Avatar PM 2022 Monthly Release 2022.02.00 Acceptance Tests

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Update 18 Summary \| Details Registry Setting - Allow Roll-Up Rule Selection During Compile Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Registry Settings (PM) Client Ledger Compile/Edit/Post/Unpost Roll-Up Services Worklist Roll-Up Services Definition Dynamic Form - Roll-Up Group Definition Client Charge Input Scenario 1: Registry Setting - Allow Roll-Up Rule Selection During Compile - Single Roll-Up Specific Setup: Registry Setting: Allow Roll-Up Rule Selection During Compile has a value of ‘1’. Roll-Up Services Definition: Two single and two group roll-up definitions exist. Note the component service codes and any requirements. At a minimum, services that meet a single roll-up definition exist for a minimum of one client. Note the client ID. Note the dates of service. Steps Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Verify that the only roll-up definitions that can be selected are single definitions. Enter the desired ‘From Date’ and ‘To Date’. Select the definitions for the services in ‘Setup’. Click [Compile Worklist]. Click [OK]. Select the ‘Post Roll-Up Services Worklist’ section. Select the desired ‘Through Date’. Select the desired 'Write Off Posting Code’. Click [Post Worklist]. Click [OK]. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Scenario 2: Registry Setting - Allow Roll-Up Rule Selection During Compile - Group Roll-Up Specific Setup: Registry Setting: Allow Roll-Up Rule Selection During Compile has a value of ‘1’. Roll-Up Services Definition: Open the 'Roll-Up Group Definition' section: Click the light bulb on the ‘Post Roll-Up Rule Individually’ field. Validate that it contains: If 'No' is selected, each roll-up rule is compiled in the specified order of execution, then the entire compile is posted. This is the default behavior for roll-up processing. If 'Yes' is selected, each roll-up rule is compiled and posted in order of execution before the next roll-up rule is compiled. Create a minimum of two 'Roll-Up Group Definitions'. One definition must have a value of 'Yes' and one definition must have a value of 'No' in ‘Post Roll-Up Rule Individually’. At a minimum, services that meet both group roll-up definitions exist for a minimum of one client. Note the client ID. Note the dates of service. Open the 'Roll-Up Services Definition' section, select edit and note the value of 'Existing Roll-Up Definition' for at least one definition. Steps Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Verify that the only roll-up definitions that can be selected are group definitions. Enter the desired ‘From Date’ and ‘To Date’ for the group definition with a value of 'Yes' in ‘Post Roll-Up Rule Individually’. Select the group definitions with a value of 'Yes' in ‘Post Roll-Up Rule Individually’. Click [Compile Worklist]. Click [OK]. Based on the light bulb message when 'Yes' is in ‘Post Roll-Up Rule Individually’, each roll-up rule is compiled and posted in order of execution before the next roll-up rule is compiled. This means that the user does not use the 'Post Roll-Up Services Worklist' section of the form. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Enter the desired ‘From Date’ and ‘To Date’ for the group definition with a value of 'No' in ‘Post Roll-Up Rule Individually’. Select the group definitions with a value of 'Yes' in ‘Post Roll-Up Rule Individually’. Click [Compile Worklist]. Click [OK]. Based on the light bulb message when 'No' is in ‘Post Roll-Up Rule Individually’, each roll-up rule is compiled in the specified order of execution, then the entire compile is posted. Select the ‘Post Roll-Up Services Worklist’ section. Select the desired ‘Through Date’. Click [Post Worklist]. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Scenario 3: Registry Setting - Allow Roll-Up Rule Selection During Compile - Single and Group Roll-Ups Specific Setup: Registry Setting: Allow Roll-Up Rule Selection During Compile has a value of ‘172’. This value indicates that the option to select either individual or group 'Roll-Up Services Definitions' will be included on the form. When an individual definition is selected the user will be unable to select a group definition, or when a group definition is selected the user will be unable to select an individual definition. Roll-Up Services Definition: At a minimum, two single and two group roll-up definitions exist. Note the component service codes and any requirements. In the group definitions: If 'No' is selected, each roll-up rule is compiled in the specified order of execution, then the entire compile is posted. This is the default behavior for roll-up processing. If 'Yes' is selected, each roll-up rule is compiled and posted in order of execution before the next roll-up rule is compiled. At a minimum, services that meet a single roll-up definition, and services that will meet a group definition, exist for a minimum of one client. Note the client ID. Note the dates of service. Steps Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Verify that the fields ‘Roll-Up Definitions’ and ‘Roll-Up Group’ are enabled. Enter the desired ‘From Date’ and ‘To Date’. Select a value in ‘Roll-Up Definitions’. Validate that no value can be selected in ‘Roll-Up Group’. Click [Compile Worklist]. Click [OK]. Select the ‘Post Roll-Up Services Worklist’ section. Select the desired ‘Through Date’. Select the desired 'Write Off Posting Code’. Click [Post Worklist]. Click [OK]. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Enter the desired ‘From Date’ and ‘To Date’. Select a value in ‘Roll-Up Group’. Validate that no value can be selected in ‘Roll-Up Definitions’. Click [Compile Worklist]. Click [OK]. If the group definition is set to roll-up the definition individually, the compile will be posted. If the group definition is not set to roll-up the definition individually, the compile will not be posted. Post the compile. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Scenario 4: Registry Setting - Allow Roll-Up Rule Selection During Compile = zero - No options to select on form Specific Setup: Registry Setting: Allow Roll-Up Rule Selection During Compile has a value of ‘0’. A value of '0' indicates that the option to select 'Roll-Up Services Definitions' will be removed from the form, and that only 'single' definitions will compile. No 'group definitions will compile. Roll-Up Services Definition: Two single and two group roll-up definitions exist. Note the component service codes and any requirements. At a minimum, services that meet a single roll-up definition, and services that will meet a group definition, exist for a minimum of one client. Note the client ID. Note the dates of service. Steps Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Verify that no roll-up definitions can be selected. Enter the desired ‘From Date’ and ‘To Date’. Click [Compile Worklist]. Click [OK]. Select the ‘Post Roll-Up Services Worklist’ section. Select the desired ‘Through Date’. Select the desired 'Write Off Posting Code’. Click [Post Worklist]. Click [OK]. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Roll-Up Services Definition - Roll-Up Group Definition Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Registry Settings (PM) Roll-Up Services Definition Dynamic Form - Roll-Up Group Definition Client Charge Input Compile/Edit/Post/Unpost Roll-Up Services Worklist Client Ledger Scenario 1: Registry Setting - Allow Roll-Up Rule Selection During Compile - Group Roll-Up Specific Setup: Registry Setting: Allow Roll-Up Rule Selection During Compile has a value of ‘1’. Roll-Up Services Definition: Open the 'Roll-Up Group Definition' section: Click the light bulb on the ‘Post Roll-Up Rule Individually’ field. Validate that it contains: If 'No' is selected, each roll-up rule is compiled in the specified order of execution, then the entire compile is posted. This is the default behavior for roll-up processing. If 'Yes' is selected, each roll-up rule is compiled and posted in order of execution before the next roll-up rule is compiled. Create a minimum of two 'Roll-Up Group Definitions'. One definition must have a value of 'Yes' and one definition must have a value of 'No' in ‘Post Roll-Up Rule Individually’. At a minimum, services that meet both group roll-up definitions exist for a minimum of one client. Note the client ID. Note the dates of service. Open the 'Roll-Up Services Definition' section, select edit and note the value of 'Existing Roll-Up Definition' for at least one definition. Steps Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Verify that the only roll-up definitions that can be selected are group definitions. Enter the desired ‘From Date’ and ‘To Date’ for the group definition with a value of 'Yes' in ‘Post Roll-Up Rule Individually’. Select the group definitions with a value of 'Yes' in ‘Post Roll-Up Rule Individually’. Click [Compile Worklist]. Click [OK]. Based on the light bulb message when 'Yes' is in ‘Post Roll-Up Rule Individually’, each roll-up rule is compiled and posted in order of execution before the next roll-up rule is compiled. This means that the user does not use the 'Post Roll-Up Services Worklist' section of the form. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Enter the desired ‘From Date’ and ‘To Date’ for the group definition with a value of 'No' in ‘Post Roll-Up Rule Individually’. Select the group definitions with a value of 'Yes' in ‘Post Roll-Up Rule Individually’. Click [Compile Worklist]. Click [OK]. Based on the light bulb message when 'No' is in ‘Post Roll-Up Rule Individually’, each roll-up rule is compiled in the specified order of execution, then the entire compile is posted. Select the ‘Post Roll-Up Services Worklist’ section. Select the desired ‘Through Date’. Click [Post Worklist]. