National Health Insurance Administration: monitor the whole process of the use of medical insurance funds

2022-05-25 0 By

China New Finance and Economics on April 8, the National Healthcare Security Administration recently issued the “Medical security fund intelligent audit and monitoring knowledge base, rule base management Measures (trial)”.It is clear that the medical security department relies on the “Two banks” to monitor the whole process of the use of medical security funds by various supervised objects in various scenarios.In the two databases, the knowledge base is the collection of knowledge and basis needed for the intelligent audit and monitoring of medical security fund.Rule base is a collection of logic, parameter index, reference threshold and judgment level to judge the legality, compliance and rationality of related behaviors of supervised objects based on knowledge base.According to the Measures (Trial), medical security agencies use the “two banks” to carry out business management activities such as reminders in advance, payment review, agreement assessment and audit of medical insurance expense settlement.Medical security administrative departments and institutions engaged in medical insurance administrative law enforcement use “Two Banks” to assist in medical insurance administrative supervision and law enforcement related activities.Encourage designated medical institutions to use “two databases” to strengthen internal management and standardize medical service behavior.The measures (Trial) stipulates that provincial and prefecture-level medical security departments should establish and improve their internal management mechanisms and formulate procedures for handling suspicious information.The handling procedures shall include preliminary examination, review, complaints from supervised objects, investigation and verification, violation handling and other links, and reasonable handling time shall be set for each link.Medical security departments, third-party technical information service institutions and their staff shall strictly regulate data management and application in the construction and management of the “Two databases”, conscientiously fulfill confidentiality obligations, and shall not provide, copy, publish, sell or trade data in disguised form to any organization or individual to ensure data information security.(End) Declaration: This article copyright belongs to the original author, if there is a source error or infringement of your legitimate rights and interests, you can contact us through email, we will promptly deal with.Email address: