Avatar MSO 2024 Monthly Release 2024.01.02 Acceptance Tests

• Internal Testing Only

• Document Management Configuration must be defined for Cache Server or Perceptive (via Avatar PM / RADplus Utilities 'Document Management Defaults' form)
• Dictionary Codes may optionally be defined for 'Other Tabled Files' Data Element '(70007) Document Type' (via Avatar MSO 'Dictionary Update' form)
• 'Provider File Attach' Widget may optionally be assigned to Chart View Definition/Home View Definition/Client Dashboard View assigned to user (via 'View Definition' form / 'NX View Definition' form)
• Clinical Document Viewer/Document Management/All Documents Widgets may optionally be assigned to Chart View Definition/Home View Definition/Client Dashboard View assigned to user (via 'View Definition' form / 'NX View Definition' form)
• One or more .PDF (Adobe Portable Document Format) and/or .TIF (Tagged Image File Format) files for Provider File Attach upload/storage
• Crystal Reports or other SQL reporting tool

1. Open Avatar MSO 'Provider File Attach' form (under 'Avatar MSO / Provider Management' menu).
2. Enter/select 'Member ID' value.
3. Enter/select 'Provider' value.
4. In 'File Type' field, ensure the following selections are available:
5. 'Authorization' (will link File Attachment to a specific Avatar MSO Service Authorization record for selected Provider)
6. 'Provider' (will link File Attachment to selected Provider)
7. 'Other' (will link File Attachment to selected Provider)
8. Select 'File Type' value (and 'Authorization' field value if applicable).
9. Select 'Document Type' value and/or enter 'Comments' value if desired.
10. Click 'Upload File' button, and select file for Provider Attachment upload/storage.
11. On completion of File Attachment upload, ensure 'File Name' field is populated with uploaded file name.
12. Click 'Store File' field to store File Attachment in Avatar MSO; ensure user is presented with confirmation dialog noting 'File successfully created'.
13. Click 'OK' button to return to 'Provider File Attach' form.
14. Select 'File Type' value for previously uploaded/stored File Attachment.
15. Ensure uploaded/stored File Attachment files are listed/available for selection in the 'Existing Files' field.
16. Close 'Provider File Attach' form.
17. Navigate to Home View, Chart View or Client Dashboard View where Avatar MSO 'Provider File Attach' Widget is assigned/present
18. Ensure that the 'Provider File Attach' Widget displays all uploaded/stored File Attachment files for selected/currently active Member ID/Client (one row in Widget display per File Attachment).
19. Navigate to Home View, Chart View or Client Dashboard View where one or more myAvatar Clinical Document Viewer/Document Management/All Documents Widgets is/are assigned/present
20. Ensure that the Clinical Document Viewer/Document Management/All Documents Widget displays all uploaded/stored File Attachment files where expected for selected/currently active Member ID/Client, including 'Form Name' value of 'Provider Document'.
21. Open Crystal Reports or other SQL reporting tool.
22. In Avatar PM/Avatar MSO SQL table 'DOCM.document_image', ensure that all uploaded/stored Provider File Attachment files are present in SQL table data (one row per File Attachment); ensure that 'formID' value for Provider File Attachment records is 'PCON' ('Provider Document').
23. Note - As 'formID' is used for 'Form Name' display in Clinical Document Viewer/Document Management/All Documents Widgets; on installation of RADPlus 2024 Update 34, all existing Provider File Attach related Document Management rows will be updated with 'formID' value 'PCON'
24. In Avatar MSO SQL table 'SYSTEM.file_attach_object', ensure that all uploaded/stored Provider File Attachment files are present in SQL table data (one row per File Attachment).
25. In Avatar MSO SQL table 'SYSTEM.file_attach_comments', ensure that all uploaded/stored Provider File Attachment 'Comments' field entries are present in SQL table data (one row per 'Comments' entry).

