National Health Insurance Bureau: 27 provinces to carry out outpatient fees cross-provincial direct settlement trial operation

On February 1, the State Health Insurance Administration announced that 15 provinces and regions, including Shanxi and Inner Mongolia, would be added as pilot projects for direct settlement of general outpatient expenses across provinces.
, 27 provinces (districts and cities) have carried out cross-provincial direct settlement trial operation of general outpatient expenses (excluding outpatient chronic diseases).
The new pilot projects include a total of 15 provinces and regions in Shanxi, Inner Mongolia, Liaoning, Jilin, Heilongjiang, Fujian, Jiangxi, Shandong, Hubei, Guangxi, Hainan, Shaanxi, Ningxia, Qinghai and Xinjiang.
2018, the Yangtze River Delta, Beijing,Tianjin-Hebei, and five provinces in the southwest have carried out pilot projects for direct settlement of general outpatient expenses in the region.
By the end of 2020, all co-ordination areas in Beijing, Tianjin, Hebei, Shanghai, Jiangsu, Zhejiang, Anhui, Chongqing and Yunnan, as well as some co-ordination areas in Sichuan, Guizhou and Tibet, have opened more than 10,000 direct settlement medical institutions and fixed-point retail pharmacies across provinces, with a cumulative total of more than 3 million direct settlements.
it is understood that the basic medical insurance has been handled cross-provincial hospital medical expenses direct settlement of the record personnel, the simultaneous opening of general outpatient expenses direct settlement services, without the need for additional records.
Other persons who have the need for general outpatient medical treatment in different places may, in accordance with the requirements of the management of medical treatment in different places of the insured places, file for medical treatment in different places, and when seeking medical treatment in the pilot fixed-point medical institutions in the above-mentioned pilot areas, they may settle directly in accordance with the provisions.
Addition, the scope of payment and relevant provisions (the scope of payment for basic medical insurance drugs, medical services and medical supplies, etc.) shall be implemented in principle for the direct settlement of outpatient expenses by medical personnel from different provinces and regions.
the provisions of the insured area shall be implemented in accordance with the reimbursement policies of the basic medical insurance fund, such as the starting standard, the proportion of payment and the maximum payment limit.
according to the introduction, the national medical insurance service platform APP to provide off-site medical records function, 22 provinces, 170 co-ordination area insured people can rely on the national unified online filing channels for filing, at the same time, online access to the opening of general outpatient pilot co-ordination areas and fixed-point pharmaceutical institutions.
in order to protect the rights and interests of the insured personnel, the original reimbursement channels are retained for the direct settlement of unsuccessful expenses during the trial run.