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Avatar PM 2023 Monthly Release 2023.03.02 Acceptance Tests

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Update 116 Summary | Details
File Import - Guarantors/Payors
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
  • Guarantors/Payors
Scenario 1: File Import: Guarantors Payors Add/Edit
Specific Setup:
  • File Import:
  • The 'Guarantors/Payors' file type is added to the File Import.
  • Create a import file to add a new 'Guarantors/Payors'.
  • Create a import file to edit above 'Guarantors/Payors'.
Steps
  1. Open the "File Import" form.
  2. Select the "Guarantors/Payors" in the 'File Type' field.
  3. Select "Upload New File" in the 'Action' field.
  4. Click [Process Action].
  5. Select the "File A".
  6. Select "Compile/Validate File" in the 'Action' field.
  7. Select the "File A" in the 'Files(s)' field.
  8. Click [Process Action].
  9. Validate an Information message is displayed stating: Compiled
  10. Click [OK].
  11. Select "Print File" in the 'Action' field.
  12. Select the "File A" in the 'Files(s)' field.
  13. Click [Process Action].
  14. Validate the Report Viewer displays the contents of the file.
  15. Click [Close Report].
  16. Select "Post File" in the 'Action' field.
  17. Click [Process Action].
  18. Select the "File A".
  19. Validate an Information message is displayed stating: Posted.
  20. Click [OK] and close the form.
  21. Open the "Guarantors/Payors" form.
  22. Click [Edit].
  23. Validate the form is filed with the data based on the uploaded file.
  24. Close the form.
  25. Follow steps 1-24 for Edit Guarantors/Payors File Import.
File Import - Guarantors/Payors
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
  • Guarantors/Payors
Scenario 1: File Import: Guarantors Payors Add/Edit
Specific Setup:
  • File Import:
  • The 'Guarantors/Payors' file type is added to the File Import.
  • Create a import file to add a new 'Guarantors/Payors'.
  • Create a import file to edit above 'Guarantors/Payors'.
Steps
  1. Open the "File Import" form.
  2. Select the "Guarantors/Payors" in the 'File Type' field.
  3. Select "Upload New File" in the 'Action' field.
  4. Click [Process Action].
  5. Select the "File A".
  6. Select "Compile/Validate File" in the 'Action' field.
  7. Select the "File A" in the 'Files(s)' field.
  8. Click [Process Action].
  9. Validate an Information message is displayed stating: Compiled
  10. Click [OK].
  11. Select "Print File" in the 'Action' field.
  12. Select the "File A" in the 'Files(s)' field.
  13. Click [Process Action].
  14. Validate the Report Viewer displays the contents of the file.
  15. Click [Close Report].
  16. Select "Post File" in the 'Action' field.
  17. Click [Process Action].
  18. Select the "File A".
  19. Validate an Information message is displayed stating: Posted.
  20. Click [OK] and close the form.
  21. Open the "Guarantors/Payors" form.
  22. Click [Edit].
  23. Validate the form is filed with the data based on the uploaded file.
  24. Close the form.
  25. Follow steps 1-24 for Edit Guarantors/Payors File Import.
Topics
• Guarantor/Payors • File Import
Update 121 Summary | Details
Admission - Support for ProviderConnect Enterprise
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Financial Investigation
  • CareFabric Monitor
  • Admission
  • Discharge
  • Diagnosis
  • Financial Eligibility
  • Admission (Outpatient)
  • Dictionary Update (PM)
Scenario 1: Admission - "ProviderConnect Enterprise" section
Specific Setup:
  • The 'Avatar CareFabric->ProviderConnect Enterprise->Contracting Providers->->->Enable External Connections' must be set to "Y".
  • The 'Managing Organization Definition' form must be configured for a valid managing organization.
  • A client must exist in the configured managing organization's system.
  • A practitioner must have a NPI that is mapped to a matching practitioner in the managing organization's system (Practitioner A).
Steps
  1. Access the 'Admission' form.
  2. Verify the 'Select Client' dialog is displayed.
  3. Enter the last name of the client that exists in the managing organization's system in the 'Last Name' field.
  4. Enter the first name of the client that exists in the managing organization's system in the 'First Name' field.
  5. Enter the sex of the client that exists in the managing organization's system in the 'Sex' field.
  6. Click [Search].
  7. Validate a "Search Results" message is displayed stating: No matches found.
  8. Click [OK] and [New Client].
  9. Validate a "Client" message is displayed stating: Auto Assign Next ID Number?
  10. Click [Yes].
  11. Enter the desired date in the 'Preadmit/Admission Date' field.
  12. Enter the desired time in the 'Preadmit/Admission Time' field.
  13. Select any program that is selected in the 'Associated Admission Programs' field in the 'Managing Organization Definition' form in the 'Program' field.
  14. Select the desired value in the 'Type Of Admission' field.
  15. Select "Practitioner A" in the 'Admitting Practitioner' field.
  16. Select the "ProviderConnect Enterprise Identifiers" section.
  17. Click [Add New Item].
  18. Select the defined managing organization in the 'External Organization' field.
  19. Click [Search].
  20. Select the matching client record in the 'Select Matching Client Record' dialog.
  21. Click [OK].
  22. Validate the 'External ID' field is disabled contains the client ID for the client in the managing organization's system.
  23. Click [Update Demographics].
  24. Validate an "Information" message is displayed stating: Client Demographics Information Updated.
  25. Click [OK].
  26. Select the "Demographics" section.
  27. Validate demographic fields have been updated to match the managing organization's record.
  28. Click [Submit].
  29. Select the client admitted in the previous steps and access the 'Admission' form.
  30. Select the "ProviderConnect Enterprise Identifiers" section.
  31. Select the mapping filed in the previous steps and click [Edit Selected Item].
  32. Validate the 'External Organization' field is disabled.
  33. Validate the 'External ID' field is disabled.
  34. Validate the 'Search' button is disabled.
  35. Close the form.
  36. Access Crystal Reports or other SQL Reporting Tool.
  37. Select the PM namespace.
  38. Create a report using the 'SYSTEM.pce_client_mapping' table.
  39. Validate a row is displayed for the client mapping created in the previous steps.
  40. Validate the 'ID' field contains a unique identifier (ex. 1||3||1).
  41. Validate the 'FACILITY' field contains the facility (ex. 1).
  42. Validate the 'external_PATID' field contains the ID of the client in the managing organization (ex. 16).
  43. Validate the 'local_PATID' field contains the ID of the client (ex. 3).
  44. Validate the 'managing_organization_ID' field contains the ID of the managing organization the client is mapped to (ex. 1).
  45. Close the report.
Scenario 2: ProviderConnect Enterprise- Validate the 'PutProgramAdmission' action
Specific Setup:
  • The 'Avatar CareFabric->ProviderConnect Enterprise->Contracting Providers->->->Enable External Connections' must be set to "Y".
  • The 'Managing Organization Definition' form must be configured for a valid managing organization.
  • A client must exist in the configured managing organization's system with the following on file: 'Date of Birth' and 'Social Security Number' (Client A).
  • A practitioner must have a NPI that is mapped to a matching practitioner in the managing organization's system (Practitioner A).
Steps
  1. Access the 'Admission' form.
  2. Verify the 'Select Client' dialog is displayed.
  3. Enter the last name of the client that exists in the managing organization's system in the 'Last Name' field.
  4. Enter the first name of the client that exists in the managing organization's system in the 'First Name' field.
  5. Enter the sex of the client that exists in the managing organization's system in the 'Sex' field.
  6. Click [Search].
  7. Validate a "Search Results" message is displayed stating: No matches found.
  8. Click [OK] and [New Client].
  9. Validate a "Client" message is displayed stating: Auto Assign Next ID Number?
  10. Click [Yes].
  11. Enter the desired date in the 'Preadmit/Admission Date' field.
  12. Enter the desired time in the 'Preadmit/Admission Time' field.
  13. Select any program that is selected in the 'Associated Admission Programs' field in the 'Managing Organization Definition' form in the 'Program' field.
