Yanda Hospital Medical Insurance Process

Recently, Beijing Social Security Center issued a notice.

Start the medical record-keeping work of the insured persons of the basic medical insurance in this city across provinces and different places.

So what is "inter-provincial and off-site filing"?

To put it bluntly, you must first have a provincial certification of your social security rights.

Let the different places know that you are going to see a doctor.

Before you can settle directly in the local area.

Surprised, surprised, unhappy?

policy analysis

It is understood that in the past, reimbursement for medical treatment in different places had to "run at both ends" at the place of medical treatment and the place of insurance, which made many insured people feel a lot of inconvenience.

This month, all provinces in China, including Beijing, except Tibet, were fully or partially connected to the national basic medical insurance settlement system for medical treatment in different places, and1140 designated medical institutions in more than 60 regions opened direct settlement of medical expenses in different provinces.

In this regard, the Municipal Social Security Center requires that the insured who need to directly settle the hospitalization expenses in different places need to file a record first.

It is reported that hospitals in different places choose two designated medical institutions in the same area to settle accounts in different places, and keep Beijing 1 designated medical institutions.

At the same time, at present, the direct hospitalization settlement filing only supports the resettlement of retirees in different places, and other long-term residents and outpatient settlement still need manual reimbursement.

Treatment process

A picture is easy to understand the process.

End of processing

Matters needing attention

1, hospitals in different places choose two designated medical institutions for settlement in different places in the same area, and keep 1 Beijing designated medical institutions. 2. At present, the direct settlement of hospitalization only supports the resettlement of retirees in different places, and other personnel and outpatient settlement can only choose manual reimbursement at present. 3. When filling out the form, if the selected designated medical institutions in different places are within the published "National Designated Medical Institutions in Different Places", there is no need to stamp the hospitals and medical insurance agencies in different places; If it is not on the list, it still needs to be stamped and confirmed by designated medical institutions and medical insurance agencies in different places. Hospitals within the scope of direct settlement hospitals can also choose manual reimbursement. 4. Processing time: the whole month. 5. Effective time of medical records in different provinces: it will take effect the day after the medical records are approved. 6. If it is found that the personnel have not collected the bank account number, they must also submit the Beijing Personal Information Change Registration Form for account collection. 7. Real-time settlement and filing of Yanda Hospital in Hebei Province: If the insured chooses Yanda Hospital in Hebei Province, he/she needs to fill in the Registration Form of Real-time Settlement and Filing of Medical Expenses in Yanda Hospital in Hebei Province, without the seal of Yanda Hospital in Hebei Province and the local medical insurance agency. After the employer goes through the formalities for filing medical treatment in different places for the insured, the insured can go to the "Yanda Hospital" with a social security card for direct medical treatment and settlement. 8. Change and cancellation of medical records in different provinces: If the insured changes or cancels the medical records in different places, the employer shall fill in the Registration Form for Direct Settlement, the Registration Form for Manual Reimbursement and the Registration Form for Medical Records in Different Provinces of Yanda Hospital in duplicate according to the actual situation, and report the change and cancellation of medical records in different places to the social security agency. 9. If only the expiration date is changed within the validity period, you only need to provide the Registration Form for Change of Personal Information of Beijing Social Insurance in duplicate. Those who have expired and those who apply for direct settlement of hospitalization expenses in different places need to re-apply according to the above-mentioned inter-provincial medical treatment filing process.

Fill in a few more knowledge points:

Direct settlement of hospitalization expenses in different provinces refers to the direct settlement of hospitalization expenses through the medical insurance information system network when the basic medical insurance of other provinces (municipalities directly under the Central Government and autonomous regions) selected by me for filing is discharged from hospital after independent selection of direct settlement for filing.

Who can enjoy the resettlement of retirees in different places: refers to those who have settled in different places after retirement and whose household registration has moved to their place of residence. Long-term residence in different places: refers to people who live in different places and meet the requirements of the insured place. Resident in different places: refers to the personnel who are sent by the employer to work in different places and meet the conditions of the insured place. Referral personnel from different places: refers to those who meet the referral conditions of the insured place.

The direct settlement standard implements the payment scope and relevant provisions stipulated by the clinic (the basic medical insurance drug list, the scope of medical service facilities and the scope of diagnosis and treatment projects); The minimum payment standard, payment proportion, maximum payment limit and settlement period of the medical insurance fund shall implement the Beijing medical insurance policy; The expenses directly settled in medical insurance coverage shall be accumulated on an average daily basis.

Reimbursement standard The hospitalization medical expenses, diagnosis and treatment procedures and service specifications directly settled by medical personnel in different places shall, in principle, implement the payment scope and relevant provisions (basic medical insurance drug list, medical service facilities and diagnosis and treatment items) stipulated by the medical treatment place. The medical insurance fund implements policies such as Qifubiaozhun, payment ratio and maximum payment limit.

Anyway, Bian Xiao would like to remind everyone here that even if you go to a different place to see a doctor, you need to bring a social security card. Oh, don't be careless and come for nothing.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.