Registry Settings - Validate Program For Staff Guarantor Coverage
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Practitioner Enrollment
- Registry Settings (PM)
- Admission (Outpatient)
- Client Charge Input
- Client Ledger
- Create Interim Billing Batch File
- Crystal Report Viewer
- Crystal Reports or other SQL Reporting tool (PM Namespace)
- Diagnosis
- Electronic Billing
- Financial Eligibility
- Guarantors/Payors
- SOAPUI - AddPractitionerGuarantorCoverage
- SOAPUI - DeletePractitionerGuarantorCoverage
- SOAPUI - WEBSVC.PractitionerRegister
- Admission
Scenario 1: Registry Setting - Validate Program For Staff Guarantor Coverage
Steps
- Open the ‘Registry Settings’ form.
- Set the ‘Limit Registry Setting to the Following Search Criteria’ field to the ‘Validate Program For’.
- Click [View Registry Settings].
- Validate the ‘Registry Setting’ field equal to ‘Avatar PM->Practitioner->Enrollment->->->Validate Program For Staff Guarantor Coverage’.
- Validate the ‘Registry Setting Details’ field contains ‘[FACILITY SPECIFIC] Enter 'Y' to add the 'Program' field to 'Practitioner Enrollment' (Guarantor Coverage). This will allow the service to be validated against the selected Programs when checking the Practitioner's Guarantor Coverage in the bills. Enter 'N' to remove the 'Program' field and the associated logic.’.
- Validate the ‘Registry Setting Value’ field defaults to ‘N’.
- Close the form.
- Open the ‘Practitioner Enrollment’ form.
- Select desired practitioner from the ‘Select Staff’ field.
- Select the ‘Guarantor Coverage’ section.
- Validate the ‘Guarantor Coverage’ section does not contain ‘Program’ field.
- Close the form.
- Open the ‘Registry Settings’ form.
- Set the ‘Limit Registry Setting to the Following Search Criteria’ field to the ‘Validate Program For’.
- Click [View Registry Settings].
- Validate the ‘Registry Setting’ field equals to ‘Avatar PM->Practitioner->Enrollment->->->Validate Program For Staff Guarantor Coverage’.
- Set the ‘Registry Setting Value’ field to ‘Y’.
- Click [Submit].
- Click [OK].
- Click [No].
- Open the ‘Practitioner Enrollment’ form.
- Select desired practitioner from the ‘Select Staff’ field.
- Select the ‘Guarantor Coverage’ section.
- Validate the ‘Guarantor Coverage’ section contains ‘Program’ field.
- Validate the ‘Program’ value displays in scrolling text box.
- Close the form.
- Open the ‘Registry Settings’ form.
- Set the ‘Limit Registry Setting to the Following Search Criteria’ field to the ‘Validate Program For’.
- Click [View Registry Settings].
- Validate the ‘Registry Setting’ field equals to ‘Avatar PM->Practitioner->Enrollment->->->Validate Program For Staff Guarantor Coverage’.
- Click [View Registry Settings].
- Set the ‘Registry Setting Value’ field to ‘1’.
- Validate the error dialog contains ‘The selected value is not valid in the current system code for the following reason: Invalid Response - Example:'Y' or 'N'’.
- Click [Enter].
- Click [OK].
- Set the ‘Registry Setting Value’ field to ‘m’.
- Validate the error dialog contains ‘The selected value is not valid in the current system code for the following reason: Invalid Response - Example:'Y' or 'N'’.
- Click [Enter].
- Click [OK].
- Set the ‘Registry Setting Value’ field to ‘YES’
- Validate the error dialog contains ‘The selected value is not valid in the current system code for the following reason: More than 1 characters.
- Click [OK].
- Set the ‘Registry Setting Value’ field to ‘’.
- Click [Submit].
- Validate the ‘Filing Error’ dialog box contains: ‘The following fields are missing: Registry Setting Value’.
- Click [OK].
- Set the ‘Registry Setting Value’ field to ‘Y’.
- Click [Submit].
- Click [OK].
- Click [No].
