판결 후 청구 및 만남 시스템
개요
캘리포니아 메디케이드( Department of Health Care Services (DHCS))는 서비스별 요금제 또는 계약된 매니지 케어 계약의 일부로 제출된 청구 및 발생에 대해 수집 및 보고할 의무가 있습니다(Medi-Cal). DHCS 내의 많은 시스템이 이 필수 기능을 지원합니다.
One such system is the Post Adjudicated Claims & Encounters System (PACES). PACES plays a vital role in the collection of encounter and provider network data from Medi-Cal’s numerous managed care plans. PACES accepts encounter transactions from both medical and dental managed care plans and also accepts encounter-related pharmacy transactions. The information PACES gathers is stored in the DHCS data warehouse (MIS/DSS), where it can be used by many downstream applications within the State.
PACES는 ASC X12 837 및 NCPDP 형식으로 제출된 데이터를 추출, 변환 및 재포맷합니다. 이 시스템은 현재 ASC X12 837I, 837P 및 837D 청구/접수 거래와 NCPDP 2.2 & 4.2 약국 거래를 지원합니다.
PACES replaces the long-standing DHCS Paid Claims and Encounters (PCES) system. The new system is designed to ensure that all available claim and encounter data is retained and available for downstream analysis. The PACES system stores and distributes a richer, more complete data set than was possible using PCES. The goal of PACES is to enforce DHCS’s data quality requirements while also abiding by federal HIPAA transaction standards.
Various DHCS program areas, such as the Encounter Data Quality Unit (EDQU), use PACES’s reporting capabilities in order to analyze encounter data on a regular basis. This heightened ability to monitor managed care and other encounters supports DHCS initiatives that strive to improve the overall health, and health coverage, of Californians.
PACE 또한 대규모 코디네이트 케어 이니셔티브의 일부인 Cal MediConnect 데모도 지원합니다.