Follow Up Entry (Edit) - Follow Up Notes report
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Guarantors/Payors
- Admission (Outpatient)
- Financial Eligibility
- Diagnosis
- Create Interim Billing Batch File
- Electronic Billing
- Follow Up Entry
- Follow Up Entry (Edit)
- Crystal Report Viewer
- Dictionary Update (PM)
Scenario 1: Follow Up Entry (Edit) - Follow Up Notes Report - Validating notes filed through 'Follow Up Entry' by multiple login users
Specific Setup:
- Identify two login users for the test system. Note the login information for both.
- Guarantors/Payors:
- An existing guarantor is identified to be assigned as the primary guarantor. Note the guarantor's code / value / financial class.
- Dictionary Update:
- File - Client
- Data Element - Collection Note Type - 1 to 2 dictionary codes/values are added. Note the Dictionary codes/values.
- Admission:
- A new client is admitted, or an existing client is identified. Note the client id, admission date, and admission program.
- Financial Eligibility: The guarantor identified above is assigned to the client as the primary guarantor.
- Diagnosis: The diagnosis record is created for the client.
- Client Charge Input:
- 2 or 3 services are rendered to the client. Note the service date and service code.
- Client Ledger:
- The services distributed to the guarantor assigned to the client.
- Close Charges:
- The services rendered to the client are closed.
- Create Interim Billing Batch:
- Create an interim billing batch to cover client/services/guarantor.
- Electronic Billing:
- Services are claimed.
Steps
- Login as a one of the login users identified above.
- Open the 'Follow Up Entry' form.
- Enter/select client for Follow Up Entry in 'Client ID' field.
- Navigate to 'Follow Up Entry' section of form.
- Enter/select values for 'Contact Date', 'Contact Time', 'Episode Number', 'Guarantor', 'Guarantor Representative' and 'Collection Note Type' fields.
- Enter value for 'Follow Up Note' field, and any other desired fields.
- Click [File Follow Up Entry].
- Verify 'Filing Completed' dialog is presented. Click 'OK' button to close dialog.
- Navigate to 'Review Follow Up Entries' section of form.
- Ensure that Follow Up Entry filed in form is displayed in the 'Previous Follow Up Notes' text display field.
- Close the form.
- Log out from the system.
- Login as the other login user identified above.
- Open the 'Follow Up Entry' form.
- Enter/select the same client for Follow Up Entry in 'Client ID' field.
- Navigate to 'Follow Up Entry' section of form.
- Enter/select values for 'Contact Date', 'Contact Time', 'Episode Number', 'Guarantor', 'Guarantor Representative' and 'Collection Note Type' fields.
- Enter value for 'Follow Up Note' field, and any other desired fields.
- Click [File Follow Up Entry].
- Verify 'Filing Completed' dialog is presented. Click 'OK' button to close dialog.
- Navigate to 'Review Follow Up Entries' section of form.
- Ensure that Follow Up Entry filed in form is displayed in the 'Previous Follow Up Notes' text display field.
- Close the form.
- Open the 'Follow Up Entry (Edit)' form.
- In the 'Client ID' field, enter the client's name or ID, and select.
- In the 'Filter By Guarantor(s)' field, select the guarantor.
- For the 'Filter By Guarantor Representative(s)' field, select the guarantor representatives.
- In the 'Filter By Episode(s)' field, select the client episodes.
- In the 'Filter By Collection Note Type(s)' field, select the collection note types.
- The 'Previous Follow Up Notes' field displays an overview of the client’s follow up notes.
- Click [Print Current Follow Up Notes].
- Verify it generates a report that details the client's current follow up notes.
- Click [Follow Up Notes Report].
- Verify it generates follow up notes report that details all notes for the client.
- Close the report.
- Close the form.
Scenario 2: Follow Up Entry (Edit) - Follow Up Notes Report - Validating notes filed through 'Follow Up Entry' by single login user
Specific Setup:
- Guarantors/Payors:
- An existing guarantor is identified to be assigned as the primary guarantor and the financial class is not a self pay. Note the guarantor code / value / financial class.
- Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
- Dictionary Update:
- File - Client
- Data Element - Collection Note Type - 1 to 2 dictionary codes/values are added. Note the Dictionary codes/values.
- Admission:
- A new client is admitted, or an existing client is identified. Note the client id, admission date and admission program.
- Financial Eligibility: The guarantor identified above is assigned to the client as the primary guarantor.
- Diagnosis: The diagnosis record is created for the client.
- Client Charge Input:
- 2 or 3 service are 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 services distributed to the self pay guarantor.
- Close Charges:
- The services rendered to the client are closed.
- Create Interim Billing Batch:
- Create an interim billing batch to cover client/services/guarantor.
- Electronic Billing:
- Services are claimed.
Steps
- Open the 'Follow Up Entry' form.
- Enter/select client for Follow Up Entry in 'Client ID' field.
- Navigate to 'Follow Up Entry' section of form.
- Enter/select values for 'Contact Date', 'Contact Time', 'Episode Number', 'Guarantor', 'Guarantor Representative' and 'Collection Note Type' fields.
- Enter value for 'Follow Up Note' field, and any other desired fields.
- Click [File Follow Up Entry].
- Verify 'Filing Completed' dialog is presented. Click 'OK' button to close dialog.
- Navigate to 'Review Follow Up Entries' section of form.
- Ensure that Follow Up Entry filed in form is displayed/included in the 'Previous Follow Up Notes' text display field.
- Close the form.
- Open the 'Follow Up Entry (Edit)' form.
- In the 'Client ID' field, enter the client's name or ID, and select.
- In the 'Filter By Guarantor(s)' field, select the guarantors.
- For the 'Filter By Guarantor Representative(s)' field, select the guarantor representatives.
- In the 'Filter By Episode(s)' field, select the client episodes.
- In the 'Filter By Collection Note Type(s)' field, select the collection note types.
- The 'Previous Follow Up Notes' field displays an overview of the client’s follow up notes.
- Click [Print Current Follow Up Notes].
- Verify it generates a report that details the client's current follow up notes.
- Click [Follow Up Notes Report].
- Verify it generates follow up notes report that details all notes for the client.
- Close the report.
- Close the form.
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Topics
• Follow Up
• NX
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Prevent use of certain special characters in the 'Financial Eligibility' form.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Financial Eligibility
- Financial Eligibility Web Service
Scenario 1: Validating address fields in Financial Eligibility form to prevent entries with certain special characters.
Steps
- Open the 'Financial Eligibility' form to add a new guarantor to a test client.
- Complete required fields.
- Enter a value containing a special character (List of special characters not permitted: `!$%*^~@) in any of the following fields:
- Guarantor's Address - Line 1
- Guarantor's Address - Line 2
- Guarantor's Address - City
- Subscriber Address - Street Line 1
- Subscriber Address - Street Line 2
- Subscriber Address - City
- Subscriber Employer 's Add - Street
- Subscriber Employer 's Add - City
- As the user tabs or clicks away from the field, the following message will display: "<Field Name> should not contain any of the following symbols: 'backtick', exclamation, dollar sign, percent, asterisk, caret, tilde, at sign."
- Click [OK] on the message.
- The invalid special characters will be removed from the field.
- Type the correct information into the field. No further messages regarding special characters will display.
- Click [Submit].
Scenario 2: Financial Eligibility Web Service - validate special characters are not permitted in select fields.
Specific Setup:
- User must have knowledge of web service set and use in SoapUI or other web service tool.
Steps
- Consume the web service for 'Financial Eligibility': WEBSVC.FinancialEligibility.cls
- Open the 'AddFinancialElig' request.
- Populate required fields:
- SystemCode
- UserName
- Password
- Set the following fields to have at least one special character from the list: ` ! $ % * ^ ~ @. Example: 1 Maple Lane@Green Street
- Guarantor's Address - Line 1
- Guarantor's Address - Line 2
- Guarantor's Address - City
- Subscriber Address - Street Line 1
- Subscriber Address - Street Line 2
- Subscriber Address - City
- Subscriber Employer 's Add - Street
- Subscriber Employer 's Add - City
- Complete other required fields.
- Click [Send].
- Verify the Response contains the following for each line item from above:
<Message>Web service request failed with error : Guarantor: 1 - GuarantorsAddress1 contains an invalid character. Guarantor: 1 - GuarantorsAddress2 contains an invalid character. Guarantor: 1 - GuarantorsAddressCity contains an invalid character. Guarantor: 1 - SubscriberAddress1 contains an invalid character. Guarantor: 1 - SubscriberAddress2 contains an invalid character. Guarantor: 1 - SubscriberCity contains an invalid character. - Correct the issues by removing the invalid special characters from each field.
- Click [Send].
- Verify the Response message is now "<Confirmation>Unique ID: 1075~1</Confirmation> <Message>Financial Eligibility web service has been filed successfully.</Message>"
- Open the 'Financial Eligibility' form for the same client.
- Verify the data sent in the Web Service is correct.
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Topics
• Financial Eligibility
• NX
• Web Services
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Site Specific Section Modeling - Demographic fields
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Site Specific Section Modeling (PM)
- Admission (Outpatient)
- Discharge
- Call Intake
Scenario 1: Site Specific Section Modeling - Validation of Site Specific Demographic fields
Steps
- Open the 'Site Specific Section Modeling' form.
- Select "PATIENT510 (Admission) Demographics" in the drop-down.
- Click [OK].
- Select the 'Prompt Definition' section.
- Select desired site specific prompt to add to the 'Demographic' section of the form. Note the name of the fields.
- Select 'No' in the 'Exclude from Data Collection Instrument' field.
- Submit the form.
- Open the 'Admission' or 'Admission(Outpatient)' form.
- Select the 'Demographics' section of the form.
- The correct site specific fields are added which are set to 'No' in the 'Exclude from Data Collection Instrument' field of the 'Site Specific Section Modeling' form from the above step.
- Open the 'Discharge' form.
- Go to the 'Demographics' section of the 'Discharge' form.
- The correct site specific fields are added which are set to 'No' in the 'Exclude from Data Collection Instrument' field of the 'Site Specific Section Modeling' form from the above step.
- Open the 'Call Intake' form.
- The correct site specific fields are added which are set to 'No' in the 'Exclude from Data Collection Instrument' field of the 'Site Specific Section Modeling' form from the above step.
- Open the 'Site Specific Section Modeling' form.
- Select "PATIENT510 (Admission) Demographics" in the drop-down.
- Click [OK].
- Select the 'Prompt Definition' section.
- Select desired site specific prompt to remove from the 'Demographic' section of the form. Note the name of the fields.
- Select 'Yes' in the 'Exclude from Data Collection Instrument' field.
- Submit the form.
- Open the 'Admission' or 'Admission(Outpatient)' form.
- Select the 'Demographics' section of the form.
- The correct site specific fields are removed which are set to 'Yes' in the 'Exclude from Data Collection Instrument' field of the 'Site Specific Section Modeling' form from the above step.
- Close the form.
- Open the 'Discharge' form.
- Go to the 'Demographics' section of the 'Discharge' form.
- The correct site specific fields are removed which are set to 'Yes' in the 'Exclude from Data Collection Instrument' field of the 'Site Specific Section Modeling' form from the above step.
- Close the form.
- Open the 'Call Intake' form.
- The correct site specific fields are removed which are set to 'Yes' in the 'Exclude from Data Collection Instrument' field of the 'Site Specific Section Modeling' form from the above step.
- Close the form.
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Topics
• NX
• Site Specific Section Modeling
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myHealthPointe Payments
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- User Definition
- Registry Settings (CFMS)
- Credit Card Configuration
- Posting/Adjustment Codes Definition
- Deposit Entry
- System Task Scheduler
- CareFabric Monitor
- Front Desk
- Dictionary Update (PM)
- Payment Acknowledgement
Scenario 1: Credit Card Configuration
Specific Setup:
- Please contact your Netsmart representative for assistance to enable credit card functionality.
- The following registry setting has a value of 'Y': Avatar PM--->Billing->Remittance Processing->->->Enable Credit Card Processing.
- General Information regarding credit card payments: At the current time, payments can be accepted from 'Deposit Entry', 'Front Desk - Check in' section only, and 'Scheduling Calendar - Check in' section only.
- In the 'Credit Care Device Setup' section:
- Note: Only one device can have a value of 'Yes' in 'Is this a Back Office MID?' and a value of 'Yes' in 'Active Device'.
- Note: Each device must have a unique 'Device Name'.
- Note: No grid rows may be deleted. Use the 'Active Device' field to set the value to 'Yes' or 'No'. Devices with either value will continue to display in the grid.
- Note: The grid displays inactive devices first, followed by active devices sorted by 'Device Name'.
- Note: The grid may be sorted by double clicking any column header in the grid.
- Note: The value of any submitted field, except device name, may be changed by clicking on the row in the grid and changing the value in the data entry fields.
- No changes can be made to a submitted device name. If needed, make the device inactive and create a new device.
- Note: The following special characters may not be used in the 'Device Name', 'Merchant ID (MID)', or 'Device Serial Number' fields:
- & - ampersand
- < - less than
- > - greater than
- ' - single quote
- " - double quote
Steps
- Open 'Credit Card Configuration’.
- Enter the desired value in 'Populate Receipt Number with Credit Card Payment Reference Number'.
- Enter the desired value in 'Default User ID for myHealthPointe Credit Card and ACH Payments'.
- Enter the desired value in 'Default Posting Code for myHealthPointe Credit Card Payments'.
- Enter the desired value in 'Default Posting Code for myHealthPointe ACH Payments'.
- Select the desired value in 'Payments Received From myHealthPointe'.
- Set the section to 'Credit Card Device Setup'.
- Click [New Row].
- Enter the desired value in 'Device Name'.
- Enter the desired value in 'Device Description'.
- Enter the desired value in 'Merchant ID (MID)'.
- Select 'Yes' in 'Is this a Back Office MID?'.
- If desired, enter the desired value in 'Device Serial Number'.
- If desired, select the desired value in 'Site'.
- Select 'Yes' in 'Active Device'.
- Click [New Row].
- Enter the desired value in 'Device Name'.
- Enter the desired value in 'Device Description'.
- Enter the desired value in 'Merchant ID (MID)'.
- Select 'No' in 'Is this a Back Office MID?'.
- Enter the desired value in 'Device Serial Number'.
- Select the desired value in 'Site'.
- Select 'Yes' in 'Active Device'.
- Click [Submit].
- Repeat steps 16 - 23 for each additional device.
- If desired, select the row for the device with 'Yes' in 'Is this a Back Office MID?' and select 'No' in 'Active Device'.
- Click [New Row].
- Enter the desired value in 'Device Name'.
- Enter the desired value in 'Device Description'.
- Enter the desired value in 'Merchant ID (MID)'.
- Select 'Yes' in 'Is this a Back Office MID?'.
- Do not enter a value in 'Device Serial Number'.
- Do not enter a value in 'Site'.
- Select 'Yes' in 'Active Device'.
- Click [Submit].
Scenario 2: CareFabric - Send 'Self Pay Balance' to myHealthPointe
Specific Setup:
- Please review the 'Credit Card Processing' configuration guide which will be located on the Netsmart Wiki, in myAvatar, Avatar Training Guides.
- Credit Card Processing Configuration has been used to create ‘Device 1’ with a value of ‘No’ in ‘Is this a Back Office MID?’.
- Credit Card Processing Configuration has been used to create ‘Device 2’ with a value of ‘Yes’ in ‘Is this a Back Office MID?’.
