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Avatar PM 'Benefit Enrollment and Maintenance (834)' Coverage Date Information
The 'Benefit Enrollment and Maintenance (834)' Coverage Date handling is updated for additional Effective Date and Expiration Date conditions.
Avatar PM 'Benefit Enrollment and Maintenance (834)' compile and post processes are modified to handle health coverage details including 2300-DTP Expiration Date without 2300-DTP Effective Date, and health coverage details where there is both an Effective Date and Expiration Date for same unique consumer/policy ID within separate 2000 loop sets.
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Avatar PM 'Use 2300-DTP with 303 Qualifier as Effective Date' Registry Setting
The 'Use 2300-DTP with 303 Qualifier as Effective Date' Registry Setting is added to Avatar PM.
The Avatar PM 'Use 2300-DTP with 303 Qualifier as Effective Date' Registry Setting allows for Benefit Enrollment and Maintenance (834) compile/post to use 2300-DTP-303 (Maintenance Effective Date) value from health coverage information detail where 2300-DTP-348 (Benefit Begin Date) is not included.
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'Default Benefit Effective Date (2300-DTP-03)' Function For 834 Processing
The 'Default Benefit Effective Date (2300-DTP-03)' field is added to the Avatar PM 'Guarantors/Payors' form ('270 / 271 / 834' section).
The 'Default Benefit Effective Date (2300-DTP-03)' field in the Avatar PM 'Guarantors/Payors' form allows for Benefit Enrollment and Maintenance (834) compile/post to use beginning/first day of Coverage Expiration Date month value from health coverage information detail as Coverage Effective Date where 2300-DTP-348 (Benefit Begin Date) and/or 2300-DTP-303 (Maintenance Effective Date) is/are not included.
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Avatar PM 'Plan Coverage Description (2300-HD-04)' Registry Setting
The Avatar PM 'Plan Coverage Description (2300-HD-04)' Registry Setting is updated.
The Avatar PM 'Plan Coverage Description (2300-HD-04)' Registry Setting is updated to allow for Benefit Enrollment and Maintenance (834) compile/post determination of guarantor using both 'Plan Coverage Description' (2300-HD-04) and 'Insurer Identifier Code' (1000B-N1-04) values from 834 file information.
In addition, the following SQL changes are made for Benefit Enrollment and Maintenance (834) information:
* Additional fields are added to the Avatar PM 'SYSTEM.eligibility_subscriber', 'SYSTEM.eligibility_demographics', and 'SYSTEM.eligibility_dependent_cov' SQL tables
* The 'SYSTEM.eligibility_dep_cov_cob' SQL table is added to Avatar PM to capture data from the 2320 loop
* The 'SYSTEM.eligibility_dep_cov_cobre' SQL table is added to Avatar PM to capture data from the 2330 loop
Included Updates
33
Product Update Description
The following modifications to the 'Benefit Enrollment and Maintenance (834)' are included: 1) The 'Use 2300-DTP with 303 Qualifier as Effective Date' registry setting is added. 2) The 'Plan Coverage Description (2300-HD-04)' registry setting is updated to allow selection to determine guarantor using both 'Plan Coverage Description (2300-HD-04)' and 'Insurer Identifier Code (1000B-N1-04)'. 3) The 'Default Benefit Effective Date (2300-DTP-03)' field is added to 'Guarantors/Payors' (270 / 271 / 834). 4) Additional fields are added to the 'SYSTEM.eligibility_subscriber', 'SYSTEM.eligibility_demographics', and 'SYSTEM.eligibility_dependent_cov' tables. 5) The 'SYSTEM.eligibility_dep_cov_cob' table is added to capture data from the 2320 loop and the 'SYSTEM.eligibility_dep_cov_cobre' table is added to capture data from the 2330 loop. 6) The compile and post are modified to handle Expiration Date without Effective Date and cases where there is both an Effective Date and Expiration Date but within separate 2000 loops.
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Topics
• Benefit Enrollment and Maintenance (834)
• Registry Settings
• NX
• Guarantor/Payors
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Client Ledger - Post Contractual Adjustments
Resolves an issue to ensure that the batch contractual adjustments are applied correctly after the claim is created while running quick billing task through system task scheduler.
