Quick Billing - Auto Upload to RevConnect
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Program Maintenance
- Quick Billing
Scenario 1: Quick Billing - Verify that 837 file is not auto uploaded to RevConnect when the 'Auto Upload To RevConnect' = 'No' in the Quick Billing Rule Definition
Specific Setup:
- Netsmart Client Alignment Associate has been contacted to enable 'RevConnect'.
- Netsmart Avatar support has completed the following:
- Enabled the 'Enable RevConnect' registry setting.
- Completed & submitted the 'RevConnect Configuration' form.
- 'System Generated Email Settings' has been used to add the tester’s email to enable notification verification.
- Registry Setting:
- The 'Enable New Quick Billing Format' registry setting is set to 'Y'.
- Facility Defaults:
- In the 'Output Path on Server For Electronic Files' field, enter the directory path to store electronic files. Note the path to see the file created after quick billing process.
- Guarantors/Payors:
- An existing guarantor is identified.
- Admission:
- The client is admitted to the inpatient or outpatient program or an existing client is identified. Note client id/name, admission date/program.
- Financial Eligibility:
- The guarantor is assigned to client.
- Client Charge Input:
- 5 Services are rendered to the client in the first episode. Be sure to use service codes that are covered by the benefit plan (insurance charge category).
- Client Ledger:
- Verify the charges are correctly distributed to the contract guarantor, and they are in 'Open' status.
- Unclaimed services that meet the 'Quick Billing Rule Definition' exist. Tester knows the date range of services.
- Quick Billing Rule Definition:
- The quick Billing Rules are created to include service(s) distributed to the client.
- The 'Auto Upload To RevConnect' field is set to "No".
Steps
- Open 'Quick Billing Rule Definition'.
- Edit the definition by adding a value of 'No' to 'Auto Upload To RevConnect'.
- Click [Submit].
- Open 'Quick Billing'.
- Enter the date range of services.
- Select the 'Billing Rule To Execute', which is the 'Quick Billing Rule Definition'.
- Select 'Create Batch', 'Close Charges', 'Generate Bills' and 'Create Claims' in 'Quick Billing Tasks to Execute'.
- Enter a 'Date of Claim'.
- Click [Submit].
- Click [OK].
- Click [No].
- Verify an 837 billing file is created and stored in the location that is specified in the 'Facility Defaults'.
- Verify that no email is received stating: 'RevConnect uploaded 837 files successfully'.
Scenario 2: Quick Billing - Verify that 837 file is not auto uploaded to RevConnect when the 'Auto Upload To RevConnect' = 'Null' in the Quick Billing Rule Definition
Specific Setup:
- Netsmart Client Alignment Associate has been contacted to enable 'RevConnect'.
- Netsmart Avatar support has completed the following:
- Enabled the 'Enable RevConnect' registry setting.
- Completed & submitted the 'RevConnect Configuration' form.
- 'System Generated Email Settings' has been used to add the tester’s email to enable notification verification.
- Registry Setting:
- The 'Enable New Quick Billing Format' registry setting is set to 'Y'.
- Facility Defaults:
- In the 'Output Path on Server For Electronic Files' field, enter the directory path to store electronic files. Note the path to see the file created after quick billing process.
- Guarantors/Payors:
- An existing guarantor is identified.
- Admission:
- The client is admitted to the inpatient or outpatient program or an existing client is identified. Note client id/name, admission date/program.
- Financial Eligibility:
- The guarantor is assigned to client.
- Client Charge Input:
- 5 Services are rendered to the client in the first episode. Be sure to use service codes that are covered by the benefit plan (insurance charge category).
- Client Ledger:
- Verify the charges are correctly distributed to the contract guarantor, and they are in 'Open' status.
- Unclaimed services that meet the 'Quick Billing Rule Definition' exist. Tester knows the date range of services.
- Quick Billing Rule Definition:
- The quick Billing Rules are created to include service(s) distributed to the client.
- Do not select any value in the 'Auto Upload To RevConnect' field.
Steps
- Open 'Quick Billing'.
- Enter the date range of services.
- Select the 'Billing Rule To Execute', which is the 'Quick Billing Rule Definition'.
- Select 'Create Batch', 'Close Charges', 'Generate Bills' and 'Create Claims' in 'Quick Billing Tasks to Execute'.
- Enter a 'Date of Claim'.
- Click [Submit].
- Click [OK].
- Click [No].
- Verify an 837 billing file is created and stored in the location that is specified in the 'Facility Defaults'.
- Verify that no email is received stating: 'RevConnect uploaded 837 files successfully'.
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Topics
• NX
• Quick Billing
• RevConnect
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Client Account Services Report
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Dynamic Form - Add To Problem List
- Service Codes
- Front Desk Information
- Dynamic Form - Deposit Entry
- Client Account Services Report
Scenario 1: Client Account Services Report - Validating payment amount
Specific Setup:
- Guarantors/Payor:
- A self pay guarantor is identified. Note the guarantor's code/value.
- Client:
- An existing client, with the above guarantor in Financial Eligibility, is selected, or a new client is admitted and assigned the above guarantor in Financial Eligibility. Note the client's id, admission date and admission program.
- A diagnosis record is created for the client.
- Service Code:
- Select a service code that has a Service Fee/Cross Reference Maintenance record, noting the 'Fee’.
- Recurring Client Charge Input:
- Services are rendered to the client that will create charges that total more than $10,000.00. Note the service date range.
- Client Ledger:
- The service distributed to the self pay guarantor.
Steps
- Open desired form and post a payment greater than $10,000.00 to the client. Note the payment date.
- Validate that the generated receipt displays the full payment amount.
- Close the receipt.
- Close the form.
- Open the 'Client Ledger' for the client / payment date and validate that the full payment amount displays.
- Close the report.
- Close the form.
- Open 'Client Account Services Report'.
- Select the client and the payment date.
- Click [Process].
- Validate that the report displays the full payment amount.
- Close the report.
- Close the form.
- Repeat steps 1 -13 with a payment amount of less than $1,000.00.
Avatar AM - Front Desk Service Information - Deposit Entry
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Dynamic Form - Add To Problem List
- Service Codes
- Receipt Definition
- Dispense Locking Maintenance
- Dynamic Form - Clear Locks
- Medication Order
- Fast Dose Dispensing
- Front Desk Information
- Dynamic Form - Deposit Entry
- Posting/Adjustment Codes Definition
Scenario 1: Avatar AM Front Desk Information - Receipt Verification
Specific Setup:
- Avatar AM module is installed.
- Guarantors/Payors:
- The guarantor is a contract guarantor with a value of ‘Contractual Allowance By Liability Distribution’ in ‘Does This Guarantor Use Contractual Allowance By Batch Or Through Liability Distribution?’.
- Service Codes:
- Select a minimum of two services codes that have a ‘Service Fee/ Cross Reference Maintenance’, ‘Guarantor Definition’ that contains values in ‘Maximum Amount To Distribute Per Service’, and ‘Contract Rate’. ‘Write-off Remaining Balance (Contract Guarantors Only)’ = Yes. ‘Ignore Specified Amounts When Distributing Liability’ = No.
- Client:
- Select a client who is assigned the above guarantor, plus a self-pay guarantor in Financial Eligibility’ or create a new client. Note the client’s id, program, and date of admission.
- Posting/Adjustment Coded Definition:
- Identify codes that will allow a receipt to be generated and codes that will not allow a receipt to be generated. At least one code should be a payment and one code should be an adjustment.
- Desired method for creating services is used to create services on the same date, using both service codes. Create services on two or more different dates. Note the service dates.
Steps
- Open ‘Front Desk Information’.
- Select the desired ‘Client Id’.
- Select ‘Deposit Entry’.
- Enter the service date in ‘Date Of Receipt Or Adjustment’.
- Select the ‘Service Code’ if not defaulted.
- Select the self-pay ‘Guarantor’.
- Enter the ‘Amount To Post’.
- Select desired ‘Posting Code’ that is for a payment.
- Enter optional data as desired.
- Click [File].
- Validate that if the ‘Posting Code’ did not allow the receipt to be generated that the receipt did not generate.
- Validate that if the ‘Posting Code’ did allow the receipt to be generated that the receipt did generate.
- Validate that the receipt contains the current information as entered in ‘Deposit Entry’.
- If desired, use ‘Client Ledger’ to verify the deposit.
- Repeat steps 1 - 15 for a Posting Code’ that is for an adjustment.
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Topics
• Billing
• Front Desk
• NX
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Topics
• Incident-To-Practitioner Daily Log
• NX
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Electronic billing - Split services workflow
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Service Codes
- CPT Code Definition (PM)
- Registry Settings (PM)
- Set System Defaults (CWS)
- Managed Care Authorizations
- Progress Notes (Group and Individual)
- Dynamic Form - Progress Notes
- SQL Query/Reporting Tool
- Electronic Billing
Scenario 1: 837 Professional - Running the bill for the split services - Service created through progress note form
Specific Setup:
- Guarantor/Payors:
- An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
- Authorization Information Section:
- Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
- Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
- Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
- Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
- Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
- Admission (Outpatient):
- A new client is admitted in an outpatient program. Note the client id/name, admission program,
- Financial Eligibility:
- The guarantor identified above is assigned to the client.
- Diagnosis:
- A new diagnosis record is created for the client.
- Service Codes:
- A new service code is added as below. Note the service code/value.
- Type Of Fee= User Defined
- Minutes per Unit = desired value
- Service Fee/Cross Reference Maintenance:
- Service fee definition is created for the above service code.
- Managed Care Authorizations:
- Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
- The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
- Enter desired value to all the required fields.
- Progress Note form:
- Please note : the split service functionality is not supported by Ambulatory Progress Note. It will be available in the next update.
- A new service is rendered through desired progress note form.
- The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
- Client Ledger:
- The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
- Close Charges:
- All the charges are closed.
- An interim billing batch is created to include the client, service and guarantor.
Steps
- Open the 'Electronic Billing' form.
- Select the '837 Professional' from the 'Billing Form'.
- Select desired value in the 'Type Of Bill'.
- Select the guarantor identified in the setup section.
- Select the 'Interim Batch' in the 'Select All Clients Or Interim Batch' field.
- Select the interim billing batch in 'Interim Batch Number'.
- Populate all the required fields.
- Compile the bill for the client, services and guarantor identified in the interim billing batch.
- Verify the bill compiles successfully.
- Select 'Run Report'.
- Select 'Print' from the 'Print Or Delete Report' field.
- Select the file compiled successfully in the previous step.
- Verify that both the split services are included in the bill.
Scenario 2: 837 Professional - Running the bill for the split services because of not having authorization through 'Client Charge Input' form
Specific Setup:
- Guarantor/Payors:
- An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
- Authorization Information Section:
- Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
- Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
- Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
- Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
- Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
- Admission (Outpatient):
- A new client is admitted in an outpatient program. Note the client id/name, admission program,
- Financial Eligibility:
- The guarantor identified above is assigned to the client.
- Diagnosis:
- A new diagnosis record is created for the client.
- Service Codes:
- A new service code is added as below. Note the service code/value.
- Type Of Fee= User Defined
- Minutes per Unit = desired value
- Service Fee/Cross Reference Maintenance:
- Service fee definition is created for the above service code.
- Managed Care Authorizations:
- Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
- The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
- Enter desired value to all the required fields.
- Client Charge Input
- A new service is rendered through desired progress note form.
- The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
- Client Ledger:
- The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
- Close Charges:
- All the charges are closed.
- An interim billing batch is created to include the client, service and guarantor.
Steps
- Open the 'Electronic Billing' form.
- Select the '837 Professional' from the 'Billing Form'.
- Select desired value in the 'Type Of Bill'.
- Select the guarantor identified in the setup section.
- Select the 'Interim Batch' in the 'Select All Clients Or Interim Batch' field.
- Select the interim billing batch in 'Interim Batch Number'.
- Populate all the required fields.
- Compile the bill for the client, services and guarantor identified in the interim billing batch.
- Verify the bill compiles successfully.
- Select 'Run Report'.
- Select 'Print' from the 'Print Or Delete Report' field.
- Select the file compiled successfully in the previous step.
- Verify that both the split services are included in the bill.
Scenario 3: 837 Institutional - Split services - Services created through 'Client Charge Input' form
Specific Setup:
- Guarantor/Payors:
- An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor code/name.
- Authorization Information Section:
- Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
- Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
- Select 'No Warning or Error If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
- Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
- Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
- Admission:
- A new client is admitted in an inpatient program. Note the client id/name, admission program,
- Financial Eligibility:
- The guarantor identified above is assigned to the client.
- Diagnosis:
- A new diagnosis record is created for the client.
- Service Codes:
- A new service code is added as below. Note the service code/value.
- Type Of Fee= User Defined
- Minutes per Unit = desired value
- Service Fee/Cross Reference Maintenance:
- Service fee definition is created for the above service code.
- Managed Care Authorizations:
- Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above.
- The 'Maximum Units' field is set to desired value such that some units do not cover by the authorization on file for the client.
- Enter desired value to all the required fields.
- Client Charge Input
- A new service is rendered through desired progress note form.
- The 'Service Duration' is set to the value that makes number of units needs to be used for the service becomes more than the 'Maximum Units' setup in the 'Managed Care Authorization' section to create a split service.
- Client Ledger:
- The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
- Close Charges:
- All the charges are closed.
- An interim billing batch is created to include the client, service and guarantor.
Steps
- Open the 'Electronic Billing' form.
- Select the '837 Institutional' from the 'Billing Form'.
- Select desired value in the 'Type Of Bill'.
- Select the guarantor identified in the setup section.
- Select the 'Interim Batch' in the 'Select All Clients Or Interim Batch' field.
- Select the interim billing batch in 'Interim Batch Number'.
- Populate all the required fields.
- Compile the bill for the client, services and guarantor identified in the interim billing batch.
- Verify the bill compiles successfully.
- Select 'Run Report'.
- Select 'Print' from the 'Print Or Delete Report' field.
- Select the file compiled successfully in the previous step.
- Verify that both the split services are included in the bill.
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Topics
• 837 Institutional
• 837 Professional
• Managed Care Authorizations
• NX
• Edit Service Information
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System Task Scheduler - processes
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- System Task Scheduler
- Task Scheduler Status - Widget
Scenario 1: 'System Task Scheduler' - Task Process(s) validation
Specific Setup:
- 'View Definition' form has been used to add the ‘Task Scheduler Status’ widget to Home View for the logged in user
- In form "System Task Scheduler", have or create a task [TaskA] that can be selected in "Schedules" field. For this test, a "State Form Definition" form file was created that selects all records in the "SYSTEM.patient_current_demographics" table and the definition was then set up in the "State Form Task Scheduler" as a task.
Steps
- Open form "System Task Scheduler".
- Select [TaskA] from the "Schedule(s)" field
- Select "Hourly" in the "Recurrence Pattern" field
- Enter "1" in "Task Occurrence Sequence" field
- Select today's date [DateA] in the "Range of Occurrence", "Start By" field
- Select the desired start time in the "Range of Occurrence", "Start Time" field, note the time entered [StartTime]
- Select tomorrows date [DateB] in the "Range of Occurrence", "End By" field
- Set the desired end time in the "Range of Occurrence", to be after "3:00 AM" the next day, for example "4:00AM". Note the end time entered [EndTime]
- Click "Schedule Task"
- At the home screen, refresh the ‘Task Scheduler Status’ widget
- Ensure [TaskA] is listed with the expected "Last Run Date" [DateA] and "Last Run Time" [StartTime] noted in step 1
- Refresh the widget periodically, for example every 5 or 10 minutes before another hour has passed
- Ensure just one row is listed for [TaskA] and it still displays the same "Last Run Date" [DateA] and "Last Run Time" as in step 2a
- Wait till one hour has passed since the [StartTime]
- Click to refresh the "Task Scheduler Status" widget
- Ensure there is still just one entry for [TaskA] and the task now displays the expected "Last Run Date" as today's date [DateA] and the "Last Run Time" equates to [StartTime] plus 1 hour
- Wait until another hour has passed since the [StartTime]
- Click to refresh the "Task Scheduler Status" widget
- Ensure there is still just one entry for [TaskA] and the task now displays the expected "Last Run Date" as today's date [DateA] and the "Last Run Time" equates to [StartTime] plus 2 hours
- Repeat step 4 periodically, for example every 3 hours up till before the [EndTime]
- Ensure there is still just one entry for [TaskA] and the task now displays the expected "Last Run Date" still as today's date [DateA] and the "Last Run Time" equates the [StartTime] plus the number hours that have passed since the [StartTime]
- Wait till the next day and when [EndTime] noted in step 1 has passed
- Ensure there is still just one entry for [TaskA] and the task now displays the expected "Last Run Date" as the [DateB] and the "Last Run Time" is equal to [End Time] noted in step 1
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Topics
• System Task Scheduler
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'Create Interim Billing Batch' Quick Billing Batch Deletion
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: 'Create Interim Billing Batch' - Verification of Interim Billing Batch Deletion
Specific Setup:
- Avatar PM 'Quick Billing Rule Definition' where 'Create Interim Billing Batch' is set to 'Yes'
- One or more Interim Billing Batch(es) created via Avatar PM 'Quick Billing' form/functionality
Steps
- Open Avatar PM 'Create Interim Billing Batch' form.
- Select 'Delete Batch' in 'Create, View Or Delete Batch' field.
- Select Interim Billing Batch created via Avatar PM 'Quick Billing' in 'Interim Batch Number' field for deletion (or select associated Quick Billing Batch in 'Quick Billing Batch Number' field).
- Click 'Submit' button to file 'Create Interim Billing Batch' form/batch deletion.
- Verify user dialog noting 'Batch Deleted' is presented on filing; click 'OK' button to close dialog.
- Select 'View Batch', 'Edit Batch' or 'Delete Batch' in 'Create, View Or Delete Batch' field.
- Click 'Interim Batch Number' field to expand; ensure that deleted Interim Billing Batch is not present/does not exist in system following deletion.
- Click 'Quick Billing Batch Number' field to expand; ensure that Quick Billing Batch associated to deleted Interim Billing Batch is not present/does not exist in system following deletion.
'Quick Billing' File Name
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: 'Quick Billing' - Verification of File Naming Convention
Specific Setup:
- Avatar PM 'Quick Billing Rule Definition' where 'Send Generated Bill To' field is set to 'File' and 'File Description' is defined for output file naming convention
- Example: 'Medicaid_<YYYY>_<MM>_<DD>_<CT100>'
- One or more unclaimed service(s) meeting 'Quick Billing Rule Definition' criteria and eligible for Quick Bill file inclusion
Steps
- Open Avatar PM 'Quick Billing' form.
- Select 'Add' in 'Add New Or Edit Existing Quick Billing Batch' field.
- Enter value for 'First Date Of Service To Include' and 'Last Date Of Service To Include' fields.
- Select value in 'Billing Rule To Execute' field (or 'Billing Rule Group To Execute' field).
- Select 'Create Batch', 'Close Charges' and 'Generate Bills' in 'Quick Billing Tasks to Execute' field (and 'Create Claims' if desired).
- Enter value for 'Date of Claim' field.
- Click 'Submit' button to execute selected Quick Billing Rule (or Quick Billing Rule Group).
- Verify user dialog noting 'Compile Complete' is presented on Quick Billing execution/completion; click 'OK' button to close dialog.
- Navigate to file creation location/directory (as defined in Quick Billing Rule Definition 'File Location' field).
- Review billing file(s) created in specified location/directory to ensure that all file names are in format specified in Quick Billing Rule Definition 'File Description' field (including case where multiple 'Guarantor/Program Billing Defaults' templates are applicable to guarantors/programs included in single Quick Billing execution).
- Example: 'Medicaid_2022_08_05_100', 'Medicaid_2022_08_05_101'
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Topics
• Interim Billing Batch
• NX
• Quick Billing
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Client Merge - Current Census
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: Client Merge - Existing episode - Validate Census after merge
Specific Setup:
- Add hospital beds to the unit using "Maintain Hospital Bed File" form.
- Admit source client to an outpatient episode.
- Admit target client a day after the source client into first a different outpatient episode than the source client and then into an inpatient episode.
Steps
- Open the "Client Merge" form.
- Enter the Source client from setup,
- Click "Yes" on "Merge All Client Data Through Single Filing".
- Enter the Target client from setup.
- Click "No" on "Create New Episode on Merge".
- Complete merge.
- Open "Current Unit Census" form and verify the target client is still listed n the hospital bed they were admitted to.
Scenario 2: Client Merge - Create new episode - Validate Census after merge
Specific Setup:
- Add hospital beds to the unit using "Maintain Hospital Bed File" form.
- Admit source client to an outpatient episode.
- Admit target client a day after the source client into first a different outpatient episode than the source client and then into an inpatient episode.
Steps
- Open the "Client Merge" form.
- Enter the Source client from setup,
- Click "Yes" on "Merge All Client Data Through Single Filing".
- Enter the Target client from setup.
- Click "Yes" on "Create New Episode on Merge".
- Complete merge.
- Open "Current Unit Census" form and verify the target client is still listed n the hospital bed they were admitted to.
Compile and Post Residential/Inpatient services - Medical diagnosis
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Program Maintenance
- Compile And Post Residential/Inpatient Charges
- Post Residential/Inpatient Worklist
Scenario 1: Compile and Post Residential/Inpatient Charges - Validate Worklist Diagnosis
Specific Setup:
- Using "Program Maintenance", select or enter an inpatient service code that has the "Primary Medical Program" selected.
- Admit a client into an inpatient episode.
- Add insurance information into "Financial Eligibility" form.
- Enter a diagnosis for the client using the "Diagnosis" form.
Steps
- Using the "Verify Unit Census", verify the census for the test client for the date of admission only.
- Using the "Compile and Post Residential/Inpatient Charges" form, compile and post the inpatient services.
- Using the preferred method to validate SQL tables, validate the column "jointodiagnosisobject1" is populated with the diagnosis code
Scenario 2: Post Resident/Inpatient Charges - Validate worklist diagnosis
Specific Setup:
- Using "Program Maintenance", select or enter an inpatient service code that has the "Primary Medical Program" selected.
- Admit a client into an inpatient episode.
- Add insurance information into "Financial Eligibility" form.
- Enter a diagnosis for the client using the "Diagnosis" form.
Steps
- Using the "Verify Unit Census", verify the census for the test client for the date of admission only.
- Using the "Compile Residential/Inpatient Charges" form, compile the inpatient services.
