It is more convenient for reimbursement!The latest notice of Hubei Medical Insurance Bureau

just

Hubei Provincial Medical Security Bureau website

Published the "Provincial Medical Security Bureau Office

Regarding further improvement in different places

Notice of Direct Settlement Convenience ""

(The following referred to as "Notice")

Clarify the further improvement of medical treatment

Direct settlement convenience

Ensure that insured persons in our province enjoy more efficient

Medical settlement service for different places

The "Notice" has deployed and optimized relevant policies to deploy and optimize the relevant policies from five aspects from five aspects to broaden medical registration channels, regulates the management of medical treatment, clarify the medical settlement policies of different places, expand the medical institution coverage of medical institutions, and accelerate the transformation of the information system. Convenience.

The following is a detailed content in 5 aspects:

1. Greed up the registration channel for medical treatment in different places

(1) Basic medical insurance insured persons in different places include: remote resettlement retirees filing, long -term residents filing in different places, filing of resident staff in different places, filing in different places, and other temporary medical staff filing The hierarchy expands to provinces, cities, counties, towns (streets), and village (community) level.

(2) Insured personnel can apply for medical treatment for different places in the township (street) government service centers and village (community) convenience service centers in the county area of ​​the insured place. Encourage cities (prefectures) to implement the city in the city.

(3) Insured personnel can apply for medical treatment filing procedures for different places on online channels such as the national medical insurance service platform app, the national medical treatment filing applet, the client of the State Council client, the Hubei Provincial Government Service Network, and the Hubei Provincial Government Service Network. Encourage conditions for regions to provide insureds with self -service filing services for real -time, real -time effectiveness.

(4) Each city (state) shall implement retirees, long -term residents, and residents in different places in different places.

2. Regulate the management of medical treatment in different places

(1) Regulate the validity period of the medical treatment for medical treatment. After the retirees, long -term residents, and residents in different places in different places have long -term valid records after the registration is registered for medical registration. After the referral personnel and other temporary temporarily go -to -medical personnel should be registered for medical treatment, the filing period is 6 months. During the validity period, you can take the medical treatment place multiple times and enjoy the direct settlement service of the medical treatment.

(2) Allowing the re -medical treatment after the medical treatment is allowed to enjoy the direct settlement service of the medical treatment. If the insured person goes through the admission procedures within the validity period of the filing, the validity limit of the filing does not be discharged at the discharge, and the corresponding medical expenses may be settled normally. If the insured person applies for a remote medical treatment to the place of insurance before the discharge settlement, the place of insurance shall be supported; the designated medical institutions of the Internet of Medicine shall make up the medical expenses of the insured person who shall make a direct settlement of the medical expenses for the insured person who will make the filing procedures before discharge. If the insured person at a different place is settled at the time of the settlement of the filing of the filing in accordance with the regulations, the medical insurance manual (sporadic) can be reimbursed in accordance with the provisions of the participation place. The validity period of the filing of the insured personnel is deemed to be a valid filing time later than the admission time but earlier than the discharge time.

(3) The convenience of insured persons who meet the conditions for medical treatment. 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 be transferred to the medical treatment due to the need, they can refer it to the medical institutions outside the overall area through the designated medical institutions specified in 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.

Third, clarify the medical settlement policy for different places

(1) Reasonably determine the reimbursement policy for medical treatment at different places. Medical expenses of hospitalization, outpatient, outpatient, outpatient clinics directly settled in different places, in principle implement the scope of payment and relevant regulations stipulated in the regulations of the medical place, and implement the basic medical insurance funds stipulated in the insurance place. , The scope of slow disease diseases such as outpatient clinics. Receives of retirees, long -term residents, and residents in different places in other places are consistent with local medical treatment in principle. In principle, the payment ratio of the referral personnel decreases by no more than 10 percentage points compared with the local medical treatment. In principle, the other temporary medical staff paying ratio decreases by no more than 20 percentage points than the local medical treatment.

(2) Support insured personnel to enjoy medical insurance treatment in both directions and the place of insurance. After the insured person handles the medical treatment for a different place, if it is necessary to return to the insurance place for medical treatment within the validity period of the filing, there is no need to revoke the filing. You can enjoy the medical insurance settlement service at the place of insurance. The medical insurance treatment is consistent with the local medical treatment.

(3) Support outpatients and drug purchase costs directly for medical treatment. All overall planning areas should allow employees to medical insurance insurers to use personal accounts to settle directly for medical institutions in different places; all overall planning areas should allow insurers to use the overall settlement of the general outpatient clinic for medical institutions in a different place. Medical institution level and quantity.

(4) Support the outpatient slow disease costs directly settled in different places. Before the end of 2022, each city (state) realizes hypertension, diabetes, malignant tumor outpatient chemotherapy, uremia dialysis, organs after transplantation of anti -reinvicing therapy. The cost of slow special diseases in outpatient diseases is directly settled in different places in the province.

The designated pharmaceutical institutions of slow special diseases in each city (state) outpatient clinic implements the province's overall planning areas. All cities (states) should reasonably determine the level of slow special disease protection of outpatient clinics, determine the annual payment limit or quota standard in accordance with the disease, and further strengthen the use of high blood pressure and diabetes outpatient drug protection work in urban and rural residents. Special diseases and urban and rural residents' hypertension and diabetic outpatient drug guarantee payment limit or quota standard. Fourth, expand the coverage of medical institutions for medical treatment at different places

The cities (states) level 2 and above medical institutions and counties (cities, districts) people's hospitals, traditional Chinese medicine hospitals, and maternal and child health care hospitals are all included in the scope of designated medical institutions for medical treatment in different places; all the designated medical institutions of slow special diseases in each overall planning area are included in different places. Settlement scope. Encourage grass -roots medical institutions such as township health centers, community health service centers, and central villages to be included in different places.

5. Accelerate the transformation of the information system

(1) Complete the in -depth docking of Hubei Medical Security Information Platform and Hubei Provincial Government Service Integrated Platform, upgrade and transform the information system, support the formulation of the medical record commitment system for medical treatment, and support the convenience services of the township (street) administrative service center, the village (community) convenience service The center handles a different place for medical treatment to achieve the nearby office, self -service office, and one window office.

(2) Improve the functions of the medical system of different places, organize the operation training of information systems, and guide the medical institution for medical institutions to develop information system transformation at different places.

(3) Strengthen the construction of medical operation and maintenance for different places, improve the operation and maintenance mechanism, standardize the processing process, and improve the quality and efficiency of the problem in response.

(Source: Hubei Provincial Medical Security Bureau website)

【Edit: Yao Hao】

For more exciting content, please download the "Da Wuhan" client in the major application markets.

- END -