- 'Service Code 1': configure a service code that will be used as the 'Pre Payment Service Code'. The 'Group Code' and 'Covered Charge Category should both be non-billable. There will be no 'Service Fee/Cross Reference Maintenance' record.
- 'Posting/Adjustment Codes Definition 1': configure a payment posting code with a value of 'Credit Card Posting Code in 'Is this a Credit Card or ACH Posting Code'.
- The following registry setting has a value of 'Y': Avatar PM--->Billing->Remittance Processing->->-> Enable Credit Card Processing Functionality.
- The following registry setting has a value of ‘Service Code 1’: Avatar PM->Scheduling->Front Desk->->->Pre Payment Service Code.
- The following registry setting has a value of 'Y': Avatar PM->Scheduling->Front Desk->->->Allow Using Front Desk With Scheduling Calendar.
- Guarantors/Payors 1: Has a 'Financial Class' of 'Self Pay'.
- Client 1:
- Note the client ID.
- Client has one episode/program.
- Is assigned Guarantors/Payors 1 in 'Financial Eligibility, with a daily deductible of $10.00.
- Use 'Client Ledger' to verify that client has a positive amount for 'Guarantors/Payors 1 in 'TOTAL BALANCE BY GUARANTOR (last page of the report). Note the amount.
- Client has an appointment on the current date that is paid, using a credit card, in the amount of $10.00, during 'Scheduling Calendar Check In'.
- Client 2:
- Note the client ID.
- Client has one episode/program.
- Is assigned Guarantors/Payors 1 in 'Financial Eligibility, with a daily deductible of $10.00.
- Use 'Client Ledger' to verify that client has a negative amount for Guarantors/Payors 1 in 'TOTAL BALANCE BY GUARANTOR (last page of the report) Note the amount.
- Client has an appointment on the current date that is paid, using a credit card, in the amount of $10.00, during 'Front Desk Check In'.
- Client 3:
- Note the client ID.
- Client has one episode/program.
- Is assigned Guarantors/Payors 1 in 'Financial Eligibility, with a daily deductible of $10.00.
- Use 'Client Ledger' to verify that client has a positive amount for Guarantors/Payors 1 in 'TOTAL BALANCE BY GUARANTOR (last page of the report). Note the amount.
- A credit card payment is processed in ‘Deposit Entry’ in the amount of $10.00.
Steps
- Open CareFabric Monitor'.
- Set 'From Date' to current date.
- Set ''Through Date' to current date.
- Select 'Client 1' in 'Client ID'.
- Click 'Click To View Record'.
- Select the 'CardConnectBalanceUpdated' event.
- Validate that the 'accountID' is equal to 'Client 1'.
- Validate that 'cardConnectPayment' is equal to 'null'.
- Validate that 'currentBalance' is equal to $10.00 less than the 'Client Ledger' amount notes for 'Client 1'.
- Click [X] on the report.
- Select 'Client 2' in 'Client ID'.
- Click 'Click To View Record'.
- Select the 'CardConnectBalanceUpdated' event.
- Validate that the 'accountID' is equal to 'Client 2'.
- Validate that 'cardConnectPayment' is equal to 'null'.
- Validate that 'currentBalance' is a negative amount that is $10.00 more than the 'Client Ledger' amount notes for 'Client 2'.
- Click [X] on the report.
- Select 'Client 3' in 'Client ID'.
- Click 'Click To View Record'.
- Select the 'CardConnectBalanceUpdated' event.
- Validate that the 'accountID' is equal to 'Client 3'.
- Validate that 'cardConnectPayment' is equal to 'null'.
- Validate that 'currentBalance' is equal to $10.00 less than the 'Client Ledger' amount notes for 'Client 1'.
- Click [X] on the report.
- Click [X] on the form.
Scenario 3: CareFabric – Receive ‘Payment Information’ from myHealthPointe - Validate 'SYSTEM.unacknowledged_payments' table.
Specific Setup:
- Registry Settings:
- Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = Y.
- Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = ‘0'.
- 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:
- 'Payment' definitions exist. The 'Payment' definition may be a 'Credit' (payment) or a 'Debit' (reversal). The definitions may have a value in the ‘Payment Acknowledgement Type’ field. Only 'Payment' definitions will be available in the 'Payment Acknowledgement' section of the 'Payment Acknowledgement' form.
- 'Adjustment' definitions exist. The definitions may have a value in the ‘Payment Acknowledgement Type’ field. All ‘Adjustment’ and 'Payment' definitions will be available in the ‘Payment Acknowledgement’ form in the ‘Post Payment Accounting Entry' section of the 'Payment Acknowledgement' form.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- Agency uses the myHealthPointe payment portal to accept patient electronic payments.
- Clients:
- Client 1:
- Is enrolled in myAvatar and has an outstanding Self-Pay balance.
- Payment is made in the myHealthPointe payment portal. Note all information regarding the payment.
- Client 2: Is enrolled in myAvatar and has an outstanding Self-Pay balance.
- Tester can create a query of SQL tables.
Steps
- Create a query of the 'SYSTEM.billing_pay_adj_history' table, specific to 'Client 1' using the 'PATID'.
- Validate the data for the following fields and any other desired fields: 'GUARANTOR_ID', 'date_of_payment', 'payment_amount', and 'option_id' which will contain 'PatientPortal' indicating that the payment was made in the myHealthPointe payment portal.
- Open 'CareFabric Monitor'.
- Validate the PatientPortalPaymentProcessed dialog contains "1. Payment Amount 2. Payment method: ACH or CC 3. Account ID 4. Transactional ID".
- Open 'Client Ledger' and process the report.
- Validate that the payment displays in the report.
- Close the report.
- Close the form.
- Open 'Registry Settings'.
- Change the value of the 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting to include minimum values of '5&6',
- Click [Submit].
- Click [OK].
- Click [No].
- A payment is made in the myHealthPointe payment portal. Note all information regarding the payment.
- Create a query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 2, using the 'PATID'.
- Validate that payment data is correct. Save the query.
- Open 'Client Ledger' and process the report.
- Validate that the payment does not display in the report.
- Close the report.
- Close the form.
- Open the 'Payment Acknowledgement' form.
- Select the 'Post Front Office and myHP Payments' section.
- Click 'T' in 'Payment Collection Date'.
- Select desired value in 'Treatment Service'.
- Select 'myHP' in 'Type'.
- Click [Review].
- Select the row specific to 'Client 2'.
- Click [OK].
- Enter desired 'Batch Number'.
- Enter desired 'Deposit Date'.
- Select desired 'Category'.
- Enter desired 'Bank Ref#'.
- Enter desired 'Comments'.
- Click [Post].
- Refresh the query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 2.
- Validate that the table no longer contains data for 'Client 2'.
- Create a query of the 'SYSTEM.billing_pay_adj_history' table, specific to 'Client 2' using the 'PATID'.
- Validate the data for the following fields and any other desired fields: 'GUARANTOR_ID', 'date_of_payment', 'payment_amount', and 'option_id' which will contain 'PatientPortal' indicating that the payment was made in the myHealthPointe payment portal.
- Open 'CareFabric Monitor'.
- Validate the PatientPortalPaymentProcessed dialog contains "1. Payment Amount 2. Payment method: ACH or CC 3. Account ID 4. Transactional ID".
- Open 'Client Ledger' and process the report.
- Validate that the payment displays in the report.
- Close the report.
- Close the form.
Scenario 4: CareFabric – Receive ‘Payment Information’ from myHealthPointe
Specific Setup:
- Agency uses the myHealthPointe payment portal to accept patient electronic payments.
- Client is enrolled in myAvatar and has an outstanding Self-Pay balance.
- Payment is made in the myHealthPointe payment portal. Note all information regarding the payment.
- Tester can create a query of SQL tables
Steps
- Create a query of the 'SYSTEM.billing_pay_adj_history' table, specific to the client using the 'PATID'.
- Validate the data for the following fields and any other desired fields: 'GUARANTOR_ID', 'date_of_payment', 'payment_amount', and 'option_id' which will contain 'PatientPortal' indicating that the payment was made in the myHealthPointe payment portal.
- Open 'CareFabric Monitor'.
- Validate the PatientPortalPaymentProcessed dialog contains "1. Payment Amount 2. Payment method: ACH or CC 3. Account ID 4. Transactional ID"
Scenario 5: CareFabric – Receive ‘Payment Information’ from myHealthPointe - Validate 'SYSTEM.unacknowledged_payments' table.
Specific Setup:
- Registry Settings:
- Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = Y.
- Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = ‘0'.
- 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:
- 'Payment' definitions exist. The 'Payment' definition may be a 'Credit' (payment) or a 'Debit' (reversal). The definitions may have a value in the ‘Payment Acknowledgement Type’ field. Only 'Payment' definitions will be available in the 'Payment Acknowledgement' section of the 'Payment Acknowledgement' form.
- 'Adjustment' definitions exist. The definitions may have a value in the ‘Payment Acknowledgement Type’ field. All ‘Adjustment’ and 'Payment' definitions will be available in the ‘Payment Acknowledgement’ form in the ‘Post Payment Accounting Entry' section of the 'Payment Acknowledgement' form.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- Agency uses the myHealthPointe payment portal to accept patient electronic payments.
- Clients:
- Client 1:
- Is enrolled in myAvatar and has an outstanding Self-Pay balance.
- Payment is made in the myHealthPointe payment portal. Note all information regarding the payment.
- Client 2: Is enrolled in myAvatar and has an outstanding Self-Pay balance.
- Tester can create a query of SQL tables.
Steps
- Create a query of the 'SYSTEM.billing_pay_adj_history' table, specific to 'Client 1' using the 'PATID'.
- Validate the data for the following fields and any other desired fields: 'GUARANTOR_ID', 'date_of_payment', 'payment_amount', and 'option_id' which will contain 'PatientPortal' indicating that the payment was made in the myHealthPointe payment portal.
- Open 'CareFabric Monitor'.
- Validate the PatientPortalPaymentProcessed dialog contains "1. Payment Amount 2. Payment method: ACH or CC 3. Account ID 4. Transactional ID".
- Open 'Client Ledger' and process the report.
- Validate that the payment displays in the report.
- Close the report.
- Close the form.
- Open 'Registry Settings'.
- Change the value of the 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting to include minimum values of '5&6',
- Click [Submit].
- Click [OK].
- Click [No].
- A payment is made in the myHealthPointe payment portal. Note all information regarding the payment.
- Create a query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 2, using the 'PATID'.
- Validate that payment data is correct. Save the query.
- Open 'Client Ledger' and process the report.
- Validate that the payment does not display in the report.
- Close the report.
- Close the form.
- Open the 'Payment Acknowledgement' form.
- Select the 'Post Front Office and myHP Payments' section.
- Click 'T' in 'Payment Collection Date'.
- Select desired value in 'Treatment Service'.
- Select 'myHP' in 'Type'.
- Click [Review].
- Select the row specific to 'Client 2'.
- Click [OK].
- Enter desired 'Batch Number'.
- Enter desired 'Deposit Date'.
- Select desired 'Category'.
- Enter desired 'Bank Ref#'.
- Enter desired 'Comments'.
- Click [Post].
- Refresh the query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 2.
- Validate that the table no longer contains data for 'Client 2'.
- Create a query of the 'SYSTEM.billing_pay_adj_history' table, specific to 'Client 2' using the 'PATID'.
- Validate the data for the following fields and any other desired fields: 'GUARANTOR_ID', 'date_of_payment', 'payment_amount', and 'option_id' which will contain 'PatientPortal' indicating that the payment was made in the myHealthPointe payment portal.
- Open 'CareFabric Monitor'.
- Validate the PatientPortalPaymentProcessed dialog contains "1. Payment Amount 2. Payment method: ACH or CC 3. Account ID 4. Transactional ID".
- Open 'Client Ledger' and process the report.
- Validate that the payment displays in the report.
- Close the report.
- Close the form.
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Topics
• CareFabric
• CareFabric Monitor
• Credit Card Processing
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Key Performance Indicators widget
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Key Performance Indicators (Home View)
- User Definition
- View Definition
Scenario 1: The 'Key Performance Indicators' widget - Validating widget when the WIDGET.collection_values' contains data
Specific Setup:
- Ensure the MW build 2086 is installed.
- The 'Key Performance Indicators' widget is added to the Home View using the 'View Definition' form.
- The WIDGET.collection_values table contains data where Collection_Type ='TotalLiability' and Collection_Freq ='M'.
- The WIDGET.collection_values table contains data where Collection_Type ='TotalPaymentsByServiceDate' and Collection_Freq ='M'.
Steps
- Login to Avatar system.
- Locate to the 'Key Performance Indicators' widget.
- Verify the widget displays data under 'Measure' column successfully.
- Verify the last row of the 'Value' column displays desired number because the table contains data.
Scenario 2: The 'Key Performance Indicators' widget - Validating widget when there is no data in the WIDGET.collection_values'
Specific Setup:
- The 'Key Performance Indicators' widget is added to the Home View using the 'View Definition' form.
- There must be no data in WIDGET.collection_values where Collection_Type ='TotalLiability' and Collection_Freq ='M'.
- There must also be no data in WIDGET.collection_values where Collection_Type ='TotalPaymentsByServiceDate' and Collection_Freq ='M'.
Steps
- Login to Avatar system.
- Locate to the 'Key Performance Indicators' widget.
- Verify the widget displays data under 'Measure' column successfully.
- Verify the last row of the 'Value' column displays as unknown% because there is no data in the table.
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Topics
• Widgets
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SYSTEM.billing_guar_table_270 - fields added
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Form and Table Documentation (PM)
- Guarantors/Payors
- Registry Settings (PM)
Scenario 1: SYSTEM.billing_guar_table_270 - Validating 'Create Single File Per Interchange Control Header (ISA)' in the 'Guarantors/Payors' form - Editing an existing guarantor
Specific Setup:
- Registry Setting:
- The 'Enable 270/271 Transaction Sets' registry setting is set to 'Y'.
- The 'Create Single File Per Interchange Control Header (ISA)' registry setting is set to 'Y'.
- Guarantors/Payors:
- An existing guarantor is identified. Note the Guarantor code/ value.
Steps
- Open the 'Guarantors/Payors' form.
- Select a guarantor to edit. Note the guarantor code.
- Navigate to the 270/271/834 tab.
- Select 'Yes' for the 'Create Single File Per Interchange Control Header (ISA)' field. Note the value.
- File the form.
- Open the 'Crystal Report' or any other SQL Data Viewer tool.
- Query the 'billing_guar_table_270' table for the guarantor identified above.
- Verify the 'single_file_isa_code' and 'single_file_isa_value' fields exist.
- Verify the 'single_file_isa_code' contains 'Y' and the 'single_file_isa_value' field contains 'Yes' when 'Yes' is selected in the 'Create Single File Per Interchange Control Header (ISA)' field.
- Open the 'Guarantors/Payors' form.
- Select a guarantor to edit. Note the guarantor code.
- Navigate to the 270/271/834 tab.
- Select 'No' for the 'Create Single File Per Interchange Control Header (ISA)' field. Note the value.
- File the form.
- Open the 'Crystal Report' or any other SQL Data Viewer tool.
- Query the 'billing_guar_table_270' table for the guarantor identified above.
- Verify the 'single_file_isa_code' contains 'N' and the 'single_file_isa_value' field contains 'No' when 'No' is selected in the 'Create Single File Per Interchange Control Header (ISA)' field.
