Avatar MSO 2023 Update 37

• Avatar MSO Registry Setting 'Enable Coverage Effective Period' must be enabled
• Crystal Reports or other SQL reporting tool

1. Open Avatar MSO 'CPT Code Definition' form.
2. Select 'Add' or 'Edit' action in 'Add/Edit/Delete CPT Code' field.
3. Enter (or search/select) CPT Code Definition to be added (or updated).
4. Ensure that the 'Coverage Period' selection field is present in form, with existing Coverage Periods (including 'Coverage Effective Date' and 'Coverage Expiration Date') and 'Create New' selections available.
5. Select 'Create New' in 'Coverage Period' field (or select existing Coverage Period for view/edit).
6. Ensure that 'Coverage Effective Date' and 'Coverage Expiration Date' fields are present in form; enter values for 'Coverage Effective Date' field, and 'Coverage Expiration Date' field if desired.
7. Note - If no value entered for 'Coverage Expiration Date', Coverage Period entry will be considered open-ended, covering all dates on or after 'Coverage Effective Date'
8. In case where value entered for 'Coverage Expiration Date' is prior to 'Coverage Effective Date' - ensure that user is presented with validation error dialog noting 'Expiration Date cannot be before Effective Date' and the entry is disallowed.
9. In case where values entered for 'Coverage Effective Date' and/or 'Coverage Expiration Date' fields overlap an existing Coverage Period entry for CPT Code - ensure that user is presented with validation error dialog noting 'The date range for the current Coverage Period overlaps an existing entry' and the entry is disallowed.
10. Ensure that the following 'CPT Code Definition' form fields are updated to be filed/stored by Coverage Period (and are enabled on selection of existing Coverage Period or 'Create New' option):
11. 'Maximum Units Per Day'
12. 'Minimum Duration'
13. 'Maximum Duration'
14. 'Duration Per Unit'
15. 'Limit License Type(s) Allowed'
16. 'Measurement Code'
17. 'Place of Service'
18. Enter/select values in one or more of the CPT Code Definition fields noted above for Coverage Period information/entry.
19. Avatar MSO Claim Processing/Service Adjudication functionality is updated to determine values for these CPT Code Definition Approve/Pend/Deny Rule service information field allowances (where defined) according to Coverage Period for related CPT Code and date of service (for all 837 inbound and manually entered claims/services)
20. When Coverage Period/CPT Code Definition fields are entered as desired, click 'File Coverage Period' button to save Coverage Period entry/values.
21. Note - Multiple Coverage Periods may be entered/filed for CPT Code prior to saving/filing CPT Code Definition by selection of 'Create New' option in 'Coverage Period' field, entry of 'Coverage Effective Date'/'Coverage Expiration Date' and CPT Code Definition field values and clicking 'File Coverage Period' button
22. Note - If CPT Code Definition is saved/filed via the 'File CPT Service Code' button prior to entry/filing of one or more Coverage Periods, CPT Code will be stored without entered/updated Coverage Period information
23. Ensure 'Saved. Please note: The changes will only take effect when you submit the form' message dialog is present on saving/filing of Coverage Period entry.
24. Ensure that Coverage Period entries may be deleted from CPT Code Definition by selecting in 'Coverage Period' field and clicking 'Delete Coverage Period' button; ensure that user is presented with 'Deleted. Please note: The changes will only take effect when you submit the form' message dialog, and the entry/row is removed from the 'Coverage Period' selection field.
25. Enter/update additional Coverage Period entries as desired.
26. Enter/select values for all other required/desired fields in 'CPT Code Definition' form.
27. Click 'File CPT Service Code' button when code entry/edit has been completed.
28. Ensure 'CPT Code Successfully Filed' message dialog is present, and click 'OK' button.
29. Select 'Edit' in the 'Add/Edit/Delete CPT Code' field and open same CPT Service Code record for review.
30. Ensure that all previously entered/filed Coverage Periods (including 'Coverage Effective Date' and 'Coverage Expiration Date') are available for selection in 'Coverage Period' field; select previously entered/filed Coverage Period.
31. Ensure that previously entered/selected values are present in Coverage Period CPT Code Definition fields noted above.
32. Select 'Edit' in the 'Add/Edit/Delete CPT Code' field and open CPT Service Code existing in Avatar MSO prior to/at time of enabling the 'Enable Coverage Effective Period' Registry Setting record for review.
33. For all CPT Codes existing in Avatar MSO prior to/at time of enabling the 'Enable Coverage Effective Period' Registry Setting - ensure that single default Coverage Period entry is created for existing CPT Codes, using '01/01/1900' as 'Coverage Effective Date', no value for 'Coverage Expiration Date' (open-ended) and with existing/current values for the CPT Code Definition Coverage Period fields noted above.
34. Open Crystal Reports or other SQL reporting tool.
35. In Avatar MSO SQL table 'SYSTEM.table_cpt_rev_cov_period', ensure that data rows are present for CPT Code/Coverage Period information filed via 'CPT Code Definition' form, including the 'ID' (assigned by system), 'SERVICE_CODE'/'SERVICE_CODE_TYPE', 'coverage_effective_date' and 'coverage_expiration_date' fields (as well as all CPT Code Definition Coverage Period fields noted above).
36. In addition - Avatar MSO SQL table 'SYSTEM.table_cpt_service_codes' is updated for complete storage of CPT Code Definition information fields in systems where the 'Enable Coverage Effective Period' Registry Setting is disabled