- Using the "Post Residential/Inpatient Charges" form, post the compiled worklist.
- Using the preferred method to validate SQL table "SYSTEM.billing_tx_history column "jointodiagnosisobject1" is populated with the diagnosis code
Chart Review - Attached forms from child namespaces
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Attach Other Application Form to Menu (CWS)
- Chart Review
- Leaves
Scenario 1: Chart Review - Validate Diagnosis form attached to a child namespace menu
Specific Setup:
- Admit or select a test client using the "Admission" form.
- Enter or verify the client has diagnosis data using the "Diagnosis" form.
- Add the "Diagnosis" form that was attached to the child namespace menu to the chart using "Chart Review".
Steps
- Open the "Attach Other Application Form to Menu" form from a child namespace such as CWS.
- Select "Avatar PM" from the "Application" dropdown list.
- Select the form to be attached to a CWS menu.
- Add the form to a child namespace menu.
- Open the "Chart Review" form.
- Open the "Diagnosis" form that was attached to the child namespace menu from the chart.
- Validate the Diagnosis data appears on the chart.
- Click the "Edit" button.
- The "Diagnosis" form launches.
- Add another diagnosis and file the data.
- After returning to the chart, click "Refresh" button.
- Validate the diagnosis data that was just added appears on the chart.
- Click "Report".
- Validate all diagnosis data for the client appears on the report.
Scenario 2: Chart Review - Validate Leaves form attached to a child namespace menu
Specific Setup:
- Admit or select a test client in an inpatient episode using the "Admission" form.
- Enter or verify the client has leave data using the "Leaves" form.
- Add the "Leaves" form that was attached to the child namespace menu to the chart using "Chart Review".
Steps
- Open the "Attach Other Application Form to Menu" form from a child namespace such as CWS.
- Select "Avatar PM" from the "Application" dropdown list.
- Select the "Leaves" form to be attached to a CWS menu.
- Add the form to a child namespace menu.
- Open the "Chart Review" form.
- Open the "Leaves" form that was attached to the child namespace menu from the chart.
- Validate the Leave data appears on the chart.
- Click "Report".
- Validate all leave data for the client appears on the report.
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Topics
• Client Merge
• NX
• Inpatient Worklist
• Leaves
• RADplus Utilities
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Quick Billing/Electronic Billing - Natural Disaster added to the Delay Reason Code data dictionary
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Quick Billing
- Electronic Billing
Scenario 1: Quick Billing - Field Validations with Delay Reason Code
Specific Setup:
- Admit a client.
- Enter a diagnosis for the new client.
- Using the "Financial Eligibility" form, enter a guarantor being sure to provide a Subscriber Policy #.
- Create or choose a "Quick Billing Rule Definition" to be used.
- Create a charge that is dated prior to the # of days from the claim date for a Guarantor/Payor who has a value in the "Number of Days From The Date of Service to the Posting Date For Which A Service Requires A Delay Reason Code".
Steps
- Open the "Quick Billing" form.
- Add a new Quick Billing batch.
- Edit the quick billing batch just created, adding a delay reason.
- Click "Launch Workscreen".
- Select "Natural Disaster" in the "Delay Reason Code" to a row in the table.
- Click "Save".
- Click "Submit".
- Using the preferred method, check the SQL table "SYSTEM.billing_qb_delay_reason.
- Validate a row is added to the table for every service processed with a delay reason code.
Scenario 2: Electronic Billing - Field Validations - Delay Reason Code
Specific Setup:
- Admit a new client.
- Add Financial Eligibility for the new client.
- Add a Diagnosis to the client.
- Add charges for the client using "Client Charge Input". Date the services 5 days prior to the current date.
- Close the charges using "Close Charges".
Steps
- Open the "Client Ledger" form and validate the charges are set to UNBILL.
- Open "Close Charges" and close the charge.
- Open the "Electronic Billing" form.
- Generate a professional 837 bill. Don't create claims.
- Validate the file using the "Dump File" "Billing Option".
- Generate a professional 837 bill. This time create claims.
- The "Clam Date" must be the current date.
- Set the field "Number of days from Date of Service to Date of Claim in which the service requires a Day Reason Code Assignment in 2300-CLM-20" to 1.
- Click "Process".
- A message pops up that instructs you to access the "837 Delay Reason Code Assignment".
- Navigate to the *837 Delay Reason Code" tab.
- Select the file that was just created.
- Select "Client" in the "Display Claims By" field.
- Select the test client.
- Click "Select Claims To Assign Delay Reason Code" button.
- Select a claim(s) to attach a Delay Reason Code to.
- Set the "Delay Reason Code" dropdown to "Natural Disaster".
- Click "Assign To File".
- Open the "Electronic Billing" form.
- Open the "Dump File" that was just created in prior steps.
- Validate the CLM segment includes a 15 at the end for the "Natural Disaster" Delay Reason Code.
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Topics
• Electronic Billing
• Quick Billing
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Avatar PM 'Practitioner Enrollment' and 'Practitioner Enrollment (Brief)' Forms
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Practitioner Enrollment
- Practitioner Enrollment (Brief)
Scenario 1: 'Practitioner Enrollment' - Update of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
- Avatar PM Practitioner Enrollment record linked to Avatar MSO Performing Provider Registration must exist
Steps
- Open Avatar PM 'Practitioner Enrollment' form.
- Search/select existing Practitioner Enrollment record for edit, using Practitioner linked to Avatar MSO Performing Provider.
- Enter/edit values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields, and any other Practitioner data fields as required/desired.
- Enter/edit values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Navigate to 'Categories/Taxonomy' section of form.
- Select existing Category/Taxonomy entry for edit, or select 'Create New' in 'Category/Taxonomy' entry field.
- Enter/edit values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment' form.
- Open Avatar MSO 'Performing Provider Registration' form.
- Select Performing Provider Registration linked to Practitioner Enrollment, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are updated with values edited/filed in Avatar PM 'Practitioner Enrollment' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are updated with values edited/filed in Avatar PM 'Practitioner Enrollment' form.
- Ensure that 'Performing Provider's License Type' field is updated with values edited/filed in Practitioner Enrollment Category/Taxonomy entry/entries 'Discipline' field.
- Ensure that entry/entries are updated in 'Primary License Type Effective Dates' field/section for Practitioner Enrollment Category/Taxonomy entry/entries, with 'Primary License Type For Claims' value as selected in 'Discipline' field (in case where only single 'Discipline' value is selected; population is based on Dictionary Code matching values).
- Close 'Performing Provider Registration' form.
Scenario 2: 'Practitioner Enrollment' - Creation of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
Steps
- Open Avatar PM 'Practitioner Enrollment' form.
- Click 'New Staff' button to create new Practitioner Enrollment (or search/select existing Practitioner Enrollment record for edit); ensure that Practitioner ID value used is not currently existing/assigned as Avatar MSO Performing Provider ID.
- Enter/select values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields (using values not present for any existing/defined Avatar MSO Performing Provider Registration record).
- Enter/select values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' fields are present in form (under 'Link Staff To Performing Provider' section); do not enter or select value for 'Performing Provider' field, leaving the field blank/empty.
- Navigate to 'Categories/Taxonomy' section of form.
- Select 'Create New' in 'Category/Taxonomy' entry field (or select existing Category/Taxonomy entry for edit).
- Enter/select values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment' form.
- Open Avatar MSO 'Performing Provider Registration' form.
- In Performing Provider search, enter value used for Practitioner Name in 'Practitioner Enrollment' form; ensure that Performing Provider Registration record is present/returned in search results.
- Select Performing Provider Registration record created via 'Practitioner Enrollment' filing, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Registration Start Date', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are populated with values filed in Avatar PM 'Practitioner Enrollment' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are populated with values filed in Avatar PM 'Practitioner Enrollment' form.
- Ensure that 'Performing Provider's License Type' field is populated with values selected in Practitioner Enrollment Category/Taxonomy entry/entries 'Discipline' field.
- Ensure that entry/entries are filed in 'Primary License Type Effective Dates' field/section for Practitioner Enrollment Category/Taxonomy entry/entries, with 'Primary License Type For Claims' value as selected in 'Discipline' field (in case where only single 'Discipline' value is selected; population is based on Dictionary Code matching values).
- Close 'Performing Provider Registration' form.
- Re-open Avatar PM 'Practitioner Enrollment' form for previously filed entry/record.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' assignment fields are populated with Avatar MSO Performing Provider Registration record linked to Practitioner Enrollment, and that fields are disabled/read-only and do not allow edit of linked values.
Scenario 3: 'Practitioner Enrollment' - Link To Existing of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
- Avatar MSO Performing Provider Registration must exist, not currently linked to Avatar PM Practitioner Enrollment record
Steps
- Open Avatar PM 'Practitioner Enrollment' form.
- Click 'New Staff' button to create new Practitioner Enrollment (or search/select existing Practitioner Enrollment record for edit); Practitioner ID value used may exist or not exist as Avatar MSO Performing Provider ID already in system.
- Enter/select values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields (using same values as existing/defined for Avatar MSO Performing Provider Registration record), and any other Practitioner data fields as required/desired.
- Enter/select values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' fields are present in form (under 'Link Staff To Performing Provider' section); enter/select existing Contracting Provider Registration record for Practitioner link in 'Performing Provider'/'Performing Provider Registration' fields if manual linking of records is desired.
- Navigate to 'Categories/Taxonomy' section of form.
- Select 'Create New' in 'Category/Taxonomy' entry field (or select existing Category/Taxonomy entry for edit).
- Enter/select values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment' form.
- Re-open Avatar PM 'Practitioner Enrollment' form for previously filed entry/record.
- In case where 'Performing Provider'/'Performing Provider Registration' field values were manually entered in previous 'Practitioner Enrollment' filing - ensure that fields are populated with Avatar MSO Performing Provider Registration record linked to Practitioner Enrollment, and that fields are disabled/read-only and do not allow edit of linked values.
- In case where 'Performing Provider'/'Performing Provider Registration' field values were not manually entered (field blank/no value) in previous 'Practitioner Enrollment' filing- ensure that fields are automatically populated/linked with Avatar MSO Performing Provider Registration record having same ID number/Registration Start Date value (and NPI Number if entered).
- Open Avatar MSO 'Performing Provider Registration' form.
- In Performing Provider search, enter value used for Performing Provider association in 'Practitioner Enrollment' form.
- Select Performing Provider Registration record associated to Practitioner via 'Practitioner Enrollment' filing, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Registration Start Date', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are populated with values filed in Avatar PM 'Practitioner Enrollment' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are populated with values filed in Avatar PM 'Practitioner Enrollment' form.
Scenario 4: 'Practitioner Enrollment (Brief)' - Creation of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
Steps
- Open Avatar PM 'Practitioner Enrollment (Brief)' form.
- Click 'New Staff' button to create new Practitioner Enrollment (or search/select existing Practitioner Enrollment record for edit); ensure that Practitioner ID value used is not currently existing/assigned as Avatar MSO Performing Provider ID.
- Enter/select values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields (using values not present for any existing/defined Avatar MSO Performing Provider Registration record).
- Enter/select values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' fields are present in form (under 'Link Staff To Performing Provider' section); do not enter or select value for 'Performing Provider' field, leaving the field blank/empty.
- Navigate to 'Categories/Taxonomy' section of form.
- Select 'Create New' in 'Category/Taxonomy' entry field (or select existing Category/Taxonomy entry for edit).
- Enter/select values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment (Brief)' form.
- Open Avatar MSO 'Performing Provider Registration' form.
- In Performing Provider search, enter value used for Practitioner Name in 'Practitioner Enrollment (Brief)' form; ensure that Performing Provider Registration record is present/returned in search results.
- Select Performing Provider Registration record created via 'Practitioner Enrollment (Brief)' filing, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Registration Start Date', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are populated with values filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are populated with values filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
- Ensure that 'Performing Provider's License Type' field is populated with values selected in Practitioner Enrollment Category/Taxonomy entry/entries 'Discipline' field.
- Ensure that entry/entries are filed in 'Primary License Type Effective Dates' field/section for Practitioner Enrollment Category/Taxonomy entry/entries, with 'Primary License Type For Claims' value as selected in 'Discipline' field (in case where only single 'Discipline' value is selected; population is based on Dictionary Code matching values).
- Close 'Performing Provider Registration' form.
- Re-open Avatar PM 'Practitioner Enrollment (Brief)' form for previously filed entry/record.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' assignment fields are populated with Avatar MSO Performing Provider Registration record linked to Practitioner Enrollment, and that fields are disabled/read-only and do not allow edit of linked values.
Scenario 5: 'Practitioner Enrollment (Brief)' - Update of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
- Avatar PM Practitioner Enrollment record linked to Avatar MSO Performing Provider Registration must exist
Steps
- Open Avatar PM 'Practitioner Enrollment (Brief)' form.
- Search/select existing Practitioner Enrollment record for edit, using Practitioner linked to Avatar MSO Performing Provider.
- Enter/edit values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields, and any other Practitioner data fields as required/desired.
- Enter/edit values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Navigate to 'Categories/Taxonomy' section of form.
- Select existing Category/Taxonomy entry for edit, or select 'Create New' in 'Category/Taxonomy' entry field.
- Enter/edit values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment (Brief)' form.
- Open Avatar MSO 'Performing Provider Registration' form.
- Select Performing Provider Registration linked to Practitioner Enrollment, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are updated with values edited/filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are updated with values edited/filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
- Ensure that 'Performing Provider's License Type' field is updated with values edited/filed in Practitioner Enrollment Category/Taxonomy entry/entries 'Discipline' field.
- Ensure that entry/entries are updated in 'Primary License Type Effective Dates' field/section for Practitioner Enrollment Category/Taxonomy entry/entries, with 'Primary License Type For Claims' value as selected in 'Discipline' field (in case where only single 'Discipline' value is selected; population is based on Dictionary Code matching values).
- Close 'Performing Provider Registration' form.
Scenario 6: 'Practitioner Enrollment (Brief)' - Link To Existing of Avatar MSO Performing Provider Registration
Specific Setup:
- Avatar PM Registry Setting 'Enable Practitioners link to Performing Providers' must be enabled
- Avatar MSO Performing Provider Registration must exist, not currently linked to Avatar PM Practitioner Enrollment record
Steps
- Open Avatar PM 'Practitioner Enrollment (Brief)' form.
- Click 'New Staff' button to create new Practitioner Enrollment (or search/select existing Practitioner Enrollment record for edit); Practitioner ID value used may exist or not exist as Avatar MSO Performing Provider ID already in system.
- Enter/select values for 'Name', 'Registration Date', 'Office Address...' and 'NPI Number' fields (using same values as existing/defined for Avatar MSO Performing Provider Registration record), and any other Practitioner data fields as required/desired.
- Enter/select values for 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields, and any other Practitioner data fields as required/desired.
- Ensure that 'Performing Provider' and 'Performing Provider Registration' fields are present in form (under 'Link Staff To Performing Provider' section); enter/select existing Contracting Provider Registration record for Practitioner link in 'Performing Provider'/'Performing Provider Registration' fields if manual linking of records is desired.
- Navigate to 'Categories/Taxonomy' section of form.
- Select 'Create New' in 'Category/Taxonomy' entry field (or select existing Category/Taxonomy entry for edit).
- Enter/select values for 'Effective Date', 'Practitioner Category', 'Discipline' and 'Practitioner Categories For Coverage' fields, and any other fields as required/desired.
- Click 'Add Practitioner Categories' button to file/save Category/Taxonomy entry.
- Click 'Submit' button to file 'Practitioner Enrollment (Brief)' form.
- Re-open Avatar PM 'Practitioner Enrollment (Brief)' form for previously filed entry/record.
- In case where 'Performing Provider'/'Performing Provider Registration' field values were manually entered in previous Practitioner Enrollment filing - ensure that fields are populated with Avatar MSO Performing Provider Registration record linked to Practitioner Enrollment, and that fields are disabled/read-only and do not allow edit of linked values.
- In case where 'Performing Provider'/'Performing Provider Registration' field values were not manually entered (field blank/no value) in previous Practitioner Enrollment filing- ensure that fields are automatically populated/linked with Avatar MSO Performing Provider Registration record having same ID number/Registration Start Date value (and NPI Number if entered).
- Open Avatar MSO 'Performing Provider Registration' form.
- In Performing Provider search, enter value used for Performing Provider association in 'Practitioner Enrollment (Brief)' form.
- Select Performing Provider Registration record associated to Practitioner via 'Practitioner Enrollment (Brief)' filing, and click 'Select' button to proceed.
- In 'Performing Provider Registration' form, ensure that 'Name', 'Registration Start Date', 'Performing Provider's Address...' and 'Provider ID' (NPI Number) fields are populated with values filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
- In 'Performing Provider Registration' form, ensure that 'Office Telephone (1)', 'Office Telephone (2)', 'Home Telephone', 'Cellular Telephone', 'Fax Number' and/or 'Secondary Provider Identification Number' fields are populated with values filed in Avatar PM 'Practitioner Enrollment (Brief)' form.
Scenario 7: 'Practitioner Enrollment' - Form Verification
Specific Setup:
- Crystal Reports or other SQL reporting tool
Steps
- Open Avatar PM 'Practitioner Enrollment' form.
- Enter/select existing Practitioner Enrollment record for view/update (or click 'New Staff' button for new Practitioner Enrollment entry).
- Enter/select values for 'Name' and 'Registration Date' fields (and any/all other form fields as required/desired).
- Ensure that 'Secondary Provider Identification Number' and 'Fax Number' fields are present in 'Practitioner Enrollment' form.
- Enter values for 'Secondary Provider Identification Number' and 'Fax Number' fields.
- Navigate to 'Categories/Taxonomy' section of form.
- Enter/update Practitioner Category information as required/desired.
- Click 'Submit' button to file 'Practitioner Enrollment' form/record.
- Re-open Avatar PM 'Practitioner Enrollment' form (selecting same Practitioner Enrollment record as entered/edited above).
- Ensure that values entered/filed for 'Secondary Provider Identification Number' and 'Fax Number' fields are present.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.staff_enrollment_history', ensure that fields 'secondary_prov_ident_num' and 'fax_number' are present, and contain values filed for 'Secondary Provider Identification Number' and 'Fax Number' fields (respectively).
Scenario 8: 'Practitioner Enrollment (Brief)' - Form Verification
Specific Setup:
- Crystal Reports or other SQL reporting tool
Steps
- Open Avatar PM 'Practitioner Enrollment (Brief)' form.
- Enter/select existing Practitioner Enrollment record for view/update (or click 'New Staff' button for new Practitioner Enrollment entry).
- Enter/select values for 'Name' and 'Registration Date' fields (and any/all other form fields as required/desired).
- Ensure that 'Secondary Provider Identification Number' and 'Fax Number' fields are present in 'Practitioner Enrollment (Brief)' form.
- Enter values for 'Secondary Provider Identification Number' and 'Fax Number' fields.
- Navigate to 'Categories/Taxonomy' section of form.
- Enter/update Practitioner Category information as required/desired.
- Click 'Submit' button to file 'Practitioner Enrollment (Brief)' form/record.
- Re-open Avatar PM 'Practitioner Enrollment (Brief)' form (selecting same Practitioner Enrollment record as entered/edited above).
- Ensure that values entered/filed for 'Secondary Provider Identification Number' and 'Fax Number' fields are present.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.staff_enrollment_history', ensure that fields 'secondary_prov_ident_num' and 'fax_number' are present, and contain values filed for 'Secondary Provider Identification Number' and 'Fax Number' fields (respectively).
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Topics
• NX
• Performing Provider
• Practitioner
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The 'CareConnect HIE Configuration' and 'Query For External CCD' forms
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- CareConnect HIE Configuration
Scenario 1: Query for External CCD - Search, Preview, Save CCD's and validate SDK actions are triggered
Specific Setup:
- A client must be enrolled in an existing episode (Client A).
Steps
- Access the 'Query for External CCD' form.
- Select "Client A" in the 'Client Search' field.
- Select an organization in the 'Organization Name or Zip' field.
- Click [Search CCDs].
- Select a CCD in the 'Available CCDs' field.
- Enter the desired provider in the 'Provider Referred To' field.
- Click [Preview].
- Validate the CCD is displayed and close it.
- Click [Save].
- Validate an "Information" message is displayed stating: Saved.
- Click [OK] and close the form.
- Access the 'CareFabric Monitor' form.
- Enter the current date in the 'From Date' and 'Through Date' fields.
- Enter "Client A" in the 'Client ID' field.
- Enter "ExternalDataAckowledgementCreated" in the 'Event/Action Search' field.
- Click [View Activity Log].
- Validate the 'CareFabric Monitor Report' contains an 'ExternalDataAcknowledgementCreated' record.
- Click [Click To View Record].
- Validate the 'referredToProviderID' - 'id' field contains the provider ID selected in the previous steps.
- Close the report and the form.
- Access Crystal Reports or other SQL Reporting Tool.
- Create a report using the 'SYSTEM.ccd_tempstorage' table.
- Validate a row is displayed for the CCD saved in the previous steps.
- Validate the 'PATID' field contains "Client A".
- Validate the 'provider_referred_to' field contains the provider ID selected in the previous steps.
- Validate the 'provider_referred_to_name' field contains the provider name selected in the previous steps.
- Close the report.
Scenario 2: CareConnect HIE Configuration - Carequality Configuration - Search Carequality Organizations
Steps
- Access the 'CareConnect HIE Configuration' form.
- Select the "Carequality Configuration" section.
- Enter the desired zip code in the 'Organization Name or Zip' field.
- Validate the 'Within N Miles of Zip' field is displayed.
- Select the 'Within N Miles of Zip' help message.
- Validate the following message is displayed: This field can be used to further limit the external provider results when a zip code is entered.
- Close the help message.
- Enter the desired value in the 'Within N Miles of Zip' field.
- Click [Search].
- Validate the applicable organizations are displayed in the 'Select Organization(s)' field.
- Select the desired organization in the 'Select Organization(s)' field.
- Validate the selected organization is now listed in the 'Organization: Exceptions and Favorites' grid.
- Select the desired value in the 'Status' field for the new organization.
- Click [Submit].
Scenario 3: Query For External CCD - Field Validations
Specific Setup:
- A client is enrolled in an existing episode (Client A).
Steps
- Access the 'Query for External CCD' form.
- Select "Client A" in the 'Client Search' field.
- Enter the desired zip code in the 'Organization Name or Zip' field.
