Conditions of medical insurance in TCM clinics

The conditions for Chinese medicine clinics to handle medical insurance are as follows:

1, officially operating for at least 3 months;

2. There are at least 1 person who have obtained the doctor's practice certificate, rural doctor's practice certificate or Chinese medicine doctor's qualification certificate and registered in the medical institution for the first time;

3, the main person in charge is responsible for medical insurance work, equipped with full-time medical insurance management personnel; /kloc-medical institutions with more than 0/00 beds should set up internal medical insurance management departments and arrange full-time staff;

4. It has a medical insurance management system, a financial system, a statistical information management system and a medical quality and safety core system that meet the management requirements of the medical insurance agreement;

5. Have hospital information system technology and interface standards that meet the requirements of medical insurance agreement management, realize effective docking with medical insurance information system, and transmit all relevant information of medical staff to medical insurance information system as required, so as to provide direct online settlement for insured personnel. The establishment of medical insurance drugs, diagnosis and treatment projects, medical service facilities, medical consumables, diseases and other basic databases, according to the provisions of the use of a unified national medical insurance code;

6, in line with laws and regulations and other conditions stipulated by the provincial and above medical security administrative departments.

The medical insurance reimbursement process is as follows:

1. When registering in hospital: you need to show your medical insurance card and ID card. The hospital will check the personal data and payment of the insured person in the medical insurance information system and handle the admission procedures for them;

2. During hospitalization: Please remind doctors that the use of self-funded drugs, diagnosis and treatment items and medical service facilities must be signed and agreed by patients or their families;

3. Discharge: If the hospitalization meets the discharge standard, the attending doctor will issue a discharge notice, and the insured will go to the discharge office with the discharge notice and medical insurance card for settlement. It usually takes no more than 7 days to get medicine from the hospital. At the time of discharge settlement, the insured person or his family members shall sign the "Guangzhou Medical Insurance Expense Statement" for confirmation.

Required information:

1, the original medical insurance card and its front and back copies;

2. The original invoice for hospitalization is stamped with the seal of the charging business of the medical institution;

3. Detailed summary list of hospitalization;

4, medical institutions stamped diagnosis proof materials;

5, the first page of hospital medical records or admission records;

6. A copy of the discharge summary is stamped with the special seal for medical records management of medical institutions.

To sum up, according to the relevant regulations of medical institutions, the establishment of medical institutions by units or individuals must be examined and approved by the health administrative department of the local people's government at or above the county level, and the Approval for the Establishment of Medical Institutions must be obtained.

Legal basis:

Article 2 of People's Republic of China (PRC) Social Insurance Law

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.