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Avatar PM 2023 Update 10

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Product Requirements / Recommendations

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Product Update Form Description

The 'Enable Submitter Identification Definition' registry setting is updated to include new fields in the 'Submitter Identification Definition' form. The 'Electronic Billing' 837 Institutional and 837 Professional are updated to pull the values from those new fields where appropriate.

Included Updates

None

Required Updates

Avatar PM 2022 Update 153
Details
NEW1 CHANGED0 FIXED0
New (1)
Avatar PM 'Enable Submitter Identification Definition' Registry Setting
The 'Enable Submitter Identification Definition' Registry Setting is updated to allow for inclusion of additional fields in the 'Submitter Identification Definition' form and support in 'Electronic Billing' 837 file generation.
The following fields will be added to the Avatar PM 'Submitter Identification Definition' form where Avatar PM 'Enable Submitter Identification Definition' Registry Setting includes value '3':
* 'Authorization Number'
* 'Program Taxonomy 2000A-PRV-03'
* 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)'
* 'Billing Provider Primary Identification # (2010AA-NM1-09)'
* 'Billing Provider Secondary Identification Number (2010BB-REF-02)'
* 'Facility Identification Code Qualifier (837P-2310C / 837P-2420C / 837I-2310E-NM1-08)'
* 'Facility Identification Code (837P-2310C / 837P-2420C / 837I-2310E-NM1-09)'
* 'Facility Reference Identification Qualifier (837P-2310C / 837P-2420C / 837I-2310E-REF-01)'
* 'Facility Reference Identification (837P-2310C / 837P-2420C / 837I-2310E-REF-02)'

Avatar PM 'Electronic Billing' 837 Professional and 837 Institutional file compilation/generation is updated to use these Submitter Identification Definition values where dictated by Guarantor/Program Billing Defaults setup. For more information, please refer to the updated details/description for Avatar PM 'Enable Submitter Identification Definition' Registry Setting.
Value Added: Updates Avatar PM 'Enable Submitter Identification Definition' Registry Setting for additional 837 field support
Topics
• 837 Institutional • 837 Professional • Electronic Billing • NX • Registry Settings
 
Acceptance Tests
AV-76314 Summary | Details
Avatar PM 'Enable Submitter Identification Definition' Registry Setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • Submitter Identification Definition
  • Dictionary Update (PM)
  • Electronic Billing
Scenario 1: Avatar PM Registry Settings - Verification of 'Enable Submitter Identification Definition' Registry Setting
Steps
  1. Open 'Registry Settings' form.
  2. Set 'Include Hidden Registry Settings' field to 'Yes'.
  3. Enter search value 'Enable Submitter Identification' and click 'View Registry Settings' button.
  4. Ensure Registry Setting is returned (under 'Avatar PM -> Billing -> Electronic Billing -> All 837 Submissions- > Enable Submitter Identification Definition' path).
  5. Ensure 'Registry Setting Details' field contains the following explanation text:

"Enabling this functionality gives an end-user the ability to optionally specify identification information based on guarantor, program, service code, and client combination for a specific date range. This is accomplished by adding the 'Submitter Identification Definition' form under 'Avatar PM->System Maintenance->System Definition'. In addition, the following 837 logic is enabled:


When generating a version 4010 837 bill, a check will be made to see if a value of 'ZZZ' is in 'Billing Provider Secondary Identification Code Qualifier 1 (2010AA-REF-01)', or 'Billing Provider Secondary Identification Code Qualifier 2 (2010AA-REF-01)' or 'Billing Provider Secondary Identification Code Qualifier 3 (2010AA-REF-01)' in the 'Guarantor/Program Billing Defaults' form. For version 5010, the system will check the 'Billing Provider Secondary Identification Code Qualifier (2010BB-REF)' field.


If '1' is selected, the 'Submitter Primary Identification Qualifier (1000A-NM1-08)' and 'Submitter Primary Identification Number (1000A-NM1-09)' will be populated with the values specified in the 'Submitter Identification Code Qualifier' and 'Submitter Identification Number' fields of the above form respectively. This functionality is available in both version 4010 and 5010.