• Avatar MSO Registry Setting 'Enable Coverage Effective Period' must be enabled
• Crystal Reports or other SQL reporting tool

1. Open Avatar MSO 'Revenue Code Definition' form.
2. Select 'Add' or 'Edit' action in 'Add/Edit/Delete Revenue Code' field.
3. Enter (or search/select) Revenue Code Definition to be added (or updated).
4. Ensure that the 'Coverage Period' selection field is present in form, with existing Coverage Periods (including 'Coverage Effective Date' and 'Coverage Expiration Date') and 'Create New' selections available.
5. Select 'Create New' in 'Coverage Period' field (or select existing Coverage Period for view/edit).
6. Ensure that 'Coverage Effective Date' and 'Coverage Expiration Date' fields are present in form; enter values for 'Coverage Effective Date' field, and 'Coverage Expiration Date' field if desired.
7. Note - If no value entered for 'Coverage Expiration Date', Coverage Period entry will be considered open-ended, covering all dates on or after 'Coverage Effective Date'
8. In case where value entered for 'Coverage Expiration Date' is prior to 'Coverage Effective Date' - ensure that user is presented with validation error dialog noting 'Expiration Date cannot be before Effective Date' and the entry is disallowed.
9. In case where values entered for 'Coverage Effective Date' and/or 'Coverage Expiration Date' fields overlap an existing Coverage Period entry for Revenue Code - ensure that user is presented with validation error dialog noting 'The date range for the current Coverage Period overlaps an existing entry' and the entry is disallowed.
10. Ensure that the following 'Revenue Code Definition' form fields are updated to be filed/stored by Coverage Period (and are enabled on selection of existing Coverage Period or 'Create New' option):
11. 'Maximum Units Per Day'
12. 'Minimum Duration'
13. 'Maximum Duration'
14. 'Duration Per Unit'
15. 'Limit License Type(s) Allowed'
16. 'Measurement Code'
17. 'Place of Service'
18. Enter/select values in one or more of the Revenue Code Definition fields noted above for Coverage Period information/entry.
19. Avatar MSO Claim Processing/Service Adjudication functionality is updated to determine values for these Revenue Code Definition Approve/Pend/Deny Rule service information field allowances (where defined) according to Coverage Period for related Revenue Code and date of service (for all 837 inbound and manually entered claims/services)
20. When Coverage Period/Revenue Code Definition fields are entered as desired, click 'File Coverage Period' button to save Coverage Period entry/values.
21. Note - Multiple Coverage Periods may be entered/filed for Revenue Code prior to saving/filing Revenue Code Definition by selection of 'Create New' option in 'Coverage Period' field, entry of 'Coverage Effective Date'/'Coverage Expiration Date' and Revenue Code Definition field values and clicking 'File Coverage Period' button
22. Note - If Revenue Code Definition is saved/filed via the 'File Revenue Code' button prior to entry/filing of one or more Coverage Periods, Revenue Code will be stored without entered/updated Coverage Period information
23. Ensure 'Saved. Please note: The changes will only take effect when you submit the form' message dialog is present on saving/filing of Coverage Period entry.
24. Ensure that Coverage Period entries may be deleted from Revenue Code Definition by selecting in 'Coverage Period' field and clicking 'Delete Coverage Period' button; ensure that user is presented with 'Deleted. Please note: The changes will only take effect when you submit the form' message dialog, and the entry/row is removed from the 'Coverage Period' selection field.
25. Enter/update additional Coverage Period entries as desired.
26. Enter/select values for all other required/desired fields in 'Revenue Code Definition' form.
27. Click 'File Revenue Code' button when code entry/edit has been completed.
28. Ensure 'Revenue Code Filed' message dialog is present, and click 'OK' button.
29. Select 'Edit' in the 'Add/Edit/Delete Revenue Code' field and open same Revenue Code record for review.
30. Ensure that all previously entered/filed Coverage Periods (including 'Coverage Effective Date' and 'Coverage Expiration Date') are available for selection in 'Coverage Period' field; select previously entered/filed Coverage Period.
31. Ensure that previously entered/selected values are present in Coverage Period Revenue Code Definition fields noted above.
32. Select 'Edit' in the 'Add/Edit/Delete Revenue Code' field and open Revenue Service Code existing in Avatar MSO prior to/at time of enabling the 'Enable Coverage Effective Period' Registry Setting record for review.
33. For all Revenue Codes existing in Avatar MSO prior to/at time of enabling the 'Enable Coverage Effective Period' Registry Setting - ensure that single default Coverage Period entry is created for existing Revenue Codes, using '01/01/1900' as 'Coverage Effective Date', no value for 'Coverage Expiration Date' (open-ended) and with existing/current values for the Revenue Code Definition Coverage Period fields noted above.
34. Open Crystal Reports or other SQL reporting tool.
35. In Avatar MSO SQL table 'SYSTEM.table_cpt_rev_cov_period', ensure that data rows are present for Revenue Code/Coverage Period information filed via 'Revenue Code Definition' form, including the 'ID' (assigned by system), 'SERVICE_CODE'/'SERVICE_CODE_TYPE', 'coverage_effective_date' and 'coverage_expiration_date' fields (as well as all Revenue Code Definition Coverage Period fields noted above).
36. In addition - Avatar MSO SQL table 'SYSTEM.table_revenue_codes' is updated for complete storage of Revenue Code Definition information fields in systems where the 'Enable Coverage Effective Period' Registry Setting is disabled

