Skip to main content

Avatar PM 2022 Monthly Release 2022.00.01 Acceptance Tests

  1. Last updated
  2. Save as PDF
Update 3 Summary | Details
Avatar State Forms 'Enable Texas TMHP Billing' Registry Setting - Financial Eligibility Field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Cross Episode Financial Eligibility
  • Family Financial Eligibility
  • Financial Eligibility Web Service
  • Cross Episode Financial Eligibility Web Service
Scenario 1: 'Cross Episode Financial Eligibility' - Form Verification
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Client record eligible for Cross Episode Financial Eligibility entry
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar PM 'Cross Episode Financial Eligibility' form.
  2. Select client for Cross Episode Financial Eligibility view/entry/update.
  3. Navigate to 'Guarantor Selection' section of 'Cross Episode Financial Eligibility' form.
  4. Click 'Add New Item' to add/enter new Guarantor information (or select existing Guarantor information row and click 'Edit Selected Item' button to view/update).
  5. Enter/select 'Guarantor #' value.
  6. Ensure 'TMHP Waiver Reference Number' field is present in form.
  7. Ensure that field help message (lightbulb icon) is present for 'TMHP Waiver Reference Number' field; click the help message icon and ensure the following field help text is displayed:
  8. 'This field is for Texas TMHP Waiver Billing. This will populate in 2300-REF-02.'
  9. Enter value for 'TMHP Waiver Reference Number' field.
  10. Enter/select values for all other 'Cross Episode Financial Eligibility' form fields as required/desired.
  11. Navigate to 'Cross Episode Financial Eligibility' main/first form section; select Guarantor order for entry.
  12. Click 'Submit' button to file 'Cross Episode Financial Eligibility' form/record.
  13. Re-open 'Cross Episode Financial Eligibility' form for same/previously filed client.
  14. Navigate to 'Guarantor Selection' section of 'Cross Episode Financial Eligibility' form, and select previous Guarantor information entry.
  15. Ensure that previously entered/filed value for 'TMHP Waiver Reference Number' field is present in form.
  16. Open Crystal Reports or other SQL reporting tool.
  17. In Avatar PM SQL table 'SYSTEM.billing_guar_subs_data_no_ep', ensure that field 'tmhp_waiver_ref_num' is present and contains value filed for 'TMHP Waiver Reference Number' field via 'Cross Episode Financial Eligibility' form.
Scenario 2: 'Family Financial Eligibility' - Form Verification
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Family entry/record eligible for Family Financial Eligibility entry (defined via 'Family Registration' form)
Steps
  1. Open Avatar PM 'Family Financial Eligibility' form.
  2. Select family record for Family Financial Eligibility view/entry/update.
  3. Navigate to 'Guarantor Selection' section of 'Family Financial Eligibility' form.
  4. Click 'Add New Item' to add/enter new Guarantor information (or select existing Guarantor information row and click 'Edit Selected Item' button to view/update).
  5. Enter/select 'Guarantor #' value.
  6. Ensure 'TMHP Waiver Reference Number' field is present in form.
  7. Ensure that field help message (lightbulb icon) is present for 'TMHP Waiver Reference Number' field; click the help message icon and ensure the following field help text is displayed:
  8. 'This field is for Texas TMHP Waiver Billing. This will populate in 2300-REF-02.'
  9. Enter value for 'TMHP Waiver Reference Number' field.
  10. Enter/select values for all other 'Family Financial Eligibility' form Guarantor Selection' fields as required/desired.
  11. Navigate to 'Guarantor Assignment' form section; enter/select family member clients for Guarantor assignment.
  12. Navigate to 'Family Financial Eligibility' main/first form section; select Guarantor order for entry.
  13. Click 'Submit' button to file 'Family Financial Eligibility' form/record.
  14. Re-open 'Family Financial Eligibility' form for same/previously filed family.
  15. Navigate to 'Guarantor Selection' section of 'Family Financial Eligibility' form, and select previous Guarantor information entry.
  16. Ensure that previously entered/filed value for 'TMHP Waiver Reference Number' field is present in form.
Scenario 3: 'Financial Eligibility' - Form Verification
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Client record/episode eligible for Financial Eligibility entry
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar PM 'Financial Eligibility' form.
  2. Select client/episode for Financial Eligibility view/entry/update.
  3. Navigate to 'Guarantor Selection' section of 'Financial Eligibility' form.
  4. Click 'Add New Item' to add/enter new Guarantor information (or select existing Guarantor information row and click 'Edit Selected Item' button to view/update).
  5. Enter/select 'Guarantor #' value.
  6. Ensure 'TMHP Waiver Reference Number' field is present in form.
  7. Ensure that field help message (lightbulb icon) is present for 'TMHP Waiver Reference Number' field; click the help message icon and ensure the following field help text is displayed:
  8. 'This field is for Texas TMHP Waiver Billing. This will populate in 2300-REF-02.'
  9. Enter value for 'TMHP Waiver Reference Number' field.
  10. Enter/select values for all other 'Financial Eligibility' form fields as required/desired.
  11. Navigate to 'Financial Eligibility' main/first form section; select Guarantor order for entry.
  12. Click 'Submit' button to file 'Financial Eligibility' form/record.
  13. Re-open 'Financial Eligibility' form for same/previously filed client/episode.
  14. Navigate to 'Guarantor Selection' section of 'Financial Eligibility' form, and select previous Guarantor information entry.
  15. Ensure that previously entered/filed value for 'TMHP Waiver Reference Number' field is present in form.
  16. Open Crystal Reports or other SQL reporting tool.
  17. In Avatar PM SQL table 'SYSTEM.billing_guar_subs_data', ensure that field 'tmhp_waiver_ref_num' is present and contains value filed for 'TMHP Waiver Reference Number' field via 'Financial Eligibility' form.
Scenario 4: 'FinancialEligibility' Web Service - Verification of 'UpdateFinancialElig' Filing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Application utilizing the Avatar PM 'FinancialEligibility' web service
Steps
  1. Using Avatar PM 'FinancialEligibility' web service, submit request to 'UpdateFinancialElig' method to update existing Avatar PM Financial Eligibility record, including value for 'TMHPWaiverRefNum' field/segment.
