Avatar PM 2023 Monthly Release 2023.01.00 Acceptance Tests

• Posting/Adjustment Codes Definition has been used to create desired definitions.
• Claim Adjustment Group/Reason Code Definition has been used to create desired definitions.
• An existing client is identified.
• Three or more guarantors are assigned to the client using 'Financial Eligibility' form. Note the liability order for the guarantors.
• Services are rendered to the client so that at least one of the guarantors has no liability.
• Client Ledger is used to validate that liability distributed to the guarantors based on the setup in the 'Financial Eligibility' form.
• An Interim billing batch is created in the 'Create Interim Billing Batch File' form which includes the client / guarantor and services.

1. Open the 'Spreadsheet Remittance Batch Posting' form.
2. Select 'Create Batch' in the 'Create, Edit Or Delete Remittance Batch' field.
3. Enter the 'Batch Description'.
4. Select the interim billing batch created in the setup section in the 'Interim Batch Number' field.
5. Enter desired date in the 'Posting Date' field.
6. Enter desired date in the 'Date Of Receipt' field.
7. If desired, enter/select values in 'Receipt'.
8. If desired, enter/select values in 'Check #'
9. If desired, enter/select values in 'Default Guarantor'.
10. If desired, enter/select values in 'Default Payment Code'.
11. If desired, enter/select values in 'Default Adjustment Code'.
12. If desired, enter/select values in 'Default Transfer Code'.
13. If desired, enter/select values in 'Service Start Date'.
14. If desired, enter/select values in 'Service End Date'.
15. Click [Launch Work Screen].
16. Validate that the 'Client' defaults.
17. Validate that other entered/selected data defaults.
18. Enter a 'Transfer Amount'.
19. Enter a 'Transfer Code'.
20. Hover over the 'Transfer Guar' field.
21. Verify that a mini table will be displayed containing a list of guarantors that are assigned to the client's episode via 'Financial Eligibility' (excluding the current guarantor) and active for the selected date of service in the same order as they set up in the 'Financial Eligibility' form.
22. Select the desired guarantor to transfer to in the mini table.
23. Click [Accept].
24. Click [Submit].
25. Click [OK].
26. Click [No].
27. Open the 'Client Ledger' form.
28. Select the 'Client ID'
29. Select 'All Episodes' in 'Claim/Episode/All Episodes'.
30. Enter the desired 'From Date'.
31. Enter the desired 'To Date'.
32. Select 'Simple' in 'Ledger Type'.
33. Click [Process].
34. Validate the payment and transfer activity.
35. Click [Dismiss].
36. Close the form.

• Registry Settings:
• Avatar PM->Billing->Financial Eligibility->->->Enable Automatic Contractual Adjustment Based On Fee Table = 'O' or 'A'.
• Avatar PM->Billing->Remittance Processing->835 Health Care Claim Payment/Advice->->Compile But Don't Post Adjustments (CAS) = Y.
• Posting/Adjustment Codes Definition has been used to create desired definitions.
• Guarantors/Payors: Select a guarantor that will be the primary guarantor for the client.
• 'Contractual Guarantor Information' section:
• All required fields are enabled.
• Enable Modified Contractual Allowance Calculation has desired value.
• '835' section:
• 'Allow Adjustment Reversals' = Yes.
• Help message = If "Yes" is selected the '835 Health Care Claim Payment/Advice' and 'Spreadsheet Batch Remittance Posting' will: 1) Determine amount of any credit contractual allowance adjustments that were automatically posted for the Guarantor during liability distribution. 2) If there is a positive amount and a 'Contractual Adjustment Code (Debit)' code is selected in the 'Guarantors/Payors' (Contractual Guarantor Information) form a debit adjustment will be automatically posted to reverse the credit adjustments.
• Service Fee/ Cross Reference Maintenance:
• Identify a service code with a standard fee and a 'Guarantor Definition' for the above guarantor with the following:
• Standard Fee:
• Fee is active based on the dates in 'From Date' and 'End Date'. Note the fee.
• Guarantor Definition:
• Note the value in 'Maximum Amount To Distribute Per Service'. It should be less than the standard fee.
• Write-off Remaining Balance (Contract Guarantors Only) = Yes.
• A new client is added, or an existing client is identified. Note the Client ID/name.
• The financial eligibility record is created for the client. The client is assigned two or more guarantors. The primary guarantor is the guarantor that has the fee definition.
• Services are rendered to the client for the service code with the fee definitions. Note the service start / end date and service code used.
• The 'Client Ledger' report for the client is processed.
• Save the report for comparison.
• Note that a portion of each has service has been adjusted off.
• Close Charges is used to close the charges.
• The services do not have to be claimed to complete testing, however if preferred, create an interim billing batch, and use Electronic Billing to create claims.

