Avatar MSO 'Claims Adjudication Rules Definition' Form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claims Adjudication Rules Definition
Scenario 1: 'Claims Adjudication Rules Definition' - Verification of Limit Rule Filing
Specific Setup:
- CPT Code Definition and/or Revenue Code Definition where dash character ('-') is used in code (Ex: 'H0004-A')
Steps
- Open Avatar MSO 'Claims Adjudication Rules Definition' form.
- Select 'Add' in 'Action' field (or 'Edit' to select/view/edit existing rule).
- Enter/select values for Rule Definition fields 'Rule ID', 'Rule Description', 'Status', 'Status Reason', 'Funding Source' (and 'From Date'/'Through Date' if desired).
- Select 'Limit' in 'Rule Type' field.
- Enter/select values for Limit Rule Definition fields - selecting CPT Code/Revenue Code where dash character ('-') is used in code (Ex: 'H0004-A') or Procedure Code Group including one or more such codes/characters.
- Click 'Add Rule' button to save Limit Rule Definition information.
- Ensure Limit Rule Definition information is displayed in 'Business Rule Viewer' field, including CPT Code/Revenue Code where dash character ('-') is used in code.
- Click 'Submit' button to file 'Claims Adjudication Rules Definition' form/rule.
- Ensure confirmation dialog noting 'Claims Adjudication Rules Definition has completed. Do you wish to return to form?' is presented; click 'Yes' button to return to form.
- Select 'Edit' in 'Action' field and select previously entered/filed 'Limit' Type Claims Adjudication Rule for review.
- Ensure previously entered/filed Limit Rule Definition information is displayed in 'Business Rule Viewer' field, including CPT Code/Revenue Code where dash character ('-') is used in code.
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Topics
• Claims Processing
• NX
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Avatar MSO 'Performing Provider Registration' form
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: 'Performing Provider Registration' - Form Verification
Specific Setup:
- Performing Provider Registration record(s) assigned to one or more Contracting Provider Registration
Steps
- Open Avatar MSO 'Performing Provider Registration' form.
- Click 'New Performing Provider' button to create new Performing Provider Registration (or search/select existing Performing Provider Registration record for edit).
- Enter/select values in 'Name' and 'Registration Start Date' fields (and 'Registration End Date' if desired).
- Select one or more values in 'Primary License Type for Claims' field.
- Select 'Create New' from the 'Primary License Type Effective Dates' field.
- Enter/select values for 'Effective Start Date', 'Primary License Type for Claims' fields.
- Click 'File Primary License Type Effective Date' button.
- Enter/select values for any other Performing Provider Registration fields as required/desired.
- Click 'Submit' button to file 'Performing Provider Registration' form.
- Open Avatar MSO 'Contracting Provider Registration' form.
- Search/select Contracting Provider/Registration record for update/Performing Provider assignment and click 'Edit' button.
- Navigate to 'Performing Provider's Information' form section.
- Click 'Add New Item' button to add new Performing Provider assignment row.
- Search/select Performing Provider Registration filed above.
- Ensure that 'Effective Start Date' and 'Effective End Date' fields are populated with values filed via 'Performing Provider Registration' form 'Registration Start Date'/'Registration End Date' fields.
- Click 'Submit' button to file 'Contracting Provider Registration' form with Performing Provider assignment included; repeat as desired for additional Contracting Provider Registration records.
- Open Avatar MSO 'Performing Provider Registration' form.
- Enter/select previously filed Performing Provider Registration record currently assigned to one or more Contracting Provider Registrations.
- Ensure that if 'Registration Start Date' value is updated to date later/more recent than current field value, user is presented with error dialog noting 'Registration Start Date cannot be changed to a later date, registration already associated to a contracting provider' and the entry is disallowed.
- Note - If Performing Provider is assigned to one or more Contracting Provider Registration records, 'Registration Start Date' may be updated to date earlier than current field date value; 'Registration Start Date' may be updated to date earlier than or later than current field date value only in case where Performing Provider is not assigned to any existing Contracting Provider Registration records,
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Topics
• NX
• Performing Provider
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Avatar MSO 'Claims Adjudication Rules Definition' Form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claims Adjudication Rules Definition
Scenario 1: 'Claims Adjudication Rules Definition' - Verification of Limit Rule Removal
Steps
- Open Avatar MSO 'Claims Adjudication Rules Definition' form.
- Select 'Add' in 'Action' field (or 'Edit' to select/view/edit existing rule).
- Enter/select values for Rule Definition fields 'Rule ID', 'Rule Description', 'Status', 'Status Reason', 'Funding Source' (and 'From Date'/'Through Date' if desired).
- Select 'Limit' in 'Rule Type' field.
- Enter/select values for Limit Rule Definition fields - including value for ICD-10 Diagnosis Code in 'For Diagnosis' field (if entering new rule).
- Click 'Add Rule' button to save Limit Rule Definition information (if entering new rule).
- Ensure entered/existing Limit Rule Definition information is displayed in 'Business Rule Viewer' field, including 'For Diagnosis' value/code.
- Click 'Remove Selected Item' button to open rule removal selection dialog.
- Select Limit Rule Definition row for removal, and click 'OK' button.
- Ensure Limit Rule Definition is removed from rule and is not displayed in 'Business Rule Viewer' field.
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Topics
• Claims Processing
• NX
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