● The application form for a designated medical institution in the city is uniformly printed by the municipal social insurance agency.
● Application for becoming a designated medical institution for social insurance in the city should meet the following conditions:
I. Non-profit medical institutions in the city that hold a valid license to practice as a medical institution may apply to become a designated medical institution if they have the following conditions:
(1) have medical and technical equipment and health care personnel that are appropriate to the level of the medical institution;
(ii) comply with national, provincial and municipal laws, regulations, standards and provisions relating to the management of medical services;
(iii) strictly implement the national, provincial and municipal regulations on non-profit medical charges and retail prices of medicines, and the implementation of a public announcement system for the charges;
(iv) undertake to strictly abide by the implementation of the relevant policies and regulations on the social medical insurance system for urban workers, and to establish an internal medical insurance system that is suitable for the management of medical insurance. Medical insurance management compatible with the internal management system, with a sound medical insurance management organization, a leader in charge of medical insurance work, equipped with the necessary part-time or full-time management personnel, equipped with computers and other equipment to meet the needs of social medical insurance.
Enterprises and institutions that meet the conditions listed in the preceding paragraph and are located in units with more than 1,000 employees may also apply to become designated medical institutions.
II. In areas where non-profit medical institutions are insufficient to undertake social medical insurance services, for-profit medical institutions that have obtained a license to practice as a medical institution and that meet the conditions listed in the first paragraph of Article 5 of these Measures may apply to become a designated medical institution for municipal social insurance.
Third, the application to become a designated medical institution shall submit the following written application materials and electronic files to the municipal social insurance agency:
(1) application for designated medical institutions;
(2) a copy of the license to practice as a medical institution (verification of the original);
(3) proof of the level of the medical institution or the relevant certificates from the health administration department;
(4) a certificate of the medical institution's rank or relevant certificates from the health administration department;<
(iv) Proof of passing the annual inspection by the drug administration;
(v) The general catalog of medicines classified by pharmacology and the list of medicines for social insurance.
The application form for designated medical institutions is uniformly printed by the municipal social insurance agencies.
Fourth, the municipal social insurance agency will not accept the application of a medical institution to become a designated medical institution under any of the following circumstances:
(a) the application information is incomplete or untrue;
(b) the qualification of a designated medical institution has been canceled for less than 2 years;
(c) there is a major violation of laws and regulations, which is under investigation and processing.
V. After accepting the application materials of the medical institutions, the municipal social insurance agency shall organize relevant experts to conduct on-site inspections of the medical institutions that have submitted applications and conduct comprehensive evaluation.
The municipal social insurance institutions based on the overall planning of the city's designated medical institutions and expert evaluation to decide whether to apply for medical institutions as designated medical institutions.
The decision in the preceding paragraph shall be made within 30 working days from the date of acceptance of the application, and the medical institution making the application shall be notified in writing.
Sixth, the application of the medical institutions identified as designated medical institutions, the municipal social insurance agency and its social insurance designated medical institutions signed an agreement, and the municipal social insurance agency issued "urban workers in the city of social health insurance designated medical institutions" sign, and announced to the community.
The agreement signed between the municipal social insurance agency and the designated medical institution shall include the following main provisions:
(1) service items, departments and other services;
(2) quality of service requirements and supervision methods;
(3) settlement of medical expenses and reimbursement standards;
(4) liability for breach of contract;
(v) conditions and procedures for changing or terminating the agreement;
(vi) other contents that both parties consider necessary to be agreed upon.
Social insurance designated medical institutions agreement is valid for two years.
VII. Before the municipal social insurance agency issues the label of "designated medical institution for social medical insurance for urban workers in the city", the designated medical institution shall, according to the requirements of the agreement, do the following:
(1) formulate the internal management system related to the social medical insurance service;
(2) carry out computerized management with the municipal social insurance agency; and ) computer networking with the municipal social insurance agency;
(iii) organizing training in medical insurance business for relevant medical staff and registration clerks, bookkeepers and computer operators.
VIII, designated medical institutions should be in accordance with the Measures and the agreement requirements, do the following:
(a) strict implementation of the relevant provisions of the management of social health insurance, in accordance with the basic medical insurance drug list, diagnostic and treatment items, medical service facilities range and the local supplemental medical insurance drug list, diagnostic and treatment items, to provide medical care;
(b) there are (b) medical facilities that meet more than 80% of the standard requirements for basic medical insurance service facilities and more than 80% of the medicines in the basic medical insurance drug catalog;
(c) separate accounts for medical expenses for social medical insurance, and are required to accurately and timely provide the relevant documents and information to the municipal social insurance agency;
(d) new diagnostic and therapeutic items in accordance with the "Basic Medical Insurance Diagnostic and Therapeutic Items and Service Facilities for Municipal Employees". (d) New diagnostic and therapeutic items are implemented in accordance with the "Measures for the Administration of the Scope of Diagnostic and Therapeutic Items and Service Facilities of the City's Urban Employees' Basic Medical Insurance", and the costs of new diagnostic and therapeutic items shall not be counted as part of the account of the social medical insurance if they have not been applied for access to the social medical insurance;
(e) when providing medical services for the insured persons, they shall use the outpatient charts, prescriptions, inpatient billing statements, and the application for large-scale medical equipment examinations and treatments that are uniformly required by the city's social insurance agencies;
(f) when providing medical consultations and treatments to the insured persons, they shall (f) Verify the "Social Insurance Card of the Municipal Employee" when treating and settling the medical expenses of the insured person, and if the licensee does not match the social insurance card of the employee, the medical expenses shall not be credited to the account of the social medical insurance;
(g) Implement the list system of the outpatient medical expenses and the daily list system of the inpatient hospitalization expenses, and provide a detailed list of the expenses of all the items before the participant is discharged from the hospital and the account is settled with a signature by the participant or his/her family members.
(viii) If diagnostic and therapeutic items, drug catalogs and service facilities outside the scope of social medical insurance are provided, the consent and signature of the participant or his/her family members shall be obtained;
(ix) Expenses for the provision of medical services to participants shall be settled in accordance with the "Measures for Settlement of Urban Workers' and Municipal Employees' Social Medical Insurance Expenses in the Municipality".
(j) Regularly checking the implementation of the Measures, agreements and the relevant rules and regulations of the organization by the relevant departments, and copying the checking information to the municipal social insurance agency on a quarterly basis.