myAvatar Billing Widgets & Console Training Guideapi.ning.com/files/826oIv68XgjwWUQ70Y6r96UTny1bQzbyNs96... · Web viewmyAvatar Billing Widgets & Console Training Guide Last Updated:

Nicki GroseNetsmart Technologies Inc.

7/17/20142014

myAvatar Billing Widgets & Console Training GuideNetsmart Technologies, Inc.

NOTICE: This document will be updated as additional functionality is released and any given version may not contain all of the information across all of the myAvatar components. Please refer to last updated notation to determine when document was last updated.

myAvatar Billing Widgets & Console Training Guide

Table of ContentsOverview.....................................................................................................................................................2

Widget Repository.......................................................................................................................................2

Phase 1 Widgets......................................................................................................................................2

Definitions and SQL.................................................................................................................................2

Missing Authorizations........................................................................................................................3

Expiring Authorizations........................................................................................................................3

Clients Requiring Insurance Verification..............................................................................................4

Financial Eligibility...............................................................................................................................5

Authorization Reviews.........................................................................................................................6

Follow-up Entry...................................................................................................................................7

Service History.....................................................................................................................................7

Phase 2 Widgets – Estimated Release Date: August 30th........................................................................8


Phase 3 Widgets – Estimated Release Date: October 15th.....................................................................8


Console Home Views.................................................................................................................................10

Create a Billing Console.........................................................................................................................10

Widget Creation.................................................................................................................................12

View Definition..................................................................................................................................19

Last Updated: 7/17/2014 1 | P a g e


OverviewIn Avatar, there are many ways that billing and billing activities can be accomplished. In order to streamline the billing process and guide users through the billing workflow, the concept for creating a new Billing Console for various user roles was developed. Billing Specialists, AR Specialists, and Billing Supervisors or Managers all have different roles, requiring different information be readily available.

For example, a Billing Specialist might want to see a Billing Dashboard that contain the widgets to be able to complete “Quick Billing”, as well as some key information that billers would need to easily view as part of the billing process in the form of additional widgets. This might include widgets that show the claims that are being generated, total amounts of liability by guarantor, batches created, etc.

For Billing Managers and Supervisors, they would want to see much different information. For example, they might want the ability to easily monitor key performance indicators to measure the success of their billing processes.

This document will provide Netsmart clients instructions on creating useful Billing Consoles for their organizations.

Widget RepositoryIn order to assist Netsmart clients with developing a Billing Console to meet their needs, a set of billing widgets are being developed for clients. This document will contain all the widgets that are being developed along with the SQL for each so that they can modified by clients to meet the needs of their organization. This document is a living document and as new widgets are released, the document will be updated accordingly.

Phase 1 WidgetsThe following widgets were developed and released in Avatar PM 2014 Update 67. Additional fixes were released in Avatar PM 2014 Update 99.

Missing Authorizations Expiring Authorizations Clients Requiring Insurance Verification Financial Eligibility Authorization Reviews Follow-up Entry Service History

Definitions and SQLThis section provides a description of each Phase 1 widget and how it could be used on a Console View. It also contains the SQL statement defined for the applicable so that clients may create new customized



widgets that meet the billing workflow needs for their organization. For example, you might want to change the sort order or column ordering, add additional columns or modify the result set being returned.

Missing AuthorizationsThe “Missing Authorizations” widget shall display all clients for which no authorization exists and the guarantor requires an authorization. This is set up in 'Guarantors/Payors', on the 'Authorization Information' tab, by checking off at least one value for 'Verify Services and Appointments Against Available Authorizations' option. This will include clients who have financial eligibility information entered through financial eligibility or Cross-episodic financial eligibility.

The following fields should be displayed in the widget:

Client (Last, First, MR#) Guarantor Episode

If the user clicks on the Client link in the list, the Managed Care Authorizations form is displayed for the selected client.

Widget SQL Statement

Because this widget was modified to include all the different financial eligibility types, it was handled in Cache code and therefore no SQL code is available. However, you want to use the queries to create separate individual widgets (Standard FE, Cross Episode FE, Family FE) you could use the following SQL statements to create your own widget to meet your organization’s needs.