1. Open 'Registry Settings' form.
2. Enter search value 'Enable Coverage Effective Period' and click 'View Registry Settings' button.
3. Ensure Registry Setting 'Enable Coverage Effective Period' is returned (under 'Avatar MSO -> Claims Processing' path).
4. Ensure that 'Enable Coverage Effective Period' Registry Setting may only be set to value 'N' (no/disabled) or 'Y' (yes/enabled); if any value other than 'N' or 'Y' is entered, ensure user is presented with error dialog noting 'The selected value is not valid in the current system code for the following reason: Invalid response -- must be Y or N' and the entry is disallowed.
5. Ensure 'Registry Setting Details' field contains the following explanation text:

"Selecting 'Y' will add the ability to define multiple coverage effective periods with the 'CPT Code Definition' and 'Revenue Code Definition' forms. This will allow users to configure different definitions for a single CPT or Revenue Code based upon non-overlapping effective date ranges. Selecting 'Y' will do the following:

1 - Add the fields 'Coverage Period', 'Coverage Effective Date', 'Coverage Expiration Date', 'File Coverage Period', and 'Delete Coverage Period' in the 'CPT Code Definition' and 'Revenue Code Definition' forms.

2 - Add the required fields 'Coverage Period' and 'Coverage Revenue Period' the 'MSO to Parent System Integration Mapping' form for the CPT Code Mapping (Page 6) and Revenue Code Mapping (Page 7).

3 - Re-file all CPT and Revenue Code Definition mappings to map the initial coverage effective date range.

4 - Re-file all CPT and Revenue Code Definitions and create an initial coverage effective date range with an effective date of 1/1/1900.

5 - Update the CPT/Revenue Code Import to support the ability to import more than one definition for a single CPT or Revenue Code as long as the effective dates are provided and are non-overlapping.

NOTE: This registry setting is a ONE WAY registry setting that can only be enabled. Once turned on, this registry setting cannot be disabled."

• One or more client record(s) eligible for Service Authorization entry/import
• Avatar MSO 'Service Authorization - Member' Import File containing one or more valid import rows, optionally including one or more 'Edit' rows/entries

1. Open 'File Import' form in Avatar PM/Cal-PM.
2. Select File Type '[Avatar MSO] Service Authorization - Member'.
3. Click 'Process Action' button.
4. Select Avatar MSO Service Authorization - Member import file and click 'Open' button.
5. Select 'Compile/Validate File' in 'Action' field.
6. Select loaded import file and click 'Process Action' button.
7. Ensure that 'Compile/Validate File' action completes, and message 'Compiled' or '(File Name) contains one or more errors. These errors can be reviewed using 'Print Errors' action' is displayed.
8. Click 'OK' button.
9. Select 'Post File' in 'Action' field.
10. Select compiled Avatar MSO Service Authorization - Member import file and click 'Process Action' button.
11. Ensure that 'Post' action completes, and message 'Posted' and/or 'The selected file contains one or more lines with compilation errors. Only those lines without compilation errors will be posted' is displayed.
12. Open Avatar MSO 'Service Authorization' form.
13. Select Client ID for 'Service Authorization' view/edit where File Import record/row posted.
14. Select Service Authorization row/record filed via File Import in form pre-display and click 'Edit' button to open.
15. Ensure that imported/filed values are present in 'Service Authorization' form fields for new or updated file import rows/entries.

• Crystal Reports or other SQL reporting tool

1. Open Avatar MSO 'Plan Definition' form.
2. Search/select existing Benefit Plan for update and click 'OK' button to open, or click 'New Plan' button to enter new Benefit Plan.
3. Enter/select values for fields in 'Plan Definition' main/first section of form as required/desired.
4. Navigate to 'Plan Coverage Definition' section of form.
5. Select existing Plan Covered Services row and click 'Edit Selected Item' button, or click 'Add New Item' button to enter new Plan Covered Services row.
6. Enter/select values for fields in 'Plan Coverage Definition' section of form as required/desired; enter/update additional Plan Covered Services row(s) as desired.
7. Click 'Submit' button to save/file 'Plan Definition' form/record.
8. Open Crystal Reports or other SQL reporting tool.
9. In Avatar MSO SQL table 'SYSTEM.plan_covered_services', ensure that entries filed via 'Plan Definition' form ('Plan Coverage Definition' section) are present in SQL table information.
10. In Avatar MSO SQL table 'SYSTEM.plan_covered_services', ensure that the field size/maximum character allowance for multi-code selection fields is 5000 characters, including the following fields:
11. 'cpt_coverage_group_code'
12. 'cpt_service_codes_code'
13. 'diag_code_for_cvg_code'
14. 'diag_code_no_cvg_code'
15. 'diag_grp_for_cvg_code'
16. 'diag_grp_no_cvg_code'
17. 'elig_reason_code'
18. 'icd10_diag_code_for_cvg_code'
19. 'icd10_diag_code_no_cvg_code'
20. 'procedure_group_code'
21. 'rev_coverage_group_code'
22. 'revenue_code_code'

