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Avatar PM 2023 Monthly Release 2023.02.00 Acceptance Tests

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Update 31 Summary | Details
Web Service - WEBSVC.AppointmentScheduling.CLS
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • SOAPUI - FileClientChargeInputICD10
  • SOAPUI - AddAppointment
Scenario 1: Client Charge Input - Validate the 'FileClientChargeInputICD10' web service
Specific Setup:
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor code/name.
  • Service codes:
  • An existing service code is identified to be used. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing client is identified or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
Steps
  1. Open SoapUI or any other web service tool.
  2. Set up the 'FileClientChargeInputICD10' method of the 'ClientChargeInput' web service.
  3. Create a new Client Charge Input request for a desired client by specifying the Date of Service, ClientID, Episode Number, diagnosis information and service code within quotes.
  4. Verify the web service displays error message: The following fields are invalid : Service Code : Invalid Service code : "[SERVICE CODE]".
  5. Remove the quotes from the web service request.
  6. File the request again.
  7. Verify the web service files successfully and displays confirmation message: "Client Charge Input web service has been filed successfully."
  8. Login to Avatar.
  9. Open the 'Edit Service Information' form.
  10. Select desired client.
  11. Select desired service.
  12. Verify the service details are correct as filed via web service request.
  13. Click [Submit].
  14. Click [No].
Scenario 2: Appointment Scheduling Web Services - Validating 'AddAppointment' method
Specific Setup:
  • Practitioner Enrollment:
  • An existing practitioner is identified. Note practitioner code/name.
  • Staff Members Hours and Exceptions:
  • The practitioner identified above is defined with hours.
  • Service codes:
  • An existing service code is identified to be used. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing client is identified or a new client is admitted. Note client id, admission program, admission date.
Steps
  1. Access SOAPUI or any other web service tool.
  2. File the 'AddAppointment' method of the Appointment Scheduling web service.
  3. Login to Avatar.
  4. Open the 'Scheduling Calendar' form.
  5. Verify that the appointment is on the calendar and the appointment details are correct as filed in the web service.
Edit Service Information - Editing service for the client
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Charge Input
Scenario 1: Edit Service Information - Field Validation
Specific Setup:
  • Registry Setting:
  • The 'Enable Program Filter By Facility Identification Code' registry setting is enabled.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor code/name.
  • Service codes:
  • An existing service code is identified to be used. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing client is identified or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
  • Client Charge Input:
  • A service is rendered to the client. Note service date, service code.
  • Client Ledger:
  • A service distributed correctly to the assigned guarantor.
Steps
  1. Open the 'Edit Service Information' form.
  2. Select the desired client in the 'Client ID' field.
  3. Select desired episode from the 'Episode Number' field.
  4. Click [Select Service(s) To Edit].
  5. Verify the 'Select Service(s) To Edit' dialog is displayed.
  6. Select desired service from the 'Select Service(s) To Edit' dialog.
  7. Enter a different value in the 'Duration (Minutes)' field.
  8. Select a new service code in the 'Service Code' field.
  9. Click [OK].
  10. Submit the form.
  11. Validate a "Form Return" message is displayed stating: Submitting has completed. Do you wish to return to form?
  12. Click [No].
  13. Query the 'SYSTEM.billing_tx_history' SQL table.
  14. Validate the 'PATID' column is equal to the correct client id identified in the setup.
  15. Validate the 'date_of_service' column is equal to correct date of service rendered to the client.
  16. Validate the 'duration' column is equal to the correct duration added in the 'Edit Service Information' form.
  17. Validate the 'Service Code' column contains correct service code submitted in the 'Edit Service Information' form.
  18. Validate the 'option_desc' column contains 'Edit Service Information'.
  19. Close the crystal report.
Widget - Advanced Billing Rule Failed Compliance
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Advanced Billing Failed Compliance Report
  • Service Codes
  • Advanced Billing Rule Definition
  • Guarantors/Payors
  • Admission (Outpatient)
  • Client Charge Input
  • Crystal Report Viewer
  • Advanced Billing Rule Failed Compliance widget
  • Financial Eligibility
  • Diagnosis
  • Advanced Billing Rule Failed Compliance
  • Service Fee/Cross Reference Maintenance
  • Client Ledger
Scenario 1: Advanced Billing Rule - Advanced Billing Failed Compliance Report
Specific Setup:
  • A service code with a code length of 20 characters exists.
  • An Advanced Billing Rule Definition exists for the above service code.
  • Note the conditions that will allow the service code to fail compliance.
  • Note the 'Reason For Failed Compliance'.
  • Create a service for a client that will cause the service code to fail compliance. Note the service date.
Steps
  1. Open 'Advance Billing Failed Compliance Report'.
  2. Enter the 'Client'.
  3. Enter the service date in 'Service From Date' and Service Through Date'.
  4. Click [Launch Failed Compliance Report].
  5. Validate the 'Client'.
  6. Validate the 'Service Code'.
  7. Validate the 'Rule Description'.
  8. Validate the 'Reason for Failed Compliance'.
  9. Close the report.
  10. Close the form.
Scenario 2: Advanced Billing Rule - Verify the Advanced Billing Rule Failed Compliance widget
Specific Setup:
  • Home View:
  • The 'Advanced Billing Rule Failed Compliance' widget is available on the home view.
  • Admission:
  • An existing client is identified in the system or create a new client with an outpatient episode. Note the client id, admission program/date.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used as a primary guarantor. Note Guarantor code/Id.
  • Financial Eligibility:
  • The guarantor identified above is assigned to the client as a primary guarantor.
  • Diagnosis:
  • Client has an admission diagnosis record. Note the ICD 10 code of the diagnosis.
  • Service Codes:
  • Two existing service code are identified. Note service codes.
  • Service fee/Cross Maintenance:
  • The fee definitions are created for the service codes.
  • Advanced Billing Rule Definition:
  • Advanced Billing Rule Description - Desired value
  • Active - Yes
  • Service Code = desired service code
  • Select Service(s) That Must Also Be Rendered For Distribution = desired service code
  • Guarantor = Primary guarantor assigned to the client
  • Effective date = desired date
  • Gender = All Genders
  • Associated To Age = No
  • Rule Defines Condition For = Compliance
  • Rule Result In = Message Only
  • Client Charge Input:
  • A service is rendered to the client using the service code identified above.
  • Client Ledger:
  • The liability distributed to the primary guarantor of the client.
Steps
  1. Locate To the 'Advanced Billing Rule Failed Compliance' widget.
  2. Verify the client is added in the widget and the diagnosis listed under 'Dx Code' column is ICD10 code of the diagnosis.
File Import - Roll-Up Services Definition
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
  • Roll-Up Services Definition
Scenario 1: Roll-Up Services Definition - File Import
Specific Setup:
  • File Import: Import files have been created to add, edit, and delete a Roll-Up Services Definition that contains multiple practitioner categories.
