Avatar PM 2022 Update 107

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Product Requirements / Recommendations

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Product Update Form Description

The following is included: 1) The issue where financial classes with the 'System Financial Class' extended dictionary set will not function correctly with the 'Crystal Self Pay Bill' form is resolved. 2) The statement message fields on the 'Progressive Self Pay Dunning Messages' form are updated to have a length of 350. 3) The 'Number Of Days Since Last Claim' field on the 'Crystal Self Pay' form is updated to be defaulted when all guarantors selected share the same default value.

Included Updates

3, 9, 13, 18, 25, 34, 41, 48, 51, 55, 58, 59, 61, 62, 67, 73, 77, 84, 87, 88, 90, 91, 94, 95, 97, 99, 100, 103

Required Updates

None

Details

NEW1 CHANGED0 FIXED0

New (1)

AV-82270 Details | User Acceptance Tests

Crystal Self Pay Bill - Support 'System Financial Class' extended dictionary

The 'Crystal Self Pay Bill' works correctly for guarantors that do not have a financial class of 'Self Pay' in the 'Guarantors/Payors' form, and the extended dictionary 'System Financial Class' (1500) for the selected class is set to 'Self Pay'.

The Self-Pay statement message fields on the 'Self Pay Progressive Dunning Messages' form are updated to a length of 350, and the 'Number Of Days Since Last Claim' field on the 'Crystal Self Pay' form is updated to default when multiple selected guarantors share the same default value.

Value Added: • The 'Crystal Self Pay Bill' process is enhanced to support the 'System Financial Class' extended dictionary data element (1500) in the ‘Payor’ File, ‘Data Element - (1000) Financial Class’.

Topics

• Crystal Self Pay Bill • Database Tables • Inhibit Billing • NX • Registry Settings

Acceptance Tests

AV-82270 Summary | Details

Crystal Self Pay Bill - Support 'System Financial Class' extended dictionary

Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:

Admission (Outpatient)
Client Charge Input
Client Ledger
Crystal Report Viewer
Crystal Self Pay Bill
Financial Eligibility
Guarantors/Payors
Inhibited Services For Billing Report
Registry Settings (PM)
Service Codes
Diagnosis
Dictionary Update (PM)
No Information Found
Form and Table Documentation (PM)
Progressive Self Pay Dunning Messages
SQL Query/Reporting
Update Client Data
Individual Cash Posting (PM)

Scenario 1: Crystal Self Pay Bill - Billing a Self Pay guarantor - Validating 'Allow For Number of Days Since Last Claim' registry setting

Specific Setup:

Registry Settings:
Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
Guarantors/Payors:
A self pay guarantor is identified. Note the guarantor code/value.
Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
Admission:
A new client is admitted. Note the client id, admission date and admission program.
Financial Eligibility: The self pay guarantor is assigned to the client. Note the guarantor code.
Diagnosis: The diagnosis record is created for the client.
Client Charge Input:
A service is rendered to the client. Note the service date and service code.
Client Ledger:
The service distributed to the self pay guarantor.
Close charges:
The charges distributed to the guarantor are closed.

Steps

Open the 'Crystal Self Pay Bill' form.
Enter a value for 'Print Charges Thru' field that will include the service rendered to the client. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired 'Date Of Claim'. Note the claim date for further testing.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support interim batch.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'Compile Complete' message displays.
Navigate to the 'Print Crystal Self Pay Bill' section of the form.
Select desired value for 'Select By Client Or File' field.
Select compiled bill file or client record for bill data display.
Click [Print Self Pay Bill].
Validate that the Self Pay Bill report displays.
In the Self Pay Bill report ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information.
Open the 'Client Charge Input' form.
Render a service to the client. Note the date of the service.
Verify the service distributed correctly to the self pay guarantor assigned to the client.
Close charges.
Open the 'Crystal Self Pay Bill' form.
Enter a value for 'Print Charges Thru' field that covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired date to the 'Date Of Claim' field such that it is after the previous claim date.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support interim batch.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'No Information Found. Cancel OK No Information Was Found For Inclusion On The Bill.' message displayed.
Click [Close Report].
Click [Discard].
Open the 'Inhibited Services For Billing Report' form.
Enter 'Start Date'.
Enter 'End Date'.
Select the client from the previous steps.
Click [Process report].
Verify the report contains all the services for the client for the episode inhibited from the billing.
Close the report.
Open the 'Crystal Self Pay Bill' form.
Enter a value for 'Print Charges Thru' field that covers the service rendered to the client and it is after the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support interim batch.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'Compile Complete' message displayed.
Navigate to the 'Print Crystal Self Pay Bill' section of the form.
Select value for 'Select By Client Or File' field.
Select compiled bill file or client record for bill data display.
Click [Print Self Pay Bill].
Ensure that it displays the Self Pay Bill report/information.
Verify the report displays the recently claimed service in the report.
Close the report.
Close the form.

