Avatar MSO 2023 Update 4

1. Open 'Registry Settings' form.
2. Enter search value 'Enable Fee Override In PM' and click 'View Registry Settings' button.
3. Ensure Registry Setting 'Enable Fee Override In PM' is returned (under 'Avatar MSO-> System Maintenance -> Provider Fee Definition Maintenance' path).
4. Ensure 'Registry Setting Details' field contains the following explanation text:

For this registry setting the allowable values are as follows:

0 - The section 'Fee Override in PM' in 'Provider Fee Definition' form is hidden. When a batch is closed, the Fee associated with each service in the batch being pushed to Avatar PM will be calculated based on the service fee table in Avatar PM.

Updating this registry setting to '0', '1', '2', or '3' will override any effective date range configured when the registry setting was set to '4'.

Selecting '1', '2', '3' or '4' will create an additional section, 'Fee Override in PM', to the 'Provider Fee Definition' form.

1 - When a batch is closed, each service in the batch being pushed to Avatar PM will use the 'Total Fee Table Amount' associated with the service, as the Fee.

2 - When a batch is closed, each service in the batch being pushed to Avatar PM will use the 'Expected Disbursement' associated with the service, as the Fee.

3 - When a batch is closed, each service in the batch being pushed to Avatar PM will use the 'Total Charge' associated with the service, as the Fee.

4 - The 'Service Filing' section in 'MSO To PM System Integration Mapping' form will be updated to include the ability to enable the fee override definition by an effective date range.

Once this setting is set to 4, the fields added to 'Service Filing' sub-section will always remain on the 'MSO to PM System Integration Mapping' form. The options will remain that when a batch is closed either the service fee table in Avatar PM, the 'Total Feel Table Amount', 'Expected Disbursement' amount or 'Total Charge' amount will be utilized as the Fee.

NOTE - The field, 'File Services On Closing Of Batch?', in the form 'MSO to Parent System Integration Mapping' must be set to 'Yes' for services to be filed in Avatar PM when a batch is closed.

• Avatar MSO Registry Setting 'Enable Fee Override in PM' must be enabled/set to '4'
• Crystal Reports or other SQL reporting tool

1. Open Avatar MSO 'MSO To Parent System Integration Mapping' form.
2. Navigate to 'Service Filing' section of form.
3. Ensure sub-section/fields for 'Enable Fee Override In PM' are present in 'Service Filing' section of 'MSO To Parent System Integration Mapping' form (sub-section/fields will be present in form where Avatar MSO Registry Setting 'Enable Fee Override in PM' has ever been enabled with value '4' in system).
4. Ensure the following 'Enable Fee Override In PM' fields are present in form:
5. 'Enable Fee Override In PM'
6. Dropdown selection field, with existing override date/type entries as well as 'Create New' selection
7. 'Effective Date'
8. Begin date for Fee Override Type entry/selection
9. 'End Date'
10. End date for Fee Override Type entry/selection
11. 'Fee Override In PM'
12. Fee override type selection field with the following options:
13. 'MSO Total Fee Table Amount'
14. 'Expected Disbursement'
15. 'Total Charge'
16. 'Parent System Service Fee Table'
17. 'File' Button
18. Select 'Create New' in 'Enable Fee Override In PM' field.
19. Enter value for 'Effective Date' and 'End Date' fields if desired.
20. If no 'End Date' defined, Fee Override Type entry will be considered applicable/effective for all dates on or after 'Effective Date'
21. Select override type to apply to selected dates in the 'Fee Override in PM' field.
22. Click 'File' button to file/save 'Fee Override in PM' date/type entry; ensure user is presented with confirmation dialog noting 'Filed'.
23. On attempting to enter and/or file a 'Fee Override in PM' date/type entry where 'Effective Date'/'End Date' range overlaps one or more existing entries, ensure entry/filing is disallowed and user is presented with an error dialog noting overlap of existing entry (as only one 'Fee Override in PM' date/type entry may exist for any given date/period).
24. Error dialog example: 'The Fee date range for the current Fee Period overlaps an existing entry (04/01/2023 - No End Date)'
25. Select 'Create New' and enter/file additional 'Fee Override in PM' date/type entries as desired.
26. Select existing/previously filed 'Fee Override in PM' date/type entry in 'Enable Fee Override In PM' drop-down field.
27. Ensure values for 'Effective Date', 'End Date' and 'Fee Override in PM' fields are populated/present as previously filed.
28. Open Crystal Reports or other SQL reporting tool.
29. In Avatar MSO SQL table 'SYSTEM.pm_fee_override', ensure that all 'Fee Override in PM' date/type entries filed via 'MSO to Parent System Integration Mapping' form are present in SQL data with field values as entered/filed via form.

