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Avatar PM 2023 Update 29

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Product Requirements / Recommendations

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Product Update Form Description

The following issues are resolved: 1) Posting/Adjustment Codes web service will not allow editing of code description. 2) 837 compile report will include errors for services that are not inclusive of the billing date range when the 'Enable Alternative Service Location Fields' registry setting is enabled, and the client has a service with incomplete alternative location data. 3) Value selected in the 'Allow Extended Matching Criteria in 835 Remittance Posting' field on the 'Guarantors/Payors' form (835 section) is not filed in the 'SYSTEM.billing_guar_table_835' table. 4) Managed Care Authorizations with a defined monthly unit limit are not validated properly when scheduling an appointment.

Included Updates

16

Required Updates

None

Details
NEW1 CHANGED0 FIXED3
New (1)
Managed Care Authorizations - Monthly Limitation
The functionality for 'Managed Care Authorizations' has been modified to enforce the monthly limit when scheduling appointments. KB0072503 v0.01
Value Added: Managed Care Authorizations limits are respected in Scheduling Calendar.
Topics
• Managed Care Authorizations • NX
 
Fixed (3)
Web Services - PostingAdjustmentCodes
Resolves an issue to ensure that the Posting/Adjustment web service can update the code definition of the posting code successfully. KB0072501 v0.01
Topics
• Web Services
 
Registry Settings - Enable Alternative Service Location Fields - Electronic billing validation
Resolves an issue to ensure that the electronic bill compiles successfully when one of the service has an incomplete information for alternate service facility location and it is outside of the service rage compiled. KB0072258 v0.01
Topics
• 837 Institutional • 837 Professional • NX
 
Guarantors/Payors - Database Management
The 'SYSTEM.billing_guar_table_835' table has been modified to retain data from the 'Allow Extended Matching Criteria in 835 Remittance Posting' field in the '835' section of the 'Guarantors/Payors' form. KB0072539 v0.01
Topics
• 835 • Guarantor/Payors
 
