DHCS Cov Ntaub Ntawv Qhia thiab Saib Xyuas Webinar Series Cov Lus Nug Nquag

Thov rov qab xyuas tsis tu ncua, nplooj ntawv no tau hloov kho txhua hli. Tseem nrhiav tsis tau koj cov lus nug lossis lus teb? Thov xa email rau MCDSS@dhcs.ca.gov.

Rov qab mus rau cov ntaub ntawv webinar

General

Cov no puas yuav nyob rau tib hnub / sijhawm txhua lub hlis raws li qhov webinar no?
Qhov webinar no yuav muaj nyob rau hnub Wednesday thib 4 ntawm txhua lub hlis.
Puas yuav swb lawj muab faib tom qab lub webinar?
Slide deck tau tshaj tawm txhua lub hlis ntawm nplooj ntawv web. Lub vev xaib webinar tam sim no nyob. Cov ntaub ntawv nyob rau hauv webinars yav dhau los, xws li kev nthuav qhia thiab kaw, FAQs, thiab lub sij hawm webinar yav tom ntej tuaj yeem pom ntawm qhov txuas no ( Quality Webinar Series (ca.gov) ).
Puas yog nws yuav tsum tau mus koom lub webinars yog tias peb qhov kev txaus siab tsis yog txog thaum lub Kaum Ib Hlis 2022?
Peb txhawb kom cov neeg tuaj koom tuaj koom ib qho kev sib tham hauv web raws li lawv nyiam thiab ua haujlwm.
Puas yuav muaj ib daim vis dis aus tso rau peb saib yog tias peb tsis nco nws lossis peb tuaj yeem xa mus rau cov neeg ua haujlwm tsim nyog?
Yog lawm, txhua qhov webinar yuav raug kaw, thiab cov ntaub ntawv kaw tseg thiab cov ntawv sau yuav raug luam tawm ntawm nplooj ntawv web Quality Webinar Series (ca.gov) .
Puas yog DHCS puas thov muab daim ntawv qhia kev koom tes ntawm EDIM division?
Peb qhia cov neeg ua haujlwm sib cuag kom raug thaum lub webinar. Yog tias koj tsis paub meej tias yuav hu rau leej twg, peb pom zoo kom siv pawg mailbox hauv qab no.
- 274 Kev Kho Mob (MCP): MCQMDProviderData@dhcs.ca.gov
- 274 Tus Cwj Pwm Kev Noj Qab Haus Huv (MHP & DMC-ODS): 274Expansion@dhcs.ca.gov
- 274 Kho Hniav: DMCdeliverables@dhcs.ca.gov
- ntsib: MMCDencounterData@dhcs.ca.gov
- BH luv Doyle: MEDCCC@dhcs.ca.gov
- DHCS Documentation Center Access thov: dataexchange@dhcs.ca.gov
- PACE: PACECompliance@dhcs.ca.gov
Peb yuav ntxiv cov tib neeg rau Webex series li cas?
Thov xa email ncaj qha rau MCDSS@dhcs.ca.gov thiab sau cov npe thiab emails ntawm cov neeg koj xav caw. Lawv kuj tuaj yeem saib cov webinar thiab slides uas peb tshaj tawm txhua hli ntawm nplooj ntawv no ( Quality Webinar Series (ca.gov) ).
Puas yog Qhov Kev Ntsuas Zoo thiab Kev Tshaj Tawm Qhov chaw qhib rau leej twg?
Yog, nws muaj rau pej xeem siv. Kev Ntsuas Zoo & Tshaj Qhia (ca.gov)
Puas yuav muaj cov ntsiab lus dav dav ntawm cov ntsiab lus (nrog rau tag nrho los ntawm cov kev nthuav qhia sib txawv) yuav muab tso rau hauv Qhov Kev Ntsuas Zoo & Kev Tshaj Tawm?
Yog lawm. Koj tuaj yeem tshawb xyuas cov npe ntawm cov ntawv luv luv thiab cov ntsiab lus hauv Quality-Webinar-Glossary (ca.gov) . Peb muaj ib txoj kev npaj mus ntxiv thiab hloov tshiab. Rau cov lus nug thiab cov lus qhia ntxiv, thov email MCDSS@dhcs.ca.gov .
Peb puas muaj lub sijhawm kwv yees kom tau txais cov lus teb los ntawm pab pawg EDIMdatasupport@dhcs.ca.gov, lossis ib qho qhia txog thaum twg peb tuaj yeem cia siab tias yuav hnov qab?
Feem ntau 1-2 hnub ua haujlwm. Yog koj tsis hnov qab, thov rov xa dua.
Yuav ua li cas lub nroog nce / thov nkag mus rau Teams View ntawm Doc Center.
Rau kev nkag mus rau Doc Center, thov xa daim ntawv thov mus rau DataExchange@dhcs.ca.gov

274 PAB

Peb tau tshaj tawm txog kev mob hlwb ntawm peb cov kev kho mob 274, suav nrog cov chij rau thaj chaw kho mob hlwb ntawm cov kws tshaj lij. Puas yog cov no yuav nyob rau ntawm cov ntaub ntawv cais tam sim no?
MCPs yuav txuas ntxiv xa 274 cov ntaub ntawv raws li cov lus qhia hauv 274 MCP Companion Guide. Cov ntaub ntawv Mental Health tau hais nyob rau hauv (CG) muaj feem xyuam rau cov kev pabcuam kev puas hlwb uas muaj los ntawm MCP tsis yog lub nroog. Qhov no suav nrog ob lub ntsiab lus hauv qab no:

B.9 Tus Kws Kho Mob Puas Hlwb Cheeb Tsam ntawm Cov Cai Kawm Txuj Ci (2100EA N202)
B.10 Mental Health Provider Practice Focus Codes (2100EA N202)

Puas yuav muaj kev hloov kho tshiab lossis hloov kho 274 tus khub phau ntawv qhia tshiab nyob rau yav tom ntej uas hais txog APLs tshiab tshwj xeeb rau cov chaw kho mob tshiab xws li Doula's thiab cov kev hloov pauv ib puag ncig Cov Kws Kho Mob uas ua tau raws li cov txheej txheem tsis tas yuav tsum tau saib xyuas tus kws kho mob thiab lwm yam kev hloov pauv?
Kev Hloov Kho Phau Ntawv Qhia Tus khub tau ua thaum twg APLs tshiab thiab lwm yam kev hloov pauv xav tau hloov tshiab. Thaum cov kev hloov pauv rau Medicaid txoj cai lossis HIPAA cov kev cai cuam tshuam yuav tsum tau hloov pauv hauv txoj hauv kev cov ntaub ntawv tau tshaj tawm ntawm kev hloov pauv uas twb muaj lawm, (xws li 274), Daim Ntawv Qhia Txog Tus khub yuav raug hloov kho kom muaj kev cuam tshuam cov kev hloov pauv no.
Lub koom haum tshiab no puas suav nrog kev saib xyuas cov ntaub ntawv Medi-Cal FFS? Yog tias muaj, cov phiaj xwm / sijhawm yuav txav deb ntawm California cov cai hauv zos yog dab tsi. Cov lej no txuas ntxiv ua rau muaj kev sib tw hauv Chaw Tswj Xyuas Kev Tswj Xyuas?
Qhov no suav nrog kev saib xyuas cov ntaub ntawv FFS, txawm li cas los xij, Phau Ntawv Qhia Tus Muab Kev Pabcuam thiab lwm yam kev taw qhia uas pom nyob rau ntawm Medi-Cal qhov chaw tsis yog npaj los muab kev coding lossis kev qhia them nqi rau cov kws kho mob uas tau cog lus rau MCPs, lossis leej twg xa daim ntawv thov rau MCPs. Cov chaw muab kev pabcuam uas xa FFS style thov rau MCPs rau kev them nyiaj tseem yuav tsum tau siv HIPAA Raws Li Txoj Cai Hauv Tebchaws. Cov lej hauv zos tsis raug tso cai.
Thov txim rau qhov rov hais dua, tab sis tsuas yog kom paub meej tias MCPs yuav tsis tas yuav xa ib qho tshiab, cais 274 rau MH thiab yuav xa ib zaug xwb 274 suav nrog cov kws kho mob thiab MH?
Lub Nroog cov ntaub ntawv kev pabcuam kev noj qab haus huv yog muab cais los ntawm lub nroog, tsis yog MCPs.
Dab tsi yog qhov tam sim no version ntawm 274 tus khub phau ntawv qhia?
Daim ntawv qhia tam sim no tshaj plaws ntawm Kev Kho Mob/Lub Cev 274 Tus Muab Kev Qhia Qhia Tus khub yog v. 2.2.
Qhov tam sim no version ntawm Mental Health Companion Guide (CG) yog v.1.7 (Thov nco ntsoov, Tus Cwj Pwm Kev Noj Qab Haus Huv CG tshiab yuav raug luam tawm uas suav nrog ob qho tib si Mental Health CG thiab DMC-ODS CG. Tus lej lej thiab cov ntawv sau yuav raug muab qhia sai sai, TBD).
Thaum twg yuav tau tshaj tawm 274 tus khub phau ntawv qhia? Zoo li cov ntaub ntawv hais txog qee tus NP tuaj yeem xyaum yam tsis tau saib xyuas cov kws kho mob yav tom ntej, xav tau kev qhia hloov tshiab yuav ua li cas qhia cov NP ntawm 274 yam tsis tau saib xyuas cov kws kho mob.
Feem ntau, Cov Lus Qhia Txog Tus Kheej (CGs) yog thawj zaug luam tawm hauv daim ntawv DRAFT thiab muab faib rau cov phiaj xwm kev tshuaj xyuas thiab kev tawm tswv yim. Thaum lub voj voog ntawd tiav lawm, daim ntawv kawg ntawm CG tau luam tawm mus rau DHCS Documentation Center (DDC).
Cov ntaub ntawv qhia txog tus khub rau Tus Neeg Saib Xyuas Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv tau hloov kho kom suav nrog ob qho tib si Kev Noj Qab Haus Huv thiab DMC-ODS cov lus qhia. A DRAFT yog nyob rau hauv kev tshuaj xyuas tam sim no thiab yuav muab qhia rau cov neeg koom nrog ua lag luam rau kev tshuaj xyuas nyob rau lub lim tiam tom ntej lossis ob.
Thov paub meej tias QMED v2 tseem ua haujlwm? / Tsis yog 274 ntsig txog, tab sis ntsib cov ntaub ntawv ntsig txog. Peb puas tuaj yeem tau txais qhov hloov tshiab ntawm cov xwm txheej ntawm QMED v2?
Yog lawm, QMED v2 tseem ua haujlwm.
Koj puas tuaj yeem piav qhia txog "rectifying tag nrho cov lus ceeb toom"? Txog tam sim no, peb tsis tas yuav ua li ntawd.
Cov phiaj xwm yuav tsum tau hais txog cov lus ceeb toom thiab xa cov ntaub ntawv rov qab yog tias muaj cov ntaub ntawv tsis sib xws hauv JSON cov ntaub ntawv. Yog tias cov phiaj xwm tsis txheeb xyuas cov ntaub ntawv teeb meem hauv qhov kev ntsuas tshwj xeeb, cov phiaj xwm yuav tsum tau ceeb toom rau DHCS los ntawm email txog vim li cas rau cov lus ceeb toom.
Peb puas yuav tsum teb rau email txawm tias cov phiaj xwm tau dhau tag nrho cov ntaub ntawv ntsuas MDC?
Yog lawm, peb cia siab tias yuav teb rau email, txawm tias nws tsuas yog kev lees paub ntawm daim ntawv txais nyiaj.
Koj puas tuaj yeem qhia rau peb paub yog tias e-consult nkaus xwb cov kws kho mob (uas tsuas yog sib txuas lus nrog lwm tus neeg muab kev pabcuam thiab tsis yog tswvcuab) yuav tsum tau suav nrog 274?
Nws yuav hloov kho sai li sai tau thaum peb muaj cov lus teb sib xws. Ua tsaug rau koj ua siab ntev.
Lub hli tas los no 274 MDC tau them rau lub sijhawm ua ntej lub hli tshaj tawm tshiab tshaj plaws. Thov qhia yog tias DHCS tau hloov pauv los ntawm kev tshaj tawm txhua hli kom them rau lub sijhawm tshaj tawm ua ntej.
274 MDC tsab ntawv ceeb toom npog cov ntaub ntawv los ntawm lub hli dhau los, ua ntej lub hli xa.
Koj puas tuaj yeem txhais QIMR? Hnub mus-nyob rau QIMR yog dab tsi?
QMIR yog Daim Ntawv Qhia Txog Kev Ua Haujlwm Peb Hlis thiab QIMR tau npaj "mus nyob" thaum ib nrab xyoo 2024.
Tam sim no QIMR daim ntawv tshaj tawm (EXCEL) yuav raug txiav tawm txij Lub Ib Hlis 2024?
Tsis yog. QIMR Excel tsab ntawv ceeb toom txuas ntxiv mus txog thaum tag nrho cov ntsiab lus ntawm Excel tsab ntawv ceeb toom tau hloov mus rau JSON hom.
274 cov ntaub ntawv raug xa los ntawm cov phiaj xwm kev noj qab haus huv, tsis yog los ntawm cov chaw pabcuam kev noj qab haus huv?
Qhov no yog lawm, 274 cov ntaub ntawv raug xa mus rau DHCS los ntawm Kev Kho Mob, Kev Kho Hniav thiab Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv uas tau cog lus rau DHCS.
Puas yog 274 lossis PNR cov ntaub ntawv suav nrog cov ntaub ntawv zoo, piv txwv li daim ntawv thov fluoride %?
Cov ntaub ntawv 274 thiab PNR tsuas yog suav nrog cov ntaub ntawv hauv network, tsis muaj cov ntaub ntawv siv.
Dab tsi depts xa tawm QMED cov ntawv ceeb toom?
Cov Ntaub Ntawv Qhia Txog Qhov Zoo Tshaj Lij xa tawm QMED Cov Ntawv Qhia rau Cov Kev Npaj Kho Mob raws li peb lub hlis twg.
Puas yog PACE cov kev pabcuam xav kom tau txais cov no?
PACE Plans/Organizations yuav tau txais QMED ua ib feem ntawm QMED 2.0 PACE. Cov kev pab cuam uas tam sim no tsis tau txais cov no yuav nyob rau yav tom ntej.
Puas yog PACE cov phiaj xwm xav kom xa 274s?
PACE cov phiaj xwm tam sim no tsis xa 274 kev hloov pauv. Ntau dua yuav muab qhia txog qhov sau cov ntaub ntawv. Tshwj xeeb, Kev Kho Hniav tam sim no tsuas yog tau txais / saib xyuas 274 cov ntaub ntawv los ntawm peb cov phiaj xwm DMC (tsis suav nrog PACE).