Episodic

SELECT "billing_guar_order_current"."PATID", "billing_guar_order_current"."guarantor_name", "billing_guar_order_current"."EPISODE_NUMBER", "billing_guar_order_current"."GUARANTOR_ID" FROM (("SYSTEM"."billing_guar_order_current" "billing_guar_order_current" INNER JOIN "SYSTEM"."billing_guar_table" "billing_guar_table" ON ("billing_guar_order_current"."GUARANTOR_ID" = "billing_guar_table"."GUARANTOR_ID" AND "billing_guar_order_current"."FACILITY" = "billing_guar_table"."FACILITY" AND



"billing_guar_table"."verify_svcapp_auth_code" IS NOT NULL)) LEFT OUTER JOIN "SYSTEM"."history_managed_care_auths" "history_managed_care_auths" ON (("billing_guar_order_current"."PATID"="history_managed_care_auths"."PATID") AND ("billing_guar_order_current"."GUARANTOR_ID"="history_managed_care_auths"."GUARANTOR_ID")) AND (("billing_guar_order_current"."EPISODE_NUMBER"="history_managed_care_auths"."EPISODE_NUMBER") OR "history_managed_care_auths"."EPISODE_NUMBER" IS NULL)) WHERE "history_managed_care_auths"."GUARANTOR_ID" IS NULL AND "billing_guar_order_current"."FACILITY"=?FACILITY

Non-Episodic / Cross-Episode

SELECT "billing_guar_order_no_ep"."PATID", "billing_guar_order_no_ep"."guarantor_name", "billing_guar_order_no_ep"."GUARANTOR_ID" FROM (("SYSTEM"."billing_guar_order_no_ep" "billing_guar_order_no_ep" INNER JOIN "SYSTEM"."billing_guar_table" "billing_guar_table" ON ("billing_guar_order_no_ep"."GUARANTOR_ID" = "billing_guar_table"."GUARANTOR_ID" AND "billing_guar_order_no_ep"."FACILITY" = "billing_guar_table"."FACILITY" AND "billing_guar_table"."verify_svcapp_auth_code" IS NOT NULL)) LEFT OUTER JOIN "SYSTEM"."history_managed_care_auths" "history_managed_care_auths" ON (("billing_guar_order_no_ep"."PATID"="history_managed_care_auths"."PATID") AND ("billing_guar_order_no_ep"."GUARANTOR_ID"="history_managed_care_auths"."GUARANTOR_ID")) AND ("history_managed_care_auths"."EPISODE_NUMBER"IS NULL)) WHERE "history_managed_care_auths"."GUARANTOR_ID" IS NULL AND "billing_guar_order_no_ep"."FACILITY"=?FACILITY

Expiring Authorizations The “Expiring Authorizations (Review 10 days / Units-Visits 5)” widget shall display all authorizations that are expiring in the next 10 days or have less than 5 visits or units remaining. This will display both managed care authorizations and cross episodic managed care authorizations. When the authorization expires it will no longer display in the widget.


MR # Client (Last, First) Episode Guarantor Auth #

Next Review Date Auth End Date Visits Remaining Units Remaining Dollars Remaining

The records should be displayed in order by Auth End Date Client Name, and Client MR#, Guarantor Name.



If the user clicks on the Client link in the list, the applicable Managed Care Authorizations or Cross Episodic Managed Care Authorizations form is displayed for the selected client.

Note: If a client has both a cross episode authorization and a regular managed care authorization, the units/visits and dollars used are only applied to the regular managed care authorization.


