Avatar PM 2023 Update 170

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Product Requirements and Recommendations

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RADplus required

Recommended Update Level

Avatar PM 2023 Monthly Release 2023.03.02
RADplus 2023 Monthly Release 2023.03.02

Product Update Description

The 'Start Date' and 'End Date' fields are added to the 'Modifiers by Practitioner Category' form.

Required Updates

None

Included Updates

7, 10, 11, 16, 17, 18, 21, 25, 29, 31, 32, 33, 34, 35, 39, 44, 48, 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, 106, 109, 110, 115, 116, 119, 120, 121, 122, 125, 128, 129, 130, 133, 134, 135, 136, 139, 140, 143, 149, 153, 154, 157, 159, 163

Details

NEW1 CHANGED0 FIXED0

New (1)

AV-93123 Details | User Acceptance Tests

Modifiers By Practitioner Category

The 'Modifiers By Practitioner Category' form has been enhanced by adding the following features: Fields ‘Start Date’ and ‘End Date’, new event logic for the ‘Duplicate Services Modifier’ field, and File Import capability for the ‘Modifiers By Practitioner Category’ form.

The following fields are added to the following table: t'SYSTEM.table_hcfa_1500_modifier': 'start_date' and 'end_date'.

Value Added: Modifiers By Practitioner Category form and it's related features are enhanced.

Topics

• File Import • Modifiers by Practitioner • NX

Acceptance Tests

AV-93123 Summary | Details

Modifiers By Practitioner Category

Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:

Client Charge Input
Client Ledger
Delete Modifiers_Acknowledgement
Electronic Billing
MODIFIERS BY PRACTITIONER CATEGORY
Crystal Report Viewer
File Import

Scenario 1: Modifiers by Practitioner Category - Validation

Specific Setup:

Registry Setting:
Set the 'Enable Duplicate Service Modifiers' registry setting as "Y".
Program Maintenance: Identify two outpatient programs: Program 1 & Program 2.
Guarantors: A, B, C, and D are identified or created.
Client:
An existing client (Client A) is identified or a new one is created and admitted to Program 1 for which the Modifiers are planned to be created during the test.
Diagnosis records are created for the client.
Client A is added with Guarantor B in his Financial Eligibility for whom the modifiers are planned to be created during the test.
Practitioner Categories: Existing Practitioner Categories are identified: Practitioner Category 1 & Practitioner Category 2.
Practitioners:
Existing Practitioners are identified or created with the same Practitioner Category 1 for which the Modifiers are planned to be created during the test: Practitioner A & Practitioner B.
CPT Code:
CPT codes 1 and 2 are identified or newly created.
Service Code:
An existing service code is identified or a new one is created: Service 1.

