(1) Medical institutions applying for health insurance designated medical institutions should have the following basic conditions:
(1) formally operated for at least three months;
(2) at least one physician who has obtained a certificate of physician practice, rural physician practice certificate or Chinese medicine (specialty) physician qualification certificate and the first place of registration in the health care institution;
(3) the main person responsible for the work of health insurance, with full-time (part-time) health insurance management personnel; more than 100 beds should have an internal medical management department. p>(3) the main person in charge of health insurance work, with full-time (part-time) health insurance management personnel; 100 beds or more medical institutions should set up an internal health insurance management department, arrange full-time staff;
(4) have a health insurance management system that meets the requirements of the management of the agreement on health insurance, financial system, statistics and information management system, the core system of quality and safety of medical care;
(5) Have hospital information system technology and interface standards that meet the management requirements of the health insurance agreement, realize effective docking with the health insurance information system, transmit all relevant information of the patients to the health insurance information system according to the requirements, and provide direct network settlement for the insured. It has set up basic databases of medicines, diagnostic and therapeutic items, medical service facilities, medical consumables, disease types, etc., and uses the unified national health insurance code as required;
(6) it meets the laws and regulations and other conditions stipulated by the administrative departments of the provincial level and above of the medical insurance.
(2) A retail pharmacy that has obtained a drug license and also meets the following conditions may apply for medical insurance designation
(1) it has been officially operating at the registered address for at least 3 months;
(2) there is at least one pharmacist who has obtained a licensed pharmacist's qualification certificate or has a professional and technical qualification certificate of pharmacy, clinical pharmacy, or traditional Chinese medicine, and the place of registration is at the retail pharmacy's location, the pharmacist shall sign a labor contract for more than 1 year and within the contract period;
(3) at least 2 full-time (part-time) health insurance management personnel familiar with the laws and regulations of medical insurance and the relevant system is responsible for the management of health insurance costs, and signed a labor contract for more than 1 year and within the contract period;
(4) in accordance with the requirements of the Code for Quality Management of Pharmaceutical Businesses, to carry out the management of the classification of drugs by zoning And set up a clear identification of medicines sold for medical insurance use;
(5) have a medical insurance drug management system, financial management system, medical insurance personnel management system, statistical information management system and medical insurance fee settlement system in line with the requirements of the medical insurance agreement;
(6) have information system technology and interface standards in line with the requirements of the medical insurance agreement management, and realize an effective interface with the medical insurance information system to provide participants with direct access to the medical insurance fees;
(7) have a comprehensive information system and interface standards to provide participants with direct access to the medical insurance fees. (6) have information system technology and interface standards that meet the requirements of the medical insurance agreement management, realize effective docking with the medical insurance information system, provide direct network settlement for the insured, set up the basic database of medical insurance drugs, and use the national unified medical insurance code according to the regulations;
(7) meet the laws and regulations and other conditions stipulated by the provincial-level and above administrative departments of the medical insurance.
II. Place of Acceptance: Yongping County Medical Insurance Service Center (Bosheng Road, Bonan Township, Yongping County)
III. Scope of Acceptance: Medical institutions (outpatient clinics) and retail pharmacies within the jurisdiction of Yongping County that voluntarily apply to be included in the management of the agreement.
Fourth, the acceptance time: the declaration will be accepted before September 10, 2021, after which it will be merged into the next acceptance.
V. Submission of materials
(1) Application for agreement management of medical institutions (outpatient) must provide the following materials:
(1) application form for designated medical institutions;
(2) a copy of the license to practice medicine or Chinese medicine clinic filing certificate or the military medical institutions for the civil service license;
(3) corresponding to the health care insurance policy Internal management system and financial system text;
(4) Medical insurance-related medical institution information system related materials;
(5) Predictive analysis report on the use of medical insurance fund after the inclusion of fixed-point;
(6) Provincial-level medical insurance administrative departments in accordance with the relevant provisions of the requirements of other information.
(2) Application for agreement management of retail pharmacies must provide the following materials:
(1) application form for designated retail pharmacies;
(2) drug business license, business license and a copy of the ID card of the legal representative, the main person in charge or the person under de facto control;
(3) certificate of qualification of a licensed pharmacist or a relevant certificate of a pharmacy technician and his or her labor contract Copy;
(4) Copy of the labor contract of the full-time (part-time) management personnel of the medical insurance;
(5) Text of the internal management system and financial system corresponding to the medical insurance policy;
(6) Relevant materials of the information system related to the medical insurance;
(7) Predictive analysis report on the use of the medical insurance fund after the incorporation of the fixed-point;
(8) other materials required by the provincial medical insurance administrative departments in accordance with relevant regulations.
Legal Basis
The Interim Measures for the Administration of Medical Insurance Designation of Medical Institutions (Decree No. 2 of the State Medical Security Bureau) stipulates in Article 6 that medical institutions applying for the designation of medical insurance designation shall have the following basic conditions at the same time.
(a) formal operation for at least three months;
(b) at least one physician who has obtained a medical practitioner's license, rural doctor's license or traditional Chinese medicine (specialty) physician's qualification certificate and whose first place of registration is in the healthcare institution;
(c) the main person in charge of the work of medical insurance, with a full-time (part-time) healthcare insurance management personnel; 100 beds or more of the medical institutions should have an internal healthcare insurance management department. (d) have a medical insurance management system, financial system, statistical information management system, medical quality and safety core system, etc. in line with the requirements of the medical insurance agreement management;
(e) have a hospital information system technology and interface standards in line with the requirements of the medical insurance agreement management, to achieve an effective docking with the medical insurance information system, and to transmit all medical consultations to the medical insurance information system according to the requirements of the medical insurance agreement. Transmit all the relevant information of the patients to the medical insurance information system, and provide direct network settlement for the insured. Establishment of basic databases of medicines, diagnostic and therapeutic items, medical service facilities, medical consumables, disease types, etc., and the use of unified national health insurance codes as required;
(vi) compliance with laws and regulations and other conditions stipulated by the provincial and higher-level health insurance administrative departments.