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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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'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.
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'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.
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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.
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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).
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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.
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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
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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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'Provider File Attach' Form - Document Conversion
The 'Provider File Attach' form is updated to support the Document Management/Perceptive Document Conversion process. Note, RADPlus 2024 Update 34 is also required for support.
For more information on the Document Management/Perceptive Document Conversion process, please contact a Netsmart client representative.
Included Updates
None
Product Update Description
The 'Provider File Attach' form is updated to support the Document Conversion process.
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Topics
• System Maintenance
• Document Management
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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.
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Topics
• Claims Processing
• Registry Settings
• 837 Health Care Claim Professional
• 837 Health Care Claim Institutional
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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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'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.
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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.
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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
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.
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Topics
• Claims Processing
• Registry Settings
• CPT Code Definition
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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.
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Topics
• Contracting Provider Service Authorization
• Service Authorizations
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Avatar MSO 'Enable Coverage Effective Period' Registry Setting
An issue is resolved to ensure that the Avatar MSO 'Enable Coverage Effective Period' Registry Setting does not allow values other than "Y" and "N" to be filed.
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File Import - Avatar MSO Service Authorization
An issue is resolved to ensure successful edit of an existing Service Authorization may be posted via File Import.
Included Updates
None
Product Update Description
The following issues are resolved: 1) The "Enable Coverage Effective Period" registry is allowing values other than "Y" and "N" to be filed. 2) The error "[VALUE OUT OF RANGE]dat+13^HRADTimeDateProcessors" produced when attempting to edit an existing service authorization via File Import.
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Topics
• Registry Settings
• Service Authorizations
• File Import
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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.
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Topics
• Service Entry
• Web Services
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'Plan Definition' Form, SQL Information
The max length of all multi-code selection fields in Avatar MSO SQL table 'SYSTEM.plan_covered_services' table have been increased to 5000 characters
The max length of the following multi-code selection fields in Avatar MSO SQL table 'SYSTEM.plan_covered_services' table have been increased from 254 to 5000 characters:
- 'cpt_coverage_group_code'
- 'cpt_service_codes_code'
- 'diag_code_for_cvg_code'
- 'diag_code_no_cvg_code'
- 'diag_grp_for_cvg_code'
- 'diag_grp_no_cvg_code'
- 'elig_reason_code'
- 'icd10_diag_code_for_cvg_code'
- 'icd10_diag_code_no_cvg_code'
- 'procedure_group_code'
- 'rev_coverage_group_code'
- 'revenue_code_code'
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'MSO To Parent System Integration Mapping' Form, SQL Information
An issue is resolved to ensure that error '[UNDEFINED]%0AmBd5+3^%sqlcq.AVMSO.cls105.1 *%CC]' does not occur when querying Avatar MSO SQL table 'SYSTEM.table_parentmap_per_prov' table and facility is not defined.
Included Updates
None
Product Update Description
The following changes are made: 1) The error '[UNDEFINED]%0AmBd5+3^%sqlcq.AVMSO.cls105.1 *%CC]' is resolved when querying the 'table_parentmap_per_prov' table and facility is not defined. 2) The max length of all multi code select fields in the 'plan_covered_services' table have been increased from 254 to 5000.
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Topics
• Plan Definition
• MSO To Parent System Integration Mapping
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Avatar MSO 'MSO Location Field' Registry Setting
The 'MSO Location Field' Registry Setting is updated to add the ability to no longer require 'Location' in 'Claims Processing (UB-04)' forms.
The Avatar MSO 'MSO Location Field' Registry Setting is updated to add the following configuration values/options:
- '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)'
Included Updates
None
Product Update Description
The registry setting 'MSO Location Field' is updated with values of 5 and 6 to add the ability to no longer require 'Location' on 'Claims Processing (UB-04)'.
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Topics
• Registry Settings
• Claims Processing
• MSO To Parent System Integration Mapping
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Included Updates
None
Product Update Description
Updated the 'Pended Services By Procedure Code' form from a menu launched report to a report definition.
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Topics
• Reports
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SYSTEM.billing_837p_claim_data and SYSTEM.billing_837p_service_data - Field validation
SQL tables SYSTEM.billing_837p_claim_data and SYSTEM.billing_837p_service_data are enhanced to add new fields to store information from the 2310D/2420D NM1 element from the 837 Health Claim Professional file.
Users can find additional fields within the SYSTEM.billing_837p_claim_data and SYSTEM.billing_837p_service_data SQL tables. These fields are specifically designed to capture and store data from the 2310D/2420D NM1 If an inbound MSO claim has supervising practitioner information included in the 2310D and/or 2420D segment of the 837 Health Claim Professional file.
Included Updates
None
Product Update Description
Avatar MSO is updated to support the '2310D' and '2420D' segments on 837 Professional files.
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Topics
• Database Management
• 837 Health Care Claim Professional
• 837 Professional
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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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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
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.
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Topics
• 837 Health Care Claim Professional
• 837 Professional
• Claims Processing
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