Steps
  1. Open ‘File Import’.
  2. Select 'Roll-Up Services Definition' in ‘File Type’.
  3. Click [Upload New File] in ‘Action’.
  4. Click [Process Action].
  5. Upload the file that will add the 'Roll-Up Services Definition'.
  6. Click [Compile/Validate File] in ‘Action’.
  7. Select the uploaded file.
  8. Click [Process Action].
  9. If there are errors, click [Print Errors] in ‘Action’.
  10. Select the compiled file.
  11. Click [Process Action].
  12. Review the report and upload and compile again to resolve the errors.
  13. Click [Print File] in ‘Action’.
  14. Click [Process Action].
  15. Review the report to validate the data.
  16. Click [Post File] in ‘Action’.
  17. Select the compiled file.
  18. Click [Process Action].
  19. If desired, Click [Delete File] in ‘Action’.
  20. Select the posted file.
  21. Click [Process Action].
  22. The ‘Delete File’ message will display.
  23. Click desired value. If [Yes], the ‘Confirm message will display. Click [OK]. If [No], the ‘Delete File’ message is removed.
  24. Close the form.
  25. Open 'Roll-Up Services Definition'.
  26. Validate that the definition imported with the correct values.
  27. Close the form.
  28. Repeat steps 1-24 for the file that will edit the 'Roll-Up Services Definition'.
  29. Open 'Roll-Up Services Definition'.
  30. Validate that the edited definition contains the correct values in the edited fields.
  31. Close the form.
  32. Repeat steps 1-24 for the file that will delete the 'Roll-Up Services Definition'.
  33. Open 'Roll-Up Services Definition'.
  34. Validate that the deleted definition does not exist.
  35. Close the form.
Topics
• Add New Appointment • Web Services • Edit Service Information • NX • Advanced Billing Rule Definition • File Import • Roll-Up Services Definition
Update 34 Summary | Details
File Import - [Support Only] Guarantor Nature
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Ledger
  • File Import
  • Guarantor Nature File Import
  • Guarantors/Payors
  • Financial Eligibility
  • Cross Episode Financial Eligibility
  • Family Financial Eligibility
  • Family Registration
Scenario 1: File Import - [Support Only] Guarantor Nature – Non-contract guarantor to Contract - 'If Customized Retain Customization' = 'Y' in File Import and client has two guarantors
Steps

**Internal testing only
Topics
• Guarantor/Payors • Guarantor • NX • File Import
Update 43 Summary | Details
Compile/Edit/Post/Unpost Roll-Up Services Worklist
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Product Updates (PM)
Internal Test Only
Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist
Update 44 Summary | Details
Avatar PM - support for Integrated eSignature functionality
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Update Client Data
  • Admission (Outpatient)
  • Discharge
  • Pre Admit
  • Pre Admit Discharge
Scenario 1: 'Admission' form - Field Validation
Specific Setup:
  • A client is enrolled in an existing episode (Client A).
Steps
  1. Select "Client A" and access the 'Admission' form.
  2. Select an existing episode and click [Edit].
  3. Select the "Demographics" section.
  4. Validate the 'Consent On File For Use of Integrated eSignature' field is present with values of "Yes" and "No".
  5. Select "No" in the 'Consent On File For Use of Integrated eSignature' field.
  6. Click [Submit].
  7. Select "Client A" and access the 'Admission' form.
  8. Select an existing episode and click [Edit].
  9. Select the "Demographics" section.
  10. Validate "No" is selected in the 'Consent On File For Use of Integrated eSignature' field.
  11. Close the form.
  12. Access Crystal Reports or other SQL reporting tool.
  13. Create a report using the 'SYSTEM.patient_current_demographics' SQL table.
  14. Navigate to the row for "Client A".
  15. Validate the 'esig_consent_on_file_code' field is present and contains "N".
  16. Validate the 'esig_consent_on_file_value' field is present and contains "No".
  17. Close the report.
  18. Create a report using the 'SYSTEM.patient_demographic_history' SQL table.
  19. Navigate to the row for "Client A".
  20. Validate the 'esig_consent_on_file_code' field is present and contains "N".
  21. Validate the 'esig_consent_on_file_value' field is present and contains "No".
  22. Close the report.
Scenario 2: 'Update Client Data' form - Verification of 'Client Demographics' form fields
Specific Setup:
  • A client is enrolled in an existing episode (Client A).
Steps
  1. Select "Client A" and access the 'Update Client Data' form.
  2. Validate the 'Consent On File For Use of Integrated eSignature' field is present with values of "Yes" and "No".
  3. Select "Yes" in the 'Consent On File For Use of Integrated eSignature' field.
  4. Click [Submit].
  5. Select "Client A" and access the 'Update Client Data' form.
  6. Validate "Yes" is selected in the 'Consent On File For Use of Integrated eSignature' field.
  7. Close the form.
  8. Access Crystal Reports or other SQL reporting tool.
  9. Create a report using the 'SYSTEM.patient_current_demographics' SQL table.
  10. Navigate to the row for "Client A".
  11. Validate the 'esig_consent_on_file_code' field is present and contains "Y".
  12. Validate the 'esig_consent_on_file_value' field is present and contains "Yes".
  13. Close the report.
  14. Create a report using the 'SYSTEM.patient_demographic_history' SQL table.
  15. Navigate to the row for "Client A".
  16. Validate the 'esig_consent_on_file_code' field is present and contains "Y".
  17. Validate the 'esig_consent_on_file_value' field is present and contains "Yes".
  18. Close the report.
Scenario 3: 'Admission (Outpatient)' form - Field Validation
Specific Setup:
  • A client is enrolled in an existing outpatient episode (Client A).
Steps
  1. Select "Client A" and access the 'Admission (Outpatient)' form.
  2. Select an existing episode and click [Edit].
  3. Select the "Demographics" section.
  4. Validate the 'Consent On File For Use of Integrated eSignature' field is present with values of "Yes" and "No".
  5. Select "Yes" in the 'Consent On File For Use of Integrated eSignature' field.
  6. Click [Submit].
  7. Select "Client A" and access the 'Admission (Outpatient)' form.
  8. Select an existing episode and click [Edit].
  9. Select the "Demographics" section.
  10. Validate "Yes" is selected in the 'Consent On File For Use of Integrated eSignature' field.
  11. Close the form.
  12. Access Crystal Reports or other SQL reporting tool.
  13. Create a report using the 'SYSTEM.patient_current_demographics' SQL table.
  14. Navigate to the row for "Client A".
  15. Validate the 'esig_consent_on_file_code' field is present and contains "Y".
  16. Validate the 'esig_consent_on_file_value' field is present and contains "Yes".
  17. Close the report.
  18. Create a report using the 'SYSTEM.patient_demographic_history' SQL table.
  19. Navigate to the row for "Client A".
  20. Validate the 'esig_consent_on_file_code' field is present and contains "Y".
  21. Validate the 'esig_consent_on_file_value' field is present and contains "Yes".
  22. Close the report.
Scenario 4: 'Discharge' form - Field Validation
Specific Setup:
  • A client is enrolled in an existing episode (Client A).
