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Avatar PM 2023 Monthly Release 2023.04.00 Acceptance Tests

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Update 106 Summary | Details
Electronic Billing - Place of Service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Financial Eligibility
  • Client Ledger
  • Admission (Outpatient)
  • Dictionary Update (PM)
  • Program Maintenance
  • Create Interim Billing Batch File
  • Electronic Billing
Scenario 1: Place of Service - Telehealth - Patient in Home
Specific Setup:
  • Registry Settings:
  • Avatar PM->Billing->Client Charge Input->->->Enable Alternative Service Location Fields = Y.
  • Avatar PM->Billing->Electronic Billing->837 Professional->->Service Facility Location 2310D/2420C = Y.
  • Dictionary Update:
  • Client Location (10006) dictionary:
  • The location that will be used for a telehealth service in the client's home = 'Telehealth - Patient in Home' in extended dictionary '(579) Place Of Service (837 Electronic Billing)'.
  • The location that will be used for a non-telehealth service in the client's home = 'Home' in extended dictionary '(579) Place Of Service (837 Electronic Billing)'.
  • The location that will be used for a service not provided in the client's home = a value other than 'Home', such as 'Office'.
  • Guarantor/Program Billing Defaults: 837 Professional and/or 837 Institutional:
  • The 'Select Type Of Information To Include In Service Facility Location (2310D/2420C)' field has the following values checked:
  • Client's Information (Name/Address) Only If Place Of Service Is '12-Home' or '10-Telehealth-Patient in Home' for 2310C/2310D.
  • Client's Information (Name/Address) Only If Place Of Service Is '12-Home' or '10-Telehealth-Patient in Home' for 2420C.
  • Client:
  • Note the 'Program Maintenance' program address information.
  • Note the client's home address.
  • The client has three closed, unclaimed services, one for each of three locations setup above in 'Dictionary Update'. Note the service dates and validate the guarantor that the liability distributed to.
Steps
  1. Open 'Electronic Billing'.
  2. Create an unclaimed bill for the three services.
  3. Use the 'Dump File' to review the location information in the CLM and SV loops, for the 'NM1*77' segments:
  4. The address information for the telehealth appointment in the client home is the client's home address.
  5. The address information for the non-telehealth appointment in the client home is the client's home address.
  6. The address information for the service not provided in the client home is the program address from 'Program Maintenance'.
  7. Close the report.
  8. Close the form.
  9. Open 'Edit Service Information':
  10. Select the client and date of service for the telehealth service in the client home. Update all 'Facility Location' fields.
  11. Submit the form and remain in the form.
  12. Select the client and date of service for the non-telehealth service in the client home. Update all 'Facility Location' fields.
  13. Submit the form and remain in the form.
  14. Select the client and date of service for the service not in the client home. Update all 'Facility Location' fields.
  15. Submit the form.
  16. Close the form.
  17. Open 'Electronic Billing'.
  18. Create an unclaimed bill for the three services.
  19. Use the 'Dump File' to review the location information in the CLM and SV loops, for the 'NM1*77' segments:
  20. The address information for the telehealth appointment in the client home is the information entered in the 'Facility Location' fields in 'Edit Service Information'.
  21. The address information for the non-telehealth appointment in the client home is the program address from 'Program Maintenance'.
  22. The address information for the service not provided in the client home is the program address from 'Program Maintenance'.
  23. Close the report.
  24. Close the form.
Topics
• Electronic Billing
Update 153 Summary | Details
File Import - Service Codes
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
  • Service Codes
Scenario 1: File Import : Add/Edit Service Codes
Specific Setup:
  • File import
  • A file import file of 'Service Code' file type is created to add a new service code.
  • A file import file of 'Service Code' file type is created to edit the above service code.
Steps
  1. Open the "File Import" form.
  2. Select the 'Service Codes' File Type.
  3. Click on 'Upload New File' radio button.
  4. Select file for 'Add' service code.
  5. Compile the 'Add' service code file.
  6. Verify that the file compiles without any error.
  7. Post the file.
  8. Verify that the file posts without any error.
  9. Select the 'Print File' option and review the report.
  10. Close the report.
  11. Close the form.
  12. Open the 'Service Codes' form.
  13. Verify all data imported correctly.
  14. Follow step 1-13 for 'Edit' service code file.
Topics
• Service Codes • File Import • NX
Update 163 Summary | Details
Client Alternate Addresses - 'Address Type' field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Alternate Addresses
Scenario 1: Client Alternate Addresses - Form Validations
Specific Setup:
  • The 'Enable Client Alternate Addresses' registry setting must be set to "Y".
  • A client is admitted in an existing episode (Client A).
Steps
  1. Access the 'Client Alternate Addresses' form.
  2. Select "Client A" in the 'Client' field.
  3. Select "Add" in the 'Add/Edit' field.
  4. Enter the desired value in the 'Description' field.
  5. Enter the desired date in the 'Address Start Date' field.
  6. Enter the desired date in the 'Address End Date' field.
  7. Enter the desired value in the 'Address Line 1' field.
  8. Enter the desired value in the 'Address Line 2' field.
  9. Enter the desired value in the 'Zip' field.
  10. Enter the desired value in the 'City' field.
  11. Select the desired value in the 'State' field.
  12. Enter the desired value in the 'Contact Name field.
  13. Enter the desired value in the 'Contact Phone' field.
  14. Enter the desired value in the 'Address Notes' field.
  15. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  16. Select "Yes" in the 'Enabled' field.
  17. Click [File].
  18. Validate a message is displayed stating: Saved.
  19. Click [OK].
  20. Validate the 'Client' field contains "Client A".
  21. Select "Edit" in the 'Add/Edit' field.
  22. Validate the 'Select Existing Address' field contains the alternate address filed in the previous steps with the 'Address Start Date', 'Address End Date', and 'Description'.
  23. Select the address filed in the previous steps in the 'Select Existing Address' field.
  24. Validate all previously filed data is displayed.
  25. Close the form.
  26. Access Crystal Reports or other SQL Reporting Tool.
  27. Select the PM namespace.
  28. Create a report using the 'SYSTEM.client_alternate_address' SQL table.
  29. Validate there is a row for "Client A" will all previously filed data.
  30. Validate the 'addr_type_code' and 'addr_type_value' fields contain the code/value filed in the previous steps.
  31. Close the report.
Client Demographic forms - 'Address Type' field
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Update Client Data
  • Discharge
  • Pre Admit Discharge
  • Assign MR#
  • SoapUI - ClientDemographics
  • SoapUI - UpdateAdmission
  • SOAPUI - ClientCallIntake - UpdateCallIntake
  • SQL Query/Reporting
  • Admission (Outpatient)
Scenario 1: Validate the 'Admission' form for a new client
Steps
  1. Access the 'Admission' form.
  2. Admit a new client into any episode.
  3. Populate all required and desired fields.
  4. Select the "Demographics" section.
  5. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  6. Click [Submit].
  7. Access the 'Admission' form for the client admitted in the previous steps.
  8. Click [Edit] for the episode added in the previous steps.
  9. Validate the previously filed data is displayed.
  10. Select the "Demographics" section.
  11. Validate the 'Address Type' field contains the value filed in the previous steps.
  12. Close the form.
Scenario 2: 'Update Client Data' - Verification of form filing
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. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  3. Populate any other desired fields.
  4. Click [Submit].
  5. Select "Client A" and access the 'Update Client Data' form.
  6. Validate the previously filed data is displayed.
  7. Validate the 'Address Type' field contains the value selected in the previous steps.
  8. Close the form.
Scenario 3: '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. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  9. Select the desired value in the 'Do you have family members that are agricultural workers?' field.
  10. Select the desired value in the 'Are you an aged and disabled former migratory agricultural worker?' field.
  11. Click [Submit].
  12. Select "Client A" and access the 'Discharge' form.
  13. Select the discharged episode and click [Edit].
  14. Validate all previously filed data is displayed.
  15. Select the "Demographics" section.
  16. Validate the 'Address Type' field contains the value filed in the previous steps.
  17. Validate the 'Do you have family members that are agricultural workers?' field contains the value filed in the previous steps.
  18. Validate the 'Are you an aged and disabled former migratory agricultural worker?' field contains the value filed in the previous steps.