1. Open the 'Spreadsheet Batch Remittance Posting' form.
2. Select "Create Batch" in the 'Create, Edit Or Delete Remittance Batch' field.
3. Enter a description in the 'Batch Description' field.
4. Enter a date in the 'Posting Date' field. Note the date.
5. Enter a date in the 'Date Of Receipt' field.
6. If desired, enter a value in 'Receipt'.
7. If desired, enter a value in 'Check #'
8. If desired, select a value in 'Default Guarantor'.
9. If desired, select a value in 'Default Payment Code'.
10. If desired, select a value in 'Default Adjustment Code'.
11. If desired, select a value in 'Default Transfer Code'.
12. If desired, enter a value in 'Service Start Date'.
13. If desired, enter a value in 'Service End Date'. Same service dates allow easier review of the Client Ledger.
14. Click [Launch Work Screen].
15. Select the 'Client'.
16. Select the 'EP #'.
17. If desired, select the 'Claim'.
18. Select the 'Payor' or verify it defaulted.
19. Enter an 'Adjust Amount'.
20. Select an 'Adjustment Code' of verify existence if a 'Default Adjustment Code' was selected.
21. Click [Accept].
22. Click [Submit].
23. Validate that the message contains 'Remittance batch 'XX' posted'.
24. Click [OK].
25. Click [No].
26. Open ‘Client Ledger’ for the client and process the report for the desired date range of services.
27. Validate that the services that were adjusted contain a reversal of the original adjustment, and the new adjustment entered in 'Spreadsheet Batch Remittance Posting'.
28. Close the report.
29. Close the form.
30. Open 'Guarantors/Payors'.
31. Edit the guarantor that was selected as the primary guarantor in Setup.
32. Select the '835' section'.
33. Change the value of 'Allow Adjustment Reversals' to 'No'.
34. Select the 'Guarantors/Payors' section.
35. Click [File].
36. Close the form.
37. Repeat steps 1 - 27.
38. Validate that the services that were adjusted do not contain a reversal of the original adjustment and do contain the new adjustment entered in 'Spreadsheet Batch Remittance Posting'.
39. Close the report.
40. Close the form.

• Registry Settings:
• Registry Setting: Avatar PM->Billing->Remittance Processing->->->Allow Posting of Zero Dollar Payment = No.
• Posting/Adjustment Codes Definition has been used to create desired definitions.
• A new client is added, or an existing client is identified. Note the Client ID/name.
• The financial eligibility record is created for the client.
• Services are rendered to the client. Note the service start / end date and service code used.
• The 'Client Ledger' report for the client is processed. Note the details of the report.
• An interim billing batch is created to include client, guarantor, and services.
• Electronic Billing is used to create claims.

1. Open the 'Spreadsheet Batch Remittance Posting' form.
2. Select "Create Batch" in the 'Create, Edit Or Delete Remittance Batch' field.
3. Enter a description in the 'Batch Description' field.
4. Enter a date in the 'Posting Date' field. Note the date.
5. Enter a date in the 'Date Of Receipt' field.
6. If desired, enter a value in 'Receipt'.
7. If desired, enter a value in 'Check #'
8. Select a value in 'Default Guarantor'.
9. If desired, enter a value in 'Service Start Date'.
10. If desired, enter a value in 'Service End Date'.
11. Click [Launch Work Screen].
12. Select the 'Client'.
13. Select the 'EP #'.
14. If desired, select the 'Claim'.
15. Select the 'Payor' or verify it defaulted.
16. Click the '+' object.
17. Verify that the correct service rows display.
18. Enter a 'Payment Amount' of '0.00'.
19. Select a 'Payment Code'.
20. Verify that 'Payment Amount' displays as required.
21. Verify that the 'Accept button is disabled.
22. Click [Cancel].
23. Click [Yes].
24. Close the form without submitting.
25. Open 'Registry Settings' and change the 'Allow Posting of Zero Dollar Payment' setting to 'Y'.
26. Click [Submit].
27. Click [OK].
28. Click [No].
29. Repeat steps 1 -19.
30. Verify that 'Payment Amount' does not display as required
31. Verify that the 'Accept button is enabled.
32. Click [Accepts].
33. Click [Submit].
34. Click [OK].
35. Click [No].

• Registry Settings:
• Avatar PM->Billing->Remittance Processing->835 Health Care Claim Payment/Advice->->Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services = N.
• Avatar PM->Billing->Remittance Processing->835 Health Care Claim Payment/Advice->->Compile But Don't Post Adjustments (CAS) = Y.
• Posting/Adjustment Codes Definition has been used to create desired definitions.
• Claim Adjustment Group/Reason Code Definition has been used to create desired definitions.
• When the ‘Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’ field has a value of 'Yes' the adjustment will not post.
• When the ‘Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’ field has a value of 'No' the adjustment will post.
• Guarantors/Payors: Select a guarantor that will be the primary guarantor for the client.
• A new client is added, or an existing client is identified. Note the Client ID/name.
• The financial eligibility record is created for the client. The client is assigned two or more guarantors. The primary guarantor is the guarantor that has the fee definition.
• Services are rendered to the client. Note the service start / end date and service code used.
• The 'Client Ledger' report for the client is processed to validate that the services distributed liability correctly.
• Close Charges is used to close the charges.
• The services do not have to be claimed to complete testing, however if preferred, create an interim billing batch, and use Electronic Billing to create claims.

