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Avatar PM 2022 Update 139

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Product Requirements / Recommendations

Avatar PM required
RADplus required

Product Update Form Description

A new field 'Location' is added to the 'Payor Based Authorization' form. This field will allow the creation of location based authorizations.

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, 123, 137

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Payor Based Authorizations
The 'Location' field is added to 'Payor Based Authorizations' functionality. The field will be added to the 'Payor Based Authorizations' form and 'File Import' - Payor Based Authorizations.
The following tables will also be updated: SYSTEM.file_import_pay_auths, SYSTEM.table_payor_auths, and SYSTEM.table_payor_auths_cpt
Value Added: Allows 'Payor Based Authorizations' authorizations to be defined by 'Location'.
Topics
• Client Charge Input • File Import • NX • Payor Based Authorizations
 
Acceptance Tests
AV-84415 Summary | Details
Payor Based Authorizations
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Dictionary Update (PM)
  • File Import
  • Guarantors/Payors
  • Payor Based Authorizations
  • Program Maintenance
  • Registry Settings (PM)
  • Service Codes
  • Admission
  • Authorization Warning
  • Client Charge Input
  • Client Ledger
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
  • Practitioner Numbers By Guarantor And Program
Scenario 1: PM - File Import - Payor Based Authorizations
Specific Setup:
  • Registry Settings:
  • Enable Payor Based Authorizations = 'Y'
  • Enable CPT Based Payor Authorizations = desired value.
  • Require Authorizations At Guarantors/Payors Level = desired value.
  • File Import: A file has been created for testing.
  • Note the values of all fields in the file for later comparison
  • The 'Avatar_PM_File_Import_Record_Layouts' is included in the update zip file to assist in creating the file.
Steps
  1. Open ‘File Import’ form.
  2. Select ‘Payor Based Authorizations’ in ‘File Type’.
  3. Upload the file.
  4. Compile the file.
  5. Print the file and validate the data.
  6. Post the file.
  7. Close the form.
  8. Open ‘Payor Based Authorizations’ form.
  9. Select ‘Edit’ in ‘Add/Edit/Delete’.
  10. Select the ‘Guarantor’ that was used in the import file.
  11. Click [Select Authorization To Edit/Delete].
  12. Select the desired row in the ‘Edit Entry’ table.
  13. Click [OK].
  14. Validate that ‘Effective Date’ contains the value in the import file.
  15. Validate that ‘Expiration Date’ contains the value in the import file.
  16. Validate that ‘Practitioner Category’ contains the value(s) in the import file.
  17. Validate that ‘Location’ contains the value(s) in the import file.
  18. Validate that ‘Authorization Group’ contains the value in the import file.
  19. Validate that ‘Service Code(s) ’ contains the value(s) in the import file.
  20. Validate that ‘Authorization Number’ contains the value in the import file.
  21. Close the form.
Scenario 2: PM - Payor Based Authorization - Location
Specific Setup:
  • Registry Settings:
  • Enable Payor Based Authorizations = 'Y'.
  • Enable CPT Based Payor Authorizations = desired value.
  • Require Authorizations At Guarantors/Payors Level = desired value.
  • Dictionary Update:
  • Client File (10006) Location = note active locations.
  • Staff File (79) Practitioner Category = note active categories.
  • Guarantors/Payors:
  • Guarantor A: Identify a guarantor to be used with 'Payor Based Authorizations'.
  • Note the values in the 'Authorization Section'.
  • Verification Level For Authorizations For Client Charge Input and Verification Level For Authorizations For Appointment Scheduling:
  • 'Disallow Service If Authorization Is Missing' will not allow the service to be submitted.
  • 'Warn User If Authorization Is Missing' will allow the service to be submitted.
  • Verification Level For Authorizations For 837 Electronic Billing:
  • 'None' will allow services that were submitted and closed to be billed.
  • 'Report As Error And Include On Bill' will allow services that were submitted and closed to be billed. An error message will be included in the 837 Billing report.
  • 'Report As Error And Do Not Include On Bill' will not allow services that were submitted and closed to be billed
  • Payor Based Authorizations: Create or edit a definition to include desired 'Locations' and any other desired fields. An error message will be included in the 837 Billing report.
  • Client A: Identify an active client that is assigned to the guarantor above.
Steps
  1. Open ‘Scheduling Calendar’.
  2. Create an appointment for Client A.
  3. Validate that the appropriate submission event occurs based on the values in the ‘Guarantors/Payors’, 'Authorization Section'.
  4. Close the form.
  5. Open ‘Client Charge Input’.
  6. Create a service for Client A.
  7. Validate that the appropriate submission event occurs based on the values in the ‘Guarantors/Payors’, 'Authorization Section'.
  8. Close the form.
  9. Open 'Close Charges’ and close charges for Client A if submission was allowed.
  10. Close the form.
  11. Open ‘Electronic Billing’ if submission was allowed.
  12. Create the bill for Client A and validate that the appropriate billing action occurs based on the values in the ‘Guarantors/Payors’, 'Authorization Section'.
  13. Close the form.
  14. Open ‘Client Ledger’ for Client A if submission was allowed.
  15. Review the ‘Simple’, ‘Ledger Type’ to confirm the billing activity.
  16. Close the form.
Topics
• Client Charge Input • File Import • NX • Payor Based Authorizations
Table Changes
Table Column Change
file_import_pay_auths location_code ADD
file_import_pay_auths location_value ADD

table_payor_auths|location_code|ADD table_payor_auths|location_value|ADD table_payor_auths|data_entry_utc|ADD

table_payor_auths_cpt|location_code|ADD table_payor_auths_cpt|location_value|ADD table_payor_auths_cpt|data_entry_utc|ADD