SELECT "history_managed_care_auths"."CER_uniqueid" <HIDE>, "history_managed_care_auths"."option_id" AS "OPTIONNAME" <HIDE>, "history_managed_care_auths"."EPISODE_NUMBER" AS "Ep" <HIDE>, "history_managed_care_auths"."PATID" as "MR#", "patient_current_demographics"."patient_name" as "Client" <LINK:OPTIONNAME:MR#:CER_uniqueid:Ep>, CASE WHEN "history_managed_care_auths"."EPISODE_NUMBER" IS NULL THEN 'Non-episodic' ELSE "history_managed_care_auths"."EPISODE_NUMBER" END as "Episode", "history_managed_care_auths"."guarantor_name" as "Guarantor" , "history_managed_care_auths"."authorization_number" as "Auth #", "history_managed_care_auths"."next_auth_review_date" as "Next Review Date", "history_managed_care_auths"."auth_end_date" as "Auth End Date", "history_managed_care_auths"."calc_rem_units" as "Units Remaining", "history_managed_care_auths"."calc_rem_visits" as "Visits Remaining", "history_managed_care_auths"."calc_rem_dollar_amount" as "Dollars Remaining" FROM "SYSTEM"."patient_current_demographics" "patient_current_demographics" INNER JOIN "SYSTEM"."history_managed_care_auths" "history_managed_care_auths" ON ("patient_current_demographics"."FACILITY"="history_managed_care_auths"."FACILITY" AND "patient_current_demographics"."PATID"="history_managed_care_auths"."PATID") WHERE ("history_managed_care_auths"."auth_end_date">=GETDATE()) AND (("history_managed_care_auths"."auth_end_date" < DATEADD(dd, 10, GETDATE())) OR "history_managed_care_auths"."calc_rem_visits"<'5') ORDER BY "history_managed_care_auths"."auth_end_date" ASC, "patient_current_demographics"."patient_name", "patient_current_demographics"."PATID", "history_managed_care_auths"."guarantor_name"

Clients Requiring Insurance Verification The “Clients Requiring Insurance Verification” widget displays all clients who still require insurance verification (meaning the Verify Eligibility flag is set to ‘N’). This widget will include financial eligibility, cross episodic financial eligibility, and family financial eligibility records.


MR # Client Name (Last, First)



Episode # Admit Date Guarantor Policy Sub SSN Guarantor Phone Patient DOB Patient SSN

The items should be listed in order by MR#, Client Name.

If the user clicks on the Guarantor link in the list, the applicable Financial Eligibility, Cross Episode Financial Eligibility, or Family Financial Eligibility form will be displayed for the selected client.



Standard Financial Eligibility

SELECT EP.PATID, EP.EPISODE_NUMBER, EP.program_value, GOEP.guarantor_order_number, GOEP.GUARANTOR_ID, GEMP.eligibility_verified_value, GUAR.customize_guar_plan_value, GEMP.cov_effective_date, GEMP.cov_expiration_date, SUBS.subs_policy, SUBS.subs_ss_number, GUAR.guar_phone_number, DEMO.patient_ssn, DEMO.date_of_birth, EP.preadmit_admission_date, GOEP.e_unique_id FROM SYSTEM.episode_history EP INNER JOIN SYSTEM.patient_current_demographics DEMO ON ((EP.PATID=DEMO.PATID) AND (EP.FACILITY=DEMO.FACILITY)) WHERE EP.FACILITY=?FACILITY AND EP.date_of_discharge IS NULL AND EP.user_row_access_code = '1' AND GEMP.eligibility_verified_code='N' ORDER BY EP.EPISODE_NUMBER DESC, GOEP.guarantor_order_number

Cross-Episode Financial Eligibility

SELECT GONOEP.PATID, GONOEP.guarantor_order_number, GONOEP.GUARANTOR_ID, GEMP.eligibility_verified_value, GUAR.customize_guar_plan_value, GEMP.cov_effective_date, GEMP.cov_expiration_date, SUBS.subs_policy, SUBS.subs_ss_number, GUAR.guar_phone_number, DEMO.patient_ssn, DEMO.date_of_birth, '' as preadmit_admission_date, GONOEP.por_unique_id FROM Last Updated: 7/17/2014 6 | P a g e


SYSTEM.billing_guar_order_no_ep GONOEP WHERE GONOEP.FACILITY=?FACILITY AND GEMP.eligibility_verified_code='N' ORDER BY GONOEP.guarantor_order_number

Family Financial Eligibility

SELECT GOF.FAMID, GOF.PATID, GOF.guarantor_order_number, GOF.GUARANTOR_ID, GEMP.eligibility_verified_value, GUAR.customize_guar_plan_value, GEMP.cov_effective_date, GEMP.cov_expiration_date, GOF.policy_number AS subs_policy, SUBS.subs_ss_number, GUAR.guar_phone_number, DEMO.patient_ssn, DEMO.date_of_birth, '' as preadmit_admission_date, GOF.por_unique_id FROM SYSTEM.patient_family_history FAMH INNER JOIN SYSTEM.family_member_guar_order GOF ON (GOF.PATID=FAMH.PATID AND GOF.FAMID=FAMH.FAMID AND GOF.FACILITY=FAMH.FACILITY) WHERE GOF.FACILITY=?FACILITY AND FAMH.start_date_of_member <= CURRENT_DATE AND (FAMH.end_date_of_member IS NULL OR FAMH.end_date_of_member >=CURRENT_DATE) AND GEMP.eligibility_verified_code='N' ORDER BY GOF.guarantor_order_number

Financial EligibilityThe “Financial Eligibility” widget displays all of the financial eligibility records entered for the specified client. This will include financial eligibility, cross episodic financial eligibility, and family financial eligibility records.


