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Avatar PM 2023 Update 183

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Product Requirements and Recommendations

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Avatar PM 2023 Monthly Release 2023.03.02
RADplus 2023 Monthly Release 2023.03.02

Product Update Description

The field 'Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting' is added to the 'Guarantors/Payors' form (835 section). This field will separate the logic for 835 and 'Spreadsheet Batch Remittance Posting'. In addition, the 'Allow Adjustment Reversals' field is renamed to 'Allow Adjustment Reversals For 835 Posting'.

Required Updates

None

Included Updates

6, 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, 74, 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, 170, 172, 180, 182

Details
NEW1 CHANGED0 FIXED0
New (1)
Guarantors/Payors - 835 section.
The 'Allow Adjustment Reversals' field is renamed to 'Allow Adjustment Reversals For 835 Posting'. The field 'Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting' is added to the section.

  1. The 'SYSTEM.billing_guar_table_835' has new fields added: 'allow_adj_rev_sbrp_code' and 'allow_adj_rev_sbrp_value'.

  2. Note: Form Designer may need to be reverted to 'Original Product Copy' for the '835' section of the 'Guarantors/Payors' form

Value Added: The two distinct fields allow clarity for 835 Posting and Spreadsheet Batch Remittance Posting.
Topics
• 835 Health Care Claim Payment/Advice • Guarantor/Payors • Spreadsheet Batch Remittance Posting
 
