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Avatar PM 2024 Update 69

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2024 Monthly Release 2024.01.02
RADplus 2024 Monthly Release 2024.01.02

Product Update Description

An issue is resolved where required services set in 'Advanced Billing Rule Definition' may not be found when entering services.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Advanced Billing Rule Definition
An issue is resolved where required services defined in 'Advanced Billing Rule Definition' may not be found when entering services. KB0076747 v0.01
Topics
• Advanced Billing Rule Definition
 
Acceptance Tests
AV-98063 Summary | Details
Advanced Billing Rule Definition
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Advanced Billing Rule Definition
  • Client Charge Input
  • Client Ledger
  • Financial Eligibility
Scenario 1: Advanced Billing Rule Definition
Specific Setup:
  • Admission:
  • An existing client is identified, or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • Two guarantors, identified in the 'Guarantors/Payors' form. are assigned to the client as a primary guarantor and secondary guarantor.
  • Service Codes:
  • Service Code 1 = selected in 'Service Code' in 'Advanced Billing Rule Definition' form.
  • Service Code 2 = selected in 'Selected Service(s) Must Be Rendered By A Practitioner With One Of The Following Practitioner Categories For Coverage' in 'Advanced Billing Rule Definition' form.
Steps
  1. Open "Advanced Billing Rule Definition" form.
  2. Click [Add] in 'Add Or Edit Advanced Billing Rule'.
  3. Click [Yes] in 'Active'.
  4. Enter any description in 'Advanced Billing Rule Description'.
  5. Select 'Service Code 1' in 'Service Code'.
  6. Select the primary guarantor in 'Guarantor'.
  7. Enter any value in 'Effective Date'.
  8. Click desired value in 'Associated To Gender'.
  9. Click [Compliance] in 'Rule Defines Conditions For *'.
  10. Select 'Service Code 2' in 'Select Service(s) That Must Also Be Rendered For Distribution'.
  11. Select desired value in 'Selected Service(s) Must Be Rendered By A Practitioner With One Of The Following Practitioner Categories For Coverage'.
  12. Set 'Selected Service(s) Must Be Rendered Within How Many Days Prior To The Service For Incident To Services' to '0'.
  13. Click [File Advanced Billing Rule].
  14. Verify the message: 'Advanced billing rule filed'.
  15. Click [OK].
  16. Click [Discard].
  17. Click [Yes].
  18. Open "Client Charge Input" form.
  19. Enter 'Client ID'.
  20. Enter desired date in 'Date of Service'.
  21. Enter 'Service Code 1' in 'Service Code'.
  22. Enter the desired 'Practitioner'.
  23. Click [Submit].
  24. Validate Form Return.
  25. Click [Yes].
  26. Repeat Steps 18-25 for 'Service Code 2' with same 'Date of Service'.
  27. Open "Close Charges" form.
  28. Click [Liability Update] in 'Liability Update Or Close Charges'.
  29. Enter the date of services given in 'Client Charge Input' in 'Thru Date'.
  30. Click [Individual] in 'Individual, All, Or Interim Batch Cycle'.
  31. Enter the 'Client ID'.
  32. Select the desired 'Episode' in 'Episode Number'.
  33. Click [Submit].
  34. Open the "Client Ledger" form.
  35. Enter the 'Client ID'.
  36. Click [All Episodes] in 'Claim/Episode/All Episodes'.
  37. Click [Simple] in 'Ledger Type'.
  38. Click [Yes] in 'Include Zero Charges'.
  39. Click [Process].
  40. Validate the report data to verify that the charges distributed to primary guarantor.
  41. Click [X].
  42. Click [No].
  43. Repeat Steps 1-17.
  44. Repeat Steps 18-39 with Date of Service for 'Service Code 1' before the Date of Service for 'Service Code 2'.
  45. Validate the report data to verify that the charges distributed to the secondary guarantor.
  46. Click [X].
  47. Click [No].
Topics
• Advanced Billing Rule Definition