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Avatar MSO 2023 Update 43

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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 following issues are resolved: 1) The "(500) Internal Server Error" produced when attempting to print any MSO file import report via the 'File Import' form. This issue only occurs in AvatarNX. 2) The error "[VALUE OUT OF RANGE]dat+13^HRADTimeDateProcessors" produced when sorting an 837 file via the 'Electronic Billing' form when it includes services pushed from MSO with OHC data. This can only occur with services filed via Web Service. 3) The 'Update Namespace for All Mappings' command button in the 'Funding Source/Guarantor Mapping' form is not updating the system code for existing entries.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED3
Fixed (3)
File Import - MSO service authorizations
Resolves an issue to ensure that the 'MSO Service Authorization' file can be printed successfully after importing through 'File Import' form. KB0075711 v0.01
Topics
• Budget Tracking • Contracting Provider Service Authorization • File Import • NX
 
Electronic Billing - "Add Support For The Input Of Third Party Payer Amounts" is set to 2
Resolves an issue to ensure that the services inbound into MSO via web service compile successfully via 'Electronic Billing' if the adjudication date is missing in the table.
Topics
• Claims Processing • NX
 
Funding Source/Guarantor Mapping - Update Namespace for All Mappings
Resolves an issue to ensure that the 'Update Namespace for All Mappings' option in the 'Funding Source/Guarantor Mapping' form updates the system code for existing entries successfully.
Topics
• Funding Source • NX
 