  14. Select the desired value in the 'Type Of Admission' field.
  15. Select desired value in the 'Source Of Admission' field.
  16. Enter "Practitioner A" in the 'Admitting Practitioner' field.
  17. Enter "Practitioner A" in the 'Attending Practitioner' field.
  18. Select the "ProviderConnect Enterprise Identifiers" section.
  19. Click [Add New Item].
  20. Select the defined managing organization in the 'External Organization' field.
  21. Click [Search].
  22. Select the matching client record in the 'Select Matching Client Record' dialog.
  23. Click [OK].
  24. Validate the 'External ID' field contains the client ID for the client in the managing organization's system.
  25. Click [Update Demographics].
  26. Validate an "Information" message is displayed stating: Client Demographics Information Updated.
  27. Click [OK].
  28. Select the "Admission" section.
  29. Validate the 'Date of Birth' field contains the value on file in the managing organization's system.
  30. Validate the 'Social Security Number' field contains the value on file in the managing organization's system.
  31. Click [Submit].
  32. Access the 'ProviderConnect Enterprise Action Log'.
  33. Enter the desired date in the 'From Date' and 'Through Date' fields.
  34. Enter the desired time in the 'From Time' and 'Through Time' fields.
  35. Select the desired organization in the 'Managing Organization' field.
  36. Select "PutProgramAdmission" in the 'Action Name' field.
  37. Click [View Action Log].
  38. Verify the 'ProviderConnect Enterprise Action Log' Report is displayed.
  39. Validate the 'ProviderConnect Enterprise Action Log' Report contains a row for the 'PutProgramAdmission' action that was triggered from the 'Admission' form with a result of "Success".
  40. Close the report and the form.
Scenario 3: Admission (Outpatient) - "ProviderConnect Enterprise" section
Specific Setup:
  • The 'Avatar CareFabric->ProviderConnect Enterprise->Contracting Providers->->->Enable External Connections' must be set to "Y".
  • The 'Managing Organization Definition' form must be configured for a valid managing organization.
  • A client must exist in the configured managing organization's system.
  • A practitioner must have a NPI that is mapped to a matching practitioner in the managing organization's system (Practitioner A).
Steps
  1. Access the 'Admission (OutPatient)' form.
  2. Verify the 'Select Client' dialog is displayed.
  3. Enter the last name of the client that exists in the managing organization's system in the 'Last Name' field.
  4. Enter the first name of the client that exists in the managing organization's system in the 'First Name' field.
  5. Enter the sex of the client that exists in the managing organization's system in the 'Sex' field.
  6. Click [Search].
  7. Validate a "Search Results" message is displayed stating: No matches found.
  8. Click [OK] and [New Client].
  9. Validate a "Client" message is displayed stating: Auto Assign Next ID Number?
  10. Click [Yes].
  11. Enter the desired date in the 'Preadmit/Admission Date' field.
  12. Enter the desired time in the 'Preadmit/Admission Time' field.
  13. Select any program that is selected in the 'Associated Admission Programs' field in the 'Managing Organization Definition' form in the 'Program' field.
  14. Select the desired value in the 'Type Of Admission' field.
  15. Select "Practitioner A" in the 'Admitting Practitioner' field.
  16. Select the "ProviderConnect Enterprise Identifiers" section.
  17. Click [Add New Item].
  18. Select the defined managing organization in the 'External Organization' field.
  19. Click [Search].
  20. Select the matching client record in the 'Select Matching Client Record' dialog.
  21. Click [OK].
  22. Validate the 'External ID' field is disabled contains the client ID for the client in the managing organization's system.
  23. Click [Update Demographics].
  24. Validate an "Information" message is displayed stating: Client Demographics Information Updated.
  25. Click [OK].
  26. Select the "Demographics" section.
  27. Validate demographic fields have been updated to match the managing organization's record.
  28. Click [Submit].
  29. Select the client admitted in the previous steps and access the 'Admission' form.
  30. Select the "ProviderConnect Enterprise Identifiers" section.
  31. Select the mapping filed in the previous steps and click [Edit Selected Item].
  32. Validate the 'External Organization' field is disabled.
  33. Validate the 'External ID' field is disabled.
  34. Validate the 'Search' button is disabled.
  35. Close the form.
  36. Access Crystal Reports or other SQL Reporting Tool.
  37. Select the PM namespace.
  38. Create a report using the 'SYSTEM.pce_client_mapping' table.
  39. Validate a row is displayed for the client mapping created in the previous steps.
  40. Validate the 'ID' field contains a unique identifier (ex. 1||3||1).
  41. Validate the 'FACILITY' field contains the facility (ex. 1).
  42. Validate the 'external_PATID' field contains the ID of the client in the managing organization (ex. 16).
  43. Validate the 'local_PATID' field contains the ID of the client (ex. 3).
  44. Validate the 'managing_organization_ID' field contains the ID of the managing organization the client is mapped to (ex. 1).
  45. Close the report.
Topics
• Admission • ProviderConnect Enterprise • Admission (Outpatient) • Discharge • NX
Update 128 Summary | Details
GuarantorsPayaors Billing defaults-837 Dental-Show SV306 Quantity in the bill
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
  • Admission (Outpatient)
  • Diagnosis
  • Financial Eligibility
  • Client Charge Input
  • Client Ledger
  • Electronic Billing
  • Crystal Reports or other SQL Reporting tool (PM Namespace)
  • File Import
Scenario 1: Guarantor/Program Billing Defaults - 837 Dental - Report Billing Units as Procedure Count (2400-SV3-06)
Specific Setup:
  • Registry Setting:
  • Avatar PM Registry Setting 'Enable Dental Billing' must be enabled/set to value 'Y'.
Steps
  1. Open the 'Guarantor/Program Billing Defaults' form.
  2. Select '837 Dental' section.
  3. Verify that fields are present.
  4. Close the form.
  5. Open 'Registry Setting'
  6. Set 'Enable Dental Billing' to 'N'.
  7. Submit and close the form.
  8. Open the 'Guarantor/Program Billing Defaults' form.
  9. Select '837 Dental' section.
  10. Verify that there are no fields present.
  11. Close the form.
Scenario 2: 837 Dental Bill - Validate Quantity – Field 'Report Billing Units as Procedure Count (2400-SV3-06)' set as YES
Specific Setup:
  • Registry Setting:
  • Avatar PM Registry Setting 'Enable Dental Billing' must be enabled/set to value 'Y'.
  • Service Code:
  • A user-defined dental Service should be created by selecting 'Is This A Dental Service' as 'Yes'.
  • Enter the 'Type Of Fee' as 'User Defined'.
  • Set the 'Minutes Per Unit' as '15'.
  • Service Fee/Cross Reference Maintenance:
  • Create a Fee for the Dental service code.
  • Client A:
  • Financial Eligibility:
  • Select an existing/ active guarantor for the client.
  • Has unclaimed dental service(s), for a particular date with a duration of more than 15 which makes the units more than one, that can be billed on the 837 Dental.
  • Has unclaimed dental service(s), for date(s) different date with a duration of 15 or less which makes the units one, that can be billed on the 837 Dental.
  • Use 'Client Ledger' to note that the liability distribution contains the correct guarantor and units.
  • The client has an active diagnosis record.
  • Close the charges using 'Close Charges'.
Steps
  1. Open 'Guarantor/Program Billing Defaults' form.
  2. Select 'Edit Template' and select the existing Defaults Template for editing, or select 'Add Template' for new entry.
  3. Select the '837 Dental' section of the form.
  4. Validate that fields appear on the form.
  5. Validate that the following new field is available in the form, where the options are 'Yes' and 'No'.
  6. 'Report Billing Units as Procedure Count (2400-SV3-06)'.
  7. Ensure no values are selected in the new field.
  8. Submit the 'Guarantor/Program Billing Defaults' Form.
  9. Open 'Electronic Billing'.
  10. Create an 837 Dental for Client A. Don't create claims.
  11. Open the dump file and validate that the bill doesn't show the Quantity when the 'Report Billing Units as Procedure Count (2400-SV3-06)' field is left blank.
  12. Close the report.
  13. Close the form.
  14. Open Avatar PM 'Guarantor/Program Billing Defaults' form.
  15. Select 'Edit Template' and select the existing Defaults Template for editing.
  16. Select the '837 Dental' section of the form.
  17. Select 'No' for the 'Report Billing Units as Procedure Count (2400-SV3-06)' field.
  18. Submit the 'Guarantor/Program Billing Defaults' Form.
  19. Open 'Electronic Billing'.
  20. Create an 837 Dental for Client A. Don't create claims.
  21. Open the dump file and validate that the bill doesn't show the Quantity when the 'Report Billing Units as Procedure Count (2400-SV3-06)' field is set as 'No'.