Cov ntaub ntawv MCPD/PCPA

Rau cov ntaub ntawv Primary Care Physician Assignment (PCPA) yog qhia rau FQHCs ua tiav ntawm qhov chaw thiab tsis mus rau PCP?
Cov ntaub ntawv PCPA siv cov ntaub ntawv los tshaj tawm Cov Kev Pab Cuam Rau Tus Kws Khomob Ntiag Tug. Kev tshaj tawm yog ua tiav ntawm qib kws kho mob. Tsis muaj qhov chaw cov ntaub ntawv theem.
Peb tau tshaj tawm cov npe ntawm cov peev txheej tshiab tsis txaus siab thiab hom txiaj ntsig ntxiv rau cov npe uas twb muaj lawm ntawm hom kev tsis txaus siab tam sim no hauv MCPD schema v3.02. Peb ntseeg tias cov no txawv ntawm hom kev tsis txaus siab uas twb muaj lawm thiab yuav pab peb kom paub meej txog peb qhov kev tsis txaus siab thiab txhim kho peb qhov kev ceeb toom tsis txaus siab. Thaum twg peb tuaj yeem cia siab tias cov no yuav raug pom zoo thiab muaj los siv?
Kev tsis txaus siab tab tom tham thiab kev hloov kho tshiab ntawm hom tshiab uas tau hais tseg yuav raug qhia sai sai.
Cov lus ceeb toom hauv MCPD thiab PCPA cov ntaub ntawv teb feem ntau cuam tshuam txog cov teeb meem ua tswv cuab uas feem ntau tau txheeb xyuas los ntawm kev xa mus tom ntej. Raws li qhov xwm txheej twg yuav xav tau kom rov xa cov ntaub ntawv MCPD thiab PCPA cov ntaub ntawv hais txog cov lus ceeb toom?
Thaum lub sijhawm ua lag luam kho kom raug siv tau, tej zaum yuav muaj qhov xwm txheej uas cov lus ceeb toom yuav raug txheeb xyuas. Cov lus ceeb toom yuav tsis ua rau tsis lees txais cov ntaub ntawv thiab yog npaj los qhia rau tus neeg xa ntawv txheeb xyuas cov teeb meem yav tom ntej uas yuav dhau los ua qhov yuam kev yav tom ntej. DHCS nug tias MCPs raug ceeb toom thiab xa cov ntaub ntawv rov qab.
Hnub Tim Production Go-Live yog dab tsi rau cov kev hloov no? DHCS puas tuaj yeem thov qhia meej ntawm PCPA Production Go-Live teem rau 01/01/2025?
Hnub tim yuav tshaj tawm sai sai. Kev Xeem Ib puag ncig yuav muaj los ntawm 01/01/2025, nrog rau Kev Tsim Kho Ib puag ncig yuav nyob los ntawm 02/01/2025, uas yuav suav nrog kev tshaj tawm rau Lub Ib Hlis cov ntaub ntawv.
Thaum twg SCHEMA cov ntaub ntawv yuav raug tso tawm kom Plans tuaj yeem kuaj thiab siv tau rau nws?
Daim ntawv schema yuav raug tso tawm thiab muaj nyob hauv DHCS Doc Center ua raws li qhov kev faib tawm ntawm Kev Sib Txuas Lus Qhia Kawg.
Rau kev kuaj PCPA, peb yuav tsum txuas ntxiv siv tsuas yog kuaj CINs?
Yog lawm, Cov phiaj xwm yuav tsum tsuas yog siv cov ntawv xeem CINs thaum xa cov ntaub ntawv xeem. Test CINs yog tsim los xyuas kom meej tias cov ntaub ntawv dhau los ntawm kev tso npe / kev tsim nyog tau txais kev pom zoo. Txhua qhov yuam kev uas tau ntsib nrog kev sim CINs hauv cov ntaub ntawv xeem tuaj yeem tsis lees paub. Txawm li cas los xij, yog tias cov ntaub ntawv xeem tsis ua tiav vim qhov kev xeem CIN yuam kev, thov hu rau DHCS rau kev pab.
DHCS puas tuaj yeem muab kev qhia meej ntawm PCPA mus nyob hnub tim 01/01/2025?
Cov phiaj xwm yuav tsum pib xa cov ntaub ntawv xeem pib txij li 01/01/2025, vim qhov chaw xeem yuav muaj nyob rau lub sijhawm ntawd.
Dab tsi yog qhov kev cia siab rau hnub mus-nyob, thiab dab tsi yog qhov txawv ntawm qhov tam sim no thiab qhov kawg version ntawm Kev Qhia Txuj Ci?
Hnub tsim tawm mus-nyob yog teem rau 02/01/2025. Tam sim no DRAFT version ntawm Cov Kev Qhia Txuj Ci yog suav tias yog FINAL DRAFT, tsis muaj kev hloov pauv ntxiv uas xav tau rau PCPA layout lossis schema. PCPA Technical Guide yav tas los yog ib feem ntawm kev sib koom ua ke MCPD/PCPA phau ntawv qhia; tam sim no tau sib cais. Qhov FINAL DRAFT version suav nrog cov ntsiab lus ntxiv rau PCPA schema, uas tau piav qhia nyob rau hauv qhov tseeb version ntawm phau ntawv qhia.
Puas yog PCPA vs 274 kev sib piv tau ua nyob rau ntawm tus kws kho mob lossis qib chaw, lossis ob qho tib si?
DHCS Cov Ntaub Ntawv Kev Tshawb Fawb, koom tes nrog DHCS cov cheeb tsam kev pab cuam (MCOD, MCQMD, QPHM), ua kev soj ntsuam ntawm cov ntaub ntawv xa tuaj. Yog xav paub ntxiv, thov hu rau koj tus neeg saib xyuas qhov kev pab cuam cheeb tsam.

