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Topics
• Incident-To-Practitioner Daily Log
• NX
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Electronic billing - Split services workflow
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Guarantors/Payors
- Service Codes
- CPT Code Definition (PM)
- Registry Settings (PM)
- Set System Defaults (CWS)
- Dynamic form- Social Security Number
- Admission (Outpatient)
- Financial Eligibility
- Managed Care Authorizations
- Progress Notes (Group and Individual)
- Dynamic Form - Progress Notes
- Client Ledger
- Diagnosis
- SQL Query/Reporting Tool
- Electronic Billing
- Crystal Report Viewer
- Client Charge Input
- Admission
- Dynamic Form - Edit Service Fee Definition
Scenario 1: 837 Professional - Running the bill for the split services - Service created through progress note form
Specific Setup:
- Guarantor/Payors:
- An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
- Authorization Information Section:
- Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
- Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
- Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
- Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
- Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
- Admission (Outpatient):
- A new client is admitted in an outpatient program. Note the client id/name, admission program,
- Financial Eligibility:
- The guarantor identified above is assigned to the client.
- Diagnosis:
- A new diagnosis record is created for the client.
- Service Codes:
- A new service code is added as below. Note the service code/value.
- Type Of Fee= User Defined
- Minutes per Unit = desired value
- Service Fee/Cross Reference Maintenance:
- Service fee definition is created for the above service code.
- Managed Care Authorizations:
- Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
- The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
- Enter desired value to all the required fields.
- Progress Note form:
- Please note : the split service functionality is not supported by Ambulatory Progress Note. It will be available in the next update.
- A new service is rendered through desired progress note form.
- The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
- Client Ledger:
- The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
- Close Charges:
- All the charges are closed.
- An interim billing batch is created to include the client, service and guarantor.
Steps
- Open the 'Electronic Billing' form.
- Select the '837 Professional' from the 'Billing Form'.
- Select desired value in the 'Type Of Bill'.
- Select the guarantor identified in the setup section.
- Select the 'Interim Batch' in the 'Select All Clients Or Interim Batch' field.
- Select the interim billing batch in 'Interim Batch Number'.
- Populate all the required fields.
- Compile the bill for the client, services and guarantor identified in the interim billing batch.
- Verify the bill compiles successfully.
- Select 'Run Report'.
- Select 'Print' from the 'Print Or Delete Report' field.
- Select the file compiled successfully in the previous step.
- Verify that both the split services are included in the bill.
Scenario 2: 837 Professional - Running the bill for the split services because of not having authorization through 'Client Charge Input' form
Specific Setup:
- Guarantor/Payors:
- An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
- Authorization Information Section:
- Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
- Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
- Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
- Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
- Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
- Admission (Outpatient):
- A new client is admitted in an outpatient program. Note the client id/name, admission program,
- Financial Eligibility:
- The guarantor identified above is assigned to the client.
- Diagnosis:
- A new diagnosis record is created for the client.
- Service Codes:
- A new service code is added as below. Note the service code/value.
- Type Of Fee= User Defined
- Minutes per Unit = desired value
- Service Fee/Cross Reference Maintenance:
- Service fee definition is created for the above service code.
- Managed Care Authorizations:
- Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
- The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
- Enter desired value to all the required fields.
- Client Charge Input
- A new service is rendered through desired progress note form.
- The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
- Client Ledger:
- The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
- Close Charges:
- All the charges are closed.
- An interim billing batch is created to include the client, service and guarantor.
Steps
- Open the 'Electronic Billing' form.
- Select the '837 Professional' from the 'Billing Form'.
- Select desired value in the 'Type Of Bill'.
- Select the guarantor identified in the setup section.
- Select the 'Interim Batch' in the 'Select All Clients Or Interim Batch' field.
- Select the interim billing batch in 'Interim Batch Number'.
- Populate all the required fields.
- Compile the bill for the client, services and guarantor identified in the interim billing batch.
- Verify the bill compiles successfully.
- Select 'Run Report'.
- Select 'Print' from the 'Print Or Delete Report' field.
- Select the file compiled successfully in the previous step.
- Verify that both the split services are included in the bill.
Scenario 3: 837 Institutional - Split services - Services created through 'Client Charge Input' form
Specific Setup:
- Guarantor/Payors:
- An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
- Authorization Information Section:
- Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
- Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
- Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
- Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
- Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
- Admission:
- A new client is admitted in an inpatient program. Note the client id/name, admission program,
- Financial Eligibility:
- The guarantor identified above is assigned to the client.
- Diagnosis:
- A new diagnosis record is created for the client.
- Service Codes:
- A new service code is added as below. Note the service code/value.
- Type Of Fee= User Defined
- Minutes per Unit = desired value
- Service Fee/Cross Reference Maintenance:
- Service fee definition is created for the above service code.
- Managed Care Authorizations:
- Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
- The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
- Enter desired value to all the required fields.
- Client Charge Input
- A new service is rendered through desired progress note form.
- The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
- Client Ledger:
- The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
- Close Charges:
- All the charges are closed.
- An interim billing batch is created to include the client, service and guarantor.
Steps
- Open the 'Electronic Billing' form.
- Select the '837 Institutional' from the 'Billing Form'.
- Select desired value in the 'Type Of Bill'.
- Select the guarantor identified in the setup section.
- Select the 'Interim Batch' in the 'Select All Clients Or Interim Batch' field.
- Select the interim billing batch in 'Interim Batch Number'.
- Populate all the required fields.
- Compile the bill for the client, services and guarantor identified in the interim billing batch.
- Verify the bill compiles successfully.
- Select 'Run Report'.
- Select 'Print' from the 'Print Or Delete Report' field.
- Select the file compiled successfully in the previous step.
- Verify that both the split services are included in the bill.
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Topics
• 837 Professional
• Managed Care Authorizations
• NX
• 837 Institutional
• Edit Service Information
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Avatar PM 'Practitioner Enrollment' and 'Practitioner Enrollment (Brief)' Forms
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Practitioner Enrollment
- Performing Provider Registration
- Practitioner Enrollment (Brief)
Scenario 1: 'Practitioner Enrollment' - Update of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
- Avatar PM Practitioner Enrollment record linked to Avatar MSO Performing Provider Registration must exist
Steps
- Open Avatar PM 'Practitioner Enrollment' form.
- Search/select existing Practitioner Enrollment record for edit, using Practitioner linked to Avatar MSO Performing Provider.
- Enter/edit values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields, and any other Practitioner data fields as required/desired.
- Enter/edit values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Navigate to 'Categories/Taxonomy' section of form.