  22. Close the report.
  23. Close the form.
  24. Open Avatar PM 'Guarantor/Program Billing Defaults' form.
  25. Select 'Edit Template' and select the existing Defaults Template for editing.
  26. Navigate to the '837 Dental' section of the form.
  27. Select 'Yes' for the 'Report Billing Units as Procedure Count (2400-SV3-06)' field.
  28. Submit the 'Guarantor/Program Billing Defaults' Form.
  29. Open 'Electronic Billing'
  30. Create an 837 Dental for Client A for the dates that have a service duration of 15 minutes or fewer. Don't create claims.
  31. Open the dump file and validate that the bill doesn't show the Quantity when the 'Report Billing Units as Procedure Count (2400-SV3-06)' field is set as 'Yes' and the Quantity is less than or equal to 1.
  32. Close the report.
  33. Close the form.
  34. Open 'Electronic Billing'
  35. Create an 837 Dental for Client A for the dates that have a service duration of greater than 15 minutes. (Don't create claims).
  36. Open the dump file and validate that the bill shows the Quantity when the 'Report Billing Units as Procedure Count (2400-SV3-06)' field is set as 'Yes' and the Quantity is more than 1.
  37. Close the report.
  38. Close the form.
  39. Open Avatar PM 'Guarantor/Program Billing Defaults' form.
  40. Select 'Template Maintenance'
  41. Select the 'Export' option in the 'Action' field.
  42. Choose the Template from the 'Select Template(s) To Export' list.
  43. Select 'Edit' in the 'Export Template As Add or Edit.' field.
  44. Click on the 'Export Template(s)' button.
  45. Ensure that the file is exported and saved.
  46. Close the form.
  47. Open 'File Import' form and import the template by selecting the exported file.
  48. Compile and Post File.
  49. Select 'Print File'.
  50. In the crystal report from the 'File Import' form, confirm that the new field as well as the below fields are on the report.
  51. sgmnts_to_suppress_code
  52. sgmnts_to_suppress_sh_val
  53. sgmnts_to_suppress_value
  54. sub_contact_name_per_2
  55. com_number_qual_per_3
  56. com_number_per_4
  57. com_number_qual_per_5
  58. com_number_per_6
  59. com_number_qual_per_7
  60. com_number_per_8
  61. ccbhc_template_code
  62. Close the report.
  63. Close the form.
  64. Open Crystal Reports or another SQL reporting tool.
  65. In SQL table 'SYSTEM.file_import_gpbdt_d837', ensure that the following fields are present:
  66. sgmnts_to_suppress_code
  67. sgmnts_to_suppress_sh_val
  68. sgmnts_to_suppress_value
  69. sub_contact_name_per_2
  70. com_number_qual_per_3
  71. com_number_per_4
  72. com_number_qual_per_5
  73. com_number_per_6
  74. com_number_qual_per_7
  75. com_number_per_8
  76. ccbhc_template_code
  77. Close the report.
  78. Close the form.
Topics
• 837 Dental
Update 132 Summary | Details
835 Health Care Claim Payment/Advice – Enable Extended Matching Criteria Functionality
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Service Codes
  • Guarantors/Payors
  • Service Fee/Cross Reference Maintenance
  • Program Maintenance
  • Admission (Outpatient)
  • Financial Eligibility
  • Diagnosis
  • Client Charge Input
  • Client Ledger
  • Electronic Billing
  • 835 Health Care Claim Payment/Advice (PM)
Scenario 1: 835 Health Care Claim Payment/Advice - Enable Extended Matching Criteria Functionality
Specific Setup:
  • Registry Setting:
  • ‘Avatar PM->Billing->Remittance Processing->835 Health Care Claim Payment/Advice->->Enable Extended Matching Criteria Functionality’ has a value of ‘Y’.
  • Service Code:
  • Service Code 1: There is a value of ‘Yes’ in ‘Include in 835 Extended Matching Criteria’.
  • Service Code 2: There is no value, or a value of ‘No’ in ‘Include in 835 Extended Matching Criteria’.
  • Guarantors/Payors:
  • There is a value of ‘Yes’ in ‘Allow Extended Matching Criteria in 835 Remittance Posting’, which is in the 835 section of the form.
  • Client:
  • Identify an active client that is assigned the above Guarantors/Payors in Financial Eligibility.
  • Client Charge Input:
  • Service Code 1: Create at least one charge. Note the date.
  • Service Code 2: Create at least one charge on a different date.
  • Close Charges is used to close the charges for the client.
  • Electronic Billing:
  • Create a claim for Service Code 1. Save the dump file for use in modifying an 835.
  • Create a separate claim for Service Code 2. Save the dump file for use in modifying an 835.
  • Modify an existing 835 to create a valid payment for the claim for Service Code 1.
  • Match a minimum of 2 out of 3 of these ‘Client’ elements: Client Name, Subscriber Policy Number or Social Security Number, and Subscriber Name (if subscriber is not the client).
  • Match all of these ‘Service’ elements: Date of Service, Cost of Service, Procedure Code/Modifiers, and the Service Code is flagged to be included in 835 extended matching criteria.
  • The claim number in the CLM segment should not match the claim number in the dump file.
  • Save the file to a local directory.
  • Modify an existing 835 to create a valid payment for the claim for Service Code 2.
  • Match a minimum of 2 out of 3 of these ‘Client’ elements: Client Name, Subscriber Policy Number or Social Security Number, and Subscriber Name (if subscriber is not the client).
  • Match all of these ‘Service’ elements: Date of Service, Cost of Service, Procedure Code/Modifiers, and the Service Code is flagged to be included in 835 extended matching criteria.
  • The claim number in the CLM segment should not match the claim number in the dump file.
Steps
  1. Open '835 Health Care Claim Payment/Advice'.
  2. Load the file created for the 'Service Code 1' claim.
  3. Validate the message: There were errors on the file load. Please run the report to view these errors. Load complete.
  4. Run the report.
  5. Validate that the error message is a warning stating: Patient Control Number ’xxxxx’ not valid. Payment will be processed for claim number '[Actual Claim Number]' based on extended matching criteria.
  6. Compile the file.
  7. Verify the 'Compile Complete' message.
  8. Click [Payments and Adjustments (These Will Be Posted Except For Those Marked As 'Compile But Do Not Post].
  9. Verify the correct payment amount displays.
  10. Post the file.
  11. Verify the 'Posting Complete' message.
  12. Open the 'Client Ledger' form.
  13. Verify the 'Client Ledger' displays the payment posted correctly.
  14. Close the form.
  15. Load the file created for the 'Service Code 2' claim.
  16. Validate the message: There were errors on the file load. Please run the report to view these errors. Load complete.
  17. Compile the file and validate that the error message states: Claim does not exist in Avatar (Patient Control Number '[Claim Number from the 835 file]').
  18. Update the 835 file with the matching claim number from the 837 file created for the Service Code 2.
  19. Open '835 Health Care Claim Payment/Advice'.
  20. Load the file for the 'Service Code 2' claim.
  21. Verify the 'Load Complete' message.
  22. Compile the file.
  23. Verify the 'Compile Complete' message.
  24. Click [Payments and Adjustments (These Will Be Posted Except For Those Marked As 'Compile But Do Not Post')].
  25. Verify the report displays correct payment amount compiled.
  26. Post the file.
  27. Verify the 'Posting Complete' message.
  28. Close the form.
  29. Open the 'Client Ledger' form.
  30. Verify the 'Client Ledger' displays the payment posted correctly.
  31. Close the form.
Topics
• 835 Health Care Claim Payment/Advice
Update 133 Summary | Details
Client Merge
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Diagnosis
  • Financial Eligibility
  • Client Charge Input
  • Client Ledger
  • CPT Code Definition (PM)
  • CPT Code Definition (MSO)
  • Funding Source Registration
  • Plan Definition
  • Applying Contracting Provider
  • Contracting Provider Registration
  • MSO to Parent System Integration Mapping
  • Member Specific Information
  • Service Authorization
  • Batch Creation - Assign ID
  • Batch Creation
  • Fast Service Entry
  • Authorization Listing
  • Fast Service Entry Filing Confirmation
  • Close Batch
  • Create Interim Billing Batch File
  • Electronic Billing
  • 837 Health Care Claim Professional
Scenario 1: 'Client Merge' - Verification of Service Information In Client Merge (Services originating in Avatar PM)
Specific Setup:
  • Client records eligible for episodic merge, where services exist for 'Source Client' record.
  • Crystal Reports or other SQL reporting tool.
