Avatar MSO 2024 Monthly Release 2024.01.01 Acceptance Tests

• Avatar ProviderConnect MSO solution must be present/installed
• 'ProviderConnect File Attach Defaults' form settings/values must be defined
• One or more client records with existing ProviderConnect File Attach attachment records and eligible for 'Client Merge' filing

1. Open Avatar PM/Cal-PM 'Client Merge' form.
2. Select 'Source Client ID', using client with existing ProviderConnect File Attach attachment record(s).
3. Select value for 'Merge All Client Data Through Single Filing' field (and select 'Non-Episodic Data' as 'Source Client Episode' value if applicable).
4. Select 'Target Client ID'.
5. Click 'File' button, and click 'Yes' button in the 'Do You Wish To Continue With The Indicated Action?' dialog.
6. Ensure that merge verification dialog is presented on completion of merge.
7. Open Avatar MSO 'ProviderConnect File Attach' form.
8. Select 'Member ID' value, using 'Target Client ID' value from Client Merge filing.
9. Select 'Provider' and 'File Type' values (and select 'Authorization' value if applicable).
10. Ensure that all ProviderConnect File Attach attachment files originally filed under 'Source Client ID' used in Client Merge are present/relocated to 'Target Client ID' record following non-episodic client data merge (including 'Provider' and 'Other' attachment types associated to Contracting Provider ID, as well as 'Authorization' attachment types associated to merged/relocated Service Authorization records).
11. Select existing/relocated ProviderConnect File Attach attachment file and click 'View File' to display.

• One or more Contracting Provider Registration record(s) where Contracting Provider Program entry has been deleted
• One or more MSO Contracting Provider/Contracting Provider Program/Procedure Code to PM/Cal-PM Program mapping(s) where Contracting Provider Program entry used in mapping has been deleted (defined via 'MSO to Parent System Integration Mapping' form)

1. Open Avatar MSO 'MSO To Parent System Integration Mapping' form.
2. Navigate to 'Mapping Delete' section of form.
3. Within 'Mapping Delete' section of form, navigate to fields for MSO Contracting Provider/Contracting Provider Program/Procedure Code to PM/Cal-PM Program mapping deletion.
4. Enter/select values for 'Contracting Provider', 'Contracting Provider Program', 'Procedure Code' and 'Program' criteria fields.
5. Ensure all existing mappings for selected Contracting Provider/Contracting Provider Program/Procedure Code/Program criteria are listed/present in the 'Available Mapping(s)' field for selection/deletion.
6. Ensure that any previously existing and deleted Contracting Provider/Contracting Provider Program/Procedure Code/Program mappings are not listed/not present in 'Available Mapping(s)' field.
7. Select one or more mapping entries for deletion; click 'Delete' button to delete selected mapping(s).
8. Re-Enter/select values for 'Contracting Provider', 'Contracting Provider Program', 'Procedure Code' and 'Program' criteria fields.
9. Ensure deleted mapping entries are not listed/not present in 'Available Mapping(s)' field.

• File path for 277CA Claim Acknowledgement file creation must be defined in the 'Output Directory' field for system (via Avatar MSO 'Set System Defaults' or 'Import/Export File Configuration' form)
• 277CA Claim Acknowledgment file may optionally be enabled for automatic generation (via Avatar MSO 'Import/Export File Configuration' form)
• 837 Professional and/or Institutional format inbound file(s) for compilation/posting

