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MSO to Parent System Integration Mapping

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Associate procedure codes in myAvatar MSO to service codes in myAvatar PM.

  • This will create services in myAvatar PM if services pushed to myAvatar PM as a batch are closed in myAvatar MSO.
  • The CPT and revenue codes in myAvatar MSO must be mapped to associated services in myAvatar PM in order to use those service code fees.

Providers, Staff, and Programs

  1. Go to: Avatar MSO > System Maintenance > MSO to Parent System Integration Mapping
  2. In the Contracting Provider field, enter the contracting provider name, select Process Search.
  3. Select OK.
  4. In the Staff field, enter the staff member name, and select.
  5. In the Program field, select the treatment program.
    • This list contains treatment programs in myAvatar PM.
    • Clicking File submits information entered on that page.
  6. In the Contracting Provider fields, enter the contracting provider.
  7. In the Performing Provider fields, a staff member can be associated with a performing provider. Select the performing provider.
  8. In the Staff field, enter the staff name, and select.
  9. In the Performing Provider field, select the performing provider.

CPT Codes

  1. In the CPT Code field, enter the CPT code description or code.
  2. In the Service Code field, enter the service code description or code to map to the CPT code.
    Note: A service code can be mapped to several CPT codes.
  3. Enter the service code and select File.

Revenue Codes

  1. In the Revenue Code field, enter the revenue code description or code.
  2. In the Service Code field, enter the service code description or code to map to the revenue code.
    Note: A service code can be mapped to several revenue codes.
  3. Enter the service code and select File.

Defaults

  1. In the Default fields, select the value that will populate the Funding Source Registration form when a new funding source is created.
    • Changes to dictionaries mapped in myAvatar MSO update the associated dictionaries in myAvatar PM.
    • In the Default Type Of Admission field, select the value to populate the Type of Admission field.
    • In the Default Source Of Admission field, select the value to populate the Source of Admission field.
    • In the Default Admitting Practitioner field, search for the practitioner by Staff ID Number or Staff Member Name, and select.
    • In the Default Attending Practitioner field, search for the practitioner by Staff ID Number or Staff Member Name, and select.
    • In the Default Practitioner Type field, select the value to populate the Practitioner Type field.
    • In the Default Room And Board Billing Code field, select the code.
    • This field is mapped to the Service Code file in myAvatar PM.
    • In the Default Discharge Practitioner field, search for the practitioner by Staff ID Number or Staff Member Name, and select.
    • In the Default Type Of Discharge field, select the value to populate the Type of Discharge field.

Filing Settings

  1. In the File Admission On Member Enrollment field:
    • Select Yes to file an admission in myAvatar PM when:
      A member is enrolled in myAvatar MSO, and that member has not been admitted in myAvatar PM.
      A client is active in myAvatar MSO and myAvatar PM. A member is enrolled in a new funding source.
      The treatment program associated with the funding source is different then the client's treatment program.
      A new admission episode is created for the client in myAvatar PM.
  2. In the File Discharge On Member Termination field:
    • Select Yes to file a discharge in myAvatar PM when:
      A member is enrolled in myAvatar MSO. The member is terminated from a funding source.
      The member is discharged from the associated treatment program in myAvatar PM.

Third Party Payments

  1. In the Adjust Services With Third Party Payments field, select whether or not to adjust services with third party payments.
  2. In the Segment Used For Third Party Payment Guarantor Identifier field, select the third party payment segment.

Service Authorizations

  1. In the End Date All Authorizations on Client Discharge field, select Yes to update the End Date of Authorization for Service Authorizations to the Discharge Date.

    Note: The Service Authorizations that will be updated are determined by the rules defined in the registry settings Use Best Valid Program Match and Use Program for Episode Match.

    Only Service Authorizations that have an End Date of Authorization after the Discharge Date will be updated.

Adjustments 

  1. In the Contractual Adjustment/Payment Code field, select the adjustment code to be applied.
  2. In the Default Adjustment Code field, select the adjustment code.
    • These codes are defined in the Posting/Adjustment Codes Definition form: Codes where Adjustment is selected in the Adjustment, Payment Or Transfer field, and Yes is selected in the Is This a Reversal Code field.
  3. In the Default Adjustment Reversal Code field, select the reversal code.
    Note: These codes are associated with the default adjustment code, in the Posting/Adjustment Codes Definition form, Which Pym/Adj Code Is This a Reversal For field.
    • The service will be closed.
    • If the third party payor matches an Avatar PM guarantor, liability will distribute to the guarantor and an adjustment will be created for the amount paid, using the code defined in the contractual adjustment, or payment code.
    • If a third party adjustment is indicated, an adjustment will be created in Avatar PM with the same Adjustment Group Code and Adjustment Reason Code.
      The code must have an associated reversal code. If no reversal code is associated, the value in the Default Adjustment Code field applied to the adjustment.
    • An additional adjustment will be filed with the reversal code, or the value in the Default Adjustment Reversal Code field, for the adjustment amount.
    • In the Default Retro Claim Adjudication Adjustment Code for Unclaimed Services field, select the default posting code for unclaimed services when a retro claim adjudication is filed in myAvatar PM.
    • In the Default Retro Claim Adjudication Adjustment Code for Claimed Services field, select the default posting code for claimed services when a retro claim adjudication is filed in myAvatar PM.

      Note: The defaults referenced will only be used if an entry has not been made in the Payment/Adjustment And Transfer Codes Extended Dictionary (these are the adjustment codes available in PM) off of the the Adjustment Code dictionary (Data Element Number 351 under Other Tabled Files) entry for the Adjustment Code that was used for a particular Retro Claim Adjudication record.
  4. If the Add Support For The Input Of Third Party Payer Amounts registry setting is enabled, and a third party payer is selected in a claims processing form (Third Party Payer Assigned to Client field), the following will occur when a service is sent from myAvatar MSO to myAvatar PM:
    Select File.
► Additional Sections
► Registry Settings
► SQL Tables
  • SYSTEM.mso_to_pm_service_failed
  • SYSTEM.mso_to_pm_svc_removed