• One or more Avatar MSO Contracting Provider/Performing Provider records eligible for PM/Cal-PM parent system Program/Practitioner mapping
• Crystal Reports or other SQL reporting tool

1. Open Avatar MSO 'MSO To Parent System Integration Mapping' form.
2. In first/main section of form, navigate to Avatar MSO 'Contracting Provider/Performing Provider' to Avatar PM/Cal-PM 'Staff/Program' mapping fields (third page/sub-section).
3. Enter/select value for 'Contracting Provider' and 'Performing Provider' fields.
4. Enter/select corresponding values for 'Staff' and 'Program' fields.
5. Click 'File' button to save/file 'Contracting Provider/Performing Provider' to 'Staff/Program' mapping entry; ensure user is presented with filing confirmation dialog noting 'Mapping Has Been Filed Successfully.'
6. Repeat selection/entry of additional 'Contracting Provider/Performing Provider' to 'Staff/Program' mapping entries as desired.
7. Open Crystal Reports or other SQL reporting tool.
8. In Avatar MSO SQL table 'SYSTEM.table_parentmap_per_prov', ensure that all Avatar MSO 'Contracting Provider/Performing Provider' to Avatar PM/Cal-PM 'Staff/Program' mapping entries filed via 'MSO To Parent System Integration Mapping' form ('Plan Coverage Definition' section) are present in SQL table information.

1. Open 'Registry Settings' form.
2. Enter search value 'MSO Location Field' and click 'View Registry Settings' button.
3. Ensure Registry Setting 'MSO Location Field' is returned (under 'Avatar MSO-> Claims Processing -> Service Detail' path).
4. Ensure 'Registry Setting Details' field contains the following explanation text:

"The following are valid values for the behavior of the 'Location' field on the claims processing options.

0: Hide 'Location' - Default

1: Display 'Location'

2: Display and push 'Location' to Parent System.

3: Display and require 'Location'

4: Display, require and push 'Location' to Parent System.

5: Display 'Location' in all forms and require 'Location' in 'Fast Service Entry', 'Claim Processing (CMS 1500)' and 'Claim Processing with Override (CMS 1500)'.

6: Display and push 'Location' to Parent System in all forms and require 'Location' in 'Fast Service Entry', 'Claim Processing (CMS 1500)' and 'Claim Processing with Override (CMS 1500)'."

• Avatar MSO Registry Setting 'MSO Location Field' may optionally be enabled/configured (Registry Setting values '0' through '6')
• Client record(s) valid for Service Entry/Claim Processing

1. Open Avatar MSO 'Claim Processing (CMS 1500)' form (and/or 'Claim Processing With Override (CMS 1500)' form).
2. Select claims processing batch for service entry/edit.
3. Open existing claim for adjudication or create new claim for service entry/edit.
4. Set value for 'Member Name or ID' and 'Provider' in claim level section (if adding new claim/services).
5. Navigate to 'Service Detail' section of form.
6. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button).
7. Ensure that the 'Location' field is present in 'Claim Processing (CMS 1500)' form (and required/optional for entry) according to the 'MSO Location Field' Registry Setting as follows:
8. Where 'MSO Location Field' Registry Setting value is '0' - ensure that 'Location' field is not present in form
9. Where 'MSO Location Field' Registry Setting value is '1' - ensure that 'Location' field is present in form as a non-required/optional entry field
10. Where 'MSO Location Field' Registry Setting value is '2' - ensure that 'Location' field is present in form as a non-required/optional entry field
11. Where 'MSO Location Field' Registry Setting value is '3' - ensure that 'Location' field is present in form as a required entry field
12. Where 'MSO Location Field' Registry Setting value is '4' - ensure that 'Location' field is present in form as a required entry field
13. Where 'MSO Location Field' Registry Setting value is '5' - ensure that 'Location' field is present in form as a required entry field
14. Where 'MSO Location Field' Registry Setting value is '6' - ensure that 'Location' field is present in form as a required entry field
15. Enter/select values in all other service detail fields as required/desired.
16. Click 'Add New Item' button to enter additional service(s) (or select additional existing service and click 'Edit Selected Item' button to update/adjudicate additional service(s)).
17. Click 'Submit' button to file 'Claim Processing (CMS 1500)' form (or 'Claim Processing With Override (CMS 1500)' form) and claim/service(s).

• Avatar MSO Registry Setting 'MSO Location Field' may optionally be enabled/configured (Registry Setting values '0' through '6')
• Client record(s) valid for Service Entry/Claim Processing

1. Open Avatar MSO 'Claim Processing (UB-04)' form (and/or 'Claim Processing With Override (UB-04)' form).
2. Select claims processing batch for service entry/edit.
3. Open existing claim for adjudication or create new claim for service entry/edit.
4. Set value for 'Member Name or ID' and 'Provider' in claim level section (if adding new claim/services).
5. Navigate to 'Service Detail' section of form.
6. Click 'Add New Item' button (or select existing service and click 'Edit Selected Item' button).
7. Ensure that the 'Location' field is present in 'Claim Processing (UB-04)' form (and required/optional for entry) according to the 'MSO Location Field' Registry Setting as follows:
8. Where 'MSO Location Field' Registry Setting value is '0' - ensure that 'Location' field is not present in form
9. Where 'MSO Location Field' Registry Setting value is '1' - ensure that 'Location' field is present in form as a non-required/optional entry field
10. Where 'MSO Location Field' Registry Setting value is '2' - ensure that 'Location' field is present in form as a non-required/optional entry field
11. Where 'MSO Location Field' Registry Setting value is '3' - ensure that 'Location' field is present in form as a required entry field
12. Where 'MSO Location Field' Registry Setting value is '4' - ensure that 'Location' field is present in form as a required entry field
13. Where 'MSO Location Field' Registry Setting value is '5' - ensure that 'Location' field is present in form as a non-required/optional entry field
14. Where 'MSO Location Field' Registry Setting value is '6' - ensure that 'Location' field is present in form as a non-required/optional entry field
15. Enter/select values in all other service detail fields as required/desired.
16. Click 'Add New Item' button to enter additional service(s) (or select additional existing service and click 'Edit Selected Item' button to update/adjudicate additional service(s)).
17. Click 'Submit' button to file 'Claim Processing (UB-04)' form (or 'Claim Processing With Override (UB-04)' form) and claim/service(s).

• Avatar MSO Registry Setting 'MSO Location Field' may optionally be enabled/configured (Registry Setting values '0' through '6')
• Client record(s) valid for Service Entry/Claim Processing

1. Open Avatar MSO 'Fast Service Entry' form (and/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', 'Provider', 'Date of Service' and 'Procedure Code' fields.
7. Ensure that the 'Location' field is present in 'Fast Service Entry' form (and required/optional for entry) according to the 'MSO Location Field' Registry Setting as follows:
8. Where 'MSO Location Field' Registry Setting value is '0' - ensure that 'Location' field is not present in form
9. Where 'MSO Location Field' Registry Setting value is '1' - ensure that 'Location' field is present in form as a non-required/optional entry field
10. Where 'MSO Location Field' Registry Setting value is '2' - ensure that 'Location' field is present in form as a non-required/optional entry field
11. Where 'MSO Location Field' Registry Setting value is '3' - ensure that 'Location' field is present in form as a required entry field
12. Where 'MSO Location Field' Registry Setting value is '4' - ensure that 'Location' field is present in form as a required entry field
13. Where 'MSO Location Field' Registry Setting value is '5' - ensure that 'Location' field is present in form as a required entry field
14. Where 'MSO Location Field' Registry Setting value is '6' - ensure that 'Location' field is present in form as a required entry field
15. Enter/select values in all other service detail fields as required/desired; repeat service entry process if desired for additional clients/services.
16. Navigate to 'Fast Service Entry Summary' main/first form section.
17. Click 'Submit Fast Service Entry' button to file services/create Avatar MSO claim processing batch(es).