- Open the ‘Practitioner Enrollment’ form.
- Select the ‘Guarantor Coverage’ section.
- Select desired practitioner from the ‘Select Staff’ field.
- Select ‘Create New’ from the ‘Guarantor Coverage Entry’ field.
- Select desired guarantor from the Guarantor field.
- Select desired program(s) form the ‘Program’ field.
- Set the ‘Effective Date’ field to desired date.
- Set the ‘Lapse Date’ field to desired date.
- Click [File Mapping].
- Validate the ‘Filed!’ dialog box contains: ‘Saved. Please note: The changes will take effect when you submit the form.’
- Click [OK].
- Click [Submit].
- Open the ‘Practitioner Enrollment’ form.
- Select the same practitioner as above from the ‘Select Staff’ field.
- Select the ‘Guarantor Coverage’ section.
- Validate the ‘Guarantor Coverage’ text area contains ‘Guarantor’, ‘Program’, ‘Effective Date’ and ‘Lapse Date’ as defined in above steps.
- Click [Submit].
Scenario 2: 837 Professional bill - Validating 'Validate Program For Staff Guarantor Coverage' registry setting
Specific Setup:
- Registry Setting:
- The 'Validate Program For Staff Guarantor Coverage' registry setting is set to 'Y'.
- Guarantors/Payors:
- An existing guarantor is identified to be used and all the options are checked in the 'Inhibit Billing if Practitioner is not Covered by this Guarantor' field. Note the guarantor's code/name.
- Service codes:
- An existing service code is identified to be used. Note the service code/description.
- Service Fee/ Cross Reference Maintenance:
- A fee definition is created for the service code identified in the 'Service Codes' form.
- Practitioner Enrollment:
- An existing practitioner is identified, or a new practitioner is created. The guarantor coverage record for the staff is created that includes guarantor identified in the 'Guarantors/Payors' and desired program(s). Note the guarantor and program.
- Admission:
- An existing client is identified, or a new client is admitted in a program which is defined in the guarantor coverage for the practitioner in the 'Practitioner Enrollment' form. Note client id, admission program, admission date.
- Financial Eligibility:
- A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
- Client Charge Input:
- A service is rendered to the client. Note service date, service code.
- Client Ledger:
- A service distributed correctly to the assigned guarantor.
- Close Charges:
- The service(s) rendered to the client is closed.
- Create Interim Billing Batch:
- An interim billing batch is created that includes desired client, service and the guarantor. Note the batch number.
Steps
- Open the 'Electronic Billing' form.
- Compile an unclaimed 837 Professional bill for the client.
- Verify the bill compiles successfully.
- Select 'Run Report' in 'Billing Options' field.
- Select 'Print' in 'Print Or Delete Report' field.
- Select the 'File' field.
- Click [Print 837 Report].
- Validate that the report launches successfully and contains correct client, service, and guarantor.
- Close the report.
- Close the form.
- Open the 'Crystal Report' or any other SQL data viewer.
- Locate to the PM namespace.
- Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
- Verify the 'ID' column displays unique id for the guarantor coverage entry created in the 'Practitioner Enrollment' form.
- Verify the 'STAFFID' column displays the correct practitioner id which is set up in the setup section.
- Verify the 'guarantor_id' column displays correct guarantor id for the guarantor assigned to the client in the 'Financial Eligibility' form.
- Verify the 'program_code' column displays correct program(s) code set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'program_shval' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'program_value' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'effective_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'lapse_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Close the 'Crystal Report' or SQL data viewer.
- Open the 'Practitioner Enrollment' form for the practitioner identified in the setup section.
- Select the 'Guarantor Coverage' section.
- Select an existing guarantor coverage entry from the 'Guarantor Coverage Entry' field.
- Verify the admission program is selected in the 'Program' field.
- Click [Delete Mapping].
- Click [Yes].
- [OK].
- Verify the guarantor coverage record removed from the 'Guarantor Coverage' text area.
- Select 'Create New' from the 'Guarantor Coverage Entry' field.
- Select the guarantor which is assigned to the client as a primary guarantor.
