Critical Information Agency Intake
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Client Search
- Critical Information
- Agency Placement [EDIT]
Scenario 1: Validate Client Agency Intake Date Can Be Updated in Different Time Zones
Specific Setup:
- Client currently enrolled in agency.
- Have the ability to change time zone.
Steps
- Navigate to "Client > Client Information > Critical Information > Enrollment Information".
- Select desired Client.
- Open Agency Intake form.
- Change the intake date to one day before the current intake date.
- Save and validate changes are saved.
- Logout.
- Change device to a different time zone.
- Login to myEvolv.
- Navigate to "Client > Client Information > Critical Information > Enrollment Information".
- Select desired Client.
- Open Agency Intake form.
- Change the intake date to one day before the current intake date.
- Save and validate changes are saved.
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Topics
• Client
|
ECS-55641
Summary
|
Details
11.0.0100, 11.0.0025.08, 11.0.0050.05, 11.0.0075.02
Program Modifier During Re-Admit To Agency
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Critical Information
- Agency Re-Admission [EDIT]
- Program Listing by Agency and Service Event
- Placement Events by Agency/Program - People
- Provider Sites by Program
- Client Search
- Unit Table
Scenario 1: Validate Program Modifier Field Resets Upon Selecting A Different Program Upon Re-Admission
Specific Setup:
- Requires a client that was enrolled into a program with a program modifier.
- Client should be discharged from the agency.
Steps
- Navigate "Client > Client Information > Critical Information > Enrollment Information".
- Select desired client.
- Click "Display Menu of Actions" button on the agency enrollment.
- Select "Re-Admit To Agency".
- Set desired "Re-Admission Date".
- Click "Re-Admit to Program" and select desired program.
- Validate the "Modifier" field does not contain previous "Program Modifier".
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Topics
• Client
|
Cost Center and Program Unit Linked to Claims Hierarchy
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Billing Batches Management
- Immediate Billing Run Request [ADD]
- Submitter Information
- Billing Run Request Limit People Subform
- All People with Benefit Assignments with LOS
- Billing Batch Management 2.0 Form Set
- BillingProcessHistory
- FinanceClaims
- Claim 2.0 [EDIT]
- Group Programs Subform
- Cost Center Definitions
- Payor-Facility License Link Subform
- Plans/Contracts by Payer and Receiver
- Client Search
- Critical Information
- Program Enrollment [Edit]
- Program Unit All
- Client Finance Related Information Form Set
- Payers of Agency
- Billing Provider Number Type
Scenario 1: Validate Cost Center Override On Consolidated Claims
Specific Setup:
- Requires two services that have been billed and they are set with "Service Line Consolidation".
- Both services should have same "Cost Center" on rate setup.
Steps
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Search for desired claim.
- Open the claim and validate it contains "Cost Center" from rate setup.
- Close the claim.
- Navigate to "Agency > Service Locations > Sites/Residentials > General Information".
- Select "Facility" associated with claim.
- Scroll to "Programs/Services Operated".
- Set the "Override Cost Center" on the program row associated with the claim.
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Reprocess the batch.
- Validate there is one consolidated claim.
- Click on the claim link to open the claim.
- Validate "Cost Center Code" on "Accounting Info" is contains the "Cost Center Override" from the "Facility Program Link".
- Close claim.
- Navigate to "Agency > Service Locations > Sites/Residentials > General Information".
- Select "Facility" associated with claim.
- Scroll to "Licensing".
- Set the "Override Cost Center" on the Payor/Plan row associated with the claim.
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Reprocess the batch.
- Validate there is one consolidated claim.
- Click on the claim link to open the claim.
- Validate "Cost Center Code" on "Accounting Info" is contains the "Cost Center Override" from the "Facility Licensing Link".
- Close claim.
- Click on "Client" name link the "Billing Batch Claims Review" window.
- Click on "Enrollment Information".
- Click "Actions" on the program associated with the claim.
- Select "Correct/Close Program Enrollment".
- Click on "Cost Center Override", select a record.
- Save and Close.
- Reprocess batch.
- Validate there is one consolidated claim.
- Click on the claim link to open the claim.
- Validate "Cost Center Code" on "Accounting Info" is contains "Cost Center" set on "Program Enrollment".
- Close the claim.
Scenario 2: Validate Cost Center Hierarchy
Specific Setup:
- System is set up with Cost Centers Units.
- Requires at least one claim that can be reprocessed.
- Claim is set up with "Cost Center" set on rate setup.
Steps
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Search for desired claim.
- Open the claim and validate it contains "Cost Center" from rate setup.
- Close the claim.
- Navigate to "Agency > Service Locations > Sites/Residentials > General Information".
- Select "Facility" associated with claim.
- Scroll to "Programs/Services Operated".
- Set the "Override Cost Center" on the program row associated with the claim.
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Reprocess the batch.
- Click on the claim link to open the claim.
- Validate "Cost Center Code" on "Accounting Info" is contains the "Cost Center Override" from the "Facility Program Link".
- Close claim.
- Navigate to "Agency > Service Locations > Sites/Residentials > General Information".
- Select "Facility" associated with claim.
- Scroll to "Licensing".
- Set the "Override Cost Center" on the Payor/Plan row associated with the claim.
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Reprocess the batch.
- Click on the claim link to open the claim.
- Validate "Cost Center Code" on "Accounting Info" is contains the "Cost Center Override" from the "Facility Licensing Link".
- Close claim.
- Click on "Client" name link the "Billing Batch Claims Review" window.