1. Open the 'Spreadsheet Batch Remittance Posting' form.
2. Select "Create Batch" in the 'Create, Edit Or Delete Remittance Batch' field.
3. Enter a description in the 'Batch Description' field.
4. Enter a date in the 'Posting Date' field. Note the date.
5. Enter a date in the 'Date Of Receipt' field.
6. If desired, enter a value in 'Receipt'.
7. If desired, enter a value in 'Check #'
8. If desired, select a value in 'Default Guarantor'.
9. If desired, select a value in 'Default Payment Code'.
10. If desired, select a value in 'Default Adjustment Code'.
11. If desired, select a value in 'Default Transfer Code'.
12. If desired, enter a value in 'Service Start Date'.
13. If desired, enter a value in 'Service End Date'. Same service dates allow easier review of the Client Ledger.
14. Click [Launch Work Screen].
15. Select the 'Client'.
16. Select the 'EP #'.
17. If desired, select the 'Claim'.
18. Select the 'Payor' or verify it defaulted.
19. Click the ‘+’ item.
20. Click [Enter CARCS].
21. Create Entries for adjustments and transfers:
22. Select desired value in ‘CAS Adjustment Group Code’.
23. Select desired value in ‘CAS Adjustment Reason Code’.
24. Enter an ‘Adjustment Amount’.
25. Verify that ‘Post’ is checked on unchecked based on the value of ‘ ‘Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’.
26. Highlight a row and click 'Copy/Paste Row'.
27. Select desired value in ‘CAS Adjustment Group Code’.
28. Select desired value in ‘CAS Adjustment Reason Code’, selecting a code that is not associated to the group code.
29. Verify that an error message s received stating: The Group and Reason Codes highlighted are not currently setup and cannot be saved.
30. Select the copied row and click 'Delete Row'.
31. Confirm that a confirmation message is received.
32. Click desired value to delete or retain the row.
33. If the row is retained, change the ‘CAS Adjustment Reason Code’ to a code that is associated to the group code.
34. Click [New Row].
35. Validate that the row is added.
36. Delete the row or add data to it.
37. Click [Close/Cancel].
38. Verify a 'Cancel Confirmation' is received.
39. Click [No].
40. Click [Save] when all desired rows have been added
41. Validate that the 'Adjust Amount' contains the total of all adjustments entered.
42. Validate that the 'Transfer Amount' contains the total of all adjustments entered.
43. Validate that the 'Adjust Amount' applies to the services rows, beginning with row 1, and pays each row in full until the full amount has been used.
44. Validate that the 'Transfer Amount' applies to the services rows, beginning with the row that the 'Adjust Amounts' ended in if not paid in full. If it was paid in full the 'Transfer Amount' begins in the next row, and pays each row in full until the full amount has been used.
45. If the 'Adjustment Code' was not defaulted, please select a value.
46. If the 'Transfer Code' was not defaulted, please select a value.
47. If the 'Transfer Guar' was not defaulted, please select a value.
48. Enter a 'Payment Amount'.
49. Validate that the 'Payment Amount' applies to the services rows, beginning with the row that the 'Transfer Amounts' ended in if not paid in full. If it was paid in full the 'Payment Amount' begins in the next row, and pays each row in full until the full amount has been used.
50. Click [Accept].
51. Click [Submit].
52. Click [OK].
53. Click [No].
54. Open ‘Client Ledger’ for the client and process the report for the date range of services with activity.
55. Validate the data for the services that were paid, adjusted, and transferred.
56. Close the report.
57. Close the form.
58. Open 'Registry Settings'.
59. Change the 'Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services' setting to Y.
60. Click [Submit].
61. Click [OK].
62. Click [No].
63. Repeat steps 1 - 50.
64. Note the validation for the 'Adjust Amount', Transfer Amount' and 'Payment Amount' will be different because the amount will be divided evenly among all service rows. The final row may contain an amount that is different by a few cents.

• Registry Settings: Avatar PM->Billing->Remittance Processing->835 Health Care Claim Payment/Advice->->Compile But Don't Post Adjustments (CAS) = Y.
• Posting/Adjustment Codes Definition has been used to create desired definitions.
• Claim Adjustment Group/Reason Code Definition has been used to create desired definitions.
• Note the value in 'Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’.
• A value of 'No' allows the entry to be posted in the 'Enter CARCs' section of the 'Spreadsheet Batch Remittance Posting' form.
• A value of 'Yes' does not allow the entry to be posted in the 'Enter CARCs' section of the 'Spreadsheet Batch Remittance Posting' form.
• A new client is added, or an existing client is identified. Note the Client ID/name.
• The financial eligibility record is created for the client. The client is assigned two or more guarantors.
• Services are rendered to the client. Note the service start / end date and service code used.
• The 'Client Ledger' report for the client is processed. Note the details of the report.
• An interim billing batch is created to include client, guarantor, and services.
• Electronic Billing is used to create claims.

1. Open the 'Spreadsheet Batch Remittance Posting' form.
2. Select "Create Batch" in the 'Create, Edit Or Delete Remittance Batch' field.
3. Enter a description in the 'Batch Description' field.
4. Enter a date in the 'Posting Date' field. Note the date.
5. Enter a date in the 'Date Of Receipt' field.
6. If desired, enter a value in 'Receipt'.
7. If desired, enter a value in 'Check #'
8. If desired, select a value in 'Default Guarantor'.
9. If desired, select a value in 'Default Payment Code'.
10. If desired, select a value in 'Default Adjustment Code'.
11. If desired, select a value in 'Default Transfer Code'.
12. If desired, enter a value in 'Service Start Date'.
13. If desired, enter a value in 'Service End Date'.
14. Click [Launch Work Screen].
15. Select the 'Client'.
16. Select the 'EP #'.
17. If desired, select the 'Claim'.
18. Select the 'Payor' or verify it defaulted.
19. Click [Enter CARCs].
20. Select a 'CAS Adjustment Group Code' to create an adjustment.
21. Select a 'CAS Adjustment Reason Code' that is not associated to the 'CAS Adjustment Group Code'.
22. Enter an 'Adjustment Amount'.
23. Validate that an error is received stating: The Group and Reason codes highlighted are not currently setup and cannot be saved.
24. Change the 'CAS Adjustment Reason Code' to one the is associated to the 'CAS Adjustment Group Code'.
25. Validate that the 'Post' checkbox is checked when the group/reason code contains a 'No' in 'Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’.
26. Validate that the 'Post' checkbox is not checked when the group/reason code contains a 'Yes' in 'Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’.
27. Select a 'CAS Adjustment Group Code' to create a transfer.
28. Select a 'CAS Adjustment Reason Code' that is associated to the 'CAS Adjustment Group Code'.
29. Enter an 'Adjustment Amount'.
30. Validate that the 'Post' checkbox contains the correct value for the group/reason code.
31. If desired, enter additional adjustments and transfers. Note the total amounts for each.
32. Click [Save].
33. Validate that 'Adjust Amount' contains the total adjustment amounts.
34. Select an 'Adjustment Code' of verify existence if a 'Default Adjustment Code' was selected.
35. Validate that 'Transfer Amount' contains the total transfer amounts.
36. Select a 'Transfer Code' of verify existence if a 'Default Transfer Code' was selected.
37. Validate that 'Transfer Guar' is required'.
38. Hover over the 'Transfer Guar' field to view the table of the client's guarantors, excluding the current 'Payor'.
39. Select the desired 'Transfer Guar'.
40. Enter a 'Payment Amount'.
41. Select a 'Payment Code' of verify existence if a 'Default Payment Code' was selected.
42. Click [Accept].
43. Click [Submit].
44. Validate that the message contains 'Remittance batch 'XX' posted'.
45. Click [OK].
46. Click [No].
47. Open ‘Client Ledger’ for the client and process the report for the date range of services with activity.
48. Validate the data for the services that were paid, adjusted, or transferred.
49. Close the report.
50. Close the form.