• Avatar MSO Registry Setting 'Enable Coverage Effective Period' must be enabled
• Avatar MSO 'CPT Code Definition' Import file containing one or more valid import row(s) where one or more Coverage Period entries (segment/field 48) is/are included with values for one or more of the following elements:
• Row ID
• Include 'NEW' for filing of new Coverage Period
• Include Row ID for update of existing Coverage Period
• 'ID' value from Avatar MSO SQL table 'SYSTEM.table_cpt_rev_cov_period'
• 'Coverage Effective Date'
• 'Coverage Expiration Date'
• 'Maximum Units Per Day'
• 'Minimum Duration'
• 'Maximum Duration'
• 'Duration Per Unit'
• 'Limit License Type(s) Allowed'
• 'Measurement Code'
• 'Place of Service'

Examples, CPT Definition Import file Coverage Period segment:

NEW~01/01/2023~03/31/2023~100~30~120~10&11~15~UN~11&12&21&22||NEW~04/01/2023~~120~30~180~13&15~15~MJ~11&12

500~01/01/2023~03/31/2023~90~20~100~10&11~10~UN~11&12&21||501~04/01/2023~04/30/2023~120~30~180~13&15~15~MJ~11&12||502~05/01/2023~~100~30~120~10~10~UN~11&12&21

Please refer to 'Avatar_MSO_2023_File_Import_Record_Layouts.xls' document included with Avatar MSO 2023 Update 37 for updated import format/definition

