CHPW waxay jeceshahay inay xasuusiso dhammaan rugaha caafimaadka iyo bixiyeyaasha sheegashada sheeganaya in lagu soo dallaco lambarro ansax ah oo ku habboon canshuur bixiyaha iyo, marka ay khuseyso, adeeg bixiyaha.
Guriga nadiifinta ee CHPW waxa uu diiday wixii sheegasho ah ee la soo gudbiyay iyada oo aan la bixin biilasha saxda ah iyo/ama bixinta codesyada cashuuraha iyo sheegashooyinkaas aan loo gudbin CHPW.
Sheegashada adeeg bixiye keli ah ayaa looga baahan yahay oo kaliya in lagu soo dallaco NPI / taxonomy heerka qaan-sheegashada sida bixiyaha biilasha iyo bixiyaha bixintu ay isku mid yihiin. Haddii magacaaga bixiyaha biilasha uu ka duwan yahay magacaaga bixiyaha bixiye, markaa NPIs gaar ah iyo madax-bannaan ayaa loo baahan yahay; xaaladdan oo kale, biil bixinta iyo bixinta ma noqon karto isku lambar taxonomy.
Bixinta Elektaroonigga ah ee Taxonomy
- Taxonomy-ka Biilasha (Billing Taxonomy) wuxuu galayaa Loop 2000A, PRV * BI Qaybta (sheegashada waraaqda: Sanduuqa 33b)
- Biilasha NPI waxay aadeysaa Loop 2010AA, NM1 * 85 Qaybta (Sanduuqa 33a)
- Lambarka Aqoonsiga Canshuurta Biilasha (TIN) wuxuu galayaa Loop 2010AA, REF * EI Segment (Sanduuqa 25)
- Bixinta NPI waxay aadeysaa Loop 2310B, NM1 * 82 Qaybta (Sanduuqa 24j - hoose)
- FQHC -yada, haddii bixiyaha bixiyaha uu ka duwan yahay kan loop 2310B, geli taxonomy ee loop 2420A.
- Raadinta Taxonomy waxay tagtaa Loop 2310B, Qaybta PRV * PE (Sanduuqa 24j - sare)
Fiiri qaybaha "Tusaalaha Sheegashada Elektarooniga ah" iyo "Tusaale Sheegashada Warqad" ee dhammaadka hagahan si aad u hesho muuqaalo.
Fadlan sii wad akhriska wixii macluumaad dheeraad ah ee ku saabsan xeerarka taxonomy ama booqo https://taxonomy.nucc.org/ si loo helo madax-bannaani kale oo laga yaabo in lagu dabaqi karo.
Bixiyeyaal Qabiil
Bixiyeyaasha qabaa'ilku waa inay biil ku bixiyaan canshuurta ku habboon ee biilka ah iyo Hindida Mareykanka / Dhaladka Alaska (AI / AN) ee ku habboon ee loo xilsaaray ama beddele qabiileedka aan ahayn AI / AN.
Canshuuraha la Aqbali karo ee Bixiyeyaasha Qabiilka
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- Sheegashooyinka caafimaad: 208D00000X, 225100000X, 225X00000X, 235Z00000X, 152W00000X, iyo 171M00000X
- Sheegashooyinka caafimaadka maskaxda: 2083P0901X
- Sheegashooyinka khalkhalka isticmaalka maandooriyaha: 261QR0405X
- Goobaha daawaynta dadka deegaanka: 324500000x ama 3245S0500x
Fadlan tixraac Hagaha Biilasha Caafimaadka Qabiilka, https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules, wixii faahfaahin ah.
