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Avatar PM 2022 Update 88

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Product Requirements / Recommendations

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Product Update Form Description

The following is added: 1) The ability to select individual 'Check / EFT #' in '835 Health Care Claim Payment/Advice' when posting. 2) The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting is added to support new '835 Health Care Claim Payment/Advice' functionality and new 'Batch Cash Posting' functionality. This registry setting can be enabled only if the 'Enable Payment Acknowledgement' registry setting is enabled. 3) The 'Posting Date for Automated 835s' registry setting. This allows either the processing date (default) or the Check/EFT date to be used as the Posting Date.

Included Updates

3, 9, 13, 18, 25, 41, 55, 59, 61, 62, 67, 77, 84, 87

Required Updates

Avatar PM 2022 Update 84
Details
NEW5 CHANGED0 FIXED0
New (5)
835 Health Care Claim Payment/Advice - Check / EFT #
The 835 posting process initiated from the ‘835 Health Care Claim Payment/Advice’ form is modified to post the transactions associated with the checks/EFTs selected.
Value Added: An updated 835 posting process gives the user the ability to post the individual checks/EFT as needed.
Topics
• 835 Health Care Claim Payment/Advice • NX
 
835 Health Care Claim Payment/Advice - Registry Setting 'Posting Date for Automated 835s'
The automation feature of an 835 is enhanced to enter desired posting date through one of the options available in the new registry setting 'Posting Date for Automated 835s'.
Value Added: The registry setting 'Posting Date for Automated 835s' is added to the system to determines the value used for the posting date for automated 835s.
Topics
• 835 Health Care Claim Payment/Advice • NX
 
835 Health Care Claim Payment/Advice - ‘Check/EFT #’ drop down
The existing ‘Check/EFT #’ drop down field is updated to include 'Acknowledged', 'Unacknowledged' and / or 'zero dollar' check/EFT#.
System does not post of 'Unacknowledged' check/EFT #s. System post partial checks if not all ‘Check/EFT #’s' are selected. There is no need for the acknowledgement if the sum of all payments/payment reversals for the same ‘Check/EFT #’ is zero.
Value Added: The '835 Health Care Claim Payment/Advice' process is modified to display acknowledged, unacknowledged and zero dollar amount payments in the 'Check/EFT#' field.
Topics
• 835 Health Care Claim Payment/Advice • NX
 
Batch Cash Posting - Payment Acknowledgement
The registry setting ‘Prevent Posting Payments Unless Payment has been Acknowledged’ is added to the system to only apply acknowledged payments against client accounts.
System does not allow the payment that has not been acknowledged by the treasury team to be applied against the client account when the ‘Prevent Posting Payments Unless Payment has been Acknowledged’ is set to 3". The adjustments and transfers can be posted without a payment acknowledgment. Please note: The ‘Enable Payment Acknowledgement’ registry setting must be enabled to enable the ‘Prevent Posting Payments Unless Payment has been Acknowledged’ registry setting.
Value Added: The 'Batch Cash Posting' process is enhanced to restrict the ability to post payments to only payments that have been acknowledged in the ‘Payment Acknowledgement’ form.
Topics
• Batch Cash Posting • NX • Payment Acknowledgement • Registry Settings
 
Registry Setting - Prevent Posting Payments Unless Payment has been Acknowledged
A new registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged' is added to the system.
This registry setting can be enabled only if the 'Enable Payment Acknowledgement' registry setting is enabled.
Value Added: The '835 Health Care Claim Payment/Advice' functionality and 'Batch Cash Posting' functionality are modified to support payment acknowledgement.
Topics
• Batch Cash Posting • NX • Payment Acknowledgement • Registry Settings
 
Acceptance Tests
AV-71888 Summary | Details
835 Health Care Claim Payment/Advice - Check / EFT #
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 835 Health Care Claim Payment/Advice (PM)
  • Admission (Outpatient)
  • Claim Adjustment Group/Reason Code Definition
  • Client Ledger
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Default Guarantor Assignment
  • Diagnosis
  • Dictionary Update (PM)
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Payment Acknowledgement
  • Posting/Adjustment Codes Definition
  • Registry Settings (PM)
  • Client Charge Input
Scenario 1: 835 Health Care Claim Payment/Advice - Partial posting of an 835s - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=1&2&3
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting includes value '1'.
  • The 'Check Number' registry setting is set to '1'.
  • The 'Posting Date for Automated 835s' registry setting is set to '1'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantors are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Open the '835 Health Care Claim Payment/Advice' form.
  2. Load and compile the 835 file created that includes the claim for the defined guarantor in the setup.
  3. Verify the 835 file loads/compiles successfully.
  4. Select 'Post File' option.
  5. Select the compiled file.
  6. Populate all the required fields with desired value.
  7. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  8. Check the Check/EFT# that is unacknowledged.
  9. Click [Process File].
  10. Verify the message: 'Selecting Unacknowledged Check/EFT numbers is not permitted.'
  11. Click [OK].
  12. Close the form.
  13. Open the ‘Payment Acknowledgment’ form.
  14. Enter desired value in ‘Batch Number’.
  15. Select desired ‘Posting Code’.
  16. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
  17. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
  18. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  19. Enter desired value in ‘Name/Source’.
  20. Enter desired value in ‘Client’, if enabled.
  21. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  22. Enter desired value in ‘Receipt Date’.
  23. Enter desired value in ‘Deposit Date’.
  24. Select desired ‘Treatment Service’.
  25. Select desired ‘Category’.
  26. Enter desired value in ‘Bank Ref #’.
  27. Enter desired value in ‘Comments’.
  28. Click [File].
  29. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  30. Click [No].
  31. Close the form.
  32. Open the '835 Health Care Claim Payment/Advice' form.
  33. Select 'Post File' option.
  34. Select the compiled file.
  35. Populate all the required fields with desired value.
  36. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  37. Check the Check/EFT# that acknowledged in above steps.
  38. Click [Process File].
  39. Verify the file posts successfully.
  40. Open the 'Client Ledger' for the client.
  41. Verify the payments are posted correctly on the ledger.
  42. Open the 'Crystal Report' or any other SQL Data viewer.
  43. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  44. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  45. Validate the date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 2: 835 Health Care Claim Payment/Advice - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=0
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting includes value '0'.
  • The 'Check Number' registry setting is set to '1'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantors are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Open the '835 Health Care Claim Payment/Advice' form.
  2. Load and compile the 835 file created that includes the claim for the defined guarantor in the setup.
  3. Verify the 835 file loads/compiles successfully.
  4. Select 'Post File' option.
  5. Select the compiled file.
  6. Populate all the required fields with desired value.
  7. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  8. Check the Check/EFT# that is unacknowledged.
  9. Click [Process File].
  10. Verify the message: 'Selecting Unacknowledged Check/EFT numbers is not permitted.'
  11. Click [OK].
  12. Close the form.
  13. Open the ‘Payment Acknowledgment’ form.
  14. Enter desired value in ‘Batch Number’.
  15. Select desired ‘Posting Code’.
  16. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
  17. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
  18. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  19. Enter desired value in ‘Name/Source’.