  19. Close the form.
  20. Access Crystal Reports or other SQL Reporting Tool.
  21. Create a report using the 'SYSTEM.patient_current_demographics' and 'SYSTEM.patient_demographic_history' SQL tables.
  22. Validate a row is displayed for "Client A".
  23. Validate the 'address_type_code' and 'address_type_value' fields contain the code/value filed in the previous steps.
  24. Validate the 'fam_agric_worker_code' and 'fam_agric_worker_value' fields contain the code/value filed in the previous steps.
  25. Validate the 'former_agric_worker_code' and 'former_agric_worker_value' fields contain the code/value filed in the previous steps.
  26. Close the reports.
Scenario 4: '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. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  5. Click [Submit].
  6. Select "Client A" and access the 'Pre Admit' form.
  7. Select an existing episode and click [Edit].
  8. Select the "Demographics" section.
  9. Validate the 'Address Type' field contains the value filed in the previous steps.
  10. Close the form.
Scenario 5: '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. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  5. Click [Submit].
  6. Select "Client A" and access the 'Call Intake' form.
  7. Select the existing call intake record and click [Edit].
  8. Select the "Demographics" section.
  9. Validate the 'Address Type' field contains the value filed in the previous steps.
  10. Close the form.
Scenario 6: Pre Admit Discharge web service validation
Specific Setup:
  • A client is enrolled in an existing Pre Admit episode (Client A).
Steps
  1. Access SoapUI for the 'ClientPreAdmitDischarge' - 'PreAdmitDischargeClient' 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 'DateOfDischarge' field.
  6. Enter the desired practitioner in the 'DischargePractitioner' field.
  7. Enter the desired time in the 'DischargeTime' field.
  8. Enter the desired value in the 'AddressType' field.
  9. Enter the desired value in the 'TypeOfDischarge' field.
  10. Enter "Client A" in the 'ClientID' field.
  11. Enter the episode number to be discharged in the 'EpisodeNumber' field.
  12. Click [Run].
  13. Validate the 'Message' field contains: Client Pre-Admit Discharge web service has been filed successfully.
  14. Select "Client A" and access the 'Pre Admit Discharge' form.
  15. Validate all populated fields are displayed as entered in the web service.
  16. Select the "Demographics" section.
  17. Validate the 'Address Type' field contains the value entered via web service.
  18. Close the form.
Scenario 7: Discharge a client via the 'ClientDischarge' web service
Specific Setup:
  • A client is enrolled in an existing episode (Client A).
Steps
  1. Access SoapUI for the 'ClientDischarge' - 'DischargeClient' 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 'DateOfDischarge' field.
  6. Enter the desired practitioner in the 'DischargePractitioner' field.
  7. Enter the desired time in the 'DischargeTime' field.
  8. Enter the desired value in the 'AddressType' field.
  9. Enter the desired value in the 'TypeOfDischarge' field.
  10. Enter "Client A" in the 'ClientID' field.
  11. Enter the episode number to be discharged in the 'EpisodeNumber' field.
  12. Click [Run].
  13. Validate the 'Message' field contains: Client Discharge web service has been filed successfully.
  14. Select "Client A" and access the 'Discharge' form.
  15. Validate all populated fields are displayed as entered in the web service.
  16. Select the "Demographics" section.
  17. Validate the 'Address Type' field contains the value entered via web service.
  18. Close the form.
Scenario 8: Client Demographic Web Service validation
Specific Setup:
  • A client is enrolled in an existing episode (Client A).
Steps
  1. Access SoapUI for the 'ClientDemographics' - 'UpdateClientDemographics' 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 value in the 'AddressType' field
  6. Populate any other desired fields.
  7. Enter "Client A" in the 'ClientID' field.
  8. Click [Run].
  9. Validate the 'Message' field contains: Client Demographics web service has been filed successfully.
  10. Select "Client A" and access the 'Update Client Data' form.
  11. Validate all populated fields are displayed.
  12. Validate the 'Address Type' field contains the value entered via web service.
  13. Close the form.
Scenario 9: The 'ClientAdmission' - 'UpdateAdmission' web service: Update Admission for an existing client
Specific Setup:
  • A client must be enrolled in an existing episode (Client A).
Steps
  1. Access SoapUI for the 'ClientAdmission' - 'UpdateAdmission' 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. Populate all required and desired fields.
  6. Enter the desired value in the 'AddressType' field.
  7. Enter "Client A" in the 'ClientID' field.
  8. Enter "Client A's" episode in the 'Episode' field.
  9. Click [Run].
  10. Validate the 'Confirmation' field contains a value such as: "Client Unique ID: # Unique ID: #".
  11. Validate the 'Message' field contains: "Client Admission web service has been filed successfully".
  12. Select "Client A" and access the 'Admission' form.
  13. Select the admission updated in the previous steps and click [Edit].
  14. Validate all populated fields are displayed.
  15. Validate the 'Address Type' field contains the value entered via web service.
  16. Close the form.
Scenario 10: Call Intake Web Service validation - ClientCallIntake
Steps
  1. Using Avatar PM 'ClientCallIntake' web service, submit an Intake record for a 'Call Intake' client:
  2. Populate all required fields.
  3. Include the "Address Type" field.
  4. Ensure that Call Intake record returns 'Client Call Intake web service has been filed successfully' message.
  5. Ensure that 'Call Intake' record/episode filed via web service is present with values filed via the web service, including 'Address Type' value filed in the previous steps.
Scenario 11: 'Admission (Outpatient)' - Verification of form filing
Specific Setup:
  • Site Registration :
  • Sites are defined with hours.
  • Registry setting :
  • Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields = 1&2&3&4&9.
  • Avatar PM->Client Information->Client Demographics->->->Allow Spaces in Client Name = N.
  • Avatar PM->Client Information->Client Demographics->->->Copy Client Name To Alias On Edit = Y.
Steps
  1. Access the 'Admission (Outpatient)' form.
  2. Admit a new client with trailing spaces in client first name and last name.
  3. Populate all required and desired fields.
  4. Validate trailing spaces are auto truncated from the first name and last name.
  5. Select the "Demographics" section.
  6. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  7. Click [Submit].
  8. Access the 'Admission (Outpatient)' form for the client admitted in the previous steps.
  9. Click [Edit] for the episode added in the previous steps.
  10. Validate the previously filed data is displayed.
  11. Select the "Demographics" section.
  12. Validate the 'Address Type' field contains the value filed in the previous steps.
  13. Close the form.
Scenario 12: 'Pre Admit Discharge' - Verification of form filing
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 [OK].
  3. Enter the desired date in the 'Date Of Discharge' field.
  4. Enter the desired time in the 'Time Of Discharge' 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. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  9. Click [Submit].
  10. Select "Client A" and access the 'Pre Admit Discharge' form.
  11. Select the discharged episode and click [OK].
  12. Validate the previously filed data is displayed.
  13. Select the "Demographics" section.
  14. Validate the 'Address Type' field contains the value filed in the previous steps.
  15. Close the form.
Scenario 13: 'Admission (Outpatient)' - Verification of form filing
Specific Setup:
  • Site Registration :
  • Sites are defined with hours.
  • Registry setting :
  • Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields = 1&2&3&4&9.
  • Avatar PM->Client Information->Client Demographics->->->Allow Spaces in Client Name = N.
  • Avatar PM->Client Information->Client Demographics->->->Copy Client Name To Alias On Edit = Y.
Steps
  1. Access the 'Admission (Outpatient)' form.
  2. Admit a new client with trailing spaces in client first name and last name.
  3. Populate all required and desired fields.
  4. Validate trailing spaces are auto truncated from the first name and last name.
  5. Select the "Demographics" section.
  6. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  7. Click [Submit].
  8. Access the 'Admission (Outpatient)' form for the client admitted in the previous steps.
  9. Click [Edit] for the episode added in the previous steps.
  10. Validate the previously filed data is displayed.
  11. Select the "Demographics" section.
  12. Validate the 'Address Type' field contains the value filed in the previous steps.
  13. Close the form.
Topics
• Registry Settings • Client Alternate Addresses • Update Client Data • Discharge • Pre Admit • Call Intake • Pre Admit Discharge • Web Services • Admission • Admission (Outpatient)
Update 170 Summary | Details
Modifiers By Practitioner Category
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • MODIFIERS BY PRACTITIONER CATEGORY
  • Delete Modifiers_Acknowledgement
  • Client Ledger
  • Electronic Billing
  • File Import
Scenario 1: Modifiers by Practitioner Category - Validation
Specific Setup:
  • Registry Setting:
  • Set the 'Enable Duplicate Service Modifiers' registry setting as "Y".
