AG真人国际厅官网

索  引  号 MB1846817/2020-00099 分        类 经办AG真人国际厅官网  
发布机构 江苏省医疗保障局 发文日期 2019-11-11
标        题 江苏省医疗保障局关于印发《江苏省医疗保障经办AG真人国际厅官网规范(试行)》的通知
文        号 苏医保发〔2020〕101号
时        效

jiangsushengyiliaobaozhangjuguanyuyinfa《jiangsushengyiliaobaozhangjingbanagzhenrenguojitingguanwangguifan(shixing)》detongzhi

geshequshiyiliaobaozhangju:

weiguancheluoshi《zhonggongzhongyangguowuyuanguanyushenhuayiliaobaozhangzhidugaigedeyijian》(zhongfa〔2020〕5hao),quanmiantuijingonggongagzhenrenguojitingguanwangguifanhua、biaozhunhua、xinxihua、yitihua“sihuaagzhenrenguojitingguanwang”,genghaodiweiguangdarenminqunzhongtigongbianjiegaoxiaodeyiliaobaozhangagzhenrenguojitingguanwang,xianjiang《jiangsushengyiliaobaozhangjingbanagzhenrenguojitingguanwangguifan(shixing)》yinfajinimen,qingrenzhenguanchezhixing。

jiangsushengyiliaobaozhangju

2020nian11yue11ri


江苏省医疗保障经办AG真人国际厅官网规范

(shixing)

第一章  总   则

AG真人国际厅官网diyitiao weijiaqiangquanshengyiliaobaozhangyewujingbanzhilinengliagzhenrenguojitingguanwang,tishengjingbanagzhenrenguojitingguanwangzhilianghexiaoneng,yiju《zhonghuarenmingongheguoshehuibaoxianfa》dengyouguanfalv、faguijizhengceguiding,zhidingbenguifan。

diertiao benguifanshiyongyujiangsushengxingzhengquyuneigejiyiliaobaozhangjingbanjigou(yixiajiancheng“yibaojingbanjigou”)chengdandezhigongjibenyiliaobaoxian(hanhebingshishideshengyubaoxian,yixiatongcheng“zhigongyibao”)、chengxiangjuminjibenyiliaobaoxian(yixiajiancheng“juminyibao”)、yiliaojiuzhudengyewujingbangongzuo。

disantiao yiliaobaozhangjingbanagzhenrenguojitingguanwangshixiangzhuyaobaokuojibenyiliaobaoxiancanbaohebiangengdengji、jiaofeijishushenbao、xinxichaxunhegerenzhanghuyicixingzhiqu、yibaoguanxizhuanyijiexu、yidijiuyibeian、menzhenmantebingbingzhongdaiyurending、yiliaofeiyongshougong(lingxing)baoxiao、shengyubaoxiandaiyuhezhunzhifu、yiliaojiuzhuduixiangdaiyuhezhunzhifu、yiyaojigoushenqingdingdianxieyiguanlihefeiyongjiesuandeng。

disitiao yiliaobaozhangjingbanagzhenrenguojitingguanwangjianchichengxiangtongchou、shijitongchouyuanze,luoshishudicanbao、tongshoutongzhi、fenjiguanliyaoqiu,zunxunguifanhua、biaozhunhua、xinxihua、yitihuaagzhenrenguojitingguanwangfangxiang,tuijinjibenzhengce、daiyubiaozhun、jijinguanli、jingbanguanli、dingdianguanli、xinxixitongdeng“liutongyi”。

第二章  基本AG真人国际厅官网通则

diwutiao yibaojingbanjigoushixingquanshengtongyideyiliaobaozhangjingbanzhengwuagzhenrenguojitingguanwangshixiangqingdanguanli,zhixingtongyidezhengwuagzhenrenguojitingguanwangshixiangqingdan、banshizhinan、jingbanguicheng、agzhenrenguojitingguanwangbiaozhunheyewuliucheng。

AG真人国际厅官网diliutiao yibaojingbanjigouquanmianshishi“qiantaizongheshouli,houtaifenleibanli,chuangkoutongyichujian”dezonghejuyuanzhiagzhenrenguojitingguanwangmoshi。

yibaojingbanjigouyingdangjiaqiangbangongchangsuoheagzhenrenguojitingguanwangchuangkoushezhiguanli,tongyishiyongyibaobiaoshi,heliguihua、kexueliyongjingbangonggongagzhenrenguojitingguanwangziyuan。

yibaojingbanjigouyingdangjianquanwanshanwenmingbangong、youzhiagzhenrenguojitingguanwang、“haochaping”gexiangzhidu,tigao“yishiban”“yichuangban”xiaolv,kaizhanrongqueshouli、yuyueshoulidengchuangxinagzhenrenguojitingguanwang。

diqitiao yibaojingbanjigouyituojiangsuyibaoyunagzhenrenguojitingguanwangpingtaidengzhinenghuapingtai,tuozhanwangshangban、zhangshangban、zhongduanzizhubandengfeixianchangbanliqudao,luoshi“bujianmian”banli。

dibatiao yibaojingbanjigouzaiyiliaobaozhangxingzhengbumenxiediaoxia,lianxixiangguanzhinengbumen、danwei,genjuzhizefengong,jiaqiangshujuxinxigongxiang,tuijinliandongxietongbanli,gongtongkaizhanyiliaobaozhangxiangguanyewu。