- Validate the 'Within N Miles of Zip' field is displayed.
- Select the 'Within N Miles of Zip' help message.
- Validate the following message is displayed: This field can be used to further limit the external provider results when a zip code is entered.
- Close the help message.
- Enter the desired value in the 'Within N Miles of Zip' field.
- For Avatar NX users only, please note: due to a known issue with the field display in Avatar NX, please populate the text box below the 'Miles of Zip' field and disregard the text box below the 'Within' field.
- Click [Search].
- Validate the applicable organizations are displayed in the 'Organizations' grid.
- Click [Clear].
- Validate the organizations are no longer displayed in the 'Organizations' grid.
- Close the form.
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Topics
• CareConnect HIE Configuration
• Query for External CCD
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Managed Care Authorizations - Authorization Group
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Program Maintenance
- Authorization Group Definition
- Managed Care Authorizations
- Registry Settings (PM)
Scenario 1: Managed Care Authorizations - Authorization Groups - Program Usage Type = Admission
Specific Setup:
- Registry Setting: ‘Avatar PM->System Maintenance->Program Maintenance->->->Enable 'Admission vs. Service Program' Functionality’ has a value of ‘Y’.
- Program Maintenance:
- Program 1: ‘Usage Type’ = Service. Desired service codes have been assigned to the program.
- Program 2: ‘Usage Type’ = Admission. No service codes have been assigned to the program. Program 1 is selected in ‘Associated Service Programs’.
- Authorization Group Definition has been used to create a group that has a minimum of two service codes.
- Client: Is admitted to Program 2 and has a Financial Eligibility record.
Steps
- Open ‘Managed Care Authorizations’ for the client.
- Select the ‘Managed Care Authorization Data’ section.
- Click [Add New Item].
- Select the ‘Guarantor Number’.
- Enter desired ‘Authorization Number’.
- Enter desired ‘Authorization Start Date’.
- Enter desired ‘Authorization End Date’.
- Select ‘Program 1’ in ‘Associated Service Program(s)’.
- Select the ‘Authorization Group’ from Setup.
- Validate that the service codes in the group are selected in ‘Service Code(s)’.
- Select desired value in ‘U/R Staff Person’.
- Select desired value in ‘Type Of Authorization’.
- Optionally enter data for other fields.
- Click [Submit].
Scenario 2: Managed Care Authorizations - Authorization Groups - Program Usage Type = Both
Specific Setup:
- Registry Setting: ‘Avatar PM->System Maintenance->Program Maintenance->->->Enable 'Admission vs. Service Program' Functionality’ has a value of ‘Y’.
- Program Maintenance: ‘Usage Type’ = Both. Desired service codes have been assigned to the program.
- Authorization Group Definition has been used to create a group that has a minimum of two service codes.
- Client: Is admitted to above program and has a Financial Eligibility record.
Steps
- Open ‘Managed Care Authorizations’ for the client.
- Select the ‘Managed Care Authorization Data’ section.
- Click [Add New Item].
- Select the ‘Guarantor Number’.
- Enter desired ‘Authorization Number’.
- Enter desired ‘Authorization Start Date’.
- Enter desired ‘Authorization End Date’.
- Select the ‘Authorization Group’ from Setup.
- Validate that the service codes in the group are selected in ‘Service Code(s)’.
- Select desired value in ‘U/R Staff Person’.
- Select desired value in ‘Type Of Authorization’.
- Optionally enter data for other fields.
- Click [Submit].
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Topics
• Managed Care Authorizations
• NX
|
'Team Assignment' is enhanced to no longer display inactive teams.
Scenario 1: 'Team Assignment' - validate Inactive and Deleted Teams are no longer included in the 'Admission' form 'Team Assignment' selection drop down field.
Specific Setup:
- RADplus 2022 Update 58 is required for full functionality.
- One or more teams are defined in the 'Team Definition' form.
- Client A is assigned to a team which will be flagged as 'Inactive'.
- Using 'Team Definition', flag the team Client A is assigned to as 'Inactive'.
- Client B is assigned to a team which will be deleted.
- Using 'Team Definition', flag the team Client B assigned to as 'Deleted'
Steps
- Create a report against SQL Table 'admission_data_other'.
- Include in the report, at a minimum, the following fields:
- PATID
- team_assignment_value
- team_assignment_code
- data_entry_date
- Run the report. Note the values entered for Client A and Client B. The team_assignment_value and team_assignment_code fields will be blank for both clients.
- Open the 'Admission (Outpatient)' form. Note that this functionality is the same in the 'Admission' form as well.
- Select Client A.
- Verify that there is no selection in the 'Team Assignment' field.
- Navigate to the 'Team Assignment' field.
- Click on the drop down list.
- Verify that no Teams defined as 'Inactive' are displayed for selection.
- Select any active Team from the list.
- Click [Submit].
- Open the 'Admission (Outpatient)' form. Note that this functionality is the same in the 'Admission' form as well.
- Select Client B.
- Verify that there is no selection in the 'Team Assignment' field. This team has been deleted from the 'Team Definition' form.
- Navigate to the 'Team Assignment' field.
- Click on the drop down list.
- Verify that no Teams which were deleted are included in the drop down list.
- Select any active Team from the list.
- Click [Submit].
- Run the report again.
- Verify the team_assignment_value and team_assignment_code fields are populated for both Client A and Client B.
|
Topics
• NX
• Team Assignment
|
Diagnosis/Enrollment Diagnosis - Future Estimated Onset Date
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Problem List
- Registry Settings (PM)
- Program Maintenance
- Enrollment Diagnosis
Scenario 1: Diagnosis / Add to Problem List
Specific Setup:
Steps
- Open the 'Diagnosis' form for the client.
- Add a diagnosis.
- Note the value of the 'Diagnosis Search’ field, and the 'SNOMED' value in the 'Code Crossmapping' field.
- Set the value of 'Add To Problem List' to "Yes".
- Set the "Estimated Onset Date" to a future date.
- Click [Submit].
- Validate a message pops up indicating that a "Future Onset Date not added to the Problem List"
- Edit the "Estimated Onset Date": to a past date.
- Click {Submit}.
- Close the form.
- Open 'Problem List' for the client.
- Select 'Active' from the 'Status' field.
- Click [View Problems].
- Validate the report contains the problem added via the Diagnosis form.
- Close the report.
- Close the form.
Scenario 2: Enrollment Diagnosis - - Add to Problem List
Specific Setup:
- Set Registry Setting "Enable Enrollments" to "2".
- Admit a new client into 2 separate episodes. Assign then both to the same "Enrollment".
Steps
- Open the "Enrollment Diagnosis" form.
- Select the enrollment for the client.
- Enter a diagnosis for the client's enrollment.
- Select "Yes" for "Add to Problem List".
- Set the "Estimated Date of Onset" to a future date.
- Validate a message pops up indicating "Future Estimated Onset Date cannot be added to the Problem List".
- Filing won't continue without resolving the future date issue.
- Set the "Estimated Date of Onset" to a past date.
- File the diagnosis.
- Open the "Problem List" form.
- Validate the diagnosis is added to the problem list.
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Topics
• Diagnosis
• NX
• Problem List
|
The 'Monthly Bed Days' widget is modified to display correct data.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: 'Monthly Bed Days' widget update process
Specific Setup:
- 'Monthly Bed Days' widget must be on the user's Home View
Steps
- Verify that the widget is displaying 'Compare From Previous Year' and 'Last 12 Months' data accurately.
- Note that prior to the install of Avatar PM 65, the Monthly Bed Days widget was prevented from being updated nightly due to an error in the background processing. No error would display to the user.
- Once Avatar PM 65 is installed, the counts for previous and current year data will be adjusted as all charges are now being included in the widget display when the nightly widget update process completes.
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Topics
• Monthly Bed Days Widget
|
Payment Acknowledgement - form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- User Definition
- Dictionary Update (PM)
- Posting/Adjustment Codes Definition
- Payment Acknowledgement
Scenario 1: Payment Acknowledgement - workflow
Specific Setup:
- Registry Setting:
- ‘Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement’ has a ‘Registry Setting Value’ of ‘Y’.
- Dictionary Update:
- Other Table Files: (5521) Program - contains dictionary codes and dictionary values.
- Other Table Files: (5522) Account - contains dictionary codes, dictionary values and extended dictionary values.
- Other Table Files: (9712) Payment Acknowledgement Type – extended dictionary values have been added to the locked dictionary.
- Posting/Adjustment Codes Definitions: Definitions exist for ‘Payment’.
- The definitions may have a value in the ‘Payment Acknowledgement Type’ field.
- All ‘Payment’ definitions will be available in the ‘Payment Acknowledgement’ form.
Steps
- Open ‘Payment Acknowledgement’ form.
- Verify that ‘Action’ defaults to ‘New’.
- Verify that ‘Transaction Number’ is read only.
- Verify that ‘Entered By’ is read only and defaults to the signed in user.
- Enter desired value in ‘Batch Number’.
- Select desired ‘Posting Code’.
- Enter desired value in ‘Check/EFT Number’.
- Enter desired value in ‘Amount’.
- Select desired ‘Guarantor’. If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
- Enter desired value in ‘Name/Source’.
- Enter desired value in ‘Client’, if enabled.
- Enter desired value in ‘Check/EFT Date’.
- Enter desired value in ‘Receipt Date’.
- Enter desired value in ‘Deposit Date’.
- Select desired ‘Treatment Service’.
- Select desired ‘Category’.
- Enter desired value in ‘Bank Ref #’.
- Enter desired value in ‘Comments’.
- Click [File].
- Verify that the ‘Payment Acknowledgement’ message is received and states the following: Filed successfully. The Transaction Number is 6. Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
- Click [Yes] to continue to Post Payment Accounting Entry section or [No] to remain in the ‘Payment Acknowledgement’ section.
- If [Yes] was clicked, go to step 30.
- If [No] was clicked, select ‘Edit or View’ in ‘Action, which will enable the ‘Payment Acknowledgement Search’ section.
- Enter data from the filed ‘Payment Acknowledgement’ into desired search fields. The ’Transaction Number’ and ‘Batch Number’ are specific to only one ‘Payment Acknowledgement’. The following fields may return results for more than one ‘Payment Acknowledgement’ when applicable: ‘Client’, ‘Guarantor’, ‘Amount Type’, ‘Check/EFT #’, ‘Check/EFT From Date’, ‘Check/EFT To Date’, ‘Deposit From Date’, and ‘Deposit To Date’.
- Click [Search].
- Select the desired item in the ‘Payment Acknowledgement’ grid.
- Click [OK] to continue or [Cancel] to end the search. Click [OK].
- The following ‘Payment Acknowledgement’ displays: Do you need to continue to Post Payment Accounting Entry?
- Click [Yes].
- Click [New Row] in ‘Post Payment Accounting Entry’.
- Select desired ‘Treatment Service’. It will default if filed in the ‘Payment Acknowledgement’.
- Select desired ‘Program’. This is from ‘Other Table Files: (5521) Program’, not a program in ‘Program Maintenance’.
- Select desired ‘Account’.
- Select desired ‘Amount’.
- Validate that the ‘Posting Code; defaulted from the ‘Payment Acknowledgement’.
- Select desired ‘Posting Date’.
- Validate that the ‘Posting Summary’ is correct.
- If desired, click [New Row] and repeat the steps.
- If desired, click [Delete Row]. A ‘Confirm Delete’ message will be displayed. Select desired value.
- Click [File].
- The following ‘Payment Acknowledgement’ displays: Filed successfully. Do you need to continue with Post Payment Accounting Entry?
- Click [Yes].
- Click the ‘Reverse’ checkbox in one row of the ‘Post Payment Accounting Entry’.
- Enter desired ‘Reversal Posting Date’.
- Enter desired ‘Reversal Reason’.
- Click [Reverse].
- Validate that a new row was added to the ‘Post Payment Accounting Entry’ grid and that it mirrors the row that was selected to reverse, except for ‘Amount’ displays in parentheses, indicating a negative amount.
- If desired, add a new row to post and additional payment.
- Close the form.
Scenario 2: Payment Acknowledgement - form & field validation
Specific Setup:
- Registry Setting:
- ‘Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement’ has a ‘Registry Setting Value’ of ‘Y’.
- Dictionary Update:
- Other Table Files: (5521) Program - contains dictionary codes and dictionary values.
- Other Table Files: (5522) Account - contains dictionary codes, dictionary values and extended dictionary values.
- Other Table Files: (9712) Payment Acknowledgement Type – extended dictionary values have been added to the locked dictionary.
- Posting/Adjustment Codes Definitions: Definitions exist for ‘Payment’.
- The definitions may have a value in the ‘Payment Acknowledgement Type’ field.
- All ‘Payment’ definitions will be available in the ‘Payment Acknowledgement’ form.
Steps
- Open ‘Payment Acknowledgement’ form.
- Verify that ‘Action’ defaults to ‘New’.
- Verify that ‘Transaction Number’ is read only.
- Verify that ‘Entered By’ is read only and defaults to the signed in user.
- Verify that ‘Batch Number’ is required.
- Verify that ‘Posting Code’’ is required.
- Verify that ‘Amount’ is required.
- Verify that ‘Guarantor’ is required.
- Verify that ‘Receipt Date’ is required.
- Verify that ‘Deposit Date’ is required.
- Enter desired value in ‘Batch Number’.
- Select desired ‘Posting Code’.
- Enter desired value in ‘Check/EFT Number’.
- Enter desired value in ‘Amount’.
- Select desired ‘Guarantor’. If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
- Enter desired value in ‘Name/Source’.
- Enter desired value in ‘Client’, if enabled.
- Enter desired value in ‘Check/EFT Date’.
- Enter desired value in ‘Receipt Date’.
- Enter desired value in ‘Deposit Date’.
- Select desired ‘Treatment Service’.
- Select desired ‘Category’.
- If the selected item, extended data dictionary value of 'Other Table Files: (5522) Account' - 'Include in Category Dictionary: Yes' the dictionary item will be available for selection. No = not available for selection.
- If the selected item, extended data dictionary value of 'Other Table Files: (5522) Account' - 'Require Name/Source in Payment Acknowledgement', has a value of 'Y' the 'Name/Source' field will become required. No = not required.
- Enter desired value in ‘Bank Ref #’.
- Enter desired value in ‘Comments’.
- Click [File].
- Verify that the ‘Payment Acknowledgement’ message is received and states the following: Filed successfully. The Transaction Number is 6. Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
- Clicking [No] returns the user to the ‘Payment Acknowledgement’ section to enter additional payments.
- Clicking [Yes] allows the user to post payments in 'Post Payment Accounting Entry'.
- Click [Yes].
- Click [New Row] in ‘Post Payment Accounting Entry’.
- Select desired ‘Treatment Service’. It will default if filed in the ‘Payment Acknowledgement’.
- Select desired ‘Program’. This is from ‘Other Table Files: (5521) Program’, not a program in ‘Program Maintenance’.
- Select desired ‘Account’.
- Select desired ‘Amount’.
- Validate that the ‘Posting Code; defaulted from the ‘Payment Acknowledgement’.
- Select desired ‘Posting Date’.
- Validate that the ‘Posting Summary’ is correct.
- If desired, and first row partially posts the 'Amount', click [New Row] and repeat the steps.
- If desired, click [Delete Row]. A ‘Confirm Delete’ message will be displayed. Select desired value.
- Click [File].
- The following ‘Payment Acknowledgement’ displays: Filed successfully. Do you need to continue with Post Payment Accounting Entry?
- Click [Yes].
- Click the ‘Reverse’ checkbox in one row of the ‘Post Payment Accounting Entry’.
- Enter desired ‘Reversal Posting Date’.
- Enter desired ‘Reversal Reason’.
- Click [Reverse].
- Validate that a new row was added to the ‘Post Payment Accounting Entry’ grid and that it mirrors the row that was selected to reverse, except for ‘Amount’ displays in parentheses, indicating a negative amount.
- If desired, add a new row to post and additional payment.
- Close the form.
- Open ‘Payment Acknowledgement’ form
- Select ‘Edit or View’ in ‘Action, which will enable the ‘Payment Acknowledgement Search’ section.
- Enter data from the ‘Payment Acknowledgement’, filed above, into desired search fields. The ’Transaction Number’ and ‘Batch Number’ are specific to only one ‘Payment Acknowledgement’. The following fields may return results for more than one ‘Payment Acknowledgement’ when applicable: ‘Client’, ‘Guarantor’, ‘Amount Type’, ‘Check/EFT #’, ‘Check/EFT From Date’, ‘Check/EFT To Date’, ‘Deposit From Date’, and ‘Deposit To Date’.
- Click [Search].
- Select the desired item in the ‘Payment Acknowledgement’ grid.
- Click [OK] to continue or [Cancel] to end the search. Click [OK].
- The following ‘Payment Acknowledgement’ displays: Do you need to continue to Post Payment Accounting Entry?
- Validate the ‘Post Payment Accounting Entry' contains the previously filed data.
|
Topics
• NX
• Payment Acknowledgement
|
Avatar PM is modified for future functionality.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Remittance Processing Widget
Scenario 1: Remittance Processing widget - Create/Edit/Delete Batch
Scenario 2: Remittance Processing Widget - SQL Table 'SYSTEM.remittance_batch' Validation.
|
Topics
• NX
• Spreadsheet Batch Remittance Posting
• Widgets
|
A new report: 'CPT License Count Report' is added to Avatar PM.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: CPT License Count Report
Steps
- Open the 'CPT License Count Report'.
- Set the Start Date input box to any date.
- Set the End Date input box to any date.
- Click [Process].
- Validate the 'Date Range' item contains the Date range as entered on the selection screen.
- Validate the '#' column contains a numeric value for each listed line item.
- Validate the 'User Name' column contains only active Users.
- Validate the 'User ID' column contains only active User IDs.
- Validate the 'Provider Name' column contains only active Providers
- Validate the 'Provider ID' column contains only active Provider IDs.
- Validate the 'Provider Category' column contains the Provider Category associated to the Provider.
- Click [Close Report]
- Click [Close Form].
CPT Code copyright notice is added to Avatar forms.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: CPT Code Definition - Field validation
Steps
- Access the 'CPT Code Definition' form.
- Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT Code' field.
- Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
- Close the form.
Scenario 2: CPT Place Of Service Override - field validations
Steps
- Open the 'CPT Place of Service Override' form.
- Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT Code' field.
- Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
- Close the form.
Scenario 3: Service Fee/Cross Reference Maintenance - field validations
Steps
- Access the 'Service Fee/Cross Reference Maintenance' form.
- Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT Code' field.
- Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
- Close the form.
Avatar PM is enhanced with updated CPT codes.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: CPT Codes: Annual code update
Steps
- Open Avatar PM 'CPT Code Definition' form.
- Click [Print CPT Codes].
- A list of the current CPT Codes will display.
- Review the list to assure new codes have been added.
- Click [Close].
Copyright notice is added to forms where CPT content is displayed.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Real Time Inquiry (270 Request)
- Program Maintenance
- Select Program
- Confirm Compile Completed
- Avatar NX Report Viewer
- Eligibility Inquiry (270) Request
- Eligibility Inquiry and Response (270/271) Report
Scenario 1: Process 'Real Time Inquiry (270) Request' with a value of 'Request Inquiry' in 'Eligibility Inquiry (270) Status'.
Specific Setup:
- Agency uses 'Real Time Inquiry (270) Request' functionality.
- Avatar PM 2018 Update 187 is installed.
- At least one 'Guarantors/Payors' has a value of 'Yes' in 'Support 270/271 Transaction Sets'. Note the guarantor.
- Selecting any client with the above 'Guarantors/Payors', update the 'Financial Eligibility' record to have a value of 'Request Inquiry' in 'Eligibility Inquiry (270) Status'. Note the client and the episode.
- If the 'Request Type' is 'Specific', a 'Service Code' with a value in 'Service Type Code (270)' must exist.
Steps
- Open 'Real Time Inquiry (270) Request'.
- Select the client.
- Select the episode.
- Select the guarantor.
- Select any value in 'Request Type'.
- Select the 'Service Code' if 'Specific' was selected above.
- Verify the AMA trademark 'CPT® Codes' is displayed above the 'CPT-4 Code' field.
- Verify the AMA Copyright Notice 'CPT copyright 2021 American Medical Association. All rights reserved.' is displayed at the bottom of the form.
- Click [Process Request].
- Validate that submission is successful.
- If a system error message is received, review the 'Eligibility Inquiry and Response (270/271) Report' to correct client or setup issues.
Scenario 2: 'Program Maintenance' - Field Validation
Steps
- Access the 'Program Maintenance' form.
- Navigate to the 'Encounter CPT Code' field.
- Verify that the AMA CPT Code Trademark 'CPT® Codes' is displayed.
- Scroll to the bottom of the form.
- Verify that 'CPT copyright 2021 American Medical Association. All rights reserved.' is displayed.
- Close the form.
Scenario 3: "Single Program Maintenance" - field validations
Steps
- Open "Single Program Maintenance" form.
- Select any program in the "Select Program" dialog.
- Click [Select].
- Navigate to the "Encounter CPT Code" field.
- Verify the AMA trademark 'CPT® Codes' is displayed.
- Scroll to the bottom of the form.
- Verify the AMA Copyright 'CPT copyright 2021 American Medical Association. All rights reserved.' is displayed.
- Click [File Program].
- Click [Close Form].
Scenario 4: Modifiers by Practitioner Category - Validation
Steps
- Open 'Modifiers by Practitioner Categories' form.
- Validate the CPT Code selection box contains 'CPT® Code'.
- Validate the AMA copyright notice displays at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
- Close the form.
Scenario 5: Eligibility Inquiry (270) Request field validation
Specific Setup:
- The following registry setting is enabled: 'Avatar PM->Billing->Electronic Submissions->Eligibility Inquiry & Response (270/271)->->Enable 270/271 Transaction Sets'.
Steps
- Open 'Eligibility Inquiry (270) Request'.
- Verify the 'CPT-4 Code' field contains the AMA Trademark 'CPT® Codes'.
- Verify the AMA copyright notice is displayed at the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'
Scenario 6: Eligibility Inquiry and Response (270/271) Report field validation
Steps
- Open 'Eligibility Inquiry and Response (270/271) Report'.
- Enter the 'Client ID' for the client that is not rejected.
- Verify the AMA Trademark displays 'CPT® Codes' above the 'CPT-4 Code' field.