  • Program Maintenance: Identify two outpatient programs: Program 1 & Program 2.
  • Guarantors: A, B, C, and D are identified or created.
  • Client:
  • An existing client (Client A) is identified or a new one is created and admitted to Program 1 for which the Modifiers are planned to be created during the test.
  • Diagnosis records are created for the client.
  • Client A is added with Guarantor B in his Financial Eligibility for whom the modifiers are planned to be created during the test.
  • Practitioner Categories: Existing Practitioner Categories are identified: Practitioner Category 1 & Practitioner Category 2.
  • Practitioners:
  • Existing Practitioners are identified or created with the same Practitioner Category 1 for which the Modifiers are planned to be created during the test: Practitioner A & Practitioner B.
  • CPT Code:
  • CPT codes 1 and 2 are identified or newly created.
  • Service Code:
  • An existing service code is identified or a new one is created: Service 1.
Steps
  1. Open the 'Modifiers by Practitioner Categories' form.
  2. Validate that the form has the field 'Duplicate Service Modifiers'.
  3. Select 'Guarantor A', 'Guarantor B', and 'Guarantor C' in the 'Guarantor ID'.
  4. Select 'Outpatient' from the 'Treatment Setting Selection' field.
  5. Check the value 'Program 1' from the 'Program' list.
  6. Select the 'CPT Code 1' from the 'CPT Code'.
  7. Select 'Practitioner Category 1' from the 'Practitioner Category' selection list field.
  8. Validate that the 'Modifier' field is marked as required when the 'Duplicate Service Modifiers' field is blank.
  9. Enter any invalid format value into the 'Duplicate Service Modifiers' similar to "Invalid_Test_for_Form".
  10. Verify that an error shows with the text "Invalid Format" with the 'OK' button.
  11. Click [OK].
  12. Enter any desired valid value for 'Duplicate Service Modifiers' similar to "D1,D2".
  13. Verify that the 'Modifier' field is not shown as required when there is already a value entered for 'Duplicate Service Modifiers'.
  14. Enter any desired valid value for 'Modifiers' similar to "M1,M2".
  15. Enter the 'Start Date' and 'End Date' values.
  16. Select [Submit].
  17. Create a query of the SQL table, ''SYSTEM.table_hcfa_1500_modifiers" and validate that the Modifiers filed for the Guarantor(s) are added in the table as individual rows.
  18. For the guarantors, verify that the following columns have the correct values- 'cpt_code', 'modifier', 'duplicate_svc_modifier', 'end_date', 'start_date', 'practitioner_category_code', and 'practitioner_category_value'.
  19. Close the SQL window and return to the NX.
  20. Open the 'Modifiers By Practitioner Category' form.
  21. Verify that there are buttons 'Print Modifiers' and 'Delete Modifiers' in the form.
  22. Select the [Print Modifiers] button.
  23. Verify that the report opens up with the modifier values that exist in the system.
  24. Close the report and return to the 'Modifiers By Practitioner Category' form.
  25. Select 'Guarantor D' in the 'Guarantor ID' field.
  26. Select 'Outpatient' from the 'Treatment Setting Selection' field.
  27. Check 'Program 2' from the 'Program' list.
  28. Select the 'CPT Code 2' from the 'CPT Code'.
  29. Select 'Practitioner Category 2' from the 'Practitioner Category' selection list field.
  30. Enter any desired valid value for 'Modifiers' similar to "M1,M2".
  31. Enter any desired valid value for 'Duplicate Service Modifiers' similar to "D3,D4".
  32. Enter the 'Start Date' and 'End Date' values.
  33. Select [Submit].
  34. Create a query of the SQL table, ''SYSTEM.table_hcfa_1500_modifiers" for the 'Guarantor D' and validate that the Modifiers filed for the 'Guarantor D' are added in the table as individual rows.
  35. Verify that the following columns have the correct values- 'cpt_code', 'modifier', 'duplicate_svc_modifier', 'end_date', 'start_date', 'practitioner_category_code', and 'practitioner_category_value'.
  36. Close the SQL window and return to the NX.
  37. Select the [Print Modifiers] button.
  38. Verify that the report opens up with the modifier values that exist in the system.
  39. Verify that the newly added modifier for 'Guarantor D' is also there in the report text.
  40. Close the report and return to the 'Modifiers By Practitioner Category' form.
  41. Select the [Delete Modifiers] button.
  42. Verify that an error shows up stating that the action 'Delete Modifiers' requires the values selected for the 'Guarantor ID', 'Program', 'CPT Code', and 'Practitioner Category' fields with the [OK] button.
  43. Click [OK].
  44. Select 'Guarantor C' in the 'Guarantor ID' field.
  45. Select 'Outpatient' from the 'Treatment Setting Selection' field.
  46. Check the value 'Program 1' from the 'Program' list.
  47. Select the 'CPT Code 1' from the 'CPT Code'.
  48. Select 'Practitioner Category 1' from the 'Practitioner Category' selection list field.
  49. Verify that the value for 'Modifiers' is populated in the respective field.
  50. Verify that the 'Start Date' and 'End Date' values are populated in the respective fields.
  51. Verify that the value for 'Modifiers' is populated in the respective field.
  52. Click the light bulb in the 'Duplicate Service Modifiers' field.
  53. Verify that the help text shown is as expected.
  54. Select the 'Return To Form' link.
  55. Select the [Print Modifiers] button.
  56. Verify that the report opens up with the selected modifier value.
  57. Close the report and return to the 'Modifiers By Practitioner Category' form.
  58. Select the [Delete Modifiers] button.
  59. Verify that an alert popup shows up stating that the "You Are About To Delete Modifiers. Are You Sure You Want To Continue?" with the [OK] and [Cancel] buttons.
  60. Click [OK].
  61. Verify the success message "Modifiers Deleted".
  62. Click [OK].
  63. Select [Discard].
  64. Select [Yes].
  65. Create a query of the SQL table, ''SYSTEM.table_hcfa_1500_modifiers" for 'Guarantor C'.
  66. Validate that there are no modifier records exist in the table.
  67. Close the SQL window.
  68. Open the 'Client Charge Input' form and create a charge with a date outside the modifier date range as below for the test Client:
  69. Client - 'Client A'.
  70. Date Of Service - Any desired date value similar to "10102023".
  71. Service Code - 'Service 1'.
  72. Practitioner - Practitioner A.
  73. Duration (Minutes) - Any desired value similar to "30".
  74. Select [Submit].
  75. Select [Yes] in the form return dialog.
  76. Create a duplicate charge with the same date and practitioner from Step 71 as below for the test Client:
  77. Client - 'Client A'.
  78. Date Of Service - Same as in Step 68(b).
  79. Service Code - 'Service 1'.
  80. Practitioner - 'Practitioner A'.
  81. Duration (Minutes) - Any desired value similar to "30".
  82. Select [Submit].
  83. Verify that the "Duplicate Service" warning popup shows up saying: "The System Identified A Possible Duplicate Entry, For The Client, For This Charge Entry. If You Continue, You Will Have To Delete Any Duplicates Via 'Delete Service'. Continue With The Filing of This Service?" with [Yes], and [No] buttons.
  84. Select [Yes].
  85. Select [Yes] in the form return dialog.
  86. Create a duplicate charge with the same date from Step 71 and a different practitioner as below for the test Client:
  87. Client - 'Client A'.
  88. Date Of Service - Same as in Step 68(b).
  89. Service Code - 'Service 1'.
  90. Practitioner - 'Practitioner B'
  91. Duration (Minutes) - Any desired value similar to "30".
  92. Select [Submit].
  93. Verify that the "Duplicate Service" warning popup shows up saying "The System Identified A Possible Duplicate Entry, For The Client, For This Charge Entry. If You Continue, You Will Have To Delete Any Duplicates Via 'Delete Service'. Continue With The Filing of This Service?" with [Yes], and [No] buttons.
  94. Select [Yes].
  95. Select [Yes] in the form return dialog.
  96. Create a duplicate charge with the same date and practitioner from Step 79 as below for the test Client:
  97. Client - 'Client A'.
  98. Date Of Service - Same as in Step 68(b).
  99. Service Code - 'Service 1'.
  100. Practitioner - 'Practitioner B'.
  101. Duration (Minutes) - Any desired value similar to "30".
  102. Select [Submit].
  103. Verify that the "Duplicate Service" warning popup shows up stating: "The System Identified A Possible Duplicate Entry, For The Client, For This Charge Entry. If You Continue, You Will Have To Delete Any Duplicates Via 'Delete Service'. Continue With The Filing of This Service?", with [Yes], and [No] buttons.
