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Avatar PM 2023 Update 139

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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

An issue is resolved where 837 Dental may not respect the 'Use Billing Guarantor to determine Provider Accept Assignment Code (2300-CLM-07)' registry setting.

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, 119, 120, 125, 129, 130, 135

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Electronic Billing - 837 Dental Bill
Resolves an issue to ensure that the 837 Dental process respects the value selected for the 'Use Billing Guarantor to determine Provider Accept Assignment Code (2300-CLM-07)' registry setting and the 2300-CLM-07 segment on the bill displays correct value. KB0074638 v0.01
Topics
• 837 Dental • 837 Institutional • NX
 
Acceptance Tests
AV-88760 Summary | Details
Electronic Billing - 837 Dental Bill
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
  • Electronic Billing
  • Financial Eligibility
  • Registry Settings (PM)
  • Admission
Scenario 1: 837 Dental Bill - Validating the 'Provider Accept Assignment Code' on the bill – Registry setting 'Use Billing Guarantor to determine Provider Accept Assignment Code (2300-CLM-07)' = Y
Specific Setup:
  • Registry Setting:
  • Set the 'Use Billing Guarantor To Determine Provider Accept Assignment Code (2300-CLM-07)' registry setting to 'Y'.
  • Guarantors/Payors:
  • Two existing Medicare guarantors are identified to be used. Note the guarantors code/name.
  • Service codes:
  • An existing dental service code is identified to be used. Note the service code/description.
  • The 'Is This A Dental Service' is set to 'Yes'.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing client is identified, or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • The guarantors identified in the 'Guarantors/Payors' form are assigned to the client as a primary and secondary guarantor.
  • Set subscriber assignment of benefits to 'No' for the primary guarantor but 'Yes' to the secondary guarantor.
  • Client Charge Input:
  • A dental service is rendered to the client. Note service date, service code.
  • Client Ledger:
  • A service distributed correctly to the primary guarantor.
Steps
  1. Open the 'Electronic Billing' form.
  2. Select the 'All Clients' in the 'Select All Clients Or Interim Batch' field.
  3. Populate all the required fields.
  4. Compile the bill for the primary guarantor.
  5. Verify the bill compiles successfully.
  6. Dump the file.
  7. Review the dump file.
  8. Verify the Provider Accept Assignment Code (2300-CLM-07) will be set to 'C' because the registry setting is set to 'Y' and the 'Subscriber Assignment of Benefits' to 'No'.
  9. Close the file.
  10. Close the form.
  11. Open the 'Financial Eligibility' form.
  12. Set the 'Subscriber Assignment of Benefits' to 'Yes' for the primary guarantor.
  13. Submit the form.
  14. Open the 'Electronic Billing' form.
  15. Select the 'All Clients' in the 'Select All Clients Or Interim Batch' field.
  16. Populate all the required fields.
  17. Compile the bill for the primary guarantor.
  18. Verify the bill compiles successfully.
  19. Dump the file.
  20. Review the dump file.
  21. Verify the Provider Accept Assignment Code (2300-CLM-07) will be set to 'A' because the registry setting is set to 'Y' and 'Subscriber Assignment of Benefits' field for the guarantor being billed is set to 'Yes'.
  22. Close the file.
  23. Close the form.
Scenario 2: 837 Professional Bill - Validating the 'Provider Accept Assignment Code' on the bill – Registry setting 'Use Billing Guarantor to determine Provider Accept Assignment Code (2300-CLM-07)' = Y
Specific Setup:
  • Registry Setting:
  • Set the 'Use Billing Guarantor To Determine Provider Accept Assignment Code (2300-CLM-07)' registry setting to 'Y'.
  • Guarantors/Payors:
  • An existing Medicare guarantor and a non-Medicare guarantor are identified to be used. Note the guarantors code/name.
  • Both the guarantors are configured for 837 professional bills.
  • Service codes:
  • An existing professional service code is identified to be used. Note the service code/description.
  • The 'Does This Code Have A Professional Component' is set to 'Yes'.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing client is identified with a professional service, or a new client is admitted in to the outpatient program which is selected in the Guarantor/Program Billing Defaults. Note client id, admission program, admission date.