Steps
  1. Create two clients with active diagnosis and financial eligibility.
  2. Open 'Client Merge' form.
  3. Select 'Source Client ID' value, using client with at least one existing episode which includes services.
  4. Select 'Source Client Episode' episode value (selecting episode which includes services), or set 'Merge All Client Data Through Single Filing' field to 'Yes'.
  5. Select 'Target Client ID' value.
  6. Click 'File' button and click 'Yes' button in the 'Do You Wish To Continue With The Indicated Action?' dialog.
  7. Ensure that merge verification dialog is presented on completion of merge.
  8. Open 'Client Ledger' form.
  9. Select 'Target Client ID' from merge in 'Client Ledger' form and enter/select any other criteria.
  10. Click 'Process' button to display Client Ledger.
  11. In Client Ledger display, ensure that all services from 'Source Client ID'/selected merged episode(s) are relocated to 'Target Client ID' and are visible in ledger.
  12. Open Crystal Reports or other SQL reporting tool.
  13. In Avatar SQL table 'SYSTEM.billing_tx_history', ensure that all service rows from the 'Source Client ID' (and episode) used in merge are updated to the 'Target Client ID' PATID value.
  14. In Avatar SQL table 'SYSTEM.billing_tx_charge_totals', ensure that all service rows from the 'Source Client ID' (and episode) used in merge are updated to the 'Target Client ID' PATID value.
  15. In Avatar SQL table 'SYSTEM.billing_tx_charge_detail', ensure that all service rows from the 'Source Client ID' (and episode) used in merge are updated to the 'Target Client ID' PATID value.
Scenario 2: Client Merge - With Service Authorization Records - Verify 'AUTuniqueid'
Specific Setup:
  • Two clients exist in programs that can be merged: Client A & Client B.
  • The programs are not the same.
  • Both clients have ‘Service Authorization’ records . Note the authorization numbers and the authorization status.
  • Registry Settings:
  • Avatar MSO->Care Management->Service Authorization->->->Enable Eligibility Check
  • This setting, along with, 'Funding Source/Guarantor Mapping' can affect the 'Current Authorization Status' of the 'Service Authorization' record after the merge.
  • Avatar PM->System Maintenance->Client Merge->->->Allow Merging Into Existing Episode = Y.
  • Avatar PM->System Maintenance->Client Merge->->->Allow Merging Of All Client Data Through Single Filing =Y.
Steps
  1. Set the set-up for '837 Health Care Claim Professional'.
  2. Load, Compile and Post the file into '837 Health Care Claim Professional'.
  3. Create an SQL Query MSO's SYSTEM.batch_clm_svc_detail table for the service that posted for Client A.
  4. Create an SQL Query PM's SYSTEM.billing_tx_history for the service that posted for Client A.
  5. Open ‘Client Merge’.
  6. Select Client A as the ‘Source Client’.
  7. Select Client B as the ‘Target Client’.
  8. Select ‘Yes’ in Merge All Client Data Through Single Filling.
  9. Click [File].
  10. Click [Yes].
  11. Click [OK].
  12. Close the form.
  13. Create an SQL Query PM's SYSTEM.billing_tx_history and note the changes in PATID and JOIN_TO_TX_HISTORY.
  14. Create an SQL Query MSO's SYSTEM.batch_clm_svc_detail table for the same CLAIMID and check that PATID and parent_nspace_link_to_DD should match.
  15. Compare the values of the two tables to validate that they match after the merge.
Topics
• Client Merge
Update 140 Summary | Details
File Import - Client Charge Input
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
  • Client Ledger
Scenario 1: File Import - Client Charge Input - Multiple add-on codes - Enable Multiple Add-On Code Per Primary Code Functionality
Specific Setup:
  • Registry Setting:
  • The Avatar PM->System Maintenance->Service Code Maintenance->->->Enable Multiple Add-On Code Per Primary Code Functionality is set to 'N'.
  • Dictionary Update:
  • File= 'Other Tabled File,
  • Data Element -291, Service Code Type'
  • Dictionary Code = 1
  • Dictionary Value = Evaluation Therapy
  • Extended dictionary 'Allow Multiple Add-On Code' = Yes
  • Service Codes:
  • A primary service code is created to have desired number of add-on with a 'Service Code Category of 'Primary Code' and a desired 'Service Code Type’. Set 'Type of Fee' to desired value. Note the code and definition.
  • A desired service code is created with a 'Service Code Category of 'Primary Add-On Code' and a desired 'Service Code Type’. Set 'Type of Fee' to desired value. Note the code and definition.
  • Maximum 10 add-on codes created with a 'Service Code Category of 'Add-On Code' and a desired 'Service Code Type. Set 'Type of Fee' to desired value. Note the code and definition.
  • All the Add-On service codes created above are checked in the 'Select Multiple Addon Codes' check list for the Primary service code.
  • A 'Service Fee/Cross Reference Maintenance' record is created for all the service codes. Note the fee for each service code.
  • An active practitioner is identified. Note the practitioner ID.
  • An active client is identified. Note the client id, name.
  • The client has an active diagnosis record. Note the diagnosis codes. The client has an active financial eligibility record. Note the financial class of the guarantor. Note the client ID. Note the episode and program.
  • Use 'Client Charge Input to create a service for the client, on the current date, using 'Service Code 5' as the 'Service Code' and 'Service Codes 1 - 4' as the 'Add-On Services'. The service has been closed.
  • File Import text files created. Note the file name and path to access that file.
  • First file is created with the valid combination of primary and associated add-on codes.
  • Second file is created with the invalid combination of primary and the add-on codes that are not associated with primary codes.
Steps
  1. Open the 'File Import' form.
  2. Select the 'Client Charge Input' from the 'File Type' field.
  3. Upload the 'Multiple Add-Ons' file created in the setup section.
  4. Compile the file.
  5. Verify the file does not compile successfully and the error message regarding the registry setting is disabled.
  6. Open the 'Registry Setting' form.
  7. Set the 'Enable Multiple Add-On Code Per Primary Code Functionality' setting and set it to 'Y'.
  8. Upload the 'Multiple Add-Ons' file created with the valid primary and add-on codes in the setup section.
  9. Compile the file.
  10. Verify the information message : 'Compiled'.
  11. Click [OK].
  12. Post the file.
  13. Verify the file posted successfully.
  14. Close the form.
  15. Open the 'Client Ledger' form.
  16. Close the form.
  17. Open the 'File Import' form.
  18. Select the 'Client Charge Input' from the 'File Type' field.
  19. Upload the 'Multiple Add-Ons' file created in the setup section with invalid primary and Add-On combination.
  20. Compile the file.
  21. Verify the file does not compile successfully and the error message regarding the unassigned add-on codes to the primary codes in the file.
  22. Close the report.
  23. Upload the 'Multiple Add-Ons' file created in the setup section with valid primary and add-on code combination.
  24. Compile the file.
  25. Verify the information message : 'Compiled'.
  26. Click [OK].
  27. Post the file.
  28. Verify the file posted successfully.
  29. Close the form.
  30. Open the 'Client Ledger' form.
  31. Validate the Primary service code display with Multiple Add-on codes.
  32. Close the form.
Topics
• File Import
Update 151 Summary | Details
835 Health Care Claim Payment/Advice - Work Compile
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission
  • Diagnosis
  • Financial Eligibility
  • Client Charge Input
  • Create Interim Billing Batch File
  • Electronic Billing
  • 835 Health Care Claim Payment/Advice (PM)
Scenario 1: 835 Health Care Claim Payment/Advice - Contains no 2110 loop, 'REF*6R*' segment
Specific Setup:
  • Admission:
  • Select an active client.
  • Financial Eligibility: Client has an active record.
  • Service:
  • The client has a service that distributed to the primary guarantor.
  • The service was claimed and the 837 file was used to create an 835 file that contains no 2110 loop, 'REF*6R*' segment. Note the value of the 'SVC01' field.
