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Avatar PM 2023 Monthly Release 2023.00.00 Acceptance Tests

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Update 1 Summary | Details
Avatar PM 2023 is Installed
Scenario 1: Validate Upgrading Avatar PM 2022 to 2023 is successful when 2022.04.00 is loaded
Specific Setup:
  • Latest Monthly Release is installed.
Steps
  1. Open the "Product Updates" form.
  2. Select the appropriate [Namespace] from the Application dropdown list
  3. Click [Select Update/Customization Pack].
  4. Browse to the location for the updates and select the Update 1.
  5. Click [OK] on the "File Upload Complete" window.
  6. Click [Review Update/Customization Pack Contents].
  7. Verify Update 1 is included.
  8. Click [Install Update/Customization Pack].
  9. Click [OK] when the install completes.
  10. Click [Close Form].
Topics
• Upgrade
Update 8 Summary | Details
Avatar PM 'Summary Trial Balance Report'
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Summary Trial Balance Report
Scenario 1: 'Summary Trial Balance Report' - Verification of report results
Steps
  1. Open Avatar PM 'Summary Trial Balance Report' form (under 'Avatar PM / Billing / Billing Reports / Monthly Closeout Reports' menu).
  2. Enter/select values for 'Summary Balance As Of ', 'Aging Category' and 'Include Bad Debt Information' report criteria fields.
  3. Click 'Process' button to run report/render result data.
  4. Ensure that 'Summary Trial Balance Report' results are rendered/displayed in the default report format within myAvatar/Avatar NX.
  5. In 'Summary Trial Balance Report' results display, ensure that the following information fields are present:
  6. 'Run Date' (current date)
  7. 'As Of' (from 'Summary Balance As Of' report criteria field)
  8. 'Revenue Group'
  9. 'Unbilled' report information
  10. 'Financial Class'
  11. 'In-House' (with dollar values)
  12. 'Disc' (discharged; with dollar values)
  13. 'Days' (with value)
  14. 'Total'/'Totals' (with dollar values)
  15. 'Billed' report information
  16. 'Financial Class'
  17. Aging Categories (default or custom entered/edited values as defined in 'Aging Category' report criteria field; '0', '30', '120', etc; with dollar values)
  18. 'Total'/'Totals' (with dollar values)
  19. Ensure that 'Summary Trial Balance Report' results display includes information/dollar values for all fields/groupings noted above with expected values based on unbilled/billed services and payments present in Avatar PM system for selected 'Summary Balance As Of' report criteria date, including 'Total'/'Totals' calculated values.
  20. Ensure that Summary Trial Balance Report' results display includes 'ALL' Revenue Group summary information (summary totals for report information); ensure that 'ALL' Revenue Group summary information includes information/dollar values for all fields/groupings noted above display with expected values based on unbilled/billed services and payments present in Avatar PM system for selected 'Summary Balance As Of' report criteria date, including 'Total'/'Totals' calculated values.
  21. In 'Summary Trial Balance Report' results display, click 'Print All Pages', 'Print Page', 'Export All Pages' and/or 'Export Page' button to print or export/save report data as desired.
  22. Click 'Close' button to close 'Summary Trial Balance Report' results display.
Scenario 2: 'Summary Trial Balance Report' - Verification of .CSV format report results
Steps
  1. Open Avatar PM 'Summary Trial Balance Report' form (under 'Avatar PM / Billing / Billing Reports / Monthly Closeout Reports' menu).
  2. Enter/select values for 'Summary Balance As Of ', 'Aging Category' and 'Include Bad Debt Information' report criteria fields.
  3. Ensure 'Export Detail Information to CSV' field is present in form, with 'Yes' checkbox/selection available.
  4. No selection in the 'Export Detail Information to CSV' field will render report results in the default report format
  5. Selecting 'Yes' in the 'Export Detail Information to CSV' field will display report results in CSV (comma-separated value) format (allowing user to export/save 'Summary Trial Balance Report' results for external use)
  6. Click 'Process' button to run report/render result data.
  7. If no value is selected in 'Export Detail Information to CSV' field, ensure that 'Summary Trial Balance Report' results are rendered/displayed in the default report format.
  8. If 'Yes' is selected for 'Export Detail Information to CSV' field, ensure that 'Summary Trial Balance Report' results are rendered/displayed in .CSV format within myAvatar/Avatar NX, with following header and individual data rows present:
  9. 'Summary Trial Balance Report' .CSV format data header (first row in report data results) will contain the following data elements:
  10. 'RRG'
  11. 'RRG Description'
  12. 'Financial Class'
  13. 'Financial Class Description'
  14. 'Unbilled In-House'
  15. 'Unbilled Disch'
  16. 'Days'
  17. Aging Categories (default or custom entered/edited values as defined in 'Aging Category' report criteria field; 'Aging 0', 'Aging 30', 'Aging 60', 'Aging 120', etc.)
  18. Header row examples:
  19. "RRG,RRG Description,Financial Class,Financial Class Description,Unbilled In-House,Unbilled Disch,Days,Billed/Aging Category 0,Billed/Aging Category 30,Billed/Aging Category 60,Billed/Aging Category 90,Billed/Aging Category 120,Total"
  20. "RRG,RRG Description,Financial Class,Financial Class Description,Unbilled In-House,Unbilled Disch,Days,Billed/Aging Category 5,Billed/Aging Category 10,Billed/Aging Category 20,Billed/Aging Category 30,Billed/Aging Category 40,Billed/Aging Category 50,Billed/Aging Category 60,Total"
  21. 'Total'
  22. 'Summary Trial Balance Report' .CSV format individual data rows (second and all subsequent rows in report data results) will contain report data for each element, one row per result.
  23. Data row examples:
  24. "5,Outpatient Substance Abuse,7,Medicare Part A,2397.15,0.00,0,1181.21,0.00,0.00,0.00,815.00,4393.36"
  25. "8,Outpatient Psychiatric,3,Blue Cross,1176903.89,0.00,0,1476.11,0.00,0.00,0.00,0.00,0.00,12365.15,1190745.15"
  26. "IP,Inpatient Psychiatric,10,Non-Recoverable,18635.12,6000.50,0,3360.52,88.00,1500.00,200.00,6526.80,40022.44"
  27. In 'Summary Trial Balance Report' results display, click 'Export All Pages' or 'Export Page' button to export/save .CSV format report data to file.
  28. Open/review exported .CSV format file, ensuring that data header and all individual data rows are present in file as displayed/defined above.
Topics
• Summary Trial Balance Report
Update 9 Summary | Details
Quick Billing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Purge Billing Files
  • Quick Billing Rule Definition
  • Create Interim Billing Batch File
  • Guarantors/Payors
  • Quick Billing
Scenario 1: Quick Billing workflow for existing unbilled services
Specific Setup:
  • Quick Billing Rule Definitions exist that allows the system to bill many services.
  • Unbilled services exist in the system that can be billed through the definitions. Note the dates of service.
Steps
  1. Open ‘Quick Billing’.
  2. Select ‘Add New’ in ‘Add New Or Edit Existing Quick Billing Batch’.
  3. Enter desired value in ‘First Date Of Service To Include’.
  4. Enter desired value in ‘Last Date Of Service To Include’.
  5. Select desired value in ‘Billing Rule Group To Execute’ or ‘Billing Rule To Execute’.
  6. Select values in ‘Quick Billing Tasks to Execute’.
  7. Click [Submit].
  8. Validate that the ‘Compile Complete’ message is received.
  9. Print the 837 report and validate the data.
Topics
• Quick Billing • NX
Update 15 Summary | Details
HCFA 1500
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission
  • Financial Eligibility
  • Client Charge Input
  • Client Charge Input With Diagnosis Entry
  • Create Interim Billing Batch File
  • Print Bill
  • Referral Source Maintenance
Scenario 1: Print Bill - HCFA-1500-NPI Version - Sorting
Specific Setup:
  • Registry Setting:
  • Avatar PM->Billing->Paper Billing->HCFA-1500->->Enable Select Type Of Information To Include For Locator 17 = Y.
  • Avatar PM->Billing->Client Charge Input->Fields To Retain After Filing->->Fields to Retain After Filing Client Charge Input = 18 at a minimum.
  • Guarantor/Program Billing Defaults - ‘Paper HCFA-1500’ section:
  • Include a value in ‘Referring Provider Or Other Source Code Qualifier (Form Locator 17)’.
  • Select 'Referring Provider/Practitioner' in ‘Select Type Of Information To Include In Name Of Referring Physician Or Other Source (Form Locator 17)’.
  • Select 'Referring Practitioner' in 'Sort Paper HCFA-1500 Claims By'.
  • Note the guarantors and programs assigned to the template.
  • Clients:
  • Identify two clients with multiple unclaimed services that can be billed from the above template.
  • Each client should have services that are provided by different practitioners.
  • Note the last service date.
  • Create Interim Billing Batch File is used to create a batch for the services.
  • Close Charge is used to close the charges for the interim batch.
Steps
  1. Open ‘Print Bill’.
  2. Enter the last service date in ‘Print Charges Thru’.
  3. Select ‘No’ in ‘Create Claims Y/N’.
  4. If the services were created with a diagnosis entry, select ‘HCFA-1500-NPI-Vesrion (Diagnosis Entry’ in ‘Print On What Form’.
  5. Select ‘Yes’ in ‘Print For Interim Batch’.
  6. Select the ‘Interim Batch Number’ created in Setup.
  7. Click [Process].
  8. Verify that the bill contains the correct information and is sorted correctly.
  9. Close the report.
  10. Select ‘HCFA-1500-NPI-Vesrion (Sort By Practitioner/Service Consolidation/Diagnosis Entry)’ in ‘Print On What Form’.
  11. Click [Process].
  12. Verify that the bill contains the correct information and is sorted correctly.
  13. Close the report.
  14. Select ‘HCFA-1500-NPI-Vesrion (Sort By Service Consolidation/Diagnosis Entry)’ in ‘Print On What Form’.
  15. Click [Process].
  16. Verify that the bill contains the correct information and is sorted correctly.
  17. Close the report.
  18. If the services were created without a diagnosis entry, select ‘HCFA-1500-NPI-Vesrion (Sort By Practitioner)’ in ‘Print On What Form’.
  19. Click [Process].
  20. Verify that the bill contains the correct information and is sorted correctly.
  21. Close the report.
  22. Select ‘HCFA-1500-NPI-Vesrion (Sort By Practitioner/Service Consolidation)’ in ‘Print On What Form’.
  23. Click [Process].
  24. Verify that the bill contains the correct information and is sorted correctly.
  25. Close the report.
  26. Select ‘HCFA-1500-NPI-Vesrion (Sort By Service Consolidation)’ in ‘Print On What Form’.
  27. Click [Process].
  28. Verify that the bill contains the correct information and is sorted correctly.
  29. Close the report.
  30. Close the form.
  31. Open 'Client Charge Input'.
  32. Create a service for a client that includes a referring practitioner with an ID code higher than '1'. Note the date of service.
  33. Create an additional service for the same client that includes a referring practitioner with an ID code that is lower than the ID code in the first service and the service date is after the first service date.
  34. Close the form.
  35. Create an 'Interim Billing Batch File' for the two services.
  36. Close the charges for the interim batch.
  37. Open 'Print Bill'.
  38. Enter the last service date in ‘Print Charges Thru’.
  39. Select ‘No’ in ‘Create Claims Y/N’.
  40. Select ‘HCFA-1500-NPI-Vesrion’ in ‘Print On What Form’.
  41. Select ‘Yes’ in ‘Print For Interim Batch’.
  42. Select the ‘Interim Batch Number’ created in Setup.
  43. Click [Process].
  44. Verify that the bill contains the correct information and is sorted by the referring practitioner ID, starting with the lowest ID number.