• User Definition has been used to give the user access to the Avatar Pm > Billing > Remittance Posting > Spreadsheet Batch Remittance Posting form.
• Identify at least one client with open claims.
• Posting/Adjustment Codes Definition:
• Create a transfer code that has values in ‘Claim Adjustment Group Code (837-2430-CAS)’ and ‘Claim Adjustment Reason Code (837-2430-CAS)’. Note the values of each field.
• Claim Adjustment Group/Reason Code Definition:
• Create an entry using the same 'Claim Adjustment Group Code', and 'Claim Adjustment Reason Code' used above.
• The ‘Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’ field had a value of 'Yes'.
• Select desired values for the 'Transfer Guarantor Rules'.

1. Open the 'Spreadsheet Batch Remittance Posting' form.
2. Select "Create Batch" in the 'Create, Edit Or Delete Remittance Batch' field.
3. Enter a description in the 'Batch Description' field.
4. Enter a date in the 'Posting Date' field. Note the date.
5. Enter a date in the 'Date Of Receipt' field.
6. If desired, enter a value in ‘Receipt'.
7. If desired, enter a value in ‘Check #’. Note the value.
8. Select a payment code in the 'Default Payment Code' field
9. Select an adjustment code in the 'Default Adjustment Code' field
10. Select the transfer from setup in the 'Default Transfer Code' field.
11. Select a guarantor in the Default Trans. To Guarantor' field.
12. If desired, enter a 'Service Start Date'.
13. If desired, enter a 'Service End Date'.
14. Click the "Launch Work Screen" button.
15. Select the 'Client'.
16. Select the 'Ep #'.
17. Select the 'Claim'.
18. Select the 'Payor'.
19. Validate that 'Total Charges' contains a value.
20. Validate that 'Liability' contains a value.
21. Validate that 'Payment Amount' is '0.00'.
22. Validate that 'Adjust Amount' is '0.00'.
23. Validate that Transfer Amount' is '0.00'.
24. Click [Enter CARC(s)].
25. Select the ’Claim Adjustment Group Code’ from setup.
26. Select the ‘Claim Adjustment Reason Code' from setup.
27. Enter an amount in ‘Adjustment’.
28. Validate that the ‘Post’ checkbox is unchecked.
29. Click [Save].
30. Click [Accept].
31. Click [Submit].
32. Click [Yes].
33. Click [OK].
34. Click [No].
35. Open ‘Claim Follow-Up’.
36. Select the desired ‘Client’.
37. Select ‘Edit’ in ‘Add, Edit Or Delete Claim Follow-Up’.
38. Select the claim in ‘Select Claim Follow-Up To Edit Or Delete’.
39. Validate that ‘Denial Type’ contains a value.
40. Validate that the ‘Service(s) box contains service dates and there are checked.
41. Validate the ‘Amount Billed’ equals the amount entered in ‘Adjustment’.
42. Select ‘Edit’ in ‘Add, Edit Or Delete Row’.
43. Select the desired row in ‘Select Row To Edit Or Delete’.
44. Validate the ‘Comments’ contains ‘Spreadsheet Batch Remittance’.
45. Validate the ‘Date Of Entry’ equals the current date.
46. Click [Update Row].
47. Click [Submit].
48. Click [No].

• Registry Setting: Allow User To Continue Filing With Mismatch In Amounts To Post = Y.
• Posting/Adjustment Codes Definition has been used to create desired definitions.
• User Definition: Signed in user has a security level of '2'.
• Client:
• Identify a client with unpaid claims. Note the dates of services and the guarantor liability has distributed to.
• Verify if the client has additional guarantors in the financial eligibility record.