Steps
  1. Open the '835 Health Care Claim Payment/Advice' form.
  2. Compile the 835 payment file.
  3. Select 'Work Compile' in 'Options'.
  4. Select the compiled file in 'Select File'.
  5. Click 'Launch Work Screen'.
  6. Validate that the 'Billed Code' is populated with the data from the 'SVC01' field in the 835 file.
  7. Close the grid.
  8. Close the form.
835 Health Care Claim Payment/Advice
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Dictionary Update (PM)
  • Service Codes
  • Service Fee/Cross Reference Maintenance
  • CCBHC PPS Service Definition
  • Program Maintenance
  • Practitioner Numbers By Guarantor And Program
  • Admission (Outpatient)
  • Diagnosis
  • Financial Eligibility
  • Practitioner Enrollment
  • Client Charge Input
  • Client Ledger
  • CCBHC PPS Compile
  • 835 Health Care Claim Payment/Advice (PM)
Scenario 1: 835 Health Care Claim Payment/Advice - CCBHC enumerated service distributed to a non-CCBHC guarantor then transferred to CCBHC guarantor
Specific Setup:
  • CCBHC Billing is enabled.
  • Admission:
  • Client is admitted into a program that provides CCBHC services.
  • Financial Eligibility: The primary guarantor is not a CCBHC guarantor. The secondary guarantor is a CCBHC guarantor.
  • Service:
  • The client has a CCBHC enumerated service that distributed to the primary guarantor.
  • The full liability for the service is transferred to the secondary guarantor.
  • The service was claimed and the 837 file was used to create an 835 file that contains adjustments for the enumerated service.
Steps
  1. Open ‘835 Health Care Claim Payment/Advice’.
  2. Load the file.
  3. Compile the file.
  4. Verify that the compile report correctly displays the adjustments made to the enumerated service.
  5. If desired, post the file.
  6. Verify that the report correctly displays the adjustments made to the enumerated service.
  7. Close the report.
  8. Close the form.
Registry Setting - Enable Service Unit Splits
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Electronic Billing
  • Service Codes
  • Service Fee/Cross Reference Maintenance
  • Guarantors/Payors
  • Admission (Outpatient)
  • Diagnosis
  • Financial Eligibility
  • Client Charge Input
  • Liability Update
  • Client Ledger
  • Create Interim Billing Batch File
Scenario 1: 837 Professional - Validating 'Service Unit (2400-SV1-04)' field- 'Enable Service Unit Splits' registry setting = 2.
Specific Setup:
  • Registry Setting:
  • The 'Enable Service Unit Splits' registry setting is set to "2".
  • Service Code:
  • The 'Type of Fee' is 'User Defined'.
  • Note the 'Minutes Per Unit'.
  • Unit Rounding Logic = Round Over 1/2 Unit.
  • Designated Degree Of Rounding = desired value noting the value.
  • There is a fee record in 'Service Fee/Cross Reference Maintenance'. Note the amount.
  • Admission:
  • An existing client is identified, or a new client is admitted.
  • Financial Eligibility:
  • Two guarantors are assigned to the client as primary and secondary.
  • Client Charge Input:
  • A service is rendered to a client with a duration that will round and create a partial unit. Example, the 'Minutes Per Unit' = 60, and the duration is 95 minutes.
  • Client Ledger:
  • The service and all units distribute to the primary guarantor.
  • Close the charges.
  • An interim billing batch is created for the client and the primary guarantor.
Steps
  1. Open the 'Electronic Billing' form.
  2. Compile the 837 Professional bill for the interim billing batch created in the setup section.
  3. Verify the bill compiles successfully.
  4. Review the dump file.
  5. Verify that the units displayed in '2400-SV1-04' contains the partial unit.
  6. Close the report.
  7. Close the form.
Guarantors/Payors - Contractual Guarantor Information
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Liability Update
  • Client Ledger
  • Service Codes
  • Guarantors/Payors
  • Admission (Outpatient)
  • Diagnosis
  • Financial Eligibility
  • Client Charge Input
  • Service Fee/Cross Reference Maintenance
  • Close Accounting Period
  • Open Closed Charges
Scenario 1: Contractual Allowance By Liability Distribution - Change Primary Guarantor
Specific Setup:
  • Admission:
  • Client is enrolled in an outpatient program.
  • Financial Eligibility:
  • The primary guarantor is a contractual guarantor with a value of ‘Contractual Allowance By Liability Distribution’ in ‘Does This Guarantor Use Contractual Allowance By Batch Or Through Liability Distribution?’
  • The secondary guarantor is a non-contractual guarantor.
  • Service: A service is rendered to the client and is distributed to the primary guarantor and the adjustments are applied to the service.
  • Financial Eligibility:
  • Change the secondary guarantor, the non-contract guarantor, to be the primary guarantor.
  • Change the original primary guarantor, the contractual guarantor, to be the secondary guarantor.
  • Use ‘Liability Update’ to update the liability for the service.
  • Use Client Ledger to validate that the service charges are now assigned to the new primary guarantor and that there are no contractual adjustments.
  • Close the charge.
  • Close the accounting period.
  • Use Open Closed Charges to reopen the charge.
  • Financial Eligibility:
  • Change the primary guarantor to be the original primary guarantor, the contractual guarantor.
  • Change the secondary guarantor to the original secondary guarantor, the non-contractual guarantor.
  • Use ‘Liability Update’ to update the liability for the service.
Steps
  1. Open ‘Client Ledger’.
  2. Process the ‘Simple’ report.
  3. Validate that the fee is distributed to the current primary guarantors, the contractual guarantor, and that the adjustments are included.
  4. Close the report.
  5. Close the form.
835 Health Care Claim Payment/Advice
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Admission (Outpatient)
  • Diagnosis
  • Financial Eligibility
  • Client Charge Input
  • Client Ledger
  • Create Interim Billing Batch File
  • Electronic Billing
  • Claim Adjustment Group/Reason Code Definition
  • 835 Health Care Claim Payment/Advice (PM)
Scenario 1: 835 Health Care Claim Payment/Advice - Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services = YP
Specific Setup:
  • Registry Setting: 'Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services' is set to "YP".
  • Client has a claimed service and the 837 is used to create an 835 which includes adjustments that overpay the service.
  • The 835 payment file is available for compiling.
Steps
  1. Open the '835 Health Care Claim Payment/Advice' form.
  2. Compile the 835 payment file.
  3. Validate that the compile report displays the adjustments correctly.
  4. If desired, post the file.
  5. Close the form.
  6. If the file was posted, open 'Client Ledger' and verify that the service has a credit balance.
  7. Close the report.
  8. Close the form.
Topics
• 835 Health Care Claim Payment/Advice • CCBHC • 837 Professional • Guarantor/Payors • Liability Update
Update 155 Summary | Details
Process Internal Referrals Form: Processing Internal Referral
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Table Definition (PM)
  • Admission (Outpatient)
  • Admission
  • Internal Referral Type Maintenance
  • Group Member Assignment
  • Internal Client Referrals
  • Process Internal Referrals
Scenario 1: Internal Referral Type Maintenance - Validating all the 'Internal Referral Type Category'
Specific Setup:
  • Form Definition:
  • Create or identify an existing a user-defined (modeled) form that collects the additional referral information needed to approve or reject a referral. Note the form name and Table name.
  • The form must contain a Non Scrolling Free Text data element that has been configured in Table Definition as a Referral Group. Note the field name.
  • Table Definition:
  • A Non Scrolling Free Text data element that has been configured as a Referral Group. Note the field name.
  • Admission:
  • Create a new client or identify an existing client. Note the client id, name.
Steps
  1. Open the 'Internal Referral Type Maintenance' form.
  2. Select 'Add Internal Referral type' in the 'Add Or Edit Internal Referral Type' field.
  3. Verify the 'Internal Referral Type Code' field displays the identification code assigned to the referral type.
  4. Enter desired name in the 'Internal Referral Type Name' field. Note the name.
  5. Select 'Program' in the 'Internal Referral Type Category' field.
  6. Select desired program from the 'Program' field.
  7. Select the modeled form created or identified in the setup section to associate with this referral type in the 'Assessment Associated With Internal Referral Type' field.
  8. Select 'No' in the 'Does This Internal Referral Type Have A Waitlist?' field.
  9. Enter desired description of this referral for use in displays and reporting in the 'Internal Referral Type Description' field.
  10. Select desired user from the 'Select User' search box.
  11. Click [Add User].
  12. Verify the 'User(s) To Receive Internal Referrals' field displays a list of users who are assigned to this referral.
  13. Click [Submit].
  14. Select 'Yes' to 'Form Return' Message.
  15. Enter desired name in the 'Internal Referral Type Name' field. Note the name.
  16. Select 'Group' in the 'Internal Referral Type Category' field.
  17. Select desired group from the 'Group' field. Note the group name/code.
  18. Select the modeled form created or identified in the setup section to associate with this referral type in the 'Assessment Associated With Internal Referral Type' field.
  19. Select 'No' in the 'Does This Internal Referral Type Have A Waitlist?' field.
  20. Enter desired description of this referral for use in displays and reporting in the 'Internal Referral Type Description' field.
  21. Select desired user from the 'Select User' search box.
  22. Click [Add User].
  23. Verify the 'User(s) To Receive Internal Referrals' field displays a list of users who are assigned to this referral.
  24. Click [Submit].
  25. Select 'Yes' to 'Form Return' Message.
  26. Enter desired name in the 'Internal Referral Type Name' field. Note the name.
  27. Select 'Team' in the 'Internal Referral Type Category' field.
  28. Select desired team from the 'Team' field. Note the team name/code.
  29. Select the modeled form created or identified in the setup section to associate with this referral type in the 'Assessment Associated With Internal Referral Type' field.
  30. Select 'No' in the 'Does This Internal Referral Type Have A Waitlist?' field.
  31. Enter desired description of this referral for use in displays and reporting in the 'Internal Referral Type Description' field.
  32. Select desired user from the 'Select User' search box.
  33. Click [Add User].
  34. Verify the 'User(s) To Receive Internal Referrals' field displays a list of users who are assigned to this referral.
  35. Click [Submit].
  36. Select 'Yes' to 'Form Return' Message.
  37. Enter desired name in the 'Internal Referral Type Name' field. Note the name.
  38. Select 'Other' in the 'Internal Referral Type Category' field.
  39. Select the modeled form created or identified in the setup section to associate with this referral type in the 'Assessment Associated With Internal Referral Type' field.
  40. Select 'No' in the 'Does This Internal Referral Type Have A Waitlist?' field.
  41. Enter desired description of this referral for use in displays and reporting in the 'Internal Referral Type Description' field.
  42. Select desired user from the 'Select User' search box.
  43. Click [Add User].
  44. Verify the 'User(s) To Receive Internal Referrals' field displays a list of users who are assigned to this referral.
  45. Click [Submit].
  46. Select 'No' to 'Form Return' Message.
  47. Open the 'Internal Client Referral' form.
  48. Select desired client in the 'Client Being Referred' field.
  49. Select 'Program' in the 'Internal Referral Type Category' field.
  50. Validate the 'Internal Referral Type Being Requested' field displays only the 'Program' type referrals.
  51. Select desired referral type from the 'Internal Referral Type Being Requested' field.
  52. Validate the 'Episode' field is enabled and the client episode for which the referral is being made is auto populated in the 'Episode' field.
  53. The Internal Referral Type Description field displays the detailed referral description that was entered on the Internal Referral Type Maintenance form.
  54. Validate the 'Internal Referral Program' field is marked as a required field and it is auto populated with the program selected in the 'Internal Referral Type Maintenance' form.
  55. Select 'Group' in the 'Internal Referral Type Category' field.
  56. Validate the 'Internal Referral Type Being Requested' field displays only the 'Group' type referrals.
  57. Select desired referral type from the 'Internal Referral Type Being Requested' field.
  58. Validate the 'Episode' field is enabled and the client episode for which the referral is being made is auto populated in the 'Episode' field.
  59. The Internal Referral Type Description field displays the detailed referral description that was entered on the Internal Referral Type Maintenance form.
  60. Validate the 'Internal Referral Group' field is marked as a required field and it is auto populated with the group selected in the 'Internal Referral Type Maintenance' form.
  61. Select 'Team' in the 'Internal Referral Type Category' field.
  62. Validate the 'Internal Referral Type Being Requested' field displays only the 'Team' type referrals.
  63. Select desired referral type from the 'Internal Referral Type Being Requested' field.
  64. Validate the 'Episode' field is enabled and the client episode for which the referral is being made is auto populated in the 'Episode' field.
  65. The 'Internal Referral Type Description' field displays the detailed referral description that was entered on the Internal Referral Type Maintenance form.
  66. Validate the 'Internal Referral Team' field is marked as a required field and it is auto populated with the team selected in the 'Internal Referral Type Maintenance' form.
  67. Close the form.
Scenario 2: Process Internal Referrals
Specific Setup:
  • Form Definition:
  • Create or identify an existing a user-defined (modeled) form that collects the additional referral information needed to approve or reject a referral. Note the form name and Table name.
  • The form must contain a Non Scrolling Free Text data element that has been configured in Table Definition as a Referral Group. Note the field name.
  • Table Definition:
  • A Non Scrolling Free Text data element that has been configured as a Referral Group. Note the field name.
  • Admission:
  • Create a new client or identify an existing client. Note the client id, name, admission program value/code.
  • Internal Referral type maintenance:
  • Desired internal referral type is created to be used for the client. Note the referral type.
  • Internal Client Referral :
  • Internal client referral created for the desired client using the referral type created.
Steps
  1. Open the 'Process Internal Referrals' form.
  2. Verify that the form lists initiated referrals ready to be processed in a grid.
  3. From the list to be processed the user will be able to assign a new status of 'Accepted', 'Rejected', 'Rejected – More Information Needed' or 'Waitlist' as well.
  4. Select desired internal referral in the grid.
  5. Verify the fields listed in the 'Internal Referral Information' section contains code and value of the field.
  6. Select desired status.
  7. Click [Process internal referral].
  8. Verify the referral processed successfully.
  9. Ensure it is removed from grid(even if it’s the only one in the grid left).
  10. Ensure that a to do item sent back to user that filed 'Internal Client Referrals' form.
Process Internal Referrals: Internal Referral Information
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Table Definition (PM)
  • Admission (Outpatient)
  • Admission
  • Internal Referral Type Maintenance
  • Group Member Assignment
  • Internal Client Referrals
  • Process Internal Referrals
Scenario 1: Internal Referral Type Maintenance - Validating all the 'Internal Referral Type Category'
Specific Setup:
  • Form Definition:
  • Create or identify an existing a user-defined (modeled) form that collects the additional referral information needed to approve or reject a referral. Note the form name and Table name.
  • The form must contain a Non Scrolling Free Text data element that has been configured in Table Definition as a Referral Group. Note the field name.
  • Table Definition:
  • A Non Scrolling Free Text data element that has been configured as a Referral Group. Note the field name.
  • Admission:
  • Create a new client or identify an existing client. Note the client id, name.
Steps
  1. Open the 'Internal Referral Type Maintenance' form.
  2. Select 'Add Internal Referral type' in the 'Add Or Edit Internal Referral Type' field.
  3. Verify the 'Internal Referral Type Code' field displays the identification code assigned to the referral type.
  4. Enter desired name in the 'Internal Referral Type Name' field. Note the name.
  5. Select 'Program' in the 'Internal Referral Type Category' field.
  6. Select desired program from the 'Program' field.
  7. Select the modeled form created or identified in the setup section to associate with this referral type in the 'Assessment Associated With Internal Referral Type' field.
  8. Select 'No' in the 'Does This Internal Referral Type Have A Waitlist?' field.
  9. Enter desired description of this referral for use in displays and reporting in the 'Internal Referral Type Description' field.
  10. Select desired user from the 'Select User' search box.
  11. Click [Add User].
  12. Verify the 'User(s) To Receive Internal Referrals' field displays a list of users who are assigned to this referral.
  13. Click [Submit].
  14. Select 'Yes' to 'Form Return' Message.
  15. Enter desired name in the 'Internal Referral Type Name' field. Note the name.
  16. Select 'Group' in the 'Internal Referral Type Category' field.
  17. Select desired group from the 'Group' field. Note the group name/code.
  18. Select the modeled form created or identified in the setup section to associate with this referral type in the 'Assessment Associated With Internal Referral Type' field.
  19. Select 'No' in the 'Does This Internal Referral Type Have A Waitlist?' field.
  20. Enter desired description of this referral for use in displays and reporting in the 'Internal Referral Type Description' field.
  21. Select desired user from the 'Select User' search box.
  22. Click [Add User].
  23. Verify the 'User(s) To Receive Internal Referrals' field displays a list of users who are assigned to this referral.
  24. Click [Submit].
  25. Select 'Yes' to 'Form Return' Message.
  26. Enter desired name in the 'Internal Referral Type Name' field. Note the name.
  27. Select 'Team' in the 'Internal Referral Type Category' field.
  28. Select desired team from the 'Team' field. Note the team name/code.
  29. Select the modeled form created or identified in the setup section to associate with this referral type in the 'Assessment Associated With Internal Referral Type' field.
