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Avatar PM 2024 Update 66

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2024 Monthly Release 2024.01.00
RADplus 2024 Monthly Release 2024.01.00

Product Update Description

The following changes are made: 1) When registry setting 'Enable Alternative Service Location Fields' is set to "Y" the facility location fields on the 'Edit Service Information' and 'Edit Service Information (Charge Fee Access)' forms will become required whenever any one of the fields is valued. Additionally, when none of the facility location fields are valued, none of the facility location fields will be required. 2) An issue has been resolved where addon services were not displaying the correct facility location information.

Required Updates

None

Included Updates

12

Details
NEW1 CHANGED0 FIXED0
New (1)
Edit Service Information
  1. An issue is resolved where the facility location display correctly for add-on services.
  2. An issue is resolved where enabling the registry setting displays facility location either required or not in 'Edit Service Information' and 'Edit Service Information (Charge Fee Access)' forms based on the input.
Value Added: Facility Default Location of Edit Service Information form displays information based on the services selected.
Topics
• 837 Institutional • 837 Professional • Edit Service Information
 
Acceptance Tests
AV-83313 Summary | Details
Edit Service Information
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Ledger
  • Registry Settings (CWS)
  • Registry Settings (PM)
  • Edit Service Information (Charge Fee Access)
  • Create Interim Billing Batch File
  • Electronic Billing
Scenario 1: Edit Service Information
Specific Setup:
  • Registry Settings:
  • Set the "Enable Alternative Service Location Fields" Registry setting to "Y".
  • System is set up to allow ‘Add-On’ services to the primary services.
  • Service Codes:
  • Use ‘Service Code Category’ to note the ‘Primary Code’. Note the associated add-on codes.
  • Guarantors/Payors:
  • Guarantor 1: Note the ‘Financial Class’. This will be the client’s primary guarantor.
  • Guarantor/Program Billing Defaults:
  • The ‘Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = 1.
  • Clients:
  • Client 1:
  • Is enrolled in an outpatient program. Note the program.
  • Client has an active diagnosis record.
  • Client has an active financial eligibility record with the above guarantor.
  • Services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
  • Client 2:
  • Is enrolled in an inpatient program. Note the program.
  • Client has an active diagnosis record.
  • Client has an active financial eligibility record with a primary guarantor.
  • Services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
Steps
  1. Open the 'Edit Service Information' form.
  2. Select 'Client 1' in ‘Client ID’.
  3. Select the 'Service Start Date' and 'Service End Date'.
  4. Click [Select Service(s) To Edit].
  5. Select the desired service in the grid.
  6. Click [OK].
  7. Verify that the 'Facility Location' fields are not required.
  8. Verify that the field ‘Facility Location Code Identifier’ is a text field.
  9. Enter a value in one of the 'Facility Location' fields.
  10. Verify that the 'Facility Location' fields are now required.
  11. Enter desired data in the 'Facility Location' fields. Note the data.
  12. Click [Submit].
  13. Click [No].
  14. Open the SQL Querying tool and validate that the filed 'Facility Location' values for the service is stored with a unique 'JOIN_TO_TX_HISTORY' ID value in the below tables:
  15. "SYSTEM".billing_tx_address
  16. "SYSTEM".billing_claim_address
  17. Close the SQL query window.
  18. Open the 'Edit Service Information' form.
  19. Select 'Client 2' in ‘Client ID’.
  20. Select the 'Service Start Date' and 'Service End Date'.
  21. Click [Select Service(s) To Edit].
  22. Select the desired service in the grid.
  23. Click [OK].
  24. Enter desired data in 'Facility Location' values similar to the above service.
  25. Enter desired data in the required fields.
  26. Select [Submit].
  27. Select [Yes].
  28. Click [Select Service(s) To Edit].
  29. Select the desired service in the grid.
  30. Click [OK].
  31. Enter desired data in the 'Facility Location' values completely different from the Service edited above.
  32. Enter desired data in the required fields.
  33. Select [Submit].
  34. Select [Yes].
  35. Click [Select Service(s) To Edit].
  36. Select the desired services in the grid.
