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Avatar MSO 2024 Update 6

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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 '835 Health Care Claim Payment/Advice' form is updated to support other Avatar modules.

Required Updates

None

Included Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
'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.

Value Added: Adds API/Fhir support for Avatar MSO Explanation Of Benefits Information
Topics
• 835 Health Care Claim Payment/Advice • CareFabric
 
Acceptance Tests
AV-96129 Summary | Details
'Explanation Of Benefits' CareFabric Support
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 835 Health Care Claim Payment/Advice (MSO)
  • CareFabric Monitor
Scenario 1: Verification of 'BulkDataStoreUpdate - Explanation Of Benefits' CareFabric Filing via Avatar MSO 835 Generation
Specific Setup:
  • 'BulkDataStoreUpdate' action must be enabled in Avatar system (via 'CareFabric Management' form)
  • EOB record(s) eligible for 835 outbound file inclusion including one or more claims/services originating via Avatar MSO 837 inbound processing
Steps
  1. Open Avatar MSO '835 Health Care Claim Payment/Advice' form.
  2. Note - Acceptance testing may also be confirmed in 835 files created via Avatar MSO Claim Processing Automation functions
  3. Select 'Sort File' in the 'Options' field.
  4. Select 'Contracting Provider' value.
  5. Select EOB(s) for 835 outbound file inclusion in the 'Select EOB(s)' field.
  6. Click 'Process' button.
  7. Ensure that '835 Health Care Claim Payment/Advice Report' is displayed following 835 sorting completion (and includes one or more successfully sorted claims/services for 835 file creation).
  8. Open Avatar PM/Cal-PM 'CareFabric Monitor' form.
  9. Enter values for 'From Date' and 'Through Date' fields (using dates which include 274 Provider Directory Provider Definition entry/edit).
  10. Enter/select values for any other CareFabric Monitor fields as desired.
  11. Click 'View Activity Log' button to display CareFabric Monitor report results.
  12. In CareFabric Monitor report results - ensure that 'BulkDataStoreUpdate' Action/Out Activity is present for all Explanation Of Benefits information/835s generated in the Avatar MSO '835 Health Care Claim Payment/Advice' form for claims/services originating via Avatar MSO 837 inbound processing (activity is per claim with 835 remittance advice generated).
Topics
• 835 Health Care Claim Payment/Advice • CareFabric