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Avatar PM 2024 Update 68

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Product Requirements and Recommendations

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Recommended Update Level

Avatar PM 2024 Monthly Release 2024.01.01
RADplus 2024 Monthly Release 2024.01.01

Product Update Description

The registry setting 'Include Guarantors with Self Pay System Financial Class' is added for the 'Self Pay Payment Redistribution' process.

Required Updates

None

Included Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Self Pay Payment Redistribution Process
An issue is resolved where THE Self Pay Payment Redistribution process only worked for Self Pay financial class (6).
A new registry setting titled ‘Include Guarantors/Payors with System Financial Class of Self Pay in the Self Pay Payment Redistribution Process’ has been introduced.
When set to ‘Y’, this feature will allow guarantors/payors with an EDE System Financial Class marked as ‘Self Pay’ to be included in the Self Pay Payment Redistribution process.
Value Added: Streamlines payment processing by including all Self Pay classes, enhancing financial operations without disrupting current workflows.
Topics
• Self Pay Payment Redistribution
 
Acceptance Tests
AV-97129 Summary | Details
Self Pay Payment Redistribution Process
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Client Charge Input
  • Client Ledger
  • Deposit Entry
  • Dictionary Update (PM)
  • Financial Eligibility
  • Guarantors/Payors
  • Posting/Adjustment Codes Definition
  • Registry Settings (CWS)
  • Registry Settings (PM)
  • Self Pay Payment Redistribution
  • Service Codes
Scenario 1: Self Pay Payment Redistribution includes System Financial Class of Self Pay
Specific Setup:
  • Service Codes:
  • Identify an existing 'prepayment' service code or create a new service code.
  • Posting/Adjustment Codes Definition:
  • An existing payment posting code (credit) is identified and posting code also has a reversal posting code associated to it to be used for the 'Self Pay Payment Redistribution' process.
  • Select 'Yes' for the 'Include in Self Pay Redistribution Payment Process' field.
  • Registry Settings:
  • Set the 'Limit Registry Settings to the Following Search Criteria' : Pre Payment Service Code.
  • Set the Pre Payment Service Code Registry Setting Value: Service Code identified or created above.
  • Set the 'Limit Registry Settings to the Following Search Criteria' : Self Pay Payment redistribution.
  • Set the 'Self Pay Payment Redistribution Posting Code' Registry Setting Value: Posting Code identified above.
  • Guarantors/Payors:
  • Add or identify a guarantor with the 'Self Pay' financial class.
  • Add a new guarantor with the new financial class added through dictionary update given below.
  • Dictionary Update:
  • File - Payor
  • Data Element - (1000) Financial Class
  • Dictionary Code - The dictionary code for the financial class of the guarantor identified above to be used as secondary guarantor.
  • Extended Dictionary Data Element - (1500) System Financial Class
  • Extended Dictionary Value - Self Pay.
  • Admission:
  • Two new clients are admitted, or existing clients are identified. Note the client id, admission date and admission program.
  • Financial Eligibility:
  • Client 1:
  • Assigned a Primary third party guarantor where the benefit plan includes a co-insurance amount.
  • Assigned self-pay guarantor defined above (with the 'Self Pay' financial class).
  • Client 2:
  • Assigned a Primary third party guarantor where the benefit plan includes a co-insurance amount.
  • Assigned new guarantor defined above (with the new financial class defined above that has a system financial class of self-pay).
  • Client Charge Input:
  • Services are rendered to the clients. Note the service date and service code.
Steps
  1. Open the “Registry Settings” form.
  2. Set the 'Limit Registry Settings' to 'Self Pay Payment Redistribution'.
  3. Click [Yes] in 'Include Hidden Registry Settings'.
  4. Click [View Registry Settings].
  5. Select 'Include Guarantors with Self Pay System Financial Class Registry Setting Value: N' item.
  6. Validate the message displayed : 'When set to 'Y', the 'Self Pay Payment Redistribution' process will consider guarantors that have a Financial Class value where the System Financial Class is set to Self Pay. When 'N' is selected, only text contains 'When set to 'Y', the 'Self Pay Payment Redistribution' process will consider guarantors that have a Financial Class value where the System Financial Class is set to Self Pay. When 'N' is selected, only guarantors with a base Financial Class of Self Pay will be considered during the 'Self Pay Payment Redistribution' process. This is the default behavior of the system'.
  7. Click [OK].
  8. Set the 'Registry Setting Value' to 'N'.
  9. Click [Submit].
  10. Validate the message displays: 'Include Guarantors with Self Pay System Financial Class Successful filing in 'xx'.
  11. Validate the form return dialog contains [Yes] [No].
  12. Click [No].
  13. Open the “Self Pay Payment Redistribution” form.
  14. Click [Individual] in 'All Or Individual Client'.
  15. Enter 'Client 1' created in setup in 'Client ID'.
  16. Click [Run Self Pay Payment Redistribution].
  17. Validates the message displays: 'The process is complete for Client 1'.
  18. Click [OK].
  19. Click [Discard].
  20. Validate that Confirm Close dialog message displays: 'Are you sure you want to close without saving? [Yes] [No].'
  21. Click [Yes].
  22. Open the "Client Ledger" form.
  23. Enter 'Client 1' created in setup in 'Client ID'.
  24. Click [All Episodes] in 'Claim/Episode/All Episodes'.
  25. Click [Simple] in 'Ledger Type'.
  26. Click [Process].
  27. Validate in the report if 'self pay amount paid using the service code created in setup has now been applied to each of the individual services for the self-pay guarantor and that each self-pay guarantor has a zero line balance'.
  28. Click [X].
  29. Click [No].
  30. Repeat Steps 13 - 29 for 'Client 2' from setup.
  31. Repeat Steps 1- 12 with the 'Registry Setting Value Y'
  32. Repeat Steps 13-26 for 'Client 2' from setup.
  33. Validate in the report if 'self pay amount paid using the service code created in setup has now been applied to each of the individual services for the self-pay guarantor and that each self-pay guarantor has a zero line balance'.
  34. Open “Client Charge Input” form.
  35. Enter any value in 'Date Of Service'.
  36. Enter 'Client 1' created in setup in 'Client ID'.
  37. Enter any valid 'Service Code' in 'Service Code'.
  38. Enter any valid 'Practitioner' in 'Practitioner'.
  39. Click [Submit].
  40. Enter any valid 'Service Code' in 'Service Code'.
  41. Click [Submit].
  42. Close the form.
  43. Open "Deposit Entry" form.
  44. Click [Y] in 'Date Of Receipt Or Adjustment'.
  45. Enter 'Client 1' created in setup in 'Client ID'.
  46. Select any Episode # from 'Episode Number'.
  47. Enter the Service Code created in setup in 'Service Code'.
  48. Select appropriate Guarantor from 'Guarantor'.
  49. Enter any value in 'Amount To Post'.
  50. Select Posting Code created in setup from 'Posting Code'.
  51. Click [Submit].
  52. Validate the report displays: 'Deposit Amount'.
  53. Click [Close Report].
  54. Repeat Steps 13-29.
Topics
• Self Pay Payment Redistribution