First, prepare the application materials.
Medical institutions need to prepare relevant application materials, including medical institution qualification certificate, medical equipment list, medical service project list, medical personnel qualification certificate, etc. These materials need to be true, accurate and complete for the medical insurance management department to review and evaluate.
Second, submit an application.
The medical institution will submit the prepared application materials to the local medical insurance management department. When submitting an application, you need to fill in the relevant application form and indicate the reasons and advantages of applying for medical insurance.
Third, audit evaluation.
The administrative department of medical insurance shall examine and evaluate the application materials submitted. The evaluation content includes the facilities, technical level and service quality of medical institutions. The medical insurance management department will also evaluate the operation and financial management of medical institutions to ensure that they meet the requirements of medical insurance designated points.
Fourth, on-site inspection
The medical insurance management department will organize experts to conduct on-site verification to verify whether the actual situation of medical institutions is consistent with the application materials. The contents of on-site inspection include the configuration and use of medical equipment, the development of medical services, the qualifications and practice of medical personnel, etc.
Verb (abbreviation for verb) approves the decision.
After examination, evaluation and on-site inspection, the medical insurance management department makes a decision on whether to agree to the designated medical insurance. Medical institutions that meet the relevant conditions are included in the designated medical insurance units and enjoy preferential policies such as medical insurance settlement.
To sum up:
The application process of designated medical insurance requires medical institutions to prepare relevant application materials and submit them to the medical insurance management department for review and evaluation. After the on-site inspection, the medical insurance management department makes a decision on whether to agree to the designated medical insurance. Medical institutions need to meet the relevant conditions before they can be included in the designated medical insurance units and enjoy preferential policies such as medical insurance settlement.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 29 provides that:
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
Regulations on the administration of medical institutions
Article 30 provides that:
Medical institutions must carry out medical activities in accordance with the approved and registered diagnosis and treatment subjects.
Article 32 provides that:
Without my physical examination, medical institutions shall not issue certificates of disease diagnosis, health or death; A medical institution may not issue a birth certificate or stillbirth report without a doctor or midwife personally delivering the baby.