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Avatar PM 2022 Update 126

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Product Requirements / Recommendations

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Product Update Form Description

837 Professional bill is updated to allow suppression of Ordering Provider Address (2420E-N3) segment via the 'Select Segments To Suppress' field on the 'Guarantor/Program Billing Defaults' form (837 Professional section).

Included Updates

3, 9, 13, 18, 19, 21, 25, 26, 34, 41, 48, 51, 55, 58, 59, 61, 62, 67, 73, 75, 77, 78, 84, 87, 88, 90, 91, 94, 95, 97, 99, 100, 103, 107, 108, 109, 110, 114, 118, 120, 125

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Guarantor/Program Billing Defaults - Select Segments To Suppress
The Situational Segment 2420E-N3 can be successfully suppressed from the 837 Professional bill.
Value Added: An 837 Professional billing process is enhanced to suppress the correct information from the bill based on the 'Select Segments To Suppress' set up in the 'Guarantor Program Billing Defaults'.
Topics
• 837 Professional • Guarantor / Program Billing Defaults • NX
 
Acceptance Tests
AV-82293 Summary | Details
Guarantor/Program Billing Defaults - Select Segments To Suppress
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
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Diagnosis
  • Dictionary Update (PM)
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Practitioner Enrollment
  • Practitioner Numbers By Guarantor And Program
  • Program Maintenance
  • Site Specific Section Modeling (PM)
Scenario 1: Guarantor/Program Billing Defaults - 837 Professional - Select Segments To Suppress
Specific Setup:
  • Site specific Section Modeling:
  • A site specific Practitioner field (SS Treatment Practitioner 1) is set up on the 'Client Charge Input' via site specific section modeling as the Ordering Provider.
  • Check the 'Use As Ordering Provider (837P-2420E)' in the 'Product Custom Logic Definition' field.
  • Please note :The 'Client Charge Input' form use the Practitioner which is specified in the 'Practitioner Enrollment' as the ordering provider.
  • Practitioner Enrollment:
  • Create a new or identify an existing practitioner to be used as an ordering practitioner. Note the Practitioner id, Name, NPI Number, Taxonomy Code.
  • Guarantors/Payors:
  • Identify an existing guarantor or create a new guarantor. Note the guarantor's code/name.
  • Program Maintenance:
  • Identify an existing outpatient program to be used for the client's admission. Note the program code/name.
  • Practitioner Numbers By Guarantor and Program:
  • Create a record using a practitioner, guarantor and program identified above.
  • Service Codes:
  • A professional service code is identified. Note the service code.
  • Dictionary Update:
  • Following loop-segments set up in the 'Other Tabled Files' and dictionary 13150 'Select Segment's to Suppress' Dictionary:
  • 2420E-N3 - Ordering Provider Address (2420E-N3)
  • 2420E-N4 - Ordering Provider City (2420E-N4)
  • 2420E-REF - Ordering ProviderSec. Info (2420E-REF)
  • 2420E-PER - Ordering Provider Contact (2420E-PER)
  • Guarantor/Program Billing Defaults template:
  • Edit an existing template to assign the guarantor identified above. Note the template name.
  • 837 Professional section:
  • Following items are selected in the 'Select Segments To Suppress':
  • 2420E-N3 - Ordering Provider Address (2420E-N3)
  • 2420E-N4 - Ordering Provider City (2420E-N4)
  • 2420E-REF - Ordering ProviderSec. Info (2420E-REF)
  • 2420E-PER - Ordering Provider Contact (2420E-PER)
  • Admission:
  • A new client is admitted in the outpatient program with attending practitioner.
  • Financial Eligibility:
  • The guarantor assigned to the template configured in the 'Guarantor/Program Billing Defaults' is assigned to the client.
  • Diagnosis:
  • An admission diagnosis record is created for the client.
  • Client Charge Input:
  • A professional service is rendered to the client on the admission date. An ordering practitioner is added for these charges.
  • Charges are closed.
  • An interim billing batch is created to include client, services, and guarantor.
Steps
  1. Open the 'Electronic Billing' form.
  2. Compile the 837 Professional for the interim billing batch created in the setup section.
  3. Verify the bill compiles successfully.
  4. Review the dump file.
  5. Verify the segments display the attending provider identification information from the 'Practitioner Enrollment' form.
  6. Close the report.
  7. Close the form.
  8. Open the 'Guarantor/Program Billing Defaults' form.
  9. Go to '837 Professional section'.
  10. Select '2420E-N3 - Ordering Provider Address (2420E-N3)', '2420E-N4 - Ordering Provider City (2420E-N4)', '2420E-REF - Ordering ProviderSec. Info (2420E-REF)' and '2420E-PER - Ordering Provider Contact (2420E-PER)' in the 'Select Segments To Suppress' checklist.
  11. Submit the form.
  12. Open the 'Electronic Billing' form.
  13. Compile an 837 Professional bill for the interim billing batch created in the setup section.
  14. Verify the bill compiles successfully.
  15. Review the dump file.
  16. Locate the 2420E loop. The 2420E loop starts with NM1*DK.
  17. Verify the following segments are suppressed correctly from the 2420E loop of the bill.
  18. 2420E-N3 - Ordering Provider Address (2420E-N3)
  19. 2420E-N4 - Ordering Provider City/State/Zip Code (2420E-N4)
  20. 2420E-REF - Ordering ProviderSec. Info (2420E-REF)
  21. 2420E-PER - Ordering Provider Contact (2420E-PER)
  22. Close the report.
  23. Close the form.
  24. Open the 'Guarantor/Program Billing Defaults' form.
  25. Go to the '837 Professional section'.
  26. Deselect '2420E-N3 - Ordering Provider Address (2420E-N3)', '2420E-N4 - Ordering Provider City (2420E-N4)', '2420E-REF - Ordering ProviderSec. Info (2420E-REF)' and '2420E-PER - Ordering Provider Contact (2420E-PER)' in the 'Select Segments To Suppress' checklist.
  27. Submit the form.
  28. Open the 'Electronic Billing' form.
  29. Compile an 837 Professional bill for the interim billing batch created in the setup section.
  30. Verify the bill compiles successfully.
  31. Review the dump file.
  32. Locate to the 2420E loop. The 2420E loop starts with NM1*DK.
  33. Verify the following segments are not suppressed and included in the 2420E loop of the bill.
  34. 2420E-N3 - Ordering Provider Address (2420E-N3)
  35. 2420E-N4 - Ordering Provider City/State/Zip Code (2420E-N4)
  36. 2420E-REF - Ordering ProviderSec. Info (2420E-REF)
  37. 2420E-PER - Ordering Provider Contact (2420E-PER)
  38. Close the report.
  39. Close the form.
  40. Open the 'Guarantor/Program Billing Defaults' form.
  41. Go to the '837 Professional section'.
  42. Select '2420E-N3 - Ordering Provider Address (2420E-N3)', and '2420E-PER - Ordering Provider Contact (2420E-PER)' in the 'Select Segments To Suppress' checklist.
  43. Submit the form.
  44. Open the 'Electronic Billing' form.
  45. Compile an 837 Professional bill for the interim billing batch created in the setup section.
  46. Verify the bill compiles successfully.
  47. Review the dump file.
  48. Locate the 2420E loop. The 2420E loop starts with NM1*DK.
  49. Verify the following segments are suppressed correctly and not included in the 2420E loop of the bill.
  50. 2420E-N3 - Ordering Provider Address (2420E-N3)
  51. 2420E-PER - Ordering Provider Contact (2420E-PER)
  52. Verify the following segments are not suppressed and included in the 2420E loop of the bill.
  53. 2420E-N4 - Ordering Provider City/State/Zip Code (2420E-N4)
  54. 2420E-REF - Ordering ProviderSec. Info (2420E-REF)
  55. Close the report.
  56. Close the form.
Topics
• 837 Professional • Guarantor / Program Billing Defaults • NX