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Avatar MSO 2023 Update 40

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Product Requirements and Recommendations

Avatar MSO required
RADplus required

Recommended Update Level

Avatar MSO 2023 Monthly Release 2023.04.00
RADplus 2023 Monthly Release 2023.04.00

Product Update Description

The maximum lengths of Service Authorization file import fields 'Comments On Authorization' and 'Internal Comments' are increased to 5000 characters. Also, the maximum length of Budget Tracking Account Level field 'Comments' is increased to 5000 characters. In addition, the following issues are resolved: 1) Provider fee changes for a specific funding source filed via the 'Provider Fee Definition' form creates retro claim adjudications for services not associated to that funding source. 2) 'Allow Duplicate Services on the Same Day?' in the 'Provider Fee Definition' form is not recognized for Procedure Code Groups. 3) In the 'Provider Fee Definition' form, invalid overlap error prevents expiration date to be added to an existing fee. 4) When associated codes are uploaded via the 'Set Associated Codes' form, existing association's 'Determine Fee Table Amount By Code Authorized or Code Claimed' values are not preserved.

Required Updates

Avatar MSO 2023 Update 34

Included Updates

2, 3, 4, 7, 8, 11, 12, 13, 17, 19, 20, 25, 26, 27, 28, 29, 30, 31, 33, 34, 36, 37, 38

Details
NEW2 CHANGED0 FIXED4
New (2)
File Import - [Avatar MSO] Service Authorization - Member
The Comments On Authorization' and 'Internal Comments' fields have been modified to allow 5000 characters. KB0074628 v0.01
Note: The 'Avatar_MSO_2021_File_Import_Record_Layouts.xls' document has not changed but is being included in the update zip file as a courtesy.
Value Added: Allows users to import more data in the two comments fields.
Topics
• File Import
 
File Import - MSO - Budget Tracking Account Level
The 'Comments' field has been modified to allow a maximum of 5000 characters. KB0074627 v0.01
Note: The 'Avatar_MSO_2021_File_Import_Record_Layouts.xls' document has not changed but is being included in the update zip file as a courtesy.
Value Added: Allows users to add more data to the Budget Tracking Account Level Comments field.
Topics
• Budget Tracking • File Import
 
Fixed (4)
Provider Fee Definition & Retro Claim Adjudication
An issue is resolved where the Retro Claim Adjudication process could be ran for a funding source/contracting provider that was not updated when a funding source for the same code was updated. KB0074589 v0.01
Topics
• Retro Claim Adjudication
 
'Provider Fee Definition - Allow Duplicate Services on the Same Day?
Resolves an issue for 'Procedure Code Groups' that was not respecting the value of the 'Allow Duplicate Services on the Same Day?' field.
Topics
• Claims Processing
 
Provider Fee Definition - Expiration Date
An issue has been resolved to allow users to add an 'Expiration Date' to a record. KB0074726 v0.01
Topics
• Retro Claim Adjudication
 
Set Associated Codes & Associated Code Upload process
Resolves an issue where codes that were manually added to the 'Set Associated Codes' form might lose data when the same code is added through the 'Associated Code Upload' process. KB0075297 v0.01
Topics
• Data Import
 
