Tsev Cov Chaw Muab Kev Pabcuam & Cov Neeg Koom Tes Kev Pab Txhawb Nqa Kev Yug Me Nyuam hauv Medi-Cal​​ 

Kev Pabcuam Midwifery hauv Medi-Cal​​ 

California tam sim no lees paub ob hom midwives: Certified Nurse Midwives (CNM) uas qee zaum hu ua Nurse Midwives (NMW) thiab Licensed Midwives (LM). Ob leeg LMs thiab CNMs tuaj yeem xyaum ua lawv tus kheej, lawv tsis tas yuav muaj kev saib xyuas tus kws kho mob thiab tsim nyog tau txais kev tso npe ua Medi-Cal cov kws kho mob nrog California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS). CNMs thiab LMs uas tau cuv npe hauv Medi-Cal tuaj yeem muab Medi-Cal cov txiaj ntsig thiab cov kev pabcuam hauv lawv cov kev siv tau ntawm kev coj ua hauv ob qho tib si tus nqi-rau-kev pabcuam (FFS) thiab los ntawm cov kev npaj khomob (MCPs) hauv cov kev tswj xyuas kev pabcuam.​​ 

Nurse-Midwives (CNM)​​ 

Daim Ntawv Tso Cai Midwives (LM)​​ 

Yuav Ua Li Cas Los Ua Tus Kws Pab Yug Me Nyuam Medi-Cal​​ 

Feem ntau ntawm cov poj niam cev xeeb tub uas tau txais Medi-Cal hauv California tau txais kev saib xyuas los ntawm Managed Care Plans (MCP) tab sis muaj tsawg dua tau txais kev saib xyuas los ntawm fee for service (FFS). Cov kws pab yug menyuam (CNMs thiab LMs) tuaj yeem sau npe los ntawm Provider Application and Validation for Enrollment (PAVE) portal kom xa lawv daim ntawv thov Medi-Cal los muab kev saib xyuas rau tib neeg los ntawm FFS thiab MCP.​​ 

Cov kws pab yug menyuam (CNMs thiab LMs) uas xav pab cov tswv cuab ntawm Medi-Cal managed care plan (MCP) kuj yuav tsum tau cog lus nrog tus tswv cuab txoj kev npaj Medi-Cal MCP. Cov LMs thiab CCNMs yuav tsum tiv tauj Medi-Cal MCP ncaj qha kom tau cov lus qhia txog yuav ua li cas los ua tus kws kho mob hauv network Medi-Cal MCP.​​ 

Medi-Cal Fee Rau Kev Pabcuam (FFS):​​ 

Kev sau npe rau hauv Medi-Cal los ntawm PAVE yog txhua yam uas yuav tsum tau ua kom pib tau txais Medi-Cal FFS. DHCS them ncaj qha rau cov nqi uas Lub Xeev tau teem tseg rau kev kho mob uas tau muab rau cov tib neeg uas FFS them. Thov saib Cov Nqi Medi-Cal Tam Sim No.​​ 

Medi-Cal Managed Care:​​ 

Cov CNMs thiab LMs uas xav muab kev pabcuam rau cov tswv cuab ntawm Medi-Cal uas tau txais kev saib xyuas los ntawm Medi-Cal MCPs yuav tsum xub sau npe nrog Medi-Cal los ntawm PAVE. Tom qab sau npe nrog PAVE lawv yuav tsum cog lus ncaj qha nrog MCPs. Tsuas yog CNMs thiab LMs uas tau nkag mus rau hauv daim ntawv cog lus nrog Medi-Cal MCPs thiaj li yuav tau txais nyiaj rov qab rau cov kev pabcuam uas tau muab rau cov tswv cuab ntawm MCP. Yog xav saib daim ntawv teev cov Medi-Cal MCPs hauv koj lub nroog, thov mus saib DHCS lub vev xaib Medi-Cal Managed Care Health Plan Directory .​​ 

DHCS daim ntawv thov thiab kev lees paub rau kev sau npe (PAVE) lub portal​​ 

For more information about PAVE, please visit DHCS’ PAVE Provider Portal (ca.gov) website. You may also call the PAVE Help Desk at (866) 252-1949, and one of DHCS’ experts will be happy to assist you (available Monday – Friday, 8:00 am – 6:00 pm Pacific time, excluding state holidays).​​ 

Medi-Cal Phau Ntawv Qhia​​ 

Medi-Cal coverage policy for both Medi-Cal FFS and managed care delivery systems as well as Medi-Cal FFS reimbursement policy can be found in the Medi-Cal Provider Manual. Medi-Cal covered benefits and services provided by CNMs and LMs within their respective scopes of practice can be found in several different sections of the Medi-Cal Provider Manual, including:​​ 

