Avatar PM 'Benefit Enrollment and Maintenance (834)'
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Benefit Enrollment and Maintenance (834)
- Benefit Enrollment and Maintenance (834) Compile/Post Report
Scenario 1: 'Benefit Enrollment and Maintenance (834)' - Verification of Effective Date/Expiration Date Information
Specific Setup:
- Avatar PM Registry Setting 'Enable 834 Transaction Set' must be enabled
- 'Default Benefit Effective Date (2300-DTP-03)' and/or 'Default Expiration Date (2300-DTP-03)' values may optionally be defined (via Avatar PM 'Guarantors/Payors' form '270 / 271 / 834' section)
- 834 Benefit Enrollment Maintenance eligibility file for loading/compilation/posting in Avatar PM system, including one or more valid health coverage details
- Crystal Reports or other SQL reporting tool
Steps
- Open Avatar PM 'Benefit Enrollment and Maintenance (834)' form.
- Select 'Load File' in 'Options' field, and enter 'File Path/Name' value for 834 file to be loaded - selecting inbound 834 file including one or valid more health coverage details.
- Select 'Compile File' in 'Options' field, and select loaded 834 file for compilation.
- Click 'Process File' button to compile inbound 834 file data.
- Select 'Run Report' in 'Options' field, and select compiled 834 file for report.
- Click 'Process File' button to open 834 inbound compile report.
- In 834 inbound compile report - ensure that in case where 2300-DTP Effective Date is included without 2300-DTP Expiration Date in health coverage detail and previously posted 834 coverage information for same Unique ID/Policy Number and Coverage Expiration Date exist in Avatar PM (existing information in SQL table 'SYSTEM.eligibility_dependent_cov'), inbound 834 health care coverage entry is successfully compiled.
- Note - 'Coverage Expiration Date' values may also be determined by Avatar PM Guarantor/Payor in cases where not directly present in 834 file health coverage information (via 'Default Expiration Date (2300-DTP-03)' field in Avatar PM 'Guarantors/Payors' form, '270 / 271 / 834' section); In case where 'Default Expiration Date (2300-DTP-03)' is defined and 2300-DTP Expiration Date is not included in 834 file health coverage information, ensure that inbound 834 health care coverage entry is successfully compiled with default 'Coverage Expiration Date' value.
- In 834 inbound compile report - ensure that in case where 2300-DTP Expiration Date is included without 2300-DTP Effective Date in health coverage detail and previously posted 834 coverage information for same Unique ID/Policy Number and Coverage Expiration Date exist in Avatar PM (existing information in SQL table 'SYSTEM.eligibility_dependent_cov'), inbound 834 health care coverage entry is successfully compiled.
- Note - 'Coverage Effective Date' values may also be determined by Avatar PM Guarantor/Payor in cases where not directly present in 834 file health coverage information (via 'Default Benefit Effective Date (2300-DTP-03)' field in Avatar PM 'Guarantors/Payors' form, '270 / 271 / 834' section); In case where 'Default Benefit Effective Date (2300-DTP-03)' is defined and 2300-DTP Effective Date is not included in 834 file health coverage information, ensure that inbound 834 health care coverage entry is successfully compiled with default 'Coverage Effective Date' value.
- In 834 inbound compile report - ensure that in case where 2300-DTP Effective Date and 2300-DTP Expiration Date are included for same Unique ID/Policy Number under separate/different 2000 loop sets, inbound 834 health care coverage entry is successfully compiled (using 2300-DTP Effective Date and 2300-DTP Expiration Date values from file where present).
- Select 'Post File' in 'Options' field, and select compiled 834 file for posting.
- Click 'Process File' button to post inbound 834 file data.
- Open Crystal Reports or other SQL reporting tool.
- In Avatar PM SQL table 'SYSTEM.eligibility_dependent_cov', ensure that 'eligibility_eff_date' and 'eligibility_exp_date' values from 834 file health coverage information (or defaulted by Avatar PM system per Guarantor configurations) are present for eligibility data row(s) created via 834 inbound file posting; For client/834 coverage information where previous coverage information existed in SQL table 'SYSTEM.eligibility_dependent_cov' prior to latest 834 file posting, ensure that 'eligibility_eff_date' and 'eligibility_exp_date' values are updated according to new/latest 834 file health coverage information where applicable.
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Topics
• Benefit Enrollment and Maintenance (834)
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