1, medical institutions to carry out medical services, in accordance with the provisions of the medical insurance policy, the relevant medical items, medical expenses and other information into the medical insurance reimbursement system;
2. The medical insurance reimbursement system will automatically conduct an audit to check whether the medical service items and expenses conform to the policy;
3. If approved, the medical insurance reimbursement system will automatically settle the reimbursement amount and transfer the reimbursement amount to the designated account of the medical institution;
4. After receiving the medical insurance reimbursement amount, the medical institution can charge the rest of the self-funded part to the patient.
Medical insurance filing refers to the behavior of medical institutions to declare their medical insurance services to the medical insurance department. The conditions for filing medical insurance are generally as follows:
1, medical institutions need to have legal qualifications: medical institutions must have legal medical practice qualifications, such as medical institution practice license, medical institution practice scope, etc.
2. Medical service items must meet the requirements of medical insurance policy: medical service items provided by medical institutions must meet the requirements of medical insurance policy, such as items within the scope of medical insurance payment and medical service standards;
3. Medical institutions need to file in the medical insurance department: medical institutions need to file in the local medical insurance department, submit relevant materials and applications, and wait for the medical insurance department to review and pass before providing medical insurance services;
4. Medical institutions need to declare service items according to regulations: when providing medical insurance services, medical institutions need to declare to the medical insurance department according to regulations, including the name of service items, service contents and service fees.
To sum up, the conditions and operation of medical insurance filing may be different due to factors such as regions and medical insurance policies, and it is necessary to understand and operate according to the actual situation. At the same time, when providing and using medical insurance services, we must abide by medical insurance policies and regulations to avoid unnecessary troubles and losses caused by improper medical insurance filing.
Legal basis:
Article 29 of People's Republic of China (PRC) Social Insurance Law
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.