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NCPDP
An issue is resolved to ensure a Claim rejection information marked as 'Forward to Pharmacy' in the 'NCPDP Response Worklist' tab of the 'Electronic Re-Billing Service Assignment' form was being displayed in the wrong pharmacy. This could occur when there were multiple pharmacies each supported by a different Avatar (sub) system code.
The following Medicare Part D re-billing related issues are resolved:
1) Items on the 'NCPDP Response Worklist' tab of the 'Electronic Re-Billing Service Assignment' form that were forwarded to the pharmacy system were being incorrectly marked as resolved when information was received back from the pharmacy system.
2) The system would not notify users via pop-up that pharmacy provided information was available for re-billing when a claim/service was selected on the 'NCPDP Re-Billing Service Assignment' tab of the 'Electronic Re-Billing Service Assignment' form unless the pharmacy provided both DUR override(s) as well as submission clarification code(s) (there are situations where the pharmacy only needs to provide one or the other type and not both).
3) Fields 'NCPDP TAB' and 'NCPDP RESPONSE TAB' in the 'Electronic Re-Billing Service Assignment' form were visible instead of hidden. This could occur when registry settings 'Enable NCPDP Billing' and 'Multiple Claim Original Reference Number/Claim Submission Reason Code' are both set to 'Y'.
Included Updates
None
Product Update Description
The following Medicare Part D re-billing related issues are resolved: 1) Items on the 'NCPDP Response Worklist' tab of the 'Electronic Re-Billing Service Assignment' form that were forwarded to the pharmacy system were being incorrectly marked as resolved when information was received back from the pharmacy system. 2) The system would not notify users via pop-up that pharmacy provided information was available for re-billing when a claim/service was selected on the 'NCPDP Re-Billing Service Assignment' tab of the 'Electronic Re-Billing Service Assignment' form unless the pharmacy provided both DUR override(s) as well as submission clarification code(s) (there are situations where the pharmacy only needs to provide one or the other type and not both). 3) Claim rejection information marked as 'Forward to Pharmacy' in the 'NCPDP Response Worklist' tab of the 'Electronic Re-Billing Service Assignment' form was being displayed in the wrong pharmacy. This could occur when there were multiple pharmacies each supported by a different Avatar (sub) system code. 4) Fields 'NCPDP TAB' and 'NCPDP RESPONSE TAB' in the 'Electronic Re-Billing Service Assignment' form were visible instead of hidden. This could occur when registry settings 'Enable NCPDP Billing' and 'Multiple Claim Original Reference Number/Claim Submission Reason Code' are both set to 'Y'.
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Topics
• NX
• NCPDP
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Discontinue or Hold Orders Upon Leave
The dictionary 'Discontinue Orders Upon Leave' (Client File, data element 772) is modified in the following ways:
1) It is renamed to 'Discontinue or Hold Orders Upon Leave'.
2) The "Yes" entry is changed to "Discontinue".
3) The "No" entry is changed to "Take no Action". 3) The "Hold" entry is added. 'Discontinue or Hold Orders Upon Leave' is an extended attribute off of the 'Type Of Leave From' dictionary (Client File, data element 757).
In systems with Avatar Order Entry, it is used to determine what action should be taken regarding a client's orders when they are put on leave via the 'Leaves' form.
Please note: Avatar Order Entry 2024 Update 35 is required to support "Hold" functionality.
Included Updates
12
Additional Requirements
Please note: Avatar OE 2024 Update 35 is required to support "Hold" functionality.
Product Update Description
The dictionary 'Discontinue Orders Upon Leave' (Client File, data element 772) is modified in the following ways: 1) It is renamed to 'Discontinue or Hold Orders Upon Leave'. 2) The "Yes" entry is changed to "Discontinue". 3) The "No" entry is changed to "Take no Action". 3) The "Hold" entry is added. 'Discontinue or Hold Orders Upon Leave' is an extended attribute off of the 'Type Of Leave From' dictionary (Client File, data element 757). In systems with Avatar Order Entry, it is used to determine what action should be taken regarding a client's orders when they are put on leave via the 'Leaves' form. Please note: Avatar Order Entry 2024 Update 35 is required to support "Hold" functionality.
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Topics
• eMAR NX
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File Import - DRG Code Table
An issue is resolved where the DRG codes imported through the ‘File Import’ form to update an existing DRG code with leading zero were not updating the "SYSTEM.table_drg_codes” table entries.
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Financial Determination - Field Verification
AN issue is resolved where Financial Determination was issuing an error when attempting to enter the effective date of 2/29/24 (leap year day).
A defect in the Financial Determination form has been addressed. Previously, an error was encountered when attempting to input the effective date as 2/29/24. This issue has now been resolved, and users can input this date without receiving the RADPlusException: [ILLEGAL VALUE]DATES+13^FinancialDetermination error. This fix enhances the overall user experience by ensuring date inputs are handled correctly by the system, even for special dates like leap year day.
Included Updates
8, 9, 28, 31, 34, 42
Product Update Description
The following issues are resolved: 1) The option to update 'DRG Code Table' in form 'File Import' does not edit "SYSTEM.tabledrgcodes" table entries. 2) The error '[ILLEGAL VALUES]Dates^FinancialDetermination' that can occur on the 'Financial Determination' form when leap days are entered.
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Topics
• Diagnosis
• 837 Institutional
• File Import
• Financial Determination
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Included Updates
None
Product Update Description
Avatar PM is enhanced to run the 'Detail of Visits By Client and Program' report as a report definition instead of a menu launched report.
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Topics
• Detail of Visits By Client and Program
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Included Updates
None
Product Update Description
The system is prepared for future functionality.
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Topics
• Forms
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Practitioner Enrollment Form - Database Validation
The SYSTEM.staff_enrollment_history table has been updated to add the fields ‘'PERFID' and 'PPIUniqueID'. This will allow mapping of the Performing Provider ID and Performing Provider Registration information submitted in the 'Practitioner Enrollment' form.
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File Import - Posting/Adjustment Posting'
An issue is resolved where 'File Import' allows inactive posting codes to be used and posted without error in 'Posting/Adjustment Posting'.
The ‘File Import’, ‘'Posting/Adjustment Posting' file will produce an error when an inactive posting code is included in the file. This will prevent the inactive posting code from being filed.
Included Updates
8, 9, 16, 17, 23, 28, 29, 31, 34, 35, 42, 44, 46, 47, 57, 60
Required Updates
Product Update Description
The 'PERFID' and 'PPIUniqueID' fields are added to the SYSTEM.staff_enrollment_history table to map the MSO performing provider ID and performing provider registration filed in the 'Practitioner Enrollment' form. Also the issue is resolved where the 'Payment/Adjustment Posting' file import is allowing inactive posting/adjustment codes to be used.
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Topics
• Practitioner
• File Import
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Included Updates
None
Product Update Description
Avatar PM is enhanced to run the 'Services By Program and Age Group' report as a report definition instead of a menu launched report.
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Topics
• Report Viewer
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Included Updates
None
Product Update Description
An issue is resolved where required services set in 'Advanced Billing Rule Definition' may not be found when entering services.
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Topics
• Advanced Billing Rule Definition
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Bed Management - 'Leave Status Change'
An issue where the 'Leave Status Change' form may result in the 'Bed Management' form displaying more than one client in the same bed.
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Bed Management - 'Client Merge' functionality
Ensure the 'Client Merge' process does not result in the target client being incorrectly displayed as occupying the source client's bed in the 'Bed Management' form.
Included Updates
None
Product Update Description
The following issues are resolved: 1) An issue where the 'Leave Status Change' form may result in the 'Bed Management' form displaying more than one client in the same bed. 2) An issue where the 'Client Merge' form may result in the target client being incorrectly displayed as occupying the source client's bed on the 'Bed Management' form.
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Topics
• Bed Management
• Leaves
• Client Merge
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Client Demographics - Personal pronouns
Avatar PM is enhanced to support codified personal pronouns using LOINC codes. The existing 'Personal Pronouns' field on the 'Admission', 'Pre Admit', 'Discharge', and 'Update Client Data' forms is retained, but may now be populated by selecting a value from the 'Select Personal Pronouns' field.
Included Updates
12, 38, 51, 66
Product Update Description
Avatar PM is enhanced to support codified personal pronouns using LOINC codes. The existing 'Personal Pronouns' field on the 'Admission', 'Pre Admit', 'Discharge', and 'Update Client Data' forms is retained, but may now be populated by selecting a value from the new 'Select Personal Pronouns' field.
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Topics
• Admission
• Update Client Data
• Discharge
• Pre Admit
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Included Updates
None
Product Update Description
Avatar PM is enhanced to run the 'Services by Program and Group Code' report as a report definition instead of a menu launched report.
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Topics
• Report Viewer
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Included Updates
None
Product Update Description
Avatar PM is enhanced to run the 'Services by Provider and Group Code' report as a report definition instead of a menu launched report.
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Topics
• Report Viewer
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Included Updates
None
Product Update Description
An issue is resolved where multiple 'Guarantor Override' sections may appear on the 'Client Charge Input' form.
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Topics
• Registry Settings
• Client Charge Input
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Avatar PM - Smart Search functionality
Avatar PM's Smart Search is enhanced to support the 'Client's Home Phone', 'Client's Cell Phone' and 'Preferred Name' fields.