• Avatar MSO Registry Setting 'Enable Fee Override in PM' must be enabled (set to '4')
• '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)
• 'Fee Override in PM' date/override type entry for service date(s) must be defined (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section, 'Enable Fee Override in PM' sub-section)
• CPT Code/Revenue Code must be selected/included for Fee Override in filing to parent system (via Avatar 'Provider Fee Definition' form)
• One or more 'Approved' status services eligible for filing to parent Avatar PM/Avatar Cal-PM system
• Crystal Reports or other SQL reporting tool

1. Open Avatar MSO 'Close Batch' form.
2. Note - Acceptance Testing may also be confirmed on service filing to parent Avatar 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 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 system.
6. Open 'Client Ledger' form in parent Avatar 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. For services originating via Avatar MSO and filed to Avatar PM parent system where Avatar MSO Registry Setting 'Enable Fee Override in PM' is enabled with value '4' - Ensure that 'Cost Of Service' value for service in Avatar PM is determined by 'Fee Override in PM' date/override type entry applicable to 'Date of Service'.
13. Example:
14. 'Fee Override In PM' entries defined as follows (via 'MSO to Parent System Integration Mapping' form):
15. 'Effective Date' 1/1/2023, 'End Date' 1/31/2023, 'Fee Override in PM' = 'MSO Total Fee Table Amount'
16. 'Effective Date' 2/1/2023, 'End Date' 2/28/2023, 'Fee Override in PM' = 'Expected Disbursement'
17. 'Effective Date' 3/1/2023, 'End Date' 3/31/2023, 'Fee Override in PM' = 'Total Charge'
18. 'Effective Date' 4/1/2023, 'End Date' open/not defined, 'Fee Override in PM' = 'Parent System Service Fee Table'
19. For services originating in Avatar MSO where 'Date of Service' = 1/1/2023 - 1/31/2023, ensure that 'Cost Of Service' value for service in Avatar PM is set as Avatar MSO 'Total Fee Table Amount' for service
20. For services originating in Avatar MSO where 'Date of Service' = 2/1/2023 - 2/28/2023, ensure that 'Cost Of Service' value for service in Avatar PM is set as Avatar MSO 'Expected Disbursement' for service
21. For services originating in Avatar MSO where 'Date of Service' = 3/1/2023 - 3/31/2023, ensure that 'Cost Of Service' value for service in Avatar PM is set as Avatar MSO 'Total Charge' for service
22. For services originating in Avatar MSO where 'Date of Service' = 4/1/2023 or later, ensure that 'Cost Of Service' value for service is set from applicable Avatar PM Service Fee/Cross Reference Maintenance fee entry for service code/date/units/duration/etc.
23. Note - 'Units' value for services originating via Avatar MSO and filed to Avatar PM parent system may be determined/configured via Avatar MSO Registry Setting 'Send Units to Avatar PM'
24. Note - In case where Avatar MSO Registry Setting 'Enable Fee Override In PM' is set to '4' and 'Fee Override in PM' date/override type entries are defined - If Registry Setting 'Enable Fee Override In PM' is subsequently changed to value other than '4', new Registry Setting value will dictate service fee override use/type for services filed to Avatar PM parent system regardless of 'Fee Override in PM' date/override type entries defined
25. Open Crystal Reports or other SQL reporting tool.
26. In Avatar MSO SQL table 'SYSTEM.mso_to_pm_service_failed', ensure that any Avatar MSO 'Approved' status services configured for filing to Avatar PM on 'Close Batch' but not filed due to one or more ineligible restrictions/configurations/missing elements are present in SQL data, including 'error_message' field value noting reason for service not filing to Avatar PM parent system.
27. Note - In case where Avatar MSO 'Approved' status service configured for filing to Avatar PM on 'Close Batch' but not filed due to lack of 'Fee Override in PM' date/override type entry applicable to 'Date of Service' are included with 'error_message' value 'Service Not Eligible for Push to PM due to date of service not covered by the fee override periods'

