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Avatar MSO 2023 Update 28

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Product Requirements and Recommendations

Avatar MSO required
RADplus required

Recommended Update Level

Avatar MSO 2023 Monthly Release 2023.02.00
RADplus 2023 Monthly Release 2023.02.00

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.

Required Updates

None

Included Updates

4, 19

Details
NEW1 CHANGED0 FIXED0
New (1)
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. KB0073879 v0.01
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.
Value Added: Adds support for linking Primary Service to Add-On/Interactive Complexity services when filing to Avatar PM/Cal-PM
Topics
• 837 Professional • Claims Processing • CPT Code Definition • MSO To Parent System Integration Mapping • NX
 
Acceptance Tests
AV-89715 Summary | Details
Avatar MSO to Avatar PM/Cal-PM Service Filing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Professional
  • Close Batch
  • CPT Code Definition (MSO)
  • Electronic Billing
  • Fast Service Entry
  • MSO to Parent System Integration Mapping
Scenario 1: 'Close Batch' - Avatar MSO to PM Parent System Service Filing, Verification of 837 Professional Bills For Primary/Add-On/Interactive Complexity CPT Codes
Specific Setup:
  • 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field must be defined for applicable Guarantor/Program Billing Template (via Avatar PM/Cal-PM 'Guarantor/Program Billing Defaults' form)
  • Avatar MSO CPT Codes defined with 'Primary Code' / 'Add-On Code' / 'Interactive Complexity' CPT Code Category (via Avatar MSO 'CPT Code Definition' form)
  • One or more Avatar MSO originating claims containing 'Approved' status Primary and Add-On/Interactive Complexity service(s) eligible for filing to Avatar Cal-PM on Batch Closing (for outbound 837 Professional file inclusion via Avatar PM/Cal-PM 'Electronic Billing' form)
  • Note - Claims/services originating in Avatar MSO for Acceptance Testing must be filed subsequent to installation of Avatar MSO 2023 Update 28
Steps
  1. In Avatar MSO, create one or more claims containing both 'Approved' status Primary and one or more Add-On/Interactive Complexity service(s) via inbound 837 Health Care Claim Professional posting/filing and/or manual entry (i.e. 'Fast Service Entry' form).
  2. Open Avatar MSO 'Close Batch' form.
  3. Note - Acceptance Testing may also be confirmed on service filing to parent Avatar PM/Cal-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
  4. Select Avatar MSO Claims Processing batch containing one or more 'Approved' status Primary and Add-On/Interactive Complexity service(s) in same/single claim eligible for filing to parent Avatar PM/Cal-PM system.
  5. Set 'Close Batch' field to 'Yes' (and click 'OK' button to close warning message dialog).
  6. Click 'Submit' button to close batch/file services to parent Avatar PM/Cal-PM system.
  7. Open 'Client Ledger' form in parent Avatar PM/Cal-PM system.
  8. Select 'Client ID' value for client where services are present in Avatar MSO closed status Claims Processing batch.
  9. Select 'Claim/Episode/All Episodes' value.
  10. Select 'Ledger Type' value.
  11. Click 'Process' button.
  12. In Client Ledger data, ensure that 'Approved' status services originating in Avatar MSO are present in Avatar PM/Cal-PM system following 'Close Batch' filing (where services are valid for filing to parent system).
  13. Close 'Client Ledger' form.
  14. Close charges for services in Avatar PM/Cal-PM via 'Close Charges' form (and/or Interim Billing Batch forms/functions if desired).
  15. Open Avatar PM/Cal-PM 'Electronic Billing' form.
  16. Note - Acceptance testing may also be confirmed via Avatar PM/Cal-PM 'Quick Billing' form/functionality
  17. Select 837 Professional in 'Billing Form' field.
  18. Enter/select 837 file sorting criteria, using values which will include service(s) originating in Avatar MSO with Primary and Add-On/Interactive Complexity service(s) in same/single claim
  19. Click 'Process' button to sort/generate 837 Professional file.
  20. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  21. Select 'Print' in the 'Print Or Delete Report' field.
  22. Select 837 Professional file sorted which includes services originating in Avatar MSO, and click 'Process' button to display 837 outbound file data.
  23. In Avatar PM/Cal-PM 837 Professional/837 Institutional format outbound electronic billing file data - for services originating via Avatar MSO with Primary and Add-On/Interactive Complexity service(s) in same/single claim, ensure that Primary Service and all related Add-On Service(s)/Interactive Complexity Service(s) are included in same/single claim (multiple 2400-LX service line entries under same/single 2300-CLM iteration), regardless of the value specified in the Guarantor/Program Billing Defaults/Template 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field/setting.
Topics
• 837 Professional • Claims Processing • CPT Code Definition • MSO To Parent System Integration Mapping • NX