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.
One such system is the Post Adjudicated Claims & Encounters System (PACES). PACES plays a vital role in the collection of encounter and provider network data from Medi-Cal’s numerous managed care plans. PACES accepts encounter transactions from both medical and dental managed care plans and also accepts encounter-related pharmacy transactions. The information PACES gathers is stored in the DHCS data warehouse (MIS/DSS), where it can be used by many downstream applications within the State.
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.
Various DHCS program areas, such as the Encounter Data Quality Unit (EDQU), use PACES’s reporting capabilities in order to analyze encounter data on a regular basis. This heightened ability to monitor managed care and other encounters supports DHCS initiatives that strive to improve the overall health, and health coverage, of Californians.
PACES kuj txhawb nqa Cal MediConnect kev ua qauv qhia, uas yog ib feem ntawm Txoj Haujlwm Pabcuam Saib Xyuas Loj dua.