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Avatar PM 2023 Update 120

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2023 Monthly Release 2023.03.00
RADplus 2023 Monthly Release 2023.03.00

Product Update Description

The following changes have been made: 1) The 'Avatar PM \ System Maintenance \ File Import \ Service Fee/Guarantor Definitions \ Disable Full Table Backups Prior To File Import' registry setting is added to the system that will allow users to optionally disable the backups on 'SYSTEM.billing_tx_master_fee_table' and 'SYSTEM.billing_tx_max_liab_by_guar' tables during file import. Additionally, performance improvements have been made to the Service Fee and Guarantor Definition file import posting process. 2) The 'Avatar PM \ System Maintenance \ File Import \ Post Full Amount When Processing Payment Adjustment Posting File Import File' registry setting is added that will allow posting of full amount specified in the 'Payment Adjustment Posting' import file regardless of the remaining liability. 3) The issue is resolved where editing a fee definition in the 'Service Fee/Cross Reference Maintenance' form might result in the incorrect display of "An existing fee definition must be selected in order to continue" error message.

Required Updates

None

Included Updates

7, 10, 17, 18, 21, 25, 31, 32, 34, 35, 39, 44, 56, 57, 59, 62, 63, 64, 65, 66, 67, 72, 73, 76, 77, 78, 79, 85, 86, 88, 89, 93, 94, 96, 98, 101, 102, 104, 105, 109, 115

Details
NEW2 CHANGED0 FIXED1
New (2)
Guarantor Fee Definition: File Import
The system allows users to add a new guarantor definition or edit the existing one through file import.
Value Added: Allow users to import guarantor definition file without taking too much time.
Topics
• File Import • NX • Service Fee/Cross Reference and Guarantor Definition Export • Service Fee/Cross Reference Maintenance
 
Payment/Adjustment Overpayments: File import
The system allows the users to post the full payment/adjustment amount even if it is more than the remaining liability by using File import.
Value Added: The system allows users to overpay services.
Topics
• File Import • NX
 
Fixed (1)
Service Fee/Cross Reference Maintenance: Allows users to edit service fee
An issue has been resolved where the system did not allow users to edit the existing service fee without throwing an error. KB0074279 v0.01
Topics
• NX • Service Fee/Cross Reference Maintenance
 
