One, general hospitals, hospitals of traditional Chinese medicine, hospitals combining traditional Chinese and Western medicine, ethnomedicine hospitals, specialized hospitals, rehabilitation hospitals;
Second, specialized disease prevention and treatment hospitals (institutes, stations), maternity and child health care hospitals;
Third, the community health service centers (stations), the central health centers, township hospitals, street health centers, outpatient clinics, clinic, health clinic (station), village health room (office);
four, independent first aid center;
five, hospice centers, hemodialysis centers, nursing homes;
six, nursing homes within the medical institutions.
Internet hospitals can rely on their entity medical institutions to apply for the signing of a supplemental agreement, and the relevant costs arising from the medical services provided by them that are in line with the scope of payment of the medical insurance shall be settled by the coordinating regional administrative organization and its entity medical institutions in accordance with the provisions of the agreement.
Application for medical insurance designated, must meet the six conditions
One, the formal operation of at least three months;
Two, at least one obtained a physician's license, rural doctor's license or traditional Chinese medicine (specialization) physician's qualification certificate and the first place of registration in the health care institution physician;
Three, the main person in charge of the work of health care, with a full-time (part-time) job Medical insurance management personnel; 100 beds or more medical institutions should set up an internal medical insurance management department, arrange full-time staff
four, with the agreement to meet the requirements of medical insurance management system, financial system, statistical information management system, medical quality and safety core system;
five, with the agreement to meet the requirements of the management of the medical insurance hospital information system technology and interface standards to achieve effective docking with the medical insurance information system, to achieve effective docking with the medical insurance information system, to achieve effective docking with the medical insurance information system. Realize the effective docking with the medical insurance information system, according to the requirements of the medical insurance information system to transmit all the relevant information of the patients, to provide direct network settlement for the insured. The establishment of medical insurance drugs, diagnostic and treatment items, medical service facilities, medical supplies, disease types and other basic databases, in accordance with the provisions of the use of the national unified medical insurance code;
VI, in line with the laws and regulations and other conditions specified by the provincial level and above the administrative department of medical insurance.
Submit an application for medical insurance designated, these materials must be
One, designated medical institutions application form;
Two, medical institutions license or Chinese medicine clinic filing certificate or military medical institutions for the civilian service license copy;
Three, with the medical insurance policy corresponds to the text of the internal management system and financial system
Directly with the medical insurance-related
V. Predictive analysis report on the use of the medical insurance fund after inclusion in the fixed-point system
VI. Other materials required by the provincial medical insurance administrative departments in accordance with the relevant regulations.
After accepting the application materials, it is necessary to assess these contents
I. Verification of the license of the medical institution practice or Chinese medicine clinic filing certificate or military medical institutions for the people's license;
II. Verification of the physicians, nurses, pharmacy and medical technology and other professional and technical personnel practice information and the physician's first place of registration information;
Third, the verification of the function of the service compatible with the Diagnosis, treatment, surgery, hospitalization, drug storage and distribution, inspection, testing and radiology and other infrastructure and instrumentation;
four, verification of the internal management system and financial system corresponding to the health insurance policy, the results of the health sector medical institution assessment;
five, verification of health insurance-related medical institutions information system to carry out the conditions of direct network settlement.
The assessment results are categorized as qualified and unqualified. The coordinating regional administrative organization shall report the assessment results to the medical insurance administrative department at the same level for the record. For the qualified assessment, it should be included in the list of medical institutions to be signed agreement, and publicized to the community. For those that fail the assessment, it shall inform them of the reasons and put forward suggestions for rectification. From the date of delivery of the results of the notification, rectification of three months after the assessment can be re-organized, the assessment is still unqualified, 1 year shall not re-apply.
Provincial medical insurance administrative departments may, on the basis of this method, formulate specific assessment rules according to the actual situation.
One of the following circumstances will not be accepted for finalization
I. Medical beauty, assisted reproduction, life care, dental implants and other non-basic medical services as the main scope of practice;
II. Basic medical services are not carried out in accordance with the pharmaceutical pricing policy formulated by the medical security administrative department;
III. Failure to carry out the responsibility of administrative penalties in accordance with the law;
Four, by fraud and other improper means to apply for a fixed point, less than three years from the date of discovery;
Five, due to violations of law and regulations by the termination of the health insurance agreement less than three years or has been three years but has not fully fulfilled the legal responsibility of the administrative penalties;
Six, due to serious violations of the agreement of the health insurance agreement is terminated less than one year or has been one year but has not fully fulfilled the responsibility of breach of contract;
< p>seven, the legal representative, the main person in charge or the actual controller has been due to serious violations of law caused by the original designated medical institutions were terminated health insurance agreement, less than 5 years;eight, the legal representative, the main person in charge or the actual controller is included in the list of defaulters;
nine, the laws and regulations of other inadmissible circumstances.
The following behaviors of the institution, will be terminated medical insurance agreement
Medicare agreement termination refers to the agency and the designated medical institutions between the medical insurance agreement is terminated, the agreement relationship is no longer in existence, the agreement is terminated after the medical costs incurred by the medical insurance fund will no longer be settled. The designated medical institutions have one of the following circumstances, the agency shall terminate the medical insurance agreement, and publish to the community to terminate the medical insurance agreement of the list of medical institutions:
One, the medical insurance agreement within the validity of a cumulative total of two or more times to be suspended from the medical insurance agreement or suspension of the medical insurance agreement during the period of the failure to rectify the requirements of rectification or rectification is not in place;
On the second, to fraud and other improper means to apply for access to designated;
Three.
Three, by the medical security department and other relevant departments found to have fraudulent insurance fraud
Four, for non-designated medical institutions or in the suspension of the medical insurance agreement during the medical institutions to provide medical insurance cost settlement;
Five, refused, obstructed or did not cooperate with the medical security department to carry out intelligent audits, performance appraisals, supervision and inspection, etc., the circumstances of the bad;
Sixth, was found to be significant information changes but did not handle the change of significant information
seventh, the designated medical institutions after the closure or suspension of business is not in accordance with the provisions of the report to the agency;
eighth, the medical security administrative department or other relevant departments in the administrative law enforcement, the designated medical institutions found to exist in the major violations of the law and may result in a significant loss of the medical security fund;
Nine, was revoked, cancellation of the license to practice medical institutions or Chinese medicine clinic filing certificate;
Ten, the legal representative, the main person in charge or the actual controller can not fulfill the agreement on medical insurance, or illegal behavior;
Eleven, failure to comply with the administrative departments of the administrative department of medical security administrative penalty decision;
Twelve, the designated medical institutions to take the initiative to put forward Termination of the medical insurance agreement and the agency agreed;
thirteen, according to the medical insurance agreement should be terminated medical insurance agreement;
nineteen, laws, regulations and rules should be terminated in other cases.