Skip to main content

Avatar PM 2022 Update 151

  1. Last updated
  2. Save as PDF

Product Requirements / Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2022 Update 139

Product Update Form Description

An issue has been resolved in the 'Payor Based Authorizations' form where selecting a 'Location' could incorrectly trigger an error for overlapping 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, 125, 126, 130, 137, 139, 140, 143, 144

Required Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Payor Based Authorizations
The 'Payor Based Authorizations' functionality has been modified to ensure that selecting a 'Location' does not cause an error for overlapping authorizations.
Topics
• Client Charge Input • NX • Payor Based Authorizations
 
Acceptance Tests
AV-85212 Summary | Details
Payor Based Authorizations
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission
  • Client Charge Input
  • Client Ledger
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Payor Based Authorizations
  • Practitioner Numbers By Guarantor And Program
  • Program Maintenance
  • Registry Settings (PM)
Scenario 1: 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 not include a 'Locations' and any other desired fields. An error message will be included in the 837 Billing report. Note the value of each field.
  • Client A: Identify an active client that is assigned to the guarantor above.
Steps
  1. Open 'Payor Based Authorizations'.
  2. Create a new record that matches the record from setup.
  3. Validate that the following message displays: An authorization already exists for this date range. Overlapping authorizations are not allowed.
  4. Remove the 'Expiration Date'.
  5. Select a 'Location'.
  6. Enter an 'Expiration Date'.
  7. Submit the form and validate that it files successfully.
  8. Open ‘Scheduling Calendar’.
  9. Create an appointment for Client A.
  10. Validate that the appropriate submission event occurs based on the values in the ‘Guarantors/Payors’, 'Authorization Section'.
  11. Close the form.
  12. Open ‘Client Charge Input’.
  13. Create a service for Client A.
  14. Validate that the appropriate submission event occurs based on the values in the ‘Guarantors/Payors’, 'Authorization Section'.
  15. Close the form.
  16. Open 'Close Charges’ and close charges for Client A if submission was allowed.
  17. Close the form.
  18. Open ‘Electronic Billing’ if submission was allowed.
  19. Create the bill for Client A and validate that the appropriate billing action occurs based on the values in the ‘Guarantors/Payors’, 'Authorization Section'.
  20. Close the form.
  21. Open ‘Client Ledger’ for Client A if submission was allowed.
  22. Review the ‘Simple’, ‘Ledger Type’ to confirm the billing activity.
  23. Close the form.
Topics
• Client Charge Input • NX • Payor Based Authorizations