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Scenario 2: Registry Setting - Allow Roll-Up Rule Selection During Compile - Single and Group Roll-Ups Specific Setup: Registry Setting: Allow Roll-Up Rule Selection During Compile has a value of ‘172’. This value indicates that the option to select either individual or group 'Roll-Up Services Definitions' will be included on the form. When an individual definition is selected the user will be unable to select a group definition, or when a group definition is selected the user will be unable to select an individual definition. Roll-Up Services Definition: At a minimum, two single and two group roll-up definitions exist. Note the component service codes and any requirements. In the group definitions: If 'No' is selected, each roll-up rule is compiled in the specified order of execution, then the entire compile is posted. This is the default behavior for roll-up processing. If 'Yes' is selected, each roll-up rule is compiled and posted in order of execution before the next roll-up rule is compiled. At a minimum, services that meet a single roll-up definition, and services that will meet a group definition, exist for a minimum of one client. Note the client ID. Note the dates of service. Steps Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Verify that the fields ‘Roll-Up Definitions’ and ‘Roll-Up Group’ are enabled. Enter the desired ‘From Date’ and ‘To Date’. Select a value in ‘Roll-Up Definitions’. Validate that no value can be selected in ‘Roll-Up Group’. Click [Compile Worklist]. Click [OK]. Select the ‘Post Roll-Up Services Worklist’ section. Select the desired ‘Through Date’. Select the desired 'Write Off Posting Code’. Click [Post Worklist]. Click [OK]. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Enter the desired ‘From Date’ and ‘To Date’. Select a value in ‘Roll-Up Group’. Validate that no value can be selected in ‘Roll-Up Definitions’. Click [Compile Worklist]. Click [OK]. If the group definition is set to roll-up the definition individually, the compile will be posted. If the group definition is not set to roll-up the definition individually, the compile will not be posted. Post the compile. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Scenario 3: Registry Setting - Allow Roll-Up Rule Selection During Compile = zero - No options to select on form Specific Setup: Registry Setting: Allow Roll-Up Rule Selection During Compile has a value of ‘0’. A value of '0' indicates that the option to select 'Roll-Up Services Definitions' will be removed from the form, and that only 'single' definitions will compile. No 'group definitions will compile. Roll-Up Services Definition: Two single and two group roll-up definitions exist. Note the component service codes and any requirements. At a minimum, services that meet a single roll-up definition, and services that will meet a group definition, exist for a minimum of one client. Note the client ID. Note the dates of service. Steps Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Verify that no roll-up definitions can be selected. Enter the desired ‘From Date’ and ‘To Date’. Click [Compile Worklist]. Click [OK]. Select the ‘Post Roll-Up Services Worklist’ section. Select the desired ‘Through Date’. Select the desired 'Write Off Posting Code’. Click [Post Worklist]. Click [OK]. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. File Import - Roll-Up Services Definition Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: File Import Roll-Up Services Definition Dynamic Form Delete File Scenario 1: File Import - Roll-Up Services Definition Specific Setup: File Import: The ‘Avatar_PM_File_Import_Record_Layouts_Roll_Ups’ document is included in the posted zip file. Import files have been created to add, edit, and delete a Roll-Up Services Definition. Steps Open ‘File Import’. Select 'Roll-Up Services Definition' in ‘File Type’. Click [Upload New File] in ‘Action’. Click [Process Action]. Upload the file that will add the 'Roll-Up Services Definition'. Click [Compile/Validate File] in ‘Action’. Select the uploaded file. Click [Process Action]. If there are errors, click [Print Errors] in ‘Action’. Select the compiled file. Click [Process Action]. Review the report and upload and compile again to resolve the errors. Click [Print File] in ‘Action’. Click [Process Action]. Review the report to validate the data. Click [Post File] in ‘Action’. Select the compiled file. Click [Process Action]. If desired, Click [Delete File] in ‘Action’. Select the posted file. Click [Process Action]. The ‘Delete File’ message will display. Click desired value. If [Yes], the ‘Confirm message will display. Click [OK]. If [No], the ‘Delete File’ message is removed. Close the form. Open 'Roll-Up Services Definition'. Validate that the definition imported with the correct values. Close the form. Repeat steps 1-24 for the file that will edit the 'Roll-Up Services Definition'. Open 'Roll-Up Services Definition'. Validate that the edited definition contains the correct values in the edited fields. Close the form. Repeat steps 1-24 for the file that will delete the 'Roll-Up Services Definition'. Open 'Roll-Up Services Definition'. Validate that the deleted definition does not exist. Close the form. Compile/Edit/Post/Unpost Roll-Up Services Worklist - Unpost Selected Roll-Up Services Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Client Ledger Compile/Edit/Post/Unpost Roll-Up Services Worklist Scenario 1: Compile/Edit/Post/Unpost Roll-Up Services Worklist - Unpost Selected Roll-Up Services Specific Setup: Compile/Edit/Post/Unpost Roll-Up Services Worklist: A minimum of two Roll-Up Services Worklists have been posted, containing a minimum of two clients. Note the 'Roll-Up Posting Date', 'Roll-Up Dates of Service' and the client IDs. Use ‘Client Ledger’ to validate that the rill-up service was created. Steps Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Select the ‘Unpost Selected Roll-Up Services’ section. Select desired value in ‘Select By Posting Date or Date of Service’. Enter desired value in ‘From Date’. Enter desired value in ‘To Date’. Select ‘Individual Client’ in ‘All or Individual Client’. Select the desired 'Client'. Select desired ‘Roll-Up Worklists’. Click [Select Roll-Ups to Unpost]. Select desired rows in the ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’ grid. Click [Save]. Click [Unpost Roll-Ups]. Click [OK]. Validate the date in the report and close the report. Close the form. Open ‘Client Ledger’. Process the ledger for the date range of the rolled-up services and the client that was selected to be unposted. Validate that the services are not rolled-up. Close the report. Process the ledger for the date range of the rolled-up services and the client that was not selected to be unposted. Validate that the services are rolled-up. Close the report. Close the form. Registry Setting - Default Write Off Posting Code Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Registry Settings (PM) Client Ledger Compile/Edit/Post/Unpost Roll-Up Services Worklist Client Charge Input Scenario 1: Registry Setting - Allow Roll-Up Rule Selection During Compile - Single Roll-Up Specific Setup: Registry Setting: Allow Roll-Up Rule Selection During Compile has a value of ‘1’. Roll-Up Services Definition: Two single and two group roll-up definitions exist. Note the component service codes and any requirements. At a minimum, services that meet a single roll-up definition exist for a minimum of one client. Note the client ID. Note the dates of service. Steps Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Verify that the only roll-up definitions that can be selected are single definitions. Enter the desired ‘From Date’ and ‘To Date’. Select the definitions for the services in ‘Setup’. Click [Compile Worklist]. Click [OK]. Select the ‘Post Roll-Up Services Worklist’ section. Select the desired ‘Through Date’. Select the desired 'Write Off Posting Code’. Click [Post Worklist]. Click [OK]. Close the form. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’ Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’. Close the report. Close the form. Scenario 2: Registry Setting - Default Write Off Posting Code Specific Setup: Registry Setting: Default Write Off Posting Code has desired value without a “#” appended to it. Roll-Up Services Definition exists. Note the component service codes and any requirements. Services that meet the Roll-Up Services Definition exist for a minimum of one client. Note the client ID. Note the dates of service. Steps Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’. Compile the worklist for the dates of service and the Roll-Up Service Definition. Click [OK]. Select the ‘Post Roll-Up Services Worklist’ section. Select the desired compile in ‘Through Date’. Validate that the posting code from the ‘Default Write Off Posting Code’ registry setting displays in ‘Write Off Posting Code‘. Change the posting code to a different value. Click [Post Worklist]. Click [OK]. Close the form. Open ‘Client Ledger’. Select the client. Select ‘All Episodes’ in ‘Claim/Episode/All Episodes’. Enter the dates of service. Select the ‘Simple’ in ‘Ledger Type’. Click [Process]. Validate that the posting code is the posting code that was selected when posting the worklist. Close the report. Close the form.	Topics • Registry Settings • Compile/Edit/Post/Unpost Roll-up Services Worklist • Roll-Up Services Definition • NX • File Import • myAvatar/myAvatar NX
Update 22 Summary \| Details 837 Professional - Billing CCBHC Enumerated service Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Guarantors/Payors Service Codes Dynamic Form - Admission - Client Admission (Outpatient) Financial Eligibility Dictionary Update (PM) Diagnosis Client Charge Input CCBHC PPS Compile Client Ledger Electronic Billing Individual Cash Posting (PM) Dynamic Form - Individual Cash Posting - Information Dynamic Form - Individual Cash Posting - Alert Dynamic Form - Individual Cash Posting - Client Crystal Report Viewer Dynamic Form - Edit Service Fee Definition Dynamic form- Social Security Number Scenario 1: CCBHC Billing - 837 Professional for the secondary guarantor when the enumerated and partial service transferred to secondary guarantor - CCBHC Claim grouping =Same Specific Setup: CCBHC setup has been completed. Dictionary Update: Two new covered charge categories are created in Client File - Data Element # 10021. Category 1: Is to be used for the CCBHC-Enumerated service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'. Category 2: Is to be used for the CCBHC-PPS service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'. Guarantors/Payors 1: Is a CCBHC Guarantor. Note the guarantor's code/name/financial class of the guarantor. The Financial Class does not equal Self-Pay. Allow Customization of Guarantor Plan = Yes. Select Category 1 in the 'Categories Available For Reviews'. Guarantors/Payors 2: Note the guarantor's code/name/financial class of the guarantor. Is a CCBHC Guarantor. The Financial Class does not equal Self-Pay and is the same financial class of Guarantor 1. Allow Customization of Guarantor Plan = Yes. Select Category 2 in the 'Categories Available For Reviews'. Admission: A client is enrolled in an outpatient program. Note the program. Diagnosis: Client has an active diagnosis record. Note the diagnosis code. Financial Eligibility: The financial eligibility record is: ‘Guarantor 1 is set up as a primary guarantor. The 'Customize Guarantor Plan' has a value of 'Yes'. In the 'Customize Plan' section the Category 1 is selected in the 'Covered Charge Categories'. ‘Guarantor 2 is set up as a secondary guarantor. The 'Customize Guarantor Plan' has a value of 'Yes'. In the 'Customize Plan' section the Category 2 is selected in the 'Covered Charge Categories'. Service Code 1: Is a CCBHC enumerated service code. Select Category 1 in the 'Covered Charge Category.' field. Note the Covered Charge Category. Has a fee definition in Service Fee/Cross Reference Maintenance. Service Code 2: Is a CCBHC non-enumerated service code. Select Category 2 in the 'Covered Charge Category.' field. Note the Covered Charge Category. Has a fee definition in Service Fee/Cross Reference Maintenance. Client Charge Input: A service for Service Code 1 is rendered to the client. Client Ledger: Services have liability distributed to Guarantor 1. Note the service dates. Note the 'CHG' amount. Use 'Close Charges' to close the charges. CCBHC PPS Definition: The CCBHC PPS service definition is created for the CCBHC PPS non-enumerated service code. Create the 'CCBHC PPS Compile' for the client/the dates of service. Review the report to verify that the client is included with no errors. Client Ledger: The CCBHC PPS service for the client is distributed to the secondary guarantor. Do not close that charge. 