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 Medi-Cal Midwife
Feem ntau ntawm California cov Medi-Cal cov menyuam cev xeeb tub tau raug saib xyuas los ntawm Managed Care Plans (MCP) ib tus lej tsawg dua raug saib xyuas los ntawm tus nqi rau kev pabcuam (FFS). Midwives (CNMs thiab LMs) tuaj yeem tso npe los ntawm Tus Muab Kev Pabcuam Daim Ntawv Thov thiab 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.
Midwives (CNMs thiab LMs) txaus siab los pab Medi-Cal cov tswvcuab tswj kev saib xyuas (MCP) cov tswvcuab kuj yuav tau sau ntawv cog lus nrog tus tswvcuab Medi-Cal MCP txoj kev npaj. LMs thiab CCNMs yuav tsum hu rau Medi-Cal MCP ncaj qha rau cov lus qhia yuav ua li cas los ua Medi-Cal MCP tus neeg muab kev pabcuam network.
Medi-Cal Fee Rau Kev Pabcuam (FFS):
Kev cuv npe hauv Medi-Cal los ntawm PAVE yog txhua yam uas yuav tsum tau pib noj Medi-Cal FFS. DHCS them ncaj qha ntawm tus nqi teev tseg los ntawm Lub Xeev rau kev saib xyuas muab rau cov tib neeg uas tau them los ntawm FFS. Thov saib Cov Nqi Medi-Cal tam sim no.
Medi-Cal Managed Care:
CNMs thiab LMs xav muab kev pabcuam rau Medi-Cal cov tswvcuab saib xyuas uas tau txais kev saib xyuas los ntawm Medi-Cal MCPs yuav tsum xub sau npe nrog Medi-Cal los ntawm PAVE. Tom qab tso npe nrog PAVE lawv yuav tsum tau cog lus ncaj qha nrog MCPs. Tsuas yog CNMs thiab LMs uas tau cog lus nrog Medi-Cal MCPs yuav tuaj yeem tau txais cov nyiaj them rov qab rau cov kev pabcuam uas muab rau cov tswvcuab MCP. Txhawm rau saib cov npe ntawm Medi-Cal MCPs hauv koj lub nroog, thov mus saib DHCS' Medi-Cal Managed Care Health Plan Directory lub vev xaib.
DHCS Cov Ntawv Thov Kev Pabcuam thiab Kev Ua Haujlwm rau Kev Sau Npe (PAVE) portal
Yog xav paub ntxiv txog PAVE, thov mus saib ntawm DHCS ' PAVE Provider Portal (ca.gov) lub vev xaib. Koj kuj tuaj yeem hu rau PAVE Help Desk ntawm (866) 252-1949, thiab ib tus ntawm DHCS cov kws tshaj lij yuav zoo siab los pab koj (muaj hnub Monday - Friday, 8:00 teev sawv ntxov - 6:00 teev tsaus ntuj Pacific sijhawm, tsis suav cov hnub so hauv xeev).
Medi- Cal tus kws kho mob phau ntawv qhia
Medi-Cal txoj cai kev pab them nqi kho mob rau ob qho tib si Medi-Cal FFS thiab cov kev tswj xyuas kev noj qab haus huv nrog rau Medi-Cal FFS txoj cai them rov qab tuaj yeem pom nyob rau hauv Medi-Cal Tus Kws Kho Mob Phau Ntawv Qhia. Medi-Cal them cov txiaj ntsig thiab cov kev pab cuam muab los ntawm CNMs thiab LMs nyob rau hauv lawv cov kev coj ua uas muaj nyob rau hauv ntau qhov sib txawv ntawm Medi-Cal Phau Ntawv Qhia, suav nrog:
- Cov kws kho mob tsis yog kws kho mob (NMP) Phau Ntawv Qhia: Phau ntawv no suav nrog kev qhia them nqi rau LM thiab CNMs thiab cov ntaub ntawv hais txog kev saib xyuas los ntawm Medi-Cal. Cov peev txheej ntxiv thiab cov ntaub ntawv tuaj yeem pom nyob rau hauv ntu ntu hauv qab no ntawm Medi-Cal tus kws kho mob phau ntawv:
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:
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 saib los yog tshawb nrhiav cov chav kawm catalog.
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.
- Daim Ntawv Tso Cai Midwife Billing Webinar : Qhov kev cob qhia no qhia txog cov ntsiab lus ntawm Medi-Cal Fee-for-Service cov nqi thiab cov lus qhia txog kev thov, nrog rau cov ntaub ntawv qhia txog txoj cai tswjfwm rau cov Midwives 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:
- Rau kev xa nqi thiab thov cov lus nug, thov hu rau DHCS 'Fiscal Intermediary hauv xov tooj los ntawm Lub Chaw Pabcuam Xov Tooj (TSC) ntawm 1-800-541-5555. Txhawm rau nkag mus sai rau TSC cov peev txheej, xa mus rau TSC Main Menu Prompt Options Guide.
- Yog xav tau kev taw qhia txoj cai, thov xa email rau Medi-Cal.Benefits@dhcs.ca.gov.