Steps
  1. Select "Client A" and access the 'Discharge' form.
  2. Select an existing episode and click [Edit].
  3. Enter the desired date in the 'Date Of Discharge' field.
  4. Enter the desired time in the 'Discharge Time' field.
  5. Select the desired value in the 'Type Of Discharge' field.
  6. Select the desired practitioner in the 'Discharge Practitioner' field.
  7. Select the "Demographics" section.
  8. Validate the 'Consent On File For Use of Integrated eSignature' field is present with values of "Yes" and "No".
  9. Select "Yes" in the 'Consent On File For Use of Integrated eSignature' field.
  10. Click [Submit].
  11. Select "Client A" and access the 'Discharge' form.
  12. Select the discharged episode and click [Edit].
  13. Select the "Demographics" section.
  14. Validate the 'Consent On File For Use of Integrated eSignature' field contains "Yes".
  15. Close the form.
  16. Access Crystal Reports or other SQL reporting tool.
  17. Create a report using the 'SYSTEM.patient_current_demographics' SQL table.
  18. Navigate to the row for "Client A".
  19. Validate the 'esig_consent_on_file_code' field is present and contains "Y".
  20. Validate the 'esig_consent_on_file_value' field is present and contains "Yes".
  21. Close the report.
  22. Create a report using the 'SYSTEM.patient_demographic_history' SQL table.
  23. Navigate to the row for "Client A".
  24. Validate the 'esig_consent_on_file_code' field is present and contains "Y".
  25. Validate the 'esig_consent_on_file_value' field is present and contains "Yes".
  26. Close the report.
Scenario 5: 'Pre Admit' form - Field Validation
Specific Setup:
  • A client is enrolled in an existing Pre Admit episode (Client A).
Steps
  1. Select "Client A" and access the 'Pre Admit' form.
  2. Select an existing episode and click [Edit].
  3. Select the "Demographics" section.
  4. Validate the 'Consent On File For Use of Integrated eSignature' field is present with values of "Yes" and "No".
  5. Select "Yes" in the 'Consent On File For Use of Integrated eSignature' field.
  6. Click [Submit].
  7. Select "Client A" and access the 'Pre Admit' form.
  8. Select an existing episode and click [Edit].
  9. Select the "Demographics" section.
  10. Validate "Yes" is selected in the 'Consent On File For Use of Integrated eSignature' field.
  11. Close the form.
  12. Access Crystal Reports or other SQL reporting tool.
  13. Create a report using the 'SYSTEM.patient_current_demographics' SQL table.
  14. Navigate to the row for "Client A".
  15. Validate the 'esig_consent_on_file_code' field is present and contains "Y".
  16. Validate the 'esig_consent_on_file_value' field is present and contains "Yes".
  17. Close the report.
  18. Create a report using the 'SYSTEM.patient_demographic_history' SQL table.
  19. Navigate to the row for "Client A".
  20. Validate the 'esig_consent_on_file_code' field is present and contains "Y".
  21. Validate the 'esig_consent_on_file_value' field is present and contains "Yes".
  22. Close the report.
Scenario 6: 'Pre Admit Discharge' form - Field Validation
Specific Setup:
  • A client is enrolled in an existing Pre Admit episode (Client A).
Steps
  1. Select "Client A" and access the 'Pre Admit Discharge' form.
  2. Select an existing episode and click [Edit].
  3. Enter the desired date in the 'Date Of Discharge' field.
  4. Enter the desired time in the 'Discharge Time' field.
  5. Select the desired value in the 'Type Of Discharge' field.
  6. Select the desired practitioner in the 'Discharge Practitioner' field.
  7. Populate any other desired fields.
  8. Select the "Demographics" section.
  9. Validate the 'Consent On File For Use of Integrated eSignature' field is present with values of "Yes" and "No".
  10. Select "No" in the 'Consent On File For Use of Integrated eSignature' field.
  11. Click [Submit].
  12. Select "Client A" and access the 'Pre Admit Discharge' form.
  13. Select the previously discharged Pre Admit episode and click [Edit].
  14. Select the "Demographics" section.
  15. Validate "No" is selected in the 'Consent On File For Use of Integrated eSignature' field.
  16. Close the form.
  17. Access Crystal Reports or other SQL reporting tool.
  18. Create a report using the 'SYSTEM.patient_current_demographics' SQL table.
  19. Navigate to the row for "Client A".
  20. Validate the 'esig_consent_on_file_code' field is present and contains "N".
  21. Validate the 'esig_consent_on_file_value' field is present and contains "No".
  22. Close the report.
  23. Create a report using the 'SYSTEM.patient_demographic_history' SQL table.
  24. Navigate to the row for "Client A".
  25. Validate the 'esig_consent_on_file_code' field is present and contains "N".
  26. Validate the 'esig_consent_on_file_value' field is present and contains "No".
  27. Close the report.
Scenario 7: 'Call Intake' form - Field Validation
Specific Setup:
  • A client is enrolled in an existing Call Intake program (Client A).
Steps
  1. Select "Client A" and access the 'Call Intake' form.
  2. Select the existing call intake record and click [Edit].
  3. Select the "Demographics" section.
  4. Validate the 'Consent On File For Use of Integrated eSignature' field is present with values of "Yes" and "No".
  5. Select "No" in the 'Consent On File For Use of Integrated eSignature' field.
  6. Click [Submit].
  7. Select "Client A" and access the 'Call Intake' form.
  8. Select the existing call intake record and click [Edit].
  9. Select the "Demographics" section.
  10. Validate "No" is selected in the 'Consent On File For Use of Integrated eSignature' field.
  11. Close the form.
  12. Access Crystal Reports or other SQL reporting tool.
  13. Create a report using the 'SYSTEM.patient_current_demographics' SQL table.
  14. Navigate to the row for "Client A".
  15. Validate the 'esig_consent_on_file_code' field is present and contains "N".
  16. Validate the 'esig_consent_on_file_value' field is present and contains "No".
  17. Close the report.
  18. Create a report using the 'SYSTEM.patient_demographic_history' SQL table.
  19. Navigate to the row for "Client A".
  20. Validate the 'esig_consent_on_file_code' field is present and contains "N".
  21. Validate the 'esig_consent_on_file_value' field is present and contains "No".
  22. Close the report.
Scenario 8: The 'ClientAdmission' - 'AddAdmission' web service: Admission of a new client
Specific Setup:
  • The 'Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields' registry setting must be set to "3" to include 'Detailed Client Name'.
Steps
  1. Access SoapUI for the 'ClientAdmission' - 'AddAdmission' web service.
  2. Enter the system code that will be used to log into Avatar in the 'SystemCode' field.
  3. Enter the user name that will be used to log into Avatar in the 'UserName' field.
  4. Enter the password that will be used to log into Avatar in the 'Password' field.
  5. Enter the desired date in the 'AdmissionDate' field.
  6. Enter the desired time in the 'AdmissionTime' field.
  7. Enter the desired practitioner in the 'AdmittingPractitioner' field.
  8. Enter the desired value in the 'ClientFirstName' field.
  9. Enter the desired value in the 'ClientLastName' field.
  10. Enter the desired value in the 'ClientMiddleName' field.
  11. Enter the corresponding name in the 'ClientName' field.
  12. Enter the desired value in the 'ESignatureConsentOnFile' field. Note: "Y" and "N" are accepted values.
  13. Enter the desired value in the 'Program' field.
  14. Enter the desired value in the 'Sex' field.
  15. Populate any other required and desired fields.
  16. Click [Run].
  17. Validate the 'Confirmation' field contains a value such as: "Client Unique ID: # Unique ID: #".
  18. Validate the 'Message' field contains: "Client Admission web service has been filed successfully".
  19. Select the client filed in the previous steps and access the 'Admission' form.
  20. Select the record filed in the previous steps and click [Edit].
  21. Validate all populated fields are displayed.
  22. Select the "Demographics" section.
  23. Validate the 'Client Last Name' field contains the value filed in the previous steps.
  24. Validate the 'Client First Name' field contains the value filed in the previous steps.
  25. Validate the 'Client Middle Name' field contains the value filed in the previous steps.
  26. Validate the 'Consent On File For Use of Integrated eSignature' field contains the value filed in the previous steps.