Adeegyada Caafimaadka Habdhaqanka
Isbeddelka loogu talogalay qorshaha / xubnaha Adeegyada Caafimaadka Habdhaqanka CHPW (BHSO) oo keliya: Macaamiisha BHSO, Maamulka Daryeelka Caafimaadka ee Gobolka Washington (HCA) ayaa mas'uul ka ah bixinta adeegyada loo tixgeliyo daryeel la'aanta heerka hoose. Sheegashooyinka caafimaadka habdhaqanka ee adeegyadan waa in lagu gudbiyaa iyada oo loo marayo ProviderOne. HCA ayaa go'aamin doonta lacag bixinta shuruudaha soo socda:
- Haddii bixiyaha uu yahay Xarunta Caafimaadka Maskaxda Bulshada, takhasusyada 251S00000X ama 261QM0801X, magdhowgu wuxuu mas'uul ka yahay ururka daryeelka la maareeyay (MCO) waxaana diidi doonta HCA oo ku wargelinaysa adeeg bixiyaha inay biil u dirto MCO / BHSO.
- Cashuuraha biilasha soo socdaa waxay muujinayaan adeegyada caafimaadka dabeecadda waxayna mas'uul ka yihiin MCO/BHSO: 261QR0405X, 261QM2800X, 324500000X, 3245S0500X, 261QM3000X, 2083P0901X261M
- Taxonomy 283Q00000X ee cisbitaalka dhimirka waa in lagu soo dallaco MCO / BHSO maadaama isbeddelada ku yimid cusbooneysiintan kaliya loogu talagalay adeegyada xirfadleyda ah.
- Canshuur-bixinno kale oo biilal ah, HCA waxay tixgelineysaa inay tahay adeegyo acuity hoose oo waxay u baaraandegi doontaa oo ay ku bixin doontaa sheegasho caafimaad, oo ka soo horjeedda sheegashada caafimaadka habdhaqanka, iyadoo aan loo eegin cudurka. HCA kaliya waxay fiirisaa taxonomy-ka biilka.
- HCA waxay bixin doontaa oo keliya adeegyada lagu bixiyo khidmadda ujrada ah; Adeegyada aan kujirin khidmadda adeegga waa in si toos ah loogu soo diraa MCO, iyadoon loo eegin taxonomy.
- HCA waxay cusboonaysiisay hagaha biilka Caafimaadka Maskaxda ee khuseeya biilka habboon iyo adeegsiga canshuuraha; fadlan eeg https://www.hca.wa.gov/assets/billers-and-providers/mental-health-svcs-bg-20210901.pdf.
- HCA waxay sare uqaadi doontaa wixii khalad ah ee xaga biil ee mustaqbalka ah ee ay soosaaraan bixiyeyaasha shaqaalaha HCA ee barnaamijka Integrity.
Dhammaan adeegyada caafimaadka habdhaqanka waa in lagu soo dallacaa canshuuraha ku habboon ee biilashada, oo ay ku jiraan laakiin aan daruuri ku koobnayn, kuwa hoos ku taxan.
- Xarumaha Caafimaadka Maskaxda Bulshada: 251S00000X ama 261QM0801X
- Wakaaladaha caafimaadka hab dhaqanka (bixiyaha biilasha): 261QR0405X, 261QM2800X, 324500000X, ama 3245S0500X
- Baxnaaninta (dhaqancelinta) cilladda isticmaalka maandooriyaha (SUD): 261QR0405X
- Bukaanka / xarunta Methadone: 261QM2800X
- Xarunta dib u soo kabashada SUD: 324500000X
- Xarunta dhaqan celinta caruurta ee SUD: 3245S0500X
Rugaha Caafimaadka Reer Miyiga (RHC)
Adeegyada RHC waa in lagu soo dallacaa taxonomy-ka RHC si loo helo kor u qaadista adeegga ku saleysan (SBE). Sida ku cad HCA-da Tilmaamaha Biilinta ee Xarumaha Caafimaadka Reer Miyiga:
Sideen ugu dallacaa koodka taxonomy ee RHCs?
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- Marka lacag bixinta adeegyada uqalma bixinta lacag bixinta, HCA waxay ubaahantahay RHCs inay adeegsadaan taxonomy taxonomy 261QR1300X heerka sheegashada.
