Avatar SF 2024 Monthly Release 2024.01.02 Acceptance Tests
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Michigan County Bill - Crystal Report and SQL table changes
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Michigan County Bill
- Michigan County Bill - Compile File
- Crystal Report Viewer
- Discharge
Scenario 1: Michigan County Bill - Validating a bill for the discharged inpatient client
Specific Setup:
- Guarantors/Payors:
- Three existing guarantors are identified to be used. One of them is with a financial class of 'Self-Pay'. Note the guarantor code/name.
- Service codes:
- An existing service code is identified to be used. Note the service code/description.
- Service Fee/ Cross Reference Maintenance:
- A fee definition is created for the service code identified in the ' Service Codes' form using the revenue code. Note the revenue codes for the service code(s) identified.
- Admission:
- An existing client is identified or a new client is admitted. Note client id, admission program, admission date.
- Financial Eligibility:
- The guarantors identified in the 'Guarantors/Payors' form is assigned to the client as a primary, Secondary and Self-Pay as a tertiary guarantor.
- A financial eligibility record for the client is created such that the liability distributed across all 3 guarantors.
- Recurring Client Charge Input:
- 5-7 services are rendered to the client. Note service dates, service codes.
- Client Ledger:
- The services are distributed correctly to the assigned guarantors.
- Dictionary Update:
- File - Payor
- Data Element - Financial Class
- Dictionary Code - Desired code for the financial class of the third party guarantor
- Dictionary Value - Financial class of the third party guarantor
- Extended Dictionary Data Element - Exclude from Michigan County Bill as Third Party
- Extended Dictionary Value - No
- Individual Cash Posting:
- Partial payments posted against the primary guarantor of the client using 'Check'. Note the amount, posting date and check number.
- Partial payments posted against the third party guarantor of the client using 'Check'. Note the amount, posting date and check number.
- Close Charges:
- The charges are closed.
- Discharge:
- Client is discharged after last date of service.
Steps
- Open the 'Michigan County Bill' form.
- Select "Compile" from the 'Compile, Print, or Delete' field.
- Set the 'Print Charges Thru' field to a desired date.
- Select "No" in the 'Create Claims' field.
- Select "No" in the 'Print For Interim Batch' field.
- Select desired guarantors from the 'Guarantor(s)' field.
- Select "Individual" from the 'Print For An Individual Or All Clients' field.
- Select desired client from 'Client ID' field.
- Click [Process County Bill].
- Validate the bill compiles successfully.
- Validate the crystal report launched successfully and includes following details:
- Validate 'DISCHARGE DATE' field exist under 'CUR ADMIT DATE' field.
- Validate 'DISCHARGE DATE' field displays the date of discharge when the client is discharged from the episode.
- Validate 'DISCHARGE DATE' field does not display any value when the client is active in the episode.
- Validate the total charges in the 'PATIENT MONTHLY TOTAL' section between days and liability.
- Validate the total charges for each patient for each month grouped by revenue code.
- Validate the guarantor name and payment amount for all third party guarantors other than billing guarantor.
- Validate the total billed to self-pay guarantor.
- Close the report.
- Close the form.
- Open the 'Crystal Report' or any other SQL data viewer.
- Run the SQL query to retrieve data from the 'STATEFORM.mich_county_bill_census' table.
- Validate the 'discharge_date' field is added in the 'STATEFORM.mich_county_bill_census' table.
- Run the SQL query to retrieve data from the 'STATEFORM.mich_county_bill_stmt' table.
- Validate the 'total_charges' field is added to the table and contains correct charges.
- Validate the 'total_billed_self_pay' is added to the table and contains correct charges distributed to the self pay gaarantor.
- Validate the 'third_party_guar_id' field is added to the table and displays correct guarantor code for the third party guarantor.
- Run the SQL query to retrieve data from the 'STATEFORM.mich_county_bill_detail' table.
- Validate the 'total_charges' field is added to the table and contains correct charges.
- Validate the 'total_billed_self_pay' is added to the table and contains correct charges distributed to the self pay gaarantor.
- Validate the 'third_party_guar_id' field is added to the table and displays correct guarantor code for the third party guarantor.
- Validate the rows with new 'type' of "THIRDPARTY" and add new field called 'third_party_guar_id'.
- Validate the 'revenue_code' field is added to the table and displays revenue code of the service code.
