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Avatar MSO 2023 Update 20

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Product Requirements and Recommendations

Avatar MSO required
RADplus required

Recommended Update Level

Avatar MSO 2023 Monthly Release 2023.02.01
RADplus 2023 Monthly Release 2023.02.01

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.

Required Updates

Avatar MSO 2023 Update 3
Avatar MSO 2023 Update 11

Included Updates

2, 3, 11, 12, 13

Details
NEW0 CHANGED0 FIXED2
Fixed (2)
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. KB0073339 v0.01
Topics
• Contracting Provider Registration • NX
 
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'. KB0073957 v0.01
Topics
• Claims Processing • NX
 
Acceptance Tests
AV-85915 Summary | Details
Contracting Provider Registration - Edit a performing provider.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Contracting Provider Registration
  • Performing Provider Registration
Scenario 1: Contracting Provider Registration - Editing an existing contracting provider to add new performing provider information with 2 registrations record and one license record
Specific Setup:
  • Performing Provider Registration:
  • Identify an existing performing provider registration or create a new performing provider registration to have 2 registration records with at least 1 license record.
  • For the first registration - Enter registration start/end date. Do not enter any license information.
  • For the second registration - Enter registration start/end date. Enter license information.
  • Note the performing provider name, number, registration dates for both the registration record and license information.
  • Contracting Provider Registration:
  • Identify an existing contracting provider registration. Note the contracting provider name and number.
Steps
  1. Open the 'Contracting Provider Registration' form.
  2. Select desired contracting provider.
  3. Edit the existing registration.
  4. Go to the 'Performing Provider information' section.
  5. Add the new performing provider that is identified in the setup section.
  6. Make sure the performing provider registration shows the 1st registration. If not, select the first registration.
  7. Go to the 'Performing Provider License Information' section.
  8. Verify that no rows are loaded as the first registration does not have license information created.
  9. Add the new performing provider again that is identified in the setup section.
  10. Select the second registration.
  11. Go to the 'Performing Provider License Information' section.
  12. Verify the performing provider license information loaded correctly for the second registration.
  13. Submit the form.
  14. Open the 'Contracting Provider Registration' form again.
  15. Select desired contracting provider.
  16. Edit the existing registration.
  17. Go to the 'Performing Provider information' section.
  18. Edit the second registration for the performing provider records again.
  19. Verify the 'Performing Provider License Information' section displays correct information for the second registration,
  20. Verify the record updated successfully.
Topics
• Contracting Provider Registration • NX
AV-89785 Summary | Details
Claim Processing (CMS 1500) - Registry setting 'Require Performing Provider'=Y.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Authorization Selection - No Authorizations On File Error
  • Batch Creation
  • Batch Creation - Assign ID
  • Claim Processing (CMS 1500)
  • Claim Processing with Override (CMS 1500)
  • Service Authorization
Scenario 1: Claim Processing (CMS 1500) - Validating approved service when the total charge is modified and performing provider is required.
Specific Setup:
  • Registry 'Avatar MSO->Claims Processing->Service Detail->->->Require Performing Provider' is set to Y.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor’s code/name.
  • Admission:
  • An existing client is identified, or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
  • Diagnosis:
  • A diagnosis record is created for the client.
  • CPT Code Definition:
  • An existing CPT code is identified, or a new CPT code is created. Note the CPT code/description.
  • Funding Source Registration:
  • An existing funding source is identified, or a new funding source is created. Note the funding source name.
  • Plan Definition:
  • A plan definition is created, or an existing plan is identified.
  • Performing Provider Registration:
  • Identify an existing performing provider registration or create a new performing provider registration to have at least one registration records with at least 1 license record. Note the performing provider number and name.
  • Contracting Provider Registration:
  • A new contracting provider is created, or an existing contracting provider is updated to include the performing provider added above. Note the contracting provider number and name.
  • Provider Fee Definition:
  • A fee definition is created. Note the fee definition.
  • MSO to Parent System Integration Mapping:
  • Create mapping for Provider, staff, program, CPT codes and Revenue Codes.
  • Member Specific Information:
  • Create a member specific record.
  • Service Authorization:
  • Create a new approved service authorization covering a CPT code created above.
  • Create a new batch. Note the batch number/name.
Steps
  1. Open the 'Claim Processing CMS 1500' form.
  2. File an approved service with a performing provider selected.
  3. Go back in the form to edit the approved service.
  4. Change the 'Total Charge'.
  5. Verify the service stays approved.
Topics
• Claims Processing • NX