  45. Close the report.
  46. Close the form.
Topics
• Print Bill • NX
Update 16 Summary | Details
Progress Notes (Group and Individual)
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Admission
  • Financial Eligibility
  • Client Charge Input
  • Payor Based Authorizations
  • Client Ledger
  • Practitioner Numbers By Guarantor And Program
  • Electronic Billing
Scenario 1: PM - Payor Based Authorization - Location
Specific Setup:
  • Registry Settings:
  • Enable Payor Based Authorizations = 'Y'.
  • Enable CPT Based Payor Authorizations = desired value.
  • Require Authorizations At Guarantors/Payors Level = desired value.
  • Dictionary Update:
  • Client File (10006) Location = note active locations.
  • Staff File (79) Practitioner Category = note active categories.
  • Guarantors/Payors:
  • Guarantor A: Identify a guarantor to be used with 'Payor Based Authorizations'.
  • Note the values in the 'Authorization Section'.
  • Verification Level For Authorizations For Client Charge Input and Verification Level For Authorizations For Appointment Scheduling:
  • 'Disallow Service If Authorization Is Missing' will not allow the service to be submitted.
  • 'Warn User If Authorization Is Missing' will allow the service to be submitted.
  • Verification Level For Authorizations For 837 Electronic Billing:
  • 'None' will allow services that were submitted and closed to be billed.
  • 'Report As Error And Include On Bill' will allow services that were submitted and closed to be billed. An error message will be included in the 837 Billing report.
  • 'Report As Error And Do Not Include On Bill' will not allow services that were submitted and closed to be billed
  • Client A: Identify an active client that is assigned to the guarantor above.
  • Payor Based Authorizations: Create or edit a definition to not include a 'Locations' and any other desired fields. An error message will be included in the 837 Billing report. Note the value of each field.
Steps
  1. Open 'Payor Based Authorizations'.
  2. Create a new record that matches the record from setup.
  3. Validate that the following message displays: An authorization already exists for this date range. Overlapping authorizations are not allowed.
  4. Remove the 'Expiration Date'.
  5. Select a 'Location'.
  6. Enter an 'Expiration Date'.
  7. Submit the form and validate that it files successfully.
  8. Open ‘Scheduling Calendar’.
  9. Create an appointment for Client A.
  10. Validate that the appropriate submission event occurs based on the values in the ‘Guarantors/Payors’, 'Authorization Section'.
  11. Close the form.
  12. Open ‘Client Charge Input’.
  13. Create a service for Client A.
  14. Validate that the appropriate submission event occurs based on the values in the ‘Guarantors/Payors’, 'Authorization Section'.
  15. Close the form.
  16. Open 'Close Charges’ and close charges for Client A if submission was allowed.
  17. Close the form.
  18. Open ‘Electronic Billing’ if submission was allowed.
  19. Create the bill for Client A and validate that the appropriate billing action occurs based on the values in the ‘Guarantors/Payors’, 'Authorization Section'.
  20. Close the form.
  21. Open ‘Client Ledger’ for Client A if submission was allowed.
  22. Review the ‘Simple’, ‘Ledger Type’ to confirm the billing activity.
  23. Close the form.
Topics
• Payor Based Authorizations • NX
2022 Update 37 Summary | Details
RADPlus - Family Entity Modeling
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Change MR#
  • Family Registration
  • Delete Last Movement
  • Table Definition (PM)
  • Family Entity User Modeled Form
Scenario 1: Change MR# - "Family" Entity Data validations
Specific Setup:
  • Have an active test client on the system [ClientA], note their current PatID# [OrigPatID#]
  • In form "Family Registration" have a family created [FamilyA], with [ClientA] added as a family member in "Family Members" section of the form.
  • Have a user modeled form [FormA] created based on the "Family" entity database that's enabled for document routing
  • A row has been filed in [FormA] for [FamilyA], selecting [ClientA] in the "Family Members" field and the document created during submission has been routed and approved
  • Have a report [ReportA], to display data in the "SYSTEM.user_modelled_fam_members" table
Steps
  1. Run [ReportA] to display data in the "SYSTEM.user_modelled_fam_members" table
  2. Validate there is a row displayed for [FamilyA] and [ClientA]
  3. Open "Change MR#" form in Avatar PM.
  4. Select [ClientA] in the "Client ID" field and note their current PatID# [OrigPatID#]
  5. Click [Assign MR#].
  6. Note the new PatID# assigned, [NewPatID#]
  7. Click [Submit].
  8. Validate the form files successfully
  9. At the home view, search for the [OrigPatID#] noted in step 3a
  10. Validate there are no results
  11. Now search for the [NewPatID#] noted in step 3b
  12. Validate the [NewPatID#] is found and the associated client is [ClientA]
  13. Run [ReportA], to display data in the "SYSTEM.user_modelled_fam_members" table
  14. Validate there is a row displayed for [FamilyA] and with new PatID# [NewPatID#] displayed for [ClientA]
Scenario 2: Client Delete - "Family" Entity Data validations
Specific Setup:
  • Have an active test client on the system [ClientA]
  • In form "Family Registration", have a family created [FamilyA] with [ClientA] added as a family member in "Family Members" section of the form.
  • Have a user modeled form [FormA] created based on the "Family" entity database that's enabled for document routing
  • A row has been filed in [FormA] for [FamilyA], selecting [ClientA] in the "Family Members" field and the document created during submission has been routed and approved
  • Have a report [ReportA] created to display data in the "SYSTEM.user_modelled_fam_members" table
  • User has launched [ReportA] and has logged into the system
Steps
  1. Run [ReportA] to display data in the "SYSTEM.user_modelled_fam_members" table
  2. Validate there is a row displayed for [FamilyA] and [ClientA]
  3. Open "Client Delete" form.
  4. Select [ClientA] in the "Client ID" field.
  5. Validate an error message is received "Client Must Be Removed From All Families Before Client Can Be Deleted."
  6. Click [OK]
  7. Close the form
  8. Open form "Family Registration"
  9. Select [FamilyA]
  10. Click the "Family Members" section
  11. Select the row for [ClientA]
  12. Click [Delete]
  13. Validate the client is removed as a family member
  14. Submit the form
  15. Open "Client Delete" form.
  16. Select [ClientA] in the "Client ID" field.
  17. Validate an error message is received "All Movements must be deleted before Client can be deleted"
  18. Click [OK]
  19. Close the form
  20. Open form "Delete Last Movement"
  21. Select [ClientA]
  22. Select the admission episode from the "Episode Number" drop down list
  23. Click [Submit]
  24. Click [Yes] to continue
  25. Validate the form submits successfully
  26. Open "Client Delete" form.
  27. Select [ClientA] in the "Client ID" field.
  28. Click [Submit]
  29. Validate the form submits successfully
  30. At the home view, search for [ClientA]
  31. Validate there are no results
  32. Run [ReportA] to display data in the "SYSTEM.user_modelled_fam_members" table
  33. Validate there is no longer a row displayed for [FamilyA] and [ClientA]
Scenario 3: "Family" Entity User Modeled Form - Create a new form
Specific Setup:
  • In form "Family Registration" have a family created [FamilyA] with one or more clients added as family member's in "Family Members" section of the form.

For this test, [ClientA], [ClientB] and [ClientC] are used

Steps
  1. Open form "Envelope Definition"
  2. Click the [New Avatar Envelope]
  3. Set the "Envelope Description" field to the desired name [EnvelopeA], for the envelope
  4. Select "Family" in the "Entity Database" field
  5. Click the "Yes - Is Envelope Eligible for Export" radio button
  6. Click the "Yes - Always Allow Export" radio button
  7. Click [Submit]
  8. Validate the form files successfully
  9. Open form "Table Definition"
  10. At the "Select Avatar Table" prompt enter the desired table name [TableA]
  11. Click the [New Avatar Table] button
  12. From the "Envelope" dialog drop down list, select [EnvelopeA]
  13. Populate the "Table Name" field with the desired table name [TableA]
  14. Populate the "Table Description" field with the desired description of the table
  15. Select the "Column Definition" section
  16. Click the [Add New Item] button
  17. Select "Family Member(s)" column from the "Type of Column" drop down list
  18. Populate the "Column Name" field
  19. Populate the "Column Description" field
  20. Populate the "Column Label" field
  21. Validate the "Column Definition" grid contains a row with values just populated
  22. Click the [Add New Item] button
  23. Select "Draft/Final (Document Routing)" column from the "Type of Column" drop down list
  24. Populate the "Column Name" field
  25. Populate the "Column Description" field
  26. Populate the "Column Label" field
  27. Validate the "Column Definition" grid contains a row with values just populated
  28. Repeat step 4 for any other desired prompts to be added from the "Type of Column" drop down list
  29. Validate results are as expected
  30. Click [Submit]
  31. Validate the form files successfully
  32. Open form "Form Definition"
  33. At the "Select Avatar Table" prompt enter the desired form name [FormA]
  34. Click the [New Avatar Form] button
  35. From the "Envelope" dialog drop down list, select [EnvelopeA]
  36. Populate the "Table Name" field with the desired table name [TableA]
  37. Populate the "Table Description" field with the desired description of the table
  38. Select a menu location for the form from the "Menu to Place Form Under" field
  39. Populate the "Form Name" field [FormA]
  40. In the "Primary Table" field, select [TableA]
  41. Click the "Pre-display" section
  42. Select one or more pre-display columns from the "Primary Table Pre-display" column prompts
  43. Click the "Section Definition" section
  44. Click [Add New Item] and populate the "Section Description" field
  45. Click the "Object Definition" section
  46. Click [Add New Item]
  47. From the "Table Column" field, select the "Family Member's" column
  48. Validate the "Object Definition" grid reflect the column added
  49. From the "Table Column" field, select the "Draft/Final" column
  50. Validate the "Object Definition" grid reflect the column added
  51. Repeat step b adding any other columns desired from the "Table Column" field
  52. Validate the "Object Definition" grid reflect the columns added
  53. Click [Submit]
  54. Validate the form files successfully
  55. Open [FormA]
  56. At the "Select Family" prompt, select [FamilyA]
  57. Validate the form loads successfully
  58. Verify the "Family Member's" field is present and contains each client added as a family member in the set up, along with a check box next to their name.
  59. Verify the "Draft/Final" field is present on the form.
  60. Verify any other fields added during "Form Definition" are present on the form, as expected.
  61. Select values for any desired fields on the form
  62. Submit the form
  63. Validate the form files successfully.
Scenario 4: "Family" Entity User Modeled Form- Form submission and Doc Routing Validations
Specific Setup:
  • The "Document Management Defaults" form has "Family - User Defined Family" selected in the field "Select Entity Types Allowed"
  • The "Document Management Definition" form has been submitted with a "Form Name" [FName] associated to the "Family" entity in the "Entity Database" field.