1. Open Avatar MSO 'CPT Code Definition' form.
2. Navigate to 'Import Codes' section of form.
3. Click 'Select Data Import File' button.
4. Select CPT Code Import file containing one or more code(s) with Coverage Period information included/defined.
5. Click 'Import Codes' button to process file and post valid CPT Code(s) and Coverage Period information.
6. In case where one or more CPT Code import rows includes invalid Coverage Period information - ensure errors are returned/displayed in the 'File Import Errors' field and the invalid Coverage Period row(s) is/are not filed.
7. Examples, CPT Code Coverage Period information File Import errors:
8. Invalid Coverage Period Row ID (Row ID not found for service code in SYSTEM.table_cpt_rev_cov_period)
9. The date range for the current Coverage Period overlaps an existing entry
10. Invalid Effective Date (Effective Date cannot be after Expiration Date)
11. Navigate to 'CPT Service Code' section of form.
12. Select 'Edit' in the 'Add/Edit/Delete CPT Code' field and select/open CPT Code with Coverage Period information defined in processed import file.
13. Ensure that all successfully imported/filed Coverage Periods are available for selection in 'Coverage Period' field; select imported/filed Coverage Period.
14. Ensure that imported/filed values are present in the following Coverage Period CPT Code Definition fields:
15. 'Coverage Effective Date'
16. 'Coverage Expiration Date'
17. 'Maximum Units Per Day'
18. 'Minimum Duration'
19. 'Maximum Duration'
20. 'Duration Per Unit'
21. 'Limit License Type(s) Allowed'
22. 'Measurement Code'
23. 'Place of Service'

• Avatar MSO Registry Setting 'Enable Coverage Effective Period' must be enabled
• Avatar MSO 'Revenue Code Definition' Import file containing one or more valid import row(s) where one or more Coverage Period entries (segment/field 48) is/are included with values for one or more of the following elements:
• Row ID
• Include 'NEW' for filing of new Coverage Period
• Include Row ID for update of existing Coverage Period
• 'ID' value from Avatar MSO SQL table 'SYSTEM.table_cpt_rev_cov_period'
• 'Coverage Effective Date'
• 'Coverage Expiration Date'
• 'Maximum Units Per Day'
• 'Minimum Duration'
• 'Maximum Duration'
• 'Duration Per Unit'
• 'Limit License Type(s) Allowed'
• 'Measurement Code'
• 'Place of Service'

Examples, Revenue Definition Import file Coverage Period segment:

NEW~01/01/2023~03/31/2023~100~30~120~10&11~15~UN~11&12&21&22||NEW~04/01/2023~~120~30~180~13&15~15~MJ~11&12

500~01/01/2023~03/31/2023~90~20~100~10&11~10~UN~11&12&21||501~04/01/2023~04/30/2023~120~30~180~13&15~15~MJ~11&12||502~05/01/2023~~100~30~120~10~10~UN~11&12&21

Please refer to 'Avatar_MSO_2023_File_Import_Record_Layouts.xls' document included with Avatar MSO 2023 Update 37 for updated import format/definition

1. Open Avatar MSO 'Revenue Code Definition' form.
2. Navigate to 'Import Codes' section of form.
3. Click 'Select Data Import File' button.
4. Select Revenue Code Import file containing one or more code(s) with Coverage Period information included/defined.
5. Click 'Import Codes' button to process file and post valid Revenue Code(s) and Coverage Period information.
6. In case where one or more Revenue Code import rows includes invalid Coverage Period information - ensure errors are returned/displayed in the 'File Import Errors' field and the invalid Coverage Period row(s) is/are not filed.
7. Examples, Revenue Code Coverage Period information File Import errors:
8. Invalid Coverage Period Row ID (Row ID not found for service code in SYSTEM.table_cpt_rev_cov_period)
9. The date range for the current Coverage Period overlaps an existing entry
10. Invalid Effective Date (Effective Date cannot be after Expiration Date)
11. Navigate to 'Revenue Code Setup' section of form.
12. Select 'Edit' in the 'Add/Edit/Delete Revenue Code' field and select/open Revenue Code with Coverage Period information defined in processed import file.
13. Ensure that all successfully imported/filed Coverage Periods are available for selection in 'Coverage Period' field; select imported/filed Coverage Period.
14. Ensure that imported/filed values are present in the following Coverage Period Revenue Code Definition fields:
15. 'Coverage Effective Date'
16. 'Coverage Expiration Date'
17. 'Maximum Units Per Day'
18. 'Minimum Duration'
19. 'Maximum Duration'

• Avatar MSO Registry Setting 'Enable Coverage Effective Period' must be enabled
• Crystal Reports or other SQL reporting tool