  104. Select [Yes].
  105. Select [No] in the form return dialog.
  106. Open the 'Client Ledger' form process the report for the test client ('Client A') and verify that the services are opened for the dates.
  107. Close the 'Client Ledger'.
  108. Open the 'Close Charges' form.
  109. Set the 'Thru Date' as today's date.
  110. Select 'Individual' and set the 'Client' as 'Client A'.
  111. Select the Episode and click [Submit].
  112. Open the 'Client Ledger' form and by processing the report for the test client ('Client A') make sure that the services are closed for the dates.
  113. Close the 'Client Ledger'.
  114. Open the 'Electronic Billing' form.
  115. Choose the bill type as "837-Professional" bill, and the financial class as "Blue Cross".
  116. Select 'Individual'.
  117. Select the guarantor as 'Guarantor B'.
  118. Select 'Outpatient' in 'Billing Type'.
  119. Click on 'Sort File ' in the 'Billing Options' radio group.
  120. Enter any desired value for 'File Description'.
  121. Select 'All Clients'.
  122. Select 'Program 1' in the program field.
  123. Select 'No' in Create Claims.
  124. Set the start and end dates.
  125. Select the [Process] button.
  126. Verify the "Compile Complete." shows up on a successful compile.
  127. Click [OK].
  128. Select 'Dump File in the Billing Options radio group.
  129. Select the 'Print' option.
  130. Select the processed file from the File dropdown list.
  131. Select the [Process] button.
  132. Validate that the electronic billing text file has the service(s) and the CPT Code(s) but does not have the modifier that was submitted because the service dates are not within the Modifier date range.
  133. Close the report.
  134. Repeat Steps 68 to 111 with a different service date something similar to "05/20/2023" and all other values as the same.
  135. Validate that the electronic billing text file has the appropriate modifier(s) if the Guarantor, Program, CPT Code, and Practitioner Category match. Also, the service date falls within the modifier's defined date range.
  136. Verify that the duplicate service(s) that has the same practitioner has the Modifier value appended with the duplicate service modifier 1 as shown in the below example,
  137. M1:M2:D1
  138. Verify that the duplicate service(s) that has the different practitioner has the Modifier value appended with the duplicate service modifier 2 as shown in the below example,
  139. M1:M2:D2
  140. Close the report.
  141. Click [No].
Scenario 2: Modifiers by Practitioner Category - File Import
Specific Setup:
  • Registry Setting:
  • 'Enable Duplicate Service Modifiers' is set to "Y".
  • Must have the following user files for import:
  • File A: Contains invalid values for 'Guarantor ID', 'Program', 'CPT Code', 'Practitioner Category', 'Modifier', 'Duplicate Service Modifiers', 'Start Date', and 'End Date'. Note: All the field values other than Start and End dates are mandatory whereas the 'Modifier' field is conditional and only required when there is no 'Duplicate Service Modifiers' value.
  • File B: Contains valid values for 'Guarantor ID', 'Program', 'CPT Code', 'Practitioner Category', 'Modifier', 'Duplicate Service Modifiers', 'Start Date', and 'End Date'.
Steps
  1. Open 'File Import'.
  2. Select the 'Modifiers By Practitioner Category' file type.
  3. Select the 'Upload New File' action radio button.
  4. Click [Process].
  5. Select File A, where invalid parameters are defined.
  6. Verify that the file is loaded.
  7. Select the 'Compile/Validate File' action radio button.
  8. Select the file from the 'File(s)' dropdown list.
  9. Click [Process].
  10. Verify that an error popup displays with the text: "File 'xxx'.txt contains one or more errors. These errors can be reviewed using 'Print Errors' action.".
  11. Click [OK].
  12. Select the [Print Errors] action button,
  13. Select the file from the 'File(s)' dropdown list.
  14. Click [Process].
  15. Verify that the report displays the errors.
  16. Close the report.
  17. Select the 'Delete' action radio button.
  18. Select the file from the 'File(s)' dropdown list.
  19. Click [Process].
  20. Verify that the alert popup shows up with the confirmation text "Are you sure?".
  21. Click [Yes].
  22. Validate that the success confirmation dialog shows up with the text containing "Deleted.".
  23. Click [OK].
  24. Select the 'Upload New File' action radio button.
  25. Click [Process].
  26. Select File B, where valid parameters are defined.
  27. Verify that the file is loaded.
  28. Select the 'Compile/Validate File' button.
  29. Select the file from the 'File(s)' dropdown list.
  30. Click [Process].
  31. Verify that the file is compiled without any errors and the confirmation text shows as "Compiled.".
  32. Click [OK].
  33. Select the 'Post File' action radio button.
  34. Select the file from the 'File(s)' dropdown list.
  35. Click [Process].
  36. Verify that the file is posted and the success message displays with the text "Posted".
  37. Click [OK].
  38. Create a query of the SQL table, ''SYSTEM".table_hcfa_1500_modifiers, for the 'Guarantor ID' and validate that the Modifiers defined for the Guarantor are added in the table as individual rows.
  39. Verify that the following columns have the correct values- 'cpt_code', 'modifier', 'duplicate_svc_modifier', 'end_date', 'start_date', 'practitioner_category_code', and 'practitioner_category_value'.
  40. Repeat Steps 39-40 for all the Guarantors included in the File B.
Topics
• NX • Modifiers by Practitioner • File Import
Update 172 Summary | Details
Admission, Admission (Outpatient), Pre Admit, and Call Intake
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Update Client Data
  • Dictionary Update (PM)
Scenario 1: 'Admission (Outpatient)' - Verification of form filing
Specific Setup:
  • Site Registration :
  • Sites are defined with hours.
  • Registry setting :
  • Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields = 1&2&3&4&9.
  • Avatar PM->Client Information->Client Demographics->->->Allow Spaces in Client Name = N.
  • Avatar PM->Client Information->Client Demographics->->->Copy Client Name To Alias On Edit = Y.
Steps
  1. Access the 'Admission (Outpatient)' form.
  2. Admit a new client with trailing spaces in client first name and last name.
  3. Populate all required and desired fields.
  4. Validate trailing spaces are auto truncated from the first name and last name.
  5. Select the "Demographics" section.
  6. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  7. Click [Submit].
  8. Access the 'Admission (Outpatient)' form for the client admitted in the previous steps.
  9. Click [Edit] for the episode added in the previous steps.
  10. Validate the previously filed data is displayed.
  11. Select the "Demographics" section.
  12. Validate the 'Address Type' field contains the value filed in the previous steps.
  13. Close the form.
Scenario 2: Admission - Validations for the invalid characters entered in the client name fields
Specific Setup:
  • Registry setting :
  • Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields = 3.
  • Avatar PM->Client Information->Client Demographics->->->Allow Spaces in Client Name = N.
  • Avatar PM->Client Information->Client Demographics->->->Copy Client Name To Alias On Edit = Y.
Steps
  1. Open the 'Admission' form.
  2. Enter "Last Name" in the 'Last Name' field.
  3. Tab or click out of the 'Last Name' field.
  4. Verify a 'Format Error' dialog opens stating 'Invalid character in last name ' '; valid special characters are ' _ -'.
  5. Click [OK].
  6. Enter "123" in the 'Last Name' field and tab or click out.
  7. Verify a 'Format Error' dialog opens stating 'Last Name must contain at least one letter (A-Z, a-z)'.
  8. Enter anything or nothing in the 'Last Name' field and click or tab out.
  9. Verify that no error dialog opens.
  10. Enter "ONE " in the 'Last Name' field and tab or click out.
  11. Verify that no error dialog opens.
  12. The 'Last Name' field is populated with the "ONE ".
  13. In the First Name field enter "123" and tab or click out.
  14. Verify a 'Format Error' dialog opens stating "First Name must contain at least one letter (A-Z, a-z)".
  15. Click [OK].
  16. In the 'First Name' field enter "First Name ***" and tab or click out.
  17. Verify a 'Format Error' dialog opens stating 'Invalid character in first name '*'; valid special characters are ' _ - '.