Acceptance Tests
AV-94295 Summary | Details
Guarantors/Payors - 835 section.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Charge Input
  • Client Ledger
  • Financial Eligibility
  • Guarantors/Payors
  • Practitioner Numbers By Guarantor And Program
  • Remittance Post Confirmation
  • Spreadsheet Batch Remittance Posting
  • 835 Health Care Claim Payment/Advice (PM)
  • Admission (Outpatient)
  • App Dashboard
  • Claim Adjustment Group/Reason Code Definition
  • Crystal Report Viewer
  • Diagnosis
  • Dynamic Form - Form and Table Documentation / File Export - File Name
  • Electronic Billing
  • Performing Provider Association - Error
  • Posting/Adjustment Codes Definition
Scenario 1: Spreadsheet Batch Remittance Posting functionality
Specific Setup:
  • Client A:
  • Select a client with claimed services. A minimum of one service has no balance due. There are other services with a balance due.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
  • Client B:
  • Select a client with claimed services for a non-contract guarantor.
  • '835' section:
  • 'Allow Adjustment Reversals For 835 Posting' = Yes.
  • 'Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting' = No.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
  • Client C:
  • Select a client with claimed services for a contract guarantor. Note the following for the guarantor:
  • 'Contractual Guarantor' section:
  • 'Does This Guarantor Use Contractual Allowance By Batch Or Through Liability Distribution?' = 'Contractual Allowance By Liability Distribution'.
  • The value of 'Contractual Adjustment Code (Credit)
  • The value of 'Contractual Adjustment Code (Debit)
  • The value of 'Contractual Write-Off Code
  • The value of 'Temporary Contractual Adjustment Code (Credit)
  • The value of 'Temporary Contractual Write-Off Code'
  • Enable Modified Contractual Allowance Calculation
  • '835' section:
  • 'Allow Adjustment Reversals For 835 Posting' = No.
  • 'Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting' = Yes.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
Steps
  1. Open 'Spreadsheet Batch Remittance Posting'.
  2. Select "Create Batch" in the 'Create, Edit Or Delete Remittance Batch' field.
  3. Enter a description in the 'Batch Description' field.
  4. Enter a date in the 'Posting Date' field.
  5. Enter a date in the 'Date Of Receipt' field.
  6. Select 'Yes' in 'Include Zero Balance Claims'.
  7. Select 'Yes' in ' 'Include Zero Balance Services'.
  8. Click the "Launch Work Screen" button.
  9. Enter an ID in the "Client" field.
  10. Select an episode for the selected client in the "Ep #" field.
  11. Select a claim number in the "Claim" field.
  12. Select a payor in the "Payor" field.
  13. Select a date in the "Begin Date/Svc Date" field.
  14. Select a date in the "End Date/Svc Code" field.
  15. Verify the "Total Charges" field auto populated when the claim was selected.
  16. Verify the "Liability" field auto populated when the claim was selected.
  17. Verify the "Liability" amount matches the amount noted in the "Client Ledger" report.
  18. Click [+] in the first column of the row.
  19. Validate that the client's services display, noting that the first row shows a summation of the services for the selected guarantor.
  20. Select a service with a balance due and enter an amount in the "Payment Amount" field.
  21. Select a code in the "Payment Code" field.
  22. Click [TAB] key.
  23. Validate the 'Payment Code' field displays the same value selected in the above step.
  24. Enter an amount in the "Adjust Amount" field.
  25. Select a code in the "Adjust Code" field.
  26. Click [TAB] key.
  27. Validate the 'Adjust Code' field displays the same value selected in the above step.
  28. Enter an amount in the "Transfer Amount" field.
  29. Select a code in the "Transfer Code" field.
  30. Click [TAB] key.
  31. Validate the 'Transfer Code' displays the same value selected in the above step.
  32. Select a guarantor in the "Transfer Guar" field.
  33. Verify the "New Balance" field is updated with the balance after all amounts are updated.
  34. Repeat steps 19 - 21 for a service that has no balance due.
  35. Click the "Accept" button.
  36. Click the "Submit" button.
  37. Open 'Client Ledger'.
  38. Select 'All Episodes' in 'Claim/Episode/All Episodes'.
  39. Select ‘Simple’ in ‘Ledger Type’.
  40. Click [Process].
  41. Validate that the payment, adjustments, and transfers are displayed and that the ‘TOTAL BALANCE BY GUARANTOR’ amount is reduced by the appropriate amount.
  42. Close the report.
  43. Close the form.
  44. Repeat above steps for Client B and validate the data.
  45. Repeat above steps for Client C and validate the data.
Scenario 2: Guarantors/Payors - Validate submission of '835' section
Specific Setup:
  • Guarantors/Payors 1 exists. No data has been submitted for the '835 section.
Steps
  1. Open 'Guarantors/Payors'.
  2. Select 'Edit' in 'Add New Or Edit Existing Guarantor'.
  3. Select 'Guarantors/Payors 1' in 'Guarantor Code'.
  4. Set the section to '835'.
  5. Select a value in 'Automated 835 Actions'. Note the selected value.
  6. Select a value in 'Process Transaction Handling Code(s)'. Note the selected value.
  7. Select a value in 'Allow overage adjustments to be posted'. Note the selected value.
  8. Enter up to sixty characters in 'Payor Name (1000A N1-02)'. Note the value entered.
  9. Enter up to forty characters in 'Payee Identification Code (1000B N1-04)'. Note the value entered.
  10. Select a value in 'Allow posting of crossover payment/adjustment prior to payment/adjustment from the original guarantor'. Note the selected value.
  11. Select a value in 'Allow Adjustment Reversals For 835 Posting'. Note the selected value.
  12. Select a value in ''Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting'.
  13. Set the section to 'Guarantors/Payors'.
  14. Click 'File'.
  15. Select 'Edit' in 'Add New Or Edit Existing Guarantor'.
  16. Select 'Guarantors/Payors 1' in 'Guarantor Code'.
  17. Set the section to '835'.
  18. Validate the value in 'Automated 835 Actions'.
  19. Validate the value in 'Process Transaction Handling Code(s)'.
  20. Validate the value in 'Allow overage adjustments to be posted'.
  21. Validate the value in 'Payor Name (1000A N1-02)'.
  22. Validate the value in 'Payee Identification Code (1000B N1-04)'.
  23. Validate the value in 'Allow posting of crossover payment/adjustment prior to payment/adjustment from the original guarantor'.
  24. Validate the value in 'Allow Adjustment Reversals For 835 Posting'.
  25. Validate the value in ''Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting'.
  26. Close the form.
Scenario 3: 835 Health Care Claim Payment/Advice - Allow Adjustment Reversals For 835 Posting
Specific Setup:
  • Client A:
  • Select a client with claimed services. A minimum of one service has no balance due. There are other services with a balance due.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
  • An 835 Health Care Claim Payment/Advice exists for the claims and contains at least one adjustment.
  • Client B:
  • Select a client with claimed services for a non-contract guarantor.
  • '835' section:
  • 'Allow Adjustment Reversals For 835 Posting' = Yes.
  • 'Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting' = No.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
  • An 835 Health Care Claim Payment/Advice exists for the claims and contains at least one adjustment.
  • Client C:
  • Select a client with claimed services for a contract guarantor. Note the following for the guarantor:
  • 'Contractual Guarantor' section:
  • 'Does This Guarantor Use Contractual Allowance By Batch Or Through Liability Distribution?' = 'Contractual Allowance By Liability Distribution'.
  • The value of 'Contractual Adjustment Code (Credit)
  • The value of 'Contractual Adjustment Code (Debit)
  • The value of 'Contractual Write-Off Code
  • The value of 'Temporary Contractual Adjustment Code (Credit)
  • The value of 'Temporary Contractual Write-Off Code'
  • Enable Modified Contractual Allowance Calculation
  • '835' section:
  • 'Allow Adjustment Reversals For 835 Posting' = No.
  • 'Allow Adjustment Reversals For Spreadsheet Batch Remittance Posting' = Yes.
  • Client Ledger is used to note the dates of service and ‘TOTAL BALANCE BY GUARANTOR’.
  • An 835 Health Care Claim Payment/Advice exists for the claims and contains at least one adjustment.
Steps
  1. Open '835 Health Care Claim Payment/Advice'.
  2. Load, compile, and post the file for Client A.
  3. Close the form.
  4. Open 'Client Ledger' for Client A.
  5. Validate that the payments and adjustments have posted correctly to the client's account.
  6. Close the form.
  7. Open '835 Health Care Claim Payment/Advice'.
  8. Load, compile, and post the file for Client B.
  9. Close the form.
  10. Open 'Client Ledger' for Client B.
  11. Validate that the payments and adjustments have posted correctly to the client's account, when the 'Allow Adjustment Reversals For 835 Posting' = Yes.
  12. Close the form.
  13. Open '835 Health Care Claim Payment/Advice'.
  14. Load, compile, and post the file for Client C.
  15. Close the form.
  16. Open 'Client Ledger' for Client C.
  17. Validate that the payments and adjustments have posted correctly to the client's account, when the 'Allow Adjustment Reversals For 835 Posting' = No.
  18. Close the form.
Topics
• 835 Health Care Claim Payment/Advice • Guarantor/Payors • Spreadsheet Batch Remittance Posting
Table Changes
Table Column Change
SYSTEM.billing_guar_table_835 allow_adj_rev_sbrp_code Added
SYSTEM.billing_guar_table_835 allow_adj_rev_sbrp_value Added