If '2' is selected, for version 4010 the 'Billing Provider Secondary Identification Code Qualifier (2010AA-REF-01)' and 'Billing Provider Secondary Identification # (2010AA-REF-02)' will be populated with the values specified in the 'Billing Provider Secondary Identification Code Qualifier' and 'Submitter Identification Number' fields specified for any iteration that contains the 'ZZZ' dictionary code. For version 5010, the 'Billing Provider Secondary Identification Code Qualifier (2010BB-REF-01)' and 'Billing Provider Secondary Identification # (2010BB-REF-02)' will be populated with the same values specified for any iteration that contains the 'ZZZ' dictionary code.


If '3' is selected the ability to optionally specify identification information based on authorization number is added and if "ZZZ" is selected in the following 'Guarantor/Program Billing Defaults' fields on the left then the appropriate 837 fields will be populated with the 'Submitter Identification Definition' fields on the right:


'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)' --

'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)' and 'Billing Provider Primary Identification # (2010AA-NM1-09)'

Note: The 'Submitter Identification Definition' 'Billing Provider Secondary Identification Number (2010BB-REF-02)' field will override the 'Submitter Identification Number' field that is used if "2" is selected.


'Facility Identification Code Qualifier'/'Facility Identification Code Qualifier (2310E-NM1-08)' --

'Facility Identification Code Qualifier (837P-2310C / 837P-2420C / 837I-2310E-NM1-08)' and 'Facility Identification Code (837P-2310C / 837P-2420C / 837I-2310E-NM1-09)'


'Facility Reference Identification Qualifier'/'Facility Reference Identification Qualifier (2310E-REF-01)' --

'Facility Reference Identification Qualifier (837P-2310C / 837P-2420C / 837I-2310E-REF-01)' and 'Facility Reference Identification (837P-2310C / 837P-2420C / 837I-2310E-REF-02)'


'Provider Taxonomy Code to Display (2000A-PRV-03)' --

'Program Taxonomy 2000A-PRV-03'

Note: The "ZZZ=Submitter Identification Definition" dictionary code/value will be added to the 'Provider Taxonomy Code to Display (2000A-PRV-03)' dictionary. For version 5010, the same code would need to be added to the 'Billing Provider Secondary Code Qualifier (2010BB-REF-01)'. This also necessitates that the bills will be sorted by submitter identification number.

Selecting '1&2&3' will add all of the functionality listed above.

Selecting '0' will remove the form from the menu and disable the 837 logic.

Note: This functionality is used to meet a PA State requirement."