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client: CCBHC Claim Grouping = None Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank Create an interim billing batch to include services for the financial class defined for the guarantors assigned to the client. Steps Open 'Electronic Billing'. Compile the 837 Professional bill for the financial class without claiming. Set the 'All Or Individual Guarantor' field to 'All'. Select the interim billing batch. Set the 'Include CCBHC Services' to 'Yes'. Compile the bill. Verify the bill compiles successfully. Select 'Run Report' in 'Billing Options'. Select 'Print' in Print Or Delete Report'. Select the 'File'. Click [Print 837 Report]. Verify that the correct primary guarantor is included for the CCBHC Enumerated service. Click [X]. Click [X]. Scenario 2: 837 Professional - Bill CCBHC Enumerated service and PPS service separately - CCBHC Claim grouping = Separate Claim Specific Setup: CCBHC setup has been completed. Dictionary Update: Two new covered charge categories are created in Client File - Data Element # 10021. Category 1: Is to be used for the CCBHC-Enumerated service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'. Category 2: Is to be used for the CCBHC-PPS service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'. Guarantors/Payors: A new CCBHC Guarantor is added. Note the guarantor’s code/name/financial class of the guarantor. The Financial Class does not equal Self-Pay. Allow Customization of Guarantor Plan = Yes. Select Categories 1 and 2 in the 'Categories Available For Reviews'. Admission: A client is enrolled in an outpatient program. Note the program. Diagnosis: Client has an active diagnosis record. Note the diagnosis code. Financial Eligibility: The financial eligibility record is: An identified guarantor is set up as a primary guarantor. The 'Customize Guarantor Plan' has a value of 'Yes'. In the 'Customize Plan' section the Categories 1 and 2 are selected in the 'Covered Charge Categories'. Service Code 1: Is a CCBHC enumerated service code. Select the Category 1 in the 'Covered Charge Category.' field. Note the Covered Charge Category. Has a fee definition in Service Fee/Cross Reference Maintenance. Service Code 2: Is a CCBHC non-enumerated service code. Select the Category 2 in the 'Covered Charge Category.' field. Note the Covered Charge Category. Has a fee definition in Service Fee/Cross Reference Maintenance. Client Charge Input: A service for Service Code 1 is rendered to the client. Client Ledger: Services have liability distributed to Guarantor 1. Note the service dates. Note the 'CHG' amount. Use 'Close Charges' to close the charges. CCBHC PPS Definition: The CCBHC PPS service definition is created for the client and CCBHC PPS service code. Create the 'CCBHC PPS Compile' for the client/the dates of service. Review the report to verify that the client is included with no errors. Client Ledger: The CCBHC PPS service for the client is distributed to the primary guarantor. Leave the PPS charges open. 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client 1: CCBHC Claim Grouping = Separate Claim Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank Steps Open 'Electronic Billing' form. Compile the 837 Professional bill for the financial class without claiming. Set the 'All Or Individual Guarantor' field to 'All'. Select the interim billing batch. Set the 'Include CCBHC Services' to 'Yes'. Compile the bill. Verify the bill compiles successfully. Select 'Run Report' in 'Billing Options'. Select 'Print' in Print Or Delete Report'. Select the 'File'. Click [Print 837 Report]. Verify that the CCBHC Enumerated service is compiled successfully. Click [X]. Click [X]. Close the CCBHC PPS service. Open 'Electronic Billing' form. Compile the 837 Professional bill for the financial class without claiming. Set the 'All Or Individual Guarantor' field to 'All'. Select the interim billing batch. Set the 'Include CCBHC Services' to 'Yes'. Compile the bill. Verify the bill compiles successfully. Select 'Run Report' in 'Billing Options'. Select 'Print' in Print Or Delete Report'. Select the 'File'. Click [Print 837 Report]. Verify that the CCBHC PPS service is compiled successfully without any error. Click [X]. Click [X]. 837 Institutional - Service diagnosis when the 'Include Services with and Without Diagnosis Entry' option is selected Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Dictionary Update (PM) Guarantors/Payors Program Maintenance Dynamic Form - Admission - Client Admission (Outpatient) Financial Eligibility Diagnosis Recurring Client Charge Input (Diagnosis Entry) Client Ledger Electronic Billing Dynamic Form - Edit Service Fee Definition Dynamic form- Social Security Number Client Charge Input With Diagnosis Entry Crystal Report Viewer Service Codes Scenario 1: 837 Professional - HCFA-1500/837-P Billing Options - Outpatient client Specific Setup: Client 1: Is admitted to an outpatient program. Note the program. Has an active ‘Financial Eligibility’ record. Note the ‘Guarantor’ and ‘Financial Class’ for the guarantor. Has an active ‘Diagnosis’ record. Note the diagnosis code. Two charges, in the same month, have been entered in ‘Client Charge Input’. Note the last service date. Two charges, in the same month as above, have been entered in ‘Client Charge Input With Diagnosis Entry. Enter a code in ‘Diagnosis 1’ that is not the same diagnosis code as in the ‘Diagnosis’ record. The last date of service is before the last date of service entered in ‘Client Charge Input’. Client 2: Is admitted the same outpatient program. Note the program. Has an active ‘Financial Eligibility’ record for the same guarantor. Has an active ‘Diagnosis’ record. Note the diagnosis code. Two charges, in the same month, have been entered in ‘Client Charge Input’. Note the last service date. Two charges, in the same month as above, have been entered in ‘Client Charge Input With Diagnosis Entry. Enter a code in ‘Diagnosis 1’ that is not the same diagnosis code as in the ‘Diagnosis’ record. The last date of service is after the last date of service entered in ‘Client Charge Input’. Use ‘Close Charges’ to close the charges. The 'Guarantor/Program Billing Defaults' template for the guarantor and program combination has a value of '1' in '837 Professional', 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)'. 'Form Designer' has been used to revert the 'Electronic Billing' section of the 'Electronic Billing' for to 'Netsmart Produced Changes'. Steps Open 'Electronic Billing'. Select '837-Professional' in 'Billing Form'. Select 'Include Services With and Without Diagnosis Entry' in 'UB/837-I Billing Options'. Select 'Diagnosis Entry' in 'HCFA-1500/837-P Billing Options'. Verify that an 'Error' message is received stating: The 'Diagnosis Entry' and 'Include Services With and Without Diagnosis Entry' billing options cannot be used together. Click [OK]. Verify that 'Include Services With and Without Diagnosis Entry' is still selected in 'HCFA-1500/837-P Billing Options'. Select the guarantor 'Financial Class' in 'Type' of Bill'. Select 'Individual' in 'Individual Or All Guarantors'. Select the desired 'Guarantor'. Select 'Outpatient' in 'Billing Type'. Select 'Sort File' in 'Billing Options'. Enter the desired 'File Description'. Select 'All Clients' in 'All Clients Or Interim Billing Batch'. Select the desired 'Program'. Select 'No' in 'Create Claims'. Enter the 'First Date of Service To Include'. Enter the 'Last Date of Service To Include'. Click [Process]. Click [OK]. Select 'Dump File' in 'Billing Options'. Select 'Print' in 'Print Or Delete Report'. Select the desired 'File'. Validate that four services are output for Client 1. Validate that for the two services created in 'Client Charge Input', that the 'HI* segments include only the diagnosis code from the 'Diagnosis' record. Validate that for the two services created in 'Client Charge Input With Diagnosis Entry', that the 'HI' segments include the diagnosis entered in 'Client Charge Input With Diagnosis Entry'. Validate that four services are output for Client 2. Validate that for the two services created in 'Client Charge Input', that the 'HI* segments include only the diagnosis code from the 'Diagnosis' record. Validate that for the two services created in 'Client Charge Input With Diagnosis Entry', that the 'HI' segments include the diagnosis entered in 'Client Charge Input With Diagnosis Entry'. Close the report. Close the form. Scenario 2: Electronic Billing - UB/837-I Billing Options - Inpatient bill for an outpatient client Specific Setup: Admission: A new client is admitted to an outpatient program. Note the program. Financial Eligibility: The client has an active ‘Financial Eligibility’ record. Note the ‘Guarantor’ and ‘Financial Class’ for the guarantor. Diagnosis: The client has an active ‘Diagnosis’ record with three diagnosis codes. (i.e. 1st row - F10.10 (Primary), 2nd row - F19.10 (Secondary), 3rd row - F70). Note the diagnosis codes. Client Charge Input With Diagnosis Entry: A service is rendered to the client. Enter a code in ‘Diagnosis 1’ that is not the same diagnosis code as in the ‘Diagnosis’ record. Note