Strategies for cross-provincial direct settlement of outpatient chronic diseases

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Up to now, on the basis of the full coverage of general outpatient expenses across provinces and direct settlement of coordination areas, all coordination areas have opened hypertension, diabetes, malignant tumor outpatient radiotherapy and chemotherapy, uremia dialysis, anti-rejection treatment after organ transplantation, etc. 5 Cross-provincial direct settlement service for treatment expenses related to chronic and special diseases in outpatient clinics.

How do I know if I am entitled to outpatient treatment for chronic and special diseases? Which institutions can settle directly? How to do direct settlement in the hospital… The National Medical Insurance Administration responded to the public on hot issues related to direct settlement of outpatient chronic diseases across provinces.

How do I know if I am entitled to relevant treatment?

Whether you can enjoy outpatient chronic and special disease treatment, the insured person needs to be certified for outpatient chronic and special disease qualifications in accordance with the regulations of the insured place.

After the insured person completes the record for medical treatment in other places, he can log in to the App of the National Medical Insurance Service Platform, click “More inquiries about medical treatment in other places” under the query service in the “Record Recording in Other Places” service area, and select “Special Eligibility for Out-of-House Medicine” to inquire about his outpatient clinics. Information on eligibility for chronic and special diseases, and information on designated medical institutions selected in accordance with the requirements of the participating places.

Picture from the official website of the National Medical Insurance Administration.

How can I check whether the relevant services have been opened in the insured area?

The insured should take the initiative to understand the policy of inter-provincial direct settlement of treatment expenses related to chronic and special diseases in outpatient clinics in the insured area, which will help the insured to better enjoy related services.

At present, the coordinating regions that have opened the direct settlement service have prepared a notification letter for direct settlement of outpatient chronic diseases related treatment expenses across provinces. The insured person can log on to the app of the national medical insurance service platform, click “More inquiries about medical treatment in other places” under the inquiry service in the “recording in other places” service area, and select “notice of outpatient chronic special diseases” to learn about outpatient chronic special diseases in the insured place. The policy and process of inter-provincial direct settlement of treatment expenses, etc.

Which medical institutions can directly settle accounts across provinces?

At present, all regions are orderly expanding the scope of designated medical institutions for outpatient chronic special disease expenses across provinces.

Before seeking medical treatment, the insured person needs to first inquire about the opening status of outpatient chronic and special disease settlement of designated medical institutions at the place of medical treatment. You can log in to the App of the National Medical Insurance Service Platform, and in the “Remote Filing” service area, click “Remote Networking Designated Medical Institution Query” under the query service “, select the place of medical treatment, enter the name of the designated medical institution, and query the opening status of the outpatient chronic and special disease settlement of the designated medical institution and the supported diseases; you can also click “More Screening”, select the outpatient chronic and special disease in the “opening category”, and query The expenses for outpatient chronic special diseases opened at the place of medical treatment are cross-provincial network designated medical institutions.

Picture from the official website of the National Medical Insurance Administration.

How can I settle directly at the hospital?

When the insured person presents the medical insurance electronic voucher or social security card to the designated medical institution that has opened the direct settlement service for outpatient chronic special diseases, he needs to actively inform the insured person’s identity and enjoyment of cross-provincial medical treatment in the process of outpatient registration, medical treatment, settlement, etc. Qualifications for outpatient chronic special diseases.

Designated medical institutions need to inquire and obtain outpatient chronic disease qualification information, so as to facilitate doctors to provide reasonable diagnosis and treatment services. Doctors will treat specific diseases in accordance with the management requirements of the place of medical treatment. The insured person will settle the settlement with the electronic medical insurance certificate or social security card at the settlement window. Other medical expenses that are not related to outpatient treatment of chronic and special diseases will be settled separately according to ordinary outpatient expenses and treatment expenses related to outpatient chronic and special diseases.

Which outpatient expenses cannot be directly settled temporarily? what to do?

Considering the different reimbursement levels for general outpatient clinics and outpatient clinics for chronic special diseases, in order to avoid affecting the treatment level of insured persons and reduce the transactional burden of repeated refunds and settlements in designated medical institutions, the following two situations still require the insured person to return to the insured place to manually to reimburse:

First, if the designated medical institution for medical treatment has not opened the inter-provincial direct settlement service for outpatient chronic and special disease-related treatment expenses, all outpatient chronic and special disease-related treatment expenses cannot be directly settled across provinces. Be careful not to settle directly across provinces according to ordinary outpatient expenses. According to the regulations of the insured place, after the full settlement at the designated medical institutions at their own expense, return to the insured place for manual reimbursement.

Second, if the designated medical institution for medical treatment has opened inter-provincial direct settlement of outpatient chronic special disease related treatment expenses, but the outpatient chronic special disease of the insured person does not belong to hypertension, diabetes, malignant tumor outpatient radiotherapy and chemotherapy, uremia dialysis, organ transplantation After postoperative anti-rejection treatment, the medical expenses incurred cannot be directly settled across provinces for the treatment expenses related to outpatient chronic special diseases. The insured should not directly settle the expenses of ordinary outpatient services across provinces. They need to settle the full amount at their own expenses at designated medical institutions according to the regulations of the insured place, and then return to the insured place for manual reimbursement.

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