1. Using Avatar MSO '837 Health Care Claim Professional' and/or '837 Health Care Claim Institutional' forms (or via Avatar MSO automated 837 file processing), load/compile/post inbound 837 file(s).
2. Open the Avatar MSO 'Claim Acknowledgement (277CA) File' form.
3. 277CA file generation/content review may also be confirmed directly in system output directory where automatic 277CA file generation is enabled
4. Select 'Create File On Server' in 'Options' field.
5. Select 'Submission Type' field value ('Institutional' or 'Professional').
6. Select 837 file for Claim Acknowledgement (277CA) file creation.
7. Click 'Process' button.
8. Ensure that for selected 837 file, Claim Acknowledgement (277CA) file is created on server in defined directory.
9. This may be confirmed via the 'Claim Acknowledgement (277CA) File' form 'Run Report' or 'Dump File' options, and/or by reviewing files in 277CA output directory
10. Select 'Dump File' in 'Options' field.
11. Select 'Submission Type' field value ('Institutional' or 'Professional').
12. Select 837 file for Claim Acknowledgement (277CA) file review.
13. Click 'Process' button.
14. 277CA file content review may also be confirmed directly in system output directory by opening/reviewing file(s).
15. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all services within claim are accepted by Avatar MSO, ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Accepted' status (A2).
16. Example:
17. STC*A2:20*20221005*WQ*500~
18. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all services within claim are rejected by Avatar MSO, ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Rejected' status (A7).
19. Example:
20. STC*A7:21*20221005*U*500******A7:454~
21. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where services within claim are both accepted and rejected by Avatar MSO (split claims), ensure that Claim level acceptance (2200D Claim Level Status Information) is reported with 'Acknowledged' status (A5).
22. Example:
23. STC*A5:0*20221005*U*500~
24. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all services within claim are accepted by Avatar MSO, ensure that Service level acceptance information (2220D Service Line Information/Service Line Level Status Information/Service Line Item Identification/Service Line Date) is not included/reported.
25. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Information (2220D SVC) is included/reported for each individual service line within claim only for rejected services (accepted services not reported within 2220D SVC detail for 'split' claims).
26. Examples:
27. SVC*HC:H0004*100*****210~
28. SVC*NU:910*54*****8~
29. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Level Status Information (2220D STC) is included/reported with 'Rejected' status (A7) for individual service line, only for rejected services (accepted services not reported within 2220D STC detail for 'split' claims).
30. Example:
31. STC*A7:21**U*******A7:455~
32. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Item Identification (2220D REF) is included/reported for individual service line, only for rejected services (accepted services not reported within 2220D REF detail for 'split' claims).
33. If 2400 Service Line Item Reference Number (2400 REF) is included in inbound 837 Professional/Institutional claim/service information, this reference number will be reported in 277CA file 2220D REF Service Line Item Identification segment.
34. If 2400 Service Line Item Reference Number (2400 REF) is not included in inbound 837 Professional/Institutional claim/service information, the line sequence number (2400 LX) for the service line within claim will be reported in 277CA file 2220D REF Service Line Item Identification segment
35. Examples:
36. REF*FJ*CX74X66110.003~
37. REF*FJ*3~
38. In 277CA Claim Acknowledgement file(s) for compiled/processed 837 Professional inbound and/or Institutional inbound claims where all or individual services within claim are rejected by Avatar MSO, ensure that Service Line Date (2220D DTP) is included/reported for individual service line only for rejected services (accepted services not reported within 2220D DTP detail for 'split' claims).
39. Examples:
40. DTP*472*D8*20220915~
41. DTP*472*RD8*20220915-20220920~

• Avatar MSO Registry Setting 'Enable Coverage Effective Period' must be enabled
• NOTE - The 'Enable Coverage Effective Period' Registry Setting is a ONE WAY registry setting that can only be enabled. Once enabled, this Registry Setting cannot be disabled
• Avatar MSO Registry Setting 'Enable Eligibility Check' must be enabled
• Avatar MSO Registry Setting 'Require Exact Program Match' may optionally be enabled
• Avatar MSO Registry Setting 'Use Program For Episode Match' may optionally be enabled
• CPT Code/Revenue Code with two or more Coverage Periods defined, where CPT Code/Revenue Code Coverage Periods are mapped to Avatar PM/Cal-PM Service Codes (via Avatar MSO 'MSO To Parent System Integration Mapping' form)
• Avatar MSO to PM/Cal-PM Parent System Financial Eligibility check must be enabled for 'Validate via Financial Eligibility Record' with criteria defined (via Avatar MSO 'Funding Source/Guarantor Mapping' form, 'Eligibility Check' section)
• Client with eligible Service Authorization record(s) valid for Service Entry/Claim Processing

