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Avatar PM 2023 Update 89

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2023 Monthly Release 2023.02.00
RADplus 2023 Monthly Release 2023.02.00

Product Update Description

An issue is resolved where 'Ethnicity' and 'Race' may appear in reverse order within the K3 segment of the 837I and 837P bills when "Yes" is selected in the 'Include Race/Ethnicity/SSN in 2300-K3' field within 'Guarantor Program Billing Defaults'.

Required Updates

None

Included Updates

35

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
837 Billing - K3 segment
The functionality of the K3 segments of 837 bills has been updated to output date in the following order: 'Ethnicity' code, 'Race' code, Social Security number (when the relationship to insured is not self). KB0074003 v0.01
Topics
• 837 Institutional • 837 Professional
 
Acceptance Tests
AV-85749 Summary | Details
837 Billing - K3 segment
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission
  • Client Charge Input
  • 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
  • User Definition
  • 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
  1. Open ‘Electronic Billing’.
  2. Create an 837 Institutional for Guarantors/Payors 2.
  3. Review the dump file to validate that the following:
  4. 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.
  5. 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.
  6. If the billing template selection for ‘Include Race/Ethnicity/SSN in 2300-K3’ is ‘No’, there will be no ‘K3’ segment.
  7. 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.
  8. Close the dump file.
  9. 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
  1. Open ‘Electronic Billing’.
  2. Create an 837 Professional for Guarantors/Payors 2.
  3. Review the dump file to validate that the following:
  4. 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.
  5. 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.
  6. If the billing template selection for ‘Include Race/Ethnicity/SSN in 2300-K3’ is ‘No’, there will be no ‘K3’ segment.
  7. 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.
  8. Close the dump file.
  9. Close the form.
Topics
• 837 Institutional • 837 Professional