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Avatar MSO 2024 Update 23

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Product Requirements and Recommendations

Avatar MSO required
RADplus required

Recommended Update Level

Avatar MSO 2024 Monthly Release 2024.01.02
RADplus 2024 Monthly Release 2024.01.02

Product Update Description

The following reports have been re-installed as report definitions to support Avatar NX: 'Active Member Enrollment', 'Denied Services By Procedure Code', 'Batch Display', 'Care Manager's Denied Authorizations'.

Required Updates

None

Included Updates

None

Details
NEW4 CHANGED0 FIXED0
New (4)
MSO - Active Member Enrollment
A new feature has been introduced to convert the menu launched report to a report definition for "Active Member Enrollment".
The feature allows the conversion of the previously menu launched report into a more accessible and efficient report definition specifically for "Active Member Enrollment". This streamlines the process of accessing and utilizing the "Active Member Enrollment" report, making it more user-friendly and efficient.
Value Added: Enhances the efficiency and accessibility of the "Active Member Enrollment" report.
Topics
• Member Enrollment
 
MSO - Batch Display
A new feature has been introduced to convert the menu launched report to a report definition for "Batch Display".
The feature allows the conversion of the previously menu launched report into a more accessible and efficient report definition specifically for "Batch Display". This streamlines the process of accessing and utilizing the "Batch Display" report, making it more user-friendly and efficient.
Value Added: Enhances the efficiency and accessibility of the "Batch Display" report.
Topics
• Claims Processing • Database Management
 
MSO - Care Manager's Denied Authorizations
A new feature has been introduced to convert the menu launched report to a report definition for "Care Manager's Denied Authorizations".
The feature allows the conversion of the previously menu-launched report into a more accessible and efficient report definition specifically for "Care Manager's Denied Authorizations". This streamlines the process of accessing and utilizing the "Care Manager's Denied Authorizations" report, making it more user-friendly and efficient.
Value Added: Enhances the efficiency and accessibility of the "Care Manager's Denied Authorizations" report.
Topics
• Service Authorizations
 
MSO - Denied Services By Procedure Code
A new feature has been introduced to convert the Menu launched report to a report definition for "Denied Services By Procedure Code".
The feature allows the conversion of the previously menu-launched report into a more accessible and efficient report definition specifically for "Denied Services By Procedure Code". This streamlines the process of accessing and utilizing the "Denied Services By Procedure Code" report, making it more user-friendly and efficient.
Value Added: Enhances the efficiency and accessibility of the "Denied Services By Procedure Code" report.
Topics
• Service Authorizations
 
Acceptance Tests
AV-97427 Summary | Details
MSO - Active Member Enrollment
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Active Member Enrollment
  • Member Enrollment
  • Registry Settings (PM)
  • User Definition
Scenario 1: Active Member Enrollment - Report
Specific Setup:

