Avatar MSO 2024 Update 4

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Product Requirements and Recommendations

Avatar MSO required
RADplus required

Recommended Update Level

RADplus 2024 Monthly Release 2024.00.00

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.

Required Updates

None

Included Updates

None

Details

NEW0 CHANGED0 FIXED1

Fixed (1)

AV-95528 Details \| User Acceptance Tests 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.	Topics • Claims Processing • NX

Acceptance Tests

AV-95528 Summary | Details

Claims Adjudication Rule Definition - Limit Rule Definition

Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:

Claims Adjudication Rules Definition
Performing Provider Association - Error

Scenario 1: 'Claims Adjudication Rules Definition' - Verification of Limit Rule Filing

Specific Setup:

CPT Code Definition and/or Revenue Code Definition are created or an existing CPT Code Definition and/or Revenue Code Definition are identified. Note the cpt codes/ revenue codes.
An existing funding source is identified. Note the funding source code/value.

Steps

Open Avatar MSO 'Claims Adjudication Rules Definition' form.
Select 'Add' in 'Action' field (or 'Edit' to select/view/edit existing rule).
Enter/select values for Rule Definition fields 'Rule ID', 'Rule Description', 'Status', 'Status Reason', 'Funding Source' (and 'From Date'/'Through Date' if desired).
Select 'Limit' in 'Rule Type' field.
Verify the 'For Diagnosis' field is exist and enabled.
Select desired diagnosis code in the field.
Verify that the selected diagnosis populated correctly in the field.
Enter/select all required values for 'Limit Rule' Definition fields.
Click 'Add Rule' button to save Limit Rule Definition information.
Ensure Limit Rule Definition information is displayed in 'Business Rule Viewer' field.
Click [Submit].
Ensure confirmation dialog noting 'Claims Adjudication Rules Definition has completed. Do you wish to return to form?' is presented.
Click [Yes].
Select 'Edit' in 'Action' field and select previously entered/filed 'Limit' Type Claims Adjudication Rule for review.
Ensure previously entered/filed Limit Rule Definition information is displayed in 'Business Rule Viewer' field, including CPT Code/Revenue Code where dash character ('-') is used in code.
Select 'Add' option from the 'Action' field.
Select 'Comparison' rule type.
Verify the 'For Diagnosis' field does not exist.
Select 'Existence' rule type.
Verify the 'For Diagnosis' field does not exist.
Click [Discard].

Scenario 2: 'Claims Adjudication Rules Definition' - Verification of Limit Rule Removal

Specific Setup:

An existing claim adjudication rule definitions are identified or new definitions are created.

Steps

Open Avatar MSO 'Claims Adjudication Rules Definition' form.
Select 'Add' in 'Action' field (or 'Edit' to select/view/edit existing rule).
Enter/select values for Rule Definition fields 'Rule ID', 'Rule Description', 'Status', 'Status Reason', 'Funding Source' (and 'From Date'/'Through Date' if desired).
Select 'Limit' in 'Rule Type' field.
Enter/select values for Limit Rule Definition fields - including value for ICD-10 Diagnosis Code in 'For Diagnosis' field (if entering new rule).
Click 'Add Rule' button to save Limit Rule Definition information (if entering new rule).
Ensure entered/existing Limit Rule Definition information is displayed in 'Business Rule Viewer' field, including 'For Diagnosis' value/code.
Click 'Remove Selected Item' button to open rule removal selection dialog.
Select Limit Rule Definition row for removal, and click 'OK' button.
Ensure Limit Rule Definition is removed from rule and is not displayed in 'Business Rule Viewer' field.

Topics

• Claims Processing • NX