Sib ntsib cov ntaub ntawv

Cov ntaub ntawv ntsib yog dab tsi?
Cov ntaub ntawv ntsib raug xa mus rau X12 837 EDI kev hloov pauv. Cov ntaub ntawv sib ntsib sawv cev rau cov ntaub ntawv thov uas twb tau txiav txim siab thiab them nyiaj. Cov ntaub ntawv sib ntsib yog siv nyob rau hauv Kev Kho Mob, Kho Hniav, thiab Tus Cwj Pwm Tswj Tus Qauv.
Thaum twg EDQ daim ntawv tshaj tawm yuav raug hloov kho kom tsis suav nrog Rx cov ntaub ntawv?
Rx cov ntaub ntawv yuav raug tshem tawm nrog QMED version tom ntej, uas tau npaj rau hloov tshiab ua ntej xyoo kawg.
Raws li peb paub Cov Ntaub Ntawv Sib Tham yuav tsum muaj cov lej hauv tebchaws rau kev thov nyiaj. Hauv DHCS lub vev xaib peb tuaj yeem pom cov ntawv ceeb toom txog kev hla kev taug kev hauv zos rau HIPAA Raws Li Txoj Cai Hauv Tebchaws, tab sis koj xav tias qhov project no yuav pib thaum twg? Peb pom muaj tsab ntawv ceeb toom pib LTC hauv 2023, tab sis tsis muaj hnub kawg? Ib qho kev nkag siab rau ncua sij hawm rau qhov project no yuav zoo siab heev.
Cov Kev Ceeb Toom thiab kev taw qhia yog npaj rau cov neeg tuaj saib ntawm Tus Nqi-Rau-Service Providers uas xa daim ntawv thov them nyiaj ncaj qha rau DHCS. DHCS tab tom npaj los piav qhia cov lus qhia uas pom nyob rau ntawm Medi-Cal qhov chaw, tab sis nws yuav tsum tau hais qhia tias cov neeg muab kev pab cuam xa daim ntawv thov rau Managed Care Plans yuav tsum tau siv HIPAA Raws Li Txoj Cai Hauv Tebchaws hauv txhua kis. Cov neeg muab kev pabcuam xa cov ntaub ntawv thov rau MCPs yuav tsum tau siv HIPAA Raws Li Txoj Cai Hauv Tebchaws.
Daim ntawv qub FFS LTC (LTC-25) tau so haujlwm. Cov kev hloov tshiab yuav raug siv nyob rau nruab nrab-2023 tab sis hnub "mus nyob" rau kev siv 837 thiab cov cai hauv tebchaws tseem tsis tau txiav txim siab vim muaj kev txhawj xeeb txog kev kawm thiab kev cob qhia txog cov neeg muab kev pabcuam tam sim no. Cov hnub tseem ceeb nyob suav nrog Lub Kaum Hli 2023.
Koj txhais li cas raws li kev sib tw sib tw?
Kev sib ntsib raug soj ntsuam rau qhov sib npaug ntawm cov kab kev pabcuam. Yog tias cov kab kev pabcuam raug pom tias yog qhov sib npaug ntawm cov kab kev pabcuam yav dhau los, tag nrho cov kev sib ntsib yuav raug tsis lees paub.
Koj puas tuaj yeem thov muab piv txwv ntawm duplicates?
Ib qho kev sib ntsib/kev pabcuam sib npaug sawv cev rau tib yam xwm txheej raws li kev sib ntsib yav dhau los. PACES ntsib qhov system muaj qhov sib npaug ntawm cov logic uas saib ntau cov ntaub ntawv los txiav txim seb qhov kev sib ntsib puas tau xa yav dhau los. Yog hais tias cov ntaub ntawv hais txog qhov kev sib ntsib dhau los, nws raug tsis lees paub tias yog qhov sib npaug. Tshooj 3.8 ntawm DHCS Cov Ntaub Ntawv Sib Tham Cov Ntaub Ntawv Tus khub muab cov ntsiab lus ntawm kev sib ntsib. Koj tuaj yeem rub tawm Cov Lus Qhia Ua Haujlwm los ntawm DHCS Documentation Center. Rau kev tso cai nkag mus rau Doc Center thov xa daim ntawv thov mus rau DataExchange@dhcs.ca.gov .
Cov ntaub ntawv no puas siv tau rau txhua hom kev thov, tshwj xeeb, Kev Pabcuam Kev Noj Qab Haus Huv?
Txij li thaum BH cov ntawv thov raug ua tiav los ntawm Short Doyle system, cov logic uas tau tham ntawm no tsis siv rau BH cov lus thov rau lub sijhawm no. Phau Ntawv Qhia Tus Khub uas tau muab tso rau hauv BHIS cov ntawv tais ceev tseg yog cov uas tau hais txog BH cov lus thov.
Cov ntawv thov uas tsis yog-BH thiab tsis yog tsev muag tshuaj thiab cov ntaub ntawv ntsib raug xa mus rau PACES raws li cov ntaub ntawv ntsib. Cov duplicate ntsib cov ntaub ntawv cuam tshuam ncaj qha rau cov lus thov thiab ntsib.
Yog tias peb muaj lus nug txog cov xwm txheej tshwj xeeb thiab / lossis piv txwv, leej twg yog tus tus neeg zoo tshaj los tiv tauj?
Thov xa email mus rau Data Quality Reporting Unit MMCDencounterData@dhcs.ca.gov
Koj puas tuaj yeem muab cov npe ntawm cov txheej txheem txheej txheem uas tuaj yeem ua tau zoo dua qub, thaum twg, piv txwv li, tus txheej txheem siv rau txhua lub qhov muag, pob ntseg, thiab lwm yam sib cais?
Peb tsis tuaj yeem muab cov npe ntawm cov lej raws li tau thov. Txawm li cas los xij, thaum muaj kev sib ntsib siv tib hom txheej txheem hauv ntau qhov kev pabcuam, kev sib tw tuaj yeem zam tau los ntawm kev siv cov txheej txheem hloov kho, xws li 59, 76, thiab 77. Tab sis ntxiv cov kev hloov kho rau qhov kev sib ntsib, qhov no qhia txog PACES system kom hla dhau qhov kev sib tw thiab kho cov kev sib ntsib / kev pabcuam raws li qhov xwm txheej tshwj xeeb thiab tsis yog qhov sib npaug ntawm kev sib ntsib dhau los. Saib Tshooj 3.8 ntawm DHCS Cov Lus Qhia Ua khub
Puas tau muaj kev sib tham txog TSIS suav cov khoom lag luam tsis muaj nuj nqis rau kev ntsuas raws sijhawm?
Tsis yog, peb tsis tau muaj qhov kev sib tham. Peb xav tau cov voids kom ntseeg tau tias kev sib ntsib ua tiav. Yuav coj tau qhov kev sib tham rau qhov hnyav ntawm qhov zoo thiab qhov tsis zoo. Yuav muab hloov tshiab thaum muaj kev sib tham.
Yog tias peb yuav tsum xa qhov tsis muaj thiab hloov pauv, DHCS puas tuaj yeem txiav txim siab txog kev nplua rau lub sijhawm rau ib qho ntawm cov kev sib ntsib es tsis yog ob qho tib si?
QMED DRMT.001 cov qhab nia Npaj rau lub sijhawm hloov pauv ntawm thaum qhov kev sib ntsib thawj zaug raug tsis lees paub thiab thaum hloov pauv / tsis lees txais. Yog tias koj yuav tsum xa ib qho kev hloov pauv thiab qhov tsis muaj, QMED yuav muab qhab nia rau koj ntawm thawj qhov uas tau txais. Tsuav koj lub sijhawm ua tau zoo, ces QMED yuav tsis poob koj cov qhab nia. Saib QMED v1.1, Tshooj 4.1 DRMT.001 kom paub meej txog kev tsis pom zoo ntsib lub sijhawm hloov pauv.
Cov phiaj xwm yuav tsum xa cov ntim loj ntawm cov kev hloov pauv uas cuam tshuam nrog Lub Hom Phiaj Tus Nqi nce ntxiv los ntawm qhov kawg ntawm lub xyoo no. DHCS puas yuav txiav txim siab zam lub sijhawm raug nplua rau cov kev hloov pauv no?
Peb yuav sib tham nrog pab pawg tswj hwm thiab PACES los txiav txim seb yuav ua li cas txog qhov ntawd. Tsis txhob ntseeg qhov ntawd tab sis yuav txheeb xyuas nrog kev tswj hwm.
Tsis yog lub algorithm rau tsis suav nrog kev hloov pauv ntsib ib feem ntawm QMED v2?
Peb yuav qhia rau koj txhua tus paub thaum QMED 2.0 ua tiav.
DHCS tuaj yeem faib cov ntaub ntawv / kev tshaj tawm txog cov ntaub ntawv ntiag tug thiab offshoring. Qhov txuas uas muab tsis yog coj koj ncaj qha mus rau txoj cai / kev taw qhia / kev tshaj tawm.
Txuas yuav raug muab faib los ntawm koj tus neeg saib xyuas kev tiv tauj.
Puas muaj tej thaj chaw loj tshaj plaws ntawm lub sijhawm los txhim kho cov ntaub ntawv zoo rau kev sib ntsib? Ib yam ntaub ntawv teb lossis hom yuam kev?
Tam sim no peb tab tom ua kev soj ntsuam ntawm thaj chaw ntawm lub sijhawm los txhim kho cov ntaub ntawv zoo. Kev sib koom tes ntau ntxiv thiab kev sib txuas lus nrog Kev Npaj yuav tuaj txog qhov ntawd.
Puas yog yuav tsum muaj kev thauj mus los rau PACE?
Yog lawm, PACE cov phiaj xwm yuav xa cov ntaub ntawv ntsib txhua lub sijhawm lawv muab kev pabcuam rau ib qho ntawm lawv cov neeg koom.
Ib qho kev txiav txim siab rau PACE cov kev pab cuam, hais txog cov tswv cuab ntawm ob lub PACE tam sim no peb tab tom ua haujlwm kom xa tag nrho cov kev sib ntsib rau txhua yam ntawm kev saib xyuas, kho mob, kho hniav, kws kho mob, chaw nruab hnub, IDT kev qhuab qhia, kev thauj mus los, thiab lwm yam rau CMS thiab DHCS. Peb tab tom ua kom tiav tag nrho ntawm kev sib ntsib cov ntaub ntawv qhia rau ob lub koom haum CMS thiab DHCS. Puas muaj ib qho kev npaj los txo qis qhov sib npaug ntawm kev sib ntsib cov ntaub ntawv qhia rau cov tswv cuab ob?
Qhov teeb meem no yuav raug tshuaj xyuas raws li ib feem ntawm Encounter Data Improvement Project.
Puas yog cov phiaj xwm yuav tsum xa cov lus tsis pom zoo hauv lawv cov ntawv xa?
a) Kom meej meej - lo lus " tsis kam kev thov txim/kev sib ntsib" yog hais txog cov lus thov uas tau xa los ntawm tus kws kho mob rau txoj kev npaj tab sis tau raug tsis lees paub kev them nyiaj los yog txais los ntawm txoj kev npaj.
b) Rau kev sib ntsib uas tau xa los ntawm Txoj Kev Npaj tab sis tsis lees paub los ntawm DHCS, thov xa mus rau DHCS-PACES 837I, 837D, thiab 837P Cov Lus Qhia Ua Haujlwm, tshwj xeeb yog Tshooj 3.4. Cov lus qhia no muaj cov lus qhia rau xa cov ntaub ntawv ntsib, suav nrog kev sib txawv ntawm tsis kam , tsis lees paub , thiab txais ntsib. Tsis kam Cov kev sib ntsib yuav tsum raug kho thiab xa rov qab mus rau DHCS PACES system.
Qhov ntsuas twg yuav raug siv rau cov nyiaj them? Qee tus neeg xa ntawv tsis kam qhia cov nyiaj them, MCPs puas xav tau qhov no?
Capitated Plans (Contract Type = 5) yuav tsum xa cov ntaub ntawv xav tau raws li tau teev tseg hauv Cov Lus Qhia Txog Kev Sib Tham, tshwj xeeb Tshooj 3.18 - 3.29. Raws li tus neeg them nyiaj Medicaid, DHCS tau tso cai kom xa cov nyiaj them rau ib qho kev pab cuam Medicaid, txawm hais tias los ntawm Capitation los yog them ncaj qha rau cov chaw muab kev cog lus los ntawm Managed Care Plan.
Ib tus kws kho mob puas tuaj yeem muaj ntau hom kev pabcuam? Puas yog DHCS saib xyuas txhua tus kws kho mob ib leeg?
Yog, ib tus kws kho mob ib leeg tuaj yeem muaj ntau hom kws kho mob. Txhawm rau kom paub meej, DHCS qhov txawv ntawm Hom 1 (cov neeg muab kev pabcuam ib leeg) thiab Hom 2 (cov koom haum pabcuam).
Puas muaj cov peev txheej lossis cov ntaub ntawv cob qhia muaj rau ntsib kev xa ntawv zoo?
Yog, muaj ntau yam kev pab cuam rau Encounter Data Submission:
- Medi-Cal Phau Ntawv Qhia
- X12 EDI Piv txwv | X 12
- HIPAA X12 EDI Training Bundle | EDI Blog
Cov neeg siv phau ntawv qhia lossis FAQ puas tuaj yeem ua rau cov lej hauv zos thiab lub xeev / tsoomfwv cov cai?
Daim ntawv qhia txog kev them nqi Medi-Cal tam sim no, tsim rau FFS cov txheej txheem them nyiaj laus, suav nrog cov lus qhia rau kev xa cov lej hauv zos. Txawm li cas los xij, DHCS 'Managed Care program txwv tsis pub siv cov lej hauv zos hauv kev xa ntawv thov. DHCS tau muab txoj kev hla kev rau MCPs los qhia cov lej hauv zos rau HIPAA-raws li lub tebchaws rau kev ntsib cov ntaub ntawv. DHCS tseem tab tom ua haujlwm los muab cov lus qhia tshwj xeeb ntxiv los pab cov neeg muab kev pabcuam hloov mus rau cov lej hauv tebchaws.
Vim li cas thiaj tsis kam lees txais kev lees paub los ntawm kev sib ntsib, thiab lawv puas tsim cov ntawv sib npaug?
DHCS tab tom ua haujlwm los daws cov teeb meem cuam tshuam txog kev sau cov ntawv tsis lees paub. Cov neeg koom nrog kev lag luam yuav raug hais kom qhia ob qho tib si thaum xub thawj xa tawm tab sis tom qab tsis lees paub cov ntaub ntawv thov / ntsib thiab cov ntaub ntawv tawm tswv yim.
Puas yog DHCS yuav xav tau ib daim teb tshiab ntawm cov ntawv thov kom txheeb xyuas qhov tsis lees paub lossis 0 qhov kev thov them nyiaj?
DHCS lees paub cov teeb meem cuam tshuam nrog kev xa cov ntawv tsis lees paub rau lub kaw lus txiav txim. Txawm hais tias tsis muaj kev txiav txim siab zaum kawg, DHCS tab tom tsim ib txoj hauv kev rau kev xa cov ntawv tsis lees paub rau PACES. Cov txheej txheem no yuav txiav txim siab cov lus thov uas tau raug txiav txim ua ntej xa mus rau DHCS.
DHCS puas tuaj yeem piav qhia qhov sib txawv ntawm cov lus qhia hauv Medi-Cal phau ntawv sau nqi thiab Encounter Data Companion Guides?
Rau kev tswj hwm kev saib xyuas kev sib ntsib, cov phiaj xwm thiab cov kws kho mob yuav tsum xa mus rau PACES 837 Cov Lus Qhia Ua khub. Medi-Cal Phau Ntawv Qhia Txog Kev Sau Nqi yog npaj rau Tus Nqi-For-Service (FFS) thov kev them nyiaj thiab tsis muaj feem cuam tshuam rau kev xa ntawv. Cov kws kho mob tau cog lus yuav tsum tso siab rau DHCS-PACES 837 Kev Sib Ntsib Cov Ntaub Ntawv Cov Lus Qhia, tsis yog Medi-Cal Phau Ntawv Sau Nqi, thaum npaj cov ntawv thov thiab ntsib rau kev xa tawm.
Phau Ntawv Qhia Tus Khub puas tuaj yeem muab cov lus qhia ntxiv txog kev thov hauv tsev, xws li hom nqi thiab hnub tso tawm?
DHCS tab tom ua haujlwm los hloov kho Cov Lus Qhia Ua Haujlwm kom suav nrog cov lej tshwj xeeb thiab lwm cov ntaub ntawv, xws li cov lej nyiaj tau los, hom lej lej, thiab LTC/PACE tshwj xeeb coding. Cov kev hloov tshiab no yuav muab tso rau hauv DHCS Documentation Center thiab tom qab ntawd hauv DHCS lub vev xaib.
Hais txog Local Codes thiab Revenue Codes, MCPs tau raug qhia kom siv cov lej hauv tebchaws, tab sis Medi-Cal lub sijhawm them nqi tseem teev cov lej hauv zos. Puas tau muaj kev vam meej?
Cov phiaj xwm yuav tsum siv cov lej nyiaj tau los ntawm cov lej hauv zos. Yog tias tus lej nyiaj tau los tau teev nyob rau hauv MCP Local Code Crosswalk, nws qhia tau tias tsis muaj tus lej txheej txheem tuaj yeem ua raws li cov cai hauv zos. Yog xav paub ntxiv txog kev hloov pauv hauv zos mus rau lub tebchaws, thov mus saib cov ntaub ntawv hauv qab no:
Puas muaj cov kev pabcuam tshwj xeeb lossis ntsib nrog kev txhawj xeeb txog ntim?
Muaj kev txhawj xeeb ntawm tus naj npawb ntawm kev ntsib xa nrog Daim Ntawv Cog Lus Hom Code = 09, lossis lwm yam (2 lab ntsib rau lub Tsib Hlis 2025). Nws raug pom zoo tias Capitated Plans yuav tsum tsis txhob xa cov kev sib ntsib mus rau DHCS PACES nrog Daim Ntawv Cog Lus Hom Code = 09. Lub Plaub Hlis 2025 thiab Tsib Hlis 2025, nws tau tshawb pom ntau dua 2 lab ntsib tau xa nrog hom ntawv cog lus no.
Kev siv Daim Ntawv Cog Lus Hom Code 09 yog dab tsi?
Hauv ASC X12N 837 hom ntawv, Daim Ntawv Cog Lus Hom lej yog siv nyob rau hauv ntu CN1 txhawm rau txheeb xyuas hom ntawv cog lus raws li cov kev pabcuam twg raug muab. Thov xa mus rau Tshooj 3.18 hauv Phau Ntawv Qhia Tus khub - Cov ntaub ntawv them nyiaj rau cov lej sib cog lus sib xws.
Cov ntaub ntawv xa tawm yuav tsum muab cov ntaub ntawv them nyiaj tiag tiag siv cov qauv tsim hauv 837P. Hom kev npaj siv los them qhov kev sib ntsib yuav tsum tau piav qhia hauv ntu CN1 hauv 2300 voj - CN101 Daim Ntawv Cog Lus Hom Code. Thaum qhov kev sib ntsib tau them rau ntawm tus nqi-rau-kev pabcuam, CN102 yog nyob nrog tus nqi them. DHCS xav kom 2300 CN1 muab thiab thov kom 2400 CN1 ntu kom suav nrog. Ib qho nyiaj them rau lwm tus neeg tuav pov hwm kev noj qab haus huv yuav tsum suav nrog hauv kev sib koom tes ntawm cov txiaj ntsigs.
Puas yog cov cai hauv zos tso cai thaum daim ntawv cog lus yog 05?
Cov lis dej num hauv zos tsis raug tso cai nyob rau hauv kev xa tawm los ntawm Managed Care Plans (MCP), tsis hais hom ntawv cog lus. Txhua qhov kev sib ntsib MCP yuav tsum ua raws li 837 kev hloov pauv thiab siv cov lej hauv tebchaws nkaus xwb.
Cov lej hauv cheeb tsam raug siv rau Cov Chaw Kho Mob uas yog Tus Nqi Them Dawb rau Kev Pabcuam thiab tsis nyob hauv lub network ntawm Kev Npaj Kho Mob. Cov kws kho mob rau npe nrog MCPs yuav tsum xa cov lej hauv tebchaws rau txoj kev npaj.
Puas yuav muaj ib daim ntawv teev tag nrho Daim Ntawv Qhia Txog Kev Npaj (APL) lub sijhawm tshuaj xyuas rau cov phiaj xwm?
Lub sijhawm tshuaj xyuas APL tau npaj rau lub Cuaj Hlis 2025.
Leej twg yuav tsum tau contacted rau PACE cuam tshuam txog kev tsis lees paub?