- Verify the AMA Copyright Notice displays on the bottom of the form: 'CPT copyright 2021 American Medical Association. All rights reserved.'.
- Close the form.
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Topics
• CPT License Count Report
• NX
• CPT Codes
• Service Fee/Cross Reference Maintenance
• Eligibility Inquiry (270) Request
• Eligibility Response (271)
• Program Maintenance
• Single Program Maintenance
|
Accounts Receivable Management – Guarantor has an ‘&’ in name
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- AR Console Configuration
- AR Console User Defaults Setup
- System Task Scheduler
- Practitioner Numbers By Guarantor And Program
- Electronic Billing
- Registry Settings (PM)
- Dictionary Update (PM)
- Service Codes
- Program Maintenance
Scenario 1: AR Console User Defaults Setup - field validation
Specific Setup:
- The following registry setting has a value of Y: Avatar PM->Billing->Accounts Receivable Management->->->Enable Accounts Receivable Management Functionality.
- User Definition has been used to give the signed in user access to the form: Avatar PM / Billing / AR Management / AR Console User Defaults Setup.
- View Definition / NX View Definition has been used to place the widget on the tester's home view.
- Note the ID of at least two more users.
- Guarantors/Payor: The 'Guarantor Name' & the 'Guarantor Name For Alpha Lookup' fields contain an '&'.
- System Task Scheduler:
- The 'Auto AR Batch Update' was processed after the claims were created.
Steps
- Open ‘AR Console User Defaults Setup’.
- Click ‘New Row’ and add a row for the signed in user, or if the signed in user exists in a row select the row.
- Click ‘All’ in the following fields: ‘Financial Class(es)’, ‘Guarantor(s)’, ‘Treatment Setting(s)’ ‘Program(s)’ and ‘Client Last Name Initials to be Worked’.
- Add desired value to ‘Aged Over # Days’. Note the value.
- Click ‘New Row’ and add a row for the first additional user from ‘Setup’, or if the user exists in a row select the row.
- Select desired values in ‘Financial Class(es)’, ‘Guarantor(s)’, ‘Treatment Setting(s)’ ‘Program(s)’, ‘Client Last Name Initials to be Worked’, and ‘Aged Over # Days’.
- Note the values of each field.
- Click ‘New Row’ and add a row for the second additional user from ‘Setup’, or if the user exists in a row select the row.
- Select desired values in ‘Financial Class(es)’, ‘Guarantor(s)’, ‘Treatment Setting(s)’ ‘Program(s)’, ‘Client Last Name Initials to be Worked’, and ‘Aged Over # Days’.
- Note the values of each field.
- Click [Submit].
- Open ‘AR Console User Defaults Setup’.
- Select the row for the signed in user.
- Validate that the following fields have every available item in the checklist selected: ‘Financial Class(es)’, ‘Guarantor(s)’, ‘Treatment Setting(s)’ ‘Program(s)’ and ‘Client Last Name Initials to be Worked’.
- Select the row for the first additional user.
- Validate that the values that were submitted were retained.
- Select the row for the second additional user.
- Validate that the values that were submitted were retained.
- Click [Discard].
- Open the 'Account Receivable Console' widget for the signed in user.
- Verify that the ‘Financial Class(es)’, ‘Guarantor(s)’, ‘Treatment Setting(s)’ ‘Program(s)’ and ‘Client Last Name Initials to be Worked' fields contain all available selections.
- Verify that ‘Aged Over # Days' contains the value entered above.
- Close the widget.
Scenario 2: Account Receivable Console - Copy Claim Follow-Up/Notes
Specific Setup:
- Guarantors/Payors:
- Guarantor 1: The 'Guarantor Name' & the 'Guarantor Name For Alpha Lookup' fields contain an '&'.
- Guarantor 2: The 'Guarantor Name' & the 'Guarantor Name For Alpha Lookup' fields do not contain an '&’.
- Clients:
- Client A: Has a minimum of two outstanding claims for Guarantor 1. Note the client’s last name and the program.
- Client B: Has a minimum of two outstanding claims for Guarantor 2. Note the client’s last name and the program.
- Tester has access to the AR Console.
- AR Console User Defaults Setup:
- Tester has been given access to both Guarantors/Payors, the client’s last name initials, and the client programs.
- System Task Scheduler:
- The 'Auto AR Batch Update' was processed after the claims were created.
Steps
- Open the ‘Account Receivable Console’ widget.
- Validate that the ‘Guarantor’ field contains the selected guarantors, including the guarantor with the ‘&’ in the 'Guarantor Name' & the 'Guarantor Name For Alpha Lookup'
- Enter the ‘Client ID for Client A.
- Click [Search].
- Select a minimum of two claims in the ‘Claims with Outstanding Receivables’ gird.
- Click [Add Claim Follow-Up/Note].
- Validate the claim number in ‘Claim Follow-Up’.
- Go to the Follow-Up Notes’ section.
- Validate the note created by the AR Console exists.
- Click [New Row].
- Enter desired ‘Follow-Up Date’, ‘Comments’ and any other desired data.
- Click [File Updates].
- Click [OK].
- Select the row that was added above.
- Click [Copy Note].
- Select the claim to copy the note to in ‘Copy Follow-Up Note’.
- Click [Save].
- Select the claim number in ‘Claim Follow-Up’ that was selected in ‘Copy Follow-Up Note’.
- Validate that the copy note, and the note created by the AR Console exist in the ‘Claim Follow-Up’.
- Select the ‘AR List’ section.
- Repeat steps 3 - 20 for Client B.
- Close the widget.
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Topics
• Accounts Receivable Management
|
'Current Unit Census' report is modified to omit Units flagged as inactive.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Unit Verification Report
- Current Unit Census
Scenario 1: 'Verify Unit Census' field validation with 'Avatar PM->System Maintenance->Program Maintenance->>>Activate Program/Unit Filter' registry setting set to 'Y'
Specific Setup:
- Registry Setting 'Avatar PM->System Maintenance->Program Maintenance->>>Activate Program/Unit Filter' registry setting set to 'Y'
- One or more Units have been associated to a Program using Program Maintenance
- One or more or the Units have been set as inactivated in Dictionary Update.
Steps
- Open 'Verify Unit Census' form.
- Set the 'Date Verified From' field to any date.
- Set the 'Date Verified Through' to any date.
- Review the 'Unit' field and verify that no inactivate Unit are included in the display.
- Select one or more Units form in the 'Unit' field.
- Click [Yes] in the 'Census Verified (Y/N)' field.
- Click [Submit].
- Click [OK] on the message 'Verifying census data for the following unit(s):'
- Verify the form closes.
Scenario 2: 'Unit Verification Report' - field validation with 'Avatar PM->System Maintenance->Program Maintenance->>>Activate Program/Unit Filter' registry setting set to 'Y'
Specific Setup:
- Avatar PM->System Maintenance->Program Maintenance->>>Activate Program/Unit Filter' registry setting set to 'Y'
- One or more Units have been associated to a Program using Program Maintenance
- One or more or the Units have been set as inactivated in Dictionary Update.
Steps
- Open the 'Unit Verification Report'.
- Set the 'From Date Of Verification' field to any date.
- Set the 'Through Date Of Verification' field to any date.
- Click [Individual] in the 'For Individual Unit Or All' field.
- Verify no deactivated units are displayed in the 'Select Unit(s)' field.
- Select any unit in the list.
- Click [Both] in the 'Unverified/Verified/Both' field.
- Click [Launch Unit Verification Report].
- Verify the report displays accurately.
- Close the report.
- Close the form.
Scenario 3: 'Current Unit Census' - field validation with 'Avatar PM->System Maintenance->Program Maintenance->>>Activate Program/Unit Filter' registry setting set to 'Y'
Specific Setup:
- Must have one or more Units defined, associated to a program in Program Maintenance, and deactivated in the Dictionary Update form.
- Registry Setting 'Avatar PM->System Maintenance->Program Maintenance->>>Activate Program/Unit Filter' registry setting set to 'Y'
Steps
- Open the 'Current Unit Census' form.
- Click [Individual] in the 'For Individual Unit Or All' field.
- Click the drop down in 'For Unit' field.
- Verify that the inactivated Units are not displayed in the drop down. Note that if any deactivated units were ever used for bed assignments, they will display in the drop down for reporting purposes.
- Click [Close Form].
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Topics
• Current Unit Census
• NX
• Verify Unit Census
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Topics
• NX
• Payment Acknowledgement
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'Maintain Hospital Bed File' - 'Bed' field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Bed Management (View Only)
- Avatar NX Report Viewer
- Bed Reservation
Scenario 1: Maintain Hospital Bed File
Specific Setup:
- Existing Units, Rooms, and Beds must be defined in 'Maintain Hospital Bed File'.
Steps
- Access the 'Maintain Hospital Bed File' form.
- Select the "Room/Bed Name Change" section.
- Select any value in the 'Unit' field.
- Select any value in the 'Room' field.
- Validate the 'New Room' field contains the current room name.
- Enter any new value in the 'New Room' field.
- Enter any new value in the 'New Bed' field.
- Leave the 'Bed' field blank.
- Click [Submit].
- Validate an error message is displayed stating: "Please select a bed first".
- Click [OK].
- Select any value in the 'Bed' field.
- Validate the 'New Bed' field contains the current bed name.
- Enter any new value in the 'New Bed' field.
- Click [Submit] and [Yes].
- Select the same value selected in the previous steps in the 'Unit' field.
- Select the same value selected in the previous steps in the 'Room' field.
- Validate the 'New Room' field contains the current room name.
- Select the same value selected in the previous steps in the 'Bed' field.
- Validate the 'New Bed' field contains the new bed name filed.
- Close the form.
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Topics
• Maintain Hospital Bed File
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Default Guarantor Assignment - multiple default guarantors
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Cross Episode Financial Eligibility
- Default Guarantor Assignment
- Pre Admit
- Back Dated Admission/Discharge
- Family Registration
- Family Financial Eligibility
Scenario 1: Default Guarantor Assignment assigned during Admission
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the order.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Filing of Admission’ in ‘Default the Guarantor(s) During’.
- Select desired value in ‘Add the Guarantor(s) to Which Form’. Note: If ‘Financial Eligibility’ is selected the ‘Default the Guarantor(s) Only If’ field becomes disabled.
- If available, select ‘None’ in ‘Default the Guarantor(s) Only If’.
- Click [Submit].
- Open ‘Admission’ and admit a client into desired episode.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’, and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- As, desired change the value of the ‘Add the Guarantor(s) to Which Form’ and 'Default the Guarantor(s) Only If" fields and continue testing clients using the 'Admission’ form, or existing clients admitted from the 'Admission' form.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
Scenario 2: Default Guarantor Assignment assigned during Admission (Outpatient)
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Filing of Admission’ in ‘Default the Guarantor(s) During’.
- Select desired value in ‘Add the Guarantor(s) to Which Form’. Note: If ‘Financial Eligibility’ is selected the ‘Default the Guarantor(s) Only If’ field becomes disabled.
- If available, select ‘None’ in ‘Default the Guarantor(s) Only If’.
- Click [Submit].
- Open ‘Admission (Outpatient)’ and admit a client into desired episode.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’, and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- As, desired change the value of the ‘Add the Guarantor(s) to Which Form’ and 'Default the Guarantor(s) Only If" fields and continue testing clients using the 'Admission (Outpatient)' form, or existing clients admitted from the 'Admission (Outpatient)' form.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
Scenario 3: Default Guarantor Assignment assigned during Pre Admit
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Filing of Admission’ in ‘Default the Guarantor(s) During’.
- Select desired value in ‘Add the Guarantor(s) to Which Form’. Note: If ‘Financial Eligibility’ is selected the ‘Default the Guarantor(s) Only If’ field becomes disabled.
- If available, select ‘None’ in ‘Default the Guarantor(s) Only If’.
- Click [Submit].
- Open 'Pre Admit' and admit a client into desired episode.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’, and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- As, desired change the value of the ‘Add the Guarantor(s) to Which Form’ and 'Default the Guarantor(s) Only If' fields and continue testing clients using the 'Pre Admit' form.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
Scenario 4: Default Guarantor Assignment assigned during Back Dated Admission/Discharge
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Filing of Admission’ in ‘Default the Guarantor(s) During’.
- Select desired value in ‘Add the Guarantor(s) to Which Form’. Note: If ‘Financial Eligibility’ is selected the ‘Default the Guarantor(s) Only If’ field becomes disabled.
- If available, select ‘None’ in ‘Default the Guarantor(s) Only If’.
- Click [Submit].
- Open ‘Back Dated Admission/Discharge’ and admit and discharge a client in a program.
- Click [Submit].
- Open the form selected in ‘Add the Guarantor(s) to Which Form’.
- Verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- As, desired change the value of the ‘Add the Guarantor(s) to Which Form’ and 'Default the Guarantor(s) Only If' fields and continue testing clients using the 'Back Dated Admission/Discharge' form.
- Open the form selected in ‘Add the Guarantor(s) to Which Form’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
Scenario 5: Default Guarantor Assignment assigned through Financial Eligibility
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
- An additional guarantor is identified. The guarantor will not be added to the 'Default Guarantor Assignment’ form.
- Clients:
- A: An existing client, with no financial eligibility record is identified, or a new client is created.
- B: An existing client, with a financial eligibility record that contains the additional guarantor not added to the 'Default Guarantor Assignment’ form, is identified.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Entry to Financial Eligibility Forms’ in ‘Default the Guarantor(s) During’.
- Select 'Financial Eligibility' in ‘Add the Guarantor(s) to Which Form’.
- Select 'None Exists' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open ‘'Financial Eligibility' for ‘Client A’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- Open ‘Default Guarantor Assignment’.
- Select 'Not a Part of Financial Eligibility/Cross Episode Financial Eligibility/Family Financial Eligibility' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open ‘'Financial Eligibility' for ‘Client B’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.Click [Submit].
Scenario 6: Default Guarantor Assignment assigned through Cross Episode Financial Eligibility
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
- An additional guarantor is identified. The guarantor will not be added to the 'Default Guarantor Assignment’ form.
- Clients:
- A: An existing client, with multiple episodes, with no financial eligibility record is identified, or a new client is created.
- B: An existing client, with multiple episodes, with a financial eligibility record that contains the additional guarantor not added to the 'Default Guarantor Assignment’ form, is identified.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Entry to Financial Eligibility Forms’ in ‘Default the Guarantor(s) During’.
- Select 'Cross Episode Financial Eligibility' in ‘Add the Guarantor(s) to Which Form’.
- Select 'None Exists' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open 'Cross Episode Financial Eligibility; for ‘Client A’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
- Open ‘Default Guarantor Assignment’.
- Select 'Not a Part of Financial Eligibility/Cross Episode Financial Eligibility/Family Financial Eligibility' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open 'Cross Episode Financial Eligibility' for ‘Client B’ and verify that the guarantor order is correct in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Click [Submit].
Scenario 7: Default Guarantor Assignment assigned through Family Financial Eligibility
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of two guarantors, with a value in default guarantor plan, are identified. The guarantors will be added to the 'Default Guarantor Assignment’ form.
- An additional guarantor is identified. The guarantor will not be added to the 'Default Guarantor Assignment’ form.
- Clients:
- Family A: is an existing family created through 'Family Registration'. There is no financial eligibility record. All members should have a social security number on file.
- Family B: is an existing family created through 'Family Registration'. There is a financial eligibility record for the additional guarantor not added to the 'Default Guarantor Assignment’ form. All members should have a social security number on file.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the orders.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Entry to Financial Eligibility Forms’ in ‘Default the Guarantor(s) During’.
- Select 'Family Financial Eligibility' in ‘Add the Guarantor(s) to Which Form’.
- Select 'None Exists' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open 'Family Financial Eligibility' for ‘Family A’.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Select the ‘Guarantor Assignment' section.
- Click [Add New Item].
- Select desired member in 'Select Family Member For Assignment.
- Select desired value in 'Guarantor # 1'.
- Select desired value in 'Relationship to Subscriber'.
- Repeat steps 16 & 17 for all guarantors.
- Repeat step 15, 16 & 17 for all desired members.
- Click [Submit].
- Open ‘Default Guarantor Assignment’.
- Select 'Not a Part of Financial Eligibility/Cross Episode Financial Eligibility/Family Financial Eligibility' in 'Default the Guarantor(s) Only If'.
- Click [Submit].
- Open 'Family Financial Eligibility' for ‘Family B’, and verify that the preexisting displays in the ‘Financial Eligibility’ section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’.
- Select the ‘Guarantor Assignment' section.
- Select an existing family member in 'Guarantor Assignment to Family Member' and click 'Edit Selected Item'.
- Click [Clear Current Assignments].
- Select desired value in 'Guarantor # 1'.
- Select desired value in 'Relationship to Subscriber'.
- Repeat steps 31 & 32 for all guarantors.
- Repeat steps 29, 30, 31 & 32 for all desired members.
- Click [Submit].
Scenario 8: Default Guarantor Assignment - form & field validation
Specific Setup:
- Registry Setting:
- ‘Enable Default Guarantor Assignment’ has a value of ‘Y’.
- 'Require Additional Subscriber Fields' has a value of 'N'.
- Guarantors/Payors:
- A minimum of one guarantor, with a value in default guarantor plan, is identified.
- A minimum of one guarantor, with no value in default guarantor plan, is identified.
Steps
- Open ‘Default Guarantor Assignment’.
- Note: if the form has a previous value it will default into the form.
- Click [Clear Guarantor Order].
- In ‘Select Guarantor to Default’ select the guarantor that will be first in the order.
- Repeat the selections in ‘Select Guarantor to Default’ until all guarantors have been added. The following message displays when the guarantor that has no value in default guarantor plan is selected: Default Guarantor Plan Missing: A default guarantor plan is not defined for guarantor (750) New Guarantor 750. A 'Financial Eligibility' record will not be filed during an admission for this guarantor. Click [OK] to remove the message.
- Verify that the ‘Guarantor Order’ text box contains the order as entered.
- Select ‘Filing of Admission’ in ‘Default the Guarantor(s) During’.
- Select desired value in ‘Add the Guarantor(s) to Which Form’. Note: If ‘Financial Eligibility’ is selected the ‘Default the Guarantor(s) Only If’ field becomes disabled.
- If available, select ‘desired value’ in ‘Default the Guarantor(s) Only If’.
- Click [Submit].
- Admit a new client.
- Open the form selected in Add the Guarantor(s) to Which Form’.
- Verify that only guarantors that have a default guarantor plan display in the financial eligibility section.
- Select the ‘Guarantor Selection’ section.
- Verify that there is a row in ‘Guarantor Information’ for each guarantor selected in ‘Default Guarantor Assignment’ that has a default guarantor plan.
- Click [Submit].
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Topics
• Default Guarantor Assignment
• Default Guarantor Order Setup
• NX
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835 Health Care Claim Payment/Advice - Check / EFT #
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claim Adjustment Group/Reason Code Definition
- Registry Settings (PM)
- Dictionary Update (PM)
- Default Guarantor Assignment
- Posting/Adjustment Codes Definition
- Electronic Billing
- Payment Acknowledgement
- 835 Health Care Claim Payment/Advice (PM)
Scenario 1: 835 Health Care Claim Payment/Advice - Partial posting of an 835s - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=1&2&3
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 date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 2: 835 Health Care Claim Payment/Advice - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=0
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 '0'.
- The 'Check Number' 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 date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 3: 835 Healthcare Claim Payment/Advice - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=1 and the 'Check Number' = 1
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.
- 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.
Scenario 4: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Validating check Date - 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:
- Two existing guarantor are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
- financial class of 'Self Pay'. Note the guarantor codes/names.
- 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.
835 Health Care Claim Payment/Advice - Registry Setting 'Posting Date for Automated 835s'
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Electronic Billing
- Claim Adjustment Group/Reason Code Definition
- 835 Health Care Claim Payment/Advice (PM)
- Payment Acknowledgement
- Registry Settings (PM)
- Dictionary Update (PM)
- Default Guarantor Assignment
- Posting/Adjustment Codes Definition
Scenario 1: 835 Healthcare Claim Payment/Advice - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=1 and the 'Check Number' = 1
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.
- 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.
Scenario 2: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Validating check Date - 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:
- Two existing guarantor are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
- financial class of 'Self Pay'. Note the guarantor codes/names.
- 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.
Scenario 3: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Validating Processing Date - 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&2'.
- 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.
- 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 Files\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 Files\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 Files\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:
- Two existing guarantor are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
- financial class of 'Self Pay'. Note the guarantor codes/names.
- 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 processing date when the 835 file is posted.
835 Health Care Claim Payment/Advice - ‘Check/EFT #’ drop down
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claim Adjustment Group/Reason Code Definition
- Registry Settings (PM)
- Dictionary Update (PM)
- Default Guarantor Assignment
- Posting/Adjustment Codes Definition
- Electronic Billing
- Payment Acknowledgement
- 835 Health Care Claim Payment/Advice (PM)
Scenario 1: 835 Health Care Claim Payment/Advice - Partial posting of an 835s - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=1&2&3
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 date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 2: 835 Health Care Claim Payment/Advice - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=0
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 '0'.
- The 'Check Number' 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 date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 3: 835 Healthcare Claim Payment/Advice - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=1 and the 'Check Number' = 1
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.
- 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.
Scenario 4: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Validating check Date - 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:
- Two existing guarantor are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
- financial class of 'Self Pay'. Note the guarantor codes/names.
- 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.
Batch Cash Posting - Payment Acknowledgement
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Dictionary Update (PM)
- Default Guarantor Assignment
- Posting/Adjustment Codes Definition
- Batch Cash Posting
- Payment Acknowledgement
Scenario 1: Prevent Posting Payments Unless Payment has been Acknowledged - Batch Cash Posting - Posting payment
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&2'.
- Admission:
- Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
- Guarantor/Payors:
- An existing guarantor is identified who has a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
- financial class of 'Self Pay'. Note the guarantor code/name.
- Financial Eligibility:
- Assign desired guarantor to the client.
- Client Charge Input:
- A service is rendered to the client.
- Client Ledger:
- Make sure the service is distributed to the guarantor assigned to the client.
Steps
- Open the 'Batch Cash Posting' form.
- Enter desired date to the 'Date of Receipt or Adjustment' field.
- Enter desired date to the 'Cash Posting Date' field.
- Validate the 'Posting Type' field exists and it marks as required field. Valid values: Payment, Adjustment.
