Avatar PM 2022 Update 76

Last updated
Save as PDF

Product Requirements / Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2021 Update 61

Product Update Form Description

An issue is resolved where a guarantor specific PPS-1 service definition might not be utilized when compiling PPS charges via the 'CCBHC PPS Compile' form.

Included Updates

None

Required Updates

None

Details

NEW0 CHANGED0 FIXED1

Fixed (1)

AV-80628 Details \| User Acceptance Tests CCBHC PPS Compile – CCBHC PPS Service Definition The CCBHC PPS Compile functionality has been updated to resolve an issue where the incorrect CCBHC PPS Service Definition could be selected if the client has more than one guarantor assigned to CCBHC services, and only one definition included a guarantor selection. KB0070086 v0.01	Topics • CCBHC • NX

Acceptance Tests

AV-80628 Summary | Details

CCBHC PPS Compile – CCBHC PPS Service Definition

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

Admission (Outpatient)
App Dashboard
CCBHC PPS Compile
CCBHC PPS Service Definition
Client Charge Input
Client Ledger
Diagnosis
Dictionary Update (PM)
Dynamic Form - Admission - Client
Dynamic Form - Plan
Dynamic Form Address Validation
Financial Eligibility
Guarantors/Payors
Practitioner Numbers By Guarantor And Program
Program Maintenance
Service Codes
Update Client Data

Scenario 1: CCBHC PPS-1 Compile - Primary guarantor has no guarantor PPS definition - Secondary guarantor has a guarantor PPS definition

Specific Setup:

Dictionary Update: Client - 10006 - Location
Note at least one location that is a CCBHC location.
Service Codes:
1: CCBHC Enumerated service. Note the ‘Covered Charge Category’.
2: CCBHC Non- Enumerated service in the same ‘Covered Charge Category’ as 1.
3: CCBHC Enumerated service in a different ‘Covered Charge Category’ than 1 & 2.
4: CCBHC Non- Enumerated service in the same ‘Covered Charge Category’ as 3.
Benefit Plan:
1: The ‘Covered Charge Category’ for Service Codes 1 & 2 is included. The ‘Covered Charge Category’ for Service Codes 3 & 4 is not included.
2: The ‘Covered Charge Category’ for Service Codes 3 & 4 is included. The ‘Covered Charge Category’ for Service Codes 1 & 2 is not included.
Guarantors/Payors: Both guarantors have a value of ‘Yes’ in CCBHC Guarantor. They can be in the same or different financial classes.
1: The ‘Default Guarantor Plan’ is Benefit Plan 1.
2: The ‘Default Guarantor Plan’ is Benefit Plan 2.
CCBHC PPS Service Definition:
1: Note the effective date. The PPS-1 Service code is Service Code 2.
2: Note the effective date. The Guarantor is guarantor 2. The PPS-1 Service code is Service Code 4.
Client:
Client's primary guarantor is guarantor 1.
Client's secondary guarantor is guarantor 2.
Client has an active diagnosis record.
Client has enumerated services, provided at a CCBHC location, for services codes 1 & 3. The dates of service must be on or after the CCBHC PPS Service Definition effective date. Note the dates of service.
Client Ledger has been used to verify that the service liability distributed to the correct guarantor.
Close Charges has been used to close the charges.

Steps

Open ‘ CCBHC PPS Compile.
Enter the desired ‘Start Date’.
Enter the desired ‘End Date’.
Enter the desired ‘Client ID’.
Click [Compile & Post Services].
Close the form.
Open ‘Client Ledger’.
Enter the desired ‘Client ID’.
Select ‘All Episodes’ in ‘Claim/Episode/All Episodes’.
Select ‘ Simple’ in ‘Ledger Type’.
Enter the desired ‘From Date’.
Enter the desired ‘ To Date’.
Click [Process].
Validate that the correct guarantor was selected for each CCBHC Non- Enumerated service.
Close the report.
Close the form.

Topics

• CCBHC • NX