Order (aka Billing Order) Guarantor Episode Number Program Verify (Yes or No to indicate FE verification) Start End End Date Policy # (indicator if missing info or blank and plan is billable for the financial class)

The items should be listed in order by Episode Number, Billing Order, and Guarantor.

If the user clicks on the Guarantor link in the list, the applicable Financial Eligibility, Cross Episode Financial Eligibility, or Family Financial Eligibility form will be displayed for the selected client.

Any fields missing required information will be indicated in red to alert user.





Standard Financial Eligibility

SELECT EP.PATID, EP.EPISODE_NUMBER, EP.program_value, GOEP.guarantor_order_number, GOEP.GUARANTOR_ID, GEMP.eligibility_verified_value, GUAR.customize_guar_plan_value, GEMP.cov_effective_date, GEMP.cov_expiration_date, SUBS.subs_policy, SUBS.subs_ss_number, GUAR.guar_phone_number, DEMO.patient_ssn, DEMO.date_of_birth, EP.preadmit_admission_date, GOEP.e_unique_id FROM SYSTEM.episode_history EP INNER JOIN SYSTEM.patient_current_demographics DEMO ON ((EP.PATID=DEMO.PATID) AND (EP.FACILITY=DEMO.FACILITY)) WHERE EP.FACILITY=?FACILITY AND EP.date_of_discharge IS NULL AND EP.user_row_access_code = '1' AND EP.PATID = ?PATID ORDER BY EP.EPISODE_NUMBER DESC, GOEP.guarantor_order_number

Cross-Episode Financial Eligibility

SELECT GONOEP.PATID, GONOEP.guarantor_order_number, GONOEP.GUARANTOR_ID, GEMP.eligibility_verified_value, GUAR.customize_guar_plan_value, GEMP.cov_effective_date, GEMP.cov_expiration_date, SUBS.subs_policy, SUBS.subs_ss_number, GUAR.guar_phone_number, DEMO.patient_ssn, DEMO.date_of_birth, '' as preadmit_admission_date, GONOEP.por_unique_id FROM SYSTEM.billing_guar_order_no_ep GONOEP WHERE GONOEP.FACILITY=?FACILITY AND GONOEP.PATID = ?PATID ORDER BY GONOEP.guarantor_order_number

Family Financial Eligibility

SELECT GOF.FAMID, GOF.PATID, GOF.guarantor_order_number, GOF.GUARANTOR_ID, GEMP.eligibility_verified_value, GUAR.customize_guar_plan_value, GEMP.cov_effective_date, GEMP.cov_expiration_date, GOF.policy_number AS subs_policy, SUBS.subs_ss_number, GUAR.guar_phone_number, DEMO.patient_ssn, DEMO.date_of_birth, '' as preadmit_admission_date, GOF.por_unique_id FROM SYSTEM.patient_family_history FAMH INNER JOIN SYSTEM.family_member_guar_order GOF ON (GOF.PATID=FAMH.PATID AND GOF.FAMID=FAMH.FAMID AND GOF.FACILITY=FAMH.FACILITY) WHERE GOF.FACILITY=?FACILITY AND FAMH.start_date_of_member <= CURRENT_DATE AND (FAMH.end_date_of_member IS NULL OR FAMH.end_date_of_member >=CURRENT_DATE) AND FAMH.PATID = ?PATID ORDER BY GOF.guarantor_order_number

Authorization Reviews The “Authorizations Due for Review” widget displays all authorizations that are due for review within the next 30 days. This will include both managed care authorization and cross episodic managed care authorizations. Once the Next Review Date has passed, the authorization will no longer be displayed in the widget.