- Validate the 'Payment Acknowledgement' field exists and it initially disabled. It becomes enable and required when the 'Payment' is selected for the 'Posting Type'. Valid values: Yes, No.
- Select 'Payment' in the 'Posting Type' field.
- Select 'No' in the 'Payment Acknowledgement' field.
- Select desired guarantor.
- Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
- Validate 'Filter Payment Acknowledgments' button exists.
- Enter desired amount in the 'Amount to Post' field.
- Validate the system defaults an amount of $0 because the ‘Posting Type’ is Payment and ‘Payment Acknowledgment’ is set to No.
- Enter desired non-zero amount in the 'Amount to Post' field.
- Verify the error message - 'Payment Acknowledgment is required for non-zero dollar payments.'
- Click [Discard].
- Open ‘Payment Acknowledgment’ form.
- Enter desired value in ‘Batch Number’.
- Select desired ‘Posting Code’.
- Enter desired value in ‘Check/EFT Number’.
- Enter desired value in ‘Amount’.
- Select desired ‘Guarantor’. If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
- Enter desired value in ‘Name/Source’.
- Enter desired value in ‘Client’, if enabled.
- Enter desired value in ‘Check/EFT Date’.
- Enter desired value in ‘Receipt Date’.
- Enter desired value in ‘Deposit Date’.
- Select desired ‘Treatment Service’.
- Select desired ‘Category’.
- Enter desired value in ‘Bank Ref #’.
- Enter desired value in ‘Comments’.
- Click [File].
- Verify that the ‘Payment 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 'Batch Cash Posting' form.
- Enter desired date to the 'Date of Receipt or Adjustment' field.
- Enter desired date to the 'Cash Posting Date' field.
- Select 'Payment' in the 'Posting Type' field.
- Select 'No' in the 'Payment Acknowledgment' field.
- Select desired guarantor.
- Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
- Select payment acknowledgement defined for the selected guarantor.
- Validate the 'Amount to Post' field defaults to the remaining amount of the selected payment acknowledgment.
- Select 'Individual' in the 'Individual or All Clients' field.
- Select desired client from the 'Client ID' field.
- Select desired program from the 'Program of Service' field.
- Select service start date in the 'From Date' field.
- Select service end date in the 'To Date' field.
- Select desired payment acknowledgement code from the 'Posting Code' field.
- Validate the 'Receipt' field defaults in the transaction number of the payment acknowledgment If payment acknowledgment is selected.
- Enter desire Check/EFT # in the 'Check #' field.
- Select 'Ignore' in the 'Write Off or Ignore Remaining Balance' field.
- Click [Process].
- Validate the form files successfully.
- Open the 'Crystal Reports' or any other SQL Data Reporting tool.
- Select the PM namespace.
- Identify desired database and SQL table - SYSTEM.billing_pay_adj_history
- Locate to the SQL Editor
- Query 'select * from SYSTEM.billing_pay_adj_history where PATID=614'
- Validate the ID cell is equal to '98||614||B66169.001||CR66169.001'
- Validate the FACILITY cell is equal to '98'
- Validate the 1st PATID cell is equal to '614'
- Validate the EPISODE_NUMBER column is equal to '1'
- Validate the GUARANTOR_ID cell is equal to '100'
- Validate the date_of_payment cell is equal to '2022-03-01'
- Validate the payment_type_code cell is equal to '6001'
- Validate the payment_type_value cell does not contain 'PAY ACKNOWLEDGEMENT - CHECK'
- Validate the payment_amount cell does not contain '50.00'
- Validate the check_number cell is equal to '96979353397'
- Validate the date_of_receipt cell is equal to '2022-03-01'
- Validate the date_of_service column is equal to '2022-03-01'
- Validate the option_desc cell is equal to 'Batch Cash Posting'
- Validate the type_of_payment cell is equal to 'PAYMENT'
- Close the SQL data viewer.
Scenario 2: Prevent Posting Payments Unless Payment has been Acknowledged - Batch Cash Posting - Posting Adjustments and $0.00 payment with Write-Off
Steps
- Open the 'Batch Cash Posting' form.
- Enter desired date to the 'Date of Receipt or Adjustment' field.
- Enter desired date to the 'Cash Posting Date' field.
- Select 'Payment' in the 'Posting Type' field.
- Select 'No' in the 'Payment Acknowledgment' field.
- Select desired guarantor.
- Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
- Select payment acknowledgement defined for the selected guarantor.
- Validate the 'Amount to Post' field defaults to the remaining amount of the selected payment acknowledgment.
- Select 'Individual' in the 'Individual or All Clients' field.
- Select desired client from the 'Client ID' field.
- Select desired program from the 'Program of Service' field.
- Select service start date in the 'From Date' field.
- Select service end date in the 'To Date' field.
- Select desired payment acknowledgement code from the 'Posting Code' field.
- Validate the 'Receipt' field defaults in the transaction number of the payment acknowledgment If payment acknowledgment is selected.
- Enter desire Check/EFT # in the 'Check #' field.
- Select 'Ignore' in the 'Write Off or Ignore Remaining Balance' field.
- Click [Process].
- Validate the form files successfully.
- Open the 'Crystal Reports' or any other SQL Data Reporting tool.
- Select the PM namespace.
- Identify desired database and SQL table - SYSTEM.billing_pay_adj_history
- Locate to the SQL Editor
- Query 'select * from SYSTEM.billing_pay_adj_history where PATID=614'
- Validate the ID cell is equal to '98||614||B66169.001||CR66169.001'
- Validate the FACILITY cell is equal to '98'
- Validate the 1st PATID cell is equal to '614'
- Validate the EPISODE_NUMBER column is equal to '1'
- Validate the GUARANTOR_ID cell is equal to '100'
- Validate the date_of_payment cell is equal to '2022-03-01'
- Validate the payment_type_code cell is equal to '6001'
- Validate the payment_type_value cell does not contain 'PAY ACKNOWLEDGEMENT - CHECK'
- Validate the payment_amount cell does not contain '50.00'
- Validate the check_number cell is equal to '96979353397'
- Validate the date_of_receipt cell is equal to '2022-03-01'
- Validate the date_of_service column is equal to '2022-03-01'
- Validate the option_desc cell is equal to 'Batch Cash Posting'
- Validate the type_of_payment cell is equal to 'PAYMENT'
- Close the SQL data viewer.
Registry Setting - Prevent Posting Payments Unless Payment has been Acknowledged
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Dictionary Update (PM)
- Default Guarantor Assignment
- Posting/Adjustment Codes Definition
- Batch Cash Posting
- Payment Acknowledgement
- Claim Adjustment Group/Reason Code Definition
- Electronic Billing
- 835 Health Care Claim Payment/Advice (PM)
Scenario 1: Registry Setting validation - Prevent Posting Payments Unless Payment has been Acknowledged
Steps
- Open the 'Registry Settings' form.
- Set the 'Enable Payment Acknowledgement' registry setting to 'N'.
- Submit the form.
- Open the 'Registry Setting' 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 and/or 3. 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. 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'.
- 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 '1&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 '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 '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 '1&2&3'.
- Click [Submit].
- Click [OK].
- Click [No].
Scenario 2: Prevent Posting Payments Unless Payment has been Acknowledged - Batch Cash Posting - Posting payment
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&2'.
- Admission:
- Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
- Guarantor/Payors:
- An existing guarantor is identified who has a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
- financial class of 'Self Pay'. Note the guarantor code/name.
- Financial Eligibility:
- Assign desired guarantor to the client.
- Client Charge Input:
- A service is rendered to the client.
- Client Ledger:
- Make sure the service is distributed to the guarantor assigned to the client.
Steps
- Open the 'Batch Cash Posting' form.
- Enter desired date to the 'Date of Receipt or Adjustment' field.
- Enter desired date to the 'Cash Posting Date' field.
- Validate the 'Posting Type' field exists and it marks as required field. Valid values: Payment, Adjustment.
- Validate the 'Payment Acknowledgement' field exists and it initially disabled. It becomes enable and required when the 'Payment' is selected for the 'Posting Type'. Valid values: Yes, No.
- Select 'Payment' in the 'Posting Type' field.
- Select 'No' in the 'Payment Acknowledgement' field.
- Select desired guarantor.
- Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
- Validate 'Filter Payment Acknowledgments' button exists.
- Enter desired amount in the 'Amount to Post' field.
- Validate the system defaults an amount of $0 because the ‘Posting Type’ is Payment and ‘Payment Acknowledgment’ is set to No.
- Enter desired non-zero amount in the 'Amount to Post' field.
- Verify the error message - 'Payment Acknowledgment is required for non-zero dollar payments.'
- Click [Discard].
- Open ‘Payment Acknowledgment’ form.
- Enter desired value in ‘Batch Number’.
- Select desired ‘Posting Code’.
- Enter desired value in ‘Check/EFT Number’.
- Enter desired value in ‘Amount’.
- Select desired ‘Guarantor’. If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
- Enter desired value in ‘Name/Source’.
- Enter desired value in ‘Client’, if enabled.
- Enter desired value in ‘Check/EFT Date’.
- Enter desired value in ‘Receipt Date’.
- Enter desired value in ‘Deposit Date’.
- Select desired ‘Treatment Service’.
- Select desired ‘Category’.
- Enter desired value in ‘Bank Ref #’.
- Enter desired value in ‘Comments’.
- Click [File].
- Verify that the ‘Payment 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 'Batch Cash Posting' form.
- Enter desired date to the 'Date of Receipt or Adjustment' field.
- Enter desired date to the 'Cash Posting Date' field.
- Select 'Payment' in the 'Posting Type' field.
- Select 'No' in the 'Payment Acknowledgment' field.
- Select desired guarantor.
- Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
- Select payment acknowledgement defined for the selected guarantor.
- Validate the 'Amount to Post' field defaults to the remaining amount of the selected payment acknowledgment.
- Select 'Individual' in the 'Individual or All Clients' field.
- Select desired client from the 'Client ID' field.
- Select desired program from the 'Program of Service' field.
- Select service start date in the 'From Date' field.
- Select service end date in the 'To Date' field.
- Select desired payment acknowledgement code from the 'Posting Code' field.
- Validate the 'Receipt' field defaults in the transaction number of the payment acknowledgment If payment acknowledgment is selected.
- Enter desire Check/EFT # in the 'Check #' field.
- Select 'Ignore' in the 'Write Off or Ignore Remaining Balance' field.
- Click [Process].
- Validate the form files successfully.
- Open the 'Crystal Reports' or any other SQL Data Reporting tool.
- Select the PM namespace.
- Identify desired database and SQL table - SYSTEM.billing_pay_adj_history
- Locate to the SQL Editor
- Query 'select * from SYSTEM.billing_pay_adj_history where PATID=614'
- Validate the ID cell is equal to '98||614||B66169.001||CR66169.001'
- Validate the FACILITY cell is equal to '98'
- Validate the 1st PATID cell is equal to '614'
- Validate the EPISODE_NUMBER column is equal to '1'
- Validate the GUARANTOR_ID cell is equal to '100'
- Validate the date_of_payment cell is equal to '2022-03-01'
- Validate the payment_type_code cell is equal to '6001'
- Validate the payment_type_value cell does not contain 'PAY ACKNOWLEDGEMENT - CHECK'
- Validate the payment_amount cell does not contain '50.00'
- Validate the check_number cell is equal to '96979353397'
- Validate the date_of_receipt cell is equal to '2022-03-01'
- Validate the date_of_service column is equal to '2022-03-01'
- Validate the option_desc cell is equal to 'Batch Cash Posting'
- Validate the type_of_payment cell is equal to 'PAYMENT'
- Close the SQL data viewer.
Scenario 3: Prevent Posting Payments Unless Payment has been Acknowledged - Batch Cash Posting - Posting Adjustments and $0.00 payment with Write-Off
Steps
- Open the 'Batch Cash Posting' form.
- Enter desired date to the 'Date of Receipt or Adjustment' field.
- Enter desired date to the 'Cash Posting Date' field.
- Select 'Payment' in the 'Posting Type' field.
- Select 'No' in the 'Payment Acknowledgment' field.
- Select desired guarantor.
- Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
- Select payment acknowledgement defined for the selected guarantor.
- Validate the 'Amount to Post' field defaults to the remaining amount of the selected payment acknowledgment.
- Select 'Individual' in the 'Individual or All Clients' field.
- Select desired client from the 'Client ID' field.
- Select desired program from the 'Program of Service' field.
- Select service start date in the 'From Date' field.
- Select service end date in the 'To Date' field.
- Select desired payment acknowledgement code from the 'Posting Code' field.
- Validate the 'Receipt' field defaults in the transaction number of the payment acknowledgment If payment acknowledgment is selected.
- Enter desire Check/EFT # in the 'Check #' field.
- Select 'Ignore' in the 'Write Off or Ignore Remaining Balance' field.
- Click [Process].
- Validate the form files successfully.
- Open the 'Crystal Reports' or any other SQL Data Reporting tool.
- Select the PM namespace.
- Identify desired database and SQL table - SYSTEM.billing_pay_adj_history
- Locate to the SQL Editor
- Query 'select * from SYSTEM.billing_pay_adj_history where PATID=614'
- Validate the ID cell is equal to '98||614||B66169.001||CR66169.001'
- Validate the FACILITY cell is equal to '98'
- Validate the 1st PATID cell is equal to '614'
- Validate the EPISODE_NUMBER column is equal to '1'
- Validate the GUARANTOR_ID cell is equal to '100'
- Validate the date_of_payment cell is equal to '2022-03-01'
- Validate the payment_type_code cell is equal to '6001'
- Validate the payment_type_value cell does not contain 'PAY ACKNOWLEDGEMENT - CHECK'
- Validate the payment_amount cell does not contain '50.00'
- Validate the check_number cell is equal to '96979353397'
- Validate the date_of_receipt cell is equal to '2022-03-01'
- Validate the date_of_service column is equal to '2022-03-01'
- Validate the option_desc cell is equal to 'Batch Cash Posting'
- Validate the type_of_payment cell is equal to 'PAYMENT'
- Close the SQL data viewer.
Scenario 4: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Validating Processing Date - 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&2'.
- 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.
- 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 Files\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 Files\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 Files\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:
- Two existing guarantor are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
- financial class of 'Self Pay'. Note the guarantor codes/names.
- 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 processing date when the 835 file is posted.
Scenario 5: Registry Setting validation - Prevent Posting Payments Unless Payment has been Acknowledged
Steps
- Open the 'Registry Settings' form.
- Set the 'Enable Payment Acknowledgement' registry setting to 'N'.
- Submit the form.
- Open the 'Registry Setting' 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 and/or 3. 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. 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'.
- 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 '1&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 '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 '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 '1&2&3'.
- Click [Submit].
- Click [OK].
- Click [No].
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Topics
• 835 Health Care Claim Payment/Advice
• NX
• Batch Cash Posting
• Payment Acknowledgement
• Registry Settings
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Avatar PM is prepared for future functionality
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Delete Bed Assignment
- CareFabric Monitor
Scenario 1: Validate 'Bed Assignment' and 'Delete Bed Assignment' on 'CareFabric Monitor' for PM
Specific Setup:
- Inpatient client assigned to a room and bed (Client A).
Steps
- Open 'Bed Assignment'.
- Select 'Client A'.
- Assign a different 'Unit', 'Room' and 'Bed' and click [Submit].
- Open 'Delete Bed Assignment'.
- Select 'Client A' and the corresponding episode.
- Select the last 'Bed assignment' from the 'Bed Assignment to Delete' field.
- Click [Submit].
- Open 'CareFabric Monitor'.
- Enter the current date in the 'From Date' field.
- Enter the current date in the 'Through Date' field.
- Select 'Client A'.
- Click [View Activity Log].
- Verify the data is correct.
- Click [Click to View Record].
- Verify the data is correct.
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Topics
• Bed Assignment
• CareFabric Monitor
• Delete Bed Assignment
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Avatar PM 'Client Call Intake' Web Service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Call Intake
Scenario 1: 'ClientCallIntake' Web Service - Verification of 'AddCallIntake' Filing
Specific Setup:
- One or more 'Call Intake' programs must be defined (via Avatar PM 'Program Maintenance' form)
- Avatar PM Registry Setting 'Auto Assign Next ID' may be enabled or disabled
- Application utilizing the Avatar PM 'ClientCallIntake' web service
Steps
- Using Avatar PM 'ClientCallIntake' web service, submit request to 'AddCallIntake' method to create new Avatar PM Call Intake record, including value for 'SlidingFeeDivideNumFamMembers' ('Divide Sliding Fee Scale Amount by Number of Family Members Receiving Services') and 'SlidingFeeDivideNumFamMembersNum' ('Sliding Fee Scale - Number of Family Members Receiving Services') fields/segments.
- Optionally, include or exclude value for 'ClientID' field/segment.
- Confirm 'ClientCallIntake' web service responds with confirmation data/Client Unique ID on successful filing of 'AddCallIntake' method.
- Example:"<Confirmation>Client Unique ID : P26 Unique ID: CAL66110.001</Confirmation>"
- Confirm 'ClientCallIntake' web service responds with confirmation message on successful filing of 'AddCallIntake' method.
- Example:"<Message>Client Call Intake web service has been filed successfully.</Message>"
- Confirm 'ClientCallIntake' web service responds with successful status value on successful filing of 'AddCallIntake' method.
- Example:"<Status>1</Status>"
- In case where Avatar PM Registry Setting 'Auto Assign Next ID' is enabled and 'ClientID' field/segment value is included in web service submission for new client creation, confirm that 'ClientCallIntake' web service responds with error status/message and 'Call Intake' form/client record is not created.
- Example: "<Message>Avatar ClientID does not exist and registry Setting 'Auto Assign Next ID' is enabled.</Message>"; "<Status>0</Status>"
- Open Avatar PM 'Call Intake' form and select client/Call Intake record filed via web service for view/update.
- Confirm new Call Intake record is created in Avatar PM, with values/data submitted via web service including 'Divide Sliding Fee Scale Amount by Number of Family Members Receiving Services' and 'Sliding Fee Scale - Number of Family Members Receiving Services' field values.
Scenario 2: 'ClientCallIntake' Web Service - Verification of 'UpdateCallIntake' Filing
Specific Setup:
- One or more 'Call Intake' programs must be defined (via Avatar PM 'Program Maintenance' form)
- Avatar PM Registry Setting 'Auto Assign Next ID' may be enabled or disabled
- Existing Avatar PM client/Call Intake record for edit via web service
- Application utilizing the Avatar PM 'ClientCallIntake' web service
Steps
- Using Avatar PM 'ClientCallIntake' web service, submit request to 'UpdateCallIntake' method to edit existing Avatar PM Call Intake record, including value for 'SlidingFeeDivideNumFamMembers' ('Divide Sliding Fee Scale Amount by Number of Family Members Receiving Services') and 'SlidingFeeDivideNumFamMembersNum' ('Sliding Fee Scale - Number of Family Members Receiving Services') fields/segments.
- Confirm 'ClientCallIntake' web service responds with confirmation data/Client Unique ID on successful filing of 'UpdateCallIntake' method.
- Example:"<Confirmation>Client Unique ID : P26 Unique ID: CAL66110.001</Confirmation>"
- Confirm 'ClientCallIntake' web service responds with confirmation message on successful filing of 'UpdateCallIntake' method.
- Example:"<Message>Client Call Intake web service has been filed successfully.</Message>"
- Confirm 'ClientCallIntake' web service responds with successful status value on successful filing of 'UpdateCallIntake' method.
- Example:"<Status>1</Status>"
- Open Avatar PM 'Call Intake' form and select client/Call Intake record updated via web service for view/update.
- Confirm Call Intake record is updated in Avatar PM with values/data submitted via web service including 'Divide Sliding Fee Scale Amount by Number of Family Members Receiving Services' and 'Sliding Fee Scale - Number of Family Members Receiving Services' field values.
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Topics
• Call Intake
• Web Services
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Edit Service Information - Editing billing inhibited 'Open' service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Inhibit Billing By Service
- Dynamic Form - Inhibit Services - Please review your selections to Inhibit services
- Dynamic Form - File Service Inhibit Information
- Inhibited Services For Billing Report
- Dynamic Form - Un-Inhibit services - Please review your selections to Un-Inhibit service
Scenario 1: Edit Service Information - Editing an open service
Specific Setup:
- Identify an existing client that has at least one existing open service.
Steps
- Open the 'Edit Service Information' form.
- Select the desired client in the 'Client ID' field.
- Select desired episode from the 'Episode Number' field.
- Click [Select Service(s) To Edit].
- Verify the 'Select Service(s) To Edit' dialog is displayed.
- Select desired service from the 'Select Service(s) To Edit' dialog.
- Enter a different value in the 'Duration (Minutes)' field.
- Select a new service code in the 'Service Code' field.
- Click [OK].
- Submit the form.
- Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
- Click [No].
- Query the 'SYSTEM.billing_tx_history' SQL table.
- Validate the 'PATID' column is equal to the correct client id identified in the setup.
- Validate the 'date_of_service' column is equal to correct date of service rendered to the client.
- Validate the 'Service Code' column contains correct service code submitted in the 'Edit Service Information' form.
- Validate the 'option_desc' column contains 'Edit Service Information'.
Scenario 2: Edit Service Information - Editing 'Open' service that is marked as billing inhibited / uninhibited
Specific Setup:
- Guarantors/Payor:
- An existing guarantor is identified. Note the guarantor's code / name.
- Admission:
- An existing client, in an outpatient episode, is identified or a new client is admitted to an outpatient program. Note the client ID, Admission date, and program.
- Financial Eligibility:
- The guarantor above is assigned to the client.
- Client Charge Input:
- A service is rendered. Note the service date.
- Client Ledger:
- The service is distributed to the guarantor assigned to the client and it is in 'Open' status.
Steps
- Open the 'Edit Service Information' form.
- Select the desired client in the 'Client ID' field.
- Select desired episode from the 'Episode Number' field.
- Click [Select Service(s) To Edit].
- Verify the 'Select Service(s) To Edit' dialog is displayed.
- Select desired service from the 'Select Service(s) To Edit' dialog.
- Select a new service code in the 'Service Code' field.
- Click [OK].
- Submit the form.
- Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
- Click [No].
- Query the 'SYSTEM.billing_tx_history' SQL table.
- Validate the 'PATID' column is equal to the correct client id identified in the setup.
- Validate the 'date_of_service' column is equal to correct date of service rendered to the client.
- Validate the 'Service Code' column contains correct service code in the 'Edit Service Information' form.