Steps

Open the 'Modifiers by Practitioner Categories' form.
Validate that the form has the field 'Duplicate Service Modifiers'.
Select 'Guarantor A', 'Guarantor B', and 'Guarantor C' in the 'Guarantor ID'.
Select 'Outpatient' from the 'Treatment Setting Selection' field.
Check the value 'Program 1' from the 'Program' list.
Select the 'CPT Code 1' from the 'CPT Code'.
Select 'Practitioner Category 1' from the 'Practitioner Category' selection list field.
Validate that the 'Modifier' field is marked as required when the 'Duplicate Service Modifiers' field is blank.
Enter any invalid format value into the 'Duplicate Service Modifiers' similar to "Invalid_Test_for_Form".
Verify that an error shows with the text "Invalid Format" with the 'OK' button.
Click [OK].
Enter any desired valid value for 'Duplicate Service Modifiers' similar to "D1,D2".
Verify that the 'Modifier' field is not shown as required when there is already a value entered for 'Duplicate Service Modifiers'.
Enter any desired valid value for 'Modifiers' similar to "M1,M2".
Enter the 'Start Date' and 'End Date' values.
Select [Submit].
Create a query of the SQL table, ''SYSTEM.table_hcfa_1500_modifiers" and validate that the Modifiers filed for the Guarantor(s) are added in the table as individual rows.
For the guarantors, verify that the following columns have the correct values- 'cpt_code', 'modifier', 'duplicate_svc_modifier', 'end_date', 'start_date', 'practitioner_category_code', and 'practitioner_category_value'.
Close the SQL window and return to the NX.
Open the 'Modifiers By Practitioner Category' form.
Verify that there are buttons 'Print Modifiers' and 'Delete Modifiers' in the form.
Select the [Print Modifiers] button.
Verify that the report opens up with the modifier values that exist in the system.
Close the report and return to the 'Modifiers By Practitioner Category' form.
Select 'Guarantor D' in the 'Guarantor ID' field.
Select 'Outpatient' from the 'Treatment Setting Selection' field.
Check 'Program 2' from the 'Program' list.
Select the 'CPT Code 2' from the 'CPT Code'.
Select 'Practitioner Category 2' from the 'Practitioner Category' selection list field.
Enter any desired valid value for 'Modifiers' similar to "M1,M2".
Enter any desired valid value for 'Duplicate Service Modifiers' similar to "D3,D4".
Enter the 'Start Date' and 'End Date' values.
Select [Submit].
Create a query of the SQL table, ''SYSTEM.table_hcfa_1500_modifiers" for the 'Guarantor D' and validate that the Modifiers filed for the 'Guarantor D' are added in the table as individual rows.
Verify that the following columns have the correct values- 'cpt_code', 'modifier', 'duplicate_svc_modifier', 'end_date', 'start_date', 'practitioner_category_code', and 'practitioner_category_value'.
Close the SQL window and return to the NX.
Select the [Print Modifiers] button.
Verify that the report opens up with the modifier values that exist in the system.
Verify that the newly added modifier for 'Guarantor D' is also there in the report text.
Close the report and return to the 'Modifiers By Practitioner Category' form.
Select the [Delete Modifiers] button.
Verify that an error shows up stating that the action 'Delete Modifiers' requires the values selected for the 'Guarantor ID', 'Program', 'CPT Code', and 'Practitioner Category' fields with the [OK] button.
Click [OK].
Select 'Guarantor C' in the 'Guarantor ID' field.
Select 'Outpatient' from the 'Treatment Setting Selection' field.
Check the value 'Program 1' from the 'Program' list.
Select the 'CPT Code 1' from the 'CPT Code'.
Select 'Practitioner Category 1' from the 'Practitioner Category' selection list field.
Verify that the value for 'Modifiers' is populated in the respective field.
Verify that the 'Start Date' and 'End Date' values are populated in the respective fields.
Verify that the value for 'Modifiers' is populated in the respective field.
Click the light bulb in the 'Duplicate Service Modifiers' field.
Verify that the help text shown is as expected.
Select the 'Return To Form' link.
Select the [Print Modifiers] button.
Verify that the report opens up with the selected modifier value.
Close the report and return to the 'Modifiers By Practitioner Category' form.
Select the [Delete Modifiers] button.
Verify that an alert popup shows up stating that the "You Are About To Delete Modifiers. Are You Sure You Want To Continue?" with the [OK] and [Cancel] buttons.
Click [OK].
Verify the success message "Modifiers Deleted".
Click [OK].
Select [Discard].
Select [Yes].
Create a query of the SQL table, ''SYSTEM.table_hcfa_1500_modifiers" for 'Guarantor C'.
Validate that there are no modifier records exist in the table.
Close the SQL window.
Open the 'Client Charge Input' form and create a charge with a date outside the modifier date range as below for the test Client:
Client - 'Client A'.
Date Of Service - Any desired date value similar to "10102023".
Service Code - 'Service 1'.
Practitioner - Practitioner A.
Duration (Minutes) - Any desired value similar to "30".
Select [Submit].
Select [Yes] in the form return dialog.
Create a duplicate charge with the same date and practitioner from Step 71 as below for the test Client:
Client - 'Client A'.
Date Of Service - Same as in Step 68(b).
Service Code - 'Service 1'.
Practitioner - 'Practitioner A'.
Duration (Minutes) - Any desired value similar to "30".
Select [Submit].
Verify that the "Duplicate Service" warning popup shows up saying: "The System Identified A Possible Duplicate Entry, For The Client, For This Charge Entry. If You Continue, You Will Have To Delete Any Duplicates Via 'Delete Service'. Continue With The Filing of This Service?" with [Yes], and [No] buttons.
Select [Yes].
Select [Yes] in the form return dialog.
Create a duplicate charge with the same date from Step 71 and a different practitioner as below for the test Client:
Client - 'Client A'.
Date Of Service - Same as in Step 68(b).
Service Code - 'Service 1'.
Practitioner - 'Practitioner B'
Duration (Minutes) - Any desired value similar to "30".
Select [Submit].
Verify that the "Duplicate Service" warning popup shows up saying "The System Identified A Possible Duplicate Entry, For The Client, For This Charge Entry. If You Continue, You Will Have To Delete Any Duplicates Via 'Delete Service'. Continue With The Filing of This Service?" with [Yes], and [No] buttons.
Select [Yes].
Select [Yes] in the form return dialog.
Create a duplicate charge with the same date and practitioner from Step 79 as below for the test Client:
Client - 'Client A'.
Date Of Service - Same as in Step 68(b).
Service Code - 'Service 1'.
Practitioner - 'Practitioner B'.
Duration (Minutes) - Any desired value similar to "30".
Select [Submit].
Verify that the "Duplicate Service" warning popup shows up stating: "The System Identified A Possible Duplicate Entry, For The Client, For This Charge Entry. If You Continue, You Will Have To Delete Any Duplicates Via 'Delete Service'. Continue With The Filing of This Service?", with [Yes], and [No] buttons.
Select [Yes].
Select [No] in the form return dialog.
Open the 'Client Ledger' form process the report for the test client ('Client A') and verify that the services are opened for the dates.
Close the 'Client Ledger'.
Open the 'Close Charges' form.
Set the 'Thru Date' as today's date.
Select 'Individual' and set the 'Client' as 'Client A'.
Select the Episode and click [Submit].
Open the 'Client Ledger' form and by processing the report for the test client ('Client A') make sure that the services are closed for the dates.
Close the 'Client Ledger'.
Open the 'Electronic Billing' form.
Choose the bill type as "837-Professional" bill, and the financial class as "Blue Cross".
Select 'Individual'.
Select the guarantor as 'Guarantor B'.
Select 'Outpatient' in 'Billing Type'.
Click on 'Sort File ' in the 'Billing Options' radio group.
Enter any desired value for 'File Description'.
Select 'All Clients'.
Select 'Program 1' in the program field.
Select 'No' in Create Claims.
Set the start and end dates.
Select the [Process] button.
Verify the "Compile Complete." shows up on a successful compile.
Click [OK].
Select 'Dump File in the Billing Options radio group.
Select the 'Print' option.
Select the processed file from the File dropdown list.
Select the [Process] button.
Validate that the electronic billing text file has the service(s) and the CPT Code(s) but does not have the modifier that was submitted because the service dates are not within the Modifier date range.
Close the report.
Repeat Steps 68 to 111 with a different service date something similar to "05/20/2023" and all other values as the same.
Validate that the electronic billing text file has the appropriate modifier(s) if the Guarantor, Program, CPT Code, and Practitioner Category match. Also, the service date falls within the modifier's defined date range.
Verify that the duplicate service(s) that has the same practitioner has the Modifier value appended with the duplicate service modifier 1 as shown in the below example,
M1:M2:D1
Verify that the duplicate service(s) that has the different practitioner has the Modifier value appended with the duplicate service modifier 2 as shown in the below example,
M1:M2:D2
Close the report.
Click [No].