- Canshuur -bixinta adeegga ayaa sidoo kale loo baahan yahay.
- Haddii macmiilka ama adeegu uusan u qalmin la kulanka RHC, RHCs waxay si joogto ah biil ahaan ugu soo dallacayaan sida non-RHC oo aan lahayn HCPCS T1015 sheegashada.
Fadlan tixraac Tilmaamaha Biilinta ee Xarumaha Caafimaadka Reer Miyiga Macluumaad dheeraad ah: https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules .
Xarumaha Caafimaadka ee u Qalma Federaalka (FQHC)
Sida dhaqanka ugu fiican, CHPW waxay raacdaa shuruudaha biilka ee HCA ee FQHCs. Sida lagu qeexay HCA's Tilmaamaha Biilida ee Xarumaha Caafimaadka ee Faderaalka ah (FQHC):
Sideen ugu dallacaa koodka taxonomy FQHCs?
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- Marka qaan -sheegashada adeegyada u -qalma lacag -bixinta kulanka, HCA waxay u baahan tahay FQHCs inay adeegsadaan cashuur -bixinta qaan -sheegga 261QF0400X heerka sheegashada.
- Canshuur -bixinta adeegga ayaa sidoo kale loo baahan yahay.
Fadlan eeg qaybta “Biilinta Elektaroonigga ah ee Taxonomy” ee kore ama tixraac Tilmaamaha Biilida ee Xarumaha Caafimaadka ee Faderaalka ah (FQHC) Macluumaad dheeraad ah: https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules.
Falanqaynta Dhaqanka ee la dabaqay (ABA) Taxonomy
Bixiyeyaasha Falanqaynta Dhaqanka ee Codsan (ABA) waa inay isticmaalaan lambarka cashuurta 103K00000X biilasha adeegyada daawaynta ABA si loo hubiyo in sheegashooyinka si habboon loo bixiyo. Bixiyeyaashu waa inay geliyaan xeerkan cashuurta ee labadaba biilasha iyo adeega goobaha cashuuraha ee CMS-1500 (HCFA) foomka sheegashada.
Fadlan eeg Cusboonaysiinta Dejinta Xeerka Taxonomy ee NUCC, https://taxonomy.nucc.org/, wixii macluumaad dheeraad ah.
Tusaalaha Sheegashada Elektaroonigga
Tusaalaha sheegashada elektiroonigga ah ee hoose:
- Qeybta PRV*BI waa taxonomy bixiyaha biilka
- Qeybta NM1*85 waa bixiyaha biilka NPI
- Qeybta REF*EI waa bixiyaha biilka biilka ah Aqoonsiga Canshuurta
- Qeybta NM1*82 waa bixiyaha bixiyaha NPI
- Qeybta PRV*PE waa taxonomy bixiyaha bixinaya
Tusaalaha Sheegashada Waraaqaha
Tusaalaha sheegashada warqadda ee hoose:
- Sanduuqa 24j - kore waa taxonomy bixiyaha bixiyaha
- Sanduuqa 24j - hoosta waa bixiyaha bixiyaha NPI
- Sanduuqa 25 waa bixiyaha biilka biilinaya Aqoonsiga Canshuurta
- Sanduuqa 33a waa bixiyaha biilka NPI
- Sanduuqa 33b waa taxonomy bixiyaha biilka
Tilmaamaha Biilka
Fadlan eeg Hagayaasha Biilasha ee HCA wixii ku saabsan canshuuraha saxda ah iyo macluumaad dheeri ah, https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules, Oo ay ku jiraan Tilmaamaha Biilinta Caafimaadka Qabiilka, Tilmaamaha Biilida ee Xarumaha Caafimaadka ee Faderaalka ah (FQHC), Tilmaamaha Biilinta ee Xarumaha Caafimaadka Reer Miyiga, Iyo in ka badan.
Su'aalo?
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