Scenario 2: 'Submitter Identification Definition' - Form Verification
Specific Setup:
  • Avatar PM Registry Setting 'Enable Submitter Identification Definition' must be enabled/include value '3'
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar PM 'Submitter Identification Definition' form (under 'Avatar PM / System Maintenance / System Definition' menu).
  2. Select value in 'Program' field.
  3. Select 'Add' in 'Add or Edit' field (or select 'Edit' and click 'Select Existing Submitter Identification Definition' button to select/view/update existing definition entry).
  4. Enter value for 'Effective Date' (and 'Expiration Date' if desired).
  5. Enter/select value in 'Guarantor' field.
  6. Enter/select value in 'Client' field if Submitter Identification Definition entry should be client-specific.
  7. If 'Client' value is defined, Submitter Identification Definition entry will apply only to services for selected client in Electronic Billing 837 file sorting/creation
  8. Ensure the following 'Authorization Number' Submitter Identification criteria field is present in 'Submitter Identification Definition' form where Avatar PM Registry Setting 'Enable Submitter Identification Definition' includes configuration value '3':
  9. Enter/select value in 'Authorization Number' field if Submitter Identification Definition entry should be Managed Care Authorization-specific or Payor Based Authorization-specific.
  10. If 'Authorization' value is defined, Submitter Identification Definition entry will apply only to services valid for selected Managed Care Authorization or Payor Based Authorization in Electronic Billing 837 file sorting/creation
  11. Note - Submitter Identification Definition requirement for Authorization is only applicable where Authorization is required for Electronic Billing service inclusion (via Avatar PM 'Guarantors/Payors' form 'Authorization Information' section for selected Guarantor).
  12. Enter/select service code(s) for Submitter Identification Definition in 'Service Code' field.
  13. Ensure the following 837 Submitter Identification Information fields are present in 'Submitter Identification Definition' form where Avatar PM Registry Setting 'Enable Submitter Identification Definition' includes configuration value '3':
  14. 'Program Taxonomy 2000A-PRV-03'
  15. 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)'
  16. 'Billing Provider Primary Identification # (2010AA-NM1-09)'
  17. 'Billing Provider Secondary Identification Number (2010BB-REF-02)'
  18. 'Facility Identification Code Qualifier (837P-2310C / 837P-2420C / 837I-2310E-NM1-08)'
  19. 'Facility Identification Code (837P-2310C / 837P-2420C / 837I-2310E-NM1-09)'
  20. 'Facility Reference Identification Qualifier (837P-2310C / 837P-2420C / 837I-2310E-REF-01)'
  21. 'Facility Reference Identification (837P-2310C / 837P-2420C / 837I-2310E-REF-02)'
  22. Enter desired values for 837 Submitter Identification Information fields listed above (as well as 'Submitter Identification Code Qualifier', 'Submitter Identification Number' and 'Billing Provider Secondary ID Code Qualifier' fields as required/desired).
  23. Click 'File Definition' button to file/save Submitter Identification Definition entry.
  24. Ensure user is presented with confirmation dialog noting 'Definition Filed'; click 'OK' button to return to form.
  25. Select same/previously used value in 'Program' and/or 'Guarantor' fields.
  26. Select 'Edit' in 'Add or Edit' field and click 'Select Existing Submitter Identification Definition' button to select/view previously filed Submitter Identification Definition entry.
  27. Ensure all fields are populated with/display previously entered and filed values (including Submitter Identification Information fields listed above).
  28. Click 'Display Submitter Identification Definitions' button to open report for display of Submitter Identification Definition entries (for selected Program and/or Guarantor if value selected in form, or for all Programs/Guarantors if no criteria values).
  29. In the 'Display Submitter Identification Definitions' report display/results, ensure that Submitter Identification Definition entry/information values are displayed as previously entered/filed in system.
  30. Open Crystal Reports or other SQL reporting tool.
  31. In Avatar PM SQL table 'SYSTEM.table_submitter_id_def', ensure that data row(s) are added/updated on filing of 'Submitter Identification Definition' form and contain values/information filed via form for all applicable fields (including Submitter Identification Information fields listed above).
Scenario 3: 'Electronic Billing' - Verification Of 'Submitter Identification Definition' Values (837 Professional)
Specific Setup:
  • Avatar PM Registry Setting 'Enable Submitter Identification Definition' must be enabled/include value '3'
  • Acceptance Testing Scenario includes 837 loops/segments for Registry Setting value '1&2&3'
  • 'Guarantor/Program Billing Defaults' template/entry applicable to Guarantor/Program for 837 service inclusion where 'Provider Taxonomy Code to Display (2000A-PRV-03)' is set to 'Submitter Identification Definition' ('837 Professional' section)
  • 'Guarantor/Program Billing Defaults' template/entry applicable to Guarantor/Program for 837 service inclusion where one or more of the following '837 Professional' section configuration fields are set to Dictionary Code value 'ZZZ':
