Department of Health Care Services (DHCS) cov ntaub ntawv qhia txog tus nqi muaj nyob rau download. Tus Nqi Them Nqi Tshaj Lij Tshaj Lij (CRTS) tau txais cov ntaub ntawv qhia txog Tus Nqi Them Nqi. CRTS yuav hloov kho cov ntawv thiab cov ntaub ntawv raws li lawv muaj.
Cov ntaub ntawv yog Adobe Acrobat PDF cov ntaub ntawv thiab Microsoft Excel cov ntaub ntawv. Yog tias koj nkag tsis tau ib daim foos thiab xav thov ib daim qauv, thov xa email rau FRDaudits.Questions@dhcs.ca.gov lossis hu rau CRTS ntawm (916) 650-6696.
Ceev faj - Txhua daim ntawv yuav raug kho dua. Thaum npaj Daim Ntawv Qhia Tus Nqi Tshiab, nkag mus rau cov ntaub ntawv los ntawm lub vev xaib no kom ntseeg tau tias siv cov qauv tam sim no. Kev xa tawm ntawm cov ntaub ntawv dhau los yuav raug tsis lees paub los ntawm CRTS thiab yuav xav tau kev xa rov qab nrog cov ntaub ntawv tshiab.
Nco tseg - Koj yuav tsum xa daim ntawv pov thawj DocuSign sib thooj nrog txhua Daim Ntawv Qhia Tus Nqi kom tsis txhob raug tso tseg.
Kev Pabcuam Tus Neeg Mob
Cov ntawv tu ncua sij hawm ntev thiab cov ntaub ntawv
Ib Lub Chaw Kho Mob Nruab Nrab - Tus Kws Kho Mob
Ib Lub Chaw Kho Mob Nruab Nrab Nruab Nrab rau Kev Txhim Kho Cov Neeg Tsis Muaj Peev Xwm / Kev Saib Xyuas Neeg Mob (ICF-DDH/N) yuav tsum ua kom tiav thiab xa DHCS 3076 Tus Nqi Tshaj Tawm txhua xyoo. Daim Ntawv Qhia Tus Nqi yuav tsum muaj qee cov ntaub ntawv nthuav tawm thiab cov nqi khiav lag luam nyiaj txiag rau lub chaw thiab Medi-Cal qhov kev pab cuam.
Ib Lub Chaw Kho Mob Nruab Nrab Nruab Nrab - Chaw Ua Haujlwm Hauv Tsev
ICF-DDH/N Cov Chaw Ua Haujlwm Hauv Tsev yuav tsum ua kom tiav thiab xa DHCS 3099 Daim Ntawv Qhia Tus Nqi Hauv Tsev nyob rau ib xyoos. Daim Ntawv Qhia Tus Nqi yog rau cov koom haum saw hlau ua haujlwm lossis tswj ob (2) lossis ntau dua ICF-DDH/N cov chaw. Daim Ntawv Qhia Tus Nqi yuav tsum muaj qee cov ntaub ntawv nthuav tawm ntawm Lub Tsev Haujlwm Hauv Tsev thiab kev faib cov nqi tsev hauv tsev rau ntau yam ICF-DDH/N cov chaw.
Qhov Kev Pab Kho Mob Sab Nraud
Federally Qualified Health Center/Rural Health Clinic (FQHC/RHC) Cov ntawv thiab cov ntaub ntawv
FQHC/RHC/Indian Health Services Memorandum of Agreement (IHS-MOA) cov chaw muab kev pab thiab FQHC/RHC Cov Chaw Ua Haujlwm Hauv Tsev yuav tsum ua kom tiav thiab xa DHCS 3088 Medi-Cal Worksheets Electronic Submission Protocol.
Chaw Ua Haujlwm Hauv Tsev - Rau (6) lossis Tsawg dua
Freestanding FQHC/RHC cov chaw muab kev pab uas muaj rau (6) lossis tsawg dua FQHC/RHC cov chaw kho mob yuav tsum ua kom tiav thiab xa DHCS 3089 Daim Ntawv Qhia Txog Tus Nqi Hauv Tsev rau Kev Npaj Them Nqi (PPS) Rate Setting (xav txog lossis qhov tseeb) thiab Hloov Hauv Kev Thov Kev Pabcuam (CSOSR). Cov chaw zov me nyuam no yog ib feem ntawm lub koom haum saw lossis ntau lub koom haum kho mob uas ua haujlwm tsawg kawg yog ob (2) lossis ntau lub tsev kho mob lossis ib qho (1) FQHC/RHC thiab ib lub koom haum tsis yog kev kho mob/kev lag luam.