- Validate the 'option_desc' column contains 'Edit Service Information'.
- Open the 'Inhibit Billing By Service' form.
- Select desired service from the 'Select Service(s) To Mark Billing-Inhibited' field.
- Click [File Updates].
- Validate a "Please review your selections" dialog is displayed.
- Click [OK].
- Validate a "File Service Inhibit Information" dialog is displayed stating: Continue Filing?
- Click [Yes].
- Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
- Click [No].
- Open the 'Edit Service Information' form.
- Select the desired client in the 'Client ID' field.
- Select desired episode from the 'Episode Number' field.
- Click [Select Service(s) To Edit].
- Verify the 'Select Service(s) To Edit' dialog is displayed.
- Select desired service from the 'Select Service(s) To Edit' dialog.
- Select a new service code in the 'Service Code' field.
- Click [OK].
- Submit the form.
- Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
- Click [No].
- Query the 'SYSTEM.billing_tx_history' SQL table.
- Validate the 'PATID' column is equal to the correct client id identified in the setup.
- Validate the 'date_of_service' column is equal to correct date of service rendered to the client.
- Validate the 'Service Code' column contains correct service code submitted in the 'Edit Service Information' form.
- Validate the 'option_desc' column contains 'Edit Service Information'.
- Open the 'Inhibit Billing By Service' form.
- Enter the practitioner associated to the logged in user in the 'Rendering Practitioner' field.
- Select desired service from the 'Select Service(s) To Mark Billing-Uninhibited' field.
- Click [File Updates].
- Validate a "Please review your selections" dialog is displayed.
- Click [OK].
- Validate a "File Service Inhibit Information" dialog is displayed stating: Continue Filing?
- Click [Yes].
- Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
- Click [No].
- Open the 'Edit Service Information' form.
- Select the desired client in the 'Client ID' field.
- Select desired episode from the 'Episode Number' field.
- Click [Select Service(s) To Edit].
- Verify the 'Select Service(s) To Edit' dialog is displayed.
- Select desired service from the 'Select Service(s) To Edit' dialog.
- Select a new service code in the 'Service Code' field.
- Click [OK].
- Submit the form.
- Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
- Click [No].
- Query the 'SYSTEM.billing_tx_history' SQL table.
- Validate the 'PATID' column is equal to the correct client id identified in the setup.
- Validate the 'date_of_service' column is equal to correct date of service rendered to the client.
- Validate the 'Service Code' column contains correct service code submitted in the 'Edit Service Information' form.
- Validate the 'option_desc' column contains 'Edit Service Information'.
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Topics
• Edit Service Information
• NX
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Edit Service Information - Admission vs. Service Program
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Program Maintenance
- Program Transfer (OutPatient)
- Service Codes
Scenario 1: Edit Service Program - Editing the service information after program transfer - Enable 'Admission vs. Service Program' Functionality registry setting
Specific Setup:
- 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 into 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 into the second admission program.
Steps
- Open the 'Edit Service Information' form.
- Fill in all required fields.
- Click [Select Service(s) to Edit].
- Verify the 'Select Service(s) to Edit' dialog box launched with all the services rendered to the selected client.
- Select desired service to edit.
- Verify the 'Program' field is populated with the service programs that was associated with the admission program at the time of service creation.
- Submit the form.
- Verify the form submits successfully.
835 Crossover Logic - Posting Code = Transfer Type - Redistribute (Close)
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Service Codes
- Practitioner Enrollment
- Program Maintenance
- Practitioner Numbers By Guarantor And Program
- Posting/Adjustment Codes Definition
- Claim Adjustment Group/Reason Code Definition
- Electronic Billing
- 835 Health Care Claim Payment/Advice (PM)
Scenario 1: Crossover Claims - Allow Billing Next Guarantor
Specific Setup:
- The following registry setting has a value of 'Y': Avatar PM->Billing->Electronic Billing->All 837 Submissions->->Enable Support For Crossover Claims.
- Practitioner Enrollment is used to identify desired service practitioner and the ‘Practitioner Categories for Coverage’.
- Service Code: Identify a service code that will be used to create services. Note the service code fee in Service Fee/Cross Reference Maintenance.
- Benefit Plan: All benefit plans contain ‘Practitioner Categories for Coverage’ in ‘Covered Charge Categories’.
- Plan for Guarantor 1 will fully cover the service fee.
- Plan for Guarantor 2 contains a value in ‘Monthly Maximum Responsibility’. Note the value.
- Plan for Guarantor 3 will fully cover the service fee.
- Guarantors/Payors: Three guarantors are identified that do not share the same ‘Default Guarantor Plan’.
- Admit a new client: Note the admission date and program.
- Add a diagnosis record.
- Add a financial eligibility record:
- Guarantor #1 = Guarantor 1.
- Guarantor #2 = Guarantor 2.
- Guarantor #31 = Guarantor 3.
- Guarantor/Program Billing Defaults:
- Edit the template for the secondary guarantor, section 837 Professional or 837 Institutional.
- Select Guarantor(s) Responsible For Crossover Claim Submission = Primary Guarantor.
- Number of Days to Hold Billing of Claim = 15. Note: Zero is a valid value for this field and if used the primary and secondary guarantors can be billed immediately.
- Client Charge Input is used to create two services 25 and 26 days in the past, ensuring they are in the same month.
- Client Ledger is used to validate that the charge distributed full liability to Guarantor 1.
- Close Charges is used to close the charge.
- Electronic Billing: Guarantor 1: has been used to create a claim 19 days in the past.
- An '835 Health Care Claim Payment/Advice’ exists that pays each of the two services, minus the ‘Monthly Maximum Responsibility’ amount noted above, for each service. Note the Claim Adjustment Group/Reason Code used in the ‘CAS’ segment.
- Verify the that ‘Claim Adjustment Group/Reason Code Definition’ exists for the guarantors and that the posting code = 'Transfer – Redistribute (Close)’.
Steps
- Open ‘835 Health Care Claim Payment/Advice’.
- Load, compile and post the '835 Health Care Claim Payment/Advice’.
- Close the form.
- Open ‘Client Ledger’ and validate that Guarantor 2 has a ‘LINE BALANCE’ equal to the ‘Monthly Maximum Responsibility’ amount due to the transfer. Also, validate that Guarantor 3 has a ‘LINE BALANCE’ equal to the ‘Monthly Maximum Responsibility’ amount due to the transfer.
- If desired post an ‘835 Health Care Claim Payment/Advice’ files for Guarantor 2 and Guarantor 3.
- Close the form.
835 Crossover Logic - CCBHC guarantors
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Service Codes
- Claim Adjustment Group/Reason Code Definition
- Posting/Adjustment Codes Definition
- Practitioner Numbers By Guarantor And Program
- Practitioner Enrollment
- Program Maintenance
- Dictionary Update (PM)
- Electronic Billing
- 835 Health Care Claim Payment/Advice (PM)
Scenario 1: Crossover Claims - Allow Billing Next Guarantor - Primary Guarantor is not CCBHC - Secondary Guarantor is CCBHC
Specific Setup:
- The following registry setting has a value of 'Y': Avatar PM->Billing->Electronic Billing->All 837 Submissions->->Enable Support For Crossover Claims.
- Practitioner Enrollment is used to identify desired service practitioner and the ‘Practitioner Categories for Coverage’.
- Service Code: Identify a CCBHC service code that will be used to create a service. Note the service code fee in Service Fee/Cross Reference Maintenance.
- Benefit Plan: All benefit plans contain ‘Practitioner Categories for Coverage’ in ‘Covered Charge Categories’.
- Plan for Guarantor 1 will fully cover the service fee.
- Plan for Guarantor 3 will fully cover the service fee.
- Guarantors/Payors:
- Guarantor 1 is not a CCBHC guarantor.
- Guarantor 2 is a CCBHC guarantor.
- Admit a new client that bills CCBHC services. Note the admission date and program.
- Add a diagnosis record.
- Add a financial eligibility record:
- Guarantor #1 = Guarantor 1.
- Guarantor #2 = Guarantor 2.
- Guarantor/Program Billing Defaults:
- Edit the CCBHC template for the secondary guarantor, section 837 Professional or 837 Institutional.
- Select Guarantor(s) Responsible For Crossover Claim Submission = Primary Guarantor.
- Number of Days to Hold Billing of Claim = 15. Note: Zero is a valid value for this field and if used the primary and secondary guarantors can be billed immediately.
- Client Charge Input is used to create two services 25 and 26 days in the past, ensuring they are in the same month.
- Client Ledger is used to validate that the charge distributed full liability to Guarantor 1.
- Close Charges is used to close the charges.
- Electronic Billing: Guarantor 1: has been used to create a claim 19 days in the past.
- An '835 Health Care Claim Payment/Advice’ exists that pays the service, minus $10.00. Note the Claim Adjustment Group/Reason Code used in the ‘CAS’ segment.
- Verify the that ‘Claim Adjustment Group/Reason Code Definition’ exists for the three guarantor and that the posting code = 'Transfer – Redistribute (Close)’.
Steps
- Open ‘835 Health Care Claim Payment/Advice’.
- Load, compile and post the '835 Health Care Claim Payment/Advice’.
- Close the form.
- Open ‘Client Ledger’ and validate that Guarantor 2 has a ‘LINE BALANCE’ equal to $10.00 due to the transfer.
- If desired post an ‘835 Health Care Claim Payment/Advice’ file for Guarantor 2.
- Close the form.
Web Service - Edit Service Information - Practitioner Disciple
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Service Codes
- Registry Settings (PM)
- Practitioner Enrollment
- SQL Query/Reporting
Scenario 1: 'Edit Service Information' web service - Editing 'Open' services
Specific Setup:
- Practitioner Enrollment is used to validate the 'Discipline' of the desired practitioner.
- Service Code 1: Is a service code that does not contain the practitioner's discipline in 'Discipline(s)'.
- Service Code 2: Is a service code that does contain the practitioner's discipline in 'Discipline(s)'.
- Identify an existing client that has at least one existing open service for Service Code 2 and the practitioner. Note the client's id/name, service code, practitioner's id, and the service date.
Steps
- Open the SoapUI or any other web service testing tool.
- Create a web service request to edit the service information, using ‘WEBSVC.EditServiceInformation:EditServiceInformationICD10'.
- The 'SystemCode' will be equal to the value used when logging into myAvatar.
- The 'UserName' will be equal to the value used when logging into myAvatar.
- The 'Password' will be equal to the value used when logging into myAvatar.
- Enter values for all required fields.
- Select Service Code 1 in ‘ServiceCode’.
- Submit the request.
- Verify the response message contains: Discipline : No common disciplines found for Practitioner and Service code selected.
- Change the service code to Service Code 2.
- Add data to one field that had no date or change existing data for a field.
- Submit the request.
- Verify the message: "Edit Service Information web service has been filed successfully".
- If desired, open 'Crystal Reports' or any other SQL Data Reporting tool.
- Select the PM namespace.
- Query the 'SYSTEM.billing_tx_history' SQL table.
- Validate the 'PATID' column is equal to the correct client id identified in the setup.
- Validate the 'date_of_service' column is equal to correct date of service rendered to the client.
- Validate the 'Service Code' column contains correct service code entered in the web service request.
- Validate the 'data_entry_source' column contains 'WEBSVC.EditServiceInformation:EditServiceInformationICD10'.
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Topics
• Edit Service Information
• Practitioner
• Program Transfer
• 835 Health Care Claim Payment/Advice
• NX
• Web Services
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Avatar PM is modified for future functionality.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Client Charge Input Web Service
Scenario 1: Client Charge Input: Support UTC fields
Scenario 2: Client Charge Input Web Service: Support UTC fields
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Topics
• Client Charge Input
• NX
• Recurring Client Charge Input
• UTC Fields
• Web Services
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837 Institutional - Claim Frequency Code, Patient Status Code and Discharge Hour
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Discharge
- Electronic Billing
Scenario 1: 837 Institutional - Validation of Claim Frequency Code (2300-CLM-05-3) and Patient Status Code (2300-CL1-03) fields and Discharge Hour segment if there are claimed services on the discharge date
Specific Setup:
- Admit a new client into an inpatient episode.
- Populate the Social Security Number field.
- Establish a Financial Eligibility record for a select guarantor.
- Using the "Diagnosis" form, enter a diagnosis for the client.
Steps
- Using the "Client Charge Input" form, enter in 2 room and board charges and 1 non room and board service on 3 consecutive days.
- Validate the charges were distributed to the correct guarantor using "Client Ledger".
- Discharge the client on the last of the 3 consecutive service dates from the first step.
- Using the "Close Charges" form, close all 3 charges.
- Using the "Electronic Billing" form to generate an 837 Professional file for the non room and board charge that was created.
- Validate the non room and board charge that was generated in previous steps is included on the bill and claim the bill.
- Using the "Electronic Billing" form to generate an 837 Institutional file for the 2 room and board charges.
- Validate the Claim Frequency Code (2300-CLM-05-3) is equal to "1" (Admit Through Discharge).
- Validate the Discharge Hour segment (2300-DTP-*96) is included in the output.
- Validate the Patient Status Code (2300-CL1-1-03) is equal to the value "Patient Status Over-Ride (2300-CL1-03) extended attribute based on the "Type of Discharge" value from the Discharge record.
Scenario 2: 837 Institutional - Validate Claim Frequency Code (2300-CLM-05-3) and Patient Status Code (2300-CL1-03) fields and Discharge Hour segment when there are unclaimed services on the discharge date
Specific Setup:
- Admit a new client into an inpatient episode.
- Populate the Social Security Number field.
- Establish a Financial Eligibility record for a select guarantor.
- Using the "Diagnosis" form, enter a diagnosis for the client.
Steps
- Using the "Client Charge Input" form, enter in 2 room and board charges and 1 non room and board service on 3 consecutive days.
- Validate the charges were distributed to the correct guarantor using "Client Ledger".
- Discharge the client on the last of the 3 consecutive service dates from the first step.
- Using the "Close Charges" form, close all 3 charges.
- Using the "Electronic Billing" form to generate an 837 Institutional file for the 2 room and board charges.
- Validate the Claim Frequency Code (2300-CLM-05-3) is equal to "1" (Admit Through Discharge).
- Validate the Discharge Hour segment (2300-DTP-*96) is included in the output.
- Validate the Patient Status Code (2300-CL1-1-03) is equal to the value "Patient Status Over-Ride (2300-CL1-03) extended attribute based on the "Type of Discharge" value from the Discharge record.
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Topics
• 837 Institutional
• NX
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Enhanced 'Address' information in several forms.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Discharge
- Call Intake
- Update Client Data
- Pre Admit
- Pre Admit Discharge
- Client Admission Web Service
Scenario 1: 'Admission (Outpatient)' - field validation
Steps
- Open 'Admission (Outpatient)' form for an existing client.
- Ensure that 'Address Start Date' field is present in 'Admission (Outpatient)' form.
- Enter a value in 'Address Start Date' field. Note that entering future dates will generate a pop up message indicating future dates are not allowed. Invalid dates will generate a pop-up message indicating the format is not valid.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open Avatar PM 'Admission (Outpatient)' form for filed record.
- Ensure 'Address Start Date' field displays 'Address Start Date' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Address Start Date' value filed in 'Admission (Outpatient)' form is present in 'address_start_date' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Address Start Date' value filed in 'Admission (Outpatient)' form is present in 'address_start_date' field.
Scenario 2: 'Discharge' form field validation
Steps
- Open 'Discharge' form for an existing client.
- Ensure that 'Address Start Date' field is present in 'Discharge' form.
- Enter a value in 'Address Start Date' field. Note that entering future dates will generate a pop up message indicating future dates are not allowed. Invalid dates will generate a pop-up message indicating the format is not valid.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open Avatar PM 'Discharge' form for filed record.
- Ensure 'Address Start Date' field displays 'Address Start Date' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Address Start Date' value filed in 'Discharge' form is present in 'address_start_date' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Address Start Date' value filed in 'Discharge' form is present in 'address_start_date' field.
Scenario 3: 'Call Intake' - field validation
Steps
- Open 'Call Intake' form.
- Set 'Last Name' to any client name.
- Set 'First Name' to any client name.
- Set 'Sex' to client gender.
- Click [Search]
- Click [New Client].
- Enter data in all required fields.
- Click [Demographics].
- Ensure that 'Address Start Date' field is present in 'Call Intake' form.
- Enter a value in 'Address Start Date' field. Note that entering future dates will generate a pop up message indicating future dates are not allowed. Invalid dates will generate a pop-up message indicating the format is not valid.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open 'Call Intake' form for filed record.
- Ensure 'Address Start Date' field displays 'Address Start Date' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Address Start Date' value filed in 'Call Intake' form is present in 'address_start_date' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Address Start Date' value filed in 'Call Intake' form is present in 'address_start_date' field.
Scenario 4: 'Admission' form - Field Validation
Steps
- Open 'Admission' form for existing client.
- Ensure that 'Address Start Date' field is present in 'Admission' form 'Demographics' section.
- Enter a value in 'Address Start Date' field. Note that entering future dates will generate a pop up message indicating future dates are not allowed. Invalid dates will generate a pop-up message indicating the format is not valid.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open Avatar PM 'Admission' form for filed record.
- In 'Admission' form, ensure that 'Address Start Date' field displays 'Address Start Date' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Address Start Date' value filed in 'Admission' form is present in 'address_start_date' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Address Start Date' value filed in 'Admission' form is present in 'address_start_date' field.
Scenario 5: 'Update Client Data' form - Verification of 'Client Demographics' form fields
Specific Setup:
- Existing client record eligible for 'Update Client Data' entry/filing.
- Crystal Reports or other SQL Reporting tool.
Steps
- Open Avatar PM 'Update Client Data' form.
- Select existing client for update/entry.
- Ensure that 'Address Start Date' field is present in 'Update Client Data' form. Note that entering future dates will generate a pop up message indicating future dates are not allowed. Invalid dates will generate a pop-up message indicating the format is not valid.
- Enter value in 'Address Start Date' field.
- Enter/select values for all other required/desired fields in form.
- Click 'Submit' button to file Client Data update.
- Re-open Avatar PM 'Update Client Data' form for filed record.
- In 'Update Client Data' form, ensure that 'Address Start Date' field displays 'Address Start Date' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Address Start Date' value filed in 'Update Client Data' form is present in 'address_start_date' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Address Start Date' value filed in 'Update Client Data' form is present in 'address_start_date' field.
Scenario 6: 'Pre Admit' form - field validation
Specific Setup:
- Client is admitted as a Pre Admit client.
Steps
- Open 'Pre Admit' form for an existing Pre Admit client.
- Ensure that 'Address Start Date' field is present in 'Pre Admit' form.
- Enter a value in 'Address Start Date' field. Note that entering future dates will generate a pop up message indicating future dates are not allowed. Invalid dates will generate a pop-up message indicating the format is not valid.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open Avatar PM ''Pre Admit'' form for filed record.
- Ensure 'Address Start Date' field displays 'Address Start Date' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Address Start Date' value filed in ''Pre Admit'' form is present in 'address_start_date' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Address Start Date' value filed in ''Pre Admit'' form is present in 'address_start_date' field.
Scenario 7: 'Pre Admit Discharge' - field validation
Steps
- Open 'Pre Admit Discharge' form for an existing client.
- Complete required fields as needed.
- Ensure that 'Address Start Date' field is present in the 'Client Demographics' section.
- Enter a value in 'Address Start Date' field. Note that entering future dates will generate a pop up message indicating future dates are not allowed. Invalid dates will generate a pop-up message indicating the format is not valid.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open the 'Pre Admit Discharge' form for the same client.
- Ensure the 'Address Start Date' field is populated with the date entered on discharge.
- Close the form.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Address Start Date' value filed in 'Pre Admit Discharge' form is present in 'address_start_date' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Address Start Date' value filed in 'Pre Admit Discharge' form is present in 'address_start_date' field.
Scenario 8: Client Admission Web Service - Add Admission field validation
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Topics
• Admission
• Admission (Outpatient)
• Call Intake
• Discharge
• NX
• Pre Admit
• Pre Admit Discharge
• Update Client Data
• Web Services
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File Import - Payment/Adjustment Posting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- Electronic Billing
- Posting/Adjustment Codes Definition
- File Import
- Dynamic Form Delete File
- Payment Acknowledgement
Scenario 1: Registry Setting validation - Prevent Posting Payments Unless Payment has been Acknowledged
Steps
- Open the 'Registry Settings' form.
- Set the 'Enable Payment Acknowledgement' registry setting to 'N'.
- Submit the form.
- Open the 'Registry Setting' 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 and/or 3. 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. 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'.
- 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 '1&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 '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 '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 '1&2&3'.
- Click [Submit].
- Click [OK].
- Click [No].
Scenario 2: File Import - Validate Payment/Adjustment import files
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 = 3, at a minimum.
- Avatar PM->System Maintenance->File Import->->->Import File Delimiter – note the value to be used when creating the file to import.
- Posting/Adjustment Codes Definition has been used to note a payment code.
- Client A: Client is identified that has multiple unpaid claims.
- Note the guarantor, service code, service date, claim number and the line balance.
- Payment Acknowledgement has been used to create a minimum of one acknowledged payment for the same guarantor as the client’s guarantor. Note the transaction number this is included in the ‘Payment Acknowledgement’ message.
- Create a file to import to the Payment/Adjustment Posting option and includes the transaction number.
- The File Import spreadsheet will be included in the zip file.
Steps
1. Open the "File Import" form. 2. Select "File Type" of "Payments/Adjustment Posting". 3. Select "Action" of "Upload New File". 4. Click "Process Action". 5. Select "Action" of "Compile/Validate File". 6. Select the file that was just uploaded in "File(s)". 7. Click "Process Action". 8. Click “OK” on the “Compiled” message. 9. Select "Action" of "Post File". 10. Select the file that was just compiled in "File(s)". 11. Click "Process Action". 12. Click “OK” on the “Posted” message. 13. Close the form. 14. Open the "Client Ledger" form. 15. Process the client ledger. 16. Validate the payment information is reflected in the client's ledger. 17. Close the form.
Scenario 3: Registry Setting validation - Prevent Posting Payments Unless Payment has been Acknowledged
Steps
- Open the 'Registry Settings' form.
- Set the 'Enable Payment Acknowledgement' registry setting to 'N'.
- Submit the form.
- Open the 'Registry Setting' 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 and/or 3. 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. 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'.
- 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 '1&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 '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 '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 '1&2&3'.