  • Guarantor/Program Billing Defaults:
  • An existing template is identified, and the template is assigned to the guarantors identified above and at least to the admission program of the client. Note the program selection.
  • Financial Eligibility:
  • The guarantors identified in the 'Guarantors/Payors' form are assigned to the client as a primary and secondary guarantor.
  • The 'Subscriber Assignment of Benefits is set to 'Yes' for the primary Medicare guarantor.
  • The 'Subscriber Assignment of Benefits is set to 'No' for the secondary guarantors.
  • Client Charge Input:
  • A professional service is rendered to the client. Note service date, service code.
  • Client Ledger:
  • A service distributed correctly to the primary guarantor.
Steps
  1. Open the 'Electronic Billing' form.
  2. Select the 'All Clients' in the 'Select All Clients Or Interim Batch' field.
  3. Populate all the required fields.
  4. Compile the bill for the primary medicare guarantor.
  5. Verify the bill compiles successfully.
  6. Dump the file.
  7. Review the dump file.
  8. Verify the Provider Accept Assignment Code (2300-CLM-07) will be set to 'A' because the registry setting is set to 'Y' and the 'Subscriber Assignment of Benefits' field for the guarantor being billed is set to 'Yes'.
  9. Close the file.
  10. Close the form.
  11. Open the 'Financial Eligibility' form.
  12. Set the 'Subscriber Assignment of Benefits' to 'No' for the Medicare guarantor.
  13. Set the 'Subscriber Assignment of Benefits' to 'Yes' for the secondary guarantor which is not the billing guarantor.
  14. Submit the form.
  15. Open the 'Electronic Billing' form.
  16. Select the 'All Clients' in the 'Select All Clients Or Interim Batch' field.
  17. Populate all the required fields.
  18. Compile the bill for the primary guarantor.
  19. Verify the bill compiles successfully.
  20. Dump the file.
  21. Review the dump file.
  22. Verify the Provider Accept Assignment Code (2300-CLM-07) will be set to 'C' because the registry setting is set to 'Y' and 'Subscriber Assignment of Benefits' field for the guarantor being billed is set to 'No'.
  23. Close the file.
  24. Close the form.
  25. Open the 'Financial Eligibility' form.
  26. Set the 'Subscriber Assignment of Benefits' to 'Yes' for the Medicare guarantor.
  27. Verify the 'Subscriber Assignment of Benefits' to 'Yes' for the secondary guarantor which is not the billing guarantor.
  28. Submit the form.
  29. Open the 'Electronic Billing' form.
  30. Select the 'All Clients' in the 'Select All Clients Or Interim Batch' field.
  31. Populate all the required fields.
  32. Compile the bill for the primary guarantor.
  33. Verify the bill compiles successfully.
  34. Dump the file.
  35. Review the dump file.
  36. Verify the Provider Accept Assignment Code (2300-CLM-07) will be set to 'A' because the registry setting is set to 'Y' and 'Subscriber Assignment of Benefits' field for the guarantor being billed is set to 'Yes'.
  37. Close the file.
  38. Close the form.
  39. Open the 'Financial Eligibility' form.
  40. Set the 'Subscriber Assignment of Benefits' to 'No' for the Medicare guarantor.
  41. Set the 'Subscriber Assignment of Benefits' to 'No' for the secondary guarantor.
  42. Submit the form.
  43. Open the 'Electronic Billing' form.
  44. Select the 'All Clients' in the 'Select All Clients Or Interim Batch' field.
  45. Populate all the required fields.
  46. Compile the bill for the primary guarantor.
  47. Verify the bill compiles successfully.
  48. Dump the file.
  49. Review the dump file.
  50. Verify the Provider Accept Assignment Code (2300-CLM-07) will be set to 'C' because the registry setting is set to 'Y' and 'Subscriber Assignment of Benefits' field for the guarantor being billed is set to 'No'.
  51. Close the file.
  52. Close the form.
Scenario 3: 837 Institutional Bill - Validating the 'Provider Accept Assignment Code' on the bill – Registry setting 'Use Billing Guarantor to determine Provider Accept Assignment Code (2300-CLM-07)' = Y
Specific Setup:
  • Registry Setting:
  • Set the 'Use Billing Guarantor To Determine Provider Accept Assignment Code (2300-CLM-07)' registry setting to 'Y'.
  • Guarantors/Payors:
  • An existing Medicare guarantor and a non-Medicare guarantor are identified to be used. Note the guarantor's code/name.
