Avatar PM 2023 Update 175

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2023 Monthly Release 2023.03.02
RADplus 2023 Monthly Release 2023.03.02

Product Update Description

An issue is resolved where add-on services in PM would not get deleted with posting codes if the delete originated from MSO.

Required Updates

None

Included Updates

None

Details

NEW0 CHANGED0 FIXED1

Fixed (1)

AV-94362 Details \| User Acceptance Tests Avatar MSO to Parent System Service Filing, Void/Replacement Claims An issue is resolved to ensure that Primary and Add-On services in Avatar PM are deleted with a Charge Payment/Reversal adjustment included if the deletion originated via Avatar MSO 'Replacement' and/or 'Void' claim processing.	Topics • 837 Professional • Delete Service

Acceptance Tests

AV-94362 Summary | Details

Avatar MSO to Parent System Service Filing, Void/Replacement Claims

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

837 Health Care Claim Professional
Client Ledger
Delete Service

Scenario 1: 'Delete Service' - Verification of Charge Reversal Posting for Replacement/Void Claims Including Add-On Services

Specific Setup:

Avatar PM/Cal-PM Registry Setting 'Enable Multiple Add-On Code Per Primary Code Functionality' may optionally be enabled/disabled.
'File Services On Closing Of Batch Or Creation of EOB?' must be set to 'Yes' (via Avatar MSO 'MSO to Parent System Integration Mapping' form 'Service Filing' section)
One or more 'Approved' status 'Void' and/or 'Replacement' claims for Avatar PM/Cal-PM services (with closed charges) originating in Avatar MSO where Primary and Add-On Service are present in original claim.

Steps

Open Avatar MSO 'Close Batch' form.
Select Avatar MSO Claims Processing batch containing one or more 'Approved' status 'Replacement' claim for Primary and Add-On services eligible for filing to parent Avatar PM/Cal-PM system (where original service charges are closed in Avatar PM/Cal-PM):
Note - Retro Claim Adjudication entries from Avatar MSO 'Void' 837 Professional/837 Institutional claims are pushed/filed to Avatar PM/Cal-PM parent system on posting in MSO, as no Avatar MSO Claims Processing Batch is created; Retro Claim Adjudication entries from Avatar MSO 'Replacement' 837 Professional/837 Institutional claims are pushed/filed to Avatar PM/Cal-PM parent system on closing of Claims Processing Batch for Replacement Claims/Services in MSO
Note - Acceptance Testing may also be confirmed via Avatar PM/Cal-PM 'Delete Service' form for Primary services with one or more associated Add-On services associated
Set 'Close Batch' field to 'Yes' (and click 'OK' button to close warning message dialog).
Click 'Submit' button to close batch/file services to parent Avatar PM/Cal-PM system.
Open 'Client Ledger' form in parent Avatar PM/Cal-PM system.
Select 'Client ID' value for client where services are present in Avatar MSO closed status Claims Processing batch.
Select 'Claim/Episode/All Episodes' value.
Select 'Ledger Type' value.
In Client Ledger data - ensure that 'Approved' status original claim services originating in Avatar MSO are present in Avatar PM/Cal-PM system following 'Close Batch' filing (where services are valid for filing to parent system).
In Client Ledger data - ensure that services originating in Avatar MSO where 'Replacement' or 'Void' claim has subsequently been processed in Avatar MSO (resulting in Retro Claim Adjudication service takeback entries) are updated in Avatar PM/Cal-PM parent system as follows:
Original Primary and Add-On services in 'Open' charge status will be deleted in Avatar PM/Cal-PM parent system, and new/replacement services will be filed/present in Avatar PM/Cal-PM system following 'Close Batch' filing (if 'Approved' status and where replacement services are valid for filing to parent system)
Original Primary and Add-On services in 'Closed' and 'Unbilled' charge status (not claimed) will have service deletion reversal code ('DELETE') filed in Avatar PM/Cal-PM parent system, and new/replacement services will be filed/present in Avatar PM/Cal-PM system following 'Close Batch' filing (if 'Approved' status and where replacement services are valid for filing to parent system)
Original Primary and associated Add-On services in 'Closed' and 'Unbilled' charge status (not claimed) will have Charge Payment/Reversal adjustment filed in Avatar PM/Cal-PM parent system for the amount of the original service:
Posting/Adjustment Code as defined via Avatar MSO 'Set System Defaults' form for MSO-originating services; Posting/Adjustment Code as selected if using Avatar PM/Cal-PM 'Delete Service' form

Topics

• 837 Professional • Delete Service