Avatar PM 2022 Update 15

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Product Requirements / Recommendations

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Known Limitations

The functionality for the 'Enumerated service cannot be billed until the associated PPS Service is ready to bill' error message is being moved to a follow-up update.
The functionality for the ‘Treatment Plan Service Count Exceeded For This Program Of Service’ error message is being released with a known issue: The current query does not complete processing if the service codes selected in the ‘Guarantors/Payors’ > ‘Treatment Plan Requirements’ > ‘Select Services’ field are not numeric service codes. This will also be included in a follow-up update.

Product Update Form Description

The unbilled services compile is updated to support new errors.

Included Updates

None

Required Updates

None

Details

NEW1 CHANGED0 FIXED0

New (1)

AV-75891 Details \| User Acceptance Tests Unbilled Services Compile Definition and Export - error messages Additional error messaging functionality has been added to the 'Unbilled Services Compile Definition and Export'. Value Added: Allows more billing error messages to be output to the 'Unbilled Services Compile Definition and Export'.	Topics • myAvatar/myAvatar NX • Unbilled Services Report

Acceptance Tests

AV-75891 Summary | Details

Unbilled Services Compile Definition and Export - error messages

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

Admission
Admission (Outpatient)
Ambulatory Progress Notes
App Dashboard
Client Charge Input
Client Ledger
Diagnosis
Dictionary Update (PM)
Discharge
Document Routing Setup (PM)
Dynamic Form - Admission - Client
Dynamic Form - Delete Compile Definition
Dynamic Form - Dictionary Update - Locked Dictionary
Dynamic Form - document routing - sign
Dynamic Form - document routing - verify password
Dynamic Form - Document Routing Setup - Select Form
Dynamic Form - Edit Service Fee Definition
Dynamic Form - Individual Cash Posting - Alert
Dynamic Form - Individual Cash Posting - Client
Dynamic Form - Individual Cash Posting - Information
Dynamic Form - Registry Settings - Registry Editor Filing
Dynamic Form - Treatment Plan
Dynamic Form - Unbilled Services Compile Definition
Dynamic Form Client Treatment Plan
Dynamic Form Plan Date
Dynamic Forms - Document Routing - Route Document To Dialog
Electronic Billing
Failed Authentication - Input Dialog
Financial Eligibility
Form Designer (PM)
Guarantors/Payors
Individual Cash Posting (PM)
Ok - Cancel Dialog
Practitioner Enrollment
Practitioner Numbers By Guarantor And Program
Program Maintenance
Registry Settings (PM)
Service Codes
System Task Scheduler
Treatment Plan
Unbilled Services Compile Definition and Export
User Definition

Scenario 1: Unbilled Services Compile Definition and Export - Error message priority validation

Specific Setup:

The following error messages have been added to the ‘Unbilled Services Compile Definition and Export’ processing:
837 Institutional Only:
Episode cannot be billed due to 3 day billing rule. Priority 33.
This Service Would Result In The Generation Of More Than One Institutional Service Line (2400-SV2) Segment, Per Claim Information (2300-CLM), For Room And Board Services. Priority 34.
Service Code Is Missing Rate Code Information For Guarantor. Priority 37.
837 Professional Only:
Missing 'Place Of Service (837 Professional)' Extended Dictionary Off Of Location. Priority 31.
Service Code Does Not Have A Professional Component. Priority 35.
Missing Note Description (2400 NTE). Priority 36.
Both 837 Institutional and 837 Professional:
Missing Subscriber Group #. Priority 29.
An Add-On or Interactive Complexity service code can only be billed if the primary service is also on the claim. Priority 30.
This Service Is Being Excluded From The Bill Due To Crossover Claim Logic Associated With Guarantor. Priority 32.
Unable to Bill Service Due To Same Day Service Hold For Progress Notes. Priority is always last.
Due To Coordination Of Benefits Logic This Claim Cannot Be Billed Out Until Prior Covering Guarantor(s) Have Received Payment. Priority 38.
Treatment Plan Service Count Exceeded For This Program Of Service. Priority 40.
Missing Field Line Adjudication Information Identification Code. Priority 41.
Progress Note On File For Service Requires A Co-Signature But One Is Not Present. Priority 28, processes at the same time as the no progress note on file error.
Unbillable services that would fall to the above errors exist.
Dictionary Update:
Client Dictionary – 83701 - 837 Error Classification is updated as desired.
Client Dictionary – 83700 - 837 Error Code is updated as desired.
Desired number of ‘Unbilled Services Compile Definition and Export’ exist for the unbillable services.
System Task Scheduler has been used to schedule the task of processing the Unbilled Services Compile Definition and Export. Note the scheduled dates/times to note when to begin the verification process.

Steps

Open ‘Unbilled Services Compile Definition and Export’.
Select the ‘Export Unbilled Services’ section.
Click [Export Unbilled Services Data].
Save the ‘NetsmartExport.csv’ file to desired location.
Open the saved file with ‘Notepad’ or another desired tool.
Validate that the expected errors exist in the export and the priority for the errors places the lowest priority as the ‘Primary Unbilled Reason’ and all other errors are listed as ‘Other Reasons’.
Update the necessary data to the ‘Primary Unbilled Reason’ for at least one service that contains other errors.
Process the ‘System Task Scheduler’ for the ‘Unbilled Services Compile Definition and Export’.
Open ‘Unbilled Services Compile Definition and Export’.
Select the ‘Export Unbilled Services’ section.
Click [Export Unbilled Services Data].
Save the ‘NetsmartExport.csv’ file to desired location.
Open the saved file with ‘Notepad’ or another desired tool.
Validate that the original ‘Primary Unbilled Reason’ does not exist and that the lowest priority ‘Other Reasons’ is now the ‘Primary Unbilled Reason’.

Topics

• myAvatar/myAvatar NX • Unbilled Services Report