Tilmaamahaaga ku saabsan caymiska daawada laguu qoray ee bukaankaaga
Ka hel liistada farmasiyada ee shabakadda Community Health Plan ee Washington (CHPW) oo aad ogaatid daawooyinka ku jira liiska:
Raadi Farmasiyada Raadinta Qaaciidooyinka
Tallaalada COVID-19: The Pfizer BioNTech, Moderna, iyo Johnson & Johnson COVID-19 tallaalada waxaa lagu daboolay qayb ka mid ah faa'iidooyinka daawada CHPW meel kasta oo lagu bixiyo.
Sida 1/1/2023 Farmashiyeyaasha Kroger kuma sii jiri doonaan shabakada CHPW. Liiska dhammaan farmasiyada shabakadayada, fadlan guji badhanka Raadinta Farmashiyaha ee sare.
Muhiim: Qaaciddada iyo raadinta ma khuseeyaan xubnaha Qorshaha Faa'iidada Medicare. Fadlan tixraac Websaydhka Faa'iidada Medicare ee CHPW wixii macluumaad ah ee ku saabsan caymiska Medicare.
Liiska Dawooyinka La Doorbiday (PDL)
1da Janaayo, 2020, dhammaan qorshooyinka daryeelka la maareeyay iyo barnaamijyada khidmadda u-adeegga ee Apple Health waxay sii wadi doonaan inay wajiga u galaan Liiska Daawooyinka Hal-doorka ah (PDL).
Isbadalkan waxaa sharciyeeyay Sharci dejinta Gobolka Washington.
Maamulka Daryeelka Caafimaadka wuxuu la shaqeynayaa qorshooyinka daryeelka la maareeyay ee u adeega macaamiisha Apple Health si loo abuuro Apple Health PDL. Qorshayaasha daryeelka la maareeyay waxay sii wadi doonaan inay isticmaalaan liisaska dawooyinka ay doorbidaan ee dawooyinka aan ku jirin Apple Health PDL.
Fadlan la xidhiidh [emailka waa la ilaaliyay] iyadoo wax su'aalo ah.
Daawooyinka la xardhay: Waxaa dabooshay Adeeg-lacag-la'aan (FFS)
Maamulka Daryeelka Caafimaadka Gobolka Washington (HCA) ayaa mas'uul ka noqon doona DHAMMAAN oggolaansho-hore iyo oggolaanshaha khidmadaha-Adeegga-For-Service (carve out) ee alaabta ku saleysan hab-raacyada caafimaad ee HCA. Si aad u codsato caymis fadlan wac HCA at 800-562-3022.
Si aad u heshid liiska alaabooyinka ujra-For-Adeeg (carve out), fadlan booqo barta internetka ee HCA https://www.hca.wa.gov/billers-providers-partners/program-information-providers/apple-health-preferred-drug-list-pdl.
Ogolaansho hore
Si aad u codsato rukhsad hore, talaabo talaabo ah, macluumaad aan rasmi ahayn, ama xad gudub xad, fadlan ka wac ESI 1-844-605-8168, 24 saacadood maalintii, 7 maalmood usbuucii, lana hadal khabiir adeegga oggolaanshaha hore ah. Khabiirkani wuxuu dib u eegi doonaa macluumaadka caafimaad iyo shuruudaha bixiyaha ama qofka loo xilsaaray ee ku saabsan baahida daawada la codsaday.
Dawooyin kasta oo aan ku liis-qornayn dawladeena waxay u baahan tahay oggolaansho hore. Daawooyinka is-maamul ee u baahan oggolaansho hore, fadlan kala xiriir Qoraallada Degdegga ah cinwaanka 1-844-605-8168 ama isticmaali https://www.CoverMyMeds.com si loo bilaabo hawsha oggolaanshaha hore.
Waxaad soo gudbin kartaa codsi ku saabsan dib u eegista go'aaminta caymiska adoo soo diraya a Foomka Codsiga Go'aaminta Caymiska ama buuxinta foomka online.
Arimaha Soo Celinta Farmashiyaha
Haddii ay dhibaato kaa haysato lacag-bixinta, fadlan wac 1-800-922-1557 ama u soo gudbi baaritaanka ESI iyaga oo adeegsanaya Xarunta Kheyraadka Farmashiistaha.