  • In form "Family Registration" have a family created [Family] with family members added in "Family Members" section of the form. For the test [ClientA] and [ClientB]
  • Have a user modeled form [Form] created based on the "Family - User Defined Family" entity database
  • [Form] contains fields from [Table] that include a "Family Member(s)" column type, a field using a "Draft/Final" column type and any other desired field types
  • [Form] is enabled for document routing with form name [FName] selected in the "Select Type" field
  • [User] is a staff member who has access to [Form] and [Table]
  • [User] has the "My To do's" widget on their home view
  • Have a report [Report], set to display data in the "SYSTEM.user_modelled_fam_members" table
  • Log in as [User]
Steps
  1. Access [Form]
  2. In the "Select Family" prompt, select [Family]
  3. Validate the "Family Member's" prompt has selections for members [ClientA] and [ClientB]
  4. Click "All", to select all members
  5. Populate any other desired fields on the form
  6. Select "Draft" in the 'Draft/Final' field.
  7. Click [Submit]
  8. Validate the form files successfully
  9. Run [Report] to display data in the "SYSTEM.user_modelled_fam_members" table
  10. Validate there is a row displayed for [Family] and [ClientA]
  11. Validate there is a row displayed for [Family] and [ClientB]
  12. Access [Form]
  13. In the "Select Family" prompt, select [Family]
  14. In the pre-display screen, click [Edit] to select the row filed in step 1
  15. Validate all fields are populated, as expected
  16. Close the form
  17. Access [Form]
  18. In the "Select Family" prompt, select [Family]
  19. In the pre-display screen, select the row filed in step1
  20. Click [Delete]
  21. Validate the row is removed from the pre-display
  22. Run [Report] to display data in the "SYSTEM.user_modelled_fam_members" table
  23. Validate the row field for [Family] and [ClientA], has been deleted
  24. Validate the row field for [Family] and [ClientB], has been deleted
  25. Access [Form]
  26. In the "Select Family" prompt, select [Family]
  27. Validate the "Family Member's" prompt has selections for members [ClientA] and [ClientB]
  28. Click "All", to select all members
  29. Populate any other desired fields on the form
  30. Select "Final in the 'Draft/Final' field.
  31. Click [Submit] and then [OK]
  32. Validate the "Confirm Document" screen displays all data submitted, including clients [ClientA] and [ClientB] listed in the "Family Member's field.
  33. Click [Accept and Route]
  34. Enter the password for the user in the 'Password' field and click [OK].
  35. At the "Route Document to" dialog, add [User] as an approver
  36. Click [Submit]
  37. Run [Report] to display data in the "SYSTEM.user_modelled_fam_members" table
  38. Validate there is a row displayed for [Family] and [ClientA]
  39. Validate there is a row displayed for [Family] and [ClientB]
  40. Navigate to the "My To Do's" widget
  41. Click the "New" tab
  42. Validate the To Do for [Form] is present in the list
  43. Validate the "Client" column indicates [Family]
  44. Click [Approve Document]
  45. Validate the document displays all data submitted, including clients [ClientA] and [ClientB] in the "Family Member's" field.
  46. Click [Accept]
  47. Validate the To Do is removed the widget, as expected
  48. In the "My Clients" widget, select any one of the clients selected as a family member in submission of [Form] in step 1. For example [Client]
  49. Double click on the client to open their "Chart"
  50. In the "Documents" section on left side panel, click the form type [Fname], associated with [Form]
  51. Locate the row listed for the document approved for [Form] in step 2
  52. Click the "View" check box and then the [View] button to display the document
  53. Validate the document displays all the data submitted as expected
  54. Close the chart
Topics
• Client Merge • NX • Database Tables
2022 Update 49 Summary | Details
Crystal Self Pay Bill - Multiple Root System Codes
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission
  • Guarantors/Payors
  • Financial Eligibility
  • Client Charge Input
  • Client Ledger
  • Crystal Self Pay Bill
Scenario 1: Crystal Self Pay Bill - Multiple Root System Codes
Specific Setup:
  • Update must be tested in a system that has multiple root system codes.
  • Select 2 root system codes to test in.
  • In each of the root system codes chosen, admit the same client who only has financial eligibility set up for a self pay guarantor.
Steps
  1. Enter in self pay charges for clients in both root system codes via "Client Charge Input".
  2. Close the charges in both root system codes.
  3. Generate "Crystal Self Pay Bills" for each client in each system code.
  4. Validate that only the charges for that particular root system code is included on the bill.
Topics
• NX
2022 Update 106 Summary | Details
System Task Scheduler - Quick Billing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Guarantors/Payors
  • Financial Eligibility
  • Client Charge Input
  • Client Ledger
  • Quick Billing Rule Definition
  • Quick Billing
  • System Task Scheduler
Scenario 1: Validating 'Quick Billing' process for the new quick billing rule - Outpatient client
Specific Setup:
  • Registry Setting:
  • The registry setting 'Enable New Quick Billing Format' is enabled.
  • Facility Defaults:
  • The file location to be used for the quick billing rule definition is defined in this form.
  • Guarantors/Payors:
  • An existing guarantor is identified or a new guarantor is created. Note the guarantors' name and code for further testing.
  • Service Codes:
  • An existing service code is identified or a new service code is created. Note the service code and covered charge category.
  • Admission:
  • A new client is admitted to the inpatient or an outpatient program based on the service code charge category defined. Note client's id/name, admission date/program.
  • Diagnosis:
  • An admission diagnosis record is created for the client.
  • Financial Eligibility:
  • A guarantor identified above is assigned to the client as a primary guarantor.
  • Client Charge Input:
  • 1-2 days of charges are rendered to the client using the service code identified above. Be sure to use service codes that are covered by the benefit plan (insurance charge category).
  • Client Ledger:
  • Verify the charges are correctly distributed to the primary guarantor, and they are in 'Open' status.
  • Quick Billing Rule Definition:
  • The quick Billing Rules are created to include service(s) distributed to the client. Note the quick billing rule name for further testing.
  • Make sure the 'Include Primary and/or Secondary Billing' field is set to 'All'.
  • Quick Billing Group Definition:
  • Add Rule Group To Scheduler = Yes
  • Execute Liability Update If It Has Not Run within the Last = desired value
  • Claim From Date for Scheduled Batch = desired days that covers all the services
  • Claim Through Date - Current Date
  • Tasks to execute = Close Charges, Generate Bills, Claim Charges
Steps
  1. Open the 'System Task Scheduler' form.
  2. Select desired task from the 'Schedule(s)' field.
  3. Set the 'Recurrence Pattern' to 'Daily'.
  4. Set the 'Start Time' to ' Current Time'.
  5. Click [Schedule Task].
  6. Click [Discard].
  7. Open the 'Client Ledger' form.
  8. Verify the services are claimed and the claim numbers are generated for the service.
  9. Open the 'Quick Billing' form.
  10. Run a new quick billing using the rule created in the setup section.
  11. Use a date range spanning services entered.
  12. Select the following in 'Quick Billing Tasks To Execute'.
  13. Create Batch, Close Charges, Generate Bills.
  14. Submit the form.
  15. Verify that compile completes and the prompt will state 'Compile Complete'. A Quick Billing Batch and an Interim Billing Batch will be created.
Topics
• Quick Billing • System Task Scheduler
2022 Update 116 Summary | Details
Caseload Changes
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Avatar Window
  • Form Search
  • Main Menu
  • Auto Assign ID
  • Selection Dialog
  • Admission (Outpatient)
  • Transfer Practitioner Caseload
  • Team Definition
  • Discharge
Scenario 1: Caseload Changes - Admission, Transfer & Discharge of a client
Specific Setup:
  • The logged in user must be associated to a practitioner (Practitioner A).
  • A second user is defined that is associated to a practitioner (Practitioner B).
  • A team is defined in 'Team Definition' with multiple users associated (Team A).
Steps
  1. Access the 'Admission (Outpatient)' form.
  2. Enter the desired value in the 'Last Name' field.
  3. Enter the desired value in the 'First Name' field.
  4. Select any value in the 'Sex' field.
  5. Click [Search], [New Client], and [Yes].
  6. Enter any value in the 'Date of Birth' field.
  7. Enter any value in the 'Preadmit/Admission Date' field.
  8. Enter any value in the 'Preadmit/Admission Time' field.
  9. Select any value in the 'Type of Admission' field.
  10. Select "Practitioner A" in the 'Admitting Practitioner' field.
  11. Select "Team A" in the 'Team' field.
  12. Click [Submit].
  13. Validate the new client displays in the caseload for "Practitioner A".
  14. Access the 'Transfer Practitioner Caseload' form.
  15. Select "Team Practitioner Caseload" in the 'Caseload Type' field.
  16. Select "Practitioner A" in the 'Transfer Caseload From' field.
  17. Select "Practitioner B" in the 'Transfer Caseload To' field.
  18. Select "Individual" in the 'Individual Or All Clients' field.
  19. Click [Select Clients to Transfer].
  20. Select the client admitted in the previous steps and Click [OK].
  21. Click [Submit] and close the form.
  22. Select the client admitted in the previous steps and access the 'Discharge' form.
  23. Click [T] in the 'Date Of Discharge' field.
  24. Click [Current Time] in the 'Discharge Time' field.
  25. Select any value in the 'Type Of Discharge' field.
  26. Select "Practitioner A" in the 'Discharge Practitioner' field.
  27. Click [Submit].
  28. Validate the client is no longer displayed in the caseload for "Practitioner A".
Topics
• Admission • Admission (Outpatient) • Discharge
2022 Update 117 Summary | Details
Consent For Access - Consent For Network / Organization
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • CareConnect HIE Configuration
  • Refresh HIE List
  • Consent For Access
Scenario 1: Consent For Access - CareConnect HIE Configuration - Consent Model = Query
Specific Setup:
  • Admission:
  • An existing client is identified, or a new client is created. Note the client's id/name.
Steps
  1. Open the 'CareConnect HIE Configuration' form.
  2. Validate the 'Consent Model' field is displayed and contains the following options: "Opt In", "Query", and "Opt Out".
  3. Select 'Query' in the 'Consent Model' field.
  4. Validate the 'Content' box on the first section.
  5. Select desired values.
  6. Click [Submit].
  7. Open the 'Crystal Report' or other SQL Reporting tool.
  8. Select the PM namespace.
  9. Create a report using the 'SYSTEM.ccd_upload_config' table.
  10. Validate the table contains '2' in the 'consent_req_for ' column.
  11. Close the report.
  12. Select a client identified in the setup section.
  13. Open the 'Consent For Access' form.
  14. Click [Add New Item].
  15. Select 'Network' in the 'Consent For' field.
  16. Select 'Carequality' network in the 'Network' field.
  17. Verify the 'Consent To Query' field is disabled.
  18. Click [Lightbulb]. (The help message icon).
  19. Verify the help message displays "The 'Consent to Query' field will be enabled if the 'Consent Model' field on the 'CareConnect HIE Configuration' form has been submitted with a value of "Query"."
  20. Verify the 'Consent To Opt In/Opt Out' field is enabled.
  21. Select desired value from the field.
  22. Enter desired date to the 'Start Date'.
  23. Click [Submit].Access Crystal Reports or other SQL Reporting tool.
  24. Select the PM namespace.
  25. Create a report using the 'SYSTEM.consent_for_access' table.
  26. Validate the table contains a row for the client with the information filed in the previous steps.
  27. Close the report.
  28. Open the 'Consent For Access' form.
  29. Click [Add New Item].
  30. Select 'Network' in the 'Consent For' field.
  31. Select Non-Carequality network in the 'Network' field.
  32. Verify the 'Consent To Query' field is enabled.
  33. Select desired value from the field.
  34. Click [Lightbulb]. (The help message icon).
  35. Verify the help message displays "The 'Consent to Query' field will be enabled if the 'Consent Model' field on the 'CareConnect HIE Configuration' form has been submitted with a value of "Query"."
  36. Verify the 'Consent To Opt In/Opt Out' field is disabled.
  37. Click [Lightbulb]. (The help message icon).
  38. Verify the help message displays "The 'Consent to Query' field will be enabled if the 'Consent Model' field on the 'CareConnect HIE Configuration' form has been submitted with a value of "Query"."
