The cost of medical treatment for nearly one million yuan is reimbursed by hand, and it will be done in one day!How did you do it?

In 2021, the Beijing Haidian Medical Insurance Bureau received an unusual huge manual fee reimbursement task: Uncle Shu, an insurer of Beijing Medical Insurance, who lived in Hainan, had a sudden illness when he lived in Hainan. The local medical insurance designated hospital emergency hospitalization was rescued, and it cost more than 980,000 yuan before and after. In March 2021, the elderly were discharged from Hainan hospitals and will be transferred back to Beijing hospital for further treatment. Due to the emergency and other reasons, the elderly did not open a direct settlement for medical treatment when they were hospitalized in Hainan. All the medical expenses of 980,000 yuan were paid at their own house, which caused a serious economic burden. It has been unable to pay the next medical expenses and urgently need to be reimbursed by manual reimbursement. The medical documents of 980,000 yuan are stacked, including invoices, expenses, medical records, etc., trivial and complicated. Under normal circumstances, the reimbursement time of such a large number of different places is 15 working days. manage? The Beijing Haidian Medical Insurance Bureau used a new means to solve this problem. It took only one day to get the review, entry and settlement of large -scale medical expenses. how did you do that?

Liberation human electronic review

The rapid settlement of Uncle Shu's medical expenses in different places has benefited from the electronic audit work carried out by the Beijing Haidian District Medical Insurance Bureau in recent years. Xiao Ping, the head of the Hand -reimbursement department of the Haidian District Medical Insurance Bureau, introduced that the electronic audit work brought great changes to the medical insurance reimbursement of the participating people:

According to the traditional review process, the manual reimbursement of a document must be reported by the front desk, the preliminary review, review, entry, settlement, and payment of the collection of information statistics; It is necessary to query the drug and diagnosis and treatment directory library, compare the comparison of compliance items, write and refuse content, etc., and it takes 10 minutes to half an hour to review a document. The workload of 980,000 yuan documents can be imagined.

At the same time, manual reimbursement also has high requirements for staff. From the information verification of the audit form, to whether the expense content meets the medical insurance reimbursement policy, it needs to be judged manually. The auditors need to remember the standards of common drugs and diagnosis and reimbursement. It is necessary to adjust and learn in real time, the changes brought about by the new policies, the adjustment of the drug library, the content of the diagnosis and treatment library, etc. At the same time, there are some shortcomings of manual reimbursement: missing documents, because the policy is not in place, but not seeing the money that should be reimbursed or refused to pay, the handwriting is not clear, and the writing is inaccurate. It is directly related to the treatment of the insured. Once the bill is archived, the error is found again, it is very inconvenient to go to the warehouse to find it.

There are many enterprises in Haidian District, and there are many medical insurance insurers. The reimbursement volume involved in various aspects is also among the top in Beijing. In order to improve the quality of the audit, accelerate the audit speed, and resolve the disadvantages, the Haidian District Medical Insurance Bureau has established a "intelligent audit system" from 2020 and carried out electronic audit: through image recognition technology, the picture of the reimbursement document is converted into electronic data, and the system is reimbursed by reimbursement. The information on the bill is compared with the preliminary examination, and the name of the name and the number of unit prices are made according to the type of medical documents. The auditors will compare the unsuccessful items and then compare it. After the review is completed, the data result system enrollment, settlement, printing and other follow -up processes are performed to realize the electronicization of archives, intelligent documents review, and entering data automation, thereby shortening the reimbursement cycle and simplifying the process of service.

The most critical part of this system is a continuous expansion database. The "looks" of all the documents of the scriptures are firmly in mind, becoming the "template" for subsequent electronic audits; with the accumulation of the number of templates, after debugging and debugging and after debugging and debugging and debugging and Learning and data are constantly improved, which can reach a high accurate recognition rate, and the comparison speed is getting faster and faster.

In addition to the acceleration of the comparison, the electronic audit can also view the image data of the original bill in real time. The system also prompts the project medical insurance reimbursement restrictions and other contents to solve the difficulty of the reviewer's dead medical insurance policy, which greatly facilitates the work of the audit personnel.

At present, the number of alien databases of the intelligent audit system of the Haidian District Medical Insurance Bureau has reached more than 60,000, and the accuracy rate of electronic audit has reached more than 98%. If the name of the reimbursement project is consistent with Beijing, the correct rate can reach 100%.

"The handmade reimbursement documents of all different places in Haidian District Medical Insurance Bureau have begun to adopt electronic audit. The non-reimbursement peak period can be completed within 2-3 days. The accuracy of reimbursement for medical expenses is greatly improved, and the reimbursement time has been greatly shortened. "Xiao Ping said.

Smart medical insurance services are beautiful

Electronic audit, online payment, mobile phone medical treatment for different places ... Many of the "high -tech" that have long been expected to the insured have now become a reality. Let the data run more, the masses running less, and the beauty brought by "smart medical insurance" brought by the "smart medical insurance" brought by the beauty of "smart medical insurance". The service experience is "accelerating flying into the people's house".

Although there is no standard definition of "smart medical insurance" at present, the purpose of "smart medical insurance" is to serve the insured, service medical insurance office, medical insurance management and policy formulation through digital information means, of course, medical insurance, of course, medical insurance, of course, medical insurance The departure starting point of the department is also to gain a sense of gain, so "Smart Medical Insurance" is ultimately to bring a better medical insurance enjoyment experience to the insured.

——It do not need a card to see a doctor, just show the medical insurance code. The birth of the medical insurance electronic certificate allows the insured to get rid of the restraint of the physical card. As long as you bring your mobile phone, you can go to the doctor normally and reimburse. There is no difficulty for medical treatment. On the National Medical Insurance Service Platform APP, you can not only check the insured payment information, but also smoothly handle the medical treatment for medical treatment.

——The medical insurance service is a Netcom, it is easy to do at a time. The electronic office system makes the data storage, China Unicom, and interaction more convenient. "Medical insurance business, no longer need to run a leg;

——In protect the people's life -saving money, intelligent monitoring is great. The supervision of the medical insurance fund has been engaged in the "old method" of post -review and assault inspection, and has gradually developed into the "new measures" of intelligent monitoring and supervision during things. Through big data Medical insurance supervision is more timely and more accurate, tighten the "money bag" of the masses to see a doctor;

——The data support is guaranteed, and medical insurance decisions are more scientific. With the completion of the national medical insurance information platform, the benefits of data information sharing are more apparent. Through the interconnection and data mutual recognition of the national medical insurance information, the analysis of big data analysis of medical insurance is also possible. Policies such as bidding and procurement of pharmaceutical consumables and procurement of medical insurance funds have provided decision -making support, which provides a strong guarantee for refined management of medical insurance.

Native

Smart medical insurance accompanied by all aspects of our medical insurance enjoyment, with outstanding grades and broad prospects. Today, informatization has become a modern strategic engine, striving to build smart medical insurance should become, and it has also become an inevitable choice and the age of the medical insurance person.

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