Auth # Client (Last, First, MR#) MC (Guarantor) Expires (Auth End Date) Units (Remaining) Visits (Remaining) Dollars (Remaining) Review (Date) Staff (Utilization Review Staff)

The items should be listed in order by Next Auth Review Date.

If the user clicks on the Client link in the list, the applicable Managed Care Authorizations or Cross Episodic Managed Care Authorizations form is displayed for the selected client.

Note: If a client has both a cross episode authorization and a regular managed care authorization, the units/visits and dollars used are only applied to the regular managed care authorization.


SELECT "history_managed_care_auths"."option_id" AS "FORMID" <HIDE:FORMID>, "history_managed_care_auths"."PATID" AS "ClientID" <HIDE:ClientID>, "history_managed_care_auths"."CER_uniqueid" AS "AUTHID" <HIDE:AUTHID>, "history_managed_care_auths"."EPISODE_NUMBER" AS "Episode" <HIDE:Episode>, "history_managed_care_auths"."authorization_number" AS "Auth", STRING("patient_current_demographics"."patient_name", ' (', "patient_current_demographics"."PATID", ')') AS "Client" <LINK:FORMID:ClientID:AUTHID:Episode::Client>, "history_managed_care_auths"."guarantor_name" as "MC", TO_CHAR("history_managed_care_auths"."auth_end_date",'MM-DD-YYYY') as "Expires", "history_managed_care_auths"."rem_units" as "Units", "history_managed_care_auths"."rem_visits" as "Vists", "history_managed_care_auths"."rem_dollar_amount" as "Dollars", TO_CHAR("history_managed_care_auths"."next_auth_review_date",'MM-DD-YYYY') as "Review", "history_managed_care_auths"."u_r_staff_person_name" as "Staff" FROM "SYSTEM"."history_managed_care_auths" "history_managed_care_auths" INNER JOIN "SYSTEM"."patient_current_demographics" "patient_current_demographics" ON ("history_managed_care_auths"."PATID" = "patient_current_demographics"."PATID" AND "history_managed_care_auths"."FACILITY" = "patient_current_demographics"."FACILITY") WHERE ("history_managed_care_auths"."next_auth_review_date" IS NOT NULL) AND ("history_managed_care_auths"."next_auth_review_date" >= CURRENT_DATE) AND ("history_managed_care_auths"."next_auth_review_date" <=



CONVERT(DATE,DATEADD(dd,30,CURRENT_DATE),1)) ORDER BY "history_managed_care_auths"."next_auth_review_date" ASC

Follow-up Entry The “Follow Up Entry” widget displays the most recent 30 contacts or follow up records by guarantor for the specified client.


Data Entry Date Data Entry By Guarantor Name Note Type (collection) Note

The items should be listed in descending order by Date Entered.


SELECT TOP 30 SYSTEM.history_follow_up_entry.data_entry_date as "Data Entry Date", SYSTEM.history_follow_up_entry.data_entry_by as "Data Entry By", SYSTEM.history_follow_up_entry.guarantor_name as "Guarantor Name", SYSTEM.history_follow_up_entry.collection_note_typ_value as "Note Type", SYSTEM.history_follow_up_entry.follow_up_note as "Note" FROM SYSTEM.history_follow_up_entry WHERE (SYSTEM.history_follow_up_entry.FACILITY=?FACILITY) AND (SYSTEM.history_follow_up_entry.PATID=?PATID) ORDER BY SYSTEM.history_follow_up_entry.data_entry_date DESC

Service History The “Service History” widget displays the most recent 30 services entered for the specified client.


Service Date Status (Appointment status) Start Time End Date Staff Name Program Service Code Duration



Costs (Charge) Location (Site)

The items should be listed in descending order by Service Date.