Buuxinta Gurmadka Farmashiyaha
Buuxinta xaaladaha degdega ah waa la dabooli karaa si looga hortago hakadka ku yimaada daaweynta inta lagu jiro xaalad deg deg ah. Eeg siyaasaddeena ku saabsan buuxinta xaaladaha degdegga ah.
Daawooyinka loo heli karo 90 maalmood oo la buuxiyo
CHPW waxay dabooshaa sahayda 90-maalmood ee loogu talagalay daawooyinka daba dheeraada. Weydiiso dhakhtarkaaga ama farmashiistaha in 90 maalmood lagaa siiyo daawooyinkaaga booqashadaada soo socota.
Biilasha ka hortagga uurka OTC
Apple Health (Medicaid) iyo CHPW waxay ku daboolaan miiska miiska (OTC), ka hortagga uurka, oo ay ku jiraan inta badan ka hortagga degdegga ah, oo leh ama la'aan warqadda daawada ee macaamiisha. Sheegashada farmashiyaha la xukumay ayaa loo baahan yahay si loo soo celiyo.
Si loo dalacsiiyo ka-hortagga uur-qaadista OTC, farmasiyadu waa inay raacaan heerka Golaha Qaranka ee Barnaamijyada Dawooyinka Dawooyinka (NCPDP) oo ay isticmaalaan xeerka qaranka ee daroogada (NDC) ama code-ka badeecada caalamiga ah (UPC) ee laga helay xirmada.
Qorista daawooyinka ka hortagga uurka ee OTC looma baahna. Farmashigu waxa uu isticmaali karaa NPI-giisa si uu uga baaraandego cabashada marka aan warqad dhakhtar qorin la heli karin.
Kaliya alaabada lagu daray xogta nidaamka farmashiyaha ee CHPW ayaa la daboolay. Liiska alaabooyinka ilaalinta dhalmada ee OTC ee daboolan, eeg Apple Health ayaa daboolay liiska ka hortagga uurka ee OTC.
Ka-hortagga uur-qaadidda degdegga ah waa la daboolay. Ma jiraan xad da'da, tirada, ama inta jeer.
Macluumaad dheeraad ah si aad uga caawiso bukaanada inay helaan ka hortagga uurka ee iyaga ku habboon, booqo bogga Waaxda Caafimaadka bogga ka hortagga uurka iyo ka hortagga degdega ah.
Wixii su'aalo ah, la xiriir [emailka waa la ilaaliyay] ama u dir HCA at [emailka waa la ilaaliyay].
Barnaamijka Tababarka Daaweynta Shakhsiyeed
Barnaamijka Tababarka Daaweynta Shakhsi ahaaneed wuxuu la shaqeeyaa dhakhaatiirta iyo bukaannada si loo hubiyo in daawooyinka ay waxtar leeyihiin oo si sax ah loo isticmaalo.
Barnaamijka Tababbarka Daaweynta Shakhsi ahaaneed waa adeeg loogu talagalay xubnaha leh xaalado caafimaad oo badan iyo kuwa qaata daawooyin badan. Barnaamijkan waxaa lagu bixiyaa iskaashi dhexmara CHPW iyo MedWiseRx.
Haddii aad rumeysan tahay in mid ka mid ah bukaannadaada uu ka faa'iideysan doono Tababbarka Daaweynta Shakhsi ahaaneed, weydii inay soo booqdaan Websaydhka MedWiseRX Ama wac 1-844-866-3730 si aad u bilowdo.
Shuruudaha xaq u yeelashada
- Liiska Hubinta Bixiyaha MTM
- MTM Bixiyaha iyo Shuruudaha Xubinta
- Foom Muunad MTM ah (caawimaadda hagida dib-u-eegista daaweynta daawada)
Haddii aad raadineyso Maareynta Daaweynta Daaweynta ee xubin ka mid ah Macaashka Medicare, booqo bogga internetka ee 'CHPW Medicare Advantage' wixii macluumaad ah ee ku saabsan Maareynta Daaweynta Daaweynta Medicare macluumaadka.
Barnaamijka Dib u Eegista Bukaanka iyo Isuduwaha
Barnaamijkeenna Dib-u-eegista iyo Isku-duwidda Bukaanka (PRC) wuxuu ka caawiyaa xubnaha inay si ammaan ah oo habboon ugu adeegsadaan adeegyadooda caafimaad.