AG真人国际厅官网dijiutiao shequshi、xian(shi、qu)yibaojingbanjigouzhidaohuoweituoxiangguanjicengagzhenrenguojitingguanwangwangdianhuodaibanjigoudengkaizhanzhengcexuanchuan、canbaodengji、xinxicaijibiangeng、shenbanyewushoulidengrichangagzhenrenguojitingguanwang,zhubushixianxiangzhen(jiedao)、cun(shequ)yibaoagzhenrenguojitingguanwangquanfugai。

第三章  具体业务规范

dishitiao yibaojingbanjigouyifatuijinyongrendanweihegerencanjiazhigongyibao,luoshishudiguanliyaoqiu,zuzhikaizhancanbaokuomiangongzuo。

AG真人国际厅官网zaicanbaokuomianshi,yingdangpandingcanbaorencanbaozhuangtaijilu,bimianzhongfucanbao。

dishiyitiao yibaojingbanjigouweiyongrendanweijiqizhigongbanlizhigongyibaocanbaodengjishouxu。

laowupaiqiandanweikuadiqupaiqianlaodongzhede,yonggongdanweisuozaidiyibaojingbanjigouyingdangweiqibanlicanbaodengji。kuatongchouqu、liudongxingdadesheng、bushuqishiyedanweijiqizhigongdeng,youqizhuguanbumenquerendecanbaodiyibaojingbanjigou,yixiangduijizhongdefangshibanlizhigongyibaocanbaodengji。

AG真人国际厅官网dishiertiao yibaojingbanjigouyingdangtigongbianlitiaojian,weilinghuojiuyerenyuandengcanjiazhigongyibaozuohaocanbaodengjiagzhenrenguojitingguanwang。   

dishisantiao yibaojingbanjigouyingdanganzhaojuminyibaozhengceguiding,zuohaozhigongyibaoyiwaideqitageleichengxiangjumincanbaogongzuo。

AG真人国际厅官网dishisitiao yibaojingbanjigouyingdanggenjuxiangguancailiao,duicanbaodanweihecanbaorendecanbaozhuangtai、canbaoleixingjijichuxinxidengfashengbianhuade,jishijinxingshenhebiangeng,bingzuohaodaiyuxianjie、canbaonianxianjisuan、daiyuzhongzhihezhuxiaodengyewu。

dishiwutiao canbaorenkuaquyuliudongjiuyeshi,yibaojingbanjigouyingdangjishizuohaoyibaoguanxizhuanyijiexugongzuo。

dishiliutiao yibaojingbanjigouyingdangjishishoulicanbaodanweishenbaodedanweihezhigongjiaofeixinxi,duiyongrendanweishenbaodecanbaorenshu、jiaofeijishudengjinxingshenhe。

AG真人国际厅官网dishiqitiao yibaojingbanjigouyingdangluoshikunnanrenyuancanbaojiaofeibuzhuzhengce,anzhizezuohaocanbaoxinxidengji、xitongshenfenbiaoshihedongtaiweihuguanli,quebaokunnanrenqunyingbaojinbao。

dishibatiao shequshiyibaojingbanjigouyingdanggenjuyiliaobaozhangxingzhengbumenzhidingdezigeshenqingtiaojian,zhidingtongyidedingdianshenqingshoulizhidu。

yibaojingbanjigouyingdanganzhaoshudiguanliyuanze,jishishouliyiliaojigou、lingshouyaodiandengnaruyibaodingdianxieyiguanlideshenqing。

dishijiutiao shequshiyibaojingbanjigouyingdangpeihetongjiyiliaobaozhangxingzhengbumenzhidingyiliaojigou、lingshouyaodianpingguguize、biaozhun、liucheng,bingxiangshehuigongkai。

AG真人国际厅官网yibaojingbanjigoutongguoxianchangkaocha、zhuanjiapingshen、disanfangpinggudengtujing,tongyizuzhihuoshouquanweituofangshianshudiyuanzekaizhandingdianyiyaojigoudingdianpinggugongzuo。

diershitiao yibaojingbanjigoujianlicanbaorenyibaomenzhenmantebingbingzhongdaiyudengjibeianzhidu,weituodingdianyiliaojigoubanlicanbaorenmenmanmentedaiyurendingshenqing。yibaojingbanjigouanguidingduidingdianyiliaojigoubanliqingkuangjinxingjihe。