1. Enter one or more claims/services in Avatar MSO using CPT Code/Revenue Code where two or more Coverage Period entries/rows are defined in system, and where CPT Code/Revenue Code Coverage Periods are mapped to Avatar PM/Cal-PM Service Codes.
2. Note - Claim/Service entry may be done via 'Fast Service Entry', 'Claim Processing (CMS 1500)' and/or 'Claim Processing (UB-04)' forms, '837 Health Care Claim Professional'/'837 Health Care Claim Institutional' file compilation/posting, as well as Avatar MSO Automated inbound 837 inbound file processing functionality
3. During or following batch/claim/service entry - open claims/services for review via 'Claim Processing (CMS 1500)' and/or 'Claim Processing (UB-04)' forms (or review directly via Avatar MSO SQL table 'SYSTEM.batch_clm_svc_detail').
4. Navigate to 'Service Detail' section of form.
5. Select service row and click 'Edit Selected Item'.
6. Ensure that Parent System Financial Eligibility Claim Processing/Service Adjudication Approve/Pend/Deny check result for each service is determined according to Coverage Period for related CPT Code/Revenue Code compared to Financial Eligibility record/coverage information, based on date of service and parent system Service Code as defined in MSO CPT Code/Revenue Code to PM/Cal-PM Service Code mapping (via Avatar MSO 'MSO To Parent System Integration Mapping' form).
7. Note - Coverage Period related to service will be entry where 'Date of Service' is on or after 'Coverage Effective Date' and on or prior to 'Coverage Effective Date' for Coverage Effective Period where defined
8. Ensure that 'Claim Status'/'Claim Status Reason' fields are set to values selected for 'Claims Status'/'Claim Status Reason' Approve/Pend/Deny fields (via Avatar MSO 'Funding Source/Guarantor Mapping' form, 'Eligibility Check' section) where Financial Eligibility check for corresponding CPT Code/Revenue Code Coverage Period and parent system Service Code mapping is failed.

• Client record eligible for Service Authorization entry/update

1. Open Avatar MSO 'Service Authorization' form.
2. Enter/select Client ID for Service Authorization entry/update.
3. Click 'Add' button in 'Service Authorization' form pre-display for new record entry (or select existing Service Authorization row/record for update and click 'Edit' button).
4. Enter/select values for 'Funding Source Authorization Is For', 'Benefit Plan' and 'Provider To Be Authorized' fields.
5. Enter values for 'Begin Date of Authorization' and/or 'End Date Of Authorization' fields.
6. Enter/select values for service code information fields (and any other 'Service Authorization' form fields as required/desired).
7. Click 'Submit' button to file 'Service Authorization' form/record.
8. On re-opening of same record in 'Service Authorization' form, ensure that previously entered/filed values for all fields are present, including 'Funding Source Authorization Is For', 'Benefit Plan', 'Provider To Be Authorized' and 'Begin Date of Authorization'/'End Date Of Authorization' fields.

1. Open Avatar MSO 'MSO EOB Message Customization' form.
2. In 'Message Type' field, select 'Miscellaneous Rules'.
3. Ensure value/entry 'Procedure Code is not valid for this date of service' is available in the 'Message Rule' field; select 'Procedure Code is not valid for this date of service'.
4. The 'Procedure Code is not valid for this date of service' Miscellaneous Rule Message will be used for 'Explanation of Coverage' and resulting 837/835 adjustment code information in claim/service adjudication where check on authorization begin/end dates is failed when validating Service Authorization and Contracting Provider Service Authorizations by Plan (in conjunction with Avatar MSO Registry Settings 'Enable Service Authorization by Plan' and 'Enforce Adjudication for Authorization Dates When Authorizing by Plan').
5. Ensure 'Custom Message' value and/or 'Adjustment Code'/'Remark Code' values may be specified for Message Rule; enter/update values as desired.
6. Click 'File' button to save/file MSO EOB Message Customization form entry/details.
7. On re-selecting 'Procedure Code is not valid for this date of service' in 'Message Rule' field, ensure that all previously entered/filed values for 'Custom Message' value and/or 'Adjustment Code'/'Remark Code' fields are present in form.

1. Open 'Registry Settings' form.
2. Enter search value 'Enforce Adjudication for Authorization Dates When Authorizing by Plan' and click 'View Registry Settings' button.
3. Ensure Registry Setting 'Set Batch File Naming Convention' is returned (under 'Avatar MSO-> Care Management -> Service Authorization' path).
4. Ensure 'Registry Setting Details' field contains the following explanation text:

"Selecting "Y" will enforce the system during claim processing to validate that the Date of Service falls within the effective date range of the reported or associated Authorization when that Service or Contracting Provider Authorization has been authorized by the Plan Definition.

Selecting "N" will enforce the system during claim processing to validate that the date of Services falls within the effective date range of the Plan Definition selected in the reported or associated Service or Contracting Provider Authorization.

To enable this registry setting, the setting 'Enable Service Authorization by Plan' must be set to "Y"."

