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Avatar PM 2024 Update 20

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2024 Monthly Release 2024.01.02
RADplus 2024 Monthly Release 2024.01.02

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'.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
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. KB0076063 v0.01

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'.
Topics
• NCPDP • NX
 
Acceptance Tests
AV-95773 Summary | Details
NCPDP
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Electronic Re-Billing Service Assignment
  • Launch RxConnect
  • RxConnect
Scenario 1: NCPDP - miscellaneous issues include claim rejection information and Medicare Part D re-billing related issues
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 'Avatar PM->Billing->Electronic Billing->Electronic Re-Billing Service Assignment->->Multiple Claim Original Reference Number/Claim Submission Reason Code' registry setting must be set to "Y".
  • The 'RADplus->Database Management->RxConnect->->->Enable RxConnect Facility ID' registry setting must be set to "Y".
  • Two inpatient programs must exist. (Program A) (Program B)
  • Two sub system codes must exist:
  • One associated with "Program A" with a 'Facility ID' of "41". (Sub System Code A)
  • One associated with "Program B" with a 'Facility ID' of "42". (Sub System Code B)
  • RxConnect must have at least two hospitals.
  • One with a 'HL7 ID' of "41" associated to "Sub System Code A". (Hospital A)
  • One with a 'HL7 ID' of "42" associated to "Sub System Code B". (Hospital B)
  • Please log out of the application and log back in after completing the above configuration.
  • Two clients must exist
  • One client must have an active episode associated with "Program A". (Client A)
  • One client must have an active episode associated with "Program B". (Client B)
  • “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" and "Client B" must have active pharmacy-type orders each with a duration of "60 Days" that starts in the past that have been processed in RxConnect. (Order A) (Order B)
  • "Order A" and "Order B" must have two active NDC#'s each. (NDC A) (NDC B) for "Order A" and (NDC C) (NDC D) for "Order B".
  • "Order A" must be administered for the first seven days using "NDC A", the second seven days using "NDC B", the third set of seven days using "NDC A", and the last set of seven days using "NDC B".
  • "Order B" must be administered for the first seven days using "NDC C", the second seven days using "NDC D", the third set of seven days using "NDC C", and the last set of seven days using "NDC D".
  • Charges must be batched in RxConnect.
  • Charges must be compiled in the 'Compile Inbound HL7 Charge Batch File' form.
  • Charges must be posted in the 'Post Inbound HL7 Charge Batch File' form.
  • Charges must be rolled up and posted in the 'Compile/Edit/Post/Unpost Roll-Up Services Worklist' form and ensure that "Client A" and "Client B" contain two fills each for fourteen days.
  • Charges must be closed for "Client A" and "Client B".
  • An NCPDP bill must be created, claimed and a file must exist on the server, this is done in the 'Electronic Billing' form.
  • The bill must be processed through CE2000 and be rejected.
  • The user must be logged into the Root System Code.
Steps
  1. Access the 'Electronic Re-Billing Service Assignment' form.
  2. Click the 'NCPDP Response Worklist' menu item.
  3. Enter the first date of service and the last date of service in the 'From Date (of Service)' and 'Through Date (of Service)' fields.
  4. Select the "NCPDP Guarantor" in the 'Guarantor' field.
  5. Select "All" in the 'Individual or All Clients' field.
  6. Select "All Unresolved Items" in the 'Include the Following' field.
  7. Click [View Worklist].
  8. Validate the worklist is displayed and contains four rows, two for "Client A" and two for "Client B".
  9. Click [Close/Cancel]
  10. Log out of the application and log back into "Sub System Code A".
  11. Access the 'Electronic Re-Billing Service Assignment' form.
  12. Click the 'NCPDP Response Worklist' menu item.
  13. Enter the first date of service and the last date of service in the 'From Date (of Service)' and 'Through Date (of Service)' fields.
  14. Select the "NCPDP Guarantor" in the 'Guarantor' field.
  15. Select "All" in the 'Individual or All Clients' field.
  16. Select "All Unresolved Items" in the 'Include the Following' field.
  17. Click [View Worklist].
  18. Validate the worklist is displayed and contains two rows for "Client A".
  19. Validate the worklist does not contain any rows for "Client B".
  20. Click [Close/Cancel]
  21. In the 'Client' field search for "Client A's Last Name' and validate that "Client A" is displayed in the results.
  22. In the 'Client' field search for "Client B's Last Name' and validate that "Client B" is not displayed in the results.
  23. Log out of the application and log back into "Sub System Code B".
  24. Access the 'Electronic Re-Billing Service Assignment' form.
  25. Click the 'NCPDP Response Worklist' menu item.
  26. Enter the first date of service and the last date of service in the 'From Date (of Service)' and 'Through Date (of Service)' fields.
  27. Select the "NCPDP Guarantor" in the 'Guarantor' field.
  28. Select "All" in the 'Individual or All Clients' field.
  29. Select "All Unresolved Items" in the 'Include the Following' field.
