1. Archive the first visit. When a patient sees a doctor for the first time, he needs to establish a medical file at the payment window, and bind his ID card and medical insurance card.
2. Use medical insurance card or electronic certificate for medical treatment. When seeing a doctor, the patient can register and pay the fee by using the medical insurance card or the medical insurance electronic certificate. Outpatient registration and intelligent audit system supports direct use of medical insurance card or electronic certificate to deduct fees, which simplifies the medical treatment process.
3. Online settlement and secondary reimbursement. In the hospital, patients can use the mobile payment function of medical insurance to complete the real-time settlement of medical insurance fund payment, personal account payment and self-funded expenses on the mobile phone. When leaving the hospital, patients can settle accounts online in the hospital and get statements and invoices. After that, patients can bring relevant information to the local social security center to apply for reimbursement of outpatient medical expenses. When reimbursing, the amount in the personal medical insurance account will be deducted first, and then the amount to be reimbursed will be approved. In some cases, such as an employee's hospitalization operation, a second reimbursement may be required.
The information required for outpatient reimbursement is as follows:
1, original ID card or social security card;
2, the original certificate of disease diagnosis issued by the designated medical institutions;
3, outpatient medical records, inspection, test results report and other original medical information;
4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;
5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;
6. Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods;
7. If it is an agent, you need to provide the original ID card of the agent.
To sum up, take all the above information to the relevant departments of the local social security center. Upon examination, if the information is complete and meets the requirements, it can be handled immediately.
Legal basis:
Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers
Article 28
Personal accounts are used to pay medical expenses beyond the scope of the overall fund payment; If the personal account is insufficient to pay, it shall be borne by me.
Article 29
The hospitalization expenses for major diseases are paid in the following ways:
(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.
(two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year.
(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses.