Avatar MSO 2024 Quarterly Release 2024.01 Details
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Product Requirements and Recommendations
Avatar MSO
required
RADplus
required
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Included Updates
None
Product Update Description
Avatar MSO 2023 is updated to Avatar MSO 2024
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Topics
• Upgrade
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Avatar MSO 'Fast Service Entry' form
An issue is resolved in the 'Fast Service Entry' form (and 'Fast Service Entry Submission' form) to ensure that services entered for distinct/multiple clients are not incorrectly denied under the 'Number of Services Per Claim Allowed' Approve/Pend/Deny Rule.
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Avatar MSO 'Approve/Pend/Deny Rules Definition' form
The Avatar MSO 'Approve/Pend/Deny Rules Definition' form is updated to allow A/P/D Rules for a Funding Source to be defined for date range periods.
Approve/Pend/Deny Rules may be defined for single or multiple/distinct date range Rule Coverage Periods for a single Funding Source, allowing Avatar MSO Claim Processing/Service Adjudication forms and functions to evaluate rules/adjudication status based on service date. In addition, Avatar MSO SQL table 'SYSTEM.apd_rule_def' is added for storage of date range coverage period Approve/Pend/Deny Rules Definition information.
On installation of Avatar MSO 2024 Update 2, a default Rule Coverage Period entry with 'Start Date' of '1/1/1990' and no 'End Date' value will be defined for each/all Funding Sources based on Approve/Pend/Deny Rules Definition information existing prior to update.
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Avatar MSO 'Approve/Pend/Deny Rules Definition' Claim Processing
Avatar MSO Claim Processing functions are updated to support Approve/Pend/Deny Rules/adjudication status based on service date.
Avatar MSO Claim Processing/Service Adjudication forms and functions are updated to support Approve/Pend/Deny Rules defined by Rule Coverage Period(s) for Funding Source compared to 'Date of Service', including the following forms/functions:
- 'Claim Processing (CMS 1500)'
- 'Claim Processing (UB-04)'
- 'Fast Service Entry'/'Fast Service Entry Submission'
- '837 Health Care Claim Professional'
- '837 Health Care Claim Institutional'
- 'Manual Batch Adjudication'
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Avatar MSO 'Fast Service Entry' form
An issue is resolved in the 'Fast Service Entry' form (and 'Fast Service Entry Submission' form) to ensure that the 'Procedure Not On Fee Schedule' error/alert dialog is not incorrectly displayed on CPT Service Code selection in case where Provider Fee for selected code is defined using Contracting Provider Program.
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Avatar MSO to Avatar Cal-PM Parent System Service Filing
An issue is resolved to ensure that Avatar MSO services including Third Party Payment/Adjustment information are filed/pushed to Avatar Cal-PM with expected disbursement as the service charge (to ensure correctly balanced Avatar Cal-PM outbound 837 claim information where Other Healthcare Coverage information is included in original claim/service).
Included Updates
None
Product Update Description
The following modifications are made: 1) The 'Approve/Pend/Deny Rules Definition' form has been updated to allow one funding source to have multiple definitions spanning over a specified date range. 2) The issue is resolved where the popup message "Procedure Not On Fee Schedule." produces incorrectly after entering a procedure code in the Fast Service Entry forms if fees are defined for specific contracting provider programs. 3) The issue is resolved where if the 'Max Services Per Claim' field in the 'Approve/Pend/Deny Rules Definition' form is set to 1 service per claim, the 'Fast Service Entry' form would deny all services when there is more than one row entered in for different clients. 4) An issue is resolved where MSO services with third party payments would not come to PM with expected disbursement as the service charge.
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Topics
• Claims Processing
• Approve/Pend/Deny Rules Definition
• 837 Health Care Claim Professional
• 837 Health Care Claim Institutional
• Registry Settings
• MSO To Parent System Integration Mapping
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Claims Processing
An issue has been resolved to ensure claims are uploaded to ProviderConnect after an 837 file is posted.
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Create EOB
An issue has been resolved to ensure that the 'Create EOB' form works correctly in IRIS systems.
Included Updates
None
Product Update Description
The following issues are resolved: 1) Claims are not being uploaded to ProviderConnect after an 837 file is posted. 2) The 'Create EOB' form fails to function properly on IRIS systems.
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Topics
• 837 Professional
• 837 Institutional
• Claims Processing
• Create EOB
• NX
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Included Updates
None
Product Update Description
The issue is resolved where in the 'Claims Adjudication Rules Definition' form, when defining a "Limit" rule, Avatar freezes when search text is entered in the 'For Diagnosis' field.
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Topics
• Claims Processing
• NX
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'Explanation Of Benefits' CareFabric Support
Avatar MSO is enhanced to support Avatar CareFabric actions and events for Explanation Of Benefits data to be available via Fhir.
The Avatar MSO '835 Health Care Claim Payment/Advice' form is updated to support filing of Explanation Of Benefits information to be available via Fhir/APIs.
Note - Avatar CareFabric 2024 Update 11 is required for full support of this functionality.
Included Updates
None
Product Update Description
The '835 Health Care Claim Payment/Advice' form is updated to support other Avatar modules.
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Topics
• 835 Health Care Claim Payment/Advice
• CareFabric
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Avatar MSO to Avatar Cal-PM Parent System Service Filing
Support is added for the Avatar Cal-PM 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting for Avatar Cal-PM outbound 'Electronic Billing' 837 file generation including claims/services originating in Avatar MSO.
Note - Avatar Cal-PM 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting is introduced in Avatar Cal-PM 2024 Update 33.
Included Updates
2
Product Update Description
Support is added for the new Avatar Cal-PM registry setting 'Enable Override MSO COB Service Charges and Line Adjustments'. Note: the registry setting is introduced in Avatar Cal-PM 2024 update 33.
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Topics
• Electronic Billing
• Client Ledger
• Claims Processing
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Avatar MSO - application mappings
"Avatar MSO" internal mapping definition entries are migrated to new data storage location. Please Note: this update only applies in event that "RADplus 2023 Update 91" (which performed this migration), was installed prior to the "Avatar MSO" module installation or when "MSO" namespace was disconnected in the system
Included Updates
None
Product Update Description
The MSO mapping definitions are updated.
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Topics
• Forms
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File Import - MSO service authorizations
Resolves an issue to ensure that the 'MSO Service Authorization' file can be printed successfully after importing through 'File Import' form.
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Electronic Billing - "Add Support For The Input Of Third Party Payer Amounts" is set to 2
Resolves an issue to ensure that the services inbound into MSO via web service compile successfully via 'Electronic Billing' if the adjudication date is missing in the table.
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Funding Source/Guarantor Mapping - Update Namespace for All Mappings
Resolves an issue to ensure that the 'Update Namespace for All Mappings' option in the 'Funding Source/Guarantor Mapping' form updates the system code for existing entries successfully.
Included Updates
None
Product Update Description
The following issues are resolved: 1) The "(500) Internal Server Error" produced when attempting to print any MSO file import report via the 'File Import' form. This issue only occurs in AvatarNX. 2) The error "[VALUE OUT OF RANGE]dat+13^HRADTimeDateProcessors" produced when sorting an 837 file via the 'Electronic Billing' form when it includes services pushed from MSO with OHC data. This can only occur with services filed via Web Service. 3) The 'Update Namespace for All Mappings' command button in the 'Funding Source/Guarantor Mapping' form is not updating the system code for existing entries.
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Topics
• File Import
• NX
• Contracting Provider Service Authorization
• Budget Tracking
• Claims Processing
• Funding Source
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Avatar_MSO_2024_Quarterly_Release_2024.01_Details.csv