  • Funding Source 1:
  • An active funding source is created or identified.
  • Provider 1:
  • An active contracting provider is created or identified.
  • Client A:
  • A new client is created or an existing one is identified and admitted to any Inpatient/ Outpatient program.
  • Has an active diagnosis record.
  • Financial Eligibility:
  • 'Guarantor 1' is filed as the primary guarantor for 'Client A'.
  • Note the 'Policy Number'.
Steps
  1. Open 'Registry Settings'.
  2. Search and select 'Require Member Enrollment' Registry Setting.
  3. Set the value to "Y".
  4. Click [Submit].
  5. Click [OK].
  6. Click [No].
  7. Refresh the forms from the User Menu.
  8. Open 'User Definition' and add the 'Member Enrollment' form to access.
  9. Refresh the forms from the User Menu.
  10. Open 'Member Enrollment'.
  11. Select 'Client A'.
  12. Verify that the form loads with the data of 'Client A'.
  13. Enter the desired date value in the 'Effective Date Of Enrollment' field.
  14. Enter the 'Provider 1' in the 'Primary Contracting Provider' field.
  15. Select 'Funding Source 1'.
  16. Validate that the 'Plan' field populates the value of the selected funding source.
  17. Set the 'Funding Source Policy Number' field with the 'Policy Number' from setup.
  18. Click [Submit].
  19. Open 'Active Member Enrollment'.
  20. Verify that the form has the below fields:
  21. Select Funding Source - Leave Blank For All:
  22. Is not required and enabled.
  23. Enter Report Run Date:
  24. Is required and enabled.
  25. Enter a future date in the 'Enter Report Run Date' field.
  26. Verify that a warning message displays: Future date entered.
  27. Click [OK].
  28. Click [Process].
  29. Verify that the report is generated with the data for 'Client A'.
  30. Verify that the report displays 'Fund Source(s)' as 'All'.
  31. Click [Close Report].
  32. Click [Yes].
  33. Enter 'Funding Source 1' in the 'Select Funding Source - Leave Blank For All' field.
  34. Click [Process].
  35. Verify that the report is generated with the data for 'Client A'.
  36. Verify that the report displays 'Fund Source(s)' as 'Funding Source 1'.
  37. Click [Close Report].
  38. Click [Yes].
  39. Enter any desired date that is before the member's enrollment date.
  40. Click [Process].
  41. Verify that the report is generated and does not have data for 'Client A'.
  42. Click [No].
  43. Open 'Registry Settings'.
  44. Search and select 'Require Member Enrollment' Registry Setting.
  45. Set the value to "N".
  46. Click [Submit].
  47. Click [OK].
  48. Click [No].
Topics
• Member Enrollment
AV-97429 Summary | Details
MSO - Batch Display
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Batch Display
Scenario 1: Batch Display - Report
Specific Setup:
  • System with:
  • Minimum of one batch with approved service(s).
  • Batch 1
  • Minimum of one batch with denied service(s).
  • Batch 2
Steps
  1. Open 'Batch Display'.
  2. Verify that the form has the below field:
  3. Select Batch Number - Leave Blank For All Batches.
  4. Is not required and enabled.
  5. Select 'Batch 1' in the 'Select Batch Number - Leave Blank For All Batches' field.
  6. Click [Process].
  7. Verify that the report is generated with the 'Batch 1' data.
  8. Click [Close Report].
  9. Click [Yes].
  10. Clear the 'Select Batch Number - Leave Blank For All Batches' field value and set it to empty.
  11. Click [Process].
  12. Verify that the report is generated and has the data for both 'Batch 1' and 'Batch 2'.
  13. Click [Close Report].
  14. Click [No].
Topics
• Claims Processing • Database Management
AV-97434 Summary | Details
MSO - Care Manager's Denied Authorizations
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Care Manager's Denied Authorizations
Scenario 1: Care Manager's Denied Authorizations - Report
Specific Setup:
  • Service Authorization:
  • Has an active service authorization for the below combination:
  • Funding source
  • Provider
  • Benefit plan
  • Begin date of authorization
  • End date of authorization
  • The 'Current Authorization Status' is set to 'Denied' with a reason selected.
  • A 'Care Manager' is assigned with the 'Date Care Manager Assigned' value selected.
  • System has a minimum of two service(s) denied due to the below reason:
  • Service(s) entered are filed as denied by the care manager assigned in the service authorization.
Steps
  1. Open 'Care Manager's Denied Authorizations'.
  2. Verify that the form has the below fields:
  3. Select Care Manager - Leave Blank For All Care Managers:
  4. Is not required and enabled.
  5. Authorization Effective Date:
  6. Is required and enabled.
  7. Enter any desired future date.
  8. Verify that the warning message displays: "Future date entered".
  9. Click [Cancel].
  10. Verify that the field is reverted to blank.
  11. Enter any desired future date, that is outside of the Authorization's begin and end date from the setup.
  12. Click [OK] in the future date warning message.
  13. Verify that the date entered is retained.
  14. Click [Process].
  15. Verify that the report is generated with no data, within the entered date range.
  16. Verify that the report displays 'All Care Managers'.
  17. Click [Close Report].
  18. Click [Yes].
  19. Enter any desired date, that is within the Authorization's begin and end date from the setup.
  20. Click [Process].
  21. Verify that the report is generated with the denied services data for all care managers, within the entered date range.
  22. Verify that the report displays 'All Care Managers'.
  23. Click [Close Report].
  24. Click [Yes].
  25. Select the care manager from the setup in the field 'Select Care Manager - Leave Blank For All Care Managers'.
  26. Click [Process].
  27. Verify that the report is generated with the denied services data for the care manager selected, within the entered date range.
  28. Verify that the report shows the care manager's ID in the header section.
  29. Click [Close Report].
  30. Click [No].
Topics
• Service Authorizations
AV-97436 Summary | Details
MSO - Denied Services By Procedure Code
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Denied Services By Procedure Code
Scenario 1: Denied Services By Procedure Code - Report
Specific Setup:
  • System has a minimum of five service(s) denied due to the below reason:
  • Service unit(s) entered exceeds the permitted amount of units filed in the service authorization of the respective procedure code.
Steps
  1. Open 'Denied Services By Procedure Code'.
  2. Verify that the form has the below field(s):
  3. Select Provider - Leave Blank For All Providers:
  4. Is not required and enabled.
  5. Include Services On Or After:
  6. Is required and enabled.
  7. Up To And Including"
  8. Is required and enabled.
  9. Leave all the fields empty.
  10. Click [Process].
  11. Verify an error message displays: "The following fields are missing: Include Service On Or After Up To And Including".
  12. Click [OK].
  13. Enter the desired date for 'Include Services On Or After date'.
  14. Enter a future date for 'Up To And Including date'.
  15. Verify the warning message displays: "Future date entered".
  16. Click [OK].
  17. Verify that the field is retained with the entered date.
  18. Enter any different future date for 'Up To And Including date'.
  19. Verify the warning message displays: "Future date entered".
  20. Click [Cancel].
  21. Verify that the field is reverted to the date that was not cancelled.
  22. Click [Process].
  23. Verify that the report is generated with the denied services data, within the entered date range.
  24. Verify that the report displays 'All Providers'.
  25. Click [Close Report].
  26. Click [Yes].
  27. Select the provider value of the services from the setup.
  28. Click [Process].
  29. Verify that the report is generated with the denied services data for the selected provider, within the entered date range.
  30. Verify that the report displays the specific Provider's Number.
  31. Click [Close Report].
  32. Click [No].
Topics
• Service Authorizations