Settlement Procedures
(1) Settlement Procedures for Hospitalization and Outpatient Treatment of Special Diseases
The designated medical institutions will submit the cost statement of patients discharged from hospitals in the previous month, the hospitalization statement and relevant information to the medical insurance agency before the 10th day of each month, which will review and approve them and then serve as the basis for the monthly preallocation and the final account at the end of the year. The medical insurance agency makes monthly advance payments of the previous month's coordinated fees for hospitalization and outpatient treatment of special diseases.
Participants who are recognized as suffering from special diseases should go to one of the designated medical institutions designated by the labor security department for medical treatment and purchase of medicines, and the medical expenses incurred will be recorded directly in the accounts and settled instantly.
(2) Emergency Settlement Procedures
Participants who are hospitalized in non-designated medical institutions in the city or in other medical institutions due to emergency medical treatment shall first pay the medical expenses incurred by themselves or their units in advance, and then, after the emergency medical treatment is over, they shall apply for reimbursement with the hospital's emergency medical records, examination and laboratory report forms, invoices, and detailed lists of medical fees and charges, etc., in accordance with the regulations of the medical insurance administration organization.
(C) Settlement Procedures for Relocated Staff
1. Relocated staff will be assigned 1-2 designated medical institutions in their place of residence by their respective units, and will be reported to the medical insurance agency for record.
2. The medical expenses incurred by a staff member residing in a designated medical institution in his/her place of residence when he/she falls ill shall be advanced by himself/herself or by his/her unit, and after the completion of the treatment, he/she shall be settled by his/her unit with the medical card of the insured person and his/her medical records, valid bills, duplicate prescriptions, and a list of the hospitalization expenses, etc. on the stipulated date at a social medical insurance agency.
(4) Referral and Transfer Settlement
1. If the insured person is referred to other medical institutions for diagnosis and treatment due to the limitations of the designated medical institutions or due to specialized diseases, he/she has to fill in the approval form for referral and transfer. By the attending physician to put forward the reasons for referral and transfer, the director of the referral and transfer opinions, the medical insurance office of the medical institution, signed by the director in charge, reported to the Municipal Medical Insurance Center for approval before the transfer of hospitals.
2, the principle of referral and transfer to the city after the city, after the province after the province. Intra-city referrals and transfers are to be made between designated medical institutions. Out-of-town referrals and transfers must be made by the designated medical institutions above the third level in the city.
3. The medical expenses incurred by the insured person after the referral to the hospital shall be advanced in cash by the individual or the unit, and after the end of medical treatment, the insured person or his/her agent shall reimburse the hospitalization expenses that are covered by the integrated fund to the medical insurance agency with the referral and transfer approval form, medical record certificate, prescriptions and valid documents.
Expanded Information
Medicare Reimbursement
I. Scope of Diagnostic and Treatment Items Not Covered by the Basic Insurance
(1) Service Item Category
1, Registration Fee, Out-of-Hospital Consultation Fee, and Medical Record Book Fee, etc.
2, Consultation Fee, Expedited Fee of Checking and Treatment (except for Emergency), and Named Surgery Fee. Except for emergency treatment), surcharge for surgery by name, quality premium fee, fee for hiring special nurses, and other special medical services.
(2) non-disease treatment program category
1, a variety of cosmetic (cosmetic life, medical cosmetology) fitness program and messy non-functional cosmetic surgery, orthopedic surgery, etc.;
2, a variety of weight loss, weight gain, increase in height;
3, a variety of health checkups;
4, a variety of preventive, health care treatment programs;
(C) diagnostic and therapeutic equipment and medical materials
1, the application of positron emission tomography device, electron beam CT, ophthalmic excimer laser therapy instrument and other large-scale medical equipment for the examination and treatment of the project;
2, eyeglasses, dental prostheses, eye prostheses, prosthetic limbs, hearing aids, and other rehabilitation appliances;
3, all kinds of health care for their own use, massage, examination, rehabilitation and treatment of the device.
(4) therapeutic items category
1, all kinds of organ transplantation or tissue transplantation of organ source or tissue source;
2, in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation other organs or tissue transplantation;
3, myopic eye orthopaedics;
4, qigong therapy, music therapy, health care of the nutritional therapy, magnetic therapy and other complementary treatment programs.
(5) Other
1, various infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;
2, various scientific research, clinical verification of diagnosis and treatment programs;
2, basic medical insurance to pay part of the cost of the diagnosis and treatment program range
(1) Diagnostic and treatment equipment and medical materials
1, the application of X-ray computed tomography devices, and the use of medical materials. -ray computed tomography (CT), stereotactic radiography (γ-knife, χ-knife), cardiac and angiography X-ray machine (including digital subtraction equipment), magnetic **** vibration imaging device (MEI), single-photon emission computerized scanning device (SPECT), Color Doppler, medical linear gas pedal and other large medical equipment for examination, treatment projects;
2, extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3, pacemakers, artificial joints, artificial crystals, vascular scaffolds in vivo replacement of artificial organs, in vivo replacement of materials;
4, the provincial price department can be charged separately for the disposable medical materials. .
(B) treatment project category
1, hemodialysis, peritoneal dialysis;
2, kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation;
3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects.
Hearing aids and other rehabilitation appliances;
3, a variety of self-use health care, massage, check rehabilitation and treatment equipment.
(3) therapeutic items category
1, all kinds of organ transplantation or tissue transplantation of organ source or tissue source;
2, in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation;
3, myopic eye orthopaedic surgery;
4, qigong therapy, music therapy, health care of the nutritional therapy, magnetic therapy and other complementary treatment programs.
(4) Other
1, a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment programs;
2, a variety of scientific research, clinical verification of diagnosis and treatment programs;
Baidu Encyclopedia - Medical Insurance Reimbursement Scope
Baidu Encyclopedia -Medicare