  27. Close the form.
Topics
• Admission • Update Client Data • Admission (Outpatient) • Discharge • Pre Admit • Pre Admit Discharge • Call Intake • Web Services
Update 48 Summary | Details
Remittance Posting - future date error
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Spreadsheet Remittance Posting
  • Crystal Report Viewer
  • Client Ledger
  • Posting/Adjustment Codes Definition
  • Spreadsheet Batch Remittance Posting
  • Remittance Post Confirmation
Scenario 1: 'Spreadsheet Remittance Posting' form - Validate 'Launch Work Screen'.
Specific Setup:
  • Payment/Adjustment Code definition:
  • Identify an existing adjustment code. Note the code value / name.
  • Admission:
  • An existing client is identified, or a new client is admitted. Note the client id.
  • Financial Eligibility:
  • Two guarantors are assigned to the client and a coverage effective date is entered. Note the guarantor codes / names.
  • Recurring Client Charge Input:
  • 5-6 services are rendered to the client. Please note, The service dates are in the coverage effective range. Note service start date/ end date.
  • Client Ledger:
  • The services are distributed to the primary guarantor.
Steps
  1. Open the 'Spreadsheet Remittance Posting' form.
  2. Select a date range for a client that contains services.
  3. Populate all required fields.
  4. Select the 'Guarantor To Post For'.
  5. Click [OK] on the guarantor balance message.
  6. Enter a 'Posting Date'.
  7. Enter a 'Date of Receipt'.
  8. Select a valid entry for 'Default Payment/Adjustment Code For Amount To Post' field.
  9. Click [Launch Work Screen].
  10. Hover over the 'Transfer Guar' field.
  11. Select a row associated with client.
  12. Verify a mini-table containing a list of guarantors that are assigned to the client's episode via 'Financial Eligibility' (excluding the current guarantor), that are active for the selected date of service, in the same order as they appear in 'Financial Eligibility'.
  13. Enter an 'Adjustment Amount'.
  14. Tab out of the field.
  15. Verify the adjustment amount does not change when tabbing out of the field.
  16. Select desired adjustment code in the 'Adjustment Code'.
  17. Tab out of the field.
  18. Verify the adjustment amount does not change when tabbing out of the field.
  19. Click [Accept].
  20. Click [Submit].
  21. Verify the payment posted successfully.
  22. Click [No].
Scenario 2: Spreadsheet Batch Remittance Posting - Validate excluded posting codes are not included in the 'Payment Code' dropdown list.
Specific Setup:
  • 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.
Steps
  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].
Topics
• Spreadsheet Remittance Posting • Spreadsheet Batch Remittance Posting
Update 57 Summary | Details
837 Professional - Payer Identifier segment (2010BB-NM1-09)
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
  • Service Codes
  • Service Fee/Cross Reference Maintenance
  • Admission (Outpatient)
  • Diagnosis
  • Financial Eligibility
  • Client Charge Input
  • Client Ledger
  • Electronic Billing
Scenario 1: 837 Professional - 2010BB
Specific Setup:
  • Registry Settings:
  • ‘Avatar PM->System Maintenance->Guarantors/Payors->->->Specify Report Only Guarantors’ = ‘Y’.
  • Guarantors/Payors: There is a minimum of two guarantors in the same ‘Financial Class’:
  • One guarantor has a value of ‘Yes’ in ‘Is This A Report Only Guarantor?’. Note the guarantor name.
  • The other guarantor has a value of ‘No’ in ‘Is This A Report Only Guarantor?’. Note the guarantor name.
  • Guarantor/Program Billing Defaults:
  • The 837 Professional Template has a value of ‘Yes’ in ‘Include This Guarantor and Program Combination For Report Only Guarantors’.
  • Client A:
  • Note the episode program.
  • Financial Eligibility: Is assigned the guarantor that has a value of ‘No’ in ‘Is This A Report Only Guarantor?’.
  • Services have been provided to the client.
  • Client Ledger: Is used to validate that the liability correctly distributed to the guarantor. Note the dates of service and guarantor.
  • Close Charges: Is used to close the charges.
  • Create Interim Billing Batch File to create a batch for the client, guarantor and service date range.
Steps
  1. Open ‘Electronic Billing’.
  2. Create an unclaimed bill for the 837 Professional using all guarantors in ‘Type of Bill’, the interim batch that was created, the service date range.
  3. Review the dump file to validate that the 2010BB contains the guarantor’s name for the guarantor with ‘Yes’ in ‘Is This A Report Only Guarantor?’.
  4. Close the report.
  5. Change the Type of Bill’ to ‘Individual’ and select the guarantor with ‘No’ in ‘Is This A Report Only Guarantor?’.
  6. Process the bill.
  7. Review the dump file to validate that the 2010BB contains the guarantor’s name for the guarantor with ‘No’ in ‘Is This A Report Only Guarantor?’.
  8. Close the report.
  9. Close the form.
Topics
• 837 Professional • NX
Update 66 Summary | Details
Quick Billing - 837 Error Report
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Quick Billing Rule Definition
  • Admission (Outpatient)
  • Client Charge Input
  • Financial Eligibility
  • Quick Billing
  • Crystal Report Viewer
Scenario 1: Quick Billing 837 Error Report form
Specific Setup:
  • Quick Billing Rule Definition:
  • Rule 1:
  • A definition is defined with a value of ‘837 Professional’ in ‘Billing Form'.
  • Note the 'Rule Description'.
  • Note the values in definition that would allow for a client/service to be selected for the rule.
  • Rule 2: An identical rule exists except the value of ‘Billing Form' is '837 Institutional'.
  • Client A:
  • Identify a client that has unclaimed services that would be selected for the rule based on the field values. Note the dates of service.
  • The client does not have a 'Diagnosis' record.