  • 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)'
  • 'Other Tabled Files' Indirect, Dictionary Data Element 1187, Code 'ZZZ' must be defined
  • 'Billing Provider Secondary Identification Code Qualifier'
  • 'Other Tabled Files' Indirect, Dictionary Data Element 13535, Code 'ZZZ' must be defined
  • 'Facility Identification Code Qualifier'
  • 'Other Tabled Files' Indirect, Dictionary Data Element 12066, Code 'ZZZ' must be defined
  • 'Facility Reference Identification Qualifier'
  • 'Other Tabled Files' Indirect, Dictionary Data Element 12068, Code 'ZZZ' must be defined
  • 'Submitter Identification Definition' record applicable to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  • One or more 837 Professional /HCFA 1500 service(s) eligible for Electronic Billing 837 inclusion
Steps
  1. Open Avatar PM 'Electronic Billing' form.
  2. Note, acceptance testing may also be confirmed via Avatar PM 'Quick Billing' form/functionality
  3. Select '837 Professional' in the 'Billing Form' field.
  4. Select 'Sort File' in the 'Billing Options' field.
  5. Enter/select 837 Professional file sorting criteria.
  6. Click 'Process' button to sort/generate 837 Professional file.
  7. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  8. Select 'Print' in the 'Print Or Delete Report' field.
  9. Select 837 Professional file sorted which includes services(s), and click 'Process' button to display 837 Professional outbound file data.
  10. Submitter Name Identification Code Qualifier/Code 1000A NM1-08/NM1-09
  11. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional includes Submitter Name Identification Code Qualifier/Code 1000A NM1-08/NM1-09 information as follows:
  12. Where 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Secondary Identification Code Qualifier' field, 1000A NM1-08/NM1-09 segments are populated from the 'Submitter Identification Code Qualifier' and 'Submitter Identification Number' fields in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  13. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Professional file sorting
  14. Where a value other than 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Secondary Identification Code Qualifier' field, 1000A NM1-08/NM1-09 segments are populated from Guarantor information and do not use values from 'Submitter Identification Definition' record
  15. Billing Provider Specialty Information Reference Identification 2000A PRV-03
  16. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional includes Billing Provider Specialty Information Reference Identification 2000A PRV-03 information as follows:
  17. Where 'Submitter Identification Definition' is selected in the Guarantor/Program Billing Defaults 'Provider Taxonomy Code To Display (2000A-PRV-03)' field, 2000A PRV-03 segment is populated from the 'Program Taxonomy 2000A-PRV-03' field in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates(and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  18. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Professional file sorting
  19. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is found but 'Program Taxonomy 2000A-PRV-03' value is not defined in Submitter Identification Definition information, 2000A PRV-03 segment is populated from Program or Guarantor/Program information
  20. Where 'Program Maintenance' or 'Guarantor/Program Billing Defaults' is selected in the Guarantor/Program Billing Defaults 'Provider Taxonomy Code To Display (2000A-PRV-03)' field, 2000A PRV-03 segment is populated from Program or Guarantor/Program information and does not use value from 'Submitter Identification Definition' record
  21. Billing Provider Name Identification Code Qualifier/Code 2010AA NM1-08/NM1-09
  22. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional includes Billing Provider Name Identification Code Qualifier/Code 2010AA NM1-08/NM1-09 information as follows:
  23. Where 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)' field, 2010AA NM1-08/NM1-09 segments are populated from the 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)' and 'Billing Provider Primary Identification # (2010AA-NM1-09)' fields in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  24. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Professional file sorting
  25. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is found but 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)' / 'Billing Provider Primary Identification # (2010AA-NM1-09)' values are not defined in Submitter Identification Definition information, 2010AA NM1-08/NM1-09 segments are populated from Guarantor/Program, Program or Facility Defaults information
  26. Where a value other than 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)' field, 2010AA NM1-08/NM1-09 segments are populated from Guarantor/Program, Program or Facility Defaults information and do not use values from 'Submitter Identification Definition' record
  27. Payer Secondary Identification Code Qualifier/Code 2010BB REF-01/REF-02
  28. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional includes Payer Secondary Identification Code Qualifier/Code 2010BB REF-01/REF-02 information as follows:
  29. Where 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Secondary Identification Code Qualifier' field, 2010BB REF-01/REF-02 segments are populated from the 'Billing Provider Secondary ID Code Qualifier' and 'Billing Provider Secondary Identification Number (2010BB-REF-02)' fields in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  30. Note - The 'Submitter Identification Definition' record 'Billing Provider Secondary Identification Number (2010BB-REF-02)' field/value will override the 'Submitter Identification Number' field/value in same record where '2' is selected/included in the 'Enable Submitter Identification Definition' Registry Setting
  31. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Professional file sorting
  32. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is found but 'Billing Provider Secondary Identification Number (2010BB-REF-02)' value is not defined in Submitter Identification Definition information, 2010BB REF-02 is populated from the 'Submitter Identification Number' field in the corresponding 'Submitter Identification Definition' record (where '2' is selected/included in the 'Enable Submitter Identification Definition' Registry Setting) or from Guarantor/Program information
  33. Where a value other than 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Secondary Identification Code Qualifier' field, 2010BB REF-01/REF-02 segments are populated from Guarantor/Program information and do not use values from 'Submitter Identification Definition' record
  34. Service Facility Location Name Identification Code Qualifier/Code 2310C and 2420C NM1-08/NM1-09
  35. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional includes Service Facility Location Name Identification Code Qualifier/Code 2310C and 2420C NM1-08/NM1-09 information as follows:
  36. Where 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Facility Identification Code Qualifier' field, 2310C and 2420C NM1-08/NM1-09 segments are populated from the 'Facility Identification Code Qualifier (837P-2310C / 837P-2420C...' and 'Facility Identification Code (837P-2310C / 837P-2420C...' fields in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  37. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Professional file sorting
  38. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is found but 'Facility Identification Code Qualifier (837P-2310C / 837P-2420C...' / 'Facility Identification Code (837P-2310C / 837P-2420C...' values are not defined in Submitter Identification Definition information, 2310C and 2420C NM1-08/NM1-09 segments are populated from Guarantor/Program information
  39. Where a value other than 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Facility Identification Code Qualifier' field, 2310C and 2420C NM1-08/NM1-09 segments are populated from Guarantor/Program information and do not use values from 'Submitter Identification Definition' record
  40. Service Facility Location Secondary Identification Code Qualifier/Code 2310C and 2420C REF-01/REF-02
  41. In Avatar PM 837 Professional format outbound electronic billing file data - ensure that 837 Professional includes Service Facility Location Secondary Identification Code Qualifier/Code 2310C and 2420C REF-01/REF-02 information as follows:
  42. Where 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Facility Reference Identification Qualifier', field, 2310C and 2420C REF-01/REF-02 segments are populated from the 'Facility Reference Identification Code Qualifier (837P-2310C / 837P-2420C...' and 'Facility Reference Identification (837P-2310C / 837P-2420C...' fields in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  43. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Professional file sorting
  44. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is found but 'Facility Reference Identification Code Qualifier (837P-2310C / 837P-2420C...' and 'Facility Reference Identification (837P-2310C / 837P-2420C...' values are not defined in Submitter Identification Definition information, 2420C REF-01/REF-02 segments are populated from Program information
  45. Where a value other than 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Facility Reference Identification Qualifier' field, 2420C REF-01/REF-02 segments are populated from Program information and do not use values from 'Submitter Identification Definition' record
Scenario 4: 'Electronic Billing' - Verification Of 'Submitter Identification Definition' Values (837 Institutional)
Specific Setup:
  • Avatar PM Registry Setting 'Enable Submitter Identification Definition' must be enabled/include value '3'
  • Acceptance Testing Scenario includes 837 loops/segments for Registry Setting value '1&2&3'
  • 'Guarantor/Program Billing Defaults' template/entry applicable to Guarantor/Program for 837 service inclusion where 'Provider Taxonomy Code to Display (2000A-PRV-03)' is set to 'Submitter Identification Definition' ('837 Institutional' section)
  • 'Guarantor/Program Billing Defaults' template/entry applicable to Guarantor/Program for 837 service inclusion where one or more of the following '837 Institutional' section configuration fields are set to Dictionary Code value 'ZZZ':
  • 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)'
  • 'Other Tabled Files' Indirect, Dictionary Data Element 12009, Code 'ZZZ' must be defined
  • 'Billing Provider Secondary Identification Code Qualifier (2010BB-REF-01)'
