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Avatar PM 2023 Update 148

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2022 Update 153
Avatar PM 2023 Monthly Release 2023.03.00
RADplus 2023 Monthly Release 2023.03.00

Product Update Description

The functionality that is enabled using the 'Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19)' registry setting is modified to not add "XX" if the value found in 'Claim Note Text (837P-2300-NTE-02)' or 'HCFA-1500 Form Locator 19' is "9999999999".

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Registry Setting - Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19)'.
When the registry setting is enabled, the functionality has been modified to no include 'XX' in the '837P-2300-NTE-02' field, or the 'HCFA-1500 Form Locator 19' field when the value of '9999999999' exists in the 'Practitioner Numbers By Guarantor and Program' form. KB0075230 v0.01
Topics
• 837 Professional • NX • Print Bill
 
Acceptance Tests
AV-91995 Summary | Details
Registry Setting - Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19)'.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission
  • Client Charge Input
  • Create Interim Billing Batch File
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
  • Practitioner Numbers By Guarantor And Program
  • Print Bill
  • Registry Settings (PM)
Scenario 1: Registry Setting - Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = Y
Specific Setup:
  • Registry Setting:
  • Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Enable New Practitioner Numbers By Guarantor and Program Form = ‘Y’.
  • Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Specify Additional Fields To Show = ‘2’, at a minimum.
  • Avatar PM->Billing->Electronic Billing->837 Professional->->Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = ‘Y’.
  • Client A: Identify an active client that can be billed using 837 Professional or HCFA-1500 billing.
  • Note the client’s program.
  • Validate that there is an active Diagnosis record.
  • Validate that there is an active Financial Eligibility record, noting the guarantor(s). Note the Financial Class(es).
  • Guarantor/Program Billing Defaults:
  • Paper CMS 1500 section: Enter any value in ‘Form Locator 19 text’. Note the value.
  • 837 Professional section:
  • Select desired value in ‘Claim Note Reference Code (837P-2300-NTE-01)’.
  • Enter desired value on ‘Claim Note Text (837P-2300-NTE-02)’.
  • Select 'Participating Provider Information for AHCCCS Billing' in 'Claim Note Text (837P-2300-NTE-02) Alternate Value'.
  • Set ‘Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ to ‘1’.
  • Practitioner Enrollment: Identify a minimum of two practitioners that will be used for billing services.
  • Practitioner Numbers By Guarantor and Program:
  • For one of the practitioners selected above, select the clients’ program and guarantors, and edit the existing record to add a unique value to the 'HCFA-1500 Form Locator 19' field and the ‘Claim Note Text (837P-2300-NTE-02)’ field.
  • For the other practitioner, add '9999999999' to the 'HCFA-1500 Form Locator 19' field and the ‘Claim Note Text (837P-2300-NTE-02)’ field.
  • Client Charge Input: Create a charge for the client and one of the practitioners. Note the date.
  • Create Interim Billing Batch File is used to create a batch for the service.
  • Close Charges is used to close the charges.
  • Client Charge Input: Create a charge for the other practitioner. Note the date.
  • Create Interim Billing Batch File is used to create a batch for the service.
  • Close Charges is used to close the charges.
Steps
  1. Open ‘Print Bill’.
  2. Enter the last date of service in ‘Print Charges Thru’.
  3. Select ‘No’ in ‘Create Claims Y/N’.
  4. Select ‘HCFA-1500-NPI Version (Sort By Practitioner) in ‘Print On What Form’.
  5. Select ‘Yes’ in ‘Print For Interim Batch’.
  6. Select the ‘Interim Batch Number’ for the practitioner that has '9999999999' to the 'HCFA-1500 Form Locator 19' field.
  7. Click [Process].
  8. Validate that ‘Form Locator 19’ field contains '9999999999' in the 'HCFA-1500 Form Locator 19' field.
  9. Close the report.
  10. Close the form.
  11. Repeat steps 1 - 8 for the other interim batch.
  12. Validate that ‘Form Locator 19’ field contains 'XX' before the unique value to the 'HCFA-1500 Form Locator 19' field
  13. Close the report.
  14. Close the form.
  15. Open ‘Electronic Billing’.
  16. Select ‘837-Professional’ in ‘Billing Form’.
  17. Select the desired ‘Financial Class’ in ‘Type Of Bill’.
  18. Select ‘Individual’ in ‘Individual Or All Guarantors’.
  19. Select the desired ‘Guarantor’.
  20. Select desired value in ‘Billing Type’.
  21. Select ‘Sort File’ in ‘Billing Options’.
  22. Enter desired ‘File Description’.
  23. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