Scenario 2: SYSTEM.billing_guar_table_270 - Validating 'Create Single File Per Interchange Control Header (ISA)' in the 'Guarantors/Payors' form - Adding a new guarantor
Specific Setup:
- Registry Setting:
- The 'Enable 270/271 Transaction Sets' registry setting is set to 'Y'.
- The 'Create Single File Per Interchange Control Header (ISA)' registry setting is set to 'Y'.
Steps
- Open the 'Guarantors/Payors' form.
- Select 'Add' in the 'Add New or Edit Existing Guarantor' field to add a guarantor.
- Enter a numeric value as the guarantor code in the 'New Guarantor Code' field. Note the guarantor code/value to be used for further testing.
- Enter desired value in the 'Guarantor Name' field.
- Enter desired value in the 'Guarantor Name For Alpha Lookup' field.
- Enter desired value in the 'Guarantor's Address - Zip Code' field.
- Select desired class from the 'Financial Class' field.
- Select desired value from the 'Guarantor Nature' field.
- Navigate to the 270/271/834 tab.
- Select 'Yes' in the 'Support 270/271 Transaction Sets' field.
- Select 'No' to 'Skip Liability Update Process If No Valid Response (271) Received For An Inquiry (270)' field.
- Set the 'Real Time 270/271 Access Point' to desired value.
- Select 'Yes' in the 'Create Single File Per Interchange Control Header (ISA)' field.
- File the form.
- Open the 'Crystal Report' or any other SQL Data Viewer tool.
- Query the 'billing_guar_table_270' table for the guarantor identified above.
- Verify the 'single_file_isa_code' and 'single_file_isa_value' fields exist.
- Verify the 'single_file_isa_code' contains 'Y' and the 'single_file_isa_value' field contains 'Yes' because 'Yes' is selected in the 'Create Single File Per Interchange Control Header (ISA)' field.
- Open the 'Guarantors/Payors' form.
- Select the same guarantor to edit. Note the guarantor code.
- Navigate to the 270/271/834 tab.
- Select 'No' in the 'Create Single File Per Interchange Control Header (ISA)' field.
- File the form.
- Open the 'Crystal Report' or any other SQL Data Viewer tool.
- Query the 'billing_guar_table_270' table for the guarantor identified above.
- Open the 'Crystal Report' or any other SQL Data Viewer tool.
- Query the 'billing_guar_table_270' table for the guarantor identified above.
- Verify the 'single_file_isa_code' contains 'N' and the 'single_file_isa_value' field contains 'No' because 'No' is selected in the 'Create Single File Per Interchange Control Header (ISA)' field.
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Topics
• Database Tables
• NX
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Topics
• NX
• Referral
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Crystal Self Pay Bill - Support 'System Financial Class' extended dictionary
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Service Codes
- Guarantors/Payors
- Registry Settings (PM)
- Admission (Outpatient)
- Financial Eligibility
- Client Charge Input
- Crystal Self Pay Bill
- Crystal Report Viewer
- Inhibited Services For Billing Report
- Dictionary Update (PM)
- Diagnosis
- Progressive Self Pay Dunning Messages
- Update Client Data
- Form and Table Documentation (PM)
- Individual Cash Posting (PM)
Scenario 1: Crystal Self Pay Bill - Billing a Self Pay guarantor - Validating 'Allow For Number of Days Since Last Claim' registry setting
Specific Setup:
- Registry Settings:
- Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
- Guarantors/Payors:
- A 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: The self pay guarantor is assigned to the client. Note the guarantor code.
- Diagnosis: The diagnosis record is created for the client.
- Client Charge Input:
- A 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:
- The charges distributed to the guarantor are closed.
Steps
- Open the 'Crystal Self Pay Bill' form.
- Enter a value for 'Print Charges Thru' field that will include the service rendered to the client. Note the date.
- Select 'Yes' in the 'Create Claims Y/N' field.
- Enter desired 'Date Of Claim'. 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 interim batch.
- Select 'All Clients' in the 'Print For An Individual Or All Clients'.
- Click [Compile Self Pay Bill].
- Verify the 'Compile Complete' message displays.
- Navigate to the 'Print Crystal Self Pay Bill' section of the form.
- Select desired value for 'Select By Client Or File' field.
- Select compiled bill file or client record for bill data display.
- Click [Print Self Pay Bill].
- Validate that the Self Pay Bill report displays.
- In the Self Pay Bill report 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 a value for 'Print Charges Thru' field that 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 interim 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 a value for 'Print Charges Thru' field that 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 interim 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 - Billing a guarantor that has the system financial class dictionary set to Self Pay - Validating 'Allow For Number of Days Since Last Claim' registry setting
Specific Setup:
- Registry Settings:
- Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
- Guarantors/Payors:
- An existing guarantor is identified to be assigned to the client as a primary guarantor and the financial class is not a self pay but is a different financial class. Note the guarantor code / value / financial class.
- Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
- Dictionary Update:
- File - Payor
- Data Element - (1000) Financial Class
- Dictionary Code - The dictionary code for the financial class of the guarantor identified above.
- Extended Dictionary Data Element - (1500) System Financial Class
- Extended Dictionary Value - Self Pay
- Admission:
- A new client is admitted, or an existing client is identified. Note the client id, admission date and admission program.
- Financial Eligibility: The 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 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 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 interim batch.
- Select desired guarantor that is identified and setup to have system financial class of Self-Pay.
- 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].
- Validate that the Self Pay Bill report displays.
- 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 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 interim 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 values for 'Print Charges Thru' field that 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].
- Validate that the Self Pay Bill report displays.
- Verify the report displays the recently claimed service in the report.
- Close the report.
- Close the form.
Scenario 3: Progressive Self Pay Dunning Messages - Validating SQL Table and Crystal Self Pay Bill for a guarantor with a system financial class of Self-Pay
Specific Setup:
- Registry Settings:
- 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/Payors:
- A self pay guarantor is identified to assign to the client's first episode. Note the guarantor code/value.
- Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
- Another existing guarantor is identified to be assigned to the client as a primary guarantor of the second episode and the financial class is not a self pay but is a different financial class. Note the guarantor code / value / financial class.
- Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
- Dictionary Update:
- File - Payor
- Data Element - (1000) Financial Class
- Dictionary Code - The dictionary code for the financial class of the guarantor identified above to be assigned to the client's second episode.
- Extended Dictionary Data Element - (1500) System Financial Class
- Extended Dictionary Value - Self Pay
- Admission:
- A new client is admitted in two admission episodes. Note the client id, admission date and admission program.
- Financial Eligibility:
- A self pay guarantor is assigned to the client as a primary guarantor of episode 1. Note the guarantor code.
- The other guarantor identified is assigned to the client as a primary guarantor of episode 2. Note the guarantor code.
- Diagnosis: The diagnosis record is created for the client for both episodes.
- Client Charge Input:
- 3-4 services are rendered to the client for each episode. Note the service date and service code.
- Client Ledger:
- The services distributed to the self pay guarantor for episode 1.
- The services from the second episode are distributed to the assigned 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 desired messages for all the message fields.
- Print the information for 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 length of the statement messages fields increased to 350 characters.
- Verify the data files successfully and correctly as entered through the form.
- 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 desired guarantor that is set up to have system financial class of self pay.
- 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 4: Crystal Self Pay Bill - - Validating services that distributed to a guarantor with the system financial class of Self-Pay - Previous claim date within the 'Number Of Days Since Last Claim'
Specific Setup:
- Registry Settings:
- Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
- Guarantors/Payors:
- The self pay guarantor is identified to be assigned to the client as a primary guarantor. Note the guarantor code/value.
- Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
- Another existing guarantor is identified to be assigned to the client as a secondary guarantor and the financial class is not a self pay but is a different financial class. Note the guarantor code / value / financial class.
- Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
- Dictionary Update:
- File - Payor
- Data Element - (1000) Financial Class
- Dictionary Code - The dictionary code for the financial class of the guarantor identified above to be used as secondary guarantor.
- Extended Dictionary Data Element - (1500) System Financial Class
- Extended Dictionary Value - Self Pay
- Admission:
- A new client is admitted, or an existing client is identified. Note the client id, admission date and admission program.
- Financial Eligibility: The guarantors identified above are assigned to the client as primary and secondary guarantors.
- 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 secondary guarantor.
- Close Charges:
- The service rendered to the client are closed.
Steps
- Open the 'Crystal Self Pay Bill' form.
- Enter 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'. 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 interim batch.
- Select the secondary guarantor.
- 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].
- Validate that the Self Pay Bill report displays.
- In the Self Pay Bill report, 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.
Scenario 5: Crystal Self Pay Bill - Billing a guarantor with the system financial class set to Self Pay - New billing cycle upon updating client's address using the 'Update Client Data' form
Specific Setup:
- Registry Settings:
- Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
- Guarantors/Payors:
- The self pay guarantor is identified to be assigned to the client as a primary guarantor. Note the guarantor code/value.
- Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
- Another existing guarantor is identified to be assigned to the client as a secondary guarantor and the financial class is not a self pay but is a different financial class. Note the guarantor code / value / financial class.
- Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
- Dictionary Update:
- File - Payor
- Data Element - (1000) Financial Class
- Dictionary Code - The dictionary code for the financial class of the guarantor identified above to be used as secondary guarantor.
- Extended Dictionary Data Element - (1500) System Financial Class
- Extended Dictionary Value - Self Pay
- Admission:
- A new client is admitted, or an existing client is identified. Note the client id, admission date and admission program.
- Financial Eligibility: The guarantors identified above are assigned to the client as primary and secondary guarantors.
- 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 secondary guarantor.
- Close Charges:
- The service rendered to the client are closed.
Steps
- Open the 'Crystal Self Pay Bill' form.
- Enter 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 interim 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].
- Validate that the Self Pay Bill report displays.
- 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 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 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 interim 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 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'.. 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 interim 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.
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Topics
• Crystal Self Pay Bill
• Database Tables
• Inhibit Billing
• NX
• Registry Settings
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Service Entry - After Treatment Plan Intervention Assigned Services
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Treatment Plan
- Registry Settings (PM)
- Program Maintenance
- Site Specific Section Modeling (CWS)
- Client Charge Input
Scenario 1: Treatment Plan (Interventions) - "Assigned Services" grid functionality
Specific Setup:
- Client must be admitted to an active episode. (Client A).
- Registry setting 'Avatar CWS->Treatment Plan->->->->Enable Service Entry Restriction by Client Treatment Plan' must be enabled.
Steps
- Select "Client A" and access the 'Treatment Plan' form.
- Click [Add].
- Set the 'Plan Date' field to the current date.
- Select any value in the 'Plan Type' field.
- Select any value from 'Problem List'.
- Enter any value in the 'Strengths' field.
- Enter any value in the 'Weakness' field.
- Enter any value in the 'Discharge Planning' field.
- Select "Draft" in the 'Draft/Final' field.
- Click [Launch Plan].
- Select the problem from the 'Tree View'.
- Select any value from the 'Status' field.
- Click [Add New Goal].
- Enter any value in the 'Goal' field.
- Select any value from the 'Status' field.
- Click [Add New Objective].
- Enter any value in the 'Objective' field.
- Select any value from the 'Status' field.
- Click [Add New Intervention].
- Enter any value in the 'Intervention' text field.
- Select any value from the 'Status' field.
- Click [Add Service] in the 'Assigned Services' field.
- Populate the 'Service Program' field.
- Enter a search value in the 'Service Code' field to bring up the listing of service code values.
- Select any service code.
- Validate the service code field is populated as expected in the 'Service Code' field.
- Select any value in the 'Frequency' field.
- Select any value in the 'Duration' field.
- Click [Return To Plan].
- Click [Submit].
- Validate the plan submits successfully.
- Select "Client A" and access the 'Treatment Plan' form.
- Click to edit the row just submitted.
- Click [Launch Plan].
- Click the 'Interventions' item on the plan tree
- Click [Add New Intervention].
- Enter any value in the 'Intervention' text field.
- Select any value from the 'Status' field.
- In the 'Assigned Services' grid, click [Copy Service].
- In the 'Add Services From Other Intervention's' dialog, choose the service added in the intervention previous submitted.
- Click [Copy].
- Validate the 'Assigned Services' grid columns are populated with the service information, as expected.
- Select the 'Assigned Services' row just added.
- Click the [Delete Service] button.
- Validate the service row is removed from the 'Assigned Services' grid, as expected.
- Click [Return to Plan].
- Click [Submit].
- Validate the plan submits successfully.
Scenario 2: Client Charge Input After Treatment Plan - Enable Service Entry Restrictions by Client Treatment Plan is enabled
Specific Setup:
- Enable "Enable Service Entry Restriction by Client Treatment Plan" by setting it to "E".
- After enabling the registry setting, log off Avatar and sign back in again.
- Admit a test client into any program.
- Using "Program Maintenance", edit the program the test client was admitted to, and set the "Enable Service Entry Restriction for Program" to "Yes".
- Using "Program Maintenance", edit another program the test client is not admitted to and set the "Enable Service Entry Restriction for Program" to "Yes".
- Using "Site Specific Section Modeling", add the "Assigned Services" to the Treatment Plan Interventions section.
Steps
- Open the "Treatment Plan" form.
- Begin a new treatment plan for the test client.
- Set it to Draft status.
- Add a problem, goal, objection, and intervention.
- In the intervention section, Click the "Add Services" button.
- Select the program the test client is enrolled in the "Service Program" field.
- Select a service code, frequency, duration, service mode, place of service, amount, agency, and staff responsible.
- Click "Add Services" button to add another row to the table.
- Select the program from setup that the client isn't enrolled in.
- Select a different service code than the first row.
- Fill out the rest of the fields.
- Click the "Return To Plan" button.
- Mark the plan as Final.
- Click "Submit" button.
- Sign or Sign and Route the document.
- If routed, sign on as the user document was routed to and from the "ToDos" widget, Accept the document.
- Open the "Client Charge Input" form.
- Select the test client.
- Set the "Service Code" field to the service code that was assigned to the program the test client is not enrolled in on the "Treatment Plan" form.
- Validate the drop down list doesn't contain the service code since it's not assigned to the program the client is enrolled in.
- Set the "Service Code" field to the service code that was assigned to the program the test client is enrolled in on the "Treatment Plan" form.
- Validate the service code listed in the drop down list is the one that is affiliated to the program the client is enrolled in.
- Complete the form by filling out all other required fields.
Advanced Billing Rules - Site Specific Section Modeling integer fields
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Site Specific Section Modeling (PM)
- Financial Eligibility
- Client Charge Input
- Advanced Billing Rule Definition
- Posting/Adjustment Codes Definition
- Individual Cash Posting (PM)
Scenario 1: Advanced Billing Rule - based on Site Specific Section Modeling Integer value > 16
Specific Setup:
- Add a Site Specific Section Modeling Treatment Integer field to the "Client Charge Input" form.
- Admit a test client.
- Add financial eligibility information to the client for two guarantors.
- Using the "Advanced Billing Rule Definition" form, set up an advanced billing rule for a specific service code and a specific guarantor. It should be set up for all genders, not associated with age and select "Compliance" in the "Rule Defines Conditions" field. Then select the "Event Rules" section and select "Site Specific Treatment History" from the Event Table drop down, select the site specific field that was added to "Client Charge Input" via Site Specific Section Modeling in setup, and set the Specific Value (Other) to a threshold level Such as ">= 16",
- Using the "Posting/Adjustment Codes Definition" form, set the "Adjustment, Payment or Transfer" field to "Transfer" and set the "Transfer Type" to "Redistribute - Open".
