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Avatar PM 2023 Update 11

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Product Requirements / Recommendations

Avatar PM required
RADplus required

Additional Requirements

A future Middleware update (RADplus Client Update 2023.01.00) will be required for full functionality.

Product Update Form Description

The following is included: 1) The registry setting 'Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services' is updated to function with the 'Spreadsheet Batch Remittance Posting' form. 2) The registry setting 'Allow User To Continue Filing With Mismatch In Amounts To Post' is updated to allow filing with mismatch based on 'User Security Level'. 3) The registry setting 'Allow Posting of Zero Dollar Payment' is added and allows zero dollar payments to be entered in the 'Spreadsheet Batch Remittance Posting' form. 4) The logic associated to the 'Allow Adjustment Reversals' field in the 'Guarantor/Payors' form is updated to function with the 'Spreadsheet Batch Remittance Posting' form. 5) The 'Spreadsheet Batch Remittance Posting' form is updated to allow entry of claim adjustment group and reason codes along with adjustment amounts. 6) The 'Batch Remittance Posting Report' form is added and will launch a report of claim information from both the 'Spreadsheet Batch Remittance Posting' form and the 835. Note: A myAvatar update or upgrade is required for full functionality.

Included Updates

None

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Spreadsheet Batch Remittance Posting
Functionality for 'Spreadsheet Batch Remittance Posting' has been updated.

Note: A future Middleware update (RADplus Client Update 2023.01.00) will be required for full functionality.
• The registry setting 'Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services' is updated to function with the 'Spreadsheet Batch Remittance Posting' form.
• The registry setting 'Allow User To Continue Filing With Mismatch In Amounts To Post' is updated to allow filing with mismatch based on 'User Security Level'.
• The registry setting 'Allow Posting of Zero Dollar Payment' is added and allows zero dollar payments to be entered in the 'Spreadsheet Batch Remittance Posting' form.
• The logic associated to the 'Allow Adjustment Reversals' field in the 'Guarantor/Payors' form is updated to function with the 'Spreadsheet Batch Remittance Posting' form.
• The 'Spreadsheet Batch Remittance Posting' form is updated to allow entry of claim adjustment group and reason codes along with adjustment amounts.
• The 'Batch Remittance Posting Report' form is added and will launch a report of claim information from both the 'Spreadsheet Batch Remittance Posting' form and the 835.
Value Added: Increased functionality on the 'Spreadsheet Batch Remittance Posting' form.
Topics
• Claim Follow-up • Spreadsheet Batch Remittance Posting
 
Acceptance Tests
AV-78643 Summary | Details
Spreadsheet Batch Remittance Posting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Claim Adjustment Group/Reason Code Definition
  • Client Ledger
  • Create Interim Billing Batch File
  • Diagnosis
  • Dictionary Update (PM)
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Posting/Adjustment Codes Definition
  • Practitioner Enrollment
  • Practitioner Numbers By Guarantor and Program
  • Program Maintenance
  • Registry Settings (PM)
  • Service Codes
  • Spreadsheet Batch Remittance Posting
  • User Definition
  • Avatar NX Report Viewer
  • Batch Remittance Posting Report
  • 835 Health Care Claim Payment/Advice (PM)
  • Client Charge Input
  • Facility Defaults
Scenario 1: Spreadsheet Remittance Batch Posting - Validating financial eligibility data upon hover over the 'Transfer Guar' field.
Specific Setup:
  • Posting/Adjustment Codes Definition has been used to create desired definitions.
  • Claim Adjustment Group/Reason Code Definition has been used to create desired definitions.
  • An existing client is identified.
  • Three or more guarantors are assigned to the client using 'Financial Eligibility' form. Note the liability order for the guarantors.
  • Services are rendered to the client so that at least one of the guarantors has no liability.
  • Client Ledger is used to validate that liability distributed to the guarantors based on the setup in the 'Financial Eligibility' form.
  • An Interim billing batch is created in the 'Create Interim Billing Batch File' form which includes the client / guarantor and services.