Scenario 2: Crystal Self Pay Bill - Billing a guarantor that has the system financial class dictionary set to Self Pay - Validating 'Allow For Number of Days Since Last Claim' registry setting

Specific Setup:

Registry Settings:
Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
Guarantors/Payors:
An existing guarantor is identified to be assigned to the client as a primary guarantor and the financial class is not a self pay but is a different financial class. Note the guarantor code / value / financial class.
Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
Dictionary Update:
File - Payor
Data Element - (1000) Financial Class
Dictionary Code - The dictionary code for the financial class of the guarantor identified above.
Extended Dictionary Data Element - (1500) System Financial Class
Extended Dictionary Value - Self Pay
Admission:
A new client is admitted, or an existing client is identified. Note the client id, admission date and admission program.
Financial Eligibility: The guarantor identified above is assigned to the client as a primary guarantor.
Diagnosis: The diagnosis record is created for the client.
Client Charge Input:
The service is rendered to the client such that it comes prior to coverage effective date of the primary guarantor. Note the service date and service code.
Client Ledger:
The service distributed to the self pay guarantor.
Close Charges:
The services rendered to the client are closed.

Steps

Open the 'Crystal Self Pay Bill' form.
Enter values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support interim batch.
Select desired guarantor that is identified and setup to have system financial class of Self-Pay.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'Compile Complete' message displayed.
Navigate to the 'Print Crystal Self Pay Bill' section of the form.
Select value for 'Select By Client Or File' field.
Select compiled bill file or client record for bill data display.
Click [Print Self Pay Bill].
Validate that the Self Pay Bill report displays.
In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information.
Open the 'Client Charge Input' form.
Render a service to the client. Note the date of the service.
Verify the service distributed correctly to the self pay guarantor assigned to the client.
Close charges.
Open the 'Crystal Self Pay Bill' form.
Enter values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired date to the 'Date Of Claim' field such that it is after the previous claim date.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support interim batch.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'No Information Found. Cancel OK No Information Was Found For Inclusion On The Bill.' message displayed.
Click [Close Report].
Click [Discard].
Open the 'Inhibited Services For Billing Report' form.
Enter 'Start Date'.
Enter 'End Date'.
Select the client from the previous steps.
Click [Process report].
Verify the report contains all the services for the client for the episode inhibited from the billing.
Close the report.
Open the 'Crystal Self Pay Bill' form.
Enter values for 'Print Charges Thru' field that covers the service rendered to the client and it is after the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'Compile Complete' message displayed.
Navigate to the 'Print Crystal Self Pay Bill' section of the form.
Select value for 'Select By Client Or File' field.
Select compiled bill file or client record for bill data display.
Click [Print Self Pay Bill].
Validate that the Self Pay Bill report displays.
Verify the report displays the recently claimed service in the report.
Close the report.
Close the form.

