Can medical insurance cards from different provinces be used interchangeably?

Legal analysis:

Medical insurance cards can be used in other places. The new medical insurance policy stipulates that medical insurance can be used nationwide. The settlement process for medical treatment in different places across provinces is three sentences: first register, select a point, and hold the card for medical treatment.

Legal basis:

"Notice of the National Medical Insurance Administration and the Ministry of Finance on Effectively Carrying Out Direct Settlement of Hospitalization Expenses for Medical Treatment in Different Places across Provinces in 2019"

1 , Strengthen publicity and training, and improve awareness of policy procedures

(1) Strengthen publicity. Enrich daily publicity content, produce publicity materials in various forms that are accessible, easy to understand, and popular with the public, and actively promote and interpret policy processes through television, newspapers, radio, the Internet, APP and other media. Continue to carry out the "five-entry" centralized publicity campaign into communities, rural areas, hospitals, employers, and stations to make it easier for migrant workers and relocated elderly people to know the policies and procedures. Carry out sample surveys in a timely manner to understand the needs of the masses and the effectiveness of policy publicity in a timely manner, and carry out targeted publicity.

(2) Carry out training. According to the progress of institutional reform and related work, we systematically design and carefully organize business training for new policies, new requirements, new staff, and new designated medical institutions. According to different training content and training objects, various methods such as going out, inviting people in, handling on-site operations, and exchanging experiences are adopted to ensure the timeliness and effectiveness of the training and effectively improve the training effect.

2. Establish a work ledger and steadily expand the coverage of cross-provincial designated hospitals

(1) Clarify goals and tasks. Before the end of 2019, we will strive to connect more than 85% of the country's third-level designated hospitals, more than 50% of the second-level designated hospitals, and more than 10% of other designated hospitals to the national off-site medical settlement system to basically meet the direct settlement needs of insured persons who are hospitalized in different places across provinces. . With the construction of a unified national medical security information platform, by the end of 2020, it will basically be possible for eligible cross-province and remote patients to be directly billed for hospitalization in all designated hospitals.

(2) Establish an expanded ledger. The medical insurance departments in each coordinating region should comprehensively sort out the specific situation of local designated hospitals. For designated hospitals that have not yet been connected to the national off-site medical settlement system, they should build a unified national medical insurance information platform based on the designated hospital's willingness to access and the medical needs of insured persons. Arrange, establish work ledgers one by one, clarify the time limit for accessing the national off-site medical settlement system, and steadily expand the coverage of cross-provincial designated hospitals. Provincial medical insurance departments organize and coordinate regions to fill in the "National Basic Medical Insurance Designated Hospital Access Work Ledger" (Appendix 1), and submit it to the National Medical Insurance Administration by fax and email before June 30.

(3) Standardize designated management. All coordinating regional medical insurance departments should comprehensively sort out whether there are discriminatory regulations in determining cross-provincial designated medical institutions, and include medical insurance designated medical institutions with different investment entities and business natures into the coverage of cross-provincial designated medical institutions according to regulations, and enjoy the same medical insurance. Policies, Administration and Services. For designated medical institutions that proactively request access to the system, they will be connected to the national off-site medical settlement system after system transformation in accordance with local policies and time limits.

(4) Maintain information well. The provincial medical insurance department is responsible for guiding all coordinating regions to dynamically maintain the information of all designated medical institutions in the national off-site medical settlement system as required to ensure that it is timely, complete, authentic and effective.

3. Standardize convenient services and continuously improve the efficiency of cross-provincial and remote medical registration registration

(1) Carry out convenient registration services. Provincial medical insurance departments are encouraged to explore and establish unified provincial filing channels to improve the efficiency of filing work. Encourage all coordinating regions to learn and promote the experience of "zero errands" and "no meetings" in registration work in some regions, and provide at least one effective and convenient registration channel for local insured persons, such as telephone, Internet, APP, etc. The provincial medical insurance department is responsible for organizing and filling in the "National Filing Management Convenient Service Work Ledger" (Appendix 2), and reporting it to the National Medical Insurance Administration by fax and email before June 30.

(2) Explore simplification of filing management. Provincial medical insurance departments should focus on the needs of the floating population and the elderly who move with them, explore further simplification of filing types, filing conditions, and application materials, and optimize and simplify the filing procedures based on local actual conditions. Encourage the province to unify the registration policy for out-of-town hospitalization.

(3) Accelerate system integration. Provinces that have not yet integrated the urban and rural residents’ medical insurance systems must accelerate the integration of urban residents’ medical insurance and the new rural cooperative medical system, and implement a unified cross-provincial and remote medical management and service system as soon as possible.

Regions that still use the national New Rural Cooperative Medical Care Inter-provincial Medical Settlement Information System should simplify the New Rural Cooperative Medical Care application materials, optimize the referral process, and make it more convenient for people to seek medical treatment.

4. Set a clear time limit to ensure that settlement funds are allocated in full and on time

(1) Allocate settlement funds on time. Provincial medical insurance departments must do a good job of daily reconciliation with the national off-site medical settlement system to ensure that the data is consistent. If the direct settlement expenses for cross-provincial medical treatment declared by designated medical institutions across provinces are correct and verified by the medical insurance agency at the place of treatment and the application is made for national unified liquidation, in principle, the settlement with the designated medical institution must be completed before the date of the next liquidation signature. In case of special circumstances, the provincial medical insurance department must promptly report to the National Medical Insurance Administration. Encourage medical treatment areas to use prepayments to settle with designated medical institutions first, and then initiate inter-provincial liquidation applications. On the basis of ensuring timely payment collection by designated medical institutions, the payment cycle should be shortened as much as possible.