Steps
  1. Open ‘Quick Billing’.
  2. Select ‘Add New’ in ‘Add New Or Edit Existing Quick Billing Batch’.
  3. Enter the ‘First Date Of Service To Include’.
  4. Enter the ‘Last Date Of Service To Include’.
  5. Select the ‘Rule 1’ in ‘Billing Rule To Execute’.
  6. Select ‘Create Batch’, ‘Close Charges’, and ‘Generate Bills’ in ‘Quick Billing Tasks to Execute’.
  7. Enter a ‘Date Of Claim’.
  8. Click [Submit].
  9. Validate that the ‘Compile Complete’ dialog contains ‘Errors Found’.
  10. Click [OK].
  11. Click [Yes].
  12. Select ‘Edit Existing’ in ‘Add New Or Edit Existing Quick Billing Batch’.
  13. Select the ‘File’ that was created with the errors.
  14. Click [Print 837 Report].
  15. Validate that the ‘Required Data Missing: Subscriber and/or Patient Name Data’ link is enabled.
  16. Click the link.
  17. Validate that the error message contains ‘No Diagnosis Information Found’.
  18. Close the report.
  19. Select ‘Add New’ in ‘Add New Or Edit Existing Quick Billing Batch’.
  20. Enter the ‘First Date Of Service To Include’.
  21. Enter the ‘Last Date Of Service To Include’.
  22. Select the ‘Rule 2’ in ‘Billing Rule To Execute’.
  23. Select ‘Create Batch’, ‘Close Charges’, and ‘Generate Bills’ in ‘Quick Billing Tasks to Execute’.
  24. Enter a ‘Date Of Claim’.
  25. Click [Submit].
  26. Validate that the ‘Compile Complete’ dialog contains ‘Errors Found’.
  27. Click [OK].
  28. Click [Yes].
  29. Select ‘Edit Existing’ in ‘Add New Or Edit Existing Quick Billing Batch’.
  30. Select the ‘File’ that was created with the errors.
  31. Click [Print 837 Report].
  32. Validate that the ‘Required Data Missing: Patient Claim Data’ link is enabled.
  33. Click the link.
  34. Validate that the error message contains ‘No Diagnosis Information Found for Service’ and provides service description and date.
  35. Close the report.
  36. Close the form.
Topics
• Quick Billing • NX
Update 73 Summary | Details
Registry Settings - Enable BBH Service Modifiers
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • User Definition
  • BBH Setup
Scenario 1: Registry Setting - Enable BBH Service Modifiers
Steps
  1. Open the "Registry Settings" form.
  2. Enable the registry setting "Enable BBH Service Modifiers".
  3. Open the "User Definition" form.
  4. Validate the 2 forms "BBH Setup" and "Adult/Child Eligibility Category" are visible.
  5. Give the user access to the "BBH Setup" form and the "Adult/Child Eligibility Category" form.
  6. Refresh menus.
  7. Validate the "BBH Setup" form can be opened.
  8. Validate the "Adult/Child Eligibility Category" form can be opened.
  9. Open the "Registry Settings" form.
  10. Disable the registry setting "Enable BBH Service Modifiers".
  11. Open the "User Definition" form.
  12. Validate the 2 forms "BBH Setup" and "Adult/Child Eligibility Category" are no longer visible.
  13. Refresh menus.
  14. Validate the "BBH Setup" form is no longer available.
  15. Validate the "Adult/Child Eligibility Category" is no longer available.
BBH Setup - Update BBH modifiers included on 837 Professional and HCFA bills.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • BBH Setup
  • User Definition
Scenario 1: BBH Setup Form - Field Validations
Specific Setup:
  • Open the "Registry Settings" form.
  • Enable the registry setting "Enable BBH Service Modifiers".
  • Open the "User Definition" form.
  • Give the user access to the "BBH Setup" form.
  • Refresh menus.
Steps
  1. Open the "BBH Setup" form.
  2. Populate each field on the form.
  3. Add multiple rows in the "Certification Category" table.
  4. File the form.
  5. Open the "BBH Setup" form.
  6. Validate the fields re display as they were previously filed.
  7. Edit one of the rows in the "Certification Category" table.
  8. Delete a row from the table.
  9. Open the "BBH Setup" form.
  10. Ensure that a default eligibility category of "Not Eligible" is established.
Adult/Child Eligibility Category form - BBH functionality for 837 Professional and HCFA-1500 bills.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Adult/Child Eligibility Category
  • User Definition
Scenario 1: Adult/Child Eligibility Category - Field validations
Specific Setup:
  • Open the "Registry Settings" form.
  • Enable the registry setting "Enable BBH Service Modifiers".
  • Open the "User Definition" form.
  • Give the user access to the "BBH Setup" form and the "Adult/Child Eligibility Category" form.
  • Refresh menus.
  • Open the "BBH Setup" form.
  • Select the "Guarantor(s)" to include.in BBH processing by selecting them in the "Avatar Guarantors for BBH".
  • Select any service codes desired to be excluded from BBH processing.
  • Select any programs to excluded from BBH processing.
  • Navigate to the "Certification Category Setup" section and enter all certification categories that apply.
  • Establish effective and lapse dates of this eligibility category.
  • Establish "Modifier 1" and "Modifier 2" for the certification category.
  • At a minimum, establish a "No Eligibility" category to avoid any billing issues with any client assigned to a guarantor that is included in BBH Setup, but for whom there is no specific BBH setup. .
  • Admit a test client into any episode that is not excluded in the "BBH Setup" form.
Steps
  1. Open the "Adult/Child Eligibility Category" form.
  2. Add a row by filing in all required fields and submitting the form.
  3. Submit the form.
  4. Add another row.
  5. Edit a row by changing some data.
  6. Retrieve the edited row and validate the changes are reflected.
  7. Delete a row and validate it's been removed.
837 Professional/HCFA-1500 Bills - BBH Service Modifiers functionality.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • User Definition
  • BBH Setup
  • Adult/Child Eligibility Category
  • Financial Eligibility
  • Diagnosis
  • Client Charge Input
  • Client Ledger
  • Electronic Billing
  • Print Bill
  • Progress Notes (Group and Individual)
  • Clinical Document Viewer
Scenario 1: 837P - BBH Modifiers
Specific Setup:
  • Open the "Registry Settings" form.
  • Enable the registry setting "Enable BBH Service Modifiers".
  • Open the "User Definition" form.
  • Give the user access to the "BBH Setup" form and the "Adult/Child Eligibility Category" form.
  • Refresh menus.
  • Open the "BBH Setup" form.
  • Select the "Guarantor(s)" to include.in BBH processing by selecting them in the "Avatar Guarantors for BBH".
  • Select any service codes desired to be excluded from BBH processing.
  • Select any programs to excluded from BBH processing.
  • Set any modifiers that must be first position modifiers in the SV1 segment of the 837 Professional file.
  • Set any modifiers that must be last position modifiers in the SV1 segment of the 837 Professional file.
  • Navigate to the "Certification Category Setup" section and enter all certification categories that apply.
  • Establish effective and lapse dates of this eligibility category.
  • Establish "Modifier 1" and "Modifier 2" for the certification category.
  • At a minimum, establish a "No Eligibility" category to avoid any billing issues with any client assigned to a guarantor that is included in BBH Setup, but for whom there is no specific BBH setup. .
  • Admit a test client into any program.
  • Using the "Adult/Child Eligibility Category" form.
  • Add a row of data for the test client.
  • Select an episode to assign this data to.
  • Select "Adult" in the "Adult or Child" field.
  • Enter a Start date and an End Date.
  • Select a "Certification Category".
  • Using the "Financial Eligibility" form.