  39. Click [Submit].
  40. Access Crystal Reports or other SQL Reporting tool.
  41. Select the PM namespace.
  42. Create a report using the 'SYSTEM.consent_for_access' table.
  43. Validate the table contains a row for the client with the information filed in the previous steps.
  44. Close the report.
  45. Open the 'Consent For Access' form.
  46. Click [Add New Item].
  47. Select 'Organization' in the 'Consent For' field.
  48. Select any organization in the 'Network' field.
  49. Verify the 'Consent To Query' field is disabled.
  50. Click [Lightbulb]. (The help message icon).
  51. Verify the help message displays ""
  52. Verify the 'Consent To Opt In/Opt Out' field is enabled.
  53. Select desired value from the field.
  54. Enter desired date to the 'Start Date'.
  55. Click [Submit].Access Crystal Reports or other SQL Reporting tool.
  56. Select the PM namespace.
  57. Create a report using the 'SYSTEM.consent_for_access' table.
  58. Validate the table contains a row for the client with the information filed in the previous steps.
  59. Close the report.
  60. Open the "CareConnect HIE Configuration" form.
  61. Validate the 'Content' box on the first section.
  62. Validate all data displays as it was data entered.
  63. Close the form.
Scenario 2: CareConnect HIE Configuration - Consent Model = Opt In/Opt Out
Specific Setup:
  • Admission:
  • An existing client is identified, or a new client is created. Note the client's id/name.
Steps
  1. Open the 'CareConnect HIE Configuration' form.
  2. Validate the 'Consent Model' field is displayed and contains the following options: "Opt In", "Query", and "Opt Out".
  3. Select 'Opt In' in the 'Consent Model' field.
  4. Validate the 'Content' box on the first section.
  5. Select desired values.
  6. Click [Submit].
  7. Access Crystal Reports or other SQL Reporting tool.
  8. Select the PM namespace.
  9. Create a report using the 'SYSTEM.ccd_upload_config' table.
  10. Validate the table contains '1' in the 'consent_req_for ' column.
  11. Close the report.
  12. Select a client identified in the setup section.
  13. Open the 'Consent For Access' form.
  14. Click [Add New Item].
  15. Select any value in the 'Network' field.
  16. Validate the 'Consent To Query' field is disabled.
  17. Validate the 'Consent To Opt In/Opt Out' field is enabled and required.
  18. Click [Lightbulb]. (The help message icon).
  19. Validate the help message displays "The 'Consent to Opt In/Opt Out' field will be enabled if the 'Consent Model' field on the 'CareConnect HIE Configuration' form has been submitted with a value of "Opt In" or "Opt Out". When using this field for Carequality, it functions as a 'consent to release information'."
  20. Select the desired value in the 'Consent To Opt In/Opt Out' field.
  21. Enter the current date in the 'Start Date' field.
  22. Click [Submit].
  23. Access Crystal Reports or other SQL Reporting tool.
  24. Select the PM namespace.
  25. Create a report using the 'SYSTEM.consent_for_access' table.
  26. Validate the table is populated and contains a row for the client with the information filed in the previous steps.
  27. Close the report.
  28. Open the "CareConnect HIE Configuration" form.
  29. Select 'Opt Out' in the 'Consent Model' field.
  30. Validate the 'Content' box on the first section.
  31. Select desired values.
  32. Click [Submit].
  33. Access Crystal Reports or other SQL Reporting tool.
  34. Select the PM namespace.
  35. Create a report using the 'SYSTEM.ccd_upload_config' table.
  36. Validate the table contains '3' in the 'consent_req_for ' column.
  37. Close the report.
  38. Select a client identified in the setup section.
  39. Open the 'Consent For Access' form.
  40. Click [Add New Item].
  41. Select any value in the 'Network' field.
  42. Validate the 'Consent To Query' field is disabled.
  43. Validate the 'Consent To Opt In/Opt Out' field is enabled and required.
  44. Click [Lightbulb]. (The help message icon).
  45. Validate the help message displays "The 'Consent to Opt In/Opt Out' field will be enabled if the 'Consent Model' field on the 'CareConnect HIE Configuration' form has been submitted with a value of "Opt In" or "Opt Out". When using this field for Carequality, it functions as a 'consent to release information'."
  46. Select the desired value in the 'Consent To Opt In/Opt Out' field.
  47. Enter the current date in the 'Start Date' field.
  48. Click [Submit].
  49. Access Crystal Reports or other SQL Reporting tool.
  50. Select the PM namespace.
  51. Create a report using the 'SYSTEM.consent_for_access' table.
  52. Validate the table is populated and contains a row for the client with the information filed in the previous steps.
  53. Close the report.
Topics
• Consent for Access • NX
2022 Update 121 Summary | Details
837 Institutional – Medicare A - No Pay Claims
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Practitioner Numbers By Guarantor And Program
  • Admission
  • Financial Eligibility
  • Service Codes
  • Client Ledger
  • Create Interim Billing Batch File
  • Electronic Billing
  • Medicare A Service Hold Management
  • Client Charge Input
  • Delete Service
  • Claim Adjustment Group/Reason Code Definition
  • 835 Health Care Claim Payment/Advice (PM)
  • Unbilled Services Compile Definition and Export
  • System Task Scheduler
Scenario 1: Guarantors/Payors Web Service - Verification of AddGuarantorsPayors and UpdateGuarantorsPayors filing
Specific Setup:
  • External application utilizing Avatar PM Guarantors/Payors web service 'AddGuarantorsPayors' and 'UpdateGuarantorsPayors' methods/functions.
Steps
  1. Using the Avatar PM Guarantors/Payors web service (WEBSVC.GuarantorsPayors.cls), ensure that the following items/elements are added to the web service definition for AddGuarantorsPayors methods:
  2. GuarantorName (field 'Guarantor Name')
  3. GuarNameForAlphaLookup (field 'Guarantor Name For Alpha Lookup')
  4. NewGuarantorCode (field 'New Guarantor Code')
  5. FinancialClass (field 'Financial Class')
  6. GuarantorNature (field 'Guarantor Nature')
  7. ValueIn837P2300K301 (field 'Value to Include in 837P (2300-K3-01)')
  8. Copy2010BATo837P2330ANM1 (field 'Copy 837P-2010BA-NM1/N3/N4 to 837P-2330A-NM1/N3/N4')
  9. Copy1000ATo837P2330BNM1 (field 'Copy 837P-1000A-NM1 to 837P-2330B-NM1')
  10. UseGenDate837P2330BDTP03 (field 'Use File Generation Date in 837P-2330B-DTP-03')
  11. IncOthPayClmCNum837P2330B (field 'Include Other Payer Claim Control Number (837P-2330B-REF)')
  12. UseGenDate837P2430DTP03 (field 'Use File Generation Date in 837P-2430-DTP-03')
  13. ValueIn837I2300K301 (field 'Value to Include in 837I (2300-K3-01)')
  14. UseGenDate837I2330BDTP03 (field 'Use File Generation Date in 837I-2330B-DTP-03')
  15. IncOthPayClmCNum837I2330B (field 'Include Other Payer Claim Control Number (837I-2330B-REF)')
  16. UseGenDate837I2430DTP03 (field 'Use File Generation Date in 837I-2430-DTP-03')
  17. AllowExtMatch (field 'Allow Extended Matching Criteria in 835 Remittance Posting') (835 section).
  18. Submit the 'AddGuarantorsPayors' web service request.
  19. In Guarantors/Payors web service response, ensure that successful filing confirmation message 'Guarantors/Payors web service has been filed successfully' is returned.
  20. Open 'Guarantors/Payors' form.
  21. Select Edit action in 'Add New or Edit Existing Guarantor' field and select Guarantor Code/Guarantor filed via web service.
  22. Validate the data in the 'Guarantors/Payors section.
  23. Navigate to '837' section of 'Guarantors/Payors' form.
  24. Ensure that values filed via web service for items/elements noted above are present in respective fields in 'Guarantors/Payors' form.
  25. Navigate to '835' section of 'Guarantors/Payors' form.
  26. Ensure that value filed via web service for item/element noted above is present in respective fields in 'Guarantors/Payors' form.
  27. Using the Avatar PM Guarantors/Payors web service (WEBSVC.GuarantorsPayors.cls), ensure that the following items/elements are added to the web service definition for UpdateGuarantorsPayors methodsUpdateGuarantorsPayors method:
  28. GuarantorName
  29. GuarNameForAlphaLookup
  30. GuarantorCode
  31. FinancialClass
  32. GuarantorNature
  33. Change the value of 'ValueIn837P2300K301 (field 'Value to Include in 837P (2300-K3-01)')'
  34. Submit the 'UpdateGuarantorsPayors' web service request.
  35. In Guarantors/Payors web service response, ensure that successful filing confirmation message 'Guarantors/Payors web service has been filed successfully' is returned.
  36. Open 'Guarantors/Payors' form.
  37. Select Edit action in 'Add New or Edit Existing Guarantor' field and select Guarantor Code/Guarantor filed via web service.
  38. Validate the data in the 'Guarantors/Payors section.
  39. Navigate to '837' section of 'Guarantors/Payors' form.
  40. Validate the data in 'ValueIn837P2300K301 (field 'Value to Include in 837P (2300-K3-01)')'.
  41. Close the form.
Scenario 2: Medicare A Service Hold Management
Specific Setup:
  • User Definition:
  • Tester has been given access to the 'Medicare A Service Hold Management' form.
  • Tester has been given access to the 'SYSTEM.medicare_a_hold' table.
  • Guarantors/Payors:
  • Guarantors/Payor:
  • Guarantor 1:
  • Select a Medicare A guarantor: Note the 'Guarantor Code', 'Guarantor Name' and 'Financial Class'.
  • Select 'Yes' in 'Generate No-Pay ##0 Claims'.
  • Select desired value in 'Include No-Pay ##0 Claims In Separate 837 File'.
  • Select desired values in 'Type of Service to Include in No-Pay ##0 Claims'.
  • Guarantor 2:
  • Select an existing guarantor to be the secondary guarantor in Financial Eligibility. Note the 'Guarantor Code', 'Guarantor Name' and 'Financial Class'.
  • Select desired value in 'Generate No-Pay ##0 Claims'.
  • In the 837 section, select 'Yes' in 'Bill Only When Full Denial Received For Medicare A No-Pay Guarantor'. Note: Services will be placed on hold during liability distribution until a full denial is received for the Medicare A guarantor in an 835.
  • Client:
  • Admission: An inpatient client is admitted. Note the client's id/name, program, and date of admission.
  • Financial Eligibility:
  • Guarantor 1 is the primary guarantor. Customize the guarantor plan to allow a portion of the service charge to distribute to Guarantor 2.
  • Guarantor 2 is the secondary guarantor, and the guarantor plan allows payment of the portion of the service charge distributed to Guarantor 2.
  • Client Charge Input: Room & Board charges are rendered to the client for a minimum of one day.
  • Client Ledger: Validate that the charges distributed to both guarantors.
  • Close the charges.
  • Create a query of the ‘SYSTEM.medicare_a_hold’ table specific to the client.
  • Validate that there is one row for each service and: ‘GUARANTOR_ID’ = Guarantor 2 guarantor code; ‘PATID’ = the client’s ID; and ‘medicare_a_id’ = Guarantor 1 guarantor code.
Steps
  1. Open 'Electronic Billing'.
  2. Create a non-claimed 837 Institutional bill for Guarantor 2.
  3. Validate that an error message is received stating 'Unable To Create 837-Institutional. Please Check The Error Report'.
