Avatar MSO 2024 Quarterly Release 2024.02 Summary
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NEW11
CHANGED1
FIXED10
New (11)
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.
Value Added: Allows Approve/Pend/Deny Rule Coverage Periods to be defined by date range
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.
Value Added: Adds support for Approve/Pend/Deny Rules by Rule Coverage Period for Claim Processing/Service Adjudication
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Topics
• Approve/Pend/Deny Rules Definition
• 837 Health Care Claim Professional
• Claims Processing
• 837 Health Care Claim Institutional
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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.
Value Added: Adds API/Fhir support for Avatar MSO Explanation Of Benefits Information
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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.
Value Added: Adds support for the Document Management/Perceptive Document Conversion process in 'Provider File Attach' form
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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.
Value Added: Allows for authorization begin/end date checks when validating Service Authorization and Contracting Provider Service Authorizations 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.
Value Added: Adds Avatar MSO support for Avatar Cal-PM 'Enable Override MSO COB Service Charges and Line Adjustments' Registry Setting
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Topics
• Electronic Billing
• Client Ledger
• Claims Processing
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Avatar MSO Service Authorization Forms Pre-Display
Pre-display sort order is updated for several Avatar MSO Service Authorization forms.
Value Added: Updates pre-display for several Avatar MSO forms to display the most recently entered Authorization first
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Topics
• Contracting Provider Service Authorization
• Service Authorizations
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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
Value Added: Increases field size for multi-code selection fields in Avatar MSO SQL table 'SYSTEM. plan_covered_services'
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Topics
• Plan Definition
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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.
Value Added: Adds new configuration options to the 'MSO Location Field' Registry Setting
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Topics
• Registry Settings
• Claims Processing
• MSO To Parent System Integration Mapping
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Avatar MSO 'Pended Services By Procedure Code' Report
The Avatar MSO 'Pended Services By Procedure Code' report is updated to a form-based report format.
Value Added: Updates 'Pended Services By Procedure Code' report/form.
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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.
Value Added: Enhance data accuracy and integrity for billing processes with new field validations, directly benefiting client’s operational efficiency. This new feature is relevant as it improves the overall user experience and ensures the precision of billing data.
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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
Value Added: Ensures mapping definition entries are migrated to their new data storage location.
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Topics
• Forms
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Changed (1)
2024 Update installation
Installation will upgrade to the 2024 version. This will not change any current functionality.
Value Added: Upgrade to current 2024 version
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Topics
• Upgrade
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Fixed (10)
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.
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.
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).
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Topics
• Claims Processing
• Approve/Pend/Deny Rules Definition
• 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.
Create EOB
An issue has been resolved to ensure that the 'Create EOB' form works correctly in IRIS systems.
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Topics
• 837 Professional
• 837 Institutional
• Claims Processing
• Create EOB
• NX
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Claims Adjudication Rule Definition - Limit Rule Definition
Resolves an issue to ensure that the 'For Diagnosis' field is enabled and accessible for the 'Limit' rule definition.
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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.
'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.
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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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'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.
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.
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Topics
• Claims Processing
• Registry Settings
• CPT Code Definition
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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.
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.
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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.
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Topics
• Service Entry
• Web Services
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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.
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Topics
• MSO To Parent System Integration Mapping
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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.
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.
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.
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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.
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Topics
• 837 Health Care Claim Professional
• 837 Professional
• Claims Processing
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Avatar_MSO_2024_Quarterly_Release_2024.02_Details.csv