  • Assign the test client to a guarantor. Select a guarantor selected in the "BBH Setup" form.
  • Be sure to fill out all required fields.
  • Populate the "Social Security Number" and "Subscriber Policy" fields.
  • Using the "Diagnosis" form.
  • Add diagnosis data for the test client.
  • Using "Client Charge Input" form.
  • Enter in at least one service. Be sure to use a service code that is specified in the "BBH Setup" form.
  • Using the "Close Charges" form.
  • Close charges for the test client.
Steps
  1. Using the "Electronic Billing" form.
  2. Generate an 837 Professional file that includes the BBH covered guarantor, service and program.
  3. Validate the modifiers in the SV1 segment, where the first modifier is equal to Modifier 1 from the appropriate certification category as set up in "BBH Defaults" form.
  4. Also, validate the modifiers in the SV1 segment, where the last modifier is equal to Modifier 2 from the appropriate certification category as set up in "BBH Defaults" form.
  5. Using the "BBH Setup" form.
  6. Edit an existing row to add a value to the "First Modifier" and for the "Last Modifier".
  7. Using the "Electronic Billing" form.
  8. Generate an 837 Professional file that includes the BBH covered guarantor, service and program.
  9. Validate the modifiers in the SV1 segment, where the first modifier is equal to a modifier from the "First Position Modifiers" field from the appropriate certification category as set up in "BBH Defaults" form.
  10. Validate the modifiers in the SV1 segment, where the last modifier is equal to a modifier from the "Last Position Modifiers" field from the appropriate certification category as set up in "BBH Defaults" form.
  11. Open the "Registry Settings" form.
  12. Disable the registry setting "Enable BBH Service Modifiers" by setting it to "N" for "No".
  13. Open the "Electronic Billing" form.
  14. Generate an 837 Professional file for the client and service created for this test.
  15. Validate there are no modifiers from any "BBH Setup" in the SV1 segment.
Scenario 2: HCFA 1500 - BBH Modifiers
Specific Setup:
  • Open the "Registry Settings" form.
  • Enable the registry setting "Enable BBH Service Modifiers".
  • Open the "User Definition" form.
  • Give the user access to the "BBH Setup" form and the "Adult/Child Eligibility Category" form.
  • Refresh menus.
  • Open the "BBH Setup" form.
  • Select the "Guarantor(s)" to include.in BBH processing by selecting them in the "Avatar Guarantors for BBH".
  • Select any service codes desired to be excluded from BBH processing.
  • Select any programs to excluded from BBH processing.
  • Navigate to the "Certification Category Setup" section and enter all certification categories that apply.
  • Establish effective and lapse dates of this eligibility category.
  • Establish "Modifier 1" and "Modifier 2" for the certification category.
  • At a minimum, establish a "No Eligibility" category to avoid any billing issues with any client assigned to a guarantor that is included in BBH Setup, but for whom there is no specific BBH setup. .
  • Admit a test client into any program.
  • Using the "Adult/Child Eligibility Category" form.
  • Add a row of data for the test client.
  • Select an episode to assign this data to.
  • Select "Adult" in the "Adult or Child" field.
  • Enter a Start date and an End Date.
  • Select a "Certification Category".
  • Repeat these steps to enter all desired adult/child certification categories needed for testing.
  • Using the "Financial Eligibility" form.
  • Assign the test client to a guarantor. Select a guarantor selected in the "BBH Setup" form.
  • Be sure to fill out all required fields.
  • Populate the "Social Security Number" and "Subscriber Policy" fields.
  • Using the "Diagnosis" form.
  • Add diagnosis data for the test client.
  • Using "Client Charge Input" form.
  • Enter in at least one service. Be sure to use a service code that is specified in the "BBH Setup" form.
  • Using the "Close Charges" form.
  • Close charges for the test client.
Steps
  1. Using the "Print Bill form.
  2. Generate a printed bill that includes the BBH covered guarantor, service and program.
  3. Validate the modifiers in the service row, where the first modifier is equal to Modifier 1 from the appropriate certification category as set up in "BBH Defaults" form.
  4. Also, validate the modifiers in the service row where the last modifier is equal to Modifier 2 from the appropriate certification category as set up in "BBH Defaults" form.
  5. Using the "BBH Setup" form.
  6. Edit an existing row to add a value to the "First Modifier" and for the "Last Modifier".
  7. Using the "Print Bill" form.
  8. Generate a printed bill that includes the BBH covered guarantor, service and program.
  9. Validate the modifiers in the service row, where the first modifier is equal to a modifier from the "First Position Modifiers" field from the appropriate certification category as set up in "BBH Defaults" form.
  10. Validate the modifiers in the service row, where the last modifier is equal to a modifier from the "Last Position Modifiers" field from the appropriate certification category as set up in "BBH Defaults" form.
  11. Open the "Registry Settings" form.
  12. Disable the registry setting "Enable BBH Service Modifiers" by setting it to "N".
  13. Open the "Print Bill" form.
  14. Generate a printed bill for the client and service created for this test.
  15. Validate there are no modifiers from any "BBH Setup" in the service row.
Scenario 3: Progress Notes - BBH Modifiers
Specific Setup:
  • Open the "Registry Settings" form.
  • Enable the registry setting "Enable BBH Service Modifiers".
  • Open the "User Definition" form.
  • Give the user access to the "BBH Setup" form and the "Adult/Child Eligibility Category" form.
  • Refresh menus.
  • Open the "BBH Setup" form.
  • Select the "Guarantor(s)" to include.in BBH processing by selecting them in the "Avatar Guarantors for BBH".
  • Select any service codes desired to be excluded from BBH processing.
  • Select any programs to excluded from BBH processing.
  • Navigate to the "Certification Category Setup" section and enter all certification categories that apply.
  • Establish effective and lapse dates of this eligibility category.
  • Establish "Modifier 1" and "Modifier 2" for the certification category.
  • At a minimum, establish a "No Eligibility" category to avoid any billing issues with any client assigned to a guarantor that is included in BBH Setup, but for whom there is no specific BBH setup. .
  • Admit a test client into any program.
  • Using the "Adult/Child Eligibility Category" form.
  • Add a row of data for the test client.
  • Select an episode to assign this data to.
  • Select "Adult" in the "Adult or Child" field.
  • Enter a Start date and an End Date.
  • Select a "Certification Category".
Steps
  1. Open the desired progress note form.
  2. Create a progress note for a New Service. Be sure the service chosen is set to be included in BBH processing by including the service code in the "Select Service Code(s) That Progress Notes Cannot Be Entered For With this Category".
  3. Finalize the progress note.
  4. Filing will be prevented because the service code is excluded.
  5. Open the "Registry Settings" form.
  6. Disable the registry setting "Enable BBH Service Modifiers.
  7. Open the desired progress note form.
  8. Create a progress note for a New Service. Be sure the service chosen is set to be included in BBH processing by including the service code in the "Select Service Code(s) That Progress Notes Cannot Be Entered For With this Category".