Xubnaha loo xushay PRC waa inay doortaan hal bixiye daryeel aasaasi ah, farmashiye, iyo isbitaal. Mid ka mid ah bixiyeyaasha daryeelka aasaasiga ah wuxuu hubiyaa in daryeelka caafimaad iyo rijeetooyinka la iskula soo duwo caafimaadka iyo amniga xubinta.
Si aad bukaan ugu dirto barnaamijka PRC ama aad waxbadan uga barato, naga soo wac at 1-866-907-1902.
Barnaamijka Fikirka Labaad
Sida uu u igmaday sharci dejiyuhu in RCW 74.09.490, HCA waxay diyaarisay barnaamijki labaad ee ra'yi si loo hagaajiyo ku dhaqanka qoritaanka ee carruurta.
Iyadoo lala kaashanayo Kooxda La-talinta Caafimaadka Maskaxda ee Caafimaadka iyo Guddiga Dib-u-Eegista Adeegsiga Maandooriyaha, HCA waxay dejisay tilmaamaha caafimaadka maskaxda ee carruurta si loo aqoonsado carruurta laga yaabo inay halis ugu jiraan sababo la xiriira isticmaalka dawada dhakhtarku qoro, isticmaalka daawooyin badan, qiyaasta daawada sare , ama isku xirnaan la'aan ka dhexeysa adeeg bixiyayaal badan oo wax qora.
Khayraad waxtar leh:
- Barnaamijka Aragtida Labaad ee Caafimaadka Apple Health Su'aalaha Badanaa La Isweydiiyo
- Geeddi-socodka Dib-u-eegista Fikradda Labaad (SON) Flowchart
Khadadka Helitaanka Iskaashiga (PAL)
Si looga caawiyo qoroyaasha inay daboolaan baahiyaha carruurta qaba cudurka maskaxda, iyo in la yareeyo baahida loo qabo dib-u-eegista loo baahan yahay SON, bixiyeyaashu waxay la xiriiri karaan Khadka Helitaanka Iskaashiga (PAL). PAL waa taleefan ku saleysan nidaamka latalinta caafimaadka maskaxda caruurta oo ay maalgaliso sharci dejinta gobolka, lagana hirgaliyo Gobolka Washington. PAL waxay shaqaaleeysaa dhakhaatiirta maskaxda carruurta, cilmu-nafsiga carruurta, iyo shaqaalaha bulshada ee gacansaarka la leh Isbitaalka Seattle Children's Hospital si ay u gaarsiiyaan adeegyada la-talinta. Kooxda PAL waxay diyaar u yihiin adeeg bixiye kasta oo aasaasi ah dhamaan Gobolka Washington.
PCP-yada ayaa wici kara 1-866-599-7257 inta udhaxeysa 8da subaxnimo ilaa 5ta galabnimo nooc kasta oo ka mid ah arrimaha caafimaadka maskaxda ee la soo baxa ilmo kasta, maahan oo keliya xubnaha CHPW. Wixii macluumaad dheeraad ah ee ku saabsan booqashada PAL Websaydhka Carruurta ee Seattle.
Guddiga Farmashiyaha iyo Daaweynta (P&T)
Gudigayaga P&T waxay kulmaan si ay u qiimeeyaan nidaamkayaga, shuruudaha ogolaanshaha hore, iyo talaabooyinka badbaadada si loo hubiyo tayada. Akhriso go’aamadii ugu dambeeyay:
- Nofeembar 15, 2019: Ma jiraan Go'aamo Caafimaad
- Juun 20, 2019: Ma Lahan Go’aamo Caafimaad
- Maarso 25, 2019: Ma Jirto Go’aamo Caafimaad
- Nofeembar 14, 2018: Ma jiraan Go'aamo Caafimaad
- July 13, 2018: Ma Jirto Go’aamo Caafimaad
- Maarso 2, 2018: Ma Jirto Go’aamo Caafimaad
Ammaanka Daawada
Hubso inaad aqriso wixii ugu dambeeyay Warbixinta Dib U Xusuusashada Daroogada wixii cusbooneysiin ah ee ku saabsan daawooyinka loo xusuusto arrimo nabadgelyo awgood.