• Avatar MSO Registry Setting 'Send Units to Avatar PM' must be enabled
• Avatar MSO Registry Setting 'MSO Location Field' may optionally be enabled/configured (Registry Setting values '0' through '6')
• '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 services originating in Avatar MSO and eligible for filing to parent Avatar PM/Cal-PM system

1. Open Avatar MSO 'Close Batch' form.
2. Note - Acceptance Testing may also be confirmed on service filing to parent Avatar PM/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 PM/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 PM/Cal-PM system.
6. In Avatar PM/Cal-PM parent system, review service information for services filed from/originating in Avatar MSO (service information may be reviewed via Avatar PM/Cal-PM 'Edit Service Information' form and/or directly via Avatar PM/Cal-PM SQL table 'SYSTEM.billing_tx_history').
7. Ensure that the 'Location' value is present in Avatar PM/Cal-PM service information for services originating in Avatar MSO according to the 'MSO Location Field' Registry Setting as follows:
8. Where 'MSO Location Field' Registry Setting value is '0' - ensure that Avatar MSO 'Location' field value is not present in Avatar PM/Cal-PM service information 'Location' field
9. Where 'MSO Location Field' Registry Setting value is '1' - ensure that Avatar MSO 'Location' field value is not present in Avatar PM/Cal-PM service information 'Location' field
10. Where 'MSO Location Field' Registry Setting value is '2' - ensure that Avatar MSO 'Location' field value is present/filed in Avatar PM/Cal-PM service information 'Location' field
11. Where 'MSO Location Field' Registry Setting value is '3' - ensure that Avatar MSO 'Location' field value is not present in Avatar PM/Cal-PM service information 'Location' field
12. Where 'MSO Location Field' Registry Setting value is '4' - ensure that Avatar MSO 'Location' field value is present/filed in Avatar PM/Cal-PM service information 'Location' field
13. Where 'MSO Location Field' Registry Setting value is '5' - ensure that Avatar MSO 'Location' field value is not present in Avatar PM/Cal-PM service information 'Location' field
14. Where 'MSO Location Field' Registry Setting value is '6' - ensure that Avatar MSO 'Location' field value is present/filed in Avatar PM/Cal-PM service information 'Location' field
15. Note - 'Location' value for Avatar PM/Cal-PM services originating in Avatar MSO may be determined/assigned by Avatar PM/Cal-PM where Avatar MSO 'Location' value is not filed under 'MSO Location Field' Registry Setting value

• One or more 'Pended' status services in Avatar MSO system

1. Open Avatar MSO 'Pended Services By Procedure Code' form/report (under 'Avatar MSO -> MSO Reporting -> Claims Processing Reports' menu path).
2. Ensure the following criteria selection fields are present in form:
3. 'Individual or All Contracting Providers'
4. 'Contracting Provider' (only enabled where 'Individual' selected in 'Individual or All Contracting Providers' field)
5. 'From Date'
6. 'Through Date'
7. Enter/select criteria for 'Pended Services By Procedure Code' report.
8. Click 'Process' button to run report/display results.
9. Ensure 'Pended Services By Procedure Code' report results are displayed in report viewer window, including the following fields/information:
10. 'Procedure Code' (CPT Code/Revenue Code)
11. 'Contracting Provider' (Name and ID)
12. 'Member Receiving Service' (Name and ID)
13. 'Date of Service'
14. 'A/P/D' (Approve/Pended/Denied claim status)
15. 'Total Fee Table Amount'
16. 'Expected Disbursement'
17. 'Member Copay'
18. 'Member Deductible'
19. 'Authorization Number'
20. 'Amount Billed'
21. Ensure that report results are limited to selected Contracting Provider' and selected 'From Date'/'Through Date' criteria; ensure that if no 'Pending' status services exist in Avatar MSO matching selected report criteria, 'No Data Found For Report' message is displayed.
22. Ensure that report results are grouped by Procedure Code (CPT Code/Revenue Code) and Contracting Provider; ensure that clicking on Procedure Code and/or Contracting Provider/display results in sub-report for only the selected data.
23. Click 'Close Report' button to close report viewer.
24. Ensure user is presented with dialog noting 'Pended Services By Procedure Code has completed. Do you wish to return to form?'; click 'Yes' button to return to 'Pended Services By Procedure Code' form or 'No' to close form.