Chinanews Client Beijing, February 1st (Reporter Zhang Ni) A few days ago, the National Medical Insurance Bureau and the Ministry of Finance jointly issued a notice stating that 15 provinces, including Shanxi and Inner Mongolia, were added as pilot provinces for direct settlement of outpatient expenses.
From February 1, 27 provinces (autonomous regions and municipalities) across the country can rely on the national remote medical settlement system to carry out a trial operation of direct settlement of ordinary outpatient expenses across provinces.
Data map: A patient uses the face recognition system to make an appointment with an expert number under guidance.
Photo by Wang Guangzhao
27 provinces launched a trial operation of direct settlement of ordinary outpatient fees across provinces
Since 2018, the five provinces of the Yangtze River Delta, Beijing-Tianjin-Hebei, and Southwest China have successively carried out pilot projects for direct settlement of ordinary outpatient expenses in the region.
According to data from the National Medical Insurance Administration, as of the end of 2020, all coordinating areas in Beijing, Tianjin, Hebei, Shanghai, Jiangsu, Zhejiang, Anhui, Chongqing, and Yunnan, as well as some coordinating areas in Sichuan, Guizhou, and Tibet, have opened outpatient services across provinces. Direct settlement of designated medical institutions and designated retail pharmacies both exceeded 10,000, and the total number of direct settlements exceeded 3 million.
On the 1st, the notice of the National Medical Insurance Administration and the Ministry of Finance on the issuance of the list of pilot provinces for direct settlement of new outpatient expenses across provinces was announced.
The "Notice" clarified that 15 new provinces including Shanxi, Inner Mongolia, Liaoning, Jilin, Heilongjiang, Fujian, Jiangxi, Shandong, Hubei, Guangxi, Hainan, Shaanxi, Qinghai, Ningxia, and Xinjiang are pilot provinces for direct settlement of outpatient expenses.
From February 1, 2021, the trial operation of direct settlement of ordinary outpatient expenses across provinces will be carried out.
The newly added 15 provinces are pilot provinces for direct settlement of ordinary outpatient expenses across provinces. The first batch of 89 coordinated areas and 663 designated medical institutions have been opened.
In addition, on the same day, the National Medical Insurance Administration issued the "Notice on the Cross-provincial Direct Settlement Service of General Outpatient Expenses in the Five Provinces of China Unicom Beijing-Tianjin-Hebei, Yangtze River Delta, and Southwest China".
The document clarifies that the overall planning areas of 11 provinces (autonomous regions and municipalities) including Beijing, Tianjin, Hebei, Shanghai, Jiangsu, Zhejiang, Anhui, Chongqing, Sichuan, Yunnan, Tibet, as well as Guizhou Province and all of the Buyi and Miao Autonomous Prefectures in Southwest Guizhou Connecting to the national remote medical settlement system and connecting ordinary outpatient expenses directly settlement services across provinces.
At the same time, 10,200 cross-provincial direct settlement designated medical institutions and 11,800 designated pharmacies were opened.
The trial operation will also start on February 1, 2021.
From February 1st, the 27 provinces (autonomous regions and municipalities) mentioned above rely on the national off-site medical settlement system to uniformly carry out the trial operation of direct settlement of ordinary outpatient expenses (excluding chronic and special outpatient diseases) across provinces.
The picture shows people going through medical insurance procedures.
Photo by Sun Rui
By the end of 2021, direct settlement of outpatient expenses across provinces will be basically achieved
According to Huang Huabo, Director of the Fund Supervision Department of the National Medical Insurance Administration, introduced in September last year, on the basis of pilot projects, the National Medical Insurance Administration will comprehensively promote the direct settlement of outpatient expenses across provinces to ensure that direct settlement of outpatient expenses across provinces is basically achieved by the end of 2021. Provide more convenient and faster, inpatient and outpatient integration direct settlement services for medical treatment in different places.
So, what preparations need to be completed in order to smoothly enjoy the direct settlement of medical expenses in other places?
According to the National Medical Insurance Bureau, those who have applied for basic medical insurance for direct settlement of medical expenses for medical treatment in different places across provinces and places for registration have simultaneously opened the direct settlement service of ordinary outpatient expenses without additional filing.
Other personnel who need general outpatient medical treatment 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 different places. When seeking medical treatment in the pilot designated medical institutions in the above-mentioned pilot areas, they can directly settle the settlement according to regulations.
In addition, for outpatient expenses directly settled by medical personnel across provinces and other places, in principle, the payment scope and related regulations (basic medical insurance drugs, medical service items, medical consumables, etc.) shall be implemented in accordance with the payment scope and related regulations of the medical treatment place.
The basic medical insurance fund minimum payment standard, payment ratio, maximum payment limit and other reimbursement policies are implemented in accordance with the regulations of the place of insurance.
According to reports, the National Medical Insurance Service Platform APP developed and launched by the National Medical Insurance Administration can provide remote medical treatment filing functions. Participants in 170 coordinating areas in 22 provinces can rely on the national unified online filing channel for filing, and at the same time, they can query and open ordinary online Coordinating areas and designated medical institutions for outpatient trials.
In order to protect the rights and interests of the insured persons, the unsuccessful expenses will be directly settled during the trial operation, and the original reimbursement channels will still be retained.
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