Avatar ProviderConnect 2024 Quarterly Release 2024.02 Acceptance Tests

1. Open the "Product Updates" form.

2. Select the appropriate [Namespace] from the Application dropdown list

3. Click [Select Update/Customization Pack].

4. Browse to the location for the updates and select the Update 1.

5. Click [OK] on the "File Upload Complete" window.

6. Click [Review Update/Customization Pack Contents].

7. Verify Update 1 is included.

8. Click [Install Update/Customization Pack].

9. Click [OK] when the install completes.

10. Click [Close Form].

• Existing client record available to one or more ProviderConnect Contracting Provider agency/users and eligible for claim/service entry via Avatar MSO
• One or more 837 Professional and/or 837 Institutional format files for compile/posting via Avatar MSO

1. Open Avatar MSO '837 Health Care Claim Professional' and/or '837 Health Care Claim Institutional' form.
2. Load, compile and post one or more 837 Professional and/or 837 Institutional format files including one or more valid claims/services. (Note, this can also be done via Avatar MSO automated 837 processing/'Import/Export File Configuration' functionality.)
3. Log in to ProviderConnect system.
4. In ProviderConnect Main Menu, open 'Lookup Client' form.
5. Enter lookup criteria for desired client and click 'Search by Criteria' button.
6. In 'Client Lookup' results, open client record for view.
7. Navigate to 'Treatment' pre-display tab.
8. Ensure claims/services filed via Avatar MSO are present in ProviderConnect 'Treatment' pre-display.
9. Click 'Tx Date' link to open service detail record for view.
10. In service detail record/data, ensure that values filed via Avatar MSO are present in ProviderConnect system.

• One or more Avatar MSO Contracting Provider(s) eligible for Provider Fee Definition entry/edit

1. Open Avatar MSO 'Provider Fee Definition' form.
2. Select value for 'Enter New' or 'Edit Existing' action.
3. Select Contracting Provider and CPT Service Code/Revenue Code (and select existing fee if using 'Edit Existing' action).
4. Enter/update Provider Fee Definition criteria field values.
5. Click 'Submit' button to file Provider Fee Definition in Avatar MSO and ProviderConnect.
6. Confirm correct receipt of Provider Fee Definition by ProviderConnect system - this can be confirmed by the availability of CPT Service Code/Revenue Code within the ProviderConnect 'Service Authorization' form for the applicable Contracting Provider/agency.

• Existing client record available to one or more ProviderConnect Contracting Provider agency/users

1. Open Avatar PM 'Update Client Data' form (or 'Admission' form) for existing client.
2. Enter or edit values for one or more Demographic data fields (Examples: 'Client Address', 'Date of Birth', 'Social Security Number').
3. Click 'Submit' button to file updated client demographic data in Avatar PM and ProviderConnect.
4. Log in to ProviderConnect system.
5. In ProviderConnect Main Menu, open 'Lookup Client' form.
6. Enter lookup criteria for desired client and click 'Search by Criteria' button.
7. In 'Client Lookup' results, open client record for view.
8. Navigate to 'Demographic' pre-display tab.
9. In Client Demographic record/data, ensure that values filed via Avatar PM are present in ProviderConnect system.

• Existing client record available to one or more ProviderConnect Contracting Provider agency/users and eligible for Service Authorization entry/update

1. Open Avatar MSO 'Service Authorization' form for existing client.
2. Click 'Add' button to enter new Service Authorization record, or 'Edit' button to update existing Service Authorization record.
3. Enter or edit values for Service Authorization fields as desired (Examples: 'Begin Date of Authorization', 'End Date of Authorization', 'Units Authorized')
4. Click 'Submit' button to file new/updated Service Authorization record in Avatar MSO and ProviderConnect.
5. Log in to ProviderConnect system.
6. In ProviderConnect Main Menu, open 'Lookup Client' form.
7. Enter lookup criteria for desired client and click 'Search by Criteria' button.
8. In 'Client Lookup' results, open client record for view.
9. Navigate to 'Authorizations' pre-display tab.
10. Ensure Service Authorization filed via Avatar MSO is present in ProviderConnect 'Authorizations' pre-display.
11. Click 'Auth Number' link to open Service Authorization record for view.
12. In Service Authorization record/data, ensure that values filed via Avatar MSO are present in ProviderConnect system.