  20. Enter desired value in ‘Client’, if enabled.
  21. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  22. Enter desired value in ‘Receipt Date’.
  23. Enter desired value in ‘Deposit Date’.
  24. Select desired ‘Treatment Service’.
  25. Select desired ‘Category’.
  26. Enter desired value in ‘Bank Ref #’.
  27. Enter desired value in ‘Comments’.
  28. Click [File].
  29. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  30. Click [No].
  31. Close the form.
  32. Open the '835 Health Care Claim Payment/Advice' form.
  33. Select 'Post File' option.
  34. Select the compiled file.
  35. Populate all the required fields with desired value.
  36. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  37. Check the Check/EFT# that acknowledged in above steps.
  38. Click [Process File].
  39. Verify the file posts successfully.
  40. Open the 'Client Ledger' for the client.
  41. Verify the payments are posted correctly on the ledger.
  42. Open the 'Crystal Report' or any other SQL Data viewer.
  43. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  44. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  45. Validate the date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 3: 835 Healthcare Claim Payment/Advice - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=1 and the 'Check Number' = 1
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting includes value '1'.
  • The 'Check Number' registry setting is set to '1'.
  • The 'Posting Date for Automated 835s' registry setting is set to '1'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantors are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Open the '835 Health Care Claim Payment/Advice' form.
  2. Load and compile the 835 file created that includes the claim for the defined guarantor in the setup.
  3. Verify the 835 file loads/compiles successfully.
  4. Select 'Post File' option.
  5. Select the file that is recently compiled successfully.
  6. Populate all the required fields with desired value.
  7. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  8. Check the Check/EFT# that is unacknowledged.
  9. Click [Process File].
  10. Verify the message: 'Selecting Unacknowledged Check/EFT numbers is not permitted.'
  11. Click [OK].
  12. Close the form.
  13. Open the ‘Payment Acknowledgment’ form.
  14. Enter desired value in ‘Batch Number’.
  15. Select desired ‘Posting Code’.
  16. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
  17. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
  18. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  19. Enter desired value in ‘Name/Source’.
  20. Enter desired value in ‘Client’, if enabled.
  21. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  22. Enter desired value in ‘Receipt Date’.
  23. Enter desired value in ‘Deposit Date’.
  24. Select desired ‘Treatment Service’.
  25. Select desired ‘Category’.
  26. Enter desired value in ‘Bank Ref #’.
  27. Enter desired value in ‘Comments’.
  28. Click [File].
  29. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  30. Click [No].
  31. Close the form.
  32. Open the '835 Health Care Claim Payment/Advice' form.
  33. Select 'Post File' option.
  34. Select the file that is recently compiled successfully.
  35. Populate all the required fields with desired value.
  36. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  37. Check the Check/EFT# that acknowledged in above steps.
  38. Click [Process File].
  39. Verify the file posts successfully.
  40. Open the 'Client Ledger' for the client.
  41. Verify the payments are posted correctly on the ledger.
  42. Open the 'Crystal Report' or any other SQL Data viewer.
  43. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  44. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  45. Validate the date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 4: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Validating check Date - Acknowledged payments
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting is set to '1'.
  • The 'Check Number' registry setting is set to '1'.
  • The 'Posting Date for Automated 835s' registry setting is set to '2'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Facility Defaults:
  • The 'File Input Path On Server For 835 Files' input box set to desired path.
  • The 'Output Path On Server For Electronic Files' input box set to the location where electronic files are saved.
  • 835 Import/Export File Configuration:
  • The 'Process File Path' input box set to desired location to be used to store the 835 file which is ready to process (i.e. "c:\Billing\835 \proc\").
  • The 'Successful File Path' input box set to desired location to be used to store the 835 file which is successfully processed (i.e. "c:\Billing\835 \succ\").
  • The 'Error File Path input box set to desired location to be used to store the 835 file which is not processed successfully (i.e. "c:\Billing\835 \error\").
  • The 'Default 835 Filing User' input box is set to desired username.
  • The 'Processing Interval' input box is set to desired value.
  • The 'Interval Units' radio button is set to desired value.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantor are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • financial class of 'Self Pay'. Note the guarantor codes/names.
  • N1*PR*1000A-N1-2*XV*1000A-N1-04~
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Place the 835 file created in the setup section in the Process File Path folder identified in the 'Facility Defaults' form (i.e. "c:\Billing\835 Files\proc\").
  2. Wait for desired time set up in the 'Facility Defaults' form.
  3. Verify that the file will be removed from the Process file folder and added to the Success folder.
  4. Open the '835 Health Care Claim Payment/Advice' form.
  5. Select 'Post File' option.
  6. Select the file that is recently moved to Success folder.
  7. Verify the status of the file is 'Partial-Posted'.
  8. Verify the Check/EFT# is populated correctly with the status of unacknowledged in the 'Check/EFT#' checkbox.
  9. Close the form.
  10. Open the ‘Payment Acknowledgment’ form.
  11. Enter desired value in ‘Batch Number’.
  12. Select desired ‘Posting Code’.
  13. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
  14. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
  15. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  16. Enter desired value in ‘Name/Source’.
  17. Enter desired value in ‘Client’, if enabled.
  18. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  19. Enter desired value in ‘Receipt Date’.
  20. Enter desired value in ‘Deposit Date’.
  21. Select desired ‘Treatment Service’.
  22. Select desired ‘Category’.
  23. Enter desired value in ‘Bank Ref #’.
  24. Enter desired value in ‘Comments’.
  25. Click [File].
  26. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  27. Click [No].
  28. Close the form.
  29. Wait for desired time set up in the 'Facility Defaults' form.
  30. Open the 'Client Ledger' for the client.
  31. Verify the payments are posted correctly on the ledger.
  32. Open the 'Crystal Report' or any other SQL Data viewer.
  33. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  34. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  35. Validate the date of payment column contains the check date as 'date of payment' when the 835 file is posted.
Topics
• 835 Health Care Claim Payment/Advice • NX
AV-76916 Summary | Details
835 Health Care Claim Payment/Advice - Registry Setting 'Posting Date for Automated 835s'
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 835 Health Care Claim Payment/Advice (PM)
  • Admission (Outpatient)
  • Claim Adjustment Group/Reason Code Definition
  • Client Charge Input
  • Client Ledger
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Default Guarantor Assignment
  • Diagnosis
  • Dictionary Update (PM)
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Payment Acknowledgement
  • Registry Settings (PM)
  • Posting/Adjustment Codes Definition
  • App Dashboard
  • Dynamic Form - Admission - Client
Scenario 1: 835 Healthcare Claim Payment/Advice - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=1 and the 'Check Number' = 1
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting includes value '1'.
  • The 'Check Number' registry setting is set to '1'.
  • The 'Posting Date for Automated 835s' registry setting is set to '1'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantors are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Open the '835 Health Care Claim Payment/Advice' form.
