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Avatar PM 2024 Update 50

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2019 Update 218
Avatar PM 2024 Monthly Release 2024.01.00
RADplus 2024 Monthly Release 2024.01.00

Product Update Description

The following issues are resolved: 1) The subscriber policy number may not default into 'Cross Episode Financial Eligibility' when using the additional policy numbers and default guarantor assignment options. 2) The 'Value to Display in 2330B NM1-09/2430 SVD-01' field is added to the 'billing_guar_table' table. 3) 'Theaputic' is corrected to 'Therapeutic' in the 'Reason for Service Code' dictionary.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED3
Fixed (3)
Cross Episode Financial Eligibility - Policy number
Resolves an issue to ensure that the subscriber policy number defaults into 'Cross Episode Financial Eligibility' when using the additional policy numbers and default guarantor assignment options. KB0076594 v0.01
Topics
• Cross Episode Financial Eligibility
 
NCPDP Response screen - Spelling error
Resolves an issue to ensure that the NCPDP responses to RxConnect does not contain spelling errors.
Topics
• Dictionary
 
SYSTEM.billing_guar_table - field validation
Resolves an issue to ensure that the 'value_to_display_in_2330B_code' and 'value_to_display_in_2330B_value' fields are added to the SYSTEM.billing_guar_table and display correct data for the guarantor based on the guarantor setup in the 'Guarantors/Payors' and 'Guarantor/Program Billing Defaults' forms. KB0076490 v0.01
Topics
• Database Tables • Guarantor/Payors
 
Acceptance Tests
AV-96339 Summary | Details
Cross Episode Financial Eligibility - Policy number
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Cross Episode Financial Eligibility
  • Default Guarantor Assignment
  • Financial Eligibility
  • Registry Settings (PM)
Scenario 1: Cross Episode Financial Eligibility - Policy Number Verification
Specific Setup:
  • Registry Settings:
  • Set the 'Avatar PM->Client Information->Client Demographics->->->Additional Fields Registry Setting Value' to the value that covers the value to add 'Additional Policy Numbers'.
  • Set the 'Avatar PM->Billing->Financial Eligibility->->->Enable Default Guarantor Assignment' to 'Y'.
  • Default Guarantor Assignment:
  • A guarantor is defined to default in 'Cross Episode Financial Eligibility' upon the filing of admission. Note the guarantor code/name.
  • Admission (Outpatient):
  • A new client is admitted. The guarantor defined above and the policy number of the guarantor are added in the 'Demographics' section. Note the client id, value of the 'Guarantor 1' field and the value added in the 'Policy Number 1' field.
Steps
  1. Open the 'Cross Episode Financial Eligibility' form.
  2. Validate the 'Guarantor #1' field populated correctly with the guarantor added in the 'Demographics' section of the admission form of the client.
  3. Navigate to the 'Guarantor Selection' section.
  4. Validate the 'Subscriber Policy #' is populated correctly with the policy number of the guarantor added in the 'Demographics' section of the admission form of the client.
  5. Click [Submit].
  6. Open the 'Default Guarantor Assignment' form.
  7. Select desired guarantor in the 'Select Guarantor to Default' field.
  8. Select the 'Filing of Admission' option in the 'Default the Guarantor(s) During' field.
  9. Select the 'Financial Eligibility' in the 'Add the Guarantor(s) to Which Form' field.
  10. Click [Submit].
  11. Open the 'Admission' or Admission(Outpatient)' form.
  12. Admit a new client.
  13. Navigate to the 'Demographics' section.
  14. Add the guarantor used in the 'Default Guarantor Assignment' form and add a policy number.
  15. Click [Submit].
  16. Open the 'Financial Eligibility' form.
  17. Validate the 'Guarantor #1' field populated correctly with the guarantor added in the 'Demographics' section of the admission form of the client.
  18. Navigate to the 'Guarantor Selection' section.
  19. Validate the 'Subscriber Policy #' is populated correctly with the policy number of the guarantor added in the 'Demographics' section of the admission form of the client.
  20. Click [Submit].
Topics
• Cross Episode Financial Eligibility
AV-96867 Summary | Details
NCPDP Response screen - Spelling error
Scenario 1: RXConnect - PM - NCPDP responses to RxConnect - Validating spelling error
Steps

Internal testing only.
Topics
• Dictionary
AV-97177 Summary | Details
SYSTEM.billing_guar_table - field validation
Scenario 1: SYSTEM.billing_guar_table' - field validations
Specific Setup:
  • Guarantors/Payors:
  • An existing non contract guarantor is identified that has data on file for the following field. Note the guarantor code/name and value from the field.
  • Guarantors/Payors section:
  • 837 Section:
  • Value to Display in 2330B NM1-09/2430 SVD-01
  • Review the help message associated with this field.
  • Guarantor/Program Bulling Defaults:
  • 837 Professional section:
  • Payer Identification # (2010BB/2330B-NM1-09)
  • 837 Institutional section:
  • Payer Identification Number
Steps
  1. Open the 'Crystal Report' or any other data viewer.
  2. Query the 'SYSTEM.billing_guar_table' for the guarantors identified in the setup section.
  3. Verify the 'value_to_display_in_2330B_code' and 'value_to_display_in_2330B_value' fields are added to the 'SYSTEM.billing_guar_table.
  4. Verify that the 'value_to_display_in_2330B_code' and 'value_to_display_in_2330B_value' displays data correctly based on the data set up in the 'Value to Display in 2330B NM1-09/2430 SVD-01' field of the 'Guarantors/Payors' form and the 'Payer Identification # (2010BB/2330B-NM1-09)' field set up in the 'Guarantor/Program Billing Defaults' form.
  5. Close the report.
Topics
• Database Tables • Guarantor/Payors
Table Changes
Table Column Change
billing_guar_table value_to_display_in_2330B_code Added
billing_guar_table value_to_display_in_2330B_value Added