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Avatar PM 2023 Update 133

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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

The Client Merge process is updated to display a warning message when performing an episodic merge for a source client who has services originating from MSO.

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, 121, 122, 125, 128, 129, 130

Details
NEW1 CHANGED0 FIXED0
New (1)
Client Merge
The Client Merge process is updated to display a warning message when performing an episodic merge for a source client who has services originating from MSO.
Value Added: The Client Merge process is updated.
Topics
• Client Merge
 
Acceptance Tests
AV-67442 Summary | Details
Client Merge
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Client Charge Input
  • Client Ledger
  • Diagnosis
  • Financial Eligibility
  • 837 Health Care Claim Professional
  • Applying Contracting Provider
  • Authorization Listing
  • Batch Creation
  • Batch Creation - Assign ID
  • Close Batch
  • Contracting Provider Registration
  • CPT Code Definition (MSO)
  • CPT Code Definition (PM)
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Dynamic Form - Form and Table Documentation / File Export - File Name
  • Electronic Billing
  • Fast Service Entry
  • Fast Service Entry Filing Confirmation
  • Funding Source Registration
  • Member Specific Information
  • MSO to Parent System Integration Mapping
  • Performing Provider Association - Error
  • Plan Definition
  • Registry Settings (PM)
  • Service Authorization
Scenario 1: 'Client Merge' - Verification of Service Information In Client Merge (Services originating in Avatar PM)
Specific Setup:
  • Client records eligible for episodic merge, where services exist for 'Source Client' record.
  • Crystal Reports or other SQL reporting tool.
Steps
  1. Create two clients with active diagnosis and financial eligibility.
  2. Open 'Client Merge' form.
  3. Select 'Source Client ID' value, using client with at least one existing episode which includes services.
  4. Select 'Source Client Episode' episode value (selecting episode which includes services), or set 'Merge All Client Data Through Single Filing' field to 'Yes'.
  5. Select 'Target Client ID' value.
  6. Click 'File' button and click 'Yes' button in the 'Do You Wish To Continue With The Indicated Action?' dialog.
  7. Ensure that merge verification dialog is presented on completion of merge.
  8. Open 'Client Ledger' form.
  9. Select 'Target Client ID' from merge in 'Client Ledger' form and enter/select any other criteria.
  10. Click 'Process' button to display Client Ledger.
  11. In Client Ledger display, ensure that all services from 'Source Client ID'/selected merged episode(s) are relocated to 'Target Client ID' and are visible in ledger.
  12. Open Crystal Reports or other SQL reporting tool.
  13. In Avatar SQL table 'SYSTEM.billing_tx_history', ensure that all service rows from the 'Source Client ID' (and episode) used in merge are updated to the 'Target Client ID' PATID value.
  14. In Avatar SQL table 'SYSTEM.billing_tx_charge_totals', ensure that all service rows from the 'Source Client ID' (and episode) used in merge are updated to the 'Target Client ID' PATID value.
  15. In Avatar SQL table 'SYSTEM.billing_tx_charge_detail', ensure that all service rows from the 'Source Client ID' (and episode) used in merge are updated to the 'Target Client ID' PATID value.
Scenario 2: Client Merge - With Service Authorization Records - Verify 'AUTuniqueid'
Specific Setup:
  • Two clients exist in programs that can be merged: Client A & Client B.
  • The programs are not the same.
  • Both clients have ‘Service Authorization’ records . Note the authorization numbers and the authorization status.
  • Registry Settings:
  • Avatar MSO->Care Management->Service Authorization->->->Enable Eligibility Check
  • This setting, along with, 'Funding Source/Guarantor Mapping' can affect the 'Current Authorization Status' of the 'Service Authorization' record after the merge.
  • Avatar PM->System Maintenance->Client Merge->->->Allow Merging Into Existing Episode = Y.
  • Avatar PM->System Maintenance->Client Merge->->->Allow Merging Of All Client Data Through Single Filing =Y.
Steps
  1. Set the set-up for '837 Health Care Claim Professional'.
  2. Load, Compile and Post the file into '837 Health Care Claim Professional'.
  3. Create an SQL Query MSO's SYSTEM.batch_clm_svc_detail table for the service that posted for Client A.
  4. Create an SQL Query PM's SYSTEM.billing_tx_history for the service that posted for Client A.
  5. Open ‘Client Merge’.
  6. Select Client A as the ‘Source Client’.
  7. Select Client B as the ‘Target Client’.
  8. Select ‘Yes’ in Merge All Client Data Through Single Filling.
  9. Click [File].
  10. Click [Yes].
  11. Click [OK].
  12. Close the form.
  13. Create an SQL Query PM's SYSTEM.billing_tx_history and note the changes in PATID and JOIN_TO_TX_HISTORY.
  14. Create an SQL Query MSO's SYSTEM.batch_clm_svc_detail table for the same CLAIMID and check that PATID and parent_nspace_link_to_DD should match.
  15. Compare the values of the two tables to validate that they match after the merge.
Topics
• Client Merge