  2. Load and compile the 835 file created that includes the claim for the defined guarantor in the setup.
  3. Verify the 835 file loads/compiles successfully.
  4. Select 'Post File' option.
  5. Select the file that is recently compiled successfully.
  6. Populate all the required fields with desired value.
  7. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  8. Check the Check/EFT# that is unacknowledged.
  9. Click [Process File].
  10. Verify the message: 'Selecting Unacknowledged Check/EFT numbers is not permitted.'
  11. Click [OK].
  12. Close the form.
  13. Open the ‘Payment Acknowledgment’ form.
  14. Enter desired value in ‘Batch Number’.
  15. Select desired ‘Posting Code’.
  16. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
  17. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
  18. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  19. Enter desired value in ‘Name/Source’.
  20. Enter desired value in ‘Client’, if enabled.
  21. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  22. Enter desired value in ‘Receipt Date’.
  23. Enter desired value in ‘Deposit Date’.
  24. Select desired ‘Treatment Service’.
  25. Select desired ‘Category’.
  26. Enter desired value in ‘Bank Ref #’.
  27. Enter desired value in ‘Comments’.
  28. Click [File].
  29. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  30. Click [No].
  31. Close the form.
  32. Open the '835 Health Care Claim Payment/Advice' form.
  33. Select 'Post File' option.
  34. Select the file that is recently compiled successfully.
  35. Populate all the required fields with desired value.
  36. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  37. Check the Check/EFT# that acknowledged in above steps.
  38. Click [Process File].
  39. Verify the file posts successfully.
  40. Open the 'Client Ledger' for the client.
  41. Verify the payments are posted correctly on the ledger.
  42. Open the 'Crystal Report' or any other SQL Data viewer.
  43. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  44. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  45. Validate the date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 2: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Validating check Date - Acknowledged payments
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting is set to '1'.
  • The 'Check Number' registry setting is set to '1'.
  • The 'Posting Date for Automated 835s' registry setting is set to '2'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Facility Defaults:
  • The 'File Input Path On Server For 835 Files' input box set to desired path.
  • The 'Output Path On Server For Electronic Files' input box set to the location where electronic files are saved.
  • 835 Import/Export File Configuration:
  • The 'Process File Path' input box set to desired location to be used to store the 835 file which is ready to process (i.e. "c:\Billing\835 \proc\").
  • The 'Successful File Path' input box set to desired location to be used to store the 835 file which is successfully processed (i.e. "c:\Billing\835 \succ\").
  • The 'Error File Path input box set to desired location to be used to store the 835 file which is not processed successfully (i.e. "c:\Billing\835 \error\").
  • The 'Default 835 Filing User' input box is set to desired username.
  • The 'Processing Interval' input box is set to desired value.
  • The 'Interval Units' radio button is set to desired value.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantor are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • financial class of 'Self Pay'. Note the guarantor codes/names.
  • N1*PR*1000A-N1-2*XV*1000A-N1-04~
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Place the 835 file created in the setup section in the Process File Path folder identified in the 'Facility Defaults' form (i.e. "c:\Billing\835 Files\proc\").
  2. Wait for desired time set up in the 'Facility Defaults' form.
  3. Verify that the file will be removed from the Process file folder and added to the Success folder.
  4. Open the '835 Health Care Claim Payment/Advice' form.
  5. Select 'Post File' option.
  6. Select the file that is recently moved to Success folder.
  7. Verify the status of the file is 'Partial-Posted'.
  8. Verify the Check/EFT# is populated correctly with the status of unacknowledged in the 'Check/EFT#' checkbox.
  9. Close the form.
  10. Open the ‘Payment Acknowledgment’ form.
  11. Enter desired value in ‘Batch Number’.
  12. Select desired ‘Posting Code’.
  13. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
  14. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
  15. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  16. Enter desired value in ‘Name/Source’.
  17. Enter desired value in ‘Client’, if enabled.
  18. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  19. Enter desired value in ‘Receipt Date’.
  20. Enter desired value in ‘Deposit Date’.
  21. Select desired ‘Treatment Service’.
  22. Select desired ‘Category’.
  23. Enter desired value in ‘Bank Ref #’.
  24. Enter desired value in ‘Comments’.
  25. Click [File].
  26. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  27. Click [No].
  28. Close the form.
  29. Wait for desired time set up in the 'Facility Defaults' form.
  30. Open the 'Client Ledger' for the client.
  31. Verify the payments are posted correctly on the ledger.
  32. Open the 'Crystal Report' or any other SQL Data viewer.
  33. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  34. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  35. Validate the date of payment column contains the check date as 'date of payment' when the 835 file is posted.
Scenario 3: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Validating Processing Date - Acknowledged payments
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting is set to '1&2'.
  • The 'Check Number' registry setting is set to '1'.
  • The 'Posting Date for Automated 835s' registry setting is set to '1'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Facility Defaults:
  • The 'File Input Path On Server For 835 Files' input box set to desired path.
  • The 'Output Path On Server For Electronic Files' input box set to the location where electronic files are saved.
  • 835 Import/Export File Configuration:
  • The 'Process File Path' input box set to desired location to be used to store the 835 file which is ready to process (i.e. "c:\Billing\835 Files\proc\").
  • The 'Successful File Path' input box set to desired location to be used to store the 835 file which is successfully processed (i.e. "c:\Billing\835 Files\succ\").
  • The 'Error File Path input box set to desired location to be used to store the 835 file which is not processed successfully (i.e. "c:\Billing\835 Files\error\").
  • The 'Default 835 Filing User' input box is set to desired username.
  • The 'Processing Interval' input box is set to desired value.
  • The 'Interval Units' radio button is set to desired value.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantor are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • financial class of 'Self Pay'. Note the guarantor codes/names.
  • Set the Submitter Payer Identification Code (1000A-N1-04) input box to the value that match with the N1*PR-04 segment of the 835 file (i.e.N1*PR*1000A-N1-2*XV*1000A-N1-04~).
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Place the 835 file created in the setup section in the Process File Path folder identified in the 'Facility Defaults' form (i.e. "c:\Billing\835 Files\proc\").
  2. Wait for desired time set up in the 'Facility Defaults' form.
  3. Verify that the file will be removed from the Process file folder and added to the Success folder.
  4. Open the '835 Health Care Claim Payment/Advice' form.
  5. Select 'Post File' option.
  6. Select the file that is recently moved to Success folder.
  7. Verify the status of the file is 'Partial-Posted'.
  8. Verify the Check/EFT# is populated correctly with the status of unacknowledged in the 'Check/EFT#' checkbox.
  9. Close the form.
  10. Open the ‘Payment Acknowledgment’ form.
  11. Enter desired value in ‘Batch Number’.
  12. Select desired ‘Posting Code’.
  13. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup .
  14. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file .
  15. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  16. Enter desired value in ‘Name/Source’.
  17. Enter desired value in ‘Client’, if enabled.
  18. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  19. Enter desired value in ‘Receipt Date’.