(2) Allocate advance payment and liquidation funds on time. Provincial medical insurance departments and financial departments in insured places must implement the "Notice of the Ministry of Human Resources and Social Security and the Ministry of Finance on the Direct Settlement of Hospitalization Expenses for Inter-Provincial Medical Insurance in Different Places for Basic Medical Insurance" (Ministry of Human Resources and Social Security [2016] No. 120) On the basis of stipulating fund disbursement conditions and processing time limit requirements, further optimize the fund collection and disbursement process and improve the efficiency of fund disbursement. In principle, the current liquidation funds must be disbursed to the provincial fiscal account at the place of medical treatment before the next liquidation signature date. . In case of special circumstances, provincial medical insurance departments must report to the National Medical Insurance Administration in a timely manner. Medical insurance and financial departments at all levels must work together to further simplify and optimize the approval procedures, strengthen information sharing, ensure timely upward collection of prepaid and liquidated funds for medical treatment in other places, and do a good job in account management to ensure that accounts are consistent and accounts are consistent.

(3) Standardize the management of advance payments. To standardize the management of annual prepayments, before the end of January each year, the National Medical Insurance Administration will determine the amount of annual prepayments based on twice the monthly average of settlement funds in the fourth quarter of the previous year. Standardize the emergency increase process. When each period of national liquidation is unified and signed, if the current liquidation funds account for more than 90% of the prepayment, the provincial medical insurance department in the place where you seek medical treatment can initiate the emergency increase process of the prepayment. The upper limit of the increase amount is the current monthly liquidation fund. The difference between the two times and the annual prepayment shall be fully disbursed by the provincial medical insurance department and financial department in the insured area within the prescribed time limit after being reviewed and confirmed by the National Medical Insurance Bureau.

(4) Improve the efficiency of payment collection. Medical insurance departments in provinces that have not yet integrated the urban and rural residents’ medical insurance systems should further simplify the list of materials for designated medical institutions to apply for reimbursement. The cost review is based on the provincial-level off-site medical settlement information system. The new rural cooperative medical settlement funds for cross-provincial and remote medical treatment must be allocated on time in accordance with the requirements of the agreement.

5. Improve the settlement system to ensure the smooth and efficient operation of various businesses

(1) Establish a national coordination mechanism. Optimize the business collaborative management module of the national off-site medical settlement system, and explore the establishment of a collaborative problem-solving working mechanism, a national expense verification mechanism, and a cross-coordinating regional insurance information comparison and verification mechanism. Provincial medical insurance departments should organize the coordinating regions under the jurisdiction of the province to collaboratively handle issues such as off-site settlement policies, business, finance, and information as required.

(2) Improve the system supervision function. Upgrade and improve the intelligent monitoring system at the place of medical treatment, combined with the requirements of combating fraud and fraudulent insurance, include all medical personnel in different places across provinces within the scope of local medical insurance supervision, and achieve full coverage of cost review. Actively promote national and provincial-level platforms to carry out intelligent monitoring of direct settlement of medical expenses across provinces and in different places.

(3) Continue to promote “one-stop” settlement. Strengthen departmental coordination, promote data sharing, and accelerate the "one-stop" settlement of hospital expenses for cross-provincial and remote medical treatment such as basic medical insurance, critical illness insurance, and urban and rural medical assistance. Provincial medical insurance departments should identify key relief recipients and registered poor people, establish special management accounts for poor people, and provide data tracking and settlement services.

6. Actively, steadily and orderly explore and promote the direct settlement of inter-provincial outpatient fees

The Yangtze River Delta region must comprehensively promote the direct settlement of inter-provincial outpatient fees in a steady and orderly manner and improve Policies are standardized, follow-up evaluations are carried out, and difficulties and problems that arise during the advancement of work are properly resolved. Qualified regions such as Beijing-Tianjin-Hebei can explore pilot projects for direct settlement of outpatient medical expenses across provinces and in different places.

7. Strengthen organizational leadership and continuously improve the people’s sense of gain

(1) Strengthen organizational leadership. Medical insurance departments at all levels must fully understand the importance, arduousness and long-term nature of direct settlement of cross-provincial medical treatment in different places, further raise awareness, strengthen leadership, and clarify responsibilities.

This work should be included as a priority, adhere to goal orientation and problem orientation, strengthen work scheduling, effectively open up the "last mile" of policy implementation, and ensure that all policy requirements are implemented in place.

(2) Effectively change the style of work. All coordinating regional medical insurance agencies must implement the people-centered service concept, be concerned about the needs of the people, think about what the people think, provide various services with sincerity, patience and care, take the people's satisfaction as the standard, and promptly and properly solve the problem of people seeking medical treatment in other places. various problems that arise during the process. If there are any changes to the consultation telephone numbers in each coordinating region, they must be reported to the National Medical Insurance Bureau for filing as soon as possible, and the National Medical Insurance Bureau will update them when it is released regularly and authoritatively. It is necessary to implement the "first inquiry responsibility system" and the "one-time notification system", strengthen consultation services, and proactively and enthusiastically respond to public concerns about filing, settlement and other policy and process issues.