  18. In the 'First Name' field, enter "First Name" and tab or click out.
  19. Verify that no error dialog opens. Please note: Spaces are considered a valid special character for First Name.
  20. In the 'First Name' field, enter "TRAILING " and tab or click out.
  21. Verify that no error dialog opens.
  22. Enter anything or nothing in the 'First Name' field, then click or tab out.
  23. Verify that no error dialog opens.
  24. Populate all other required fields to process the new admission.
  25. Verify trailing spaces are auto truncated from the first name and last name.
  26. Verify the new admission process completes successfully and the client with desired client name is created in the system.
Scenario 3: Pre Admit - Validating mailing address fields - The 'Client Demographics - Additional Fields' registry setting = "Y"
Specific Setup:
  • Registry setting :
  • Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields = 3.
  • Avatar PM->Client Information->Client Demographics->->->Allow Spaces in Client Name = N.
  • Avatar PM->Client Information->Client Demographics->->->Copy Client Name To Alias On Edit = Y.
Steps
  1. Open the 'Pre Admit' form.
  2. Set the 'Last Name' field to 'THREE '.
  3. Set the 'First Name' field to 'TRAILING '.
  4. Set the 'Sex' field to "Male".
  5. Click [Search].
  6. Click [OK].
  7. Click [New Client].
  8. Click [Yes].
  9. Validate client name display without any trailing spaces.
  10. Set the 'Preadmit/Admission Date' field to desired value.
  11. Set the 'Preadmit/Admission Time' field to desired time.
  12. Select any program from the 'Program' field.
  13. Select the desired value from the 'Type Of Admission' field.
  14. Click the 'Demographics' tab:
  15. Set the 'Client's Mailing Address - Street' to any address. Note the value.
  16. Set the 'Client's Mailing Address - Street 2' to any address. Note the value.
  17. Set the 'Client's Mailing Address - Zip code' to any Zip code. Note the value.
  18. Validate the 'Client's Mailing Address - City' field auto populates with the city based on the value entered in the 'Client's Mailing Address - Zip code' field. Note the value.
  19. Validate the 'Client's Mailing Address - State' field auto populates with the city based on the value entered in the 'Client's Mailing Address - Zip code' field. Note the value.
  20. Select any value in the 'Client's Mailing Address - Country' drop down list. Note the value.
  21. Click [Submit].
  22. Open the 'Pre Admit' form for the same client.
  23. Edit the Pre-Admission record created in previous steps.
  24. Click the 'Demographics' tab:
  25. Verify the 'Client's Mailing Address - Street' restores the same value entered during adding client's admission.
  26. Verify the 'Client's Mailing Address - Street 2' restores the same value entered during adding client's admission.
  27. Verify the 'Client's Mailing Address - Zip code' restores the same value entered during adding client's admission.
  28. Verify the 'Client's Mailing Address - City' restores the same value entered during adding client's admission.
  29. Verify the 'Client's Mailing Address - State' restores the same value entered during adding client's admission.
  30. Verify a value in the 'Client's Mailing Address - Country' restores the same value entered during adding client's admission.
  31. Click [Close Form].
Scenario 4: Call Intake - Demographics section - Registry setting 'Add Demographics to Call Intake'
Specific Setup:
  • Registry setting :
  • Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields = 3.
  • Avatar PM->Client Information->Client Demographics->->->Allow Spaces in Client Name = N.
  • Avatar PM->Client Information->Client Demographics->->->Copy Client Name To Alias On Edit = Y.
Steps
  1. Open 'Call Intake' form.
  2. Verify the form contains 'Demographics' section.
  3. Set 'Last Name' to 'FOUR ' (not an existing client).
  4. Set 'First Name' to 'TRAILING '.
  5. Select any gender in the 'Sex' drop down list.
  6. Click [Search].
  7. Click [New Client].
  8. Click [Call] in the 'Call Or Walk-in' field.
  9. Verify trailing spaces are auto truncated from the first name and last name.
  10. Set the 'Caller Name' to any LastName, FirstName.
  11. Set the 'Call Date' to any date.
  12. Set the 'Call Time' to any time.
  13. Select any value from the 'Program' drop down list.
  14. Select any value from the 'Disposition' drop down list.
  15. Enter any text in the 'Comments for the call intake' text box.
  16. Set the 'Date of Birth' to any date in the past.
  17. Set the 'Social Security Number' to any SSN.
  18. Click the 'Demographics' tab.
  19. Validate First name display without trailing spaces.
  20. Validate Last name display without trailing spaces.
  21. Set the 'Client's Address - Street' to any address.
  22. Set the 'Client's Address - Zip code' to any Zip code.
  23. Select any value in the 'Primary Language' drop down list.
  24. Select any value in the 'Client Race' drop down list.
  25. Select any value in the 'Other Race(s)' list.
  26. Select any value in the 'Ethnic Origin' drop down list.
  27. Select any value from the 'Religion' drop down list.
  28. Set the 'Place of Birth' to any value.
  29. Select any value from the 'Marital Status' drop down list.
  30. Select any value from the 'Education' drop down list.
  31. Select any value from the 'Employment Status' drop down list.
  32. Select any value from the 'Occupation' drop down list.
  33. Click [Submit].
  34. Open the 'Call Intake' form for the same client.
  35. Verify the Demographic data is retained and correct.
  36. Close the form.
  37. Open the 'Registry setting' Form.
  38. Set the 'Add Demographics to Call Intake' to 'N'.
  39. Submit the form.
  40. Open 'Call Intake' form.
  41. Verify the form does not contain 'Demographics' section.
  42. Submit the form.
Scenario 5: 'Admission (Outpatient)' - Verification of form filing
Specific Setup:
  • Site Registration :
  • Sites are defined with hours.
  • Registry setting :
  • Avatar PM->Client Information->Client Demographics->->->Client Demographics - Additional Fields = 1&2&3&4&9.
  • Avatar PM->Client Information->Client Demographics->->->Allow Spaces in Client Name = N.
  • Avatar PM->Client Information->Client Demographics->->->Copy Client Name To Alias On Edit = Y.
Steps
  1. Access the 'Admission (Outpatient)' form.
  2. Admit a new client with trailing spaces in client first name and last name.
  3. Populate all required and desired fields.
  4. Validate trailing spaces are auto truncated from the first name and last name.
  5. Select the "Demographics" section.
  6. Select the desired value in the 'Address Type' field. Please note: this will display values defined in the '(10006) Location' dictionary.
  7. Click [Submit].
  8. Access the 'Admission (Outpatient)' form for the client admitted in the previous steps.
  9. Click [Edit] for the episode added in the previous steps.
  10. Validate the previously filed data is displayed.
  11. Select the "Demographics" section.
  12. Validate the 'Address Type' field contains the value filed in the previous steps.
  13. Close the form.
Topics
• Admission (Outpatient) • Admission • Pre Admit • NX • Call Intake
Update 175 Summary | Details
Avatar MSO to Parent System Service Filing, Void/Replacement Claims
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • 837 Health Care Claim Professional
  • Client Ledger
  • Delete Service
Scenario 1: 'Delete Service' - Verification of Charge Reversal Posting for Replacement/Void Claims Including Add-On Services
Specific Setup:
  • Avatar PM/Cal-PM Registry Setting 'Enable Multiple Add-On Code Per Primary Code Functionality' may optionally be enabled/disabled.
  • 'File Services On Closing Of Batch Or Creation of EOB?' must be set to 'Yes' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section)
  • One or more 'Approved' status 'Void' and/or 'Replacement' claims for Avatar PM/Cal-PM services (with closed charges) originating in Avatar MSO where Primary and Add-On Service are present in original claim.
Steps
  1. Open Avatar MSO 'Close Batch' form.
  2. Select Avatar MSO Claims Processing batch containing one or more 'Approved' status 'Replacement' claim for Primary and Add-On services eligible for filing to parent Avatar PM/Cal-PM system (where original service charges are closed in Avatar PM/Cal-PM):
  3. Note - Retro Claim Adjudication entries from Avatar MSO 'Void' 837 Professional/837 Institutional claims are pushed/filed to Avatar PM/Cal-PM parent system on posting in MSO, as no Avatar MSO Claims Processing Batch is created; Retro Claim Adjudication entries from Avatar MSO 'Replacement' 837 Professional/837 Institutional claims are pushed/filed to Avatar PM/Cal-PM parent system on closing of Claims Processing Batch for Replacement Claims/Services in MSO
  4. Note - Acceptance Testing may also be confirmed via Avatar PM/Cal-PM 'Delete Service' form for Primary services with one or more associated Add-On services associated
  5. Set 'Close Batch' field to 'Yes' (and click 'OK' button to close warning message dialog).
  6. Click 'Submit' button to close batch/file services to parent Avatar PM/Cal-PM system.
  7. Open 'Client Ledger' form in parent Avatar PM/Cal-PM system.
  8. Select 'Client ID' value for client where services are present in Avatar MSO closed status Claims Processing batch.
  9. Select 'Claim/Episode/All Episodes' value.
  10. Select 'Ledger Type' value.
  11. In Client Ledger data - ensure that 'Approved' status original claim services originating in Avatar MSO are present in Avatar PM/Cal-PM system following 'Close Batch' filing (where services are valid for filing to parent system).