- Select existing Category/Taxonomy entry for edit, or select 'Create New' in 'Category/Taxonomy' entry field.
- Enter/edit values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment' form.
- Open Avatar MSO 'Performing Provider Registration' form.
- Select Performing Provider Registration linked to Practitioner Enrollment, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are updated with values edited/filed in Avatar PM 'Practitioner Enrollment' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are updated with values edited/filed in Avatar PM 'Practitioner Enrollment' form.
- Ensure that 'Performing Provider's License Type' field is updated with values edited/filed in Practitioner Enrollment Category/Taxonomy entry/entries 'Discipline' field.
- Ensure that entry/entries are updated in 'Primary License Type Effective Dates' field/section for Practitioner Enrollment Category/Taxonomy entry/entries, with 'Primary License Type For Claims' value as selected in 'Discipline' field (in case where only single 'Discipline' value is selected; population is based on Dictionary Code matching values).
- Close 'Performing Provider Registration' form.
Scenario 2: 'Practitioner Enrollment' - Creation of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
Steps
- Open Avatar PM 'Practitioner Enrollment' form.
- Click 'New Staff' button to create new Practitioner Enrollment (or search/select existing Practitioner Enrollment record for edit); ensure that Practitioner ID value used is not currently existing/assigned as Avatar MSO Performing Provider ID.
- Enter/select values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields (using values not present for any existing/defined Avatar MSO Performing Provider Registration record).
- Enter/select values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' fields are present in form (under 'Link Staff To Performing Provider' section); do not enter or select value for 'Performing Provider' field, leaving the field blank/empty.
- Navigate to 'Categories/Taxonomy' section of form.
- Select 'Create New' in 'Category/Taxonomy' entry field (or select existing Category/Taxonomy entry for edit).
- Enter/select values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment' form.
- Open Avatar MSO 'Performing Provider Registration' form.
- In Performing Provider search, enter value used for Practitioner Name in 'Practitioner Enrollment' form; ensure that Performing Provider Registration record is present/returned in search results.
- Select Performing Provider Registration record created via 'Practitioner Enrollment' filing, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Registration Start Date', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are populated with values filed in Avatar PM 'Practitioner Enrollment' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are populated with values filed in Avatar PM 'Practitioner Enrollment' form.
- Ensure that 'Performing Provider's License Type' field is populated with values selected in Practitioner Enrollment Category/Taxonomy entry/entries 'Discipline' field.
- Ensure that entry/entries are filed in 'Primary License Type Effective Dates' field/section for Practitioner Enrollment Category/Taxonomy entry/entries, with 'Primary License Type For Claims' value as selected in 'Discipline' field (in case where only single 'Discipline' value is selected; population is based on Dictionary Code matching values).
- Close 'Performing Provider Registration' form.
- Re-open Avatar PM 'Practitioner Enrollment' form for previously filed entry/record.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' assignment fields are populated with Avatar MSO Performing Provider Registration record linked to Practitioner Enrollment, and that fields are disabled/read-only and do not allow edit of linked values.
Scenario 3: 'Practitioner Enrollment' - Link To Existing of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
- Avatar MSO Performing Provider Registration must exist, not currently linked to Avatar PM Practitioner Enrollment record
Steps
- Open Avatar PM 'Practitioner Enrollment' form.
- Click 'New Staff' button to create new Practitioner Enrollment (or search/select existing Practitioner Enrollment record for edit); Practitioner ID value used may exist or not exist as Avatar MSO Performing Provider ID already in system.
- Enter/select values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields (using same values as existing/defined for Avatar MSO Performing Provider Registration record), and any other Practitioner data fields as required/desired.
- Enter/select values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' fields are present in form (under 'Link Staff To Performing Provider' section); enter/select existing Contracting Provider Registration record for Practitioner link in 'Performing Provider'/'Performing Provider Registration' fields if manual linking of records is desired.
- Navigate to 'Categories/Taxonomy' section of form.
- Select 'Create New' in 'Category/Taxonomy' entry field (or select existing Category/Taxonomy entry for edit).
- Enter/select values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment' form.
- Re-open Avatar PM 'Practitioner Enrollment' form for previously filed entry/record.
- In case where 'Performing Provider'/'Performing Provider Registration' field values were manually entered in previous 'Practitioner Enrollment' filing - ensure that fields are populated with Avatar MSO Performing Provider Registration record linked to Practitioner Enrollment, and that fields are disabled/read-only and do not allow edit of linked values.
- In case where 'Performing Provider'/'Performing Provider Registration' field values were not manually entered (field blank/no value) in previous 'Practitioner Enrollment' filing- ensure that fields are automatically populated/linked with Avatar MSO Performing Provider Registration record having same ID number/Registration Start Date value (and NPI Number if entered).
- Open Avatar MSO 'Performing Provider Registration' form.
- In Performing Provider search, enter value used for Performing Provider association in 'Practitioner Enrollment' form.
- Select Performing Provider Registration record associated to Practitioner via 'Practitioner Enrollment' filing, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Registration Start Date', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are populated with values filed in Avatar PM 'Practitioner Enrollment' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are populated with values filed in Avatar PM 'Practitioner Enrollment' form.
Scenario 4: 'Practitioner Enrollment (Brief)' - Creation of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
Steps
- Open Avatar PM 'Practitioner Enrollment (Brief)' form.
- Click 'New Staff' button to create new Practitioner Enrollment (or search/select existing Practitioner Enrollment record for edit); ensure that Practitioner ID value used is not currently existing/assigned as Avatar MSO Performing Provider ID.
- Enter/select values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields (using values not present for any existing/defined Avatar MSO Performing Provider Registration record).
- Enter/select values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' fields are present in form (under 'Link Staff To Performing Provider' section); do not enter or select value for 'Performing Provider' field, leaving the field blank/empty.
- Navigate to 'Categories/Taxonomy' section of form.
- Select 'Create New' in 'Category/Taxonomy' entry field (or select existing Category/Taxonomy entry for edit).
- Enter/select values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment (Brief)' form.
- Open Avatar MSO 'Performing Provider Registration' form.
- In Performing Provider search, enter value used for Practitioner Name in 'Practitioner Enrollment (Brief)' form; ensure that Performing Provider Registration record is present/returned in search results.
- Select Performing Provider Registration record created via 'Practitioner Enrollment (Brief)' filing, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Registration Start Date', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are populated with values filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are populated with values filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
- Ensure that 'Performing Provider's License Type' field is populated with values selected in Practitioner Enrollment Category/Taxonomy entry/entries 'Discipline' field.