  2. Confirm 'FinancialEligibility' web service responds with confirmation data on successful filing of 'UpdateFinancialElig' method.
  3. Example: "<Confirmation>Unique ID: 123~1</Confirmation>"
  4. Confirm 'FinancialEligibility' web service responds with confirmation message on successful filing of 'UpdateFinancialElig' method.
  5. Example: "<Message>Financial Eligibility web service has been filed successfully.</Message>"
  6. Confirm 'FinancialEligibility' web service responds with successful status value on successful filing of 'UpdateFinancialElig' method.
  7. Example: " <Status>1</Status>"
  8. Open Avatar PM 'Financial Eligibility' form and select client/episode filed via web service for view/update.
  9. Confirm Financial Eligibility record is updated in Avatar PM, with values/data submitted via web service including 'TMHP Waiver Reference Number' field value.
Scenario 5: 'FinancialEligibility' Web Service - Verification of 'AddFinancialElig' Filing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Application utilizing the Avatar PM 'FinancialEligibility' web service
Steps
  1. Using Avatar PM 'FinancialEligibility' web service, submit request to 'AddFinancialElig' method to create new Avatar PM Financial Eligibility record, including value for 'TMHPWaiverRefNum' field/segment.
  2. Confirm 'FinancialEligibility' web service responds with confirmation data on successful filing of 'AddFinancialElig' method.
  3. Example: "<Confirmation>Unique ID: 123~1</Confirmation>"
  4. Confirm 'FinancialEligibility' web service responds with confirmation message on successful filing of 'AddFinancialElig' method.
  5. Example: "<Message>Financial Eligibility web service has been filed successfully.</Message>"
  6. Confirm 'FinancialEligibility' web service responds with successful status value on successful filing of 'AddFinancialElig' method.
  7. Example: " <Status>1</Status>"
  8. Open Avatar PM 'Financial Eligibility' form and select client/episode filed via web service for view/update.
  9. Confirm new Financial Eligibility record is created in Avatar PM, with values/data submitted via web service including 'TMHP Waiver Reference Number' field value.
Scenario 6: 'CrossEpisodeFinancialEligibility' Web Service - Verification of 'AddCrossEpFinancialElig' Filing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Application utilizing the Avatar PM 'CrossEpisodeFinancialEligibility' web service
Steps
  1. Using Avatar PM 'CrossEpisodeFinancialEligibility' web service, submit request to 'AddCrossEpFinancialElig' method to create new Avatar PM Cross Episode Financial Eligibility record, including value for 'TMHPWaiverRefNum' field/segment.
  2. Confirm 'CrossEpisodeFinancialEligibility' web service responds with confirmation data on successful filing of 'AddCrossEpFinancialElig' method.
  3. Example: "<Confirmation>Unique ID: 123~POR.00001</Confirmation>"
  4. Confirm 'CrossEpisodeFinancialEligibility' web service responds with confirmation message on successful filing of 'AddCrossEpFinancialElig' method.
  5. Example: "<Message>Cross Episode Financial Eligibility web service has been filed successfully.</Message>"
  6. Confirm 'CrossEpisodeFinancialEligibility' web service responds with successful status value on successful filing of 'AddCrossEpFinancialElig' method.
  7. Example: " <Status>1</Status>"
  8. Open Avatar PM 'Cross Episode Financial Eligibility' form and select client filed via web service for view/update.
  9. Confirm new Cross Episode Financial Eligibility record is created in Avatar PM, with values/data submitted via web service including 'TMHP Waiver Reference Number' field value.
Scenario 7: 'CrossEpisodeFinancialEligibility' Web Service - Verification of 'UpdateCrossEpFinancialElig' Filing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Application utilizing the Avatar PM 'CrossEpisodeFinancialEligibility' web service
Steps
  1. Using Avatar PM 'CrossEpisodeFinancialEligibility' web service, submit request to 'UpdateCrossEpFinancialElig' method to update existing Avatar PM Cross Episode Financial Eligibility record, including value for 'TMHPWaiverRefNum' field/segment.
  2. Confirm 'CrossEpisodeFinancialEligibility' web service responds with confirmation data on successful filing of 'UpdateCrossEpFinancialElig' method.
  3. Example: "<Confirmation>Unique ID: 123~POR.00001</Confirmation>"
  4. Confirm 'CrossEpisodeFinancialEligibility' web service responds with confirmation message on successful filing of 'UpdateCrossEpFinancialElig' method.
  5. Example: "<Message>Cross Episode Financial Eligibility web service has been filed successfully.</Message>"
  6. Confirm 'CrossEpisodeFinancialEligibility' web service responds with successful status value on successful filing of 'UpdateCrossEpFinancialElig' method.
  7. Example: " <Status>1</Status>"
  8. Open Avatar PM 'Cross Episode Financial Eligibility' form and select client filed via web service for view/update.
  9. Confirm Cross Episode Financial Eligibility record is updated in Avatar PM, with values/data submitted via web service including 'TMHP Waiver Reference Number' field value.
Avatar State Forms 'Enable Texas TMHP Billing' Registry Setting - Service Code Fields
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Service Code Upload Process
  • Service Code Upload Accepted Codes
Scenario 1: 'Service Code Upload Process' - Verification of Service Code Upload
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Avatar PM Service Code Upload file containing one or more valid rows/entries including values for 'TMHP Type Of Service' field (Import File Segment/Location 134) and 'Line Item Control Number - Positions 5 to 20 (2400-REF)' (Import File Segment/Location135)
  • Please refer to updated 'Avatar_PM_Service_Code_Upload_Layout.xls' document included with Avatar PM 2022 Update 3 for Service Code Upload format/layout
Steps
  1. Open Avatar PM 'Service Code Upload Process' form.
  2. Click 'Select File' button, and select Avatar PM Service Code Upload file containing one or more valid rows/entries including values for 'TMHP Type Of Service' and 'Line Item Control Number - Positions 5 to 20 (2400-REF)' fields/segments.
