How to designate a hospital with a medical insurance card

Legal analysis: In general, each insured person can choose four designated hospitals for medical insurance, including 1 compulsory community hospitals, hospitals close to home, and comprehensive 3A hospitals. If the designated medical hospital needs to change the designated medical institutions for medical insurance due to moving or job changes, it needs to be changed through the social security center one year later, and the change will take effect the next month.

Legal basis: Interim Measures for the Fixed-point Management of Medical Security in Medical Institutions

Article 4 The administrative department of medical security in the overall planning area shall determine the allocation of designated medical service resources in the overall planning area according to the public health demand, management service demand, medical insurance fund revenue and expenditure, regional health planning and medical institution setting planning.

Article 5 The following medical institutions that have obtained the Practice License of Medical Institutions or the Registration Certificate of Chinese Medicine Clinics, as well as military medical institutions that serve the people with the approval of the competent military departments, may apply for designated medical insurance:

(1) General hospitals, traditional Chinese medicine hospitals, integrated traditional Chinese and western medicine hospitals, ethnic medicine hospitals, specialized hospitals and rehabilitation hospitals;

(2) Specialized disease prevention hospitals (stations) and maternal and child health centers;

(3) Community health service centers (stations), central hospitals, township hospitals, street hospitals, out-patient departments, clinics, hospitals (stations) and village clinics (institutes);

(4) Independent emergency center;

(5) Hospice care centers, hemodialysis centers and sanatoriums;

(six) medical institutions set up in the old-age care institutions.

Internet hospitals can rely on their physical medical institutions to apply for signing supplementary agreements, and the related expenses incurred by the medical services provided by them that meet the scope of medical insurance payment shall be settled by the regional agencies and the physical medical institutions they rely on according to regulations.

Article 6 A medical institution applying for designated medical insurance shall meet the following basic conditions:

(a) formal operation for at least 3 months;

(2) There are at least 1 doctor who has obtained the doctor's practice certificate, rural doctor's practice certificate or Chinese medicine (specialist) qualification certificate and is registered in a medical institution for the first time;

(three) the main person in charge is responsible for the medical insurance work, equipped with full-time (part-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) Having 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) Having hospital information system technology and interface standards that meet the requirements of medical insurance agreement management, realizing effective docking with the medical insurance information system, transmitting relevant information of all patients to the medical insurance information system as required, and providing direct online settlement for the insured. 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;

(six) meet other conditions stipulated by laws and regulations and provincial and above medical security administrative departments.

Seventh medical institutions to apply for medical insurance designated agencies in the overall planning area, at least provide the following materials:

(a) the designated medical institutions application form;

(2) A copy of the practice license of a medical institution or the registration certificate of a Chinese medicine clinic or the service license of a military medical institution for the people;

(3) Internal management system and financial system that are compatible with the medical insurance policy;

(4) Information system related materials of medical institutions related to medical insurance;

(5) A forecast analysis report on the use of the medical insurance fund after it is included in the designated place;

(six) other materials provided by the provincial medical security administrative department in accordance with the relevant provisions.

Eighth medical institutions put forward designated applications, regional agencies shall immediately accept. If the application materials are incomplete, the agency shall inform the medical institution of one-time correction within 5 working days from the date of receiving the materials.