Steps
  1. Open the 'Spreadsheet Remittance Batch Posting' form.
  2. Select 'Create Batch' in the 'Create, Edit Or Delete Remittance Batch' field.
  3. Enter the 'Batch Description'.
  4. Select the interim billing batch created in the setup section in the 'Interim Batch Number' field.
  5. Enter desired date in the 'Posting Date' field.
  6. Enter desired date in the 'Date Of Receipt' field.
  7. If desired, enter/select values in 'Receipt'.
  8. If desired, enter/select values in 'Check #'
  9. If desired, enter/select values in 'Default Guarantor'.
  10. If desired, enter/select values in 'Default Payment Code'.
  11. If desired, enter/select values in 'Default Adjustment Code'.
  12. If desired, enter/select values in 'Default Transfer Code'.
  13. If desired, enter/select values in 'Service Start Date'.
  14. If desired, enter/select values in 'Service End Date'.
  15. Click [Launch Work Screen].
  16. Validate that the 'Client' defaults.
  17. Validate that other entered/selected data defaults.
  18. Enter a 'Transfer Amount'.
  19. Enter a 'Transfer Code'.
  20. Hover over the 'Transfer Guar' field.
  21. Verify that a mini table will be displayed containing a list of guarantors that are assigned to the client's episode via 'Financial Eligibility' (excluding the current guarantor) and active for the selected date of service in the same order as they set up in the 'Financial Eligibility' form.
  22. Select the desired guarantor to transfer to in the mini table.
  23. Click [Accept].
  24. Click [Submit].
  25. Click [OK].
  26. Click [No].
  27. Open the 'Client Ledger' form.
  28. Select the 'Client ID'
  29. Select 'All Episodes' in 'Claim/Episode/All Episodes'.
  30. Enter the desired 'From Date'.
  31. Enter the desired 'To Date'.
  32. Select 'Simple' in 'Ledger Type'.
  33. Click [Process].
  34. Validate the payment and transfer activity.
  35. Click [Dismiss].
  36. Close the form.
Scenario 2: Spreadsheet Batch Remittance Posting - Guarantor/Payors - 835 - Allow Adjustment Reversals'
Specific Setup:
  • Registry Settings:
  • Avatar PM->Billing->Financial Eligibility->->->Enable Automatic Contractual Adjustment Based On Fee Table = 'O' or 'A'.
  • Avatar PM->Billing->Remittance Processing->835 Health Care Claim Payment/Advice->->Compile But Don't Post Adjustments (CAS) = Y.
  • Posting/Adjustment Codes Definition has been used to create desired definitions.
  • Guarantors/Payors: Select a guarantor that will be the primary guarantor for the client.
  • 'Contractual Guarantor Information' section:
  • All required fields are enabled.
  • Enable Modified Contractual Allowance Calculation has desired value.
  • '835' section:
  • 'Allow Adjustment Reversals' = Yes.
  • Help message = If "Yes" is selected the '835 Health Care Claim Payment/Advice' and 'Spreadsheet Batch Remittance Posting' will: 1) Determine amount of any credit contractual allowance adjustments that were automatically posted for the Guarantor during liability distribution. 2) If there is a positive amount and a 'Contractual Adjustment Code (Debit)' code is selected in the 'Guarantors/Payors' (Contractual Guarantor Information) form a debit adjustment will be automatically posted to reverse the credit adjustments.
  • Service Fee/ Cross Reference Maintenance:
  • Identify a service code with a standard fee and a 'Guarantor Definition' for the above guarantor with the following:
  • Standard Fee:
  • Fee is active based on the dates in 'From Date' and 'End Date'. Note the fee.
  • Guarantor Definition:
  • Note the value in 'Maximum Amount To Distribute Per Service'. It should be less than the standard fee.
  • Write-off Remaining Balance (Contract Guarantors Only) = Yes.
  • A new client is added, or an existing client is identified. Note the Client ID/name.
  • The financial eligibility record is created for the client. The client is assigned two or more guarantors. The primary guarantor is the guarantor that has the fee definition.
  • Services are rendered to the client for the service code with the fee definitions. Note the service start / end date and service code used.
  • The 'Client Ledger' report for the client is processed.
  • Save the report for comparison.
  • Note that a portion of each has service has been adjusted off.
  • Close Charges is used to close the charges.
  • The services do not have to be claimed to complete testing, however if preferred, create an interim billing batch, and use Electronic Billing to create claims.
Steps
  1. Open the 'Spreadsheet Batch Remittance Posting' form.
  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. Note the date.