  30. Select 'No' in the 'Does This Internal Referral Type Have A Waitlist?' field.
  31. Enter desired description of this referral for use in displays and reporting in the 'Internal Referral Type Description' field.
  32. Select desired user from the 'Select User' search box.
  33. Click [Add User].
  34. Verify the 'User(s) To Receive Internal Referrals' field displays a list of users who are assigned to this referral.
  35. Click [Submit].
  36. Select 'Yes' to 'Form Return' Message.
  37. Enter desired name in the 'Internal Referral Type Name' field. Note the name.
  38. Select 'Other' in the 'Internal Referral Type Category' field.
  39. Select the modeled form created or identified in the setup section to associate with this referral type in the 'Assessment Associated With Internal Referral Type' field.
  40. Select 'No' in the 'Does This Internal Referral Type Have A Waitlist?' field.
  41. Enter desired description of this referral for use in displays and reporting in the 'Internal Referral Type Description' field.
  42. Select desired user from the 'Select User' search box.
  43. Click [Add User].
  44. Verify the 'User(s) To Receive Internal Referrals' field displays a list of users who are assigned to this referral.
  45. Click [Submit].
  46. Select 'No' to 'Form Return' Message.
  47. Open the 'Internal Client Referral' form.
  48. Select desired client in the 'Client Being Referred' field.
  49. Select 'Program' in the 'Internal Referral Type Category' field.
  50. Validate the 'Internal Referral Type Being Requested' field displays only the 'Program' type referrals.
  51. Select desired referral type from the 'Internal Referral Type Being Requested' field.
  52. Validate the 'Episode' field is enabled and the client episode for which the referral is being made is auto populated in the 'Episode' field.
  53. The Internal Referral Type Description field displays the detailed referral description that was entered on the Internal Referral Type Maintenance form.
  54. Validate the 'Internal Referral Program' field is marked as a required field and it is auto populated with the program selected in the 'Internal Referral Type Maintenance' form.
  55. Select 'Group' in the 'Internal Referral Type Category' field.
  56. Validate the 'Internal Referral Type Being Requested' field displays only the 'Group' type referrals.
  57. Select desired referral type from the 'Internal Referral Type Being Requested' field.
  58. Validate the 'Episode' field is enabled and the client episode for which the referral is being made is auto populated in the 'Episode' field.
  59. The Internal Referral Type Description field displays the detailed referral description that was entered on the Internal Referral Type Maintenance form.
  60. Validate the 'Internal Referral Group' field is marked as a required field and it is auto populated with the group selected in the 'Internal Referral Type Maintenance' form.
  61. Select 'Team' in the 'Internal Referral Type Category' field.
  62. Validate the 'Internal Referral Type Being Requested' field displays only the 'Team' type referrals.
  63. Select desired referral type from the 'Internal Referral Type Being Requested' field.
  64. Validate the 'Episode' field is enabled and the client episode for which the referral is being made is auto populated in the 'Episode' field.
  65. The 'Internal Referral Type Description' field displays the detailed referral description that was entered on the Internal Referral Type Maintenance form.
  66. Validate the 'Internal Referral Team' field is marked as a required field and it is auto populated with the team selected in the 'Internal Referral Type Maintenance' form.
  67. Close the form.
Scenario 2: Process Internal Referrals
Specific Setup:
  • Form Definition:
  • Create or identify an existing a user-defined (modeled) form that collects the additional referral information needed to approve or reject a referral. Note the form name and Table name.
  • The form must contain a Non Scrolling Free Text data element that has been configured in Table Definition as a Referral Group. Note the field name.
  • Table Definition:
  • A Non Scrolling Free Text data element that has been configured as a Referral Group. Note the field name.
  • Admission:
  • Create a new client or identify an existing client. Note the client id, name, admission program value/code.
  • Internal Referral type maintenance:
  • Desired internal referral type is created to be used for the client. Note the referral type.
  • Internal Client Referral :
  • Internal client referral created for the desired client using the referral type created.
Steps
  1. Open the 'Process Internal Referrals' form.
  2. Verify that the form lists initiated referrals ready to be processed in a grid.
  3. From the list to be processed the user will be able to assign a new status of 'Accepted', 'Rejected', 'Rejected – More Information Needed' or 'Waitlist' as well.
  4. Select desired internal referral in the grid.
  5. Verify the fields listed in the 'Internal Referral Information' section contains code and value of the field.
  6. Select desired status.
  7. Click [Process internal referral].
  8. Verify the referral processed successfully.
  9. Ensure it is removed from grid(even if it’s the only one in the grid left).
  10. Ensure that a to do item sent back to user that filed 'Internal Client Referrals' form.
Topics
• Referral
Update 157 Summary | Details
Future Functionality
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Payment Acknowledgement
  • 835 Health Care Claim Payment/Advice (PM)
  • Dictionary Update (PM)
  • Create Interim Billing Batch File
  • Client Ledger
  • Electronic Billing
Scenario 1: Payment Acknowledgement - Posting an 835
Steps

Internal testing only.
Topics
• 835 Health Care Claim Payment/Advice • NX • Payment Acknowledgement
Update 158 Summary | Details
Electronic Billing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Financial Eligibility
  • Diagnosis
  • Client Ledger
  • Create Interim Billing Batch File
  • Electronic Billing
  • Admission
  • Product Updates (PM)
Internal Test Only
Topics
• 837 Professional • 837 Institutional • NX
Update 159 Summary | Details
Registry Setting - Use Site or Service Based Appointment Color Coding
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Dictionary Update (PM)
  • Service Codes
  • Site Registration
Scenario 1: Registry Settings - Use Site or Service Based Appointment Color Coding
Specific Setup:
  • Using the "Dictionary Update" form from the PM menu.
  • Navigate to the "Print Dictionary" section.
  • Select the "Other Tabled Files" from the "File" dropdown.
  • Print the dictionary for the data element number "60050".
  • Validate there are background colors already defined.
  • Add custom colors if desired by defining the color's hexadecimal code.
  • Print the dictionary for the data element number "60051".
  • Validate there are background colors already defined.
  • Add custom colors if desired by defining the color's hexadecimal code.
  • Print the dictionary for the data element number "60052".
  • Validate there are background colors already defined.
  • Add custom colors if desired by defining the color's hexadecimal code.
Steps
  1. Open the "Registry Settings" form.
  2. Search for the registry setting "Use Site or Service Based Appointment Coding".
  3. Validate it is initially set to "0".
  4. Attempt to set the registry setting to "3".
  5. Validate it informs that "0,1,2" are the only valid options.
  6. Set the registry setting to "0".
  7. Submit the form to file.
  8. Close the form.
  9. Note that in myAvatar systems, this functionality isn't available, and the registry setting can't be set.
  10. Open the "Site Registration" form.
  11. Note that there are no color coding related fields.
  12. Close the form.
  13. Open the "Service Codes" form.
  14. Note that there are no color coding related fields.
  15. Close the form.
  16. Open the "Registry Settings" form.
  17. Search for the registry setting "Use Site or Service Based Appointment Coding".
  18. Set the registry setting to "1".
  19. Submit the form to file.
  20. Close the form.
  21. Open the "Site Registration" form.
  22. Set unique values into the 3 new color coding fields so you can distinguish one appointment type from another.
  23. Submit the form to file.
  24. Open the "Site Registration" form.
  25. Validate the values of the 3 new color coding fields match what was recorded in previous step.
  26. Open the "Service Codes" form.
  27. Validate there are no color coding related fields.
  28. Close the form.
  29. Open the "Registry Settings" form.
  30. Search for the registry setting "Use Site or Service Based Appointment Coding".
  31. Set the registry setting to "2".
  32. Submit the form to file.
  33. Close the form.
  34. Open the "Site Registration" form.
  35. Validate there are no color coding related fields.
  36. Close the form.
  37. Open the "Service Codes" form.
  38. Set unique values into the 3 new color coding fields so you can distinguish one appointment type from another.
  39. Submit the form to file.
Scenario 2: Service Codes - Color Coding
Specific Setup:
  • Using the "Dictionary Update" form from the PM menu.
  • Navigate to the "Print Dictionary" section.
  • Select the "Other Tabled Files" from the "File" dropdown.
  • Print the dictionary for the data element number "60050".
  • Validate there are background colors already defined.
  • Add custom colors if desired by defining the color's hexadecimal code.
  • Print the dictionary for the data element number "60051".
  • Validate there are background colors already defined.
