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Avatar ProviderConnect NX 2024 Update 3

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Product Update Description

The 'Replacement Claim Assignment (CMS-1500)' and 'Replacement Claim Assignment (UB-04)' forms are added to ProviderConnect NX.

Required Updates

None

Included Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Avatar ProviderConnect NX Supported Forms
Avatar ProviderConnect NX is updated to support/allow the Avatar MSO 'Replacement Claim Assignment (CMS-1500)' and 'Replacement Claim Assignment (UB-04)' forms in 'User Role Definition' and 'User Definition' forms for sub-system code users where ProviderConnect NX is enabled.
Value Added: Adds support for 'Replacement Claim Assignment...' forms in Avatar ProviderConnect NX
Topics
• ProviderConnect NX • ProviderConnect NX Configuration
 
Acceptance Tests
AV-99905 Summary | Details
Avatar ProviderConnect NX Supported Forms
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • User Definition
  • User Role Definition
  • Authorization Hardcopy
  • Claim Processing (CMS 1500)
  • Contracting Provider Service Authorization
  • Contracting Provider Service Authorization Request
  • Fast Service Entry Submission
  • Performing Provider Association
  • Provider Activity Authorization Request
  • Provider Activity Invoice
  • Provider EOB Report
  • Provider File Attach
  • Replacement Claim Assignment (CMS-1500)
  • Replacement Claim Assignment (UB-04)
  • Service Authorization Request
  • Void Claim Assignment
Scenario 1: ProviderConnect NX - 'User Definition' Restrictions
Specific Setup:
  • One or more sub-system codes must be enabled/defined in Avatar PM/Cal-PM
  • One or more sub-system codes where 'ProviderConnect NX Enabled' is set to 'Yes' (via 'ProviderConnect NX Defaults' form)
Steps
  1. Open 'User Role' form.
  2. Enter value for 'User ID' field for new User ID entry, or enter/select User ID for edit in 'Select User' field.
  3. Select value in 'Associate User with a User Role' field (and one or more User Role(s) for association if 'Yes').
  4. If 'Yes' is selected in 'Associate User with a User Role' field, select 'Yes' in 'Allow User Role Customization' field.
  5. If 'User Role(s)' selection for User ID includes only User Roles associated to sub-system codes where ProviderConnect NX is enabled (and 'Yes' is selected for 'Allow User Role Customization'), ensure that user is presented with alert dialog noting 'The System Code '((System Code Name))' is enabled for ProviderConnect NX. Several features including the following sections will be disabled: User CaseLoad and Appointment Scheduling.'
  6. Navigate 'Forms and Tables' section of form.
  7. Select one or more system codes/sub-system codes for User ID association/allowance in the 'System Code(s)' field.
  8. If 'System Code(s)' selection for User ID includes only sub-system codes where ProviderConnect NX is enabled, ensure that user is presented with alert dialog noting 'The System Code '((System Code Name))' is enabled for ProviderConnect NX. Several features including the following sections will be disabled: User CaseLoad and Appointment Scheduling.'
  9. If 'System Code(s)' selection for User ID includes only sub-system codes where ProviderConnect NX is enabled, ensure that the following fields in 'Forms and Tables' section of 'User Definition' form are disabled: 'Allow Product SQL Access', 'Allow Product SQL Access to Additional Datasets' and 'Netsmart Mobile App Access'.
  10. Navigate to 'Document Management' section of form.
  11. If 'System Code(s)' selection for User ID includes only sub-system codes where ProviderConnect NX is enabled, ensure that all fields in the 'Document Management' section of 'User Definition' form are enabled.
  12. Navigate to 'Document Routing' section of form.
  13. If 'System Code(s)' selection for User ID includes only sub-system codes where ProviderConnect NX is enabled, ensure that all fields in the 'Document Routing' section of 'User Definition' form are enabled.
