Lub luag haujlwm ntawm Lub Chaw Pabcuam Kev Sau Npe (PED) yog txhawm rau tso npe cov neeg muab kev pabcuam tsim nyog hauv Medi-Cal qhov kev pabcuam raws sijhawm thiab txuas ntxiv hloov kho Cov Ntaub Ntawv Tus Kws Pabcuam kom raug cuam tshuam raws li tus neeg muab kev pabcuam.​​ 

Allied & Kws Kho Mob Section​​ 

Two of the three units in this section are responsible for the analytical review, verification of information, approval and processing of provider applications for enrollment of provider types such as physicians, non-physician medical practitioners, and allied healthcare providers into the Medi-Cal program. These units are also responsible for the enrollment of health care provider groups. The third unit in this section is responsible for researching and resolving returned warrants, which includes verification of current addresses and communication with the State Controller’s Office, providers, and HP Enterprise Services for the reissuance of warrants and/or deactivation of provider number, if appropriate.​​ 

Facility / Pharmacy / PMF Ceg​​ 

Cov ceg no muaj peb lub tsev. Ob ntawm cov chav nyob yog lub luag haujlwm rau kev tshuaj xyuas, kev txheeb xyuas cov ntaub ntawv, kev pom zoo thiab ua cov ntawv thov rau kev tso npe rau kev kho mob sab nraud, cov khoom siv thiab cov khoom siv xws li lub tsev muag tshuaj, chav kuaj, thiab cov chaw muab khoom siv kho mob ruaj khov rau hauv qhov kev pab cuam Medi-Cal. Lawv kuj yog lub luag haujlwm rau kev txheeb xyuas thiab kev pom zoo rau kev tso npe rau Medi-Cal cov kws kho mob sau npe hauv cov kev pabcuam tshwj xeeb xws li Kev Tshawb Fawb Txog Thaum Ntxov thiab Kev Kho Mob (EPSDT), thiab Family Planning Access, Care and Treatment (FPACT). Chav tsev thib peb, Tus Muab Kev Pabcuam Master File Unit (PMF), yog lub luag haujlwm rau cov haujlwm tshwj xeeb thiab cov haujlwm uas txhawb lossis txhim kho cov chaw muab kev pabcuam rau npe, xws li kev tswj xyuas cov ntaub ntawv thiab kev xa mus rau chaw. Chav tsev no ua haujlwm nrog tus neeg nruab nrab nyiaj txiag los tsim cov ntaub ntawv muab kev pabcuam thiab siv cov kev hloov pauv uas ua tau raws li lub koomhaum cov cai. Chav tsev no tseem muab kev saib xyuas ntawm Technical Support Unit uas yog lub luag haujlwm rau cov ntaub ntawv tseem ceeb nkag ntawm txhua cov ntaub ntawv mus rau Tus Kws Pab Tswv Yim Cov Ntaub Ntawv.​​ 

Txoj Cai & Chaw Tswj Xyuas​​ 

Cov ceg no muaj plaub chav. Txoj Cai Lij Choj, nrog rau ob lub luag haujlwm, yog lub luag haujlwm los tsim thiab siv txoj cai rau npe kawm thiab cov txheej txheem, muab kev tshawb fawb tob tob thiab tshuaj xyuas, tsim thiab siv cov kev cai tshiab, tshuaj xyuas kev cai lij choj thiab tsim cov ntawv thiab cov ntaub ntawv online hauv kev txhawb nqa ntawm tus kws kho mob rau npe thiab rov - cov txheej txheem rau npe. Cov koog no ua haujlwm ze nrog ntau lub tuam tsev thiab cov ceg, Lub Tsev Haujlwm Saib Xyuas Kev Ncaj Ncees, thiab lwm lub xeev thiab tsoomfwv cov koomhaum. Lub Tsev Haujlwm Saib Xyuas Kev Ua Haujlwm yog lub luag haujlwm rau kev tshawb fawb tob thiab txhim kho cov peev txheej hloov pauv cov tswv yim thiab cov lus pom zoo, thiab cov ntawv cog lus. Chav tsev no yog tus neeg saib xyuas kev cai lij choj thiab tsoomfwv txoj haujlwm (LGA), Lub Tsev Haujlwm Saib Xyuas Neeg Ua Haujlwm, thiab lwm lub xeev thiab tsoomfwv cov chaw haujlwm. Cov neeg ua haujlwm tshawb nrhiav thiab teb rau Public Records Act thov, ntawv pov thawj daim ntawv thov, ntawv xov xwm los ntawm txhua theem ntawm tsoomfwv, thiab cov lus nug ntawm tus kws kho mob. Lub Chaw Pabcuam Kev Pabcuam yog lub luag haujlwm rau kev txheeb xyuas thiab xa tawm tag nrho cov ntawv xa tuaj thiab xa tawm, sau npe thiab taug qab txhua daim ntawv thov tau txais kev tso npe rau hauv Medi-Cal qhov kev pab cuam, nrhiav cov ntaub ntawv, thiab cov haujlwm tshwj xeeb. Chav tsev no tseem muaj lub luag haujlwm rau kev ntaus ntawv, formatting, thiab tso tawm cov ntawv sau, xa rov qab, xa cov ntaub ntawv scanning thiab indexing, thiab kev rhuav tshem cov ntaub ntawv.​​ 

Re-Enrollment Section​​ 

Ob chav nyob hauv ntu no yog lub luag haujlwm los nthuav tawm cov haujlwm tiv thaiv kev dag ntxias los ntawm kev rov sau npe ntawm cov chaw muab kev pabcuam uas twb muaj lawm. Cov koog no tshuaj xyuas cov ntawv thov rov sau npe, cov lus tshaj tawm, daim ntawv cog lus muab kev pabcuam thiab txhua daim ntawv tso cai siv tau rau txhua hom kws kho mob raws li kev hloov pauv. Tsis tas li ntawd, ntu no muab kev txheeb xyuas qhov tob thiab kev txheeb xyuas keeb kwm yav dhau los los pab Kev Tshawb Fawb thiab Kev Tshawb Fawb hauv lawv qhov chaw tshuaj xyuas ntawm cov chaw muab kev pabcuam rov sau npe, thiab tswj xyuas Daim Ntawv Teev Npe Kho Mob thiab Tsis Tsim Nyog.​​