Steps
- Using the "Client Charge Input" form, add a service for the client from the advanced billing rule setup, be sure to populate the Site Specific Section Modeling Integer field added in setup with a value that is equal to or greater than the threshold established in setup.
- Using "Client Ledger", validate the service went to the guarantor #1 for the test client.
- Using "Individual Cash Posting", apply a payment and transfer the balance to the other guarantor that was set up for the test client using the transfer code from setup.
- Using "Close Charges", update the liability for the client.
- Using "Client Ledger", validate the balance of the service was transferred to the other guarantor.
Scenario 2: Advanced Billing Rule - based on Site Specific Section Modeling Integer value < 16
Specific Setup:
- Add a Site Specific Section Modeling Treatment Integer field to the "Client Charge Input" form.
- Admit a test client.
- Add financial eligibility information to the client for two guarantors.
- Using the "Advanced Billing Rule Definition" form, set up an advanced billing rule for a specific service code and a specific guarantor. It should be set up for all genders, not associated with age and select "Compliance" in the "Rule Defines Conditions" field. Then select the "Event Rules" section and select "Site Specific Treatment History" from the Event Table drop down, select the site specific field that was added to "Client Charge Input" via Site Specific Section Modeling in setup, and set the Specific Value (Other) to a threshold level. Such as "< 16",
- Using the "Posting/Adjustment Codes Definition" form, set up a transfer code and set the "Adjustment, Payment or Transfer" field to "Transfer" and set the "Transfer Type" to "Redistribute - Open".
Steps
- Using the "Client Charge Input" form, add a service from the advanced billing rule from setup for the client, be sure to populate the Site Specific Section Modeling Integer field added in setup with a value that is less than the threshold.
- Using "Client Ledger", validate the service went to the guarantor #1 for the test client.
- Using "Individual Cash Posting", apply a payment and transfer the balance to the other guarantor that was set up for the test client using the transfer code from setup.
- Using "Close Charges", update the liability for the client.
- Using "Client Ledger", validate the balance of the service was transferred to the default guarantor (9999) because it was under the threshold for the Advanced Billing Rule from setup.
Compile and Post Partial Hospitalization/Day Treatment
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Diagnosis
- Financial Eligibility
- Compile Partial Hospitalization/Day Worklist
- Post Partial Hospitalization/Day Worklist
- Attending Practitioner
Scenario 1: Compile Partial Hospitalization/Day Worklist - Validate change in practitioner
Specific Setup:
- Using "Maintain Hospital Bed File", add a test room to an existing unit.
- Admit a test client into a partial hospitalization or day treatment program.
- Using the "Diagnosis" form, assign a diagnosis to the test client.
- Using the "Financial Eligibility" form, assign a guarantor to the test client.
Steps
- Open the "Compile Partial Hospitalization/Day Worklist" form.
- Create a new worklist and validate the test client is included on the report.
- Open the "Post Hospitalization/Day Worklist" form.
- Select the program that test client is enrolled in.
- Validate the test client is included on the report generated.
- Change the attending practitioner to a different practitioner using the "Attending Practitioner" form.
- Open the "Compile Partial Hospitalization/Day Worklist" form.
- Create a new worklist for a different date range and validate the test client is included on the report.
- Open the "Post Hospitalization/Day Worklist" form.
- Select the program that test client is enrolled in.
- Validate the test client is included on the report generated.
- Open the "Client Ledger" form.
- Validate the charges generated are included on the client's ledger.
- Using the preferred method to validate SQL tables, validate the v_provider_name column of the SYSTEM.billing_tx_history table contains the name of the attending practitioner the client was switched to.
Scenario 2: Compile Partial Hospitalization/Day Worklist
Specific Setup:
- Using "Maintain Hospital Bed File", add a test room to an existing unit.
- Admit a test client into a partial hospitalization or day treatment program.
- Using the "Diagnosis" form, assign a diagnosis to the test client.
- Using the "Financial Eligibility" form, assign a guarantor to the test client.
Steps
- Open the "Compile Partial Hospitalization/Day Worklist" form.
- Create a new worklist and validate the test client is included on the report.
- Open the "Post Hospitalization/Day Worklist" form.
- Select the program that test client is enrolled in.
- Validate the test client is included on the report generated.
- Open the "Compile Partial Hospitalization/Day Worklist" form.
- Create a new worklist for a different date range and validate the test client is included on the report.
- Open the "Post Hospitalization/Day Worklist" form.
- Select the program that test client is enrolled in.
- Validate the test client is included on the report generated.
- Open the "Client Ledger" form.
- Validate the charges generated are included on the client's ledger.
Service Code Upload - Error Handling
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Service Code Upload Process
- Service Code Upload Accepted Codes
- Service Codes
- Registry Settings (PM)
- Dynamic Form Service Code Upload
- Crystal Report Viewer
Scenario 1: 'Service Code Upload Process' - Verification of Service Code Upload
Specific Setup:
- Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled
- Avatar PM Service Code Upload file containing one or more valid rows/entries including values for 'TMHP Type Of Service' field (Import File Segment/Location 134) and 'Line Item Control Number - Positions 5 to 20 (2400-REF)' (Import File Segment/Location135)
- Please refer to updated 'Avatar_PM_Service_Code_Upload_Layout.xls' document included in the zip file for this update.
Steps
- Open Avatar PM 'Service Code Upload Process' form.
- Click 'Select File' button and select Avatar PM Service Code Upload file containing one or more valid rows/entries including values for 'TMHP Type Of Service' and 'Line Item Control Number - Positions 5 to 20 (2400-REF)' fields/segments.
- Select 'Compile' in 'Compile Or Post' field.
- Select Yes or No value for 'Override Existing Service Codes' field.
- Click 'Submit' button to file form/compile Service Code Upload file.
- Ensure that dialog noting 'Compile Completed' is presented; click 'OK' button to close dialog/proceed.
- Open Avatar PM 'Service Code Upload Accepted Codes' form.
- Select compiled file in 'Select Desired Service Code Import File Name' field.
- Click 'Process' button to file form/display Service Code Upload Accepted Codes report.
- Ensure 'TMHP Type Of Service' and 'Line Item Control Number - Positions 5 to 20 (2400-REF)' fields are included in Service Code Upload Accepted Codes report display, and contains value filed for 'TMHP Type Of Service'/'Line Item Control Number - Positions 5 to 20 (2400-REF)' fields/segments for valid compiled rows/entries.
- Close Service Code Upload Accepted Codes report.
- Return to Avatar PM 'Service Code Upload Process' form.
- Select 'Post' in 'Compile Or Post' field to post compiled Service Code Upload file row(s).
- Click 'Submit' button to file form/post Service Code Upload file.
- Ensure that dialog noting 'Posting Completed' is presented; click 'OK' button to close dialog/proceed.
- Return to Avatar PM 'Service Code Upload Accepted Codes' form.
- Select posted file in 'Select Desired Service Code Import File Name' field.
- Click 'Process' button to file form/display Service Code Upload Accepted Codes report.
- Ensure 'TMHP Type Of Service' and 'Line Item Control Number - Positions 5 to 20 (2400-REF)' fields are included in Service Code Upload Accepted Codes report display, and contains value filed for 'TMHP Type Of Service'/'Line Item Control Number - Positions 5 to 20 (2400-REF)' fields/segments for valid/posted rows/entries.
- Open Avatar PM 'Service Codes' form.
- Select 'Edit Existing' action and select Service Code filed via 'Service Code Upload Process' file posting.
- Ensure that value for 'TMHP Type Of Service' field is present/selected in form as defined in Service Code Upload file row/entry.
- Ensure that value for 'Line Item Control Number - Positions 5 to 20 (2400-REF)' field is present/selected in form as defined in Service Code Upload file row/entry.
Scenario 2: Service Code Upload - Validate Discipline string with an &
Specific Setup:
- Create a test service code upload file that contains an extra "&" in the Discipline field, e.g. 10&11&. Designate this "File A".
- Create a test service code upload file that contains the following in the Discipline field. e.g. 10&11. Designate this "File B".
- Please refer to updated 'Avatar_PM_Service_Code_Upload_Layout.xls' document included in the zip file for this update.
Steps
- Open the "Service Code Upload Process" form.
- In the "Select File" drop down list, select the file designated as "File A".
- Select "Compile" in the "Compile or Post" field.
- Select "Yes" in the "Override Existing Service Codes" field.
- Click "Submit" button.
- Validate a "Filing Error" message displays indicating "No accepted data compiled. To view results review rejected report".
- Open the "Service Code Upload Rejected Codes" form.
- Select "File A" from the "Select Desired Service Code Import File Name" drop down list.
- Validate the report contains "Invalid Dictionary Code" error message.
- Exit the form.
- Open the "Service Code Upload Process" form.
- In the "Select File" drop down list, select the file designated as "File B".
- Select "Compile" in the "Compile or Post" field.
- Select "Yes" in the "Override Existing Service Codes" field.
- Click "Submit" button.
- Validate the message "Compile completed. To view results review accepted and rejected reports" displays.
- Open the "Service Code Upload Accepts Codes" form.
- Select "File B" from the "Select Desired Service Code Import File Name" drop down.
- Click "Process" button.
- Validate the report indicates the service codes that will be uploaded.
- Open the "Service Code Upload Process File" form.
- Select "File B" in the "Select File" field.
- Select "Post" in the "Compile or Post" field.
- Click "Submit".
- Validate the message displays that indicates "Posting Completed".
- Open the "Service Codes" Form.
- Click the "Service Code Report" section.
- Select a service code that was uploaded when the file was posted.
- Click "Display Service Codes" button.
- Validate the service code was uploaded.
Electronic Billing - 837 Institutional Non Covered Days
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Electronic Billing
- Financial Eligibility
- Diagnosis
- Client Charge Input
- Dictionary Update (PM)
- Leaves
- Discharge
- Create Interim Billing Batch File
Scenario 1: 837 Institutional - Non Billable Leave Days
Specific Setup:
- Using the "Dictionary Update" form under the PM namespace, edit the "Client" data element "Type of Leave From", add desired dictionary code, and a value similar to "Non-Billable Leave".
- Set the Extended Dictionary Data Element "(10031) Chargeable Leave Y/N" to "No".
- Admit a client into an inpatient program. Note the admission date.
- Using the "Financial Eligibility" form, add a guarantor for the client.
- Using the "Diagnosis" form, enter an admission diagnosis for the client.
- Using "Client Charge Input", enter in 10 days of partial hospitalization/day charges. (Example: 8/01 - 8/10).
- Using "Client Ledger", validate there are 10 days of partial hospitalization/day charges.
- Using the "Leaves" form, put the client on non billable leave on the day after the 10 hospitalization/day charges. (Example: 8/11).
- Open the "Return From Leaves" form and set the return date to 4 days after the Leave Date. (Example: 8/15).
- Using the "Discharge" form, discharge the client on the day they are returning from leave (Example: 8/15).
- Using the "Close Charges" form, close the charges for the date range (Example: 8/1 - 8/15).
- Using the "Create Interim Billing Batch File" form, create an interim billing batch for the test client.
Steps
- Open the "Electronic Billing" form.
- Process an 837 Institutional bill for the guarantor, program and test client that was put on non-billable leave and subsequently discharged on the date of return from leave.
- The date range would be from the day the client was admitted until to the day the client was discharged. (Example 8/1 - 8/15).
- Print the dump file for the 837 Institutional and validate the file contains a line similar to "HI*BE:80:::10*BE:81:::4" with 4 being the days of non billable leave.
Scenario 2: 837 Institutional - Billable Leave Days
Specific Setup:
- Using the "Dictionary Update" form under the PM namespace, edit the "Client" data element "Type of Leave From", add a dictionary code, and a value would similar to Billable Leave".
- Set the Extended Dictionary Data Element "(10031) Chargeable Leave Y/N" to "Yes".
- Admit a client into an inpatient program. Note the admission date.
- Using the "Financial Eligibility" form, add a guarantor for the client.
- Using the "Diagnosis" form, enter an admission diagnosis for the client.
- Using "Client Charge Input", enter in 10 days of partial hospitalization/day charges. (Example: 8/01 - 8/10)
- Using "Client Ledger", validate there are 10 days of partial hospitalization/day charges.
- Using the "Leaves" form, put the client on billable leave on the day after the 10 hospitalization/day charges. (Example: 8/11).
- Open the "Return From Leaves" form and set the return date to 4 days after the Leave Date. (Example: 8/15).
- Using the "Discharge" form, discharge the client on the day they are returning from leave (Example: 8/15).
- Using the "Close Charges" form, close the charges for the date range (Example: 8/1 - 815).
- Using the "Create Interim Billing Batch File" form, create an interim billing batch for the test client.
Steps
- Open the "Electronic Billing" form.
- Process an 837 Institutional bill for the guarantor, program and test client that was put on billable leave and subsequently discharged on the date of return from leave.
- The date reange will bw from the day the client was admitted until to the day the client was discharged. (Example 8/1 - 8/15).
- Print the dump file for the 837 Institutional and validate the file contains a line similar to "HI*BE:80:::10*BE:81:::0" with 0 being the days of non billable leave.
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Topics
• Client Charge Input
• NX
• Treatment Plan
• Advanced Billing Rule Definition
• Inpatient Worklist
• Registry Settings
• Service Code Upload Process
• Service Codes
• Electronic Billing
• Leaves
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Payment Acknowledgment
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Payment Acknowledgement
- User Definition
- Dictionary Update (PM)
- Posting/Adjustment Codes Definition
- Admission (Outpatient)
- Diagnosis
- Financial Eligibility
- Program Maintenance
- Deposit Entry
Scenario 1: Payment Acknowledgement - form & field validation
Specific Setup:
- Registry Setting:
- ‘Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement’ has a ‘Registry Setting Value’ of ‘Y’.
- ‘Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged’ has a ‘Registry Setting Value’ of 5’ at a minimum.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- 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:
- 'Payment' definitions exist. The 'Payment' definition may be a 'Credit' (payment) or a 'Debit' (reversal). The definitions may have a value in the ‘Payment Acknowledgement Type’ field. Only 'Payment' definitions will be available in the 'Payment Acknowledgement' section of the 'Payment Acknowledgement' form.
- 'Adjustment' definitions exist. The definitions may have a value in the ‘Payment Acknowledgement Type’ field. All ‘Adjustment’ and 'Payment' definitions will be available in the ‘Payment Acknowledgement’ form in the ‘Post Payment Accounting Entry' section of the 'Payment Acknowledgement' form.
- Client to use in the 'Post Front Office and myHP Payments' section of the 'Payment Acknowledgement' form:
- Client 1: A client with a self-pay balance is identified. Note the program.
- Program Maintenance is used to identify the 'Treatment Service'.
- Deposit Entry’ is used to create a payment for the self-pay guarantor. Note the data entry date.
- Query the ‘SYSTEM.unacknowledged_payments’ table, specific to the client. Validate that the deposit entry payment information is correct.
- Client Ledger is used to validate that the payment was not applied to the client's account.
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.
- Close the form.
- Open ‘Payment Acknowledgement’ form.
- Select the 'Post Front Office and myHP Payments.
- Set the 'Payment Collection’ date to the current date.
