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Avatar PM 2023 Update 92

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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 system is updated as follows: 1) SQL tables 'SYSTEM.ncpdp_system_defaults' and 'SYSTEM.ncpdp_system_defaults_sub' are added to support reporting on form 'NCPDP System Defaults'. 2) An issue is resolved where the 'NCPDP Claim Submission Response Report' could throw the following error: 'The page size was not large enough to format the contents of an object in the report?'. This could occur when the 'Response File Notes' section of the report contained a sizeable amount of data.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
NCPDP - new tables and NCPDP Claim Submission Response Report

The system is updated as follows:

  1. SQL tables 'SYSTEM.ncpdp_system_defaults' and 'SYSTEM.ncpdp_system_defaults_sub' are added to support reporting on form 'NCPDP System Defaults'.
  2. An issue is resolved where the 'NCPDP Claim Submission Response Report' could error with the following message: 'The page size was not large enough to format the contents of an object in the report?'. This could occur when the 'Response File Notes' section of the report contained a sizable amount of data. KB0069375 v0.01
Topics
• NCPDP • NCPDP System Defaults
 
Acceptance Tests
AV-79667 Summary | Details
NCPDP - new tables and NCPDP Claim Submission Response Report
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Electronic Billing
  • NCPDP Claim Submission Response Report
  • NCPDP System Defaults
Scenario 1: NCPDP Claim Submission Response Report
Specific Setup:
  • The Avatar application must be associated with an RxConnect Instance and configured to communicate via HL7.
  • There must be active connections between Avatar and RxConnect for "ADT", "ORDERS", "FILL DETAILS", and "BILLING".
  • The "ADT" and "ORDERS" connections must have both values selected in the 'Sub System Code Facility ID(s) Supported' field and the 'Include Sub System Code Facility ID in Outbound Message' field in the 'HL7 Connection Manager' form, which is a Netsmart Staff Only form. Please contact your Netsmart Representative.
  • CE2000 must be installed and configured on the Database server.
  • The 'Avatar PM->Billing->Electronic Billing->NCPDP->->Enable NCPDP Billing' registry setting must be set to "Y".
  • The 'Create New Fill For Every Change In NDC' field must be set to "Yes" in the 'NCPDP System Defaults' form.
  • The user logged into the application must have access to the 'SYSTEM.ncpdp_system_defaults' table.
  • Please log out of the application and log back in after completing the above configuration.
  • A client must have an active inpatient episode. (Client A)
  • “Client A” and "Client B" must have a ‘Date of Birth’, ‘Sex’ and address on file in the ‘Update Client Data’ form, as well as information filed in the ‘Allergies and Hypersensitivities’ form, ‘Diagnosis’ form, and in the ‘Height’ and ‘Weight’ fields in the ‘Vitals Entry’ form.
  • "Client A" and "Client B" must be associated with an NCPDP guarantor in the 'Financial Eligibility' form.
  • "Client A" must have three active pharmacy-type orders each with a duration of "60 Days" that starts in the past and have been processed in RxConnect. (Order A) (Order B) (Order C)
  • "Order A" must have a 'Frequency' of "Every Day"
  • "Order B" must have a 'Frequency' of "Twice A Day" administration times at "09:00 AM" and "09:00 PM".
  • "Order C" must have a 'Frequency of "3 Times A Day" with administration times at "09:00 AM", "03:00 PM", and "09:00 PM".
  • "Order A" and "Order C" must have one active NDC #.(NDC A) (NDC B)
  • "Order B" must have two active NDC #'s. (NDC C) (NDC D)
  • "Order A" must be administered for the first 14 days of a month using "NDC A".
  • "Order B" must be administered for the first 14 days of a month, where the "09:00 AM" administration on each day is using "NDC C" and administered for the "09:00 PM" administration for the same days with "NDC D".
  • "Order C" must be administered seven times starting at the first of a month using "NDC B".
  • Charges must be batched in RxConnect.
  • Charges must be compiled and posted in the 'Compile Inbound HL7 Charge Batch File' and 'Post Inbound HL7 Charge Batch File' forms.
  • Charges must be rolled up and posted in the 'Compile/Edit/Post/Unpost Roll-Up Services Worklist' form.
  • Charges must be closed for "Client A".
Steps
  1. Access the 'NCPDP System Defaults' form.
  2. Select "No" in the 'Create New Fill For Every Change In NDC' field and click [Submit].
  3. Validate a "Filed" message is displayed and click [OK].
  4. Close the form.
  5. Access the 'Electronic Billing' form.
  6. Select "NCPDP" in the 'Billing Form' field.
  7. Select "Medicare Part D" in the 'Type Of Bill' field.
