How to handle medical insurance referral procedures?

On-site processing, medical insurance online service hall processing, online processing.

I. Referrals and transfers:

(1) Applicant: insured residents who are permanently insured and need medical treatment outside the overall planning area.

(2) Application place: You need to go to a designated medical institution above the second level in the overall planning area for medical treatment or transfer to another hospital.

(3) Handler: Designated medical institutions handle the registration of referral and transfer and upload it (within 5 working days from the date when the designated medical institutions issue the certificate of referral and transfer);

(4) Examiner: The medical insurance agency conducts the examination on the medical insurance information platform, which is valid for 3 months from the date of referral.

(5) Term of transfer treatment: If the transfer treatment lasts for more than 3 months, the patient shall go to the medical insurance agency to apply for transfer again with the disease certificate of the medical institution (for long-term hospitalization, it is 1 hospitalization every 90 days, or 1 hospitalization for less than 90 days).

Second, the remote emergency:

Short-term hospitalization across the overall planning area (refers to the insured person living in different places, visiting relatives and traveling across the overall planning area, etc.). No more than 3 months), due to emergency hospitalization, emergency hospitalization certificate (emergency diagnosis certificate, emergency outpatient cases or emergency admission records) should be provided, and online filing procedures should be handled within 5 working days of hospitalization.

Three, long-term cross-regional medical treatment (hospitalization):

Cross-regional overall employment or living in different places (more than 3 months), and those who have been in different places for a long time shall be put on record. Conditions for filing permanent residents in different places and information materials to be provided,

1. Living in a different place for more than 3 months (condition)

2. Electronic medical insurance certificate or valid ID card or social security card of the filer;

3. Provide proof of residence (one of my or my relatives' foreign household registration certificate, residence permit, real estate license and rental contract, proof of my relationship with relatives, household registration book, marriage certificate, community residence certificate, etc.). ). When will the filing of long-term residents in different places be successful and effective?

Fourth, the treatment method:

1. On-site handling: at the referral office of the service center of the Medical Insurance Bureau;

2, through the (WeChat search, computer online search) provincial medical insurance online service hall;

3. Online processing:

Online processing: provincial medical insurance online service hall → medical insurance online service hall → click to enter → register → personal login → enter the personal online hall → I want to do it → put on record in different places → put on record for medical treatment in different places (see personal record notice-I have read it and agreed) → record object (I and others put on record) → basic information (complete information: name, certificate type and certificate number).

Verb (the abbreviation of verb) especially reminds:

1. If the settlement cannot be made immediately due to one of the following circumstances, the insured person can submit his social security card, medical record, expense list and settlement documents to the social insurance agency for sporadic reimbursement after paying the relevant medical expenses:

Medical expenses incurred by the insured in handling long-term medical procedures abroad in designated medical institutions during his stay abroad; Because of the limited medical technology and equipment in this city, it is impossible to diagnose and treat difficult and serious diseases, and the hospitalization medical expenses occurred after being diagnosed by hospitals at or above the municipal level and going through the treatment procedures in foreign tertiary hospitals or hospitals where national key specialties are located.

2. If the insured transferred to other places for medical treatment is referred according to the prescribed procedures and hospitalized in designated medical institutions outside the city, the payment ratio will be reduced by 5 percentage points on the basis of the original proportion; Not in accordance with the provisions of the direct referral in the city directly under and other counties in the city designated medical institutions for hospitalization, the proportion of payment on the basis of the original ratio decreased 15 percentage points; Failing to refer to the designated medical institutions outside the city for hospitalization, the proportion of payment will drop by 20 percentage points on the basis of the original proportion.

To sum up: "Patients who can't be treated in the hospital due to limited technical and equipment conditions should be discussed by the department or put forward by the department director. With the consent of the medical department, they should contact the transfer hospital in advance and get the consent before they can be transferred to the hospital. " "If the patient is transferred to another hospital, if it is estimated that his illness or death may be aggravated on the way, he should be hospitalized and transferred to another hospital after his condition is stable or dangerous. The heavier patients should be escorted by medical staff when they are transferred to hospital. When the patient is transferred to another hospital, the medical record summary should be transferred with the patient. When the patient leaves the hospital, he should write a treatment summary, submit it to the medical record room and return it to the hospital. Patients who transfer to nursing homes only bring medical records. "

Legal basis:

Detailed rules for the implementation of the regulations on the administration of medical institutions

Article 88

Special examination and special treatment refers to the diagnosis and treatment activities under any of the following circumstances:

Examination and treatment that are dangerous and may have adverse consequences;

(2) due to the patient's special physique or critical illness, it may have adverse consequences and dangerous inspection and treatment for patients.