  20. Enter desired value in ‘Deposit Date’.
  21. Select desired ‘Treatment Service’.
  22. Select desired ‘Category’.
  23. Enter desired value in ‘Bank Ref #’.
  24. Enter desired value in ‘Comments’.
  25. Click [File].
  26. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  27. Click [No].
  28. Close the form.
  29. Wait for desired time set up in the 'Facility Defaults' form.
  30. Open the 'Client Ledger' for the client.
  31. Verify the payments are posted correctly on the ledger.
  32. Open the 'Crystal Report' or any other SQL Data viewer.
  33. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  34. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  35. Validate the date of payment column contains the processing date when the 835 file is posted.
Topics
• 835 Health Care Claim Payment/Advice • NX
AV-80265 Summary | Details
835 Health Care Claim Payment/Advice - ‘Check/EFT #’ drop down
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 835 Health Care Claim Payment/Advice (PM)
  • Admission (Outpatient)
  • Claim Adjustment Group/Reason Code Definition
  • Client Ledger
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Default Guarantor Assignment
  • Diagnosis
  • Dictionary Update (PM)
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Payment Acknowledgement
  • Posting/Adjustment Codes Definition
  • Registry Settings (PM)
  • Client Charge Input
Scenario 1: 835 Health Care Claim Payment/Advice - Partial posting of an 835s - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=1&2&3
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting includes value '1'.
  • The 'Check Number' registry setting is set to '1'.
  • The 'Posting Date for Automated 835s' registry setting is set to '1'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantors are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Open the '835 Health Care Claim Payment/Advice' form.
  2. Load and compile the 835 file created that includes the claim for the defined guarantor in the setup.
  3. Verify the 835 file loads/compiles successfully.
  4. Select 'Post File' option.
  5. Select the compiled file.
  6. Populate all the required fields with desired value.
  7. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  8. Check the Check/EFT# that is unacknowledged.
  9. Click [Process File].
  10. Verify the message: 'Selecting Unacknowledged Check/EFT numbers is not permitted.'
  11. Click [OK].
  12. Close the form.
  13. Open the ‘Payment Acknowledgment’ form.
  14. Enter desired value in ‘Batch Number’.
  15. Select desired ‘Posting Code’.
  16. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
  17. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
  18. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  19. Enter desired value in ‘Name/Source’.
  20. Enter desired value in ‘Client’, if enabled.
  21. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  22. Enter desired value in ‘Receipt Date’.
  23. Enter desired value in ‘Deposit Date’.
  24. Select desired ‘Treatment Service’.
  25. Select desired ‘Category’.
  26. Enter desired value in ‘Bank Ref #’.
  27. Enter desired value in ‘Comments’.
  28. Click [File].
  29. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  30. Click [No].
  31. Close the form.
  32. Open the '835 Health Care Claim Payment/Advice' form.
  33. Select 'Post File' option.
  34. Select the compiled file.
  35. Populate all the required fields with desired value.
  36. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  37. Check the Check/EFT# that acknowledged in above steps.
  38. Click [Process File].
  39. Verify the file posts successfully.
  40. Open the 'Client Ledger' for the client.
  41. Verify the payments are posted correctly on the ledger.
  42. Open the 'Crystal Report' or any other SQL Data viewer.
  43. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  44. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  45. Validate the date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 2: 835 Health Care Claim Payment/Advice - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=0
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting includes value '0'.
  • The 'Check Number' registry setting is set to '1'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantors are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Open the '835 Health Care Claim Payment/Advice' form.
  2. Load and compile the 835 file created that includes the claim for the defined guarantor in the setup.
  3. Verify the 835 file loads/compiles successfully.
  4. Select 'Post File' option.
  5. Select the compiled file.
  6. Populate all the required fields with desired value.
  7. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  8. Check the Check/EFT# that is unacknowledged.
  9. Click [Process File].
  10. Verify the message: 'Selecting Unacknowledged Check/EFT numbers is not permitted.'
  11. Click [OK].
  12. Close the form.
  13. Open the ‘Payment Acknowledgment’ form.
  14. Enter desired value in ‘Batch Number’.
  15. Select desired ‘Posting Code’.
  16. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
  17. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
  18. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  19. Enter desired value in ‘Name/Source’.
  20. Enter desired value in ‘Client’, if enabled.
  21. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  22. Enter desired value in ‘Receipt Date’.
  23. Enter desired value in ‘Deposit Date’.
  24. Select desired ‘Treatment Service’.
  25. Select desired ‘Category’.
  26. Enter desired value in ‘Bank Ref #’.
  27. Enter desired value in ‘Comments’.
  28. Click [File].
  29. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  30. Click [No].
  31. Close the form.
  32. Open the '835 Health Care Claim Payment/Advice' form.
  33. Select 'Post File' option.
  34. Select the compiled file.
  35. Populate all the required fields with desired value.
  36. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  37. Check the Check/EFT# that acknowledged in above steps.
  38. Click [Process File].
  39. Verify the file posts successfully.
  40. Open the 'Client Ledger' for the client.
  41. Verify the payments are posted correctly on the ledger.
  42. Open the 'Crystal Report' or any other SQL Data viewer.
  43. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  44. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  45. Validate the date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 3: 835 Healthcare Claim Payment/Advice - Registry setting 'Prevent Posting Payments Unless Payment has been Acknowledged'=1 and the 'Check Number' = 1
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting includes value '1'.
  • The 'Check Number' registry setting is set to '1'.
  • The 'Posting Date for Automated 835s' registry setting is set to '1'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantors are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Open the '835 Health Care Claim Payment/Advice' form.
  2. Load and compile the 835 file created that includes the claim for the defined guarantor in the setup.
  3. Verify the 835 file loads/compiles successfully.
  4. Select 'Post File' option.
  5. Select the file that is recently compiled successfully.
  6. Populate all the required fields with desired value.
  7. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  8. Check the Check/EFT# that is unacknowledged.
  9. Click [Process File].
  10. Verify the message: 'Selecting Unacknowledged Check/EFT numbers is not permitted.'
  11. Click [OK].
  12. Close the form.
  13. Open the ‘Payment Acknowledgment’ form.
  14. Enter desired value in ‘Batch Number’.
  15. Select desired ‘Posting Code’.
  16. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
  17. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
  18. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  19. Enter desired value in ‘Name/Source’.
  20. Enter desired value in ‘Client’, if enabled.
  21. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  22. Enter desired value in ‘Receipt Date’.
  23. Enter desired value in ‘Deposit Date’.
  24. Select desired ‘Treatment Service’.
  25. Select desired ‘Category’.
  26. Enter desired value in ‘Bank Ref #’.
  27. Enter desired value in ‘Comments’.
  28. Click [File].
  29. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  30. Click [No].
  31. Close the form.
  32. Open the '835 Health Care Claim Payment/Advice' form.
  33. Select 'Post File' option.
  34. Select the file that is recently compiled successfully.
  35. Populate all the required fields with desired value.
  36. Verify the Check/EFT# is populated correctly with the status of acknowledged or unacknowledged in the 'Check/EFT#' checkbox.
