Avatar PM 2022 Quarterly Release 2022.01 Acceptance Tests

• Guarantors/Payors:
• An existing guarantor is identified. Note the guarantor name / id.
• Guarantor/Program Billing Defaults:
• 837 Professional section:
• Set the 'Select Type Of Information To Include In Rendering Provider Name (2310B)' field to the 'Rendering Practitioner for the Majority of Services' option.
• Practitioner Enrollment:
• Two practitioners are identified, or two new practitioners are created with NPI number. Note the practitioner id/name.
• Admission:
• A new client is admitted in the outpatient program. Note the client id / name.
• Financial Eligibility:
• The guarantor identified above is assigned to the client as the primary guarantor.
• Diagnosis:
• An admission diagnosis record is created for the client.
• Service Codes:
• Two existing professional service codes are identified. Note the service code.
• Service Fee/Cross Reference Maintenance:
• Make sure the fee definition is created for the service code and CPT Code is assigned to the service fee definition.
• Client Charge Input: The test will require one practitioner to provide more services than the other practitioner.
• Enter desired number of services for practitioner 1, using service code 1. Note the dates of service.
• Enter desired number of services for practitioner 2, using service code 2, different dates of service, and providing at least one more service that practitioner 1 provided.
• Client Ledger:
• All the services rendered to the client are distributed correctly to the guarantor assigned to the client.
• Close Charges:
• All the services rendered to the client are closed.
• Create Interim Billing Batch:
• An interim billing batch is created to include client, guarantor and services rendered to the client.

1. Open an 'Electronic Billing' form.
2. Compile an 837 professional bill.
3. Verify the bill compiles successfully.
4. Review the dump file.
5. Verify the dump file includes rendering practitioner with the highest service count in the 2310B loop (NM1*82 at claim level) of the bill.
6. Close the form.

• Guarantors/Payors:
• An existing guarantor is identified. Note the guarantor name / id.
• Guarantor/Program Billing Defaults:
• 837 Professional section:
• Set the 'Select Type Of Information To Include In Rendering Provider Name (2310B)' field to the 'Rendering Practitioner for the Majority of Services' option.
• Practitioner Enrollment:
• Two practitioner are identified, or two new practitioners are created with NPI number to be used as a rendering practitioner while rendering services to the client. Note the practitioner id / name.
• Two practitioner are identified, or two new practitioners are created with NPI number to be used as a supervising practitioner of the rendering practitioner. Note the practitioner id/name.
• Practitioner Numbers by Guarantor and Program:
• A supervising practitioner is selected for each rendering practitioner.
• Admission:
• A new client is admitted in the outpatient program. Note the client id / name.
• Financial Eligibility:
• The guarantor identified above is assigned to the client as the primary guarantor.
• Diagnosis:
• An admission diagnosis record is created for the client.
• Service Codes:
• Two existing professional service codes are identified. Note the service code.
• Service Fee/Cross Reference Maintenance:
• Make sure the fee definition is created for the service code and CPT Code is assigned to the service fee definition.
• Client Charge Input: The test will require one practitioner to provide more services that the other practitioner.
• Enter desired number of services for practitioner 1, using service code 1. Note the dates of service.
• Enter desired number of services for practitioner 2, using service code 2, different dates of service, and providing at least one more service that practitioner 1 provided.
• Client Ledger:
• All the services rendered to the client are distributed correctly to the guarantor assigned to the client.
• Close Charges:
• All the services rendered to the client are closed.

1. Open an 'Electronic Billing' form.
2. Compile an 837 professional bill.
3. Verify the bill compiles successfully.
4. Review the dump file.
5. Verify the dump file includes correct supervising practitioner with the highest service count in the 2310B loop (NM1*82 at claim level) of the bill.
6. Close the form.

• Guarantors/Payors:
• An existing guarantor is identified. Note the guarantor name / id.
• Guarantor/Program Billing Defaults:
• 837 Professional section:
• Set the 'Select Type Of Information To Include In Rendering Provider Name (2310B)' field to the 'Rendering Practitioner for the Majority of Services' option.
• Practitioner Enrollment:
• Two practitioners are identified, or two new practitioners are created with NPI number. Note the practitioner id/name.
• Admission:
• A new client is admitted in the outpatient program. Note the client id / name.
• Financial Eligibility:
• The guarantor identified above is assigned to the client as the primary guarantor.
• Diagnosis:
• An admission diagnosis record is created for the client.
• Service Codes:
• Two existing professional service codes are identified. Note the service code.
• Service Fee/Cross Reference Maintenance:
• Make sure the fee definition is created for the service code and CPT Code is assigned to the service fee definition.
• Client Charge Input: The test will require same count of the services are rendered by each practitioner.
• Enter desired number of services for practitioner 1, using service code 1. Note the dates of service.
• Enter desired number of services for practitioner 2, using service code 2, different dates of service. Note the id/name of the practitioner used as a rendering practitioner.
• Client Ledger:
• All the services rendered to the client are distributed correctly to the guarantor assigned to the client.
• Close Charges:
• All the services rendered to the client are closed.
• Create Interim Billing Batch:
• An interim billing batch is created to include client, guarantor and services rendered to the client.

1. Open an 'Electronic Billing' form.
2. Compile an 837 professional bill.
3. Verify the bill compiles successfully.
4. Review the dump file.
5. Verify the dump file includes the practitioner with the earliest service date in the 2310B loop (NM1*82 at claim level) of the bill.
6. Close the form.

• Guarantors/Payors:
• An existing guarantor is identified. Note the guarantor name / id.
• Guarantor/Program Billing Defaults:
• 837 Institutional section:
• Set the ‘Specify Rendering Practitioner As Attending Practitioner In Loop 2310A (Attending Physician Name)’ field to 'Y'.
• Practitioner Enrollment:
• Four practitioners are identified, or new practitioners are created with NPI number to be used as an admitting, attending, and rendering practitioner. Note the practitioner id/name.
• Admission:
• A new client is admitted in the inpatient program. Note the client id / name.
• Financial Eligibility:
• The guarantor identified above is assigned to the client as the primary guarantor.
• Diagnosis:
• An admission diagnosis record is created for the client.
• Service Codes:
• Two existing professional service codes are identified. Note the service code.
• Service Fee/Cross Reference Maintenance:
• Make sure the fee definition is created for the service code and CPT Code is assigned to the service fee definition.
• Client Charge Input: Client Charge Input: The test will require one practitioner to provide more services that the other practitioner.
• Enter desired number of services for practitioner 1, using service code 1. Note the dates of service.
• Enter desired number of services for practitioner 2, using service code 2, different dates of service, and providing at least one more service that practitioner 1 provided.
• Client Ledger:
• All the services rendered to the client are distributed correctly to the guarantor assigned to the client.
• Close Charges:
• All the services rendered to the client are closed.
• Create Interim Billing Batch:
• An interim billing batch is created to include client, guarantor and services rendered to the client.