- Click on "Enrollment Information".
- Click "Actions" on the program associated with the claim.
- Select "Correct/Close Program Enrollment".
- Click on "Cost Center Override", select a record.
- Save and Close.
- Reprocess batch.
- Click on the claim link to open the claim.
- Validate "Cost Center Code" on "Accounting Info" is contains "Cost Center" set on "Program Enrollment".
- Close the claim.
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Topics
• Client
• Finance
• Finance Setup
|
Nexus – Invoice for Educational Services
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claims Maintenance NX Form Set
- Claim 2.0 [EDIT]
- Claim Receivers Setup Form Set
- Receiver Information - All
- Receiver Information Generic [EDIT]
- Alternative Claim Output
- Billing Batches Management
- Claim Output Ready
- Claim Output
- FinanceClaims
- Client Finance Related Information Form Set
- Benefit Assignment [EDIT]
- Related People
- Relationship - Family Table
Scenario 1: “Nexus – Invoice for Educational Services” Custom Invoice for Nexus Family Healing (Nexus)
Specific Setup:
- Billing batch with at least one claim that has multiple service lines.
- Client should have Benefit Assignment billing setup for service.
- Available Guardian/Parent to link to Client's Benefit Assignment.
- A second Billing batch with one claim that only has one service line.
- Alternative Claim Output Format set to "Nexus – Invoice for Educational Services".
Steps
- Navigate to "Finance > Claim Maintenance > Automatic > Claim Information".
- Search for 1st desired claim from setup.
- Take note of 1st Service Lines "Units" and 1st Billed Services "Program Modifier".
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Filter for desired batch.
- Click "Actions > Nexus – Invoice for Educational Services".
- Generate the output.
- Validate "Days" under the “Membership” segment and the “Total Number of Education Service” matches "Units" from step 3.
- Validate "Comments" section under "Billing Information" contains "Program Modifier" from step 3.
- Validate Parent's (Guardian's) Full Name, Address, City, State, and Zip Code under "Parent Information" section is blank.
- Navigate to "Client > Client Information > Personal Information > Benefit Assignments".
- Search for desired client from claim.
- Add a Guardian/Parent to the "Name of Insured (If not Client)" section for the Benefit Assignment.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Filter for desired batch.
- Click "Actions > Nexus – Invoice for Educational Services".
- Generate the output.
- Validate Parent's (Guardian's) Full Name, Address, City, State, and Zip Code under "Parent Information" section matches "Name of Insured (If not Client)" person.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Filter for desired batch with only 1 service.
- Click "Actions > Nexus – Invoice for Educational Services".
- Generate the output.
- Validate "Days" under the “Membership” segment and the “Total Number of Education Service” matches "Units" for that service.
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Topics
• Finance
• Finance Setup
|
ECS-57713
Summary
|
Details
11.0.0100, 11.0.0025.08, 11.0.0050.05, 11.0.0075.02
Finance Setup -Copying Contracts
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Payers/Contracts Setup 2.0 Form Set
- Payers Setup Table
- ContractsRatesSetup
- Billing Plan Setup NX [EDIT]
- Billing Qualifying Services Subform
Scenario 1: Copy Rate Functionality - Rate Headers
Specific Setup:
- Existing plan/contract on record.
- User has access to Finance setup module.
Steps
- Navigate to "Finance Setup > Payer/Contract/Rates Setup > Payer/Contract/Rates Setup > Contracts Setup".
- Click the "Select Payer" button.
- Select desired payer.
- Click the "New Contract" button.
- Select "Copy from existing plan/contract" from the drop-down listing.
- Select the desired record from the listing to be copied.
- Set the "Description", "Receiver Information", and any other desired fields.
- Click the "Continue" button.
- Click the "Refresh" link.
- Validate the newly created contract displays.
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Topics
• Finance Setup
|
ECS-58053
Summary
|
Details
11.0.0100, 11.0.0025.08, 11.0.0050.05, 11.0.0075.02
"CCD" Search
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Client > Client Information > Personal Information > Demographics
- Select Client
- Client > Case Management > Service Management > Service Entry
- Query CQN
- Netsmart Technologies, Inc. [CCD Preview]
Scenario 1: Validate "CCD" Information Displays In "CQN"
Specific Setup:
- CQN-enabled myEvolv environment.
- At least one client to search for.
Steps
- Navigate to "Client > Client Information > Personal Information > Demographics" and select the Client.
- Select "CQN" from the "Actions" menu.
- Enter a Provider Name.
- Click on the "Search" button.
- Select a provider from the "Care Quality Organizations" table.
- Click on the "Find Available CCDs" button.
- Validate the table is populated.
- Click the "Preview CCD" (magnifying glass) button to preview the CCD.
- Redo the test with multiple providers selected.
- Validate the table populates.
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Topics
• CQN/HIE
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Multi Agency Walk-In Appointments
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Agency [EDIT]
- FrontDeskCheckIn
- Client Related Task Walk Ins [ADD]
- Staff - Service Providers (by Staff_id)
- All Clients With Security Listing by PeopleID
- Program by Person and Agency (Active)
- Facilities Listing by Program
- Event Definitions with Security by Program
Scenario 1: Multi Agency - Validate Viewing Events In Common Programs Are Agency Specific - Walk In
Specific Setup:
- Multiple agencies exist in the system. In this example they will be called "AgencyA" and "AgencyB".
- The staff have logins to the multiple agencies.
- Each agency is using the same program name. The program in each agency has a different list of service events configured.
- At least one event is able to be scheduled.
