Cov Cai Kho Mob Yuav Tsum Tau

Beacon's Medical Necessity Criteria (MNC), tseem hu ua cov txheej txheem kho mob, raug tshuaj xyuas thiab hloov kho yam tsawg kawg ib xyoos ib zaug kom ntseeg tau tias lawv cuam tshuam txog qhov kev txhim kho tshiab tshaj plaws hauv kev pabcuam rau cov tib neeg nrog kev kuaj mob tus cwj pwm. Beacon's Corporate Medical Management Committee (CMMC) txais yuav, tshuaj xyuas, kho dua thiab pom zoo Cov Kev Cai Kho Mob rau ib tus neeg siv khoom thiab cov cai tswj hwm.

Cov Kev Xav Tau Kev Kho Mob txawv raws li lub xeev thiab/lossis cov ntawv cog lus thiab cov kev pab cuam rau cov tswv cuab. Txhawm rau txiav txim siab qhov tsim nyog Kev Kho Mob, siv cov hauv qab no ua ib qho kev qhia:

  1. Rau txhua tus tswvcuab Medicare, ua ntej txheeb xyuas Lub Chaw rau Medicare thiab Medicaid (CMS) National Coverage Determinations (NCD) lossis Local Coverage Determinations (LCD) Criteria.
  2. Yog tias tsis muaj CMS cov txheej txheem rau Medicare cov tswv cuab thiab rau tag nrho cov tswv cuab tsis yog Medicare, txheeb xyuas cov txheej txheem kho mob uas tsim nyog.
  3. Yog tias tsis muaj cov txheej txheem kev cai muaj nyob rau qib kev saib xyuas thiab kev kho mob yog kev siv yeeb tshuaj, American Society of Addiction Medicine (ASAM) cov txheej txheem yuav tsim nyog.
    * Kev zam: Kev Siv Tshuaj Siv Tshuaj Ntsuam Xyuas Kev Ntsuas yog nyob rau hauv InterQual® Cwj Pwm Kev Noj Qab Haus Huv.
  4. Yog hais tias theem ntawm kev saib xyuas tsis muaj feem cuam tshuam txog kev siv tshuaj, Hloov Kho Kev Kho Mob Interqual® Kev coj cwj pwm zoo yuav tsim nyog.
  5. Yog tias 1-4 saum toj no tsis tau ntsib, Beacon's National Medical Necessity Criteria yuav tsim nyog.

Cov txheej txheem keeb kwm yog muab rau cov ntaub ntawv xov xwm nkaus xwb thiab tsis raug rau tib cov txheej txheem tshuaj xyuas / sijhawm. Cov Txheej Txheem Kev Kho Mob muaj nyob hauv online ntawm hyperlinks thaum twg los tau thiab muaj nyob rau thaum thov.

Cov hauv qab no yog Beacon's Medical Necessity Criteria:

  1. Chaw rau Medicare thiab Medicaid (CMS) Cov Cai
    • Medicare Coverage Database (MCD) kom muaj tag nrho Cov Kev Pabcuam Hauv Lub Tebchaws (NCDs) thiab Kev Txiav Txim Hauv Nroog (LCDs).
    • Rau txhua tus tswvcuab Medicare, ua ntej txheeb xyuas qhov cuam tshuam txog NCD lossis LCD Cov Qauv.
  2. Hloov Kho Kho Mob InterQual ® Cwj Pwm Kev Noj Qab Haus Huv
    • Beacon siv Change Healthcare's InterQual® Behavioral Health Medical Necessity Criteria for mental health level of care and drug use lab testing, tshwj tsis yog tau sau tseg tias Custom Criteria yuav tsum tau siv.
  3. American Society of Addiction Medicine (ASAM) Cov Cai
    • American Society of Addiction Medicine (ASAM) Cov Txheej Txheem tsom mus rau kev siv tshuaj kho mob.
    • Yog xav paub ntxiv txog ASAM Cov Cai, mus saib hauv Taw qhia rau ASAM Cov Cai rau Cov Neeg Mob thiab Tsev Neeg Copyright 2015 los ntawm American Society of Addiction Medicine. Reprinted nrog kev tso cai. Tsis muaj lwm tus neeg tuaj yeem luam daim ntawv no tag nrho lossis ib feem hauv ib hom ntawv lossis nruab nrab yam tsis muaj kev tso cai ua ntej ntawm ASAM.
    • Tshwj tsis yog tias muaj cov txheej txheem kev cai (piv txwv li, LOCADTR hauv New York) lossis rau Kev Tshawb Fawb Siv Tshuaj (uas muaj nyob hauv InterQual® Cwj Pwm Kev Noj Qab Haus Huv), ASAM cov txheej txheem yog cov txheej txheem rau kev pabcuam tshuaj siv tshuaj.
  4. Kev Cai Lij Choj
  5. Beacon's National Medical Necessity Criteria