  3. Select 'Compile' in 'Compile Or Post' field.
  4. Select Yes or No value for 'Override Existing Service Codes' field.
  5. Click 'Submit' button to file form/compile Service Code Upload file.
  6. Ensure that dialog noting 'Compile Completed' is presented; click 'OK' button to close dialog/proceed.
  7. Open Avatar PM 'Service Code Upload Accepted Codes' form.
  8. Select compiled file in 'Select Desired Service Code Import File Name' field.
  9. Click 'Process' button to file form/display Service Code Upload Accepted Codes report.
  10. Ensure 'TMHP Type Of Service' and 'Line Item Control Number - Positions 5 to 20 (2400-REF)' fields are included in Service Code Upload Accepted Codes report display, and contains value filed for 'TMHP Type Of Service'/'Line Item Control Number - Positions 5 to 20 (2400-REF)' fields/segments for valid compiled rows/entries.
  11. Close Service Code Upload Accepted Codes report.
  12. Return to Avatar PM 'Service Code Upload Process' form.
  13. Select 'Post' in 'Compile Or Post' field to post compiled Service Code Upload file row(s).
  14. Click 'Submit' button to file form/post Service Code Upload file.
  15. Ensure that dialog noting 'Posting Completed' is presented; click 'OK' button to close dialog/proceed.
  16. Return to Avatar PM 'Service Code Upload Accepted Codes' form.
  17. Select posted file in 'Select Desired Service Code Import File Name' field.
  18. Click 'Process' button to file form/display Service Code Upload Accepted Codes report.
  19. Ensure 'TMHP Type Of Service' and 'Line Item Control Number - Positions 5 to 20 (2400-REF)' fields are included in Service Code Upload Accepted Codes report display, and contains value filed for 'TMHP Type Of Service'/'Line Item Control Number - Positions 5 to 20 (2400-REF)' fields/segments for valid/posted rows/entries.
  20. Open Avatar PM 'Service Codes' form.
  21. Select 'Edit Existing' action and select Service Code filed via 'Service Code Upload Process' file posting.
  22. Ensure that value for 'TMHP Type Of Service' field is present/selected in form as defined in Service Code Upload file row/entry.
  23. Ensure that value for 'Line Item Control Number - Positions 5 to 20 (2400-REF)' field is present/selected in form as defined in Service Code Upload file row/entry.
Scenario 2: 'Service Codes' - Form Verification
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar PM 'Service Codes' form.
  2. Select 'Add New' or 'Edit Existing' action (and select existing Service Code if 'Edit Existing' selected).
  3. Ensure 'TMHP Type Of Service' field is present in form, and allows the following selections:
  4. 'EVV'
  5. 'Nursing and Transportation'
  6. 'Non-Accumulated'
  7. Select value for 'TMHP Type Of Service' field.
  8. Ensure 'Line Item Control Number - Positions 5 to 20 (2400-REF)' field is present in form.
  9. Ensure that field help message (lightbulb icon) is present for 'Line Item Control Number - Positions 5 to 20 (2400-REF)' field; click the help message icon and ensure the following field help text is displayed:
  10. 'This field is for Texas TMHP Billing. This will represent positions 5 to 20 for the 'Line Item Control Number' in 2400-REF.'
  11. Enter value for 'Line Item Control Number - Positions 5 to 20 (2400-REF)' field.
  12. Enter/select values for all other 'Service Codes' form fields as required/desired.
  13. Click 'Submit' button to file 'Service Codes' form/record.
  14. Click 'Yes' in the 'Form Return' dialog to return to 'Service Codes' form.
  15. Select 'Edit Existing' action and select previously filed Service Code.
  16. Ensure that previously selected/filed value for 'TMHP Type Of Service' field is present/selected in form.
  17. Ensure that previously entered/filed value for 'Line Item Control Number - Positions 5 to 20 (2400-REF)' field is present/selected in form.
  18. Open Crystal Reports or other SQL reporting tool.
  19. In Avatar PM SQL table 'SYSTEM.billing_tx_master_table', ensure that fields 'tmhp_type_of_service_code' / 'tmhp_type_of_service_value' are present and contain value filed for 'TMHP Type Of Service' field via 'Service Codes' form.
  20. In Avatar PM SQL table 'SYSTEM.billing_tx_master_table', ensure that field 'line_item_control_num' is present and contains value filed for 'Line Item Control Number - Positions 5 to 20 (2400-REF)' field via 'Service Codes' form.
Avatar State Forms 'Enable Texas TMHP Billing' Registry Setting - Practitioner Enrollment Field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Practitioner Enrollment
Scenario 1: 'ClinicianServices' Web Service - Verification Of 'putClinicianCreation' Filing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Application utilizing the Avatar PM 'ClinicianServices' web service
Steps
  1. Using Avatar PM 'ClinicianServices' web service, submit request to 'putClinicianCreation' method to create new Avatar PM Practitioner Enrollment (and optionally Avatar MSO Performing Provider Registration record), including value for 'AttendantID' field/segment.
  2. Confirm 'ClinicianServices' web service responds with confirmation data on successful filing of 'putClinicianCreation' method.
  3. Example: "<Confirmation>Practitioner ID:000017||||First Name:FIRSTNAME||Last Name:LASTNAME||Registration Date:01/01/2022||NPI:123456789</Confirmation>"
  4. Confirm 'ClinicianServices' web service responds with confirmation message on successful filing of 'putClinicianCreation' method.
  5. Example: "<Message>Clinician Services web service has been filed successfully.</Message>"
  6. Confirm 'ClinicianServices' web service responds with successful status value on successful filing of 'putClinicianCreation' method.
  7. Example: " <Status>1</Status>"
  8. Open Avatar PM 'Practitioner Enrollment' form and select Practitioner Enrollment record filed via web service for view/update.
  9. Confirm new Practitioner Enrollment record is created in Avatar PM, with values/data submitted via web service including 'Attendant ID' field value (as well as values assigned for Avatar MSO 'Performing Provider' and 'Performing Provider Registration' practitioner association/link fields if enabled).
Scenario 2: 'ClinicianServices' Web Service - Verification Of 'putClinicianUpdate' Filing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Application utilizing the Avatar PM 'ClinicianServices' web service
Steps
  1. Using Avatar PM 'ClinicianServices' web service, submit request to 'putClinicianUpdate' method to edit/update Avatar PM Practitioner Enrollment (and optionally Avatar MSO Performing Provider Registration record if linked), including value for 'AttendantID' field/segment.