  5. Enter a date in the 'Date Of Receipt' field.
  6. If desired, enter a value in 'Receipt'.
  7. If desired, enter a value in 'Check #'
  8. If desired, select a value in 'Default Guarantor'.
  9. If desired, select a value in 'Default Payment Code'.
  10. If desired, select a value in 'Default Adjustment Code'.
  11. If desired, select a value in 'Default Transfer Code'.
  12. If desired, enter a value in 'Service Start Date'.
  13. If desired, enter a value in 'Service End Date'. Same service dates allow easier review of the Client Ledger.
  14. Click [Launch Work Screen].
  15. Select the 'Client'.
  16. Select the 'EP #'.
  17. If desired, select the 'Claim'.
  18. Select the 'Payor' or verify it defaulted.
  19. Enter an 'Adjust Amount'.
  20. Select an 'Adjustment Code' of verify existence if a 'Default Adjustment Code' was selected.
  21. Click [Accept].
  22. Click [Submit].
  23. Validate that the message contains 'Remittance batch 'XX' posted'.
  24. Click [OK].
  25. Click [No].
  26. Open ‘Client Ledger’ for the client and process the report for the desired date range of services.
  27. Validate that the services that were adjusted contain a reversal of the original adjustment, and the new adjustment entered in 'Spreadsheet Batch Remittance Posting'.
  28. Close the report.
  29. Close the form.
  30. Open 'Guarantors/Payors'.
  31. Edit the guarantor that was selected as the primary guarantor in Setup.
  32. Select the '835' section'.
  33. Change the value of 'Allow Adjustment Reversals' to 'No'.
  34. Select the 'Guarantors/Payors' section.
  35. Click [File].
  36. Close the form.
  37. Repeat steps 1 - 27.
  38. Validate that the services that were adjusted do not contain a reversal of the original adjustment and do contain the new adjustment entered in 'Spreadsheet Batch Remittance Posting'.
  39. Close the report.
  40. Close the form.
Scenario 3: Spreadsheet Batch Remittance Posting - Allow Posting of Zero Dollar Payment
Specific Setup:
  • Registry Settings:
  • Registry Setting: Avatar PM->Billing->Remittance Processing->->->Allow Posting of Zero Dollar Payment = No.
  • Posting/Adjustment Codes Definition has been used to create desired definitions.
  • A new client is added, or an existing client is identified. Note the Client ID/name.
  • The financial eligibility record is created for the client.
  • Services are rendered to the client. Note the service start / end date and service code used.
  • The 'Client Ledger' report for the client is processed. Note the details of the report.
  • An interim billing batch is created to include client, guarantor, and services.
  • Electronic Billing is used to create claims.
Steps
  1. Open the 'Spreadsheet Batch Remittance Posting' form.
  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. Note the date.
  5. Enter a date in the 'Date Of Receipt' field.
  6. If desired, enter a value in 'Receipt'.
  7. If desired, enter a value in 'Check #'
  8. Select a value in 'Default Guarantor'.
  9. If desired, enter a value in 'Service Start Date'.
  10. If desired, enter a value in 'Service End Date'.
  11. Click [Launch Work Screen].
  12. Select the 'Client'.
  13. Select the 'EP #'.
  14. If desired, select the 'Claim'.
  15. Select the 'Payor' or verify it defaulted.
  16. Click the '+' object.
  17. Verify that the correct service rows display.
  18. Enter a 'Payment Amount' of '0.00'.
  19. Select a 'Payment Code'.
  20. Verify that 'Payment Amount' displays as required.
  21. Verify that the 'Accept button is disabled.
  22. Click [Cancel].
  23. Click [Yes].
  24. Close the form without submitting.
  25. Open 'Registry Settings' and change the 'Allow Posting of Zero Dollar Payment' setting to 'Y'.
  26. Click [Submit].
  27. Click [OK].
  28. Click [No].
  29. Repeat steps 1 -19.
  30. Verify that 'Payment Amount' does not display as required
  31. Verify that the 'Accept button is enabled.
  32. Click [Accepts].
  33. Click [Submit].
  34. Click [OK].
  35. Click [No].
Scenario 4: Spreadsheet Batch Remittance Posting - Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services
Specific Setup:
  • Registry Settings:
  • Avatar PM->Billing->Remittance Processing->835 Health Care Claim Payment/Advice->->Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services = N.
  • Avatar PM->Billing->Remittance Processing->835 Health Care Claim Payment/Advice->->Compile But Don't Post Adjustments (CAS) = Y.
  • Posting/Adjustment Codes Definition has been used to create desired definitions.
  • Claim Adjustment Group/Reason Code Definition has been used to create desired definitions.
  • When the ‘Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’ field has a value of 'Yes' the adjustment will not post.
  • When the ‘Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’ field has a value of 'No' the adjustment will post.
  • Guarantors/Payors: Select a guarantor that will be the primary guarantor for the client.
  • A new client is added, or an existing client is identified. Note the Client ID/name.
  • The financial eligibility record is created for the client. The client is assigned two or more guarantors. The primary guarantor is the guarantor that has the fee definition.