  4. Print the report and open the 'Required Data Missing: Patient Claim Data' link.
  5. Validate that the error is similar to ‘Full denial not yet received from prior Medicare A No-Pay Guarantor: Medicare Part A (5). (Loop: 2320 Segment: CAS)’.
  6. Close the report.
  7. Close the form.
  8. Open 'Medicare A Service Hold Management'.
  9. Enter the desired 'Client ID'.
  10. Select the desired 'Episode Number'.
  11. Enter the desired 'From Service Date'.
  12. Enter the desired 'Through Service Date'/
  13. Enter 'Guarantor 2' in 'Guarantor'.
  14. Select 'Service' in 'Service or Claim'.
  15. Click [Select Service(s) or Claim(s)].
  16. Select the desired service in the 'Medicare A Holds' checklist.
  17. Click [OK].
  18. Click [Submit].
  19. Close the form.
  20. Refresh the menu.
  21. Create a query of the ‘SYSTEM.medicare_a_hold’ table specific to the client. Validate that the services selected in the 'Medicare A Holds' checklist are not in the table.
  22. Close the query.
  23. Open 'Electronic Billing'.
  24. Create a claimed 837 Institutional bill for Guarantor 2.
  25. Validate that the 'Compile Complete' message is received.
  26. Print the report and open the '837 Institutional Submission' link.
  27. Verify that the services selected in the 'Medicare A Holds' checklist are included in the bill.
  28. Close the report.
  29. Close the form.
  30. Open 'Client Ledger' for the client and verify that the claims were created.
  31. Close the report.
  32. Close the form.
Scenario 3: 837 Institutional - Bill Only When Full Denial Received For Medicare A No-Pay Guarantor
Specific Setup:
  • User Definition:
  • Tester has been given access to the 'Medicare A Service Hold Management' form.
  • Tester has been given access to the 'SYSTEM.medicare_a_hold' table.
  • Guarantors/Payor:
  • Guarantor 1:
  • Select a Medicare A guarantor: Note the 'Guarantor Code', 'Guarantor Name' and 'Financial Class'.
  • Select 'Yes' in 'Generate No-Pay ##0 Claims'.
  • Select desired value in 'Include No-Pay ##0 Claims In Separate 837 File'.
  • Select desired values in 'Type of Service to Include in No-Pay ##0 Claims'.
  • Guarantor 2:
  • Select an existing guarantor to be the secondary guarantor in Financial Eligibility. Note the 'Guarantor Code', 'Guarantor Name' and 'Financial Class'.
  • Select desired value in 'Generate No-Pay ##0 Claims'.
  • In the 837 section, select 'Yes' in 'Bill Only When Full Denial Received For Medicare A No-Pay Guarantor'. Note: Services will be placed on hold during liability distribution until a full denial is received for the Medicare A guarantor in an 835.
  • Client:
  • Admission: An inpatient client is admitted. Note the client's id/name, program, and date of admission.
  • Financial Eligibility:
  • Guarantor 1 is the primary guarantor. Customize the guarantor plan to allow a portion of the service charge to distribute to Guarantor 2.
  • Guarantor 2 is the secondary guarantor, and the guarantor plan allows payment of the portion of the service charge distributed to Guarantor 2.
  • Client Charge Input: Room & Board charges are rendered to the client for a minimum of one day.
  • Client Ledger: Validate that the charges distributed to both guarantors.
  • Close the charges.
  • Electronic Billing: Create 837 Institutional claims for Guarantor 1.
  • Save the dump file to use to create a mockup 835 file that fully denies the claims. Save the file for further testing.
  • Create a query of the ‘SYSTEM.medicare_a_hold’ table specific to the client.
  • Validate that there is one row for each service and: ‘GUARANTOR_ID’ = Guarantor 2 guarantor code; ‘PATID’ = the client’s ID; and ‘medicare_a_id’ = Guarantor 1 guarantor code.
Steps
  1. Open ‘Electronic Billing’.
  2. Create a non-claimed bill for Guarantor 2.
  3. Validate that the 837 Report, Required Data Missing: Patient Claim Data link contains a message similar to: Full denial not yet received from prior Medicare A No-Pay Guarantor: Medicare Part A (5). (Loop: 2320 Segment: CAS).
  4. Close the report.
  5. Close the form.
  6. Open ‘835 Health Care Claim Payment/Advice’.
  7. Load, compile and post the 835 mocked up in Setup.
  8. Close the report.
  9. Close the form.
  10. Create a query of the ‘SYSTEM.medicare_a_hold’ table specific to the client.
  11. Validate that no results are returned for the query.
  12. Open ‘Electronic Billing’.
  13. Create 837 Institutional claims for Guarantor 2.
  14. Validate that the 837 Report, Required Data Missing: Patient Claim Data link does not exist.
  15. Validate that the claim was created in the Dump file.
  16. Close the report.
  17. Close the form.
  18. Open ‘Client Ledger’ and validate that Guarantor 2 contains a number in ‘CLAIM NUMBER’.
  19. Close the report.
  20. Close the form.
Topics
• Guarantor/Payors • Web Services • 837 Institutional • NX
2022 Update 128 Summary | Details
Avatar PM - support for future functionality
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Edit Service Information (Charge Fee Access)
  • Spreadsheet Edit Service Information
  • Admission (Outpatient)
  • Client Charge Input
Scenario 1: Edit Service Information - Validation
Specific Setup:
  • A service has been provided to a client (Client A).
Steps
  1. Access the 'Edit Service Information' form.
  2. Enter "Client A" in the 'Client ID' field.
  3. Click [Select Service(s) To Edit].
  4. Select an existing service and click [OK].
  5. Enter "08:00 AM" in the 'Service Start Time' field.
  6. Enter "08:30 AM" in the 'Service End Time' field.
  7. Click [OK] and validate the "Warning" message is no longer displayed.
  8. Click [Submit].
Scenario 2: Edit Service Information - Update a Service that includes a Time Zone entry.
Specific Setup:
  • The 'Time Zone Determination for UTC Service Entry' registry setting must be set to "3".
  • A "Time Zone (Time Zone A)" should be defined for the "(10006) Location" Data Element in the 'Dictionary Update' form.
  • A Program (Program A) must be defined with the "Time Zone A" in the 'Program Maintenance' form.
  • A Service Code (Service Code A) must be mapped with "Program A" in the 'Program Maintenance' form.
  • A Program (Program B) must be defined without the Time Zone in the 'Program Maintenance' form.
  • A Service Code (Service Code B) must be mapped with "Program B" in the 'Program Maintenance' form.
  • "Client A" should be enrolled in an active episode with "Program B".
Steps
  1. Select “Client A” and access the ‘Client Charge Input’ form.
  2. Set desired Service Start Time in the 'Service Start Time' field.
  3. Set desired Service End Time in the 'Service End Time' field.
  4. Set "Client A" in the 'Client ID' field.
  5. Select "Service Code B" in the 'Service Code' field.
  6. Set the desired Practitioner in the 'Practitioner' field.
  7. Click [Submit] and close the form.
  8. Access SQL or other reporting tool.
  9. Select the PM namespace and query the 'billing_tx_history' SQL table.
  10. Validate the columns are "Blank".
  11. Access the ‘Edit Service Information’ form.
  12. Set "Client A" in the 'Client ID' field.
  13. Click [Select Service(s) To Edit].
  14. Select the entry filed in the previous steps.
  15. Click [OK].
  16. Set "Service Code A" in the 'Service Code' field.
  17. Select "Program A" in the 'Program' field.
  18. Click [Submit].
  19. Access SQL or other reporting tool.
  20. Select the PM namespace and query the 'billing_tx_history' SQL table.
  21. Validate the columns has values.
Scenario 3: Edit Service Information (Charge Fee Access) - Update a Service that includes a Time Zone entry.
Specific Setup:
  • The 'Time Zone Determination for UTC Service Entry' registry setting must be set to "3".
  • A "Time Zone (Time Zone A)" should be defined for the "(10006) Location" Data Element in the 'Dictionary Update' form.
  • A Program (Program A) must be defined with "Time Zone A" in the 'Program Maintenance' form.
  • A Service Code (Service Code A) must be mapped with "Program A" in the 'Program Maintenance' form.
  • A Program (Program B) must be defined without the Time Zone in the 'Program Maintenance' form.
  • A Service Code (Service Code B) must be mapped with "Program B" in the 'Program Maintenance' form.
  • "Client A" should be enrolled in an active episode with "Program B".
Steps
  1. Select “Client A” and access the ‘Client Charge Input’ form.
  2. Set desired Service Start Time in the 'Service Start Time' field.
  3. Set desired Service End Time in the 'Service End Time' field.
  4. Set "Client A" in the 'Client ID' field.
  5. Select "Service Code B" in the 'Service Code' field.
  6. Set the desired Practitioner in the 'Practitioner' field.
  7. Click [Submit] and close the form.
  8. Access SQL or other reporting tool.
  9. Select the PM namespace and query the 'billing_tx_history' SQL table.
  10. Validate the columns are "Blank".
  11. Access the ‘Edit Service Information (Charge Fee Access)’ form.
  12. Set "Client A" in the 'Client ID' field.
  13. Click [Select Service(s) To Edit].
  14. Select the entry filed in the previous steps.
  15. Click [OK].
  16. Set "Service Code A" in the 'Service Code' field.
  17. Select "Program A" in the 'Program' field.
  18. Click [Submit].
  19. Access SQL or other reporting tool.
  20. Select the PM namespace and query the 'billing_tx_history' SQL table.
  21. Validate the columns has values.
Scenario 4: Spreadsheet Edit Service Information - Update a Service that includes a Time Zone entry.
Specific Setup:
  • The 'Time Zone Determination for UTC Service Entry' registry setting must be set to "3".
  • A Program (Program A) must be defined without the Time Zone in the 'Program Maintenance' form.
  • A Service Code (Service Code A) must be mapped with "Program A" in the 'Program Maintenance' form.
  • "Client A" should be enrolled in an active episode with the "Program A".
Steps
  1. Select “Client A” and access the ‘Client Charge Input’ form.
  2. Set desired Service Start Time in the 'Service Start Time' field.
  3. Set desired Service End Time in the 'Service End Time' field.
  4. Set "Client A" in the 'Client ID' field.
  5. Select "Service Code B" in the 'Service Code' field.
  6. Set the desired Practitioner in the 'Practitioner' field.
  7. Click [Submit] and close the form.
  8. Access SQL or other reporting tool.
  9. Select the PM namespace and query the 'billing_tx_history' SQL table.
  10. Validate the columns are "Blank".
  11. Access the ‘Spreadsheet Edit Service Information’ form.
  12. Set "Client A" in the 'Client ID' field.
  13. Click [T] in the 'Begin Date Of Service' field.
  14. Click [T] in the 'End Date Of Service' field.
  15. Click [Edit Service Information].
  16. Select the desired diagnosis in the 'Diagnosis 1' field.
  17. Click [Save] and close the form.
  18. Access SQL or other reporting tool.
  19. Select the PM namespace and query the 'billing_tx_history' SQL table.
  20. Validate the columns has values.
Topics
• Edit Service Information • Spreadsheet Edit Service Information
2022 Update 138 Summary | Details
Service Codes - 'Clinic Hours' field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Service Codes
  • Service Code Upload Process
  • Service Code Upload Accepted Codes
  • Service Code Upload Rejected Codes
Scenario 1: 'Service Code Upload Process' - Upload Provider Only Service Code
Specific Setup:
  • Avatar PM Service Code Upload file for upload containing a valid row that includes "Provider" as the value for 'Service Provided By' and a value for 'Clinic Hours' (File A).