  14. Navigate to 'Appointment Scheduling' section of form.
  15. If 'System Code(s)' selection for User ID includes only sub-system codes where ProviderConnect NX is enabled, ensure that the following fields in the Appointment Scheduling' section of 'User Definition' form are disabled: 'Allow Check In Of Appointments', 'Allow Check Out Of Appointments', 'Allow Posting Payment From Check In', 'Allow Posting Payment From Check Out', 'Allow Remove Check In', 'Financial Eligibility Form To Launch', 'Allow Deleting Appointment If Progress Note Attached', 'Allow Adding Appointments After Date Is Posted' and all 'Site Scheduling...' fields.
  16. Navigate to 'Forms and Tables' section of form.
  17. Click 'Select Forms For User Access' button to assign allowed forms to User ID.
  18. In 'User Definition' form assignment list, ensure that only the following myAvatar PM/Cal-PM, MSO and CWS forms are available for assignment if 'System Code(s)' selection for User ID includes only sub-system codes where ProviderConnect NX is enabled:
  19. Avatar PM/Cal-PM Forms:
  20. 'Admission'
  21. 'Admission (Outpatient)'
  22. 'Cal-OMS Admission'
  23. 'Cal-OMS Annual Update'
  24. 'Cal-OMS Discharge'
  25. 'Cal-OMS Youth/Detox Discharge'
  26. 'Cal-OMS Administrative Discharge'
  27. 'Change Current Password'
  28. 'Client Other Healthcare Coverage'
  29. 'Cross Episode Financial Eligibility'
  30. 'CSI Admission'
  31. 'CSI Assessment'
  32. 'Diagnosis'
  33. 'Discharge'
  34. 'Fast Financial Eligibility'
  35. 'Final to Draft Override'
  36. 'Financial Eligibility'
  37. 'Financial Investigation'
  38. 'Internal Client Consents'
  39. 'Key Event Tracking Form'
  40. 'Partnership Assessment Form'
  41. 'Practitioner Enrollment (Brief)'
  42. 'Quarterly Assessment Form'
  43. 'Real Time Inquiry (270) Request'
  44. 'Update Client Data'
  45. 'Women's Health History'
  46. Avatar MSO Forms:
  47. '837 Health Care Claim Professional'
  48. '837 Health Care Claim Institutional'
  49. 'Batch Creation'
  50. 'Claim Processing (CMS 1500)'
  51. 'Claim Processing (UB-04)'
  52. 'Close Batch'
  53. 'Contracting Provider Service Authorization Request'
  54. 'Contracting Provider Program Availability'
  55. 'Contracting Provider Program Availability Search'
  56. 'Fast Service Entry Submission'
  57. 'Final to Draft Override'
  58. 'Member Specific Information'
  59. 'Provider Activity Authorization Request'
  60. 'Provider Activity Invoice'
  61. 'Provider File Attach'
  62. 'Retro Claim Adjudication'
  63. 'Service Authorization Request'
  64. 'Authorization Hard Copy'
  65. 'Provider EOB Report'
  66. 'Void Claim Assignment'
  67. 'Replacement Claim Assignment (CMS-1500)'
  68. 'Replacement Claim Assignment (UB-04)'
  69. 'Performing Provider Association'
  70. 'ProviderConnect File Attach'
  71. Avatar CWS Forms:
  72. 'Child and Adolescent Needs and Strengths'
  73. Additional Avatar Module Forms (if installed):
  74. 'ASAM Assessment'
  75. 'Finalize ASAM Assessment'
  76. 'CareConnect Inbox'
  77. In 'User Definition' form assignment list, ensure that additional allowed User-Defined RADplus Modeled Forms and Report Forms are available for assignment if 'System Code(s)' selection for User ID includes only sub-system codes where ProviderConnect NX is enabled. Allowed Modeled Forms are those defined under 'PATIENT', 'STAFF', 'PROGRAM' and 'PROVIDER' indirects; allowed User Defined Reports are those defined with only 'PATIENT', 'PROGRAM', 'PROVIDER', 'STAFF' and/or 'MSOBAT' indirect lookup/search criteria fields.
