Post-Adjudicated Claims thiab Encounters System
Txheej txheem cej luam
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) raug yuam kom sau thiab tshaj tawm txog California Medicaid (Medi-Cal) cov lus thov thiab ntsib, txawm hais tias lawv raug xa mus ua ib feem ntawm cov nqi-rau-kev pabcuam lossis daim ntawv cog lus kev saib xyuas. Ntau lub tshuab hauv DHCS txhawb nqa qhov kev xav tau no.
Ib qho system zoo li no yog Post Adjudicated Claims & Encounters System (PACES). PACES ua lub luag haujlwm tseem ceeb hauv kev sau cov ntaub ntawv ntsib thiab cov ntaub ntawv hauv network ntawm Medi-Cal ntau cov phiaj xwm kev kho mob uas tau tswj hwm. PACES lees txais cov kev sib ntsib los ntawm ob qho kev npaj kho mob thiab kev kho hniav thiab kuj lees txais cov kev sib ntsib hauv tsev muag tshuaj. Cov ntaub ntawv uas PACES sau tau khaws cia rau hauv DHCS lub chaw khaws ntaub ntawv (MIS/DSS), qhov chaw uas ntau daim ntawv thov hauv lub Xeev siv tau.
PACES rho tawm, hloov pauv, thiab hloov pauv tau ntsib cov ntaub ntawv uas tau xa hauv ASC X12 837 thiab NCPDP hom ntawv. Lub kaw lus tam sim no txhawb nqa ASC X12 837I, 837P, thiab 837D thov / ntsib kev lag luam nrog rau NCPDP 2.2 & 4.2 kev lag luam muag tshuaj.
PACES replaces the long-standing DHCS Paid Claims and Encounters (PCES) system. The new system is designed to ensure that all available claim and encounter data is retained and available for downstream analysis. The PACES system stores and distributes a richer, more complete data set than was possible using PCES. The goal of PACES is to enforce DHCS’s data quality requirements while also abiding by federal HIPAA transaction standards.
Ntau qhov chaw ntawm DHCS cov kev pab cuam, xws li Encounter Data Quality Unit (EDQU), siv PACES cov peev xwm tshaj tawm kom tshuaj xyuas cov ntaub ntawv ntsib tsis tu ncua. Qhov kev muaj peev xwm siab dua no los saib xyuas kev saib xyuas thiab lwm yam kev sib ntsib txhawb nqa DHCS cov kev pib uas siv zog los txhim kho kev noj qab haus huv tag nrho, thiab kev pov hwm kev noj qab haus huv, ntawm cov neeg California.
PACES kuj txhawb nqa Cal MediConnect kev ua qauv qhia, uas yog ib feem ntawm Txoj Haujlwm Pabcuam Saib Xyuas Loj dua.