- Select the 'Treatment Service' if desired.
- Select the 'Type'.
- Click [Review].
- Select the Deposit Entry item in the 'Unacknowledged Payments' checklist for Client 1.
- Click [OK].
- Enter desired 'Batch Number'.
- Enter desired 'Deposit Date'.
- Select the desired 'Category'.
- Enter the desired 'Bank Ref #'.
- Enter 'Comments' if desired.
- Click [Post].
- Click [OK].
- Close the form.
- Open the 'Client Ledger' for the client.
- Process the report.
- Verify the client ledger displays the deposit entry correctly.
- Close the Report.
- Close the form.
Deposit Entry
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Deposit Entry
- Registry Settings (PM)
- Service Codes
- Admission (Outpatient)
- Diagnosis
- Financial Eligibility
- Program Maintenance
- Posting/Adjustment Codes Definition
- File Import
- User Definition
- Payment Acknowledgement
- Guarantors/Payors
Scenario 1: Deposit Entry web service validation
Specific Setup:
- Select a client to use for a payment through a 'Deposit Entry' web service request. Note the guarantor assigned to the client.
Steps
- SoapUI or other web service tool is used to create a request for Deposit Entry.
- Use the client ID and guarantor from setup. Note amount of payment, date of payment, and any other desired information.
- Process the request and validate that it completed successfully.
- Open ‘Client Ledger’ for the client.
- Process the report and validate that the web service deposit entry payment displays in the client’s record and that the submitted data was retained.
- Close the report.
- Close the form.
Scenario 2: PM - Deposit Entry - field, error messages, and process validation
Specific Setup:
- This can be tested with and without credit card functionality. If credit card functionality is not enabled, please use non-credit card posting codes. For our testing credit card functionality is enabled.
- The following registry setting has a value of 'Y': Avatar PM--->Billing->Remittance Processing->->->Enable Credit Card Processing.
- 'Receipt Definition' has been defined.
- 'Service Code 1, will be used to accept client payments in the 'Deposit Entry' form:
- Service Code = any value.
- Service Code Definition = any value.
- Service Required By = Client Only.
- Type of Service = Individual.
- Type of Fee = any value.
- Group Code = any value, typically meaning non-billable.
- Covered Charge Category = any value, typically meaning non-billable.
- Is This A Balance Forward Service Code = No.
- Does This Code Have A Professional Component = any value.
- Is This Service A Visit = No.
- Is This Service An Intervention = No.
- 'Service Code 2:
- Service Code = any value.
- Service Code Definition = any value.
- Service Required By = Both or Provider.
- Type of Service = Individual.
- Type of Fee = any value.
- Group Code = any value.
- Covered Charge Category = any value.
- Is This A Balance Forward Service Code = No.
- Does This Code Have A Professional Component = any value.
- Is This Service A Visit = any value.
- Is This Service An Intervention = any value.
- 'Posting/Adjustment Codes Definition 1':
- Note the ‘Code Definition’.
- 'Adjustment, Payment or Transfer’ = 'Payment'.
- ‘Credit or Debit’ = 'Credit'.
- ‘Is this a Credit Card or ACH Payment Code’ = 'No' or is blank.
- After creating 'Posting/Adjustment Codes Definition 2', return to this code in ‘Edit’ mode and add a value of ‘Yes’ to ‘Generate Receipt’ and a value of 'Posting/Adjustment Codes Definition 2' to ‘Void Receipt Posting Code'.
- Posting/Adjustment Codes Definition 2':
- Note the ‘Code Definition’.
- 'Adjustment, Payment or Transfer’ = 'Payment'.
- ‘Credit or Debit’ = 'Debit'.
- ‘Is This a Reversal Code’ = 'Yes’.
- 'Which Pym/Adj Code Is This A Reversal For' = 'Posting/Adjustment Codes Definition 1'.
- 'Posting/Adjustment Codes Definition 3':
- Note the ‘Code Definition’.
- 'Adjustment, Payment or Transfer’ = 'Payment'.
- ‘Credit or Debit’ = 'Credit'.
- ‘Is this a Credit Card or ACH Payment Code’ = 'Yes'.
- After creating 'Posting/Adjustment Codes Definition 4', return to this code in ‘Edit’ mode and add a value of ‘Yes’ to ‘Generate Receipt’ and a value of 'Posting/Adjustment Codes Definition 4' to ‘Void Receipt Posting Code'.
- Posting/Adjustment Codes Definition 4':
- Note the ‘Code Definition’.
- 'Adjustment, Payment or Transfer’ = 'Payment'.
- ‘Credit or Debit’ = 'Debit'.
- ‘Is This a Reversal Code’ = 'Yes’.
- 'Which Pym/Adj Code Is This A Reversal For' = 'Posting/Adjustment Codes Definition 3'.
- The following registry setting has a value of 'Service Code 1': Avatar PM->Services->Ancillary/Ambulatory Services->Deposit Entry->->Default Service Code.
- The following registry setting has a value of 'Posting/Adjustment Codes Definition 1': Avatar PM->Scheduling->Front Desk->->->Pre Payment Default Posting Code.
- Credit Card Configuration:
- Has 'No' in 'Populate Receipt Number with Credit Card Payment Reference Number'.
- Enter desired values for the other fields.
- In the 'Credit Card Device Setup' section: '
- Credit Card Device 1': Has a value of 'No' in 'Is this a Back Office MID?'. Note the device name. Enter desired values for the other fields.
- 'Credit Card Device 2': Has a value of 'Yes' in 'Is this a Back Office MID?'. Note the device name. Enter desired values for the other fields.
- 'Guarantors/Payors 1': Has a 'Financial Class' of 'Self Pay'.
- 'Client 1':
- Note the episode/program.
- Use 'Program Maintenance' to note the program default location.
- Is assigned Guarantors/Payors 1 in 'Financial Eligibility.
- Use 'Client Ledger' client to note the balance for 'Guarantors/Payors 1' in 'TOTAL BALANCE BY GUARANTOR.
- 'Client 2':
- Note the episode/program.
- Use 'Program Maintenance' to note the program default location.
- Is assigned Guarantors/Payors 1 in 'Financial Eligibility.
- Use 'Client Ledger' client to note the balance for 'Guarantors/Payors 1' in 'TOTAL BALANCE BY GUARANTOR.
- 'Client 3':
- Note the episode/program. There is no 'Attending Practitioner' in the admission record.
- Use 'Program Maintenance' to note the program default location.
- Is assigned Guarantors/Payors 1 in 'Financial Eligibility.
- Use 'Client Ledger' client to note the balance for 'Guarantors/Payors 1' in 'TOTAL BALANCE BY GUARANTOR.
Steps
- Open 'Deposit Entry'.
- Validate 'Date Of Receipt Or Adjustment' is equal to "required".
- Validate 'Client ID' is equal to "required".
- Validate 'Episode Number' is equal to "required".
- Validate 'Guarantor' is equal to "required".
- Validate 'Service Code' is equal to "required".
- Validate 'Amount To Post' is equal to "required".
- Validate 'Posting Code' is equal to "required".
- Validate 'Receipt' is "enabled".
- Validate 'Check #' is equal to "enabled".
- Validate 'Program Of Service' is equal to "required".
- Validate 'Location' is equal to "required".
- Validate 'Transaction Type' is equal to "disabled".
- Validate 'Select Credit Card Device' is equal to "disabled".
- Validate 'Pay With Credit Card button is equal to "disabled".
- Click [Submit].
- Validate that a 'Submitting' message is received stating: The following fields are missing: Amount To Post, Client ID, Date of Receipt Or Adjustment, Episode Number, Guarantor, Location, Posting Code, Program Of Service, Service Code.
- Click [OK].
- Click the 'Y - Date Of Receipt Or Adjustment' button.
- Validate 'Date Of Receipt Or Adjustment' is equal to "yesterday's date".
- Click the 'T - Date Of Receipt Or Adjustment' button.
- Validate 'Date Of Receipt Or Adjustment' is equal to "current date".
- Set 'Client ID' to "Client 1".
- Select desired 'Episode Number'.
- Validate 'Program Of Service' is equal to "Client 1 program of service".
- Validate 'Location' is equal to "Client 1 program of service default location".
- Set 'Service Code' to "Service Code 1".
- Select "Guarantors/Payors 1" in 'Guarantor'.
- Set 'Amount To Post' to "5".
- Select "Posting/Adjustment Codes Definition 1" in 'Posting Code'.
- Click [Submit].
- Validate the receipt is generated and contains data including: 'Payment Received For ' = Client 1, 'The Sum of $5.00' and 'Type of Payment:' = ‘'Posting/Adjustment Codes Definition 1', Code Definition’. Note the value of 'Receipt #'.
- Close the receipt.
- Open 'Deposit Entry'.
- Click the 'T - Date Of Receipt Or Adjustment' button.
- Set 'Client ID' to "Client 2".
- Select desired 'Episode Number'.
- Set 'Service Code' to "Service Code 1".
- Select "Guarantors/Payors 1" in 'Guarantor'.
- Set 'Amount To Post' to "5".
- Select "Posting/Adjustment Codes Definition 3" in 'Posting Code'.
- Validate 'Pay With Credit Card' is equal to "enabled".
- Validate 'Transaction Type' is equal to "enabled and required".
- Validate 'Transaction Type' is equal to "Insert/Swipe Card".
- Validate 'Select Credit Card Device' is equal to "enabled and required".
- Click [Submit].
- Validate the 'Error' message is equal to: Please use the 'Pay With Credit Card' command button to process a credit card posting code or select a different code.
- Click [OK].
- Select the desired 'Transaction Type'.
- Click [Pay With Credit Card] and follow the prompts to process the payment.
- Review the 'Card Connect Payment' message. A successful payment will generate a receipt.
- Click [OK] on the 'Card Connect Payment' message.
- Validate the receipt, if generated, contains data including: 'Payment Received For' = Client 2, 'The Sum of $5.00' and 'Type of Payment' = ‘'Posting/Adjustment Codes Definition 3', Code Definition’. Note the value of 'Receipt #'.
- Click the 'T - Date Of Receipt Or Adjustment' button.
- Set 'Client ID' to "Client 3".
- Select desired 'Episode Number'.
- Set 'Service Code' to "Service Code 2".
- Select "Guarantors/Payors 1" in 'Guarantor'.
- Set 'Amount To Post' to "5".
- Select "Posting/Adjustment Codes Definition 1" in 'Posting Code'.
- Click [Submit].'
- Validate the 'Error' message is equal to "Attending Practitioner Is Not Assigned. Process Aborted".
- Click [OK].
- Select "Posting/Adjustment Codes Definition 3" in 'Posting Code'.
- Click [Submit].'
- Validate the 'Error' message is equal to "Attending Practitioner Is Not Assigned. Process Aborted".
- Click [OK].
- Click [X] to close the form.
- Open 'Client Ledger' for 'Client 1'.
- Validate that a $5.00 payment was made on the current date for "Posting/Adjustment Codes Definition 1", and 'Service Code 1'.
- Update the 'Client Ledger' to 'Client 2'.
- Validate that a $5.00 payment was made on the current date for "Posting/Adjustment Codes Definition 3", and 'Service Code 1'.
- Update the 'Client Ledger' to 'Client 3'.
- Validate that no payment was made on the current date.
Scenario 3: File Import - Deposit Entry' - file with all the required/optional fields
Specific Setup:
- Registry Setting:
- Set the 'Avatar PM->System Maintenance->File Import->->->Import File Delimiter' registry setting to the desired value.
- Guarantors/Payor:
- An existing guarantor is identified to be assigned to the client. Note the guarantor code/value.
- Program Maintenance:
- Identify an existing program code / value to be used for client's admission.
- Identify the location of the program to be used for Client's admission.
- Admission:
- An inpatient or outpatient client is created using the program identified above or an existing client is identified. Note the Client id/name, admission date/program.
- Financial Eligibility: The existing guarantor is assigned to the client.
- Service code:
- An existing service code to be used with inpatient/ outpatient program is identified. Note the service code for further validation.
- Posting/Adjustment Code Definition:
- An existing payment, adjustment or transfer code is identified to be used. Note the code and type of the code.
- File Import:
- An import file is created to process the deposit entry. Ensure that the file contains all required fields and desired optional fields. Note the file name / location of the file.
Steps
1. Open the 'File Import' form. 2. Select the 'Deposit Entry' from the File Type field. 3. Upload the file Import file created in the setup section. 4. Compile the file. 5. Verify the file compiles successfully. 6. Post the compiled file. 7. Verify the file posted successfully. 8. Open the 'Client Ledger' for the client. 9. Process the report. 10. Verify the client ledger displays the deposit entry correctly. 11. Close the Report. 12. Close the form.
Scenario 4: Registry Setting validation - Prevent Posting Payments Unless Payment has been Acknowledged
Steps
- Open the 'Registry Settings' form.
- Set the Limit Registry Settings to 'Enable Payment Acknowledgement'
- Set the Registry Setting Value input box to ‘N’.
- Click [Submit].
- Click [OK].
- Click [Yes].
- Submit the form.
- Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
- Validate the Registry Setting input box contains 'Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged'.
- Validate the Registry Setting Details text area contains: [FACILITY SPECIFIC] - The 'Enable Payment Acknowledgement' registry setting must be enabled to select any values. The valid values are: 0 or 1, 2, 3, 4, 5 and/or 6. Multiple values can be selected. They will be separated by ampersands. Example: 1&2. When '1' is selected, it will restrict the ability to post payments in the '835 Health Care Claim Payment/Advice' form to only payments that have been acknowledged in the 'Payment Acknowledgement' form. When '2' is selected, it will restrict the ability to post payments in the 'Batch Cash Posting' form to only payments that have been acknowledged in the 'Payment Acknowledgement' form. When '3' is selected, it will restrict the ability to post payments in the "Payment/Adjustment Posting" 'File Import' to only payments that have been acknowledged in the 'Payment Acknowledgement' form. When '4' is selected, it will prevent the system from applying payments entered in 'Scheduling Calendar - Check In' until those payments have been acknowledged in the 'Payment Acknowledgement' form. This will also add the 'Name on Card' field to 'Scheduling Calendar - Check In'. When '5' is selected, it will prevent the system from applying payments entered in 'Deposit Entry' until those payments have been acknowledged in the 'Payment Acknowledgement' form. This will also add the 'Name on Card' field to 'Deposit Entry'. When '6' is selected, it will prevent the system from applying payments entered in myHealthPointe until those payments have been acknowledged in the 'Payment Acknowledgement' form. Selecting '0' will remove this functionality. This is the default behavior.
- Set the Registry Setting Value input box to '1'.
- Validate the error message dialog contains 'The selected value is not valid in the current system code for the following reason: The 'Enable Payment Acknowledgement' registry setting must be enabled to make any selections other than zero.'
- Set the Limit Registry Settings to 'Enable Payment Acknowledgement'.
- Set the 'Enable Payment Acknowledgement' registry setting to 'Y'.
- Click [Submit].
- Click [OK].
- Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
- Validate that the Registry Setting Value defaults to ‘0’.
- Set the Registry Setting Value input box to 'Y'.
- Click [TAB].
- Validate the error message dialog contains 'The selected value is not valid in the current system code for the following reason: Invalid selection found (Y).'
- Set the Registry Setting Value input box to 'N'.
- Click [TAB].
- Validate the error message dialog contains 'The selected value is not valid in the current system code for the following reason: Invalid selection found (N).'
