar MSO Registry Setting 'Additional Checking' (837 Professional) must be enabled (Set to '1', '2', '3', '1,2' or '1,3')
• 837 Health Care Claim Professional file with one or more valid claims

1. Open Avatar MSO '837 Health Care Claim Professional' 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 Professional format file and click 'Process' button.
5. Select 'Compile File' in the 'Options' field, and select loaded 837 Professional file.
6. Click 'Process' button.
7. In 837 Professional Compile Report - ensure 'Additional Checking' Registry Setting for SSN/DOB value matching is enforced as follows:
8. Where 'Additional Checking' Registry Setting includes value '1' - If social security number in 837 Professional inbound file data (2010BA-REF02) does not match the social security number value in corresponding client/member Avatar demographic record information, ensure that claims/services for member are not successfully compiled (and error returned in Avatar MSO 837 Professional Error Report as in Step 9 below)
9. If social security number in 837 Professional inbound file data (2010BA-REF02) matches the social security number value in corresponding client/member Avatar demographic record information, ensure that claims/services for member are successfully compiled (subject to all other claim/service compilation requirements)
10. Where 'Additional Checking' Registry Setting includes value '2' - If date of birth in 837 Professional inbound file data (2010BA-DMG02) does not match the date of birth value in corresponding client/member Avatar demographic record information for complete/exact year, month and day value, ensure that claims/services for member are not successfully compiled (and error returned in Avatar MSO 837 Professional Error Report as in Step 9 below)
11. If date of birth in 837 Professional inbound file data (2010BA-DMG02) matches the date of birth value in corresponding client/member Avatar demographic record information for complete/exact year, month and day value, ensure that claims/services for member are successfully compiled (subject to all other claim/service compilation requirements)
12. Where 'Additional Checking' Registry Setting includes value '3' - If date of birth in 837 Professional inbound file data (2010BA-DMG02) does not match the date of birth value in corresponding client/member Avatar demographic record information for year and month values, ensure that claims/services for member are not successfully compiled (and error returned in Avatar MSO 837 Professional Error Report as in Step 9 below)
13. If date of birth in 837 Professional inbound file data (2010BA-DMG02) matches the date of birth value in corresponding client/member Avatar demographic record information for year and month values but not for day value, ensure that claims/services for member are successfully compiled (subject to all other claim/service compilation requirements)
14. Select 'Run Error Report' in the 'Options' field, and select compiled 837 Professional file.
15. Click 'Process' button.
16. In 837 Professional Error Report - ensure that 837 Professional client/member information with SSN/DOB values failing the 'Additional Checking' Registry Setting as noted above is included in 837 Professional Error Report as follows:
17. Where 'Additional Checking' Registry Setting SSN check is failed, ensure Error Message 'The social security number contained in the file does not match the social security number on file for member id' is included in report
18. Error Message Example: 'The social security number contained in the file: 111221111 does not match the social security number on file for member id: 999'
19. Where 'Additional Checking' Registry Setting exact/full DOB check is failed, ensure Error Message 'The date of birth contained in the file does not match the date of birth on file for member id' is included in report
20. Error Message Example: 'The date of birth contained in the file: 01/01/88 does not match the date of birth: 02/20/86 on file for member id: 999'
21. Where 'Additional Checking' Registry Setting partial year/month DOB check is failed, ensure Error Message 'The date of birth contained in the file does not match the date of birth on file for member id' is included in report
22. Error Message Example: 'The date of birth contained in the file: 01/88 does not match the date of birth: 11/86 on file for member id: 999'
23. Select 'Post File' in the 'Options' field.
24. Select compiled 837 Professional format file and click 'Process' button.
25. In 837 Professional Post Report and resulting Avatar MSO claim/service data - ensure 'Additional Checking' Registry Setting for SSN/DOB value matching is enforced as detailed above, and that 837 Professional client/member information failing Registry Setting check as noted above is not posted in Avatar MSO (claims/services not created in system).

• Avatar MSO Registry Setting 'Additional Checking' (837 Institutional) must be enabled (Set to '1', '2', '3', '1,2' or '1,3')
• 837 Health Care Claim Institutional file with one or more valid claims

1. Open Avatar MSO '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 - ensure 'Additional Checking' Registry Setting for SSN/DOB value matching is enforced as follows:
8. Where 'Additional Checking' Registry Setting includes value '1' - If social security number in 837 Institutional inbound file data (2010BA-REF02) does not match the social security number value in corresponding client/member Avatar demographic record information, ensure that claims/services for member are not successfully compiled (and error returned in Avatar MSO 837 Institutional Error Report as in Step 9 below)
9. If social security number in 837 Institutional inbound file data (2010BA-REF02) matches the social security number value in corresponding client/member Avatar demographic record information, ensure that claims/services for member are successfully compiled (subject to all other claim/service compilation requirements)
10. Where 'Additional Checking' Registry Setting includes value '2' - If date of birth in 837 Institutional inbound file data (2010BA-DMG02) does not match the date of birth value in corresponding client/member Avatar demographic record information for complete/exact year, month and day value, ensure that claims/services for member are not successfully compiled (and error returned in Avatar MSO 837 Institutional Error Report as in Step 9 below)
11. If date of birth in 837 Institutional inbound file data (2010BA-DMG02) matches the date of birth value in corresponding client/member Avatar demographic record information for complete/exact year, month and day value, ensure that claims/services for member are successfully compiled (subject to all other claim/service compilation requirements)
12. Where 'Additional Checking' Registry Setting includes value '3' - If date of birth in 837 Institutional inbound file data (2010BA-DMG02) does not match the date of birth value in corresponding client/member Avatar demographic record information for year and month values, ensure that claims/services for member are not successfully compiled (and error returned in Avatar MSO 837 Institutional Error Report as in Step 9 below)
13. If date of birth in 837 Institutional inbound file data (2010BA-DMG02) matches the date of birth value in corresponding client/member Avatar demographic record information for year and month values but not for day value, ensure that claims/services for member are successfully compiled (subject to all other claim/service compilation requirements)
14. Select 'Run Error Report' in the 'Options' field, and select compiled 837 Institutional file.
15. Click 'Process' button.
16. In 837 Institutional Error Report - ensure that 837 Institutional client/member information with SSN/DOB values failing the 'Additional Checking' Registry Setting as noted above is included in 837 Institutional Error Report as follows:
17. Where 'Additional Checking' Registry Setting SSN check is failed, ensure Error Message 'The social security number contained in the file does not match the social security number on file for member id' is included in report
18. Error Message Example: 'The social security number contained in the file: 111221111 does not match the social security number on file for member id: 999'
19. Where 'Additional Checking' Registry Setting exact/full DOB check is failed, ensure Error Message 'The date of birth contained in the file does not match the date of birth on file for member id' is included in report
20. Error Message Example: 'The date of birth contained in the file: 01/01/88 does not match the date of birth: 02/20/86 on file for member id: 999'
21. Where 'Additional Checking' Registry Setting partial year/month DOB check is failed, ensure Error Message 'The date of birth contained in the file does not match the date of birth on file for member id' is included in report
22. Error Message Example: 'The date of birth contained in the file: 01/88 does not match the date of birth: 11/86 on file for member id: 999'
23. Select 'Post File' in the 'Options' field.
24. Select compiled 837 Institutional format file and click 'Process' button.
25. In 837 Institutional Post Report and resulting Avatar MSO claim/service data - ensure 'Additional Checking' Registry Setting for SSN/DOB value matching is enforced as detailed above, and that 837 Institutional client/member information failing Registry Setting check as noted above is not posted in Avatar MSO (claims/services not created in system).