- At least one client that is enrolled in the program for the agency.
Steps
- Login to "AgencyA".
- Navigate to "Taskbar > Attendance Check In/Out > Check In/Out > Front Desk NX".
- Click "Walk In" button.
- Fill in the required fields.
- When the "Activity" look up is selected, validate the look up table displays with the events.
- Validate only the events in "AgencyA" display.
- Validate events in "AgencyB" that are not in "AgencyA" do not display.
- Close the Form
- Exit out of "AgencyA".
- Log into "AgencyB".
- Redo the above test.
- Validate events in "AgencyA" that are not in "AgencyB" do not display.
- Validate "AgencyB" events display.
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Topics
• Agency
• Event Setup
|
Claim Receiver Output
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claim Receivers Setup Form Set
- Receiver Information - All
- Alternative Claim Output
- Billing Batches Management
- Claim Output Ready
- Claim Output
- Receiver Information Generic [EDIT]
- Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management
Scenario 1: Finance Claim Output – "Northeast Parent and Child Society DDS- 1104"
Specific Setup:
Available billing batch to output.
Steps
- Navigate to "Finance Setup > Agency Setup > Claim Receivers Setup > Receiver General Info".
- Select desired "Claim Receiver".
- Change "Alternative Claim Output Format" to "Northeast Parent and Child Society DSS -1104".
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Filter for a "Billing Batch" using desired "Claim Receiver" from step 2.
- Click "Actions > Northeast Parent and Child Society DSS -1104".
- Click "Generate Paper Output".
- Validate output displays desired results and aligns with headers/columns/footers.
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Topics
• Finance
• Finance Setup
|
ECS-59038
Summary
|
Details
11.0.0100, 11.0.0025.08, 11.0.0050.05, 11.0.0075.02
Opening Forms From Standalone Form Sets
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- My Referral Information Form Set
- Select File for Upload
- Text Templates
- Program Listing by Agency and Service Event
- Provider Sites by Program
- My Client Information Form Set
- Basic Assessment [ADD]
- Program by Client's Service Track and Service
- Basic Assessment [EDIT]
Scenario 1: Widgets Pending Referral - Validate "Upload Document" Window Closes
Specific Setup:
A "Pending Referral" exists on the "My Pending Referrals" Widget.
Steps
- Navigate to "Taskbar > My Homeview > Homeview Launcher > Homeview".
- Select the "My Pending Referrals" Widget.
- Access a referral from the widget.
- Click the "Assessment" Tab.
- Add an assessment that contains a document upload feature.
- Upload a file.
- Save the file.
- Fill in any other required fields.
- Save the form.
- Validate all forms closed prior do not display.
- Exit the "My Referral Information" form.
- Validate the form displays the widget selections.
- Select the same referral.
- Edit the assessment just created.
- Remove the image and load a second image.
- Validate all forms close appropriately.
- Save the file.
- Validate prior forms closed display.
- Close the form.
- Validate the widgets form displays.
- Validate no forms closed in prior steps display.
Scenario 2: Widgets My Clients - Validate "Text Template" Window Closes
Specific Setup:
- Staff that has clients displaying in the "My Clients Widget".
- An "Assessment" exists that contains a "Note" area.
- The "Note" area has existing templates.
Steps
- Navigate to "Taskbar > My Homeview > Homeview Launcher > Homeview".
- Select the "My Clients" Widget.
- Access a client from the widget.
- Click the "Assessment" Tab.
- Add an assessment that contains a document upload feature.
- Fill in any required fields.
- Select the "Progress Note" template.
- Validate the template is entered into the progress note.
- Validate the "Text Template" look up table clears.
- Save the form.
- Validate all forms closed prior do not display.
- Exit the "Client Information" form.
- Validate the form displays the widget selections.
- Validate all items closed prior, do not display.
- Select the same client.
- Edit the assessment just created.
- Modify the progress note with a new template.
- Validate the "Text Template" look up table closes.
- Save the form.
- Validate prior forms closed do not display.
- Close the form.
- Validate the widgets form displays.
- Validate no forms closed in prior steps display.
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Topics
• Forms
• SubForm
|
Inbound Messages Configured For Payload "V2"
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Import Services Form Set
- Import File Templates
- ImportFileLog
- Referral Search
- Referral Information Form Set
- Agency Referral Personal Information [EDIT]
- Race Subform
- Members Personal Form [EDIT]
- Address by ZIP code Subform
- Alternative IDs Subform
- Marital History Sub Form Subform
- Benefit Assignment [EDIT]
Scenario 1: Inbound EPICADT04 and EPICADT08- Create, Update Patient- Validate Version "V2" Payload Functionality
Specific Setup:
- A referral record that will be added into the system. This will be the "EPICADT04" record.
- A second referral record to update a pre-existing referral in the system, This will be the "EPICADT08" record.
- The user knows the values in the fields.
Steps
- Send the "EPICADT04" record, this will be the new referral.
- Navigate to "Taskbar > System Maintenance > Import Services > Import File Log".
- Select the template used, "EPIC Create New Referral".
- Validate no errors occurred for the import.
- Navigate to "Referral > Agency Referral > Referral Information > Demographics".
- Validate the referral was added.
- Validate the demographic data that was sent is accurate.
- Navigate to the "Benefit Assignments" tab.
- Validate the benefit assignment data matches what was sent.
- Update the referral with the "EPICADT08" record.
- Validate modifications sent were updated on the referral record.
- Validate changes in the address create a new address line.
- Resend the same data files a second time.
- Validate the extra send does not modify the records or add additional records.