the date of service. Close Charges: Close the charges. The 'Guarantor/Program Billing Defaults' template for the guarantor and program combination has a value of '1' in '837 Institutional', 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)'. Steps Open 'Electronic Billing'. Select '837-Institutional' in 'Billing Form'. Select 'Include Services With and Without Diagnosis Entry' in 'UB/837-I Billing Options'. Verify that an 'Error' message is received stating: The 'Diagnosis Entry' and 'Include Services With and Without Diagnosis Entry' billing options cannot be used together. Select the guarantor 'Financial Class' in 'Type' of Bill'. Select 'Individual' in 'Individual Or All Guarantors'. Select the desired 'Guarantor'. Select 'Outpatient' in 'Billing Type'. Select 'Sort File' in 'Billing Options'. Enter the desired 'File Description'. Select 'All Clients' in 'All Clients Or Interim Billing Batch'. Select the desired 'Program'. Select 'No' in 'Create Claims'. Enter the 'First Date of Service To Include'. Enter the 'Last Date of Service To Include'. Click [Process]. Click [OK]. Select 'Dump File' in 'Billing Options'. Select 'Print' in 'Print Or Delete Report'. Select the desired 'File'. Validate that for the service created in the 'Client Charge Input With Diagnosis Entry', that the 'HIABF' segment includes the diagnosis entered in 'Client Charge Input With Diagnosis Entry'. Close the report. Close the form Functional or Implementation Acknowledgment (997/999) - loading an Implementation Acknowledgment (999) file* Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Functional or Implementation Acknowledgement (997/999) Crystal Report Viewer Scenario 1: Functional or Implementation Acknowledgment (997/999) - Load / Compile an Implementation Acknowledgment (999) file Specific Setup: This scenario needs to be tested in the system that has multiple root system codes (not sub-system codes). Create a 999 file to load/compile. Note the File name/ Path of the 999 file. Steps Open the 'Functional or Implementation Acknowledgement (997/999)' form. Load the 999 file. Verify the file loads successfully. Compile the recently loaded file. Verify that there is no hard error found during compile the file. Close the report. Close the form. 837 Institutional - CCBHC Bill for the updated Component/Enumerated service Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Open Closed Charges Dynamic Form - Edit Service Information - Select Service(s) to Edit Client Ledger Dynamic Form - Edit Service Fee Definition Electronic Billing Dictionary Update (PM) Guarantors/Payors Service Codes Dynamic Form - Admission - Client Dynamic form- Social Security Number Admission (Outpatient) Financial Eligibility Diagnosis Client Charge Input CCBHC PPS Compile Admission CCBHC PPS Service Definition Crystal Report Viewer Scenario 1: 837 Institutional CCBHC bill - Editing Component/Enumerated after it has an associated PPS charge - Claim Grouping =Same Claim Specific Setup: CCBHC setup has been completed. Dictionary Update: Two new covered charge categories are created in Client File - Data Element # 10021. Category 1: Is to be used for the CCBHC-Enumerated service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'. Category 2: Is to be used for the CCBHC-PPS service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'. Guarantors/Payors: An existing guarantor is identified to be used as a CCBHC Guarantor. Note the guarantor's code/name/financial class of the guarantor. The Financial Class does not equal Self-Pay. Allow Customization of Guarantor Plan = Yes. Select Category 1 and 2 in the 'Categories Available For Reviews'. Admission: A client is enrolled in an outpatient program. Note the program. Diagnosis: Client has an active diagnosis record. Note the diagnosis code. Financial Eligibility: The financial eligibility record is: A guarantor identified above is set up as a primary guarantor. The 'Customize Guarantor Plan' has a value of 'Yes'. In the 'Customize Plan' section the Category 1 and Category 2 are selected in the 'Covered Charge Categories'. Service Code 1: Is a CCBHC enumerated service code. Select Category 1 in the 'Covered Charge Category.' field. Note the Covered Charge Category. Has a fee definition in Service Fee/Cross Reference Maintenance. Service Code 2: Is a CCBHC non-enumerated service code. Select Category 2 in the 'Covered Charge Category.' field. Note the Covered Charge Category. Has a fee definition in Service Fee/Cross Reference Maintenance. Client Charge Input: A service for Service Code 1 is rendered to the client. Client Ledger: Services have liability distributed to Guarantor 1. Note the service dates. Note the 'CHG' amount. Use 'Close Charges' to close the charges. CCBHC PPS Definition: The CCBHC PPS service definition is created for the CCBHC PPS non-enumerated service code. Create the 'CCBHC PPS Compile' for the client/the dates of service. Review the report to verify that the client is included with no errors. Client Ledger: The CCBHC PPS service for the client is distributed to the secondary guarantor. Do not close that charge. 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client: CCBHC Claim Grouping = Same Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank Create an interim billing batch to include services for the financial class defined for the guarantors assigned to the client. Steps Open 'Electronic Billing'. Compile the 837 Institutional bill for the financial class without claiming. Set the 'All Or Individual Guarantor' field to 'All'. Select the interim billing batch. Set the 'Include CCBHC Services' to 'Yes'. Compile the bill. Verify the bill compiles successfully. Claim the service. Verify the bill compiles successfully. Select 'Run Report' in 'Billing Options'. Select 'Print' in Print Or Delete Report'. Select the 'File'. Click [Print 837 Report]. Verify that the correct primary guarantor is included for the CCBHC Enumerated service. Select 'Dump File' in 'Billing Options'. Select 'Print' in Print Or Delete Report'. Select the 'File'. Click [Process]. Verify that the PPS and Enumerated services are in same claim and also the claim total displayed in the 2300-CLM-02 segment is correct. Click [X]. Click [X]. Scenario 2: CCBHC Enumerated services - Validate 837 Institutional billing for the CCBHC services when CCBHC Claim Grouping = Same Specific Setup: All CCBHC setup is complete. Service Codes: Service Code 1 has a value of 'Yes' in 'Is this a CCBHC Service' and a value of 'Yes' in 'CCBHC Enumerated Services'. Note the 'Insurance Charge Category'. Service Code 2 has a value of 'Yes' in 'Is this a CCBHC Service' and a value of 'Yes' in 'CCBHC Enumerated Services'. The 'Insurance Charge Category' must be any value other than the value selected for Service Code 1. Guarantor 1 is a CCBHC guarantor. Allow Customization Of Guarantor Plan' has a value of 'Yes'. Note the 'Financial Class'. Admission: A client is enrolled in an outpatient program. Note the program. Client has an active diagnosis record. Note the diagnosis code. The financial eligibility record is: ‘Guarantor # 1’ = Guarantor 1. The 'Customize Guarantor Plan' has a value of 'Yes'. In the 'Customize Plan' section all 'Covered Charge Categories' are selected. Client Charge Input: A service for Service Code 1 and Service Code 2 are rendered to the client on the same date. Use 'Client Ledger' to verify that these services have liability distributed to Guarantor 1. Note the service dates. Note the 'CHG' amount. Use 'Close Charges' to close the charges. Create the 'CCBHC PPS Compile' for the client/the dates of service. Review the report to verify that the client is included with no errors. Use the 'Client Ledger' to verify that the enumerated charge for Service Code 1 was created and liability distributed to Guarantor 1. Note the 'Date'. Note the 'CHG' amount. 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client 1: CCBHC Claim Grouping = Same. Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank Close the charges. Steps Open 'Electronic Billing'. Create an '837 Institutional' for the 'CCBHC services, selecting 'Yes' in 'Include CCBHC Services'. Select 'Dump File' in 'Billing Options'. Select 'Print' in Print Or Delete Report'. Select the 'File'. Click [Process]. Verify the PPS compile service and enumerated services are included on the same claim. Click [X]. Click [X]. CCBHC Billing – Transferring services to a secondary guarantor Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Guarantors/Payors Service Codes Dynamic Form - Admission - Client Admission (Outpatient) Financial Eligibility Dictionary Update (PM) Diagnosis Client Charge Input CCBHC PPS Compile Client Ledger Electronic Billing Individual Cash Posting (PM) Dynamic Form - Individual Cash Posting - Information Dynamic Form - Individual Cash Posting - Alert Dynamic Form - Individual Cash Posting - Client Crystal Report Viewer Dynamic Form - Edit Service Fee Definition Scenario 1: CCBHC Billing - 837 Professional for the secondary guarantor when the enumerated and partial service transferred to secondary guarantor - CCBHC Claim grouping =Same Specific Setup: CCBHC setup has been completed. Dictionary Update: Two new covered charge categories are created in Client File - Data Element # 10021. Category 1: Is to be used for the CCBHC-Enumerated service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'. Category 2: Is to be used for the CCBHC-PPS service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'. Guarantors/Payors 1: Is a CCBHC Guarantor. Note the guarantor's code/name/financial class of the guarantor. The Financial Class does not equal Self-Pay. Allow Customization of Guarantor Plan = Yes. Select Category 1 in the 'Categories Available For Reviews'. Guarantors/Payors 2: Note the guarantor's code/name/financial class of the guarantor. Is a CCBHC Guarantor. The Financial Class does not equal Self-Pay and is the same financial class of Guarantor 1. Allow Customization of Guarantor Plan = Yes. Select Category 2 in the 'Categories Available For Reviews'. Admission: A client is enrolled in an outpatient program. Note the program. Diagnosis: Client has an active diagnosis record. Note the diagnosis code. Financial Eligibility: The financial eligibility record is: ‘Guarantor 1 is set up as a primary guarantor. The 'Customize Guarantor Plan' has a value of 'Yes'. In the 'Customize Plan' section the Category 1 is selected in the 'Covered Charge Categories'. ‘Guarantor 2 is set up as a secondary guarantor. The 'Customize Guarantor Plan' has a value of 'Yes'. In the 'Customize Plan' section the Category 2 is selected in the 'Covered Charge Categories'. Service Code 1: Is a CCBHC enumerated service code. Select Category 1 in the 'Covered Charge Category.' field. Note the Covered Charge Category. Has a fee definition in Service Fee/Cross Reference Maintenance. Service Code 2: Is a CCBHC non-enumerated service code. Select Category 2 in the 'Covered Charge Category.' field. Note the Covered Charge Category. Has a fee definition in Service Fee/Cross Reference Maintenance. Client Charge Input: A service for Service Code 1 is rendered to the client. Client Ledger: Services have liability distributed to Guarantor 1. Note the service dates. Note the 'CHG' amount. Use 'Close Charges' to close the charges. CCBHC PPS Definition: The CCBHC PPS service definition is created for the CCBHC PPS non-enumerated service code. Create the 'CCBHC PPS Compile' for the client/the dates of service. Review the report to verify that the client is included with no errors. Client Ledger: The CCBHC PPS service for the client is distributed to the secondary guarantor. Do not close that charge. 