- Ensure that entry/entries are filed in 'Primary License Type Effective Dates' field/section for Practitioner Enrollment Category/Taxonomy entry/entries, with 'Primary License Type For Claims' value as selected in 'Discipline' field (in case where only single 'Discipline' value is selected; population is based on Dictionary Code matching values).
- Close 'Performing Provider Registration' form.
- Re-open Avatar PM 'Practitioner Enrollment (Brief)' form for previously filed entry/record.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' assignment fields are populated with Avatar MSO Performing Provider Registration record linked to Practitioner Enrollment, and that fields are disabled/read-only and do not allow edit of linked values.
Scenario 5: 'Practitioner Enrollment (Brief)' - Update of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
- Avatar PM Practitioner Enrollment record linked to Avatar MSO Performing Provider Registration must exist
Steps
- Open Avatar PM 'Practitioner Enrollment (Brief)' form.
- Search/select existing Practitioner Enrollment record for edit, using Practitioner linked to Avatar MSO Performing Provider.
- Enter/edit values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields, and any other Practitioner data fields as required/desired.
- Enter/edit values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Navigate to 'Categories/Taxonomy' section of form.
- Select existing Category/Taxonomy entry for edit, or select 'Create New' in 'Category/Taxonomy' entry field.
- Enter/edit values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment (Brief)' form.
- Open Avatar MSO 'Performing Provider Registration' form.
- Select Performing Provider Registration linked to Practitioner Enrollment, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are updated with values edited/filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are updated with values edited/filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
- Ensure that 'Performing Provider's License Type' field is updated with values edited/filed in Practitioner Enrollment Category/Taxonomy entry/entries 'Discipline' field.
- Ensure that entry/entries are updated in 'Primary License Type Effective Dates' field/section for Practitioner Enrollment Category/Taxonomy entry/entries, with 'Primary License Type For Claims' value as selected in 'Discipline' field (in case where only single 'Discipline' value is selected; population is based on Dictionary Code matching values).
- Close 'Performing Provider Registration' form.
Scenario 6: 'Practitioner Enrollment (Brief)' - Link To Existing of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
- Avatar MSO Performing Provider Registration must exist, not currently linked to Avatar PM Practitioner Enrollment record
Steps
- Open Avatar PM 'Practitioner Enrollment (Brief)' form.
- Click 'New Staff' button to create new Practitioner Enrollment (or search/select existing Practitioner Enrollment record for edit); Practitioner ID value used may exist or not exist as Avatar MSO Performing Provider ID already in system.
- Enter/select values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields (using same values as existing/defined for Avatar MSO Performing Provider Registration record), and any other Practitioner data fields as required/desired.
- Enter/select values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' fields are present in form (under 'Link Staff To Performing Provider' section); enter/select existing Contracting Provider Registration record for Practitioner link in 'Performing Provider'/'Performing Provider Registration' fields if manual linking of records is desired.
- Navigate to 'Categories/Taxonomy' section of form.
- Select 'Create New' in 'Category/Taxonomy' entry field (or select existing Category/Taxonomy entry for edit).
- Enter/select values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment (Brief)' form.
- Re-open Avatar PM 'Practitioner Enrollment (Brief)' form for previously filed entry/record.
- In case where 'Performing Provider'/'Performing Provider Registration' field values were manually entered in previous Practitioner Enrollment filing - ensure that fields are populated with Avatar MSO Performing Provider Registration record linked to Practitioner Enrollment, and that fields are disabled/read-only and do not allow edit of linked values.
- In case where 'Performing Provider'/'Performing Provider Registration' field values were not manually entered (field blank/no value) in previous Practitioner Enrollment filing- ensure that fields are automatically populated/linked with Avatar MSO Performing Provider Registration record having same ID number/Registration Start Date value (and NPI Number if entered).
- Open Avatar MSO 'Performing Provider Registration' form.
- In Performing Provider search, enter value used for Performing Provider association in 'Practitioner Enrollment (Brief)' form.
- Select Performing Provider Registration record associated to Practitioner via 'Practitioner Enrollment (Brief)' filing, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Registration Start Date', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are populated with values filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are populated with values filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
Scenario 7: 'Practitioner Enrollment' - Form Verification
Specific Setup:
- Crystal Reports or other SQL reporting tool
Steps
- Open Avatar PM 'Practitioner Enrollment' form.
- Enter/select existing Practitioner Enrollment record for view/update (or click 'New Staff' button for new Practitioner Enrollment entry).
- Enter/select values for 'Name' and 'Registration Date' fields (and any/all other form fields as required/desired).
- Ensure that 'Secondary Provider Identification Number' and 'Fax Number' fields are present in 'Practitioner Enrollment' form.
- Enter values for 'Secondary Provider Identification Number' and 'Fax Number' fields.
- Navigate to 'Categories/Taxonomy' section of form.
- Enter/update Practitioner Category information as required/desired.
- Click 'Submit' button to file 'Practitioner Enrollment' form/record.
- Re-open Avatar PM 'Practitioner Enrollment' form (selecting same Practitioner Enrollment record as entered/edited above).
- Ensure that values entered/filed for 'Secondary Provider Identification Number' and 'Fax Number' fields are present.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.staff_enrollment_history', ensure that fields 'secondary_prov_ident_num' and 'fax_number' are present, and contain values filed for 'Secondary Provider Identification Number' and 'Fax Number' fields (respectively).
Scenario 8: 'Practitioner Enrollment (Brief)' - Form Verification
Specific Setup:
- Crystal Reports or other SQL reporting tool
Steps
- Open Avatar PM 'Practitioner Enrollment (Brief)' form.
- Enter/select existing Practitioner Enrollment record for view/update (or click 'New Staff' button for new Practitioner Enrollment entry).
- Enter/select values for 'Name' and 'Registration Date' fields (and any/all other form fields as required/desired).
- Ensure that 'Secondary Provider Identification Number' and 'Fax Number' fields are present in 'Practitioner Enrollment (Brief)' form.
- Enter values for 'Secondary Provider Identification Number' and 'Fax Number' fields.
- Navigate to 'Categories/Taxonomy' section of form.
- Enter/update Practitioner Category information as required/desired.
- Click 'Submit' button to file 'Practitioner Enrollment (Brief)' form/record.
- Re-open Avatar PM 'Practitioner Enrollment (Brief)' form (selecting same Practitioner Enrollment record as entered/edited above).