- Select the program different from the admission program of the client in the 'Program' field.
- Enter desired date in the 'Effective Date' and 'Lapse Date' fields.
- Click [File Mapping].
- Click [Submit].
- Verify the user navigates to the home page.
- Open 'Electronic Billing' form.
- Compile an unclaimed bill for the client.
- Validate that a message is received stating: No Valid Information Found. Please Check The Error Report.
- Click [OK].
- Select 'Run Report' in 'Billing Options'.
- Select 'Print' in 'Print Or Delete Report'.
- Select the 'File'.
- Click [Print 837 Report].
- Validate that the report launches and contains a link to 'Required Data Missing: Patient Claim Data'.
- Click the 'Required Data Missing: Patient Service Data' link.
- Verify that the error is - 'No Guarantor Coverage in Effect for Rendering Practitioner'.
- Close the report.
- Close the form.
- Open the 'Crystal Report' or any other SQL data viewer.
- Locate to the PM namespace.
- Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
- Verify the 'ID' column displays unique id for the guarantor coverage entry created in the 'Practitioner Enrollment' form.
- Verify the 'STAFFID' column displays the correct practitioner id which is set up in the setup section.
- Verify the 'guarantor_id' column displays correct guarantor id for the guarantor set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'program_code' column displays correct program(s) code for the program set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'program_shval' column displays correct program(s) description for the program set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'program_value' column displays correct program(s) description for the program set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'effective_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'lapse_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Close the 'Crystal Report' or SQL data viewer.
- Open the 'Registry Settings' form.
- Set the 'Validate Program For Staff Guarantor Coverage' registry setting to 'N'.
- Click [Submit].
- Open the 'Practitioner Enrollment' form for the practitioner identified in the setup section.
- Select the 'Guarantor Coverage' section.
- Verify the guarantor coverage record exist in the 'Guarantor Coverage' text area.
- Close the form.
- Verify the user navigates to the home page.
- Open the 'Electronic Billing' form.
- Compile an unclaimed 837 Professional bill for the client.
- Verify the bill compiles successfully.
- Select 'Run Report' in 'Billing Options' field.
- Select 'Print' in 'Print Or Delete Report' field.
- Select the 'File' field.
- Click [Print 837 Report].
- Validate that the report launches successfully and contains correct client, service, and guarantor.
- Close the report.
- Close the form.
- Verify the user navigates to the home page.
Scenario 3: WEBSVC.PractitionerRegister - AddPractitionerGuarantorCoverage / DeletePractitionerGuarantorCoverage - Registry setting 'Validate Program For Staff Guarantor Coverage'
Specific Setup:
- Registry Setting:
- The 'Validate Program For Staff Guarantor Coverage' registry setting is set to 'Y'.
- Guarantors/Payors:
- An existing guarantor is identified to be used and all the options are checked in the 'Inhibit Billing if Practitioner is not Covered by this Guarantor' field. Note the guarantor's code/name.
- Practitioner:
- An existing practitioner is identified, or a new practitioner is created. Note the practitioner id.
- Admission:
- An existing client is identified, or a new client is admitted in a desired program. Note the client id, admission program, admission date.
- Financial Eligibility:
- The guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
Steps
- Access SOAPUI or any other web service tool.
- File the 'AddPractitionerGuarantorCoverage' method of the WEBSVC.PractitionerRegister web service for the desired guarantor and practitioner by entering desired value to the 'Guarantor', 'EffectiveDate', 'LapseDate','Program', and 'PractitionerID' fields. Note all the values.
- Verify the web service files successfully.
- Open the 'Crystal Report' or any other SQL data viewer.
- Locate to the PM namespace.
- Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
- Verify the 'ID' column displays unique id for the guarantor coverage entry created in the 'Practitioner Enrollment' form. Note this 'ID' number for later use.
- Verify the 'STAFFID' column displays the correct practitioner id which is set up in the setup section.
- Verify the 'guarantor_id' column displays correct guarantor id for the guarantor assigned to the client in the 'Financial Eligibility' form.