Rau kev lees paub qhov yuam kev cov lis dej num tsim nyob rau hauv Validation Response File, thov hu rau DataQualityReportingUnit@dhcs.ca.gov
Rau cov lus nug tshwj xeeb ntawm PACE, hu rau koj tus thawj tswj hwm daim ntawv cog lus DHCS lossis PACECompliance@dhcs.ca.gov
Peb tau txais cov lej hauv zos uas DHCS tau hais tias tso cai. Txawm li cas los xij, yog tias peb xa cov lej hauv zos rau DHCS lawv yuav tsis lees paub.
DHCS PACES yog qhov kev txiav txim siab tom qab uas txawv ntawm CA-MMIS (tus nqi-rau-kev pabcuam) uas Cov Chaw Pabcuam xa cov ntawv foob mus rau CA-MMIS rau kev them rov qab los ntawm Lub Xeev. Cov lej hauv zos tsuas yog siv rau FFS cov lus thov uas dhau los ntawm CA-MMIS system. Peb txaus siab rau cov lus tawm tswv yim thiab yuav hais nyob rau hauv ib qho webinar cais.
Thov nco ntsoov: Cov chaw muab kev pabcuam uas tshwjxeeb rau Kev Pabcuam, tsuas yog xa cov lej hauv zos rau CA-MMIS. Txhua tus kws kho mob uas xa cov ntawv foob mus rau Managed Care Plan nrog cov lej hauv zos yuav tsum tsis lees paub qhov kev thov ntawd thiab kom tus kws kho mob xa cov ntawv foob uas siv cov cai hauv tebchaws rau Managed Care Plan los tshuaj xyuas. DHCS tau nthuav tawm cov kev npaj tsim nyog nrog cov phiaj xwm los xyuas kom meej Cov Kev Npaj Kho Mob yuav sau cov ntaub ntawv ntsib raws li 837 X12 cov kev cai hloov pauv.
Yog tias koj muaj lus nug ntxiv txog cov lej hauv zos, thov hu rau DataQualityReportingUnit@dhcs.ca.gov

Cov ntaub ntawv ntxiv thiab cov peev txheej
DHCS Documentation Center (DDC): Muab Cov Lus Qhia thiab cov ntaub ntawv siv rau Post Adjudicated Claims & Encounters System (PACES), Capitation Payment Management System (CAPMAN), Managed Care Program Data (MCPD), thiab Primary Care Provider Assignment (PCPA) muaj.
A ccess thov rau DDC tuaj yeem xa mus rau dataexchange@dhcs.ca.gov
PACES tuav 837 thiab 274 cov ntaub ntawv. CAPMAN npog 820 thiab 834 cov ntaub ntawv. MCPD thiab PCPA JSON cov lus qhia tau muab khaws cia rau hauv cov ntawv tshwj xeeb hauv DDC.
Rau cov phiaj xwm capitated, Daim Ntawv Cog Lus Hom Codes hauv CN101 yog 01, 02, 03, 04, lossis 06, sawv cev rau cov nyiaj them los ntawm txoj kev npaj raws li daim ntawv cog lus nrog Medi-Cal. Cov nyiaj no sib raug rau AMT * D tus nqi rau cov neeg them nyiaj raug xaiv nrog SBR09 = "MC." Daim Ntawv Cog Lus Hom Code 09 (Lwm Yam) yuav tsum tsis txhob siv rau kev npaj ua tiav.

Data Exchange & Xa

Puas yog 274 mus rau PACES?
Yog lawm. Tag nrho 274 cov ntaub ntawv xa mus rau DHCS yog ua tiav los ntawm PACES.
Txoj Cai Kho Mob Kho Mob yog dab tsi?
Cov kab lis kev cai kho mob hais txog cov cai teev (HCPCS, thiab lwm yam uas yuav tsum tau muaj ntawm X12 EDI thiab lwm yam kev hloov pauv. Feem ntau cov cai teev siv nyob rau hauv 837 kev lag luam tau teev nyob rau hauv ib daim ntawv txuas ntxiv pom nyob rau hauv X12 5010 837 Cov Lus Qhia Ua Haujlwm.
Peb nquag pom ntsib cov ntaub ntawv tsis lees paub uas hais tias "Tsuas yog cov lej teev tseg hauv cov lej teev npe 130 tau tso cai." Yog daim ntawv teev npe 130 muaj rau pej xeem ?
Txhua X12 Daim Ntawv Qhia Txog Kev Ua Haujlwm tshaj tawm cov npe ntawm Code npe hais txog hauv Phau Ntawv Qhia lossis xav tau hauv kev hloov pauv. Daim Ntawv Teev Npe 130 tau teev nyob rau hauv Cov Ntawv Ntxiv A ntawm 837 Cov Lus Qhia Ua Haujlwm, uas muaj los ntawm X12.
- Cov npe Code 130 - Healthcare Common Procedural Coding System (HCPCS)
- NTAWM NO:
  Chaw rau Medicare & Medicaid Services
  7500 Security Boulevard
  Baltimore, MD 21244
Peb puas tuaj yeem tau txais kev taw qhia txog kev lim dej siv rau FQHC ntim kom peb tuaj yeem sim rov ua dua rau kev sib piv?
Kev taw qhia tau tshaj tawm rau cov koom haum thiab cov neeg thov FQHC APM. Yog tias koj xav tau daim ntawv luam, thov hu rau FQHCAPM@dhcs.ca.gov mailbox.
Peb tuaj yeem nrhiav Cov Lus Qhia Txog Tus Kheej tam sim no rau EDI kev lag luam nyob qhov twg?
Managed Care Encounter Companion Guide yog muab tso rau hauv DHCS Documentation Center, uas yog siv tau rau txhua tus DHCS Trading Partners thaum thov. Thov xa daim ntawv thov nkag mus rau dataexchange@dhcs.ca.gov. Cov lus qhia muaj nyob rau hauv ntau txoj hauv kev hauv DHCS Documentation Center.
Puas muaj ib phau ntawv txhais lus metadata/cov ntaub ntawv uas peb tuaj yeem muab los siv rau hauv tes nrog 274 Phau Ntawv Qhia Tus Khub?
Tsis yog. Txhua txoj cai kev lag luam raug txheeb xyuas nyob rau hauv 274 Companion Guide thiab X12 274x109 Daim Ntawv Qhia Kev Ua Haujlwm, muaj los ntawm X12.
Cov ntaub ntawv thov tam sim no yog 10 hnub tom qab COM?
Tsis yog, tsis yog. PACES cov txheej txheem ua haujlwm ntsib cov ntaub ntawv thiab cov chaw muab kev pabcuam network cov ntaub ntawv txaus. Cov ntaub ntawv sib ntsib yuav tsum xa sai li sai tau tom qab kev sib ntsib, tab sis tsis muaj hnub kawg. Tus Muab Kev Pabcuam Network Cov ntaub ntawv xa tawm txaus qhia txog cov xwm txheej ntawm ib qho kev npaj pabcuam hauv lub hlis twg. Vim li no, Cov Chaw Pabcuam Network Cov ntaub ntawv tsim nyog yuav tsum xa los ntawm X12 274 kev hloov pauv los ntawm^10th ntawm txhua lub hlis.
Qhov URL rau "Documentation Center" yog dab tsi?
Nov yog nplooj ntawv tso tawm rau lub chaw khaws ntaub ntawv. https://teams.microsoft.com/l/team/19%3aMTndJi9glI7WQS1AhqVyLh3AeBMf8syywgxG8KQ1Loo1%40thread.tacv2/co nversations?groupId=3862053f-5e17-47be-9fd8-5bbe497e593a&tenantId=265c2dcd-2a6e-43aa-b2e8-26421a8c8526
Puas muaj kev txwv rau Tus lej ntawm cov neeg ua haujlwm uas tuaj yeem nkag mus rau DHCS Documentation Center (DDC)?
Tsis muaj kev txwv tam sim no ntawm tus nqi ntawm cov neeg ua haujlwm ua lag luam uas tuaj yeem tso cai nkag mus rau DHCS Documentation Center (DDC). Yog tias tus lej ntawm cov nyiaj uas muaj kev nkag mus dhau qhov siab tshaj plaws ntawm pawg, Lub Tsev Haujlwm yuav txiav txim siab txog qhov txwv.
Peb tau txais kev xeem CIN yav dhau los los ntawm DHCS. Peb puas yuav tsum txuas ntxiv siv Test CIN's rau kev sim cov ntaub ntawv Encounter?
Yog, thov siv Test CINs yog tias koj muaj lawv. Test CINs tam sim no muab tso rau hauv DHCS Documentation Center. Txhawm rau kom paub meej, DHCS yuav muab Kev Ntsuas CINs rau txhua qhov Kev Pabcuam Tswjhwm Saib Xyuas thiab PACE lub sijhawm no. Peb kuj tseem yuav muab cov ntaub ntawv hais txog Test CINs nrog BHPs thaum lub sijhawm los rau BHPs siv lawv. Txog tam sim no, BHPs tsis tas yuav txhawj xeeb nrog Test CINs. Yog tias koj pom lub Chaw Cov Ntaub Ntawv tsis muaj Test CINs rau koj txoj kev npaj, lossis yog tias Test CINs ua rau muaj kev tsim nyog yuam kev hauv koj cov ntaub ntawv xeem, thov hu rau koj Tus Kws Paub Txog Cov Ntaub Ntawv.
BHP sawv cev rau dab tsi?
BHP sawv cev rau Cwj Pwm Kev Noj Qab Haus Huv. Kalifonias cov nroog muab kev pabcuam Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv rau cov tswvcuab Medicaid. Cov kev pabcuam yog tswj hwm los ntawm cov koomhaum hauv nroog, uas raug hu ua BHPs.
Qhov tseeb version ntawm 837 kuv thiab P yog dab tsi?
Qhov tseeb version ntawm HIPAA mandated 837 yog 5010. Thov mus saib x12.org yog xav paub ntxiv.
Puas muaj cov phiaj xwm tso cai siv CINs tiag tiag rau MCPs siv hauv Kev Xeem Ib puag ncig?
Tsis yog. Siv cov CIN tiag tiag sab nraum qhov chaw tsim khoom qhia txog qee qhov kev nyab xeeb thiab lwm yam kev txhawj xeeb txog PHI. Kev sim CINs tau muab los txhawm rau txo qhov kev pheej hmoo ntawm PHI breech.
Puas yuav EVRs nyob rau hauv X12 hom?
EVR's nyob hauv .xml hom ntawv, tab sis ua raws li schema ntawm 837. Hauv lwm lo lus, EVR teev cov kev ua yuam kev thiab cov lus ceeb toom nyob rau hauv tib qho kev txiav txim uas cov ntaub ntawv hais nyob rau hauv 837 kev hloov pauv qauv. Cov hom ntawv .xml yuav tsis hloov.
Raws li Tus Neeg Thib Peb Xa rau ntau qhov kev npaj, puas muaj cov lus qhia rau leej twg peb xav tau hu rau txhawm rau ntxiv Cov Kev Npaj Tshiab rau tus neeg xa khoom uas twb muaj lawm?
Txhua tus neeg thib peb xa mus rau Cov Kev Npaj Khomob tam sim no yuav tsum tau mus dhau Txoj Kev Npaj Khomob los tham txog kev nkag mus rau kev xa cov ntaub ntawv mus rau DHCS PACES SFTP site. Piv txwv li, yog tias Daim Phiaj Xwm Saib Xyuas Kev Noj Qab Haus Huv tab tom siv (lossis yuav siv) EDIFECS los tsim thiab xa cov ntaub ntawv ntsib, EDIFECS yuav tsum muaj Lub Hom Phiaj Kho Mob hu rau DHCS Tus Thawj Saib Xyuas Daim Ntawv Cog Lus kom thov ntxiv EDIFECS cov neeg ua haujlwm rau hauv daim phiaj xwm saib xyuas kev noj qab haus huv DHCS PACES SFTP cov npe nkag. Cov ntaub ntawv uas Tus Thawj Saib Xyuas Daim Ntawv Cog Lus xav tau suav nrog: Edifecs cov neeg ua haujlwm lub npe, lub npe, tus lej xov tooj, e-mail, nkag mus rau cov ntawv tais ceev tseg (xws li seb puas yog rau Kev Xeem thiab Ntau Lawm), thiab hom ntawv nkag (nyeem / sau / rho tawm). Tsis tas li ntawd, yog tias tus neeg sab nrauv xav tsim cov ntaub ntawv automated upload rau DHCS PACES SFTP, qhov no yuav xav tau cov txheej txheem pov thawj ntxiv thiab teeb tsa "kev pabcuam tshwj xeeb". Thov e-mail DataExchange@dhcs.ca.gov thiab Health Care Plan's Contract Manager kom nug txog hom kev teeb tsa no.
Lub sijhawm ntsuas nruab nrab yog dab tsi?
Lub sij hawm ntsuas nws txawv nyob ntawm qhov Kev Npaj Kho Mob uas tab tom sim. Tus neeg tsav tsheb loj tshaj plaws ntawm kev nce lub sijhawm sim yog seb Txoj Kev Npaj Khomob puas yog tshiab rau Medi-Cal thiab seb cov neeg ua haujlwm puas muaj kev paub ua haujlwm nrog Medi-Cal 837 thiab NCPDP cov ntaub ntawv. Pawg DHCS Cov Ntaub Ntawv Zoo yuav ua haujlwm nrog Txoj Kev Npaj Khomob kom ntseeg tau tias qhov kev kuaj xyuas tau ua tiav thiab nyob rau lub sijhawm tsim nyog.
Yog tias Txoj Kev Npaj Khomob muaj kev paub dhau los hauv kev xa cov ntaub ntawv ntsib uas tau hais los saum toj no, lub sijhawm kuaj yuav kav ntev li 1 lub hlis lossis tsawg dua. Yog tias Txoj Kev Npaj Khomob tau siv tus neeg muag khoom thib peb uas tsim tau zoo los xa cov ntaub ntawv Medi-Cal ntsib, lub sijhawm xeem yuav raug muab luv ntxiv yog tias cov ntaub ntawv xa tuaj ua raws li Kev Xeem Xeem.
Kuv yuav tau txais cov kev xeem CINs los ntawm qhov twg?
Qhov Test CINs rau LA Care muaj nyob rau hauv DHCS Documentation Center. Txhawm rau kom ntseeg tau tias koj tau nkag mus rau qhov chaw ntawd, thiab tuaj yeem rub tawm qhov Test CINs rau LA Care, thov xa email rau DataExchange@dhcs.ca.gov
Txij li thaum LTC yog tshiab rau peb thiab kuv tsis xav tias peb puas tau txais daim ntawv thov LTC, DHCS puas muab LTC thov / ntsib zoo li cas?
LTC ntsib cov ntaub ntawv siv 837 tus qauv kev hloov pauv, tib yam li kev thov kev kho mob / kev sib ntsib siv 837 tus qauv. Txhua qhov kev hloov pauv tau piav qhia nyob rau hauv 837 Cov Lus Qhia Ua khub.
Peb tsis paub dab tsi daim nqi thiab kev pabcuam code raug suav tias yog LTC, koj puas tuaj yeem coj kuv mus rau LTC nqi? Peb tsis tau ntsib LTC thov lossis qhov no zoo ib yam li SNF?
Yog lawm, cov ntsiab lus ntxiv hais txog hom nqi / cov lis dej num yuav muab qhia sai sai.
Qhov kev sim no puas siv tau rau PACE txoj kev npaj?
Yog lawm, kev sim siv tau rau PACE Cov Koom Haum/Plans thiab. PACE Plans uas xa cov ntaub ntawv ntsib rau Institutional, Professional (837 I/P files) yog tib hom ntaub ntawv xa los ntawm Managed Care Plans. Qee qhov PACE Plans kuj tseem yuav muaj kev sib ntsib kho hniav (837D) thiab tseem yuav raug kuaj kom xa cov ntaub ntawv no.
Rau PACE cov kev pab cuam tam sim no qhia tib cov ntaub ntawv Encounter rau DHCS ncaj qha raws li lawv ua rau Medicare. Puas yog lub hom phiaj xa cov ntaub ntawv sib ntsib uas twb tau tshaj tawm rau DHCS/Medicare, hauv cov txheej txheem tshiab no rau lub xeev los ntawm cov ntaub ntawv uas twb tau xa mus rau Medicare? raws li nws yuav zoo li duplicate rau cov ntaub ntawv twb xa mus rau DHCS. Los yog lub hom phiaj tsuas yog tshaj tawm cov ntaub ntawv uas tsis tau tshaj tawm rau DHCS, ib yam li yuav yog rooj plaub rau Medicare nkaus xwb pts. Mus rau pem hauv ntej yog lub hom phiaj kom muaj PACE cov kev pab cuam txuas ntxiv mus tshaj tawm cov ntaub ntawv sib ntsib nyob rau hauv ob txoj kev cais rau lub xeev? Los yog peb tuaj yeem cia siab tias qhov no yuav yog lub sijhawm txwv.