  • Services are rendered to the client. Note the service start / end date and service code used.
  • The 'Client Ledger' report for the client is processed to validate that the services distributed liability correctly.
  • Close Charges is used to close the charges.
  • The services do not have to be claimed to complete testing, however if preferred, create an interim billing batch, and use Electronic Billing to create claims.
Steps
  1. Open the 'Spreadsheet Batch Remittance Posting' form.
  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. Note the date.
  5. Enter a date in the 'Date Of Receipt' field.
  6. If desired, enter a value in 'Receipt'.
  7. If desired, enter a value in 'Check #'
  8. If desired, select a value in 'Default Guarantor'.
  9. If desired, select a value in 'Default Payment Code'.
  10. If desired, select a value in 'Default Adjustment Code'.
  11. If desired, select a value in 'Default Transfer Code'.
  12. If desired, enter a value in 'Service Start Date'.
  13. If desired, enter a value in 'Service End Date'. Same service dates allow easier review of the Client Ledger.
  14. Click [Launch Work Screen].
  15. Select the 'Client'.
  16. Select the 'EP #'.
  17. If desired, select the 'Claim'.
  18. Select the 'Payor' or verify it defaulted.
  19. Click the ‘+’ item.
  20. Click [Enter CARCS].
  21. Create Entries for adjustments and transfers:
  22. Select desired value in ‘CAS Adjustment Group Code’.
  23. Select desired value in ‘CAS Adjustment Reason Code’.
  24. Enter an ‘Adjustment Amount’.
  25. Verify that ‘Post’ is checked on unchecked based on the value of ‘ ‘Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’.
  26. Highlight a row and click 'Copy/Paste Row'.
  27. Select desired value in ‘CAS Adjustment Group Code’.
  28. Select desired value in ‘CAS Adjustment Reason Code’, selecting a code that is not associated to the group code.
  29. Verify that an error message s received stating: The Group and Reason Codes highlighted are not currently setup and cannot be saved.
  30. Select the copied row and click 'Delete Row'.
  31. Confirm that a confirmation message is received.
  32. Click desired value to delete or retain the row.
  33. If the row is retained, change the ‘CAS Adjustment Reason Code’ to a code that is associated to the group code.
  34. Click [New Row].
  35. Validate that the row is added.
  36. Delete the row or add data to it.
  37. Click [Close/Cancel].
  38. Verify a 'Cancel Confirmation' is received.
  39. Click [No].
  40. Click [Save] when all desired rows have been added
  41. Validate that the 'Adjust Amount' contains the total of all adjustments entered.
  42. Validate that the 'Transfer Amount' contains the total of all adjustments entered.
  43. Validate that the 'Adjust Amount' applies to the services rows, beginning with row 1, and pays each row in full until the full amount has been used.
  44. Validate that the 'Transfer Amount' applies to the services rows, beginning with the row that the 'Adjust Amounts' ended in if not paid in full. If it was paid in full the 'Transfer Amount' begins in the next row, and pays each row in full until the full amount has been used.
  45. If the 'Adjustment Code' was not defaulted, please select a value.
  46. If the 'Transfer Code' was not defaulted, please select a value.
  47. If the 'Transfer Guar' was not defaulted, please select a value.
  48. Enter a 'Payment Amount'.
  49. Validate that the 'Payment Amount' applies to the services rows, beginning with the row that the 'Transfer Amounts' ended in if not paid in full. If it was paid in full the 'Payment Amount' begins in the next row, and pays each row in full until the full amount has been used.
  50. Click [Accept].
  51. Click [Submit].
  52. Click [OK].
  53. Click [No].
  54. Open ‘Client Ledger’ for the client and process the report for the date range of services with activity.
  55. Validate the data for the services that were paid, adjusted, and transferred.
  56. Close the report.
  57. Close the form.
  58. Open 'Registry Settings'.
  59. Change the 'Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services' setting to Y.
  60. Click [Submit].
  61. Click [OK].
  62. Click [No].
  63. Repeat steps 1 - 50.
  64. Note the validation for the 'Adjust Amount', Transfer Amount' and 'Payment Amount' will be different because the amount will be divided evenly among all service rows. The final row may contain an amount that is different by a few cents.
Scenario 5: Spreadsheet Batch Remittance Posting - Select Client
Specific Setup:
  • Registry Settings: Avatar PM->Billing->Remittance Processing->835 Health Care Claim Payment/Advice->->Compile But Don't Post Adjustments (CAS) = Y.
  • Posting/Adjustment Codes Definition has been used to create desired definitions.