  37. Check the Check/EFT# that acknowledged in above steps.
  38. Click [Process File].
  39. Verify the file posts successfully.
  40. Open the 'Client Ledger' for the client.
  41. Verify the payments are posted correctly on the ledger.
  42. Open the 'Crystal Report' or any other SQL Data viewer.
  43. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  44. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  45. Validate the date of payment column contains the posting date from the '835 Health Care Claim Payment/Advice' form.
Scenario 4: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Validating check Date - Acknowledged payments
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting is set to '1'.
  • The 'Check Number' registry setting is set to '1'.
  • The 'Posting Date for Automated 835s' registry setting is set to '2'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Facility Defaults:
  • The 'File Input Path On Server For 835 Files' input box set to desired path.
  • The 'Output Path On Server For Electronic Files' input box set to the location where electronic files are saved.
  • 835 Import/Export File Configuration:
  • The 'Process File Path' input box set to desired location to be used to store the 835 file which is ready to process (i.e. "c:\Billing\835 \proc\").
  • The 'Successful File Path' input box set to desired location to be used to store the 835 file which is successfully processed (i.e. "c:\Billing\835 \succ\").
  • The 'Error File Path input box set to desired location to be used to store the 835 file which is not processed successfully (i.e. "c:\Billing\835 \error\").
  • The 'Default 835 Filing User' input box is set to desired username.
  • The 'Processing Interval' input box is set to desired value.
  • The 'Interval Units' radio button is set to desired value.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantor are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • financial class of 'Self Pay'. Note the guarantor codes/names.
  • N1*PR*1000A-N1-2*XV*1000A-N1-04~
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Place the 835 file created in the setup section in the Process File Path folder identified in the 'Facility Defaults' form (i.e. "c:\Billing\835 Files\proc\").
  2. Wait for desired time set up in the 'Facility Defaults' form.
  3. Verify that the file will be removed from the Process file folder and added to the Success folder.
  4. Open the '835 Health Care Claim Payment/Advice' form.
  5. Select 'Post File' option.
  6. Select the file that is recently moved to Success folder.
  7. Verify the status of the file is 'Partial-Posted'.
  8. Verify the Check/EFT# is populated correctly with the status of unacknowledged in the 'Check/EFT#' checkbox.
  9. Close the form.
  10. Open the ‘Payment Acknowledgment’ form.
  11. Enter desired value in ‘Batch Number’.
  12. Select desired ‘Posting Code’.
  13. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup.
  14. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file.
  15. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  16. Enter desired value in ‘Name/Source’.
  17. Enter desired value in ‘Client’, if enabled.
  18. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  19. Enter desired value in ‘Receipt Date’.
  20. Enter desired value in ‘Deposit Date’.
  21. Select desired ‘Treatment Service’.
  22. Select desired ‘Category’.
  23. Enter desired value in ‘Bank Ref #’.
  24. Enter desired value in ‘Comments’.
  25. Click [File].
  26. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  27. Click [No].
  28. Close the form.
  29. Wait for desired time set up in the 'Facility Defaults' form.
  30. Open the 'Client Ledger' for the client.
  31. Verify the payments are posted correctly on the ledger.
  32. Open the 'Crystal Report' or any other SQL Data viewer.
  33. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  34. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  35. Validate the date of payment column contains the check date as 'date of payment' when the 835 file is posted.
Topics
• 835 Health Care Claim Payment/Advice • NX
AV-80273 Summary | Details
Batch Cash Posting - Payment Acknowledgement
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Batch Cash Posting
  • Client Charge Input
  • Client Ledger
  • Default Guarantor Assignment
  • Dictionary Update (PM)
  • Financial Eligibility
  • Guarantors/Payors
  • Payment Acknowledgement
  • Posting/Adjustment Codes Definition
  • Registry Settings (PM)
Scenario 1: Prevent Posting Payments Unless Payment has been Acknowledged - Batch Cash Posting - Posting payment
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting is set to '1&2'.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • An existing guarantor is identified who has a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • financial class of 'Self Pay'. Note the guarantor code/name.
  • Financial Eligibility:
  • Assign desired guarantor to the client.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to the guarantor assigned to the client.
Steps
  1. Open the 'Batch Cash Posting' form.
  2. Enter desired date to the 'Date of Receipt or Adjustment' field.
  3. Enter desired date to the 'Cash Posting Date' field.
  4. Validate the 'Posting Type' field exists and it marks as required field. Valid values: Payment, Adjustment.
  5. Validate the 'Payment Acknowledgement' field exists and it initially disabled. It becomes enable and required when the 'Payment' is selected for the 'Posting Type'. Valid values: Yes, No.
  6. Select 'Payment' in the 'Posting Type' field.
  7. Select 'No' in the 'Payment Acknowledgement' field.
  8. Select desired guarantor.
  9. Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
  10. Validate 'Filter Payment Acknowledgments' button exists.
  11. Enter desired amount in the 'Amount to Post' field.
  12. Validate the system defaults an amount of $0 because the ‘Posting Type’ is Payment and ‘Payment Acknowledgment’ is set to No.
  13. Enter desired non-zero amount in the 'Amount to Post' field.
  14. Verify the error message - 'Payment Acknowledgment is required for non-zero dollar payments.'
  15. Click [Discard].
  16. Open ‘Payment Acknowledgment’ form.
  17. Enter desired value in ‘Batch Number’.
  18. Select desired ‘Posting Code’.
  19. Enter desired value in ‘Check/EFT Number’.
  20. Enter desired value in ‘Amount’.
  21. Select desired ‘Guarantor’. If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  22. Enter desired value in ‘Name/Source’.
  23. Enter desired value in ‘Client’, if enabled.
  24. Enter desired value in ‘Check/EFT Date’.
  25. Enter desired value in ‘Receipt Date’.
  26. Enter desired value in ‘Deposit Date’.
  27. Select desired ‘Treatment Service’.
  28. Select desired ‘Category’.
  29. Enter desired value in ‘Bank Ref #’.
  30. Enter desired value in ‘Comments’.
  31. Click [File].
  32. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  33. Click [No].
  34. Close the form.
  35. Open the 'Batch Cash Posting' form.
  36. Enter desired date to the 'Date of Receipt or Adjustment' field.
  37. Enter desired date to the 'Cash Posting Date' field.
  38. Select 'Payment' in the 'Posting Type' field.
  39. Select 'No' in the 'Payment Acknowledgment' field.
  40. Select desired guarantor.
  41. Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
  42. Select payment acknowledgement defined for the selected guarantor.
  43. Validate the 'Amount to Post' field defaults to the remaining amount of the selected payment acknowledgment.
  44. Select 'Individual' in the 'Individual or All Clients' field.
  45. Select desired client from the 'Client ID' field.
  46. Select desired program from the 'Program of Service' field.
  47. Select service start date in the 'From Date' field.
  48. Select service end date in the 'To Date' field.
  49. Select desired payment acknowledgement code from the 'Posting Code' field.
  50. Validate the 'Receipt' field defaults in the transaction number of the payment acknowledgment If payment acknowledgment is selected.