1. Open Avatar MSO 'MSO To Parent System Integration Mapping' form.
2. Search/select value in 'CPT Code' field for Avatar MSO 'CPT Code' to Avatar PM/Cal-PM 'Service Code' mapping.
3. Ensure that 'Coverage Period' selection field is present in form for the Avatar MSO 'CPT Code' to Avatar PM/Cal-PM 'Service Code' mapping (Page 6), with existing Coverage Periods for selected CPT Code (including 'Coverage Effective Date' and 'Coverage Expiration Date').
4. Select value in 'Coverage Period' field.
5. Search/select value in 'Service Code' field for Avatar MSO 'CPT Code' to Avatar PM/Cal-PM 'Service Code' mapping.
6. Click 'File' button to file/save Avatar MSO 'CPT Code' and Coverage Period to Avatar PM/Cal-PM 'Service Code' mapping entry; ensure user is presented with confirmation dialog noting 'Mapping has been filed successfully.'
7. Avatar MSO CPT Code to Avatar PM/Cal-PM Service Code mappings are updated to be filed/stored by CPT Code Coverage Period where Avatar MSO Registry Setting 'Enable Coverage Effective Period' is enabled
8. The MSO to PM/Cal-PM Parent System service push/filing is updated to determine Avatar PM/Cal-PM Service Code values from 'MSO To Parent System Integration Mapping' entries according to Coverage Period for related Avatar MSO CPT Code and date of service where Avatar MSO Registry Setting 'Enable Coverage Effective Period' is enabled
9. Select same 'CPT Code' and 'Coverage Period' values where mapping previously entered/filed.
10. Ensure 'Service Code' field is populated with Avatar PM/Cal-PM 'Service Code' value as entered/filed.
11. Select 'CPT Code' with an Avatar MSO CPT Code to Avatar PM/Cal-PM Service Code mapping existing in Avatar MSO prior to/at time of enabling the 'Enable Coverage Effective Period' Registry Setting for review.
12. For all CPT Codes with CPT Code to Service Code mapping existing in Avatar MSO prior to/at time of enabling the 'Enable Coverage Effective Period' Registry Setting - ensure that a default MSO CPT Code and Coverage Period to Avatar PM/Cal-PM Service Code mapping entry is created for all existing CPT Code to Service Code mappings, using the default '01/01/1900' Effective Date Coverage Period entry created for all CPT Codes (and with existing/current Service Code value).
13. Search/select value in 'Revenue Code' field for Avatar MSO 'Revenue Code' to Avatar PM/Cal-PM 'Service Code' mapping.
14. Ensure that 'Revenue Coverage Period' selection field is present in form for the Avatar MSO 'Revenue Code' to Avatar PM/Cal-PM 'Service Code' mapping (Page 7), with existing Coverage Periods for selected Revenue Code (including 'Coverage Effective Date' and 'Coverage Expiration Date').
15. Select value in 'Revenue Coverage Period' field.
16. Search/select value in 'Service Code' field for Avatar MSO 'Revenue Code' to Avatar PM/Cal-PM 'Service Code' mapping.
17. Click 'File' button to file/save Avatar MSO 'Revenue Code' and Revenue Coverage Period to Avatar PM/Cal-PM 'Service Code' mapping entry; ensure user is presented with confirmation dialog noting 'Mapping has been filed successfully.'
18. Avatar MSO Revenue Code to Avatar PM/Cal-PM Service Code mappings are updated to be filed/stored by Revenue Code Coverage Period where Avatar MSO Registry Setting 'Enable Coverage Effective Period' is enabled
19. The MSO to PM/Cal-PM Parent System service push/filing is updated to determine Avatar PM/Cal-PM Service Code values from 'MSO To Parent System Integration Mapping' entries according to Coverage Period for related Avatar MSO Revenue Code and date of service where Avatar MSO Registry Setting 'Enable Coverage Effective Period' is enabled
20. Select same 'Revenue Code' and 'Revenue Coverage Period' values where mapping previously entered/filed.
21. Ensure 'Service Code' field is populated with Avatar PM/Cal-PM 'Service Code' value as entered/filed.
22. Select 'Revenue Code' with an Avatar MSO Revenue Code to Avatar PM/Cal-PM Service Code mapping existing in Avatar MSO prior to/at time of enabling the 'Enable Coverage Effective Period' Registry Setting for review.
23. For all Revenue Codes with Revenue Code to Service Code mapping existing in Avatar MSO prior to/at time of enabling the 'Enable Coverage Effective Period' Registry Setting - ensure that a default MSO Revenue Code and Coverage Period to Avatar PM/Cal-PM Service Code mapping entry is created for all existing Revenue Code to Service Code mappings, using the default '01/01/1900' Effective Date Coverage Period entry created for all Revenue Codes (and with existing/current Service Code value).
24. Navigate to 'Mapping Delete' section of form.
25. Select values for 'CPT Code'/Service Code' or 'Revenue Code'/'Service Code' where one or more mapping entries exist.
26. Ensure existing mappings (including 'Coverage Effective Date' and 'Coverage Expiration Date') are available for selection in the 'Available Mapping(s)' field.
27. Select one or more CPT Code/Service Code or Revenue Code/Service Code MSO to Parent System Mapping entries for deletion and click 'Delete' button to remove/delete.
28. Open Crystal Reports or other SQL reporting tool.
29. In Avatar MSO SQL table 'SYSTEM.table_parentmap_cpt_cov', ensure that data rows are present for CPT Code/Coverage Period to Service Code mapping information filed via 'MSO To Parent System Integration Mapping' form, including the 'CPT_SERVICE_CODE'/'cpt_code_description', 'coverage_period' and 'SERVICECODE'/'service_value' fields.
30. In addition - Avatar MSO SQL table 'SYSTEM.table_parentmap_cpt' is updated for complete storage of CPT Code to Service Code mapping information in systems where the 'Enable Coverage Effective Period' Registry Setting is disabled
31. In Avatar MSO SQL table 'SYSTEM.table_parent_map_rev_cov', ensure that data rows are present for Revenue Code/Coverage Period to Service Code mapping information filed via 'MSO To Parent System Integration Mapping' form, including the 'REV_SERVICE_CODE'/'rev_code_description', 'coverage_period' and 'SERVICECODE'/'service_value' fields.
32. In addition - Avatar MSO SQL table 'SYSTEM.table_parent_map_rev is updated for complete storage of Revenue Code to Service Code mapping information in systems where the 'Enable Coverage Effective Period' Registry Setting is disabled