  24. Select the ‘Interim Billing Batch Number’ for the practitioner that has '9999999999' in the ‘Claim Note Text (837P-2300-NTE-02)’ field.
  25. Select ‘No’ in ‘Create Claims’.
  26. Enter the ‘First Date Of Service To Include’.
  27. Enter the ‘Last Date Of Service To Include’.
  28. Select ‘All’ in ‘Include Primary and/or Secondary Billing’.
  29. Click [Process].
  30. Click [OK] on ‘Compile Complete’ message.
  31. Select ‘Dump File’ in ‘Billing Options’.
  32. Select ‘Print’ in ‘Select ‘Dump File’ in ‘Billing Options’.
  33. Select the ‘File’, which contains the ‘File Description’ added above.
  34. Click [Process].
  35. Validate that the NTE segment contains '9999999999' before the practitioner name.
  36. Close the report.
  37. Repeat steps 16-34 for the other interim batch.
  38. Validate that the NTE segment contains 'XX' before the unique value and the practitioner name.
  39. Close the report.
  40. Close the form.
Scenario 2: Registry Setting - Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = N
Specific Setup:
  • Registry Setting:
  • Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Enable New Practitioner Numbers By Guarantor and Program Form = ‘Y’.
  • Avatar PM->System Maintenance->System Definition->Practitioner Numbers->->Specify Additional Fields To Show = ‘2’, at a minimum.
  • Avatar PM->Billing->Electronic Billing->837 Professional->->Define Alternate Values for 837P-2300-NTE-02 (HCFA-1500 Form Locator 19) = ‘N’.
  • Client A: Identify an active client that can be billed using 837 Professional or HCFA-1500 billing.
  • Note the client’s program.
  • Validate that there is an active Diagnosis record.
  • Validate that there is an active Financial Eligibility record, noting the guarantor(s). Note the Financial Class(es).
  • Guarantor/Program Billing Defaults:
  • Paper CMS 1500 section: Enter any value in ‘Form Locator 19 text’. Note the value.
  • 837 Professional section: Select desired value in ‘Claim Note Reference Code (837P-2300-NTE-01)’. Enter desired value on ‘Claim Note Text (837P-2300-NTE-02)’. Set ‘Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ to ‘1’.
  • Practitioner Enrollment: Identify a minimum of two practitioners that will be used for billing services.
  • Practitioner Numbers By Guarantor and Program:
  • For the practitioners selected above, select the clients’ program and guarantors, and edit the existing record to add unique values to the 'HCFA-1500 Form Locator 19' field and the ‘Claim Note Text (837P-2300-NTE-02)’ field.
  • Client Charge Input: Create a charge for the client and one of the practitioners. Note the date.
  • Create Interim Billing Batch File is used to create a batch for the service.
  • Close Charges is used to close the charges.
  • Client Charge Input: Create a charge for the other practitioner. Note the date.
  • Create Interim Billing Batch File is used to create a batch for the service.
  • Close Charges is used to close the charges.
Steps
  1. Open ‘Print Bill’.
  2. Enter the last date of service in ‘Print Charges Thru’.
  3. Select ‘No’ in ‘Create Claims Y/N’.
  4. Select ‘HCFA-1500-NPI Version (Sort By Practitioner) in ‘Print On What Form’.
  5. Select ‘Yes’ in ‘Print For Interim Batch’.
  6. Select desired ‘Interim Batch Number’.
  7. Click [Process].
  8. Validate that ‘Form Locator 19’ field contains the value added to ‘Practitioner Numbers By Guarantor and Program’ during setup for the service practitioner.
  9. Close the report.
  10. Close the form.
  11. Repeat steps 1-9 for the other interim batch.
  12. Open ‘Electronic Billing’.
  13. Select ‘837-Professional’ in ‘Billing Form’.
  14. Select the desired ‘Financial Class’ in ‘Type Of Bill’.
  15. Select ‘Individual’ in ‘Individual Or All Guarantors’.
  16. Select the desired ‘Guarantor’.
  17. Select desired value in ‘Billing Type’.
  18. Select ‘Sort File’ in ‘Billing Options’.
  19. Enter desired ‘File Description’.
  20. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
  21. Select ‘desired ‘Interim Billing Batch Number’.
  22. Select ‘No’ in ‘Create Claims’.
  23. Enter the ‘First Date Of Service To Include’.
  24. Enter the ‘Last Date Of Service To Include’.
  25. Select ‘All’ in ‘Include Primary and/or Secondary Billing’.
  26. Click [Process].
  27. Click [OK] on ‘Compile Complete’ message.
  28. Select ‘Dump File’ in ‘Billing Options’.
  29. Select ‘Print’ in ‘Select ‘Dump File’ in ‘Billing Options’.
  30. Select the ‘File’, which contains the ‘File Description’ added above.
  31. Click [Process].
  32. Validate that the NTE segment contains the values added to ‘Claim Note Reference Code (837P-2300-NTE-01)’ in ‘Practitioner Numbers By Guarantor and Program’.
  33. Close the report.
  34. Repeat steps 12- 33 for the other interim batch.
Topics
• 837 Professional • NX • Print Bill