Acceptance Tests
AV-76398 Summary | Details
Web Services - PostingAdjustmentCodes
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Posting/Adjustment Codes Definition
Scenario 1: 'PostingAdjustmentCodes' Web Service - Verification Of 'AddPostingAdjustmentCodes' and 'UpdatePostingAdjustmentCodes' filing
Specific Setup:
  • Web service testing tool:
  • SoapUI or any other web service testing tool needs to be set up to test this scenario.
Steps
  1. Create a SoapUI project for Avatar PM 'PostingAdjustmentCodes' web service.
  2. Submit a request for 'AddPostingAdjustmentCodes' method to add new posting adjustment code. Note the posting code/definition.
  3. Verify the 'PostingAdjustmentCodes' web service files successfully and responds with confirmation message for 'AddPostingAdjustmentCodes' method. <Message>Posting/Adjustment Codes Input web service has been filed successfully.</Message>.
  4. Verify the 'PostingAdjustmentCodes' web service responds with successful status value on successful filing of 'AddPostingAdjustmentCodes' method. Example: <Status>1</Status>.
  5. Open 'Posting/Adjustment Codes Definition' form.
  6. Verify the newly added posting adjustment code displays correctly with all the values entered through web service.
  7. Note the posting code and code definition.
  8. Navigate to the SoapUI.
  9. Submit a request for 'UpdatePostingAdjustmentCodes' method to update a code definition for the recently added posting adjustment code in above steps.
  10. Enter different code definition for the posting code added above. Note the posting definition.
  11. Verify the 'PostingAdjustmentCodes' web service files successfully and responds with confirmation message for 'UpdatePostingAdjustmentCodes' method. <Message>Posting/Adjustment Codes Input web service has been filed successfully.</Message>
  12. Verify the 'PostingAdjustmentCodes' web service responds with successful status value on successful filing of 'UpdatePostingAdjustmentCodes' method. Example: <Status>1</Status>.
  13. Open 'Posting/Adjustment Codes Definition' form.
  14. Verify the recently updated posting adjustment code displays correct code definition updated through web service.
Topics
• Web Services
AV-78037 Summary | Details
Registry Settings - Enable Alternative Service Location Fields - Electronic billing validation
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • Client Ledger
  • Crystal Report Viewer
  • Electronic Billing
Scenario 1: Registry Settings - Enable Alternative Service Location Fields - Validating electronic billing
Specific Setup:
  • Registry settings:
  • The 'Avatar PM->Billing->Client Charge Input->->->Enable Alternative Service Location Fields' registry setting is enabled. Please note: This is a hidden registry setting and may require a Netsmart Support Associate's assistance in checking and setting.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor's code/name.
  • Service codes:
  • An existing service code is identified to be used. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the ' Service Codes' form.
  • Admission:
  • An existing client is identified, or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
  • Diagnosis:
  • An admission diagnosis record is created for the client.
  • Client Charge Input:
  • 5-6 services are rendered to the client in one month and other 5-6 services in another month. Note service dates, service code.
  • Client Ledger:
  • A service distributed correctly to the assigned guarantor.
Steps
  1. Open the 'Edit Service Information' form.
  2. Select a desired client.
  3. Validate the alternative service location fields listed on the form are. Facility Location Name, Facility Location State, Facility Location Code Qualifier, Facility Location Code Identifier, Facility Location Address Street, Facility Location City, Facility Location Zip Code.
  4. Click [Select Services to Edit].
  5. Select one of the service from the second month to be edited.
  6. Select / enter desired values for one of the new fields added via the registry setting.
  7. Leave other fields blank.
  8. File the form.
  9. Open the 'Electronic Billing' form.
  10. Select 837 Professional or 837 Institutional in 'Billing Form' field.
  11. Select values for 837 bill generation in the 'Type of Bill', 'Individual or All Guarantors' and 'Billing Type' fields.
  12. Select 'Sort File' in the 'Billing Options' field.
  13. Select/enter values for service inclusion in 'All Clients or Interim Billing Batch' and 'Program(s)' fields.
  14. Select only first month of service to bill.
  15. Select/enter values for 'Create Claims' (and 'Date of Claim' if 'Yes'), 'First Date of Service to Include' and 'Last Date of Service to Include' fields.
  16. Select/enter values for any other bill sorting criteria fields as required/desired.
  17. Click [Process].
  18. Verify the bill compiles successfully.
Scenario 2: 837 Error Report - Items outside of date range selected for billing
Specific Setup:
  • Registry Setting:
  • 'Enable Alternative Service Location Fields' is enabled.
  • Note the fields that will be added to 'Edit Service Information'.
  • Identify a client with unbilled services. Note the service date range and the guarantor.
  • Edit the last service to add data for only the fields enabled by the above registry setting.
Steps
  1. Open ‘Electronic Billing’.
  2. Create a bill for the services that does not include the date of services for the edited service.
  3. Print the report.
  4. Validate that no error is reported for the date of service of the edited bill.
  5. Close the report.
  6. Close the form.
Topics
• 837 Institutional • 837 Professional • NX
AV-79178 Summary | Details
Guarantors/Payors - Database Management
Scenario 1: 'Guarantors/Payors' - Form Verification
Specific Setup:
  • Avatar State Forms Registry Setting 'Enable Texas TMHP Billing' must be enabled.
Steps
  1. Open the Avatar PM 'Guarantors/Payors' form.
  2. Select Add or Edit action in 'Add New or Edit Existing Guarantor' field.
  3. Enter new (or select existing) Guarantor Code.
  4. Complete all required/desired fields in main section of 'Guarantors/Payors' form.
  5. Navigate to '837' section of 'Guarantors/Payors' form.
  6. Ensure that the 'TMHP Waiver Skip 2300-REF Segment' field is available in form.
  7. If 'Yes' is selected in this field, 837 Professional files sorted/created for this Guarantor via 'Electronic Billing' forms/functions (and subject to 'Enable Texas TMHP Billing' functionality/values) will conditionally skip/omit the 2300-REF segment/value for 'TMHP Waiver Reference Number'.
  8. Select value for 'TMHP Waiver Skip 2300-REF Segment' field (and any other desired fields in '837' section of form).
  9. Navigate to main section of 'Guarantors/Payors' form.
  10. Click 'File' button to save/file Guarantor/Payor definition information.
  11. Select 'Edit' action and select previously filed Guarantor Code.
  12. Navigate to '837' section of 'Guarantors/Payors' form.
  13. Ensure that previously selected/filed value for 'TMHP Waiver Skip 2300-REF Segment' field is present/selected in form.
Topics
• 835 • Guarantor/Payors
AV-80058 Summary | Details
Managed Care Authorizations - Monthly Limitation
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Diagnosis
  • Financial Eligibility
  • Guarantors/Payors
  • Managed Care Authorizations
  • Registry Settings (PM)
  • Service Codes
Scenario 1: Managed Care Authorizations - Monthly Limitations - Scheduling Calendar
Specific Setup:
  • Managed Care Authorizations:
  • Identify a client with a 'Managed Care Authorization’ that contains a monthly limitation.
  • Note the guarantor that the authorization is for.
  • Note the limitation and if any of the units/dollars or visits have been used.
  • Guarantors/Payors: Note the value of the ‘Verification Level For Authorizations For Appointment Scheduling’.
  • ‘Warn User If Authorization Is Missing’ will display a warning in scheduling but allow the user to file the appointment.
  • Disallow Service If Authorization Is Missing’ will display an error message and prevent the appointment from being filed.
Steps
  1. Open ‘Scheduling Calendar’.
  2. Schedule an appointment that will not cause the service to be over the monthly limitation.
  3. Validate that the appointment files successfully.
  4. Schedule an appointment on the same day, with a different service code, or on the following day that will cause the service to be over the monthly limitation.
  5. Validate that the appropriate warning message or error message displays.
  6. If the warning message displays, click [OK] and [Submit].
  7. Verify that the appointment filed successfully.
  8. If the error message displays, click [OK] and validate that the ‘Service Code’ field is null and discard the form.
  9. Validate that the ‘Are you sure you want to Close without saving’ message is received.
  10. Click [Yes].
  11. Click [Dismiss].
Topics
• Managed Care Authorizations • NX