• Avatar MSO Registry Setting 'Enable Coverage Effective Period' must be enabled
• CPT Code/Revenue Code with one or more Coverage Period(s) defined
• Avatar MSO To Parent System Integration Mapping Import file containing one or more valid CPT Code/Coverage Period to Service Code and/or Revenue Code/Coverage Period to Service Code mapping import row(s)

Please refer to 'Avatar_MSO_2023_File_Import_Record_Layouts.xls' document included with Avatar MSO 2023 Update 37 for updated import format/definition

1. Open Avatar MSO 'MSO To Parent System Integration Mapping' form.
2. Navigate to 'Mapping Upload' section of form.
3. Click 'Select Upload File' button and select MSO To Parent Mapping Import file for upload/processing.
4. Select 'Upload' (to add only new mappings) or 'Replace' (to delete all existing mappings and add new mappings) in the 'Upload Function' field.
5. Click 'Process Upload File' button to process selected MSO To Parent Mapping Import file.
6. In 'MSO to Parent System Integration Mapping Upload' report - ensure that successfully compiled Avatar MSO CPT Code and Coverage Period to Avatar PM/Cal-PM Service Code mappings are displayed with mapping information in the 'CPT Code to Service Code' sub-report section (with Coverage Period ID and Effective Date/Expiration Date values included).
7. In 'MSO to Parent System Integration Mapping Upload' report - ensure that successfully compiled Avatar MSO Revenue Code and Coverage Period to Avatar PM/Cal-PM Service Code mappings are displayed with mapping information in the 'Revenue Code to Service Code' sub-report section (with Coverage Period ID and Effective Date/Expiration Date values included).
8. In 'MSO to Parent System Integration Mapping Upload' report - ensure that Avatar MSO Revenue Code and Coverage Period to Avatar PM/Cal-PM Service Code mapping rows encountering error(s) on processing are displayed with error message information in the 'File Error Messages' sub-report section.
9. Error Message Examples:
10. 'Coverage Period must be entered.'
11. 'Coverage Period Row ID is not valid for the CPT code.'
12. Navigate to 'MSO To Parent System Integration Mapping' section of form (main section).
13. Select 'CPT Code' and 'Coverage Period' values where mapping filed via 'Mapping Upload' file import.
14. Ensure 'Service Code' field is populated with Avatar PM/Cal-PM 'Service Code' value as entered/filed via import.
15. Select 'Revenue Code' and 'Revenue Coverage Period' values where mapping filed via 'Mapping Upload' file import.
16. Ensure 'Service Code' field is populated with Avatar PM/Cal-PM 'Service Code' value as entered/filed via import.