Acceptance Tests
AV-81832 Summary | Details
File Import - [Avatar MSO] Service Authorization - Member
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
  • Registry Settings (PM)
  • Service Authorization
Scenario 1: File Import - [Avatar MSO] Service Authorization - Member - Comments On Authorization' and 'Internal Comments'
Specific Setup:
  • File Import - [Avatar MSO] Service Authorization - Member:
  • A file is prepared for a client that is eligible for a Service Authorization record.
  • The file contains more than 500 characters in the 'Comments On Authorization' and 'Internal Comments' fields.
  • Note the values for all fields that will be imported.
Steps
  1. Open 'File Import'.
  2. Select 'File Import - [Avatar MSO] Service Authorization - Member' in 'File Type'.
  3. Upload, compile, and post the file prepared in Setup.
  4. Open 'Service Authorization' for the client.
  5. Select the desired record and click [Edit].
  6. Validate that the 'Member Service Authorization' section contains the values in the file.
  7. Validate that the 'Comments' section contains the values in the file.
  8. If desired, edit the file, adding the correct authorization number, and upload. compile, and post it.
  9. Verify that the edited fields contain the data that was filed.
Topics
• File Import
AV-86275 Summary | Details
File Import - MSO - Budget Tracking Account Level
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Budget Tracking Account Setup
  • File Import
Scenario 1: File Import - [Avatar MSO] Budget Tracking Account Level
Specific Setup:
  • The following registry setting is enabled: Avatar MSO->System Maintenance->Budget Tracking->->->Enable Budget Tracking.
  • a "Budget Tracking Account Code" exists
  • Import file for '[Avatar MSO] Budget Tracking Account Code' file type contains the following:
  • Note: The maximum length of the fields is 40 characters. If desired, that can be validated by using more than 40 characters, and changing the fields after the "Compile" produces the error(s).
  • Required fields:
  • Account Code.
  • Begin Date.
  • End Date.
  • Status.
  • Account Level Description.
  • Amount.
  • Comments: Field length is 5000 characters.
Steps
  1. Open the 'File Import' form.
  2. Select "[Avatar MSO] Budget Tracking Account Level" in the "File Type" field.
  3. Select "Upload New File" in "Action".
  4. Click [Process Action].
  5. Select the "[Avatar MSO] Budget Tracking Account Level" import file.
  6. Select "Compile/Validate File" in "Action".
  7. Select the import file in "File(s)".
  8. Click [Process Action].
  9. If not validating the maximum length of the fields, skip to step 21.
  10. The "Compile" will produce errors if testing the maximum length of the fields.
  11. Click [OK].
  12. Select "Print Error" in "Action".
  13. Select the import file in "File(s)".
  14. Click [Process Action].
  15. Verify the error message is "Length exceeded allowable limit. Max length: 40".
  16. Close the report.
  17. Select "Delete File" in "Action".
  18. Select the import file in "File(s)".
  19. Click [Process Action].
  20. Correct the errors in the import file and save it.
  21. Select "Compile/Validate File" in "Action".
  22. Select the import file in "File(s)".
  23. Click [Process Action].
  24. Select "Print File" in "Action".
  25. Select the import file in "File(s)".
  26. Click [Process Action].
  27. Verify the data is correct.
  28. Close the report.
  29. Select "Post File" in "Action".
  30. Select the import file in "File(s)".
  31. Click [Process Action].
  32. If desired, Select "Print File" in "Action".
  33. Select the import file in "File(s)".
  34. Click [Process Action].
  35. Close the form.
  36. If desired, validate the imported "Budget Tracking Account Level" in "Budget Tracking Account Setup".
Topics
• Budget Tracking • File Import
AV-89578 Summary | Details
Provider Fee Definition & Retro Claim Adjudication
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Authorization Listing
  • Batch Creation
  • Batch Creation - Assign ID
  • Claim Processing (CMS 1500)
  • Close Batch
  • CPT Code Definition (MSO)
  • CPT Code Definition (PM)
  • Diagnosis
