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Avatar PM 2023 Update 128

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2023 Monthly Release 2023.03.01
RADplus 2023 Monthly Release 2023.03.01

Product Update Description

A new field 'Report Billing Units as Procedure Count (2400-SV3-06)' is added to the 'Guarantor/Program Billing Defaults' form (837 Dental section) that will allow users to report billing units as Procedure Count (2400-SV3-06) for services when billing units are greater than one.

Required Updates

None

Included Updates

7, 10, 11, 16, 17, 18, 21, 25, 29, 31, 32, 33, 34, 35, 39, 44, 56, 57, 58, 59, 62, 63, 64, 65, 66, 67, 72, 73, 76, 77, 78, 79, 82, 85, 86, 88, 89, 93, 94, 96, 98, 100, 101, 102, 103, 104, 105, 109, 110, 115, 116, 119, 120, 122, 125

Details
NEW1 CHANGED0 FIXED0
New (1)
GuarantorsPayaors Billing defaults-837 Dental-Show SV306 Quantity in the bill
A new field 'Report Billing Units as Procedure Count (2400-SV3-06)' is added to control the ability to show the SV3-06 Quantity in the 837-Dental bill. New table columns are added to the File Import table for the Guarantor template. KB0074910 v0.01
Value Added: A new field is added to control display of the SV3-06 Quantity in the 837-Dental bill.
Topics
• 837 Dental
 