AG真人国际厅官网diershiyitiao yibaojingbanjigouanguidingweicanbaorenbanliyibaoteyaodaiyurendingbeian,bingzuzhixiangguandingdianyiyaojigouweiteyaodaiyurenyuantigongagzhenrenguojitingguanwang。

AG真人国际厅官网diershiertiao yibaojingbanjigouyingdanganzhao《jiangsushengyidijiuyijingbanagzhenrenguojitingguanwangguicheng》dengyouguanguidingweicanbaorenbanliyidijiuyibeiandengyewu。

diershisantiao yinxinxixitongguzhangdengyuanyinweinengshixianzhijiejiesuandegerendianfudeyiliaofeiyong,keyoucanbaodiyibaojingbanjigouanguidingjiyubaoxiao。

yinjizhen、qiangjiuzaifeidingdianyiliaojigoufashengdegerendianfudeyiliaofeiyong,canbaodiyibaojingbanjigouyingdangzaiguidingshijianneijiyubaoxiao。

diershisitiao yibaojingbanjigouyingdangjianlicanbaodengji、jiaonafeiyong、gerenzhanghuhuabo、jiuyigouyao、daiyuzhifudenggerenquanyixinxishujuku,bingzuohaogerenquanyixinxideguanliyuweihu。

AG真人国际厅官网diershiwutiao yibaojingbanjigouyingdangtigongjibenyiliaobaoxiangerenquanyijiluchaxunagzhenrenguojitingguanwang,binganguidingtigongquanyijiluzhengming。

AG真人国际厅官网diershiliutiao yibaojingbanjigouyingdangliyongxinxihuashouduan,jianliduoxingshi、quanfangweidechaxunagzhenrenguojitingguanwangpingtai,tongguojicengagzhenrenguojitingguanwangzhongduan、hulianwanghuoyidongtongxunpingtaidengfangshi,weicanbaorentigongfangbiankuaijiedechaxunagzhenrenguojitingguanwang。

第四章  配套保障措施

diershiqitiao yibaojingbanjigouyingdanganzhao《danganfa》heguojiajishengyibaoyewudanganguanliyaoqiu,jianlijianquandanganguanliguizhangzhidu,zuohaoyibaoyewudanganguanligongzuo。

diershibatiao yibaojingbanjigouyingdangdingqizuzhigonggongagzhenrenguojitingguanwangzhuanxiangpingjia,chongfenliyongyibaoagzhenrenguojitingguanwangshuju,kaizhanqunzhongmanyiducepingjiagzhenrenguojitingguanwangjixiaofenxigongzuo,jiaqiangjianceyuce。

AG真人国际厅官网diershijiutiao yibaojingbanjigouyingdangjianlijianquanyewu、caiwu、anquanhefengxianjineibujianduguanlizhidu,wanshanjingbancaozuodeheguixing、zhunquexing,guifanneibuzhinengbumenjiqigongzuorenyuanjingbanxingwei,kaizhanjingbanyewufengxianpaichaheneibukongzhijianchapinggugongzuo,jianliwanshanyunzuoguifan、guanlikexue、jiankongyouxiao、kaopingyange、jiucuoyoulideneibukongzhitixi。

AG真人国际厅官网disanshitiao sheng、shequshiyibaojingbanjigoucanyuyibaoxinxixitongagzhenrenguojitingguanwangzongtiguihua,jieheyewufazhanqingkuang,wanshanyibaojingbanxinxixitonggongneng,youxiaofugaisuoyouyewuhuanjieheliucheng。

disanshiyitiao yibaojingbanjigouyingdangzaiyiliaobaozhangxingzhengbumenxiediaoxia,wanshanyibaoxinxiku,tuiguangyingyongquanguotongyideyibaoxinxiyewubiaozhunbianma,jianlijianquanxinxijiaohuanjizhi,shixianxinxishujugongxiang。

AG真人国际厅官网yibaojingbanjigouyingdangchongfenliyongxinxixitongkaizhanshujudecaiji、shenhe、zhuanhuanyijishujuzhiliangjiancha,binganguidingshangbaojiaohuankushuju。

AG真人国际厅官网disanshiertiao yibaojingbanjigouyingdangchongfenjiezhuxiandaixinxijishushouduan,fahui“hulianwang+”youshi,qianghuatongyideyunpingtaiagzhenrenguojitingguanwang,shixiangaoxiaobianjiebanli。

AG真人国际厅官网disanshisantiao yibaojingbanjigouyingdangjiaqiangyibaojingbanlingyuanquanguanli,jianquananquanguanlizerenzhi,fangfanxitongxingfengxian。

第五章  附    则

disanshisitiao benguifanyoujiangsushengyiliaobaozhangjufuzejieshi。

AG真人国际厅官网disanshiwutiao benguifanzi2020nian12yue1riqishixing。

AG真人国际厅官网1

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