  • Financial Eligibility
  • Guarantors/Payors
  • Member Specific Information
  • MSO to Parent System Integration Mapping
  • Plan Definition
  • Provider Fee Definition
  • Registry Settings (PM)
  • Retro Claim Adjudication
  • Service Authorization
  • Service Fee/Cross Reference Maintenance
Scenario 1: Retro Claim Adjudication - Change to Provider Fee Definition
Specific Setup:
  • Registry Setting: 'Enable Retro Rate Adjudication' is not enabled.
  • A CPT code is associated to two funding sources.
  • 'Funding Source A' covers all CPT Codes.
  • 'Funding Source B' covers only the specific CPT code.
  • Provider Fee Definition:
  • A definition exists for both funding sources:
  • The 'Effective Date' and 'Amount' are the same for both funding sources.
  • The expiration date can be blank, or contain a value. Note the value if present.
  • Batch Creation is used to create a batch for 'Funding Source A'.
  • Claim Processing (CSM 1500) is used to create a service for 'Funding Source A'.
  • Batch Creation is used to create a batch for 'Funding Source B'.
  • Claim Processing (CSM 1500) is used to create a service for 'Funding Source B'.
  • Provider Fee Definition: Change the 'Amount' for 'Funding Source A'. Submit the change.
Steps
  1. Open 'Registry Setting'.
  2. Set the 'Enable Retro Rate Adjudication' setting to 'Y'.
  3. Submit the form.
  4. Close the form.
  5. Open 'Provider Fee Definition'.
  6. Change the 'Amount' for 'Funding Source B'. Submit the change.
  7. Add or change the value of the 'Expiration Date'.
  8. Submit the changes.
  9. Close the form.
  10. Open 'Retro Claim Adjudication'.
  11. Validate that there is no record for the change in the 'Amount' for 'Funding Source A' because the registry setting was disabled when the fee was changed.
  12. Validate that there is a record for the change in the 'Amount' for 'Funding Source B' because the registry setting was enabled when the fee was changed.
  13. Close the form.
Topics
• Retro Claim Adjudication
AV-89980 Summary | Details
'Provider Fee Definition - Allow Duplicate Services on the Same Day?
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Authorization Listing
  • CPT Code Definition (MSO)
  • Fast Service Entry
  • Financial Eligibility
  • Member Specific Information
  • Plan Definition
  • Procedure Code Group Definition
  • Provider Fee Definition
  • Registry Settings (PM)
  • Service Authorization
Scenario 1: 'Claim Processing...' form and functions - Verification of duplicate service check at Provider Fee Definition level
Specific Setup:
  • Provider Fee Definition must exist where 'Allow Duplicate Services on the Same Day?' field is set to 'No' (via 'Provider Fee Definition' form).
  • Client record eligible for claim/service entry.
Steps
  1. Enter two or more services in Avatar MSO (via manual entry, 837 inbound posting and/or Netsmart ProviderConnect), having same client ID, service date and CPT/Revenue Code.
  2. Adjudicate batches (manually via 'Manual Batch Adjudication' form, nightly automatic process and/or 'Close Batch' function).
  3. Open claims/services for review via 'Claim Processing....' forms (or review directly via Avatar MSO SQL table 'SYSTEM.batch_clm_svc_detail').
  4. In Avatar MSO 'Claim Processing...' forms/functions and service adjudication data - ensure that duplicate services (single client ID, same service date and using same CPT/Revenue Code and fee criteria as another existing 'Approved' service) are adjudicated with 'Denied' claim status and the 'Explanation of Coverage' field includes value 'The service was denied for the following reason: Duplicate Service Found' where 'Allow Duplicate Services on the Same Day?' field is set to 'No' for applicable Provider Fee Definition.
Topics
• Claims Processing
AV-91236 Summary | Details
Provider Fee Definition - Expiration Date
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Authorization Listing
  • Batch Creation
  • Batch Creation - Assign ID
  • Claim Processing (CMS 1500)
  • Close Batch
  • CPT Code Definition (MSO)
  • CPT Code Definition (PM)
  • Diagnosis
  • Financial Eligibility
  • Guarantors/Payors
  • Member Specific Information
