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Avatar PM 2022 Update 93

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Product Requirements / Recommendations

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Product Update Form Description

Medicare Part D processing is enhanced as follows: 1) The electronic billing sort process will flag as an error any service where the associated Order Entry order was not active as of the date of service. 2) Support is added for NCPDP field 'Quantity Dispensed' (460-ET) but limited to DEA Schedule II drug claims only. The value of this field will always match the value included for NCPDP field 'Quantity Dispensed' (442-E7). 3) Support is added for NCPDP fields 'Intermediary Authorization Type (463-EW) and 'Intermediary Authorization ID' (464-EX). This is made possible by the introduction of new form 'NCPDP Intermediary Authorizations' to the menu. Please note: Support of NCPDP fields 'Quantity Dispensed' (460-ET), 'Intermediary Authorization Type' (463-EW) and 'Intermediary Authorization ID' (464-EX) also requires that Netsmart update the CE2000 data map.

Included Updates

None

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
NCPDP Enhancements
Medicare Part D processing is enhanced as follows:
1) The electronic billing sort process will flag as an error any service where the associated Order Entry order was not active as of the date of service.
2) Support is added for NCPDP field 'Quantity Dispensed' (460-ET) but limited to DEA Schedule II drug claims only. The value of this field will always match the value included for NCPDP field 'Quantity Dispensed' (442-E7).
3) Support is added for NCPDP fields 'Intermediary Authorization Type (463-EW) and 'Intermediary Authorization ID' (464-EX). This is made possible by the introduction of new form 'NCPDP Intermediary Authorizations' to the menu. Please note: Support of NCPDP fields 'Quantity Dispensed' (460-ET), 'Intermediary Authorization Type' (463-EW) and 'Intermediary Authorization ID' (464-EX) also requires that Netsmart update the CE2000 data map. KB0070466 v0.01
Value Added: Support is added for NCPDP.
Topics
• HL7 • NCPDP • NX
 
