Cov Chaw Kho Mob Tau Txais Kev Tso Cai Los Ntawm Tsoom Fwv Teb Chaws (FQHCs) yuav tsum xa cov ntawv thov TotalCare uas ua raws li cov cai ntawm Medicare. TotalCare yog Alliance's Dual-Eligible Special Needs Plan (D-SNP) rau cov tswv cuab uas tsim nyog rau Medicare thiab Medi-Cal. Cov ntawv thov xa rau ntawm daim ntawv thov tsis raug lossis nrog Hom Ntawv Thov Tsis raug (TOB) yuav raug tsis lees paub lossis ncua sijhawm.
Cov Kev Cai Them Nqi - siv rau kev siv
| Kev xav tau | FQHC |
| Daim Ntawv Thov Yuav Tsum Tau | UB-04 (CMS-1450) los yog 8371 |
| Cov Ntawv Thov Kev Pab Cuam | CMS-1500 / 837P Tsis Pub |
| Hom Ntawv Them Nqi (TOB) Yuav Tsum Tau | 77X |
| Piv txwv TOB | 771 (Txais - Tawm) 772 (Ib Nrab - Thawj) 773 (Ib Nrab - Txuas Ntxiv) 774 (Ib Nrab - Kawg) 779 (Zaum Kawg) |
| Cov Cai Txog Cov Nyiaj Tau Los | 0521, 0522, 0524 (yog tias muaj) |
| Cov lej HCPCS | Cov lej cim ntsib FQHC ib Medicare |
Cov peev txheej thiab cov ntaub ntawv siv
- Phau Ntawv Qhia Txog Kev Ua Haujlwm Thov Nyiaj Medicare (MCPM), Luam Tawm. 100-04, Tshooj 9 - Cov Chaw Kho Mob Uas Tau Txais Kev Pom Zoo Los Ntawm Tsoom Fwv Teb Chaws (FQHCs)
- Tshooj 40 & 40.2:
Yuav tsum tau xa cov ntaub ntawv thov FQHC raws li UB-04 (CMS-1450) lossis 837I hom ntawv ntawm lub koom haum. - Tshooj 40.2.1:
Txhais hom Bill 77X uas yuav tsum tau rau FQHCs. - Tshooj 50 & 60:
Cov ntsiab lus ntawm kev ntsib teeb meem, cov lej nyiaj tau los, thiab cov kev cai xa daim ntawv thov.
Cov lus nug?
Yog xav paub ntxiv, thov hu rau Claims Customer Service ntawm 831-430-5503, hnub Monday txog Friday, 8:30 sawv ntxov txog 4:30 tsaus ntuj thiab xaiv qhov kev xaiv 3.
