Family Medical - CHAMPVA

Uhlelo Lwezempilo Nezokwelapha Lomnyango Wezindaba Zomakadebona (CHAMPVA), olwabantu abangaba umlingani womshado noma izingane zomakadebona okhubazekile, noma umlingani ophilayo noma ingane Yomakadebona oshonile FUTHI abangayifanelekeli i-TRICARE.

Uhlelo lokusebenza lweselula loMnyango Wezindaba Zomakadebona (VA) CHAMPVA (uhlelo lokusebenza) lwenzelwe abahlinzeki benkonzo yezokwelapha (i-VA kanye nomkhuba wangasese) kanye nabazuzayo njengoba behlela ukunakekelwa nezinqubo zezokwelapha. Abahlomuli nabahlinzeki basebenzisa uhlelo lokusebenza ngabodwana, noma ndawonye ngesikhathi sokuhlangana kwesiguli, ukuze banqume ukuthi i-VA izokhokha yini ukulethwa kokunakekelwa.

Uhlelo lokusebenza lwe-CHAMPVA lusebenzisa amasethi amaningana ekhodi yezokwelapha ukuze linqume ukuthi izinsiza kanye/noma izinto zokusebenza zimboziwe. Bangaphezu kuka-270,000 amakhodi ezokwelapha angawodwana afakwe ohlwini lolwazi olufakiwe. Amakhodi ekhodi yezokwelapha afaka:

Amakhodi wamanje we-Procedural Terminology (CPT), achaza izinsizakalo zezokwelapha, zokuhlinza, nezokuxilonga. Ukubhala ngekhodi kwe-CPT kukhomba amasevisi ahlinzekiwe.

Amakhodi e-ICD-10, ahlobene nokubuyekezwa kwe-10 kwe-International Statistical Classification of Diseases and Related Health Problems (ICD). Iqukethe amakhodi ezifo, izimpawu nezimpawu, okutholakele okungavamile, izikhalazo, izimo zomphakathi, kanye nezimbangela zangaphandle zokulimala noma izifo. Uhlelo lokusebenza lwe-CHAMPVA lusebenzisa idatha ye-ICD-10-CM evela kuCenters for Medicare and Medicaid Services (CMS).

Amakhodi e-Healthcare Common Procedure Coding System (HCPCS), ahlinzeka ngohlelo lokufaka amakhodi olujwayelekile lokuchaza izinto ezithile kanye nezinsizakalo ezihlinzekwa ekulethweni kokunakekelwa kwezempilo. Ukufaka amakhodi okunjalo kuyadingeka ku-CHAMPVA, Medicare, Medicaid, nezinye izinhlelo zomshuwalense wezempilo ukuze kuqinisekiswe ukuthi izicelo zomshwalense zicutshungulwa ngendlela ehlelekile nengaguquguquki.

Amakhodi e-Durable Medical Equipment (DME) abhekisela kumishini engamelana nokusetshenziswa ngokuphindaphindiwe, ngokuyinhloko esetshenziselwa ukufeza injongo yezokwelapha, ngokuvamile ayisebenziseki lapho kungekho ukugula noma ukulimala futhi ifaneleka ukusetshenziswa ekhaya. Amakhodi e-DME afakwe namakhodi e-HCPCS.

Amakhodi kazwelonke ezidakamizwa (NDC) angamadijithi ayi-10 ahlukile, amakhodi ezinombolo amasegimenti amathathu ahlonza izidakamizwa ezihloselwe ukusetshenziswa abantu. Ingxenye yokuqala iyidijithi ezi-4 kuye kwezi-5, i-Food and Drug Administration (i-FDA) inikeze ikhodi yelebula ukuze ikhombe inkampani ekhiqiza noma esabalalisa umuthi. Ingxenye yesibili ikhodi yomkhiqizo, ekhomba umuthi, okuhlanganisa amandla athile, ifomu lomthamo, kanye nokwakheka. Ingxenye yesithathu, ikhodi yephakheji, ikhomba osayizi bephakheji nezinhlobo.

Ngezinjongo zokukhokha kusetshenziswa ikhodi yefomethi engu-5-4-2 enamadijithi angu-11 ngokusekelwe kukhodi ye-NDC. Uhlelo lokusebenza lwe-CHAMPVA lusebenzisa ulwazi olushicilelwe yi-FDA futhi luguqule ikhodi ye-NDC ibe ikhodi yokukhokha.

Amakhodi ezokwelapha ayasesheka ngekhodi ye-alphanumeric, igama noma incazelo.

Uma ikhodi yezokwelapha efiselekayo isihlonziwe, isiguli noma umhlinzeki angase ayikhethe ukuze anqume ukuthi Ikhaviwe yini yi-CHAMPVA. Imiphumela AYIKUQINISEKILE ukugunyazwa nguMnyango Wezindaba Zomakadebona wase-United States (VA) nganoma yikuphi ukuthenga.

Umhlahlandlela wohlelo we-CHAMPVA ufakiwe ohlinzeka ngencazelo enemininingwane eminingi yezinzuzo ze-CHAMPVA. Umhlahlandlela we-CHAMPVA uqukethe izixhumanisi zamawebhusayithi asebenzayo kanye nezinombolo zocingo ongashayelwa ngocingo lwakho ngokuthinta inombolo. Lo mhlahlandlela usesheka ngethebula lokuqukethwe kanye nenkomba.

Uhlelo lokusebenza lwe-CHAMPVA luhlanganisa nendawo yokuthola indawo evumela ukusesha ngohlobo lwesikhungo ukuze kutholwe abahlinzeki eduze nawe ezikhungweni ze-VA ezingaphezu kuka-2400 ezweni lonke. Ukwengeza, abahlinzeki namakhemisi abamba iqhaza kuHlelo Lokunakekelwa Komphakathi lwe-VA angase aseshwe ukuze kuqinisekiswe ukuthi uthola ukunakekelwa okungcono kakhulu.