Chaw Ua Haujlwm Hauv Tsev - Xya (7) lossis Ntau
Freestanding FQHC/RHC cov chaw muab kev pab uas muaj xya (7) lossis ntau dua FQHC/RHC cov chaw kho mob yuav tsum ua kom tiav thiab xa DHCS 3089.1 Daim Ntawv Qhia Tus Nqi Hauv Tsev rau PPS Rate Setting (xav txog lossis qhov tseeb) thiab CSOSR. Cov chaw zov me nyuam no yog ib feem ntawm lub koom haum saw lossis ntau lub koom haum kho mob uas ua haujlwm tsawg kawg yog ob (2) lossis ntau lub tsev kho mob lossis ib qho (1) FQHC/RHC thiab ib lub koom haum tsis yog kev kho mob/kev lag luam.
Rate Setting ua ntej Lub Ib Hlis 1, 2021
FQHC thiab RHC cov chaw muab kev pabcuam nrog Lub Sijhawm Kawg (FPE) hnub ua ntej Lub Ib Hlis 1, 2021 yuav tsum ua kom tiav thiab xa DHCS 3090 Tus Nqi Tshaj Tawm los txiav txim siab nws tus nqi PPS.
Rate Setting tom qab Lub Ib Hlis 1, 2021
FQHC thiab RHC cov chaw muab kev pabcuam nrog FPE hnub tom qab Lub Ib Hlis 1, 2021 yuav tsum ua kom tiav thiab xa DHCS 3090 (Post FPE Lub Ib Hlis 1, 2021) Daim Ntawv Qhia Tus Nqi los txiav txim nws tus nqi PPS.
Hloov hauv Scope-of-Service Thov ua ntej Lub Ib Hlis 1, 2021
FQHC thiab RHC cov chaw muab kev pabcuam nrog FPE hnub ua ntej Lub Ib Hlis 1, 2021 yuav tsum ua kom tiav thiab xa DHCS 3096 CSOSR Daim Ntawv Thov kom hloov PPS tus nqi yog tias muaj cov qauv tshwj xeeb.
Hloov hauv Scope-of-Service Thov tom qab Lub Ib Hlis 1, 2021
FQHC thiab RHC cov chaw muab kev pabcuam nrog FPE hnub tom qab Lub Ib Hlis 1, 2021 yuav tsum ua kom tiav thiab xa DHCS 3096 (Post FPE Lub Ib Hlis 1, 2021) CSOSR Daim Ntawv Thov kom hloov PPS tus nqi yog tias muaj cov qauv tshwj xeeb.
Kev Thov Kev Pom Zoo (hloov kho Lub Kaum Hli 31, 2024)
FQHC thiab RHC cov kws kho mob yuav tsum ua kom tiav thiab xa DHCS 3097 Daim Ntawv Thov Kev Sib Tham Txhua Xyoo rau DHCS los ua kev sib haum xeeb rau Managed Care Plans (MCPs) thiab Medicare crossover mus ntsib kom ntseeg tau tias cov chaw kho mob tau them tus nqi sib npaug ntawm nws tus nqi PPS.
Ua raws li Kev Noj Qab Haus Huv & Cov Tsev Kawm Ntawv (W&I) Tshooj Cai 14105.201, DHCS tau tsim cov phiaj xwm nce (TRI) rau cov neeg muab kev pabcuam hauv Medi-Cal muaj txiaj ntsig rau cov hnub ua haujlwm rau lossis tom qab Lub Ib Hlis 1, 2024. Xav paub ntau ntxiv txog TRI tuaj yeem nrhiav tau ntawm Medi-Cal Targeted Provider Rate nce thiab nqis peev.
W&I Code Tshooj 14087.325(d) xav kom MCPs them rov qab cov kev cog lus FQHC thiab RHC cov chaw muab kev pab raws li qhov tsis tsawg dua li qib thiab cov nyiaj them uas MCP yuav ua rau tib qhov kev pabcuam yog tias cov kev pabcuam tau muab los ntawm tus kws khomob uas tsis yog FQHC lossis RHC. Txawm hais tias tus nqi TRI tsis cuam tshuam ncaj qha rau FQHC lossis RHC cov chaw muab kev pabcuam, DHCS lees paub tias qee lub sijhawm, qhov nce ntawm MCP tus nqi them rau cov neeg tsis yog FQHC thiab RHC yuav ua rau MCPs nce cov nqi cog lus them rau FQHC thiab RHC cov chaw muab kev pabcuam. FQHC thiab RHC cov chaw muab kev pabcuam yuav tsum suav tag nrho cov nyiaj them MCP hauv kev thov kom rov sib haum, suav nrog cov nyiaj tau los ntawm TRI.
Raws li lub sijhawm ua haujlwm TRI, DHCS tab tom txuas ntxiv rau Xyoo Nyiaj Txiag Xaus (FYE) 2024 DHCS 3097 Daim Ntawv Thov Kev Sib Raug Zoo rau hnub kawg rau FQHC thiab RHC cov chaw muab kev pabcuam nrog Nyiaj Txiag Xyoo Kawg (FYE) thaum Lub Ib Hlis 31st thiab Cuaj Hlis 30th. Qhov txuas ntxiv yog tsim los tso cai rau lub sijhawm txaus rau FQHC thiab RHC cov chaw muab kev pabcuam tau txais thiab sau tag nrho cov nyiaj them MCP, suav nrog txhua qhov tshwm sim los ntawm TRI. FYE 2024 DHCS 3097 Reconciliation Request for FQHC and RHC providers with a FYE between January 31st and September 30th will be the them by March 31, 2025.
