It does not affect the reimbursement.
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 of the year-end. 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 and Social Security Department for medical treatment and purchase of medicines, and 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.
(3) 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 his/her medical certificate, medical records, valid fee
bills, duplicate prescriptions, and list of hospitalization expenses, etc. on the stipulated date with the medical insurance administration 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 is required to fill in the approval form for referral and transfer to other medical institutions. 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:
In accordance with the "Scope of the National Basic Medical Insurance Diagnostic and Treatment Programs," the following are specified:
(a) The category of service programs.
(1) registration fee, out-of-hospital consultation fee, medical record cost, etc.;
(2) visit fee, examination and treatment of expedited fee, name surgery surcharge, quality premium fee, self-employed special nurse and other special medical services.
(2) Disease treatment program category.
(1) a variety of beauty, fitness and non-functional cosmetic, orthopedic surgery, etc.
(2) a variety of weight loss, fat, height projects;
(3) a variety of health checkups;
(4) a variety of preventive, health care treatment programs;
(5) a variety of medical consultations, medical appraisal.
(3) diagnostic and treatment equipment and medical materials.
(1) the application of positron emission tomography (PET), electron beam cT, ophthalmic excimer laser therapy and other large-scale medical equipment for the examination and treatment program;
(2) glasses, dentures, eye prostheses, prosthetic limbs, hearing aids and other rehabilitative appliances;
(3) all kinds of health care for their own use, massage, checking and treatment equipment;
(4) the provincial price of the medical materials.
(4) Provincial price departments stipulate that the disposable medical use can not be charged separately.
(4) treatment program category.
(1) all kinds of organ 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 orthopedic surgery;
(4) qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other auxiliary treatment programs.
(5) Others.
(1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program;
(2) a variety of scientific research, clinical verification of the diagnosis and treatment program.
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