Social medical insurance card, referred to as medical insurance card or medical insurance card, is a special card for medical insurance personal account, personal identification card as the identification code, stored in the record of the personal identification number, name, gender, as well as the account of the allocation of funds, consumption and other detailed information. The medical insurance card is organized by the local designated agent bank and is a kind of multi-functional debit card of the bank. The local health insurance department will entrust the bank to pay the individual account fund to the insured employee's personal health insurance card at the end of the month after the insured unit pays the fee.
Management system of medical insurance card:
I. Establishment of hospital medical insurance management group, under the leadership of the director of the work. The establishment of medical insurance office and equipped with a full-time (part-time) managers, specifically responsible for the hospital's medical insurance work.
Second, the development of medical insurance management measures and specific assessment of rewards and punishments, medical insurance office has a clear job responsibilities, and improve the internal management system and corresponding measures appropriate to the management of medical insurance.
Three.
Establishment of the medical insurance management network, and implementation of the relevant medical insurance rules and regulations. It is responsible for regulating, coordinating, evaluating and supervising the medical insurance business and medical behavior on a regular basis, as well as conducting regular self-examination, random examination, evaluation, monitoring and analysis of the volume of outpatient prescriptions, discharge medical records, mastery of the criteria for entering and leaving the hospital, and the situation of discharging patients with medicines.
Four, standardize medical behavior, conscientiously implement the medical insurance policies and regulations, on time with the Municipal Medical Insurance Center signed a medical insurance designated service agreement, in accordance with the agreement to perform the corresponding rights and obligations.
Fifth, the strict implementation of the health administrative departments of the provisions of the medical technology standards of operation, case management and related business policies and regulations, reasonable inspection, rational use of medication, reasonable treatment.
Sixth, to take measures to eliminate such as crime, alcoholism, fighting, suicide, self-inflicted injuries and other behaviors occurring in the medical costs, the implementation of the medical costs for insured patients to inform the system of out-of-pocket expenses.
Seven, take practical measures to implement the medical insurance hospitalization cost control standards, reasonable control of medical
The rapid growth of medical costs, to put an end to fraudulent hospitalization, decomposition of hospitalization, hospitalization of the name and other improper medical behavior, control and reduce the proportion of hospitalized medicines, out-of-pocket expenses accounted for the proportion of medicines to ensure that medical insurance drug preparation rate of the standard, health insurance assessment indexes are incorporated into the overall hospital evaluation The medical insurance assessment indexes are included in the overall assessment management system of the hospital.
VIII. Do a good job of medical insurance fee program announcement, open medical prices and charges. Standardize the management of the drug storehouse and the expense storehouse, and standardize the management of the use of disposable medical materials.
9, strict implementation of medical insurance regulations, to ensure accurate and timely transmission of data and the normal smooth operation of the network.
Ten, timely coordination work to strengthen the hospital health insurance, information, finance, pricing departments and social security center of the relevant departments of the counterpart contact and communication.
Xi, regularly organize medical staff to study health insurance-related policies and business operations, correct
understanding, timely implementation of health insurance regulations, in accordance with health insurance policies and medical norms to guide and check the implementation of health insurance departments.
Twelve, strengthen the publicity and explanation of medical insurance, set up a "medical insurance bulletin board", published
reporting incentives and supervisory telephone number, and publicize the integrity of the service commitment. Correctly and timely handling of complaints of insured patients, and strive to resolve conflicts, to ensure the normal development of medical insurance work.
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