1. Open an 'Electronic Billing' form.
2. Compile an 837 professional bill.
3. Verify the bill compiles successfully.
4. Review the dump file.
5. Verify the dump file includes attending practitioner in the 2310A loop (NM1*71 at claim level) of the bill.
6. Close the form.
7. Open the ' Guarantor / Program Billing Defaults' form.
8. Set the ‘Specify Rendering Practitioner As Attending Practitioner In Loop 2310A (Attending Physician Name)’ field to 'Y'.
9. Open the 'Practitioner Numbers By Guarantor And Program' form.
10. Create an entry of rendering practitioner, Guarantor and Program.
11. Open an 'Electronic Billing' form.
12. Compile an 837 professional bill.
13. Verify the bill compiles successfully.
14. Review the dump file.
15. Verify the dump file includes rendering practitioner as an attending practitioner in the 2310A loop (NM1*71 at claim level) of the bill.
16. Close the file.
17. Close the form.

• Admission:
• An existing outpatient client is identified, or a new client is admitted to the outpatient program. Note the client ID/name, admission program code/value, admission date.
• Financial Eligibility:
• An existing non contract guarantor is identified. Note the Guarantor name and ID.
• Diagnosis:
• A diagnosis record is created for the client.
• Client Charge Input:
• The professional service is rendered to the client. Make sure there is a practitioner for the services. Note the practitioner category of your test practitioner via the Practitioner Enrollment form (Categories/Taxonomy section). Note the service code, date of the service and place of service.
• Client Ledger:
• Verify the services distributed correctly to the guarantor assigned to the client.
• Close Charges:
• Close the charges rendered to the client.

1. Open the 'CPT Place of Service Override' form.
2. Select desired financial class(es) in the 'Financial Class Selection' field.
3. Select desired guarantor(s) in the 'Guarantor' field.
4. Select desired treatment setting(s) in the 'Treatment Setting Selection' field.
5. Select desired program(s) for the override in the 'Program' field. Note: This is the program of admission and not the program of service. Note the admission program code/value.
6. Select desired value in the 'All or Individual Service Code' field. Note: Specify whether the override should apply to all service codes or just one individual code. If Individual, select the specific code in the Service Code field. Note the code/value.
7. Select desired value in the 'All or Individual CPT Code' field. Note: Specify whether the override should apply to all CPT codes or just one individual code. If Individual, select the specific code in the CPT Code field. Note the CPT code/value.
8. Select desired value in the 'All or Individual Location' field, specify whether the override should apply to all locations or just one specific location. If Individual, select the same location that is used during rendering the service to the client from the setup section. Note the code/value.
9. Select the place of service for use on the paper HCFA bill in the 'Place of Service (HCFA 24-B)' field. Note the location code/value.
10. Select the place of service for use on the 837 Professional bill in the 'Place of Service (837 Professional)' field.
11. Click [Display CPT Place of Service Overrides].
12. Verify a CPT Place of Service Overrides report launched.
13. Review the report.
14. Verify the 'HCFA 24-B' and '837 Professional' fields display the correct data.
15. Click [Submit].
16. Open the 'Crystal Report' or any other 'SQL Data Viewer'.
17. Query the 'System.table_cpt_place_override' table.
18. Verify the 'HCFA 24-B' and '837 Professional' fields display the correct data.
19. Open the 'Electronic Billing' form.
20. Compile the 837 Professional bill for the interim billing batch created in the setup section.
21. Verify the file compiles successfully.
22. Dump the file.
23. Review an 837 professional file.
24. Verify the 2300-CLM 05 and 2400-SV1 05 segments displays the correct place of the service.
25. Close the file.
26. Close the form.

• Admission:
• An existing outpatient client is identified, or a new client is admitted to the outpatient program. Note the client id/name, admission program code/value, admission date.
• Financial Eligibility:
• An existing non contract guarantor is identified. Note the Guarantor name and ID.
• Diagnosis:
• A diagnosis record is created for the client.
• Client Charge Input:
• The professional service is rendered to the client. Make sure there is a practitioner for the services. Note the practitioner category of your test practitioner via the Practitioner Enrollment form (Categories/Taxonomy section). Note the service code, date of the service and place of service.
• Client Ledger:
• Verify the services distributed correctly to the guarantor assigned to the client.
• Close Charges:
• Close the charges rendered to the client.

1. Open the 'CPT Place of Service Override' form.
2. Select desired financial class(es) in the 'Financial Class Selection' field.
3. Select desired guarantor(s) in the 'Guarantor' field.
4. Select desired treatment setting(s) in the 'Treatment Setting Selection' field.
5. Select desired program(s) for the override in the 'Program' field. Note: This is the program of admission and not the program of service. Note the admission program code/value.
6. Select desired value in the 'All or Individual Service Code' field. Note: Specify whether the override should apply to all service codes or just one individual code. If Individual, select the specific code in the Service Code field. Note the code/value.
7. Select desired value in the 'All or Individual CPT Code' field. Note: Specify whether the override should apply to all CPT codes or just one individual code. If Individual, select the specific code in the CPT Code field. Note the CPT code/value.
8. Select desired value in the 'All or Individual Location' field, specify whether the override should apply to all locations or just one specific location. If Individual, select the same location that is used during rendering the service to the client from the setup section. Note the code/value.
9. Select the place of service for use on the paper HCFA bill in the 'Place of Service (HCFA 24-B)' field. Note the location code/value.
10. Select the place of service for use on the 837 Professional bill in the 'Place of Service (837 Professional)' field.
11. Click [Display CPT Place of Service Overrides].
12. Verify a CPT Place of Service Overrides report launched.
13. Review the report.
14. Verify the 'HCFA 24-B' and '837 Professional' fields display the values selected in the form correctly.
15. Click [Submit].
16. Open the 'Crystal Report' or any other 'SQL Data Viewer'.
17. Query the 'System.table_cpt_place_override' table.
18. Verify the 'hcfa_place_of_svc_value' and 'p837_place_of_svc_value' fields display the values selected in the form correctly.
19. Open the 'Print Bill' form.
20. Select 'No' in the 'Create Claims (Y/N)' field.
21. Select 'HCFA-1500 NPI Version' in the 'Print On What Form' field.
22. Select 'No' in the 'Print For Interim Batch'.
23. Select desired guarantor in the 'Guarantor #' field.
24. Select 'Individual' in the 'Print For An Individual Or All Clients' field.
25. Select desired client in the 'Client ID' field.
26. Select 'Yes' in the 'All Episodes' field.
27. Click [Process].
28. Review the report.
29. Verify the correct place of value displays on the bill.
30. Click [X].
31. Click [No].

