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Avatar MSO 2023 Update 29

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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) When compiling an 837 Institutional file via the '837 Health Care Claim Institutional' form, claims without an admission segment (DTP*435) are rejected with critical error "Invalid admission date for claim ()". 2) The 277 file produced via the 'Claim Acknowledgement (277CA) File' form is incorrectly adding a rejected record in the SYSTEM.clmstatusresp table for 0 dollar claims that are accepted.

Required Updates

Avatar MSO 2023 Update 12

Included Updates

2, 3, 11, 12, 13, 20, 27

Details
NEW0 CHANGED0 FIXED2
Fixed (2)
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 ()". KB0074581 v0.01
Topics
• 837 Health Care Claim Institutional
 
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.
Topics
• Claim Acknowledgement (277CA)
 
Acceptance Tests
AV-90675 Summary | Details
Avatar MSO '837 Health Care Claim Institutional'
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Institutional
  • 837 Health Care Claim Institutional - Compile Report
  • 837 Health Care Claim Institutional - Error Report
  • 837 Health Care Claim Institutional - Post Report
Scenario 1: '837 Health Care Claim Institutional' - Validation of 2300 DTP Admission Date Format
Specific Setup:
  • 837 Health Care Claim Institutional file with one or more claims not including 2300 DTP Admission Date loop/segment/value
  • Optionally - 837 Health Care Claim Institutional file with one or more claims containing invalid 2300 DTP Admission Date value
  • Example: DTP*435*DT*2022101~
Steps
  1. Open '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 - in case where one or more claim(s) does not include 2300 DTP Admission Date loop/segment/value, ensure that claim/service(s) are successfully compiled (and are included in 837 compile report).
  8. In 837 Institutional Compile Report - in case where one or more claim(s) includes an invalid 2300 DTP Admission Date value, ensure that claim/service(s) are not successfully compiled (and are not included in 837 compile report).
  9. Select 'Run Error Report' in the 'Options' field, and select compiled 837 Institutional file.
  10. In 837 Institutional Error Report - in case where one or more claim(s) include an invalid 2300 DTP Admission Date value, ensure that claim is included in 837 error report with Error Type 'Critical Error' and Error Message 'Invalid admission date for claim.'
  11. Select 'Post File' in the 'Options' field, and select compiled 837 Institutional file.
  12. Click 'Process' button.
  13. In 837 Institutional Post Report - in case where one or more claim(s) does not include 2300 DTP Admission Date loop/segment/value, ensure that claim/service(s) are successfully posted (and are included in 837 compile report).
  14. In 837 Institutional Post Report - in case where one or more claim(s) includes an invalid 2300 DTP Admission Date value, ensure that claim/service(s) are not successfully posted (and are not included in 837 post report).
Topics
• 837 Health Care Claim Institutional
AV-90916 Summary | Details
Avatar MSO 'Claim Acknowledgement (277CA) File'
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Institutional
  • 837 Health Care Claim Professional
  • Claim Acknowledgement (277CA) File
Scenario 1: 'Claim Acknowledgement (277CA) File' - Verification of Claim Acknowledgement File Status Service Information (Zero-Charge Claims/Services)
Specific Setup:
  • File path for 277CA Claim Acknowledgement file creation must be defined in the 'Output Directory' field for system (via Avatar MSO 'Set System Defaults' or 'Import/Export File Configuration' form)
  • 277CA Claim Acknowledgment file may optionally be enabled for automatic generation (via Avatar MSO 'Import/Export File Configuration' form)
  • 837 Professional and/or Institutional format inbound file(s) for compilation/posting including one or more zero-charge claims/services
  • Crystal Reports or other SQL reporting tool
Steps
  1. Using Avatar MSO '837 Health Care Claim Professional' and/or '837 Health Care Claim Institutional' forms (or via Avatar MSO automated 837 file processing), load/compile/post inbound 837 file(s).
  2. Open the Avatar MSO 'Claim Acknowledgement (277CA) File' form.
  3. 277CA file generation/content review may also be confirmed directly in system output directory where automatic 277CA file generation is enabled
  4. Select 'Create File On Server' in 'Options' field.
  5. Select 'Submission Type' field value ('Institutional' or 'Professional').
  6. Select 837 file for Claim Acknowledgement (277CA) file creation.
  7. Click 'Process' button.
  8. Ensure that for selected 837 file, Claim Acknowledgement (277CA) file is created on server in defined directory.
  9. This may be confirmed via the 'Claim Acknowledgement (277CA) File' form 'Run Report' or 'Dump File' options, and/or by reviewing files in 277CA output directory
  10. Select 'Dump File' in 'Options' field.
  11. Select 'Submission Type' field value ('Institutional' or 'Professional').
  12. Select 837 file for Claim Acknowledgement (277CA) file review.
  13. Click 'Process' button.
  14. 277CA file content review may also be confirmed directly in system output directory by opening/reviewing file(s).
  15. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all services within claim are accepted by Avatar MSO and including one or more zero-charge claims/services, ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Accepted' status (A2) or 'Split' status (A5).
  16. Examples:
  17. STC*A2:20*20221005*WQ*500~
  18. STC*A5:0*20221005*U*500~
  19. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound zero-charge claims where all or individual services within claim are accepted by Avatar MSO, ensure that Service Line Level Status Information (2220D STC) is included/reported with 'Accepted' or status (A2) for individual accepted zero-charge service lines.
  20. Example:
  21. STC*A2:20**WQ~
  22. Open Crystal Reports or other SQL reporting tool.
  23. In Avatar MSO SQL table 'SYSTEM.svc_status_resp', ensure that claim/service level information is present for processed 837 inbound files; ensure that 'status_cat_code' value = 'A2' or 'A5' for all accepted zero-charge claims/services.
Topics
• Claim Acknowledgement (277CA)