Scenario 3: Progressive Self Pay Dunning Messages - Validating SQL Table and Crystal Self Pay Bill for a guarantor with a system financial class of Self-Pay

Specific Setup:

Registry Settings:
The registry setting 'Enable Progressive Self-Pay Dunning Messages' is set to 'Y'.
The registry setting 'Allow For Number Of Days Since Last Claim' set to 'I'.
User Definition:
Verify the form 'Progressive Self Pay Dunning Messages' is added to the system.
Select the form and submit the user definition.
Form Search:
Verify the form 'Progressive Self Pay Dunning Messages' is available in the system.
Guarantors/Payors:
A self pay guarantor is identified to assign to the client's first episode. Note the guarantor code/value.
Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
Another existing guarantor is identified to be assigned to the client as a primary guarantor of the second episode and the financial class is not a self pay but is a different financial class. Note the guarantor code / value / financial class.
Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
Dictionary Update:
File - Payor
Data Element - (1000) Financial Class
Dictionary Code - The dictionary code for the financial class of the guarantor identified above to be assigned to the client's second episode.
Extended Dictionary Data Element - (1500) System Financial Class
Extended Dictionary Value - Self Pay
Admission:
A new client is admitted in two admission episodes. Note the client id, admission date and admission program.
Financial Eligibility:
A self pay guarantor is assigned to the client as a primary guarantor of episode 1. Note the guarantor code.
The other guarantor identified is assigned to the client as a primary guarantor of episode 2. Note the guarantor code.
Diagnosis: The diagnosis record is created for the client for both episodes.
Client Charge Input:
3-4 services are rendered to the client for each episode. Note the service date and service code.
Client Ledger:
The services distributed to the self pay guarantor for episode 1.
The services from the second episode are distributed to the assigned guarantor.
Close Charges:
Services are closed.

Steps

Open the 'Progressive Self Pay Dunning Messages' form.
Select the guarantor.
Verify the first message field is enabled.
Verify that each subsequent message field enables when the prior field has a value.
File desired messages for all the message fields.
Print the information for the selected guarantor.
Verify the report includes data filed for the selected guarantor.
Open the 'Crystal Report' or any other SQL Data Viewer.
Query the SQL table SYSTEM.billing_prog_sp_dunn_msg.
Verify the length of the statement messages fields increased to 350 characters.
Verify the data files successfully and correctly as entered through the form.
Open the 'Crystal Self Pay Bill' form.
Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
Select desired guarantor that is set up to have system financial class of self pay.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'Compile Complete' message displayed.
Navigate to the 'Print Crystal Self Pay Bill' section of the form.
Select value for 'Select By Client Or File' field.
Select compiled bill file or client record for bill data display.
Click [Print Self Pay Bill].
Ensure that it displays the first message defined in the form in the Self Pay Bill report/information.
Run the bill for the second service.
Ensure that it displays the second message defined in the form in the Self Pay Bill report/information.
Run the bill for the second service.
Ensure that it displays the third message defined in the form in the Self Pay Bill report/information.
Run the bill for the second service.
Ensure that it displays the fourth message defined in the form in the Self Pay Bill report/information.
Run the bill for the second service.
Ensure that it displays the fifth message defined in the form in the Self Pay Bill report/information.
Close the report.
Close the form.

Scenario 4: Crystal Self Pay Bill - - Validating services that distributed to a guarantor with the system financial class of Self-Pay - Previous claim date within the 'Number Of Days Since Last Claim'

Specific Setup:

Registry Settings:
Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
Guarantors/Payors:
The self pay guarantor is identified to be assigned to the client as a primary guarantor. Note the guarantor code/value.
Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
Another existing guarantor is identified to be assigned to the client as a secondary guarantor and the financial class is not a self pay but is a different financial class. Note the guarantor code / value / financial class.
Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
Dictionary Update:
File - Payor
Data Element - (1000) Financial Class
Dictionary Code - The dictionary code for the financial class of the guarantor identified above to be used as secondary guarantor.
Extended Dictionary Data Element - (1500) System Financial Class
Extended Dictionary Value - Self Pay
Admission:
A new client is admitted, or an existing client is identified. Note the client id, admission date and admission program.
Financial Eligibility: The guarantors identified above are assigned to the client as primary and secondary guarantors.
Diagnosis: The diagnosis record is created for the client.
Client Charge Input:
The service is rendered to the client such that it comes prior to coverage effective date of the primary guarantor. Note the service date and service code.
Client Ledger:
The service distributed to the secondary guarantor.
Close Charges:
The service rendered to the client are closed.