• Registry Setting:
• The "Enable 'Admission vs. Service Program' Functionality" registry setting is set to 'Y'.
• Program Maintenance:
• Two new outpatient admission programs are created such that there is no overlap of the associated service programs between the two admission programs. Note the admission programs and associated service programs.
• Admission (Outpatient):
• The client is admitted in to the first admission program.
• Client Charge Input:
• A service is rendered to the client under one of the associated service programs. Note the service date and service code.
• Program Transfer (Outpatient):
• The client is transferred in to the second admission program.

1. Open the 'Edit Service Information' form.
2. Fill in all required fields.
3. Click [Select Service(s) to Edit].
4. Verify the 'Select Service(s) to Edit' dialog box launched with all the services rendered to the selected client.
5. Select desired service to edit.
6. Verify the 'Program' field is populated with the service programs that was associated with the admission program at the time of service creation.
7. Submit the form.
8. Verify the form submits successfully.

• Registry Setting:
• The "Enable 'Admission vs. Service Program' Functionality" registry setting is set to 'Y'.
• Program Maintenance:
• Two new outpatient admission programs are created such that there is no overlap of the associated service programs between the two admission programs. Note the admission programs and associated service programs.
• Admission (Outpatient):
• The client is admitted in to the first admission program.
• Client Charge Input:
• A service is rendered to the client under one of the associated service programs. Note the service date and service code.

1. Open the 'Edit Service Information' form.
2. Fill in all required fields.
3. Click [Select Service(s) to Edit].
4. Verify the 'Select Service(s) to Edit' dialog box launched with all the services rendered to the selected client.
5. Select desired service to edit.
6. Verify the 'Program' field is populated with the service programs that were associated with the admission program at the time of service creation.
7. Change the service program.
8. Enter desired practitioner.
9. Submit the form.
10. Verify the form submits successfully.

• Registry Setting:
• The 'Enable Incident-To Practitioner' registry setting is set to 'YC'.
• The 'Service Panel Charge Input - Fields To Include' registry setting is set to desired value to add 'Service Start Time' and 'Service End Time' fields to 'Service Panel Charge Input' form.
• Practitioner Enrollment:
• Create a new practitioner or edit an existing practitioner. Note the practitioner id and practitioner name.
• The 'Incident-To Practitioner' field is set to "Yes" for the practitioner identified above.
• Service Code:
• Parent service codes should be defined before they are used in this form. Note the service code.
• Service Fee/Cross Reference:
• The service fee is defined for the service code.
• The 'Incident-To' field is set to Y.

1. Open the 'Incident-To Practitioner Daily Log' form.
2. Select the 'Add Daily Log Entry' tab.
3. Select the practitioner identified in the setup section. Note the practitioner.
4. Select the desired date to 'Date' field. Note the date.
5. Select 'Start Time'. Note the time.
6. Select the 'End time'. Note the time.
7. Select desired 'Location'. Note the location.
8. Click [File Entry].
9. Validate the 'Information' dialogue contains 'Filed Successfully' message.
10. Click [OK].
11. Open the 'Service Panel' form.
12. Select 'Add' In the 'Add New or Edit Existing Service Panel' field.
13. Select an existing service code in the 'Service Code' field (i.e. Service Code 1).
14. Enter desired date based on the date defined in the 'Effective Date' field.
15. Select 'Yes' in the 'File The Parent Service With This Panel' field.
16. Select another existing service code from the 'Select Service Code To Add To Panel' search box (i.e. Service Code 2).
17. Click [Add selected Service To Panel].
18. Verify the service code selected is displayed in the 'Service Panel' item.
19. Submit the form.
20. Verify that the form submitted successfully.
21. Open the 'Service Panel Charge Input' form.
22. Enter desired date in the 'Date Of Service' field.
23. Select the client in the 'Client ID' field.
24. Enter 'Service Start Time' based on the time range defined for the Incident-To Practitioner in the 'Incident-To Practitioner Daily Log' form.
25. Enter 'Service End Time' based on the time range defined for the Incident-To Practitioner in the 'Incident-To Practitioner Daily Log' form.
26. Select the 'Panel Description'.
27. Select the 'Panel Service(s)'.
28. Select the 'Incident-To Practitioner'.
29. Verify the panel service files successfully.
30. Open the 'Crystal Report' or any other SQL data viewer.
31. Query the 'SYSTEM.billing_tx_history' SQL table.
32. Verify the Incident To practitioner is filed correctly for the service.

• Registry Setting:
• The 'Enable Incident-To Practitioner' registry setting is set to 'Y'.
• The 'Service Panel Charge Input - Fields To Include' registry setting is set to desired value to add 'Service Start Time' and 'Service End Time' fields to 'Service Panel Charge Input' form.
• Practitioner Enrollment:
• Create a new practitioner or edit an existing practitioner. Note the practitioner id and practitioner name.
• The 'Incident-To Practitioner' field is set to "Yes" for the practitioner identified above.
• Service Code:
• Parent service codes should be defined before they are used in this form. Note the service code.
• Service Fee/Cross Reference:
• The service fee is defined for the service code.
• The 'Is This Incident-To Service' field is set to 'Y'.

