Txheej txheem daws teeb meem kev tsis txaus siab ntawm tus kws kho mob​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) suav nrog cov kev pabcuam doula hauv ob qho tib si tswj kev saib xyuas thiab them nqi-rau-kev pabcuam kev pabcuam rau cov menyuam cev xeeb tub thiab tomqab yug menyuam. Cov kev pabcuam muaj xws li kev pabcuam tsis yog khomob rau kev mus ntsib ua ntej yug menyuam thiab tomqab yug menyuam, thiab thaum lub sijhawm ua haujlwm thiab yug menyuam, nchuav menyuam, thiab rho menyuam.​​ 

1. Thaum twg kuv tuaj yeem tau txais kev them nyiaj los ntawm MCP tom qab kuv xa daim ntawv thov rau cov kev pabcuam muab rau tus tswvcuab Medi-Cal?​​ 

• Managed Care Plans (MCPs) are required to pay 90 percent of all “clean claims” wsithin 30 calendar days of receipt, unless the provider and MCP have agreed in writing to an alternate payment schedule. A “clean claim” is a claim that does not need to returned to the provider for corrections or additional information in order to be paid.​​ 

2. Dab tsi yog cov txheej txheem rau doulas uas tab tom cuam tshuam nrog kev tsis lees paub lossis ncua sij hawm ntawm kev thov rov qab?​​ 

• Raws li cov chaw muab kev pabcuam hauv network, doulas muaj txoj cai los daws lawv cov kev txhawj xeeb txog kev them nyiaj raws sijhawm los ntawm kev ua raws li lawv cov txheej txheem kev daws teeb meem MCPs (saib nqe lus nug #3).​​ 
• MCPs yuav tsum muaj cov txheej txheem daws teeb meem kev tsis sib haum xeeb uas suav nrog cov txheej txheem daws teeb meem raws sij hawm, ncaj ncees, thiab muaj txiaj ntsig zoo uas cov kws kho mob tuaj yeem xa cov lus tsis txaus siab.​​ 
• Cov kws kho mob tuaj yeem xa cov lus tsis txaus siab rau MCPs txog:​​ 
  • Kev tso cai los yog tsis kam lees txais kev pabcuam.​​ 
  • Kev ua haujlwm ntawm kev them nyiaj lossis tsis them nyiaj ntawm kev thov.​​ 
  • Lub sijhawm ntawm kev them nyiaj rov qab rau ntawm qhov tsis sib haum xeeb thov kom huv thiab cov paj laum uas MCP yuav tsum tau them rau cov nyiaj them rov qab.​​ 

3. Kuv yuav pib txheej txheem daws teeb meem kev tsis sib haum xeeb nrog MCP li cas?​​ 

• Thov hu rau koj lub Chaw Pabcuam Kev Pabcuam MCP kom pib txheej txheem daws teebmeem kev tsis txaus siab.​​ 
• Cov peev txheej ntxiv:​​ 
  • DHCS’ Medi-Cal Managed Care Health Plan Directory​​ 
  • For additional assistance locating MCP contact information, doulas may also contact DHCS at DoulaBenefit@dhcs.ca.gov.​​ 

4. Kuv yuav ua li cas kuv tseem ntsib teeb meem tom qab pib qhov kev tsis sib haum xeeb nrog MCP?​​ 

• If a doula has initiated a provider dispute with their applicable MCP and continues to face challenges, the doula can reach out to DHCS for further assistance via email at DoulaBenefit@dhcs.ca.gov.​​ 
• Doulas yuav tsum muab cov ncauj lus kom ntxaws txaus los pab kom DHCS ua raws li MCPs zoo. Thov suav nrog cov ntaub ntawv, xws li:​​ 
  • Doula npe​​ 
  • Doula National Provider Identifier tus lej​​ 
  • Lub npe ntawm MCP (cov) uas koj tab tom muaj kev nyuaj siab​​ 
  • Daim ntawv cog lus (ua tiav daim ntawv cog lus lossis Daim Ntawv Pom Zoo / Daim Ntawv Pom Zoo Ib Leeg)​​ 
  • Cov lus piav qhia luv luv ntawm qhov teeb meem. Thov suav nrog:​​ 
    • Hnub tim (s) kev pab​​ 
    • Kev lees paub / tus lej foob​​ 
    • Qhov seem tshuav​​ 
    • Hnub nyoog ntawm kev thov cuam tshuam nrog qhov teeb meem​​ 
  • Thaum twg Doula pib MCPs tus neeg muab kev pabcuam kev tsis sib haum xeeb?​​ 
  • Cov lus teb tshwj xeeb dab tsi uas tus doul tau txais los ntawm MCP los ntawm cov txheej txheem kev tsis sib haum xeeb?​​ 
  • Lub npe ntawm ib tus neeg sawv cev ntawm MCP uas koj tau hais txog qhov teeb meem, MCPs email lossis xov tooj siv los tiv tauj.​​ 
  • Douls tiv tauj cov ntaub ntawv rau kev taug qab (email thiab / lossis tus xov tooj nyiam).​​ 
  • TSIS TXHOB suav nrog cov ntaub ntawv tiv thaiv kev noj qab haus huv (PHI) tshwj tsis yog thov thiab muab faib kom ruaj ntseg.​​