Direct settlement of medical insurance in different places in Liaoning Province

Liaoning issued the Administrative Measures for Medical Insurance Settlement in Different Places in Liaoning Province (2022 Edition) (hereinafter referred to as the new measures), which will be implemented in the whole province on June 5438+ 10/day, 2023.

After the implementation of the new measures, when the medical insurance participants in the whole province settle medical expenses in different places, they only need to bear the part that the individual should pay, and other compliant medical expenses will be settled by the medical treatment agency.

Today's headline copyright map

Medical insurance settlement in different places is no longer "advanced"

Wang Dawei, director of the Medical Service Management Office of Liaoning Medical Insurance Bureau, said that promoting direct settlement of medical insurance in different places is an important reform measure to adapt to population mobility, improve medical insurance services and solve people's concerns. At present, Liaoning covers more than 2,000 hospitals and 1 0,000 pharmacies, and at least1designated hospitals in each county can provide inter-provincial direct settlement services for inpatient, general outpatient and outpatient chronic diseases and special diseases, and constantly promote the settlement services for medical treatment in different places to improve quality and efficiency and enhance the sense of acquisition of insured people.

The direct settlement of medical treatment in different places implements the "catalogue of medical treatment places, treatment of insured places and management of medical treatment places". The scope of direct settlement includes basic medical insurance pooling fund and personal account, maternity insurance, large medical expenses subsidy for employees, serious illness insurance for urban and rural residents, medical assistance for civil servants, urban and rural medical assistance and commercial health insurance.

When the insured person settles the medical expenses for medical treatment in different places, he only needs to bear the part that the individual should pay, and other compliant medical expenses shall be settled by the agency of the medical treatment place.

Eight aspects benefit the insured in the province.

Wang Dawei introduced that after the implementation of the new measures, it will bring eight advantages for the insured people in the province to seek medical treatment in different places:

Improvement of settlement treatment for medical treatment in different places

Compared with the past, this new method has also changed greatly for the settlement treatment of medical treatment in different places that residents in the province are concerned about.

Keep the treatment unchanged:

Long-term residents seek medical treatment in different places, college students who participate in medical insurance for urban and rural residents are hospitalized in different places, and female employees are hospitalized in the province. , and implement the local medical standards of the insured area.

Appropriate downward adjustment of treatment:

According to the standards of designated medical institutions at the same level in the insured area, the treatment standards of temporary medical personnel are appropriately reduced by raising the minimum payment standard and reducing the reimbursement ratio. Among them, the proportion of reimbursement for off-site referral and emergency rescue decreased by no more than 10 percentage point, which was 5 percentage points higher than before, and the proportion of reimbursement for non-emergency and non-temporary medical treatment decreased by no more than 20 percentage points, which was 10 percentage point higher than before; In areas included in the category of temporary medical records, the proportion of reimbursement for temporary medical treatment will be reduced by no more than 10 percentage point.

Open two-way direct settlement for long-term residents:

After the insured submits the proof materials of long-term residence records, they can be hospitalized and settled directly in the designated medical institutions connected to the insured place and the medical treatment place, and all the local medical treatment standards of the insured place are implemented.

Broaden the designated point of inter-provincial direct settlement of outpatient expenses

After the general outpatient and outpatient chronic special diseases are filed in different places, the designated medical institutions connected in different places can enjoy direct settlement service, and there is no limit to the number of designated places.

In addition, the new method also unified the processing time limit. If the long-term residence takes effect, it may not be changed or cancelled within 6 months; Referral filing is valid for 6 months, and there is no limit to the number of direct medical settlements within the validity period; Commitment to the supplementary system for the record, commitment to supplementary materials agreed time limit of 6 months.

Please see here for the specific operation.

Question 1: how to fully open the two-way direct settlement service for medical treatment in long-term residents' insured places? What are the benefits to the insured?

Wang Dawei introduced that in the past, according to relevant regulations, long-term residents could only enjoy the direct settlement service at the place where they went to see a doctor, but could not enjoy the direct settlement service at the place where they were insured, or they needed to make direct settlement according to the reduced treatment of going out for medical treatment temporarily. Some "migrant-bird" elderly people who travel to and from the insured place and the medical treatment place every six months need to cancel or apply for medical treatment in different places once every six months in order to realize direct settlement at the insured place and the medical treatment place according to local treatment standards.

After the two-way direct settlement service for medical treatment is opened in the places where long-term residents are insured, these elderly people can apply for filing at one time, that is, they can enjoy the direct settlement service between the two places according to the local treatment standards of the insured places.

Specifically, the insured can enjoy it directly by providing relevant materials for the record in accordance with relevant regulations, without other special procedures.

It should be noted that if long-term residents are put on record in the form of commitment supplement, relevant materials need to be provided according to the commitment, so as to realize the two-way opening of the insured place and the medical place.

Question 2: What is the difference between automatic filing for temporary medical treatment in different places and long-term residence filing?

Wang Dawei introduced that the new method is clear: "Temporary medical personnel who are hospitalized in designated medical institutions connected to medical treatment in different places shall be appropriately reduced according to the treatment standard of designated medical institutions at the same level in the insured place, and the increase of Qifubiaozhun shall not exceed times", and "the reduction of temporary medical payment for non-emergency patients without referral shall not exceed 20 percentage points".

Automatic filing service is aimed at the insured who need temporary medical treatment and enjoy direct settlement service according to the standard of temporary medical treatment without emergency and referral. Compared with the local long-term residents' medical treatment standard, the corresponding treatment level will decline.

Therefore, it is suggested that the insured who meets the conditions of long-term residents should be put on record according to the regulations.