1. Open the 'Spreadsheet Remittance Batch Posting' form.
2. Select 'Create Batch' in the 'Create, Edit Or Delete Remittance Batch' field.
3. Enter the 'Batch Description'.
4. Enter desired date in the 'Posting Date' field.
5. Enter desired date in the 'Date Of Receipt' field.
6. If desired, enter/select values in 'Receipt'.
7. If desired, enter/select values in 'Check #'
8. If desired, enter/select values in 'Default Guarantor'.
9. If desired, enter/select values in 'Default Payment Code'.
10. If desired, enter/select values in 'Default Adjustment Code'.
11. If desired, enter/select values in 'Default Transfer Code'.
12. If desired, enter/select values in 'Service Start Date'.
13. If desired, enter/select values in 'Service End Date'.
14. Click [Launch Work Screen].
15. Select the 'Client'.
16. Select the 'EP #'.
17. Validate that other entered/selected data defaults.
18. Click the '+' item.
19. Review the balance due for the first service row.
20. Enter a partial payment amount in 'Payment Amount', noting the amount.
21. If not defaulted, select a 'Payment Code'.
22. Enter a partial adjustment amount in 'Adjust Amount', noting the amount.
23. If not defaulted, select a 'Adjust Code'.
24. Enter a partial transfer amount in 'Adjust Amount', noting the amount.
25. If not defaulted, select a 'Transfer Code'.
26. If not defaulted, select a 'Transfer Guar'.
27. Validate the amount in the 'New Balance' field.
28. Click [Accept].
29. Select the 'Remittance Totals' section.
30. Validate that 'Payment Amount Posted' contains the amount entered.
31. Validate that 'Adjustment Amount Posted' contains the amount entered.
32. Validate that 'Transfer Amount Posted' contains the amount entered.
33. Enter a value that differs from the payment amount in 'Payment Amount Total'.
34. Note the value in 'Payment Amount Remaining'.
35. Enter a value that differs from the adjustment amount in 'Adjustment Amount Total'.
36. Note the value in 'Adjustment Amount Remaining'.
37. Enter a value that differs from the transfer amount in 'Transfer Amount Total'.
38. Note the value in 'Transfer Amount Remaining'.
39. Click [Submit].
40. Validate that the message dialog contains Remittance is not balanced. Do you wish to continue posting?
41. Click [Yes].
42. Click [OK].
43. Click [No].
44. Open 'Registry Settings'.
45. Set 'Limit Registry Settings to the Following Search Criteria' to 'Allow User To Continue Filing With'.
46. Click [View Registry Settings].
47. Validate that the 'Registry Setting' contains 'Avatar PM->Billing->Remittance Processing->->->Allow User To Continue Filing With Mismatch In Amounts To Post'.
48. Set the 'Registry Setting Value' to 'N'.
49. Click [Submit].
50. Click [OK].
51. Click [No].
52. Repeat steps 2 - 39.
53. Validate that the message dialog contains 'Remittance is not balanced'.
54. Click [OK].
55. Click [Discard].
56. Click [Yes].
57. Open 'Registry Settings'.
58. Set 'Limit Registry Settings to the Following Search Criteria' to 'Allow User To Continue Filing With'.
59. Click [View Registry Settings].
60. Validate that the 'Registry Setting' contains 'Avatar PM->Billing->Remittance Processing->->->Allow User To Continue Filing With Mismatch In Amounts To Post'.
61. Set the 'Registry Setting Value' to 'S'.
62. Click [Submit].
63. Click [OK].
64. Click [No].
65. Repeat steps 2 - 39.
66. Validate that the message dialog contains 'Remittance is not balanced'.
67. Click [OK].
68. Click [Discard].
69. Click [Yes].

• An existing client with unpaid claims is identified (Client A). Note the guarantor that liability is distributed to.
• Posting/Adjustment Codes Definition:
• A payment posting code is defined to 'Exclude Guarantors' for the client's liability guarantor. Note the code/description.
• An additional payment posting code is defined to not exclude the client's liability guarantor. Note the code/description.
• User Definition': The user has access to the 'Spreadsheet Batch Remittance' form.

1. Open the 'Spreadsheet Batch Remittance Posting' form.
2. Click the 'Create Batch' field.
3. Enter the 'desired value' in the 'Batch Description' field.
4. Select the 'desired value' in 'Default Payment Code' field.
5. Enter the desired 'Posting Date'.
6. Enter the desired 'Date Of Receipt'.
7. Click [Launch Work Screen].
8. Select "Client A" in the 'Client' field.
9. Select the 'desired episode'.
10. Validate there is Liability to be remitted against.
11. Select the "excluded" guarantor from the 'Payor' field.
12. Enter the 'desired value' in the 'Payment Amount' field.
13. Double Click the 'Payment Code' field and validate it does not contain the "excluded" payment code.
14. Select the "non-excluded" payment code.
15. Click [Accept].
16. Click [Submit].
17. Click [OK].
18. Click [Yes].

• Posting/Adjustment Codes Definition has been used to create desired definitions.
• Claim Adjustment Group/Reason Code Definition has been used to create desired definitions.
• A new client is added, or an existing client is identified. Note the Client ID/name.
• The financial eligibility record is created for the client. Note the Guarantor code/name. The client is assigned two or more guarantors.
• Services are rendered to the client. Note the service start / end date and service code used.
• The 'Client Ledger' report for the client is processed. Note the details of the report.
• An interim billing batch is created to include client, guarantor, and services.
• Electronic Billing is used to create claims.

1. Open the 'Spreadsheet Remittance Batch Posting' form.
2. Select 'Create Batch' in the 'Create, Edit Or Delete Remittance Batch' field.
3. Enter the 'Batch Description'.
4. Select the interim billing batch created in the setup section in the 'Interim Batch Number' field.
5. Enter desired date in the 'Posting Date' field.
6. Enter desired date in the 'Date Of Receipt' field.
7. Enter desired value in ‘Receipt’.
8. Enter desired value in ‘Check #’.
9. Select the ‘Default Guarantor’.
10. Select the ‘Default Payment Code’.
11. Select the ‘Default Adjustment Code.
12. Select the ‘Default Transfer Code.
13. If desired, enter a 'Service Start Date'.
14. If desired, enter a 'Service End Date'.
15. Click [Launch Work Screen].
16. Validate that the data from the interim batch defaults.
17. Click [Enter CARC(s)].
18. Select desired value in 'CAS Adjustment Group Code'.
19. Select desired value in 'CAS Adjustment Reason Code'.
20. Enter an amount in 'Adjustment'.
21. Validate that the 'Post' field is checked if the group/reason code has a value of 'No' in 'Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835.
22. Enter additional CARC(s) as desired.
23. Click [Save].
24. Validate that the 'Adjust Amount' contains the total of the adjustments.
25. Validate that the 'Adjust Code' contains the default value.
26. If a transfer CARC was added, validate that the 'Transfer Amount' contains the total of the transfers.
27. Validate that the 'Transfer Code' contains the default value.
28. Hover over the 'Transfer Guar' to validate the table displays the client's guarantors, excluding the guarantor in 'Payor'.
29. Select a 'Transfer Guar'.
30. Enter a 'Payment Amount'.
31. Validate that the 'Payment Code' contains the default value.
32. If desired, click the '+' item to display the individual services.
33. Validate the payments, adjustments, and transfers within the individual services, noting the date range of services with activity.
34. Click [Accept].
35. Click [Submit].
36. Validate that the message contains 'Remittance batch 'XX' posted'.
37. Click [OK].
38. Click [No].
39. Open ‘Client Ledger’ for the client and process the report for the date range of services with activity.
40. Validate the data for the services that were paid, adjusted, or transferred.
41. Close the report.
42. Close the form.