- Verify the 'program_code' column displays correct program(s) code set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'program_shval' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'program_value' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'effective_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'lapse_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Close the 'Crystal Report' or SQL data viewer.
- Login to myAvatar.
- Open the 'Practitioner Enrollment' form for the practitioner identified in the setup section.
- Select the 'Guarantor Coverage' section.
- Verify the guarantor coverage entry created through the 'AddPractitionerGuarantorCoverage' is available in the 'Guarantor Coverage Entry' text area.
- Close the form.
- Open the 'Client Charge Input' form.
- Render a service to the client identified in the setup section. Note the service date, service code.
- Open the 'Client Ledger' form.
- Verify the service distributed correctly to the assigned guarantor.
- Open the 'Close Charges' form.
- Close the service rendered to the client.
- Open the 'Create Interim Billing Batch' form.
- Create an interim billing batch that includes desired client, service, and the guarantor. Note the batch number.
- Close the form.
- Open the 'Electronic Billing' form.
- Compile an unclaimed 837 Professional bill for the client.
- Verify the bill compiles successfully.
- Select 'Run Report' in 'Billing Options' field.
- Select 'Print' in 'Print Or Delete Report' field.
- Select the 'File' field.
- Click [Print 837 Report].
- Validate that the report launches successfully and contains correct client, service, and guarantor.
- Close the report.
- Close the form.
- Access SOAPUI or any other web service tool.
- Locate to the 'DeletePractitionerGuarantorCoverage' method of the WEBSVC.PractitionerRegister web service.
- Enter the practitioner id in the 'PractitionerID' field which is used in the 'AddPractitionerGuarantorCoverage' method.
- Enter the value noted above from the 'ID' field of the SYSTEM.staff_guarantor_coverage SQL table in the 'PractitionerGuarantorCoverageID' field.
- Submit the request.
- Verify the web service files successfully.
- Open the 'Crystal Report' or any other SQL data viewer.
- Locate to the PM namespace.
- Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
- Verify the row with the ID used in the 'DeletePractitionerGuarantorCoverage' is deleted.
- Close the report.
- Open 'Electronic Billing' form.
- Compile an unclaimed bill for the client.
- Validate that a message is received stating: No Valid Information Found. Please Check The Error Report.
- Click [OK].
- Select 'Run Report' in 'Billing Options'.
- Select 'Print' in 'Print Or Delete Report'.
- Select the 'File'.
- Click [Print 837 Report].
- Validate that the report launches and contains a link to 'Required Data Missing: Patient Claim Data'.
- Click the 'Required Data Missing: Patient Service Data' link.
- Verify that the error is - 'No Guarantor Coverage in Effect for Rendering Practitioner'.
- Close the report.
- Close the form.
- Open the 'Registry Settings' form.
- Set the 'Validate Program For Staff Guarantor Coverage' registry setting to 'N'.
- Click [Submit].
- Click [OK].
- Click [No] on the [Form Return] dialog.
- Verify the user navigates to the home page.
- Open the 'Electronic Billing' form.
- Compile an unclaimed 837 Professional bill for the client.
- Verify the bill compiles successfully.
- Select 'Run Report' in 'Billing Options' field.
- Select 'Print' in 'Print Or Delete Report' field.
- Select the 'File' field.
- Click [Print 837 Report].
- Validate that the report launches successfully and contains correct client, service, and guarantor.
- Close the report.
- Close the form.
- Verify the user navigates to the home page.
Scenario 4: 837 Institutional bill - Validating 'Validate Program For Staff Guarantor Coverage' registry setting
Specific Setup:
- Registry Setting:
- The 'Validate Program For Staff Guarantor Coverage' registry setting is set to 'Y'.
- Guarantors/Payors:
- An existing guarantor is identified to be used and all the options are checked in the 'Inhibit Billing if Practitioner is not Covered by this Guarantor' field. Note the guarantor'scode/name.
- Service codes:
- An existing service code is identified to be used. Note the service code/description.
- Service Fee/ Cross Reference Maintenance:
- A fee definition is created for the service code identified in the 'Service Codes' form.