- Ensure that values entered/filed for 'Secondary Provider Identification Number' and 'Fax Number' fields are present.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.staff_enrollment_history', ensure that fields 'secondary_prov_ident_num' and 'fax_number' are present, and contain values filed for 'Secondary Provider Identification Number' and 'Fax Number' fields (respectively).
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Topics
• Practitioner
• Performing Provider
• NX
|
Managed Care Authorizations - Authorization Group
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Program Maintenance
- Authorization Group Definition
- Admission (Outpatient)
- Financial Eligibility
- Managed Care Authorizations
- Registry Settings (PM)
Scenario 1: Managed Care Authorizations - Authorization Groups - Program Usage Type = Admission
Specific Setup:
- Registry Setting: ‘Avatar PM->System Maintenance->Program Maintenance->->->Enable 'Admission vs. Service Program' Functionality’ has a value of ‘Y’.
- Program Maintenance:
- Program 1: ‘Usage Type’ = Service. Desired service codes have been assigned to the program.
- Program 2: ‘Usage Type’ = Admission. No service codes have been assigned to the program. Program 1 is selected in ‘Associated Service Programs’.
- Authorization Group Definition has been used to create a group that has a minimum of two service codes.
- Client: Is admitted to Program 2 and has a Financial Eligibility record.
Steps
- Open ‘Managed Care Authorizations’ for the client.
- Select the ‘Managed Care Authorization Data’ section.
- Click [Add New Item].
- Select the ‘Guarantor Number’.
- Enter desired ‘Authorization Number’.
- Enter desired ‘Authorization Start Date’.
- Enter desired ‘Authorization End Date’.
- Select ‘Program 1’ in ‘Associated Service Program(s)’.
- Select the ‘Authorization Group’ from Setup.
- Validate that the service codes in the group are selected in ‘Service Code(s)’.
- Select desired value in ‘U/R Staff Person’.
- Select desired value in ‘Type Of Authorization’.
- Optionally enter data for other fields.
- Click [Submit].
Scenario 2: Managed Care Authorizations - Authorization Groups - Program Usage Type = Both
Specific Setup:
- Registry Setting: ‘Avatar PM->System Maintenance->Program Maintenance->->->Enable 'Admission vs. Service Program' Functionality’ has a value of ‘Y’.
- Program Maintenance: ‘Usage Type’ = Both. Desired service codes have been assigned to the program.
- Authorization Group Definition has been used to create a group that has a minimum of two service codes.
- Client: Is admitted to above program and has a Financial Eligibility record.
Steps
- Open ‘Managed Care Authorizations’ for the client.
- Select the ‘Managed Care Authorization Data’ section.
- Click [Add New Item].
- Select the ‘Guarantor Number’.
- Enter desired ‘Authorization Number’.
- Enter desired ‘Authorization Start Date’.
- Enter desired ‘Authorization End Date’.
- Select the ‘Authorization Group’ from Setup.
- Validate that the service codes in the group are selected in ‘Service Code(s)’.
- Select desired value in ‘U/R Staff Person’.
- Select desired value in ‘Type Of Authorization’.
- Optionally enter data for other fields.
- Click [Submit].
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Topics
• Managed Care Authorizations
• NX
|
'Team Assignment' is enhanced to no longer display inactive teams.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: 'Team Assignment' - validate Inactive and Deleted Teams are no longer included in the 'Admission' form 'Team Assignment' selection drop down field.
Specific Setup:
- RADplus 2022 Update 58 is required for full functionality.
- One or more teams are defined in the 'Team Definition' form.
- Client A is assigned to a team which will be flagged as 'Inactive'.
- Using 'Team Definition', flag the team Client A is assigned to as 'Inactive'.
- Client B is assigned to a team which will be deleted.
- Using 'Team Definition', flag the team Client B assigned to as 'Deleted'
Steps
- Create a report against SQL Table 'admission_data_other'.
- Include in the report, at a minimum, the following fields:
- PATID
- team_assignment_value
- team_assignment_code
- data_entry_date
- Run the report. Note the values entered for Client A and Client B. The team_assignment_value and team_assignment_code fields will be blank for both clients.
- Open the 'Admission (Outpatient)' form. Note that this functionality is the same in the 'Admission' form as well.
- Select Client A.
- Verify that there is no selection in the 'Team Assignment' field.
- Navigate to the 'Team Assignment' field.
- Click on the drop down list.
- Verify that no Teams defined as 'Inactive' are displayed for selection.
- Select any active Team from the list.
- Click [Submit].
- Open the 'Admission (Outpatient)' form. Note that this functionality is the same in the 'Admission' form as well.
- Select Client B.
- Verify that there is no selection in the 'Team Assignment' field. This team has been deleted from the 'Team Definition' form.
- Navigate to the 'Team Assignment' field.
- Click on the drop down list.
- Verify that no Teams which were deleted are included in the drop down list.
- Select any active Team from the list.
- Click [Submit].
- Run the report again.
- Verify the team_assignment_value and team_assignment_code fields are populated for both Client A and Client B.
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Topics
• NX
• Team Assignment
|
Payment Acknowledgement - form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- User Definition
- Dictionary Update (PM)
- Posting/Adjustment Codes Definition
- Payment Acknowledgement
Scenario 1: Payment Acknowledgement - workflow
Specific Setup:
- Registry Setting:
- ‘Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement’ has a ‘Registry Setting Value’ of ‘Y’.
- Dictionary Update:
- Other Table Files: (5521) Program - contains dictionary codes and dictionary values.
- Other Table Files: (5522) Account - contains dictionary codes, dictionary values and extended dictionary values.
- Other Table Files: (9712) Payment Acknowledgement Type – extended dictionary values have been added to the locked dictionary.
- Posting/Adjustment Codes Definitions: Definitions exist for ‘Payment’.
- The definitions may have a value in the ‘Payment Acknowledgement Type’ field.
- All ‘Payment’ definitions will be available in the ‘Payment Acknowledgement’ form.
Steps
- Open ‘Payment Acknowledgement’ form.
- Verify that ‘Action’ defaults to ‘New’.
- Verify that ‘Transaction Number’ is read only.
- Verify that ‘Entered By’ is read only and defaults to the signed in user.
- Enter desired value in ‘Batch Number’.
- Select desired ‘Posting Code’.
- Enter desired value in ‘Check/EFT Number’.
- Enter desired value in ‘Amount’.
- Select desired ‘Guarantor’. If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
- Enter desired value in ‘Name/Source’.
- Enter desired value in ‘Client’, if enabled.