• Existing client record available to one or more ProviderConnect Contracting Provider agency/users and eligible for Financial Eligibility entry/update

1. Open Avatar PM/Cal-PM 'Financial Eligibility' form for existing client.
2. Enter or edit values for 'Guarantor Selection' and/or 'Customize Plan' sections of 'Financial Eligibility' form as desired, including values for 'Subscriber Client Index Number', 'Eligibility Code', 'Aid Code', 'EVC Tracking Number', 'Effective Date of Medi-Cal Eligibility' and/or 'Subscriber MEDS ID #' fields where applicable. (Note, the specific fields/properties listed here are only applicable to/available in Avatar Cal-PM systems.)
3. Click 'Submit' button to file new/updated Financial Eligibility record in Avatar PM/Cal-PM and ProviderConnect.
4. Log in to ProviderConnect system.
5. In ProviderConnect Main Menu, open 'Lookup Client' form.
6. Enter lookup criteria for desired client and click 'Search by Criteria' button.
7. In 'Client Lookup' results, open client record for view.
8. Navigate to 'Financial Eligibility' pre-display tab.
9. Ensure Financial Eligibility record filed via Avatar PM is present in ProviderConnect 'Financial Eligibility' pre-display.
10. Click 'Record Date' link to open Financial Eligibility record for view.
11. In ProviderConnect Financial Eligibility record/data, ensure that values filed via Avatar PM/Cal-PM are present in ProviderConnect system.
12. In ProviderConnect Financial Eligibility record/data, ensure that value(s) are present for 'Subscriber Client Index Number', 'Eligibility Code', 'Aid Code', 'EVC Tracking Number' and/or 'Effective Date of Medi-Cal Eligibility' fields/properties where value(s) are filed via Avatar Cal-PM, including case where no value is filed/present for 'Subscriber MEDS ID #' field/property.

• One or more clients with valid Service Authorization(s) eligible for ProviderConnect Treatment/Service entry

1. Log in to ProviderConnect system.
2. In ProviderConnect Main Menu, open 'Lookup Client' form.
3. Enter lookup criteria for desired client and click 'Search by Criteria' button.
4. In 'Client Lookup' results, open client record for view.
5. Navigate to 'Treatment' pre-display tab.
6. Click 'Add Professional Treatment' or 'Add Institutional Treatment' button.
7. Enter values for 'Service Date', 'Authorization', 'CPT Code', 'Clinician' and 'Performing Provider License Type' (if applicable).
8. Click 'Set Treatment Date' button.
9. In 'Treatment Details' form, enter required/desired field values, and click 'Add Treatment(s)' button.
10. Navigate to ProviderConnect Main Menu.
11. In ProviderConnect Main Menu, open 'Billing' menu.
12. Select fiscal year under which service entered above exists, and click 'Generate New Bill' button
13. Click 'Bill Details' button.
14. Click 'Submit Bill' button; this will transmit the service entered to Avatar MSO.
15. In Avatar MSO, open 'Claim Processing (CMS 1500)' or 'Claim processing (UB-04)' form for the claims processing batch created by ProviderConnect.
16. Ensure claim(s) containing service(s) filed via ProviderConnect is/are present in form pre-display.
17. Select claim, and click 'Edit' button.
18. Navigate to 'Service Detail' section of form.
19. Ensure all service rows entered via ProviderConnect are present in claim/service detail section of form.
20. Click 'Submit' button to file claim/service adjudication information from Avatar MSO and ProviderConnect. (Note, this can also be done via system adjudication functions and/or 'Manual Batch Adjudication' form).
21. In Avatar MSO, open 'Close Batch' form and select claims processing batch created for ProviderConnect services.
22. Set 'Close Batch' field to 'Yes' and click 'Submit' button to close batch.
23. In Avatar MSO, create Voucher(s) for services (via 'Create Voucher' form or via 'Claims Processing Automation' functionality).
24. In Avatar MSO, create EOB(s) for services (via 'Create EOB' form or via 'Claims Processing Automation' functionality).
25. In ProviderConnect Main Menu, open 'Lookup Client' form.
26. Enter lookup criteria for desired client and click 'Search by Criteria' button.
27. In 'Client Lookup' results, open client record for view.
28. Navigate to 'Treatment' pre-display tab.
29. Ensure claims/service information updated and filed via Avatar MSO are present in ProviderConnect 'Treatment' pre-display.
30. Ensure that 'Status' and 'Expected Disbursement' columns in 'Treatment' pre-display reflect claim adjudication/EOB data filed via Avatar MSO.

• Netsmart ProviderConnect must be connected to myAvatar PM/MSO instance
• Contracting Provider eligible for entry/update of Contracting Provider Registration record

1. Open Avatar MSO 'Contracting Provider Registration' form.
2. Select Contracting Provider to be registered (or select existing Contracting Provider Registration row for edit).
3. Enter/select values for all required fields, and any additional fields as desired.
4. Navigate to 'Performing Provider's Information' section of form.
5. Add/update/delete Performing Provider assignment records as desired.
6. Click the 'Submit' button to file 'Contracting Provider Registration' form/save changes.
7. In Netsmart ProviderConnect system, ensure that latest Contracting Provider Registration/Performing Provider information is received. (This can be confirmed via availability of Contracting Provider information in 'Manage Agencies' Administrative-level Utility, and/or via Performing Provider records/information available in 'Service Authorization' and 'Treatment Entry' forms for Provider-level users under added/updated Contracting Provider agency.)