  • MSO to Parent System Integration Mapping
  • Plan Definition
  • Provider Fee Definition
  • Registry Settings (PM)
  • Retro Claim Adjudication
  • Service Authorization
  • Service Fee/Cross Reference Maintenance
Scenario 1: Retro Claim Adjudication - Change to Provider Fee Definition
Specific Setup:
  • Registry Setting: 'Enable Retro Rate Adjudication' is not enabled.
  • A CPT code is associated to two funding sources.
  • 'Funding Source A' covers all CPT Codes.
  • 'Funding Source B' covers only the specific CPT code.
  • Provider Fee Definition:
  • A definition exists for both funding sources:
  • The 'Effective Date' and 'Amount' are the same for both funding sources.
  • The expiration date can be blank, or contain a value. Note the value if present.
  • Batch Creation is used to create a batch for 'Funding Source A'.
  • Claim Processing (CSM 1500) is used to create a service for 'Funding Source A'.
  • Batch Creation is used to create a batch for 'Funding Source B'.
  • Claim Processing (CSM 1500) is used to create a service for 'Funding Source B'.
  • Provider Fee Definition: Change the 'Amount' for 'Funding Source A'. Submit the change.
Steps
  1. Open 'Registry Setting'.
  2. Set the 'Enable Retro Rate Adjudication' setting to 'Y'.
  3. Submit the form.
  4. Close the form.
  5. Open 'Provider Fee Definition'.
  6. Change the 'Amount' for 'Funding Source B'. Submit the change.
  7. Add or change the value of the 'Expiration Date'.
  8. Submit the changes.
  9. Close the form.
  10. Open 'Retro Claim Adjudication'.
  11. Validate that there is no record for the change in the 'Amount' for 'Funding Source A' because the registry setting was disabled when the fee was changed.
  12. Validate that there is a record for the change in the 'Amount' for 'Funding Source B' because the registry setting was enabled when the fee was changed.
  13. Close the form.
Topics
• Retro Claim Adjudication
AV-93064 Summary | Details
Set Associated Codes & Associated Code Upload process
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Associated Code Upload
  • Set Associated Codes
Scenario 1: Set Associated Codes
Specific Setup:
  • Set Associated Codes:
  • Desired Funding Source is selected.
  • CPT Codes section:
  • At least one record is added with a value in 'Determine Fee Table Amount By Code Authorized or Code Claimed', and a value in 'Select CPT Code To Add'. Note the values for the two fields.
  • Revenue Codes section:
  • At least one record is added with a value in 'Determine Fee Table Amount By Code Authorized or Code Claimed', and a value in 'Select Revenue Code To Add'. Note the values for the two fields.
  • Associated Code Upload:
  • A file is prepared with the same CPT code and no value in 'Determine Fee Table Amount By Code Authorized or Code Claimed'.
  • A file is prepared with the same Revenue code and no value in 'Determine Fee Table Amount By Code Authorized or Code Claimed'.
Steps
  1. Open 'Associated Code Upload'.
  2. Select the file for the CPT code.
  3. Click [Process File].
  4. Review the data in 'Upload Results'.
  5. Repeat the steps for the Revenue code.
  6. Close the form.
  7. Open 'Set Associated Codes'.
  8. Select the desired Funding Source.
  9. Select the 'CPT Codes' section.
  10. Edit the row that was manually entered and validate that the 'Determine Fee Table Amount By Code Authorized or Code Claimed', and the 'Associated CPT Codes Included In This Entry' contain the values that were added/noted in Setup.
  11. Edit the row that was imported and validate that the 'Determine Fee Table Amount By Code Authorized or Code Claimed' contains no value.
  12. Select the 'Revenue Codes' section.
  13. Edit the row that was manually entered and validate that the 'Determine Fee Table Amount By Code Authorized or Code Claimed', and the 'Associated Revenue Codes Included In This Entry' contain the values that were added/noted in Setup.
  14. Edit the row that was imported and validate that the 'Determine Fee Table Amount By Code Authorized or Code Claimed' contains no value.
Topics
• Data Import
Table Changes
Table Column Change
SYSTEM.tableproviderfeeinfo Exists Logic changes