  30. Click [View Worklist].
  31. Validate the worklist does not contain any rows for "Client A".
  32. Validate the worklist is displayed and contains two rows for "Client B".
  33. Click [Close/Cancel]
  34. In the 'Client' field search for "Client A's Last Name' and validate that "Client A" is not displayed in the results.
  35. In the 'Client' field search for "Client B's Last Name' and validate that "Client B" is displayed in the results.
  36. Log out of the application and log back into the Root System Code.
  37. Access the 'Electronic Re-Billing Service Assignment' form.
  38. Click the 'NCPDP Response Worklist' menu item.
  39. Enter the first date of service and the last date of service in the 'From Date (of Service)' and 'Through Date (of Service)' fields.
  40. Select the "NCPDP Guarantor" in the 'Guarantor' field.
  41. Select "All" in the 'Individual or All Clients' field.
  42. Select "All Unresolved Items" in the 'Include the Following' field.
  43. Click [View Worklist].
  44. Validate the worklist is displayed and contains four rows, two for "Client A" and two for "Client B".
  45. Check the 'Forward to Pharmacy' checkbox for the two rows for "Client A" and for one row for "Client B".
  46. Click [Save].
  47. Validate a "Successfully filed!" message is displayed and click [OK].
  48. Select "All Unresolved Items Flagged for Pharmacy (no response)" in the 'Include the Following' field.
  49. Click [View Worklist].
  50. Validate the worklist is displayed and contains three rows, two for "Client A" and one for "Client B".
  51. Close the form.
  52. Access the 'Launch RxConnect' form and click [Launch RxConnect].
  53. Click 'Configuration' and select "Active Hospital".
  54. Select "Hospital A" in the 'Select Hospital' field and click [Change Hospital].
  55. Click 'RxSummary'.
  56. Click the 'NCPDP Response' tab.
  57. Validate two rows are displayed for "Client A".
  58. Click the first row.
  59. Populate the first set of 'Response DUR Reason Codes' with values.
  60. Populate the first 'Submission Clarification Codes' field with any value and click [Submit].
  61. Click the second row.
  62. Populate the first 'Submission Clarification Codes' field with any value and click [Submit].
  63. Click 'Configuration' and select "Active Hospital".
  64. Select "Hospital B" in the 'Select Hospital' field and click [Change Hospital].
  65. Click 'RxSummary'.
  66. Click the 'NCPDP Response' tab.
  67. Validate one row is displayed for "Client B".
  68. Click the row.
  69. Populate the first set of 'Response DUR Reason Codes' with values and click [Submit].
  70. Click 'Log Out' and close the 'Launch RxConnect' form.
  71. Access the 'Electronic Re-Billing Service Assignment' form.
  72. Click the 'NCPDP Response Worklist' menu item.
  73. Enter the first date of service and the last date of service in the 'From Date (of Service)' and 'Through Date (of Service)' fields.
  74. Select the "NCPDP Guarantor" in the 'Guarantor' field.
  75. Select "All" in the 'Individual or All Clients' field.
  76. Select "All Unresolved Items Flagged for Pharmacy (with response)" in the 'Include the Following' field.
  77. Click [View Worklist].
  78. Validate the worklist is displayed and contains three rows, two for "Client A" and one for "Client B".
  79. Click [Close/Cancel]
  80. Select "All Resolved Items" in the 'Include the Following' field.
  81. Click [View Worklist].
  82. Validate the worklist is displayed and contains no data.
  83. Click [Close/Cancel].
  84. Click the 'NCPDP Re-Billing Service Assignment' menu item.
  85. Search for and select "Client A" in the 'Client ID' field.
  86. Select "Add Claim To Re-Bill" in the 'Add/Delete' field.
  87. Select the first claim number in the 'Claim Number' field.
  88. Validate a message is displayed stating "Information for re-billing has been provided by the pharmacy for this claim. Would you like to default in this information?" and click [Yes].
  89. Click [DUR Overrides].
  90. Validate the information entered in the 'Response DUR Reason Codes' fields is displayed and click [Close/Cancel].
  91. Select the second claim number in the 'Claim Number' field.
  92. Validate a message is displayed stating "Information for re-billing has been provided by the pharmacy for this claim. Would you like to default in this information?" and click [Yes].
  93. Click [DUR Overrides].
  94. Validate that no information is displayed and click [Close/Cancel].
  95. Search for and select "Client B" in the 'Client ID' field
  96. Validate "Add Claim To Re-Bill" is selected in the 'Add/Delete' field.
  97. Select the first claim number in the 'Claim Number' field.
  98. Validate a message is displayed stating "Information for re-billing has been provided by the pharmacy for this claim. Would you like to default in this information?" and click [Yes].
  99. Click [DUR Overrides].
  100. Validate the information entered in the 'Response DUR Reason Codes' fields is displayed and click [Close/Cancel].
  101. Select the second claim number in the 'Claim Number' field.
  102. Validate that no message is displayed. This is because no clarification or DUR information was entered for this claim.
  103. Close the form.
Topics
• NCPDP • NX

 

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  2. Tags
    1. Avatar PM 2024 Update 20
    2. content:release
    3. llm-no-index
    4. NCPDP
    5. NX
    6. role:sysadmin