  51. Enter desire Check/EFT # in the 'Check #' field.
  52. Select 'Ignore' in the 'Write Off or Ignore Remaining Balance' field.
  53. Click [Process].
  54. Validate the form files successfully.
  55. Open the 'Crystal Reports' or any other SQL Data Reporting tool.
  56. Select the PM namespace.
  57. Identify desired database and SQL table - SYSTEM.billing_pay_adj_history
  58. Locate to the SQL Editor
  59. Query 'select * from SYSTEM.billing_pay_adj_history where PATID=614'
  60. Validate the ID cell is equal to '98||614||B66169.001||CR66169.001'
  61. Validate the FACILITY cell is equal to '98'
  62. Validate the 1st PATID cell is equal to '614'
  63. Validate the EPISODE_NUMBER column is equal to '1'
  64. Validate the GUARANTOR_ID cell is equal to '100'
  65. Validate the date_of_payment cell is equal to '2022-03-01'
  66. Validate the payment_type_code cell is equal to '6001'
  67. Validate the payment_type_value cell does not contain 'PAY ACKNOWLEDGEMENT - CHECK'
  68. Validate the payment_amount cell does not contain '50.00'
  69. Validate the check_number cell is equal to '96979353397'
  70. Validate the date_of_receipt cell is equal to '2022-03-01'
  71. Validate the date_of_service column is equal to '2022-03-01'
  72. Validate the option_desc cell is equal to 'Batch Cash Posting'
  73. Validate the type_of_payment cell is equal to 'PAYMENT'
  74. Close the SQL data viewer.


Scenario 2: Prevent Posting Payments Unless Payment has been Acknowledged - Batch Cash Posting - Posting Adjustments and $0.00 payment with Write-Off
Steps
  1. Open the 'Batch Cash Posting' form.
  2. Enter desired date to the 'Date of Receipt or Adjustment' field.
  3. Enter desired date to the 'Cash Posting Date' field.
  4. Select 'Payment' in the 'Posting Type' field.
  5. Select 'No' in the 'Payment Acknowledgment' field.
  6. Select desired guarantor.
  7. Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
  8. Select payment acknowledgement defined for the selected guarantor.
  9. Validate the 'Amount to Post' field defaults to the remaining amount of the selected payment acknowledgment.
  10. Select 'Individual' in the 'Individual or All Clients' field.
  11. Select desired client from the 'Client ID' field.
  12. Select desired program from the 'Program of Service' field.
  13. Select service start date in the 'From Date' field.
  14. Select service end date in the 'To Date' field.
  15. Select desired payment acknowledgement code from the 'Posting Code' field.
  16. Validate the 'Receipt' field defaults in the transaction number of the payment acknowledgment If payment acknowledgment is selected.
  17. Enter desire Check/EFT # in the 'Check #' field.
  18. Select 'Ignore' in the 'Write Off or Ignore Remaining Balance' field.
  19. Click [Process].
  20. Validate the form files successfully.
  21. Open the 'Crystal Reports' or any other SQL Data Reporting tool.
  22. Select the PM namespace.
  23. Identify desired database and SQL table - SYSTEM.billing_pay_adj_history
  24. Locate to the SQL Editor
  25. Query 'select * from SYSTEM.billing_pay_adj_history where PATID=614'
  26. Validate the ID cell is equal to '98||614||B66169.001||CR66169.001'
  27. Validate the FACILITY cell is equal to '98'
  28. Validate the 1st PATID cell is equal to '614'
  29. Validate the EPISODE_NUMBER column is equal to '1'
  30. Validate the GUARANTOR_ID cell is equal to '100'
  31. Validate the date_of_payment cell is equal to '2022-03-01'
  32. Validate the payment_type_code cell is equal to '6001'
  33. Validate the payment_type_value cell does not contain 'PAY ACKNOWLEDGEMENT - CHECK'
  34. Validate the payment_amount cell does not contain '50.00'
  35. Validate the check_number cell is equal to '96979353397'
  36. Validate the date_of_receipt cell is equal to '2022-03-01'
  37. Validate the date_of_service column is equal to '2022-03-01'
  38. Validate the option_desc cell is equal to 'Batch Cash Posting'
  39. Validate the type_of_payment cell is equal to 'PAYMENT'
  40. Close the SQL data viewer.
Topics
• Batch Cash Posting • NX • Payment Acknowledgement • Registry Settings
AV-81719 Summary | Details
Registry Setting - Prevent Posting Payments Unless Payment has been Acknowledged
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • App Dashboard
  • Registry Settings (PM)
  • Admission (Outpatient)
  • Batch Cash Posting
  • Client Charge Input
  • Client Ledger
  • Default Guarantor Assignment
  • Dictionary Update (PM)
  • Financial Eligibility
  • Guarantors/Payors
  • Payment Acknowledgement
  • Posting/Adjustment Codes Definition
  • 835 Health Care Claim Payment/Advice (PM)
  • Claim Adjustment Group/Reason Code Definition
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Diagnosis
  • Dynamic Form - Admission - Client
  • Electronic Billing
Scenario 1: Registry Setting validation - Prevent Posting Payments Unless Payment has been Acknowledged
Steps
  1. Open the 'Registry Settings' form.
  2. Set the 'Enable Payment Acknowledgement' registry setting to 'N'.
  3. Submit the form.
  4. Open the 'Registry Setting' form.
  5. Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
  6. Validate the Registry Setting input box contains 'Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged'.
  7. Validate the Registry Setting Details text area contains '[FACILITY SPECIFIC] ------------------------------------------------------------------------------- The 'Enable Payment Acknowledgement' registry setting must be enabled to select any values. The valid values are: 0 or 1, 2 and/or 3. Multiple values can be selected. They will be separated by ampersands. Example: 1&2. When '1' is selected, it will restrict the ability to post payments in the '835 Health Care Claim Payment/Advice' form to only payments that have been acknowledged in the 'Payment Acknowledgement' form. When '2' is selected, it will restrict the ability to post payments in the 'Batch Cash Posting' form to only payments that have been acknowledged in the 'Payment Acknowledgement' form. When '3' is selected, it will restrict the ability to post payments in the "Payment/Adjustment Posting" 'File Import' to only payments that have been acknowledged in the 'Payment Acknowledgement' form. Selecting '0' will remove this functionality. This is the default behavior."
  8. Set the Registry Setting Value input box to '1'.
  9. Validate the error message dialog contains 'The selected value is not valid in the current system code for the following reason: The 'Enable Payment Acknowledgement' registry setting must be enabled to make any selections other than zero.'