  37. Click the [OK] button.
  38. Verify that the 'Facility Location' information field values are populated and displayed in the form when the 'Facility Location' fields of the services are same.
  39. If desired, edit one of more of the 'Facility Location' fields.
  40. Select [Submit].
  41. Select [Yes].
  42. Click [Select Service(s) To Edit].
  43. Select the desired services in the grid.
  44. Click [OK].
  45. Verify that the newly updated location value is being shown.
  46. Open the SQL Querying tool and validate that the filed 'Facility Location' values for the service are added with the new value(s) with a unique 'JOIN_TO_TX_HISTORY' ID values in the below tables:
  47. "SYSTEM".billing_tx_address
  48. "SYSTEM".billing_claim_address
  49. Close the SQL query window.
  50. Open the 'Edit Service Information' form.
  51. Click [Select Service(s) To Edit].
  52. Click [Yes].
  53. Select the desired services in the grid.
  54. Click [OK].
  55. Verify that the 'Facility Location' information field values are not displayed in the form when the services selected for edit have different values in the 'Facility Location 'fields.
  56. Enter desired data in the 'Facility Location' field(s).
  57. Click [Submit].
  58. Click [Yes].
  59. Click [Select Service(s) To Edit].
  60. Click [Yes].
  61. Select the desired services in the grid.
  62. Click [OK].
  63. Verify that the 'Facility Location' fields are displayed in the form when the services selected for edit have the same 'Facility Location' values.
  64. Click [Discard].
  65. Click [Yes].
Scenario 2: Edit Service Information (Charge Fee Access) - Validation
Specific Setup:
  • Registry Settings:
  • Set the "Enable Alternative Service Location Fields" to "Y".
  • System is set up to allow ‘Add-On’ services to the primary services.
  • Service Codes:
  • Use ‘Service Code Category’ to note the ‘Primary Code’. Note the associated add-on codes.
  • Guarantors/Payors:
  • Guarantor 1: Note the ‘Financial Class’. This will be the client’s primary guarantor.
  • Guarantor/Program Billing Defaults:
  • The ‘Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = 1.
  • Clients:
  • Client 1:
  • Is enrolled in an outpatient program. Note the program.
  • Client has an active diagnosis record.
  • Client has an active financial eligibility record with the above guarantor.
  • Services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
  • Client 2:
  • Is enrolled in an inpatient program. Note the program.
  • Client has an active diagnosis record.
  • Client has an active financial eligibility record with a primary guarantor.
  • Services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
Steps
  1. Open the 'Edit Service Information(Charge Fee Access)' form.
  2. Select 'Client 1' in 'Client ID'.
  3. Select the 'Service Start Date' and 'Service End Date'.
  4. Click [Select Service(s) To Edit].
  5. Select the desired service in the grid
  6. Click [OK].
  7. Verify that the 'Facility Location' fields are not required.
  8. Verify that the field ‘Facility Location Code Identifier’ is a text field.
  9. Enter a value in one of the 'Facility Location' fields.
  10. Verify that the 'Facility Location' fields are now required.
  11. Enter desired data in the 'Facility Location' fields. Note the data.
  12. Click [Submit].
  13. Click [No].
  14. Open the SQL Querying tool and validate that the filed Facility Location values for the service is stored with a unique 'JOIN_TO_TX_HISTORY' ID value in the below tables:
  15. "SYSTEM".billing_tx_address
  16. "SYSTEM".billing_claim_address
  17. Close the SQL query window.
  18. Open the 'Edit Service Information' form.
  19. Select 'Client 2' in 'Client ID'.
  20. Select the 'Service Start Date' and 'Service End Date'.
  21. Click [Select Service(s) To Edit] button.
  22. Select the desired services in the grid.
  23. Click [OK].
  24. Enter desired data in 'Facility Location' values similar to the above service.
  25. Enter desired data in the required fields.
  26. Select [Submit].
  27. Select [Yes].
  28. Click [Select Service(s) To Edit].
  29. Select the desired services in the grid
  30. Click [OK].
  31. Enter desired data in the 'Facility Location' values completely different from the Service-2.
  32. Enter desired data in the required fields.
  33. Click [Submit].
  34. Click [Yes].
  35. Click [Select Service(s) To Edit].
  36. Select the desired services in the grid.
  37. Click [OK].