- Validate the 'check_eft_num' field exist in the table and displays the correct value of the check/EFT numbers.
- Close the report.
Scenario 2: Michigan County Bill - Active Outpatient client
Specific Setup:
- Guarantors/Payors:
- Three existing guarantors are identified to be used. One of them is with a financial class of 'Self-Pay'. Note the guarantor code/name.
- Service codes:
- An existing service code is identified to be used. Note the service code/description.
- Service Fee/ Cross Reference Maintenance:
- A fee definition is created for the service code identified in the ' Service Codes' form using the revenue code. Note the revenue codes for the service codes identified.
- Admission (Outpatient):
- An existing client is identified or a new client is admitted. Note client id, admission program, admission date.
- Financial Eligibility:
- The guarantors identified in the 'Guarantors/Payors' form is assigned to the client as a primary, Secondary and Self-Pay as a tertiary guarantor.
- A financial eligibility record for the client is created such that the liability distributed across all 3 guarantors.
- Diagnosis:
- The diagnosis record is created for the client. Not the diagnosis date. Client should have active diagnosis record at the date of service.
- Recurring Client Charge Input:
- 5-7 services are rendered to the client. Note service dates, service codes.
- Client Ledger:
- The services are distributed correctly to the assigned guarantors.
- Dictionary Update:
- File - Payor
- Data Element - Financial Class
- Dictionary Code - Desired code for the financial class of the third party guarantor
- Dictionary Value - Financial class of the third party guarantor
- Extended Dictionary Data Element - Exclude from Michigan County Bill as Third Party
- Extended Dictionary Value - No
- Individual Cash Posting:
- Partial payments posted against the primary guarantor of the client using 'Check'. Note the amount, posting date and check number.
- Partial payments posted against the third party guarantor of the client using 'Check'. Note the amount, posting date and check number.
- Close Charges:
- The charges are closed.
Steps
- Open the 'Michigan County Bill' form.
- Select "Compile" from the 'Compile, Print, or Delete' field.
- Set the 'Print Charges Thru' field to a desired date.
- Select "No" in the 'Create Claims' field.
- Select "No" in the 'Print For Interim Batch' field.
- Select desired guarantors from the 'Guarantor(s)' field.
- Select "Individual" from the 'Print For An Individual Or All Clients' field.
- Select desired client from 'Client ID' field.
- Click [Process County Bill].
- Validate the bill compiles successfully.
- Validate the crystal report launched successfully and includes following details:
- Validate 'DISCHARGE DATE' field exist under 'CUR ADMIT DATE' field.
- Validate 'DISCHARGE DATE' field does not display any value as the client is active in the episode.
- Validate the total charges in the 'PATIENT MONTHLY TOTAL' section between days and liability.
- Validate the total charges for each patient for each month grouped by revenue code.
- Validate the guarantor name and payment amount for all third party guarantors other than billing guarantor.
- Validate the total liability distributed to the self-pay guarantor.
- Close the report.
- Close the form.
- Open the 'Crystal Report' or any other SQL data viewer.
- Run the SQL query to retrieve data from the 'STATEFORM.mich_county_bill_census' table.
- Validate the 'discharge_date' field is added in the 'STATEFORM.mich_county_bill_census' table.
- Run the SQL query to retrieve data from the 'STATEFORM.mich_county_bill_stmt' table.
- Validate the 'total_charges' field is added to the table and contains correct charges.
- Validate the 'total_billed_self_pay' is added to the table and contains correct charges distributed to the self pay gaarantor.
- Validate the 'third_party_guar_id' field is added to the table and displays correct guarantor code for the third party guarantor.
- Run the SQL query to retrieve data from the 'STATEFORM.mich_county_bill_detail' table.
- Validate the 'total_charges' field is added to the table and contains correct charges.
- Validate the 'total_billed_self_pay' is added to the table and contains correct charges distributed to the self pay gaarantor.
- Validate the 'third_party_guar_id' field is added to the table and displays correct guarantor code for the third party guarantor.
- Validate the rows with new 'type' of "THIRDPARTY" and add new field called 'third_party_guar_id'.
- Validate the 'revenue_code' field is added to the table and displays revenue code of the service code.
- Validate the 'check_eft_num' field exist in the table and displays the correct value of the check/EFT numbers.
- Close the report.
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Topics
• Michigan County Bill
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Avatar_SF_2024_Monthly_Release_2024.01.02_Details.csv