  • Add custom colors if desired by defining the color's hexadecimal code.
  • Print the dictionary for the data element number "60052".
  • Validate there are background colors already defined.
  • Add custom colors if desired by defining the color's hexadecimal code.
Steps
  1. Open the "Registry Settings" form.
  2. Search for the registry setting "Use Site or Service Based Appointment Color Coding".
  3. Set the registry setting value to "2".
  4. Submit the form.
  5. Open the "Service Codes" form.
  6. Add a new service code for the "Client/Staff Appointment Color".
  7. Fill out all required fields.
  8. Set the "Client/Staff Appointment Color" to the desired background/text color combination.
  9. Click "File Service Code".
  10. Add a new service code for the "Staff-Only Appointment Color".
  11. Fill out all required fields.
  12. Set the "Staff-Only Appointment Color" to the desired background/text color combination.
  13. Click "File Service Code".
  14. Add a new service code for the "Group Appointment Color".
  15. Fill out all required fields.
  16. Set the "Group Appointment Color" to the desired background/text color combination.
  17. Click "File Service Code".
  18. Open the "Service Codes" form.
  19. Validate all 3 new service codes just entered display as previously stored.
  20. Open the "Scheduling Calendar".
  21. Create a staff/client appointment using the service code added for Client/Staff Appointment.
  22. Validate the colors of the appointment's background and text match what was selected for this appointment type.
  23. Validate the appointment type edge indicator is appropriate for this type of appointment.
  24. Create a staff only appointment using the service code added for Staff Only Appointment.
  25. Validate the colors of the appointment's background and text match what was selected for this appointment type.
  26. Validate the appointment type edge indicator is appropriate for this type of appointment.
  27. Create a group appointment using the service code added for group appointment.
  28. Validate the colors of the appointment's background and text match what was selected for this appointment type.
  29. Validate the appointment type edge indicator is appropriate for this type of appointment.
Scenario 3: Site Registration - Color Coding
Specific Setup:
  • Using the "Dictionary Update" form from the PM menu.
  • Navigate to the "Print Dictionary" section.
  • Select the "Other Tabled Files" from the "File" dropdown.
  • Print the dictionary for the data element number "60050".
  • Validate there are background colors already defined.
  • Add custom colors if desired by defining the color's hexadecimal code.
  • Print the dictionary for the data element number "60051".
  • Validate there are background colors already defined.
  • Add custom colors if desired by defining the color's hexadecimal code.
  • Print the dictionary for the data element number "60052".
  • Validate there are background colors already defined.
  • Add custom colors if desired by defining the color's hexadecimal code.
Steps
  1. Open the "Site Registration" form:
  2. Add a new site.
  3. Populate all required fields.
  4. Click "Add Site Hours of Operation".
  5. Enter hours of operation for each day.
  6. Click "Site Holidays".
  7. Enter days the site isn't open for appointments.
  8. Validate the "Client/Staff Appointment Color" dropdown exists on the form.
  9. Validate the "Staff-Only Appointment Color" dropdown exists on the form.
  10. Validate the "Group Appointment Color" dropdown exists on the form.
  11. Select a background/text color combination in the "Client/Staff Appointment Color" dropdown.
  12. Select a background/text color combination in the "Staff-Only Appointment Color" dropdown.
  13. Select a background/text color combination in the "Group Appointment Color" dropdown.
  14. Submit the form.
  15. Open the "Site Registration" form:
  16. Edit the site that was just added.
  17. Validate the background/text color combination in the "Client/Staff Appointment Color" dropdown reflects what was entered.
  18. Validate background/text color combination in the "Staff-Only Appointment Color" dropdown reflects what was entered.
  19. Open the "Scheduling Calendar".
  20. Schedule a client/staff appointment.
  21. Validate the background/text color coding matches what was established in the "Site Registration" form for the site.
  22. Validate the appointment type edge indicator is appropriate for this type of appointment.
  23. Schedule a staff only appointment.
  24. Validate the background/text color coding matches what was established in the "Site Registration" form for the site.
  25. Validate the appointment type edge indicator is appropriate for this type of appointment.
  26. Schedule a group appointment.
  27. Validate the background/text color coding matches what was established in the "Site Registration" form for the site.
  28. Validate the appointment type edge indicator is appropriate for this type of appointment.
Topics
• Registry Settings • Service Codes • Site Registration • NX
Update 165 Summary | Details
Compile Residential/Inpatient Charges
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Dictionary Update (PM)
  • Service Codes
  • Service Fee/Cross Reference Maintenance
  • Admission
  • Program Maintenance
  • Diagnosis
  • Financial Eligibility
  • Discharge
  • Leaves
  • Post Residential/Inpatient Worklist
  • Client Ledger
Scenario 1: Compile Residential/Inpatient Charges - Registry Setting: Enable Hourly Billing
Specific Setup:
  • Registry Settings: 'Enable Hourly Billing' = 'N'.
  • Service Codes:
  • Code 1 is a Room & Board service code defined where 'Type of Fee' = 'Fixed Fee (Per Event)''
  • Code 2 is a Room & Board service code defined where 'Type of Fee' = 'User Defined'. Please note the 'Minutes Per Unit', the 'Unit Rounding Logic' and the 'Designated Degree Of Rounding'.
  • Clients:
  • Client A is admitted to an inpatient unit and the 'Room And Board Billing Code' = Code 1. Note the date of admission and the unit.
  • Client A is discharged. Note the date of discharge.
  • Client B is admitted to an inpatient unit and the 'Room And Board Billing Code' = Code 2. Note the date of admission and the unit.
  • Client B is discharged. Note the date of discharge.
  • Verify Unit Census has been used to verify the unit(s).
Steps
  1. Open 'Compile Residential/Inpatient Charges'.
  2. Select 'Individual' in 'Individual Or All Units'.
  3. Select desired 'Unit(s)'.
  4. Enter desired value in 'Compile Charges From Date'.
  5. Enter desired value in 'Compile Charges Through Date'.
  6. Select 'Yes' in 'Do You Wish To Recreate The Residential/Inpatient Worklist'.
  7. Click [Process].
  8. Review the report pages to verify that service are created for both client on all days before the discharge date and that no services are created for either client on or after the date of discharge.
  9. Close the form.
  10. If desired, use 'Post Residential/Inpatient Worklist' to post the inpatient charges.
  11. Close the form.
  12. Use 'Client Ledger' to review the charges, verifying that the charges are only for the dates before the discharge date.
  13. Close the form.
  14. Open 'Registry Settings'.
  15. Change the 'Enable Hourly Billing' to 'Y'.
  16. Close the form.
  17. Re-admit each client in a new month. Close the form.
  18. Discharge the clients. Close the form.
  19. Verify Unit Census. Close the form.
  20. Repeat step 1 above.
  21. Client A will not have a room and board service created on the discharge date.
  22. Client B will have a room and board service created on the discharge date.
  23. If desired, repeat step 2 above and use 'Client Ledger' to verify:
  24. Client A has no room and board service on the discharge date.
  25. Client B has a room and board service created on the discharge date.
Topics
• Billing
Update 171 Summary | Details
File Import - Benefit Plan
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
Scenario 1: File Import - Benefit Plans
Specific Setup:
  • The registry setting 'Import File Delimiter' is enabled with desired value.
  • File Import:
  • A file import file of 'Benefit Plan' file type is created to add a new plan.
  • A file import file of 'Benefit Plan' file type is created to edit the above plan.
Steps
  1. Open the 'File Import' form.
  2. Select the 'Benefit Plan' from the 'File Type' field.
  3. Upload the 'add' file created in the setup section.
  4. Compile the file.
  5. Verify the information message: 'Compiled'.
  6. Click [OK].
  7. Post the file.
  8. Verify the file posted successfully.
  9. Close the form.
  10. Open the 'Benefit Plan' form.
  11. Validate the plan contains the imported data.
  12. Close the form.
  13. Open the 'File Import' form.
  14. Select the 'Benefit Plan' from the 'File Type' field.
  15. Upload the 'edit' file created in the setup section.
  16. Compile the file.
  17. Verify the information message: 'Compiled'.
  18. Click [OK].
  19. Post the file.
  20. Verify the file posted successfully.
  21. Close the form.
  22. Open the 'Benefit Plan' form.
  23. Validate the plan contains the edited imported data.
  24. Close the form.
Topics
• File Import • NX
 

Avatar_PM_2023_Monthly_Release_2023.03.02_Details.csv