  38. Verify that the 'Facility Location' information field values are populated and displayed in the form when the 'Facility Location' fields of service are same.
  39. If desired, edit one of more of the Facility Location fields.
  40. Click [Submit].
  41. Click [Yes].
  42. Click [Select Service(s) To Edit].
  43. Select the desired services in the grid
  44. Click [OK].
  45. Verify that the newly updated location value is being shown.
  46. Open the SQL Querying tool and validate that the filed Facility Location values for the service are added with the new value(s) with a unique 'JOIN_TO_TX_HISTORY' ID values in the below tables:
  47. "SYSTEM".billing_tx_address
  48. "SYSTEM".billing_claim_address
  49. Close the SQL query window.
  50. Return to the form.
  51. Click [Select Service(s) To Edit] button.
  52. Click [Yes].
  53. Select the desired services in the grid.
  54. Click [OK].
  55. Verify that the 'Facility Location' information field values are not displayed in the form when the services selected for edit have different values in the Facility Location fields.
  56. Enter desired data in the 'Facility Location' fields.
  57. Click [Submit].
  58. Click [Yes].
  59. Select the desired services in the grid.
  60. Click [OK].
  61. Verify that the 'Facility Location' fields are displayed in the form when the services selected for edit have the same 'Facility Location' values.
  62. Click [Discard].
  63. Click [Yes].
Scenario 3: Filing an 837 Institutional and 837 Professional - Add on Services - Validating the service location information of parent and add on remain same
Specific Setup:
  • Registry Settings:
  • Set the "Enable Alternative Service Location Fields" Registry setting to "Y".
  • System is set up to allow ‘Add-On’ services to the primary services.
  • Service Codes:
  • Use ‘Service Code Category’ to note the ‘Primary Code’. Note the associated add-on codes.
  • Client 1:
  • Is enrolled in an outpatient program. Note the program.
  • Client has an active diagnosis record.
  • Client has an active financial eligibility record.
  • Services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
  • Client 2:
  • Is enrolled in an inpatient program. Note the program.
  • Client has an active diagnosis record.
  • Client has an active financial eligibility record with a primary and secondary guarantor.
  • Services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
  • The 'Guarantor/Program Billing Defaults' template for the guarantor and program combination has a value of '1' in '837 Institutional', 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)'.
Steps
  1. Open 'Electronic Billing' form.
  2. Select '837-Institutional' in 'Billing Form'.
  3. Select the guarantor 'Financial Class' in 'Type' of Bill'.
  4. Select 'Individual' in 'Individual Or All Guarantors'.
  5. Select the desired 'Guarantor'.
  6. Select 'Inpatient' in 'Billing Type'.
  7. Select 'Sort File' in 'Billing Options'.
  8. Enter the desired 'File Description'.
  9. Select 'Interim Billing Batch' in 'All Clients Or Interim Billing Batch'.
  10. Select 'No' in 'Create Claims'.
  11. Enter the 'First Date of Service To Include'.
  12. Enter the 'Last Date of Service To Include'.
  13. Click [Process].
  14. Click [OK].
  15. Select 'Dump File' in 'Billing Options'.
  16. Select 'Print' in 'Print Or Delete Report'.
  17. Select the desired 'File'.
  18. Click [Process].
  19. Validate the facility defaults of primary service is displayed.
  20. Close the report.
  21. Close the form.
  22. Open 'Electronic Billing' form.
  23. Select '837-Professional' in 'Billing Form'.
  24. Select the guarantor 'Financial Class' in 'Type' of Bill'.
  25. Select 'Individual' in 'Individual Or All Guarantors'.
  26. Select the desired 'Guarantor'.
  27. Select 'Outpatient' in 'Billing Type'.
  28. Select 'Sort File' in 'Billing Options'.
  29. Enter the desired 'File Description'.
  30. Select 'Interim Billing Batch' in 'All Clients Or Interim Billing Batch'.
  31. Select 'No' in 'Create Claims'.
  32. Enter the 'First Date of Service To Include'.
  33. Enter the 'Last Date of Service To Include'.
  34. Click [Process].
  35. Click [OK].
  36. Select 'Dump File' in 'Billing Options'.
  37. Select 'Print' in 'Print Or Delete Report'.
  38. Select the desired 'File'.
  39. Click [Process].
  40. Validate the facility defaults of Primary and add-on service are displayed.
  41. Close the report.
  42. Close the form.
Topics
• 837 Institutional • 837 Professional • Edit Service Information