Ukuphathwa Kokusetshenziswa Nokugunyazwa
Funda mayelana nezidingo zethu zangaphambili zokugunyaza impilo yempilo nokuziphatha.
Ukugunyazwa
Silwela ukwenza inqubo yokugunyazwa kwangaphambili ibe lula ngangokunokwenzeka kuwe. Okulandelayo isifinyezo semithetho yethu yokugunyazwa futhi akuqinisekisi ukufakwa.Ungathola ulwazi olwengeziwe ku Umhlinzeki Wezinhlinzeko.
Izinsizakalo ezithile zidinga ukugunyazwa ngaphambilini ukuze zithole ukukhokhelwa kwezinsizakalo ezinikeziwe. Uma unikeza ngezinsizakalo ngaphandle kokugunyazwa, isimangalo sakho singanqatshelwa.
Izinyathelo Zokucela Ukugunyazwa Okuqala
- Ngaphambi kokuthumela isigunyazo, sicela uqinisekise ukufaneleka kwelungu lapha noma i-Colorado Department of Health Care Policy & Financing (HCPF) indawo yokufaneleka.
- Gcwalisa iFomu Lokugunyazwa Kwangaphambili nefeksi, ngolwazi olufanele lomtholampilo, kwinombolo efakwe kwifomu. Uyacelwa ukuthi ugcwalise zonke izinkambu ezidingekayo - amafomu aphelele ngeke amukelwe futhi abuyiselwe kumthumeli.
- Uzokwaziswa uma kudingeka imininingwane eyengeziwe, uma insizakalo igunyaziwe, noma uma insizakalo ingeke igunyazwe.
- Uma unemibuzo ngicela shayela nathi.
Ukugunyazwa Kwezempilo Okuziphatha
Sigunyaza izinsizakalo zezempilo zokuziphatha ngaphansi kwe-Health First Colorado (Uhlelo lwe-Colorado's Medicaid Program) Isivumelwano se-Accountable Entity Entity kanye ne-Child Health Plan plus izinkontileka zohlelo lwethu lwe-HMO. Sitholakala amahora angama-24 ngosuku, izinsuku eziyisikhombisa ngesonto ukuthatha izicelo zokugunyazwa.
Chofoza lapha ukuze uthole ulwazi mayelana nezinsizakalo zezempilo zokuziphatha ezidinga ukugunyazwa kuqala. Sicela uqaphele ukuthi zonke izinsizakalo ezinikezwa ngumhlinzeki ongabambe iqhaza zidinga imvume yokukhokha; okuwukuphela kwalokhu kulezi zimo eziphuthumayo futhi eziphuthumayo njengoba kuchazwe kuMqulu Wezinhlinzeko.
Kulawo masevisi adinga ukugunyazwa, ukwehluleka ukucela ukugunyazwa kuzoholela ekulaleni kokuphatha. Asikwazi ukubuyisela emuva ngokuphindaphindiwe izinzuzo zokwelashwa ezitholakale ngaphambi kokugunyazwa ngaphandle kwamacala okukhwabanisa, ukuhlukumeza, noma uma ilungu lilahlekelwa ukufaneleka.
Ukugunyazwa kweMpilo ngokomzimba
Sigunyaza ezinye izinsizakalo zezempilo ngokomzimba ohlelweni lwezempilo lwezingane plus(CHP +) HMO. Sitholakala kusukela ngo-8 ekuseni kuya ku-5 ntambama ngoMsombuluko kuze kube uLwesihlanu ukuthola izicelo zokugunyazwa impilo.
Chofoza lapha ukuze uthole ulwazi mayelana nezinsizakalo ze-CHP + ezidinga ukugunyazwa ngaphambilini (amanothi okuzulazula: ungasebenzisa i-CTRL F kanye nokusebenza kwesihlungi ukusesha ngekhodi yenqubo). Sicela uqaphele ukuthi zonke izinsizakalo ezinikezwa ngumhlinzeki ongabambe iqhaza zidinga imvume yokukhokha; okuwukuphela kwalokhu kulezi zimo eziphuthumayo futhi eziphuthumayo njengoba kuchazwe kuMqulu Wezinhlinzeko.
Kulawo masevisi adinga ukugunyazwa, ukwehluleka ukucela ukugunyazwa kuzoholela ekulaleni kokuphatha. Asikwazi ukubuyisela emuva ngokuphindaphindiwe izinzuzo zokwelashwa ezitholakale ngaphambi kokugunyazwa ngaphandle kwamacala okukhwabanisa, ukuhlukumeza, noma uma ilungu lilahlekelwa ukufaneleka.
Sicela uchofoze lapha ukuze uthole ulwazi mayelana nenzuzo yekhemisi ye-CHP +, amafomula, nenqubo okufanele ucele ukugunyazwa kwemithi.
Icela ukubuyiselwa kabusha kwemisebenzi eqhubekayo
Zonke izicelo zezinsizakalo eziqhubekayo ngaphandle kokugunyazwa kokuqala zidinga ukugunyazwa kabusha. Sicela ugcwalise futhi uhambise ifomu eligunyaziwe lokugunyazwa kwangaphambili kanye nefeksi njengoba kuboniswe ngenhla okungenani usuku olulodwa lwebhizinisi ngaphambi kokuphela kokugunyazwa kwangaphambilini. Abahlinzeki banesibopho sokulandela izinsuku zokuqala zokugunyazwa, izinsuku zokuphela, inombolo yamayunithi asetshenzisiwe, nokufaneleka kwamalungu. Abahlinzeki kumele bafonele noma bafekise ulwazi lomtholampilo olusekela isidingo sezokwelapha sokuqhubeka nokuhlala ngosuku olulodwa lokusebenza kwesicelo solwazi oluvela e-Colorado Access.
Uma isicelo sokuhlala isikhathi esinqunyiwe sokuphika senqatshelwa umqondisi wezokwelapha, umhlinzeki kanye nomsebenzi ozoya khona bazokwaziswa futhi bangacela ukubuyekezwa kontanga phakathi nosuku olulodwa lebhizinisi. Isicelo sokubuyekezwa kontanga nokubhekwa akubhekwa njengesikhalazo noma isikhalazo.
Izinqubomgomo nezinqubo
Sicela ubheke izinqubomgomo ezingezansi ukuthola eminye imininingwane.
UM100 - Iziqu Zabasebenzi Abenza Imisebenzi Yokuphatha Ukusetshenziswa
UM101 – Imibandela Yokubuyekezwa Kokusetshenziswa
UM102 - Izinqumo Zokubuyekezwa Kokusetshenziswa
UM103 - Ukunakekelwa Kwezimo Eziphuthumayo kanye Nangemuva Kokuzinza
UM104 – Ukuhlolwa Kwangaphambi kwesikhathi Nezikhathi ezithile, Ukuxilonga, kanye Nezinsizakalo Zokwelapha (EPSDT)
UM105 - Inqubo Yokubuyekeza Kontanga
UM106 – Inqubo Yokudlulisa Isikhalazo Selungu