Avatar PM 2022 Update 153

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Product Requirements / Recommendations

Avatar PM required
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Recommended Update Level

Avatar CWS 2022 Update 129

Product Update Form Description

The following is included: 1) "HCFA-1500 Form Locator 19" is added to selection '2' of the 'Specify Additional Fields To Show' registry setting. 2) The 'Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19)' registry setting is added. Note: Avatar CWS 2022 update 129 is required for full use of this functionality.

Included Updates

3, 9, 13, 18, 19, 20, 21, 22, 25, 26, 34, 37, 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, 117, 118, 120, 123, 125, 126, 128, 130, 137, 138, 139, 140, 143, 144, 151

Required Updates

None

Details

NEW1 CHANGED0 FIXED0

New (1)

AV-85228 Details | User Acceptance Tests

837 Professional - Print Bill

Registry Settings:

1. "HCFA-1500 Form Locator 19" is added to selection '2' of the 'Specify Additional Fields To Show' registry setting.
2. The 'Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19)' registry setting is added.

File Import:
1. Practitioner Numbers By Guarantor and Program has been updated to include the field 'HCFA-1500 Form Locator 19'.

Note: Avatar CWS 2022 update 129 is required for full use of this functionality.

Value Added: Provides the ability to define output to the 837P and Print Bill files.

Topics

• 837 Professional • File Import • NX • Print Bill • Progress Notes

Acceptance Tests

AV-85228 Summary | Details

837 Professional - Print Bill

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

File Import
Practitioner Numbers By Guarantor And Program
Admission (Outpatient)
Client Ledger
Create Interim Billing Batch File
Diagnosis
Dictionary Update (CWS)
Electronic Billing
Financial Eligibility
Practitioner Enrollment
Print Bill
Program Maintenance
Progress Notes (Group and Individual)
Site Specific Section Modeling (CWS)
Registry Settings (PM)

Scenario 1: File Import - Practitioner Numbers By Guarantors and Programs

Specific Setup:

An existing Practitioner Numbers By Guarantor and Program record is identified. Note the practitioner.
A 'Practitioner Numbers By Guarantor and Program' file import file is created that contains desired fields for the existing record.
Note the practitioner, guarantors, programs, and effective dates included in the file. Note the file name.
The File Import spreadsheet is included in the update zip file for guidance in creating the file.

Steps

Open the "File Import" form.
Select 'Practitioner Numbers By Guarantor and Program Dates' in 'File Type'
Upload the file from Setup.
Compile the uploaded file.
Verify the file compiles successfully.
Select the 'Print File' option and review the report.
Verify the report displays correct data correctly.
Post the compiled file.
Verify that the file posts successfully.
Close the form.
Open the 'Practitioner Numbers By Guarantor and Program' form.
Select the 'Print Practitioner Numbers' option.
Select the practitioner identified in the file import file.
Select the guarantors and programs included in the file import file.
Process the report.
Verify the report displays the imported data for the practitioner.
Close the report.
Close the form.

Scenario 2: Registry Setting - Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = Y

Specific Setup:

Registry Setting:
Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Enable New Practitioner Numbers By Guarantor and Program Form = ‘Y’.
Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Specify Additional Fields To Show = ‘2’, at a minimum.
Avatar PM->Billing->Electronic Billing->All 837 Submissions->->Include Notes From Charge Input = 'N'.
Avatar PM->Billing->Electronic Billing->837 Professional->->Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = ‘Y’.
Client A: Identify an active client that can be billed using 837 Professional or HCFA-1500 billing.
Note the client’s program.
Validate that there is an active Diagnosis record.
Validate that there is an active Financial Eligibility record, noting the guarantor(s). Note the Financial Class(es).
Guarantor/Program Billing Defaults
Edit the desired template that contains the client's program and guarantor(s).
Paper CMS 1500: Place a checkmark in the 'Participating Provider Information for AHCCCS Billing' checkbox of the 'Form Locator 19 Alternate Value' field.
837 Professional: Place a checkmark in the 'Participating Provider Information for AHCCCS Billing' checkbox of the 'Claim Note Text (837P-2300-NTE-02) Alternate Value' field.
Practitioner Enrollment: Identify a minimum of two practitioners that are used for billing services.
Practitioner Numbers By Guarantor and Program: Add unique values, for each practitioner, to the following fields, noting the values.
'HCFA-1500 Form Locator 19'.
'Claim Note Reference Code (837P-2300-NTE-01)'.
'Claim Note Text (837P-2300-NTE-01)'.
CWS Dictionary Update: Other CWS Tabled Files – Select a ‘SS Note Single Response Dictionary’. In this example this dictionary was selected: (7271.3) SS Note Single Response Dictionary 100. Add ‘Dictionary Codes and Values. The codes represent the School ID and the values represent the School Name.
CWS Dictionary Update: CWS – Select the same ‘SS Note Single Response Dictionary’. In this example this dictionary was selected: (7271.3) SS Note Single Response Dictionary 100. Add ‘Dictionary Codes and Values. The codes represent the School ID and the values represent the School Name.
Site Specific Section Modeling (CWS).
Select a 'Progress Note' form to add a modeled field to, such as Progress Notes (Group and Individual).
Add a new row that will use the ‘SS Note Single Response Dictionary’ selected above.
Select desired value in 'Initially Required'.
Select desired value in 'Exclude from Data Collection Instrument'.
Select 'Use as 'File as Claim Note Text' in 837P-2300-NTE-02/HCFA-1500 FL 19 - Single Response Dictionary
Submit the form.
Client Charge Input: Create a charge for the client and one of the practitioners. Note the date.
Progress Notes: Using the modeled form, create a charge for the client and the other practitioner. Note the date.
Create Interim Billing Batch File is used to create a batch for the two services.
Close Charges is used to close the charges.

Steps

Open ‘Print Bill’.
Enter the last date of service in ‘Print Charges Thru’.
Select ‘No’ in ‘Create Claims Y/N’.
Select ‘HCFA-1500-NPI Version (Sort By Practitioner) in ‘Print On What Form’.
Select ‘Yes’ in ‘Print For Interim Batch’.
Select desired ‘Interim Batch Number’.
Click [Process].
Validate that ‘Form Locator 19’ field contains the value added to ‘Practitioner Numbers By Guarantor and Program’ during setup for the service practitioner.
Go to the next page of the bill and validate that ‘Form Locator 19’ field contains the value added to ‘ Practitioner Numbers By Guarantor and Program’ during setup for the service practitioner.
Close the report.
Close the form.
Open ‘Electronic Billing’.
Select ‘837-Professional’ in ‘Billing Form’.
Select the desired ‘Financial Class’ in ‘Type Of Bill’.
Select ‘Individual’ in ‘Individual Or All Guarantors’.
Select the desired ‘Guarantor’.
Select desired value in ‘Billing Type’.
Select ‘Sort File’ in ‘Billing Options’.
Enter desired ‘File Description’.
Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
Select ‘desired ‘Interim Billing Batch Number’.
Select ‘No’ in ‘Create Claims’.
Enter the ‘First Date Of Service To Include’.
Enter the ‘Last Date Of Service To Include’.
Select ‘All’ in ‘Include Primary and/or Secondary Billing’.
Click [Process].
Click [OK] on ‘Compile Complete’ message.
Select ‘Dump File’ in ‘Billing Options’.
Select ‘Print’ in ‘Select ‘Dump File’ in ‘Billing Options’.
Select the ‘File’, which contains the ‘File Description’ added above.
Click [Process].
Validate that the claim loop does contains an NTE segment, that displays the data added to 'Practitioner Numbers by Guarantor and Program' during Setup, for fields 'Claim Note Reference Code (837P-2300-NTE-01' and 'Claim Note Text (837P-2300-NTE-01)'. The NTE segment will also contain the data from the Site Specific Section Modeling field for the service created by the progress note. The field will dispaly as 'OBxx', where 'OB' is the prefix and 'xx' is the dictionary code
Close the report.
Close the form.

Scenario 3: Registry Setting - Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = N

Specific Setup:

Registry Setting:
Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Enable New Practitioner Numbers By Guarantor and Program Form = ‘Y’.
Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Specify Additional Fields To Show = ‘2’, at a minimum.
Avatar PM->Billing->Electronic Billing->All 837 Submissions->->Include Notes From Charge Input = 'N'.
Avatar PM->Billing->Electronic Billing->837 Professional->->Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = ‘N’.
Client A: Identify an active client that can be billed using 837 Professional or HCFA-1500 billing.
Note the client’s program.
Validate that there is an active Diagnosis record.
Validate that there is an active Financial Eligibility record, noting the guarantor(s). Note the Financial Class(es).
Practitioner Enrollment: Identify a minimum of two practitioners that are used for billing services.
Practitioner Numbers By Guarantor and Program: The field 'HCFA-1500 Form Locator 19' has been added to the form. For the practitioners selected above, select the clients’ program and guarantors, and edit the existing record to add unique values to the 'HCFA-1500 Form Locator 19' field.
CWS Dictionary Update: Other CWS Tabled Files – Select a ‘SS Note Single Response Dictionary’. In this example this dictionary was selected: (7271.3) SS Note Single Response Dictionary 100. Add ‘Dictionary Codes and Values. The codes represent the School ID and the values represent the School Name.
CWS Dictionary Update: CWS – Select the same ‘SS Note Single Response Dictionary’. In this example this dictionary was selected: (7271.3) SS Note Single Response Dictionary 100. Add ‘Dictionary Codes and Values. The codes represent the School ID and the values represent the School Name.
Site Specific Section Modeling (CWS).
Select a 'Progress Note' form to add a modeled field to, such as Progress Notes (Group and Individual).
Add a new row that will use the ‘SS Note Single Response Dictionary’ selected above.
Select desired value in 'Initially Required'.
Select desired value in 'Exclude from Data Collection Instrument'.
Select 'Use as 'File as Claim Note Text' in 837P-2300-NTE-02/HCFA-1500 FL 19 - Single Response Dictionary
Submit the form.
Client Charge Input: Create a charge for the client and one of the practitioners. Note the date.
Progress Notes: Using the modeled form, create a charge for the client and the other practitioner. Note the date.
Create Interim Billing Batch File is used to create a batch for the two services.
Close Charges is used to close the charges.

Steps

Open ‘Print Bill’.
Enter the last date of service in ‘Print Charges Thru’.
Select ‘No’ in ‘Create Claims Y/N’.
Select ‘HCFA-1500-NPI Version (Sort By Practitioner) in ‘Print On What Form’.
Select ‘Yes’ in ‘Print For Interim Batch’.
Select desired ‘Interim Batch Number’.
Click [Process].
Validate that ‘Form Locator 19’ field contains the value added to ‘ Practitioner Numbers By Guarantor and Program’ during setup for the service practitioner.
Go to the next page of the bill and validate that ‘Form Locator 19’ field contains the value added to ‘ Practitioner Numbers By Guarantor and Program’ during setup for the service practitioner.
Close the report.
Close the form.
Open ‘Electronic Billing’.
Select ‘837-Professional’ in ‘Billing Form’.
Select the desired ‘Financial Class’ in ‘Type Of Bill’.
Select ‘Individual’ in ‘Individual Or All Guarantors’.
Select the desired ‘Guarantor’.
Select desired value in ‘Billing Type’.
Select ‘Sort File’ in ‘Billing Options’.
Enter desired ‘File Description’.
Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
Select ‘desired ‘Interim Billing Batch Number’.
Select ‘No’ in ‘Create Claims’.
Enter the ‘First Date Of Service To Include’.
Enter the ‘Last Date Of Service To Include’.
Select ‘All’ in ‘Include Primary and/or Secondary Billing’.
Click [Process].
Click [OK] on ‘Compile Complete’ message.
Select ‘Dump File’ in ‘Billing Options’.
Select ‘Print’ in ‘Select ‘Dump File’ in ‘Billing Options’.
Select the ‘File’, which contains the ‘File Description’ added above.
Click [Process].
Validate that the claim loop does not contain an NTE segment.
Close the report.
Close the form.

Topics

• 837 Professional • File Import • NX • Print Bill • Progress Notes

Table Changes

Table	Column	Change
SYSTEM.file_import_staff_prov_num_dates	hcfa_1500_form_loc_19	new
SYSTEM.table_prac_num_guar_prog	hcfa_1500_form_loc_19	new
SYSTEM.file_import_gpbdt_p_837	claim_note_alt_code	new
SYSTEM.file_import_gpbdt_p_837	claim_note_alt_value	new
SYSTEM.table_837_p_facility_prov_num	claim_note_alt_code	new
SYSTEM.table_837_p_facility_prov_num	claim_note_alt_value	new
SYSTEM.file_import_gpbdt_paper_hcfa	form_loc_19_alt_code	new
SYSTEM.file_import_gpbdt_paper_hcfa	form_loc_19_alt_code	new
SYSTEM.table_facility_provider_numbers	form_loc_19_alt_value	new
SYSTEM.table_facility_provider_numbers	form_loc_19_alt_value	new