  8. Select "Individual" in the 'Individual Or All Guarantors' field.
  9. Select the NCPDP guarantor associated with "Client A" in the 'Guarantor' field.
  10. Select "Inpatient" in the 'Billing Type' field
  11. Select "Sort File" in the 'Billing Options' field
  12. Set the 'File Description' field to any value.
  13. Select "All Clients" in the 'All Clients Or Interim Billing Batch' field.
  14. Select the program associated with "Client A" in the 'Program(s)' field.
  15. Select "Yes" in the 'Create Claims' field.
  16. Set the 'Date Of Claim' field to the first date of service for all orders.
  17. Set the 'First Date Of Service To Include' field to the first date of service for all orders.
  18. Set the 'Last Date of Service To Include' field to the last date of service for all orders.
  19. Click [Process].
  20. Validate a "Compile Complete" message is displayed and click [OK].
  21. Select "Create File On Server" in the 'Billing Options' field.
  22. Select the file description name in the 'File' field
  23. Click [Process].
  24. Validate a "File(s) created." message is displayed and click [OK].
  25. Close the form.
  26. The file is processed through CE2000.
  27. Access the 'NCPDP Claim Submission Response Report' form.
  28. Select the appropriate file description in the 'Claim Submission File' form and click [Run Report].
  29. Validate the 'NCPDP Claim Submission Response Report' is displayed and contains values in the 'Processing Notes' section of the report and all relevant data.
  30. Click [Close Report].
  31. Create a report using the 'SYSTEM.ncpdp_system_defaults' table and validate that the information filed in the 'NCPDP System Defaults' form are displayed.
Topics
• NCPDP • NCPDP System Defaults
Table Changes
Table Column Change
SYSTEM.ncpdp_system_defaults FACILITY ADD
SYSTEM.ncpdp_system_defaults billing_mode_code ADD
SYSTEM.ncpdp_system_defaults billing_mode_value ADD
SYSTEM.ncpdp_system_defaults cms_qualified_code ADD
SYSTEM.ncpdp_system_defaults cms_qualified_value ADD
SYSTEM.ncpdp_system_defaults data_entry_by ADD
SYSTEM.ncpdp_system_defaults data_entry_by_option ADD
SYSTEM.ncpdp_system_defaults data_entry_date ADD
SYSTEM.ncpdp_system_defaults data_entry_offset ADD
SYSTEM.ncpdp_system_defaults data_entry_source ADD
SYSTEM.ncpdp_system_defaults data_entry_time ADD
SYSTEM.ncpdp_system_defaults data_entry_time_j ADD
SYSTEM.ncpdp_system_defaults data_entry_timezone_info_all ADD
SYSTEM.ncpdp_system_defaults data_entry_timezone_short ADD
SYSTEM.ncpdp_system_defaults data_entry_user_id ADD
SYSTEM.ncpdp_system_defaults data_entry_user_name ADD
SYSTEM.ncpdp_system_defaults data_entry_utc ADD
SYSTEM.ncpdp_system_defaults default_fill_days_supply ADD
SYSTEM.ncpdp_system_defaults file_input_path ADD
SYSTEM.ncpdp_system_defaults file_output_path ADD
SYSTEM.ncpdp_system_defaults min_charge_amt_for_billing ADD
SYSTEM.ncpdp_system_defaults new_fill_on_ndc_change_code ADD
SYSTEM.ncpdp_system_defaults new_fill_on_ndc_change_value ADD
SYSTEM.ncpdp_system_defaults option_desc ADD
SYSTEM.ncpdp_system_defaults option_id ADD
SYSTEM.ncpdp_system_defaults pharmacy_npi_number ADD
SYSTEM.ncpdp_system_defaults plan_id ADD
SYSTEM.ncpdp_system_defaults prescription_origin_code ADD
SYSTEM.ncpdp_system_defaults prescription_origin_value ADD
SYSTEM.ncpdp_system_defaults rebill_payors_code ADD
SYSTEM.ncpdp_system_defaults rebill_payors_sh_val ADD
SYSTEM.ncpdp_system_defaults rebill_payors_value ADD
SYSTEM.ncpdp_system_defaults rounding_logic_code ADD
SYSTEM.ncpdp_system_defaults rounding_logic_value ADD
SYSTEM.ncpdp_system_defaults surcharge_amount ADD
SYSTEM.ncpdp_system_defaults_sub FACILITY ADD
SYSTEM.ncpdp_system_defaults_sub cms_qualified_code ADD
SYSTEM.ncpdp_system_defaults_sub cms_qualified_value ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_by ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_by_option ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_date ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_offset ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_source ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_time ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_time_j ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_timezone_info_all ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_timezone_short ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_user_id ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_user_name ADD
SYSTEM.ncpdp_system_defaults_sub data_entry_utc ADD
SYSTEM.ncpdp_system_defaults_sub option_desc ADD
SYSTEM.ncpdp_system_defaults_sub option_id ADD
SYSTEM.ncpdp_system_defaults_sub pharmacy_npi_number ADD
SYSTEM.ncpdp_system_defaults_sub prescription_origin_code ADD
SYSTEM.ncpdp_system_defaults_sub prescription_origin_value ADD
SYSTEM.ncpdp_system_defaults_sub system_code_facility_id ADD