• Avatar MSO Registry Setting 'Enable Fee Override in PM' must be enabled (set to '1','2' or '3')
• '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)
• CPT Code/Revenue Code must be selected/included for Fee Override in filing to parent system (via Avatar 'Provider Fee Definition' form)
• One or more 'Approved' status services eligible for filing to parent Avatar PM/Avatar Cal-PM system
• Crystal Reports or other SQL reporting tool

1. Open Avatar MSO 'Close Batch' form.
2. Note - Acceptance Testing may also be confirmed on service filing to parent Avatar 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 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 system.
6. Open 'Client Ledger' form in parent Avatar 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. For services originating via Avatar MSO and filed to Avatar PM parent system where Avatar MSO Registry Setting 'Enable Fee Override in PM' is enabled with value '1' - Ensure that 'Cost Of Service' value for service in Avatar PM is set as Avatar MSO 'Total Fee Table Amount' for service.
13. Note - 'Units' value for services originating via Avatar MSO and filed to Avatar PM parent system may be determined/configured via Avatar MSO Registry Setting 'Send Units to Avatar PM'
14. For services originating via Avatar MSO and filed to Avatar PM parent system where Avatar MSO Registry Setting 'Enable Fee Override in PM' is enabled with value '2' - Ensure that 'Cost Of Service' value for service in Avatar PM is set as Avatar MSO 'Expected Disbursement' for service.
15. Note - 'Units' value for services originating via Avatar MSO and filed to Avatar PM parent system may be determined/configured via Avatar MSO Registry Setting 'Send Units to Avatar PM'
16. For services originating via Avatar MSO and filed to Avatar PM parent system where Avatar MSO Registry Setting 'Enable Fee Override in PM' is enabled with value '3' - Ensure that 'Cost Of Service' value for service in Avatar PM is set as Avatar MSO 'Total Charge' for service.
17. Note - 'Units' value for services originating via Avatar MSO and filed to Avatar PM parent system may be determined/configured via Avatar MSO Registry Setting 'Send Units to Avatar PM'
18. Open Crystal Reports or other SQL reporting tool.
19. In Avatar MSO SQL table 'SYSTEM.mso_to_pm_service_failed', ensure that any Avatar MSO 'Approved' status services configured for filing to Avatar PM on 'Close Batch' but not filed due to one or more ineligible restrictions/configurations/missing elements are present in SQL data, including 'error_message' field value noting reason for service not filing to Avatar PM parent system.

• Avatar MSO Registry Setting 'Enable Fee Override in PM' must be disabled (set to '0')
• '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
• Crystal Reports or other SQL reporting tool

1. Open Avatar MSO 'Close Batch' form.
2. Note - Acceptance Testing may also be confirmed on service filing to parent Avatar 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 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 system.
6. Open 'Client Ledger' form in parent Avatar 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. For services originating via Avatar MSO and filed to Avatar PM parent system where Avatar MSO Registry Setting 'Enable Fee Override in PM' is disabled - Ensure that 'Cost Of Service' value for service is set from applicable Avatar PM Service Fee/Cross Reference Maintenance fee entry for service code/date/units/duration/etc.
13. Note - 'Units' value for services originating via Avatar MSO and filed to Avatar PM parent system may be determined/configured via Avatar MSO Registry Setting 'Send Units to Avatar PM'
14. Open Crystal Reports or other SQL reporting tool.
15. In Avatar MSO SQL table 'SYSTEM.mso_to_pm_service_failed', ensure that any Avatar MSO 'Approved' status services configured for filing to Avatar PM on 'Close Batch' but not filed due to one or more ineligible restrictions/configurations/missing elements are present in SQL data, including 'error_message' field value noting reason for service not filing to Avatar PM parent system.