1. Open the 'Incident-To Practitioner Daily Log' form.
2. Select the 'Add Daily Log Entry' tab.
3. Select the practitioner identified in the setup section. Note the practitioner.
4. Select the desired date to 'Date' field. Note the date.
5. Select 'Start Time'. Note the time.
6. Select the 'End time'. Note the time.
7. Select desired 'Location'. Note the location.
8. Click [File Entry].
9. Validate the 'Information' dialogue contains 'Filed Successfully' message.
10. Click [OK].
11. Open the 'Service Panel' form.
12. Select 'Add' In the 'Add New or Edit Existing Service Panel' field.
13. Select an existing service code in the 'Service Code' field (i.e. Service Code 1).
14. Enter desired date based on the date defined in the 'Effective Date' field.
15. Select 'Yes' in the 'File The Parent Service With This Panel' field.
16. Select another existing service code from the 'Select Service Code To Add To Panel' search box (i.e. Service Code 2).
17. Click [Add selected Service To Panel].
18. Verify the service code selected is displayed in the 'Service Panel' item.
19. Submit the form.
20. Verify that the form submitted successfully.
21. Open the 'Service Panel Charge Input' form.
22. Enter desired date in the 'Date Of Service' field.
23. Select the client in the 'Client ID' field.
24. Enter 'Service Start Time' based on the time range defined for the Incident-To Practitioner in the 'Incident-To Practitioner Daily Log' form.
25. Enter 'Service End Time' based on the time range defined for the Incident-To Practitioner in the 'Incident-To Practitioner Daily Log' form.
26. Select the 'Panel Description'.
27. Select the 'Panel Service(s)'.
28. Select the 'Incident-To Practitioner'.
29. Verify the panel service files successfully.
30. Open the 'Crystal Report' or any other SQL data viewer.
31. Query the 'SYSTEM.billing_tx_history' SQL table.
32. Verify the Incident To Practitioner is not filed for the service.

• Registry Setting:
• The 'Enable New Quick Billing Format' registry setting is enabled.
• Please note: This is a one-time, system-wide registry setting and the associated functionality cannot be disabled once the registry setting is enabled. Once this setting has been enabled, it will no longer be able to be viewed in the 'Registry Settings' form.
• Admission:
• Two outpatient clients are identified. Please note the admission program of the clients.
• Guarantors/Payor:
• An existing guarantor is identified.
• Financial Eligibility:
• Guarantor identified above is assigned to the clients.
• Client Charge Input:
• 1-2 days of professional charges are rendered to the clients. Please note the service codes used during rendering services.
• Client Ledger:
• The charges are distributed to the guarantors assigned to the clients.
• Quick Billing Rule Definition:
• A new quick billing rule is created as follows:
• The admission programs are selected in the 'Program' field.
• An '837 Professional' is selected in the 'Billing Form' field.
• The guarantors assigned to the clients in their financial eligibility are selected in the 'Guarantors' field.
• All required fields are populated.
• The 'Create Interim Billing Batch' field is set to 'Yes'.

1. Open the 'Quick Billing' form.
2. Run a new quick billing batch using the rule created in the setup section.
3. Use a date range spanning services entered.
4. Select 'Create Batch', 'Close Charges', and 'Generate Bills' in the 'Quick Billing Tasks To Execute' field.
5. Submit the form.
6. Verify that compile completes and the prompt states 'Compile Complete'. A Quick Billing Batch and an Interim Billing Batch will be created.
7. Select the 'Edit Existing' option.
8. Select the quick bill that was created in previous step.
9. Submit the form again.
10. Click [OK].
11. Select the 'Edit Existing' option.
12. Select the quick bill that was created in previous step.
13. Click [Print 837 Report].
14. Verify the report launched successfully.
15. Close the report.
16. Click [Launch Workscreen].
17. Verify the work screen contains all the clients included in the batch.
18. Deselect one client from the 'Client' filter at the top of the work screen.
19. Verify the grid does not display the services of that client.
20. Select the same client again from the 'Client' filter at the top of the work screen.
21. Verify the grid displays the services of that client.
22. Save the grid.
23. Verify the grid saves successfully.
24. Close the form.

• Posting/Adjustment Codes Definition:
• Identify an existing posting code. Note the code/value of the posting code.
• Security level is set up to desired level. Note the security level of the code.
• User Definition:
• Set the security level of the user to a lower level than the security level set up for the posting code identified.
• Admission:
• An existing client is identified. Note the client ID and client name.
• Financial Eligibility:
• An existing guarantor is assigned to the client. Note the guarantor code and value.
• Client Charge Input:
• 5-6 services are rendered to the client.
• Close Charges:
• The services rendered to the client are closed.
• Client Ledger:
• The services are distributed correctly to the guarantor.
• Create Interim Billing Batch:
• An interim billing batch is created to include client/guarantor and services. Note the interim billing batch number generated and name.

1. Open the 'Spreadsheet Batch Remittance Posting' form.
2. Select "Create Batch" in the "Create, Edit Or Delete Remittance Batch" field.
3. Enter a description in the “Batch Description” field. Note the batch description.
4. Select the interim billing batch created in the setup section in the 'Interim Batch Number' field.
5. Enter a date in the “Posting Date” field.
6. Enter a date in the “Date Of Receipt” field.
7. Select all other fields as required.
8. Click the "Launch Work Screen" button.
9. Validate the Client, Ep#, Payor, Begin Date/Svc Date, End Date, Total Charges, Liability fields populated correctly based on the client, guarantor and services included in the interim billing batch.
10. Validate the 'Payment Code' dropdown field does not contain the payment code created in the 'Posting /Adjustment Code Definition' form.
11. Click [Cancel].
12. Click [Close Form].
13. Open the 'User Definition' form.
14. Update the security level of the user so that it is greater than or equal to the security level of the posting code identified above in the setup section.
15. Click "Refresh Forms" icon.
16. Open the 'Spreadsheet Batch Remittance Posting' form.
17. Select "Create Batch" in the "Create, Edit Or Delete Remittance Batch" field.
18. Enter a description in the “Batch Description” field. Note the batch description.
19. Select the interim billing batch created in the setup section in the 'Interim Batch Number' field.
20. Enter a date in the “Posting Date” field.
21. Enter a date in the “Date Of Receipt” field.
22. Select all other fields as required.
23. Click the "Launch Work Screen" button.
24. Validate the Client, Ep#, Payor, Begin Date/Svc Date, End Date, Total Charges, Liability fields populated correctly based on the client, guarantor and services included in the interim billing batch.
25. Validate the 'Payment Code' dropdown field contains the payment code created in the 'Posting /Adjustment Code Definition' form.
26. Select the posting amount/code identified in the setup section.
27. Click [Accept].
28. Click [Submit].
29. Validate the 'Remittance Batch [Batch# created] Posted' message.
30. Click [OK].
31. Select "No" to form return message.

