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The Hebei Medical Security Bureau on the launch of the outpatient medical expenses at the provincial level to handle the handmade reimbursement online for trial operation work

Provincial insurance units at the provincial level:

In order to continue to deepen the reform of "Internet+government services", and vigorously promote medical expenses hand -reimbursement of "online office" and "hand -in -hand office" to further enhance the service capacity of medical insurance. From June 15, 2022 The hand -made reimbursement online for trial operation, the relevant matters are notified as follows.

1. Scope of application

In the case of normal participation in the provincial level, due to the normal insurance status, due to the fact that the exterior places are resettled, resident in different places, and long -term residence in different places, the outpatient cash medical expenses incurred by fixed -point medical institutions in different places in different places are mainly due to the direct settlement of medical insurance. Including: ordinary outpatient, outpatient chronic diseases, outpatient special diseases.

2. Online processing process

(1) Personal declaration. The applicant himself (I cannot declare "help others to declare" due to special circumstances, and the report on behalf of others) Log in to WeChat search for "Hebei Smart Medical Insurance" applet and complete the registration. Inner click "Sporast Reimbursement Report" into the sporadic reimbursement declaration page, select the "outpatient expenses reimbursement" module, fill in the application information and upload information provided by each step. Medical institutions charges bills, detailed expenses, and prescriptions for drug prescriptions. After the personal application is completed, the application information is submitted to the unit side for verification and confirmation.

(2) The unit verification and confirmation. The person in charge of the insured unit confirmed the unit information, identity information, medical information, and the shooting angle (vertical upper) and clarity of the application of the applicant's unit information, identity information, medical information, and uploading video materials. Medical Insurance Economic Affairs Audit Department.

(3) Expense review and allocation. The audit department of the Medical Insurance Office is accepted from the 1st-20th of the month to the preliminary examination of the integrity, photo shooting angle and clarity of the insured unit, and the reasons for the preliminary examination will not be passed and the reasons are not passed; , The Medical Insurance Economic Affairs Office is accepted and determined to be successfully declared; the medical expenses that have been successfully reported, and the staff scanned the bills, fee details projects through the OCR scanning, converted the name, specifications, quantity, amount, etc. into electronic data, and the medical insurance system was from the medical insurance system. After reviewing the medical insurance policy, and after the medical insurance office personnel are reviewed, the review and settlement information will be passed to the fund settlement department. The fund settlement department will allocate the reimbursement fee to the unit after re -reviewing the settlement information.

(4) Inquiry and reimbursement progress and results. After completing the declaration of the individual side, the applicant can "Submit the Information" function on the "Introduction to the Business" module or the "sporadic reimbursement declaration" module of the "Hebei Smart Medical Insurance" mini -program. Progress in place.

Third, relevant requirements

(1) Applicants.

First, the applicant provides medical expenses for the real and effective personal cash pads of the designated medical institutions in different places;

The second is to ensure that the light is sufficient when taking the photos. Put the information on the table case. The mobile phone is directly above the vertical of the data. After the focus is clear

Third, the medical expenses of direct settlement of medical insurance in designated medical institutions (the bills that have paid by the medical insurance overall fund or the personal account fund) cannot be declared again;

The fourth is that the applicant should not provide false reimbursement materials. Once found, the reimbursement qualification will be canceled.

Fifth, after the online declaration is successful, please notify the unit in time and transfer the paper information to the unit in time for archiving and preservation.

(2) Insured unit.

The first is that the insured unit must clarify the person responsible, fully understand the health status of the applicants and the information of the medical treatment, and do a good job of propaganda and guidance for the insured of the unit;

The second is that after the applicant completes the declaration of the individual, the insured unit shall complete the verification and confirmation of the application for information (identity information, medical information, and photo definition) within 3 working days. Complete, incorrect camera angle, and the reasons for the reason for unclear upload photos;

Third, after the reimbursement fee is allocated to the unit, the unit shall be issued as soon as possible;

Fourth, all information such as paper bills and expenses such as paper bills and expenses applied online.

(3) Medical Insurance Economic Office.

First, after receiving the application information information, the reviewing department's submitted information was preliminarily reviewed, and the reason for the findings was returned and indicated. Under normal circumstances (except for special circumstances), the expense review should be completed and transferred to the fund settlement department within 20 working days;

Second, after the fund settlement department receives the review and settlement information, in general (except for special circumstances), the review and allocation of reimbursement fees should be completed within 10 working days to the insured unit.

The third is that the reviewing department shall store the declaration of the application fee details and the drug prescription bottom, etc. Monthly archived electronic archives. The fund settlement department shall store the charging bills to the monthly archive of the electronic archives.

The implementation of online reimbursement is a new reform measure. Please actively cooperate with each insured unit to actively cooperate and vigorously promote them.During the trial operation, there may be incomplete upload information, unclear uploaded information, photos, and incorrect photo shooting angle, which causes OCR to be recognized. You need to re -shoot and upload it.Work, communicate in time when you encounter problems to ensure smooth and orderly trial operation.Contact: The audit department 85518173

The settlement department 85518083

Information Department 66906520

Hebei Provincial Medical Security Bureau

June 14, 2022

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