- Enter desired value in ‘Check/EFT Date’.
- Enter desired value in ‘Receipt Date’.
- Enter desired value in ‘Deposit Date’.
- Select desired ‘Treatment Service’.
- Select desired ‘Category’.
- Enter desired value in ‘Bank Ref #’.
- Enter desired value in ‘Comments’.
- Click [File].
- Verify that the ‘Payment Acknowledgement’ message is received and states the following: Filed successfully. The Transaction Number is 6. Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
- Click [Yes] to continue to Post Payment Accounting Entry section or [No] to remain in the ‘Payment Acknowledgement’ section.
- If [Yes] was clicked, go to step 30.
- If [No] was clicked, select ‘Edit or View’ in ‘Action, which will enable the ‘Payment Acknowledgement Search’ section.
- Enter data from the filed ‘Payment Acknowledgement’ into desired search fields. The ’Transaction Number’ and ‘Batch Number’ are specific to only one ‘Payment Acknowledgement’. The following fields may return results for more than one ‘Payment Acknowledgement’ when applicable: ‘Client’, ‘Guarantor’, ‘Amount Type’, ‘Check/EFT #’, ‘Check/EFT From Date’, ‘Check/EFT To Date’, ‘Deposit From Date’, and ‘Deposit To Date’.
- Click [Search].
- Select the desired item in the ‘Payment Acknowledgement’ grid.
- Click [OK] to continue or [Cancel] to end the search. Click [OK].
- The following ‘Payment Acknowledgement’ displays: Do you need to continue to Post Payment Accounting Entry?
- Click [Yes].
- Click [New Row] in ‘Post Payment Accounting Entry’.
- Select desired ‘Treatment Service’. It will default if filed in the ‘Payment Acknowledgement’.
- Select desired ‘Program’. This is from ‘Other Table Files: (5521) Program’, not a program in ‘Program Maintenance’.
- Select desired ‘Account’.
- Select desired ‘Amount’.
- Validate that the ‘Posting Code; defaulted from the ‘Payment Acknowledgement’.
- Select desired ‘Posting Date’.
- Validate that the ‘Posting Summary’ is correct.
- If desired, click [New Row] and repeat the steps.
- If desired, click [Delete Row]. A ‘Confirm Delete’ message will be displayed. Select desired value.
- Click [File].
- The following ‘Payment Acknowledgement’ displays: Filed successfully. Do you need to continue with Post Payment Accounting Entry?
- Click [Yes].
- Click the ‘Reverse’ checkbox in one row of the ‘Post Payment Accounting Entry’.
- Enter desired ‘Reversal Posting Date’.
- Enter desired ‘Reversal Reason’.
- Click [Reverse].
- Validate that a new row was added to the ‘Post Payment Accounting Entry’ grid and that it mirrors the row that was selected to reverse, except for ‘Amount’ displays in parentheses, indicating a negative amount.
- If desired, add a new row to post and additional payment.
- Close the form.
Scenario 2: Payment Acknowledgement - form & field validation
Specific Setup:
- Registry Setting:
- ‘Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement’ has a ‘Registry Setting Value’ of ‘Y’.
- Dictionary Update:
- Other Table Files: (5521) Program - contains dictionary codes and dictionary values.
- Other Table Files: (5522) Account - contains dictionary codes, dictionary values and extended dictionary values.
- Other Table Files: (9712) Payment Acknowledgement Type – extended dictionary values have been added to the locked dictionary.
- Posting/Adjustment Codes Definitions: Definitions exist for ‘Payment’.
- The definitions may have a value in the ‘Payment Acknowledgement Type’ field.
- All ‘Payment’ definitions will be available in the ‘Payment Acknowledgement’ form.
Steps
- Open ‘Payment Acknowledgement’ form.
- Verify that ‘Action’ defaults to ‘New’.
- Verify that ‘Transaction Number’ is read only.
- Verify that ‘Entered By’ is read only and defaults to the signed in user.
- Verify that ‘Batch Number’ is required.
- Verify that ‘Posting Code’’ is required.
- Verify that ‘Amount’ is required.
- Verify that ‘Guarantor’ is required.
- Verify that ‘Receipt Date’ is required.
- Verify that ‘Deposit Date’ is required.
- Enter desired value in ‘Batch Number’.
- Select desired ‘Posting Code’.
- Enter desired value in ‘Check/EFT Number’.
- Enter desired value in ‘Amount’.
- Select desired ‘Guarantor’. If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
- Enter desired value in ‘Name/Source’.
- Enter desired value in ‘Client’, if enabled.
- Enter desired value in ‘Check/EFT Date’.
- Enter desired value in ‘Receipt Date’.
- Enter desired value in ‘Deposit Date’.
- Select desired ‘Treatment Service’.
- Select desired ‘Category’.
- If the selected item, extended data dictionary value of 'Other Table Files: (5522) Account' - 'Include in Category Dictionary: Yes' the dictionary item will be available for selection. No = not available for selection.
- If the selected item, extended data dictionary value of 'Other Table Files: (5522) Account' - 'Require Name/Source in Payment Acknowledgement', has a value of 'Y' the 'Name/Source' field will become required. No = not required.
- Enter desired value in ‘Bank Ref #’.
- Enter desired value in ‘Comments’.
- Click [File].
- Verify that the ‘Payment Acknowledgement’ message is received and states the following: Filed successfully. The Transaction Number is 6. Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
- Clicking [No] returns the user to the ‘Payment Acknowledgement’ section to enter additional payments.
- Clicking [Yes] allows the user to post payments in 'Post Payment Accounting Entry'.
- Click [Yes].
- Click [New Row] in ‘Post Payment Accounting Entry’.
- Select desired ‘Treatment Service’. It will default if filed in the ‘Payment Acknowledgement’.
- Select desired ‘Program’. This is from ‘Other Table Files: (5521) Program’, not a program in ‘Program Maintenance’.
- Select desired ‘Account’.
- Select desired ‘Amount’.
- Validate that the ‘Posting Code; defaulted from the ‘Payment Acknowledgement’.
- Select desired ‘Posting Date’.
- Validate that the ‘Posting Summary’ is correct.
- If desired, and first row partially posts the 'Amount', click [New Row] and repeat the steps.
- If desired, click [Delete Row]. A ‘Confirm Delete’ message will be displayed. Select desired value.
- Click [File].
- The following ‘Payment Acknowledgement’ displays: Filed successfully. Do you need to continue with Post Payment Accounting Entry?
- Click [Yes].