- Set the Registry Setting Value input box to '1'.
- Click [Submit].
- Click [OK].
- Click [Yes].
- Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
- Set the Registry Setting Value input box to '2'.
- Click [Submit].
- Click [OK].
- Click [Yes].
- Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
- Set the Registry Setting Value input box to '3'.
- Click [Submit].
- Click [OK].
- Click [Yes].
- Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
- Set the Registry Setting Value input box to '4'.
- Click [Submit].
- Click [OK].
- Click [Yes].
- Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
- Set the Registry Setting Value input box to '5'.
- Click [Submit].
- Click [OK].
- Click [Yes].
- Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
- Set the Registry Setting Value input box to '6'.
- Click [Submit].
- Click [OK].
- Click [Yes].
- Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
- Set the Registry Setting Value input box to '1&2&3&4&5&6'.
- Click [Submit].
- Click [OK].
- Click [Yes].
- Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
- Validate the Registry Setting Value input box contains '1&2&3&4&5&6'.
- Close the form.
Scenario 5: File Import - Deposit Entry - Registry Setting = Prevent Posting Payments Unless Payment has been Acknowledged
Specific Setup:
- Registry Setting:
- Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = 'Y'.
- Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = '5', at a minimum, but may contain any combination of '1&2&3&4&5&6'.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- Guarantors/Payors:
- An existing guarantor is identified to be assigned to the client. Note the guarantor's code/value.
- Program Maintenance:
- Identify an existing program code / value to be used for client's admission.
- Note the location of the program to be used for Client's admission.
- Admission:
- An inpatient or outpatient client is created using the program identified above or an existing client is identified. Note the client's id/name, admission date/program.
- Financial Eligibility: The existing guarantor is assigned to the client. Note the guarantor's code/name.
- Service code:
- An existing service code to be used with inpatient/ outpatient program is identified. Note the service code for further validation.
- Posting/Adjustment Code Definition:
- An existing payment, adjustment or transfer code is identified to be used. Note the code and type of the code.
- File Import:
- An import file is created to process the deposit entry. Ensure that the file contains all required fields and desired optional fields. Note the file name / location of the file.
Steps
- Open the 'File Import' form.
- Select the 'Deposit Entry' from the File Type field.
- Upload the file Import file created in the setup section.
- Compile the file.
- Verify the file compiles successfully.
- Post the compiled file.
- Verify the file posted successfully.
- Open the 'Client Ledger' for the client.
- Process the report.
- Verify the client ledger does not display the deposit entry payment.
- Close the Report.
- Close the form.
- If desired, query the ‘SYSTEM.unacknowledged_payments’ table, specific to the client.
- Verify that the query results display the Deposit Entry item correctly.
- Close the query.
- Open 'Payment Acknowledgement'.
- Select the 'Post Front Office and myHP Payments.
- Set the 'Payment Collection’ date to the current date.
- Select the 'Treatment Service' if desired.
- Select the 'Type'.
- Click [Review].
- Select the Deposit Entry item in the 'Unacknowledged Payments' checklist.
- Click [OK].
- Enter desired 'Batch Number'.
- Enter the 'Deposit Date' which would the 'Date Of Receipt Or Adjustment' in the Deposit Entry file.
- Select the desired 'Category'.
- Enter the desired 'Bank Ref #'.
- Enter 'Comments' if desired.
- Click [Post].
- Click [OK].
- Close the form.
- Open the 'Client Ledger' for the client.
- Process the report.
- Verify the client ledger displays the deposit entry correctly.
- Close the Report.
- Close the form.
Scenario 6: PM - Deposit Entry - Validate 'SYSTEM.unacknowledged_payments' table.
Specific Setup:
- Registry Settings:
- Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = Y.
- Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = ‘5’ at a minimum.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- Admit a new test client or select an existing self-pay client. Note the client’s ID.
- Assign a self-pay Financial Eligibility record to the client.
- Use 'Deposit Entry' to post a payment to the client. Note the details of the payment.
- Use 'Client Ledger' to validate that the payment did not post to the account.
- Use Crystal Reports or other SQL reporting tool to query the 'SYSTEM.unacknowledged_payments' table, specific to the client. Validate that payment data is correct. Save the query.
Steps
- Open ‘Payment Acknowledgement’.
- Select the ‘Post Front Office and myHP Payments’ section.
- Click [T] on ‘Payment Collection Date’.
- Select ‘Front Office’ in ‘Type’.
- Click [Review].
- Select the row with the 'Deposit Entry' payment for the client.
- Click [OK].
- Enter desired ‘Batch Number’.
- Enter desired ‘Deposit Date’.
- Select desired ‘Category’.
- Enter desired ‘Bank Ref #’.
- Enter desired ‘Comments.
- Click [Post].
- Open ‘Client Ledger’ for the client.
- Process the ‘Simple’ ledger report.
- Validate that the 'Deposit Entry' payment posted to the client’s account.
- Close the report.
- Close the form.
- Use Crystal Reports or other SQL reporting tool to query the 'SYSTEM.unacknowledged_payments' table, specific to the client. Validate that no results are returned.
Scenario 7: Deposit Entry web service validation - Validate 'SYSTEM.unacknowledged_payments' table.
Specific Setup:
- Registry Setting:
- ‘Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement’ has a ‘Registry Setting Value’ of ‘Y’.
- ‘Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged’ has a ‘Registry Setting Value’ of 5’ at a minimum.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- Select a client to use for a payment through a 'Deposit Entry' web service request. Note the guarantor assigned to the client.
Steps
- SoapUI or other web service tool is used to create a request for Deposit Entry.
- Use the client ID and guarantor from setup. Note amount of payment, date of payment, and any other desired information.
- Process the request and validate that it completed successfully.
- Open ‘Client Ledger’ for the client.
- Process the report and validate that the web service deposit entry payment is not included in the client’s account.
- Close the report.
- Close the form.
- Query the ‘SYSTEM.unacknowledged_payments’ table, specific to the client.
- Verify that the query results display the web service deposit entry item correctly.
- Close the query.
- Open 'Payment Acknowledgement'.
- Select the 'Post Front Office and myHP Payments.
- Set the 'Payment Collection’ date to the current date.
- Select the 'Treatment Service' if desired.
- Select the 'Type'.
- Click [Review].
- Select the web service deposit entry item in the 'Unacknowledged Payments' checklist.
- Click [OK].
- Enter desired 'Batch Number'.
- Enter the 'Deposit Date' which would the 'Date Of Receipt Or Adjustment' in the Deposit Entry file.
- Select the desired 'Category'.
- Enter the desired 'Bank Ref #'.
- Enter 'Comments' if desired.
- Click [Post].
- Click [OK].
- Close the form.
- Query the ‘SYSTEM.unacknowledged_payments’ table, specific to the client.
- Verify that no query results are returned.
- Close the query.
- Open the 'Client Ledger' for the client.
- Process the report.
- Verify the client ledger displays the deposit entry correctly.
- Close the Report.
- Close the form.
SQL - 'SYSTEM.unacknowledgement_payments’ table added to system.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Deposit Entry
- Registry Settings (PM)
- Service Codes
- Admission (Outpatient)
- Diagnosis
- Financial Eligibility
- Program Maintenance
- Claim Adjustment Group/Reason Code Definition
- Crystal Report Viewer
- Guarantors/Payors
- Dictionary Update (PM)
- Default Guarantor Assignment
- Posting/Adjustment Codes Definition
- 835 Health Care Claim Payment/Advice (PM)
- Create Interim Billing Batch File
- Electronic Billing
- Payment Acknowledgement
- Client Charge Input
- User Definition
- Delete Service
- Delete Last Movement
- Change MR#
Scenario 1: PM - Deposit Entry - field, error messages, and process validation
Specific Setup:
- This can be tested with and without credit card functionality. If credit card functionality is not enabled, please use non-credit card posting codes. For our testing credit card functionality is enabled.
- The following registry setting has a value of 'Y': Avatar PM--->Billing->Remittance Processing->->->Enable Credit Card Processing.
- 'Receipt Definition' has been defined.
- 'Service Code 1, will be used to accept client payments in the 'Deposit Entry' form:
- Service Code = any value.
- Service Code Definition = any value.
- Service Required By = Client Only.
- Type of Service = Individual.
- Type of Fee = any value.
- Group Code = any value, typically meaning non-billable.
- Covered Charge Category = any value, typically meaning non-billable.
- Is This A Balance Forward Service Code = No.
- Does This Code Have A Professional Component = any value.
- Is This Service A Visit = No.
- Is This Service An Intervention = No.
- 'Service Code 2:
- Service Code = any value.
- Service Code Definition = any value.
- Service Required By = Both or Provider.
- Type of Service = Individual.
- Type of Fee = any value.
- Group Code = any value.
- Covered Charge Category = any value.
- Is This A Balance Forward Service Code = No.
- Does This Code Have A Professional Component = any value.
- Is This Service A Visit = any value.
- Is This Service An Intervention = any value.
- 'Posting/Adjustment Codes Definition 1':
- Note the ‘Code Definition’.
- 'Adjustment, Payment or Transfer’ = 'Payment'.
- ‘Credit or Debit’ = 'Credit'.
- ‘Is this a Credit Card or ACH Payment Code’ = 'No' or is blank.
- After creating 'Posting/Adjustment Codes Definition 2', return to this code in ‘Edit’ mode and add a value of ‘Yes’ to ‘Generate Receipt’ and a value of 'Posting/Adjustment Codes Definition 2' to ‘Void Receipt Posting Code'.
- Posting/Adjustment Codes Definition 2':
- Note the ‘Code Definition’.
- 'Adjustment, Payment or Transfer’ = 'Payment'.
- ‘Credit or Debit’ = 'Debit'.
- ‘Is This a Reversal Code’ = 'Yes’.
- 'Which Pym/Adj Code Is This A Reversal For' = 'Posting/Adjustment Codes Definition 1'.
- 'Posting/Adjustment Codes Definition 3':
- Note the ‘Code Definition’.
- 'Adjustment, Payment or Transfer’ = 'Payment'.
- ‘Credit or Debit’ = 'Credit'.
- ‘Is this a Credit Card or ACH Payment Code’ = 'Yes'.
- After creating 'Posting/Adjustment Codes Definition 4', return to this code in ‘Edit’ mode and add a value of ‘Yes’ to ‘Generate Receipt’ and a value of 'Posting/Adjustment Codes Definition 4' to ‘Void Receipt Posting Code'.
- Posting/Adjustment Codes Definition 4':
- Note the ‘Code Definition’.
- 'Adjustment, Payment or Transfer’ = 'Payment'.
- ‘Credit or Debit’ = 'Debit'.
- ‘Is This a Reversal Code’ = 'Yes’.
- 'Which Pym/Adj Code Is This A Reversal For' = 'Posting/Adjustment Codes Definition 3'.
- The following registry setting has a value of 'Service Code 1': Avatar PM->Services->Ancillary/Ambulatory Services->Deposit Entry->->Default Service Code.
- The following registry setting has a value of 'Posting/Adjustment Codes Definition 1': Avatar PM->Scheduling->Front Desk->->->Pre Payment Default Posting Code.
- Credit Card Configuration:
- Has 'No' in 'Populate Receipt Number with Credit Card Payment Reference Number'.
- Enter desired values for the other fields.
- In the 'Credit Card Device Setup' section: '
- Credit Card Device 1': Has a value of 'No' in 'Is this a Back Office MID?'. Note the device name. Enter desired values for the other fields.
- 'Credit Card Device 2': Has a value of 'Yes' in 'Is this a Back Office MID?'. Note the device name. Enter desired values for the other fields.
- 'Guarantors/Payors 1': Has a 'Financial Class' of 'Self Pay'.
- 'Client 1':
- Note the episode/program.
- Use 'Program Maintenance' to note the program default location.
- Is assigned Guarantors/Payors 1 in 'Financial Eligibility.
- Use 'Client Ledger' client to note the balance for 'Guarantors/Payors 1' in 'TOTAL BALANCE BY GUARANTOR.
- 'Client 2':
- Note the episode/program.
- Use 'Program Maintenance' to note the program default location.
- Is assigned Guarantors/Payors 1 in 'Financial Eligibility.
- Use 'Client Ledger' client to note the balance for 'Guarantors/Payors 1' in 'TOTAL BALANCE BY GUARANTOR.
- 'Client 3':
- Note the episode/program. There is no 'Attending Practitioner' in the admission record.
- Use 'Program Maintenance' to note the program default location.
- Is assigned Guarantors/Payors 1 in 'Financial Eligibility.
- Use 'Client Ledger' client to note the balance for 'Guarantors/Payors 1' in 'TOTAL BALANCE BY GUARANTOR.
Steps
- Open 'Deposit Entry'.
- Validate 'Date Of Receipt Or Adjustment' is equal to "required".
- Validate 'Client ID' is equal to "required".
- Validate 'Episode Number' is equal to "required".
- Validate 'Guarantor' is equal to "required".
- Validate 'Service Code' is equal to "required".
- Validate 'Amount To Post' is equal to "required".
- Validate 'Posting Code' is equal to "required".
- Validate 'Receipt' is "enabled".
- Validate 'Check #' is equal to "enabled".
- Validate 'Program Of Service' is equal to "required".
- Validate 'Location' is equal to "required".
- Validate 'Transaction Type' is equal to "disabled".
- Validate 'Select Credit Card Device' is equal to "disabled".
- Validate 'Pay With Credit Card button is equal to "disabled".
- Click [Submit].
- Validate that a 'Submitting' message is received stating: The following fields are missing: Amount To Post, Client ID, Date of Receipt Or Adjustment, Episode Number, Guarantor, Location, Posting Code, Program Of Service, Service Code.
- Click [OK].
- Click the 'Y - Date Of Receipt Or Adjustment' button.
- Validate 'Date Of Receipt Or Adjustment' is equal to "yesterday's date".
- Click the 'T - Date Of Receipt Or Adjustment' button.
- Validate 'Date Of Receipt Or Adjustment' is equal to "current date".
- Set 'Client ID' to "Client 1".
- Select desired 'Episode Number'.
- Validate 'Program Of Service' is equal to "Client 1 program of service".
- Validate 'Location' is equal to "Client 1 program of service default location".
- Set 'Service Code' to "Service Code 1".
- Select "Guarantors/Payors 1" in 'Guarantor'.
- Set 'Amount To Post' to "5".
- Select "Posting/Adjustment Codes Definition 1" in 'Posting Code'.
- Click [Submit].
- Validate the receipt is generated and contains data including: 'Payment Received For ' = Client 1, 'The Sum of $5.00' and 'Type of Payment:' = ‘'Posting/Adjustment Codes Definition 1', Code Definition’. Note the value of 'Receipt #'.
- Close the receipt.
- Open 'Deposit Entry'.
- Click the 'T - Date Of Receipt Or Adjustment' button.
- Set 'Client ID' to "Client 2".
- Select desired 'Episode Number'.
- Set 'Service Code' to "Service Code 1".
- Select "Guarantors/Payors 1" in 'Guarantor'.
- Set 'Amount To Post' to "5".
- Select "Posting/Adjustment Codes Definition 3" in 'Posting Code'.
- Validate 'Pay With Credit Card' is equal to "enabled".
- Validate 'Transaction Type' is equal to "enabled and required".
- Validate 'Transaction Type' is equal to "Insert/Swipe Card".
