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Avatar MSO 2024 Monthly Release 2024.01.00 Acceptance Tests

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Update 6 Summary | Details
'Explanation Of Benefits' CareFabric Support
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 835 Health Care Claim Payment/Advice (MSO)
  • CareFabric Monitor
Scenario 1: Verification of 'BulkDataStoreUpdate - Explanation Of Benefits' CareFabric Filing via Avatar MSO 835 Generation
Specific Setup:
  • 'BulkDataStoreUpdate' action must be enabled in Avatar system (via 'CareFabric Management' form)
  • EOB record(s) eligible for 835 outbound file inclusion including one or more claims/services originating via Avatar MSO 837 inbound processing
Steps
  1. Open Avatar MSO '835 Health Care Claim Payment/Advice' form.
  2. Note - Acceptance testing may also be confirmed in 835 files created via Avatar MSO Claim Processing Automation functions
  3. Select 'Sort File' in the 'Options' field.
  4. Select 'Contracting Provider' value.
  5. Select EOB(s) for 835 outbound file inclusion in the 'Select EOB(s)' field.
  6. Click 'Process' button.
  7. Ensure that '835 Health Care Claim Payment/Advice Report' is displayed following 835 sorting completion (and includes one or more successfully sorted claims/services for 835 file creation).
  8. Open Avatar PM/Cal-PM 'CareFabric Monitor' form.
  9. Enter values for 'From Date' and 'Through Date' fields (using dates which include 274 Provider Directory Provider Definition entry/edit).
  10. Enter/select values for any other CareFabric Monitor fields as desired.
  11. Click 'View Activity Log' button to display CareFabric Monitor report results.
  12. In CareFabric Monitor report results - ensure that 'BulkDataStoreUpdate' Action/Out Activity is present for all Explanation Of Benefits information/835s generated in the Avatar MSO '835 Health Care Claim Payment/Advice' form for claims/services originating via Avatar MSO 837 inbound processing (activity is per claim with 835 remittance advice generated).
Topics
• 835 Health Care Claim Payment/Advice • CareFabric
Update 10 Summary | Details
Avatar MSO to Avatar Cal-PM Parent System Service Filing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • MSO to Parent System Integration Mapping
  • Client Ledger
Scenario 1: 'Close Batch' - Avatar MSO to Cal-PM Parent System Service Filing, Verification of 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting
Specific Setup:
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' must be enabled
  • Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' may only be accessed/enabled by Netsmart; please contact Netsmart representative/associate for more information
  • Avatar Cal-PM Registry Setting 'Support MSO Other Healthcare Coverage' must be enabled
  • Avatar MSO Registry Setting 'Add Support For The Input Of Third Party Payer Amounts' must be enabled
  • Avatar MSO Registry Setting 'Enable Fee Override in PM' must be set to use Parent System Service Fee Table (set to '0' or '4')
  • If Avatar MSO Registry Setting 'Enable Fee Override in PM' is set to '4', 'Fee Override in PM' date/override type entry for service date(s) must be defined to use 'Parent System Service Fee Table' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section, 'Enable Fee Override in PM' sub-section)
  • '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 Avatar MSO services eligible for filing to parent Avatar Cal-PM system and including Third Party Payment/Adjustment 'Other Healthcare Coverage' information
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar MSO 'Close Batch' form.
  2. Note - Acceptance Testing may also be confirmed on service filing to parent Avatar 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 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 Cal-PM system.
  6. Open 'Client Ledger' form in parent Avatar 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 Cal-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 Cal-PM parent system (where Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' is enabled):
  13. Services including Third Party Payment/Adjustment 'Other Healthcare Coverage' information - Ensure that Avatar Cal-PM Client Ledger 'Charge' value for service(s) reflects the applicable Cal-PM Service Fee Table Amount for service(s)
  14. Note - Avatar Cal-PM 'Cost of Service'/'Guarantor Liability' value for service(s) originating in Avatar MSO with Other Healthcare Coverage information will reflect full Cal-PM Service Fee Table Amount, not including 'Other Healthcare Coverage' Third Party Payment amounts for service filed to Avatar Cal-PM
  15. Note - Third Party Payment/Adjustment 'Other Healthcare Coverage' information from Avatar MSO will be stored with Cal-PM parent service to ensure correctly balanced Avatar Cal-PM outbound 837 claim information where Other Healthcare Coverage information is included in original claim/service (via SQL tables noted below)
  16. Services not including Third Party Payment/Adjustment 'Other Healthcare Coverage' information - Ensure that Avatar Cal-PM 'Charge'/'Cost Of Service' (as well as 'Guarantor Liability') value for service(s) in Avatar Cal-PM reflects the applicable Cal-PM Service Fee Table Amount
  17. Open Crystal Reports or other SQL reporting tool.
  18. In Avatar Cal-PM SQL table 'SYSTEM.mso_service_cob', ensure that claim/service Third Party Payer 'Other Healthcare Coverage' filed with service via Avatar MSO is present.
  19. Note - Avatar Cal-PM instance of SQL table 'SYSTEM.mso_service_cob' will on be populated with data where Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' is enabled
  20. In Avatar Cal-PM SQL table 'SYSTEM.mso_claim_adjustments', ensure that claim/service Third Party Adjustment 'Other Healthcare Coverage' filed with service via Avatar MSO is present.
  21. Note - Avatar Cal-PM instance of SQL table 'SYSTEM.mso_claim_adjustments' will on be populated with data where Avatar Cal-PM Registry Setting 'Enable Override MSO COB Service Charges and Line Adjustments' is enabled
Topics
• Electronic Billing • Client Ledger • Claims Processing
 

Avatar_MSO_2024_Monthly_Release_2024.01.00_Details.csv