Included Updates
12, 38, 51, 66, 75
Required Updates
Product Update Description
Avatar PM's Smart Search is enhanced to support the 'Client's Home Phone', 'Client's Cell Phone' and 'Preferred Name' fields.
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Topics
• Client Search
• Registry Settings
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File Import
An issue is resolved in "Guarantors/Payors" file type where an alert message displays for every record.
In the 'Guarantors/Payors' file type, when a guarantor is imported through 'file import', each record would display a pop-up notification. This is now resolved.
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File Import
An issue is resolved to allow posting 'Guarantors/Payors 835' through 'File Import' to successfully complete.
Included Updates
8, 9, 16, 17, 23, 28, 29, 31, 34, 35, 42, 44, 46, 47, 57, 60, 61, 70, 77, 80
Product Update Description
Issues in the 'File Import' form are resolved: 1) The issue with the "Guarantors/Payors" file type where a pop-up message box may be presented to the user for every record in the file. 2) The "[UNDEFINED] ValidateTransfer+14^FileImport835 *postingData" error that can occur with the "Guarantors/Payors 835" file type.
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Topics
• Guarantor/Payors
• File Import
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Included Updates
None
Product Update Description
The 'Race OMB Standards' dictionary is updated to include the following codes - "2131-1","ASKU" and "UNK" and remove "2108-9" code.
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Topics
• Dictionary
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CCBHC Billing - CCBHC 837 Professional Billing
An issue is resolved where for a specific scenario, CCBHC 837P billing gives incorrect error about waiting on remittance from private insurance when the service has no liability remaining and the service is claimed.
The issue was that if a service had been contractually adjusted off in full at the time of service entry, and it contained a claim number, an error message would appear in the 837P report. This was preventing the client from determining the actual remittance errors. Note, this scenario will not error. If the contractual adjustment is taken in full at the time of service entry, the posting code cannot be changed.
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CCBHC Billing - Subsequent Bills
An issue is resolved where the CCBHC service that was appearing on the error report had already been previously billed and claimed.
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CCBHC Billing - Secondary CCBHC billing from a non-CCBHC primary guarantor
An issue is resolved where a CCBHC enumerated service was incorrectly included on the 837 bill even when it had been claimed on a prior bill.
With this update, users will find that a Certified Community Behavioral Health Clinic (CCBHC) enumerated service is now correctly handled on the 837 bill. This corrects the previously reported error where the service was incorrectly included even when it had been claimed on a prior bill.
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CCBHC Billing - Enhanced Secondary Claims Handling
An issue is resolved where secondary claims for a CCBHC 837P bill were missing the 2300-HI segment for diagnosis codes.
With this update, users will find that secondary claims for a Certified Community Behavioral Health Clinic (CCBHC) 837 Professional bill now include the necessary 2300-HI segment, ensuring accurate submission of diagnosis codes. This corrects the previously reported error and aligns with compliance requirements.
Included Updates
None
Product Update Description
The following issues are resolved with CCBHC bills: 1) "Service [service description] is still awaiting remittance from private insurance." error message is incorrectly reported. 2) "Service [service description] is still awaiting remittance from private insurance." error message is incorrectly reported when billing CCBHC guarantor on secondary 837 bill for the services that have already been claimed by the billing guarantor. 3) A CCBHC enumerated service is incorrectly included on the 837 bill even when it has been claimed on a prior bill. 4) "Missing Field/Invalid Format: Industry Code - Diagnosis Code ..." is incorrectly reported when billing a CCBHC add-on service.
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Topics
• 837 Professional
• CCBHC
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Included Updates
8, 9, 16, 17, 23, 28, 29, 31, 34, 35, 42, 44, 46, 47, 57, 60, 61, 70, 77, 80, 84
Product Update Description
The 'Disclosure Management', 'Edit Service Information' and 'Service Fee/Cross Reference Maintenance' forms are enhanced for filing stability.
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Topics
• Disclosure
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Remittance Processing Widget
An issue is resolved where the 'Refresh' button is enabled on the 'Remittance Processing' widget. In addition, the help text for the registry setting 'Enable Sort By Guarantor Name' is updated to include the 'Remittance Processing' widget.
Included Updates
None
Product Update Description
An issue is resolved where the refresh button was not displayed in the 'Remittance Processing' widget. Additionally, the help text for the registry setting 'Enable Sort By Guarantor Name' is updated to include the 'Remittance Processing' widget.
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Topics
• Registry Settings
• Widgets
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Client Merge
'Client Merge' form is enhanced to add a warning message.
When 'Client Merge' form is opened, users now get a warning message stating the performance impact.