  2. Confirm 'ClinicianServices' web service responds with confirmation data on successful filing of 'putClinicianUpdate' method.
  3. Example: "<Confirmation>Practitioner ID:000017||||First Name:FIRSTNAME||Last Name:LASTNAME||Registration Date:01/01/2022||NPI:123456789</Confirmation>"
  4. Confirm 'ClinicianServices' web service responds with confirmation message on successful filing of 'putClinicianUpdate' method.
  5. Example: "<Message>Clinician Services web service has been filed successfully.</Message>"
  6. Confirm 'ClinicianServices' web service responds with successful status value on successful filing of 'putClinicianUpdate' method.
  7. Example: " <Status>1</Status>"
  8. Open Avatar PM 'Practitioner Enrollment' form and select Practitioner Enrollment record filed via web service for view/update.
  9. Confirm Practitioner Enrollment record is updated in Avatar PM, with values/data submitted via web service including 'Attendant ID' field value.
Scenario 3: 'ClinicianServicesV2' Web Service - Verification Of 'putClinicianCreation' Filing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Application utilizing the Avatar PM 'ClinicianServicesV2' web service
Steps
  1. Using Avatar PM 'ClinicianServicesV2' web service, submit request to 'putClinicianCreation' method to create new Avatar PM Practitioner Enrollment (and optionally Avatar MSO Performing Provider Registration record), including value for 'AttendantID' field/segment.
  2. Confirm 'ClinicianServicesV2' web service responds with confirmation data on successful filing of 'putClinicianCreation' method.
  3. Example: "<Confirmation>Practitioner ID:000017||||First Name:FIRSTNAME||Last Name:LASTNAME||Registration Date:01/01/2022||NPI:123456789</Confirmation>"
  4. Confirm 'ClinicianServicesV2' web service responds with confirmation message on successful filing of 'putClinicianCreation' method.
  5. Example: "<Message>Clinician Services web service has been filed successfully.</Message>"
  6. Confirm 'ClinicianServicesV2' web service responds with successful status value on successful filing of 'putClinicianCreation' method.
  7. Example: " <Status>1</Status>"
  8. Open Avatar PM 'Practitioner Enrollment' form and select Practitioner Enrollment record filed via web service for view/update.
  9. Confirm new Practitioner Enrollment record is created in Avatar PM, with values/data submitted via web service including 'Attendant ID' field value (as well as values assigned for Avatar MSO 'Performing Provider' and 'Performing Provider Registration' practitioner association/link fields if enabled).
Scenario 4: 'ClinicianServicesV2' Web Service - Verification Of 'putClinicianUpdate' Filing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Application utilizing the Avatar PM 'ClinicianServicesV2' web service
Steps
  1. Using Avatar PM 'ClinicianServicesV2' web service, submit request to 'putClinicianUpdate' method to edit/update Avatar PM Practitioner Enrollment (and optionally Avatar MSO Performing Provider Registration record if linked), including value for 'AttendantID' field/segment.
  2. Confirm 'ClinicianServicesV2' web service responds with confirmation data on successful filing of 'putClinicianUpdate' method.
  3. Example: "<Confirmation>Practitioner ID:000017||||First Name:FIRSTNAME||Last Name:LASTNAME||Registration Date:01/01/2022||NPI:123456789</Confirmation>"
  4. Confirm 'ClinicianServicesV2' web service responds with confirmation message on successful filing of 'putClinicianUpdate' method.
  5. Example: "<Message>Clinician Services web service has been filed successfully.</Message>"
  6. Confirm 'ClinicianServicesV2' web service responds with successful status value on successful filing of 'putClinicianUpdate' method.
  7. Example: " <Status>1</Status>"
  8. Open Avatar PM 'Practitioner Enrollment' form and select Practitioner Enrollment record filed via web service for view/update.
  9. Confirm Practitioner Enrollment record is updated in Avatar PM, with values/data submitted via web service including 'Attendant ID' field value.
Scenario 5: 'Practitioner Enrollment' - Form Verification
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar PM 'Practitioner Enrollment' form.
  2. Enter/select existing Practitioner Enrollment record for viewing/update (or click 'New Staff' button for new Practitioner Enrollment entry).
  3. Ensure new input field 'Attendant ID' is added to 'Practitioner Enrollment' form (in 'Practitioner Enrollment' first/primary form section).
  4. Ensure that field help message (lightbulb icon) is present for 'Attendant ID' field; click the help message icon and ensure the following field help text is displayed:
  5. 'This field allows users to enter the Attendant ID for EVV services when billing Texas TMHP. The system will print this Attendant ID in positions 5 to 20 of the 'Line Item Control Number' in 2400-REF for EVV services for guarantors whose financial class has 'Texas TMHP Billing' set to Yes. Services are designated as EVV services when 'TMHP Type of Service' is set to 'EVV' in the Service Code form.'
  6. Enter value for 'Attendant ID' field.
  7. Enter/select values for all other form fields as required/desired.
  8. Click 'Submit' button to file 'Practitioner Enrollment' form/record.
  9. Re-open Avatar PM 'Practitioner Enrollment' form and select same/previously filed Practitioner Enrollment record for view/update.
  10. Ensure that previously entered/filed value for 'Attendant ID' field is present/displayed in form for selected record.
  11. Open Crystal Reports or other SQL reporting tool.
  12. In Avatar PM SQL table 'SYSTEM.staff_enrollment_history', ensure that field 'attendant_ID' is available, and contains value filed for 'Attendant ID' via Avatar PM 'Practitioner Enrollment' form.
Scenario 6: 'PractitionerRegister' Web Service - Verification Of 'PractitionerRegister' Filing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Application utilizing the Avatar PM 'PractitionerRegister' web service
Steps
  1. Using Avatar PM 'PractitionerRegister' web service, submit request to 'PractitionerRegister' method to create new Avatar PM Practitioner Enrollment, including value for 'AttendantID' field/segment.
  2. Confirm 'PractitionerRegister' web service responds with confirmation data/ID on successful filing of 'PractitionerRegister' method.