  10. Set the Limit Registry Settings to 'Enable Payment Acknowledgement'.
  11. Set the 'Enable Payment Acknowledgement' registry setting to 'Y'.
  12. Click [Submit].
  13. Click [OK].
  14. Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
  15. Set the Registry Setting Value input box to '1'.
  16. Click [Submit].
  17. Click [OK].
  18. Click [Yes].
  19. Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
  20. Set the Registry Setting Value input box to '2'.
  21. Click [Submit].
  22. Click [OK].
  23. Click [Yes].
  24. Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
  25. Set the Registry Setting Value input box to '1&2'.
  26. Click [Submit].
  27. Click [OK].
  28. Click [Yes].
  29. Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
  30. Set the Registry Setting Value input box to 'Y'.
  31. Click [TAB].
  32. Validate the error message dialog contains 'The selected value is not valid in the current system code for the following reason: Invalid selection found (Y).'
  33. Set the Registry Setting Value input box to 'N'.
  34. Click [TAB].
  35. Validate the error message dialog contains 'The selected value is not valid in the current system code for the following reason: Invalid selection found (N).'
  36. Set the Registry Setting Value input box to '3'.
  37. Click [Submit].
  38. Click [OK].
  39. Click [Yes].
  40. Set the Limit Registry Settings to 'Prevent Posting Payments Unless Payment has been Acknowledged'.
  41. Set the Registry Setting Value input box to '1&2&3'.
  42. Click [Submit].
  43. Click [OK].
  44. Click [No].
Scenario 2: Prevent Posting Payments Unless Payment has been Acknowledged - Batch Cash Posting - Posting payment
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting is set to '1&2'.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • An existing guarantor is identified who has a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • financial class of 'Self Pay'. Note the guarantor code/name.
  • Financial Eligibility:
  • Assign desired guarantor to the client.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to the guarantor assigned to the client.
Steps
  1. Open the 'Batch Cash Posting' form.
  2. Enter desired date to the 'Date of Receipt or Adjustment' field.
  3. Enter desired date to the 'Cash Posting Date' field.
  4. Validate the 'Posting Type' field exists and it marks as required field. Valid values: Payment, Adjustment.
  5. Validate the 'Payment Acknowledgement' field exists and it initially disabled. It becomes enable and required when the 'Payment' is selected for the 'Posting Type'. Valid values: Yes, No.
  6. Select 'Payment' in the 'Posting Type' field.
  7. Select 'No' in the 'Payment Acknowledgement' field.
  8. Select desired guarantor.
  9. Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
  10. Validate 'Filter Payment Acknowledgments' button exists.
  11. Enter desired amount in the 'Amount to Post' field.
  12. Validate the system defaults an amount of $0 because the ‘Posting Type’ is Payment and ‘Payment Acknowledgment’ is set to No.
  13. Enter desired non-zero amount in the 'Amount to Post' field.
  14. Verify the error message - 'Payment Acknowledgment is required for non-zero dollar payments.'
  15. Click [Discard].
  16. Open ‘Payment Acknowledgment’ form.
  17. Enter desired value in ‘Batch Number’.
  18. Select desired ‘Posting Code’.
  19. Enter desired value in ‘Check/EFT Number’.
  20. Enter desired value in ‘Amount’.
  21. Select desired ‘Guarantor’. If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  22. Enter desired value in ‘Name/Source’.
  23. Enter desired value in ‘Client’, if enabled.
  24. Enter desired value in ‘Check/EFT Date’.
  25. Enter desired value in ‘Receipt Date’.
  26. Enter desired value in ‘Deposit Date’.
  27. Select desired ‘Treatment Service’.
  28. Select desired ‘Category’.
  29. Enter desired value in ‘Bank Ref #’.
  30. Enter desired value in ‘Comments’.
  31. Click [File].
  32. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  33. Click [No].
  34. Close the form.
  35. Open the 'Batch Cash Posting' form.
  36. Enter desired date to the 'Date of Receipt or Adjustment' field.
  37. Enter desired date to the 'Cash Posting Date' field.
  38. Select 'Payment' in the 'Posting Type' field.
  39. Select 'No' in the 'Payment Acknowledgment' field.
  40. Select desired guarantor.
  41. Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
  42. Select payment acknowledgement defined for the selected guarantor.
  43. Validate the 'Amount to Post' field defaults to the remaining amount of the selected payment acknowledgment.
  44. Select 'Individual' in the 'Individual or All Clients' field.
  45. Select desired client from the 'Client ID' field.
  46. Select desired program from the 'Program of Service' field.
  47. Select service start date in the 'From Date' field.
  48. Select service end date in the 'To Date' field.
  49. Select desired payment acknowledgement code from the 'Posting Code' field.
  50. Validate the 'Receipt' field defaults in the transaction number of the payment acknowledgment If payment acknowledgment is selected.
  51. Enter desire Check/EFT # in the 'Check #' field.
  52. Select 'Ignore' in the 'Write Off or Ignore Remaining Balance' field.
  53. Click [Process].
  54. Validate the form files successfully.
  55. Open the 'Crystal Reports' or any other SQL Data Reporting tool.
  56. Select the PM namespace.
  57. Identify desired database and SQL table - SYSTEM.billing_pay_adj_history
  58. Locate to the SQL Editor
  59. Query 'select * from SYSTEM.billing_pay_adj_history where PATID=614'
  60. Validate the ID cell is equal to '98||614||B66169.001||CR66169.001'
  61. Validate the FACILITY cell is equal to '98'
  62. Validate the 1st PATID cell is equal to '614'
  63. Validate the EPISODE_NUMBER column is equal to '1'
  64. Validate the GUARANTOR_ID cell is equal to '100'
  65. Validate the date_of_payment cell is equal to '2022-03-01'
  66. Validate the payment_type_code cell is equal to '6001'
  67. Validate the payment_type_value cell does not contain 'PAY ACKNOWLEDGEMENT - CHECK'
  68. Validate the payment_amount cell does not contain '50.00'
  69. Validate the check_number cell is equal to '96979353397'
  70. Validate the date_of_receipt cell is equal to '2022-03-01'
  71. Validate the date_of_service column is equal to '2022-03-01'
  72. Validate the option_desc cell is equal to 'Batch Cash Posting'
  73. Validate the type_of_payment cell is equal to 'PAYMENT'
  74. Close the SQL data viewer.


Scenario 3: Prevent Posting Payments Unless Payment has been Acknowledged - Batch Cash Posting - Posting Adjustments and $0.00 payment with Write-Off
Steps
  1. Open the 'Batch Cash Posting' form.
  2. Enter desired date to the 'Date of Receipt or Adjustment' field.
  3. Enter desired date to the 'Cash Posting Date' field.
  4. Select 'Payment' in the 'Posting Type' field.
  5. Select 'No' in the 'Payment Acknowledgment' field.
  6. Select desired guarantor.
  7. Validate the 'Selected Payment Acknowledgment' field exist and lists all payment acknowledgments that have a balance greater than $0. If a guarantor is selected in the prior field, filter by that guarantor.