• Posting/Adjustment Codes Definition:
• Identify an existing posting code. Note the code/value of the posting code.
• Security level is set up to desired level. Note the security level of the code.
• User Definition:
• Set the security level of the user to a same level as the security level set up for the posting code identified.
• Admission:
• An existing client is identified. Note the client ID and client name.
• Financial Eligibility:
• An existing guarantor is assigned to the client. Note the guarantor code and value.
• Client Charge Input:
• 5-6 services are rendered to the client.
• Close Charges:
• The services rendered to the client are closed.
• Client Ledger:
• The services are distributed correctly to the guarantor.
• Create Interim Billing Batch:
• An interim billing batch is created to include client/guarantor and services. Note the interim billing batch number generated and name.

1. Open the 'Individual Cash Posting' form.
2. Select desired client.
3. Click the 'Select the Item(s) to Post Against'.
4. Select the desired row.
5. Enter 'Posting Date'.
6. Enter 'Date of Receipt'.
7. Select the desired 'Guarantor'.
8. Enter the 'Dollar Amount To Be Posted'.
9. Select the payment posting code set up in the setup section.
10. Click [Update Temporary Files].
11. Click [OK].
12. Click [Submit].
13. Verify the posting submitted successfully.

• Posting/Adjustment Codes Definition:
• Identify an existing posting code. Note the code/value of the posting code.
• Security level is set up to desired level. Note the security level of the code.
• User Definition:
• Set the security level of the user to a lower level than the security level set up for the posting code identified.
• Admission:
• An existing client is identified. Note the client ID and client name.
• Financial Eligibility:
• An existing guarantor is assigned to the client. Note the guarantor code and value.
• Client Charge Input:
• 5-6 services are rendered to the client.
• Close Charges:
• The services rendered to the client are closed.
• Client Ledger:
• The services are distributed correctly to the guarantor.
• Create Interim Billing Batch:
• An interim billing batch is created to include client/guarantor and services. Note the interim billing batch number generated and name.

1. Open the 'Spreadsheet Remittance Posting' form.
2. Select desired client.
3. Enter a date in the “Posting Date” field.
4. Enter a date in the “Date Of Receipt” field.
5. Select all other fields as required.
6. Click the "Launch Work Screen" button.
7. Validate the Client, Ep#, Payor, Begin Date/Svc Date, End Date, Total Charges, Liability fields populated correctly based on the client, guarantor and services included in the interim billing batch.
8. Validate the 'Payment Code' dropdown field contains the payment code created in the 'Posting /Adjustment Code Definition' form.
9. Select the payment code created in the 'Posting /Adjustment Code Definition' form.
10. Enter desired amount in the 'Payment Amount' field.
11. Click [Accept].
12. Click [Submit].
13. Verify the error message for the security level.
14. Open the 'User Definition' form.
15. Update the security level of the user such that it is greater than or equal to the security level of the posting code identified above in the setup section.
16. Open the 'Spreadsheet Remittance Posting' form.
17. Select desired client.
18. Enter a date in the “Posting Date” field.
19. Enter a date in the “Date Of Receipt” field.
20. Select all other fields as required.
21. Click the "Launch Work Screen" button.
22. Validate the Client, Ep#, Payor, Begin Date/Svc Date, End Date, Total Charges, Liability fields populated correctly based on the client, guarantor and services included in the interim billing batch.
23. Validate the 'Payment Code' dropdown field contains the payment code created in the 'Posting /Adjustment Code Definition' form.
24. Select the payment code created in the 'Posting /Adjustment Code Definition' form.
25. Enter desired amount in the 'Payment Amount' field.
26. Click [Accept].
27. Click [Submit].
28. Validate the amount posted successfully.
29. Click [X].
30. Select "No" to form return message.

;

• Identify an existing client that have at least one existing open service.

1. Open the 'Edit Service Information' form.
2. Select the desired client in the 'Client ID' field.
3. Select desired episode from the 'Episode Number' field.
4. Click [Select Service(s) To Edit].
5. Verify the 'Select Service(s) To Edit' dialog is displayed.
6. Select desired service from the 'Select Service(s) To Edit' dialog.
7. Enter a different value in the 'Duration (Minutes)' field.
8. Select a new service code in the 'Service Code' field.
9. Click [OK].
10. Submit the form.
11. Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
12. Click [No].
13. Query the 'SYSTEM.billing_tx_history' SQL table.
14. Validate the 'PATID' column is equal to the correct client id identified in the setup.
15. Validate the 'date_of_service' column is equal to correct date of service rendered to the client.
16. Validate the 'Service Code' column contains correct service code entered in the 'Edit Service Information' form.
17. Validate the 'data_entry_source' column contains 'Edit Service Information'.

• Identify an existing client that have at least one existing open service. Note the client id/name, service code and service date.

1. Open the SoapUI or any other web service testing tool.
2. Create a web service request to edit the service information.
3. Enter same value in the SYSTEMCODE which is used to sign in to Avatar.
4. Enter same value in the USERNAME which is used to sign in to Avatar.
5. Enter values for all required fields.
6. Select desired service from the 'Select Service(s) To Edit' dialog.
7. Select a new service code in the 'Service Code' field.
8. Submit the request.
9. Verify the message: "Edit Service Information web service has been filed successfully."
10. Select desired items from the 'Content' checkbox.
11. Click [Submit].
12. Open the 'Crystal Reports' or any other SQL Data Reporting tool.
13. Select the PM namespace.
14. Query the 'SYSTEM.billing_tx_history' SQL table.
15. Validate the 'PATID' column is equal to the correct client id identified in the setup.
16. Validate the 'date_of_service' column is equal to correct date of service rendered to the client.
17. Validate the 'Service Code' column contains correct service code entered in the web service request.
18. Validate the 'data_entry_source' column contains 'WEBSVC.EditServiceInformation:EditServiceInformationICD10'.