  12. In Client Ledger data - ensure that services originating in Avatar MSO where 'Replacement' or 'Void' claim has subsequently been processed in Avatar MSO (resulting in Retro Claim Adjudication service takeback entries) are updated in Avatar PM/Cal-PM parent system as follows:
  13. Original Primary and Add-On services in 'Open' charge status will be deleted in Avatar PM/Cal-PM parent system, and new/replacement services will be filed/present in Avatar PM/Cal-PM system following 'Close Batch' filing (if 'Approved' status and where replacement services are valid for filing to parent system)
  14. Original Primary and Add-On services in 'Closed' and 'Unbilled' charge status (not claimed) will have service deletion reversal code ('DELETE') filed in Avatar PM/Cal-PM parent system, and new/replacement services will be filed/present in Avatar PM/Cal-PM system following 'Close Batch' filing (if 'Approved' status and where replacement services are valid for filing to parent system)
  15. Original Primary and associated Add-On services in 'Closed' and 'Unbilled' charge status (not claimed) will have Charge Payment/Reversal adjustment filed in Avatar PM/Cal-PM parent system for the amount of the original service:
  16. Posting/Adjustment Code as defined via Avatar MSO 'Set System Defaults' form for MSO-originating services; Posting/Adjustment Code as selected if using Avatar PM/Cal-PM 'Delete Service' form
Topics
• Delete Service • 837 Professional
Update 180 Summary | Details
Pro-Rate Fees
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Post Residential/Inpatient Worklist
  • Client Ledger
  • Service Codes
  • Service Fee/Cross Reference Maintenance
  • Dictionary Update (PM)
  • Program Maintenance
  • Financial Eligibility
  • Leaves
  • Discharge
Scenario 1: Validate Pro-Rated Fees Calculation - Client without leave or discharge
Specific Setup:
  • Registry Settings:
  • The following registry setting has a value of '2', at a minimum: Avatar PM->System Maintenance->Service Code Maintenance->->->Additional Service Fee Configuration Fields.
  • The following registry setting has a value of '5': Avatar PM->Services->Inpatient/Residential->->->Number Of Daily Charge Codes.
  • Guarantors/Payors 1 is an active guarantor.
  • Service Codes:
  • Service Code 1: Is an active service code that will be used for pro-rated services room and board charges.
  • Service Code 2: Is an active service code that will be used for pro-rated services daily charge (1).
  • Service Code 3: Is an active service code that will be used for pro-rated services daily charge (2).
  • Service Code 4: Is an active service code that will be used for pro-rated services daily charge (3).
  • Service Code 5: Is an active service code that will be used for pro-rated services daily charge (4).
  • Service Code 6: Is an active service code that will be used for pro-rated services daily charge (5).
  • Service Fee/Cross Reference Maintenance:
  • Service Code 1 - Service Code 6:
  • From Date = desired date.
  • Fee = desired amount, which is distributed across the monthly services. Note each value.
  • UB-94 Revenue Code = desired value.
  • Fee type = Monthly.
  • Pro-Rate Fee For = desired values.
  • Pro-Rated Fee Calculation = Fee/Monthly Days.
  • Client:
  • Is admitted to an inpatient program on or after the earliest 'Service Fee/Cross Reference Maintenance', 'From Date'. Note the ‘Unit’ the client is assigned to. Client has not been placed on leave or discharged during the month.
  • Has a 'Financial Eligibility' record for Guarantors/Payors 1.
  • Equations are used for fee verification based on the value in 'Pro-Rated Fee Calculation'.
  • The value of 'Pro-Rated Fee Calculation' is 'Fee/Monthly Days'. The equation is: the 'Fee' divided by the number of days in the month, times the number of valid days, divided by the number of days in the month.
  • Example 1: Fee is 350.00. Days in month = 31. Valid days = 31. 350/31 = 11.29 for days 1-30, and 11.30 for day 31.
  • Example 2: Fee is 120.00. Days in month = 30. Valid days = 15. 120.00/30x15/30 = 2.00 for the valid days.
Steps
  1. Open ‘Compile Residential/Inpatient Charges’.
  2. Select ‘Individual’ in ‘Individual Or All Units’.
  3. Select desired Unit in ‘Select Unit(s)’.
  4. Set the ‘Compile Charges From Date’ to desired value.
  5. Set the ‘Compile Charges Through Date’ to desired value.
  6. Select ‘Yes’ in ‘Do You Wish To Recreate The Residential/Inpatient Worklist’
  7. Click [Process].
  8. Validate that the report fees are correct for each service code, ensuring that at a minimum the first and last page of the report are verified. Calculate the fees to verify that the fee in ‘Service Fee/Cross Reference Maintenance’ is correct for the valid number of days in the month.
  9. Open ‘Post Residential/Inpatient Worklist’.
  10. Select ‘Individual’ in ‘Individual Or All Units’.
  11. Select desired Unit in ‘Select Unit(s)’.
  12. Set the ‘Post Charges From Date’ to desired value.
  13. Set the ‘Post Charges Through Date’ to desired value.
  14. Click [Process].
  15. Validate that the report fees are the same as above.
  16. If desired, open ‘Client Ledger’ for the client and verify the fees for the date range and services.
Scenario 2: Validate Pro-Rated Fees Calculation - Client with leave only & Client with leave & discharge
Specific Setup:
  • Registry Settings:
  • The following registry setting has a value of '2', at a minimum: Avatar PM->System Maintenance->Service Code Maintenance->->->Additional Service Fee Configuration Fields.
  • The following registry setting has a value of '5': Avatar PM->Services->Inpatient/Residential->->->Number Of Daily Charge Codes.
  • Guarantors/Payors 1 is an active guarantor.
  • Service Codes:
  • Service Code 1: Is an active service code that will be used for pro-rated services room and board charges.
  • Service Code 2: Is an active service code that will be used for pro-rated services daily charge (1).
  • Service Code 3: Is an active service code that will be used for pro-rated services daily charge (2).
  • Service Code 4: Is an active service code that will be used for pro-rated services daily charge (3).
  • Service Code 5: Is an active service code that will be used for pro-rated services daily charge (4).
  • Service Code 6: Is an active service code that will be used for pro-rated services daily charge (5).
  • Service Fee/Cross Reference Maintenance:
  • Service Code 1 - Service Code 6:
  • From Date = desired date.
  • Fee = desired amount, which is distributed across the monthly services. Note each value.
  • UB-94 Revenue Code = desired value.
  • Fee type = Monthly.
  • Pro-Rate Fee For = desired values. If 'Missing Service Code' is not selected in the field, leave days will be counted as valid days.
  • Pro-Rated Fee Calculation = Fee/Monthly Days.
  • Dictionary Update:
  • Client - Type of Leave From (757):
  • Extended Dictionaries:
  • Chargeable Leave Y/N = Y.
  • Room And Board Billing Code Override = a Room & Board Code that is not Service Code 1.
  • Client:
  • Is admitted to an inpatient program on or after the earliest 'Service Fee/Cross Reference Maintenance', 'From Date'. Note the ‘Unit’ the client is assigned to. The service codes noted above are used in the 'Inpatient/Partial/Day Treatment' section of the form.
  • Client has a billable leave during the month. Note the number of leave days. The client has not been discharged during the month.
  • Has a 'Financial Eligibility' record for Guarantors/Payors 1.
  • Equations are used for fee verification based on the value in 'Pro-Rated Fee Calculation'.
  • The value of 'Pro-Rated Fee Calculation' is 'Fee/Monthly Days'. The equation is: the 'Fee' divided by the number of days in the month, times the number of valid days, divided by the number of days in the month.