- Practitioner Enrollment:
- An existing practitioner is identified, or a new practitioner is created. The guarantor coverage record for the staff is created that includes guarantor identified in the 'Guarantors/Payors' and desired program(s). Note the guarantor and program.
- Admission:
- An existing client is identified, or a new client is admitted in a program which is defined in the guarantor coverage for the practitioner in the 'Practitioner Enrollment' form. Note client id, admission program, admission date.
- Financial Eligibility:
- A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
- Client Charge Input:
- A service is rendered to the client. Note service date, service code.
- Client Ledger:
- A service distributed correctly to the assigned guarantor.
- Close Charges:
- The service(s) rendered to the client is closed.
- Create Interim Billing Batch:
- An interim billing batch is created that includes desired client, service and the guarantor. Note the batch number.
Steps
- Open the 'Electronic Billing' form.
- Compile an unclaimed 837 Institutional bill for the client.
- Verify the bill compiles successfully.
- Select 'Run Report' in 'Billing Options' field.
- Select 'Print' in 'Print Or Delete Report' field.
- Select the 'File' field.
- Click [Print 837 Report].
- Validate that the report launches successfully and contains correct client, service, and guarantor.
- Close the report.
- Close the form.
- Open the 'Crystal Report' or any other SQL data viewer.
- Locate to the PM namespace.
- Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
- Verify the 'ID' column displays unique id for the guarantor coverage entry created in the 'Practitioner Enrollment' form.
- Verify the 'STAFFID' column displays the correct practitioner id which is set up in the setup section.
- Verify the 'guarantor_id' column displays correct guarantor id for the guarantor assigned to the client in the 'Financial Eligibility' form.
- Verify the 'program_code' column displays correct program(s) code set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'program_shval' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'program_value' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'effective_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Verify the 'lapse_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
- Close the 'Crystal Report' or SQL data viewer.
- Open the 'Practitioner Enrollment' form for the practitioner identified in the setup section.
- Select the 'Guarantor Coverage' section.
- Select an existing guarantor coverage entry from the 'Guarantor Coverage Entry' field.
- Verify the admission program is selected in the 'Program' field.
- Click [Delete Mapping].
- Click [Yes].
- [OK].
- Verify the guarantor coverage record for the admission program of the client is removed from the 'Guarantor Coverage' text area.
- Click [Submit].
- Open the 'Crystal Report' or any other SQL data viewer.
- Locate to the PM namespace.
- Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
- Verify the guarantor coverage created for the client's admission program is deleted from the SQL table.
- Close the 'Crystal Report' or SQL data viewer.
- Verify the user navigates to the home page.
- Open 'Electronic Billing' form.
- Compile an unclaimed bill for the client.
- Validate that a message is received stating: No Valid Information Found. Please Check The Error Report.
- Click [OK].
- Select 'Run Report' in 'Billing Options'.
- Select 'Print' in 'Print Or Delete Report'.
- Select the 'File'.
- Click [Print 837 Report].
- Validate that the report launches and contains a link to 'Required Data Missing: Patient Claim Data'.
- Click the 'Required Data Missing: Patient Service Data' link.
- Verify that the error is - 'No Guarantor Coverage in Effect for Rendering Practitioner'.
- Close the report.
- Close the form.
- Open the 'Registry Settings' form.
- Set the 'Validate Program For Staff Guarantor Coverage' registry setting to 'N'.
- Click [Submit].
- Click [OK].
- Click [No] on the [Form Return] dialog.
- Verify the user navigates to the home page.
- Open the 'Electronic Billing' form.
- Compile an unclaimed 837 Institutional bill for the client.
- Verify the bill compiles successfully.
- Select 'Run Report' in 'Billing Options' field.
- Select 'Print' in 'Print Or Delete Report' field.
- Select the 'File' field.
- Click [Print 837 Report].
- Validate that the report launches successfully and contains correct client, service, and guarantor.
- Close the report.
- Close the form.
- Verify the user navigates to the home page.
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Topics
• 837 Institutional
• 837 Professional
• Practitioner
• Registry Settings
• Web Services
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