Steps
  1. Access the 'Service Code Upload Process' form.
  2. Click [Select File].
  3. Select "File A" click [Open].
  4. Select "Compile" in the 'Compile Or Post' field.
  5. Select "No" in the 'Override Existing Service Codes' field.
  6. Click [Submit].
  7. Validate a message is displayed stating: Compile Completed. To view results review accepted and rejected reports.
  8. Click [OK] and leave the form opened.
  9. Access the 'Service Code Upload Accepted Codes' form.
  10. Select "File A" in the 'Select Desired Service Code Import File Name' field.
  11. Click [Process].
  12. Validate "File A" contents are displayed in the report.
  13. Validate the 'Clinic Hours' field is populated with the value defined in the file.
  14. Close the report and the form.
  15. Navigate back to the 'Service Code Upload Process' form.
  16. Select "Post" in the 'Compile Or Post' field.
  17. Click [Submit].
  18. Validate a message is displayed stating: Posting completed.
  19. Click [OK] and close the form.
  20. Access the 'Service Codes' form.
  21. Select "Edit" in the 'Add New Or Edit Existing' field.
  22. Select the service code uploaded in the previous steps in the 'Service Code' field.
  23. Validate 'Clinic Hours' field contains the uploaded value.
  24. Validate all other information displays as expected.
  25. Close the form
  26. Access Crystal Reports or other SQL reporting tool.
  27. Create a report using the 'SYSTEM.batchload_tx_accepted' SQL table.
  28. Validate a row is displayed for the service code uploaded in the previous steps.
  29. Validate the 'clinic_hours_code' field contains the uploaded value.
  30. Validate the 'clinic_hours_value' field contains the uploaded value.
  31. Close the report.
Scenario 2: 'Service Code' - Add a Provider Only Service Code
Specific Setup:
  • Must have Crystal Reports or other SQL reporting tool.
Steps
  1. Access the 'Service Codes' form.
  2. Select "Add" in the 'Add New Or Edit Existing' field.
  3. Validate the 'Clinic Hours' field is displayed and disabled.
  4. Populate the required and desired fields.
  5. Select "Provider" in the 'Service Required By' field.
  6. Validate the 'Clinic Hours' field is now enabled.
  7. Select the desired value in the 'Clinic Hours' field.
  8. Click [Submit].
  9. Access Crystal Reports or other SQL reporting tool.
  10. Create a report using the 'SYSTEM.billing_tx_master_table' SQL table.
  11. Validate a row is displayed for the service code filed in the previous steps.
  12. Validate the 'clinic_hours_code' field contains the code associated to the value selected in the previous steps.
  13. Validate the 'clinic_hours_value' field contains the value selected in the previous steps.
  14. Access the 'Service Codes' form.
  15. Select "Edit" in the 'Add New Or Edit Existing' field.
  16. Select the service code filed in the previous steps.
  17. Select any new value in the 'Clinic Hours' field.
  18. Click [Submit].
  19. Access Crystal Reports or other SQL reporting tool.
  20. Refresh the report using the 'SYSTEM.billing_tx_master_table' SQL table.
  21. Validate the 'clinic_hours_code' field contains the updated code associated to the value selected in the previous steps.
  22. Validate the 'clinic_hours_value' field contains the updated value selected in the previous steps.
  23. Close the report.
Service Codes - 'Available Electronic Visit Verification Tasks' field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Service Codes
  • Service Code Upload Process
  • Service Code Upload Accepted Codes
  • Service Code Upload Rejected Codes
Scenario 1: 'Service Code' - Add an EVV Service Code
Specific Setup:
  • Must have Crystal Reports or other SQL reporting tool.
  • Dictionary values must be defined for the 'Other Tabled Files' - '(424) Available Electronic Visit Verification Tasks' Data Element in 'Dictionary Update (PM)'.
Steps
  1. Access the 'Service Codes' form.
  2. Select "Add" in the 'Add New Or Edit Existing' field.
  3. Validate the 'Available Electronic Visit Verification Tasks' field is displayed and disabled.
  4. Populate the required and desired fields.
  5. Select "Yes" in the 'Does Service Code Require Electronic Visit Verification' field.
  6. Validate the 'Available Electronic Visit Verification Tasks' field is now enabled.
  7. Select the desired value(s) in the 'Available Electronic Visit Verification Tasks' field.
  8. Click [Submit].
  9. Access Crystal Reports or other SQL reporting tool.
  10. Create a report using the 'SYSTEM.billing_tx_master_table' SQL table.
  11. Validate a row is displayed for the service code filed in the previous steps.
  12. Validate the 'evv_tasks_code' field contains the code(s) associated to the task(s) selected in the previous steps.
  13. Validate the 'evv_tasks_value' field contains the value(s) selected in the previous steps.
  14. Access the 'Service Codes' form.
  15. Select "Edit" in the 'Add New Or Edit Existing' field.
  16. Select the service code filed in the previous steps.
  17. Select any new value(s) in the 'Available Electronic Visit Verification Tasks' field.
  18. Click [Submit].
  19. Access Crystal Reports or other SQL reporting tool.
  20. Refresh the report using the 'SYSTEM.billing_tx_master_table' SQL table.
  21. Validate the 'evv_tasks_code' field contains the updated code(s) associated to the task(s) selected in the previous steps.
  22. Validate the 'evv_tasks_value' field contains the updated value(s) selected in the previous steps.
  23. Close the report.
Scenario 2: 'Service Code Upload Process' - Upload EVV Service Code
Specific Setup:
  • Avatar PM Service Code Upload file for upload containing a valid row that includes "Yes" as the value for 'Does This Visit Require Electronic Visit Verification' and value(s) for 'Available Electronic Visit Verification Tasks' field (File A).
  • Dictionary values must be defined for the 'Other Tabled Files' - '(424) Available Electronic Visit Verification Tasks' Data Element in 'Dictionary Update (PM)'.
Steps
  1. Access the 'Service Code Upload Process' form.
  2. Click [Select File].
  3. Select "File A" click [Open].
  4. Select "Compile" in the 'Compile Or Post' field.
  5. Select "No" in the 'Override Existing Service Codes' field.
  6. Click [Submit].
  7. Validate a message is displayed stating: Compile Completed. To view results review accepted and rejected reports.
  8. Click [OK] and leave the form opened.
  9. Access the 'Service Code Upload Accepted Codes' form.
  10. Select "File A" in the 'Select Desired Service Code Import File Name' field.
  11. Click [Process].
  12. Validate "File A" contents are displayed in the report.
  13. Validate the 'Available Electronic Visit Verification Tasks' field is populated with the value(s) defined in the file.
  14. Close the report and the form.
  15. Navigate back to the 'Service Code Upload Process' form.
  16. Select "Post" in the 'Compile Or Post' field.
  17. Click [Submit].
  18. Validate a message is displayed stating: Posting completed.
  19. Click [OK] and close the form.
  20. Access the 'Service Codes' form.
  21. Select "Edit" in the 'Add New Or Edit Existing' field.
  22. Select the service code uploaded in the previous steps in the 'Service Code' field.
  23. Validate the 'Available Electronic Visit Verification Tasks' field contains the uploaded value(s).
  24. Validate all other information displays as expected.
  25. Close the form
  26. Access Crystal Reports or other SQL reporting tool.
  27. Create a report using the 'SYSTEM.batchload_tx_accepted' SQL table.
  28. Validate a row is displayed for the service code uploaded in the previous steps.
  29. Validate the 'evv_tasks_code' field contains the uploaded value(s).
  30. Validate the 'evv_tasks_value' field contains the uploaded value(s).
  31. Close the report.
Topics
• Service Codes • Service Code Upload Process
2022 Update 142 Summary | Details
Service/Fee Cross Reference - CPT-4 / HCPCS Modifier
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Service Codes
  • CPT Code Definition (PM)
  • File Import
Scenario 1: Service Fee/Cross Reference Maintenance - Add/Edit Service Fee Definition
Specific Setup:
  • Service Codes:
  • Add a new service code for testing purposes. Note the service code/name.
Steps
  1. Open the ‘Service Fee/Cross Reference Maintenance’ form.
  2. Select ‘Enter New’ in the ‘Enter New Or Edit Existing Fee/Cross Reference’ field.
  3. Enter the service code from setup.
  4. Enter the ‘From Date’.
  5. Enter a 'Fee'.
  6. Enter a 'CPT-4 / HCPCS Code'.
  7. Enter desired value with quotation marks into the 'CPT-4 / HCPCS Modifier' field.
  8. Click [Submit].
  9. Click [Yes].
  10. Select ‘Edit Existing’ in ‘Enter New Or Edit Existing Fee/Cross Reference’.
  11. Enter the service code from setup.
  12. Enter the ‘From Date’.
  13. Click [Select Fee/Cross Ref To Edit/Default From Existing Row].
  14. Select the desired row that filed in above steps.
  15. Click [OK].
  16. Validate that the entered 'Fee' exists.
  17. Validate that the entered 'CPT-4 / HCPCS Code' exists.
  18. Validate that the selected ‘CPT-4 / HCPCS Modifier’ exists.
  19. Click [Discard].
  20. Click [Yes].
Scenario 2: File Import - Service Fee/Cross Reference - Import Process Type = FU&GU
Specific Setup:
  • Registry Setting:
  • Set the registry setting 'Import Process Type' to 'FU&GU'.
  • Set the registry setting 'Import File Delimiter' to 2.
  • Service Codes:
  • Add a new service code for testing purposes. Note the service code/name.
  • Create a tab delimited file that contains a value with quotation marks entered for the 'CPT-4 / HCPCS Modifier' field to be used for the service code fee definition file import. Note the location of the file.
Steps
  1. Open the 'File Import' form.
  2. Import the service fee import file created in setup.
  3. Process a file through file upload, compile and posting processes.
  4. Open the 'Service Fee/Cross Reference Maintenance' form.
  5. Click the [Service Fee/Cross Reference Definition Report].
  6. Validate the report contains the service fee data that was added via the file import.
Topics
• Service Fee/Cross Reference Maintenance • NX
2022 Update 145 Summary | Details
Payment Acknowledgement
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Posting/Adjustment Codes Definition
  • Payment Acknowledgement
  • Client Ledger
  • Deposit Entry
  • Service Codes
  • Financial Eligibility
  • Admission (Outpatient)
  • Guarantors/Payors
Scenario 1: Payment Acknowledgement - workflow
Specific Setup:
  • Registry Setting:
  • ‘Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement’ has a ‘Registry Setting Value’ of ‘Y’.
  • Dictionary Update:
  • Other Table Files: (5521) Program - contains dictionary codes and dictionary values.
  • Other Table Files: (5522) Account - contains dictionary codes, dictionary values and extended dictionary values.
  • Other Table Files: (9712) Payment Acknowledgement Type – extended dictionary values have been added to the locked dictionary.
  • Posting/Adjustment Codes Definitions: Definitions exist for ‘Payment’.
  • The definitions may have a value in the ‘Payment Acknowledgement Type’ field.
  • All ‘Payment’ definitions will be available in the ‘Payment Acknowledgement’ form.
  • Clients:
  • Identify one or more clients that a balance due to a self-pay guarantor. Note the balance due amounts.
  • Note the 'Treatment Setting' of the client's program.
