Article 2 These Interim Measures shall apply to the collection, credit commitment, evaluation, release and application of medical insurance credit information of medical insurance credit subjects (hereinafter referred to as credit subjects) within the administrative area of this province.
Article 3 The credit subjects mentioned in these Interim Measures are mainly divided into institutions and individuals.
(1) Institutional credit entity
1. Designated medical institutions for basic medical insurance;
2. Designated retail pharmacies for basic medical insurance;
3. Basic medical insurance units;
4. Third-party institutions that undertake medical insurance handling business;
5. Pharmaceutical enterprises participating in medical security activities;
6 other institutions involved in medical security activities.
(B) human credit subject
1. Doctors, nurses (teachers), technicians, pharmacists and other professionals who provide medical security services;
2. Insured personnel;
3 other individuals involved in medical security activities.
Article 4 Credit subjects shall consciously abide by relevant national laws, regulations, rules, normative documents and service agreements, strengthen honesty and self-discipline, and standardize medical security-related behaviors; In accordance with the provisions of the Interim Measures, provide corresponding data and information to the medical security department and its entrusted institutions, and cooperate with the credit management.
Article 5 The credit management of medical insurance shall focus on people's health, adhere to the principles of legality, fairness, openness, dynamic adjustment, protection of rights and interests, and enjoyment of * * * * *, and shall not harm the interests of the state and society, and shall not disclose state secrets, business secrets and personal privacy.
Sixth provincial medical security administrative department is responsible for the system construction and standard formulation of medical security credit management in the whole province; Responsible for the development and maintenance of medical insurance credit evaluation management platform; Responsible for guiding and supervising the credit management.
The municipal administrative department of medical security is responsible for the medical security credit management within their respective administrative areas, the collection, entry and review of information related to medical security credit management, credit evaluation according to laws and regulations, and the use and publicity of evaluation results.
Article 7 The medical security department shall speed up the construction of the medical security credit evaluation management platform, strengthen the contact with development and reform, public security, civil affairs, justice, human resources and social security, health and wellness, market supervision, taxation and other departments, establish a credit information sharing mechanism, and promote the linkage management of medical security credit and other social credits.
Chapter two? Credit information collection
Article 8 The municipal and state medical insurance bureaus shall establish medical insurance credit files of various credit subjects. Institutional credit files are identified by unified social credit code, and personal credit files are identified by ID number and entry-exit certificate number. Medical insurance credit file consists of basic information of credit subject, trustworthy information, untrustworthy information, credit objection and repair information.
Article 9 The basic information of the credit subject of an institution includes the nature, name, legal representative and unified social credit code of the unit; The basic information of personal credit subject includes name, resident ID number, entry and exit certificate number, practice registration information, etc.
Article 10 Trustworthy information includes information such as commendations and awards related to honesty recognized by the people's governments at or above the county level and their departments and organizations authorized by laws and regulations to manage public affairs in accordance with the prescribed procedures; Active and credible commitment information; Performance information of credit subjects in daily activities of medical insurance; Other trustworthy information that should be recorded in the credit file as stipulated by laws, regulations and rules.
Article 11 General dishonesty information refers to the information generated by the credit subject due to the circumstances specified in Articles 36, 38, 39, 41, paragraph 1 and 46 of the Regulations on the Supervision and Administration of the Use of Medical Insurance Funds or other dishonesty risk behaviors, and the validity period is 1 year.
Article 12 The information of serious dishonesty refers to the information generated by the credit subject due to the circumstances specified in Article 37, Article 40 and Article 41, paragraph 2 of the Regulations on the Supervision and Administration of the Use of Medical Insurance Funds or other serious violations of laws and regulations, and the validity period is 3 years.
Thirteenth medical insurance credit information is collected through the following channels:
(a) the credit subject meets the requirements of the construction of medical insurance credit system;
(two) illegal information and administrative punishment information identified by the medical security department through intelligent audit, intelligent monitoring, daily supervision and special actions;
(3) * * * * data obtained by the medical security department from the public credit information platform and the national enterprise credit information publicity system;
(four) other collection methods that meet the requirements.
Fourteenth credit subjects should actively cooperate with the administrative department of medical security to provide relevant credit information, and credit subjects are responsible for the authenticity and integrity of the information they provide, and may not conceal, fabricate or tamper with it.