Chinanews.com, October 9th. According to the Ministry of Finance website news, the National Medical Insurance Bureau and the Ministry of Finance recently jointly issued the "Notice on Promoting the Pilot Work of Cross-provincial Direct Settlement of Outpatient Expenses" (hereinafter referred to as the "Notice"). On the basis of 12 pilot provinces (autonomous regions, municipalities) in 5 provinces (Chongqing, Sichuan, Guizhou, Yunnan, Tibet) in the Yangtze River Delta, the Yangtze River Delta, and 5 provinces in Southwest China, steadily expand the pilot areas, the coverage of designated medical institutions and the scope of outpatient settlement.
Data map: Citizens queue up for registration in the outpatient hall of the hospital.
Photo by China News Agency reporter Yang Di
The "Notice" proposes that by the end of 2020, the pilot experience that can be replicated and promoted in pilot areas such as Beijing-Tianjin-Hebei, Yangtze River Delta, and Southwestern 5 provinces will be summarized, relying on the National Medical Insurance Administration's cross-provincial remote medical treatment management subsystem (hereinafter referred to as the national remote medical management System) to further expand the scope of the trial scope of direct settlement of outpatient expenses across provinces, and explore the national unified system, operating mechanism and implementation path of the direct settlement of outpatient expenses across provinces.
The "Notice" clarified that 12 provinces (autonomous regions and municipalities) of Beijing, Tianjin, Hebei, Shanghai, Jiangsu, Zhejiang, Anhui, Chongqing, Sichuan, Guizhou, Yunnan, and Tibet are pilot areas for direct settlement of outpatient expenses across provinces.
At the same time, provinces with the following conditions can apply for the national pilot:
——The provincial people's government attaches great importance to and supports the direct settlement of outpatient expenses across provinces. The medical insurance department and the financial department have worked together to facilitate the direct settlement and settlement of medical treatment and hospitalization in different places across provinces.
Provincial-level medical security administrative departments have the ability to undertake national pilot tasks, take the lead in formulating local supporting policies, and coordinate the promotion of pilot projects; provincial-level medical security agencies have strong organizational capabilities and management service capabilities.
——The province's outpatient overall planning policy standards, management services, and information systems are relatively unified, and the direct settlement of outpatient expenses in the province has basically been achieved.
With a unified online filing service channel, the filing service is convenient and fast.
——Able to complete the cross-provincial direct settlement interface transformation of outpatient expenses in high quality in accordance with the national pilot tasks and time schedule (the interface standards will be issued separately).
The "Notice" pointed out that the unified transfer process for medical treatment in different places.
In accordance with the national unified "Regulations for the Direct Settlement of Outpatient Expenses across Provinces" (Trial), the pilot work of direct settlement of outpatient expenses across provinces was carried out.
Persons who have already applied for basic medical insurance for direct settlement of medical expenses for medical treatment in different places across provinces and places for the record will simultaneously activate the direct settlement service for outpatient expenses without additional filing.
Other personnel with outpatient medical needs in different places shall apply for the record of medical treatment in different places in accordance with the management requirements of the insured place for medical treatment in other places, and the places of insured may provide online self-service registration for medical treatment in different places.
Participants choose designated medical institutions for direct settlement services for cross-provincial medical treatment in the place of medical treatment filed.
Create convenient and efficient remote medical settlement services.
Conditional pilot areas can combine the pilot work of direct settlement of outpatient expenses across provinces, and simultaneously promote self-service settlement services for medical treatment in different places and realize convenient services such as medical treatment and drug purchase with medical insurance electronic vouchers, and actively promote medical insurance disease diagnosis and surgical operation classification and codes, Information service coding standards such as medical service items, medical insurance drug classification and codes, and medical insurance outpatient chronic diseases are applied.
The "Notice" requires that the scope of the pilot be expanded in a steady and orderly manner.
After the Beijing-Tianjin-Hebei, Yangtze River Delta, and Southwestern five provinces have unified access to the national off-site medical management system, the coverage of pilot areas and designated medical institutions should be further expanded based on local conditions.
Before October 10, other provinces with conditions and willingness can submit a pilot application to the National Medical Insurance Bureau. The system will be reformed before the end of November, and the trial operation will be completed by the National Medical Insurance Bureau before the end of December.