  9. Finalize the progress note.
  10. Filing will be permitted as the BBH Service Modifiers logic isn't enabled.
Topics
• 837 Professional • NX • HCFA-1500 • Progress Notes
Update 77 Summary | Details
‘Inhibit Billing By Service’ and ‘File Import'
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Inhibit Billing By Service
  • Inhibited Services For Billing Report
  • Avatar NX Report Viewer
  • Crystal Report Viewer
  • Admission (Outpatient)
  • Financial Eligibility
  • File Import
  • Client Ledger
  • Diagnosis
  • Electronic Billing
  • Client Inhibited Services (Service Date Less Than 1 Year Old)
Scenario 1: Inhibited Services For Billing Report
Specific Setup:
  • Inhibit Billing by Service has been used to inhibit at least one service for a client. Note the field values.
Steps
  1. Open ‘Inhibited Services For Billing Report’.
  2. Process the report for the client.
  3. Validate that the correct data displays in the report.
  4. Close the report.
  5. Close the form.
Scenario 2: File Import - 'Client Charge Input' file type - Render a service to the client that is marked as a billing inhibited
Specific Setup:
  • Registry Settings:
  • The registry setting 'Import File Delimiter' is set to desired value.
  • Home View:
  • The 'CLIENT INHIBITED FROM BILLING (SERVICE DATE LESS THAN 1 YEAR)' widget available on the home view.
  • Program Maintenance:
  • Identify an existing program code / name. Note the program code.
  • Admission:
  • An existing client is identified. Note the client id/name, admission date, admission program code/name.
  • A 'Client Charge Input' import file is created to render a service to the client and mark that service billing inhibited.
  • The predefined client, episode number, practitioner id, service code, admission program and cost of the service are entered in the file.
Steps
  1. Open the 'File Import' form.
  2. Select the 'Client Charge Input' from the 'File Type' field.
  3. Upload the file Import file created in the setup section to mark a service as a billing inhibited.
  4. Compile the file.
  5. Verify that the file compiles successfully.
  6. Select the 'Print File' option.
  7. Review the information on compile report.
  8. Verify that all the information entered through the 'File Import' file displayed correctly in the specific field.
  9. Post the compiled file.
  10. Verify that the file posted successfully.
  11. Open the 'Crystal Report' or any other SQL data viewer.
  12. Run the query against SYSTEM.billing_tx_history table.
  13. Verify the 'billable_code' displays 'X'.
  14. Run the query against SYSTEM.inhibit_billing SQL table.
  15. Verify the inhibited service record is added in this table.
  16. Close the Crystal Report or the SQL Data Viewer.
  17. Locate to the 'CLIENT INHIBITED SERVICES (SERVICE DATE LESS THAN 1 YEAR OLD)' WIDGET.
  18. Verify the 'Client Name' and 'Episode' column displays the client name and episode for the client for whom the inhibited service is rendered through file import.
  19. Open the 'Inhibited Services For Billing report' form.
  20. Enter desired date in the 'Start Date' field.
  21. Enter desired date in the 'End Date' field.
  22. Select desired client in the 'Client' field.
  23. Click [Process Report].
  24. Verify the inhibited service record displays in the report correctly.
  25. Close the report.
Topics
• Inhibit Billing • File Import
Update 81 Summary | Details
File Import - Electronic Re-Billing Service Assignment
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
  • Crystal Report Viewer
  • Electronic Re-Billing Service Assignment
  • Client Ledger
Scenario 1: File Import - Verification of 'Electronic Re-Billing Service Assignment' file type import, 'Add' record
Specific Setup:
  • Previously generated bills containing one or more valid claim(s).
  • 'Electronic Re-Billing Service Assignment' File Import file containing one or valid import rows for 'Add' record type (value 'ADD' in segment 4).

Note - Values '3' and '4' for 'Service Inclusion/Exclusion Default' (segment 5) are only allowed where Registry Setting 'Multiple Claim Original Reference Number/Claim Submission Reason Code' is enabled.

Note - Allowed values for ' Claim Submission Reason Code' (segment 8) in import file may be restricted based on Registry Setting 'Claim Submission Reason Codes'.

Note - Allowed values for 'Claim Original Reference Number' (segment 9) in import file may be required based on Registry Setting 'Require Claim Original Reference Number'.


Steps
  1. Open 'File Import' form.
  2. Select File Type 'Electronic Re-Billing Service Assignment'.
  3. Click 'Process Action' button.
  4. Select Avatar Cal-PM 'Electronic Re-Billing Service Assignment' import file and click 'Open' button.
  5. Select 'Compile/Validate File' in 'Action' field.
  6. Select loaded import file and click 'Process Action' button.
  7. Ensure that 'Compile/Validate File' action completes.
  8. Select 'Print File' in 'Action' field.
  9. Select compiled import file and click 'Process Action' button.
  10. In 'Electronic Re-Billing Service Assignment File Import Report', ensure that all valid import row(s) are included in report results, with values from import file.
  11. Select 'Post File' in 'Action' field.
  12. Select compiled import file and click 'Process Action' button.
  13. Ensure that 'Post File' action completes.
  14. Open 'Electronic Re-Billing Service Assignment' form.
  15. Enter 'Client ID' and/or 'Claim Number' value(s) from 'Electronic Re-Billing Service Assignment' import file.
  16. Click 'Display Re-Bill Information' button.
  17. In 'Electronic Re-Billing Service Assignment Report', ensure that all re-billing records/data filed via 'File Import' are included in report results, with values from import file.
  18. In 'Electronic Re-Billing Service Assignment Report', ensure that if 'Service Inclusion/Exclusion Default' field/segment in import file is set to '1' ('Include All'), '3' ('Include All Assigned Services for Re-bill') or '4' ('Include all Un-Assigned Services For Re-Bill'), all services from claim (or assigned/unassigned services from claim) are selected/filed for re-billing inclusion.
  19. In 'Electronic Re-Billing Service Assignment Report', ensure that if 'Service Inclusion/Exclusion Default' field/segment in import file is set to '2' ('Exclude All'), only service IDs identified in import file are selected/filed for re-billing inclusion with claim.
  20. In 'Electronic Re-Billing Service Assignment Report', ensure that fields are filed with data values from import file ('Billing Form', 'Claim Submission Reason Code', 'Claim Original Reference Number').
  21. In 'Electronic Re-Billing Service Assignment Report', ensure that if 'Claim Submission Reason Code' segment/value is not included in import file row(s), value '6' ('Corrected Adjustment of Prior Claim') is filed as default.
  22. In 'Electronic Re-Billing Service Assignment Report', ensure that if 'Add' type record is filed via 'File Import' where an unbilled 'Electronic Re-Billing Service Assignment' entry already exists, the data from most recent file import is present/replaces previously filed entries.



Scenario 2: File Import - Verification of 'Electronic Re-Billing Service Assignment' file type import, 'Delete' record
Specific Setup:
  • Previously generated bills containing one or more valid claim(s).
  • Previously filed and unbilled 'Electronic Re-Billing Service Assignment' information for one or more valid claim(s)/service(s).
  • 'Electronic Re-Billing Service Assignment' File Import file containing one or valid import rows for 'Delete' record type (value 'DEL' in segment 4).