- DHCS 3097 Kev Thov Kev Pom Zoo tuaj yeem nkag tau los ntawm lub vev xaib tshiab ntawm lub vev xaib Enterprise Cost Reporting Settlement System (ECRS) .
- Txhua lub tsev kho mob yuav tsum muaj tus thawj tswj hwm ntxiv rau hauv qhov system. Yog tias koj tsis muaj tus thawj tswj hwm, xa email rau CRTS ntawm Reconciliation.clinics@dhcs.ca.gov thiab muab cov hauv qab no: Tus Neeg Muab Kev Pabcuam Hauv Tebchaws (NPI) tus lej, Lub Npe Raws Cai (lub tsev kho mob), Chaw Pabcuam, Tus Thawj Saib Xyuas Lub Npe thiab Lub Npe, thiab email (thov siv lub tuam txhab email).
- Yog tias koj muaj teeb meem technical, thov email ECRS@dhcs.ca.gov .
Indian Health Services Memorandum of Agreement Reconciliation
Txhua lub tsev kho mob IHS-MOA, 638 Lub Tsev Kho Mob thiab Pab Pawg Pab Pawg Saib Xyuas Kev Noj Qab Haus Huv (TRIBAL-FQHC) yuav tsum ua kom tiav thiab xa DHCS 3098 Daim Ntawv Thov Kev Sib Koom Ua Ke txhua xyoo rau DHCS los ua kev sib haum xeeb rau Managed Care Plans thiab Medicare crossover mus xyuas kom ntseeg tau tias cov chaw kho mob tau them tus nqi sib npaug.
- DHCS 3098 IHS Reconciliation Request tuaj yeem nkag tau los ntawm lub vev xaib tshiab ECRS.
- Txhua lub tsev kho mob yuav tsum muaj tus thawj tswj hwm ntxiv rau hauv qhov system. Yog tias koj tsis muaj tus thawj tswj hwm, xa email rau CRTS ntawm Reconciliation.clinics@dhcs.ca.gov thiab muab cov hauv qab no: NPI tus lej, Lub Npe Raws Cai (lub tsev kho mob), Chaw Pabcuam, Tus Thawj Saib Xyuas Lub Npe thiab Lub Xeem, thiab email (thov siv a tuam txhab email).
- Yog tias koj muaj teeb meem kev lag luam, thov email ECRS@dhcs.ca.gov.
Kev thov tus nqi sib txawv
FQHC thiab RHC cov kws kho mob yuav tsum ua kom tiav thiab xa DHCS 3100 Daim Ntawv Thov Kev Sib Nrauj Sib txawv los tsim lossis hloov Tus Txheej Txheem Kev Pabcuam Kev Tswjhwm Sib txawv, tus lej 521 T1015 SE (yav dhau los code 18). Daim foos no yog tsim los txiav txim siab tus nqi ib ntus rau cov neeg muab kev pab them rov qab rau qhov sib txawv ntawm lawv tus nqi PPS thiab lawv cov Medi-Cal Managed Care Plan them.
Medicare Advantage Plan Code 529
FQHC thiab RHC cov kws kho mob yuav tsum ua kom tiav thiab xa daim ntawv thov DHCS 3104 los tsim lossis hloov Medicare Advantage Plan tus nqi, code 529 G0466-G0470 (yav dhau los code 20). Daim foos no yog tsim los txiav txim siab tus nqi ib ntus los them rov qab cov neeg muab kev pabcuam rau qhov sib txawv ntawm lawv tus nqi PPS thiab lawv cov Capitated Medicare Advantage Plan them.
Thawj Tus Nqi Them Daim Ntawv Thov Pob
FQHC/RHC Thawj Tus Nqi Them Daim Ntawv Thov pob, DHCS 3106, suav nrog:
- Cov lus qhia rau kev thov (nplooj 1-4),
- Daim Ntawv Pov Thawj Them Nqi Xaiv Tsa (nplooj 5-6),
- Kev xaiv tsa (nplooj 7-8),
- Cov ntsiab lus ntawm cov kev pabcuam tam sim no muab los ntawm Clinic (nplooj 9), thiab
- Cov ntsiab lus ntawm Cov Kws Kho Mob (nplooj 10).
Cov ntaub ntawv no yuav raug siv los tsim tus nqi pib PPS rau FQHC thiab RHC tau pom zoo tshiab. Yog tias koj muaj lus nug txog pob ntawv no, thov xa email rau clinics@dhcs.ca.gov lossis hu rau CRTS ntawm (916) 650-6696.
