Avatar MSO 'Create EOB' Form/Function
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Create EOB
- Registry Settings (PM)
- Retro Claim Adjudication
Scenario 1: 'Create EOB' - Verification of 'Create EOB By Fiscal Year' and 'Include In EOB Retros For Replaced Services Not On EOB' Registry Settings
Specific Setup:
- Avatar MSO Registry Setting 'Include In EOB Retros For Replaced Services Not On EOB' must be enabled
- Avatar MSO Registry Setting 'Create EOB By Fiscal Year' must be enabled ('MM/DD' Fiscal Year boundary date defined)
- One or more claims/services in 'Closed' status Claims Processing Batch(es), included on Voucher and not yet included on EOB
- One or more 'replacement' Retro Claim Adjudication entries not yet included on an EOB, for claims/services in different Fiscal Year period than claims/services for EOB inclusion above (as defined by 'Create EOB By Fiscal Year' Registry Setting date) and where original services have previously been included in EOB
- Crystal Reports or other SQL tool
Steps
- Open 'Create EOB' form.
- Note - Acceptance testing may also be confirmed via Avatar MSO Claims Processing Automation EOB creation
- Select 'All' or 'Individual Providers' for EOB creation.
- Click 'Submit' button.
- Ensure EOB creation confirmation message is displayed on process completion.
- In EOB creation confirmation message, ensure that 'Total Amount of EOB(s) Created' value reflects/includes sum of all service 'Expected Disbursement' amounts and Retro Claim Adjudication entry/entries 'Take Back Amount' included in EOB(s) generated.
- In EOB creation confirmation message, ensure that 'Total Number of EOB(s) Created' value reflects total number of EOB(s) created - ensuring that distinct/multiple EOBs are created by Fiscal Year in case where claims/services in Claims Processing Batch(es) and 'replacement claim' Retro Claim Adjudication entries included in EOB creation criteria exist for different Fiscal Year periods (as defined by 'Create EOB By Fiscal Year' Registry Setting date), including Retro Claim Adjudication entries where original services have previously been included in EOB.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar MSO SQL table 'SYSTEM.table_eob_core', ensure that distinct/multiple row(s) are present in table for all services and/or Retro Claim Adjudication entries included in EOB creation where distinct/multiple EOBs are created by Fiscal Year, including 'replacement claim' Retro Claim Adjudication entries where original services have previously been included in EOB.
- In Avatar MSO SQL table 'SYSTEM.retro_claim_adjudications', ensure that 'EOBID' value is updated to newly created EOB number for all Retro Claim Adjudication entries included in EOB(s) including case where original services have previously been included in EOB.
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Topics
• myAvatar/myAvatar NX
• NX
• Registry Settings
• Retro Claim Adjudication
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