Note - Explanation text/'Registry Setting Details' field contents for Avatar MSO Registry Setting 'Enable Service Authorization By Plan' has also been updated as follows:

"Selecting 'Y' will add "All" as a choice for the field 'Authorization Grouping Or Individual Authorizations' on both the 'Service Authorization' and 'Contracting Provider Service Authorization' forms. When "All" is selected for an authorization, the authorization will cover all services defined within the plan. When this is set to 'Y', during claim processing, the system will validate the Date of Service against the effective dates of the authorized Plan Definition. To validate the Date of Service against the effective dates within the reported Authorization, the registry setting "Enforce Adjudication for Authorization Dates When Authorizing by Plan" must also be enabled.

Selecting 'N' will remove "All" as a choice for the field 'Authorization Grouping Or Individual Authorizations' on both the 'Service Authorization' and 'Contracting Provider Service Authorization' forms."

• Avatar MSO Registry Setting 'Enable Service Authorization By Plan' must be enabled
• Avatar MSO Registry Setting 'Enforce Adjudication for Authorization Dates When Authorizing by Plan' must be enabled
• Client with eligible Service Authorization record and/or Contracting Provider Service Authorization record valid for Service Entry/Claim Processing, where 'All' is selected for 'Authorization Grouping Or Individual Authorizations' field

1. Enter one or more claims/services in Avatar MSO, associated to Service Authorization record or Contracting Provider Service Authorization record where 'All' is selected for 'Authorization Grouping Or Individual Authorizations' field (authorization by plan).
2. Note - Claim/service entry may be done via 837 Professional/837 Institutional inbound file posting, as well as 'Fast Service Entry', 'Claim Processing (CMS 1500)' and/or 'Claim Processing (UB-04)' forms
3. Open claims/services for review via 'Claim Processing (CMS 1500)' and/or 'Claim Processing (UB-04)' forms following entry, or review in form during manual service entry (service adjudication information may also be reviewed directly via Avatar MSO SQL table 'SYSTEM.batch_clm_svc_detail').
4. Navigate to 'Service Detail' section of form.
5. Select service row for and click 'Edit Selected Item'.
6. For claims/services associated to Service Authorization record or Contracting Provider Service Authorization record where 'All' is selected for 'Authorization Grouping Or Individual Authorizations' field (authorization by plan), ensure that services are adjudicated as follows:
7. Where Registry Setting 'Enforce Adjudication for Authorization Dates When Authorizing by Plan' is enabled (and Registry Setting 'Enable Service Authorization By Plan' is enabled):
8. In case where date of service is outside of associated/selected Service Authorization record or Contracting Provider Service Authorization dates ('Begin Date of Authorization'/'End Date of Authorization'), service will be adjudicated with 'Denied' claim status
9. 'Explanation of Coverage' field will include value 'Procedure Code is not valid for this date of service' or customized EOB message if defined (via 'MSO EOB Message Customization' form)
10. Date of service check against associated/selected Service Authorization record or Contracting Provider Service Authorization dates will also incorporate 'Days Permitted Prior To Authorization Begin Date'/'Days Permitted Beyond Authorization Begin Date' settings if defined (via 'Approve/Pend/Deny Rules Definition' form)
11. In case where date of service is within associated/selected Service Authorization record or Contracting Provider Service Authorization and within associated Benefit Plan effective dates, service will be adjudicated with 'Approved' claim status (Subject to all other defined/applicable Approve/Pend/Deny Rules and Claim Processing settings)
12. Where Registry Setting 'Enforce Adjudication for Authorization Dates When Authorizing by Plan' is disabled (only Registry Setting 'Enable Service Authorization By Plan' enabled):
13. In case where date of service is outside of associated/selected Service Authorization record or Contracting Provider Service Authorization dates but is within associated Benefit Plan effective dates ('Date Plan Offered Effective Date'/'Date Plan Offered Expiration Date', from 'Plan Definition' form), service will be adjudicated with 'Approved' claim status
14. In case where date of service is outside of associated Benefit Plan effective dates (regardless of associated/selected Service Authorization record or Contracting Provider Service Authorization dates), service will be adjudicated with 'Denied' claim status
15. 'Explanation of Coverage' field will include value 'Date Of Service Is Beyond Plan Expiration Date'/'Date Of Service Is Prior To Plan Effective Date' or customized EOB message if defined (via 'MSO EOB Message Customization' form)

1. Open Avatar MSO 'MSO EOB Message Customization' form.
2. In 'Message Type' field, select 'Miscellaneous Rules'.
3. Ensure value/entry 'Total Expected Disbursement exceeds current Account Level amount' is available in the 'Message Rule' field; select 'Total Expected Disbursement exceeds current Account Level amount'.
4. The 'Total Expected Disbursement exceeds current Account Level amount' Miscellaneous Rule Message will be used for 'Explanation of Coverage' and resulting 835 Adjustment Code information in claim/service adjudication where the Budget Tracking Account Level amount allowance claim/service adjudication rule results in denied service/reduced expected disbursement amount (in conjunction with Avatar MSO Registry Setting 'Enable Budget Tracking').
5. Ensure 'Custom Message' value and/or 'Adjustment Code'/'Remark Code' values may be specified for Message Rule; enter/update values as desired.
6. Click 'File' button to save/file MSO EOB Message Customization form entry/details.
7. On re-selecting 'Procedure Code is not valid for this date of service' in 'Message Rule' field, ensure that all previously entered/filed values for 'Custom Message' value and/or 'Adjustment Code'/'Remark Code' fields are present in form.

• Avatar MSO Registry Setting 'Enable Service Times' must be enabled
• CPT Code Definition where 'Require Service Time' is set to 'Yes' (via Avatar MSO 'CPT Code Definition' form)
• Client record(s) valid for Service Entry/Claim Processing

1. Open Avatar MSO 'Fast Service Entry' form (or 'Fast Service Entry Submission' form).
2. Enter/select value in 'Date Claims Received' and 'Close Batches' fields (if applicable).
3. Navigate to 'Fast Service Detail' section of form.
4. Click 'Add New Item' button to enter new service.
5. Enter/select client for service entry in 'Member Name or ID', field.
6. Enter/Select value in 'Funding Source' field.
7. Enter/select value in 'Provider' field.
8. Enter/select 'Date of Service' field value.
9. Enter/select 'Procedure Code' field value.
10. If 'Require Service Time' is set to 'Yes' for CPT Code entered/selected in 'Procedure Code' field, ensure that 'Service Start Time' and 'Service End Time' fields are enabled and required in form.
11. Enter/select values for all required/desired fields in form, including 'Service Start Time' and 'Service End Time' fields.
12. In case where 'Allow Service Time Overlap' is set to 'No' for CPT Code entered/selected in 'Procedure Code' field (or where 'Allow Service Time Overlap is set to 'Yes' and CPT Code entered/selected in 'Procedure Code' field is not selected for 'Overlap With Procedure Codes' field) - ensure that services for different/distinct Member IDs are not denied in Fast Service Entry form for 'Service times overlap with another service' adjudication check/reason where service times overlap for same CPT Code across two or more different/distinct Member IDs.
13. In case where 'Allow Service Time Overlap' is set to 'No' for CPT Code entered/selected in 'Procedure Code' field (or where 'Allow Service Time Overlap is set to 'Yes' and CPT Code entered/selected in 'Procedure Code' field is not selected for 'Overlap With Procedure Codes' field)- ensure that services for same/single Member ID are denied in Fast Service Entry form for 'Service times overlap with another service' adjudication check/reason where service times overlap for same CPT Code and same/single Member IDs.
14. Click 'Submit' button to file 'Fast Service Entry' form (or 'Fast Service Entry Submission' form).

• CPT Code/Service Code with Provider Fee Definition where 'Allow Duplicate Services On The Same Day?' is set to 'No' (via Avatar MSO 'Provider Fee Definition' form)
• Adjudication status for (Approve/Pend/Deny) for rule 'Duplicate Service Found' must be defined (via Avatar MSO 'Approve/Pend/Deny Rules Definition' form)
• Client record(s) valid for Service Entry/Claim Processing