- Click [Submit].
- Click [OK].
- Click [No].
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Topics
• NX
• Payment Acknowledgement
• Registry Settings
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Personal Pronouns may be included on client demographic forms and in client headers.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Client Lookup/Header Configuration Manager
- Update Client Data
- Progress Notes (Group and Individual)
- Pre Admit
- Pre Admit Discharge
- Call Intake
- Entity Information Display
- Discharge
- Admission Web Service
- Client Search
- SQL Query/Reporting
Scenario 1: Client Lookup/Header Configuration Manager - Client Header
Specific Setup:
- RADplus 2022 Update 109 is required for full functionality.
- Registry Setting "Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields" must include a value of '10'.
Steps
- Open 'Client Lookup/Header Configuration Manager'.
- Click 'Client Header' section.
- Click [Add New Item].
- Select 'Personal Pronouns' from the 'Field to Include in Client Header' drop down list.
- Select any available location in the 'Field Order'' drop down list.
- Click [Submit].
- Display the client Chart for any client where 'Personal Pronouns' have been entered via an admission form.
- Verify the 'Personal Pronouns' column displays as defined.
- Verify the client's preferred pronoun(s) are displayed.
- Open 'Client Lookup/Header Configuration Manager'.
- Click 'Client Header Override' section. This will allow setup of the 'Personal Pronouns' to display based on the client's admission program.
- Click [Add New Item].
- Select 'Personal Pronouns' from the 'Field to Include in Client Header' drop down list.
- Select any program from the 'Program' drop down list.
- Select any available location in the 'Field Order'' drop down list.
- Click [Submit].
- Open any form such as Progress Notes (Group and Individual) for a client assigned to the selected program and who has 'Personal Pronouns' setup in an admission form.
- Verify the Client Header displays the 'Personal Pronouns' in the location defined for the program.
- Close the form.
- Open the same form for a client who has 'Personal Pronouns' setup in an admission form, but who is not in the selected program.
- Verify the Client Header displays the 'Personal Pronouns' in the location defined for the 'Client Header' without a program associated.
- Close the form.
Scenario 2: 'Admission' form - Field Validation
Specific Setup:
- RADplus 2022 Update 109 is required for full functionality.
- Registry Setting "Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields" must include a value of '10'.
Steps
- Open 'Admission' form for existing client.
- Ensure that 'Personal Pronouns' field is present in 'Admission' form 'Demographics' section.
- Enter a value in 'Personal Pronouns' field.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open Avatar PM 'Admission' form for filed record.
- In 'Admission' form, ensure that 'Personal Pronouns' field displays 'Personal Pronouns' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Personal Pronouns' value filed in 'Admission' form is present in 'personal_pronouns' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Personal Pronouns' value filed in 'Admission' form is present in 'personal_pronouns' field.
Scenario 3: 'Update Client Data' form - Verification of 'Client Demographics' form fields
Specific Setup:
- Existing client record eligible for 'Update Client Data' entry/filing.
- Crystal Reports or other SQL Reporting tool.
Steps
- Open Avatar PM 'Update Client Data' form.
- Select existing client for update/entry.
- Ensure that 'Personal Pronouns' field is present in 'Update Client Data' form.
- Enter value in 'Personal Pronouns' field. This is a free text field, allows alphanumeric characters as well as special characters. Maximum length is 40 characters.
- Enter/select values for all other required/desired fields in form.
- Click 'Submit' button to file Client Data update.
- Re-open Avatar PM 'Update Client Data' form for filed record.
- In 'Update Client Data' form, ensure that 'Personal Pronouns' field displays 'Personal Pronouns' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Personal Pronouns' value filed in 'Update Client Data' form is present in 'personal_pronouns' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Personal Pronouns' value filed in 'Update Client Data' form is present in 'personal_pronouns' field.
Scenario 4: 'Admission (Outpatient)' - field validation
Specific Setup:
- RADplus 2022 Update 109 is required for full functionality.
- Registry Setting "Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields" must include a value of '10'.
Steps
- Open 'Admission (Outpatient)' form for an existing client.
- Ensure that 'Personal Pronouns' field is present in 'Admission (Outpatient)' form.
- Enter a value in 'Personal Pronouns' field.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open Avatar PM 'Admission (Outpatient)' form for filed record.
- Ensure 'Personal Pronouns' field displays ''Personal Pronouns' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Personal Pronouns' value filed in 'Admission (Outpatient)' form is present in 'personal_pronoun' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Personal Pronouns' value filed in 'Admission (Outpatient)' form is present in 'personal_pronoun' field.
Scenario 5: 'Pre Admit' form - field validation
Specific Setup:
- RADplus 2022 Update 109 is required for full functionality.
Steps
- Open 'Pre Admit' form for an existing Pre Admit client.
- Ensure that 'Personal Pronouns' field is present in 'Pre Admit' form.
- Enter a value in 'Personal Pronouns' field.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open Avatar PM ''Pre Admit'' form for filed record.
- Ensure 'Personal Pronouns' field displays 'Personal Pronouns' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Personal Pronouns' value filed in ''Pre Admit'' form is present in 'personal_pronouns' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Personal Pronouns' value filed in ''Pre Admit'' form is present in 'personal_pronouns' field.
Scenario 6: 'Pre Admit Discharge' - field validation
Specific Setup:
- RADplus 2022 Update 109 is required for full functionality
- Registry Setting "Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields" must have value of '10' added in order to display the Personal Pronouns to client demographics forms.
Steps
- Open 'Pre Admit Discharge' form for an existing client.
- Complete required fields as needed.
- Ensure that 'Personal Pronouns' field is present in the 'Client Demographics' section.
- Enter a value in 'Personal Pronouns' field.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open the 'Pre Admit Discharge' form for the same client.
- Ensure the 'Personal Pronouns' field is populated with the date entered on discharge.
- Close the form.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Personal Pronouns' value filed in 'Pre Admit Discharge' form is present in 'personal_pronouns' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Personal Pronouns' value filed in 'Pre Admit Discharge' form is present in ;personal_pronouns; field.
Scenario 7: 'Call Intake' - field validation
Specific Setup:
- RADplus 2022 Update 109 is required for full functionality.
- Registry Setting "Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields" must include a value of '10'.
Steps
- Open 'Call Intake' form.
- Set 'Last Name' to any client name.
- Set 'First Name' to any client name.
- Set 'Sex' to client gender.
- Click [Search]
- Click [New Client].
- Enter data in all required fields.
- Click [Demographics].
- Ensure that 'Personal Pronouns' field is present in 'Call Intake' form.
- Enter a value in 'Personal Pronouns' field. This is a free text alphanumeric field which also allows special characters. Maximum length is 40 characters.
- Enter/select values for all other required/desired fields in form.
- Click [Submit].
- Re-open 'Call Intake' form for filed record.
- Ensure 'Personal Pronouns' field displays 'Personal Pronouns' value from previously filed record.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.patient_current_demographics', ensure that 'Personal Pronouns' value filed in 'Call Intake' form is present in 'personal_pronouns' field.
- In Avatar PM SQL table 'SYSTEM.patient_demographic_history', ensure that 'Personal Pronouns' value filed in 'Call Intake' form is present in 'personal_pronouns' field.
Scenario 8: 'Entity Information Display' - 'Personal Pronouns'.
Specific Setup:
- RADplus 2022 Update 109 is required for full functionality.
- Registry Setting "Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields" is set to include a value of "10" for the Personal Pronouns field to be added to client demographics in various forms.
Steps
- To add the 'Personal Pronouns' to client search windows:
- Open 'Entity Information Display' form.
- Select 'Client' from the 'Entity Database' drop down list.
- Select 'One' in the 'Number of Additional Columns to Display' field. Note that depending on your setup, if there are entries already defined, you may need to select 'Two' or 'Three'.
- Set the 'Entity name Header Text' to any description.
- Set the 'Approximate Number of Characters to Display for Entity Name' to any numeric. This will be the number of characters to display in the entity column in the search window.
- Select 'Personal Pronouns' from the 'Entity Information Display Column 1' drop down list.
- Set the 'Entity Information Display Column 1 Header Name' to 'Personal Pronouns' or any other description you require.
- Set the 'Approximate Number of Characters to Display for Entity Lookup Column 1' to any value.
- Click [Submit].
- Open any form where a client search window will pop-up such as 'Update Client Data'.
- Set the 'Select Client' field to any existing client to search for.
- When the search selections display, verify the 'Personal Pronouns' column is displayed. This column may be blank at this time.
- Select any client from the list.
- In the selected form, 'Update Client Data' was used for this test, navigate to the 'Personal Pronouns' field. This may be at the bottom of the form.
- Enter any 'Personal Pronouns' as appropriate. This is a free form text field and will accept numbers and letters, as well as special characters. Maximum length is 40.
- Click [Submit].
- Open the same form again. Search for the same client. Verify that the 'Personal Pronouns' column on the search window is now populated with the value entered in the form.
- Close the form.
Scenario 9: Client Discharge web service
Specific Setup:
- SoapUI or other web service tool.
Steps
- Open SoapUI or another web service tool.
- Consume the WebSvc.ClientDischarge.cls wsdl.
- Set the 'SystemCode', 'UserName', and 'Password' to correct values.
- Set 'DateofDischarge' field to the client discharge date.
- Set 'DischargePractitioner' to the discharging practitioner ID.
- Set 'DischargeReferral Type' to the Type code for the discharge.
- Set 'DischargeTime' to the time of the discharge.
- Set 'PersonalPronouns' to any text value, maximum 40 characters.
- Set 'ClientID' to the client id to be discharged.
- Set 'EpisodeNumber' to the client episode to be discharged.
- Click 'Send' request.
- Validate the response displays 'Client Discharge web service has been filed successfully'.
- Open the 'Discharge' form in Avatar PM.
- Select the client discharged in the web service.
- Verify the 'Personal Pronouns' display the value entered in the Web Service.
- Close the form.
Scenario 10: Client Admission Web Service - Verification of web service filing
Specific Setup:
- Any Web Service tool such as 'SoapUI'.
Steps
- Using Avatar PM 'Client Admission' web service, submit an 'Admission' record for a client and episode, including the 'Personal Pronouns' field.
- Ensure that Admission record returns a confirmation message in the web service of successful filing.
- Open Avatar PM 'Admission' form.
- Select client record used in 'Client Admission' web service filing.
- Ensure that 'Admission' record/episode filed via web service is present with values filed via web service, including the 'Personal Pronouns'.
Scenario 11: Call Intake Web Service validation - Intake, Update, Delete records
Specific Setup:
- Any web service tool such as 'SoapUI'
- Crystal Reports or other SQL tool.
Steps
- Using Avatar PM 'ClientCallIntake' web service, submit an Intake record for a 'Call Intake' client, including the 'Personal Pronouns' field.
- Ensure that Call Intake record returns 'Client Call Intake web service has been filed successfully' message.
- Open Avatar PM 'Call Intake' form.
- Select client the record used in web service filing.
- Ensure that 'Call Intake' record/episode filed via web service is present with values filed via the web service, including the 'Personal Pronouns'.
- Using Avatar PM 'UpdateCallIntake' web service, submit an updated record for a 'Call Intake' client, including the 'Personal Pronouns' field.
- Ensure that the Update Call Intake record returns 'Update Call Intake web service has been filed successfully' message.
- Open Avatar PM 'Call Intake' form.
- Select client the record used in web service filing.
- Ensure that 'Call Intake' record/episode filed via web service is present with values filed via the web service, including the 'Personal Pronouns'.
- Using Avatar PM 'DeleteCallIntake' web service, submit a delete record for a 'Call Intake' client.
- Ensure that Call Intake record returns 'Delete Client Call Intake web service has been filed successfully' message.
- Using Crystal reports, or other SQL reporting tool, create a report against SYSTEM.patient_current_demographics.
- Include, at a minimum, the following fields:
- PATID
- personal_pronouns
- patient_name
- Run the report.
- Verify the above records filed via web services are displayed.
- Close the report.
Scenario 12: Client Demographics Web Service validation
Specific Setup:
- SoapUI or other web service tool.
Steps
- Using SoapUI or any other Web Service tool, consume the WSDL for WEBSVC.ClientDemographics.cls
- In the Request, set the SystemCode, UserName, and Password to the correct value.
- Set the 'PersonalPronouns' field to any characters (up to 40 maximum characters).
- Set the 'Sex' field to the gender for the selected client.
- Set the ClientID to any client number.
- Complete other fields as desired.
- Click the Send button.
- Validate the Response message displays : 'Client Demographics web service has been filed successfully.'
- In 'Avatar PM', open the 'Update Client Data' form for the client used in the web service.
- Navigate to the 'Personal Pronouns' field.
- Validate that the data displays as entered in the Web Service.
- Close the form.
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Topics
• Admission
• Admission (Outpatient)
• Call Intake
• NX
• Pre Admit
• Pre Admit Discharge
• Update Client Data
• Web Services
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Practitioner Enrollment - The 'Staff EVV Type' and 'Email Address' fields
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Practitioner Enrollment
- Practitioner Enrollment (Brief)
Scenario 1: 'ClinicianServicesV2' Web Service - Verification Of 'putClinicianCreation' Filing
Specific Setup:
- Application utilizing the Avatar PM 'ClinicianServicesV2' web service
Steps
- Using the 'ClinicianServicesV2' web service, submit a request using the 'putClinicianCreation' method to create new 'Practitioner Enrollment' record (and optionally Avatar MSO Performing Provider Registration record), including values for the 'EmailAddress' and 'StaffEVVType' fields/segments.
- Confirm the 'ClinicianServicesV2' web service responds with confirmation data on successful filing of 'putClinicianCreation' method.
- Example: "<Confirmation>Practitioner ID:000017||||First Name:FIRSTNAME||Last Name:LASTNAME||Registration Date:01/01/2022||NPI:123456789</Confirmation>"
- Confirm the 'ClinicianServicesV2' web service responds with confirmation message on successful filing of 'putClinicianCreation' method.
- Example: "<Message>Clinician Services web service has been filed successfully.</Message>"
- Confirm the 'ClinicianServicesV2' web service responds with successful status value on successful filing of 'putClinicianCreation' method.
- Example: " <Status>1</Status>"
- Access the 'Practitioner Enrollment' form and select the 'Practitioner Enrollment' record filed via web service for view/update.
- Confirm new 'Practitioner Enrollment' record is created in Avatar PM, with values/data submitted via web service including 'Email Address' and 'Staff EVV Type' field values (as well as values assigned for Avatar MSO 'Performing Provider' and 'Performing Provider Registration' practitioner association/link fields if enabled).
Scenario 2: 'ClinicianServicesV2' Web Service - Verification Of 'putClinicianUpdate' Filing
Specific Setup:
- Application utilizing the Avatar PM 'ClinicianServicesV2' web service.
Steps
- Using the 'ClinicianServicesV2' web service, submit a request using the 'putClinicianUpdate' method to edit/update a 'Practitioner Enrollment' record (and optionally Avatar MSO Performing Provider Registration record if linked), including values for the 'EmailAddress' and 'StaffEVVType' fields/segments.
- Confirm the 'ClinicianServicesV2' web service responds with confirmation data on successful filing of 'putClinicianUpdate' method.
- Example: "<Confirmation>Practitioner ID:000017||||First Name:FIRSTNAME||Last Name:LASTNAME||Registration Date:01/01/2022||NPI:123456789</Confirmation>"
- Confirm the 'ClinicianServicesV2' web service responds with confirmation message on successful filing of 'putClinicianUpdate' method.
- Example: "<Message>Clinician Services web service has been filed successfully.</Message>"
- Confirm the 'ClinicianServicesV2' web service responds with successful status value on successful filing of 'putClinicianUpdate' method.
- Example: " <Status>1</Status>"
- Access the 'Practitioner Enrollment' form and select the 'Practitioner Enrollment' record filed via web service for view/update.
- Confirm the 'Practitioner Enrollment' record is updated in Avatar PM, with values/data submitted via web service including 'Email Address' and 'Staff EVV Type' field values.
Scenario 3: 'PractitionerRegister' Web Service - Verification Of 'PractitionerRegister' Filing
Steps
- Using the 'PractitionerRegister' web service, submit a request using the 'PractitionerRegister' method to create a new 'Practitioner Enrollment' record, including values for the 'EmailAddress' and 'StaffEVVType' fields/segments.
- Confirm the 'PractitionerRegister' web service responds with confirmation data/ID on successful filing of 'PractitionerRegister' method.
- Example:"<Confirmation>Unique ID : 000056</Confirmation>"
- Confirm the 'PractitionerRegister' web service responds with confirmation message on successful filing of 'PractitionerRegister' method.
- Example:"<Message>Practitioner Enrollment web service has been filed successfully.</Message>"
- Confirm the 'PractitionerRegister' web service responds with successful status value on successful filing of 'PractitionerRegister' method.
- Example:" <Status>1</Status>"
- Access the 'Practitioner Enrollment' form and select the 'Practitioner Enrollment' record filed via web service for view/update.
- Confirm new Practitioner/Practitioner Enrollment record is created in Avatar PM, with values/data submitted via web service including 'Email Address' and 'Staff EVV Type' field values.
Scenario 4: 'PractitionerRegister' Web Service - Verification Of 'EditPractitionerRegister' Filing
Specific Setup:
- A practitioner must be defined in 'Practitioner Enrollment'.
Steps
- Using the 'PractitionerRegister' web service, submit a request using the 'EditPractitionerRegister' method to edit/update a 'Practitioner Enrollment' record, including values for the 'EmailAddress' and 'StaffEVVType' fields/segments.
- Confirm the 'PractitionerRegister' web service responds with confirmation data/ID on successful filing of 'EditPractitionerRegister' method.
- Example:"<Confirmation>Unique ID : 000056</Confirmation>"
- Confirm the 'PractitionerRegister' web service responds with confirmation message on successful filing of 'EditPractitionerRegister' method.
- Example:"<Message>Practitioner Enrollment web service has been filed successfully.</Message>"
- Confirm the 'PractitionerRegister' web service responds with successful status value on successful filing of 'EditPractitionerRegister' method.
- Example:" <Status>1</Status>"
- Access the 'Practitioner Enrollment' form and select the 'Practitioner Enrollment' record filed via web service for view/update.
- Confirm Practitioner/Practitioner Enrollment record is updated in Avatar PM, with values/data submitted via web service including 'Email Address' and 'Staff EVV Type' values.
Scenario 5: 'Practitioner Enrollment' - Form Verification
Specific Setup:
- Crystal Reports or other SQL Reporting Tool.
Steps
- Access the 'Practitioner Enrollment' form.
- Select any existing practitioner for view/update.
- Validate the 'Staff EVV Type' and 'Email Address' fields are displayed.
- Enter any value in the 'Staff EVV Type' field.
- Enter any value in the 'Email Address' field.
- Populate any other required and desired fields.
- Click [Submit].
- Access the 'Practitioner Enrollment' form.
- Select the same practitioner from the previous steps.
- Validate the 'Staff EVV Type' field contains the value filed in the previous steps.
- Validate the 'Email Address' field contains the value filed in the previous steps.
- Validate any other previously field data is displayed.
- Close the form.
- Access Crystal Reports or other SQL Reporting Tool.
- Create a report using the 'SYSTEM.staff_enrollment_history' SQL table.
- Navigate to the row for the practitioner used in the previous steps.
- Validate the 'Staff_EVV_Type' field contains the value filed in the previous steps.
- Validate the 'email_address' field contains the value filed in the previous steps.
- Close the report.
Scenario 6: 'Practitioner Enrollment (Brief)' - Form Verification
Specific Setup:
- Crystal Reports or other SQL reporting tool.
Steps
- Access the 'Practitioner Enrollment (Brief)' form.
- Select any existing practitioner for view/update.
- Validate the 'Staff EVV Type' and 'Email Address' fields are displayed.
- Enter any value in the 'Staff EVV Type' field.
- Enter any value in the 'Email Address' field.
- Populate any other required and desired fields.
- Click [Submit].
- Access the 'Practitioner Enrollment (Brief)' form.
- Select the same practitioner from the previous steps.
- Validate the 'Staff EVV Type' field contains the value filed in the previous steps.
- Validate the 'Email Address' field contains the value filed in the previous steps.
- Validate any other previously field data is displayed.
- Close the form.
- Access Crystal Reports or other SQL Reporting Tool.
- Create a report using the 'SYSTEM.staff_enrollment_history' SQL table.
- Navigate to the row for the practitioner used in the previous steps.
- Validate the 'Staff_EVV_Type' field contains the value filed in the previous steps.
- Validate the 'email_address' field contains the value filed in the previous steps.
- Close the report.
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Topics
• Practitioner
• Web Services
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Registry Setting - Enable Payment Acknowledgement
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Registry Settings (PM)
- User Definition
- Posting/Adjustment Codes Definition
- General Ledger Payment Acknowledgement Interface Components
- General Ledger Payment Acknowledgement Account Numbers
- Compile General Ledger Payment/Adjustment Interface File
- Dictionary Update (PM)
- General Ledger Payment/Adjustment Account Numbers
- General Ledger Charge Account Numbers
- Payment Acknowledgement
- Batch Cash Posting
- Compile General Ledger Charge Interface File
Scenario 1: Enable Payment Acknowledgement - Forms, Fields and Table validation
Steps
- Open the 'Registry Settings' form.
- Set the 'Enable Payment Acknowledgement' registry setting to 'N'.
- Submit the form.
- Open the 'User Definition' form.
- Select the login user from the 'Select User' field.
- Click 'Forms and Tables' item.
- Click [Select Forms for User Access].
- Verify the 'Payment Acknowledgement' form is not available under the 'Remittance Processing' item.
- Verify the 'General Ledger Payment Acknowledgement Interface Components' and 'General Ledger Payment Acknowledgement Account Numbers' forms are not available under the 'General Ledger Interface' item.
- Click [OK].
- Click [Select Tables for Product SQL Access].
- Verify the 'payack_account_numbers' sql table is not available under 'GL' database and in the Avatar PM namespace.
- Click [OK].
- Click [Submit].
- Click [No].
- Open the ‘Posting/Adjustment Code Definition’ form.
- Select ‘Edit’ and select any posting code.
- Verify that the 'Payment Acknowledgement Type' field is not displayed on the form.
- Close the form.
- Open the ‘Compile General Ledger Payment/Adjustment Interface File’ form.
- Verify that the ‘Include Payments Acknowledgments’ field not displayed on the form.