  • Example 1: Fee is 350.00. Days in month = 31. Valid days = 31. 350/31 = 11.29 for days 1-30, and 11.30 for day 31.
  • Example 2: Fee is 120.00. Days in month = 30. Valid days = 15. 120.00/30x15/30 = 2.00 for the valid days.
Steps
  1. Open ‘Compile Residential/Inpatient Charges’.
  2. Select ‘Individual’ in ‘Individual Or All Units’.
  3. Select desired Unit in ‘Select Unit(s)’.
  4. Set the ‘Compile Charges From Date’ to desired value.
  5. Set the ‘Compile Charges Through Date’ to desired value.
  6. Select ‘Yes’ in ‘Do You Wish To Recreate The Residential/Inpatient Worklist’
  7. Click [Process].
  8. Validate that the report fees are correct for each service code, ensuring that at a minimum the first and last page of the report are verified. Calculate the fees to verify that the fee in ‘Service Fee/Cross Reference Maintenance’ is correct for the valid number of days in the month.
  9. Open ‘Post Residential/Inpatient Worklist’.
  10. Select ‘Individual’ in ‘Individual Or All Units’.
  11. Select desired Unit in ‘Select Unit(s)’.
  12. Set the ‘Post Charges From Date’ to desired value.
  13. Set the ‘Post Charges Through Date’ to desired value.
  14. Click [Process].
  15. Validate that the report fees are the same as above.
  16. If desired, open ‘Client Ledger’ for the client and verify the fees for the date range and services.
  17. In the next month, place the client on a billable leave on desired date. Return the client from leave on desired date. Discharge the client at least one day after returning from leave.
  18. Repeat steps 1-17 for the new month of services.
Topics
• Pro Rated Fee
Update 182 Summary | Details
Future Functionality
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Remittance Processing Widget
  • Client Ledger
Internal Test Only
Payment Acknowledgement
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Close Accounting Period
  • Payment Acknowledgement
  • Deposit Entry
  • Client Ledger
Scenario 1: Payment Acknowledgement : Post Front Office and myHP Payments section
Specific Setup:
  • Registry Settings:
  • Enable Payment Acknowledgement Registry Setting Value: Y.
  • Prevent Posting Payments Unless Payment: 5.
  • Admission:
  • Create a client with active diagnosis and financial eligibility.
  • Client charge input:
  • Assign a few services to the above created client.
  • Closed Accounting Period: Note the last closed accounting period.
Steps
  1. Open 'Deposit Entry.
  2. Enter 'Date of receipt or adjustment'.
  3. Select 'Client id'.
  4. Select 'Episode number'.
  5. Select 'Service code'.
  6. Select 'Guarantor'.
  7. Enter 'Amount to post'.
  8. Select 'Posting code'.
  9. Click 'Submit'.
  10. Verify the generated crystal report.
  11. Open 'Close Accounting Period'.
  12. Validate the date of 'Month/Year Of Close For Charge/Payment Postings'.
  13. Open 'Payment Acknowledgement'.
  14. Click on 'Post Front Office and myHP Payments' item.
  15. Enter 'Payment Collection Date'.
  16. Select 'Treatment Service'.
  17. Select 'Type'.
  18. Click on 'Review button'.
  19. Select the record which you created by using Deposit entry form.
  20. Enter a Deposit date that is in a closed accounting period and validate an error message is received stating: 'Date Must Be In An Open Accounting Period'.
  21. Enter a future date in 'Deposit date' and validate an error message is received stating: 'Future Dates Are Not Allowed'.
  22. Enter desired values to all required fields.
  23. Click on 'Post' button.
  24. Open 'Client ledger'.
  25. Validate the posted amount displaying in the crystal report.
Scenario 2: PM_Payment Acknowledgement - Post payments made on Deposit Entry form.
Specific Setup:
  • Registry Setting:
  • The 'Enable Payment Acknowledgement' registry setting is enabled.
  • The 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting includes value '1'.
  • Client A has a payment collected in Scheduling Calendar Check In. Note the payment date. Note the receipt number in the generated receipt. There is no data in 'Name on Card'.
  • Client B has a payment collected in 'Deposit Entry’. Add a value to 'Name on Card'. Note the payment date. Note the receipt number in the generated receipt.
Steps
  1. Open the ‘Payment Acknowledgment’ form.
  2. Select the ‘Post Front Office and myHP Payments’ section.
  3. Enter the desired ‘Payment Collection Date’.
  4. If desired, select a ‘Treatment Service’.
  5. Select the desired ‘Type’.
  6. Click [Review].
  7. Validate that the grid contains a row for each client and the correct data for the appropriate columns.
  8. Add data to 'Name on Card' for Client A.
  9. Click the checkbox for both rows.
  10. Click [Save].
  11. Click [Yes].
  12. Enter desired ‘Batch Number’.
  13. Enter desired ‘Deposit Date’.
  14. Select desired ‘Category’.
  15. Enter desired ‘Bank Ref #’.
  16. If desired, enter ‘Comments’.
  17. Click [Post].
  18. Validate that a ‘Conform’ message is received stating ‘Filed successfully’.
  19. Click [OK].
  20. Click [Discard].
  21. Click [Yes] on the ‘Confirm Close’ message.
Topics
• NX • Payment Acknowledgement • Deposit Entry
2024 Update 183 Summary | Details
Guarantors/Payors - 835 section.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Practitioner Numbers By Guarantor And Program
  • Admission (Outpatient)
  • Financial Eligibility
  • Client Ledger
  • Electronic Billing
  • Dynamic Form - Form and Table Documentation / File Export - File Name
  • Posting/Adjustment Codes Definition
  • Claim Adjustment Group/Reason Code Definition
  • 835 Health Care Claim Payment/Advice (PM)
  • Spreadsheet Batch Remittance Posting
  • Remittance Post Confirmation
Scenario 1: 835 Health Care Claim Payment/Advice - Allow Adjustment Reversals For 835 Posting
Specific Setup:
  • Client A:
  • Select a client with claimed services. A minimum of one service has no balance due. There are other services with a balance due.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
  • An 835 Health Care Claim Payment/Advice exists for the claims and contains at least one adjustment.
  • Client B:
  • Select a client with claimed services for a non-contract guarantor.
  • '835' section:
  • 'Allow Adjustment Reversals For 835 Posting' = Yes.
  • 'Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting' = No.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
  • An 835 Health Care Claim Payment/Advice exists for the claims and contains at least one adjustment.
  • Client C:
  • Select a client with claimed services for a contract guarantor. Note the following for the guarantor:
  • 'Contractual Guarantor' section:
  • 'Does This Guarantor Use Contractual Allowance By Batch Or Through Liability Distribution?' = 'Contractual Allowance By Liability Distribution'.
  • The value of 'Contractual Adjustment Code (Credit)
  • The value of 'Contractual Adjustment Code (Debit)
  • The value of 'Contractual Write-Off Code
  • The value of 'Temporary Contractual Adjustment Code (Credit)
  • The value of 'Temporary Contractual Write-Off Code'
  • Enable Modified Contractual Allowance Calculation
  • '835' section:
  • 'Allow Adjustment Reversals For 835 Posting' = No.
  • 'Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting' = Yes.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
  • An 835 Health Care Claim Payment/Advice exists for the claims and contains at least one adjustment.
Steps
  1. Open '835 Health Care Claim Payment/Advice'.
  2. Load, compile, and post the file for Client A.
  3. Close the form.
  4. Open 'Client Ledger' for Client A.
  5. Validate that the payments and adjustments have posted correctly to the client's account.
  6. Close the form.
  7. Open '835 Health Care Claim Payment/Advice'.
  8. Load, compile, and post the file for Client B.
  9. Close the form.
  10. Open 'Client Ledger' for Client B.
  11. Validate that the payments and adjustments have posted correctly to the client's account, when the 'Allow Adjustment Reversals For 835 Posting' = Yes.
  12. Close the form.
  13. Open '835 Health Care Claim Payment/Advice'.
  14. Load, compile, and post the file for Client C.
  15. Close the form.
  16. Open 'Client Ledger' for Client C.
  17. Validate that the payments and adjustments have posted correctly to the client's account, when the 'Allow Adjustment Reversals For 835 Posting' = No.
  18. Close the form.
Scenario 2: Spreadsheet Batch Remittance Posting functionality
Specific Setup:
  • Client A:
  • Select a client with claimed services. A minimum of one service has no balance due. There are other services with a balance due.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
  • Client B:
  • Select a client with claimed services for a non-contract guarantor.