  78. Select form(s) for User ID assignment and click 'OK' button to save selections.
  79. Enter/select values for all required/desired User ID definition fields in form.
  80. Click 'Submit' button to file 'User Definition' form/User ID entry or edit.
  81. If 'System Code(s)' selection for User ID includes one or more system codes and/or sub-system codes where ProviderConnect NX is disabled/not enabled, ensure that the form and field restrictions noted above are not enforced (all User Definition fields are enabled and all myAvatar solution/user-defined forms/reports are available for role assignment).
Scenario 2: ProviderConnect NX - 'User Role Definition' Restrictions
Specific Setup:
  • One or more sub-system codes must be enabled/defined in Avatar PM/Cal-PM
  • One or more sub-system codes where 'ProviderConnect NX Enabled' is set to 'Yes' (via 'ProviderConnect NX Defaults' form)
Steps
  1. Open 'User Role Definition' form.
  2. Enter value for 'User Role ID' field for new User Role entry, or click 'Select Existing User Role' button and select existing User Role for edit.
  3. Select one or more system codes/sub-system codes for User Role association/allowance in the 'System Code(s)' field.
  4. If 'System Code(s)' selection for User Role includes only sub-system codes where ProviderConnect NX is enabled, ensure that user is presented with alert dialog noting 'The System Code '((System Code Name))' is enabled for ProviderConnect NX. Several features including the following sections will be disabled: User CaseLoad and Appointment Scheduling.'
  5. If 'System Code(s)' selection for User Role includes only sub-system codes where ProviderConnect NX is enabled, ensure that the following fields in main section of 'User Role Definition' form are disabled: 'Allow Product SQL Access', 'Allow Product SQL Access to Additional Datasets' and 'Netsmart Mobile App Access'.
  6. Navigate to 'Document Management' section of form.
  7. If 'System Code(s)' selection for User Role includes only sub-system codes where ProviderConnect NX is enabled, ensure that all fields in the 'Document Management' section of 'User Role Definition' form are enabled.
  8. Navigate to 'Document Routing' section of form.
  9. If 'System Code(s)' selection for User Role includes only sub-system codes where ProviderConnect NX is enabled, ensure that all fields in the 'Document Routing' section of 'User Role Definition' form are enabled.
  10. Navigate to 'Appointment Scheduling' section of form.
  11. If 'System Code(s)' selection for User Role includes only sub-system codes where ProviderConnect NX is enabled, ensure that the following fields in the Appointment Scheduling' section of 'User Role Definition' form are disabled: 'Allow Check In Of Appointments', 'Allow Check Out Of Appointments', 'Allow Posting Payment From Check In', 'Allow Posting Payment From Check Out', 'Allow Remove Check In', 'Financial Eligibility Form To Launch', 'Allow Deleting Appointment If Progress Note Attached', 'Allow Adding Appointments After Date Is Posted' and all 'Site Scheduling...' fields.