SELECT TOP 30 TO_CHAR(date_of_service,'MM-DD-YYYY') as "Date" , SYSTEM.billing_tx_history.appointment_status_value as "Status", SYSTEM.billing_tx_history.appt_start_time as "Start Time", SYSTEM.billing_tx_history.appt_end_time as "End Time", SYSTEM.billing_tx_history.v_PROVIDER_NAME as "Staff Name", SYSTEM.billing_tx_history.program_value as "Program", SYSTEM.billing_tx_history.SERVICE_CODE as "Service Code", SYSTEM.billing_tx_history.duration as "Duration", SYSTEM.billing_tx_history.cost_of_service as "Cost", SYSTEM.billing_tx_history.location_value as "Location" FROM SYSTEM.billing_tx_history WHERE (SYSTEM.billing_tx_history.FACILITY=?FACILITY) AND (SYSTEM.billing_tx_history.PATID=?PATID) ORDER BY SYSTEM.billing_tx_history.date_of_service DESC

Phase 2 Widgets – Estimated Release Date: July 31st Claims Payments Posted Claim Follow-up Records Advanced Billing Rule Failed Compliance Open Services by Guarantor Unbilled Services by Guarantor Billed Services by Guarantor (Last 7 Days) Billed Services by Guarantor (Current Month) Billed Services by Guarantor (Previous Month) Rebilled Claims 3+ Times with an Outstanding Balance

Definitions and SQLTo be updated later.

Phase 3 Widgets – Estimated Release Date: October 15th Clients with Expired Eligibility Gross Average Daily Revenue (MTD) Expected Average Daily Revenue (MTD) Gross Average Daily Revenue (YTD) Expected Average Daily Revenue (YTD) Net Collections Rate Days in Receivables Outstanding (DRO) Receivables Outstanding > 90 Days



Definitions and SQLTo be updated later.



Console Home ViewsIn RAD 2014 Enhancement #85, Netsmart released the ability to create a Console Home View. A Console Home View is a user Home View that has been assigned multiple views. Users can switch views by clicking on the appropriate view button. Widgets can be added to the views and organized workflow. Also, separate Console Home Views can be setup and displayed based upon user roles.

Create a Billing ConsoleBelow is an example of a Billing Console comprised of multiple dashboards. In the sections below, we will provide detailed instructions to aid you in building these easy-to-use dashboards.





Widget CreationThere are three ways to create widgets with the myAvatar design tools. You are able to leverage the Widget Wizard, Wizard Definition and Console Widget Definition.



Widget WizardEasily define and create widgets with the use of an easy to use wizard.

– Define widgets easily by selecting a table and the fields you would like to display on the widget.

– Identify sort columns and fields to associate with hyperlinks

– Once you select ‘Submit’ the widget will be available for selection in the Widget Library that resides in View Definition.

Widget DefinitionUsing HTML and/or SQL statements, develop a widget to display information that is client specific or for a defined group of clients.



Console Widget Configuration• This is a new form in myAvatar. Allows users to quickly create Widgets to be displayed on

Console Views

– Select client forms with a Pre-Display

– Widgets will provide edit/add capabilities

• Edit Default Configuration



– Default the fields to display in the Widget

– Fields can be added, deleted or copied

• SQL Query Override

– Override the fields selected in the Edit Default Configuration

• Write your own Query

• Time Limit (seconds)

– Netsmart recommends Widgets have a time limit of 1.0 second if it will be placed on many Home Views



This prevents a scenario where long running Widgets processing at the same time slows system performance.

• Table Widgets display with pre-display columns

• Rows will sort with the newest records on top

– Clicking on any column header will resort the table by that column (Note: This functionality is only available for widgets created via Widget Console Definition.)



• Episode selection is provided so user can filter by episode

• "All Episodes" will default

• Double-click on a row to view the form

– No patient lookup or pre-display needed

• A New Record button allows addition of data

• Allows users to select multiple forms to be used in a single Widget

– Add New or Open Existing


Double click row to

select


Multiple Form Widget

- Double click on a record in the grid to display the applicable form.

• New tab labeled Site Last Updated: 7/17/2014 21 | P a g e

Multiple Form Selection


– Smart Search by Site or Unit

– Scrolling list box of patients from that Site (Unit)

– Home View Widgets refresh with selected client

View Definition• To create a Console Home View

• Use the form View Definition to associate multiple views to the Home View

Widgets are managed in the View Definition form when you launch the View designer.

Available widgets can be assigned to a user in the User Definition, and User Role Definition forms.

Widgets must be associated with a user, or user role before they can be accessed in the Home View.

Once a widget is assigned to a user (or user role), the user can add the widget to their Home or Chart

View.



View Designer

In the Available column, select a widget and click .These widgets can be added to the Default Role Layout section.



Note: Once the new view is assigned, you can use User Role Definition to assign the view to a specific role.


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