• User Definition has been used to give two users access to the Avatar Pm > Billing > Remittance Posting > Spreadsheet Batch Remittance Posting form and the Avatar PM > Billing > Billing Reports > Batch Remittance Posting Report form. Note the User IDs and User Descriptions.
• Posting/Adjustment Codes Definition has been used to create desired definitions.
• Claim Adjustment Group/Reason Code Definition has been used to create desired definitions.
• Identify at least one client with open claims.
• Spreadsheet Batch Remittance Posting has been used to create at least one batch per user. Use different values in 'Posting Date', and 'Check #'. Note the value and the signed in user. Note the details of the batches.
• 835 Health Care Claim Payment/Advice has been used to post at least one 835 file. Note the details of the file.

1. Open 'Batch Remittance Posting Report' form.
2. Enter the desired value in the required 'Posting Date' field.
3. If desired, enter a value in the 'Posting End Date' field.
4. If desired, enter a value in the 'Check/EFT #' field.
5. If desired, enter a value in the 'Remittance File By User'.
6. Click [Process].
7. Validate that the 'Batch Remittance Posting Report' report opens and contains the following fields:
8. Batch
9. Status
10. Posting Option
11. Posting Date
12. Check/EFT Number
13. Description
14. Filed By
15. Patient
16. Ep #
17. Claim
18. Payor
19. Total Charges
20. Liability
21. Payment Amount
22. Payment Code
23. Adjust Amount
24. Adjust Code
25. Transfer Amount
26. Transfer Code
27. Transfer Guar
28. New Balance.
29. Validate that the data in the fields is correct based on the selection criteria.
30. Close the report.
31. Close the form.

• Avatar PM Registry Setting 'Claim Follow-Up' must be enabled.
• Client with claim(s)/service(s) eligible for 'Claim Follow-Up' entry.

1. Open Avatar PM 'Claim Follow-Up' form; select client record for Claim Follow-Up entry.
2. Select 'Add' in 'Add, Edit Or Delete Claim Follow-Up' field (or select 'Edit' for review/update of existing entry).
3. Select value in 'Guarantor' field.
4. Select value in 'Claim' field.
5. Select value in 'Denial Type' field.
6. Select value in 'Service(s)', 'Insurance Based Denial Reason' and '835 Denial Reason' if desired.
7. Select value in 'Assign Claim For Electronic Re-Billing' field (and 'Claim Submission Reason Code' field if applicable).
8. In Follow-Up Status/Comments form sub-section, select 'Add' in 'Add, Edit or Delete Row' field (or select 'Edit' for view/update of existing Follow-Up Status/Comments entry).
9. Select value in 'Follow-Up Status' and 'Followed Up' fields.
10. Enter/select values in 'Denial CRN#', 'Current CRN#', 'Next Follow-Up Date' and 'Completion Date' fields if desired.
11. Enter value in 'Comments' field.
12. Click 'Update Row' button to save Follow-Up Status/Comments entry.
13. Click 'Submit' button to file 'Claim Follow-Up' form/record.
14. Ensure filing confirmation dialog noting 'Claim Follow-Up has completed. Do you wish to return to form?' is presented; click 'Yes' button to return to 'Claim Follow-Up' form.
15. Select 'Edit' in 'Add, Edit Or Delete Claim Follow-Up' field for review of existing entry.
16. Select existing entry in 'Select Claim Follow-Up To Edit Or Delete' field.
17. Ensure values for all fields are present in 'Claim Follow-Up' form as previously entered/field for selected entry, including rows/entries in the Follow-Up Status/Comments form sub-section.

• Registry Setting:
• The "Enable 'Admission vs. Service Program' Functionality" registry setting is set to 'Y'.
• Program Maintenance:
• Two new outpatient admission programs are created such that there is no overlap of the associated service programs between the two admission programs. Note the admission programs and associated service programs.
• Admission (Outpatient):
• The client is admitted into the first admission program.
• Client Charge Input:
• A service is rendered to the client under one of the associated service programs. Note the service date and service code.
• Program Transfer (Outpatient):
• The client is transferred into the second admission program.

1. Open the 'Edit Service Information' form.
2. Fill in all required fields.
3. Click [Select Service(s) to Edit].
4. Verify the 'Select Service(s) to Edit' dialog box launched with all the services rendered to the selected client.
5. Select desired service to edit.
6. Verify the 'Program' field is populated with the service programs that was associated with the admission program at the time of service creation.
7. Submit the form.
8. Verify the form submits successfully.

• Client was admitted to an outpatient program and then transferred to another outpatient program. Note the program the client was transferred to and the date of transfer.

