According to the requirements of "Xuancheng City Medical Security Bureau on the implementation of the implementation of medical insurance information business coding standards" (Xuancheng City Medical Security Secret_2021_2), Xuancheng City medical insurance information system will be enabled to use the State Medical Insurance Bureau unified 15 medical insurance information business code, the fixed-point medical institutions must be the current self-use code and the old code of the health care insurance mapping (cross-referencing) relationship, the Each designated medical institution must convert the existing self-use code and the old code mapping (control) relationship with the new code of the national health insurance mapping (control) relationship. Now, according to the unified deployment of Xuancheng City, the relevant work matters are notified as follows:
First, the HIS system transformation and coordination
The fixed-point medical institutions, according to the Xuancheng City Medical Insurance Bureau issued the "Xuancheng City Medical Insurance Information System Interface Specification V2.0-20210121", should immediately contact the HIS system developers, hospital information system interfaces to carry out the transformation, the State Health Company is responsible for cooperating with each fixed-point medical institution to carry out the co-tuning test. In order not to affect the overall progress of the city's standardization work, each designated medical institution should complete the HIS system interface transformation work before February 2nd.
Second, the project mapping (control)
Xuancheng City health insurance information system has been docked to the national health insurance information coding standards database, the fixed-point medical institutions can be downloaded directly from the interface to use. Among them, the medical insurance disease diagnosis and surgical operation code direct mapping (control), this work was completed on February 5; medical insurance drugs, medical insurance medical supplies, medical service projects, medical insurance outpatient slow special diseases, medical insurance by disease settlement of diseases and medical insurance day surgery types of six codes, and Xuancheng City Medical Insurance Bureau issued by the Si-logo policy of the information business code for the self-use of the code with the new code of medical insurance mapping, in February Completed by February 10th. Completion of full coverage mapping (against) identification, dual-code operation in the existing system.
Third, the basic code maintenance control
Specified medical institutions and health insurance physicians, health insurance nurses and designated retail pharmacies and health insurance pharmacist five codes, by the designated medical institutions in the system for their own code and the new code of the mapping (against), the full amount of maintenance, timely entry, and the implementation of dynamic management, real-time updates.
Fourth, through the standard test
The fixed-point medical institutions in the system to complete the mapping (control), the need to carry out through the standard test, the various types of protection of various reimbursement of the object of the test to assess the actual settlement of the data test in November 2020, in order to avoid the mapping error of the various codes of the cross-impact of the code in accordance with the test of only one code at a time, each through the application of a. And with reference to the quality audit in Xuancheng City, the city of Xuancheng, the city's quality audit. And with reference to the "Xuancheng City Quality Control Audit Self-Assessment Table" (see the attached table for details), we will carry out the audit and self-assessment to ensure that the new and old data of health insurance will be seamlessly connected and migrated in a safe and complete manner, and that the people's access to the medical settlement will be unaffected, and that the treatment will be enjoyed without any error. After the completion of the coherence test, before March 31, through the hospital information system to generate the settlement list of medical insurance fund and upload, and to ensure that the data is true, accurate and complete.
Fifth, the old and new code switching
According to the unified deployment of the Xuancheng City through the standard work, the old code of health insurance on March 31 to stop using the city's unified time node to switch to the new code of health insurance settlement.
Sixth, the requirements
(a) attach great importance to. The standard work is related to the insured people's interests, time is tight, the task, the designated medical institutions should attach great importance to the unification of ideas and understanding, the establishment of a task force, the layers of responsibility, strengthen communication and coordination, and make every effort to grasp the implementation of the standard work.
(ii) Compact responsibility. The designated medical institutions should be in accordance with the timetable, strictly grasp the progress and quality requirements, timely detection and resolution of contradictions and problems in the work, to ensure that the standardization of work in an orderly manner, on time, quality and quantity to complete the task issued by Xuancheng City.
Problems in the standardization work, please contact the Municipal Medical Insurance Bureau. Contact person: Yan Peng, contact number: 4014058.