裁決後索賠和遭遇系統
概述
Department of Health Care Services (DHCS) ) 被授權收集和報告加州醫療補助健康保健計劃) 索賠和遭遇，無論它們是作為服務收費還是合約管理式護理的一部分提交的安排。 DHCS 內的許多系統都支援此所需功能。
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.
PACES 擷取、轉換和重新格式化已以 ASC X12 837 和 NCPDP 格式提交的遇見資料。 該系統目前支持 ASC X12 837I、837P 和 837D 索償/遇見交易，以及 NCPDP 2.2 & 4.2 藥房交易。
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也支持Cal MediConnect演示，這是更大的協調護理計劃的一部分。