  8. Select payment acknowledgement defined for the selected guarantor.
  9. Validate the 'Amount to Post' field defaults to the remaining amount of the selected payment acknowledgment.
  10. Select 'Individual' in the 'Individual or All Clients' field.
  11. Select desired client from the 'Client ID' field.
  12. Select desired program from the 'Program of Service' field.
  13. Select service start date in the 'From Date' field.
  14. Select service end date in the 'To Date' field.
  15. Select desired payment acknowledgement code from the 'Posting Code' field.
  16. Validate the 'Receipt' field defaults in the transaction number of the payment acknowledgment If payment acknowledgment is selected.
  17. Enter desire Check/EFT # in the 'Check #' field.
  18. Select 'Ignore' in the 'Write Off or Ignore Remaining Balance' field.
  19. Click [Process].
  20. Validate the form files successfully.
  21. Open the 'Crystal Reports' or any other SQL Data Reporting tool.
  22. Select the PM namespace.
  23. Identify desired database and SQL table - SYSTEM.billing_pay_adj_history
  24. Locate to the SQL Editor
  25. Query 'select * from SYSTEM.billing_pay_adj_history where PATID=614'
  26. Validate the ID cell is equal to '98||614||B66169.001||CR66169.001'
  27. Validate the FACILITY cell is equal to '98'
  28. Validate the 1st PATID cell is equal to '614'
  29. Validate the EPISODE_NUMBER column is equal to '1'
  30. Validate the GUARANTOR_ID cell is equal to '100'
  31. Validate the date_of_payment cell is equal to '2022-03-01'
  32. Validate the payment_type_code cell is equal to '6001'
  33. Validate the payment_type_value cell does not contain 'PAY ACKNOWLEDGEMENT - CHECK'
  34. Validate the payment_amount cell does not contain '50.00'
  35. Validate the check_number cell is equal to '96979353397'
  36. Validate the date_of_receipt cell is equal to '2022-03-01'
  37. Validate the date_of_service column is equal to '2022-03-01'
  38. Validate the option_desc cell is equal to 'Batch Cash Posting'
  39. Validate the type_of_payment cell is equal to 'PAYMENT'
  40. Close the SQL data viewer.
Scenario 4: 835 Healthcare Claim Payment/Advice - Automated 835s posting - Validating Processing Date - Acknowledged payments
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting is set to '1&2'.
  • The 'Check Number' registry setting is set to '1'.
  • The 'Posting Date for Automated 835s' registry setting is set to '1'.
  • Claim Adjustment Group/ reason code Definition:
  • A group code is selected for the credit adjustment code and debit adjustment reversal code. Note the adjustment codes and group code setup.
  • Facility Defaults:
  • The 'File Input Path On Server For 835 Files' input box set to desired path.
  • The 'Output Path On Server For Electronic Files' input box set to the location where electronic files are saved.
  • 835 Import/Export File Configuration:
  • The 'Process File Path' input box set to desired location to be used to store the 835 file which is ready to process (i.e. "c:\Billing\835 Files\proc\").
  • The 'Successful File Path' input box set to desired location to be used to store the 835 file which is successfully processed (i.e. "c:\Billing\835 Files\succ\").
  • The 'Error File Path input box set to desired location to be used to store the 835 file which is not processed successfully (i.e. "c:\Billing\835 Files\error\").
  • The 'Default 835 Filing User' input box is set to desired username.
  • The 'Processing Interval' input box is set to desired value.
  • The 'Interval Units' radio button is set to desired value.
  • Admission:
  • Admit a client into an outpatient episode. Note the Client id/name, Admission date/program.
  • Guarantor/Payors:
  • Two existing guarantor are identified who have a Financial Class that has the Extended Data Element for (1500) System Financial Class set to Self Pay.
  • financial class of 'Self Pay'. Note the guarantor codes/names.
  • Set the Submitter Payer Identification Code (1000A-N1-04) input box to the value that match with the N1*PR-04 segment of the 835 file (i.e.N1*PR*1000A-N1-2*XV*1000A-N1-04~).
  • Financial Eligibility:
  • The desired guarantors identified above are assigned to the client. Note the primary and secondary guarantor.
  • Client Charge Input:
  • A service is rendered to the client.
  • Client Ledger:
  • Make sure the service is distributed to one of the guarantors assigned to the client.
  • Close charges.
  • Electronic Billing:
  • Claim the service using the 837 Professional bill for the guarantor.
  • Create an 835 file based on the claim information found in the 837 professional bill.
Steps
  1. Place the 835 file created in the setup section in the Process File Path folder identified in the 'Facility Defaults' form (i.e. "c:\Billing\835 Files\proc\").
  2. Wait for desired time set up in the 'Facility Defaults' form.
  3. Verify that the file will be removed from the Process file folder and added to the Success folder.
  4. Open the '835 Health Care Claim Payment/Advice' form.
  5. Select 'Post File' option.
  6. Select the file that is recently moved to Success folder.
  7. Verify the status of the file is 'Partial-Posted'.
  8. Verify the Check/EFT# is populated correctly with the status of unacknowledged in the 'Check/EFT#' checkbox.
  9. Close the form.
  10. Open the ‘Payment Acknowledgment’ form.
  11. Enter desired value in ‘Batch Number’.
  12. Select desired ‘Posting Code’.
  13. Enter desired value in ‘Check/EFT Number’ from the TRN*02 segment of the 835 file created in the setup .
  14. Enter desired value in ‘Amount’ that matches the amount entered in the CLP*04 segment of the 835 file .
  15. Select desired ‘Guarantor’ set up in the setup section. Note: If a ‘Self-Pay guarantor is selected, the ‘Client’ field will be enabled.
  16. Enter desired value in ‘Name/Source’.
  17. Enter desired value in ‘Client’, if enabled.
  18. Enter desired value in ‘Check/EFT Date’ that matches the date entered in the BPR*16 segment of the 835 file.
  19. Enter desired value in ‘Receipt Date’.
  20. Enter desired value in ‘Deposit Date’.
  21. Select desired ‘Treatment Service’.
  22. Select desired ‘Category’.
  23. Enter desired value in ‘Bank Ref #’.
  24. Enter desired value in ‘Comments’.
  25. Click [File].
  26. Verify that the ‘Payment Acknowledgment’ message is received and states the following: Filed successfully. The Transaction Number is [number] Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  27. Click [No].
  28. Close the form.
  29. Wait for desired time set up in the 'Facility Defaults' form.
  30. Open the 'Client Ledger' for the client.
  31. Verify the payments are posted correctly on the ledger.
  32. Open the 'Crystal Report' or any other SQL Data viewer.
  33. Create a query to retrieve data from the SYSTEM.billing_pay_adj_history table.
  34. Validate the check number field contains check number from the TRN-02 segment of the 835 file.
  35. Validate the date of payment column contains the processing date when the 835 file is posted.
Topics
• Batch Cash Posting • NX • Payment Acknowledgement • Registry Settings
Table Changes
Table Column Change
SYSTEM.billing_pay_adj_history pay_ack_transaction_num added
SYSTEM.payment_acknowledgement updated GetPayAck method