Scenario 2: Inbound Orchard - Validate Version "V2" Payload Functionality
Specific Setup:
- A referral and client record that will be added into the system.
- The user knows the values in the fields.
Steps
- Send the "Orchard" record, this will be the new referral.
- Navigate to "Taskbar > System Maintenance > Import Services > Import File Log".
- Select the template used.
- Validate no errors occurred for the import.
- Navigate to Referral > Agency Referral > Referral Information > Demographics".
- Validate the referral was added.
- Validate the demographic data that was sent is accurate.
- Navigate to "Client > Client Information > Personal Information > Demographics".
- Select the client.
- Validate the demographic data that was sent is accurate.
|
Topics
• CareConnect
• Third Party Solution
|
Claim Submission
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Billing Batches Management
- AR Management
- Billing Request Action Based Run [ADD]
- Action Based Run - Claim Action Types
- Billing Batch Management 2.0 Form Set
- BillingProcessHistory
- Cash Receipts for Remittance
- All Clients With Security Listing by PeopleID
- FinanceClaims
- Claim 2.0 [EDIT]
- Claim/Invoice Batch [VIEW]
- Claim Output Ready
- ActionsView
- Claim Action Reasons
Scenario 1: Validate Bulk Calculate Rate Adjustment/Replacement Claims
Specific Setup:
- Scenario works with claims that have been paid.
- Services have been changed to include new units.
Steps
- Navigate to "Finance > Remittance Processing > Remittance Application > AR Management".
- Select desired remittance check.
- Set parameter's to search for desired claims.
- Click "Paid" link to group the claims together.
- Click "Bulk Actions" button.
- Select "Adjustment/Replacement".
- Check the desired claims to be included in the "Action Based Run".
- At the bottom of the screen click "Remaining Balance" and select "Calculate Rate - Billing".
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run" and select and "Action Based Run".
- Set desired description.
- Click on "Action Type" and select "Adjustment/Waterfall".
- Set desired date range.
- Scroll to "Run for Receiver".
- Validate desired "Receiver" is listed with the amount of claims that were checked with "Bulk Adjustment and Calculate Rate".
- Check the "Receiver" checkbox.
- Click "Save".
- Wait for billing to run.
- Validate the billing run returns desired claims.
- Click on the "Claim" link.
- Validate the claims generated with the correct "Submission # 2".
- Validate the claim generated with the correct number of units.
- Click on the claim to view the "Accounting Info".
- Validate the "Journal Entries" contain desired amount.
Scenario 2: Validate Resubmit With Bulk Calculate Rate Includes Additional Units
Specific Setup:
- Requires claims that can be remitted.
- Scenario works with at least 5 claims.
- Services for each of the billed claims have been edited so that they rebill with more units.
Steps
- Navigate to "Finance > Remittance Processing > Remittance Application > AR Management".
- Select desired remittance check.
- Set parameter's to search for desired claims.
- Click "Denied" link to group the claims together.
- Click "Bulk Actions" button.
- Select "Resubmit".
- Check the desired claims to be included in the "Action Based Run".
- At the bottom of the screen click "Remaining Balance" and select "Calculate Rate - Billing".
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run" and select and "Action Based Run".
- Set desired description.
- Click on "Action Type" and select "Resubmit".
- Set desired date range.
- Scroll to "Run for Receiver".
- Validate desired "Receiver" is listed with the amount of claims that were checked with "Bulk Resubmit and Calculate Rate".
- Check the "Receiver" checkbox.
- Click "Save".
- Wait for billing to run.
- Validate the billing run returns desired claims.
- Click on the "Claim" link.
- Validate the claims generated with the next "Submission # 2".
- Validate the claim generated with the expected number of units.
Scenario 3: Validate Resubmit With Bulk Calculate Rate Includes Additional Units
Specific Setup:
- Requires claims that can be remitted.
- Scenario works with at least 5 claims.
- Services for each of the billed claims have been edited so that they rebill with more units.
Steps
- Navigate to "Finance > Remittance Processing > Remittance Application > AR Management".
- Select desired remittance check.
- Set parameter's to search for desired claims.
- Click "Denied" link to group the claims together.
- Click "Bulk Actions" button.
- Select "Resubmit".
- Check the desired claims to be included in the "Action Based Run".
- At the bottom of the screen click "Remaining Balance" and select "Calculate Rate - Billing".
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run" and select and "Action Based Run".
- Set desired description.
- Click on "Action Type" and select "Resubmit".
- Set desired date range.
- Scroll to "Run for Receiver".
- Validate desired "Receiver" is listed with the amount of claims that were checked with "Bulk Resubmit and Calculate Rate".
- Check the "Receiver" checkbox.
- Click "Save".
- Wait for billing to run.
- Validate the billing run returns desired claims.
- Click on the "Claim" link.
- Validate the claims generated with the next "Submission # 2".
- Validate the claim generated with the expected number of units.
|
Topics
• Finance
|
ECS-59330
Summary
|
Details
11.0.0100, 11.0.0025.07, 11.0.0050.04, 11.0.0075.01
Printing Test/Assessment
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Client Search
- Client Service Entry
- Print Preview
Scenario 1: Validate Printing An Assessment With Multiple SubReports
Specific Setup:
- Requires an assessment with multiple "SubReports" on various areas of the event.
- Questions on the assessment are also flagged with "Two questions on one row".
Steps
- Navigate to "Client > Case Management > Service Management > Service Entry".
- Select desired client.
- Click on desired "Completed Event".