  • Claim Adjustment Group/Reason Code Definition has been used to create desired definitions.
  • Note the value in 'Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’.
  • A value of 'No' allows the entry to be posted in the 'Enter CARCs' section of the 'Spreadsheet Batch Remittance Posting' form.
  • A value of 'Yes' does not allow the entry to be posted in the 'Enter CARCs' section of the 'Spreadsheet Batch Remittance Posting' form.
  • A new client is added, or an existing client is identified. Note the Client ID/name.
  • The financial eligibility record is created for the client. The client is assigned two or more guarantors.
  • Services are rendered to the client. Note the service start / end date and service code used.
  • The 'Client Ledger' report for the client is processed. Note the details of the report.
  • An interim billing batch is created to include client, guarantor, and services.
  • Electronic Billing is used to create claims.
Steps
  1. Open the 'Spreadsheet Batch Remittance Posting' form.
  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. Note the date.
  5. Enter a date in the 'Date Of Receipt' field.
  6. If desired, enter a value in 'Receipt'.
  7. If desired, enter a value in 'Check #'
  8. If desired, select a value in 'Default Guarantor'.
  9. If desired, select a value in 'Default Payment Code'.
  10. If desired, select a value in 'Default Adjustment Code'.
  11. If desired, select a value in 'Default Transfer Code'.
  12. If desired, enter a value in 'Service Start Date'.
  13. If desired, enter a value in 'Service End Date'.
  14. Click [Launch Work Screen].
  15. Select the 'Client'.
  16. Select the 'EP #'.
  17. If desired, select the 'Claim'.
  18. Select the 'Payor' or verify it defaulted.
  19. Click [Enter CARCs].
  20. Select a 'CAS Adjustment Group Code' to create an adjustment.
  21. Select a 'CAS Adjustment Reason Code' that is not associated to the 'CAS Adjustment Group Code'.
  22. Enter an 'Adjustment Amount'.
  23. Validate that an error is received stating: The Group and Reason codes highlighted are not currently setup and cannot be saved.
  24. Change the 'CAS Adjustment Reason Code' to one the is associated to the 'CAS Adjustment Group Code'.
  25. Validate that the 'Post' checkbox is checked when the group/reason code contains a 'No' in 'Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’.
  26. Validate that the 'Post' checkbox is not checked when the group/reason code contains a 'Yes' in 'Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’.
  27. Select a 'CAS Adjustment Group Code' to create a transfer.
  28. Select a 'CAS Adjustment Reason Code' that is associated to the 'CAS Adjustment Group Code'.
  29. Enter an 'Adjustment Amount'.
  30. Validate that the 'Post' checkbox contains the correct value for the group/reason code.
  31. If desired, enter additional adjustments and transfers. Note the total amounts for each.
  32. Click [Save].
  33. Validate that 'Adjust Amount' contains the total adjustment amounts.
  34. Select an 'Adjustment Code' of verify existence if a 'Default Adjustment Code' was selected.
  35. Validate that 'Transfer Amount' contains the total transfer amounts.
  36. Select a 'Transfer Code' of verify existence if a 'Default Transfer Code' was selected.
  37. Validate that 'Transfer Guar' is required'.
  38. Hover over the 'Transfer Guar' field to view the table of the client's guarantors, excluding the current 'Payor'.
  39. Select the desired 'Transfer Guar'.
  40. Enter a 'Payment Amount'.
  41. Select a 'Payment Code' of verify existence if a 'Default Payment Code' was selected.
  42. Click [Accept].
  43. Click [Submit].
  44. Validate that the message contains 'Remittance batch 'XX' posted'.
  45. Click [OK].
  46. Click [No].
  47. Open ‘Client Ledger’ for the client and process the report for the date range of services with activity.
  48. Validate the data for the services that were paid, adjusted, or transferred.
  49. Close the report.
  50. Close the form.
Scenario 6: Spreadsheet Batch Remittance Posting - Create Claim Follow-Up
Specific Setup:
  • User Definition has been used to give the user access to the Avatar Pm > Billing > Remittance Posting > Spreadsheet Batch Remittance Posting form.
  • Identify at least one client with open claims.
  • Posting/Adjustment Codes Definition:
  • Create a transfer code that has values in ‘Claim Adjustment Group Code (837-2430-CAS)’ and ‘Claim Adjustment Reason Code (837-2430-CAS)’. Note the values of each field.
  • Claim Adjustment Group/Reason Code Definition:
  • Create an entry using the same 'Claim Adjustment Group Code', and 'Claim Adjustment Reason Code' used above.
  • The ‘Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835’ field had a value of 'Yes'.
