Avatar PM 2023 Update 184

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2023 Monthly Release 2023.04.00
RADplus 2023 Monthly Release 2023.04.00

Product Update Description

The selection "Yes, but exclude SSN" is added to the 'Include Race/Ethnicity/SSN in 2300-K3' fields in 'Guarantor/Program Billing Defaults' (837 Professional) and 'Guarantor/Program Billing Defaults' (837 Institutional).

Required Updates

None

Included Updates

6, 7, 10, 11, 16, 17, 18, 21, 25, 29, 31, 32, 33, 34, 35, 39, 41, 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, 156, 157, 159, 161, 163, 164, 170, 172, 177, 178, 179, 180, 182, 183

Details

NEW1 CHANGED0 FIXED0

New (1)

AV-93109 Details \| User Acceptance Tests 837 Electronic Billing - 2300-K3 segment A new option, "Yes, but exclude SSN", is added to the 'Include Race/Ethnicity/SSN in 2300-K3' field in the 837 Professional & 837 Institutional sections of the 'Guarantor/Program Billing Defaults' form. Value Added: Allows additional reporting options in the 837 2300-K3 segment.	Topics • 837 Institutional • 837 Professional • NX

Acceptance Tests

AV-93109 Summary | Details

837 Electronic Billing - 2300-K3 segment

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
Dictionary Update (PM)
Electronic Billing
Financial Eligibility
Guarantors/Payors
Practitioner Numbers By Guarantor And Program
Registry Settings (PM)
Service Codes
Service Fee/Cross Reference Maintenance
Admission (Outpatient)

Scenario 1: 837 Institutional - Report Only Guarantor - Validate (2010BA-REF) and (2300-K3) segments

Specific Setup:

Registry Settings:
Avatar PM->Billing->Electronic Billing->837 Report Only->->Include Subscriber Secondary ID Info (2010BA-REF) has a value of ‘Y’.
Dictionary Update:
Other Tabled Files:
‘(12125) Specify Information To Include Subscriber Secondary ID Information (2010BA-REF) – Report Only’ has values of ‘Client Social Security Number’ and ‘Client Social Security Number (No Dashes, Only When Subscriber Equals Self)’.
Client: Dictionary:
‘(350) State Reporting Ethnic Origin’ has desired values.
‘(8) Ethnic Origin’ has extended dictionary values in ‘(350) State Reporting Ethnic Origin’.
‘(351) State Reporting Client Race’ has desired values.
‘(116) Client Race’ has extended dictionary values in ‘(351) State Reporting Client Race’.
‘(247) Client's Relationship To Subscriber’ has extended dictionary value for the ‘Billing Patient's Relationship To Insured’.
Guarantors/Payors 1:
Has a value of ‘No’ or a null value in ‘Is This A Report Only Guarantor’, in the ‘837’ section.
Note the Financial Class.
Guarantors/Payors 2:
Has the same Financial Class as Guarantors/Payors 1.
Has a value of ‘Yes’ in ‘Is This A Report Only Guarantor’, in the ‘837’ section.
Has a value of Guarantors/Payors 1 in 'Only Include Services In The Report Only 837 If Liability For The Service Distributes To The Following Guarantor(s)', in the ‘837’ section.
Client 1:
Client is the subscriber and has values in ‘Race’, ‘Ethnicity’, and ‘Social Security Number’.
Note the client ID, admission date, and program.
Client is assigned Guarantors/Payors 1 in Financial Eligibility.
Client 2:
Client is not the subscriber and has values in ‘Race’, ‘Ethnicity’, and ‘Social Security Number’.
Note the client ID, admission date, and program.
Client is assigned Guarantors/Payors 1 in Financial Eligibility. The client is not ‘Self’ in ‘Client’s Relationship To Subscriber’. The ‘Subscriber’s Name’ and ‘‘Subscriber’s Social Security #’ contain values.
Guarantor/Program Billing Defaults:
Select templates for the selected guarantor(s) and the client program(s).
837 Institutional section:
Select desired value in ‘Specify Information To Include In Subscriber Secondary ID Information (2010BA-REF) - Report Only’ noting the value.
Select desired value in ‘Include Race/Ethnicity/SSN in 2300-K3’, noting the value.
Service Codes:
Service Code must have a value of ‘Yes’ in ‘Include This Service For Report Only Guarantors’. Note the selected service codes.
Services:
Create services for the clients, noting the date of service.
Close Charges for the clients.

Steps

Open ‘Electronic Billing’.
Create an 837 Institutional for Guarantors/Payors 2.
Review the dump file to validate that the following:
If the billing template selection for ‘Specify Information To Include In Subscriber Secondary ID Information (2010BA-REF) - Report Only’ is 'Client Social Security Number’ the output in the REF segment will contain the following: ‘REF*SY*xxx-xx-xxxx, which represents the SSN with dashes. This segment will exist for Client 1 and Client 2.
If the billing template selection for ‘Specify Information To Include In Subscriber Secondary ID Information (2010BA-REF) - Report Only’ is '‘Client Social Security Number (No Dashes, Only When Subscriber Equals Self)’ the output in the REF for Client 1 will contain the following: ‘REF*SY*xxxxxxxxx, which represents the SSN with no dashes. There will not be a ‘REF*SY* segment for Client 2.
If the billing template selection for ‘Include Race/Ethnicity/SSN in 2300-K3’ is ‘No’, there will be no ‘K3’ segment.
If the billing template selection for ‘Include Race/Ethnicity/SSN in 2300-K3’ is ‘Yes’ the ‘K3’ will include the following, if it exists for the client:
Field 1 = the dictionary codes for ‘Ethnicity’.
Field 2 = the dictionary codes for ‘Race’.
Field 3 = the ‘Social Security Number’ of the client, when the client is not the subscriber. No ‘Social Security Number’ is output when the subscriber is the client.
If the billing template selection for ‘Include Race/Ethnicity/SSN in 2300-K3’ is ‘Yes, but exclude SSN' will include the following, if it exists for the client:
Field 1 = the dictionary codes for ‘Ethnicity’.
Field 2 = the dictionary codes for ‘Race’.
Close the dump file.
Close the form.