- Click "Print" and select "Print Form".
- Validate the assessment prints and displays desired "SubReports".
|
Topics
• Assessments
|
VRS/Private Pay Claim Output
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claim Receivers Setup Form Set
- Receiver Information - All
- Receiver Information Generic [EDIT]
- Billing Batches Management
- FinanceClaims
- Claim/Invoice Batch [VIEW]
- Claim Output Ready
- Claim Output
- Print Preview
Scenario 1: Validate VRS/Private Pay Claim Output
Specific Setup:
Requires a client with services that can be billed.
Steps
- Navigate to "Finance Setup > Agency Setup > Claim Receivers Setup > Receiver General Info".
- Select desired "Receiver".
- Click "Claim Output Format" lookup table.
- Select "VRS/Private Pay Claim Output".
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run" and select "Immediate Run".
- Fill in required fields to generate desired claims.
- Save.
- Wait for billing to run.
- Click "Actions" button and select the "VRS/Private Pay Claim Output".
- Download the file and open it.
- Validate it contains desired claim information including "Service Name, Unit and Amounts".
|
Topics
• Finance
|
UB 04 Claim Output
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claim Receivers Setup Form Set
- Receiver Information - All
- Receiver Information Generic [EDIT]
- Billing Batches Management
- Immediate Billing Run Request [ADD]
- Submitter Information
- Claim Output
- Billing Place of Service
- Claim Output Ready
- Alternative Claim Output
- Payor-Facility License Link Subform
- Payers of Agency
- Plans/Contracts by Payer and Receiver
- Billing Provider Number Type
- Program by Managing Office and Agency
Scenario 1: Validate Billing Custom Output - UB-04
Specific Setup:
- User has access to "PaperUB04" receiver in "Finance Setup".
- Client must have payor setup in "Benefit Assignment".
- Facility is configured with Licensing Information at "Agency > Service Locations > Sites/Residentials > General Information".
Steps
- Navigate to "Finance Setup > Agency Setup > Claim Receivers Setup > Receiver General Info".
- Click the "Claim Receiver" button.
- Search and select desired receiver.
- Validate the "Is Active" checkbox is checked.
- Set the "Claim Output Format" LUT button to desired claim output.
- Set the "Output File Name (Prefix)" input box to "ub04.txt".
- Set the "Alternative Claim Output Format" input box to "UB-04 without formatting".
- Click "Save".
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run".
- Select "Immediate Run" from the drop down list.
- Fill out required fields.
- Check the "Receiver" checkbox that contains "UB-04".
- Click "Save".
- Wait until the next billing run is complete.
- Click the "Receivers" button.
- Select receiver used from the "Receivers" drop down list.
- Click "Apply Filters".
- Click "Actions".
- Select the "UB-04 without formatting" output from the drop down list.
- Click the "Generate Paper Output" button.
- In the claim output page,
- Validate the page layout is equal to "UB-04 without formatting".
- Validate the page contains the claim information listed in the recently submitted billing run.
- Click "Close".
- Close out of the "Claim Output Ready" page.
- Navigate to "Finance Setup > Agency Setup > Claim Receivers Setup > Receiver General Info".
- Set the "Alternative Claim Output Format" input box to "UB-04 without formatting - one line per claim".
- Click "Save".
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "Refresh".
- Click "Actions".
- Select "UB-04 without formatting - one line per claim" from the drop down list.
- Click the "Generate Paper Output" button.
- In the claim output page,
- Validate multiple claim lines are listed.
- Validate the page contains the claim information listed in the recently submitted billing run.
- Click "Close".
- Close out of the "Claim Output Ready" page.
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Topics
• Finance
• Finance Setup
|
Recreate To New Payer Action
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claim/Invoice Batch [VIEW]
- AR Management
- Claim 2.0 [EDIT]
- FinanceClaims
- Claim Output Ready
- 837 File
- Cash Receipts for Remittance
- Claims Submission For Remittance NX [EDIT]
- Claim Service Lines NX Subform
- Authorization - Finance [EDIT]
- Client Search
- All Clients With Security Listing by PeopleID
Scenario 1: Validate Recreate To New Payer Action
Specific Setup:
- Requires a client with a billed service.
- Client must have a new "Primary Benefit Assignment" the service can be rebilled to.
Steps
- Navigate to "Finance > Remittance Processing > Remittance Application > AR Management".
- Select desired remittance.
- Set parameters to search for desired claim.
- Add a "Denial" status.
- Click "Add Action"
- Under "Action" select "Recreate To New Payer".
- Validate "Submit To" field only the new "Primary" payer is listed.
- Save.
- Wait for billing to run.
- Open the "Action Based Billing Run".
- Create Output.
- Validate the contains only "Primary Payer" information.
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Topics
• Finance
• Finance Setup
• Widgets
|
SCO Millin Encounter
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Billing Batches Management
- FinanceClaims
- Claim Output Ready
Scenario 1: Validate "SCO Millin Encounter" Claim Output for a Batch That Contains Two Different Claims Tied to the Same Service
Specific Setup:
- Contract setup for Millin Encounter.
- Contract should have 2 rates that can apply to the same service.
- Client with a benefit assignment with Plan for Millin.
- Client has a service that can be billed.
- Batch containing 2 claims for the same service.
Steps
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Filter for Batch from setup.
- Click "Actions > SCO Milin Encounter".
- Click "Download Electronic File".
- Validate csv file downloads.