  • Select desired values for the 'Transfer Guarantor Rules'.
Steps
  1. Open the 'Spreadsheet Batch Remittance Posting' form.
  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. Note the date.
  5. Enter a date in the 'Date Of Receipt' field.
  6. If desired, enter a value in ‘Receipt'.
  7. If desired, enter a value in ‘Check #’. Note the value.
  8. Select a payment code in the 'Default Payment Code' field
  9. Select an adjustment code in the 'Default Adjustment Code' field
  10. Select the transfer from setup in the 'Default Transfer Code' field.
  11. Select a guarantor in the Default Trans. To Guarantor' field.
  12. If desired, enter a 'Service Start Date'.
  13. If desired, enter a 'Service End Date'.
  14. Click the "Launch Work Screen" button.
  15. Select the 'Client'.
  16. Select the 'Ep #'.
  17. Select the 'Claim'.
  18. Select the 'Payor'.
  19. Validate that 'Total Charges' contains a value.
  20. Validate that 'Liability' contains a value.
  21. Validate that 'Payment Amount' is '0.00'.
  22. Validate that 'Adjust Amount' is '0.00'.
  23. Validate that Transfer Amount' is '0.00'.
  24. Click [Enter CARC(s)].
  25. Select the ’Claim Adjustment Group Code’ from setup.
  26. Select the ‘Claim Adjustment Reason Code' from setup.
  27. Enter an amount in ‘Adjustment’.
  28. Validate that the ‘Post’ checkbox is unchecked.
  29. Click [Save].
  30. Click [Accept].
  31. Click [Submit].
  32. Click [Yes].
  33. Click [OK].
  34. Click [No].
  35. Open ‘Claim Follow-Up’.
  36. Select the desired ‘Client’.
  37. Select ‘Edit’ in ‘Add, Edit Or Delete Claim Follow-Up’.
  38. Select the claim in ‘Select Claim Follow-Up To Edit Or Delete’.
  39. Validate that ‘Denial Type’ contains a value.
  40. Validate that the ‘Service(s) box contains service dates and there are checked.
  41. Validate the ‘Amount Billed’ equals the amount entered in ‘Adjustment’.
  42. Select ‘Edit’ in ‘Add, Edit Or Delete Row’.
  43. Select the desired row in ‘Select Row To Edit Or Delete’.
  44. Validate the ‘Comments’ contains ‘Spreadsheet Batch Remittance’.
  45. Validate the ‘Date Of Entry’ equals the current date.
  46. Click [Update Row].
  47. Click [Submit].
  48. Click [No].
Scenario 7: Spreadsheet Batch Remittance Posting - Security Level - Allow User To Continue Filing With Mismatch In Amounts To Post
Specific Setup:
  • Registry Setting: Allow User To Continue Filing With Mismatch In Amounts To Post = Y.
  • Posting/Adjustment Codes Definition has been used to create desired definitions.
  • User Definition: Signed in user has a security level of '2'.
  • Client:
  • Identify a client with unpaid claims. Note the dates of services and the guarantor liability has distributed to.
  • Verify if the client has additional guarantors in the financial eligibility record.