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client: CCBHC Claim Grouping = None Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank Create an interim billing batch to include services for the financial class defined for the guarantors assigned to the client. Steps Open 'Electronic Billing'. Compile the 837 Professional bill for the financial class without claiming. Set the 'All Or Individual Guarantor' field to 'All'. Select the interim billing batch. Set the 'Include CCBHC Services' to 'Yes'. Compile the bill. Verify the bill compiles successfully. Select 'Run Report' in 'Billing Options'. Select 'Print' in Print Or Delete Report'. Select the 'File'. Click [Print 837 Report]. Verify that the correct primary guarantor is included for the CCBHC Enumerated service. Click [X]. Click [X].	Topics • 837 Professional • NX • 837 Institutional • Functional or Implementation Acknowledgement (997/999)
Update 50 Summary \| Details Avatar PM - Team Caseload Assignment Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Dynamic Form - Admission - Client Admission Scenario 1: Avatar PM - Team Caseload Assignment Specific Setup: The 'RADplus->System Security->Team Definition->->->Update Physician Team Caseload based on Admitting or Attending Practitioner' registry setting must be set to "Y". Please log out of the application and log back in after completing the above configuration. Three practitioners must exist (Practitioner A) (Practitioner B) (Practitioner C). Three users must exist (User A) (User B) (User C). "User A" must be associated with "Practitioner A", "User B" must be associated with "Practitioner B", and "User C" must be associated with "Practitioner C". Two teams must exist. (Team 1) (Team 2). In the "Team Definition" form "Team 1" must have 'Active', 'Physician Team', and 'Disable Adding Clients to Caseload' all set to "Yes". In the "Team Definition" form assign "User A" and "User B" to "Team 1". In the "Team Definition" form "Team 2" must have 'Active' and 'Physician Team' set to "yes" and 'Disable Adding Clients to Caseload' set to "No". In the "Team Definition" form assign "User A" and "User C" to "Team 2". Steps Access the 'Admission' form and admit a new client (Client A). Assign "Practitioner A" as "Client A's" admitting practitioner and administering practitioner. Access the 'Admission' form and admit a new client (Client B). Assign "Practitioner B" as "Client B's" admitting practitioner and administering practitioner. Access the 'Admission' form and admit a new client (Client C). Assign "Practitioner C" as "Client C's" admitting practitioner and administering practitioner. Access the 'Admission' form and admit a new client (Client D). Assign "Practitioner B" as "Client D's" admitting practitioner and "Practitioner C" as "Client D's" administering practitioner. Log out and then log back in under "User A" Validate that the 'Client and Data' widget contains "Client A", "Client C", and "Client D". Log out and then log back in under "User B" Validate that the 'Client and Data' widget contains "Client B" and "Client D". Log out and then log back in under "User C" Validate that the 'Client and Data' widget contains "Client A", "Client C", and "Client D".	Topics • NX • myAvatar/myAvatar NX
Update 59 Summary \| Details Allow For Number of Days Since Last Claim - Option added to Inhibit services Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Service Codes Default Guarantor Assignment Guarantors/Payors Registry Settings (PM) Dynamic Form - Admission - Client Dynamic form- Social Security Number Admission (Outpatient) Financial Eligibility Client Charge Input Client Ledger Crystal Self Pay Bill Crystal Report Viewer No Information Found Inhibited Services For Billing Report Diagnosis Individual Cash Posting (PM) Dynamic Form - Individual Cash Posting - Information Dynamic Form - Individual Cash Posting - Alert Dynamic Form - Individual Cash Posting - Client Inhibit Billing By Service Dynamic Form - Un-Inhibit services - Please review your selections to Un-Inhibit service Dynamic Form - File Service Inhibit Information Progressive Self Pay Dunning Messages Update Client Data SQL Query/Reporting Admission Dynamic Form - Edit Service Fee Definition Scenario 1: Crystal Self Pay Bill - Previous claim date within the 'Number Of Days Since Last Claim' - Registry Setting 'Allow For Number of Days Since Last Claim' = I Specific Setup: Registry Settings: Set the 'Allow For Number Of Days Since Last Claim' set to 'I'. Guarantors/Payor: The self pay guarantor is identified. Note the guarantor code/value. Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days. Admission: A new client is admitted. Note the client id, admission date and admission program. Financial Eligibility: A self pay guarantor is assigned to the client. Note the guarantor code. Diagnosis: The diagnosis record is created for the client. Client Charge Input: The service is rendered to the client. Note the service date and service code. Client Ledger: The service distributed to the self pay guarantor. Steps Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the Self Pay Bill report/information. In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information. Open the 'Client Charge Input' form. Render a service to the client. Note the date of the service. Verify the service distributed correctly to the self pay guarantor assigned to the client. Close charges. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the previous claim date. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'No Information Found. Cancel OK No Information Was Found For Inclusion On The Bill.' message displayed. Click [Close Report]. Click [Discard]. Open the 'Inhibited Services For Billing Report' form. Enter 'Start Date'. Enter 'End Date'. Select the client from the previous steps. Click [Process report]. Verify the report contains all the services for the client for the episode inhibited from the billing. Close the report. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is after the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the Self Pay Bill report/information. Verify the report displays the recently claimed service in the report. Close the report. Close the form. Scenario 2: Crystal Self Pay Bill - Previous claim date within the 'Number Of Days Since Last Claim' - Make payments so that the self pay balance for that client/episode is zero Specific Setup: Registry Settings: Set the 'Allow For Number Of Days Since Last Claim' set to 'I'. Guarantors/Payor: The self pay guarantor is identified. Note the guarantor code/value. Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days. Admission: A new client is admitted. Note the client id, admission date and admission program. Financial Eligibility: A self pay guarantor is assigned to the client. Note the guarantor code. Diagnosis: The diagnosis record is created for the client. Client Charge Input: The service is rendered to the client. Note the service date and service code. Client Ledger: The service distributed to the self pay guarantor. Steps Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select the self pay guarantor assigned to the client. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the Self Pay Bill report/information. In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information. Open the 'Client Charge Input' form. Render a service to the client. Note the date of the service. Verify the service distributed correctly to the self pay guarantor assigned to the client. Close charges. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the previous claim date. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'No Information Found. Cancel OK No Information Was Found For Inclusion On The Bill.' message displayed. Click [Close Report]. Click [Discard]. Open the 'Inhibited Services For Billing Report' form. Enter 'Start Date'. Enter 'End Date'. Select the client from the previous steps. Click [Process report]. Verify the report contains all the services for the client for that episode inhibited from the billing. Close the report. Open the 'Individual Cash Posting' form. Enter the 'Client' identified in the setup section. Select desired value in 'Post By'. Review 'Start Date' and 'Stop Date'. Change the values if desired. Click [Select Item(s) to Post Against]. Highlight the first two services. Click [OK]. Note the 'balance due'. Click [OK]. Enter the 'Posting Date'. Enter the 'Date of Receipt'. Enter the 'balance due' in 'Dollar Amount To Be Posted'. Enter the 'Posting Code'. Click [Update Temporary File]'. Click [OK]. Click [Submit]. Click [Yes]. Click [No]. Open 'Client Ledger'. Enter the 'Client ID'. Select 'All Episodes' in 'Claim/Episode/All Episodes'. Select 'Simple' in 'Ledger Type'. Set the 'From Date' to the first date of service. Set the 'To Date' to the last date of service. Click [Process]. Services one and two have been paid in full. The 'LINE BALANCE' is '0.00'. The balance for the 'Self Pay' guarantor is 0.00. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the Self Pay Bill report/information. Verify the report displays the recently claimed service in the report. Close the report. Close the form. Scenario 3: Compile Self Pay bill - Previous claim date does not fall within the 'Number Of Days Since Last Claim' - Validating registry setting 'Allow For Number of Days Since Last Claim' Specific Setup: Registry Settings: Set the 'Allow For Number Of Days Since Last Claim' set to 'I'. Guarantors/Payor: The self pay guarantor is identified. Note the guarantor code/value. Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days. Admission: A new client is admitted. Note the client id, admission date and admission program. Financial Eligibility: A self pay guarantor is assigned to the client. Note the guarantor code. Diagnosis: The diagnosis record is created for the client. Client Charge Input: The service is rendered to the client. Note the service date and service code. Client Ledger: The service distributed to the self pay guarantor. Close Charges: Services rendered to the client are closed. Steps Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select the self pay guarantor assigned to the client. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the Self Pay Bill report/information. In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information. Open the 'Client Charge Input' form. Render another service to the client. Note the date of the service. Verify the service distributed correctly to the self pay guarantor assigned to the client. Open the 'Close Charges' form. Close the service rendered to the client. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the last claim date. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the last claim date and 'Print Charges Thru' date. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'No Information Found. Cancel OK No Information Was Found For Inclusion On The Bill.' message displayed. Click [Close Report]. Click [Discard]. Open the 'Inhibited Services For Billing Report' form. Enter 'Start Date'. Enter 'End Date'. Select the client from the previous steps. Click [Process report]. Verify the report contains all the services for the client for that episode inhibited from the billing. Close the report. Open the 'Individual Cash Posting' form. Enter the 'Client' identified in the setup section. Select desired value in 'Post By'. Review 'Start Date' and 'Stop Date'. Change the values if desired. Click [Select Item(s) to Post Against]. Highlight the first two services. Click [OK]. Note the 'balance due'. Click [OK]. Enter the 'Posting Date'. Enter the 'Date of Receipt'. Enter the 'balance due' in 'Dollar Amount To Be Posted'. Enter the 'Posting Code'. Click [Update Temporary File]'. Click [OK]. Click [Submit]. Click [Yes]. Click [No]. Open 'Client Ledger'. Enter the 'Client ID'. Select 'All Episodes' in 'Claim/Episode/All Episodes'. Select 'Simple' in 'Ledger Type'. Set the 'From Date' to the first date of service. Set the 'To Date' to the last date of service. Click [Process]. Services one and two have been paid in full. The 'LINE BALANCE' is '0.00'. The balance for the 'Self Pay' guarantor is 0.00. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the last claim date and 'Print Charges Thru' date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the Self Pay Bill report/information. Verify the report displays the recently claimed service in the report. Close the report. Close the form. Open the 'Registry Setting' form. Set the 'Allow For Number Of Days Since Last Claim' registry setting to 'Y'. Open the 'Admission (Outpatient)' form for the client. Add new episode to the client. Assign a self pay guarantor to the client. Open the 'Client Charge Input' form. Render a service to the client. Close the charges. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the services are not claimed and no information found message displayed. Open the 'Inhibited Services For Billing Report' form. Enter 'Start Date'. Enter 'End Date'. Select the client from the previous steps. Click [Process report]. Verify the report does not contain all the services for the client for that episode inhibited from the billing. Close the report. Open the 'Registry Setting' form. Set the 'Allow For Number Of Days Since Last Claim' registry setting to 'I'. Open the 'Admission (Outpatient)' form for the client. Add new episode to the client. Assign a self pay guarantor to the client. Open the 'Client Charge Input' form. Render a service to the client. Close the charges. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the services are not claimed and no information found message displayed. Open the 'Inhibited Services For Billing Report' form. Enter 'Start Date'. Enter 'End Date'. Select the client from the previous steps. Click [Process report]. Verify the report does contain all the services for the client for that episode inhibited from the billing. Close the report. Close the form. Scenario 4: Progressive Self Pay Dunning Messages - Form validation - Validating registry setting 'Enable Progressive Self-Pay Dunning Messages' Specific Setup: Registry Settings: The registry setting 'Enable Progressive Self-Pay Dunning Messages' is added. The registry setting 'Enable Progressive Self-Pay Dunning Messages' is set to 'Y'. The registry setting 'Allow For Number Of Days Since Last Claim' set to 'I'. User Definition: Verify the form 'Progressive Self Pay Dunning Messages' is added to the system. Select the form and submit the user definition. Form Search: Verify the form 'Progressive Self Pay Dunning Messages' is available in the system. Guarantors/Payor: The self pay guarantor is identified. Note the guarantor code/value. Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days. Admission: A new client is admitted. Note the client id, admission date and admission program. Financial Eligibility: A self pay guarantor is assigned to the client. Note the guarantor code. Diagnosis: The diagnosis record is created for the client. Client Charge Input: 6-7 services are rendered to the client. Note the service date and service code. Client Ledger: The services distributed to the self pay guarantor. Close Charges: Services are closed. Steps Open the 'Progressive Self Pay Dunning Messages' form. Select the guarantor. Verify the first message field is enabled. Verify that each subsequent message field enables when the prior field has a value. File data for multiple guarantors. Print the information for the selected guarantor. Verify the report displays data for all the guarantors. Select a desired guarantor. Click [Print Only the selected guarantor]. Verify the report includes data filed for the selected guarantor.Open the 'Crystal Report' or any other SQL Data Viewer. Query the SQL table SYSTEM.billing_prog_sp_dunn_msg. Verify the data files successfully and correctly as entered through the form. Select a desired guarantor. Click [Delete]. Verify the data filed for the guarantor deleted. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the first message defined in the form in the Self Pay Bill report/information. Run the bill for the second service. Ensure that it displays the second message defined in the form in the Self Pay Bill report/information. Run the bill for the second service. Ensure that it displays the third message defined in the form in the Self Pay Bill report/information. Run the bill for the second service. Ensure that it displays the fourth message defined in the form in the Self Pay Bill report/information. Run the bill for the second service. Ensure that it displays the fifth message defined in the form in the Self Pay Bill report/information. Close the report. Close the form. Scenario 5: Crystal Self Pay Bill - Previous claim date within the 'Number Of Days Since Last Claim' - Validating new billing cycle - Updating client's address using the 'Update Client Data' form - Inpatient client - Multiple guarantors Specific Setup: Registry Settings: Set the 'Allow For Number Of Days Since Last Claim' set to 'I'. Guarantors/Payor: The self pay guarantor is identified to be assigned to the client as a secondary guarantor. Note the guarantor code/value. Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days. Any other existing guarantor is identified to be assigned to the client as a primary guarantor. Note the guarantor code/value. Admission: A new client is admitted. Note the client id, admission date and admission program. Financial Eligibility: The guarantor identified above is assigned to the client as a primary guarantor. A self pay guarantor is assigned to the client as a secondary guarantor. Note the guarantor code. The 'Coverage Effective Date' of the primary guarantor is set to the date that comes after the 'Service Date' and the primary guarantor does not cover the services rendered to the client and they distributed to the next guarantor. Diagnosis: The diagnosis record is created for the client. Client Charge Input: The service is rendered to the client such that it comes prior to coverage effective date of the primary guarantor. Note the service date and service code. Client Ledger: The service distributed to the self pay guarantor. Close Charges: The services rendered to the client are closed. Steps Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the Self Pay Bill report/information. In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information. Open the 'Client Charge Input' form. Render a service to the client. Note the date of the service. Verify the service distributed correctly to the self pay guarantor assigned to the client. Close charges. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the previous claim date. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'No Information Was Found For Inclusion On The Bill.' message displayed. Click [Close Report]. Click [Discard]. Open the 'Inhibited Services For Billing Report' form. Enter 'Start Date'. Enter 'End Date'. Select the client from the previous steps. Click [Process report]. Verify the report contains all the services for the client for the episode inhibited from the billing. Close the report. Open the 'Update Client Data' form for the client. Navigate to 'Demographics' section of form. Change any of the Client's Address field. Click [Submit]. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the Self Pay Bill report/information. Verify the report displays the recently claimed service in the report. Close the report. Close the form. Scenario 6: Crystal Self Pay Bill - Previous claim date within the 'Number Of Days Since Last Claim' - Validating services that are transferred to the Self-Pay guarantor Specific Setup: Registry Settings: Set the 'Allow For Number Of Days Since Last Claim' set to 'I'. Guarantors/Payor: The self pay guarantor is identified to be assigned to the client as a secondary guarantor. Note the guarantor code/value. Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days. Any other existing guarantor is identified to be assigned to the client as a primary guarantor. Note the guarantor code/value. Admission: A new client is admitted. Note the client id, admission date and admission program. Financial Eligibility: A self pay guarantor is assigned to the client as a secondary guarantor. Note the guarantor code. The other guarantor identified above is assigned to the client as a primary guarantor. Diagnosis: The diagnosis record is created for the client. Client Charge Input: The service is rendered to the client. Note the service date and service code. Client Ledger: The service distributed to the primary guarantor. Steps Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the Self Pay Bill report/information. In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information. Open the 'Client Charge Input' form. Render a service to the client. Note the date of the service. Verify the service distributed correctly to the self pay guarantor assigned to the client. Close charges. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the previous claim date. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'No Information Was Found For Inclusion On The Bill.' message displayed. Click [Close Report]. Click [Discard]. Open the 'Inhibited Services For Billing Report' form. Enter 'Start Date'. Enter 'End Date'. Select the client from the previous steps. Click [Process report]. Verify the report contains all the services for the client for the episode inhibited from the billing. Close the report. Open the 'Update Client Data' form for the client. Navigate to 'Demographics' section of form. Change client's address field. Click [Submit]. Open the 'Crystal Self Pay Bill' form. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date. Select 'Yes' in the 'Create Claims Y/N' field. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch. Select 'All Clients' in the 'Print For An Individual Or All Clients'. Click [Compile Self Pay Bill]. Verify the 'Compile Complete' message displayed. Navigate to the 'Print Crystal Self Pay Bill' section of the form. Select value for 'Select By Client Or File' field. Select compiled bill file or client record for bill data display. Click [Print Self Pay Bill]. Ensure that it displays the Self Pay Bill report/information. Verify the report displays the recently claimed service in the report. Close the report. Close the form.	Topics • Registry Settings • Inhibit Billing • NX • 837 Professional • Crystal Self Pay Bill
Update 64 Summary \| Details The SQL file 'data_entry_by' in the 'History_Bed_Assignment' table is updated. Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Change Program/Admission Date Scenario 1: 'Change Program/Admission Date' SQL data verification. Steps For internal testing only.	Topics • Change Program/Admission Date
Update 68 Summary \| Details Prevent 'staff only' appointments from being opened by multiple users at one time. Scenario 1: Scheduling Calendar - Staff Only appointments: validate 'Details/Edit' can only be edited by one user at a time. Specific Setup: For Avatar PM facilities: Avatar PM 2022 Update 66 is required to resolve this issue. For Avatar Cal-PM facilities: Avatar Cal-PM Update 35 is required to resolve this issue. Two users (User 1 and User 2) have permissions to view other practitioner's schedules in the "Scheduling Calendar". A 'Staff Only' appointment has been added to one of the practitioner's schedule. Both users are logged in. Steps Both users should have the 'Scheduling Calendar' opened. User 1: right click on the 'Staff Only' appointment. Select 'Details/Edit'. Do not change anything, and leave the form open. User 2: right click on the same 'Staff Only' appointment. Select 'Details/Edit'. User 2 will see a message: 'The appointment is currently locked by: User 1. Editing is unavailable at this time.' Click [OK] to exit the message. User 1: exit the form. User 2: right click on the same 'Staff Only' appointment. Select 'Details/Edit'. The form will open for User 2.	Topics • Scheduling Calendar • NX
Update 69 Summary \| Details AR Console - Claim Follow-Up Entry Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Registry Settings (PM) AR Console Configuration AR Console User Defaults Setup Financial Eligibility Client Ledger Client Charge Input Guarantors/Payors Electronic Billing System Task Scheduler User Definition Diagnosis Dynamic Form - Add To Problem List Program Maintenance Scenario 1: Account Receivable Console - Add Claim Follow-Up/Notes Specific Setup: Note the tester's 'User Definition', 'User Description'. Registry Setting: Set the 'Avatar PM->Billing->Accounts Receivable Management->->->Enable Accounts Receivable Management Functionality' registry setting to "Yes". Accounts Receivable functionality has been defined. Identify a client with three or more unpaid claims. Note the client's last name initial, ID, admission program. Note the guarantor the claim liability distributed to. Use ‘AR Console User Defaults’ to give the tester access to the following: First initial of the client's last name. Admission program Guarantor the claim liability distributed to. Use ‘System Task Scheduler’ to process the ‘Auto AR Batch’ after the claims were created. Steps Access the ‘AR Console’. Enter the desired ‘Client’. Enter desired dates in ‘Service Date From’ and ‘Service Date To’. Click [Search]. Validate that the claims display in the ‘Claims with Outstanding Receivables’ grid. Select one claim row, noting the claim number. Click [Add Claim Follow-Up/Notes]. Validate that ‘Claim Follow-Up’ contains the selected claim number. Enter desired value in ‘Edit Payer ICN#’. Select desired value in ‘Claim Submission Reason Code’. Go to the ‘Follow-Up Notes’ section. Verify that a row has been created for the current date and with a comment of ‘AR Console Follow-Up Created’. Click [New Row]. Enter desired values for ‘Follow-Up Date’ and ‘Comments’ at a minimum. Data may be added to other fields if desired. Click [File Updates]. Click [OK]. Click [AR List] to return to the first section of the form. Select the same claim in the ‘Claims with Outstanding Receivables’ grid. Click [Add Claim Follow-Up/Notes]. Validate that the data added to the ‘Edit Payer ICN#’ and 'Claim Submission Reason Code’ fields displays correctly. Go to the ‘Follow-Up Notes’ section. Verify that the row created by with the comment of ‘AR Console Follow-Up Created’ displays correctly. Verify that the new row that was added displays the submitted data correctly. Click [AR List] to return to the first section of the form. Repeat steps 6 -24, selecting a minimum of two claims in the ‘Claims with Outstanding Receivables’ grid, and toggling between the claims in the ‘Claim Follow-Up Entry' section.	Topics • Accounts Receivable Management • NX
Update 71 Summary \| Details Avatar PM 'Payment/Adjustment Report' Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Payment/Adjustment Report Scenario 1: Payment/Adjustment Report - Verification of .CSV format report results - By Revenue Group, Payment/Adjustment, & Financial Class Steps Open Avatar PM 'Payment/Adjustment Report' form (under 'Avatar PM / Billing / Billing Reports / Ad Hoc Reports' menu). Enter/select values for 'From Date', 'Thru Date', 'Individual Or All Or Grouped Codes' and all other required/desired report criteria fields. Ensure 'Export Detail Information to CSV' field is present in form. No selection in the 'Export Detail Information to CSV' field will render report results in the default report format Selecting 'By Revenue Group, Payment/Adjustment, & Financial Class' in the 'Export Detail Information to CSV' field will display Payment/Adjustment Report Revenue Group/Payment/Financial Class summary results in CSV (comma-separated value) format (allowing user to export/save 'Summary Trial Balance Report' results for external use) Selecting 'By Revenue Group, Financial Class, Group Code & Service Code' in the 'Export Detail Information to CSV' field will display Payment/Adjustment Report Revenue Group/Financial Class/Group Code/Service Code detail results in CSV (comma-separated value) format (allowing user to export/save 'Summary Trial Balance Report' results for external use) Click 'Process' button to run report/render result data. If no value is selected in 'Export Detail Information to CSV' field, ensure that 'Payment/Adjustment Report' results are rendered/displayed in the default report format. If 'By Revenue Group, Payment/Adjustment, & Financial Class' is selected for 'Export Detail Information to CSV' field, ensure that 'Payment/Adjustment Report' results are rendered/displayed in .CSV format within myAvatar/Avatar NX, with following header and individual data rows present: 'Payment/Adjustment Report' .CSV format data header (first row in report data results) will contain the following data elements: 'Revenue Group Code' 'Revenue Group Description' 'Payment/Adjustment Code' 'Payment/Adjustment Description' 'Financial Class Code' 'Financial Class Description' 'Amount' Header row example: "Revenue Group Code,Revenue Group Description,Payment/Adjustment Code,Payment/Adjustment Description,Financial Class Code,Financial Class Description,Amount" 'Payment/Adjustment Report' .CSV format individual data rows (second and all subsequent rows in report data results) will contain report data for each element, one row per result. Data row examples: "4,"Outpatient Psychiatric",380,"Administrative Discount",3,"Medicaid",1687.50" "5,"Outpatient Substance Abuse",200,"Transfer",9,"Blue Cross",45.75" "7,"Partial Substance Abuse",100,"Payment - Check",5,"Commercial",280.00" If 'By Revenue Group, Financial Class, Group Code & Service Code' is selected for 'Export Detail Information to CSV' field, ensure that 'Payment/Adjustment Report' results are rendered/displayed in .CSV format within myAvatar/Avatar NX, with following header and individual data rows present: 'Payment/Adjustment Report' .CSV format data header (first row in report data results) will contain the following data elements: 'Revenue Group Code' 'Revenue Group Description' 'Client Name' 'Client MR #' 'Client Episode #' 'Client Claim #' 'Transaction Date' 'Post Date' 'Payment Adjustment Code' 'Payment Adjustment Description' 'Service Code' 'Service Code Description' 'Amount' 'Financial Class Code' 'Financial Class Description' 'Posted By' Header row example: "Revenue Group Code,Revenue Group Description,Client Name,Client MR #,Client Episode #,Client Claim #,Transaction Date,Post Date,Payment Adjustment Code,Payment Adjustment Description,Service Code,Service Code Description,Amount,Financial Class Code,Financial Class Description,Posted By" 'Payment/Adjustment Report' .CSV format individual data rows (second and all subsequent rows in report data results) will contain report data for each element, one row per result. Data row examples: "4,"Outpatient Psychiatric","LASTNAME,FIRSTNAME","464",1,"137",10/18/2021,10/18/2021,310,"Contractual Adjustment - CR",600,"Brief Visit",25.00,3,"Medicaid","SYSTEM USER ONE"" "5,"Outpatient Substance Abuse","ZLASTNAME,ZFIRSTNAME","465",1,"Unbilled",01/29/2022,01/29/2022,100,"Payment - Check",700,"Intensive Visit",400.00,3,"Medicaid","SYSTEM USER TWO"" In 'Payment/Adjustment Report' results display, click 'Export All Pages' or 'Export Page' button to export/save .CSV format report data to file. Open/review exported .CSV format file, ensuring that data header and all individual data rows are present in file as displayed/defined above.	Topics • Payment/Adjustment Report • NX
