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Avatar MSO 2024 Update 29

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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

Updated the 'Members By Authorized Provider' and 'Paid Services by Procedure Code' forms from menu launched reports to report definitions.

Required Updates

None

Included Updates

None

Details
NEW2 CHANGED0 FIXED0
New (2)
MSO - Member by Authorized Provider
The menu launched report is converted to a report definition for "Member by Authorized Provider".
Value Added: This enhancement streamlines report processing.
Topics
• Contracting Provider Service Authorization • Member Enrollment • Service Authorizations
 
MSO - Paid Services by Procedure Code
The menu launched report is converted to a report definition "Paid Services by Procedure Code".
Value Added: This enhancement streamlines report processing.
Topics
• Contracting Provider Service Authorization • Create EOB • Create Voucher • Service Authorizations
 
Acceptance Tests
AV-97438 Summary | Details
MSO - Member by Authorized Provider
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Members By Authorized Provider
Scenario 1: Members By Authorized Provider
Specific Setup:
  • 'Client A':
  • A new client is created or an existing one is identified and admitted to any Inpatient/ Outpatient program.
  • Has active diagnosis and financial eligibility records.
  • 'Funding Source 1':
  • An active funding source is created or identified.
  • 'Provider 1':
  • An active contracting provider is created or identified.
  • 'Provider 2':
  • An active contracting provider is created or identified.
  • Service Authorization(s):
  • For 'Client A' there are active service authorization records with valid begin and end dates, for 'Provider 1' and 'Provider 2'.
Steps
  1. Open 'Members By Authorized Provider'.
  2. Verify that the form has the following fields:
  3. Individual or All Providers:
  4. Is required and enabled.
  5. Provider:
  6. Verify this field is required or not based on the selected value in 'Individual or All Providers'.
  7. When 'Individual' is selected in 'Individual or All Providers' then it is required and enabled.
  8. When 'All' is selected in 'Individual or All Providers' then it is not required and disabled.
  9. Date:
  10. Is required and enabled.
  11. Leave all the required fields empty and click [Process].
  12. Verify the message displays for the missing mandatory fields.
  13. Click [OK].
  14. Select 'Individual' in the 'Individual or All Providers' field.
  15. Click [Process].
  16. Verify the message displays for the missing mandatory fields.
  17. Click [OK].
  18. Select 'Provider 1'.
  19. Enter any desired date in 'Date', that falls outside the 'Provider 1' authorization begin and end date range from the setup.
  20. Click [Process].
  21. Verify that the report generated contains 'No Data Found For Report'.
  22. Click [Close Report].
  23. Click [Yes].
  24. Enter any desired date in 'Date', that falls in the 'Provider 1' authorization begin and end date range from the setup.
  25. Click [Process].
  26. Verify that the report contains the members details with the active service authorizations for 'Provider 1'.
  27. Click [Close Report].
  28. Click [Yes].
  29. Select 'All' in the 'Individual or All Providers' field.
  30. Enter any desired date in 'Date', that falls in both 'Provider 1' and 'Provider 2' authorization begin and end date range from the setup.
  31. Click [Process].
  32. Verify that the report contains the members details with the active service authorizations for 'Provider 1' and 'Provider 2'.
  33. Click [Close Report].
  34. Click [No].
Topics
• Contracting Provider Service Authorization • Member Enrollment • Service Authorizations
AV-97439 Summary | Details
MSO - Paid Services by Procedure Code
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Paid Services By Procedure Code
Scenario 1: Paid Services By Procedure Code report
Specific Setup:
  • 'Client A':
  • A new client is created, or an existing one is identified and admitted to any Inpatient/ Outpatient program.
  • Has active diagnosis and financial eligibility records.
  • 'Funding Source 1':
  • An active funding source is created or identified.
  • 'Provider 1':
  • An active contracting provider is created or identified.
  • 'Provider 2':
  • An active contracting provider is created or identified.
  • Service Authorization:
  • For 'Client A' there are active service authorization records with valid begin and end dates, for 'Provider 1' and 'Provider 2'.
  • Claim Processing:
  • Services are created in different batches for 'Provider 1' and 'Provider 2'.
  • The respective batches are closed.
  • EOB:
  • EOB's are created for the above services.
Steps
  1. Open 'Paid Services By Procedure Code'.
  2. Verify that the form has the following fields:
  3. Individual or All Providers:
  4. Is required and enabled.
  5. Provider:
  6. Verify this field is required or not based on the selected value in 'Individual or All Providers'.
  7. When 'Individual' is selected in 'Individual or All Providers' then it is required and enabled.
  8. When 'All' is selected in 'Individual or All Providers' then it is not required and disabled.
  9. From Date:
  10. Is required and enabled.
  11. Through Date:
  12. Is required and enabled.
  13. Leave all the required fields empty and click [Process].
  14. Verify the message displays for the missing mandatory fields.
  15. Click [OK].
  16. Select 'Individual' in the 'Individual or All Providers' field.
  17. Click [Process].
  18. Verify the message displays for the missing mandatory fields.
  19. Click [OK].
  20. Select 'Provider 1'.
  21. Enter any desired 'From Date' and 'Through Date', that does not cover the 'Provider 1' service(s) from the setup.
  22. Click [Process].
  23. Verify that the report contains 'No Data Found For Report'.
  24. Click [Close Report].
  25. Click [Yes].
  26. Enter any desired 'From Date' and 'Through Date', that covers the 'Provider 1' service(s) from the setup.
  27. Click [Process].
  28. Verify that the report contains the service details of the members with 'Provider 1' that are paid within the entered date range.
  29. Click [Close Report].
  30. Click [Yes].
  31. Select 'All' in the 'Individual or All Providers' field.
  32. Enter any desired date in 'Date', that falls in both 'Provider 1' and 'Provider 2' authorization begin and end date range from the setup.
  33. Click [Process].
  34. Verify that the report contains the service details of the members with 'Provider 1' and 'Provider 2' that are paid within the entered date range.
  35. Click [Close Report].
  36. Click [No].
Topics
• Contracting Provider Service Authorization • Create EOB • Create Voucher • Service Authorizations