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 zoo li no yog Post Adjudicated Claims & Encounters System (PACES). PACES ua lub luag haujlwm tseem ceeb hauv kev sau cov ntaub ntawv sib ntsib thiab tus kws kho mob hauv lub network los ntawm Medi-Cal ntau yam kev npaj kho mob. PACES lees txais kev sib ntsib kev lag luam los ntawm ob qho kev kho mob thiab kho hniav cov phiaj xwm tswj hwm kev kho hniav thiab tseem lees txais kev sib ntsib cuam tshuam txog kev muag tshuaj. Cov ntaub ntawv PACES sau tau khaws cia hauv DHCS cov ntaub ntawv warehouse (MIS/DSS), uas nws tuaj yeem siv tau los ntawm ntau daim ntawv thov hauv qab hauv Xeev.
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 hloov DHCS Paid Claims and Encounters (PCES) mus ntev. Cov txheej txheem tshiab yog tsim los xyuas kom meej tias tag nrho cov ntaub ntawv thov thiab ntsib cov ntaub ntawv raug khaws cia thiab muaj rau kev soj ntsuam hauv qab. PACES system khaws cia thiab faib cov ntaub ntawv ntau dua, ua tiav ntau dua li qhov ua tau siv PCES. Lub hom phiaj ntawm PACES yog txhawm rau tswj hwm DHCS cov ntaub ntawv kom zoo thaum tseem ua raws li tsoomfwv HIPAA cov qauv kev hloov pauv.
Ntau qhov kev pabcuam DHCS, xws li Encounter Data Quality Unit (EDQU), siv PACES cov peev xwm tshaj tawm txhawm rau txheeb xyuas cov ntaub ntawv ntsib tsis tu ncua. Qhov kev muaj peev xwm nce siab los saib xyuas kev saib xyuas thiab lwm yam kev sib ntsib txhawb nqa DHCS cov phiaj xwm uas siv zog los txhim kho kev noj qab haus huv tag nrho, thiab kev pab them nqi kho mob, ntawm Californians.
PACES kuj txhawb nqa Cal MediConnect kev ua qauv qhia, uas yog ib feem ntawm Txoj Haujlwm Pabcuam Saib Xyuas Loj dua.
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