Medi-Cal Managed Care Encounter Data Reporting
Keeb kwm
Raws li tsoomfwv txoj cai lij choj, DHCS daim ntawv cog lus xav kom Medi-Cal Managed Care Plans (MCPs) xa mus rau DHCS cov ntaub ntawv ua tiav, raug, thiab raws sijhawm rau cov kev pabcuam muab rau cov neeg tau txais kev pabcuam. Ua ntej lub Kaum Ib Hlis 2014, MCPs ib txwm ua tau raws li lawv daim ntawv cog lus kom xa cov ntaub ntawv ntsib mus rau DHCS siv ntau hom tswv thiab cov qauv. Tom qab lub Kaum Ib Hlis 1, 2014, DHCS tau siv cov txheej txheem tshiab kom tau txais thiab ua cov ntaub ntawv ntsib hauv lub teb chaws tus qauv kev lag luam, ASC X12 837 5010 thiab NCPDP. Cov txheej txheem tshiab no tau siv los ua kom tau raws li lub xeev thiab tseemfwv qib siab Medicaid saib xyuas thiab tshaj tawm cov cai thiab kom haum raws li qhov tau txais ICD10 Kev Ntsuas Cov Cai raws li HIPAA cov cai.
Pib txij Lub Ib Hlis Ntuj Tim 1, 2015, DHCS, hauv kev txhawb nqa nws cov kev sib ntsib tsis tu ncua ntawm cov ntaub ntawv kev txhim kho kom zoo, tsuas yog lees txais lub teb chaws tus qauv cov ntaub ntawv tawm tswv yim thiab coding schemes rau kev tswj xyuas ntsib cov ntaub ntawv xa tawm. Txog rau lub Tsib Hlis 2015, txhua tus MCPs tau hloov pauv los ntawm cov tswv cuab yav dhau los rau kev tsim cov ntaub ntawv xa tawm hauv cov qauv qauv hauv tebchaws.
Sib ntsib cov ntaub ntawv qhia txog kev xav tau
MCPs yuav tsum xa cov ntaub ntawv ntsib nyob rau hauv qab no Health Insurance Portability thiab Accountability Act ua raws li lub teb chaws tus qauv kev lag luam nyob rau hauv raws li DHCS Companion Guides tsis ntev los no tshaj tawm rau txhua hom kev lag luam:
a) Cov ntaub ntawv ntsib hauv tsev kawm ntawv yuav tsum raug xa mus ua raws li Pawg Neeg Saib Xyuas Kev Pom Zoo (ASC) X12 837 Institutional (837I), version 5010 x223;
b) Cov ntaub ntawv ntsib kev tshaj lij yuav tsum raug xa mus ua raws li ASC X12 837 Professional (837P), version 5010 x222; thiab
c) Cov ntaub ntawv ntsib lub tsev muag tshuaj yuav tsum xa ua raws li NCPDP Encounter Data Transaction format, Post Adjudication Payer Sheet version 2.2 lossis 4.2.
Rau lwm cov kev qhia yuav tsum tau ua, xws li kev xa ntawv zaus thiab cov txheej txheem, cov ntaub ntawv teb, kho cov ntaub ntawv ntsib, thiab kev xa mus, thov xa mus rau Daim Ntawv Qhia Tag Nrho tsis ntev los no rau Kev Sib Tham Cov Ntaub Ntawv Xa Khoom.
Kev ntsuas zoo rau cov ntaub ntawv ntsib
DHCS ntsuas qhov zoo ntawm Medi-Cal tswj kev saib xyuas ntsib cov ntaub ntawv kom tiav, raug, tsim nyog, thiab raws sijhawm siv cov ntaub ntawv tshaj tawm tsis ntev los no ntawm Quality Measures for Encounter Data (QMED). Cov txiaj ntsig ntsuas tau suav, qhia rau MCPs, thiab siv los tsav cov ntaub ntawv kev txhim kho kom zoo. Thov xa mus rau APL 14-020, Kev Ntsuas Zoo rau Cov Ntaub Ntawv Sib Tham thiab QMED Cov Ntaub Ntawv, Kev Ntsuas Zoo rau Cov Ntaub Ntawv Sib Tham, Version 1.1, rau cov kev ntsuas tshwj xeeb DHCS siv los ntsuas qhov zoo ntawm cov ntaub ntawv xa tawm.
Tiv tauj
Cov lus nug txog kev ntsib cov ntaub ntawv kev teeb meem lossis kev ua haujlwm yuav raug xa mus rau pab
pawg PACES.
Pab Links thiab Resources
Medi-Cal Managed Care ntsib cov ntaub ntawv qhia txog cov ntaub ntawv ntsig txog:
APL 14-009 (PDF), Kev hloov pauv ntawm Kev Sib Tham Cov Ntaub Ntawv Xa mus rau Kev Lag Luam Hauv Tebchaws (ASC X12 837 5010, NCPDP 2.2 lossis 4.2)