• Guarantors/Payors:
• A new guarantor is created or an existing guarantor is identified.
• Note the guarantor code/name to be used during creating financial eligibility record for the client.
• Admission:
• The client is admitted to the outpatient program or an existing outpatient client is identified. Note the admission date/program.
• Financial Eligibility:
• The guarantor identified above is assigned to the client.
• Diagnosis:
• An admission diagnosis record is created for the client.
• Dictionary Update:
• File = Client
• Dictionary Element - Location
• Dictionary Code - Desired code that is different than the default location for the admission program
• Dictionary Value - Desired value
• Extended Dictionary Data Element - Place Of Service (837 Electronic Billing)
• Extended Dictionary Value (Single Dictionary) - Desired value
• Service Codes:
• An add-on code is created of desired 'Service Code Type'. Note the code/value.
• A primary service code is created of the desired 'Service Type Code'. Note the code/value.
• Service Fee/Cross Reference Maintenance:
• Fee definitions are created for the service codes and CPT codes are assigned to the service code.
• Client Charge Input:
• A service is rendered to the client in the first episode. Be sure to use service codes that are covered by the benefit plan (insurance charge category).
• Close Charges:
• Charges are closed.
• Client Ledger:
• Verify the charges are correctly distributed to the desired guarantor, and they are in 'Unbill' status.
• Create Interim Billing Batch:
• A billing batch is created for the client, service and guarantor. Note the batch number to be used during 'Electronic Billing'.

1. Open the 'Electronic Billing' form.
2. Compile an 837 professional bill for the interim billing batch created in the setup section.
3. Verify the bill compiles successfully.
4. Dump the file.
5. Review an 837 professional dump file.
6. Verify the 'Place of Service Code' at the claim level (2300-CLM-05-1) is based on the location selected for the service.
7. Click [X].
8. Click [Discard].

• Guarantors/Payors:
• A new guarantor is created or an existing guarantor is identified.
• Note the guarantor code/name to be used during creating financial eligibility record for the client.
• Admission:
• The client is admitted to the outpatient program or an existing outpatient client is identified. Note the admission date/program.
• Financial Eligibility:
• The guarantor identified above is assigned to the client.
• Diagnosis:
• An admission diagnosis record is created for the client.
• Dictionary Update:
• File = Client
• Dictionary Element - Location
• Dictionary Code - Desired code that is different than the default location for the admission program
• Dictionary Value - Desired value
• Extended Dictionary Data Element - Place Of Service (837 Electronic Billing)
• Extended Dictionary Value (Single Dictionary) - Desired value
• Service Codes:
• An existing service code is identified or a new service code is created of desired 'Service Code Type'. Note the code/value.
• Service Fee/Cross Reference Maintenance:
• Fee definitions is created for the service code and CPT code is assigned to the service code.
• Client Charge Input:
• A service is rendered to the client in the first episode. Be sure to use service codes that are covered by the benefit plan (insurance charge category).
• Close Charges:
• Charges are closed.
• Client Ledger:
• Verify the charges are correctly distributed to the desired guarantor, and they are in 'Unbill' status.
• Create Interim Billing Batch:
• A billing batch is created for the client, service and guarantor. Note the batch number to be used during 'Electronic Billing'.

1. Open the 'Electronic Billing' form.
2. Compile an 837 professional bill for the interim billing batch created in the setup section.
3. Verify the bill compiles successfully.
4. Dump the file.
5. Review an 837 professional dump file.
6. Verify the 'Place of Service Code' at the claim level (2300-CLM-05-1) is based on the location selected for the service.
7. Click [X].
8. Click [Discard].

Set the 'Limit Registry Settings to the Following Search Criteria' to "Include Non-Chargeable Leaves in Client".

Click [View Registry Settings].

Validate the 'Registry Setting' field contains "Avatar PM->Billing->Client Ledger->->->Include Non-Chargeable Leaves in Client Ledger View".

Validate the Registry Setting Details text area contains "[FACILITY SPECIFIC] Selecting 'Y' allows for Leaves defined as non-chargeable to report on the simple view of the Client Ledger. The system will include any '(757) Type of Leave From' value that has the defined extended dictionary element '(10031) Chargeable Leave Y/N' set to 'No' as a line item on the Client Ledger. The claim view will also show all leaves.

Please Note: this will add information to the Client Ledger for reporting purposes only. The system will not generate charges for these types of Leaves.

Selecting 'N' continues to not report non-chargeable Leaves in the Client Ledger. This is the default behavior of the system."

Validate the 'Registry Setting Value' field is equal to "N".

Set the 'Registry Setting Value' input box to "1".

Validate the Error dialog contains "The selected value is not valid in the current system code for the following reason: Invalid response -- Must be Y or N".

Click [OK].

Set the 'Registry Setting Value' input box to "0".

Validate the Error dialog contains "The selected value is not valid in the current system code for the following reason: Invalid response -- Must be Y or N".

Click [OK].

Set the 'Registry Setting Value' input box to "".

Click [Submit].

Validate the Filing Error dialog contains "Filing Error The following fields are missing: Registry Setting Value"

Click [OK].

Set the Registry Setting Value input box to "@"

Validate the Error dialog contains "The selected value is not valid in the current system code for the following reason: Invalid response -- Must be Y or N".

Click [OK].

Set the Registry Setting Value input box to "Y".

Click [Submit].

Validate the Filing Results text area contains "Results filing value Y to Avatar PM->Billing->Client Ledger->->->Include Non-Chargeable Leaves in Client Ledger View Successful filing in System Code SBOX. "

Click [OK].

Validate the Form Return dialog contains "Form Return Registry Settings has completed. Do you wish to return to form?"

Click [No].

• Posting/Adjustment Codes Definition:
• Identify an existing payment, adjustment and/or transfer codes. Note the codes/values for further testing.
• Admission:
• A new client is admitted in the inpatient program. Note the client id/name, admission program, admission date.
• Guarantor/Payors:
• An existing guarantor is identified to assign to the client.
• Financial Eligibility:
• The existing guarantor is assigned to the client. Note the Guarantor code/value.
• Service Codes:
• An existing room and board service code is identified to render services to the client. Note the service code.
• Client Charge Input:
• 5-6 days of the room and board services are rendered to the client.
• Close Charges:
• The charges rendered to the client are closed.

