Avatar PM 2023 Update 62

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Product Requirements / Recommendations

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Product Update Form Description

The following issues are resolved: 1) Duplicate service modifiers are incorrectly included on the 837 Professional bills when billing secondary guarantor. 2) Primary and Add-On services are included in separate claims on the 837 Professional bills when billing secondary guarantor.

Included Updates

Required Updates

None

Details

NEW0 CHANGED0 FIXED2

Fixed (2)

AV-81894 Details \| User Acceptance Tests 837 Professional - SV1 segment An issue has been resolved to ensure that modifiers are not included in the SV1 segment for services that have been transferred from one guarantor to another guarantor. KB0073216 v0.01	Topics • 837 Professional • NX

AV-85531 Details \| User Acceptance Tests 837 Professional - CLM segment An issue has been resolved to ensure that primary and add-on or interactive complexity services are included in the same claim. KB0071610 v0.01	Topics • 837 Professional • NX

Acceptance Tests

AV-81894 Summary | Details

837 Professional - SV1 segment

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

Admission (Outpatient)
Avatar NX Report Viewer
Client Charge Input
Client Ledger
Crystal Report Viewer
Electronic Billing
Financial Eligibility
Guarantors/Payors
Individual Cash Posting (PM)
MODIFIERS BY PRACTITIONER CATEGORY
Practitioner Enrollment
Practitioner Numbers By Guarantor And Program
Registry Settings (PM)
Service Fee/Cross Reference Maintenance

Scenario 1: 837 Professional - Enable Duplicate Service Modifiers

Specific Setup:

Registry Setting: ‘Enable Duplicate Service Modifiers’ = ‘Y’.
Modifiers By Practitioner Category:
Verify a definition the contains values in the ‘Modifier’ and ‘Duplicate Service Modifiers’ fields.
Note the values in ‘Modifier’, ‘Duplicate Service Modifiers’, ‘Guarantor ID’, ‘Program’ and ‘Practitioner Category’.
Unclaimed services that can be billed on the 837 Professional for the ‘Guarantor ID’, ‘Program’ and ‘Practitioner Category’ are identified. At least one occurrence of a duplicated service occurs, or a service that was transferred to another guarantor exists.

Steps

Open ‘Electronic Billing’.
Create an 837 Professional for the services.
Review the ‘Dump File’
Validate that the SV1 segment contain the appropriate modifiers for non-duplicated services.
Validate that the SV1 segment contain the appropriate modifiers for duplicated services.
Close the report.
Close the form.

Topics

• 837 Professional • NX

AV-85531 Summary | Details

837 Professional - CLM segment

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
Diagnosis
Dictionary Update (PM)
Electronic Billing
Financial Eligibility
Guarantors/Payors
Program Maintenance
Registry Settings (PM)
Service Codes
Service Fee/Cross Reference Maintenance

Scenario 1: PM - Electronic Billing - 837 Professional - Include primary and associated add-on services in the same claim

Specific Setup:

System is set up to allow ‘Add-On’ services to the primary services.
Service Codes:
Use ‘Service Code Category’ to note the ‘Primary Code’. Note the associated add-on codes.
Guarantors/Payors:
Guarantor 1: Note the ‘Financial Class’. This will be the client’s primary guarantor.
Guarantor 2: Note the ‘Financial Class’. This will be the client’s secondary guarantor.
Guarantor/Program Billing Defaults:
The ‘Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = 1.
Clients:
Client 1:
Is enrolled in an outpatient program. Note the program.
Client has an active diagnosis record.
Client has an active financial eligibility record with the above guarantors.
Services have been provided for the above ‘Primary Code’ that include add-on codes.
Close Charges was used to close the charges.
Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
Client 2:
Is enrolled in an inpatient program. Note the program.
Client has an active diagnosis record.
Client has an active financial eligibility record with a primary and secondary guarantor.
Services have been provided for the above ‘Primary Code’ that include add-on codes.
Close Charges was used to close the charges.
Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.

Steps

Open ‘Electronic Billing’.
Select ‘837-Professional’ in ‘Billing Form’.
Select the primary guarantor ‘Financial Class in ‘Type Of Bill’.
Select ‘Individual’ in ‘Individual Or All Guarantors’.
Select the primary guarantor in ‘Guarantor’.
Select ‘Outpatient’ in ‘Billing Type’.
Select ‘Sort File’ in ‘Billing Options’.
Enter the desired value in ‘File Description/Name’.
Select ‘All Clients’ in ‘All Clients Or Interim Billing Batch’.
Select desired value in ‘Program(s)’.
Select ‘No’ in ‘Create Claims’.
Enter the desired value in ‘First Date Of Service To Include’.
Enter the desired value in ‘Last Date Of Service To Include’.
Select ‘All in ‘Include Primary and/or Secondary Billing.
Click [Process].
Validate the ‘Processing Report’ message contains ‘Compile Complete’.
Click [OK].
Select ‘Dump File’ in ‘Billing Options’.
Select ‘Print’ in ‘Print Or Delete Report’.
Select the desired report in ‘File’.
Click [Process].
Validate that there is one ‘CLM’ segment per service,
Close the report.
Close the form.
If desired, use 'Individual Cash Posting' to transfer the services to the secondary guarantor, transferring an add-on code before the transferring the primary code.
If the transfer was performed, process the ‘837-Professional’ again to validate that only one claim is created for the service.

Topics

• 837 Professional • NX