Steps
  1. Open the 'Spreadsheet Remittance Batch Posting' form.
  2. Select 'Create Batch' in the 'Create, Edit Or Delete Remittance Batch' field.
  3. Enter the 'Batch Description'.
  4. Enter desired date in the 'Posting Date' field.
  5. Enter desired date in the 'Date Of Receipt' field.
  6. If desired, enter/select values in 'Receipt'.
  7. If desired, enter/select values in 'Check #'
  8. If desired, enter/select values in 'Default Guarantor'.
  9. If desired, enter/select values in 'Default Payment Code'.
  10. If desired, enter/select values in 'Default Adjustment Code'.
  11. If desired, enter/select values in 'Default Transfer Code'.
  12. If desired, enter/select values in 'Service Start Date'.
  13. If desired, enter/select values in 'Service End Date'.
  14. Click [Launch Work Screen].
  15. Select the 'Client'.
  16. Select the 'EP #'.
  17. Validate that other entered/selected data defaults.
  18. Click the '+' item.
  19. Review the balance due for the first service row.
  20. Enter a partial payment amount in 'Payment Amount', noting the amount.
  21. If not defaulted, select a 'Payment Code'.
  22. Enter a partial adjustment amount in 'Adjust Amount', noting the amount.
  23. If not defaulted, select a 'Adjust Code'.
  24. Enter a partial transfer amount in 'Adjust Amount', noting the amount.
  25. If not defaulted, select a 'Transfer Code'.
  26. If not defaulted, select a 'Transfer Guar'.
  27. Validate the amount in the 'New Balance' field.
  28. Click [Accept].
  29. Select the 'Remittance Totals' section.
  30. Validate that 'Payment Amount Posted' contains the amount entered.
  31. Validate that 'Adjustment Amount Posted' contains the amount entered.
  32. Validate that 'Transfer Amount Posted' contains the amount entered.
  33. Enter a value that differs from the payment amount in 'Payment Amount Total'.
  34. Note the value in 'Payment Amount Remaining'.
  35. Enter a value that differs from the adjustment amount in 'Adjustment Amount Total'.
  36. Note the value in 'Adjustment Amount Remaining'.
  37. Enter a value that differs from the transfer amount in 'Transfer Amount Total'.
  38. Note the value in 'Transfer Amount Remaining'.
  39. Click [Submit].
  40. Validate that the message dialog contains Remittance is not balanced. Do you wish to continue posting?
  41. Click [Yes].
  42. Click [OK].
  43. Click [No].
  44. Open 'Registry Settings'.
  45. Set 'Limit Registry Settings to the Following Search Criteria' to 'Allow User To Continue Filing With'.
  46. Click [View Registry Settings].
  47. Validate that the 'Registry Setting' contains 'Avatar PM->Billing->Remittance Processing->->->Allow User To Continue Filing With Mismatch In Amounts To Post'.
  48. Set the 'Registry Setting Value' to 'N'.
  49. Click [Submit].
  50. Click [OK].
  51. Click [No].
  52. Repeat steps 2 - 39.
  53. Validate that the message dialog contains 'Remittance is not balanced'.
  54. Click [OK].
  55. Click [Discard].
  56. Click [Yes].
  57. Open 'Registry Settings'.
  58. Set 'Limit Registry Settings to the Following Search Criteria' to 'Allow User To Continue Filing With'.
  59. Click [View Registry Settings].
  60. Validate that the 'Registry Setting' contains 'Avatar PM->Billing->Remittance Processing->->->Allow User To Continue Filing With Mismatch In Amounts To Post'.
  61. Set the 'Registry Setting Value' to 'S'.
  62. Click [Submit].
  63. Click [OK].
  64. Click [No].
  65. Repeat steps 2 - 39.
  66. Validate that the message dialog contains 'Remittance is not balanced'.
  67. Click [OK].
  68. Click [Discard].
  69. Click [Yes].
Scenario 8: Spreadsheet Batch Remittance Posting - Validate excluded posting codes are not included in the 'Payment Code' dropdown list.
Specific Setup:
  • An existing client with unpaid claims is identified (Client A). Note the guarantor that liability is distributed to.
  • Posting/Adjustment Codes Definition:
  • A payment posting code is defined to 'Exclude Guarantors' for the client's liability guarantor. Note the code/description.
  • An additional payment posting code is defined to not exclude the client's liability guarantor. Note the code/description.
  • User Definition': The user has access to the 'Spreadsheet Batch Remittance' form.
Steps
  1. Open the 'Spreadsheet Batch Remittance Posting' form.
  2. Click the 'Create Batch' field.
  3. Enter the 'desired value' in the 'Batch Description' field.
  4. Select the 'desired value' in 'Default Payment Code' field.
  5. Enter the desired 'Posting Date'.
  6. Enter the desired 'Date Of Receipt'.
  7. Click [Launch Work Screen].
  8. Select "Client A" in the 'Client' field.
  9. Select the 'desired episode'.
  10. Validate there is Liability to be remitted against.
  11. Select the "excluded" guarantor from the 'Payor' field.
  12. Enter the 'desired value' in the 'Payment Amount' field.
  13. Double Click the 'Payment Code' field and validate it does not contain the "excluded" payment code.
  14. Select the "non-excluded" payment code.
  15. Click [Accept].
  16. Click [Submit].
  17. Click [OK].
  18. Click [Yes].
Scenario 9: Spreadsheet Batch Remittance Posting - Validating remittance batch posting using 'Interim Billing Batch'
Specific Setup:
  • Posting/Adjustment Codes Definition has been used to create desired definitions.
  • Claim Adjustment Group/Reason Code Definition has been used to create desired definitions.
  • A new client is added, or an existing client is identified. Note the Client ID/name.
  • The financial eligibility record is created for the client. Note the Guarantor code/name. The client is assigned two or more guarantors.
  • Services are rendered to the client. Note the service start / end date and service code used.