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Functional Or Implementation Acknowledgement (997/999) - Compiling the 999 file created from the 270 file
Resolves an issue to ensure that the 999 files created from 270 files compile successfully when the registry setting 'Maintain Unique Functional Group Control Numbers by Root System Code' is set to Y.
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Eligibility Inquiry 270 Request - Delete inquiry
Resolves an issue to ensure that the eligibility inquiry deleted successfully.
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Service/Fee Cross Reference - CPT-4 / HCPCS Modifier If Not First Instance For Service Date
Resolves an issue to ensure that the 837 professional bill does not include the modifier from the 'CPT-4 / HCPCS Modifier If Not First Instance For Service Date' field for the first instance of the service If the service is transferred to the secondary guarantor and then transferred back to the original guarantor.
Included Updates
10, 17, 21, 25, 39, 44, 57, 62, 63, 66, 67, 73, 76, 77, 78, 79
Product Update Description
The following issues are resolved: 1) The "[UNDEFINED]rp2+1^BICA" error might occur when posting contractual adjustments in the 'Contractual Allowance (Inpatient)' form. 2) 'Reference to functional group and transaction set number not created by Avatar' error message is incorrectly reported when processing a 999 Implementation Acknowledgement File in the 'Functional Or Implementation Acknowledgement (997/999)' form. 3) Deleting a generic eligibility inquiry via the 'Delete Inquiry' button in the 'Eligibility Inquiry (270) Request' form will not delete the selected inquiry. 4) Service modifier from the 'CPT-4 / HCPCS Modifier If Not First Instance For Service Date' field on the 'Service Fee/Cross Reference Maintenance' form is incorrectly included on the 837 bill.
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Topics
• Quick Billing
• System Task Scheduler
• NX
• Contractual Allowance (Outpatient)
• Contractual Allowance (Inpatient)
• Functional or Implementation Acknowledgement (997/999)
• Eligibility Inquiry (270) Request
• 837 Professional
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Registry Setting - Avatar PM - Billing - End Date California Billing
The registry setting allows entry of a date after the current date. Services with a 'Date of Service' after the date will not be subject to California billing functionality, if enabled.
Included Updates
10, 35, 57, 62, 66, 79
Required Updates
Product Update Description
The registry setting 'Avatar PM - Billing - End Date California Billing' is added to Avatar PM. Any services with a 'Date of Service' after the date entered in this registry setting will not be subject to California billing functionality, if enabled.
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Topics
• 837 Professional
• 837 Institutional
• NX
• Print Bill
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837 Billing - K3 segment
The functionality of the K3 segments of 837 bills has been updated to output date in the following order: 'Ethnicity' code, 'Race' code, Social Security number (when the relationship to insured is not self).
Included Updates
35
Product Update Description
An issue is resolved where 'Ethnicity' and 'Race' may appear in reverse order within the K3 segment of the 837I and 837P bills when "Yes" is selected in the 'Include Race/Ethnicity/SSN in 2300-K3' field within 'Guarantor Program Billing Defaults'.
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Topics
• 837 Institutional
• 837 Professional
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Accounts Receivable Console - AR Console Configuration
A new field, 'Maximum Number of Claims to Return in Search' is added to the form. The field will accept values between 50 and 999,999,999.
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Accounts Receivable Console - AR Console User Defaults Setup
A new field, 'Allow 'Copy Note' from one client to another' field is added to the form. When this new field is set to "Yes" for a given user, they will be able to copy a 'Claim Follow-Up Note' to claims for other clients.
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Accounts Receivable Console - AR Console Configuration
The 'Allow 'Claim Follow-Up Record Exists' filter to include system-generated 'AR Console Follow-Up Created' notes in search results' and 'Allow 'Claim Follow-Up Record Exists' filter to include system-generated '835 Remittance' notes in search results' fields are added to the 'AR Console Configuration' form. Setting either to "No" causes system-generated follow-up notes of the respective type to not be recognized as an existing follow-up for the purposes of the 'Claim Follow-Up Record Exists' filter.
Included Updates
10, 17, 21, 25, 35, 39, 44, 57, 62, 63, 66, 67, 73, 76, 77, 78, 79, 85, 88, 89, 93
Product Update Description
The following enhancements are made to the AR Console: 1) The 'Allow 'Copy Note' from one client to another' field is added to the 'AR Console User Defaults Setup' form. Under current functionality, a user can only copy a 'Claim Follow-Up Note' to claims for the same client. When this new field is set to "Yes" for a given user, they will be able to copy a 'Claim Follow-Up Note' to claims for other clients as well. 2) The 'Maximum Number of Claims to Return in Search' field is added to the 'AR Console Configuration' form. This enables the number of claims returned for a search in the AR Console to be configurable. 3) The 'Allow 'Claim Follow-Up Record Exists' filter to include system-generated 'AR Console Follow-Up Created' notes in search results' and 'Allow 'Claim Follow-Up Record Exists' filter to include system-generated '835 Remittance' notes in search results' fields are added to the 'AR Console Configuration' form. Setting either to "No" causes system-generated follow-up notes of the respective type to not be recognized as an existing follow-up for the purposes of the 'Claim Follow-Up Record Exists' filter.
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Topics
• Accounts Receivable Management
• NX
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Client Demographic forms - Preferred Appointment Site
myAvatar NX is enhanced to include a field labeled 'Preferred Appointment Site' on the demographic sections of the following forms - 'Update Client Data', 'Admission', 'Admission (Outpatient)', 'Call Intake', 'Pre Admit', 'Pre Admit Discharge', and 'Discharge'. Additionally, the Web Services associated with the forms are updated. The value of the 'Preferred Appointment Site' field is used to specify a default Site value when scheduling appointments for a client.
Avatar Appointment Scheduling 2023 Update 21 is required for full functionality.
Included Updates
17, 21, 39, 44, 56, 63, 67, 73, 76, 78
Product Update Description
myAvatar NX is enhanced to include a field labeled 'Preferred Appointment Site' on the client demographic forms - 'Update Client Data', 'Admission', 'Admission (Outpatient)', 'Call Intake', 'Pre Admit', 'Pre Admit Discharge', and 'Discharge'. The Web Services associated with the forms are updated. The value of the 'Preferred Appointment Site' field is used to specify a default Site value when Scheduling Appointments for a client. Avatar Appointment Scheduling 2023 Update 21 is required for full functionality.
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Topics
• Admission
• Update Client Data
• Web Services
• Pre Admit
• Call Intake
• Pre Admit Discharge
• Discharge
• Demographics
• Admission (Outpatient)
• NX
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Compile/Edit/Post/Unpost Roll-Up Services Worklist
A new registry setting, 'Use Compile Date as Posting Date for Roll-Up Component Services', is added which allows the user to determine the 'Posting Date' value.
Included Updates
None
Product Update Description
The registry setting 'Use Compile Date as Posting Date for Roll-Up Component Services' is added.
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Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist
• Roll-Up Services Definition
• NX
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Included Updates
10, 17, 18, 21, 25, 35, 39, 44, 56, 57, 62, 63, 66, 67, 72, 73, 76, 77, 78, 79, 85, 88, 89, 93, 94, 96
Product Update Description
The new field 'Always Allow Overbooking' is added to the 'Service Codes' form. The 'Service Code Upload Process' form is updated accordingly. Please note: If no custom modifications were made, form designer changes will also be applied to the 'Service Codes' form.
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Topics
• Service Codes
• Service Code Upload Process
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Included Updates
10, 17, 21, 25, 35, 39, 44, 56, 57, 62, 63, 66, 67, 73, 76, 77, 78, 79, 85, 88, 89, 93, 94, 96
Product Update Description
The 'AR Console Export' form is added.
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Topics
• Accounts Receivable Management
• NX
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Included Updates
17, 21, 39, 44, 56, 63, 67, 73, 76, 78, 96, 102
Product Update Description
The system is prepared for future functionality.
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Topics
• Remittance Processing
• NX
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Included Updates
10, 17, 18, 21, 25, 35, 39, 44, 56, 57, 62, 63, 66, 67, 72, 73, 76, 77, 78, 79, 85, 88, 89, 93, 94, 96, 98, 101, 102, 109
Required Updates
Avatar PM 2023 Update 109
Product Update Description
The system is prepared for future functionality.
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Topics
• Remittance Processing
• NX
• Widgets
• Spreadsheet Batch Remittance Posting
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Included Updates
None
Product Update Description
"ClientDischarge" and "ClientPreAdmitDischarge" web services are updated to support future functionality.
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Topics
• Discharge
• Web Services
• Pre Admit Discharge
• CareFabric
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