Scenario 2: 837 Professional - Report Only Guarantor - Validate (2010BA-REF) and (2300-K3) segments

Specific Setup:

Registry Settings:
Avatar PM->Billing->Electronic Billing->837 Report Only->->Include Subscriber Secondary ID Info (2010BA-REF) has a value of ‘Y’.
Dictionary Update:
Other Tabled Files:
‘(12125) Specify Information To Include Subscriber Secondary ID Information (2010BA-REF) – Report Only’ has values of ‘Client Social Security Number’ and ‘Client Social Security Number (No Dashes, Only When Subscriber Equals Self)’.
Client: Dictionary:
‘(350) State Reporting Ethnic Origin’ has desired values.
‘(8) Ethnic Origin’ has extended dictionary values in ‘(350) State Reporting Ethnic Origin’.
‘(351) State Reporting Client Race’ has desired values.
‘(116) Client Race’ has extended dictionary values in ‘(351) State Reporting Client Race’.
‘(247) Client's Relationship To Subscriber’ has extended dictionary value for the ‘Billing Patient's Relationship To Insured’.
Guarantors/Payors 1:
Has a value of ‘No’ or a null value in ‘Is This A Report Only Guarantor’, in the ‘837’ section.
Note the Financial Class.
Guarantors/Payors 2:
Has the same Financial Class as Guarantors/Payors 1.
Has a value of ‘Yes’ in ‘Is This A Report Only Guarantor’, in the ‘837’ section.
Has a value of Guarantors/Payors 1 in 'Only Include Services In The Report Only 837 If Liability For The Service Distributes To The Following Guarantor(s)', in the ‘837’ section.
Client 1:
Client is the subscriber and has values in ‘Race’, ‘Ethnicity’, and ‘Social Security Number’.
Note the client ID, admission date, and program.
Client is assigned Guarantors/Payors 1 in Financial Eligibility.
Client 2:
Client is not the subscriber and has values in ‘Race’, ‘Ethnicity’, and ‘Social Security Number’.
Note the client ID, admission date, and program.
Client is assigned Guarantors/Payors 1 in Financial Eligibility. The client is not ‘Self’ in ‘Client’s Relationship To Subscriber’. The ‘Subscriber’s Name’ and ‘‘Subscriber’s Social Security #’ contain values.
Guarantor/Program Billing Defaults:
Select templates for the selected guarantor(s) and the client program(s).
837 Professional section:
Select desired value in ‘Specify Information To Include In Subscriber Secondary ID Information (2010BA-REF) - Report Only’ noting the value.
Select desired value in ‘Include Race/Ethnicity/SSN in 2300-K3’, noting the value.
Service Codes:
Service Code must have a value of ‘Yes’ in ‘Include This Service For Report Only Guarantors’. Note the selected service codes.
Services:
Create services for the clients, noting the date of service.
Close Charges for the clients.

Steps

Open ‘Electronic Billing’.
Create an 837 Professional for Guarantors/Payors 2.
Review the dump file to validate that the following:
If the billing template selection for ‘Specify Information To Include In Subscriber Secondary ID Information (2010BA-REF) - Report Only’ is 'Client Social Security Number’ the output in the REF segment will contain the following: ‘REF*SY*xxx-xx-xxxx, which represents the SSN with dashes. This segment will exist for Client 1 and Client 2.
If the billing template selection for ‘Specify Information To Include In Subscriber Secondary ID Information (2010BA-REF) - Report Only’ is '‘Client Social Security Number (No Dashes, Only When Subscriber Equals Self)’ the output in the REF for Client 1 will contain the following: ‘REF*SY*xxxxxxxxx, which represents the SSN with no dashes. There will not be a ‘REF*SY* segment for Client 2.
If the billing template selection for ‘Include Race/Ethnicity/SSN in 2300-K3’ is ‘No’, there will be no ‘K3’ segment.
If the billing template selection for ‘Include Race/Ethnicity/SSN in 2300-K3’ is ‘Yes’ the ‘K3’ will include the following, if it exists for the client:
Field 1 = the dictionary codes for ‘Ethnicity’.
Field 2 = the dictionary codes for ‘Race’.
Field 3 = the ‘Social Security Number’ of the client, when the client is not the subscriber. No ‘Social Security Number’ is output when the subscriber is the client.
If the billing template selection for ‘Include Race/Ethnicity/SSN in 2300-K3’ is ‘Yes, but exclude SSN' will include the following, if it exists for the client:
Field 1 = the dictionary codes for ‘Ethnicity’.
Field 2 = the dictionary codes for ‘Race’.
Close the dump file.
Close the form.

Topics

• 837 Institutional • 837 Professional • NX