Acceptance Tests
AV-91384 Summary | Details
File Import - MSO service authorizations
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Applying Contracting Provider
  • Contracting Provider Registration
  • CPT Code Definition (MSO)
  • CPT Code Definition (PM)
  • Crystal Report Viewer
  • File Import
  • Financial Eligibility
  • Funding Source Registration
  • Member Specific Information
  • Performing Provider Association - Error
  • Plan Definition
  • Provider Fee Definition
  • Service Authorization
  • Budget Tracking Account Setup
  • Contracting Provider Service Authorization
Scenario 1: File Import - [Avatar MSO] Service Authorization - Member - No Claimed Services
Specific Setup:
  • Member has an authorized service record that has no claimed services. Note the 'Provider To Be Authorized' value.
  • Create a File Import that will edit the contracting provider. The 'File Type' is [Avatar MSO] Service Authorization - Member'.
  • The value of the 'Provider To Be Authorized' in position seven of the file, must be different from the value noted above.
  • The File Import Mapping guide is included in the update zip file.
Steps
  1. Open 'File Import'.
  2. Select '[Avatar MSO] Service Authorization - Member in 'File Type'.
  3. Select 'Upload New File' in 'Action'.
  4. Click [Process Action].
  5. Select the file.
  6. Click [Open].
  7. Select 'Compile/Validate File' in 'Action'.
  8. Select the file in 'File(s)'.
  9. Click [Process Action].
  10. Verify the file compiles successfully.
  11. Click [OK].
  12. Select 'Print File' in 'Action'.
  13. Select the file in 'File(s)'.
  14. Click [Process Action].
  15. Validate that the report ''Provider To Be Authorized'' field contains the value of the 'Provider To Be Authorized' in position seven of the file.
  16. Close the report.
  17. Select 'Post File' in 'Action'.
  18. Select the file in 'File(s)'.
  19. Click [Process Action].
  20. Verify the file posted successfully.
  21. Click [OK].
  22. Open 'Service Authorization' for the member.
  23. Verify the member service authorization contains same data as the file import file.
  24. Validate that 'Provider' contains the edited value of the 'Provider To Be Authorized', from position seven of the file.
  25. Close the form.
Scenario 2: File Import - [Avatar MSO] Contracting Provider Service Authorization - Verification of Import with Budget Tracking Accounts Enabled
Specific Setup:
  • Avatar MSO Registry Setting 'Enable Budget Tracking' must be enabled (setting 'YA' or 'YC').
  • Avatar MSO 'Contracting Provider Service Authorization' Import file where Budget Tracking 'Account'/'Account Level Begin Date' values/fields are populated (import file segments 13/14).
Steps
  1. Open 'File Import' form in Avatar PM.
  2. Select File Type '[Avatar MSO] Service Authorization - Contracting Provider'.
  3. Click 'Process Action' button.
  4. Select Avatar MSO 'Contracting Provider Service Authorization' import file and click 'Open' button.
  5. Select 'Compile/Validate File' in 'Action' field.
  6. Click 'Process Action' button.
  7. Ensure that 'Compile/Validate File' action is completed, and user is presented with dialog noting compile completion (and file errors where present in compilation).
  8. Select 'Print Errors' in 'Action' field.
  9. Select loaded and compiled 'Contracting Provider Service Authorization' import file.
  10. Click 'Process Action' button.
  11. In 'File Import Error' report, ensure that in case where Budget Tracking 'Account'/'Account Level Begin Date' values/fields are populated (import file segments 13/14) and 'Total Estimated Liability' value/field is not populated (import file segment 21), import row is not compiled and is included in error report with message 'Missing Total Estimated Liability'.
  12. Select 'Print File' in 'Action' field.
  13. Click 'Process Action' button.
  14. In 'Contracting Provider Service Authorization Import' report, ensure that all valid import row(s) are successfully compiled, and record data is correct (including rows where 'Account'/'Account Level Begin Date' and 'Total Estimated Liability' fields/values are populated).
  15. Select 'Post File' in 'Action' field.
  16. Select loaded and compiled 'Contracting Provider Service Authorization' import file.
  17. Click 'Process Action' button.
  18. Ensure that 'Post File' action is completed, and user is presented with dialog noting post completion.
  19. Open 'Contracting Provider Service Authorization' form.
  20. Select imported/posted Contracting Provider Service Authorization record from pre-display.
  21. Ensure that all valid import row(s) for new or updated Contracting Provider Service Authorization records are correct and complete (including values for 'Account' and 'Total Estimated Liability' fields).
  22. Close the form.
Topics
• Budget Tracking • Contracting Provider Service Authorization • File Import • NX
AV-94361 Summary | Details
Electronic Billing - "Add Support For The Input Of Third Party Payer Amounts" is set to 2
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Professional
  • Admission (Outpatient)
  • Client Ledger
  • Close Batch
  • Contracting Provider Registration
  • CPT Code Definition (MSO)
  • Crystal Report Viewer
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
  • Member Specific Information
  • MSO to Parent System Integration Mapping
  • Provider Fee Definition
  • Registry Settings (PM)
  • Service Authorization
Scenario 1: Electronic Billing - Adjudication or Payment Date validation in DTP*573 - when the registry setting 'Add Support For The Input Of Third Party Payer Amounts'=2
Specific Setup:
  • Registry Settings:
  • The 'Support MSO Other Healthcare Coverage' is set to 'Y'.
  • The 'Add Support For The Input Of Third Party Payer Amounts' set to '2'.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor’s code/name.
  • The 'Bill As Primary Guarantor (837/UB92)' is set to No.
  • Another existing guarantor is identified. Note the submitter id populated for the guarantor to be used in the 837 inbound file.
  • Admission:
  • An existing client is identified, or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
  • Diagnosis:
  • An admission diagnosis record is created for the client.
  • CPT Code Definition:
  • An existing CPT code is identified, or a new CPT code is created. Note the CPT code/description.
  • Funding Source Registration:
  • An existing funding source is identified, or a new funding source is created. Note the funding source name.
  • Plan Definition:
  • A plan definition is created, or an existing plan is identified. Note the plan id/name.
  • Contracting Provider Registration:
  • A new contracting provider is created, or an existing contracting provider is updated. Note the contracting provider number, name and submitter id to be used in the 837 inbound file.
  • Provider Fee Definition:
  • A fee definition is created. Note the fee definition.
  • MSO to Parent System Integration Mapping:
  • Create mapping for Provider, staff, program, CPT codes and Revenue Codes.
  • Member Specific Information:
  • Create a member specific record. Note the policy number to be used in the 837 inbound file.
  • Service Authorization:
  • Create a new service authorization covering a CPT code created above. Note the authorization number to be used in the 837 inbound file.
  • Set System Defaults (MSO):
  • Set the 'Output Directory text' field to the path where the 837 inbound file will be located.
  • The '837 Custom Prefix to Identify Client ID in 2010BA-NM1-09' is set to desired value. Note the value. The same value to be used in the 837 inbound file before client id. (i.e. NM1*IL*1*TEST*ELEVEN*A***MI*MSO934~).
  • An inbound 837 professional/ institutional file containing the Remaining Patient Liability Amount segment is created and stored to the specific location. Note the path of the file location.
Steps
  1. Open the '837 Health Care Claim Professional' or '837 Health Care Claim Institutional' form.
  2. Load an inbound 837 Professional/ institutional file containing the Remaining Patient Liability Amount segment.
  3. Verify the file loads successfully.
  4. Compile the recently loaded file.
  5. Verify the file compiles successfully.
  6. Verify the report generates successfully.
  7. Review the report.
  8. Verify that the services included in the file are approved.
  9. Post the file.
  10. Verify the file posted successfully.
  11. Open the 'Client Ledger' form.
  12. Verify the services from MSO displays correctly with the '*' next to them.
  13. Close the client ledger.
  14. Open the 'Close Charges'.
  15. Close the charges distributed to the client/guarantor.
  16. Open the 'Electronic Billing' form.
  17. Compile an 837 professional/institutional bill for the time period that covers the services rendered to the client.
  18. Verify the 837 bill compiles successfully.
  19. Dump the file.
  20. Review the file.
  21. Verify in the 837 file have SVD and CAS segments producing with the correct date in the DTP*573 segment. Please note if the adjudication payment date is missing from the OHC table, the DTP*573 segment is displays with a '18401231' date.
  22. Close the file.
  23. Close the form.
Topics
• Claims Processing • NX
AV-94701 Summary | Details
Funding Source/Guarantor Mapping - Update Namespace for All Mappings
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Funding Source/Guarantor Mapping
Scenario 1: Funding Source - Guarantor Mapping validation
Specific Setup:
  • An existing funding source is identified, or a new funding source is created. Note the funding source code/value.
Steps
  1. Open the 'Funding Source/Guarantor Mapping' form.
  2. Set the 'Select Funding' to an existing funding source.
  3. Select desired namespace from the 'Namespace' field.
  4. Select desired system code from the 'System Code' field.
  5. Select desired username from the 'Username' field.
  6. Click [Update Namespace/System Code For All Mappings].
  7. Click [OK].
  8. Validate the confirm dialog contains 'Namespace and System Code updated for all mappings on file.'.
  9. Click [OK].
  10. Validate the 'Funding Source/Guarantor Mapping' area contains list of guarantors.
  11. Select desired guarantors.
  12. Click [Submit].
Topics
• Funding Source • NX
Table Changes
Table Column Change
SYSTEM.msoservicecob GetOHCData Method Update