  • 'Other Tabled Files' Indirect, Dictionary Data Element 12157, Code 'ZZZ' must be defined
  • 'Facility Identification Code Qualifier (2310E-NM1-08)'
  • 'Other Tabled Files' Indirect, Dictionary Data Element 12052, Code 'ZZZ' must be defined
  • 'Facility Reference Identification Qualifier (2310E-REF-01)'
  • 'Other Tabled Files' Indirect, Dictionary Data Element 12054, Code 'ZZZ' must be defined
  • 'Submitter Identification Definition' record applicable to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  • One or more 837 Institutional / UB-04 service(s) eligible for Electronic Billing 837 inclusion
Steps
  1. Open Avatar PM 'Electronic Billing' form.
  2. Note, acceptance testing may also be confirmed via Avatar PM 'Quick Billing' form/functionality
  3. Select '837 Institutional' in the 'Billing Form' field.
  4. Select 'Sort File' in the 'Billing Options' field.
  5. Enter/select 837 Institutional file sorting criteria.
  6. Click 'Process' button to sort/generate 837 Institutional file.
  7. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  8. Select 'Print' in the 'Print Or Delete Report' field.
  9. Select 837 Institutional file sorted which includes services(s), and click 'Process' button to display 837 Institutional outbound file data.
  10. Submitter Name Identification Code Qualifier/Code 1000A NM1-08/NM1-09
  11. In Avatar PM 837 Institutional format outbound electronic billing file data - ensure that 837 Institutional includes Submitter Name Identification Code Qualifier/Code 1000A NM1-08/NM1-09 information as follows:
  12. Where 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Secondary Identification Code Qualifier (2010BB-REF-01)' field, 1000A NM1-08/NM1-09 segments are populated from the 'Submitter Identification Code Qualifier' and 'Submitter Identification Number' fields in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  13. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Institutional file sorting
  14. Where a value other than 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Secondary Identification Code Qualifier' field, 1000A NM1-08/NM1-09 segments are populated from Guarantor information and do not use values from 'Submitter Identification Definition' record
  15. Billing Provider Specialty Information Reference Identification 2000A PRV-03
  16. In Avatar PM 837 Institutional format outbound electronic billing file data - ensure that 837 Institutional includes Billing Provider Specialty Information Reference Identification 2000A PRV-03 information as follows:
  17. Where 'Submitter Identification Definition' is selected in the Guarantor/Program Billing Defaults 'Provider Taxonomy Code To Display (2000A-PRV-03)' field, 2000A PRV-03 segment is populated from the 'Program Taxonomy 2000A-PRV-03' field in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates(and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  18. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Institutional file sorting
  19. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is found but 'Program Taxonomy 2000A-PRV-03' value is not defined in Submitter Identification Definition information, 2000A PRV-03 segment is populated from Program or Guarantor/Program information
  20. Where 'Program Maintenance' or 'Guarantor/Program Billing Defaults' is selected in the Guarantor/Program Billing Defaults 'Provider Taxonomy Code To Display (2000A-PRV-03)' field, 2000A PRV-03 segment is populated from Program or Guarantor/Program information and does not use value from 'Submitter Identification Definition' record
  21. Billing Provider Name Identification Code Qualifier/Code 2010AA NM1-08/NM1-09
  22. In Avatar PM 837 Institutional format outbound electronic billing file data - ensure that 837 Institutional includes Billing Provider Name Identification Code Qualifier/Code 2010AA NM1-08/NM1-09 information as follows:
  23. Where 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)' field, 2010AA NM1-08/NM1-09 segments are populated from the 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)' and 'Billing Provider Primary Identification # (2010AA-NM1-09)' fields in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  24. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Institutional file sorting
  25. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is found but 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)' / 'Billing Provider Primary Identification # (2010AA-NM1-09)' values are not defined in Submitter Identification Definition information, 2010AA NM1-08/NM1-09 segments are populated from Guarantor/Program, Program or Facility Defaults information
  26. Where a value other than 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08)' field, 2010AA NM1-08/NM1-09 segments are populated from Guarantor/Program, Program or Facility Defaults information and do not use values from 'Submitter Identification Definition' record
  27. Payer Secondary Identification Code Qualifier/Code 2010BB REF-01/REF-02
  28. In Avatar PM 837 Institutional format outbound electronic billing file data - ensure that 837 Institutional includes Payer Secondary Identification Code Qualifier/Code 2010BB REF-01/REF-02 information as follows:
  29. Where 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Secondary Identification Code Qualifier' field, 2010BB REF-01/REF-02 segments are populated from the 'Billing Provider Secondary ID Code Qualifier' and 'Billing Provider Secondary Identification Number (2010BB-REF-02)' fields in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  30. Note - The 'Submitter Identification Definition' record 'Billing Provider Secondary Identification Number (2010BB-REF-02)' field/value will override the 'Submitter Identification Number' field/value in same record where '2' is selected/included in the 'Enable Submitter Identification Definition' Registry Setting
  31. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Institutional file sorting
  32. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is found but 'Billing Provider Secondary Identification Number (2010BB-REF-02)' value is not defined in Submitter Identification Definition information, 2010BB REF-02 is populated from the 'Submitter Identification Number' field in the corresponding 'Submitter Identification Definition' record (where '2' is selected/included in the 'Enable Submitter Identification Definition' Registry Setting) or from Guarantor/Program information
  33. Where a value other than 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Billing Provider Secondary Identification Code Qualifier' field, 2010BB REF-01/REF-02 segments are populated from Guarantor/Program information and do not use values from 'Submitter Identification Definition' record
  34. Service Facility Location Name Identification Code Qualifier/Code 2310E NM1-08/NM1-09
  35. In Avatar PM 837 Institutional format outbound electronic billing file data - ensure that 837 Institutional includes Service Facility Location Name Identification Code Qualifier/Code 2310E NM1-08/NM1-09 information as follows:
  36. Where 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Facility Identification Code Qualifier (2310E-NM1-08)' field, 2310E NM1-08/NM1-09 segments are populated from the 'Facility Identification Code Qualifier (...837I-2310E-NM1-08)' and 'Facility Identification Code (...837I-2310E-NM1-09)' fields in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  37. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Institutional file sorting
  38. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is found but 'Facility Identification Code Qualifier (...837I-2310E-NM1-08)' / 'Facility Identification Code (...837I-2310E-NM1-09)' values are not defined in Submitter Identification Definition information, 2310E NM1-08/NM1-09 segments are populated from Guarantor/Program information
  39. Where a value other than 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Facility Identification Code Qualifier' field, 2310E NM1-08/NM1-09 segments are populated from Guarantor/Program information and do not use values from 'Submitter Identification Definition' record
  40. Service Facility Location Secondary Identification Code Qualifier/Code 2310E REF-01/REF-02
  41. In Avatar PM 837 Institutional format outbound electronic billing file data - ensure that 837 Institutional includes Service Facility Location Secondary Identification Code Qualifier/Code 2310E REF-01/REF-02 information as follows:
  42. Where 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Facility Reference Identification Qualifier (2310E-REF-01)', field, 2310E REF-01/REF-02 segments are populated from the 'Facility Reference Identification Code Qualifier (...837I-2310E-REF-01)' and 'Facility Reference Identification (...837I-2310E-REF-02)' fields in the 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified in the 'Submitter Identification Definition' record)
  43. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is not found, claim(s)/service(s) will not be included in 837 Institutional file sorting
  44. In case where 'Submitter Identification Definition' record corresponding to Program/Guarantor/service dates (and Client/Authorization if specified) is found but 'Facility Reference Identification Code Qualifier (...837I-2310E-REF-01)' and 'Facility Reference Identification (...837I-2310E-REF-02)' values are not defined in Submitter Identification Definition information, 2310E REF-01/REF-02 segments are populated from Program information
  45. Where a value other than 'ZZZ' is defined/selected in the Guarantor/Program Billing Defaults 'Facility Reference Identification Qualifier (2310E-REF-01)' field, 2310E REF-01/REF-02 segments are populated from Program information and do not use values from 'Submitter Identification Definition' record
Topics
• 837 Institutional • 837 Professional • Electronic Billing • NX • Registry Settings
Table Changes
Table Column Change
SYSTEM.table_submitter_id_def data_entry_utc new
SYSTEM.table_submitter_id_def data_entry_timezone_info_all new
SYSTEM.table_submitter_id_def data_entry_time_j new
SYSTEM.table_submitter_id_def data_entry_offset new
SYSTEM.table_submitter_id_def data_entry_timezone_short new
SYSTEM.table_submitter_id_def prov_prim_id new
SYSTEM.table_submitter_id_def prov_prim_id_qua_code new
SYSTEM.table_submitter_id_def fac_id new
SYSTEM.table_submitter_id_def fac_id_qua_code new
SYSTEM.table_submitter_id_def fac_ref_id new
SYSTEM.table_submitter_id_def fac_ref_id_qua_code new
SYSTEM.table_submitter_id_def reference_ident new
SYSTEM.table_submitter_id_def bill_prov_sec_id new
SYSTEM.table_submitter_id_def authorization_number new