Avatar PM 2022 Update 96

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Product Update Form Description

The issue is resolved where the Claim Frequency Code (2300-CLM-05-3) and Patient Status Code (2300-CL1-03) fields are not valued correctly on an 837 Institutional bill if there are services on the discharge date that have been claimed on a previous bill.

Included Updates

None

Required Updates

None

Details

NEW0 CHANGED0 FIXED1

Fixed (1)

AV-82521 Details \| User Acceptance Tests 837 Institutional - Claim Frequency Code, Patient Status Code and Discharge Hour An issue is resolved where claimed 837P services on day of discharge could affect subsequent 837I claims causing incorrect Claim Frequency Code, Patient Status Code, and omission of the Discharge Hour segment (DTP*96). KB0070610 v0.01	Topics • 837 Institutional • NX

Acceptance Tests

AV-82521 Summary | Details

837 Institutional - Claim Frequency Code, Patient Status Code and Discharge Hour

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

Admission
Client Charge Input
Client Ledger
Diagnosis
Discharge
Electronic Billing
Financial Eligibility
Dynamic Form - Admission - Client

Scenario 1: 837 Institutional - Validation of Claim Frequency Code (2300-CLM-05-3) and Patient Status Code (2300-CL1-03) fields and Discharge Hour segment if there are claimed services on the discharge date

Specific Setup:

Admit a new client into an inpatient episode.
Populate the Social Security Number field.
Establish a Financial Eligibility record for a select guarantor.
Using the "Diagnosis" form, enter a diagnosis for the client.

Steps

Using the "Client Charge Input" form, enter in 2 room and board charges and 1 non room and board service on 3 consecutive days.
Validate the charges were distributed to the correct guarantor using "Client Ledger".
Discharge the client on the last of the 3 consecutive service dates from the first step.
Using the "Close Charges" form, close all 3 charges.
Using the "Electronic Billing" form to generate an 837 Professional file for the non room and board charge that was created.
Validate the non room and board charge that was generated in previous steps is included on the bill and claim the bill.
Using the "Electronic Billing" form to generate an 837 Institutional file for the 2 room and board charges.
Validate the Claim Frequency Code (2300-CLM-05-3) is equal to "1" (Admit Through Discharge).
Validate the Discharge Hour segment (2300-DTP-*96) is included in the output.
Validate the Patient Status Code (2300-CL1-1-03) is equal to the value "Patient Status Over-Ride (2300-CL1-03) extended attribute based on the "Type of Discharge" value from the Discharge record.

Scenario 2: 837 Institutional - Validate Claim Frequency Code (2300-CLM-05-3) and Patient Status Code (2300-CL1-03) fields and Discharge Hour segment when there are unclaimed services on the discharge date

Specific Setup:

Admit a new client into an inpatient episode.
Populate the Social Security Number field.
Establish a Financial Eligibility record for a select guarantor.
Using the "Diagnosis" form, enter a diagnosis for the client.

Steps

Using the "Client Charge Input" form, enter in 2 room and board charges and 1 non room and board service on 3 consecutive days.
Validate the charges were distributed to the correct guarantor using "Client Ledger".
Discharge the client on the last of the 3 consecutive service dates from the first step.
Using the "Close Charges" form, close all 3 charges.
Using the "Electronic Billing" form to generate an 837 Institutional file for the 2 room and board charges.
Validate the Claim Frequency Code (2300-CLM-05-3) is equal to "1" (Admit Through Discharge).
Validate the Discharge Hour segment (2300-DTP-*96) is included in the output.
Validate the Patient Status Code (2300-CL1-1-03) is equal to the value "Patient Status Over-Ride (2300-CL1-03) extended attribute based on the "Type of Discharge" value from the Discharge record.

Topics

• 837 Institutional • NX