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Topics
• Finance
• Finance Setup
|
My Client Widget
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Client Search
- ProgramReferralSearch
- Worker Assignments Form Set
- Workgroup Assignment - Referrals Made [VIEW]
- Program Referrals > Program Referrals > Worker Assignments > Staff Responsible for Referral
- Program Referrals > Program Referrals > Worker Assignments > Auto-assigned Workgroups
Scenario 1: "My Client" Widget - Validate Staff Cannot View Clients With Referrals-Only Access
Specific Setup:
- Client that has a Referral record.
- Staff 1:
- assigned as "Staff Responsible for Referral" for the Client.
- is not assigned directly assigned to the Client.
- is not enrolled in a Workgroup assigned to the client (manually or automatically).
- is not enrolled in a Workgroup that is automatically assigned to both the referral and client (usually via program).
- has access to myClient Widget.
- Staff 2 has direct access to Client and myClient Widget.
Steps
- Login as Staff 1 that has access to Client.
- Navigate to "Taskbar > My Homeview > Homeview Launcher > Homeview".
- Search for Client from setup.
- Validate Client link displays.
- Logout and login as Staff 2(that only has Referral access to client).
- Navigate to "Taskbar > My Homeview > Homeview Launcher > Homeview".
- Search for Client from setup.
- Validate Client does not display.
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Topics
• Client
• Program Referrals
• Taskbar
• Widgets
|
Nexus – Invoice for Educational Services
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claims Maintenance NX Form Set
- Claim 2.0 [EDIT]
- Client Finance Related Information Form Set
- Critical Information
- Billing Batches Management
- Claim Output Ready
- Claim Output
- Claim Receivers Setup Form Set
- Receiver Information - All
- Receiver Information Generic [EDIT]
- Alternative Claim Output
Scenario 1: "Nexus - Invoice for Educational Services" - Validate "Program Modifier" Displays under Billing Information "Comments"
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Topics
• Finance
|
KY State Reporting - 837 File
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Claim Receivers Setup Form Set
- Receiver Information - All
- Receiver Information X12 Submissions [EDIT]
- Client Search
- Benefit Assignment [EDIT]
- Billing Batches Management
- Immediate Billing Run Request [ADD]
- Submitter Information
- Billing Run Request Limit People Subform
- All People with Benefit Assignments with LOS
- Billing Batch Management 2.0 Form Set
- BillingProcessHistory
- Claim Output Ready
- Notepad++
Scenario 1: Wellspring KY Receiver
Specific Setup:
- Within " Finance Setup > Agency Setup > Claim Receivers Setup > Receiver Setup X12" select the desired receiver, check off the "Segment Terminator with CRLF" field.
- Billing batch on record containing claims for desired receiver.
Steps
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click the "New Run" button.
- Select "Immediate Run" from the list box.
- Set the desired "Submitter", "Run Description" "From Date", "Through Date", and any other fields.
- Set the "Run for Receivers", to the desired receiver that contains the "Segment Terminator with CRLF" field set.
- Click the "Save" button.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Processing History".
- Click the "Start Billing Now" button.
- Click "OK" on the "Billing job started" message.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click the "Actions" button on the completed billing batch.
- Select "ASC X12N 837 Professional Claims Ver. 5 Release 1".
- Click the "Download Electronic File" link and open the file.
- Validate the file does not contain any "Carriage Return + Line Feed".
- Click "X" to close the claim output ready window.
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Topics
• Finance
• Finance Setup
|
Improved Performance of Action Based Billing Runs
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- AR Management
- Cash Receipts for Remittance
- All Clients With Security Listing by PeopleID
- Billing Batches Management
- Billing Request Action Based Run [ADD]
- Billing Batch Management 2.0 Form Set
- BillingProcessHistory
- FinanceClaims
- Claim/Invoice Batch [VIEW]
- Claim Output Ready
- Claim 2.0 [EDIT]
- Notepad
- Action Based Run - Claim Action Types
- Claims Maintenance NX Form Set
- Claim Submission 2.0 [EDIT]
- Billing Run Request Limit People Subform
- All People with Benefit Assignments with LOS
- ActionsView
- Claim Action Reasons
Scenario 1: Validate Resubmit To Other/Waterfall Using Bulk Calculate Rate
Specific Setup:
- Scenario works with claims that can remitted and "Waterfalled" to "Secondary Payer".
- Claims have been "Partially Paid" and contain "Adjustment Amounts".
- No other action based runs for "Resubmit", "Recreate" or "Adjustment" action can be queued.
- No other action based runs for "Resubmit to Other/Waterfall" can be queued.
Steps
- Navigate to "Finance > Remittance Processing > Remittance Application > AR Management".
- Select desired remittance check.
- Set parameters to search for desired claims.
- Click "Partially Paid" link to group the claims together.
- Click "Bulk Actions" button.
- Select "Resubmit to Other/Waterfall".
- Check the desired claims to be included in the "Action Based Run".
- At the bottom of the screen click "Remaining Balance" and select "Calculate Rate - Billing".
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run" and select and "Action Based Run".
- Set desired description.
- Click on "Action Type" and select "Resubmit to Other/Waterfall".
- Set desired date range.
- Scroll to "Run for Receiver".
- Validate desired "Receiver" is listed with the amount of claims that were checked with "Bulk Resubmit and Calculate Rate".
- Check the "Receiver" checkbox.
- Click "Save".
- Wait for billing to run.
- Validate the billing run returns desired claims.
- Click on the "Claim" link.
- Validate the claims generated with the correct "Submission # 2".
- Validate the claim generated to the correct "Payer and Amounts".
- Open one of the claims.
