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Avatar PM 2024 Update 93

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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

Real-time eligibility (270) enhancements are introduced. See documentation for details.

Required Updates

None

Included Updates

8, 9, 16, 17, 23, 28, 29, 31, 34, 35, 42, 44, 46, 47, 57, 60, 61, 70, 77, 80, 84, 88

Details
NEW1 CHANGED0 FIXED0
New (1)
Real Time Inquiry (270) Request

New fields have been added to the following tables. The changes are displayed in the release note.

  1. SYSTEM.billing270rptheader
  2. SYSTEM.billing271beneinfo
  3. SYSTEM.billing271dependent
  4. SYSTEM.billing271reject
  5. SYSTEM.billing271subscriber
  6. SYSTEM.billing271updatedinfo
  7. SYSTEM.billing271validateinfo

In addition, changes have been made to the 'Real Time Inquiry (270) Request' form

  1. The ‘Request Type’ defaults to 'Generic' value.
  2. The following fields have been removed from the form: 'CPT-4 Code, 'Modifier' and 'Diagnosis Code'.
  3. The data that was displayed in the 'Response’ text field will now be displayed in a report launched by clicking the 'View Raw Response File' button.
  4. New text fields have been added to display the 271 response information: Eligibility Information, Request Validation, and Subscriber/Dependent Details.
  5. The ‘View Eligibility Report’ button launches the same report as was auto-launched prior to this update. It is the same report as the one in the ‘Eligibility Inquiry (270) Submission’ form.
Value Added: Enhances the efficiency of the 'Real Time Inquiry (270) Request' functionality.
Topics
• Real Time Inquiry (270) Request • RevConnect
 
Acceptance Tests
AV-98767 Summary | Details
Real Time Inquiry (270) Request
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Eligibility Inquiry (270/271) Real-Time Setup
  • Eligibility Response (271) Report
  • Financial Eligibility
  • Guarantors/Payors
  • Real Time Inquiry (270) Request
  • Registry Settings (PM)
Scenario 1: PM - Enable RevConnect = YA - Real Time Inquiry (270) Request
Specific Setup:
  • Netsmart Client Alignment Associate has been contacted to enable 'RevConnect'.
  • Netsmart Avatar support has completed the following:
  • Enabled the 'Enable RevConnect' registry setting has been updated to contain 'YA'.
  • Completed & submitted the 'RevConnect Configuration' form.
  • 'System Generated Email Settings' has been used to add the tester’s email to enable notification verification.
  • Registry Setting:
  • The 'Enable 270/271 Transaction Sets' registry setting is set to 'Y'.
  • Eligibility Inquiry (270/271) Real-Time Setup:
  • The 'Access Point Type' contains a 'RevConnect' option only when the 'Enable RevConnect' registry setting has a value of 'YA'.
  • The 'RevConnect Account Key' field is added to the form when the 'Enable RevConnect' registry setting has a value of 'YA'.
  • Guarantors/Payors:
  • An existing guarantor is identified and has a value of:
  • 'Yes' in 'Support 270/271 Transaction Sets' of the '270 / 271 / 834' sections.
  • A value in 'Real Time 270/271 Access Point'.
  • Add desired data to other fields, noting the values.
  • Admission:
  • A client is admitted to a program, or an existing client is identified. Note client id/name, admission date/program.
  • Financial Eligibility: The above guarantor is assigned to client.
  • Based on the setup in the '270 / 271 / 834' section of 'Guarantors/Payors', the client either has one, or any combination of the following: services, appointments, or an eligibility request in financial eligibility.
  • Eligibility Inquiry (270/271) Real-Time Setup:
  • The 'Access Point Type' contains a 'RevConnect' option only when the 'Enable RevConnect' registry setting has a value of 'YA'.
  • The 'RevConnect Account Key' field is added to the form when the 'Enable RevConnect' registry setting has a value of 'YA'.
Steps
  1. Open 'Real Time Inquiry (270) Request'.
  2. Create a request for the client.
  3. Close the form.
  4. Open 'Eligibility Inquiry And Response (270/271) Report'.
  5. Enter the 'Client' ID' and other desired data.
  6. Click 'Display Report'.
  7. Validate the report data.
  8. Close the report.
  9. Close the form.
  10. Open 'Real Time Inquiry (270) Request'.
  11. Enter the 'Client ID', 'Guarantor' and other desired data.
  12. Click [Process Report].
  13. Click [OK].
  14. Review the report data.
  15. Validate that the 'Response' field contains the correct data.
  16. If desired, click [Post Inquiry].
  17. Close the form.
  18. Open 'CareFabric Monitor'.
  19. Enter the desired 'From Date', 'Through Date' and 'Client ID'.
  20. Click [View Activity Log].
  21. Review the data to ensure the events/actions were created.
  22. Close the report.
  23. Close the form.
Topics
• Real Time Inquiry (270) Request • RevConnect
Table Changes
Table Column Change
SYSTEM.billing270rptheader data_entry_offset ADD
SYSTEM.billing270rptheader data_entry_source ADD
SYSTEM.billing270rptheader data_entry_time_j ADD
SYSTEM.billing270rptheader data_entry_timezone_info_all ADD
SYSTEM.billing270rptheader data_entry_timezone_short ADD
SYSTEM.billing270rptheader data_entry_utc ADD
SYSTEM.billing270rptheader option_desc ADD
SYSTEM.billing270rptheader option_id ADD
SYSTEM.billing270rptheader real_time_indicator ADD
SYSTEM.billing270rptheader submit_entry_offset ADD
SYSTEM.billing270rptheader submit_entry_time_j ADD
SYSTEM.billing270rptheader submit_entry_timezone_info_all ADD
SYSTEM.billing270rptheader submit_entry_timezone_short ADD
SYSTEM.billing270rptheader submit_entry_utc ADD
SYSTEM.billing271beneinfo grp ADD
SYSTEM.billing271dependent ref_id_qua_value ADD
SYSTEM.billing271reject data_entry_offset ADD
SYSTEM.billing271reject data_entry_time_j ADD
SYSTEM.billing271reject data_entry_timezone_info_all ADD
SYSTEM.billing271reject data_entry_timezone_short ADD
SYSTEM.billing271reject data_entry_utc ADD
SYSTEM.billing271subscriber has_dependent_data_YN ADD
SYSTEM.billing271subscriber ref_id_qua_value ADD
SYSTEM.billing271subscriber reject_rea_value ADD
SYSTEM.billing271updatedinfo grp ADD
SYSTEM.billing271validateinfo grp ADD