Regarding the direct settlement of cross -provincial medical treatment, the latest notice comes!

Recently, the State Medical Insurance Bureau and the Ministry of Finance jointly issued the "Notice on Further Doing a Basic Medical Insurance Cross -Provincial Different Place Different Settlement Work". How to check in a different place? How to settle? Look at it together-

Record

Scope of record personnel

Participants who have lived in a long -term residence or inter -provincial medical treatment for a long time can enjoy the direct settlement service of cross -provincial medical treatment after medical treatment for medical treatment.

Long -term residents of cross -provinces include remote resettlement retirees, long -term residents in different places, and resident residents who have stayed in the province, autonomous regions, and municipalities (hereinafter referred to as provinces) for a long time.

Cross -provincial temporary medical personnel include referral personnel in different places, and due to work, tourism and other reasons for different places emergency rescue personnel and other inter -provincial temporary medical treatment personnel.

Filing process

Before the insured person across provinces, you can go through online and offline channels such as the national medical insurance service platform APP, the national medical treatment filing applet, the client applet of the State Council, or the window of the insured place.

Code recognition into the client applet of the State Council

When applying for a medical treatment for a different place, the insured person can directly record the medical area or municipality, and enjoy the inter -provincial -integrated medical institution for all inter -provincial networking medical institutions that are opened to the provincial direct settlement service. Select medical management regulations for medical institutions across the provincial network to buy medicines for medical institutions.

Emergency rescuers in different places have been filed.

Pilot period

After the long -term residents of inter -provincial and different places are registered for registration, the record is effective for a long time;

In principle, the validity period of the inter -provincial temporary medical staff is not less than 6 months. During the validity period, you can take the doctor several times and enjoy the direct settlement service of cross -provincial medical treatment.

Make up for the record

Participating agencies in the insurance place should earnestly do a good job of publicizing and interpretation of cross -provincial medical settlement policies, simplify the processing process, shorten the time limit for handling, and support eligible insured personnel to re -apply for medical treatment procedures.

If the insured person is filled in a different area before discharging and settlement of the province, a fixed -point medical institution on the Internet should handle the medical expenses for the insured directly to settle the medical expenses across provinces.

If the inter -provincial and off -provincial medical participants are discharged from the hospital at their own expenses, the filing procedures shall be made in accordance with the regulations, and the medical insurance shall be applied for reimbursement of medical insurance in accordance with the regulations.

Seek medical treatment

Medical treatment

When the insured persons are medical treatment across provinces, the inter -provincial network -intensive medical institutions should actively show the identity of the insured and present the effective voucher such as medical insurance electronic vouchers or social security cards.

Code recognition to enter

The designated pharmaceutical institutions of the inter -provincial network should do a good job of insured authentication of insured personnel, and guide the record procedures for noticizing the filing personnel in time to provide reasonable and standardized diagnosis and treatment services in accordance with the regulations of the medical place (emergency) diagnosis and hospitalization patients, and provide reasonable and standardized diagnosis and treatment services and treatment services Convenient and fast cross -provincial medical treatment direct settlement service.

Inter -provincial referral

Participants shall seek medical treatment in an orderly manner in accordance with the relevant provisions of the hierarchical diagnosis and treatment. If they need to seek medical treatment across provinces due to the disease, they can refer to medical institutions outside the province through designated medical institutions prescribed by the insured place.

Fixed -point medical institutions should formulate a reasonable diagnosis and treatment plan for the patient's condition. You can arrange referrals through different forms during referrals, and shall not be hospitalized as a prerequisite for referrals.

If the insured person really needs to continue treatment or transfer to medical treatment again because of the same disease, the agency of the insured place shall simplify the medical treatment procedures for the medical treatment, so that the insured persons can enjoy the direct settlement service of cross -provincial medical treatment.

Reimbursement settlement

Unified payment policy

Cross -provincial medical expenses directly settled in hospitals, general outpatient and outpatient medical expenses, in principle implement the scope of payment specified in the medical place and relevant regulations (basic medical insurance drugs, medical service items, medical consumables and other payment scope), implement participation participation) The relevant policies such as starting standards, payment ratios, maximum payment limit, and outpatient slow disease scope of basic medical insurance funds stipulated in the preservation ground are.

Long -term residents of cross -provincial and different places

Support long -term residents of inter -provincial and different places can enjoy medical insurance benefits in two -way registered and insurance place. When long -term residents of cross -provincial and different places are settled in the registered place for medical treatment, the basic medical insurance funds' starting standards, payment ratios, and maximum payment limit are implemented in principle. For medical treatment, you can enjoy medical insurance settlement services in the place of insurance. In principle, it is not lower than the treatment level of cross -provincial referrals and referrals.

Among them, the insured person who handles the filing procedures for long -term residents in the provincial and different places in a personal commitment, shall perform the commitment matters, and can enjoy medical insurance treatment in both directions and the two -way insured place after supplementary filing materials. If the long -term residents of inter -provincial and different places meet the regulations of the transfer of medical treatment abroad, they will implement the policy of cross -provincial referral transfer treatment policy.

Cross -provincial temporary goal to medical treatment

Cross -provincial temporary medical staff can be lower than the level of medical institutions at the same level of the insurance place. In principle, the percentage of the payment ratio of the referral personnel and the emergency rescue personnel in different places does not exceed 10 percentage points. The drop in the payment ratio of temporarily going out to medical personnel does not exceed 20 percentage points.

Settlement process

During the direct settlement of cross -provinces and different places, the detailed information details information of the hospital for medical treatment should be converted into a national unified large -scale category expense information. The expense details are divided into expenses. After the national and provincial -level medical treatment and settlement systems are transmitted in real time to the place of insurance, the place of participation is calculated in accordance with local policies and the amount paid by the insured persons and the amount paid by various medical insurance funds. Back to the designated pharmaceutical institutions for medical treatment, it is used to settle directly with the designated pharmaceutical institutions and insured persons. If the insured cannot be settled directly due to some reason, the inter -provincial network -intensive pharmaceutical institution shall collect relevant information on the insured person in accordance with the medical insurance electronic voucher or the social security card, and upload the information of medical expenses in detail, diagnosis, etc. Guarantee the information platform and support the nationwide cross -provincial medical manual reimbursement online pilot.

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The notice requires that the medical insurance departments in various places should adjust relevant policies and measures in a timely manner to ensure that they will be connected with national policies by the end of December 2022. Relevant policies will be officially implemented from January 1, 2023.

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