1. Open 'Admission (Outpatient)' for the client.
2. Set the 'Preadmit/Admission Time' to a date before the transfer date.
3. Set the 'Program' to the program the client was transferred to.
4. An error is correctly received because the client is currently enrolled in the program.
5. Set the 'Preadmit/Admission Time' to a date after the transfer date.
6. Set the 'Program' to the program the client was transferred to.
7. An error is correctly received because the client is currently enrolled in the program.

• A client must be enrolled in an existing episode (Client A).

1. Select "Client A" and access the 'Program Transfer' form.
2. Validate a Pre-Display is displayed.
3. Select "Episode 1" in the Pre-Display and click [OK].
4. Enter the current date in the 'Date Of Transfer' field.
5. Enter the current time in the 'Time of Transfer' field.
6. Validate the 'Program Transferred From' field contains the program "Client A" is enrolled in.
7. Select any outpatient program in the 'Program' field.
8. Click [Submit].
9. Access Crystal Reports or other SQL Reporting tool.
10. Create a query, specific to "Client A", using the 'SYSTEM.history_program_transfer' table.
11. Validate that the data in the query is correct.
12. Close the report.

• Admission:

• A new inpatient client is admitted, or an existing inpatient client is identified. Note the client’s id/name, admission date/admission program.
• A new outpatient client is admitted, or an existing outpatient client is identified. Note the client’s id/name, admission date/admission program.

1. Select the 'Program Transfer' form.
2. Select the inpatient client identified in the setup section.
3. Validate the 'Program Transferred From' field contains the admission program of the client.
4. Select desired new program from the admission program in the 'Program' field.
5. Enter desired date in the 'Date Of Transfer' field.
6. Enter desired time in the 'Time Of Transfer' field.
7. Select desired 'Unit'.
8. Select desired 'Room'.
9. Select desired 'Bed'
10. Click [Submit].
11. Open the 'Admission form' for the client.
12. Verify the client transferred to the correct program.
13. Close the form.
14. Select the 'Program Transfer (Outpatient)' form.
15. Select the outpatient client identified in the setup section.
16. Validate the 'Program Transferred From' field contains the admission program of the client.
17. Select the new program from the admission program in the 'Program' field.
18. Enter desired date in the 'Date Of Transfer' field.
19. Enter desired time in the 'Time Of Transfer' field.
20. Click [Submit].
21. Open the 'Admission' or 'Admission (Outpatient)' form for the client.
22. Verify the client transferred to the correct program.
23. Close the form.

• Registry Setting - Enable Default Guarantor Assignment = N.
• Family Registration:
• Family 1 has no ‘Family Financial Eligibility’ record.
• Family 2 has a Family Financial Eligibility’ record. Note the assigned guarantors.
• Client:
• Client 1: Is admitted in one episode and has no ‘Financial Eligibility’ record.
• Client 2: Is admitted in one episode and has a Financial Eligibility’ record. Note the assigned guarantors.
• Client 3: Is admitted in multiple episodes and has no ‘Cross Episode Financial Eligibility’ record.
• Client 4: Is admitted in multiple episodes and has a ‘Cross Episode Financial Eligibility’ record. Note the assigned guarantors.
• Guarantors/Payors:
• Guarantors are identified that will be added to ‘Guarantor Order’ in the ‘Default Guarantor Assignment’ form. The guarantors that were noted in the financial eligibility records will be added and guarantors that were not in the financial eligibility records will also be added.

1. Open ‘Registry Settings’.

2. Add a value of ‘Y’ to the ‘Enable Default Guarantor Assignment’ setting.

3. Click [Submit].

4. Close the form.

5. Open ‘Default Guarantor Assignment’.

6. Click [Clear Guarantor Oder], if the ‘Guarantor Order’ text box contains data.

7. In ‘Select Guarantor to Default‘ field select guarantors in the order that will default into the financial eligibility records. Note the values.

8. Select ‘Entry to Financial Eligibility Forms’ in ‘Default the Guarantor(s) During’.

9. Select ‘Family Financial Eligibility’ in ‘Add the Guarantor(s) to Which Form’.

10. Select ‘None Exists’ in ‘Default the Guarantor(s) Only If’.

11. Click [Submit].

12. Open ‘Family Financial Eligibility’ for Family 1.

13. Select the ‘Guarantor Selection’ item.

14. Validate that a ‘Guarantor Selection’ row exists for each of the guarantors in the ‘Guarantor Order’ and that row 1 contains the first guarantor in the order, row 2 contains the second guarantor in the order, and so forth.

15. If desired, select the ‘Guarantor Assignment’ item and assign desired guarantors to the family members.

16. Close the form.

17. Open ‘Default Guarantor Assignment’.

18. Select ‘Not a Part of Financial Eligibility/Cross Episode Financial Eligibility/Family Financial Eligibility’ in ‘Default the Guarantor(s) Only If’.

19. Open ‘Family Financial Eligibility’ for Family 2.

20. Select the ‘Guarantor Selection’ item.

21. Validate that a ‘Guarantor Selection’ row exists for each of the guarantors in the ‘Guarantor Order’ and that the existing guarantor is in row 1.

22. If desired, select the ‘Guarantor Assignment’ item and assign desired guarantors to the family members. It will be necessary to click [Clear Current Assignments] after selecting the family member.