- Validate 'Select Credit Card Device' is equal to "enabled and required".
- Click [Submit].
- Validate the 'Error' message is equal to: Please use the 'Pay With Credit Card' command button to process a credit card posting code or select a different code.
- Click [OK].
- Select the desired 'Transaction Type'.
- Click [Pay With Credit Card] and follow the prompts to process the payment.
- Review the 'Card Connect Payment' message. A successful payment will generate a receipt.
- Click [OK] on the 'Card Connect Payment' message.
- Validate the receipt, if generated, contains data including: 'Payment Received For' = Client 2, 'The Sum of $5.00' and 'Type of Payment' = ‘'Posting/Adjustment Codes Definition 3', Code Definition’. Note the value of 'Receipt #'.
- Click the 'T - Date Of Receipt Or Adjustment' button.
- Set 'Client ID' to "Client 3".
- Select desired 'Episode Number'.
- Set 'Service Code' to "Service Code 2".
- Select "Guarantors/Payors 1" in 'Guarantor'.
- Set 'Amount To Post' to "5".
- Select "Posting/Adjustment Codes Definition 1" in 'Posting Code'.
- Click [Submit].'
- Validate the 'Error' message is equal to "Attending Practitioner Is Not Assigned. Process Aborted".
- Click [OK].
- Select "Posting/Adjustment Codes Definition 3" in 'Posting Code'.
- Click [Submit].'
- Validate the 'Error' message is equal to "Attending Practitioner Is Not Assigned. Process Aborted".
- Click [OK].
- Click [X] to close the form.
- Open 'Client Ledger' for 'Client 1'.
- Validate that a $5.00 payment was made on the current date for "Posting/Adjustment Codes Definition 1", and 'Service Code 1'.
- Update the 'Client Ledger' to 'Client 2'.
- Validate that a $5.00 payment was made on the current date for "Posting/Adjustment Codes Definition 3", and 'Service Code 1'.
- Update the 'Client Ledger' to 'Client 3'.
- Validate that no payment was made on the current date.
Scenario 2: 835 Health Care Claim Payment/Advice - Three checks per file - Posting Acknowledged, Unacknowledged and Zero dollar payments
Specific Setup:
- Registry Setting:
- The 'Enable Payment Acknowledgement' registry setting is enabled.
- The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting includes value '1'.
- The 'Check Number' registry setting is set to '1'.
- The 'Posting Date for Automated 835s' registry setting is set to '1'.
- Claim Adjustment Group/ reason code Definition:
- A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
- Admission:
- Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
- Guarantor/Payors:
- Two existing guarantors are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
- Financial Eligibility:
- The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
- Client Charge Input:
- A service is rendered to the client.
- Client Ledger:
- Make sure the service is distributed to one of the guarantors assigned to the client.
- Close charges.
- Electronic Billing:
- Claim the service using the 837 Professional bill for the guarantor.
- Create an 835 file based on the claim information found in the 837 professional bill.
Steps
- Open the '835 Health Care Claim Payment/Advice' form.
- Load and compile the 835 file created that includes the claim for the defined guarantor in the setup.
- Verify the 835 file loads/compiles successfully.
- Select 'Post File' option.
- Select the compiled file.
- Populate all the required fields with desired value.
- Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
- Check the Check/EFT# that is unacknowledged.
- Click [Process File].
- Verify the message: 'Selecting Unacknowledged Check/EFT numbers is not permitted.'
- Click [OK].
- Close the form.
- Open the ‘Payment Acknowledgment’ form.
- Enter desired value in ‘Batch Number’.
- Select desired ‘Posting Code’.
- Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
- Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
- Select desired ‘Guarantor’ set up in the setup section. Note: 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’ that matches the date entered in the BPR*16 segment of the 835 file.
- 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 Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
- Click [No].
- Close the form.
- Open the '835 Health Care Claim Payment/Advice' form.
- Select 'Post File' option.
- Select the compiled file.
- Populate all the required fields with desired value.
- Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
- Check the Check/EFT# that acknowledged in above steps.
- Click [Process File].
- Verify the file posts successfully.
- Open the 'Client Ledger' for the client.
- Verify the payments are posted correctly on the ledger.
- Open the 'Crystal Report' or any other SQL Data viewer.
- Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
- Validate the check number field contains check number from the TRN-02 segment of the 835 file.
- Validate the 'pay_acknowledge_trans_num' column contains the transaction number from the 'Payment Acknowledgement' form for the Check/EFT.
Scenario 3: 835 Healthcare Claim Payment/Advice - One check per file - Posting acknowledged payments and adjustments
Specific Setup:
- Registry Setting:
- The 'Enable Payment Acknowledgement' registry setting is enabled.
- The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting includes value '1'.
- The 'Check Number' registry setting is set to '1'.
- The 'Posting Date for Automated 835s' registry setting is set to '1'.
- Claim Adjustment Group/ reason code Definition:
- A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
- Admission:
- Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
- Guarantor/Payors:
- Two existing guarantors are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
- Financial Eligibility:
- The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
- Client Charge Input:
- A service is rendered to the client.
- Client Ledger:
- Make sure the service is distributed to one of the guarantors assigned to the client.
- Close charges.
- Electronic Billing:
- Claim the service using the 837 Professional bill for the guarantor.
- Create an 835 file based on the claim information found in the 837 professional bill.
Steps
- Open the '835 Health Care Claim Payment/Advice' form.
- Load and compile the 835 file created that includes the claim for the defined guarantor in the setup.
- Verify the 835 file loads/compiles successfully.
- Select 'Post File' option.
- Select the file that is recently compiled successfully.
- Populate all the required fields with desired value.
- Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
- Check the Check/EFT# that is unacknowledged.
- Click [Process File].
- Verify the message: 'Selecting Unacknowledged Check/EFT numbers is not permitted.'
- Click [OK].
- Close the form.
- Open the ‘Payment Acknowledgment’ form.
- Enter desired value in ‘Batch Number’.
- Select desired ‘Posting Code’.
- Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
- Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
- Select desired ‘Guarantor’ set up in the setup section. Note: 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’ that matches the date entered in the BPR*16 segment of the 835 file.
- 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 Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing. Note the transaction number.
- Click [No].
- Close the form.
- Open the '835 Health Care Claim Payment/Advice' form.
- Select 'Post File' option.
- Select the file that is recently compiled successfully.
- Populate all the required fields with desired value.
- Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
- Check the Check/EFT# that acknowledged in above steps.
- Click [Process File].
- Verify the file posts successfully.
- Open the 'Client Ledger' for the client.
- Verify the payments are posted correctly on the ledger.
- Open the 'Crystal Report' or any other SQL Data viewer.
- Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
- Validate the check number field contains check number from the TRN-02 segment of the 835 file.
- Validate the date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
- Validate the 'pay_acknowledge_trans_num' column contains the transaction number from the 'Payment Acknowledgement' form for the Check/EFT.
Scenario 4: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Acknowledged payments
Specific Setup:
- Registry Setting:
- The 'Enable Payment Acknowledgement' registry setting is enabled.
- The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting is set to '1'.
- The 'Check Number' registry setting is set to '1'.
- The 'Posting Date for Automated 835s' registry setting is set to '2'.
- Claim Adjustment Group/ reason code Definition:
- A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
- Facility Defaults:
- The 'File Input Path On Server For 835 Files' input box set to desired path.
- The 'Output Path On Server For Electronic Files' input box set to the location where electronic files are saved.
- 835 Import/Export File Configuration:
- The 'Process File Path' input box set to desired location to be used to store the 835 file which is ready to process (i.e. "c:\Billing\835 \proc\").
- The 'Successful File Path' input box set to desired location to be used to store the 835 file which is successfully processed (i.e. "c:\Billing\835 \succ\").
- The 'Error File Path input box set to desired location to be used to store the 835 file which is not processed successfully (i.e. "c:\Billing\835 \error\").
- The 'Default 835 Filing User' input box is set to desired username.
- The 'Processing Interval' input box is set to desired value.
- The 'Interval Units' radio button is set to desired value.
- Admission:
- Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
- Guarantor/Payors:
- An existing guarantor is identified who have a Financial Class that has the Extended Data Element for '(1500) System Financial Class' set to 'Self Pay'. Note the guarantor codes/names.
- 837 section:
- Set the Submitter Payer Identification Code (1000A-N1-04) input box to the value that match with the N1*PR-04 segment of the 835 file (i.e.N1*PR*1000A-N1-2*XV*1000A-N1-04~).
- Financial Eligibility:
- The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
- Client Charge Input:
- A service is rendered to the client.
- Client Ledger:
- Make sure the service is distributed to one of the guarantors assigned to the client.
- Close charges.
- Electronic Billing:
- Claim the service using the 837 Professional bill for the guarantor.
- Create an 835 file based on the claim information found in the 837 professional bill.
Steps
- Place the 835 file created in the setup section in the Process File Path folder identified in the 'Facility Defaults' form (i.e. "c:\Billing\835 Files\proc\").
- Wait for desired time set up in the 'Facility Defaults' form.
- Verify that the file will be removed from the Process file folder and added to the Success folder.
- Open the '835 Health Care Claim Payment/Advice' form.
- Select 'Post File' option.
- Select the file that is recently moved to Success folder.
- Verify the status of the file is 'Partial-Posted'.
- Verify the Check/EFT# is populated correctly with the status of unacknowledged in the 'Check/EFT#' checkbox.
- Close the form.
- Open the ‘Payment Acknowledgment’ form.
- Enter desired value in ‘Batch Number’.
- Select desired ‘Posting Code’.
- Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
- Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
- Select desired ‘Guarantor’ set up in the setup section. Note: 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’ that matches the date entered in the BPR*16 segment of the 835 file.
- 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 Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
- Click [No].
- Close the form.
- Wait for desired time set up in the 'Facility Defaults' form.
- Open the 'Client Ledger' for the client.
- Verify the payments are posted correctly on the ledger.
- Open the 'Crystal Report' or any other SQL Data viewer.
- Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
- Validate the check number field contains check number from the TRN-02 segment of the 835 file.
- Validate the date of payment column contains the check date as 'date of payment' when the 835 file is posted.
- Validate the 'pay_ack_transaction_num' displays correct transaction number for the check which is acknowledged in the 'Payment Acknowledgement' form.
Scenario 5: Client Merge - Validate 'SYSTEM.unacknowledged_payments' table.
Specific Setup:
- Registry Settings:
- Avatar PM->System Maintenance->Client Merge->->->Allow Merging Into Existing Episode = Y.
- Avatar PM->System Maintenance->Client Merge->->->Allow Merging Of All Client Data Through Single Filing = Y.
- Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = Y.
- Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = ‘5’ at a minimum.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- Program Maintenance:
- Program 1 exists.
- Program 2 exists.
- Client 1:
- Is enrolled in Program 1. Note the client ID.
- Financial Eligibility record is for a self-pay guarantor.
- Client Charge Input has been used to create a charge that distributed to the self-pay guarantor.
- Deposit Entry has been used to make a payment for the self-pay guarantor. Note the date and amount.
- Crystal Reports or other SQL reporting tool has been used to create a query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 1. The query results have been validated and saved.
- Client 2: Is enrolled in Program 2. Note the client ID.
Steps
- Open ‘Client Merge’.
- Enter ‘Client 1’ in ‘Source Client’.
- Enter ‘Client 2’ in ‘Target Client’.
- Select ‘Yes’ in ‘Merge All Client Data Through Single Filing’.
- Select ‘Yes’ in ‘Create New Episode On Merge’.
- Click [File].
- Click [Yes].
- Click [OK].
- Close the form.
- Use Crystal Reports or other SQL reporting tool to create a query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 1.
- Validate that no results are returned.
- Use Crystal Reports or other SQL reporting tool to create a query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 2.
- Validate that the query results are equal to the saved results from setup, except for the ‘Episode_Number’, which will be ‘2’, and the ‘PATID’ field, which will be the ID of Client 2.
- Close the query results.
Scenario 6: Client Delete - Validate 'SYSTEM.unacknowledged_payments' table.
Specific Setup:
- Registry Settings:
- Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = Y.
- Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = ‘5’ at a minimum.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- Admit a new test client that will be used in the ‘Client Delete’ form. Note the client’s ID.
- Assign a Financial Eligibility record to the client.
- Use 'Deposit Entry' to post a payment to the client. Note the details of the payment.
- Use Crystal Reports or other SQL reporting tool to query the 'SYSTEM.unacknowledged_payments' table, specific to the client. Validate that payment data is correct. Save the query.
Steps
- Open ‘Delete Service’
- Select the desired ‘Client ID’.
- Enter the desired ‘Start Date’.
- Click the ‘End Date’ ‘T’ button.
- Select ‘No’ in ‘Would You Like To Post A Charge Reversal Against The Selected Services’.
- Click [Display Client].
- Select the payment in the ‘Service Delete’ checklist.
- Click [OK].
- Click [Delete].
- Click [OK].
- Click [Yes].
- Click [OK].
- Close the form.
- Open ‘Delete Last Movement’.
- Enter desired client in ‘Select Client’.
- Click [OK].
- Click [OK].
- Click [OK].
- Select the ‘Episode Number’.
- Click [Submit].
- Click [Yes].
- Open ‘Client Delete’.
- Click [OK].
- Enter the desired ‘Client ID’.
- Click [Submit].
- Use Crystal Reports or other SQL reporting tool to query the 'SYSTEM.unacknowledged_payments' table, specific to the client. Validate that no results are returned.
Scenario 7: Change MR# - Validate 'SYSTEM.unacknowledged_payments' table.
Specific Setup:
- Registry Settings:
- Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = Y.
- Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = ‘5’ at a minimum.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- Admit a new test client that will be used in the ‘Change MR#’ form. Note the client’s ID.
- Assign a Financial Eligibility record to the client.
- Use 'Client Charge Input' to place a charge on the client's account.
- Use 'Deposit Entry' to post a payment to the client. Note the details of the payment.
- Use Crystal Reports or other SQL reporting tool to query the 'SYSTEM.unacknowledged_payments' table, specific to the client. Validate that payment data is correct. Save the query.
Steps
- Open ‘Change MR#’.
- Select the client admitted above.
- Click [Assign MR#].
- Validate that the ‘New Client ID#’ contains a different client ID noted in setup. Note the ID.
- Click [Submit].
- Use Crystal Reports or other SQL reporting tool to query the 'SYSTEM.unacknowledged_payments' table, specific to the client ID noted in setup.
- Validate that no results are returned.
- Use Crystal Reports or other SQL reporting tool to query the 'SYSTEM.unacknowledged_payments' table, specific to the client ID noted in ‘Change MR#’.
- Validate that the results data is the same as the saved query, except for ‘PATID’, which will contain the ID noted in ‘Change MR#’.
- Close the query.
myHealthPointe payments
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Posting/Adjustment Codes Definition
- User Definition
- Credit Card Configuration
- Deposit Entry
- System Task Scheduler
- CareFabric Monitor
- Dictionary Update (PM)
- Payment Acknowledgement
Scenario 1: CareFabric – Receive ‘Payment Information’ from myHealthPointe - Validate 'SYSTEM.unacknowledged_payments' table.
Specific Setup:
- Registry Settings:
- Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = Y.
- Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = ‘0'.
- 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:
- 'Payment' definitions exist. The 'Payment' definition may be a 'Credit' (payment) or a 'Debit' (reversal). The definitions may have a value in the ‘Payment Acknowledgement Type’ field. Only 'Payment' definitions will be available in the 'Payment Acknowledgement' section of the 'Payment Acknowledgement' form.