• Avatar MSO Registry Setting 'Enable Coverage Effective Period' must be enabled
• CPT Code/Revenue Code with one or more Coverage Period(s) defined
• Following Approve/Pend/Deny Claim Process/Service Adjudication Rules must be defined (via 'Approve/Pend/Deny Rules Definition' form):
• 'Maximum Units Per Day Exceeded'
• 'Specified Duration is not valid for Procedure Code'
• 'Duration Per Unit For Procedure Code Is Incorrect'
• 'Invalid Measurement Code for Procedure Code
• 'Invalid Place Of Service For Procedure Code'
• Performing Provider Registration for one or more Performing Providers with 'Performing Provider's License Type' values defined
• Client with eligible Service Authorization record(s) valid for Service Entry/Claim Processing

1. Enter one or more claims/services in Avatar MSO using CPT Code/Revenue Code where one or more Coverage Period entries/rows including are defined in system.
2. Note - Claim/Service entry may be done via 'Fast Service Entry', 'Claim Processing (CMS 1500)' and/or 'Claim Processing (UB-04)' forms, '837 Health Care Claim Professional'/'837 Health Care Claim Institutional' file compilation/posting, as well as Avatar MSO Automated inbound 837 inbound file processing functionality
3. Note - If using '837 Health Care Claim Professional' or '837 Health Care Claim Institutional' forms for 837 compilation/posting, claim processing adjudication status for services may also be reviewed in the 837 Professional or Institutional Compile/Post report
4. During or following batch/claim/service entry - open claims/services for review via 'Claim Processing (CMS 1500)' and/or 'Claim Processing (UB-04)' forms (or review directly via Avatar MSO SQL table 'SYSTEM.batch_clm_svc_detail').
5. Navigate to 'Service Detail' section of form.
6. Select service row and click 'Edit Selected Item'.
7. Ensure that the following Claim Processing/Service Adjudication Approve/Pend/Deny Rule field allowances/requirements are determined according to Coverage Period for related CPT Code/Revenue Code, based on date of service (Coverage Period related to service will be entry where 'Date of Service' is on or after 'Coverage Effective Date' and on or prior to 'Coverage Effective Date' for Coverage Effective Period where defined):
8. 'Maximum Units Per Day'
9. For 'Maximum Units Per Day Exceeded' Approve/Pend/Deny Rule
10. 'Minimum Duration'/'Maximum Duration'
11. For 'Specified Duration is not valid for Procedure Code' Approve/Pend/Deny Rule
12. 'Duration Per Unit'
13. For 'Duration Per Unit For Procedure Code Is Incorrect' Approve/Pend/Deny Rule
14. 'Limit License Type(s) Allowed'
15. For Allowable Performing Provider License Type Approve/Pend/Deny Rule
16. 'Measurement Code'
17. For 'Invalid Measurement Code for Procedure Code' Approve/Pend/Deny Rule
18. 'Place of Service' (based on 'Location' value for service)
19. For 'Invalid Place Of Service For Procedure Code' Approve/Pend/Deny Rule
20. Ensure that 'Claim Status' field is set to value selected for corresponding Approve/Pend/Deny Rule fields noted above for services where Approve/Pend/Deny Rule allowances from corresponding CPT Code/Revenue Code Coverage Period are not met and/or exceeded.
21. 'Explanation of Coverage' field will include values from failed Approve/Pend/Deny Rule condition
22. 'Explanation of Coverage' Examples:
23. 'Specified Duration is not valid for Procedure Code'
24. 'Duration Per Unit For Procedure Code Is Incorrect'
25. 'Maximum Number Of Units Of Procedure Code Per Day Exhausted'
26. 'Performing Provider does not have any License Types that match the CPT Code's allowed License Types'
27. 'Invalid Measurement Code for Procedure Code'
28. In case where CPT Code/Revenue Code Coverage Period is not defined for date of service, ensure that Approve/Pend/Deny Rules noted above are not enforced for Claim Processing/Service Adjudication.