23. Close the form.

24. Repeat steps 4 - 22 for the 'Financial Eligibility’ form and Client 1, and Client 2.

25. Repeat steps 4 - 22 for the 'Cross Episode Financial Eligibility’ form and Client 3, and Client 4.

26. Open ‘Default Guarantor Assignment’.

27. Select 'Filing of Admission' in 'Default the Guarantor(s) During'

28. Select 'Financial Eligibility' in 'Add the Guarantor(s) to Which Form'.

29. Click [Submit].

30. Enroll Client 1 in a new episode.

31. Open ‘Financial Eligibility’ for Client 1.

32. Validate that a ‘Guarantor Selection’ row exists for each of the guarantors in the ‘Guarantor Order’ and that row 1 contains the first guarantor in the order, row 2 contains the second guarantor in the order, and so forth.

33. Click [Discard].

34. Open 'Cross Episode Financial Eligibility' for Client 3.

35. Delete all guarantors.

36. Click [Submit].

37. Open ‘Default Guarantor Assignment’.

38. Select 'Filing of Admission' in 'Default the Guarantor(s) During'

39. Select 'Cross Episode Financial Eligibility' in 'Add the Guarantor(s) to Which Form'.

40. Click [Submit].

41. Enroll Client 3 into another episode,

42. Open 'Cross Episode Financial Eligibility'.

43. Validate that a ‘Guarantor Selection’ row exists for each of the guarantors in the ‘Guarantor Order’ and that row 1 contains the first guarantor in the order, row 2 contains the second guarantor in the order, and so forth.

44. Click [Discard].

• Client A: Has one or more episodes eligible for a Financial Eligibility record.
• The 'FinancialEligibility' web services has been used to add a Financial Eligibility record and used to update the added record.
• Note the field values when the record is added. Validate that a successful filing message is received.
• Change at least one field. Note the field values for all changed fields. Validate that a successful filing message is received.

1. Open ‘Financial Eligibility’ for Client A, selecting the episode if needed.
2. Verify that the guarantor order is correct.
3. Select the ‘Guarantor Selection’ section.
4. Select the desired guarantor in ‘Guarantor Information’
5. Click [Edit Selected Item].
6. Verify that the values filed in the web service application are correct, and that the fields that were changed contain the new value.
7. Repeat steps 4 & 5 for additional guarantors if more than one guarantor was added through the web service request.
8. Close the form.

• Application utilizing the Avatar PM 'CrossEpisodeFinancialEligibility' web service.

1. Using Avatar PM 'CrossEpisodeFinancialEligibility' web service, submit request to 'AddCrossEpFinancialElig' method to create new Avatar PM Cross Episode Financial Eligibility record.
2. Confirm 'CrossEpisodeFinancialEligibility' web service responds with confirmation data on successful filing of 'AddCrossEpFinancialElig' method.
3. Example: "<Confirmation>Unique ID: 123~POR.00001</Confirmation>"
4. Confirm 'CrossEpisodeFinancialEligibility' web service responds with confirmation message on successful filing of 'AddCrossEpFinancialElig' method.
5. Example: "<Message>Cross Episode Financial Eligibility web service has been filed successfully.</Message>"
6. Confirm 'CrossEpisodeFinancialEligibility' web service responds with successful status value on successful filing of 'AddCrossEpFinancialElig' method.
7. Example: " <Status>1</Status>"
8. Open Avatar PM 'Cross Episode Financial Eligibility' form and select client filed via web service for view/update.
9. Confirm new Cross Episode Financial Eligibility record is created in Avatar PM, with values/data submitted via web service.

• Application utilizing the Avatar PM 'CrossEpisodeFinancialEligibility' web service.

1. Using Avatar PM 'CrossEpisodeFinancialEligibility' web service, submit request to 'UpdateCrossEpFinancialElig' method to update existing Avatar PM Cross Episode Financial Eligibility record.
2. Confirm 'CrossEpisodeFinancialEligibility' web service responds with confirmation data on successful filing of 'UpdateCrossEpFinancialElig' method.
3. Example: "<Confirmation>Unique ID: 123~POR.00001</Confirmation>"
4. Confirm 'CrossEpisodeFinancialEligibility' web service responds with confirmation message on successful filing of 'UpdateCrossEpFinancialElig' method.
5. Example: "<Message>Cross Episode Financial Eligibility web service has been filed successfully.</Message>"
6. Confirm 'CrossEpisodeFinancialEligibility' web service responds with successful status value on successful filing of 'UpdateCrossEpFinancialElig' method.
7. Example: " <Status>1</Status>"
8. Open Avatar PM 'Cross Episode Financial Eligibility' form and select client filed via web service for view/update.
9. Confirm Cross Episode Financial Eligibility record is updated in Avatar PM, with values/data submitted via web service.

• User with Provider credentials
• User with access to Women's Health History form
• Female Client with "expected due date" filed via the "Admission" form

1. Log into Avatar with a Provider login.
2. Open "Women's Health History" form.
3. Enter values for the following fields (Pregnancy Status, Expected Due Date, and Lactating Status).
4. Add desired values to the 'Para and Gravida' section.
5. Click [Add/Update].
6. Click [File Para Records].
7. Click [Submit].
8. Click [Yes].
9. Open "Women's Health History" form.
10. Select 'Edit' on the record that was added.
11. Validate that all the data that was entered displays correctly in the form.
12. Close the form.
13. Open 'Crystal Reports' or another SQL reporting tool.
14. Execute the query: 'SELECT * FROM SYSTEM.client_condition_preg where PATID=client id AND assessment_date =current date'.
15. Validate the table cells "pregnancy_status", "expected_due_date", "lactating_status" match the inputted values from the "Women's Health History" form.
16. Open 'Crystal Reports' or another SQL reporting tool.
17. Execute the query: 'SELECT * FROM SYSTEM.patient_demographic_history where PATID=client id'.
18. Validate the table cells "pregnancy_status", "expected_due_date", "lactating_status" match the values from the ‘SYSTEM.client_condition_preg' table.