1. Open the 'Electronic Billing' form.
2. Run an 837 Institutional bill for the client.
3. Verify the bill compiles successfully.
4. Claim the services.
5. Verify the bill compiles successfully.
6. Open the 'Client Ledger' form.
7. Process the report using 'Claim' ledger type and validate that the claim based report displays all the claim specific information.
8. Open the ‘Individual Cash Posting’ form.
9. Select the ‘Client’.
10. Select desired value in the ‘Post By’ field.
11. Click [Select Item(s) To Post Against].
12. A grid opens containing a row for all services.
13. Select a desired row.
14. Click [OK] when all desired rows have been selected.
15. Note the ‘Information’ message and the current balance for the guarantor.
16. Click [OK].
17. Enter desired value in ‘Posting Date’.
18. Enter desired value in ‘Date of Receipt’.
19. Validate that the ‘Guarantor’ defaulted to the guarantor in the current balance message.
20. Enter desired value in ‘Dollar Amount To Be Posted’. Amount entered can be the full amount due or a partial amount due.
21. Enter desired value in ‘Posting Code’.
22. If desired, enter a value in ‘Check #’.
23. Enter desired value in ‘Action For Remaining Balance If Applicable’.
24. Click [Update Temporary File].
25. If desired, continue to add payment/adjustments/transfers using the steps above for all other services.
26. Click [Submit] when all payment/adjustments/transfers have been completed.
27. Open ‘Client Ledger’ for the client’.
28. Process the report using ‘Simple' ledger type and validate that the payment/adjustments/transfers posted correctly.
29. Process the report using ‘Claim' ledger type and validate that the payment/adjustments/transfers posted correctly specific to claim.
30. Close the form.

• Registry Setting:
• The 'Include Non-Chargeable Leaves in Client Ledger View' registry setting is set to "Y".
• Dictionary Update:
• Dictionary = Client
• Data Element = Type of Leave From
• Identify an existing non-billable leave type or create a new dictionary code/value for a non-billable leave type that has the defined extended dictionary value for ‘Chargeable Leave Y/N’ set to ‘No’. Note the type of leave.
• Identify an existing same day leave type or create a new dictionary code/value for a same day leave that has the defined extended dictionary value for ‘Chargeable Leave Y/N’ set to ‘No’. Note the type of leave.
• Identify an existing billable leave type or create a new dictionary code/value for a billable leave that has the defined extended dictionary value for ‘Chargeable Leave Y/N’ set to ‘Yes’. Note the type of leave.
• Guarantor/Payors:
• An existing guarantor is identified to assign to the client.
• Admission:
• A new client is admitted in an inpatient program. Note the client id/name, admission program, admission date.
• Financial Eligibility:
• The existing guarantor is assigned to the client. Note the Guarantor code/value.
• Service Codes:
• An existing service code is identified to render services to the client. Note the service code.

1. Open the 'Client Charge Input' form.
2. Render desired days of the service to the client starting from the admission date.
3. Open the 'Leaves' form.
4. Place the client on a non-billable leave for desired days after the admission date. Note the date.
5. Open the 'Return From Leaves' form.
6. Return the client. Note the date of return.
7. Open the 'Client Charge Input' form.
8. Render desired days of the service to the client starting after date of the return.
9. Open the 'Leaves' form.
10. Place a client on a billable leave for desired days after last date of the service. Note the date.
11. Open the 'Return From Leaves' form.
12. Return the client after desired days from the leave start date. Note the date of return.
13. Open the 'Client Charge Input' form.
14. Render desired days of the service to the client after date of return.
15. Open the 'Leaves' form.
16. Place a client on a same day leave after last date of the service. Note the date.
17. Open the 'Return From Leaves' form.
18. Return the client on a same day a few hours from the leave start time.
19. Open the 'Client Ledger' form for the client.
20. Process the 'Simple' ledger for the client.
21. Review the report.
22. Verify the ledger displays no-billable leaves along with the services rendered to the client in the report and does not display billable and/or same day leave in the report.
23. Close the report.
24. Process the 'Claim' ledger for the client.
25. Verify the ledger displays non-billable leaves, billable leaves and/or same day leave in the report.
26. Close the report.

• Posting/Adjustment Codes Definition:
• Identify an existing payment, adjustment and/or transfer codes. Note the codes/values for further testing.
• Admission:
• A new client is admitted in the inpatient program. Note the client id/name, admission program, admission date.
• Guarantor/Payors:
• An existing guarantor is identified to assign to the client.
• Financial Eligibility:
• The existing guarantor is assigned to the client. Note the Guarantor code/value.
• Service Codes:
• An existing room and board service code is identified to render services to the client. Note the service code.
• Client Charge Input:
• 5-6 days of the room and board services are rendered to the client.
• Close Charges:
• The charges rendered to the client are closed.

1. Open the 'Electronic Billing' form.
2. Run an 837 Institutional bill for the client.
3. Verify the bill compiles successfully.
4. Claim the services.
5. Verify the bill compiles successfully.
6. Open the 'Client Ledger' form.
7. Process the report using 'Claim' ledger type and validate that the claim based report displays all the claim specific information.
8. Open the ‘Individual Cash Posting’ form.
9. Select the ‘Client’.
10. Select desired value in the ‘Post By’ field.
11. Click [Select Item(s) To Post Against].
12. A grid opens containing a row for all services.
13. Select a desired row.
14. Click [OK] when all desired rows have been selected.
15. Note the ‘Information’ message and the current balance for the guarantor.
16. Click [OK].
17. Enter desired value in ‘Posting Date’.
18. Enter desired value in ‘Date of Receipt’.
19. Validate that the ‘Guarantor’ defaulted to the guarantor in the current balance message.
20. Enter desired value in ‘Dollar Amount To Be Posted’. Amount entered can be the full amount due or a partial amount due.
21. Enter desired value in ‘Posting Code’.
22. If desired, enter a value in ‘Check #’.
23. Enter desired value in ‘Action For Remaining Balance If Applicable’.
24. Click [Update Temporary File].
25. If desired, continue to add payment/adjustments/transfers using the steps above for all other services.
26. Click [Submit] when all payment/adjustments/transfers have been completed.
27. Open ‘Client Ledger’ for the client’.
28. Process the report using ‘Simple' ledger type and validate that the payment/adjustments/transfers posted correctly.
29. Process the report using ‘Claim' ledger type and validate that the payment/adjustments/transfers posted correctly specific to claim.
30. Close the form.

