I. Preparation of application materials
Medical institutions need to prepare the relevant application materials, including the qualification certificate of the medical institution, the list of medical equipments, the list of medical services, the qualification certificate of the medical staff, etc. These materials need to be true, accurate and complete. These materials need to be true, accurate and complete so that the medical insurance management department can review and evaluate them.
Two, submit the application
The medical institution will submit the prepared application materials to the local medical insurance management department. When submitting the application, you need to fill out the relevant application form, and indicate the reasons for applying for medical insurance designated and advantages.
Third, review and assessment
The medical insurance management department will review and assess the application materials submitted. The assessment includes the facility conditions of the medical institution, the level of medical technology, service quality and other aspects. The medical insurance management department will also assess the business management and financial management of the medical institution to ensure that it meets the requirements of the medical insurance designation.
Fourth, on-site inspection
The medical insurance management department will organize experts to conduct on-site inspections to verify whether the actual situation of the medical institution is consistent with the application materials. The on-site inspection includes the configuration and use of medical equipment, the development of medical services, and the qualifications and practice of medical staff.
V. Approval Decision
After the audit and evaluation and on-site inspection, the medical insurance management department will make a decision on whether or not to approve the medical insurance designation. If the medical institution meets the relevant conditions, it will be included in the medical insurance designated units and enjoy preferential policies such as medical insurance settlement.
In summary:
The application process for medical insurance designation requires the medical institution to prepare the relevant application materials, submit them to the medical insurance management department for review and evaluation, and after an on-site inspection, the medical insurance management department will make a decision on whether or not to agree with the medical insurance designation. Medical institutions need to meet the relevant conditions in order to be included in the medical insurance designated units, to enjoy the medical insurance settlement and other preferential policies.
Legal basis:
The Social Insurance Law of the People's Republic of China
Article 29 stipulates that:
The portion of a participant's medical expenses that should be paid for by the basic medical insurance fund is to be settled directly between the social insurance administration organization and the medical institutions and drug business units.
Social insurance administrative departments and health administrative departments shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.
The Regulations on the Administration of Medical Institutions
Article 30 stipulates:
Medical institutions must carry out diagnostic and treatment activities in accordance with the approved and registered diagnostic and treatment subjects.
Article 32 provides:
Without a physician's personal diagnosis, medical institutions shall not issue documents such as diagnosis of disease, health certificates or death certificates; without a physician or midwife to deliver the baby, medical institutions shall not issue birth certificates or stillbirth reports.