Acceptance Tests
AV-87594 Summary | Details
Guarantor Fee Definition: File Import
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Crystal Report Viewer
  • File Import
  • Guarantors/Payors
  • Service Codes
  • Service Fee/Cross Reference Maintenance
  • Registry Settings (PM)
  • App Dashboard
  • Service Fee/Cross Reference and Guarantor Definition Export
Scenario 1: File Import - Service Guarantor Definitions
Specific Setup:
  • Note: This functionality is for any service code type, including CCBHC service codes.
  • Please contact your Netsmart representative to enable CCBHC Billing functionality, if desired.
  • CCBHC setup has been completed.
  • The 'Avatar_PM_File_Import_Record_Layouts' spreadsheet is included in the update zip file to assist in creating the 'Service Guarantor Definitions' file to import.
  • Identify an existing service code.
  • Create a 'File Import' for the 'Service Guarantor Definition' file type that contains the service code. Note the value of each field included in the file.
Steps
  1. Open 'File Import'.
  2. Select Service Guarantor Definitions’ in 'File Type'.
  3. Load, compile and post the file.
  4. Open 'Service Fee/Cross Reference Maintenance', 'Guarantor Definitions', and review the imported record in edit mode.
  5. Validate that all values equal the values in the imported file.
  6. Click [Guarantor Definitions Report].
  7. Validate that guarantor information is correct for the service code.
  8. Close the report.
  9. Close the form.
Scenario 2: File Import - Guarantor Definitions
Specific Setup:
  • Set the registry setting "Import Process Type" to "FU&GU".
  • Using the "Service Codes" form, add a new service code for testing purposes.
  • Create a delimited file to be used for the service code guarantor definition file import.
  • Set the registry setting "Import File Delimiter" to the desired value to match the format of the delimited file created in the previous steps.
Steps
  1. Open the "File Import" form.
  2. Import the service fee import file created in setup.
  3. Process a file through file upload, compile and posting processes.
  4. Open the "Service Fee/Cross Reference Maintenance" form.
  5. Navigate to the "Guarantor Definition" section.
  6. Validate the data from the import file is displayed in the form.
Scenario 3: File Import - Service Guarantor Definitions - 'Import Process Type' Registry Setting
Specific Setup:
  • Registry Settings:
  • The 'Avatar PM->System Maintenance->File Import->->->Import Process Type'' has the following values: 'FU&GU'.
  • Service Fee/Cross Reference and Guarantor Definition Export has been used to export the 'Guarantor Definition. Select a service code with a definition to update.
  • File Import:
  • A 'Service Guarantor Definition' file exists to update the guarantor fee for the service code.
Steps
  1. Open 'File Import'.
  2. Select 'Service Guarantor Definitions' in 'File Type'.
  3. Upload/compile/post the 'Service Guarantor Definition' file.
  4. Open 'Service Fee/Cross Reference Maintenance'.
  5. Select the 'Guarantor Definitions' section.
  6. Click [Guarantor Definitions Report].
  7. Validate that the fee for the service code was updated.
  8. Close the report.
  9. Select the 'Restore Definitions' section.
  10. Click [Restore Maximum Liability Assignment Definition That Existed Prior to Last File Import].
  11. Select the 'Guarantor Definitions' section.
  12. Click [Guarantor Definitions Report].
  13. Validate that the fees were restored.
Topics
• File Import • NX • Service Fee/Cross Reference and Guarantor Definition Export • Service Fee/Cross Reference Maintenance
AV-89460 Summary | Details
Payment/Adjustment Overpayments: File import
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Ledger
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Electronic Billing
  • File Import
  • Payment Acknowledgement
  • Posting/Adjustment Codes Definition
  • Registry Settings (PM)
  • Admission (Outpatient)
  • Client Charge Input
  • Diagnosis
  • Financial Eligibility
Scenario 1: File Import - Validate Payment/Adjustment import files
Specific Setup:
  • Registry Settings:
  • Avatar PM->Billing->Remittance Processing->->->Enable Payment Acknowledgement = Y.
  • Avatar PM->Billing->Remittance Processing->->->Prevent Posting Payments Unless Payment has been Acknowledged = 3, at a minimum.
  • Avatar PM->System Maintenance->File Import->->->Import File Delimiter – note the value to be used when creating the file to import.
  • Posting/Adjustment Codes Definition has been used to note a payment code.
  • Client A: Client is identified that has multiple unpaid claims.
  • Note the guarantor, service code, service date, claim number and the line balance.
  • Payment Acknowledgement has been used to create a minimum of one acknowledged payment for the same guarantor as the client’s guarantor. Note the transaction number this is included in the ‘Payment Acknowledgement’ message.
  • Create a file to import to the Payment/Adjustment Posting option and includes the transaction number.
  • The File Import spreadsheet will be included in the zip file.
Steps

1. Open the "File Import" form.

2. Select "File Type" of "Payments/Adjustment Posting".

3. Select "Action" of "Upload New File".

4. Click "Process Action".

5. Select "Action" of "Compile/Validate File".

6. Select the file that was just uploaded in "File(s)".

7. Click "Process Action".

8. Click “OK” on the “Compiled” message.

9. Select "Action" of "Post File".

10. Select the file that was just compiled in "File(s)".

11. Click "Process Action".

12. Click “OK” on the “Posted” message.

13. Close the form.

14. Open the "Client Ledger" form.

15. Process the client ledger.

16. Validate the payment information is reflected in the client's ledger.

17. Close the form.

Scenario 2: File Import - Payment Adjustment - Registry Setting: Post Full Amount When Processing Payment Adjustment Posting File Import File
Specific Setup:
  • The registry setting 'Import File Delimiter' is enabled with desired value.
  • File Import:
  • A file import file of 'Payment Adjustment' file type is created to add a new posting code.
Steps