  12. Navigate to main section of form.
  13. Click 'Select Forms For User Access' button to assign allowed forms to User Role.
  14. In 'User Role Definition' form assignment list, ensure that only the following myAvatar PM/Cal-PM, MSO and CWS forms are available for assignment if 'System Code(s)' selection for User Role includes only sub-system codes where ProviderConnect NX is enabled:
  15. Avatar PM/Cal-PM Forms:
  16. 'Admission'
  17. 'Admission (Outpatient)'
  18. 'Cal-OMS Admission'
  19. 'Cal-OMS Annual Update'
  20. 'Cal-OMS Discharge'
  21. 'Cal-OMS Youth/Detox Discharge'
  22. 'Cal-OMS Administrative Discharge'
  23. 'Change Current Password'
  24. 'Client Other Healthcare Coverage'
  25. 'Cross Episode Financial Eligibility'
  26. 'CSI Admission'
  27. 'CSI Assessment'
  28. 'Diagnosis'
  29. 'Discharge'
  30. 'Fast Financial Eligibility'
  31. 'Final to Draft Override'
  32. 'Financial Eligibility'
  33. 'Financial Investigation'
  34. 'Internal Client Consents'
  35. 'Key Event Tracking Form'
  36. 'Partnership Assessment Form'
  37. 'Practitioner Enrollment (Brief)'
  38. 'Quarterly Assessment Form'
  39. 'Real Time Inquiry (270) Request'
  40. 'Update Client Data'
  41. 'Women's Health History'
  42. Avatar MSO Forms:
  43. '837 Health Care Claim Professional'
  44. '837 Health Care Claim Institutional'
  45. 'Batch Creation'
  46. 'Claim Processing (CMS 1500)'
  47. 'Claim Processing (UB-04)'
  48. 'Close Batch'
  49. 'Contracting Provider Service Authorization Request'
  50. 'Contracting Provider Program Availability'
  51. 'Contracting Provider Program Availability Search'
  52. 'Fast Service Entry Submission'
  53. 'Final to Draft Override'
  54. 'Member Specific Information'
  55. 'Provider Activity Authorization Request'
  56. 'Provider Activity Invoice'
  57. 'Provider File Attach'
  58. 'Retro Claim Adjudication'
  59. 'Service Authorization Request'
  60. 'Authorization Hard Copy'
  61. 'Provider EOB Report'
  62. 'Void Claim Assignment'
  63. 'Replacement Claim Assignment (CMS-1500)'
  64. 'Replacement Claim Assignment (UB-04)'
  65. 'Performing Provider Association'
  66. 'ProviderConnect File Attach'
  67. Avatar CWS Forms:
  68. 'Child and Adolescent Needs and Strengths'
  69. Additional Avatar Module Forms (if installed):
  70. 'ASAM Assessment'
  71. 'Finalize ASAM Assessment'
  72. 'CareConnect Inbox'
  73. In 'User Role Definition' form assignment list, ensure that additional allowed User-Defined RADplus Modeled Forms and Report Forms are available for assignment if 'System Code(s)' selection for User Role includes only sub-system codes where ProviderConnect NX is enabled. Allowed Modeled Forms are those defined under 'PATIENT', 'STAFF', 'PROGRAM' and 'PROVIDER' indirects; allowed User Defined Reports are those defined with only 'PATIENT', 'PROGRAM', 'PROVIDER', 'STAFF' and/or 'MSOBAT' indirect lookup/search criteria fields.
  74. Select form(s) for User Role assignment and click 'OK' button to save selections.
  75. Enter/select values for all required/desired User Role definition fields in form.
  76. Click 'Submit' button to file 'User Role Definition' form/User Role entry or edit.
  77. If 'System Code(s)' selection for User Role includes one or more system codes and/or sub-system codes where ProviderConnect NX is disabled/not enabled, ensure that the form and field restrictions noted above are not enforced (all User Role Definition fields are enabled and all myAvatar solution/user-defined forms/reports are available for role assignment).
Scenario 3: ProviderConnect NX - Verification of Avatar MSO Contracting Provider Form and Lookup Restrictions
Specific Setup:
  • One or more sub-system codes where 'ProviderConnect NX Enabled' is set to 'Yes' and with 'Associated Contracting Providers' assigned (via 'ProviderConnect NX Defaults' form)