  • The 'Client Ledger' report for the client is processed. Note the details of the report.
  • An interim billing batch is created to include client, guarantor, and services.
  • Electronic Billing is used to create claims.
Steps
  1. Open the 'Spreadsheet Remittance Batch Posting' form.
  2. Select 'Create Batch' in the 'Create, Edit Or Delete Remittance Batch' field.
  3. Enter the 'Batch Description'.
  4. Select the interim billing batch created in the setup section in the 'Interim Batch Number' field.
  5. Enter desired date in the 'Posting Date' field.
  6. Enter desired date in the 'Date Of Receipt' field.
  7. Enter desired value in ‘Receipt’.
  8. Enter desired value in ‘Check #’.
  9. Select the ‘Default Guarantor’.
  10. Select the ‘Default Payment Code’.
  11. Select the ‘Default Adjustment Code.
  12. Select the ‘Default Transfer Code.
  13. If desired, enter a 'Service Start Date'.
  14. If desired, enter a 'Service End Date'.
  15. Click [Launch Work Screen].
  16. Validate that the data from the interim batch defaults.
  17. Click [Enter CARC(s)].
  18. Select desired value in 'CAS Adjustment Group Code'.
  19. Select desired value in 'CAS Adjustment Reason Code'.
  20. Enter an amount in 'Adjustment'.
  21. Validate that the 'Post' field is checked if the group/reason code has a value of 'No' in 'Compile but do not post adjustments (CAS) associated with the indicated Claim Adjustment Group/Reason codes when processing an 835.
  22. Enter additional CARC(s) as desired.
  23. Click [Save].
  24. Validate that the 'Adjust Amount' contains the total of the adjustments.
  25. Validate that the 'Adjust Code' contains the default value.
  26. If a transfer CARC was added, validate that the 'Transfer Amount' contains the total of the transfers.
  27. Validate that the 'Transfer Code' contains the default value.
  28. Hover over the 'Transfer Guar' to validate the table displays the client's guarantors, excluding the guarantor in 'Payor'.
  29. Select a 'Transfer Guar'.
  30. Enter a 'Payment Amount'.
  31. Validate that the 'Payment Code' contains the default value.
  32. If desired, click the '+' item to display the individual services.
  33. Validate the payments, adjustments, and transfers within the individual services, noting the date range of services with activity.
  34. Click [Accept].
  35. Click [Submit].
  36. Validate that the message contains 'Remittance batch 'XX' posted'.
  37. Click [OK].
  38. Click [No].
  39. Open ‘Client Ledger’ for the client and process the report for the date range of services with activity.
  40. Validate the data for the services that were paid, adjusted, or transferred.
  41. Close the report.
  42. Close the form.
Scenario 10: Batch Remittance Posting Report
Specific Setup:
  • User Definition has been used to give two users access to the Avatar Pm > Billing > Remittance Posting > Spreadsheet Batch Remittance Posting form and the Avatar PM > Billing > Billing Reports > Batch Remittance Posting Report form. Note the User IDs and User Descriptions.
  • Posting/Adjustment Codes Definition has been used to create desired definitions.
  • Claim Adjustment Group/Reason Code Definition has been used to create desired definitions.
  • Identify at least one client with open claims.
  • Spreadsheet Batch Remittance Posting has been used to create at least one batch per user. Use different values in 'Posting Date', and 'Check #'. Note the value and the signed in user. Note the details of the batches.
  • 835 Health Care Claim Payment/Advice has been used to post at least one 835 file. Note the details of the file.
Steps
  1. Open 'Batch Remittance Posting Report' form.
  2. Enter the desired value in the required 'Posting Date' field.
  3. If desired, enter a value in the 'Posting End Date' field.
  4. If desired, enter a value in the 'Check/EFT #' field.
  5. If desired, enter a value in the 'Remittance File By User'.
  6. Click [Process].
  7. Validate that the 'Batch Remittance Posting Report' report opens and contains the following fields:
  8. Batch
  9. Status
  10. Posting Option
  11. Posting Date
  12. Check/EFT Number
  13. Description
  14. Filed By
  15. Patient
  16. Ep #
  17. Claim
  18. Payor
  19. Total Charges
  20. Liability
  21. Payment Amount
  22. Payment Code
  23. Adjust Amount
  24. Adjust Code
  25. Transfer Amount
  26. Transfer Code
  27. Transfer Guar
  28. New Balance.
  29. Validate that the data in the fields is correct based on the selection criteria.
  30. Close the report.
  31. Close the form.
Topics
• Claim Follow-up • Spreadsheet Batch Remittance Posting