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Service Filing Section

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Define service filing settings, inhibition rules, and fee overrides that differ by date of service within the Service Filing Section of the MSO To Parent System Integration Mapping form.
Service Filing
  1. In the File Services On Closing Of Batch Or Creation of EOB field, select Yes to file services in myAvatar PM when a batch is closed (Close Batch form), or when an EOB is created (Create EOB form).
  2. Enter the Number of Days Past Batch Closure to Attempt Pushing Services. Any services that were included in a batch that was closed over the number of days specified in this field will be removed from SYSTEM.mso_to_pm_service_failed, and added to a new audit table SYSTEM.mso_to_pm_svc_removed table. Once these services have been removed, no further attempts will be made to push them to PM.
  3. In the Excluded Providers For Service Filing To Parent System field, select the providers to exclude when filing services from MSO to the parent system.
  4. Click File.
Inhibit Rules
  1. In the Define Service Filing Inhibit Rule field, select whether to trigger inhibit rules based on the Individual, a Classification, or All.
  2. In the Provider/Classification field, choose the classifications or providers to trigger the inhibition.
  3. In the Service Filing Inhibit Rule, select the rule.
    • Check Number for EOB - Services will not file to the parent namespace when a check number is missing. 
      Once an EOB Check Number has been recorded in the EOB table for these charges and they are not missing any other required information, then they will be triggered to file into the PM or Cal-PM parent namespace on the next closing of a batch. The EOB Check Number can be entered in the Create EOB form (Other EOB Information section), or from posting a file via the PeopleSoft Interface Post Return File form.
    • EOB Creation - Services will not file until the charges are included on an EOB, in addition to any other missing required information.
      Once the charges are created via the Create EOB form (or via the auto process if the field Automatically Create EOB After Creating Voucher is set to Yes in the Claim Processing Automation form), they will be triggered to file into the PM or Cal-PM parent namespace on the next closing of a batch. 
Enable Fee Override in PM
  • This section is added when the registry setting Enable Fee Override in PM is set to 4. 
  • This section allows an organization to define different fee overrides in PM definitions based on a date of service.
    • For example, an organization could apply a fee override for service dates 1/1/2000-6/30/2023, then create a new fee override for services dated 7/1/2023 and on.
    • This functionality helps provide organizations with flexibility on fee override definitions should configurations change over time.
  • It is imperative that the override definitions cover all possible dates of service that will be processed through myAvatar MSO. Any date of service that is not covered in these definitions will fail to push to PM.
  1. In the Enable Fee Override in PM drop-down, select Create New to create a new fee override definition, or select an existing definition to edit. 
  2. In the Effective Date field, input the date of service the fee override definition should begin.
    Note: When creating multiple fee override definitions, overlapping date ranges are not allowed.
  3. In the End Date field, input the date of service the fee override definition should end, if applicable. 
    • This field can be left blank should the fee override definition remain applicable for current and future dates of service.
  4. Select the applicable Fee Override in PM definition to apply to services in the entered date range. Options are:
    • MSO Total Fee Table Amount - When the batch is closed, each service in the batch being pushed to myAvatar PM will use the MSO Total Fee Table Amount associated with the service as the fee.
    • Expected Disbursement - When the batch is closed, each service in the batch being pushed to myAvatar PM will use the Expected Disbursement associated with the service as the fee. 
    • Total Charge - When the batch is closed, each service in the batch being pushed to myAvatar PM will use the Total Charge associated with the service as the fee.
    • Parent System Service Fee Table - When the batch is closed, each service in the batch being pushed to myAvatar PM will be calculated based on the service fee table in myAvatar PM.
  5. Select File.