- Click the ‘Reverse’ checkbox in one row of the ‘Post Payment Accounting Entry’.
- Enter desired ‘Reversal Posting Date’.
- Enter desired ‘Reversal Reason’.
- Click [Reverse].
- Validate that a new row was added to the ‘Post Payment Accounting Entry’ grid and that it mirrors the row that was selected to reverse, except for ‘Amount’ displays in parentheses, indicating a negative amount.
- If desired, add a new row to post and additional payment.
- Close the form.
- Open ‘Payment Acknowledgement’ form
- Select ‘Edit or View’ in ‘Action, which will enable the ‘Payment Acknowledgement Search’ section.
- Enter data from the ‘Payment Acknowledgement’, filed above, into desired search fields. The ’Transaction Number’ and ‘Batch Number’ are specific to only one ‘Payment Acknowledgement’. The following fields may return results for more than one ‘Payment Acknowledgement’ when applicable: ‘Client’, ‘Guarantor’, ‘Amount Type’, ‘Check/EFT #’, ‘Check/EFT From Date’, ‘Check/EFT To Date’, ‘Deposit From Date’, and ‘Deposit To Date’.
- Click [Search].
- Select the desired item in the ‘Payment Acknowledgement’ grid.
- Click [OK] to continue or [Cancel] to end the search. Click [OK].
- The following ‘Payment Acknowledgement’ displays: Do you need to continue to Post Payment Accounting Entry?
- Validate the ‘Post Payment Accounting Entry' contains the previously filed data.
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Topics
• NX
• Payment Acknowledgement
|
A new report: 'CPT License Count Report' is added to Avatar PM.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: CPT License Count Report
Steps
- Open the 'CPT License Count Report'.
- Set the Start Date input box to any date.
- Set the End Date input box to any date.
- Click [Process].
- Validate the 'Date Range' item contains the Date range as entered on the selection screen.
- Validate the '#' column contains a numeric value for each listed line item.
- Validate the 'User Name' column contains only active Users.
- Validate the 'User ID' column contains only active User IDs.
- Validate the 'Provider Name' column contains only active Providers
- Validate the 'Provider ID' column contains only active Provider IDs.
- Validate the 'Provider Category' column contains the Provider Category associated to the Provider.
- Click [Close Report]
- Click [Close Form].
CPT Code copyright notice is added to Avatar forms.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: CPT Code Definition - Field validation
Steps
- Access the 'CPT Code Definition' form.
- Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT Code' field.
- Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
- Close the form.
Scenario 2: CPT Place Of Service Override - field validations
Steps
- Open the 'CPT Place of Service Override' form.
- Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT Code' field.
- Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
- Close the form.
Scenario 3: Service Fee/Cross Reference Maintenance - field validations
Steps
- Access the 'Service Fee/Cross Reference Maintenance' form.
- Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT Code' field.
- Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
- Close the form.
Avatar PM is enhanced with updated CPT codes.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: CPT Codes: Annual code update
Steps
- Open Avatar PM 'CPT Code Definition' form.
- Click [Print CPT Codes].
- A list of the current CPT Codes will display.
- Review the list to assure new codes have been added.
- Click [Close].
Copyright notice is added to forms where CPT content is displayed.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Real Time Inquiry (270 Request)
- Program Maintenance
- Select Program
- Confirm Compile Completed
- Avatar NX Report Viewer
- Eligibility Inquiry (270) Request
- Eligibility Inquiry and Response (270/271) Report
Scenario 1: Process 'Real Time Inquiry (270) Request' with a value of 'Request Inquiry' in 'Eligibility Inquiry (270) Status'.
Specific Setup:
- Agency uses 'Real Time Inquiry (270) Request' functionality.
- Avatar PM 2018 Update 187 is installed.
- At least one 'Guarantors/Payors' has a value of 'Yes' in 'Support 270/271 Transaction Sets'. Note the guarantor.
- Selecting any client with the above 'Guarantors/Payors', update the 'Financial Eligibility' record to have a value of 'Request Inquiry' in 'Eligibility Inquiry (270) Status'. Note the client and the episode.
- If the 'Request Type' is 'Specific', a 'Service Code' with a value in 'Service Type Code (270)' must exist.
Steps
- Open 'Real Time Inquiry (270) Request'.
- Select the client.
- Select the episode.
- Select the guarantor.
- Select any value in 'Request Type'.
- Select the 'Service Code' if 'Specific' was selected above.
- Verify the AMA trademark 'CPT® Codes' is displayed above the 'CPT-4 Code' field.
- Verify the AMA Copyright Notice 'CPT copyright 2021 American Medical Association. All rights reserved.' is displayed at the bottom of the form.
- Click [Process Request].
- Validate that submission is successful.
- If a system error message is received, review the 'Eligibility Inquiry and Response (270/271) Report' to correct client or setup issues.
Scenario 2: 'Program Maintenance' - Field Validation
Steps
- Access the 'Program Maintenance' form.
- Navigate to the 'Encounter CPT Code' field.
- Verify that the AMA CPT Code Trademark 'CPT® Codes' is displayed.
- Scroll to the bottom of the form.
- Verify that 'CPT copyright 2021 American Medical Association. All rights reserved.' is displayed.
- Close the form.
Scenario 3: "Single Program Maintenance" - field validations
Steps
- Open "Single Program Maintenance" form.
- Select any program in the "Select Program" dialog.
- Click [Select].
- Navigate to the "Encounter CPT Code" field.
- Verify the AMA trademark 'CPT® Codes' is displayed.
- Scroll to the bottom of the form.
- Verify the AMA Copyright 'CPT copyright 2021 American Medical Association. All rights reserved.' is displayed.
- Click [File Program].
- Click [Close Form].
Scenario 4: Modifiers by Practitioner Category - Validation
Steps
- Open 'Modifiers by Practitioner Categories' form.
- Validate the CPT Code selection box contains 'CPT® Code'.
- Validate the AMA copyright notice displays at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
- Close the form.
Scenario 5: Eligibility Inquiry (270) Request field validation
Specific Setup:
- The following registry setting is enabled: 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Enable 270/271 Transaction Sets'.
Steps
- Open 'Eligibility Inquiry (270) Request'.
- Verify the 'CPT-4 Code' field contains the AMA Trademark 'CPT® Codes'.
- Verify the AMA copyright notice is displayed at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'
Scenario 6: Eligibility Inquiry and Response (270/271) Report field validation
Steps
- Open 'Eligibility Inquiry and Response (270/271) Report'.
- Enter the 'Client ID' for the client that is not rejected.
- Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT-4 Code' field.
- Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
- Close the form.
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Topics
• NX
• CPT License Count Report
• CPT Codes
• Service Fee/Cross Reference Maintenance
• Program Maintenance
• Single Program Maintenance
• Eligibility Inquiry (270) Request
• Eligibility Response (271)
|
Default Guarantor Assignment - multiple default guarantors
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Admission
- Financial Eligibility
- Guarantors/Payors
- Cross Episode Financial Eligibility
- Default Guarantor Assignment
- Admission (Outpatient)
- Pre Admit
- Back Dated Admission/Discharge
- Family Registration
- Family Financial Eligibility
Scenario 1: Default Guarantor Assignment assigned during Admission
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the order.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Filing of Admission’ in ‘Default the Guarantor(s) During’.
- Select desired value in ‘Add the Guarantor(s) to Which Form’. Note: If ‘Financial Eligibility’ is selected the ‘Default the Guarantor(s) Only If’ field becomes disabled.
- If available, select ‘None’ in ‘Default the Guarantor(s) Only If’.
- Click [Submit].
- Open ‘Admission’ and admit a client into desired episode.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’, and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- As, desired change the value of the ‘Add the Guarantor(s) to Which Form’ and 'Default the Guarantor(s) Only If" fields and continue testing clients using the 'Admission’ form, or existing clients admitted from the 'Admission' form.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
Scenario 2: Default Guarantor Assignment assigned during Admission (Outpatient)
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Filing of Admission’ in ‘Default the Guarantor(s) During’.
- Select desired value in ‘Add the Guarantor(s) to Which Form’. Note: If ‘Financial Eligibility’ is selected the ‘Default the Guarantor(s) Only If’ field becomes disabled.
- If available, select ‘None’ in ‘Default the Guarantor(s) Only If’.
- Click [Submit].
- Open ‘Admission (Outpatient)’ and admit a client into desired episode.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’, and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- As, desired change the value of the ‘Add the Guarantor(s) to Which Form’ and 'Default the Guarantor(s) Only If" fields and continue testing clients using the 'Admission (Outpatient)' form, or existing clients admitted from the 'Admission (Outpatient)' form.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
Scenario 3: Default Guarantor Assignment assigned during Pre Admit
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Filing of Admission’ in ‘Default the Guarantor(s) During’.
- Select desired value in ‘Add the Guarantor(s) to Which Form’. Note: If ‘Financial Eligibility’ is selected the ‘Default the Guarantor(s) Only If’ field becomes disabled.
- If available, select ‘None’ in ‘Default the Guarantor(s) Only If’.
- Click [Submit].
- Open 'Pre Admit' and admit a client into desired episode.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’, and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- As, desired change the value of the ‘Add the Guarantor(s) to Which Form’ and 'Default the Guarantor(s) Only If' fields and continue testing clients using the 'Pre Admit' form.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
Scenario 4: Default Guarantor Assignment assigned during Back Dated Admission/Discharge
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Filing of Admission’ in ‘Default the Guarantor(s) During’.
- Select desired value in ‘Add the Guarantor(s) to Which Form’. Note: If ‘Financial Eligibility’ is selected the ‘Default the Guarantor(s) Only If’ field becomes disabled.
- If available, select ‘None’ in ‘Default the Guarantor(s) Only If’.
- Click [Submit].
- Open ‘Back Dated Admission/Discharge’ and admit and discharge a client in a program.
- Click [Submit].
- Open the form selected in ‘Add the Guarantor(s) to Which Form’.
- Verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- As, desired change the value of the ‘Add the Guarantor(s) to Which Form’ and 'Default the Guarantor(s) Only If' fields and continue testing clients using the 'Back Dated Admission/Discharge' form.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
Scenario 5: Default Guarantor Assignment assigned through Financial Eligibility
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
- An additional guarantor is identified. The guarantor will not be added to the 'Default Guarantor Assignment’ form.
- Clients:
- A: An existing client, with no financial eligibility record is identified, or a new client is created.
- B: An existing client, with a financial eligibility record that contains the additional guarantor not added to the 'Default Guarantor Assignment’ form, is identified.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Entry to Financial Eligibility Forms’ in ‘Default the Guarantor(s) During’.
- Select 'Financial Eligibility' in ‘Add the Guarantor(s) to Which Form’.
- Select 'None Exists' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open ‘'Financial Eligibility' for ‘Client A’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- Open ‘Default Guarantor Assignment’.
- Select 'Not a Part of Financial Eligibility/Cross Episode Financial Eligibility/Family Financial Eligibility' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open ‘'Financial Eligibility' for ‘Client B’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.Click [Submit].
Scenario 6: Default Guarantor Assignment assigned through Cross Episode Financial Eligibility
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
- An additional guarantor is identified. The guarantor will not be added to the 'Default Guarantor Assignment’ form.
- Clients:
- A: An existing client, with multiple episodes, with no financial eligibility record is identified, or a new client is created.
- B: An existing client, with multiple episodes, with a financial eligibility record that contains the additional guarantor not added to the 'Default Guarantor Assignment’ form, is identified.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Entry to Financial Eligibility Forms’ in ‘Default the Guarantor(s) During’.
- Select 'Cross Episode Financial Eligibility' in ‘Add the Guarantor(s) to Which Form’.
- Select 'None Exists' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open 'Cross Episode Financial Eligibility; for ‘Client A’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- Open ‘Default Guarantor Assignment’.
- Select 'Not a Part of Financial Eligibility/Cross Episode Financial Eligibility/Family Financial Eligibility' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open 'Cross Episode Financial Eligibility' for ‘Client B’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
Scenario 7: Default Guarantor Assignment assigned through Family Financial Eligibility
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
- An additional guarantor is identified. The guarantor will not be added to the 'Default Guarantor Assignment’ form.
- Clients:
- Family A: is an existing family created through 'Family Registration'. There is no financial eligibility record. All members should have a social security number on file.
- Family B: is an existing family created through 'Family Registration'. There is a financial eligibility record for the additional guarantor not added to the 'Default Guarantor Assignment’ form. All members should have a social security number on file.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Entry to Financial Eligibility Forms’ in ‘Default the Guarantor(s) During’.
- Select 'Family Financial Eligibility' in ‘Add the Guarantor(s) to Which Form’.
- Select 'None Exists' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open 'Family Financial Eligibility' for ‘Family A’.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Select the ‘Guarantor Assignment' section.
- Click [Add New Item].
- Select desired member in 'Select Family Member For Assignment.