Txhua Daim Ntawv Npaj (APL)​​ 

Medi-Cal tswj hwm kev saib xyuas sib txuas lus nrog Medi-Cal MCPs los ntawm APLs, uas qhia cov ntaub ntawv lossis txhais cov kev hloov pauv hauv txoj cai lossis cov txheej txheem ntawm tsoomfwv qib siab thiab / lossis lub xeev, thiab muab kev qhia rau cov neeg cog lus, yog tias tsim nyog siv cov kev hloov pauv no raws li kev ua haujlwm. Cov ntaub ntawv rau CNMs thiab LMs tuaj yeem pom hauv ntau qhov sib txawv APLs, suav nrog:​​ 

  • APL 18-022: Kev Nkag Mus Rau Cov Chaw yug menyuam dawb thiab kev pabcuam Midwife​​ 
  • APL 16-017: Kev Pab Certified Nurse Midwife thiab Alternative Birth Center Facility Services (Supersedes APL 15-017)​​ 
  • APL 18-022: Kev Nkag Mus Rau Cov Chaw Kho Mob Tsis Muaj Hnub Nyoog thiab Kev Pab Cuam Rau Midwife (Supersedes APL 16-017)​​ 

  • APL 24-003: Kev Pab Cuam Rho Me Nyuam​​ 

Kev cob qhia Medi-Cal​​ 

Medi-Cal Learning Portal muaj Medi-Cal cov chaw muab kev pab, suav nrog CNMs thiab LMs, thiab cov neeg sau nqi them nqi kawm ntawv tus kheej hauv online txog kev them nqi, cov cai, cov txheej txheem, kev pib tshiab, thiab kev hloov pauv rau Medi-Cal yav tom ntej.​​ 

  • Cov neeg siv thawj zaug: Ua kom tiav daim ntawv teev npe ib zaug ntawm learn.medi-cal.ca.gov​​ 
  • Cov neeg siv rov qab los: Nkag mus rau hauv learn.medi-cal.ca.gov kom pom lossis tshawb nrhiav cov ntawv teev cov chav kawm.​​ 

Cov hauv qab no yog cov kev qhia qhia rau CNM thiab LMs:​​ 

  • Kev Them Nqi Them Nqi: Cov kev cob qhia no tsom mus rau Medi-Cal Cov Nqi Them Nqi Nqis nrog rau cov neeg tau txais kev pab tsim nyog, Kev Sib Koom Tus Nqi, Kev Thov Kev Tso Cai Kho Mob (TAR), CMS-1500 lossis UB-04 Kev Thov Ua tiav thiab Kev Thov Rov Qab.​​ 
  • CPSP Cov Ntaub Ntawv Teev Npe Webinar: Cov qauv no yuav paub cov neeg koom nrog ntau yam kev pabcuam muaj rau cov neeg tau txais Medi-Cal cev xeeb tub uas tau cuv npe hauv CPSP txij hnub pib xeeb mus txog 60 hnub tom qab lub hli yug. Kev koom tes ntawm tus neeg txais kev pab thiab tus neeg muab kev pab yog yeem. Cov ntaub ntawv them nqi kuj raug them.​​ 
  • Kev Sib Tham Hauv Is Taws Nem Txog Kev Them Nqi Rau Tus Kws Pab Yug Me Nyuam Uas Muaj Ntawv Tso Cai: Kev cob qhia no muab kev piav qhia txog cov lus qhia txog kev them nqi thiab kev thov nyiaj ntawm Medi-Cal, nrog rau cov ntaub ntawv dav dav txog txoj cai ntawm cov kev pab cuam rau Cov Kws Pab Yug Me Nyuam Uas Muaj Ntawv Tso Cai.​​ 

Cov peev txheej​​ 

Cov hauv qab no yog cov peev txheej ntxiv uas CNMs thiab LMs tuaj yeem pom muaj txiaj ntsig:​​ 

Tiv tauj peb​​ 

Yog tias CNMs thiab LMs muaj lus nug ntxiv, lawv tuaj yeem tiv tauj DHCS rau kev pab ntxiv, raws li hauv qab no:​​ 

  • For billing and claim submission questions, please contact DHCS’ Fiscal Intermediary via phone through the Telephone Service Center (TSC) at 1-800-541-5555. For faster access to TSC resources, refer to the TSC Main Menu Prompt Options Guide.​​ 
  • For policy guidance, please send an email to Medi-Cal.Benefits@dhcs.ca.gov.​​