PACE Cov phiaj xwm uas tsis tau dhau los ntawm cov txheej txheem sim rau 837I, 837P, 837D, lossis NCPDP cov ntaub ntawv thiab cia siab tias yuav muaj cov kev sib ntsib no yuav tsum mus dhau ntawm cov txheej txheem xeem. Yog tias PACE txoj kev npaj tau dhau los ntawm kev sim yuav tsis tas yuav rov mus kuaj dua, tshwj tsis yog PO tau dhau los hloov pauv cov ntaub ntawv tseem ceeb raws li tau tham hauv webinar.
Lub DHCS PACES SFTP Test neeg rau zaub mov tsom iav DHCS PACES SFTP Production yog li cov phiaj xwm xav "tsim" cov ntaub ntawv uas yuav xa mus rau Kev Tsim Khoom los ntawm kev xa mus rau Test server. Cov ntaub ntawv teb uas tsim los ntawm Test server yog tib yam li Production.
Yog tias lo lus nug yog hais txog kev sib tw uas tau xa hauv 837 cov ntaub ntawv rau DHCS PACES SFTP, kev sib tw sib tw ntawm cov kab kev pabcuam yuav tsum raug kho. Tus naj npawb ntawm cov kev sib tw uas twb muaj lawm yog qhov paub txog cov ntaub ntawv zoo qhov teeb meem uas DHCS tau tsom mus rau kev txhim kho thiab lub hom phiaj rau Encounter Data Quality Improvement Project.
Yog tias lo lus nug nug seb PO puas xav tau xa ib daim ntawv ntsib rau Medicare (yog tias tus neeg txais txiaj ntsig tau txais kev tso npe) thiab tsis tas yuav xa cov ntaub ntawv ntsib mus rau DHCS PACES SFTP, qhov ntawd tsis raug. CMS ua thiab tshawb xyuas DHCS cov ntaub ntawv thiab nws tseem ceeb heev rau DHCS kom tau txais cov ntaub ntawv tib yam uas PO tau tshaj tawm. Kuv xav xa mus saib lub vev xaib no - Cov Khoom Siv thiab Cov Qauv (ca.gov) thiab https://www.dhcs.ca.gov/provgovpart/Pages/PACE.aspx
Puas tau pom qhov hloov pauv rau MDCPD (ECM). Puas yog qhov schema hloov pauv rau PCPA?
Ib qho kev hloov pauv tam sim no lossis muaj peev xwm hloov pauv hauv cov phiaj xwm yuav raug qhia thawj zaug nrog Cov Kev Npaj Kho Mob thiab peb cov neeg koom tes nrog cov phiaj xwm los tshuaj xyuas thiab muab tswv yim. DHCS tau sib txuas lus nrog cov neeg koom tes nrog Plan thaum lub Plaub Hlis 2024 cov kev hloov pauv rau MCPD/PCPA Cov Lus Qhia Qhia Txog Kev Pabcuam Ntxiv rau Tshooj 2.1.4. Koj tuaj yeem pom cov ntaub ntawv MCPD/PCPA tam sim no ntawm DHCS Docs qhov chaw ntawm no: MCPD, PCPA Cov Ntaub Ntawv thiab Schemas
Nyob rau yav dhau los DHCS muaj qee lub sijhawm sim (Lub Ib Hlis-Lub Peb Hlis, Lub Rau Hli-Lub Yim Hli Kuv xav). Puas tseem muaj li no?
Peb cia siab tias yuav rov qab mus rau cov sij hawm sim xws li cov teev saum toj no. Cov Ntaub Ntawv Zoo vam tias yuav muaj kev sim rau Lub Rau Hli - Lub Yim Hli rau cov koom haum PACE yav tom ntej xav tias yuav nyob rau hauv lub Xya hli ntuj 2024 ib HCPs tam sim no uas tab tom hloov pauv loj.
Puas muaj qhov txwv ntawm PACES nkag mus rau cov ntaub ntawv pov thawj rau cov kev sim sib txawv?
Qhov kev txwv ib txwm ntawm cov neeg ua haujlwm uas yuav xa cov ntaub ntawv mus rau DHCS PACES Test lossis Server yog plaub tus neeg. Yog tias HCP xav tau cov neeg sib txawv rau kev nkag mus rau Test server lossis Production, HCP tsuas yog yuav tsum tau sau cov ntawv ntawd hauv e-mail nrog DHCS Tus Thawj Tswj Daim Ntawv Cog Lus. Feem ntau, peb xav kom cov koom haum txwv tus lej ntawm SFTP tus lej rau 5, tab sis qhov ntawd tuaj yeem sib tham tau yog tias xav tau kev nkag mus ntxiv
Puas yuav DHCS xa email rau Cov Kev Npaj hais txog PACES SFTP sijhawm kuaj?
Yog, qhov ntawd yuav ua tiav.
Puas yog txoj kev npaj yuav tsum kho thiab xa rov qab yog tias cov ntaub ntawv tau txais nrog w/WARNING(s)? los ntawm 10th thiab?
Yog lawm, koj tuaj yeem xa rov qab cov ntaub ntawv kho dua tom qab xa thawj zaug.
Peb yuav tau txais cov ntaub ntawv qhia tshiab thaum CCM cov ntsiab lus yuav suav nrog, puas yog?
Yog. Technical Documentation yuav muab faib thiab muab tso rau hauv DHCS Documentation Center. Txhawm rau nkag mus rau Doc Center, thov xa daim ntawv thov mus rau DataExchange@dhcs.ca.gov
Puas yog cov ntawv xa rov qab mus rau qhov chaw sim suav nrog hauv daim ntawv tshaj tawm ib nrab xyoo? Lossis tsuas yog cov uas xa rov qab mus rau qhov chaw ua haujlwm?
Kev xa rov qab mus rau qhov chaw xeem tsis suav nrog hauv Daim Ntawv Qhia Ib Nrab Xyoo.
Puas yog DHCS tso cai rau hnub ntxiv rau kev sim txiav txim siab yuav tso tawm cov qauv tshiab thaum JSON Phase II yuav nyob? Peb tau hais kom siv V2.0 hauv kev sim
Yog. Ib qho email yuav tawm mus nrog schema thiab cov lus qhia kev qhia thaum Lub Yim Hli^1st ntawm EDIM mailbox nrog cov lus hloov kho tshiab.
Txoj Kev Npaj yuav tsum ua li cas rau cov txheej txheem zam rau MDC pawg ua tsis tiav rau 274 cov ntaub ntawv?
Thov xa mus rau APLs tshwj xeeb rau 274 teev hauv qhov kev nthuav qhia. Qhov no yog ib txoj cai nug uas yuav tsum tau coj mus rau MCQMD@dhcs.ca.gov vim qhov kev faib no tswj cov ntawv cog lus thiab saib xyuas cov ntaub ntawv zoo.
Losntawm kev dhau los dhau los, kev sim ib puag ncig tsis ib txwm tsom iav qhov chaw tsim khoom raws nraim. Kaw tab sis tsis tag.
Yog tias koj xa mus rau PACES system, Production ua mirror qhov Test/Staging ib puag ncig. Cov txheej txheem txheej txheem yog xa cov lej hloov tshiab rau qhov chaw kuaj thawj zaug, thiab 2 lub lis piam tom qab xa mus rau Kev Tsim Khoom. Peb tsis paub txog qhov sib txawv ntawm ib puag ncig. Yog tias koj pom qhov sib txawv, thov xa email rau DataExchange@dhcs.ca.gov .
Nws tuaj yeem muaj qee qhov teeb meem nrog CINs - tsis tas li ntawd, tus neeg rau zaub mov kuaj kuj tseem tuaj yeem ua lub luag haujlwm ntawm cov ntaub ntawv txuas ntxiv uas tso cai rau Managed Care Plans lub sij hawm los kho cov schema tshiab. Piv txwv li, MCPD cov ntaub ntawv hauv cov neeg rau zaub mov kuaj suav nrog cov txiaj ntsig ntxiv uas tau tshaj tawm rau Cov Kev Npaj Kho Mob thaum lub Plaub Hlis 2024. Tam sim no, Prod server yuav tsis lees txais cov ntaub ntawv MCPD "tshiab" no kom txog thaum Lub Yim Hli 2024. Kuv yuav xa mus rau Data Exchange rau cov hnub tim.
Tsis tas li ntawd, thov cia MCQMDProviderData@dhcs.ca.gov paub yog tias muaj qhov sib txawv tseem ceeb rau qhov kev xeem neeg rau zaub mov uas cuam tshuam koj lub peev xwm siv tau zoo.
Yog xav paub ntxiv txog PACE?
Rau cov koom haum PACE thiab txoj cai, thov xa mus rau All Inclusive Care for the Elderly. Koj kuj tuaj yeem hu rau: PACECompliance@dhcs.ca.gov
Puas yog qhov "Grievance Type" yuav tsis raug rau kev thov rov hais dua?
Yog, yog lawm.
Hom "Kev Tsis Txaus Siab" tsis raug tshem tawm los ntawm Cov Ntaub Ntawv Thov Kev Txiav Txim Siab hauv MCPD Cov Ntaub Ntawv Cov Ntaub Ntawv (Lub Kaum Ob Hlis 2024) raws li kev piav qhia ntawm kev hloov pauv. Qhov no puas tuaj yeem qhia meej?
Cov kev hloov pauv tau tshwm sim hauv version 3.05 ntawm MCPD Cov Ntaub Ntawv Cov Ntaub Ntawv, uas tau muab tso rau hauv DHCS Cov Ntaub Ntawv Chaw rau Lub Ib Hlis 24, 2025.
Thaum twg tus tshiab schema 3.05 yuav nyob hauv kev tsim khoom, thiab thaum twg yuav pib sim?
Hnub kawg ntawm kev xa mus rau MCPD cov ntaub ntawv yuav nyob twj ywm hnub tim 10 ntawm txhua lub hlis rau cov ntaub ntawv lub hli dhau los. Kev sim yuav pib rau lub Ob Hlis 1, 2025, thiab hnub tsim khoom yog teem rau lub Plaub Hlis 1, 2025. Thawj hnub kawg rau xa 3.05 version MCPD cov ntaub ntawv yuav yog lub Plaub Hlis 10, 2025, rau lub Peb Hlis 2025 cov ntaub ntawv. Pab pawg PACES yuav xa cov lej MCPD tshiab rau Kev Ntsuas thaum Lub Ob Hlis 1, 2025, thiab rau Kev Tsim Khoom rau lub Plaub Hlis 1, 2025. Tom qab lub Plaub Hlis 1, 2025, tag nrho cov ntaub ntawv tsim tawm MCPD yuav tsum xa los ntawm lub Plaub Hlis 10, 2025. Hnub kawg ntawm 10th ntawm lub hli no siv rau tag nrho cov ntaub ntawv tsim khoom xa tuaj rau ntawm MCPD cov ntaub ntawv.
Qhov "Denial of Payment Request" yog ib qho ntawm peb hom kev tsis txaus siab saum toj kawg nkaus. Nws zoo nkaus li tau raug tshem tawm, tab sis zoo li tsis muaj cov kev xaiv them nqi ntxiv ntxiv raws li Hom Kev Tsis Txaus Siab. Koj puas tuaj yeem muab kev qhia meej?
Raws li tsoom fwv teb chaws txhais, qhov no yuav tsum tau tshaj tawm tam sim no raws li kev thov rov hais dua es tsis yog kev tsis txaus siab.
Hloov rau MCPD Cov Ntaub Ntawv Cov Ntsiab Lus:
- Kev hloov tshiab thiab ntxiv tau ua rau 3.05 MCPD Cov Ntaub Ntawv Element Dictionary uas twb muaj lawm, suav nrog:
Cov kev hloov kho tshiab kuj suav nrog kev hloov kho rau MCPD Cov Ntaub Ntawv Layout (Tshooj 2.2), MCPD Cov Ntaub Ntawv Teb (Tshooj 3), Piv Txwv MCPD Cov Ntaub Ntawv (Tshooj 4), thiab MCPD JSON Cov Ntaub Ntawv (Tshooj 4.2).
Yog tias koj tseem tsis tuaj yeem nrhiav tsis tau Daim Ntawv Thov Kev Tsis Txaus Siab uas tau muab tshem tawm los ntawm cov ntaub ntawv thov rov hais dua, thov xyuas kom koj tau xa mus rau cov ntaub ntawv MCPD tam sim no.
Nyob rau hauv MCPD Technical Document Draft V3.05, nws tau hais tias Hom Kev Tsis Txaus Siab "Kev Pabcuam Ntxiv" yuav hloov mus rau "Kev Pabcuam Ntxiv (Kev Pabcuam)," tab sis qhov kev hloov no tsis tau teev nyob rau hauv daim swb rau Kev Tsis Txaus Siab Hom Hloov. Qhov kev hloov no puas tseem yuav siv tau?

Yog lawm, qhov kev hloov pauv no tseem tau teem sijhawm los siv rau hauv version 3.05. Thov nco ntsoov tias tsis yog txhua qhov kev hloov pauv tau suav nrog hauv cov swb.
Dab tsi yog qhov siab tshaj plaws ntawm kev xeem CINs uas tuaj yeem siv tau?
T nws qhov siab tshaj plaws ntawm Test CINs uas DHCS tuaj yeem muab tau rau lub sijhawm no tsuas yog tsib (5). Qee qhov xwm txheej, Test CINs tuaj yeem rov qab siv dua, tab sis muaj kev pheej hmoo tias lub kaw lus tuaj yeem kho lawv li qhov sib npaug, uas tuaj yeem ua rau tsis lees paub thaum kuaj.
Vim tias muaj tsawg tsawg ntawm Test CINs, DHCS pom zoo tias cov koom tes ua lag luam txiav txim siab siv "dummy" Test CINs. Cov "dummy" Test CINs yuav tsum ua raws li Test CIN formatting cov cai: yim (8) tus lej cim ua raws li ib (1) alpha cim, xws li "A". Thaum siv "dummy" Test CINs yuav ua rau muaj kev ceeb toom, tsis muaj cov ntaub ntawv tsis lees paub yuav tshwm sim, thiab cov lus ceeb toom no tuaj yeem tsis lees paub thaum kuaj.
Puas yog peb siv cov ntaub ntawv 274 Lub Chaw Pabcuam Lub Nroog Production lossis BHIN PACES folder los xa cov ntaub ntawv tshiab?
PACES directory yog DHCS-PACES/Production/Counties/CountyName_XX/Submit and DHCS-PACES/Production/Counties/CountyName_XX/Teb.
(CountyName yog lub npe ntawm koj Lub Nroog) - Hauv qhov no, DHCS-PACES/Prod/Counties/Los Angeles_19/Submit and so on.
Yog tias cov suav suav txawv txawv tab sis cov lus teb raug lees txais; puas yuav tsum tau xa rov qab?
Yog lawm. Yog tias cov ntaub ntawv tau txais tab sis suav tsis tau raws li qhov xav tau lossis xav tau, koj yuav tsum kho thiab xa cov ntaub ntawv rov qab raws li cov lus qhia tau hais hauv CG.
Dab tsi yog qhov txuas rau VRF 1.4 tshiab?
Txuas mus rau schema thiab cov ntaub ntawv: DHCS Documentation Center | General | Microsoft Teams
Txuas mus rau BH CG 3.01: Behavioral Health 274 Cov Ntaub Ntawv Qhia Txog Tus Kws Kho Mob

JSON, ECM/CS

JSON file yog dab tsi?
JSON cov ntaub ntawv yog ib hom ntawv tshwj xeeb siv hauv kev xa cov ntaub ntawv.
Kuv tseem tsis paub meej tias SRF JSON yog dab tsi. Tej zaum nws yuav pab tau kom sau cov lus luv luv.
SRF = Cov ntaub ntawv xa rov qab
JSON = JavaScript Object Notation
SRF JSON = Cov ntaub ntawv xa rov qab xa hauv JSON
DHCS tau xa ib daim ntawv qhia ECM-CS kho dua tshiab uas yuav siv tau rau lub Kaum Ib Hlis rau Q3 2023 cov ntaub ntawv. Lawv puas yuav raug hloov thaum kawg ntawm lub xyoo?
Xav paub ntau ntxiv tuaj. Thov nyob twj ywm!
Peb tau pib xa ECM ntsib, yog li peb puas yuav tau xa cov ntaub ntawv JSON rau ECM yav tom ntej?
Yog lawm, MCPs yuav tsum xa ob daim ntawv JSON thiab ntsib rau ECM.

