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Avatar MSO 2023 Update 19

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Product Update Form 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.

Included Updates

4

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
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.
Value Added: Updates 'Enable Fee Override in PM' Registry Setting for services with Other Healthcare Coverage information
Topics
• Claims Processing • MSO To Parent System Integration Mapping • NX • Registry Settings
 
Acceptance Tests
AV-88207 Summary | Details
Avatar MSO 'Enable Fee Override in PM' Registry Setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Ledger
  • Close Batch
  • MSO to Parent System Integration Mapping
  • Registry Settings (PM)
Scenario 1: 'Close Batch' - Avatar MSO to Cal-PM Parent System Service Filing, Verification of Service Filing With Fee Override Enabled for Services with Other Healthcare Coverage Information
Specific Setup:
  • Avatar Cal-PM Parent System is required for Acceptance Testing with Registry Setting 'Support MSO Other Healthcare Coverage' enabled
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • Avatar MSO Registry Setting 'Enable Fee Override in PM' must be enabled (set to '1','2', '3' or '4')
  • If Avatar MSO Registry Setting 'Enable Fee Override in PM' is set to '4', 'Fee Override in PM' date/override type entry for service date(s) must be defined (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section, 'Enable Fee Override in PM' sub-section)
  • 'File Services On Closing Of Batch Or Creation of EOB?' must be set to 'Yes' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section)
  • CPT Code/Revenue Code must be selected/included for Fee Override in filing to parent system (via Avatar 'Provider Fee Definition' form)
  • One or more 'Approved' status services eligible for filing to parent Avatar Cal-PM system and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
Steps
  1. Open Avatar MSO 'Close Batch' form.
  2. Note - Acceptance Testing may also be confirmed on service filing to parent Avatar PM system via Avatar MSO 'Create EOB' or 'Other EOB Information' entry/filing where 'Inhibit Service Filing' restrictions are defined via 'MSO to Parent System Integration Mapping' form 'Service Filing' section
  3. Select Avatar MSO Claims Processing batch containing one or more 'Approved' status services eligible for filing to parent Avatar Cal-PM system.
  4. Set 'Close Batch' field to 'Yes' (and click 'OK' button to close warning message dialog).
  5. Click 'Submit' button to close batch/file services to parent Avatar PM system.
  6. Open 'Client Ledger' form in parent Avatar Cal-PM system.
  7. Select 'Client ID' value for client where services are present in Avatar MSO closed status Claims Processing batch.
  8. Select 'Claim/Episode/All Episodes' value.
  9. Select 'Ledger Type' value.
  10. Click 'Process' button.
  11. In Client Ledger data, ensure that 'Approved' status services originating in Avatar MSO are present in Avatar Cal-PM system following 'Close Batch' filing (where services are valid for filing to parent system).
  12. For services originating via Avatar MSO and filed to Avatar Cal-PM parent system (where Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' and Avatar MSO Registry Setting 'Enable Fee Override in PM' are enabled):
  13. Services including Third Party Payment/Adjustment 'Other Healthcare Coverage' information - Ensure that Avatar Cal-PM Client Ledger 'Charge' value for service(s) reflects the 'Allowed Amount' value from Avatar MSO Other Healthcare Coverage information for service(s)
  14. Note - Avatar Cal-PM 'Cost of Service'/'Guarantor Liability' value for service(s) originating in Avatar MSO with Other Healthcare Coverage information will reflect Client Ledger Charge/Allowed Amount value not including Other Healthcare Coverage' Third Party Payment amounts for service filed to Avatar Cal-PM
  15. Services not including Third Party Payment/Adjustment 'Other Healthcare Coverage' information - Ensure that Avatar Cal-PM 'Charge'/'Cost Of Service' (as well as 'Guarantor Liability') value for service(s) in Avatar Cal-PM reflects the selected/applicable Avatar MSO Fee Override Type (Expected Disbursement/Fee Table Amount/Total Charge), or PM Service Fee Table Amount where override not selected
Topics
• Claims Processing • MSO To Parent System Integration Mapping • NX • Registry Settings

 

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