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Avatar PM 2023 Update 5

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Product Requirements / Recommendations

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Avatar PM 2021 Update 122

Product Update Form Description

The 'Require Subscriber Group Number' field is added to the table SYSTEM.billing_guar_table.

Included Updates

None

Required Updates

None

Details
NEW0 CHANGED1 FIXED1
Changed (1)
SYTEM.billing_guar_table - Require Subscriber Group Number
Two new SQL fields 'req_sub_group_num_code' and 'req_sub_group_num_value' are added to the 'SYSTEM.billing_guar_table' to store the data from the 'Require Subscriber Group Number’ field of the 'Guarantors/Payors'.

Value Added: To prevent claims from being denied by adding required fields to SQL table.
Topics
• Database Tables • Guarantor/Payors
 
Fixed (1)
Program Transfer - Inpatient and outpatient episode
Verify the client transfers to different program from the admission program using 'Program Transfer' or 'Program Transfer (Outpatient)' form successfully.
Topics
• Program Transfer
 
Acceptance Tests
AV-76720 Summary | Details
SYTEM.billing_guar_table - Require Subscriber Group Number
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Client Charge Input
  • Client Ledger
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Service Codes
  • SQL Query/Reporting
Scenario 1: 837 Professional - Validating ‘Require Group #’ workflow of the 'Guarantors/Payor' - Guarantor assignment through 'Financial Eligibility' form.
Specific Setup:
  • Guarantors/Payors:
  • A new guarantor is created or an existing guarantor is identified.
  • The 'Require Group #' field is set to "No".
  • Note the guarantor code/name to be used during creating financial eligibility record for the client.
  • Admission:
  • The client is admitted to the outpatient program or an existing outpatient client is identified. Note client id/name and admission date/program.
  • Diagnosis:
  • An admission diagnosis record is created for the client.
  • Financial Eligibility:
  • The guarantor identified above is assigned to the client.
  • The 'Subscriber Group #' field is not marked as a required field in the form for the guarantor.
  • Leave the 'Subscriber Group #' field blank.
  • Service Codes:
  • An existing professional service code is identified. Note the service code.
  • Service Fee/Cross reference maintenance:
  • Make sure the fee definition is created for the service code and CPT code is assigned to the service code.
  • Client Charge Input:
  • A service is rendered to the client in the first episode. Be sure to use service codes that are covered by the benefit plan (insurance charge category). Note the date of the service.
  • Close Charges:
  • Charges are closed.
  • Client Ledger:
  • Verify the charges are correctly distributed to the desired guarantor, and they are in 'Unbill' status.
  • Create Interim Billing Batch:
  • An interim billing batch is created to cover the client, guarantor and services rendered to the client. Note the interim billing batch number and name.
Steps
  1. Open an 'Electronic Billing' form.
  2. Compile an '837 Professional' bill for the interim batch created in the setup section.
  3. Verify the bill compiles successfully.
  4. Review the dump file.
  5. Verify the dump file includes the service(s) rendered to the client correctly.
  6. Open the 'Guarantors/Payor' form.
  7. Set the 'Require Group #' field to "Yes".
  8. Open an 'Electronic Billing' form.
  9. Compile an '837 Professional' bill for the interim batch created in the setup section.
  10. Verify the bill does not compile successfully.
  11. Review the error report.
  12. Verify the report displays the 'Missing Subscriber Group #' error on the report for the guarantor/client/service.
  13. Open the 'Financial Eligibility' form for the client.
  14. Verify the 'Subscriber Group #' field is marked as required field.
  15. Make sure the 'Subscriber Group #' field is empty.
  16. Submit the form.
  17. Verify the missing field error message for the 'Subscriber Group #' field.
  18. Enter desired group number in the 'Subscriber Group #' field.
  19. Submit the form.
  20. Open an 'Electronic Billing' form.
  21. Compile an '837 Professional' bill for the interim batch created in the setup section.
  22. Verify the bill compiles successfully.
  23. Claim the service.
  24. Review the dump file.
  25. Verify the dump file includes the service rendered to the client correctly.
  26. Verify the SBR segment contains the 'Subscriber Group #' assigned to the client from the 'Financial Eligibility' form.
  27. Close the form.
  28. Open the 'Crystal Report' or any other SQL data viewer.
  29. Query the 'SYSTEM.billing_guar_table' sql table.
  30. Verify the req_sub_group_num_code and req_sub_group_num_value columns are added to the table and displays correct data from the 'Guarantors/Payors' form for the identified guarantor.
  31. Query the 'SYSTEM.billing_guar_subs_data' table.
  32. Verify the 'subs_group' field populated with the 'Subscriber Group #' field from the 'Financial Eligibility' form.
Topics
• Database Tables • Guarantor/Payors
AV-80416 Summary | Details
Program Transfer - Inpatient and outpatient episode
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission
  • Admission (Outpatient)
  • Program Transfer
  • Program Transfer (OutPatient)
Scenario 1: Program Transfer - Validating program transfer for an inpatient and outpatient episode
Specific Setup:
  • Admission:
  • A new inpatient client is admitted or an existing inpatient client is identified. Note the client id/name, admission date/admission program.
  • A new outpatient client is admitted or an existing outpatient client is identified. Note the client id/name, admission date/admission program.
Steps
  1. Select the 'Program Transfer' form.
  2. Select the inpatient client identified in the setup section.
  3. Validate the 'Program Transferred From' field contains the admission program of the client.
  4. Select desired program different from the admission program in the 'Program' field.
  5. Enter desired date in the 'Date Of Transfer' field.
  6. Enter desired time in the 'Time Of Transfer' field.
  7. Select desired 'Unit'.
  8. Select desired 'Room'.
  9. Select desired 'Bed'
  10. Click [Submit].
  11. Verify the form submits successfully.
  12. Verify the client transferred to the correct program.
  13. Select the 'Program Transfer (Outpatient)' form.
  14. Select the outpatient client identified in the setup section.
  15. Validate the 'Program Transferred From' field contains the admission program of the client.
  16. Select desired program different from the admission program in the 'Program' field.
  17. Enter desired date in the 'Date Of Transfer' field.
  18. Enter desired time in the 'Time Of Transfer' field.
  19. Click [Submit].
  20. Verify the form submits successfully.
  21. Verify the client transferred to the correct program.
Topics
• Program Transfer
Table Changes
Table Column Change
SYSTEM.billing_guar_table req_sub_group_num_code Added
SYSTEM.billing_guar_table req_sub_group_num_value Added