  3. Example:"<Confirmation>Unique ID : 000056</Confirmation>"
  4. Confirm 'PractitionerRegister' web service responds with confirmation message on successful filing of 'PractitionerRegister' method.
  5. Example:"<Message>Practitioner Enrollment web service has been filed successfully.</Message>"
  6. Confirm 'PractitionerRegister' web service responds with successful status value on successful filing of 'PractitionerRegister' method.
  7. Example:" <Status>1</Status>"
  8. Open Avatar PM 'Practitioner Enrollment' form and select Practitioner Enrollment record filed via web service for view/update.
  9. Confirm new Practitioner/Practitioner Enrollment record is created in Avatar PM, with values/data submitted via web service including 'Attendant ID' field value.
Scenario 7: 'PractitionerRegister' Web Service - Verification Of 'EditPractitionerRegister' Filing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Application utilizing the Avatar PM 'PractitionerRegister' web service
Steps
  1. Using Avatar PM 'PractitionerRegister' web service, submit request to 'EditPractitionerRegister' method to edit/update Avatar PM Practitioner Enrollment, including value for 'AttendantID' field/segment.
  2. Confirm 'PractitionerRegister' web service responds with confirmation data/ID on successful filing of 'EditPractitionerRegister' method.
  3. Example:"<Confirmation>Unique ID : 000056</Confirmation>"
  4. Confirm 'PractitionerRegister' web service responds with confirmation message on successful filing of 'EditPractitionerRegister' method.
  5. Example:"<Message>Practitioner Enrollment web service has been filed successfully.</Message>"
  6. Confirm 'PractitionerRegister' web service responds with successful status value on successful filing of 'EditPractitionerRegister' method.
  7. Example:" <Status>1</Status>"
  8. Open Avatar PM 'Practitioner Enrollment' form and select Practitioner Enrollment record filed via web service for view/update.
  9. Confirm Practitioner/Practitioner Enrollment record is updated in Avatar PM, with values/data submitted via web service including 'Attendant ID' field value.
Avatar State Forms 'Enable Texas TMHP Billing' Registry Setting - Guarantors/Payors Field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
Scenario 1: 'Guarantors/Payors' - Form Verification
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
Steps
  1. Open the Avatar PM 'Guarantors/Payors' form.
  2. Select Add or Edit action in 'Add New or Edit Existing Guarantor' field.
  3. Enter new (or select existing) Guarantor Code.
  4. Complete all required/desired fields in main section of 'Guarantors/Payors' form.
  5. Navigate to '837' section of 'Guarantors/Payors' form.
  6. Ensure that the 'TMHP Waiver Skip 2300-REF Segment' field is available in form.
  7. If 'Yes' is selected in this field, 837 Professional files sorted/created for this Guarantor via 'Electronic Billing' forms/functions (and subject to 'Enable Texas TMHP Billing' functionality/values) will conditionally skip/omit the 2300-REF segment/value for 'TMHP Waiver Reference Number'
  8. Select value for 'TMHP Waiver Skip 2300-REF Segment' field (and any other desired fields in '837' section of form).
  9. Navigate to main section of 'Guarantors/Payors' form.
  10. Click 'File' button to save/file Guarantor/Payor definition information.
  11. Select 'Edit' action and select previously filed Guarantor Code.
  12. Navigate to '837' section of 'Guarantors/Payors' form.
  13. Ensure that previously selected/filed value for 'TMHP Waiver Skip 2300-REF Segment' field is present/selected in form.
Avatar State Forms 'Enable Texas TMHP Billing' Registry Setting - 837 and 835 Functionality
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Practitioner Enrollment
  • 835 Health Care Claim Payment/Advice (PM)
  • 835 Health Care Claim Payment/Advice Report
Scenario 1: 'Electronic Billing' - Support for 837 Professional 2300-REF Referral Number 'Texas TMHP Billing' Reporting
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Extended Dictionary Data Element entry '(941) Texas TMHP Billing' (under Data Element '(1000) Financial Class') must be set to 'Yes' for selected Guarantor/Financial Class
  • 'TMHP Waiver Skip 2300-REF Segment' value (Yes/No) must be defined for selected Guarantor (via Avatar PM 'Guarantors/Payors' form)
  • Financial Eligibility/Cross Episode Financial Eligibility/Family Financial Eligibility record for client(s) where 'TMHP Waiver Reference Number' value is defined
  • One or more 837 Professional /HCFA1500 service(s) eligible for Electronic Billing inclusion
Steps
  1. Open Avatar PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar PM 'Quick Billing' form/functionality.)
  2. Select '837 Professional' in the 'Billing Form' field.
  3. Select 'Sort File' in the 'Billing Options' field.
  4. Enter/select 837 Professional file sorting criteria.
  5. Click 'Process' button to sort/generate 837 Professional file.
  6. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional file sorted which includes services(s), and click 'Process' button to display 837 Professional outbound file data.
  9. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional claim data includes 2300-REF Referral Number/Reference Identification loop/segment with 'TMHP Waiver Reference Number' value defined for client via applicable Financial Eligibility form/record. (2300-REF-01 Qualifier = '9F' Referral Number)
  10. Examples:
  11. 'REF*9F*TMHP12345678A~'
  12. 'REF*9F*TMHPW-9999~'
  13. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional claim data does not include 2300-REF Referral Number/Reference Identification loop/segment with 'TMHP Waiver Reference Number' value in case where 'TMHP Waiver Skip 2300-REF Segment' is set to 'Yes' for selected/applicable Guarantor.
  14. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional claim data does not include 2300-REF Referral Number/Reference Identification loop/segment with 'TMHP Waiver Reference Number' value in case where Extended Dictionary Data Element entry '(941) Texas TMHP Billing' is set to 'No' (or not defined) for selected/applicable Guarantor/Financial Class.
  15. Select 'Run Report' in the 'Billing Options' field.
  16. Select 'Print' in the 'Print Or Delete Report' field.
  17. Select 837 Professional file sorted which includes services(s), and click 'Process' button to display 837 Professional outbound file report/errors.
  18. Click 'Required Data Missing: Patient Claim Data' link in 837 Professional outbound report to open error sub-report/section.