Acceptance Tests
AV-78498 Summary | Details
NCPDP Enhancements
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Avatar eMAR
  • Client Ledger
  • Compile Inbound HL7 Charge Batch File
  • Compile/Edit/Post/Unpost Roll-Up Services Worklist
  • Diagnosis
  • Electronic Billing
  • Launch RxConnect
  • NCPDP Intermediary Authorizations
  • Orders This Episode
  • Post Inbound HL7 Charge Batch File
  • RxConnect
Scenario 1: NCPDP enhancements: support added for 'Quantity Dispensed' but limited to Schedule II meds, 'NCPDP Intermediary Authorizations' and ensuring charges are not included when an order was not active
Specific Setup:
  • Avatar must be configured to communicate with RxConnect via Avatar HL7.
  • Configuration must exist for all RxConnect connections.
  • CE2000 must be configured on the server where the application resides, but it must not be started.
  • The 'Avatar PM->Billing->Electronic Billing->NCPDP->->Enable NCPDP Billing' registry setting must be set to "Y".
  • The user logged into the application must have access to the 'NCPDP Intermediary Authorizations' form and the 'SYSTEM.ncpdp_intermediary_auths' table.
  • Please log out of the application and log back in after completing the above configuration.
  • A client must have an active inpatient episode. (Client A)
  • "Client A" must have an active 'Diagnosis' and must be associated with an NCPDP guarantor.
Steps
  1. Select "Client A" and access the Order Entry Console.
  2. Create an order for a Schedule II order code (OXYCODONE HCL), ensuring that a 'Frequency Code' of "TWICE A DAY", with a 'Duration' of "28 Days", with a 'Start Date' of "05/01/2022" and a 'Start Time' of "0700".
  3. Create a second order for a non-controlled substance (IBUPROFEN) with a 'Frequency Code' of "AS NEEDED", with a 'Duration' of "30 Days", with 'Start Date' of "05/01/2022" and a 'Start Time' of "0700".
  4. Access the 'Launch RxConnect' form.
  5. Click [Launch RxConnect].
  6. Click the 'RxSummary' tab.
  7. Process the "OXYCODONE HCL" order for "Client A" and receive "Rx#1".
  8. Process the "IBUPROFEN" order for "Client A" and receive "Rx#2".
  9. Close the application and the form.
  10. Validate that "Client A" is selected and click on the 'eMAR' widget.
  11. Set the 'Administration Date' field to "05/01/2022" and click [Refresh].
  12. Validate the "OXYCODONE HCL" order is displayed with "0900" and "2100" in the cells under date columns for "05/01/2022" through "05/28/2022".
  13. Validate the "IBUPROFEN" order is displayed with no scheduled administration times.
  14. Administer the "OXYCODONE HCL" for the exact day at the correct time for "05/01/2022" through "05/30/2022".
  15. Administer the "IBUPROFEN" order for each day between "05/01/2022" through "05/30/2022".
  16. Note: Charges will be batched on a daily basis. The following steps are after the charges have been batched.
  17. Compile and Post the Inbound HL7 Charge Batch File.
  18. Access the 'Compile/Edit/Post/Unpost Roll-Up Services Worklist' form and compile the worklist for a 'Through Date' of "05/31/2022".
  19. Validate the 'Roll-Up Service Worklist' report is displayed and contains the following:
  20. A 'Date' of "05/01/2022" for the "OXYCODONE HCL" order with a 'Quantity' of "56" and a 'Fill#' of "0" containing two rows for each date ranging from "05/01/2022" through "05/28/2022".
  21. A 'Date' of "05/29/2022" for the "OXYCODONE HCL" order with a 'Quantity' of "4" and a 'Fill#' of "1" containing two rows for each date ranging from "05/29/2022" through "05/30/2022".
  22. A 'Date' of "05/01/2022" for the "IBUPROFEN" order with a 'Quantity' of "28" and a 'Fill#' of "0" containing two rows for each date ranging from "05/01/2022" through "05/28/2022".
  23. A 'Date' of "05/29/2022" for the "OXYCODONE HCL" order with a 'Quantity' of "2" and a 'Fill#' of "1" containing two rows for each date ranging from "05/29/2022" through "05/30/2022".
  24. Post the worklist and close the form.
  25. Close the charges.
  26. Validate that "Client A" is selected and access the 'NCPDP Intermediary Authorizations' form.
  27. Set the 'Intermediary Authorization ID' field to "123ABC".
  28. Select "Intermediary Authorization" in the 'Intermediary Authorization Type' field.
  29. Set the 'Effective Date' field to "01/01/2022".
  30. Search for and select "OXYCODONE HCL" in the 'Select Service' field.
  31. Validate the 'Selected Service(s)' field contains "OXYCODONE HCL" with the checkbox checked.
  32. Set the 'Prescription Number' field to the 'Rx#' received when processing the order, "Rx#1".