Steps

Open the 'Crystal Self Pay Bill' form.
Enter values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired date to the 'Date Of Claim'. Note the claim date for further testing.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support interim batch.
Select the secondary guarantor.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'Compile Complete' message displayed.
Navigate to the 'Print Crystal Self Pay Bill' section of the form.
Select value for 'Select By Client Or File' field.
Select compiled bill file or client record for bill data display.
Click [Print Self Pay Bill].
Validate that the Self Pay Bill report displays.
In the Self Pay Bill report, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information.

Scenario 5: Crystal Self Pay Bill - Billing a guarantor with the system financial class set to Self Pay - New billing cycle upon updating client's address using the 'Update Client Data' form

Specific Setup:

Registry Settings:
Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
Guarantors/Payors:
The self pay guarantor is identified to be assigned to the client as a primary guarantor. Note the guarantor code/value.
Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
Another existing guarantor is identified to be assigned to the client as a secondary guarantor and the financial class is not a self pay but is a different financial class. Note the guarantor code / value / financial class.
Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
Dictionary Update:
File - Payor
Data Element - (1000) Financial Class
Dictionary Code - The dictionary code for the financial class of the guarantor identified above to be used as secondary guarantor.
Extended Dictionary Data Element - (1500) System Financial Class
Extended Dictionary Value - Self Pay
Admission:
A new client is admitted, or an existing client is identified. Note the client id, admission date and admission program.
Financial Eligibility: The guarantors identified above are assigned to the client as primary and secondary guarantors.
Diagnosis: The diagnosis record is created for the client.
Client Charge Input:
The service is rendered to the client such that it comes prior to coverage effective date of the primary guarantor. Note the service date and service code.
Client Ledger:
The service distributed to the secondary guarantor.
Close Charges:
The service rendered to the client are closed.

Steps

Open the 'Crystal Self Pay Bill' form.
Enter values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support interim batch.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'Compile Complete' message displayed.
Navigate to the 'Print Crystal Self Pay Bill' section of the form.
Select value for 'Select By Client Or File' field.
Select compiled bill file or client record for bill data display.
Click [Print Self Pay Bill].
Validate that the Self Pay Bill report displays.
In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information.
Open the 'Client Charge Input' form.
Render a service to the client. Note the date of the service.
Verify the service distributed correctly to the self pay guarantor assigned to the client.
Close charges.
Open the 'Crystal Self Pay Bill' form.
Enter values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired date to the 'Date Of Claim' field that it is after the previous claim date.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support interim batch.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'No Information Was Found For Inclusion On The Bill.' message displayed.
Click [Close Report].
Click [Discard].
Open the 'Inhibited Services For Billing Report' form.
Enter 'Start Date'.
Enter 'End Date'.
Select the client from the previous steps.
Click [Process report].
Verify the report contains all the services for the client for the episode inhibited from the billing.
Close the report.
Open the 'Update Client Data' form for the client.
Navigate to 'Demographics' section of form.
Change any of the Client's Address field.
Click [Submit].
Open the 'Crystal Self Pay Bill' form.
Enter values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date.
Select 'Yes' in the 'Create Claims Y/N' field.
Enter desired date to the 'Date Of Claim'.. Note the claim date for further testing.
Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support interim batch.
Select 'All Clients' in the 'Print For An Individual Or All Clients'.
Click [Compile Self Pay Bill].
Verify the 'Compile Complete' message displayed.
Navigate to the 'Print Crystal Self Pay Bill' section of the form.
Select value for 'Select By Client Or File' field.
Select compiled bill file or client record for bill data display.
Click [Print Self Pay Bill].
Ensure that it displays the Self Pay Bill report/information.
Verify the report displays the recently claimed service in the report.
Close the report.
Close the form.

Topics

• Crystal Self Pay Bill • Database Tables • Inhibit Billing • NX • Registry Settings

Table Changes

Table	Column	Change
SYSTEM.billing_prog_sp_dunn_msg	first_message	Increased length to 350
SYSTEM.billing_prog_sp_dunn_msg	second_message	Increased length to 350
SYSTEM.billing_prog_sp_dunn_msg	third_message	Increased length to 350
SYSTEM.billing_prog_sp_dunn_msg	fourth_message	Increased length to 350
SYSTEM.billing_prog_sp_dunn_msg	fifth_message	Increased length to 350