- View the "Account Info".
- Validate contains desired "Journal Entries" and posted to desired "Month".
Scenario 2: Validate Bulk Resubmit Action With Calculate Rate With 100 Claims
Specific Setup:
Requires at least 100 denied claims that can be resubmitted.
Steps
- Navigate to "Finance > Remittance Processing > Remittance Application > AR Management".
- Select desired remittance check.
- Set parameter's to search for desired claims.
- Click "Denied" link to group the claims together.
- Click "Bulk Actions" button.
- Select "Resubmit".
- Check the desired claims to be included in the "Action Based Run".
- At the bottom of the screen click "Remaining Balance" and select "Calculate Rate - Billing".
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run" and select and "Action Based Run".
- Set desired description.
- Click on "Action Type" and select "Resubmit".
- Set desired date range.
- Scroll to "Run for Receiver".
- Validate desired "Receiver" is listed with the amount of claims that were checked with "Bulk Resubmit and Calculate Rate".
- Check the "Receiver" checkbox.
- Click "Save".
- Wait for billing to run.
- Validate the billing run returns desired claims.
- Click on the "Claim" link.
- Validate the claims generated with the next "Submission # 2".
Scenario 3: Validate Resubmit With Bulk Calculate Rate Includes Additional Units
Specific Setup:
- Requires claims that can be remitted.
- Scenario works with at least 5 claims.
- Services for each of the billed claims have been edited so that they rebill with more units.
Steps
- Navigate to "Finance > Remittance Processing > Remittance Application > AR Management".
- Select desired remittance check.
- Set parameter's to search for desired claims.
- Click "Denied" link to group the claims together.
- Click "Bulk Actions" button.
- Select "Resubmit".
- Check the desired claims to be included in the "Action Based Run".
- At the bottom of the screen click "Remaining Balance" and select "Calculate Rate - Billing".
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run" and select and "Action Based Run".
- Set desired description.
- Click on "Action Type" and select "Resubmit".
- Set desired date range.
- Scroll to "Run for Receiver".
- Validate desired "Receiver" is listed with the amount of claims that were checked with "Bulk Resubmit and Calculate Rate".
- Check the "Receiver" checkbox.
- Click "Save".
- Wait for billing to run.
- Validate the billing run returns desired claims.
- Click on the "Claim" link.
- Validate the claims generated with the next "Submission # 2".
- Validate the claim generated with the expected number of units.
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Topics
• Finance
|
Calculate Rate-Billing Runs
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- AR Management
- Cash Receipts for Remittance
- All Clients With Security Listing by PeopleID
- Billing Batches Management
- Billing Request Action Based Run [ADD]
- Action Based Run - Claim Action Types
- Billing Run Request Limit People Subform
- All People with Benefit Assignments with LOS
- Billing Batch Management 2.0 Form Set
- BillingProcessHistory
- FinanceClaims
- ActionsView
- Claim/Invoice Batch [VIEW]
- Claim 2.0 [EDIT]
- Claim Output Ready
- Claim Action Reasons
Scenario 1: Validate Bulk Resubmit Action With Calculate Rate With 100 Claims
Specific Setup:
Requires at least 100 denied claims that can be resubmitted.
Steps
- Navigate to "Finance > Remittance Processing > Remittance Application > AR Management".
- Select desired remittance check.
- Set parameter's to search for desired claims.
- Click "Denied" link to group the claims together.
- Click "Bulk Actions" button.
- Select "Resubmit".
- Check the desired claims to be included in the "Action Based Run".
- At the bottom of the screen click "Remaining Balance" and select "Calculate Rate - Billing".
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run" and select and "Action Based Run".
- Set desired description.
- Click on "Action Type" and select "Resubmit".
- Set desired date range.
- Scroll to "Run for Receiver".
- Validate desired "Receiver" is listed with the amount of claims that were checked with "Bulk Resubmit and Calculate Rate".
- Check the "Receiver" checkbox.
- Click "Save".
- Wait for billing to run.
- Validate the billing run returns desired claims.
- Click on the "Claim" link.
- Validate the claims generated with the next "Submission # 2".
Scenario 2: Validate Resubmit With Bulk Calculate Rate Includes Additional Units
Specific Setup:
- Requires claims that can be remitted.
- Scenario works with at least 5 claims.
- Services for each of the billed claims have been edited so that they rebill with more units.
Steps
- Navigate to "Finance > Remittance Processing > Remittance Application > AR Management".
- Select desired remittance check.
- Set parameter's to search for desired claims.
- Click "Denied" link to group the claims together.
- Click "Bulk Actions" button.
- Select "Resubmit".
- Check the desired claims to be included in the "Action Based Run".
- At the bottom of the screen click "Remaining Balance" and select "Calculate Rate - Billing".
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run" and select and "Action Based Run".
- Set desired description.
- Click on "Action Type" and select "Resubmit".
- Set desired date range.
- Scroll to "Run for Receiver".
- Validate desired "Receiver" is listed with the amount of claims that were checked with "Bulk Resubmit and Calculate Rate".
- Check the "Receiver" checkbox.
- Click "Save".
- Wait for billing to run.
- Validate the billing run returns desired claims.
- Click on the "Claim" link.
- Validate the claims generated with the next "Submission # 2".
