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Avatar MSO 2023 Update 36

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Product Requirements and Recommendations

Avatar MSO required
RADplus required

Recommended Update Level

Avatar MSO 2023 Monthly Release 2023.03.00
RADplus 2023 Monthly Release 2023.03.00

Product Update Description

The issue is resolved where "Beginning Of Fiscal Year For A Batch" registry setting is not creating separate batches.

Required Updates

None

Included Updates

2, 3, 4, 7, 8, 11, 12, 13, 17, 19, 20, 27, 28, 29, 30, 33, 34

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Registry Setting - Beginning Of Fiscal Year For A Batch
Functionality has been updated to create separate batches for different fiscal years. KB0075091 v0.01
Topics
• 837 Health Care Claim Institutional • 837 Health Care Claim Professional • Claims Processing
 
Acceptance Tests
AV-92307 Summary | Details
Registry Setting - Beginning Of Fiscal Year For A Batch
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
  • Authorization Listing
  • Batch Creation
  • Batch Creation - Assign ID
  • Claim Processing (CMS 1500)
  • Claim Processing (UB-04)
  • Claim Processing with Override (CMS 1500)
  • Claim Processing with Override (UB-04)
  • Crystal Report Viewer
  • Member Specific Information
  • Registry Settings (PM)
  • Service Authorization
Scenario 1: Claim Processing - Registry setting - Beginning Of Fiscal Year For A Batch = 7 (July)
Specific Setup:
  • Registry setting: Beginning Of Fiscal Year For A Batch = desired value. Note the value.
  • Select a Client that is set up to be used in the various Claim Processing form and the 837 Healthcare Claim Institutional or Professional forms.
  • Batch Creation is used to create a new batch that will allow a minimum of two services.
  • An 837 Healthcare Claim Institutional or Professional file exists for loading/compiling/posting.
  • The file contains a minimum of one service in the prior fiscal year and a minimum of one service in the current fiscal year.
  • Note the number of services in the file and the order of the services. For example, the first service in prior fiscal year, second service in current fiscal year, and third service in prior fiscal year. This order will create three batches.
Steps
  1. Open 'Claim Processing (CMS 1500)'.
  2. Select the batch created in 'Setup',
  3. Select the 'Member Name Or ID'.
  4. Select the 'Provider'.
  5. Select the 'Service Detail' section.
  6. Click [Add New Item].
  7. Enter a service date in the previous fiscal year.
  8. Enter service data that will receive an approval.
  9. Click [Add New Item].
  10. Enter a service date in the current fiscal year.
  11. Validate that a message is received stating: The registry 'Beginning Of Fiscal Year For A Batch' is currently enabled and this date of service is not within the fiscal year for this batch.
  12. Click [OK].
  13. Click [Discard].
  14. Click [Yes].
  15. Repeat steps 1-14 for 'Claim Processing with Override (CMS 1500)'.
  16. Repeat steps 1-14 for 'Claim Processing (UB-04)'.
  17. Repeat steps 1-14 for 'Claim Processing with Override (UB-04)'.
  18. Open '837 Health Care Claim Institutional'.
  19. Upload, compile and post the file.
  20. When the posted file report opens validate that a new batch is created for each fiscal year.
  21. Example: Three batches will be created if the order of service is one fiscal year, different fiscal year, and then back to the first fiscal year.
  22. Close the form.
  23. Repeat steps 18 - 21 for '837 Health Care Claim Professional'.
Topics
• 837 Health Care Claim Institutional • 837 Health Care Claim Professional • Claims Processing