- Select desired value in 'Guarantor # 1'.
- Select desired value in 'Relationship to Subscriber'.
- Repeat steps 16 & 17 for all guarantors.
- Repeat step 15, 16 & 17 for all desired members.
- Click [Submit].
- Open ‘Default Guarantor Assignment’.
- Select 'Not a Part of Financial Eligibility/Cross Episode Financial Eligibility/Family Financial Eligibility' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open 'Family Financial Eligibility' for ‘Family B’, and verify that the preexisting displays in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Select the ‘Guarantor Assignment' section.
- Select an existing family member in 'Guarantor Assignment to Family Member' and click 'Edit Selected Item'.
- Click [Clear Current Assignments].
- Select desired value in 'Guarantor # 1'.
- Select desired value in 'Relationship to Subscriber'.
- Repeat steps 31 & 32 for all guarantors.
- Repeat steps 29, 30, 31 & 32 for all desired members.
- Click [Submit].
Scenario 8: Default Guarantor Assignment - form & field validation
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of one guarantor, with a value in default guarantor plan, is identified.
- A minimum of one guarantor, with no value in default guarantor plan, is identified.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the order.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added. The following message displays when the guarantor that has no value in default guarantor plan is selected: Default Guarantor Plan Missing: A default guarantor plan is not defined for guarantor (750) New Guarantor 750. A 'Financial Eligibility' record will not be filed during an admission for this guarantor. Click [OK] to remove the message.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Filing of Admission’ in ‘Default the Guarantor(s) During’.
- Select desired value in ‘Add the Guarantor(s) to Which Form’. Note: If ‘Financial Eligibility’ is selected the ‘Default the Guarantor(s) Only If’ field becomes disabled.
- If available, select ‘desired value’ in ‘Default the Guarantor(s) Only If’.
- Click [Submit].
- Admit a new client.
- Open the form selected in Add the Guarantor(s) to Which Form’.
- Verify that only guarantors that have a default guarantor plan display in the financial eligibility section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’ that has a default guarantor plan.
- Click [Submit].
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Topics
• NX
• Default Guarantor Assignment
• Default Guarantor Order Setup
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Avatar PM 'Client Call Intake' Web Service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Call Intake
Scenario 1: 'ClientCallIntake' Web Service - Verification of 'AddCallIntake' Filing
Specific Setup:
- One or more 'Call Intake' programs must be defined (via Avatar PM 'Program Maintenance' form)
- Avatar PM Registry Setting 'Auto Assign Next ID' may be enabled or disabled
- Application utilizing the Avatar PM 'ClientCallIntake' web service
Steps
- Using Avatar PM 'ClientCallIntake' web service, submit request to 'AddCallIntake' method to create new Avatar PM Call Intake record, including value for 'SlidingFeeDivideNumFamMembers' ('Divide Sliding Fee Scale Amount by Number of Family Members Receiving Services') and 'SlidingFeeDivideNumFamMembersNum' ('Sliding Fee Scale - Number of Family Members Receiving Services') fields/segments.
- Optionally, include or exclude value for 'ClientID' field/segment.
- Confirm 'ClientCallIntake' web service responds with confirmation data/Client Unique ID on successful filing of 'AddCallIntake' method.
- Example:"<Confirmation>Client Unique ID : P26 Unique ID: CAL66110.001</Confirmation>"
- Confirm 'ClientCallIntake' web service responds with confirmation message on successful filing of 'AddCallIntake' method.
- Example:"<Message>Client Call Intake web service has been filed successfully.</Message>"
- Confirm 'ClientCallIntake' web service responds with successful status value on successful filing of 'AddCallIntake' method.
- Example:"<Status>1</Status>"
- In case where Avatar PM Registry Setting 'Auto Assign Next ID' is enabled and 'ClientID' field/segment value is included in web service submission for new client creation, confirm that 'ClientCallIntake' web service responds with error status/message and 'Call Intake' form/client record is not created.
- Example: "<Message>Avatar ClientID does not exist and registry Setting 'Auto Assign Next ID' is enabled.</Message>"; "<Status>0</Status>"
- Open Avatar PM 'Call Intake' form and select client/Call Intake record filed via web service for view/update.
- Confirm new Call Intake record is created in Avatar PM, with values/data submitted via web service including 'Divide Sliding Fee Scale Amount by Number of Family Members Receiving Services' and 'Sliding Fee Scale - Number of Family Members Receiving Services' field values.
Scenario 2: 'ClientCallIntake' Web Service - Verification of 'UpdateCallIntake' Filing
Specific Setup:
- One or more 'Call Intake' programs must be defined (via Avatar PM 'Program Maintenance' form)
- Avatar PM Registry Setting 'Auto Assign Next ID' may be enabled or disabled
- Existing Avatar PM client/Call Intake record for edit via web service
- Application utilizing the Avatar PM 'ClientCallIntake' web service
Steps
- Using Avatar PM 'ClientCallIntake' web service, submit request to 'UpdateCallIntake' method to edit existing Avatar PM Call Intake record, including value for 'SlidingFeeDivideNumFamMembers' ('Divide Sliding Fee Scale Amount by Number of Family Members Receiving Services') and 'SlidingFeeDivideNumFamMembersNum' ('Sliding Fee Scale - Number of Family Members Receiving Services') fields/segments.
- Confirm 'ClientCallIntake' web service responds with confirmation data/Client Unique ID on successful filing of 'UpdateCallIntake' method.
- Example:"<Confirmation>Client Unique ID : P26 Unique ID: CAL66110.001</Confirmation>"
- Confirm 'ClientCallIntake' web service responds with confirmation message on successful filing of 'UpdateCallIntake' method.
- Example:"<Message>Client Call Intake web service has been filed successfully.</Message>"
- Confirm 'ClientCallIntake' web service responds with successful status value on successful filing of 'UpdateCallIntake' method.
- Example:"<Status>1</Status>"
- Open Avatar PM 'Call Intake' form and select client/Call Intake record updated via web service for view/update.
- Confirm Call Intake record is updated in Avatar PM with values/data submitted via web service including 'Divide Sliding Fee Scale Amount by Number of Family Members Receiving Services' and 'Sliding Fee Scale - Number of Family Members Receiving Services' field values.
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Topics
• Call Intake
• Web Services
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Avatar PM is prepared for future functionality
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- External Client ID Maintenance
- Patient Account Number Maintenance
Scenario 1: Validate UTC fields with UTC support enabled
Scenario 2: Validate UTC fields with UTC support disabled
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Topics
• HL7
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