for reimbursement of outpatient service, hospitalization and observation, the data of bills need to be uploaded through the data collection enterprise edition, and handwritten bills for drug expenses are no longer accepted. Insured units can download software and patches in www.bjld.gov.cn

, and the hotline is 9612.

moderator: login user name: admin

password: 1; Open the data acquisition module, enter "data exchange" → "medical basic data import", and import the personal information of the unit medical basic data exported from the social security center into the system; Open the manual reimbursement module, enter View → Medical Insurance Contact Management, and fill in relevant information.

entry of uploaded bills: open the uploaded information management, and select Upload Clinic for entry. Operating steps: enter ID number-query-add-enter bill document number (14-digit barcode number or invoice number), enter bill total amount

and save. Tick "√" in the cost of medical treatment project to summarize and enter the medical treatment fee and medical service fee. After all the bills are entered in turn, click Generate Audit Form and print one. Note: For-profit hospital bill number is 18 digits. Input method: information code+invoice number.

pharmacy purchases, ambulance charges and off-site outpatient charges are entered from the "medical expenses entry" window, and made into manual documents. The entry method is the same as uploading documents.

data offer: upload data offer: open the uploaded fee information management, select to generate an uploaded fee offer file, click "offer" to save the file on a USB flash drive, and print a list at the same time. The manual offer file is formed according to the method of uploading files.

3. What is the proportion of medical reimbursement?

proportion of reimbursement for hospitalization expenses of basic medical care for urban workers: within one year, the minimum payment for the first hospitalization is 1,3 yuan, followed by 65 yuan, where the overall payment period of basic medical insurance is 1, yuan and the large payment period is 2, yuan, that is, the reimbursement ceiling line is 3, yuan. Basic on-the-job reimbursement is 85%-97%, with a large amount of 85%; Retirement 91%-98%, 9% in large amount.

reimbursement ratio of outpatient (emergency) consultation expenses for urban employees' basic medical insurance:

For outpatient (emergency) consultation expenses that meet the requirements of basic medical insurance, within one year, the minimum threshold for on-the-job employees is 1,8 yuan, the minimum threshold for retired employees is 1,3 yuan, and the reimbursement ratio above the minimum threshold is shown in the table below, and the reimbursement ceiling is 2, yuan. Reimbursement ratio: 7% in the job, 85% under 7 years old after retirement, and 9% over 7 years old (inclusive).

proportion of reimbursement for hospitalization expenses of basic medical insurance for urban residents

Basic medical insurance for urban residents includes three groups: urban elderly, students and children, and unemployed residents.

The hospitalization expenses incurred by students and children that meet the requirements of the basic medical insurance and serious illness medical insurance for students and children are included in the scope of payment, and the qifubiaozhun for the first and subsequent hospitalization is 65 yuan.

The hospitalization expenses incurred by the urban elderly and unemployed residents that meet the requirements of the basic medical insurance in this city are included in the payment scope, and the minimum payment standard for the first hospitalization is 1,3 yuan; The qifubiaozhun for the second and subsequent hospitalization is 65 yuan.

7% of the part above the threshold for the three categories of people will be paid by the urban residents' basic medical insurance fund, and the maximum amount (i.e. the reimbursement ceiling) paid in a medical insurance year is 17, yuan.

reimbursement ratio of outpatient (emergency) medical expenses for urban residents

insured persons who have paid for more than one year and continue to pay continuously can enjoy reimbursement treatment of outpatient (emergency) medical expenses. Those who meet the conditions of insurance in that year are regarded as continuous payment.

the outpatient (emergency) medical expenses incurred by the insured that meet the requirements of the basic medical insurance and medical insurance for serious illness of students and children in this municipality are included in the scope of payment, and the qifubiaozhun for reimbursement is 65 yuan. The above part of Qifubiaozhun is paid by the basic medical insurance fund for urban residents by 5%, and the maximum amount accumulated in a medical insurance year (i.e. reimbursement ceiling line) is 2 yuan.

The first consultation system of designated community health service institutions shall be implemented for the elderly and unemployed residents in urban areas. Without the first referral of designated community health service institutions to other medical institutions for medical treatment, the outpatient (except emergency) medical expenses incurred shall be borne by themselves.