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Avatar MSO 2024 Monthly Release 2024.01.01 Details

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Product Requirements and Recommendations

Avatar MSO required
RADplus required

  • 'Client Merge' for 'ProviderConnect File Attach' Records
    An issue is resolved to ensure that ProviderConnect File Attach attachments associated to Client/Provider are moved to 'Target Client' record for non-episodic information merged via Avatar PM/Cal-PM 'Client Merge' form.
  • 'MSO To Parent System Integration Mapping' Form
    An issue is resolved to ensure that error "[UNDEFINED]GetProcCodeMapping+41^MSPPMMAPEditUtils" does not occur in the 'MSO to Parent System Integration Mapping' form 'Mapping Delete' section in case where Contracting Provider Programs with existing Provider/Program/Service Code mapping(s) are deleted.
  • Avatar MSO 'Claim Acknowledgement (277CA) File' Service Line Information
    An issue is resolved to ensure that 277CA files generated via the Avatar MSO 'Claim Acknowledgement (277CA) File' form do not produce/include service line information for approved services.
  • Avatar MSO Claim Processing Eligibility Check
    An issue is resolved to ensure that Avatar MSO Claim Processing Parent System Financial Eligibility adjudication/check correctly recognizes CPT Code/Revenue Code Coverage Effective Periods where used in mappings defined via the 'MSO to Parent System Integration' form (where Avatar MSO Registry Setting 'Enable Coverage Effective Period' is enabled).
  • Avatar MSO 'Service Authorization' Form
    An issue is resolved to prevent form latency issues after a 'Begin Date Of Authorization' is entered/selected in the Avatar MSO 'Service Authorization' form.
Included Updates
None
Product Update Description
The following issues are resolved: 1) ProviderConnect attachments fail to move to merged member. 2) The "[UNDEFINED]GetProcCodeMapping+41^MSPPMMAPEditUtils" error produced in the 'MSO to Parent System Integration Mapping' form. 3) 277CA files generated via the 'Claim Acknowledgement (277CA) File' form is producing service information for approved services. 4) Financial Eligibility adjudication check is not recognizing coverage effective periods in the 'MSO to Parent System Integration' form. 5) Latency issues after a 'Begin Date Of Authorization' is entered in the 'Service Authorization' form.
Topics
• Client Merge • MSO To Parent System Integration Mapping • 837 Health Care Claim Professional • Claims Processing • 837 Health Care Claim Institutional • Registry Settings • CPT Code Definition • Revenue Code Definition • Service Authorizations
  • Avatar MSO Registry Settings
    Registry Setting 'Enforce Adjudication for Authorization Dates When Authorizing by Plan' is added to Avatar MSO.
    Avatar MSO Registry Setting 'Enforce Adjudication for Authorization Dates When Authorizing by Plan' will allow/enforce a check on authorization begin/end dates when validating Service Authorization and Contracting Provider Service Authorizations by Plan (in conjunction with Avatar MSO Registry Setting 'Enable Service Authorization by Plan'). In addition, 'Miscellaneous' type message/rule 'Procedure Code is not valid for this date of service' is added to the Avatar MSO 'MSO EOB Message Customization' form for Explanation of Coverage field use where begin/end dates check for Service Authorization/Contracting Provider Service Authorization is failed.
Included Updates
2, 7
Product Update Description
The registry setting 'Enforce Adjudication for Authorization Dates When Authorizing by Plan' is added will add a check on authorization dates when validating an authorization by plan.
Topics
• Claims Processing • Registry Settings • 837 Health Care Claim Professional • 837 Health Care Claim Institutional
  • 'MSO EOB Message Customization' Messages
    'Miscellaneous' type message/rule 'Total Expected Disbursement exceeds current Account Level amount' is added to the 'MSO EOB Message Customization' form.
    'Miscellaneous' type message/rule 'Total Expected Disbursement exceeds current Account Level amount' in the Avatar MSO 'MSO EOB Message Customization' form may be used for Explanation of Coverage field/835 Claim Adjustment Reason Code information where the Budget Tracking Account Level amount allowance claim/service adjudication rule results in denied service/reduced expected disbursement amount.
  • Avatar MSO 'Fast Service Entry' form
    An issue is resolved to ensure that the Avatar MSO 'Fast Service Entry' form does not incorrectly trigger service time overlap denials across different/distinct member IDs.
  • Avatar MSO Claim Processing Duplicate Service Check
    An issue is resolved in Avatar MSO 'Claim Processing...' forms/functions to ensure that services are not incorrectly denied for failing the duplicate service check across different/distinct member IDs.
Included Updates
2, 7, 9, 10
Required Updates
Avatar MSO 2024 Update 2
Product Update Description
Miscellaneous EOB Message is added for the "Total Expected Disbursement exceeds current Account Level amount" adjudication rule to allow CAS adjustments to produce on the outbound 835. Also, the following issues are resolved: 1) Fast Service Entry forms falsely trigger time overlap denials for different members. 2) Services incorrectly being denied for duplicate service when member IDs are different.
Topics
• Claims Processing • Registry Settings • CPT Code Definition
  • Avatar MSO Service Authorization Forms Pre-Display
    Pre-display sort order is updated for several Avatar MSO Service Authorization forms.
    The sort order in the pre-display for the following Avatar MSO forms is updated to display the most recently entered Authorization first: * 'Service Authorization Request' * 'Service Authorization' * 'Contracting Provider Service Authorization Request' * 'Contracting Provider Service Authorization' * 'Funding Source Service Authorization'
Included Updates
None
Product Update Description
Updated the Authorization sort in the pre-display for the forms: 'Service Authorization Request', 'Service Authorization', 'Contracting Provider Service Authorization Request', 'Contracting Provider Service Authorization', 'Funding Source Service Authorization' to display the most recently entered Authorization first.
Topics
• Contracting Provider Service Authorization • Service Authorizations
  • Web service - WEBSVC.ServiceAuthorization.GetRemainingUnits
    Resolves an issue to ensure that the 'GetRemainingUnits' method of the web service displays the correct remaining units after each service entry.
Included Updates
2, 7, 9, 10
Product Update Description
Resolved the issue where the 'Set Treatment Date' button does not respond causing providers to not be able to enter services via PCONN, as well as the 'Service Authorization' web service erroring when submitting.
Topics
• Service Entry • Web Services
  • Approve/Pend/Deny Rule Definition - Duplicate service check
    Resolves an issue to ensure that any 'Claim Processing' forms correctly defined the status of the claim when duplicate claims/services are created for the member.
Included Updates
2
Required Updates
Avatar MSO 2024 Update 2
Product Update Description
The issue is resolved where the error "[UNDEFINED]GetTotalUnitsForDay+73^MSOCLAIM1" is produced when entering a service in any of the Claim Processing forms, and when compiling 837 files via the '837 Health Care Claim Professional' and '837 Health Care Claim Institutional' forms.
Topics
• 837 Health Care Claim Professional • 837 Professional • Claims Processing
 

Avatar_MSO_2024_Monthly_Release_2024.01.01_Details.csv