1. Open the "File Import" form.

2. Select "File Type" of "Payments/Adjustment Posting".

3. Select "Action" of "Upload New File".

4. Click "Process Action".

5. Select "Action" of "Compile/Validate File".

6. Select the file that was just uploaded in "File(s)".

7. Click "Process Action".

8. Click “OK” on the “Compiled” message.

9. Select "Action" of "Post File".

10. Select the file that was just compiled in "File(s)".

11. Click "Process Action".

12. Click “OK” on the “Posted” message.

13. Close the form.

14. Open the "Client Ledger" form.

15. Process the client ledger.

16. Validate the payment information is reflected in the client's ledger.

17. Close the form.
Topics
• File Import • NX
AV-90298 Summary | Details
Service Fee/Cross Reference Maintenance: Allows users to edit service fee
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Guarantors/Payors
  • Service Codes
  • Service Fee/Cross Reference Maintenance
  • CPT Code Definition (PM)
Scenario 1: Service Fee/Cross Reference Maintenance - Add/Edit Guarantor Definitions
Specific Setup:
  • Please contact your Netsmart representative to enable CCBHC Billing functionality.
  • CCBHC setup has been completed.
  • An existing 'Service Code' is identified.
  • An existing 'Guarantors'Payors' is identified.
Steps
  1. Open 'Service Fee/Cross Reference Maintenance'.
  2. Set the Section 'Guarantor Definition'.
  3. Select 'Enter New' in 'Enter New Or Edit Existing'.
  4. Enter the 'Service Code'
  5. Enter the 'From Date'.
  6. Select the 'Guarantor'.
  7. Enter data for all desired fields, noting the values.
  8. Click [Submit].
  9. Click [Yes].
  10. Edit the same guarantor and service code combination in 'Guarantor Definition'.
  11. Review the data in each field to validate that it matches the value that was entered.
Scenario 2: Service Fee/Cross Reference Maintenance - Add/Edit Service Fee Definition
Specific Setup:
  • Service Codes:
  • Add a new service code for testing purposes (Service Code A).
  • CPT Code Definition:
  • A CPT Code must be defined (CPT Code A).
Steps
  1. Access the ‘Service Fee/Cross Reference Maintenance’ form.
  2. Select "Enter New" in the ‘Enter New Or Edit Existing Fee/Cross Reference’ field.
  3. Enter "Service Code A" in the 'Service Code' field.
  4. Enter the desired date in the ‘From Date’ field.
  5. Enter the desired value in the 'Fee' field.
  6. Enter "CPT Code A" in the 'CPT-4 / HCPCS Code' field.
  7. Enter desired value with quotation marks into the 'CPT-4 / HCPCS Modifier' field.
  8. Click [Submit].
  9. Click [Yes].
  10. Select "Edit Existing" in the ‘Enter New Or Edit Existing Fee/Cross Reference’ field.
  11. Enter "Service Code A" in the 'Service Code' field.
  12. Enter the same date in the ‘From Date’ field.
  13. Click [Select Fee/Cross Ref To Edit/Default From Existing Row].
  14. Select the desired row that filed in above steps.
  15. Click [OK].
  16. Validate that the entered 'Fee' exists.
  17. Validate that the entered 'CPT-4 / HCPCS Code' exists.
  18. Validate that the selected ‘CPT-4 / HCPCS Modifier’ exists.
  19. Close the form.
  20. Access the ‘Service Fee/Cross Reference Maintenance’ form.
  21. Select "Enter New" in the ‘Enter New Or Edit Existing Fee/Cross Reference’ field.
  22. Enter "Service Code A" in the 'Service Code' field.
  23. Enter the same date entered in the previous steps in the 'From Date' field.
  24. Click [Submit].
  25. Validate a dialog is displayed stating, "Fee Definition already exists, please edit the existing definition".
  26. Click [OK].
  27. Validate the dialog closes.
  28. Validate a 'Filing Error' dialog stating, "Filing aborted" is received.
  29. Click [OK].
  30. Validate the form is still open with the data entered in the previous steps.
  31. Close the form.
Topics
• NX • Service Fee/Cross Reference Maintenance