  19. In Avatar PM 837 Professional format outbound electronic billing file report - ensure that where 2300-REF Referral Number/Reference Identification loop/segment cannot be created due to missing 'TMHP Waiver Reference Number' value for client via applicable Financial Eligibility form/record, client/claim is included in 'Required Data Missing: Patient Claim Data' sub-report/section with Error Message 'Required Data Missing: Patient Claim Data (Loop: 2300 Segment REF).'
Scenario 2: 'Electronic Billing' - Support for 837 Professional 2400-REF Line Item Control Number 'Texas TMHP Billing' Reporting
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Extended Dictionary Data Element entry '(941) Texas TMHP Billing' (under Data Element '(1000) Financial Class') must be set to 'Yes' for selected Guarantor/Financial Class
  • 'TMHP Type Of Service' must be defined for Service Code (via Avatar PM 'Service Codes' form)
  • 'Attendant ID' must be defined for Practitioner where applicable for 'TMHP Type Of Service' value 'EVV' (via Avatar PM 'Practitioner Enrollment' form)
  • 'Line Item Control Number - Positions 5 to 20 (2400-REF)' must be defined for Service Code where applicable for 'TMHP Type Of Service' value 'Nursing and Transportation Services' (via Avatar PM 'Service Codes' form)
  • One or more 837 Professional /HCFA1500 service(s) eligible for Electronic Billing inclusion, where 'Service Start Time' value is entered/defined
Steps
  1. Open Avatar PM 'Electronic Billing' form. (Note, acceptance testing may also be confirmed via Avatar PM 'Quick Billing' form/functionality.)
  2. Select '837 Professional' in the 'Billing Form' field.
  3. Select 'Sort File' in the 'Billing Options' field.
  4. Enter/select 837 Professional file sorting criteria.
  5. Click 'Process' button to sort/generate 837 Professional file.
  6. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  7. Select 'Print' in the 'Print Or Delete Report' field.
  8. Select 837 Professional file sorted which includes services(s), and click 'Process' button to display 837 Professional outbound file data.
  9. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional claim data includes 2400-REF Line Item Control Number loop/segment with values defined for Service Start Time, Service Code/Practitioner Enrollment information and Service ID information as follows (2400-REF-01 Qualifier = '6R' Provider Control Number )
  10. Segment 2400-REF-02 Reference Identification positions 1-4 will be populated with 'Service Start Time' value entered/filed for service (24 hour/military time format 0000-2359)
  11. Examples:
  12. REF*6R*0930...~
  13. REF*6R*1445...~
  14. Segment 2400-REF-02 Reference Identification positions 5-20 will be populated with 'Attendant ID' value for applicable Practitioner Enrollment record where Service Code 'TMHP Type Of Service' value = 'EVV' (padded with spaces on end of value if required)
  15. Examples:
  16. REF*6R*09301122GREEN_______...~
  17. REF*6R*14453344SMITH-WEST__...~
  18. Segment 2400-REF-02 Reference Identification positions 5-20 will be populated with 'Line Item Control Number - Positions 5 to 20 (2400-REF)' value for Service Code where Service Code 'TMHP Type Of Service' value = 'Nursing and Transportation' (padded with spaces on end of value if required)
  19. Examples:
  20. REF*6R*0930ACCUM.NUR_______...~
  21. REF*6R*1530(ACCUM.LVN)_____...~
  22. Segment 2400-REF-02 Reference Identification Positions 5-20 will be populated with 'Name' value for applicable Practitioner Enrollment record (LastName,FirstName format) where Service Code 'TMHP Type Of Service' value = 'Non-Accumulated' (padded with spaces on end of value if required, truncated if value exceeds 16 characters)
  23. Examples:
  24. REF*6R*0930GREEN,SUE_______...~
  25. REF*6R*1445GREEN-SMITH,SUSA...~
  26. Segment 2400-REF-02 Reference Identification Positions 21-30 will be populated with the Avatar PM internal Claim/Service Unique ID value for service (from Patient Control Number/Service Date)
  27. Examples:
  28. REF*6R*09301122GREEN_______66132.0001~
  29. REF*6R*1530ACCUM.NUR_______66115.001~
  30. REF*6R*1445GREEN-SMITH,SUSA66129.002~
  31. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional service data does not include 2400-REF Line Item Control Number loop/segment with Texas TMHP Billing values in case where 'Service Start Time' value is not entered/filed for service. Note that 2400-REF Line Item Control Number loop/segment may be included according to other Avatar PM Billing configurations for Claim/Service Unique ID, such as 'IDX475X1X66114.001' or 'CX154X66110.001~'. etc.
  32. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional service data does not include 2400-REF Line Item Control Number loop/segment with Texas TMHP Billing values in case where 'TMHP Type Of Service' value is not defined for Service Code. Note that 2400-REF Line Item Control Number loop/segment may be included according to other Avatar PM Billing configurations for Claim/Service Unique ID, such as 'IDX475X1X66114.001' or 'CX154X66110.001~', etc.
  33. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional service data does not include 2400-REF Line Item Control Number loop/segment with Texas TMHP Billing values in case where Extended Dictionary Data Element entry '(941) Texas TMHP Billing' is set to 'No' (or not defined) for selected/applicable Guarantor/Financial Class. Note that 2400-REF Line Item Control Number loop/segment may be included according to other Avatar PM Billing configurations for Claim/Service Unique ID, such as 'IDX475X1X66114.001' or 'CX154X66110.001~', etc.
  34. Select 'Run Report' in the 'Billing Options' field.
  35. Select 'Print' in the 'Print Or Delete Report' field.
  36. Select 837 Professional file sorted which includes services(s), and click 'Process' button to display 837 Professional outbound file report/errors.
  37. Click 'Required Data Missing: Patient Service Data' link in 837 Professional outbound report to open error sub-report/section.