Update 72 Summary \| Details Avatar PM 'Earned Income Report' Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Earned Income Report Scenario 1: 'Earned Income Report' - Verification of .CSV format report results Steps Open Avatar PM 'Earned Income Report' form (under 'Avatar PM / Billing / Billing Reports / Monthly Closeout Reports' menu). Enter/select values for 'From Month/Year' and 'Thru Month/Year' report criteria fields. Ensure 'Export Detail Information to CSV' field is present in form. No selection in the 'Export Detail Information to CSV' field will render report results in the default report format Selecting 'By Revenue Group and Service Group' in the 'Export Detail Information to CSV' field will display Revenue Code/Service Group report detail results in CSV (comma-separated value) format (allowing user to export/save 'Earned Income Report' results for external use) Selecting 'By Revenue Group, Financial Class and Service Group' in the 'Export Detail Information to CSV' field will display Revenue Code/Financial Class/Service Group report detail results in CSV (comma-separated value) format (allowing user to export/save 'Earned Income Report' results for external use) Click 'Process' button to run report/render result data. If no value is selected in 'Export Detail Information to CSV' field, ensure that 'Earned Income Report' results are rendered/displayed in the default report format. If 'By Revenue Group and Service Group' is selected for 'Export Detail Information to CSV' field, ensure that 'Earned Income Report' results are rendered/displayed in .CSV format within myAvatar/Avatar NX, with following header and individual data rows present: 'Earned Income Report' .CSV format data header (first row in report data results) will contain the following data elements: 'Revenue Group Code' 'Revenue Group Description' 'Service Group Code' 'Service Group Description' 'Earned Income Amount' Header row example: "Revenue Group Code,Revenue Group Description,Service Group Code,Service Group Description,Earned Income Amount" 'Earned Income Report' .CSV format individual data rows (second and all subsequent rows in report data results) will contain report data for each element, one row per result. Data row examples: "1,"Inpatient Psychiatric",1,"Room & Board",51575.00" "5,"Outpatient Substance Abuse",2,"Professional Services",170466.98" If 'By Revenue Group, Financial Class and Service Group' is selected for 'Export Detail Information to CSV' field, ensure that 'Earned Income Report' results are rendered/displayed in .CSV format within myAvatar/Avatar NX, with following header and individual data rows present: 'Earned Income Report' .CSV format data header (first row in report data results) will contain the following data elements: 'Revenue Group Code' 'Revenue Group Description' 'Financial Class Code' 'Financial Class Description' 'Service Group Code' 'Service Group Description' 'Earned Income Amount' Header row example: "Revenue Group Code,Revenue Group Description,Financial Class Code,Financial Class Description,Service Group Code,Service Group Description,Earned Income Amount" 'Earned Income Report' .CSV format individual data rows (second and all subsequent rows in report data results) will contain report data for each element, one row per result. Data row examples: "1,"Inpatient Psychiatric",7,"Medicare A",1,"Room & Board",22740.00" "5,"Outpatient Substance Abuse",3,"Medicaid",2,"Professional Services",103799.11" In 'Earned Income Report' results display, click 'Export All Pages' or 'Export Page' button to export/save .CSV format report data to file. Open/review exported .CSV format file, ensuring that data header and all individual data rows are present in file as displayed/defined above.	Topics • Earned Income Report • NX
Update 76 Summary \| Details CCBHC PPS Compile – CCBHC PPS Service Definition Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Guarantors/Payors Service Codes Dictionary Update (PM) Program Maintenance Practitioner Numbers By Guarantor And Program CCBHC PPS Service Definition Dynamic Form - Admission - Client Admission (Outpatient) Dynamic Form Address Validation Diagnosis Update Client Data Financial Eligibility Client Charge Input Dynamic Form - Plan Client Ledger CCBHC PPS Compile Scenario 1: CCBHC PPS-1 Compile - Primary guarantor has no guarantor PPS definition - Secondary guarantor has a guarantor PPS definition Specific Setup: Dictionary Update: Client - 10006 - Location Note at least one location that is a CCBHC location. Service Codes: 1: CCBHC Enumerated service. Note the ‘Covered Charge Category’. 2: CCBHC Non- Enumerated service in the same ‘Covered Charge Category’ as 1. 3: CCBHC Enumerated service in a different ‘Covered Charge Category’ than 1 & 2. 4: CCBHC Non- Enumerated service in the same ‘Covered Charge Category’ as 3. Benefit Plan: 1: The ‘Covered Charge Category’ for Service Codes 1 & 2 is included. The ‘Covered Charge Category’ for Service Codes 3 & 4 is not included. 2: The ‘Covered Charge Category’ for Service Codes 3 & 4 is included. The ‘Covered Charge Category’ for Service Codes 1 & 2 is not included. Guarantors/Payors: Both guarantors have a value of ‘Yes’ in CCBHC Guarantor. They can be in the same or different financial classes. 1: The ‘Default Guarantor Plan’ is Benefit Plan 1. 2: The ‘Default Guarantor Plan’ is Benefit Plan 2. CCBHC PPS Service Definition: 1: Note the effective date. The PPS-1 Service code is Service Code 2. 2: Note the effective date. The Guarantor is guarantor 2. The PPS-1 Service code is Service Code 4. Client: Client's primary guarantor is guarantor 1. Client's secondary guarantor is guarantor 2. Client has an active diagnosis record. Client has enumerated services, provided at a CCBHC location, for services codes 1 & 3. The dates of service must be on or after the CCBHC PPS Service Definition effective date. Note the dates of service. Client Ledger has been used to verify that the service liability distributed to the correct guarantor. Close Charges has been used to close the charges. Steps Open ‘ CCBHC PPS Compile. Enter the desired ‘Start Date’. Enter the desired ‘End Date’. Enter the desired ‘Client ID’. Click [Compile & Post Services]. Close the form. Open ‘Client Ledger’. Enter the desired ‘Client ID’. Select ‘All Episodes’ in ‘Claim/Episode/All Episodes’. Select ‘ Simple’ in ‘Ledger Type’. Enter the desired ‘From Date’. Enter the desired ‘ To Date’. Click [Process]. Validate that the correct guarantor was selected for each CCBHC Non- Enumerated service. Close the report. Close the form.	Topics • CCBHC • NX
Update 81 Summary \| Details Default 'Add to Problem List' field on 'Diagnosis' form. Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: Diagnosis Scenario 1: Diagnosis - Verify Registry Setting "Default 'Add To Problem List'" Specific Setup: Avatar 2022 CWS Update 69 is required for full functionality. Avatar 2022 CareFabric Update 54 is required for full functionality. Steps Open 'Registry Settings' form. Set 'Limit Registry Settings to the Following Search Criteria' field to 'add to problem list'. Click [View Registry Settings]. Verify 'Registry Setting' contains 'Avatar PM->Client Information->Diagnosis->->->Default 'Add To Problem List' to "Yes" on New Diagnosis' Confirm the 'Registry Setting Value' is defaulted to 'Y'. Selecting 'Y' defaults the value for the field 'Add To Problem List' to "Yes" when adding new diagnosis record. Click [Submit]. Open the 'Diagnosis' form for a test client (Client A). Set the 'Type Of Diagnosis' to any value. Set the 'Date Of Diagnosis' to the current date. Set the 'Time Of Diagnosis' to the current time. Click [New Row]. Verify the 'Add To Problem List' field is defaulted to 'Yes'. Click the 'Problem Classification' field. Verify the values for 'Problem Classification' are displayed. Note that this field can be made required by setting 'Registry Setting' 'Avatar CWS->Problem List->->->->Problem Classification Required' to 'R'. Please see the description in the Registry Setting for more information. Complete the fields as needed and file the diagnosis. Open the 'Diagnosis' form for the same client. Select the diagnosis record entered above. Verify the fields contain the data as filed. Click [Close Form]. Return to the 'Registry Settings' form and select "Default 'Add To Problem List'". Change the setting to 'N'. Return to the 'Diagnosis' form. Set the 'Type Of Diagnosis' to any value. Set the 'Date Of Diagnosis' to the current date. Set the 'Time Of Diagnosis' to the current time. Click [New Row]. Verify the 'Add To Problem List' field is not defaulted. Verify the Click the 'Problem Classification' field is disabled. Exit the form.	Topics • Diagnosis • NX
2021 Update 121 Summary \| Details Patient/PCP Association - Search Results Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following: PCP Definition and Communication Preferences Dynamic Form PCP Definition Dynamic Form - Admission - Client Admission Patient/PCP Association Scenario 1: 'PCP Definition and Communications Preferences'. Steps Open 'PCP Definition And Communication Preferences' Fill out and submit the form. Open 'PCP Definition And Communication Preferences' Validate that the new PCP Definition has been created. Scenario 2: PCP/Patient Association Specific Setup: Admit a new client or select an existing client with multiple episodes. Note the programs the client is admitted to. Steps Using the "PCP Definition and Communication Preference" form, enter in 50+ primary care physicians with the same last name. Check the PCP search to validate that the search will search on 3 characters of the last name,1st 3 characters of the first name. Open the "Patient/PCP Association" form. Enter the test client. Search the PCP field. Validate that the results returned only include the providers who are associated with the same program(s) as the client is enrolled in. Select a PCP for the client. File the form.	Topics • NX