  • '835' section:
  • 'Allow Adjustment Reversals For 835 Posting' = Yes.
  • 'Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting' = No.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
  • Client C:
  • Select a client with claimed services for a contract guarantor. Note the following for the guarantor:
  • 'Contractual Guarantor' section:
  • 'Does This Guarantor Use Contractual Allowance By Batch Or Through Liability Distribution?' = 'Contractual Allowance By Liability Distribution'.
  • The value of 'Contractual Adjustment Code (Credit)
  • The value of 'Contractual Adjustment Code (Debit)
  • The value of 'Contractual Write-Off Code
  • The value of 'Temporary Contractual Adjustment Code (Credit)
  • The value of 'Temporary Contractual Write-Off Code'
  • Enable Modified Contractual Allowance Calculation
  • '835' section:
  • 'Allow Adjustment Reversals For 835 Posting' = No.
  • 'Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting' = Yes.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
Steps
  1. Open 'Spreadsheet Batch Remittance Posting'.
  2. Select "Create Batch" in the 'Create, Edit Or Delete Remittance Batch' field.
  3. Enter a description in the 'Batch Description' field.
  4. Enter a date in the 'Posting Date' field.
  5. Enter a date in the 'Date Of Receipt' field.
  6. Select 'Yes' in 'Include Zero Balance Claims'.
  7. Select 'Yes' in ' 'Include Zero Balance Services'.
  8. Click the "Launch Work Screen" button.
  9. Enter an ID in the "Client" field.
  10. Select an episode for the selected client in the "Ep #" field.
  11. Select a claim number in the "Claim" field.
  12. Select a payor in the "Payor" field.
  13. Select a date in the "Begin Date/Svc Date" field.
  14. Select a date in the "End Date/Svc Code" field.
  15. Verify the "Total Charges" field auto populated when the claim was selected.
  16. Verify the "Liability" field auto populated when the claim was selected.
  17. Verify the "Liability" amount matches the amount noted in the "Client Ledger" report.
  18. Click [+] in the first column of the row.
  19. Validate that the client's services display, noting that the first row shows a summation of the services for the selected guarantor.
  20. Select a service with a balance due and enter an amount in the "Payment Amount" field.
  21. Select a code in the "Payment Code" field.
  22. Click [TAB] key.
  23. Validate the 'Payment Code' field displays the same value selected in the above step.
  24. Enter an amount in the "Adjust Amount" field.
  25. Select a code in the "Adjust Code" field.
  26. Click [TAB] key.
  27. Validate the 'Adjust Code' field displays the same value selected in the above step.
  28. Enter an amount in the "Transfer Amount" field.
  29. Select a code in the "Transfer Code" field.
  30. Click [TAB] key.
  31. Validate the 'Transfer Code' displays the same value selected in the above step.
  32. Select a guarantor in the "Transfer Guar" field.
  33. Verify the "New Balance" field is updated with the balance after all amounts are updated.
  34. Repeat steps 19 - 21 for a service that has no balance due.
  35. Click the "Accept" button.
  36. Click the "Submit" button.
  37. Open 'Client Ledger'.
  38. Select 'All Episodes' in 'Claim/Episode/All Episodes'.
  39. Select ‘Simple’ in ‘Ledger Type’.
  40. Click [Process].
  41. Validate that the payment, adjustments, and transfers are displayed and that the ‘TOTAL BALANCE BY GUARANTOR’ amount is reduced by the appropriate amount.
  42. Close the report.
  43. Close the form.
  44. Repeat above steps for Client B and validate the data.
  45. Repeat above steps for Client C and validate the data.
Scenario 3: Guarantors/Payors - Validate submission of '835' section
Specific Setup:
  • Guarantors/Payors 1 exists. No data has been submitted for the '835 section.
Steps
  1. Open 'Guarantors/Payors'.
  2. Select 'Edit' in 'Add New Or Edit Existing Guarantor'.
  3. Select 'Guarantors/Payors 1' in 'Guarantor Code'.
  4. Set the section to '835'.
  5. Select a value in 'Automated 835 Actions'. Note the selected value.
  6. Select a value in 'Process Transaction Handling Code(s)'. Note the selected value.
  7. Select a value in 'Allow overage adjustments to be posted'. Note the selected value.
  8. Enter up to sixty characters in 'Payor Name (1000A N1-02)'. Note the value entered.
  9. Enter up to forty characters in 'Payee Identification Code (1000B N1-04)'. Note the value entered.
  10. Select a value in 'Allow posting of crossover payment/adjustment prior to payment/adjustment from the original guarantor'. Note the selected value.
  11. Select a value in 'Allow Adjustment Reversals For 835 Posting'. Note the selected value.
  12. Select a value in ''Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting'.
  13. Set the section to 'Guarantors/Payors'.
  14. Click 'File'.
  15. Select 'Edit' in 'Add New Or Edit Existing Guarantor'.
  16. Select 'Guarantors/Payors 1' in 'Guarantor Code'.
  17. Set the section to '835'.
  18. Validate the value in 'Automated 835 Actions'.
  19. Validate the value in 'Process Transaction Handling Code(s)'.
  20. Validate the value in 'Allow overage adjustments to be posted'.
  21. Validate the value in 'Payor Name (1000A N1-02)'.
  22. Validate the value in 'Payee Identification Code (1000B N1-04)'.
  23. Validate the value in 'Allow posting of crossover payment/adjustment prior to payment/adjustment from the original guarantor'.
  24. Validate the value in 'Allow Adjustment Reversals For 835 Posting'.
  25. Validate the value in ''Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting'.
  26. Close the form.
Topics
• 835 Health Care Claim Payment/Advice • Spreadsheet Batch Remittance Posting • Guarantor/Payors
Update 189 Summary | Details
Future Functionality
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Financial Eligibility
  • Eligibility Inquiry and Response (270/271) Report
  • CareFabric Monitor
Scenario 1: Enable RevConnect = YA - Real Time Inquiry (270) Request
Specific Setup:
  • Netsmart Client Alignment Associate has been contacted to enable 'RevConnect'.
  • Netsmart Avatar support has completed the following:
  • Enabled the 'Enable RevConnect' registry setting has been updated to contain 'YA'.
  • Completed & submitted the 'RevConnect Configuration' form.
  • 'System Generated Email Settings' has been used to add the tester’s email to enable notification verification.
  • Registry Setting:
  • The 'Enable 270/271 Transaction Sets' registry setting is set to 'Y'.
  • Guarantors/Payors:
  • An existing guarantor is identified and has a value of 'Yes' in 'Support 270/271 Transaction Sets' of the '270 / 271 / 834' sections. Note all selections on the form.
  • Admission:
  • A client is admitted to a program, or an existing client is identified. Note client id/name, admission date/program.
  • Financial Eligibility: The above guarantor is assigned to client.
  • Based on the setup in the '270 / 271 / 834' section of 'Guarantors/Payors', the client either has one, or any combination of the following: services, appointments, or an eligibility request in financial eligibility.
  • Eligibility Inquiry (270/271) Real-Time Setup:
  • The 'Access Point Type' contains a 'RevConnect' option only when the 'Enable RevConnect' registry setting has a value of 'YA'.
  • The 'RevConnect Account Key' field is added to the form when the 'Enable RevConnect' registry setting has a value of 'YA'.
Steps
  1. Open 'Real Time Inquiry (270) Request'.
  2. Create a request for the client.
  3. Close the form.
  4. Open 'Eligibility Inquiry And Response (270/271) Report'.
  5. Enter the 'Client' ID' and other desired data.
  6. Click 'Display Report'.
  7. Validate the report data.
  8. Close the report.
  9. Close the form.
  10. Open 'Real Time Inquiry (270) Request'.
  11. Enter the 'Client ID', 'Guarantor' and other desired data.
  12. Click [Process Report].
  13. Click [OK].
  14. Review the report data.
  15. Validate that the 'Response' field contains the correct data.
  16. If desired, click [Post Inquiry].
  17. Close the form.
  18. Open 'CareFabric Monitor'.
  19. Enter the desired 'From Date', 'Through Date' and 'Client ID'.
  20. Click [View Activity Log].
  21. Review the data to ensure the events/actions were created.
  22. Close the report.
  23. Close the form.
Topics
• Real Time Inquiry (270) Request • RevConnect
 

Avatar_PM_2023_Monthly_Release_2023.04.00_Details.csv