• Avatar MSO Registry Setting 'Enable Coverage Effective Period' must be enabled
• CPT Code/Revenue Code with one or more Coverage Period(s) defined (via Avatar MSO 'CPT Code Definition' and/or 'Revenue Code Definition' forms)
• One or more CPT Codes/Revenue Codes and Coverage Period(s) with mapping to Avatar PM/Cal-PM Service Code defined (via Avatar MSO 'MSO to Parent System Integration Mapping' form)
• 'File Services On Closing Of Batch Or Creation of EOB?' must be set to 'Yes' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section)
• One or more 'Approved' status services eligible for filing to parent Avatar PM/Avatar Cal-PM system

1. Open Avatar MSO 'Close Batch' form.
2. 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
3. Select Avatar MSO Claims Processing batch containing one or more 'Approved' status services eligible for filing to parent Avatar PM/Cal-PM system.
4. Set 'Close Batch' field to 'Yes' (and click 'OK' button to close warning message dialog).
5. Click 'Submit' button to close batch/file services to parent Avatar PM/Cal-PM system.
6. Open 'Client Ledger' form in parent Avatar PM/Cal-PM system.
7. Select 'Client ID' value for client where services are present in Avatar MSO closed status Claims Processing batch.
8. Select 'Claim/Episode/All Episodes' value.
9. Select 'Ledger Type' value.
10. Click 'Process' button.
11. In Client Ledger data - ensure that 'Approved' status services originating in Avatar MSO are present in Avatar PM system following 'Close Batch' filing (where services are valid for filing to parent system).
12. In Client Ledger data - ensure that Avatar PM/Cal-PM Service Code for services originating in Avatar MSO is determined from 'MSO To Parent System Integration Mapping' entries according to Coverage Period for related Avatar MSO CPT Code/Revenue Code and date of service (Coverage Period related to service will be entry where 'Date of Service' is on or after 'Coverage Effective Date' and on or prior to 'Coverage Effective Date' for Coverage Effective Period where defined).
13. In case where CPT Code/Revenue Code Coverage Period is not defined for date of service, ensure that Avatar MSO service is not filed/pushed to Avatar PM/Cal-PM on 'Close Batch' or related function.
14. Note - Services which are not filed/pushed to Avatar PM/Cal-PM on 'Close Batch' or related function due to lack of Coverage Period/mapping information will be present in Avatar MSO SQL table 'SYSTEM.mso_to_pm_service_failed', with 'error_message' value 'Invalid service code'
15. In case where CPT Code/Revenue Code Coverage Period applicable to date of service does not have mapping to Avatar PM/Cal-PM Service Code defined, ensure that Avatar MSO service is not filed/pushed to Avatar PM/Cal-PM on 'Close Batch' or related function.
16. Note - Services which are not filed/pushed to Avatar PM/Cal-PM on 'Close Batch' or related function due to lack of Coverage Period/mapping information will be present in Avatar MSO SQL table 'SYSTEM.mso_to_pm_service_failed', with 'error_message' value 'Invalid service code'

1. Open 'Registry Settings' form.
2. Enter search value 'Enable Coverage Effective Period' and click 'View Registry Settings' button.
3. Ensure Registry Setting 'Enable Coverage Effective Period' is returned (under 'Avatar MSO -> Claims Processing' path).
4. Ensure 'Registry Setting Details' field contains the following explanation text:

"Selecting 'Y' will add the ability to define multiple coverage effective periods with the 'CPT Code Definition' and 'Revenue Code Definition' forms. This will allow users to configure different definitions for a single CPT or Revenue Code based upon non-overlapping effective date ranges. Selecting 'Y' will do the following:

1 - Add the fields 'Coverage Period', 'Coverage Effective Date', 'Coverage Expiration Date', 'File Coverage Period', and 'Delete Coverage Period' in the 'CPT Code Definition' and 'Revenue Code Definition' forms.

2 - Add the required fields 'Coverage Period' and 'Coverage Revenue Period' the 'MSO to Parent System Integration Mapping' form for the CPT Code Mapping (Page 6) and Revenue Code Mapping (Page 7).

3 - Re-file all CPT and Revenue Code Definition mappings to map the initial coverage effective date range.

4 - Re-file all CPT and Revenue Code Definitions and create an initial coverage effective date range with an effective date of 1/1/1900.

5 - Update the CPT/Revenue Code Import to support the ability to import more than one definition for a single CPT or Revenue Code as long as the effective dates are provided and are non-overlapping.

NOTE: This registry setting is a ONE WAY registry setting that can only be enabled. Once turned on, this registry setting cannot be disabled."