Steps
  1. Login to ProviderConnect NX enabled Avatar sub-system code.
  2. Open Avatar MSO ProviderConnect NX-supported form with one or more Contracting Provider lookup fields included (and/or Contracting Provider-based form):
  3. '837 Health Care Claim Professional'
  4. '837 Health Care Claim Institutional'
  5. 'Claim Processing (CMS 1500)'
  6. 'Claim Processing (UB-04)'
  7. 'Close Batch'
  8. 'Contracting Provider Service Authorization Request'
  9. 'Contracting Provider Program Availability'
  10. 'Contracting Provider Program Availability Search'
  11. 'Fast Service Entry Submission'
  12. 'Final to Draft Override'
  13. 'Provider Activity Authorization Request'
  14. 'Provider Activity Invoice'
  15. 'Provider File Attach'
  16. 'Retro Claim Adjudication'
  17. 'Service Authorization Request'
  18. 'Authorization Hardcopy'
  19. 'Provider EOB Report'
  20. 'Void Claim Assignment'
  21. 'Replacement Claim Assignment (CMS-1500)'
  22. 'Replacement Claim Assignment (UB-04)'
  23. 'Performing Provider Association'
  24. In Avatar MSO ProviderConnect NX-supported form pre-display for new or existing records under Contracting Provider-based form, ensure that pre-display Contracting Provider selection includes only Contracting Provider(s) applicable to/allowed for current sub-system code (as defined in 'ProviderConnect NX Defaults' form 'Associated Contracting Providers' field).
  25. Examples:
  26. 'Contracting Provider Service Authorization Request' form pre-display Contracting Provider selection
  27. 'Provider Activity Authorization Request' form pre-display Contracting Provider selection
  28. 'Performing Provider Association' form pre-display Contracting Provider selection
  29. In Avatar MSO ProviderConnect NX-supported form pre-display for existing claims processing batches, ensure that pre-display includes only claims processing batches for Contracting Provider(s) applicable to/allowed for current sub-system code (as defined in 'ProviderConnect NX Defaults' form 'Associated Contracting Providers' field, and where association data exists for Provider ID/Batch ID in Avatar MSO SQL table 'SYSTEM.batch_current_providers').
  30. Examples:
  31. 'Claim Processing (CMS 1500)' form pre-display
  32. 'Close Batch' form pre-display
  33. In Avatar MSO ProviderConnect NX-supported form, ensure that 'Contracting Provider' lookup/selection/entry fields allow selection of only Contracting Provider(s) applicable to/allowed for current sub-system code (as defined in 'ProviderConnect NX Defaults' form 'Associated Contracting Providers' field).
  34. Examples:
  35. 'Fast Service Entry Submission' form 'Provider' field
  36. 'Service Authorization Request' form 'Provider To Be Authorized' field
  37. 'Provider File Attach' form 'Provider' field
  38. 'Provider EOB Report' form 'Contracting Provider' field
  39. 'Void Claim Assignment' form 'Contracting Provider' field
  40. 'Replacement Claim Assignment (CMS-1500)' form 'Contracting Provider' field
  41. 'Replacement Claim Assignment (UB-04)' form 'Contracting Provider' field
  42. 'Authorization Hardcopy' form 'Provider' field
  43. In Avatar MSO ProviderConnect NX-supported form, ensure that 'Contracting Provider' lookup/selection/entry fields are automatically populated with Contracting Provider applicable to/allowed for current sub-system code and disabled/read-only in case where only single 'Associated Contracting Provider' value is defined for sub-system code.
  44. Examples:
  45. 'Fast Service Entry Submission' form 'Provider' field
  46. 'Service Authorization Request' form 'Provider To Be Authorized' field
  47. In Avatar MSO ProviderConnect NX-supported form, ensure that lookup/selection fields for existing claims processing batches include only claims processing batches under Contracting Provider(s) applicable to/allowed for current sub-system code (as defined in 'ProviderConnect NX Defaults' form 'Associated Contracting Providers' field, and where data exists for Provider ID/Batch ID in Avatar MSO SQL table 'SYSTEM.batch_current_providers').
  48. Example:
  49. '837 Health Care Claim Professional' form 'Select File' field
Topics
• ProviderConnect NX • ProviderConnect NX Configuration