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Hebei Provincial Medical Insurance Bureau Latest release Notice on the online processing of manual and sporadic reimbursement of hospitalized medical expenses at the provincial level↓↓↓
Hebei Provincial Medical Insurance Bureau on the manual and sporadic reimbursement of hospitalized medical expenses at the provincial level
Notice of Online Processing Work
All insurance units at the provincial level:
In order to continue to deepen the reform of "Internet + Government Services", vigorously promote the "online" and "mobile" of manual and sporadic reimbursement of medical expenses, and further improve the convenience of medical insurance services, will carry out manual sporadic reimbursement of hospitalized medical expenses at the provincial level from October 10, 2022, and will now notify the relevant matters as follows.
1. Scope of application
Provincial insured persons at the provincial level have completed long-term residence across provinces, temporary medical treatment across provinces, referrals and transfers, etc., and have not settled directly at designated medical institutions for medical insurance in other places, mainly including: general hospitalization, emergency hospitalization transfer, non-work accidental injury and other expenses.
2. Online processing process
(I) Personal declaration. The applicant himself (if he is unable to declare due to special circumstances, he can choose "Help others to declare" and the application will be made by others) log in to WeChat to search for the "Hebei Smart Medical Insurance" mini program and complete the registration. Click "Sporadic reimbursement declaration" in the "Business Processing" column in the homepage of the mini program to enter the sporadic reimbursement declaration page, select the "Inpatient expense reimbursement" module, fill in the declaration information and upload the information according to the operation prompts of each step. The applicant must provide his or her ID card photo (front and back), charging receipts, fee details, and diagnostic certificates at designated medical institutions. After the operation of the personal application end is completed, submit the application information to the unit end for verification and confirmation.
(II) Unit verification and confirmation. The medical insurance head of the insured unit confirms the applicant's unit information, identity information, medical information, total expense details and the invoice amount, the shooting angle (vertical and directly above) and clarity of the uploaded image data. After confirming that it is correct, click to pass, the unit-side operation is completed and uploaded to the medical insurance agency review department.
(III) Fee review and allocation. The medical insurance agency review department will conduct a preliminary review of the completeness of the uploaded materials, the angle and clarity of the photos uploaded by the insured unit from 1 to 20 every month. If the initial review is not approved, the medical insurance agency will accept it and determine that the application is successful. For successful medical expenses, the handling personnel will identify and manually enter the bills and expense details items into the national unified medical insurance information platform through OCR or enter the national unified medical insurance information platform one by one according to the name, specifications, quantity, amount, etc. The medical insurance handling personnel will review them on the national unified medical insurance information platform in accordance with the provisions of the medical insurance policy. After the review step by step, the review and settlement data will be transmitted to the fund settlement department. The fund settlement department will allocate the reimbursement expenses to the unit in accordance with the financial accounting regulations.
(IV) Query the reimbursement progress and results. After the applicant completes the application on his personal side, he can track and view the business processing progress at any time in the "Business I handled" module of the "Hebei Smart Medical Insurance" WeChat mini program homepage or the "Submitted Information" module in the "Sporadic reimbursement declaration".
3. Relevant requirements
(I) applicants. First, the applicant provides medical expenses for real and valid personal cash advances in designated medical institutions in other places; second, the applicant must ensure sufficient light when taking photos, spread the information flat on the table, and focus on the mobile phone directly above the data taken, and take pictures one by one after another; third, the medical expenses for direct medical insurance settlement in designated medical institutions (bills that have been paid by medical insurance funds or personal account funds) cannot be declared again; fourth, the applicant must not provide false reimbursement materials, once discovered, the reimbursement qualification will be cancelled, and if the circumstances are serious, they will bear corresponding legal responsibilities; fifth, after the online declaration is successful, please notify the unit in time and pass the paper information to the unit for archives and preservation.
(II) Insured unit.First, the insured unit must clarify the responsibility of the person responsible, fully understand the health status and medical information of the applicant, and do a good job in publicity and guidance of the insured persons of the unit; second, after the applicant completes the application on the personal side, the insured unit should complete the verification and confirmation of the information submitted by the applicant (identity information, medical information, photo clarity, invoice amount and fee details) within 3 working days. For medical information that is not true, incomplete submitted information, incorrect photo angle, unclear uploaded photos, inconsistent invoice amount and fee details, and indicate the reasons; third, after the reimbursement expenses are allocated to the unit, the unit should issue them to the individual as soon as possible; fourth, all paper bills, fee details and other materials reported online, the unit must properly keep them for a long time for verification.
(III) Medical insurance agency. First, after the review department receives the application information, it conducts a preliminary review of the submitted information. If the problem is found, it will be returned and the reason will be stated. The applicant or the insured unit will modify it and submit it again. If the preliminary review is passed, it is confirmed that the declaration is successful. Generally, (except for special circumstances) should complete the cost review within 20 working days and hand it over to the fund settlement department; second, after the fund settlement department receives the review and settlement information, it should complete the reimbursement of the reimbursement expenses within 10 working days and allocate it to the insured unit. Third, the review and handling department should archive and store electronic files by monthly fee details and diagnostic certificates, and the fund settlement department should archive and store electronic files by monthly fee receipts.
promotes online reimbursement of hospitalization expenses, which is another benefit measure for the people following the online reimbursement of outpatient expenses. All insured units are requested to actively cooperate and vigorously publicize and jointly do a good job in related work. In the early stage of operation, there may be incomplete uploaded information, unclear uploaded information photos, incorrect photo shooting angles, etc., which may cause OCR to not be recognized. Re-shoot and upload, which will increase personal workload. Please understand and support it, and do a good job in publicity and explanation. If you encounter problems, please communicate in time to ensure smooth and orderly operation.
Contact information: Treatment review 0311-85518173
Fund settlement 0311-85518083
Information technology 0311-66906520
Attachment: Online application operation guide
Hebei Provincial Medical Insurance Bureau
October 10, 2022
Source Hebei Provincial Medical Insurance Bureau