- Validate the claim generated with the expected number of units.
|
Topics
• Finance
|
Cost Center and Program Unit Hierarchy On Claims Linked To Foster Home
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Billing Batches Management
- Immediate Billing Run Request [ADD]
- Submitter Information
- Billing Run Request Limit People Subform
- All People with Benefit Assignments with LOS
- Billing Batch Management 2.0 Form Set
- BillingProcessHistory
- FinanceClaims
- Claim 2.0 [EDIT]
- Group Programs Subform
- Cost Center Definitions
- FinanceInvoices
- Invoice [EDIT]
- Foster Home [EDIT]
- Program Unit for Facilities
Scenario 1: Validate Cost Center And Program Unit On Facility Placement Claims Linked To Foster Care Facility
Specific Setup:
- Requires a facility placement claim linked to a "Foster Home".
- "Foster Home" should be linked to "Office Responsible" that is "Managing Office".
Steps
- Navigate to "Agency > Service Locations > Sites/Residentials > General Information".
- Select "Facility (Managing Office)" for the "Foster Home" associated with claim.
- Scroll to "Programs/Services Operated".
- Set the "Override Cost Center and Program Unit" on the program row associated with the claim.
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Click "New Run" and select "Immediate Run".
- Fill in required fields to generate desired claim.
- Save.
- Wait for billing to run.
- Click on the claim link to open the claim.
- Validate "Cost Center Code and Program Unit" on "Accounting Info" contains the "Cost Center Override and Program Unit" from the "Facility Program Link".
- Close claim.
- Navigate to "Resource Families > Foster/Adoptive Home > Information > General Information".
- Select "Foster Home" associated with claim.
- Scroll to Programs Operated".
- Set the "Cost Center Override and Program Unit" on the Program row associated with the claim.
- Save.
- Navigate to "Finance > Claim/Invoice Processing > Batch Listing > Billing Batches Management".
- Reprocess the batch.
- Click on the claim link to open the claim.
- Validate "Cost Center Code and Program Unit" on "Accounting Info" contains the "Cost Center Override and Program" from the "Foster Home".
- Close claim.
- Click on "Client" name link the "Billing Batch Claims Review" window.
- Click on "Enrollment Information".
- Click "Actions" on the program associated with the claim.
- Select "Correct/Close Program Enrollment".
- Set "Cost Center and Program Unit Override".
- Save and Close.
- Reprocess batch.
- Click on the claim link to open the claim.
- Validate "Cost Center Code and Program Unit" on "Accounting Info" contains "Cost Center and Program Unit" set on "Program Enrollment".
- Close the claim.
|
Topics
• Finance
|
Drug Library And Medication Order Additions
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Drug Library Form Set
- Drug Category
- Drug Library Maintenance [EDIT]
- Client Search
- Program Enrollments For Use With OrderConnect
- OrderConnect Current Medication Profile
- OrderConnect Custom Orders
- OrderConnect Order Confirmation
- Medication Item No Program [ADD]
- Drug Library Table
- Medication Item [ADD]
Scenario 1: OrderConnect - Validate A Drug Library Record Is Created In myEvolv - Using Micromedex Values
Specific Setup:
- The drug to be used exists in OrderConnect but not in myEvolv.
- The drug being used is a "Code 0" drug classification. These match on Micromedex Numbers.
- A client to be used.
- OrderConnect is configured.
Steps
- Navigate to "Client > Public Health > Medications > Medication History".
- Select the client.
- Select "OC e-Prescription".
- In OrderConnect, add a new order using the medication not in myEvolv and accept it.
- In myEvolv click "Refresh".
- Validate the "Medication History" displays the "Drug Name".
- Navigate to "Agency > Inventory Management > Inventory Item Setup > Medication Item No Program Setup".
- Add a new medication.
- Click the "Medication" look up table on the "MEDICATION ITEM NO PROGRAM" form.
- On the "Drug Library" look up table set the "Drug Name" to the drug name on the medication order.
- Validate the drug name displays.
- Close the look up table and the form.
Scenario 2: OrderConnect - Validate Matches of the Micromedex Number Generates The Medication Order - Using Micromedex Matches
Specific Setup:
- The Micromedex Number exists both in OrderConnect and myEvolv.
- The Micromedex Number only occurs one time in myEvolv.
- A client to be used.
- OrderConnect is configured.
- The drug that OrderConnect is using is a code "0" drug. This is a drug that matches on Micromedex numbers.
Steps
- Navigate to "Client > Public Health > Medications > Medication History".
- Select the client.
- Select "OC e-Prescription"
- In OrderConnect, add a new order using the medication not in myEvolv and accept it.
- In myEvolv click "Refresh".
- Validate the "Medication History" displays the "Drug Name" entered in myEvolv.
Scenario 3: OrderConnect - Validate "Code 1" Drug Libraries, For Micromedex Values, Match On Drug Description And Generates A New Drug Entry In myEvolv
Specific Setup:
- OrderConnect is using a drug classified as a "Code 1" drug to create a Medication Order. This will match based off description values.
- The myEvolv System will not have this description in the "Drug Library".
- A client to be used.
- OrderConnect is configured.
Steps
- Navigate to "Client > Public Health > Medications > Medication History".
- Select the client.
- Select "OC e-Prescription"
- In OrderConnect, add a new order using the "Code 1" drug type and accept it.
- In myEvolv click "Refresh".
- Validate the "Medication History" displays the order with the same "Drug Name" used in OrderConnect.
- Navigate to "Setup > Medication/Substance > Drug Library > Substance/Medications".
- Select the category the drug is configured in that is a direct match.
- Validate the drug is added to the "Drug Library".
- Redo the test.
- Validate the medication order is created.
- Validate only one entry for that drug name exists in the drug library.
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Topics
• Inventory - Medications
|