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Avatar PM 2023 Update 110

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Product Requirements and Recommendations

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Recommended Update Level

Avatar PM 2023 Monthly Release 2023.03.00
RADplus 2023 Monthly Release 2023.03.00

Product Update Description

The registry setting 'Specify LX Order On A Claim' is added and gives the ability to specify the order in which services should be displayed on an 837.

Required Updates

None

Included Updates

10, 11, 17, 18, 21, 25, 33, 35, 39, 44, 56, 57, 58, 62, 63, 66, 67, 72, 73, 76, 77, 78, 79, 82, 85, 88, 89, 93, 94, 96, 98, 101, 102, 109

Details
NEW3 CHANGED0 FIXED0
New (3)
Guarantors/Payaors form-Claim Order section-Multiple iteration table.
A new multiple iteration table section (‘837 – LX Order’) is added to the ‘Guarantors/Payors’-Claim Order section. On filing, this data is saved into an SQL table.
Value Added: Agencies can define the 837 LX Order buy service code, revenue code, or CPT code.
Topics
• Guarantor/Payors • NX • Registry Settings • Web Services
 
Electronic Billing - Registry Setting
The registry setting 'Specify LX Order On A Claim' is added and gives the ability to specify the order in which services should be displayed on an 837 Institutional or Professional.

In addition, the following table its added to the system: SYSTEM.billing_guar_table_order

Value Added: Agencies can control the feature of defining the 837 LX Order by setting the value as Y/N to this new registry setting 'Specify LX Order On A Claim'.
Topics
• 837 Institutional • 837 Professional • Guarantor/Payors • NX • Registry Settings • Web Services
 
Guarantors/Payors form-Specify LX Order-Electronic Billing 837 Sort
The LX order specified in the Claim Order section of the Guarantors/Payors form is followed in the Electronic Billing 837I and 837P files.
Value Added: Agencies can sort the 837 I and P LX orders by service code, revenue code, or CPT code by configuring the order details in the Claim Order section.
Topics
• 837 Institutional • 837 Professional • Guarantor/Payors • NX
 
