CHPW waxay jeclaan lahayd inay xasuusiso bixiyeyaasha taas Medicare waa bixiyaha koowaad ee ka-faa'iideystayaasha labada xaq u leh ee hela adeegyada Barnaamijyada Daaweynta Opioid (OTP).
- "Laba-faa'iideyste-u-qalma" macnaheedu waa dadka ka diiwaangashan Medicare iyo Medicaid labadaba.
- Medicare waxa ay ku bixisaa OTP iyada oo loo marayo lacag-bixinno la isku daray oo loogu talagalay adeegyada daaweynta xanuunka isticmaalka opioid (OUD).
- Adeegyada OUD waxa ka mid ah baadhista toxicology-ga, daawaynta lagu caawiyo dawooyinka (MAT), iyo la-talin.
Medicare
Bixiyeyaasha waa in loo diwaan galiyo bixiye OTP ahaan sida hoos timaada Medicare. Medicare waxa ay u ogolaataa bixiyayaasha in ay dib isugu qoraan 30 maalmood ka hor taariikhda go'aanka in bixiyaha uu u qalmo. Bixiyaha ayaa markaa dallaci kara taariikhda adeegga (DOS) ee dhaqan galaysa ilaa 30ka maalmood.
Koodhadhka HCPCS G waxa loo isticmaalaa dib u bixinta ay bixiso Medicare.
Fadlan tixraac Xarumaha Medicare & Adeegyada Medicaid (CMS) Kharashka Kharashka Isticmaalka Opioid websaydhka si aad u hesho macluumaad dheeraad ah.
Medicaid
Maamulka Daryeelka Caafimaadka Gobolka Washington (HCA) ayaa aqoonsaday in koodka H0020 uu yahay ma lagu dalacayo Medicaid haddii bixiyaha uu ka diiwaangashan yahay bixiye OTP oo leh Medicare; Bixiyeyaashaas waa inay biilasha ku soo dallacaan Medicare sida bixiyaha koowaad. Haddii bixiyaha uu ka diiwaangashan yahay bixiye OTP ahaan, sheegashooyinka loo gudbiyay CHPW waa loo diidi doonaa Medicare Sharaxaada Faa'iidooyinka (EOB). Fadlan eeg HCA Tilmaamaha Biilasha Qalalaasaha Isticmaalka Walaxda, "Barnaamijyada Daaweynta Opioid (Daawaynta Bedelka Opiate)" qaybta.
Waajibaadka Bixiyaha
Bixiyeyaasha ku jira Medicare waa in ay ogeysiiyaan HCA marka la oggolaado diiwaangelinta Medicare.
Haddii bixiyeyaasha ay awood u leeyihiin in ay sidaas sameeyaan, waxaa laga yaabaa in ay dhamaystiraan is xisaabin, dib u eegaan sheegashooyinkooda, oo ay soo gudbiyaan wax ka beddelka ama faaruqinta ka dib marka Medicare bixiso lacag. Bixiyeyaasha iskood u xisaabiya oo soo dira jeeg hagaajin ahaan waa inay ku jiraan dukumeenti taageeraya oo muujinaya sheegashada(yaasha) jeegagu khuseeyo.
Bixiyeyaasha ayaa u soo gudbin doona sheegashooyinka CHPW (ama Ururka Daryeelka la Maareeyay) oo ay la socdaan Medicare EOB marka loo eego nidaamka Isku-dubbaridka Faa'iidooyinka (COB). Tan waxaa ku jira sheegashooyinka ku jira 30-ka maalmood ee dib-u-diiwaangelinta wakhtiga.
Su'aalo?
Haddii aad hayso su'aalo ku saabsan bixinta adeegyada OTP/OUD, fadlan kala xidhiidh Waaxda Adeegga Macmiilka:
- CHPW Washington Apple Health Integrated Care Managed Care (IMC) Adeegga Macmiilka: 1 (800) 440-1561 (Toll Free) Isniinta ilaa Jimcaha, 8 subaxnimo ilaa 5 galabnimo
- CHPW Medicare Advantage Service Service: 1 (800) 942-0247 (Toll Free) 7 maalmood/toddobaadkii, 8 subaxnimo ilaa 8 galabnimo
Dad badan oo Mareykan ah ma helaan hurdo ku filan tanina waxay gacan ka geysan kartaa arrimo caafimaad oo dhowr ah. Nasasho yar inta lagu jiro maalintii waxay ka caawin kartaa jirkaaga inuu dib isu soo celiyo wuxuuna kobciyaa caafimaadka maskaxda iyo wadnaha. Hurdo yar oo 20 daqiiqo ah waxay leedahay faa'iidooyin caafimaad oo kaladuwan - laga bilaabo niyadda oo hagaagtay, iyo feejignaan wanaagsan iyo shaqada xusuusta. Dhaqamada qaar, hurdada ayaa xitaa loo qoondeeyaa daaweyn caafimaad oo ay dhakhaatiirtu u sameeyaan!