- Close the form.
- Open the 'Registry Settings' form.
- Select the 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting.
- Verify the registry setting is set to '0' and system does not allow to make any selections other than zero.
- Open the 'Registry Settings' form.
- Set the 'Enable Payment Acknowledgement' registry setting to 'Y'.
- Submit the form.
- Open the 'User Definition' form.
- Select the login user from the 'Select User' field.
- Click 'Forms and Tables' item.
- Click [Select Forms for User Access].
- Verify the 'Payment Acknowledgement' form is available under the 'Remittance Processing' item.
- Verify the 'General Ledger Payment Acknowledgement Interface Components' and 'General Ledger Payment Acknowledgement Account Numbers' forms are available under the 'General Ledger Interface' item.
- Select the 'Payment Acknowledgement', 'General Ledger Payment Acknowledgement Interface Components' and 'General Ledger Payment Acknowledgement Account Numbers' forms.
- Click [OK].
- Click [Select Tables for Product SQL Access].
- Verify the 'payack_account_numbers' sql table is available under 'GL' database and in the Avatar PM namespace.
- Select the 'payack_account_numbers' sql table.
- Click [OK].
- Click [Submit].
- Click [No].
- Verify the 'Payment Acknowledgement', 'General Ledger Payment Acknowledgement Interface Components' and 'General Ledger Payment Acknowledgement Account Numbers' forms are accessible from the menu.
- Open the ‘Posting/Adjustment Code Definition’.
- Select ‘Edit’ and select any posting code.
- Verify that the 'Payment Acknowledgement Type' field is displayed on the form.
- Close the form.
- Open the ‘Compile General Ledger Payment/Adjustment Interface File’ form.
- Verify that the ‘Include Payments Acknowledgments’ field displayed on the form with two options: 1. Payment Acknowledgement 2. Post Payment Entry
- Close the form.
- Open the 'Registry Settings' form.
- Select the 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting.
- Verify the system allows user to select any value from the available values.
- Close the form.
Scenario 2: Payment Acknowledgement - Compile General Ledger Payment/Adjustment Interface File-Batch Cash Posting
Specific Setup:
- System updated with Avatar GL module.
- General Ledger Charge Account Numbers and default account numbers are defined.
- General Ledger Payment/Adjustment components and account numbers are defined.
- 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&2'.
- Dictionary Update:
- File: Client
- (101) - Treatment Service - enter a code/value and then select the Program extended dictionary and enter desired value (i.e. 000111). Note dictionary code/value. Please note - The value entered here will also need to be added to the 'Program (5521)' dictionary in other tabled files for testing the GL compile.
- File: Other Table Files:
- (5521) Program - contains dictionary codes and dictionary values. Add the extended dictionary value from the '(101) Client' file and 'Treatment Service' dictionary.
- (5522) Account - contains dictionary codes, dictionary values and extended dictionary values.
- File: G/L Interface
- (204) - Credit G/L Payment Acknowledgement Account Number - contains dictionary codes and dictionary values.
- (205) - Debit G/L Payment Acknowledgement Account Number - contains dictionary codes and dictionary values.
- Admission:
- A client is identified with charges that resulted in payments, and/or adjustments being posted to the charges.
- Guarantor/Payors:
- An existing guarantor is identified who does not have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay. Note the guarantor's code/name.
- Financial Eligibility:
- Assign desired guarantor to the client.
- Client Charge Input:
- A service is rendered to the client.
- Client Ledger:
- Make sure the service is distributed to the guarantor assigned to the client.
Steps
- Open the 'Payment Acknowledgement General Ledger Interface Components' form.
- Select components.
- Submit the form.
- Open the 'General Ledger Payment Acknowledgement Account Numbers' form.
- Select component and the component value for each of the components.
- Select credit and debit account numbers.
- File Account numbers for each component and date range (optional) combination.
- Go to section 'G/L Payment Acknowledgement Defaults'.
- Add default account numbers.
- File Default account numbers.
- Submit the form.
- Use Crystal Reports or any other SQL data viewer.
- Validate the SQL Table GL.payack_account_numbers displays data as they entered in the 'General Ledger Payment Acknowledgement Account Numbers' form.
- Open ‘Payment Acknowledgment’ form.
- 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’. Note the Check/EFT number to be used in the 'Batch Cash Posting'.
- Enter desired value in ‘Receipt Date’.
- Enter desired value in ‘Deposit Date’.
- Select desired ‘Treatment Service’. Please note: The treatment service used must have program extended dictionary setup in the setup section.
- Select desired ‘Category’ from 'Account' dictionary.
- 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].
- Add the new row for post payment accounting entry.
- File the form.
- Open the 'Batch Cash Posting' form.
- Enter desired date to the 'Date of Receipt or Adjustment' field.
- Enter desired date to the 'Cash Posting Date' field.
- Select 'Payment' in the 'Posting Type' field.
- Select 'No' in the 'Payment Acknowledgment' field.
- Select desired guarantor.
- Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
- Select payment acknowledgement defined for the selected guarantor.
- Validate the 'Amount to Post' field defaults to the remaining amount of the selected payment acknowledgment.
- Select desired value in the 'Individual or All Clients' field.
- Select desired client from the 'Client ID' field if the 'Client ID' field is marked as the required field.
- Select desired program from the 'Program of Service' field.
- Select service start date in the 'From Date' field.
- Select service end date in the 'To Date' field.
- Select desired payment acknowledgement code from the 'Posting Code' field.
- Validate the 'Receipt' field defaults in the transaction number of the payment acknowledgment If payment acknowledgment is selected.
- Enter the same Check/EFT # in the 'Check #' field that is entered in the 'Payment Acknowledgement'.
- Select 'Ignore' in the 'Write Off or Ignore Remaining Balance' field.
- Click [Process].
- Validate the form files successfully.
- Open the 'Compile General Ledger Payment/Adjustment Interface File' form.
- Select dates that cover the transactions above and select 'no' for pre compile.
- Do not select anything in the new 'Include Payment Acknowledgements' field.
- Click [Process].
- Verify it generates the payment adjustment GL strings.
- Return to the form.
- Select 'Payment Acknowledgements' in the new field.
- Click [Process].
- Verify the GL strings for the Payment Acknowledgement GL Account Numbers are generated.
- Return to the form.
- Select 'Post Payment Entry' in the new field.
- Click [Process].
- Verify the GL strings for the Post Payment Entry account numbers are generated.
- Open the 'Crystal Reports' or any other SQL Data Reporting tool.
- Select the PM namespace.
- Identify desired database and SQL table - GL.comp_pay_ack_int_detail
- Locate to the SQL Editor
- Query 'Select * from GL.comp_pay_ack_int_detail WHERE PATID=[Desired ClientId].
- Validate the FACILITY cell is equal to '98'
- Validate the 1st PATID cell is equal to the client id identified in the setup section.
- Validate the EPISODE_NUMBER column displays correct value.
- Validate the GUARANTOR_ID column displays correct value.
- Validate the 'amount 'cell displays the correct amount from the payment acknowledgement form.
- Validate the gl_credit_number cell displays the correct account number set up.
- Validate the gl_debit_number cell displays the correct account number set up.
- Validate the 'interface_component_1_cd' displays the correct value from the setup.
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Topics
• 835 Health Care Claim Payment/Advice
• NX
• Payment Acknowledgement
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Extended dictionaries are added to 'Type of Discharge' (970).
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: Dictionary Update (PM) - validate extended dictionary codes
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Topics
• Dictionary
• NX
|
Select reports are modified to prevent overlapping data displays.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claim Follow-Up Productivity Report
- Unbilled Services Report
- Service Fee Definition Report
Scenario 1: 'Claim Follow-Up Productivity' Report
Steps
- Open the "Claim Follow-Up Productivity Report" form.
- Set the "Summary or Detail Report" field to "Detail Report".
- Leave the "User" field blank. This will pick up all rows for the report.
- Enter the "Start Date" and "End Date".
- Process the report.
- Validate the 'Guarantor' name field does not overlap with the 'Follow-Up Note Entry Date' field.
- Validate the 'Follow-Up Note' field displays text as entered in the 'AR Console'.
- Click [Close Report].
- Return to the form.
- Click [Close form].
Scenario 2: 'Client Ledger' report - validate fields have no overlaps.
Specific Setup:
- Client with a Guarantor and Services filed.
Steps
- Open the 'Client Ledger' report from 'Client Ledger Avatar PM / Billing / Remittance Processing'.
- Select a client in the 'Client ID' field. The selected client should have a guarantor assigned and several services filed.
- Select 'All Episodes' in the 'Claim/Episode/All Episodes' field.
- Select 'Crystal' in the 'Ledger Type' field.
- Set the 'From Date' to a date when the services were rendered.
- Set the 'To Date' to a date through which services were rendered.
- Click [Process].
- Review the report and verify the following:
- 'Service Description' field does not overlap with 'Units' field.
- 'Guarantor' field does not overlap with 'Guarantor Liability'.
- Close the report.
Scenario 3: 'Unbilled Services Report' - validation no fields overlap.
Steps
- Open the 'Unbilled Services Report'.
- Set 'Service Start Date' to any date where services were rendered.
- Set 'Service End Date' to any date to include services.
- Select 'All' in the 'Financial Class(es)' field.
- Select 'All' in the 'Program(s)' field.
- Select 'All' in the 'Service Status' field.
- Select 'No' in the 'Include 0 Liability' field.
- Click [Process].
- Review the report and note the following:
- 'Guarantor' field data does not overlap with the 'FE Expired?' field.
- A long Guarantor name wraps to prevent overlapping other fields.
- Close the report.
- Close the form.
Scenario 4: Service Fee/Cross Reference Definition Report - field validation
Steps
- Open the 'Service Fee/Cross Reference Maintenance' form.
- Click [Service Fee/Cross Reference Definition Report].
- Validate 'Practitioner' field does not overlap the 'Location' field.
- Validate 'Location' field does not overlap the 'Program' field.
- Validate 'Program' field does not overlap the 'Duration' field.
- Click [Close Report].
- Click [Close Form].
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Topics
• Client Ledger
• NX
• Service Fee/Cross Reference Maintenance
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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:
- Delete Last Practitioner Termination Date
- Practitioner Termination
- CareFabric Monitor
Scenario 1: Delete Last Practitioner Termination Date - Validate form functionality
Specific Setup:
- A practitioner has been terminated in the 'Practitioner Termination' form (Practitioner A).
Steps
- Access the 'Delete Last Practitioner Termination Date' form for "Practitioner A".
- Validate the 'Termination Date' field contains the termination date.
- Click [Submit].
- Validate a message is displayed stating: Are you sure you want to delete termination date ##/##/#### for practitioner "Practitioner A".
- Click [Yes].
- Access the 'Practitioner Termination' form for "Practitioner A".
- Validate the 'Termination Date' field does not contain a value.
- Validate the 'Reason For Termination' field does not contain a value.
- Close the form.
Scenario 2: Delete Last Practitioner Termination Date - Validate the 'ProviderUpdated' SDK event
Specific Setup:
- An active practitioner is defined that has hours for scheduling in the 'Staff Members Hours and Exceptions' form (Practitioner A).
Steps
- Access the 'Practitioner Termination' form for "Practitioner A".
- Enter the desired date in the 'Termination Date' field.
- Populate any other desired fields.
- Click [Submit].
- Access the 'CareFabric Monitor' form.
- Enter the current date in the 'From Date' and 'Through Date' fields.
- Search for and select "ProviderUpdated" in the 'Event/Action Search' field.
- Click [View Activity Log].
- Validate the 'CareFabric Monitor Report' contains a "ProviderUpdated" event triggered from the 'Practitioner Termination' form.
- Click [Click To View Record].
- Validate the 'isActive' field contains "false".
- Close the report and the form.
- Access the 'Delete Last Practitioner Termination' form for "Practitioner A".
- Validate the 'Termination Date' field contains the termination date.
- Click [Submit].
- Validate a message is displayed stating: Are you sure you want to delete termination date ##/##/#### for practitioner "Practitioner A".
- Click [Yes].
- Access the 'CareFabric Monitor' form.
- Enter the current date in the 'From Date' and 'Through Date' fields.
- Search for and select "ProviderUpdated" in the 'Event/Action Search' field.
- Click [View Activity Log].
- Validate the 'CareFabric Monitor Report' contains a "ProviderUpdated" event triggered from the 'Delete Last Practitioner Termination' form.
- Click [Click To View Record].
- Validate the 'isActive' field contains "true".
- Close the report and the form.
Scenario 3: Delete Last Practitioner Termination Date - Validate the 'StaffMemberUpdated' SDK event
Specific Setup:
- An active practitioner is defined in 'Practitioner Enrollment' (Practitioner A).
Steps
- Access the 'Practitioner Termination' form for "Practitioner A".
- Enter the desired date in the 'Termination Date' field.
- Populate any other desired fields.
- Click [Submit].
- Access the 'CareFabric Monitor' form.
- Enter the current date in the 'From Date' and 'Through Date' fields.
- Search for and select "StaffMemberUpdated" in the 'Event/Action Search' field.
- Click [View Activity Log].
- Validate the 'CareFabric Monitor Report' contains a "StaffMemberUpdated" event triggered from the 'Practitioner Termination' form.
- Click [Click To View Record].
- Validate the 'terminatedDate' field contains the 'Termination Date' filed.
- Close the report and the form.
- Access the 'Delete Last Practitioner Termination' form for "Practitioner A".
- Validate the 'Termination Date' field contains the termination date.
- Click [Submit].
- Validate a message is displayed stating: Are you sure you want to delete termination date ##/##/#### for practitioner "Practitioner A".
- Click [Yes].
- Access the 'CareFabric Monitor' form.
- Enter the current date in the 'From Date' and 'Through Date' fields.
- Search for and select "StaffMemberUpdated" in the 'Event/Action Search' field.
- Click [View Activity Log].
- Validate the 'CareFabric Monitor Report' contains a "StaffMemberUpdated" event triggered from the 'Delete Last Practitioner Termination' form.
- Click [Click To View Record].
- Validate the 'terminatedDate' field contains "null".
- Close the report and the form.
Scenario 4: Delete Last Practitioner Termination Date - Validate the 'EvvResourceUpdated' SDK event
Specific Setup:
- Avatar is configured to integrate with Mobile CareGiver+. Please note: This must be done by a Netsmart Representative.
- One or more program(s) is defined with a value populated in the 'EVV Provider Organization ID' field in the 'Program Maintenance' form.
- A service code must be defined that has "Yes" selected in the 'Does This Service Require Electronic Visit Verification' field in the 'Service Codes' form and must be assigned to "Program A".
- An active practitioner is defined in 'Practitioner Enrollment' with the following on file: 'Name', 'Date Of Birth', 'Cellular Telephone', 'Staff EVV ID', 'Email Address', 'Staff EVV Type'.
Steps
- Access the 'Practitioner Termination' form for "Practitioner A".
- Enter the desired date in the 'Termination Date' field.
- Populate any other desired fields.
- Click [Submit].
- Access the 'CareFabric Monitor' form.
- Enter the current date in the 'From Date' and 'Through Date' fields.
- Search for and select "EvvResourceUpdated" in the 'Event/Action Search' field.
- Click [View Activity Log].
- Validate the 'CareFabric Monitor Report' contains a "EvvResourceUpdated" event triggered from the 'Practitioner Termination' form.
- Click [Click To View Record].
- Validate the 'isActive' field contains "false".
- Close the report and the form.
- Access the 'Delete Last Practitioner Termination' form for "Practitioner A".
- Validate the 'Termination Date' field contains the termination date.
- Click [Submit].
- Validate a message is displayed stating: Are you sure you want to delete termination date ##/##/#### for practitioner "Practitioner A".
- Click [Yes].
- Access the 'CareFabric Monitor' form.
- Enter the current date in the 'From Date' and 'Through Date' fields.
- Search for and select "EvvResourceUpdated" in the 'Event/Action Search' field.
- Click [View Activity Log].
- Validate the 'CareFabric Monitor Report' contains a "EvvResourceUpdated" event triggered from the 'Delete Last Practitioner Termination' form.
- Click [Click To View Record].
- Validate the 'isActive' field contains "true".
- Close the report and the form.
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Topics
• CareFabric
• Electronic Visit Verification
• Practitioner
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PM UTC functionality
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
Scenario 1: Validating Practitioner Enrollment with UTC Enabled - data entry time after midnight
Specific Setup:
- The system must be configured to use UTC.
- Data entry needs to occur after midnight.
- A practitioner must be enrolled in the system.
Steps
- Open the "Practitioner Enrollment" form.
- Select the practitioner from setup and update their enrollment.
- Click "Submit" to file the data.
- Using the preferred method to validate SQL tables, validate the following columns exist in the SQL table SYSTEM.sfaff_category_history: data_entry_offset (e.g -4), data_entry_time_j (e.g. 0:02:12), data_entry_timezone_info_all (e.g. EDT;Eastern Daylight Time;-0400), data_entry_timezone_short (e.g EDT), data_entry_utc (e.g. 9/21/2022 4:02).
Scenario 2: Validating Practitioner Enrollment with UTC disabled - data entry time after midnight
Specific Setup:
- Data entry needs to occur after midnight.
- A practitioner must be enrolled in the system.
Steps
- Open the "Practitioner Enrollment" form.
- Select the practitioner from setup and update their enrollment.
- Click "Submit" to file the data.
- Using the preferred method to validate SQL tables, validate the following columns do not exist in the SQL table SYSTEM.sfaff_category_history: data_entry_offset, data_entry_time_j, data_entry_timezone_info_all, data_entry_timezone_short, data_entry_utc.
- Using the preferred method to validate SQL tables, validate the value in the data_entry_time column in the SYSTEM.staff_category_history table appropriately reflects the time of data entry, which would be after midnight.
Scenario 3: Validating Client Charge Input with UTC enabled - data entry after midnight
Specific Setup:
- The system must be configured to use UTC.
- Data entry needs to occur after midnight.
- Admit a new client or select an existing client for the test client.
Steps
- Open the "Client Charge Input" form.
- Enter a service charge for the test client.
- Using the "Client Ledger" form, validate the service was generated.
- Using the preferred method to validate SQL tables, validate the following columns in the SYSTEM.billing_tx_history table: data_entry_offset (e.g. -4), data _entry_time_j (e.g. 0:02:04), data_entry_timezone_info_all (e.g. EDT;Eastern Daylight Time;-0400), data_entry_timezone_short (e.g. EDT), data_entry_utc (e.g. 9/21/2022 4:02).
- Using the preferred method to validate SQL tables, validate the data_entry_time column in the SYSTEM.billing_tx_history table:reflects the time of service entry after midnight.
Scenario 4: Validating Client Charge Input with UTC disabled - data entry after midnight
Specific Setup:
- Data entry needs to occur after midnight.
- Admit a new client or select an existing client for the test client.
Steps
- Open the "Client Charge Input" form.
- Enter a service charge for the test client.
- Using the "Client Ledger" form, validate the service was generated.
- Using the preferred method to validate SQL tables, validate the following columns don't exist in the SYSTEM.billing_tx_history table: data_entry_offset, data _entry_time_j, data_entry_timezone_info_all, data_entry_timezone_short, data_entry_utc.
- Using the preferred method to validate SQL tables, validate the data_entry_time column in the SYSTEM.billing_tx_history table:reflects the time of service entry after midnight.
Scenario 5: Validating Practitioner Enrollment with UTC Enabled
Specific Setup:
- The system must be configured to use UTC.
- A practitioner must be enrolled in the system.
Steps
- Open the "Practitioner Enrollment" form.
- Select the practitioner from setup and update their enrollment.
- Click "Submit" to file the data.
- Using the preferred method to validate SQL tables, validate the following columns exist in the SQL table SYSTEM.sfaff_category_history: data_entry_offset (e.g -4), data_entry_time_j (e.g. 12:26:13), data_entry_timezone_info_all (e.g. EDT;Eastern Daylight Time;-0400), data_entry_timezone_short (e.g EDT), data_entry_utc (e.g. 9/21/2022 16:26).
- Using the preferred method to validate SQL tables, validate the data_entry_time (e.g. 12:26 PM) in the SQL table SYSTEM.sfaff_category_history appropriately reflects the time of data entry.
Scenario 6: Validating Practitioner Enrollment with UTC disabled
Specific Setup:
- A practitioner must be enrolled in the system.
Steps
- Open the "Practitioner Enrollment" form.
- Select the practitioner from setup and update their enrollment.
- Click "Submit" to file the data.
- Using the preferred method to validate SQL tables, validate the following columns don't exist in the SQL table SYSTEM.sfaff_category_history: data_entry_offset, data_entry_time_j, data_entry_timezone_info_all, data_entry_timezone_short), data_entry_utc.
- Using the preferred method to validate SQL tables, validate the data_entry_time (e.g. 12:26 PM) in the SQL table SYSTEM.sfaff_category_history appropriately reflects the time of data entry.
Scenario 7: Validating Client Charge Input with UTC enabled
Specific Setup:
- The system must be configured to use UTC.
- Admit a new client or select an existing client for the test client.
Steps
- Open the "Client Charge Input" form.
- Enter a service charge for the test client.
- Using the "Client Ledger" form, validate the service was generated.
- Using the preferred method to validate SQL tables, validate the following columns in the SYSTEM.billing_tx_history table: data_entry_offset (e.g. -4), data _entry_time_j (e.g. 12:26:13), data_entry_timezone_info_all (e.g. EDT;Eastern Daylight Time;-0400), data_entry_timezone_short (e.g. EDT), data_entry_utc (e.g. 09/20/2022 16:26)
- Using the preferred method to validate SQL tables, validate the data_entry_time column in the SYSTEM.billing_tx_history table:reflects the time of service entry.
Scenario 8: Validating Client Charge Input with UTC disabled
Specific Setup:
- Admit a new client or select an existing client for the test client.
Steps
- Open the "Client Charge Input" form.
- Enter a service charge for the test client.
- Using the "Client Ledger" form, validate the service was generated.
- Using the preferred method to validate SQL tables, validate the following columns don't exist in the SYSTEM.billing_tx_history table: data_entry_offset, data _entry_time_j, data_entry_timezone_info_all, data_entry_timezone_short, data_entry_utc.
- Using the preferred method to validate SQL tables, validate the data_entry_time column in the SYSTEM.billing_tx_history table:reflects the time of service entry.
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Topics
• Client Charge Input
• NX
• Practitioner
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