Acceptance Tests
AV-86578 Summary | Details
Guarantors/Payaors form-Claim Order section-Multiple iteration table.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • SOAPUI - GuarantorsPayors
  • SOAPUI - UpdateGuarantorsPayors
  • Registry Settings (PM)
Scenario 1: Guarantors/Payors - Web Services - Registry Setting 'Specify LX Order On A Claim'
Specific Setup:
  • Registry Setting:
  • 'Specify LX Order On A Claim' is added to the system and defaults to 'N'.
  • Set the registry setting to 'Y' and submit the form.
Steps
  1. Using SOAPUI or some other web service tool, file the AddGuarantorsPayors method of the GuarantorsPayors web service, which includes the Claim Order data.
  2. Open the "Guarantors/Payors" form, in Edit mode search for the Guarantor newly added and validate that the Guarantor is created and the respective details are correct as filed in the web service, including Claim Order data.
  3. Using SOAPUI or some other web service tool, file the UpdateGuarantorsPayors method of the GuarantorsPayors web service, edit at least one item in Claim Order data.
  4. Open the "Guarantors/Payors" form, in Edit mode search for the Guarantor and validate that the Guarantor is updated with the respective details as filed using the web service, including Claim Order data.
Scenario 2: Guarantors/Payors - Registry Setting 'Specify LX Order On A Claim
Specific Setup:
  1. Registry Setting: 'Specify LX Order On A Claim' is added to the system and defaults to 'N'.
Steps
  1. Open 'Guarantors/Payors'.
  2. Validate that there is no 'Claim Order' section exists.
  3. Select the Edit option.
  4. Search and select a Guarantor.
  5. Select '837' section.
  6. Validate that when the Registry setting 'Specify LX Order On A Claim' is set to 'N', the 837 section has the field named Sort Room and Board Codes First (837I/UB04).
  7. Select Discard.
  8. Open 'Registry Settings'.
  9. Search for the Registry setting 'Specify LX Order On A Claim' and set the value as 'Y'
  10. Submit and close the form.
  11. Open 'Guarantors/Payors'.
  12. Validate that the 'Claim Order' section exists.
  13. Select the Edit option.
  14. Search and select a Guarantor.
  15. Select '837' section.
  16. Validate that when the Registry setting 'Specify LX Order On A Claim' is set to 'Y', the 'Sort Room and Board Codes First (837I/UB04)' field is changed to 'Sort Room and Board Codes First (UB04)'.
  17. Select the 'Claim Order' section.
  18. Validate the form elements available.
  19. Add data into the 'Claim Order' section and submit the form.
  20. Go back to the form in 'Edit' mode and validate that the data exists in the 'Claim Order' section.
Topics
• Guarantor/Payors • NX • Registry Settings • Web Services
AV-86579 Summary | Details
Electronic Billing - Registry Setting
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • SOAPUI - GuarantorsPayors
  • SOAPUI - UpdateGuarantorsPayors
  • Electronic Billing
  • Registry Settings (PM)
Scenario 1: Guarantors/Payors - Web Services - Registry Setting 'Specify LX Order On A Claim'
Specific Setup:
  • Registry Setting:
  • 'Specify LX Order On A Claim' is added to the system and defaults to 'N'.
  • Set the registry setting to 'Y' and submit the form.
Steps
  1. Using SOAPUI or some other web service tool, file the AddGuarantorsPayors method of the GuarantorsPayors web service, which includes the Claim Order data.
  2. Open the "Guarantors/Payors" form, in Edit mode search for the Guarantor newly added and validate that the Guarantor is created and the respective details are correct as filed in the web service, including Claim Order data.
  3. Using SOAPUI or some other web service tool, file the UpdateGuarantorsPayors method of the GuarantorsPayors web service, edit at least one item in Claim Order data.
  4. Open the "Guarantors/Payors" form, in Edit mode search for the Guarantor and validate that the Guarantor is updated with the respective details as filed using the web service, including Claim Order data.
Scenario 2: 837 Institutional - Registry Setting 'Specify LX Order On A Claim'
Specific Setup:
  • Registry Setting:
  • 'Specify LX Order On A Claim' is added to the system and defaults to 'N'.
  • Set the registry setting to 'Y' and submit the form.
  • Client A:
  • Has unclaimed services, for different service codes, that can be billed on the 837 Institutional.
  • Use 'Client Ledger' to note the service codes, dates of service, financial class, and guarantor.
  • Use 'Service Fee/Cross Reference Maintenance' to note the Revenue Code.
  • Create Interim Batch.
  • Close the charges using 'Close Charges'.
  • Guarantors/Payors:
  • Claim Order definition exists by service code or revenue code. Note the order.
Steps
  1. Open the 'Electronic Billing' form.
  2. Select the 'Billing Form' as 837-Institutional.
  3. Select the 'Type Of Bill'.
  4. Select the 'Individual Or All Guarantors'.
  5. Select the 'Guarantor'.
  6. Select the 'Billing Type'.
  7. Select 'Sort File' in the 'Billing Option' field.
  8. Enter any desired value in the 'File Description' field.
  9. Select 'Interim Batch' in the 'All Clients Or Interim Billing Batch' field.