  38. In Avatar PM 837 Professional format outbound electronic billing file report - ensure that where 2400-REF Line Item Control Number loop/segment cannot be created due to missing 'Name'/'Attendant ID' value for applicable Practitioner Enrollment record or missing 'Line Item Control Number - Positions 5 to 20 (2400-REF)' value for Service Code, client/service is included in 'Required Data Missing: Patient Service Data' sub-report/section with Error Messages 'Required Data Missing: Patient Service Data (Loop: 2400 Segment REF). Missing Field/Invalid Format: Reference Identification (Loop: 2400 Segment: REF Iteration: For Practitioner. Unable To Create Segment: REF (Loop: 2400)'.
Scenario 3: 'Dictionary Update' - Verification of 'Financial Class' Extended Dictionary for 'Texas TMHP Billing'
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
Steps
  1. Open Avatar PM 'Dictionary Update' form ('Input Dictionary Code(s)' main/first form section).
  2. Select 'Payor' in 'File' field.
  3. Enter/select '(1000) Financial Class' in 'Data Element' field.
  4. Enter value for existing or new Financial Class entry in 'Dictionary Code' field.
  5. Click to expand 'Extended Dictionary Data Element' field.
  6. Ensure Extended Dictionary Data Element entry '(941) Texas TMHP Billing' is available for selection; select '(941) Texas TMHP Billing' in field.
  7. Click to expand 'Extended Dictionary Value (Single Dictionary)' field.
  8. Ensure values 'Yes' and 'No' are available for selection; select 'Yes' or 'No' value for Extended Dictionary Data Element entry '(941) Texas TMHP Billing'.
  9. Click 'Apply Changes' to file form/Dictionary updates.
  10. Select previously filed '(1000) Financial Class' Data Element/Dictionary Code value.
  11. Select '(941) Texas TMHP Billing' in 'Extended Dictionary Data Element' field.
  12. Ensure that previously selected/filed value for '(941) Texas TMHP Billing' Extended Dictionary Data Element is present/selected in form.
Scenario 4: '835 Health Care Claim Payment/Advice' - Support for 2400-REF Line Item Control Number 'Texas TMHP Billing' Processing
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
  • Extended Dictionary Data Element entry '(941) Texas TMHP Billing' (under Data Element '(1000) Financial Class') must be set to 'Yes' for applicable Guarantor/Financial Class
  • Inbound 835 Health Care Claim Payment/Advice file containing one or more successfully compiled entries for Avatar PM claims where outbound/original 837 Professional Claim/Service information includes 2400-REF Line Item Control Number loop/segment with Texas TMHP Billing values in 2400-REF-02
  • Outbound/original 837 Professional 2400-REF Line Item Control Number Examples:
  1. REF*6R*09301122GREEN_______66132.0001~
  2. REF*6R*1530ACCUM.NUR_______66115.001~
  3. REF*6R*1445GREEN-SMITH,SUSA66129.002~
Steps
  1. Open Avatar PM '835 Health Care Claim Payment/Advice' form.
  2. Select 'Load File' in the 'Options' field.
  3. Enter 'File Path/Name' value for 835 inbound file to be loaded, and click 'Process File' button.
  4. Ensure 835 file is successfully loaded.
  5. Select 'Compile File' in the 'Options' field.
  6. Select loaded inbound 835 file in the 'Select File' field, and click 'Process File' button.
  7. In 835 Compile Report - In case where Avatar PM outbound/original 837 Professional Claim/Service information includes 2400-REF Line Item Control Number loop/segment with Texas TMHP Billing values in 2400-REF-02 (and thus not using Avatar PM Claim/Service Unique ID combination), ensure that inbound 835 payments/adjustments are successfully compiled/matched to Avatar PM claim/service using 2100-CLP Claim Payment Information (as compared to original 837 Professional 2300-CLM Claim Information) and do not require full/exact 2110-REF-02 segment match where loop/segment is present in 835 information.
  8. Select 'Post File' in the 'Options' field.
  9. Select compiled inbound 835 file in the 'Select File' field, enter values for 'Posting Date' and 'Date of Receipt' fields (as well as any other fields as required/desired), and click 'Process File' button.
  10. In 835 Posting Report - In case where Avatar PM outbound/original 837 Professional Claim/Service information includes 2400-REF Line Item Control Number loop/segment with Texas TMHP Billing values in 2400-REF-02 (and thus not using Avatar PM Claim/Service Unique ID combination), ensure that inbound 835 payments/adjustments are successfully posted/matched to Avatar PM claim/service using 2100-CLP Claim Payment Information (as compared to original 837 Professional 2300-CLM Claim Information) and do not require full/exact 2110-REF-02 segment match where loop/segment is present in 835 information.
  11. Open 'Client Ledger' form.
  12. Enter/select values for 'Client ID', 'Claim/Episodes/All Episodes' and 'Ledger Type' fields (and any other fields as required/desired).
  13. Click 'Process' button to display Client Ledger information.
  14. In Client Ledger information display - for service(s) where Avatar PM outbound/original 837 Professional Claim/Service information includes 2400-REF Line Item Control Number loop/segment with Texas TMHP Billing values, ensure that inbound 835 Health Care Claim Payment/Advice file payments/adjustments successfully posted are present/displayed in ledger.
Topics
• Registry Settings • Financial Eligibility • NX • Web Services • Service Codes • Service Code Upload Process • Practitioner • Practitioner Enrollment • Guarantor/Payors • Electronic Billing • 837 Professional • Dictionary • 835 Health Care Claim Payment/Advice
Update 15 Summary | Details
Unbilled Services Compile Definition and Export - error messages
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • User Definition
  • Dynamic Form - Dictionary Update - Locked Dictionary
  • Guarantors/Payors
  • Form Designer (PM)
  • Program Maintenance
  • Practitioner Enrollment
  • Practitioner Numbers By Guarantor And Program
  • Admission (Outpatient)
  • Dynamic Form - Edit Service Fee Definition
  • Unbilled Services Compile Definition and Export
  • Dynamic Form - Unbilled Services Compile Definition
  • System Task Scheduler
  • Ambulatory Progress Notes
  • Dynamic Form - document routing - sign
  • Dynamic Form - document routing - verify password
  • Dynamic Forms - Document Routing - Route Document To Dialog
  • Dynamic Form - Delete Compile Definition
  • Discharge
  • Treatment Plan
  • Failed Authentication - Input Dialog
  • Dynamic Form - Treatment Plan
  • Dynamic Form Client Treatment Plan
  • Dynamic Form Plan Date
  • Individual Cash Posting (PM)
  • Dynamic Form - Individual Cash Posting - Information
  • Dynamic Form - Individual Cash Posting - Alert
  • Dynamic Form - Individual Cash Posting - Client
  • Document Routing Setup (PM)
  • Dynamic Form - Document Routing Setup - Select Form
Scenario 1: Unbilled Services Compile Definition and Export - Error message priority validation
Specific Setup:
  • The following error messages have been added to the ‘Unbilled Services Compile Definition and Export’ processing:
  • 837 Institutional Only:
  • Episode cannot be billed due to 3 day billing rule. Priority 33.