  33. Click [Submit].
  34. Validate that "Client A" is selected and access the 'NCPDP Intermediary Authorizations' form.
  35. Validate a pre-display is displayed that contains the previous data entered.
  36. Click [Add].
  37. Set the 'Intermediary Authorization ID' field to "BC".
  38. Select "Not Specified" in the 'Intermediary Authorization Type' field.
  39. Set the 'Effective Date' field to "01/01/2022".
  40. Set the 'Expiration Date' field to "01/01/2023".
  41. Search for and select "IBUPROFEN" in the 'Select Service' field.
  42. Validate the 'Selected Service(s)' field contains "IBUPROFEN" with the checkbox checked.
  43. Validate the 'Prescription Number' field does not contain a value.
  44. Click [Submit].
  45. Access he 'Electronic Billing' form.
  46. Create a claim for "NCPDP" for a date range of "05/01/2022" through "05/31/2022" and click [Process].
  47. Validate the 'Compile Complete' message is displayed and click [OK].
  48. View the report and validate the 'NCPDP Claim Submission Data' report contains the following:
  49. A 'Service Date' of "05/01/2022" for a 'Service' of "OXYCODONE HCL" for 'Rx# (Actual)' of "206" with a 'Fill#' of "0" with a 'Days Supply' of "28" and a 'Quantity Dispensed' of "56".
  50. A 'Service Date' of "05/01/2022" for a 'Service' of "IBUPROFEN" for 'Rx# (Actual)' of "207" with a 'Fill#' of "0" with a 'Days Supply' of "28" and a 'Quantity Dispensed' of "28".
  51. Go back to the main page of the report and click 'NCPDP' Error Report'.
  52. Validate the report contains an 'Error Message' of "OE Order# was no longer active as of the date of service : OXYCODONE HCL - service date: 05/29/2022".
  53. Close the report.
  54. Create a file on the server.
  55. The file created would contain two messages:
  56. The first message is for the "OXYCODONE HCL" order and contains the following:
  57. A value of "56" in the 120th segment for 'Quantity Prescribed', because it is a Schedule II medication.
  58. A value of "1" in the 123rd segment for 'Intermediary Auth Type', which is the code for the value that was selected in the 'NCPDP Intermediary Authorizations' form.
  59. A value of "123ABC" in the 124th segment for 'Intermediary Auth ID', which was entered in the 'NCPDP Intermediary Authorizations' form.
  60. The second message is for the "IBUPROFEN" order and contains the following:
  61. No value in the 120th segment for 'Quantity Prescribed', because it is not a Schedule II medication.
  62. A value of "0" in the 123rd segment for 'Intermediary Auth Type', which is the code for the value that was selected in the 'NCPDP Intermediary Authorizations' form.
  63. A value of "BC" in the 124th segment for 'Intermediary Auth ID', which was entered in the 'NCPDP Intermediary Authorizations' form.
Topics
• HL7 • NCPDP • NX
Table Changes
Table Column Change
SYSTEM.ncpdp_intermediary_auths EPISODE_NUMBER ADD
SYSTEM.ncpdp_intermediary_auths FACILITY ADD
SYSTEM.ncpdp_intermediary_auths IAU_uniqueid ADD
SYSTEM.ncpdp_intermediary_auths ID ADD
SYSTEM.ncpdp_intermediary_auths PATID ADD
SYSTEM.ncpdp_intermediary_auths data_entry_by ADD
SYSTEM.ncpdp_intermediary_auths data_entry_by_option ADD
SYSTEM.ncpdp_intermediary_auths data_entry_date ADD
SYSTEM.ncpdp_intermediary_auths data_entry_offset ADD
SYSTEM.ncpdp_intermediary_auths data_entry_source ADD
SYSTEM.ncpdp_intermediary_auths data_entry_time ADD
SYSTEM.ncpdp_intermediary_auths data_entry_time_j ADD
SYSTEM.ncpdp_intermediary_auths data_entry_timezone_info_all ADD
SYSTEM.ncpdp_intermediary_auths data_entry_timezone_short ADD
SYSTEM.ncpdp_intermediary_auths data_entry_user_id ADD
SYSTEM.ncpdp_intermediary_auths data_entry_user_name ADD
SYSTEM.ncpdp_intermediary_auths data_entry_utc ADD
SYSTEM.ncpdp_intermediary_auths effective_date ADD
SYSTEM.ncpdp_intermediary_auths expiration_date ADD
SYSTEM.ncpdp_intermediary_auths int_auth_id ADD
SYSTEM.ncpdp_intermediary_auths int_auth_type_code ADD
SYSTEM.ncpdp_intermediary_auths int_auth_type_value ADD
SYSTEM.ncpdp_intermediary_auths option_desc ADD
SYSTEM.ncpdp_intermediary_auths option_id ADD
SYSTEM.ncpdp_intermediary_auths prescription_num ADD
SYSTEM.ncpdp_intermediary_auths service_codes ADD
SYSTEM.ncpdp_intermediary_auths service_codes_shval ADD
SYSTEM.ncpdp_intermediary_auths service_codes_value ADD
SYSTEM.ncpdp_intermediary_auths user_row_access_code ADD

 

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  2. Tags
    1. content:release
    2. HL7
    3. llm-no-index
    4. NCPDP
    5. NX
    6. nx:nx
    7. role:sysadmin
    8. search:ready