  10. Choose the Interim batch from the 'Interim Batch Number' drop-down field.
  11. Select 'No' for the 'Create Claims' field.
  12. Enter the date value for the 'First Date Of Service To Include' and 'Last Date Of Service To Include' fields (Should cover the services that you want to run the bill for).
  13. Select 'All' for the 'Include Primary and/or Secondary Billing' field.
  14. Select the 'Process' button.
  15. Validate that the confirmation message contains: ‘Compile Complete'.
  16. Select 'OK'.
  17. Select 'Dump File' in the 'Billing Option' field.
  18. Click 'Print' in the 'Print Or Delete Report' field.
  19. Select 'File' from the drop-down.
  20. Click the 'Print 837 Report' button.
  21. Select the 'Process' button.
  22. Verify that the Dump file launched without any error.
  23. Validate that the LX order shown in the file is based on the preferred LX order configured in the Guarantors/Payors- Claim Order section.
Scenario 3: Guarantors/Payors - Registry Setting 'Specify LX Order On A Claim
Specific Setup:
  1. Registry Setting: 'Specify LX Order On A Claim' is added to the system and defaults to 'N'.
Steps
  1. Open 'Guarantors/Payors'.
  2. Validate that there is no 'Claim Order' section exists.
  3. Select the Edit option.
  4. Search and select a Guarantor.
  5. Select '837' section.
  6. Validate that when the Registry setting 'Specify LX Order On A Claim' is set to 'N', the 837 section has the field named Sort Room and Board Codes First (837I/UB04).
  7. Select Discard.
  8. Open 'Registry Settings'.
  9. Search for the Registry setting 'Specify LX Order On A Claim' and set the value as 'Y'
  10. Submit and close the form.
  11. Open 'Guarantors/Payors'.
  12. Validate that the 'Claim Order' section exists.
  13. Select the Edit option.
  14. Search and select a Guarantor.
  15. Select '837' section.
  16. Validate that when the Registry setting 'Specify LX Order On A Claim' is set to 'Y', the 'Sort Room and Board Codes First (837I/UB04)' field is changed to 'Sort Room and Board Codes First (UB04)'.
  17. Select the 'Claim Order' section.
  18. Validate the form elements available.
  19. Add data into the 'Claim Order' section and submit the form.
  20. Go back to the form in 'Edit' mode and validate that the data exists in the 'Claim Order' section.
Scenario 4: 837 Professional - Registry Setting 'Specify LX Order On A Claim'
Specific Setup:
  • Registry Setting:
  • 'Specify LX Order On A Claim' is added to the system and defaults to 'N'.
  • Set the registry setting to 'Y' and submit the form.
  • Client A:
  • Has unclaimed services, for different service codes, that can be billed on the 837 Professional.
  • Use 'Client Ledger' to note the service codes, dates of service, financial class, and guarantor.
  • Use 'Service Fee/Cross Reference Maintenance' to note the Revenue Code.
  • Create Interim Batch.
  • Close the charges using 'Close Charges'.
  • Guarantors/Payors:
  • Claim Order definition exists by service code or revenue code. Note the order.
Steps
  1. Open the 'Electronic Billing' form.
  2. Select the 'Billing Form' as 837-Professional.
  3. Select the 'Type Of Bill'.
  4. Select the 'Individual Or All Guarantors'.
  5. Select the 'Guarantor'.
  6. Select the 'Billing Type'.
  7. Select 'Sort File' in the 'Billing Option' field.
  8. Enter any desired value in the 'File Description' field.
  9. Select 'Interim Batch' in the 'All Clients Or Interim Billing Batch' field.
  10. Choose the Interim batch from the 'Interim Batch Number' drop-down field.
  11. Select 'No' for the 'Create Claims' field.
  12. Enter the date value for the 'First Date Of Service To Include' and 'Last Date Of Service To Include' fields (Should cover the services that you want to run the bill for).
  13. Select 'All' for the 'Include Primary and/or Secondary Billing' field.
  14. Select the 'Process' button.
  15. Will get the dialogue for the confirmation that says 'Compile Complete'.
  16. Select 'OK'.
  17. Select 'Dump File' in the 'Billing Option' field.
  18. Click 'Print' in the 'Print Or Delete Report' field.
  19. Select 'File' from the drop-down.
  20. Click the 'Print 837 Report' button.
  21. Select the 'Process' button.
  22. Verify that the Billing report file launched without any error.
  23. Validate that the LX order shown in the file is based on the preferred LX order configured in the Guarantors/Payors- Claim Order section.
Topics
• 837 Institutional • 837 Professional • Guarantor/Payors • NX • Registry Settings • Web Services
AV-86580 Summary | Details
Guarantors/Payors form-Specify LX Order-Electronic Billing 837 Sort
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Electronic Billing
  • Guarantors/Payors
  • Registry Settings (PM)
Scenario 1: 837 Institutional - Registry Setting 'Specify LX Order On A Claim'
Specific Setup:
  • Registry Setting:
  • 'Specify LX Order On A Claim' is added to the system and defaults to 'N'.
  • Set the registry setting to 'Y' and submit the form.
  • Client A:
  • Has unclaimed services, for different service codes, that can be billed on the 837 Institutional.
  • Use 'Client Ledger' to note the service codes, dates of service, financial class, and guarantor.