- 'Adjustment' definitions exist. The definitions may have a value in the ‘Payment Acknowledgement Type’ field. All ‘Adjustment’ and 'Payment' definitions will be available in the ‘Payment Acknowledgement’ form in the ‘Post Payment Accounting Entry' section of the 'Payment Acknowledgement' form.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- Agency uses the myHealthPointe payment portal to accept patient electronic payments.
- Clients:
- Client 1:
- Is enrolled in myAvatar and has an outstanding Self-Pay balance.
- Payment is made in the myHealthPointe payment portal. Note all information regarding the payment.
- Client 2: Is enrolled in myAvatar and has an outstanding Self-Pay balance.
- Tester can create a query of SQL tables.
Steps
- Create a query of the 'SYSTEM.billing_pay_adj_history' table, specific to 'Client 1' using the 'PATID'.
- Validate the data for the following fields and any other desired fields: 'GUARANTOR_ID', 'date_of_payment', 'payment_amount', and 'option_id' which will contain 'PatientPortal' indicating that the payment was made in the myHealthPointe payment portal.
- Open 'CareFabric Monitor'.
- Validate the PatientPortalPaymentProcessed dialog contains "1. Payment Amount 2. Payment method: ACH or CC 3. Account ID 4. Transactional ID".
- Open 'Client Ledger' and process the report.
- Validate that the payment displays in the report.
- Close the report.
- Close the form.
- Open 'Registry Settings'.
- Change the value of the 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting to include minimum values of '5&6',
- Click [Submit].
- Click [OK].
- Click [No].
- A payment is made in the myHealthPointe payment portal. Note all information regarding the payment.
- Create a query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 2, using the 'PATID'.
- Validate that payment data is correct. Save the query.
- Open 'Client Ledger' and process the report.
- Validate that the payment does not display in the report.
- Close the report.
- Close the form.
- Open the 'Payment Acknowledgement' form.
- Select the 'Post Front Office and myHP Payments' section.
- Click 'T' in 'Payment Collection Date'.
- Select desired value in 'Treatment Service'.
- Select 'myHP' in 'Type'.
- Click [Review].
- Select the row specific to 'Client 2'.
- Click [OK].
- Enter desired 'Batch Number'.
- Enter desired 'Deposit Date'.
- Select desired 'Category'.
- Enter desired 'Bank Ref#'.
- Enter desired 'Comments'.
- Click [Post].
- Refresh the query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 2.
- Validate that the table no longer contains data for 'Client 2'.
- Create a query of the 'SYSTEM.billing_pay_adj_history' table, specific to 'Client 2' using the 'PATID'.
- Validate the data for the following fields and any other desired fields: 'GUARANTOR_ID', 'date_of_payment', 'payment_amount', and 'option_id' which will contain 'PatientPortal' indicating that the payment was made in the myHealthPointe payment portal.
- Open 'CareFabric Monitor'.
- Validate the PatientPortalPaymentProcessed dialog contains "1. Payment Amount 2. Payment method: ACH or CC 3. Account ID 4. Transactional ID".
- Open 'Client Ledger' and process the report.
- Validate that the payment displays in the report.
- Close the report.
- Close the form.
Scenario 2: CareFabric – Receive ‘Payment Information’ from myHealthPointe - Validate 'SYSTEM.unacknowledged_payments' table.
Specific Setup:
- Registry Settings:
- Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = Y.
- Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = ‘0'.
- 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:
- 'Payment' definitions exist. The 'Payment' definition may be a 'Credit' (payment) or a 'Debit' (reversal). The definitions may have a value in the ‘Payment Acknowledgement Type’ field. Only 'Payment' definitions will be available in the 'Payment Acknowledgement' section of the 'Payment Acknowledgement' form.
- 'Adjustment' definitions exist. The definitions may have a value in the ‘Payment Acknowledgement Type’ field. All ‘Adjustment’ and 'Payment' definitions will be available in the ‘Payment Acknowledgement’ form in the ‘Post Payment Accounting Entry' section of the 'Payment Acknowledgement' form.
- User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
- Agency uses the myHealthPointe payment portal to accept patient electronic payments.
- Clients:
- Client 1:
- Is enrolled in myAvatar and has an outstanding Self-Pay balance.
- Payment is made in the myHealthPointe payment portal. Note all information regarding the payment.
- Client 2: Is enrolled in myAvatar and has an outstanding Self-Pay balance.
- Tester can create a query of SQL tables.
Steps
- Create a query of the 'SYSTEM.billing_pay_adj_history' table, specific to 'Client 1' using the 'PATID'.
- Validate the data for the following fields and any other desired fields: 'GUARANTOR_ID', 'date_of_payment', 'payment_amount', and 'option_id' which will contain 'PatientPortal' indicating that the payment was made in the myHealthPointe payment portal.
- Open 'CareFabric Monitor'.
- Validate the PatientPortalPaymentProcessed dialog contains "1. Payment Amount 2. Payment method: ACH or CC 3. Account ID 4. Transactional ID".
- Open 'Client Ledger' and process the report.
- Validate that the payment displays in the report.
- Close the report.
- Close the form.
- Open 'Registry Settings'.
- Change the value of the 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting to include minimum values of '5&6',
- Click [Submit].
- Click [OK].
- Click [No].
- A payment is made in the myHealthPointe payment portal. Note all information regarding the payment.
- Create a query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 2, using the 'PATID'.
- Validate that payment data is correct. Save the query.
- Open 'Client Ledger' and process the report.
- Validate that the payment does not display in the report.
- Close the report.
- Close the form.
- Open the 'Payment Acknowledgement' form.
- Select the 'Post Front Office and myHP Payments' section.
- Click 'T' in 'Payment Collection Date'.
- Select desired value in 'Treatment Service'.
- Select 'myHP' in 'Type'.
- Click [Review].
- Select the row specific to 'Client 2'.
- Click [OK].
- Enter desired 'Batch Number'.
- Enter desired 'Deposit Date'.
- Select desired 'Category'.
- Enter desired 'Bank Ref#'.
- Enter desired 'Comments'.
- Click [Post].
- Refresh the query of the 'SYSTEM.unacknowledged_payments' table, specific to Client 2.
- Validate that the table no longer contains data for 'Client 2'.
- Create a query of the 'SYSTEM.billing_pay_adj_history' table, specific to 'Client 2' using the 'PATID'.
- Validate the data for the following fields and any other desired fields: 'GUARANTOR_ID', 'date_of_payment', 'payment_amount', and 'option_id' which will contain 'PatientPortal' indicating that the payment was made in the myHealthPointe payment portal.
- Open 'CareFabric Monitor'.
- Validate the PatientPortalPaymentProcessed dialog contains "1. Payment Amount 2. Payment method: ACH or CC 3. Account ID 4. Transactional ID".
- Open 'Client Ledger' and process the report.
- Validate that the payment displays in the report.
- Close the report.
- Close the form.
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Topics
• Payment Acknowledgement
• Deposit Entry
• File Import
• Registry Settings
• Web Services
• 835 Health Care Claim Payment/Advice
• Client Management
• Database Tables
• CareFabric
• CareFabric Monitor
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Support is added for other products and modules
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Financial Eligibility
- Client Charge Input
- Guarantors/Payors
- Managed Care Authorizations
- Authorization Warning
Scenario 1: Client Charge Input - Validate error message when authorizations are required
Specific Setup:
- A guarantor is defined that requires authorizations and will disallow service if missing (Guarantor A).
- A client has "Guarantor A" selected as their guarantor in 'Financial Eligibility' (Client A).
- "Client A" does not have any valid authorizations on file in 'Managed Care Authorization'.
Steps
- Access the 'Client Charge Input' form.
- Enter the current date in the 'Date Of Service' field.
- Select "Client A" in the 'Client ID' field.
- Select the desired value in the 'Service Code' field.
- Select the desired practitioner in the 'Practitioner' field.
- Validate an error message is displayed stating: No valid authorizations found on file.
- Click [OK] and close the form.
Scenario 2: Client Charge Input - Validate warning message when authorizations are required
Specific Setup:
- A guarantor is defined that requires authorizations and will warn if missing (Guarantor A).
- A client has "Guarantor A" selected as their guarantor in 'Financial Eligibility' (Client A).
- "Client A" does not have any valid authorizations on file in 'Managed Care Authorization'.
Steps
- Access the 'Client Charge Input' form.
- Enter the current date in the 'Date Of Service' field.
- Select "Client A" in the 'Client ID' field.
- Select the desired value in the 'Service Code' field.
- Select the desired practitioner in the 'Practitioner' field.
- Validate a warning message is displayed stating: No valid authorizations found on file.
- Click [OK] and [Submit]. Please note: since this is just a warning, the user can proceed without authorization, if desired.
- Access the 'Client Ledger' form.
- Select "Client A" in the 'Client ID' field.
- Select "All Episodes" in the 'Claim/Episode/All Episodes' field.
- Select "Simple" in the 'Ledger Type' field.
- Select "Yes" in the 'Include Zero Charges' field.
- Click [Process].
- Validate the report contains the service filed in the previous steps.
- Close the report and the form.
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Topics
• Client Charge Input
• Client Ledger
• Managed Care Authorizations
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Avatar PM 'Summary Trial Balance Report'
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Summary Trial Balance Report
Scenario 1: 'Summary Trial Balance Report' - Verification of report results
Steps
- Open Avatar PM 'Summary Trial Balance Report' form (under 'Avatar PM / Billing / Billing Reports / Monthly Closeout Reports' menu).
- Enter/select values for 'Summary Balance As Of ', 'Aging Category' and 'Include Bad Debt Information' report criteria fields.
- Click 'Process' button to run report/render result data.
- Ensure that 'Summary Trial Balance Report' results are rendered/displayed in the default report format within myAvatar/Avatar NX.
- In 'Summary Trial Balance Report' results display, ensure that the following information fields are present:
- 'Run Date' (current date)
- 'As Of' (from 'Summary Balance As Of' report criteria field)
- 'Revenue Group'
- 'Unbilled' report information
- 'Financial Class'
- 'In-House' (with dollar values)
- 'Disc' (discharged; with dollar values)
- 'Days' (with value)
- 'Total'/'Totals' (with dollar values)
- 'Billed' report information
- 'Financial Class'
- Aging Categories (default or custom entered/edited values as defined in 'Aging Category' report criteria field; '0', '30', '120', etc; with dollar values)
- 'Total'/'Totals' (with dollar values)
- Ensure that 'Summary Trial Balance Report' results display includes information/dollar values for all fields/groupings noted above with expected values based on unbilled/billed services and payments present in Avatar PM system for selected 'Summary Balance As Of' report criteria date, including 'Total'/'Totals' calculated values.
- Ensure that Summary Trial Balance Report' results display includes 'ALL' Revenue Group summary information (summary totals for report information); ensure that 'ALL' Revenue Group summary information includes information/dollar values for all fields/groupings noted above display with expected values based on unbilled/billed services and payments present in Avatar PM system for selected 'Summary Balance As Of' report criteria date, including 'Total'/'Totals' calculated values.
- In 'Summary Trial Balance Report' results display, click 'Print All Pages', 'Print Page', 'Export All Pages' and/or 'Export Page' button to print or export/save report data as desired.
- Click 'Close' button to close 'Summary Trial Balance Report' results display.
Scenario 2: 'Summary Trial Balance Report' - Verification of .CSV format report results
Steps
- Open Avatar PM 'Summary Trial Balance Report' form (under 'Avatar PM / Billing / Billing Reports / Monthly Closeout Reports' menu).
- Enter/select values for 'Summary Balance As Of ', 'Aging Category' and 'Include Bad Debt Information' report criteria fields.
- Ensure 'Export Detail Information to CSV' field is present in form, with 'Yes' checkbox/selection available.
- No selection in the 'Export Detail Information to CSV' field will render report results in the default report format
- Selecting 'Yes' in the 'Export Detail Information to CSV' field will display report 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 'Summary Trial Balance Report' results are rendered/displayed in the default report format.
- If 'Yes' is selected for 'Export Detail Information to CSV' field, ensure that 'Summary Trial Balance Report' results are rendered/displayed in .CSV format within myAvatar/Avatar NX, with following header and individual data rows present:
- 'Summary Trial Balance Report' .CSV format data header (first row in report data results) will contain the following data elements:
- 'RRG'
- 'RRG Description'
- 'Financial Class'
- 'Financial Class Description'
- 'Unbilled In-House'
- 'Unbilled Disch'
- 'Days'
- Aging Categories (default or custom entered/edited values as defined in 'Aging Category' report criteria field; 'Aging 0', 'Aging 30', 'Aging 60', 'Aging 120', etc.)
- Header row examples:
- "RRG,RRG Description,Financial Class,Financial Class Description,Unbilled In-House,Unbilled Disch,Days,Billed/Aging Category 0,Billed/Aging Category 30,Billed/Aging Category 60,Billed/Aging Category 90,Billed/Aging Category 120,Total"
- "RRG,RRG Description,Financial Class,Financial Class Description,Unbilled In-House,Unbilled Disch,Days,Billed/Aging Category 5,Billed/Aging Category 10,Billed/Aging Category 20,Billed/Aging Category 30,Billed/Aging Category 40,Billed/Aging Category 50,Billed/Aging Category 60,Total"
- 'Total'
- 'Summary Trial Balance 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:
- "5,Outpatient Substance Abuse,7,Medicare Part A,2397.15,0.00,0,1181.21,0.00,0.00,0.00,815.00,4393.36"
- "1,Inpatient Psychiatric,10,Non-Recoverable,18635.12,6000.50,0,3360.52,88.00,1500.00,200.00,6526.80,40022.44"
- "5,Outpatient Psychiatric,3,Blue Cross,1176903.89,0.00,0,1476.11,0.00,0.00,0.00,0.00,0.00,12365.15,1190745.15"
- In 'Summary Trial Balance 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.
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Topics
• NX
• Summary Trial Balance Report
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Validate the 'Problem Classification' field in 'Diagnosis' form populates with selections.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Dictionary Update (CWS)
- Diagnosis
Scenario 1: 'Diagnosis' form 'Problem Classification' field validation when defaulting diagnosis from a previous episode.
Specific Setup:
- Avatar CWS->Problem List->->->->Problem Classification Required
- A new code has been added to the Avatar CWS 'Dictionary Update' file 'Problem Classification'. This is in field 16250.
Steps
- Open 'Diagnosis' for any client.
- Add a new diagnosis for the client. Note the episode selected as it will be used in later steps.
- Complete required fields as needed.
- Select 'Y' in the 'Add to Problem List' field.
- Do not populate the 'Problem Classification' field at this time.
- Click [Submit].
- Enter the 'Diagnosis' form again for the same client.
- Select 'Add' on the pre-display. Do not select the existing diagnosis.
- Select the episode used in the above steps in the 'Select Episode To Default Diagnosis Information From' field.
- Select the diagnosis entered in the above steps in the 'Select Diagnosis To Default Information From' field.
- Click on the existing diagnosis row to populate the detail fields.
- Click on the 'Problem Classification' field. Verify that all codes for selection display in the drop down list, including the newly added code (see Setup section).
- Select a code from the drop down list.
- Click [Submit].
- Click [No] on the 'Pre-Display Confirmation: Do you want to return to Pre-Display?' pop up window.
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Topics
• Diagnosis
• NX
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