• Registry Setting:
• The 'Include Non-Chargeable Leaves in Client Ledger View' registry setting is set to "N".
• Dictionary Update:
• Dictionary = Client
• Data Element = Type of Leave From
• Identify an existing non-billable leave type or create a new dictionary code/value for the non-billable leave type that has the defined extended dictionary value for ‘Chargeable Leave Y/N’ set to ‘No’. Note the type of leave.
• Identify an existing same day leave type or create a new dictionary code/value for the same day leave that has the defined extended dictionary value for ‘Chargeable Leave Y/N’ set to ‘No’. Note the type of leave.
• Identify an existing billable leave type or create a new dictionary code/value for the billable leave that has the defined extended dictionary value for ‘Chargeable Leave Y/N’ set to ‘Yes’. Note the type of leave.
• Guarantor/Payors:
• An existing guarantor is identified to assign to the client.
• Admission:
• A new client is admitted in the inpatient program. Note the client id/name, admission program, admission date.
• Financial Eligibility:
• The existing guarantor is assigned to the client. Note the Guarantor code/value.
• Service Codes:
• An existing service code is identified to render services to the client. Note the service code.

1. Open the 'Client Charge Input' form.
2. Render desired days of the service to the client starting from the admission date.
3. Open the 'Leaves' form.
4. Place the client on a non-billable leave for desired days after the admission date. Note the date.
5. Open the 'Return From Leaves' form.
6. Return the client. Note the date of return.
7. Open the 'Client Charge Input' form.
8. Render desired days of the service to the client starting after date of the return.
9. Open the 'Leaves' form.
10. Place the client on a billable leave for desired days after last date of the service. Note the date.
11. Open the 'Return From Leaves' form.
12. Return the client after desired days from the leave start date. Note the date of return.
13. Open the 'Client Charge Input' form.
14. Render desired days of the service to the client after date of return.
15. Open the 'Leaves' form.
16. Place the client on a same day leave after last date of the service. Note the date.
17. Open the 'Return From Leaves' form.
18. Return the client on a same day after few hours from the leave start time.
19. Open the 'Client Ledger' form for the client.
20. Process the 'Simple' ledger for the client.
21. Review the report.
22. Verify the ledger does not include no-billable leaves in the report and does not display billable and/or same day leave in the report.
23. Close the report.
24. Process the 'Claim' ledger for the client.
25. Verify the ledger does not include non-billable leaves, billable leaves and/or same day leave in the report.
26. Close the report.

• Registry Setting:
• The 'Include Non-Chargeable Leaves in Client Ledger View' registry setting is set to "Y".
• Dictionary Update:
• Dictionary = Client
• Data Element = Type of Leave From
• Identify an existing non-billable leave type or create a new dictionary code/value for the non-billable leave type that has the defined extended dictionary value for ‘Chargeable Leave Y/N’ set to ‘No’. Note the type of leave.
• Identify an existing same day leave type or create a new dictionary code/value for the same day leave that has the defined extended dictionary value for ‘Chargeable Leave Y/N’ set to ‘No’. Note the type of leave.
• Identify an existing billable leave type or create a new dictionary code/value for the billable leave that has the defined extended dictionary value for ‘Chargeable Leave Y/N’ set to ‘Yes’. Note the type of leave.
• Guarantor/Payors:
• An existing guarantor is identified to assign to the client.
• Admission:
• A new client is admitted in two inpatient episodes. Note the client id/name, admission program, admission date.
• Financial Eligibility:
• The existing guarantor is assigned to the client. Note the Guarantor code/value.
• Service Codes:
• An existing room and board service code is identified to render services to the client. Note the service code.

1. Open the 'Client Charge Input' form.
2. Render desired days of the service to the client starting from the admission date.
3. Open the 'Leaves' form.
4. Place the client on a non-billable leave for desired days after the admission date. Note the date.
5. Open the 'Return From Leaves' form.
6. Return the client. Note the date of return.
7. Open the 'Client Charge Input' form.
8. Render desired days of the service to the client starting after date of the return.
9. Open the 'Leaves' form.
10. Place the client on a billable leave for desired days after last date of the service. Note the date.
11. Open the 'Return From Leaves' form.
12. Return the client after desired days from the leave start date. Note the date of return.
13. Open the 'Client Charge Input' form.
14. Render desired days of the service to the client after date of return.
15. Open the 'Leaves' form.
16. Place the client on a same day leave after last date of the service. Note the date.
17. Open the 'Return From Leaves' form.
18. Return the client on a same day after few hours from the leave start time.
19. Open the 'Client Ledger' form for the client.
20. Process the 'Simple' ledger for the client.
21. Review the report.
22. Verify the ledger displays no-billable leaves along with the services rendered to the client in the report and does not display billable and/or same day leave in the report.
23. Close the report.
24. Process the 'Claim' ledger for the client.
25. Verify the ledger displays non-billable leaves, billable leaves and/or same day leave in the report.
26. Close the report.
27. Open the 'Discharge' form.
28. Discharge the client. Note the discharge date.
29. Open the 'Admission' form for the same client.
30. Admit the client in a new inpatient episode.
31. Open the 'Financial Eligibility' form.
32. Assign an existing guarantor to the second episode of the client. Note the guarantor id/name.
33. Open the 'Client Charge Input' form.
34. Render three days of the service to the client starting from the admission date.
35. Open the 'Leaves' form.
36. Place a client on a non-billable leave for desired days after 1 week from the admission date. Note the date.
37. Open the 'Return From Leaves' form.
38. Return the client. Note the date of return.
39. Open the 'Client Charge Input' form.
40. Render desired days of the service to the client starting after date of the return.
41. Open the 'Leaves' form.
42. Place a client on a billable leave for desired days after last date of the service. Note the date.
43. Open the 'Return From Leaves' form.
44. Return the client after desired days from the leave start date. Note the date of return.
45. Open the 'Client Charge Input' form.
46. Render desired days of the service to the client after date of return.
47. Open the 'Leaves' form.
48. Place a client on a same day leave after last date of the service. Note the date.
49. Open the 'Return From Leaves' form.
50. Return the client on a same day after few hours from the leave start time.
51. Open the 'Client Ledger' form for the client.
52. Process the 'Simple' ledger for the client.
53. Review the report.
54. Verify the ledger displays no-billable leaves along with the services rendered to the client in the report and does not display billable and/or same day leave in the report.
55. Close the report.
56. Process the 'Claim' ledger for the client.
57. Verify the ledger displays non-billable leaves, billable leaves and/or same day leave in the report.
58. Close the report.