  • Use 'Service Fee/Cross Reference Maintenance' to note the Revenue Code.
  • Create Interim Batch.
  • Close the charges using 'Close Charges'.
  • Guarantors/Payors:
  • Claim Order definition exists by service code or revenue code. Note the order.
Steps
  1. Open the 'Electronic Billing' form.
  2. Select the 'Billing Form' as 837-Institutional.
  3. Select the 'Type Of Bill'.
  4. Select the 'Individual Or All Guarantors'.
  5. Select the 'Guarantor'.
  6. Select the 'Billing Type'.
  7. Select 'Sort File' in the 'Billing Option' field.
  8. Enter any desired value in the 'File Description' field.
  9. Select 'Interim Batch' in the 'All Clients Or Interim Billing Batch' field.
  10. Choose the Interim batch from the 'Interim Batch Number' drop-down field.
  11. Select 'No' for the 'Create Claims' field.
  12. Enter the date value for the 'First Date Of Service To Include' and 'Last Date Of Service To Include' fields (Should cover the services that you want to run the bill for).
  13. Select 'All' for the 'Include Primary and/or Secondary Billing' field.
  14. Select the 'Process' button.
  15. Validate that the confirmation message contains: ‘Compile Complete'.
  16. Select 'OK'.
  17. Select 'Dump File' in the 'Billing Option' field.
  18. Click 'Print' in the 'Print Or Delete Report' field.
  19. Select 'File' from the drop-down.
  20. Click the 'Print 837 Report' button.
  21. Select the 'Process' button.
  22. Verify that the Dump file launched without any error.
  23. Validate that the LX order shown in the file is based on the preferred LX order configured in the Guarantors/Payors- Claim Order section.
Scenario 2: 837 Professional - Registry Setting 'Specify LX Order On A Claim'
Specific Setup:
  • Registry Setting:
  • 'Specify LX Order On A Claim' is added to the system and defaults to 'N'.
  • Set the registry setting to 'Y' and submit the form.
  • Client A:
  • Has unclaimed services, for different service codes, that can be billed on the 837 Professional.
  • Use 'Client Ledger' to note the service codes, dates of service, financial class, and guarantor.
  • Use 'Service Fee/Cross Reference Maintenance' to note the Revenue Code.
  • Create Interim Batch.
  • Close the charges using 'Close Charges'.
  • Guarantors/Payors:
  • Claim Order definition exists by service code or revenue code. Note the order.
Steps
  1. Open the 'Electronic Billing' form.
  2. Select the 'Billing Form' as 837-Professional.
  3. Select the 'Type Of Bill'.
  4. Select the 'Individual Or All Guarantors'.
  5. Select the 'Guarantor'.
  6. Select the 'Billing Type'.
  7. Select 'Sort File' in the 'Billing Option' field.
  8. Enter any desired value in the 'File Description' field.
  9. Select 'Interim Batch' in the 'All Clients Or Interim Billing Batch' field.
  10. Choose the Interim batch from the 'Interim Batch Number' drop-down field.
  11. Select 'No' for the 'Create Claims' field.
  12. Enter the date value for the 'First Date Of Service To Include' and 'Last Date Of Service To Include' fields (Should cover the services that you want to run the bill for).
  13. Select 'All' for the 'Include Primary and/or Secondary Billing' field.
  14. Select the 'Process' button.
  15. Will get the dialogue for the confirmation that says 'Compile Complete'.
  16. Select 'OK'.
  17. Select 'Dump File' in the 'Billing Option' field.
  18. Click 'Print' in the 'Print Or Delete Report' field.
  19. Select 'File' from the drop-down.
  20. Click the 'Print 837 Report' button.
  21. Select the 'Process' button.
  22. Verify that the Billing report file launched without any error.
  23. Validate that the LX order shown in the file is based on the preferred LX order configured in the Guarantors/Payors- Claim Order section.
Topics
• 837 Institutional • 837 Professional • Guarantor/Payors • NX
Table Changes
Table Column Change
SYSTEM.billing_guar_table_order FACILITY Added
SYSTEM.billing_guar_table_order GUARANTOR_ID Added
SYSTEM.billing_guar_table_order effective_date Added
SYSTEM.billing_guar_table_order end_date Added
SYSTEM.billing_guar_table_order order Added
SYSTEM.billing_guar_table_order code_type_code Added
SYSTEM.billing_guar_table_order code_type_value Added
SYSTEM.billing_guar_table_order service_code Added
SYSTEM.billing_guar_table_order cpt_code Added
SYSTEM.billing_guar_table_order revenue_code Added
SYSTEM.billing_guar_table_order data_entry_by Added
SYSTEM.billing_guar_table_order data_entry_by_option Added
SYSTEM.billing_guar_table_order data_entry_date Added
SYSTEM.billing_guar_table_order data_entry_time Added
SYSTEM.billing_guar_table_order data_entry_user_id Added
SYSTEM.billing_guar_table_order data_entry_source Added
SYSTEM.billing_guar_table_order option_id Added
SYSTEM.billing_guar_table_order option_desc Added
SYSTEM.billing_guar_table_order data_entry_user_name Added
SYSTEM.billing_guar_table_order data_entry_utc Added
SYSTEM.billing_guar_table_order data_entry_timezone_info_all Added
SYSTEM.billing_guar_table_order data_entry_time_j Added
SYSTEM.billing_guar_table_order data_entry_offset Added
SYSTEM.billing_guar_table_order data_entry_timezone_short Added