Shanxi medical insurance remote medical treatment network

When seeking medical treatment in different places, medical expenses should be paid in advance, and relevant hospitalization materials and certificates should be brought back to the insured place for reimbursement after discharge. Such troubles are gradually becoming history.

At about 7: 50 pm on March 1 this year, Guangdong took the lead in realizing instant settlement of medical treatment in different provinces through the national inter-provincial medical treatment settlement platform. Ms. Chen, a 70-year-old patient of Hainan Medical Insurance, completed the real-time settlement of hospitalization expenses through the nationwide inter-provincial medical networking settlement platform in zhujiang hospital, Guangzhou Southern Medical University. Recently, two Guangzhou insured people went abroad for medical treatment, realizing direct settlement of employment across provinces and different places.

As early as 2065438+February 2007, Guangdong Province officially launched the national inter-provincial medical settlement platform, and Guangzhou, as a pilot city, was launched together with five hospitals. In the past two months, it has docked with Hainan, Hunan, Shanxi, Henan, Jiangsu and other provinces through the national platform, and settled a total of 12 insured persons (including 2 insured persons from Guangzhou who went abroad for medical treatment). With Sichuan, Anhui, Shandong, Zhejiang, Yunnan, Jilin, Xinjiang, Guangxi and other provinces, it has passed the online settlement test of the national inter-provincial medical treatment platform, and has settlement conditions. The next step will be to gradually connect all provinces in China.

So who can achieve direct settlement of medical treatment across provinces and different places? What are the procedures? How to calculate the standard of medical treatment in different places? The relevant person in charge of the Provincial People's Social Welfare Department gave a detailed introduction.

Relocation in different places, long-term residence in different places and permanent residence in different places have been covered.

According to the relevant person in charge of the Provincial People's Social Welfare Department, this year, the key work of our province is to promote the docking and online of medical insurance business systems in various cities through provincial platforms and national platforms. At the same time, there will be a certain number of hospitals on-line settlement in all co-ordination areas, and no less than two hospitals will be on-line in each co-ordination area before the end of the year. (Inter-provincial medical networking has been realized in all co-ordination areas, and more than 370 hospitals have achieved networking services, which is expected to reach 500 by the end of the year. The premise of online medical treatment in different places is to be online.

In accordance with the relevant regulations and arrangements of the state, the online co-ordination area will first solve the direct settlement of hospitalization expenses for retirees resettled in different provinces, and gradually expand to the direct settlement of hospitalization expenses for those who meet the referral conditions at the end of the year. (For foreign medical staff, if the settlement has not been opened in the insured place, it cannot be settled online).

The specific personnel are classified as follows:

(1) 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. (At present, services have been opened in online hospital)

(2) Long-term residents in different places: refers to those who live in different places and meet the requirements of the insured place. (online hospital, our province can provide settlement service, but the insured place needs to be opened. )

(3) 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. (online hospital, our province can provide settlement service, but the insured place needs to be opened. )

(4) Referral personnel from different places: refers to those who meet the referral conditions of the insured place. (Not yet open)

Before seeking medical treatment across provinces, you need to register with the agency in the insured area.

At present, insured persons who meet the requirements of medical treatment in different places in Guangzhou can hold social security cards that meet the national standards and immediately settle hospitalization medical expenses in other networked areas of the country after going through the filing procedures according to regulations. Insured persons in Guangzhou need to go through medical treatment procedures in different places outside the province first. They can choose 1-3 designated hospitals in other provinces that have been included in the national medical insurance network as their designated hospitals for medical treatment in different places.

Insured persons from other places who come to Guangzhou for medical treatment in different places should go through the medical treatment procedures in different places according to the regulations of the insured place. The specific filing process and required materials shall be subject to the place of insurance. At the same time, he/she must ensure that the place where the insured belongs has been connected with the national medical insurance network and can seek medical treatment in different places.

According to the relevant person in charge of the Provincial People's Social Welfare Department, the insured person should register with the agency of the insured place before seeking medical treatment across provinces. According to the local regulations, the handling agency of the insured place handles the filing procedures for medical treatment in different places for the insured person and establishes a database for medical treatment in different places. The insurance agencies will report the information of medical personnel in different places to Ministry of Human Resources and Social Security social insurance agencies (hereinafter referred to as ministerial agencies) to form a national database of medical personnel in different places for medical institutions and designated medical institutions to obtain the information of medical personnel in different places. If the registration has not been completed or the insured institution has not uploaded personnel information, online settlement cannot be conducted.

The person in charge reminded that the social security card (medical insurance card) needs to be registered when filing and registering. According to the relevant provisions of the state, the social security card is the only identification and direct settlement voucher for the insured to seek medical treatment in different places within the national medical insurance network. When the insured person goes to the national medical insurance network for medical treatment in different places, he needs to bring a card for immediate settlement. The social security card held by the insured must conform to the national norms, and the personnel information must be accurate. Resettlement of retirees in different places, long-term residents in different places, and permanent residents in different places shall choose designated medical institutions for medical treatment within the scope of designated medical institutions across provinces when going through the formalities for medical treatment in different places. 3. Referral personnel from different places shall, when handling the procedures for filing medical treatment in different places, determine the designated medical institutions for referral within the scope of designated medical institutions across provinces according to the provisions of the insured places.

Insured persons who have completed the registration of medical treatment in different places shall, when seeking medical treatment in selected medical institutions, hold social security cards for medical treatment, and implement the medical treatment procedures and service specifications of medical institutions in medical places.

When the insured person is discharged from the hospital, the insured place shall calculate the amount that the insured person and various medical insurance funds should pay in accordance with local policies and regulations, and settle the expenses that should be borne by the individual; The expenses paid by the medical insurance fund shall be settled by the agency in the place of medical treatment and the designated medical institution according to the agreement.

The person in charge also introduced that the scope of payment for medical treatment in different provinces and places and related regulations (basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards) should be implemented in principle. Qifubiaozhun, payment ratio and maximum payment limit of the basic medical insurance pooling fund shall be implemented in principle. (All Media Reporter/Tian Didi Correspondent/Yue)

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