  • This Service Would Result In The Generation Of More Than One Institutional Service Line (2400-SV2) Segment, Per Claim Information (2300-CLM), For Room And Board Services. Priority 34.
  • Service Code Is Missing Rate Code Information For Guarantor. Priority 37.
  • 837 Professional Only:
  • Missing 'Place Of Service (837 Professional)' Extended Dictionary Off Of Location. Priority 31.
  • Service Code Does Not Have A Professional Component. Priority 35.
  • Missing Note Description (2400 NTE). Priority 36.
  • Both 837 Institutional and 837 Professional:
  • Missing Subscriber Group #. Priority 29.
  • An Add-On or Interactive Complexity service code can only be billed if the primary service is also on the claim. Priority 30.
  • This Service Is Being Excluded From The Bill Due To Crossover Claim Logic Associated With Guarantor. Priority 32.
  • Unable to Bill Service Due To Same Day Service Hold For Progress Notes. Priority is always last.
  • Due To Coordination Of Benefits Logic This Claim Cannot Be Billed Out Until Prior Covering Guarantor(s) Have Received Payment. Priority 38.
  • Treatment Plan Service Count Exceeded For This Program Of Service. Priority 40.
  • Missing Field Line Adjudication Information Identification Code. Priority 41.
  • Progress Note On File For Service Requires A Co-Signature But One Is Not Present. Priority 28, processes at the same time as the no progress note on file error.
  • Unbillable services that would fall to the above errors exist.
  • Dictionary Update:
  • Client Dictionary – 83701 - 837 Error Classification is updated as desired.
  • Client Dictionary – 83700 - 837 Error Code is updated as desired.
  • Desired number of ‘Unbilled Services Compile Definition and Export’ exist for the unbillable services.
  • System Task Scheduler has been used to schedule the task of processing the Unbilled Services Compile Definition and Export. Note the scheduled dates/times to note when to begin the verification process.
Steps
  1. Open ‘Unbilled Services Compile Definition and Export’.
  2. Select the ‘Export Unbilled Services’ section.
  3. Click [Export Unbilled Services Data].
  4. Save the ‘NetsmartExport.csv’ file to desired location.
  5. Open the saved file with ‘Notepad’ or another desired tool.
  6. Validate that the expected errors exist in the export and the priority for the errors places the lowest priority as the ‘Primary Unbilled Reason’ and all other errors are listed as ‘Other Reasons’.
  7. Update the necessary data to the ‘Primary Unbilled Reason’ for at least one service that contains other errors.
  8. Process the ‘System Task Scheduler’ for the ‘Unbilled Services Compile Definition and Export’.
  9. Open ‘Unbilled Services Compile Definition and Export’.
  10. Select the ‘Export Unbilled Services’ section.
  11. Click [Export Unbilled Services Data].
  12. Save the ‘NetsmartExport.csv’ file to desired location.
  13. Open the saved file with ‘Notepad’ or another desired tool.
  14. Validate that the original ‘Primary Unbilled Reason’ does not exist and that the lowest priority ‘Other Reasons’ is now the ‘Primary Unbilled Reason’.
Topics
• Unbilled Services Report • myAvatar/myAvatar NX
Update 17 Summary | Details
'Eligibility Response (271)' File Posting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Eligibility Response (271)
  • Eligibility Response (271) Report
  • Eligibility Inquiry and Response (270/271) Report
Scenario 1: 'Eligibility Response (271)' Form - Verification of 271 Eligibility Response File Posting
Specific Setup:
  • Avatar PM Registry Setting 'Enable 270/271 Transaction Sets' must be enabled
  • 271 Eligibility Response File configurations must be defined (via Avatar PM 'Guarantors/Payors' form)
  • Inbound 271 Eligibility Response file containing one or more valid entries for loading/compilation/posting
Steps
  1. Open Avatar PM 'Eligibility Response (271)' form (under 'Avatar PM / Billing / Electronic Submission' menu path).
  2. Select 'Load File' in 'Options' field, and enter 'File Path\Name' value for 271 Eligibility Response file to be loaded.
  3. Click 'Process File' button to load specified 271 Eligibility Response file.
  4. Select 'Compile File' in 'Options' field, and select loaded 271 Eligibility Response file to be compiled in 'Select File' field.
  5. Click 'Process File' button to compile selected 271 Eligibility Response file.
  6. In 'Eligibility Response (271)' Report results, ensure that one or more valid response entries are compiled and present in report (in 'Response Data' sub-report/section).
  7. Select 'Post File' in 'Options' field, and select compiled 271 Eligibility Response file to be posted in 'Select File' field.
  8. Click 'Process File' button to post selected 271 Eligibility Response file.
  9. In 'Eligibility Response (271)' Report results, ensure that one or more valid response entries are posted and present in report (in 'Response Data' sub-report/section).
  10. Open Avatar PM 'Eligibility Inquiry and Response (270/271) Report' form (under 'Avatar PM / Billing / Electronic Submission' menu path).
  11. Enter/select value for 'Client ID', 'Episode Number' and 'Guarantor' criteria fields (as well as 'Service Code' and 'CPT-4 Code' criteria fields where applicable).
  12. Click 'Display Report' button to view Eligibility Inquiry and Response (270/271) Report results.
  13. In Eligibility Inquiry and Response (270/271) Report results, ensure that inquiry/response entry/entries is/are present in report for selected Client/Episode/Guarantor (in 'Eligibility Inquiries and Responses (Verified)' sub-report/section).
Topics
• Eligibility Response (271) • NX