1. Enter two or more Professional/CMS 1500 claims/services in Avatar MSO using CPT Code/Service Code where 'Allow Duplicate Services On The Same Day?' is set to 'No' for applicable Provider Fee Definition, for two or more different/distinct Member IDs.
2. Note - Professional/CMS 1500 Claim/Service entry may be done via 837 Health Care Claim Professional inbound file compilation/posting, as well as via 'Fast Service Entry' and/or 'Claim Processing (CMS 1500)' forms
3. For claims/services originating via 837 Professional inbound file posting, adjudicate batches/claims/services (via 'Manual Batch Adjudication' form, system automatic adjudication processes and/or 'Close Batch' function).
4. During or following batch/claim/service entry - open claims/services for review via 'Claim Processing (CMS 1500)' form (or review directly via Avatar MSO SQL table 'SYSTEM.batch_clm_svc_detail').
5. Navigate to 'Service Detail' section of form.
6. Select service row and click 'Edit Selected Item'.
7. In Avatar MSO 'Claim Processing...' forms/functions and service adjudication data - ensure that 'Duplicate service check from Provider Fee Definition' Claim Processing/Service Adjudication Approve/Pend/Deny check result for each service is determined per-Member ID (with other potentially duplicated services only being considered for single/distinct Member ID across same or different claims in system).
8. In Avatar MSO 'Claim Processing...' forms/functions and service adjudication data - ensure that duplicate services (same/single Member ID, same service date and using same CPT/Revenue Code and fee criteria as another existing 'Approved' service) are adjudicated with Claim Status value selected for 'Duplicate Service Found' Approve/Pend/Deny fields (via Avatar MSO 'Approve/Pend/Deny Rules Definition' form).
9. 'Explanation of Coverage' field will include notice of Duplicate Service entry failed for adjudication
10. Example: 'The service was denied for the following reason: Duplicate Service Found'

• Revenue Code/Service Code with Provider Fee Definition where 'Allow Duplicate Services On The Same Day?' is set to 'No' (via Avatar MSO 'Provider Fee Definition' form)
• Adjudication status for (Approve/Pend/Deny) for rule 'Duplicate Service Found' must be defined (via Avatar MSO 'Approve/Pend/Deny Rules Definition' form)
• Client record(s) valid for Service Entry/Claim Processing

1. Enter two or more Institutional/UB-04 claims/services in Avatar MSO using Revenue Code/Service Code where 'Allow Duplicate Services On The Same Day?' is set to 'No' for applicable Provider Fee Definition, for two or more different/distinct Member IDs.
2. Note - Institutional/UB-04 Claim/Service entry may be done via 837 Health Care Claim Institutional inbound file compilation/posting, as well as via 'Claim Processing (UB-04)' form
3. For claims/services originating via 837 Institutional inbound file posting, adjudicate batches/claims/services (via 'Manual Batch Adjudication' form, system automatic adjudication processes and/or 'Close Batch' function).
4. During or following batch/claim/service entry - open claims/services for review via 'Claim Processing (UB-04)' form (or review directly via Avatar MSO SQL table 'SYSTEM.batch_clm_svc_detail').
5. Navigate to 'Service Detail' section of form.
6. Select service row and click 'Edit Selected Item'.
7. In Avatar MSO 'Claim Processing...' forms/functions and service adjudication data - ensure that 'Duplicate service check from Provider Fee Definition' Claim Processing/Service Adjudication Approve/Pend/Deny check result for each service is determined per-Member ID (with other potentially duplicated services only being considered for single/distinct Member ID across same or different claims in system).
8. In Avatar MSO 'Claim Processing...' forms/functions and service adjudication data - ensure that duplicate services (same/single Member ID, same service date and using same CPT/Revenue Code and fee criteria as another existing 'Approved' service) are adjudicated with Claim Status value selected for 'Duplicate Service Found' Approve/Pend/Deny fields (via Avatar MSO 'Approve/Pend/Deny Rules Definition' form).
9. 'Explanation of Coverage' field will include notice of Duplicate Service entry failed for adjudication
10. Example: 'The service was denied for the following reason: Duplicate Service Found'

• Avatar MSO Registry Setting 'Display Requested Units Fields' may optionally be enabled
• Avatar MSO Registry Setting 'Set Service Authorization Pre-Display' may optionally be defined with pre-display fields other than system default

1. Open one or more of the following Avatar MSO Service Authorization forms:
2. 'Service Authorization Request'
3. 'Service Authorization'
4. 'Contracting Provider Service Authorization Request'
5. 'Contracting Provider Service Authorization'
6. 'Funding Source Service Authorization'
7. Select entity for Service Authorization entry/edit (Member/Contracting Provider/Funding Source).
8. In Service Authorization form pre-display, ensure that existing Service Authorization records for selected Member/Contracting Provider/Funding Source are present and are displayed in descending order by entry date (with most recently entered record first in pre-display).
9. Ensure that clicking column heading (ex: 'Begin Date', 'Auth #') re-sorts existing records in pre-display in ascending or descending order by selected data element.
10. Select existing row and click 'Edit' for view/update, or click 'Add' button for new Service Authorization record entry.