Steps
  1. Open 'File Import' form.
  2. Select File Type 'Electronic Re-Billing Service Assignment'.
  3. Click 'Process Action' button.
  4. Select 'Electronic Re-Billing Service Assignment' import file and click 'Open' button.
  5. Select 'Compile/Validate File' in 'Action' field.
  6. Select loaded import file and click 'Process Action' button.
  7. Ensure that 'Compile/Validate File' action completes.
  8. Select 'Print File' in 'Action' field.
  9. Select compiled import file and click 'Process Action' button.
  10. In 'Electronic Re-Billing Service Assignment File Import Report', ensure that all valid import 'Delete' row(s) are included in report results, with values from import file.
  11. Select 'Post File' in 'Action' field.
  12. Select compiled import file and click 'Process Action' button.
  13. Ensure that 'Post File' action completes.
  14. Open 'Electronic Re-Billing Service Assignment' form.
  15. Enter 'Client ID' and/or 'Claim Number' value(s) from 'Electronic Re-Billing Service Assignment' import file.
  16. Click 'Display Re-Bill Information' button.
  17. In 'Electronic Re-Billing Service Assignment Report', ensure that all re-billing records/data deleted via 'File Import' are deleted/not present in report results.
Topics
• File Import • Re-Bill
Update 84 Summary | Details
Roll-up Services Definition
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Service Codes
  • Service Fee/Cross Reference Maintenance
  • Roll-Up Services Definition
Scenario 1: Roll-Up Services Definition - Form / Field Validation
Specific Setup:
  • Many fields on the 'Roll-Up Services Definition' form are controlled by registry settings. To review the fields selected by your agency search 'Roll-Up' in the registry setting form.
  • Service Codes:
  • Service Code 1: Roll-Up service code. 'Type of 'Fee' = desired value. Minutes Per Unit = desired value. Note the service code/value, Minutes Per Unit and 'Covered Charge Category' for the service code.
  • Service Code 2: Component service code. 'Type of 'Fee' = desired value, Minutes Per Unit = desired value. Note the service.
  • Service Fee/Cross Reference Maintenance:
  • All service codes have a 'Fee', 'UB-04 Revenue Code' and/or 'CPT-4 / HCPCS Code' defined in 'Service Fee/Cross Reference Maintenance'. Note the fees.
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Add' in 'Add/Edit/Delete Roll-Up Services Definition'.
  3. Enter a 'Roll-Up Description'.
  4. Select a 'Roll-Up Service'.
  5. Select desired 'Component Services'.
  6. Select desired 'Required Component Service(s) for Roll-Up to Occur'.
  7. Select desired 'Component Service Date Rules'.
  8. Select desired value in 'Is This Roll-Up Services Dependent On Units, Duration, Or None'.
  9. Select desired 'Date Of Service For Roll-Up Service'.
  10. Enter data in remaining required fields, noting the values.
  11. Validate the 'Service Start Time For Roll-Up Service' field is available with the 'Time Of First Component Service' option to the 'Roll-Up Services Definition' form.
  12. Verify the 'Time Of First Component Service' option is unchecked in the 'Service Start Time For Roll-Up Service' field.
  13. Select the 'Time Of First Component Service' in the Service Start Time For Roll-Up Service' field.
  14. Click [Submit].
  15. Click [Yes] to return to the form.
  16. Select 'Edit' in 'Add/Edit/Delete Roll-Up Services Definition'.
  17. Select the same definition.
  18. Verify the fields retained all the values.
  19. Click [Submit].
  20. Click [No] to return to the form.
Topics
• Roll-Up Services Definition
Update 86 Summary | Details
Guarantor/Program Billing Defaults - CCBHC Claim Grouping
Scenario 1: Guarantor/Program Billing Defaults - CCBHC Claim Grouping - Help Message
Steps
  1. Open 'Guarantor/Program Billing Defaults'/
  2. Select 'Edit Template' in 'Action'.
  3. Select the desired template in 'Select Template'.
  4. Select the '837 Professional' section.
  5. Click the help message on the 'CCBHC Claim Grouping; field.
  6. Validate that the message contains:
  7. When 'None' is selected, the PPS charge will be billed immediately with no special claims grouping. If a CCBHC component charge associated with the PPS charge is still awaiting remittance from private insurance, it will be indicated on the billing report but the PPS charge will not be inhibited for billing.
  8. When 'Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim' is selected, the PPS charge will be inhibited for billing until the remittances for all CCBHC component charges are received. The PPS charge will be output to the same claim as the associated CCBHC component services, with the PPS charge listed first. Please Note: Selecting this value will also set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' and 'Maximum Service Information Per Claim Information For Re-Billing (Maximum LX Per CLM)' fields to a value of "1" during the 837 bill creation.
  9. When 'Separate Claims: Hold PPS Charges for Remittances from Private Insurance and Include Component Services on Separate Claims' is selected, the PPS charge will be inhibited for billing until the remittances for all CCBHC component charges are received. The PPS charge and associated CCBHC component charges will not be output to the same claim. Instead, the billing template associated to each PPS charge and CCBHC component charge will be used, making it possible for them to be output to different claims and/or billing files.
  10. Note: PPS charges are only held for remittances from private insurance when the guarantor for the associated CCBHC component charges have the Extended Dictionary Data Element 'CCBHC Billing - Exclude from check for remittance from private insurance' set to 'No'. This Extended Dictionary Data Element can be found off of the Financial Class (1000) dictionary.
  11. Click 'Return to Form'.
  12. Select the '837 Institutional' section.
  13. Click the help message on the 'CCBHC Claim Grouping; field.
  14. Validate that the message contains:
  15. When 'None' is selected, the PPS charge will be billed immediately with no special claims grouping. If a CCBHC component charge associated with the PPS charge is still awaiting remittance from private insurance, it will be indicated on the billing report but the PPS charge will not be inhibited for billing.
  16. When 'Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim' is selected, the PPS charge will be inhibited for billing until the remittances for all CCBHC component charges are received. The PPS charge will be output to the same claim as the associated CCBHC component services, with the PPS charge listed first. Please Note: Selecting this value will also set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' and 'Maximum Service Information Per Claim Information For Re-Billing (Maximum LX Per CLM)' fields to a value of "1" during the 837 bill creation.
  17. When 'Separate Claims: Hold PPS Charges for Remittances from Private Insurance and Include Component Services on Separate Claims' is selected, the PPS charge will be inhibited for billing until the remittances for all CCBHC component charges are received. The PPS charge and associated CCBHC component charges will not be output to the same claim. Instead, the billing template associated to each PPS charge and CCBHC component charge will be used, making it possible for them to be output to different claims and/or billing files.
  18. Note: PPS charges are only held for remittances from private insurance when the guarantor for the associated CCBHC component charges have the Extended Dictionary Data Element 'CCBHC Billing - Exclude from check for remittance from private insurance' set to 'No'. This Extended Dictionary Data Element can be found off of the Financial Class (1000) dictionary.
  19. Click 'Return to Form'.
  20. Click [Discard].
  21. Click [Yes].
Topics
• 837 Professional • 837 Institutional • Guarantor / Program Billing Defaults • NX
 

Avatar_PM_2023_Monthly_Release_2023.02.00_Details.csv