  • Both the guarantors are configured for 837 professional bills.
  • Service codes:
  • An existing inpatient service code is identified to be used. Note the service code/description.
  • The 'Does This Code Have A Professional Component' is set to 'Yes'.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing inpatient client is identified with an inpatient service, or a new client is admitted into the inpatient program. Note client id, admission program, admission date.
  • Guarantor/Program Billing Defaults:
  • An existing template is identified, and the template is assigned to the guarantors identified above and to the admission program of the client. Note the program selection.
  • Financial Eligibility:
  • The Medicare guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary and Non Medicare guarantor is assigned to the client as a secondary guarantor.
  • The 'Subscriber Assignment of Benefits is set to 'Yes' for the primary Medicare guarantor.
  • The 'Subscriber Assignment of Benefits is set to 'No' for the secondary guarantors.
  • Client Charge Input:
  • An inpatient service is rendered to the client. Note service date, service code.
  • Client Ledger:
  • A service distributed correctly to the primary guarantor.
Steps
  1. Open the 'Electronic Billing' form.
  2. Select the 'All Clients' in the 'Select All Clients Or Interim Batch' field.
  3. Populate all the required fields.
  4. Compile the bill for the primary Medicare guarantor.
  5. Verify the bill compiles successfully.
  6. Dump the file.
  7. Review the dump file.
  8. Verify the Provider Accept Assignment Code (2300-CLM-07) will be set to 'A' because the registry setting is set to 'Y' and the 'Subscriber Assignment of Benefits' field for the guarantor being billed is set to 'Yes'.
  9. Close the file.
  10. Close the form.
  11. Open the 'Financial Eligibility' form.
  12. Set the 'Subscriber Assignment of Benefits' to 'No' for the Medicare guarantor.
  13. Set the 'Subscriber Assignment of Benefits' to 'Yes' for the secondary guarantor which is not the billing guarantor.
  14. Submit the form.
  15. Open the 'Electronic Billing' form.
  16. Select the 'All Clients' in the 'Select All Clients Or Interim Batch' field.
  17. Populate all the required fields.
  18. Compile the bill for the primary guarantor.
  19. Verify the bill compiles successfully.
  20. Dump the file.
  21. Review the dump file.
  22. Verify the Provider Accept Assignment Code (2300-CLM-07) will be set to 'C' because the registry setting is set to 'Y' and 'Subscriber Assignment of Benefits' field for the guarantor being billed is set to 'No'.
  23. Close the file.
  24. Close the form.
  25. Open the 'Financial Eligibility' form.
  26. Set the 'Subscriber Assignment of Benefits' to 'Yes' for the Medicare guarantor.
  27. Verify the 'Subscriber Assignment of Benefits' to 'Yes' for the secondary guarantor which is not the billing guarantor.
  28. Submit the form.
  29. Open the 'Electronic Billing' form.
  30. Select the 'All Clients' in the 'Select All Clients Or Interim Batch' field.
  31. Populate all the required fields.
  32. Compile the bill for the primary guarantor.
  33. Verify the bill compiles successfully.
  34. Dump the file.
  35. Review the dump file.
  36. Verify the Provider Accept Assignment Code (2300-CLM-07) will be set to 'A' because the registry setting is set to 'Y' and 'Subscriber Assignment of Benefits' field for the guarantor being billed is set to 'Yes'.
  37. Close the file.
  38. Close the form.
  39. Open the 'Financial Eligibility' form.
  40. Set the 'Subscriber Assignment of Benefits' to 'No' for the Medicare guarantor.
  41. Set the 'Subscriber Assignment of Benefits' to 'No' for the secondary guarantor.
  42. Submit the form.
  43. Open the 'Electronic Billing' form.
  44. Select the 'All Clients' in the 'Select All Clients Or Interim Batch' field.
  45. Populate all the required fields.
  46. Compile the bill for the primary guarantor.
  47. Verify the bill compiles successfully.
  48. Dump the file.
  49. Review the dump file.
  50. Verify the Provider Accept Assignment Code (2300-CLM-07) will be set to 'C' because the registry setting is set to 'Y' and 'Subscriber Assignment of Benefits' field for the guarantor being billed is set to 'No'.
  51. Close the file.
  52. Close the form.
Topics
• 837 Dental • 837 Institutional • NX