Steps
  1. Open ‘Payment Acknowledgement’ form.
  2. Verify that ‘Action’ defaults to ‘New’.
  3. Verify that ‘Transaction Number’ is read only.
  4. Verify that ‘Entered By’ is read only and defaults to the signed in user.
  5. Enter desired value in ‘Batch Number’.
  6. Select desired ‘Posting Code’. All payment posting codes will display.
  7. Enter desired value in ‘Check/EFT Number’.
  8. Enter desired value in ‘Amount’.
  9. Select desired ‘Guarantor’. If a ‘Self-Pay' guarantor is selected, the ‘Client’ field will be enabled.
  10. Enter desired value in ‘Name/Source’.
  11. Enter desired value in ‘Client’, if enabled. The field is only available for ‘Self-Pay' guarantors.
  12. Enter desired value in ‘Check/EFT Date’.
  13. Enter desired value in ‘Receipt Date’.
  14. Enter desired value in ‘Deposit Date’.
  15. Select desired ‘Treatment Service’.
  16. Select desired ‘Category’. Inactive dictionary codes will not display in this filed.
  17. Enter desired value in ‘Bank Ref #’.
  18. Enter desired value in ‘Comments’.
  19. Click [File].
  20. Verify that the ‘Payment Acknowledgement’ message is received and states the following: Filed successfully. The Transaction Number is 6. Do you need to continue to Post Payment Accounting Entry? Note: The Transaction Number’ increments by one number with each filing.
  21. Click [Yes] to continue to Post Payment Accounting Entry section or [No] to remain in the ‘Payment Acknowledgement’ section.
  22. If [Yes] was clicked, go to step 30.
  23. If [No] was clicked, select ‘Edit or View’ in ‘Action, which will enable the ‘Payment Acknowledgement Search’ section.
  24. Enter data from the filed ‘Payment Acknowledgement’ into desired search fields. The ’Transaction Number’ and ‘Batch Number’ are specific to only one ‘Payment Acknowledgement’. The following fields may return results for more than one ‘Payment Acknowledgement’ when applicable: ‘Client’, ‘Guarantor’, ‘Amount Type’, ‘Check/EFT #’, ‘Check/EFT From Date’, ‘Check/EFT To Date’, ‘Deposit From Date’, and ‘Deposit To Date’.
  25. Click [Search].
  26. Select the desired item in the ‘Payment Acknowledgement’ grid.
  27. Click [OK] to continue or [Cancel] to end the search. Click [OK].
  28. The following ‘Payment Acknowledgement’ displays: Do you need to continue to Post Payment Accounting Entry?
  29. Click [Yes].
  30. Validate that the grid is not enabled.
  31. Click [New Row] in ‘Post Payment Accounting Entry’.
  32. Validate that the grid becomes enabled.
  33. Select desired ‘Treatment Service’. It will default if filed in the ‘Payment Acknowledgement’.
  34. Select desired ‘Program’. This is from ‘Other Table Files: (5521) Program’, not a program in ‘Program Maintenance’.
  35. Select desired ‘Account’.
  36. Select desired ‘Amount’. If the amount is an even dollar amount such as $500.00, enter '500' and validate that the field displays as '500.00'.
  37. Validate that the ‘Posting Code; defaulted from the ‘Payment Acknowledgement’.
  38. Select desired ‘Posting Date’.
  39. Validate that the ‘Posting Summary’ is correct.
  40. If desired, click [New Row] and repeat the steps.
  41. If desired, click [Delete Row]. A ‘Confirm Delete’ message will be displayed. Select desired value.
  42. Click [File].
  43. The following ‘Payment Acknowledgement’ displays: Filed successfully. Do you need to continue with Post Payment Accounting Entry?
  44. Click [Yes].
  45. Click the ‘Reverse’ checkbox in one row of the ‘Post Payment Accounting Entry’.
  46. Enter desired ‘Reversal Posting Date’.
  47. Enter desired ‘Reversal Reason’.
  48. Click [Reverse].
  49. Validate that a new row was added to the ‘Post Payment Accounting Entry’ grid and that it mirrors the row that was selected to reverse, except for ‘Amount’ displays in parentheses, indicating a negative amount.
  50. If desired, add a new row to post an additional payment.
  51. Close the form.
  52. Open ‘Deposit Entry’.
  53. Make a payment for the self-pay guarantor for one or more clients. Add a value to 'Name on Card' field, no matter the payment type. It is needed to post the payment in the 'Payment Acknowledgement' form and will be transferred to the 'Post Front Office and myHP Payments' grid in the 'Payment Acknowledgement' form. Note all payment details.
  54. Open ‘Payment Acknowledgement’ form.
  55. Select the ‘Post Front Office and myHP Payments’ section.
  56. Set the ‘Payment Collection Date’ to the current date.
  57. If desired, select a value in ‘Treatment Service’.
  58. Select a ‘Front Office’ in ‘Type’.
  59. Click [Review].
  60. Validate that a grid is launched with payment information.
  61. A row will display for each payment made in ‘Deposit Entry’.
  62. Validate the payment information.
  63. Add a check mark to the rows that will be posted. Note the clients and payment amounts.
  64. Click [Save].
  65. Click [Yes].
  66. Enter desired ‘Batch Number’.
  67. Enter desired ‘Deposit Date’.
  68. Select desired ‘Category’.
  69. Enter desired ‘Bank Ref #’.
  70. If desired, enter ‘Comments’.
  71. Click [Post].
  72. Click [OK].
  73. Close the form.
  74. Open ‘Client Ledger’.
  75. Select the desired client and verify that the payment posted.
  76. Repeat for additional clients as desired.
  77. Close the report.
  78. Close the form.
Scenario 2: PM - Deposit Entry - Validate 'SYSTEM.unacknowledged_payments' table.
Specific Setup:
  • Registry Settings:
  • Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = Y.
  • Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = ‘5’ at a minimum.
  • User Definition has been used to give the tester access to the 'Payment Acknowledgement' form and the ‘SYSTEM.unacknowledged_payments’ table.
  • Admit a new test client or select an existing self-pay client. Note the client’s ID.
  • Assign a self-pay Financial Eligibility record to the client.
  • Use 'Deposit Entry' to post a payment to the client. Note the details of the payment.
  • Add a value to 'Name on Card' field, no matter the payment type. It is needed to post the payment in the 'Payment Acknowledgement' form and will be transferred to the 'Post Front Office and myHP Payments' grid in the 'Payment Acknowledgement' form.
  • Use 'Client Ledger' to validate that the payment did not post to the account.
  • Use Crystal Reports or other SQL reporting tool to query the 'SYSTEM.unacknowledged_payments' table, specific to the client. Validate that payment data is correct. Save the query.
Steps
  1. Open ‘Payment Acknowledgement’.
  2. Select the ‘Post Front Office and myHP Payments’ section.
  3. Click [T] on ‘Payment Collection Date’.
  4. Select ‘Front Office’ in ‘Type’.
  5. Click [Review].
  6. Select the row with the 'Deposit Entry' payment for the client.
  7. Click [OK].
  8. Enter desired ‘Batch Number’.
  9. Enter desired ‘Deposit Date’.
  10. Select desired ‘Category’.
  11. Enter desired ‘Bank Ref #’.
  12. Enter desired ‘Comments.
  13. Click [Post].
  14. Open ‘Client Ledger’ for the client.
  15. Process the ‘Simple’ ledger report.
  16. Validate that the 'Deposit Entry' payment posted to the client’s account.
  17. Close the report.
  18. Close the form.
  19. Use Crystal Reports or other SQL reporting tool to query the 'SYSTEM.unacknowledged_payments' table, specific to the client. Validate that no results are returned.
Topics
• NX • Payment Acknowledgement • Deposit Entry
2022 Update 149 Summary | Details
Diagnosis - Add Diagnosis
Scenario 1: Enrollment Diagnosis - Add a diagnosis when Avatar PM is not connected to Avatar CWS
Specific Setup:
  • The 'Avatar PM->Episode Management->Movement Options->->Enable Enrollments' registry setting is enabled.
  • Programs must be defined as Enrollment Programs in the 'Program Maintenance' form.
  • Client must be admitted to an active episode (Client A).
  • Avatar CWS is disconnected form Avatar PM in the 'Connect/Disconnect Application Namespace' form.
Steps
  1. Select "Client A" and access the ‘Enrollment Diagnosis’ form.
  2. Select the desired enrollment in the 'Enrollment Number' field.
  3. Enter the desired date in the 'Date of Diagnosis' field.
  4. Enter the desired time in the 'Time of Diagnosis' field.
  5. Click [New Row].
  6. Select the desired value in the 'Diagnosis Search' field.
  7. Select "Active" in the 'Status' field.
  8. Enter the desired date in the 'Estimated Onset Date' field.
  9. Select "Primary" in the 'Ranking' field.
  10. Enter the desired practitioner in the 'Diagnosis Practitioner' field.
  11. Click [Submit] and [Yes].
  12. Select the diagnosis row edited in the previous steps.
  13. Click [Edit].
  14. Validate the new diagnosis data is displayed.
  15. Close the form.
Scenario 2: Diagnosis - Add a diagnosis when Avatar PM is not connected to Avatar CWS
Specific Setup:
  • Client must be enrolled in an active episode (Client A).
  • Avatar CWS is disconnected form Avatar PM in the 'Connect/Disconnect Application Namespace' form.
Steps
  1. Select "Client A" and access the ‘Diagnosis’ form.
  2. Select the desired value in the 'Type Of Diagnosis' field.
  3. Enter the desired date in the 'Date Of Diagnosis' field.
  4. Enter the desired time in the 'Time Of Diagnosis' field.
  5. Click [New Row].
  6. Select the desired value in the 'Diagnosis Search' field.
  7. Select "Active" in the 'Status' field.
  8. Enter the desired date in the 'Estimated Onset Date' field.
  9. Select "Primary" in the 'Ranking' field.
  10. Enter the desired practitioner in the 'Diagnosis Practitioner' field.
  11. Click [Submit] and [Yes].
  12. Select the diagnosis row edited in the previous steps.
  13. Click [Edit].
  14. Validate the new diagnosis data is displayed.
  15. Close the form.
Topics
• Diagnosis
2022 Update 153 Summary | Details
837 Professional - Print Bill
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
  • Practitioner Numbers By Guarantor And Program
  • Admission (Outpatient)
  • Financial Eligibility
  • Site Specific Section Modeling (CWS)
  • Dictionary Update (CWS)
  • Practitioner Enrollment
  • Progress Notes (Group and Individual)
  • Client Ledger
  • Create Interim Billing Batch File
  • Print Bill
  • Electronic Billing
Scenario 1: File Import - Practitioner Numbers By Guarantors and Programs
Specific Setup:
  • An existing Practitioner Numbers By Guarantor and Program record is identified. Note the practitioner.
  • A 'Practitioner Numbers By Guarantor and Program' file import file is created that contains desired fields for the existing record.
  • Note the practitioner, guarantors, programs, and effective dates included in the file. Note the file name.
  • The File Import spreadsheet is included in the update zip file for guidance in creating the file.
Steps
  1. Open the "File Import" form.
  2. Select 'Practitioner Numbers By Guarantor and Program Dates' in 'File Type'
  3. Upload the file from Setup.
  4. Compile the uploaded file.
  5. Verify the file compiles successfully.
  6. Select the 'Print File' option and review the report.
  7. Verify the report displays correct data correctly.
  8. Post the compiled file.
  9. Verify that the file posts successfully.
  10. Close the form.
  11. Open the 'Practitioner Numbers By Guarantor and Program' form.
  12. Select the 'Print Practitioner Numbers' option.
  13. Select the practitioner identified in the file import file.
  14. Select the guarantors and programs included in the file import file.
  15. Process the report.
  16. Verify the report displays the imported data for the practitioner.
  17. Close the report.
  18. Close the form.
Scenario 2: Registry Setting - Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = Y
Specific Setup:
  • Registry Setting:
  • Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Enable New Practitioner Numbers By Guarantor and Program Form = ‘Y’.
  • Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Specify Additional Fields To Show = ‘2’, at a minimum.
  • Avatar PM->Billing->Electronic Billing->All 837 Submissions->->Include Notes From Charge Input = 'N'.
  • Avatar PM->Billing->Electronic Billing->837 Professional->->Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = ‘Y’.
  • Client A: Identify an active client that can be billed using 837 Professional or HCFA-1500 billing.
  • Note the client’s program.
  • Validate that there is an active Diagnosis record.
  • Validate that there is an active Financial Eligibility record, noting the guarantor(s). Note the Financial Class(es).
  • Guarantor/Program Billing Defaults
  • Edit the desired template that contains the client's program and guarantor(s).
  • Paper CMS 1500: Place a checkmark in the 'Participating Provider Information for AHCCCS Billing' checkbox of the 'Form Locator 19 Alternate Value' field.
  • 837 Professional: Place a checkmark in the 'Participating Provider Information for AHCCCS Billing' checkbox of the 'Claim Note Text (837P-2300-NTE-02) Alternate Value' field.
  • Practitioner Enrollment: Identify a minimum of two practitioners that are used for billing services.
  • Practitioner Numbers By Guarantor and Program: Add unique values, for each practitioner, to the following fields, noting the values.
  • 'HCFA-1500 Form Locator 19'.
  • 'Claim Note Reference Code (837P-2300-NTE-01)'.
  • 'Claim Note Text (837P-2300-NTE-01)'.
  • CWS Dictionary Update: Other CWS Tabled Files – Select a ‘SS Note Single Response Dictionary’. In this example this dictionary was selected: (7271.3) SS Note Single Response Dictionary 100. Add ‘Dictionary Codes and Values. The codes represent the School ID and the values represent the School Name.
  • CWS Dictionary Update: CWS – Select the same ‘SS Note Single Response Dictionary’. In this example this dictionary was selected: (7271.3) SS Note Single Response Dictionary 100. Add ‘Dictionary Codes and Values. The codes represent the School ID and the values represent the School Name.
  • Site Specific Section Modeling (CWS).
  • Select a 'Progress Note' form to add a modeled field to, such as Progress Notes (Group and Individual).
  • Add a new row that will use the ‘SS Note Single Response Dictionary’ selected above.
  • Select desired value in 'Initially Required'.
  • Select desired value in 'Exclude from Data Collection Instrument'.
  • Select 'Use as 'File as Claim Note Text' in 837P-2300-NTE-02/HCFA-1500 FL 19 - Single Response Dictionary
  • Submit the form.
  • Client Charge Input: Create a charge for the client and one of the practitioners. Note the date.
  • Progress Notes: Using the modeled form, create a charge for the client and the other practitioner. Note the date.
  • Create Interim Billing Batch File is used to create a batch for the two services.
  • Close Charges is used to close the charges.
Steps
  1. Open ‘Print Bill’.
  2. Enter the last date of service in ‘Print Charges Thru’.
  3. Select ‘No’ in ‘Create Claims Y/N’.
  4. Select ‘HCFA-1500-NPI Version (Sort By Practitioner) in ‘Print On What Form’.
  5. Select ‘Yes’ in ‘Print For Interim Batch’.
  6. Select desired ‘Interim Batch Number’.
  7. Click [Process].
  8. Validate that ‘Form Locator 19’ field contains the value added to ‘Practitioner Numbers By Guarantor and Program’ during setup for the service practitioner.
  9. Go to the next page of the bill and validate that ‘Form Locator 19’ field contains the value added to ‘ Practitioner Numbers By Guarantor and Program’ during setup for the service practitioner.
  10. Close the report.
  11. Close the form.
  12. Open ‘Electronic Billing’.
  13. Select ‘837-Professional’ in ‘Billing Form’.
  14. Select the desired ‘Financial Class’ in ‘Type Of Bill’.
  15. Select ‘Individual’ in ‘Individual Or All Guarantors’.
  16. Select the desired ‘Guarantor’.
  17. Select desired value in ‘Billing Type’.
  18. Select ‘Sort File’ in ‘Billing Options’.
  19. Enter desired ‘File Description’.
  20. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
  21. Select ‘desired ‘Interim Billing Batch Number’.
  22. Select ‘No’ in ‘Create Claims’.
  23. Enter the ‘First Date Of Service To Include’.
  24. Enter the ‘Last Date Of Service To Include’.
  25. Select ‘All’ in ‘Include Primary and/or Secondary Billing’.
  26. Click [Process].
  27. Click [OK] on ‘Compile Complete’ message.
  28. Select ‘Dump File’ in ‘Billing Options’.
  29. Select ‘Print’ in ‘Select ‘Dump File’ in ‘Billing Options’.
  30. Select the ‘File’, which contains the ‘File Description’ added above.
  31. Click [Process].
  32. Validate that the claim loop does contains an NTE segment, that displays the data added to 'Practitioner Numbers by Guarantor and Program' during Setup, for fields 'Claim Note Reference Code (837P-2300-NTE-01' and 'Claim Note Text (837P-2300-NTE-01)'. The NTE segment will also contain the data from the Site Specific Section Modeling field for the service created by the progress note. The field will dispaly as 'OBxx', where 'OB' is the prefix and 'xx' is the dictionary code
  33. Close the report.
  34. Close the form.
Scenario 3: Registry Setting - Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = N
Specific Setup:
  • Registry Setting:
  • Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Enable New Practitioner Numbers By Guarantor and Program Form = ‘Y’.
  • Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Specify Additional Fields To Show = ‘2’, at a minimum.
  • Avatar PM->Billing->Electronic Billing->All 837 Submissions->->Include Notes From Charge Input = 'N'.
  • Avatar PM->Billing->Electronic Billing->837 Professional->->Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = ‘N’.
  • Client A: Identify an active client that can be billed using 837 Professional or HCFA-1500 billing.
  • Note the client’s program.
  • Validate that there is an active Diagnosis record.
  • Validate that there is an active Financial Eligibility record, noting the guarantor(s). Note the Financial Class(es).
  • Practitioner Enrollment: Identify a minimum of two practitioners that are used for billing services.
  • Practitioner Numbers By Guarantor and Program: The field 'HCFA-1500 Form Locator 19' has been added to the form. For the practitioners selected above, select the clients’ program and guarantors, and edit the existing record to add unique values to the 'HCFA-1500 Form Locator 19' field.
  • CWS Dictionary Update: Other CWS Tabled Files – Select a ‘SS Note Single Response Dictionary’. In this example this dictionary was selected: (7271.3) SS Note Single Response Dictionary 100. Add ‘Dictionary Codes and Values. The codes represent the School ID and the values represent the School Name.
  • CWS Dictionary Update: CWS – Select the same ‘SS Note Single Response Dictionary’. In this example this dictionary was selected: (7271.3) SS Note Single Response Dictionary 100. Add ‘Dictionary Codes and Values. The codes represent the School ID and the values represent the School Name.
  • Site Specific Section Modeling (CWS).
  • Select a 'Progress Note' form to add a modeled field to, such as Progress Notes (Group and Individual).
  • Add a new row that will use the ‘SS Note Single Response Dictionary’ selected above.
  • Select desired value in 'Initially Required'.
  • Select desired value in 'Exclude from Data Collection Instrument'.
  • Select 'Use as 'File as Claim Note Text' in 837P-2300-NTE-02/HCFA-1500 FL 19 - Single Response Dictionary
  • Submit the form.
  • Client Charge Input: Create a charge for the client and one of the practitioners. Note the date.
  • Progress Notes: Using the modeled form, create a charge for the client and the other practitioner. Note the date.
  • Create Interim Billing Batch File is used to create a batch for the two services.
  • Close Charges is used to close the charges.
Steps
  1. Open ‘Print Bill’.
  2. Enter the last date of service in ‘Print Charges Thru’.
  3. Select ‘No’ in ‘Create Claims Y/N’.
  4. Select ‘HCFA-1500-NPI Version (Sort By Practitioner) in ‘Print On What Form’.
  5. Select ‘Yes’ in ‘Print For Interim Batch’.
  6. Select desired ‘Interim Batch Number’.
  7. Click [Process].
  8. Validate that ‘Form Locator 19’ field contains the value added to ‘ Practitioner Numbers By Guarantor and Program’ during setup for the service practitioner.
  9. Go to the next page of the bill and validate that ‘Form Locator 19’ field contains the value added to ‘ Practitioner Numbers By Guarantor and Program’ during setup for the service practitioner.
  10. Close the report.
  11. Close the form.
  12. Open ‘Electronic Billing’.
  13. Select ‘837-Professional’ in ‘Billing Form’.
  14. Select the desired ‘Financial Class’ in ‘Type Of Bill’.
  15. Select ‘Individual’ in ‘Individual Or All Guarantors’.
  16. Select the desired ‘Guarantor’.
  17. Select desired value in ‘Billing Type’.
  18. Select ‘Sort File’ in ‘Billing Options’.
  19. Enter desired ‘File Description’.
  20. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
  21. Select ‘desired ‘Interim Billing Batch Number’.
  22. Select ‘No’ in ‘Create Claims’.
  23. Enter the ‘First Date Of Service To Include’.
  24. Enter the ‘Last Date Of Service To Include’.
  25. Select ‘All’ in ‘Include Primary and/or Secondary Billing’.
  26. Click [Process].
  27. Click [OK] on ‘Compile Complete’ message.
  28. Select ‘Dump File’ in ‘Billing Options’.
  29. Select ‘Print’ in ‘Select ‘Dump File’ in ‘Billing Options’.
  30. Select the ‘File’, which contains the ‘File Description’ added above.
  31. Click [Process].
  32. Validate that the claim loop does not contain an NTE segment.
  33. Close the report.
  34. Close the form.
Topics
• File Import • NX • Print Bill • Progress Notes • 837 Professional
2022 Update 154 Summary | Details
File Import - Service Guarantor Definition Performance Improvement
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Service Codes
  • File Import
  • Service Fee
Scenario 1: File Import - Guarantor Definitions
Specific Setup:
  • Set the registry setting "Import Process Type" to "FU&GU".
  • Using the "Service Codes" form, add a new service code for testing purposes.
  • Create a delimited file to be used for the service code guarantor definition file import.
  • Set the registry setting "Import File Delimiter" to the desired value to match the format of the delimited file created in the previous steps.
Steps
  1. Open the "File Import" form.
  2. Import the service fee import file created in setup.
  3. Process a file through file upload, compile and posting processes.
  4. Open the "Service Fee/Cross Reference Maintenance" form.
  5. Navigate to the "Guarantor Definition" section.
  6. Validate the data from the import file is displayed in the form.
Scenario 2: File Import - Service Fee/Cross Reference
Specific Setup:
  • Set the registry setting "Import Process Type" to "FU&GU".
  • Using the "Service Codes" form, add a new service code for testing purposes.
  • Create a delimited file to be used for the service code file import.
  • Set the registry setting "Import File Delimiter" to the desired value to match the format of the delimited file created in the previous steps.
Steps
  1. Open the "File Import" form.
  2. Import the service fee import file created in setup.
  3. Process a file through file upload, compile and posting processes.
  4. Open the "Service Fee/Cross Reference Maintenance" form.
  5. Click the "Service Fee/Cross Reference Definition Report" button.
  6. Validate the report contains the service fee data that was added via the file import.
Topics
• Service Fee/Cross Reference and Guarantor Definition Export • Service Fee/Cross Reference Maintenance