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Avatar PM 2024 Update 51

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2023 Update 73
Avatar PM 2024 Monthly Release 2024.01.01
RADplus 2024 Monthly Release 2024.01.01

Product Update Description

The extended dictionary 'Adult Or Child' is added for the 'Certification Category' field.

Required Updates

None

Included Updates

12

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Dictionary Update - extended dictionary is added for the 'Certification Category' field.
The extended dictionary 'Adult Or Child' is added for the 'Certification Category' field. KB0076331 v0.01
Topics
• 837 Professional • Registry Settings
 
Acceptance Tests
AV-96555 Summary | Details
Dictionary Update - extended dictionary is added for the 'Certification Category' field.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • BBH Setup
  • Registry Settings (PM)
  • User Definition
  • Admission
  • Adult/Child Eligibility Category
  • Client Charge Input
  • Client Ledger
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
Scenario 1: Registry Setting - Enable BBH Service Modifiers
Steps
  1. Open the "Registry Settings" form.
  2. Enable the registry setting "Enable BBH Service Modifiers".
  3. Open the "User Definition" form.
  4. Validate the 2 forms "BBH Setup" and "Adult/Child Eligibility Category" are visible.
  5. Give the user access to the "BBH Setup" form and the "Adult/Child Eligibility Category" form.
  6. Refresh menus.
  7. Validate the "BBH Setup" form can be opened.
  8. Validate the "Adult/Child Eligibility Category" form can be opened.
  9. Open the "Registry Settings" form.
  10. Disable the registry setting "Enable BBH Service Modifiers".
  11. Open the "User Definition" form.
  12. Validate the 2 forms "BBH Setup" and "Adult/Child Eligibility Category" are no longer visible.
  13. Refresh menus.
  14. Validate the "BBH Setup" form is no longer available.
  15. Validate the "Adult/Child Eligibility Category" is no longer available.
Scenario 2: Adult/Child Eligibility Category - Field validations
Specific Setup:
  • Open the "Registry Settings" form.
  • Enable the registry setting "Enable BBH Service Modifiers".
  • Open the "User Definition" form.
  • Give the user access to the "BBH Setup" form and the "Adult/Child Eligibility Category" form.
  • Refresh menus.
  • Open the "BBH Setup" form.
  • Select the "Guarantor(s)" to include.in BBH processing by selecting them in the "Avatar Guarantors for BBH".
  • Select any service codes desired to be excluded from BBH processing.
  • Select any programs to excluded from BBH processing.
  • Navigate to the "Certification Category Setup" section and enter all certification categories that apply.
  • Establish effective and lapse dates of this eligibility category.
  • Establish "Modifier 1" and "Modifier 2" for the certification category.
  • At a minimum, establish a "No Eligibility" category to avoid any billing issues with any client assigned to a guarantor that is included in BBH Setup, but for whom there is no specific BBH setup.
  • Admit a test client into any episode that is not excluded in the "BBH Setup" form.
Steps
  1. Open the "Adult/Child Eligibility Category" form.
  2. Add a row by filing in all required fields and submitting the form.
  3. Submit the form.
  4. Add another row.
  5. Edit a row by changing some data.
  6. Retrieve the edited row and validate the changes are reflected.
  7. Delete a row and validate it's been removed.
Scenario 3: BBH Setup Form - Field Validations
Specific Setup:
  • Open the "Registry Settings" form.
  • Enable the registry setting "Enable BBH Service Modifiers".
  • Open the "User Definition" form.
  • Give the user access to the "BBH Setup" form.
  • Refresh menus.
Steps
  1. Open the "BBH Setup" form.
  2. Populate each field on the form.
  3. Add multiple rows in the "Certification Category" table.
  4. File the form.
  5. Open the "BBH Setup" form.
  6. Validate the fields re display as they were previously filed.
  7. Edit one of the rows in the "Certification Category" table.
  8. Delete a row from the table.
  9. Open the "BBH Setup" form.
  10. Ensure that a default eligibility category of "Not Eligible" is established.
Scenario 4: 837P - BBH Modifiers
Specific Setup:
  • Open the "Registry Settings" form.
  • Enable the registry setting "Enable BBH Service Modifiers".
  • Open the "User Definition" form.
  • Give the user access to the "BBH Setup" form and the "Adult/Child Eligibility Category" form.
  • Refresh menus.
  • Open the "BBH Setup" form.
  • Select the "Guarantor(s)" to include.in BBH processing by selecting them in the "Avatar Guarantors for BBH".
  • Select any service codes desired to be excluded from BBH processing.
  • Select any programs to excluded from BBH processing.
  • Set any modifiers that must be first position modifiers in the SV1 segment of the 837 Professional file.
  • Set any modifiers that must be last position modifiers in the SV1 segment of the 837 Professional file.
  • Navigate to the "Certification Category Setup" section and enter all certification categories that apply.
  • Establish effective and lapse dates of this eligibility category.
  • Establish "Modifier 1" and "Modifier 2" for the certification category.
  • At a minimum, establish a "No Eligibility" category to avoid any billing issues with any client assigned to a guarantor that is included in BBH Setup, but for whom there is no specific BBH setup.
  • Admit a test client into any program.
  • Using the "Adult/Child Eligibility Category" form.
  • Add a row of data for the test client.
  • Select an episode to assign this data to.
  • Select "Adult" in the "Adult or Child" field.
  • Enter a Start date and an End Date.
  • Select a "Certification Category".
  • Using the "Financial Eligibility" form.
  • Assign the test client to a guarantor. Select a guarantor selected in the "BBH Setup" form.
  • Be sure to fill out all required fields.
  • Populate the "Social Security Number" and "Subscriber Policy" fields.
  • Using the "Diagnosis" form.
  • Add diagnosis data for the test client.
  • Using "Client Charge Input" form.
  • Enter in at least one service. Be sure to use a service code that is specified in the "BBH Setup" form.
  • Using the "Close Charges" form.
  • Close charges for the test client.
Steps
  1. Using the "Electronic Billing" form.
  2. Generate an 837 Professional file that includes the BBH covered guarantor, service, and program.
  3. Validate the modifiers in the SV1 segment, where the first modifier is equal to Modifier 1 from the appropriate certification category as set up in "BBH Defaults" form.
  4. Also, validate the modifiers in the SV1 segment, where the last modifier is equal to Modifier 2 from the appropriate certification category as set up in "BBH Defaults" form.
  5. Using the "BBH Setup" form.
  6. Edit an existing row to add a value to the "First Modifier" and for the "Last Modifier".
  7. Using the "Electronic Billing" form.
  8. Generate an 837 Professional file that includes the BBH covered guarantor, service, and program.
  9. Validate the modifiers in the SV1 segment, where the first modifier is equal to a modifier from the "First Position Modifiers" field from the appropriate certification category as set up in "BBH Defaults" form.
  10. Validate the modifiers in the SV1 segment, where the last modifier is equal to a modifier from the "Last Position Modifiers" field from the appropriate certification category as set up in "BBH Defaults" form.
  11. Open the "Registry Settings" form.
  12. Disable the registry setting "Enable BBH Service Modifiers" by setting it to "N" for "No".
  13. Open the "Electronic Billing" form.
  14. Generate an 837 Professional file for the client and service created for this test.
  15. Validate there are no modifiers from any "BBH Setup" in the SV1 segment.
Topics
• 837 Professional • Registry Settings