Koj puas tuaj yeem muab cov ntsiab lus ntxiv txog ECM thiab CCM cov ntaub ntawv uas yuav hloov mus rau JSON hom tshiab? Cov ntaub ntawv twg yuav raug hloov?
Xav paub ntau ntxiv tuaj. Thov nyob twj ywm!
Koj puas tuaj yeem hais qhia ECM / CS Cov Lus Qhia yuav tsim rau JSON cov ntaub ntawv?
Xav paub ntau ntxiv tuaj. Thov nyob twj ywm!
Puas yog ECM/CS cov ntaub ntawv (JSON) xa mus rau txhua hli?
Yog lawm.
Rau tus chij tshiab uas tsis muaj tsev nyob uas yuav tsum tau muaj rau cov kev pabcuam ECM/CS, cov ntaub ntawv no yuav tsum raug xa mus rau cov chaw muab kev them nqi hluav taws xob li cas ntawm 837 lossis los ntawm daim ntawv ntawm CMS 1500 daim ntawv?
Nws yuav hloov kho sai li sai tau thaum peb muaj cov lus teb sib xws. Ua tsaug rau koj ua siab ntev.
JSON cov ntaub ntawv cais los ntawm MCPD cov ntaub ntawv?
Yog, nws yuav cais.
Puas muaj kev npaj hloov 274 cov ntaub ntawv rau JSON?
274 cov ntaub ntawv hom ntawv yog cov ntaub ntawv tus kheej delimited ntawv tsim thiab muaj los ntawm X12 lub koom haum. X12 yog Lub Koom Haum Txhim Kho Cov Qauv uas muaj npe nyob rau hauv HIPAA cov cai raws li tus tsim tawm cov ntaub ntawv tawm tswv yim rau Electronic Data Interchange. Cov ntaub ntawv 274 yog tsim los siv tib hom ntawv raws li X12 837 Cov Ntaub Ntawv Thov / Sib Tham, cov ntaub ntawv qhia txog kev them nyiaj 835, cov ntaub ntawv sau npe 834 tus tswv cuab, thiab lwm yam kev hloov pauv rau kev siv cov ntaub ntawv kho mob sib pauv. Tsis muaj cov phiaj xwm tam sim no los hloov 274 hom ntawv rau JSON. Tab sis nws yuav nthuav.
Thaum twg cov phiaj xwm tuaj yeem cia siab tias yuav muaj ECM / CS / CCM cais Phau Ntawv Qhia? Puas yuav muaj tsab ntawv qhia ntxov ntawm ECM/CS/CCM tus khub phau ntawv qhia rau cov lus pom?
Xav paub ntau ntxiv tuaj. Thov nyob twj ywm!
Peb siv email dab tsi los xyuas kom meej tias peb nyob rau hauv daim ntawv teev npe tau txais cov ntawv ceeb toom ECM/CS JSON?
Cov ntawv ceeb toom no yuav raug xa tawm mus rau MCPs siv peb cov npe email uas twb muaj lawm ua haujlwm uas peb muaj nyob hauv.
Thaum twg qhov kev xeem ECM/CS Json theem 2 yuav tiav?
Kev xeem ECM yuav ua tiav los ntawm Lub Yim Hli 1, 2024.
Thaum twg 274 kev xa mus yuav yog ib feem ntawm JSON Format for Counties?
274 yog X12 kev hloov pauv tus qauv, thiab yog li tsis yog JSON hom. Cov ntaub ntawv hloov pauv cov qauv yog ntau dua ntawm "daim ntawv qhia" ntawm yuav ua li cas cov ntaub ntawv cov ntsiab lus tau nteg tawm (qhov kev txiav txim uas lawv tau tshaj tawm, thiab lwm yam. raws li cov cai rau txhua lub ntsiab lus). JSON yog ntau hom ntaub ntawv, zoo ib yam li .xml
Puas muaj json schema file rau ECM/CS? Peb nrhiav tsis tau nws hauv Pab Pawg?
Yog, nyob rau hauv qhov kev pab cuam template cov ntaub ntawv cov ntaub ntawv, muaj schema thiab tech qhia rau nws
Puas muaj kev pom zoo rau cov cuab yeej uas tuaj yeem hloov cov ntaub ntawv Excel rau JSON?
Notepad++, Zappysys, excel2jason tsev qiv ntawv uas yog python qiv.

274 MHP thiab 274 DMC-ODS

DHCS puas tau nug txog cov neeg sib cuag (txog plaub) twb raug xa mus rau MHP/DMC-ODS Lub Nroog?
DHCS tau nug txog MHP thiab DMC/ODS kev sib cuag los ntawm 274 Lub Nroog Workgroup cov rooj sib tham txhua hli. Lub hom phiaj yog kom muaj plaub lub nroog tiv tauj ib hom phiaj xwm (xws li MHP piv rau DMC-ODS). DHCS tseem tsis tau xa tawm daim ntawv thov tsuas yog plaub tus neeg hu. Peb tab tom siv daim ntawv teev npe tam sim no xa los ntawm lub nroog.
Koj puas yuav cia siab tias yuav cais 274 rau txhua pawg? Ib qho rau kev coj tus cwj pwm noj qab haus huv, ib qho rau tshuaj thiab ib qho rau kev kho hniav? Los yog ib qho suav nrog lawv tag nrho?
DHCS yuav tsum cais 274 EDI kev xa mus rau Kev Kho Mob, Kev Kho Hniav thiab Tus Cwj Pwm Kev Noj Qab Haus Huv tau tswj hwm tus qauv kev saib xyuas.
MHP thiab DMC-ODS puas yuav muaj 274 kev xa tawm? Los yog nws yuav yog ib qho kev xa tawm?
Sib cais 274 EDI xa ntawv yuav tsum tau xa rau MHP thiab DMC-ODS cov ntawv xa. Phau Ntawv Qhia Txog Tus Cwj Pwm Kev Noj Qab Haus Huv 274 Tus khub yuav muab cov lus qhia rau kev xa MHP thiab DMC-ODS cov ntaub ntawv xa mus. Lub npe EDI cov ntaub ntawv thiab Kev Npaj Khomob (HCP) code yuav paub qhov txawv ntawm hom phiaj xwm.
Rau 274 BH, puas yog qhov kev cia siab tias MCPs yuav xa ib qho 274 cais uas tsuas yog suav nrog lawv BH network ntxiv rau lawv qhov kev xa tawm tam sim no 274?
DHCS tseem yuav muaj cais 274 EDI xa mus rau Lub Nroog Behavioral Health Managed Care Plans (MHP thiab DMC-ODS).
Puas yog qhov ntawd txhais tau tias txoj hauv kev tam sim no xa MHP 274 (X12 EDI hom) yuav raug hloov los ntawm JSON mus tom ntej?
Lub 274 tsis raug hloov nrog JSON hom. X12 4050 274x109 yog formatted nyob rau hauv proprietary thiab HIPAA mandated Electronic Data Interchange (EDI) hom ntawv, uas yog tsim thiab tswj los ntawm lub koom haum X12.
MS Excel raws li Tus Muab Kev Pabcuam Cov Ntaub Ntawv Xa Cov Ntaub Ntawv (PDSRF) yuav raug hloov los ntawm cov ntaub ntawv zoo sib xws siv JSON hom. Cov ntaub ntawv hloov pauv no yog hu ua "Submission Reconciliation File (SRF)". Kev hloov pauv ntawm PDSRF rau JSON hom tseem tsis tau tshwm sim.
Peb muaj cais 274 rau SUD/(tshuaj yeeb tshuaj) thiab Mental health ces koj hais li cas?
DHCS tab tom npaj kom muaj 274 EDI cov ntaub ntawv xa mus rau Mental Health Plans thiab Drug Medi-Cal Organized Delivery Systems.
Puas muaj qhov hloov tshiab thaum twg DMC-ODS 274 tus khub qhia yuav muaj? Koj puas tuaj yeem thov qhia qhov twg daim ntawv qhia kev pom zoo tuaj yeem pom?
Daim Ntawv Qhia Draft twb muaj rau DMC-ODS 274. Nws tuaj yeem pom ntawm 274 Expansion Website; nws yog Version 2 ntawm Tus Thawj Coj Qhia.
Sab nraud ntawm 274 lub thawv ntawv, lub nroog yuav txheeb xyuas lawv li cas?
Kev sib txuas lus tseem tsis tau muab vim tias tsis nyob hauv kev tsim khoom. Tag nrho cov kev txhawb nqa hauv nroog yuav nyob hauv pawg neeg ua haujlwm coj los ntawm Sara Rivera, kom txog rau thaum cov nroog nyob hauv cov xwm txheej tsim khoom.
Nrog rau kev hloov pauv tau tshwm sim hauv cov nroog, lub nroog yuav ua li cas thiaj paub cov neeg sib cuag tam sim no ntawm DHCS, hloov kho cov neeg nyob hauv nroog tam sim no (nrhiav leej twg tam sim no nyob rau hauv cov ntaub ntawv nrog DHCS raws li kev sib cuag thiab kev sib txuas lus)?
Txhua nqe lus nug ntsig txog lub nroog 274 Expansion Project yuav tsum raug xa mus rau 274Expansion@dhcs.ca.gov . Peb kuj muaj ib lub mailbox rau Network Adequacy hais txog cov lus nug: NAOS@dhcs.ca.gov .
Lub sijhawm kwv yees rau DHCS tso tawm cov lus qhia ntawm QMED 2.0?
Lub sijhawm ua haujlwm tam sim no yuav yog lub hom phiaj 2025 rau cov ntsiab lus ntxiv ntawm QMED 2.0.

Kev coj cwj pwm noj qab haus huv Short Doyle

Cov ntaub ntawv luv-Doyle puas yuav raug rub txhua hnub los ntawm SDMC qhov system thov, lossis MHP puas yuav tsum xa cov ntaub ntawv sib txawv rau txhua hnub?
MHPs tuaj yeem xa daim ntawv thov kev mob hlwb tshwj xeeb rau Short Doyle txhua hnub. Feem ntau, txawm li cas los xij, MHPs tuaj yeem xa cov ntaub ntawv thov 1-3 zaug hauv ib hlis.
Puas yog qhov txwv ntawm plaub (4) tus neeg nyob hauv ib lub nroog tsuas yog cuam tshuam nrog cov ntaub ntawv zoo lossis puas yog hla lub rooj tsavxwm? Piv txwv li, peb muaj plaub lossis tsib tus neeg hu rau MedCCC rau cov lus nug thov, ob peb tus neeg nug txog kev tshaj lij, lwm tus nug txog kev tshaj tawm, thiab lwm yam. Peb puas yuav tau hloov pauv li cas peb triage / muab cov lus nug?
Puas yog qhov xa mus rau 4 tus neeg sib cuag txog tus lej ntawm 'tus tswv' rau Short Doyle? (2 rau SMHS, 2 rau DMC) Cov tswv pom zoo thiab tshem tawm cov neeg siv cov ntaub ntawv rau ib lub nroog.
Rau MEDCCC, tsis muaj kev txwv rau cov neeg ua haujlwm hauv nroog uas tuaj yeem xa cov lus nug.
Puas muaj cov cai kho mob hlwb tshiab uas peb yuav tau siv? Puas muaj cov lej qub uas yuav tas sijhawm? Yog tias muaj, cov lej qub no puas yuav tas sijhawm rau cov chaw muab kev pabcuam, lossis cov no puas yuav tsum tau hla kev taug kev zoo li cov lej hauv zos?
Pib txij thaum 7/1/23, nyob rau hauv CalAIM, DHCS tab tom hloov mus rau CPT cov lej rau kev coj tus cwj pwm kev noj qab haus huv thov hauv Short Doyle. Cov nroog tuaj yeem tau txais cov npe ntawm CPT thiab HCPCS cov lej thiab thov cov cai hauv Cov Kev Pabcuam Kev Puas Siab Puas Hlwb Tshwj Xeeb thiab Tshuaj Medi-Cal Phau Ntawv Sau Nqi Tshaj Tawm hauv MEDCCC Library. Cov peev txheej thov nyiaj ntxiv muaj nyob rau ntawm nplooj ntawv MEDCCC.