Scenario 2: Modifiers by Practitioner Category - File Import

Specific Setup:

Registry Setting:
'Enable Duplicate Service Modifiers' is set to "Y".
Must have the following user files for import:
File A: Contains invalid values for 'Guarantor ID', 'Program', 'CPT Code', 'Practitioner Category', 'Modifier', 'Duplicate Service Modifiers', 'Start Date', and 'End Date'. Note: All the field values other than Start and End dates are mandatory whereas the 'Modifier' field is conditional and only required when there is no 'Duplicate Service Modifiers' value.
File B: Contains valid values for 'Guarantor ID', 'Program', 'CPT Code', 'Practitioner Category', 'Modifier', 'Duplicate Service Modifiers', 'Start Date', and 'End Date'.

Steps

Open 'File Import'.
Select the 'Modifiers By Practitioner Category' file type.
Select the 'Upload New File' action radio button.
Click [Process].
Select File A, where invalid parameters are defined.
Verify that the file is loaded.
Select the 'Compile/Validate File' action radio button.
Select the file from the 'File(s)' dropdown list.
Click [Process].
Verify that an error popup displays with the text: "File 'xxx'.txt contains one or more errors. These errors can be reviewed using 'Print Errors' action.".
Click [OK].
Select the [Print Errors] action button,
Select the file from the 'File(s)' dropdown list.
Click [Process].
Verify that the report displays the errors.
Close the report.
Select the 'Delete' action radio button.
Select the file from the 'File(s)' dropdown list.
Click [Process].
Verify that the alert popup shows up with the confirmation text "Are you sure?".
Click [Yes].
Validate that the success confirmation dialog shows up with the text containing "Deleted.".
Click [OK].
Select the 'Upload New File' action radio button.
Click [Process].
Select File B, where valid parameters are defined.
Verify that the file is loaded.
Select the 'Compile/Validate File' button.
Select the file from the 'File(s)' dropdown list.
Click [Process].
Verify that the file is compiled without any errors and the confirmation text shows as "Compiled.".
Click [OK].
Select the 'Post File' action radio button.
Select the file from the 'File(s)' dropdown list.
Click [Process].
Verify that the file is posted and the success message displays with the text "Posted".
Click [OK].
Create a query of the SQL table, ''SYSTEM".table_hcfa_1500_modifiers, for the 'Guarantor ID' and validate that the Modifiers defined for the Guarantor are added in the table as individual rows.
Verify that the following columns have the correct values- 'cpt_code', 'modifier', 'duplicate_svc_modifier', 'end_date', 'start_date', 'practitioner_category_code', and 'practitioner_category_value'.
Repeat Steps 39-40 for all the Guarantors included in the File B.

Topics

• File Import • Modifiers by Practitioner • NX

Table Changes

Table	Column	Change
SYSTEM.table_hcfa_1500_modifiers	start_date
SYSTEM.table_hcfa_1500_modifiers	end_date