Included Updates
71
Product Update Description
The 'Client Merge' form is enhanced to add a warning message about system performance impact.
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Topics
• Client Merge
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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.
Included Updates
None
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.
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Topics
• NCPDP System Defaults
• NCPDP
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Real Time Inquiry (270) Request
New fields have been added to the following tables. The changes are displayed in the release note.
1. SYSTEM.billing270rptheader
2. SYSTEM.billing271beneinfo
3. SYSTEM.billing271dependent
4. SYSTEM.billing271reject
5. SYSTEM.billing271subscriber
6. SYSTEM.billing271updatedinfo
7. SYSTEM.billing271validateinfo
In addition, changes have been made to the 'Real Time Inquiry (270) Request' form
1. The ‘Request Type’ defaults to 'Generic' value.
2. The following fields have been removed from the form: 'CPT-4 Code, 'Modifier' and 'Diagnosis Code'.
3. The data that was displayed in the 'Response’ text field will now be displayed in a report launched by clicking the 'View Raw Response File' button.
4. New text fields have been added to display the 271 response information: Eligibility Information, Request Validation, and Subscriber/Dependent Details.
5. The ‘View Eligibility Report’ button launches the same report as was auto-launched prior to this update. It is the same report as the one in the ‘Eligibility Inquiry (270) Submission’ form.
Included Updates
8, 9, 16, 17, 23, 28, 29, 31, 34, 35, 42, 44, 46, 47, 57, 60, 61, 70, 77, 80, 84, 88
Product Update Description
Real-time eligibility (270) enhancements are introduced. See documentation for details.
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Topics
• Real Time Inquiry (270) Request
• RevConnect
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Scheduling Calendar
An issue is resolved If a pre pay service was created as a result of posting an unacknowledged payment received during the Scheduling Calendar Check-In process, the pre pay amount was not being applied to the current self pay balance when the appointment was posted.
Registry settings were modified to selection '4' (Check In) within the 'Prevent Posting Payments Unless Payment has been Acknowledged' and selection '1' in the 'Add Previous Balance to Expected Self Pay Amount'.
Included Updates
22, 49
Product Update Description
The functionality related to selection '4' (Check In) within the 'Prevent Posting Payments Unless Payment has been Acknowledged' registry setting and selection '1' in the 'Add Previous Balance to Expected Self Pay Amount' registry setting is modified to resolve the following issue: If a pre pay service was created as a result of posting an unacknowledged payment received during the Scheduling Calendar Check-In process, the pre pay amount was not being applied to the current self pay balance when the appointment was posted. Note: Avatar Appointment Scheduling 2024 Update 15 is needed for this functionality.
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Topics
• Scheduling Calendar
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Included Updates
8, 9, 16, 17, 23, 28, 29, 31, 34, 35, 42, 44, 46, 47, 57, 60, 61, 70, 77, 80, 84, 88, 93
Product Update Description
The 'Day Program Attendance' widget is modified to include 'Practitioner' in the grid to allow different Practitioners to be assigned to each row.
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Topics
• Program Maintenance
• Widgets
• Day Program Attendance
• Scheduling Calendar
• Client Ledger
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Included Updates
None
Product Update Description
An issue is resolved where admission data may display from the wrong episode in the Console Widget Viewer.
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Topics
• Admission
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SQL table
A new table 'SYSTEM.mods_by_category' has been added to the system. Please review the release note to see the table details.
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Modifiers by Practitioner Category
The 'Modifiers by Practitioner Category' form and the report launched from the form are updated to support multiple modifier definitions for a given 'Guarantor', 'Program', 'Practitioner Category' and 'CPT Code' combination.
- The billing functionality for the 'Modifiers by Practitioner Category' has been updated to support multiple modifier definitions for a given 'Guarantor', 'Program', 'Practitioner Category' and 'CPT Code' combination.
2. A new table 'SYSTEM.mods_by_category' has been added to the system. Please review the release note for details.
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File Import - Modifiers by Practitioner Category
Multiple rows can now exist with the same Guarantor, Program, Category and CPT combination, if the rows have no overlapping date ranges.
Included Updates
8, 9, 16, 17, 23, 28, 29, 31, 34, 35, 42, 44, 46, 47, 57, 60, 61, 70, 77, 80, 84, 88, 93, 101
Product Update Description
The 'Modifiers by Practitioner Category' form is updated to support multiple modifier definitions for a given 'Guarantor', 'Program', 'Practitioner Category' and 'CPT Code' combination.
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Topics
• Database Tables
• Modifiers by Practitioner
• File Import
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Included Updates
71, 90
Product Update Description
The Client Merge process has been updated to file into a new audit table 'SYSTEM.client_merge_log'.
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Topics
• Update Client Data
• CareFabric Monitor
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