Medical institutions put forward fixed-point applications, and medical insurance agencies immediately accept them. If the application materials are incomplete, the medical insurance agency shall inform the medical institution to make corrections once within 5 working days from the date of receiving the materials.
(2) Comprehensive evaluation:
The medical insurance agency shall organize an evaluation team or entrust a third-party agency that meets the requirements to carry out the evaluation in written and on-site form. The members of the evaluation team are composed of professionals such as medical security, medicine and health, financial management and information technology. From the date of accepting the application materials, the evaluation time shall not exceed 3 months, and the time for medical institutions to supplement the materials shall not be included in the evaluation period. The evaluation contents include:
1. Check the practice license of medical institutions or the registration certificate of Chinese medicine clinics or the service license of military medical institutions for the people;
2. Check the practice information of doctors, nurses, pharmacy, medical technology and other professional and technical personnel and the first registration information of doctors;
3 inspection and service functions to adapt to the diagnosis, treatment, surgery, hospitalization, drug storage and distribution, radiation inspection and inspection and other infrastructure, equipment;
4. Check the internal management system and financial system corresponding to the medical insurance policy, and the evaluation results of medical institutions by the health department;
5. Check whether the information system of medical institutions related to medical insurance has the conditions to carry out online direct settlement.
The evaluation results are divided into qualified and unqualified. If the evaluation is unqualified, it shall inform the reasons and put forward rectification suggestions. From the date of delivery of the result notice, the review can be organized again after 3 months of rectification. If the evaluation is still unqualified, you may not apply again within 1 year.
(3) publicity:
For those who pass the examination, the medical insurance agency will be included in the list of medical institutions that have signed the medical insurance agreement, and the list will be publicized on the portal of the municipal medical insurance administrative department for a period of 5 working days.
(4) Negotiation and installation of information systems:
After publicity without objection, the medical insurance agency and the medical institution that signed the medical insurance agreement reached an agreement through consultation, and the medical institution should install the medical insurance information system as required.
(5) Signing a medical insurance agreement:
Medical institutions operating normally after the installation of the medical insurance information system signed a letter of commitment for honest service, and medical insurance agencies signed a medical insurance agreement with them.
(6) Information release:
The medical insurance agency announced to the public the information of the designated medical institutions that signed the medical insurance agreement, including the name and address, for the insured to choose.