Acceptance Tests
AV-86624 Summary | Details
GuarantorsPayaors Billing defaults-837 Dental-Show SV306 Quantity in the bill
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • Admission (Outpatient)
  • Client Charge Input
  • Client Ledger
  • Crystal Report Viewer
  • Crystal Reports or other SQL Reporting tool (PM Namespace)
  • Diagnosis
  • Electronic Billing
  • File Import
  • Financial Eligibility
  • Service Codes
  • Service Fee/Cross Reference Maintenance
Scenario 1: Guarantor/Program Billing Defaults - 837 Dental - Report Billing Units as Procedure Count (2400-SV3-06)
Specific Setup:
  • Registry Setting:
  • Avatar PM Registry Setting 'Enable Dental Billing' must be enabled/set to value 'Y'.
Steps
  1. Open the 'Guarantor/Program Billing Defaults' form.
  2. Select '837 Dental' section.
  3. Verify that fields are present.
  4. Close the form.
  5. Open 'Registry Setting'
  6. Set 'Enable Dental Billing' to 'N'.
  7. Submit and close the form.
  8. Open the 'Guarantor/Program Billing Defaults' form.
  9. Select '837 Dental' section.
  10. Verify that there are no fields present.
  11. Close the form.
Scenario 2: 837 Dental Bill - Validate Quantity – Field 'Report Billing Units as Procedure Count (2400-SV3-06)' set as YES
Specific Setup:
  • Registry Setting:
  • Avatar PM Registry Setting 'Enable Dental Billing' must be enabled/set to value 'Y'.
  • Service Code:
  • A user-defined dental Service should be created by selecting 'Is This A Dental Service' as 'Yes'.
  • Enter the 'Type Of Fee' as 'User Defined'.
  • Set the 'Minutes Per Unit' as '15'.
  • Service Fee/Cross Reference Maintenance:
  • Create a Fee for the Dental service code.
  • Client A:
  • Financial Eligibility:
  • Select an existing/ active guarantor for the client.
  • Has unclaimed dental service(s), for a particular date with a duration of more than 15 which makes the units more than one, that can be billed on the 837 Dental.
  • Has unclaimed dental service(s), for date(s) different date with a duration of 15 or less which makes the units one, that can be billed on the 837 Dental.
  • Use 'Client Ledger' to note that the liability distribution contains the correct guarantor and units.
  • The client has an active diagnosis record.
  • Close the charges using 'Close Charges'.
Steps
  1. Open 'Guarantor/Program Billing Defaults' form.
  2. Select 'Edit Template' and select the existing Defaults Template for editing, or select 'Add Template' for new entry.
  3. Select the '837 Dental' section of the form.
  4. Validate that fields appear on the form.
  5. Validate that the following new field is available in the form, where the options are 'Yes' and 'No'.
  6. 'Report Billing Units as Procedure Count (2400-SV3-06)'.
  7. Ensure no values are selected in the new field.
  8. Submit the 'Guarantor/Program Billing Defaults' Form.
  9. Open 'Electronic Billing'.
  10. Create an 837 Dental for Client A. Don't create claims.
  11. Open the dump file and validate that the bill doesn't show the Quantity when the 'Report Billing Units as Procedure Count (2400-SV3-06)' field is left blank.
  12. Close the report.
  13. Close the form.
  14. Open Avatar PM 'Guarantor/Program Billing Defaults' form.
  15. Select 'Edit Template' and select the existing Defaults Template for editing.
  16. Select the '837 Dental' section of the form.
  17. Select 'No' for the 'Report Billing Units as Procedure Count (2400-SV3-06)' field.
  18. Submit the 'Guarantor/Program Billing Defaults' Form.
  19. Open 'Electronic Billing'.
  20. Create an 837 Dental for Client A. Don't create claims.
  21. Open the dump file and validate that the bill doesn't show the Quantity when the 'Report Billing Units as Procedure Count (2400-SV3-06)' field is set as 'No'.
  22. Close the report.
  23. Close the form.
  24. Open Avatar PM 'Guarantor/Program Billing Defaults' form.
  25. Select 'Edit Template' and select the existing Defaults Template for editing.
  26. Navigate to the '837 Dental' section of the form.
  27. Select 'Yes' for the 'Report Billing Units as Procedure Count (2400-SV3-06)' field.
  28. Submit the 'Guarantor/Program Billing Defaults' Form.
  29. Open 'Electronic Billing'
  30. Create an 837 Dental for Client A for the dates that have a service duration of 15 minutes or fewer. Don't create claims.
  31. Open the dump file and validate that the bill doesn't show the Quantity when the 'Report Billing Units as Procedure Count (2400-SV3-06)' field is set as 'Yes' and the Quantity is less than or equal to 1.
  32. Close the report.
  33. Close the form.
  34. Open 'Electronic Billing'
  35. Create an 837 Dental for Client A for the dates that have a service duration of greater than 15 minutes. (Don't create claims).
  36. Open the dump file and validate that the bill shows the Quantity when the 'Report Billing Units as Procedure Count (2400-SV3-06)' field is set as 'Yes' and the Quantity is more than 1.
  37. Close the report.
  38. Close the form.
  39. Open Avatar PM 'Guarantor/Program Billing Defaults' form.
  40. Select 'Template Maintenance'
  41. Select the 'Export' option in the 'Action' field.
  42. Choose the Template from the 'Select Template(s) To Export' list.
  43. Select 'Edit' in the 'Export Template As Add or Edit.' field.
  44. Click on the 'Export Template(s)' button.
  45. Ensure that the file is exported and saved.
  46. Close the form.
  47. Open 'File Import' form and import the template by selecting the exported file.
  48. Compile and Post File.
  49. Select 'Print File'.
  50. In the crystal report from the 'File Import' form, confirm that the new field as well as the below fields are on the report.
  51. sgmnts_to_suppress_code
  52. sgmnts_to_suppress_sh_val
  53. sgmnts_to_suppress_value
  54. sub_contact_name_per_2
  55. com_number_qual_per_3
  56. com_number_per_4
  57. com_number_qual_per_5
  58. com_number_per_6
  59. com_number_qual_per_7
  60. com_number_per_8
  61. ccbhc_template_code
  62. Close the report.
  63. Close the form.
  64. Open Crystal Reports or another SQL reporting tool.
  65. In SQL table 'SYSTEM.file_import_gpbdt_d837', ensure that the following fields are present:
  66. sgmnts_to_suppress_code
  67. sgmnts_to_suppress_sh_val
  68. sgmnts_to_suppress_value
  69. sub_contact_name_per_2
  70. com_number_qual_per_3
  71. com_number_per_4
  72. com_number_qual_per_5
  73. com_number_per_6
  74. com_number_qual_per_7
  75. com_number_per_8
  76. ccbhc_template_code
  77. Close the report.
  78. Close the form.
Topics
• 837 Dental