QMED 2.0

Dab tsi yuav yog lub sijhawm kawm rau QMED 2.0 tso tawm hauv Q2 2025? Q1 2025 Kev xa tawm?
Cov ntawv ceeb toom peb lub hlis twg rau QMED 2.0 yuav ua raws li cov qauv ntawm QMED 1.1. Piv txwv li, QMED Daim Ntawv Qhia Txog Q2 2025 yuav soj ntsuam cov ntaub ntawv raug xa mus rau DHCS thaum lub Plaub Hlis - Lub Rau Hli 2025. Cov ntawv tshaj tawm feem ntau yog muab tawm li ntawm ib hlis tom qab lub quarter kawg vim muaj cov txheej txheem de-identification thiab lub sijhawm pom zoo.
Puas yog PACE Plans raug zam los ntawm QMED 1-2?
a) Yog. Cov phiaj xwm PACE tam sim no tsis raug rau QMED 1. Tsis tas li ntawd, QMED 2.0 yuav raug nthuav tawm hauv theem. Managed Care Plans twb tau txais QMED Daim Ntawv Ceeb Toom yuav yog thawj tus tau txais QMED 2.0 Daim Ntawv Qhia Tshaj Tawm pib hauv Q2 2025, nrog rau kev tswj hwm pib kwv yees li 12 lub hlis tom qab thawj QMED 2.0 Daim Ntawv Qhia Tshaj Tawm tau tshaj tawm.
b) PACE Cov koom haum thiab lwm cov phiaj xwm tam sim no tsis tau txais QMED 1.1 Daim Ntawv Ceeb Toom yuav raug txiav mus rau qhov tau txais QMED 2.0 Daim Ntawv Qhia. Qhov kev ua tau zoo thiab cov qhab nia yuav tsis mus rau kev ua tub ceev xwm li ntawm 12 lub hlis tom qab daim phiaj xwm thawj QMED 2.0 Daim Ntawv Qhia. Lub sijhawm 12-hli kev tshav ntuj yuav tso cai rau lub sijhawm txaus rau Cov Kev Npaj los hloov kho cov qhab nia, thiab lwm yam.
Puas yog lub sijhawm nthuav tawm muab sijhawm txaus rau cov phiaj xwm saib xyuas kom nkag siab thiab siv cov kev hloov pauv?
DHCS tso cai rau Managed Care Plans 12 lub hlis (tau txais plaub Daim Ntawv Ceeb Toom) los tshuaj xyuas QMED 2.0 Daim Ntawv Ceeb Toom ua ntej yuav raug txiav txim, xws li Txoj Kev Npaj Kho Kom Zoo (CAP) lossis CAP raug xa mus rau DHCS Enforcement Committee. Lub sijhawm muaj txiaj ntsig no tso cai rau lub sijhawm txaus los tshuaj xyuas lawv cov qhab nia thiab siv cov kev hloov pauv tsim nyog.

Encounter Data Improvement Project

Puas yog cov lej hauv zos yog qhov tseem ceeb tshaj plaws ntsib cov ntaub ntawv zoo?
Yog lawm, cov lej hauv zos yog qhov tseem ceeb tshaj plaws uas tau hais txog.
Hloov kho 274 Tus Muab Kev Pabcuam Cov Ntaub Ntawv Phau Ntawv Qhia tseem tsis tau hloov kho tshiab hauv Documentation Center? Cov qauv ntaub ntawv xa email tsis qhib kom raug.
Daim ntawv ceeb toom tshaj tawm ib qho tshiab ntawm 274 Phau Ntawv Qhia Tus khub raug xa mus ua yuam kev. Nws yog qhov tshwm sim ntawm automation uas yog inadvertently sab laug qhib thaum nws yuav tsum tau muab tua. Cov ntawv ceeb toom tau raug kaw lawm, thiab tsis muaj kev hloov kho tshiab yuav raug xa mus rau cov koom tes ua lag luam.
Qhov kev ceeb toom tau tshwm sim los ntawm kev xa tawm cov ntaub ntawv piv txwv ntsig txog kev hloov pauv hauv 274 Cov Ntaub Ntawv Validation Response (VRF). VRF yog cov ntsiab lus ntawm kev ua tiav / kev lees paub cov txiaj ntsig thaum ib qho 274 cov ntaub ntawv xa mus rau DHCS tau ua tiav.
274 VRF tau hloov kho kom suav nrog cov ntsiab lus suav hais txog cov ntaub ntawv xa tawm 274. Cov kev suav cov ntsiab lus no tau muab ntxiv los ua qhov chaw ntawm cov ntaub ntawv xa mus rau qhov kev sib tham tsis tu ncua. Cov ntaub ntawv hais txog cov kev hloov pauv no yuav raug muab ntxiv rau 274 Cov Lus Qhia Txog Tus Kheej thiab rau 274 Cov Lus Qhia yuam kev, thiab cov koom tes ua lag luam yuav raug ceeb toom thaum cov kev hloov tshiab tau tshaj tawm.
Ntxiv rau:
Kev Kho Mob Tswj Xyuas Kev Kho Mob (MMC) 274 Companion Guide v.3.0 tab tom tos kev tshaj tawm tom qab kev tshuaj xyuas sab hauv los ntawm DHCS Program thiab Cov Neeg Ua Haujlwm Txoj Cai.
Phau Ntawv Qhia Txog Tus Cwj Pwm Kev Noj Qab Haus Huv (IBH) 274 Companion Guide v.3.0 tsis ntev los no tau tshaj tawm. Tom qab kev tshaj tawm, pom qhov yuam kev. Qhov kev ua yuam kev no tau raug kho, thiab ib qho kev hloov kho tshiab ntawm Kev Coj Tus Cwj Pwm Kev Noj Qab Haus Huv 274 Companion Guide v. 3.01 yuav tshaj tawm sai sai no. (los ntawm 3/10/2025)
Cov ntawv ceeb toom yuav raug xa los ntawm DHCS thaum hloov kho MMC 274 CG, lossis kho IBH 274 CG tau tshaj tawm.
Dab tsi yog qee qhov piv txwv ntawm qhov tsis sib xws thiab sib xws?
Uniqueness: duplicate cov kev pabcuam kab: cais kev ntsuas rau 837 Institutional transactions thiab 837 Professional. Cov ntaub ntawv teev tseg hauv Tshooj 3.8 ntawm phau ntawv qhia tus khub yuav raug suav tias yog cov kab kev pabcuam sib npaug.

Consistency: Feem pua ntawm Cov Neeg Muab Kev Pabcuam Hauv Lub Tebchaws (NPIs) ntawm kev sib ntsib uas pom muaj nyob rau ntawm Txoj Kev Npaj tau xa 274 cov ntaub ntawv.
Kev tsim nyog muaj feem cuam tshuam txog kev tsis pom zoo yuav raug suav tias tsis raug
Nws nyob ntawm qhov laj thawj n rau kev tsis lees paub. Yog tias qhov tsis raug CIN rau ib tus tswvcuab uas tsis muaj nyob, ces qhov ntawd tsis raug thiab yuav tsum tau muab pov tseg. Yog hais tias nws tsuas yog ib qho yooj yim typo nyob rau hauv ib tug siv tau thiab tsim nyog CIN, los yog yog hais tias (piv txwv li) muaj ib tug mismatch ntawm lub hnub pab thiab cov tswv cuab tsim nyog hnub, ces nws yog kho nrog ib tug hloov.
Puas yog DHCS xav tias yuav raug xa rov qab yog tias them nyiaj ntxiv rau cov kev sib ntsib uas yog ib feem ntawm 2024 TRI qhov yuav tsum tau ua? Yog xav tau kev xa rov qab, qhov no yuav cuam tshuam li cas rau QMED kev xam sijhawm rau txoj kev npaj?
DHCS yuav muab cov lus nug no los txiav txim siab ua ib feem ntawm QMED 2.0 qhov project.
Cov lej hauv zos puas yuav raug tshem tawm ntawm Medi-Cal lub sijhawm them nqi?
Cov nqi them rau cov lej yog ib feem ntawm kev daws teeb meem hauv zos. Cov lis dej num hauv cheeb tsam cuam tshuam ncaj qha rau tus nqi-rau-kev pabcuam vs. Nyob twj ywm kom paub meej ntxiv.
DHCS puas yuav luam tawm phau ntawv qhia txog kev ntsib cov neeg muab kev pabcuam los hais txog cov xwm txheej them nqi uas Medi-Cal FFS phau ntawv sau nqi siv tau thiab tsis siv rau kev ntsib cov ntaub ntawv? Piv txwv yog kev siv NTE ntu tshwj xeeb rau FFS cov nqi, SV109 ED cov cim qhia uas Medicare tso tseg, kev hloov tsheb thauj mus los.
Yog lawm, kev them nqi tsim nyog yog ib feem ntawm peb cov hom phiaj ntawm Encounter Data Improvement Project.
Puas yog DHCS txiav txim siab zam qhov kev ntsuas ncua sij hawm hauv Q4 2024 QMED vim qhov kev xa tawm ntawm kev sib ntsib rau TRI kev hloov kho?
DHCS yuav muab cov lus nug no los txiav txim siab ua ib feem ntawm QMED 2.0 qhov project.

Medi-Cal Connect FAQ Tej zaum/2025

Lwm tus

Koj puas yuav muab cov txheej txheem uas koj tau siv los xam cov nqi sib tw? Koj puas tseem yuav muab kev taw qhia txog yuav ua li cas cov #s tuaj yeem txhim kho?
DHCS tau muab cov txheej txheem sib txuam rau FQHCs thiab MCPs. Yog tias koj xav tau daim ntawv luam, thov email FQHCAPM@dhcs.ca.gov . DHCS tab tom ua haujlwm txhawm rau txheeb xyuas cov laj thawj tom qab tus nqi qis qis hauv cov neeg thov rau APM. Peb yuav muab kev taw qhia txog peb qhov kev tshawb pom thiab seb peb xav kom FQHCS thiab MCPs ua haujlwm li cas los txhim kho cov ntaub ntawv.
Puas yog DHCS muaj tus qauv txhais rau Kev Saib Xyuas Kev Nyab Xeeb Kev Nyab Xeeb, thiab cov cai no puas raug txheeb xyuas?
Rau tus txheej txheem txhais, thov hu rau koj tus neeg saib xyuas cheeb tsam.
Thaum twg 834 cov ntaub ntawv qhia txog kev hloov pauv rau Kev Saib Xyuas Kev Ua Haujlwm Saib Xyuas Kev Nyab Xeeb Kev Nyab Xeeb yuav muaj?
Thov xa mus rau CAPMAN Documentation channel ntawm DHCS Documentation Center, uas muaj cov qauv tam sim no ntawm 834, nrog rau cov qauv tshiab tom ntej uas yuav siv rau 02/24/2025. Yog xav paub ntxiv, thov hu rau DHCS Tus Thawj Saib Xyuas Kev Cog Lus lossis koj tus DHCS rau npe / tus neeg saib xyuas kev tsim nyog, yog muab rau koj lub koom haum.

Hnub hloov tshiab kawg: 7/16/2025 9:53 AM

DHCS Cov Ntaub Ntawv Qhia thiab Saib Xyuas Webinar Series Cov Lus Nug Nquag​​

General​​

274 PAB​​

Cov ntaub ntawv MCPD/PCPA​​

Sib ntsib cov ntaub ntawv​​

Data Exchange & Xa​​

JSON, ECM/CS​​

274 MHP thiab 274 DMC-ODS​​

Kev coj cwj pwm noj qab haus huv Short Doyle​​

QMED 2.0​​

Encounter Data Improvement Project​​

Medi-Cal Connect FAQ Tej zaum/2025​​

Lwm tus​​