What about the referral procedure? How to handle the procedures for referral and transfer for medica

Off-site referral process:

1. The applicant or the client shall submit an application to the hospital that undertakes the referral business;

2. Attending physicians and above fill in the approval form for referral from other places;

3. The hospital organizes expert consultations and puts forward opinions;

4. Examination and registration by the hospital medical insurance office; The dean in charge reviews and signs for approval;

5. The applicant or the client should bring the approval form for referral to the social security institution for approval.

The designated medical institutions transferred out shall also report the referral information to the municipal social insurance institution for the record.

If the insured person needs to be re-referred after being transferred to another city for treatment, a re-referral certificate shall be issued by the medical institution outside the city where the patient is treated.

Extended data: Criteria for remote referrals.

1. Diseases.

It is a difficult disease that cannot be diagnosed after expert consultation organized by the hospital undertaking the referral business.

2. Diseases.

Limited by the medical technology and equipment conditions of the city's designated hospitals, it is impossible to further improve the situation.

3. If you are transferred to a hospital for treatment in a different place, it should be a designated medical institution for local social security.

4. In principle, the level of diagnosis and treatment of hospitals referred to other places for medical treatment should be higher than that of this city, and only one hospital can be selected for hospitalization for each referral**.

Now the vast majority of people have participated in urban and rural medical insurance or employee medical insurance, when the patient is sick and hospitalized, and the local medical technology or medical equipment can not meet the needs of the patient, the patient needs to handle the referral to the medical technology and medical equipment better upper level hospital, let's see how to handle the remote referral?

How do I make a referral?

Method steps.

Generally speaking, the hospital will only agree to handle the referral due to the needs of the patient's condition, which requires a diagnosis certificate from the attending doctor; If the local hospital is able to handle the disease, they are generally reluctant to make a referral because it will tie up their public health care fund.

How do I make a referral?

Contact the patient's attending physician in advance, and the attending doctor shall fill in the "Approval Form for Transfer of Basic Medical Insurance in XX City", and attach expert consultation opinions, which will be reviewed by the medical insurance department of the hospital and signed by the hospital leaders.

How do I make a referral?

How do I make a referral?

After the materials are ready, bring the above materials to the corresponding window of the local social security bureau for review and filing, so that you can easily be reimbursed after medical treatment in other places.

How do I make a referral?

After the filing procedures of the social security bureau are completed, you can be referred to the hospital, and after receiving treatment in a different hospital, you must bring back the inpatient medical records, expense lists, and invoices to the corresponding window of the local social security bureau for expense reimbursement.

How do I make a referral?

In addition, if the condition is very critical, the hospital can first issue a referral certificate, transfer to the hospital first, and then go to the local social security bureau to complete the approval procedures within the specified time.

The procedures for referral and transfer for medical treatment in other places are as follows:

1. First of all, the applicant or the client needs to apply to the hospital that undertakes the referral business;

2. Then the attending physician or above fills in the approval form for referral from another place, and then the hospital organizes expert consultation and puts forward opinions;

3. Then the hospital medical insurance office reviews and registers the dean in charge of reviewing and signing for approval;

4. Finally, the applicant or the client shall bring the approval form for referral to the social security institution for approval.

Legal basisArticle 29 of the Social Insurance Law of the People's Republic of China.

The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit.

The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

Article 31.

According to the needs of management services, social insurance agencies may sign service agreements with medical institutions and drug business units to standardize medical service behavior.

Medical institutions shall provide reasonable and necessary medical services to insured persons.

What materials are required for reimbursement for medical treatment in other places.

1. Discharge summary;

2. Copy of inpatient medical record;

3. Hospitalization list;

4. Original voucher of medical expenses;

5. Original and photocopy of social security card;

6. Original and photocopy of ID card.

Patients only need to bring the referral certificate to the new hospital for hospitalization, and when discharged, the relevant departments will sign and seal, and the hospital will settle the discharge according to the requirements of the hospital.

2. Abnormal referral: If the patient is in an emergency department and does not go through the county-level hospital, but goes directly to the higher-level hospital for diagnosis and treatment, then it is necessary to go to the NCMS referral office within 3 days of hospitalization to go through the procedures.

3. When the urban employee insured person is treated in a designated medical institution (second-level) due to illness, he needs to be transferred to a designated referral hospital at the next level when he needs to be transferred to a designated referral hospital at the next level, and the chief physician shall apply for it, fill in the "Application Form for Referral of Basic Medical Insurance for District and Urban Employees" in detail, and review it by the medical insurance office or medical department of the hospital, approve it by the president in charge, report to the district medical insurance office for approval and filing, and then go to the designated referral hospital for hospitalization. All cases of emergency, critical and infectious diseases can be transferred to the hospital in advance, and the relevant procedures will be completed within 3 working days.

Legal basis

1) The treatment policy of "long-term residents in other places". If you seek medical treatment in your long-term place of residence after filing for the record, the one-time filing is valid for a long time, and you can enjoy the same medical insurance reimbursement ratio as the medical treatment in the insured place; For medical treatment outside the place of long-term residence for the record, it shall be implemented in accordance with the policy of temporary medical treatment.

2) The treatment policy of "temporary medical personnel". The medical expenses incurred in line with the provisions of the policy shall be borne by the individual first, and the remaining part shall be settled according to the medical insurance treatment policy of our city according to the level of the medical institution being treated; Among them, the inpatient and outpatient treatment of the place of temporary medical treatment shall be subject to the management policy of the place of insurance.

3) Abolish restrictions on contracting contracts with designated medical institutions. Insured persons in the province cross-city, cross-provincial and non-local medical treatment is not limited by the scope and level of contracted medical institutions, can enjoy outpatient co-ordination treatment and can be networked in the designated medical institutions in the place of medical treatment to achieve online settlement, the amount of reimbursement in different places and the amount of local reimbursement are calculated together, not exceeding the amount of outpatient co-ordination reimbursement in the current year.

4) Cancel the restrictions on the number of designated medical institutions for medical treatment in other places. The insured can choose to seek medical treatment independently among all networked general outpatient and inpatient designated medical institutions in the place of medical treatment, and realize direct settlement; The restriction on the number of designated medical institutions for outpatient chronic diseases of the insured will be abolished.

Legal analysis: The legal basis for the filing of non-local referral in Luoyang is several regulations in the "Notice on Effectively Doing a Good Job in the Direct Settlement of Cross-provincial and Non-local Medical Treatment and Hospitalization Expenses in 2019". I hope you find the following helpful.

Legal basis: "Notice on Effectively Doing a Good Job in the Direct Settlement of Cross-provincial and Non-local Medical Treatment and Hospitalization Expenses in 2019" 1. Materials for the filing of Luoyang non-local referral 1ID card or medical insurance electronic voucher (social security card can be used during the transition period).

2.Provincial and non-local medical treatment registration and filing form.

3.A referral certificate issued by a designated medical institution with referral qualifications (a relevant disease diagnosis certificate and a referral certificate issued for the first time for medical treatment in a different place within the same disease process).

2. Conditions for Luoyang to refer to other places for the record.

1.The insured person enjoys the medical insurance treatment normally;

2.The disease suffered by the insured person cannot be diagnosed in the designated medical institution of the provincial medical insurance;

3.After being diagnosed, there is no condition in a designated medical institution under the provincial medical insurance**;

4.The designated medical institutions in the cities and provinces selected by the filing personnel are unconditional**.

5.Precautions.

1) If the insured person needs to be referred to the insured place for hospitalization, the provincial designated medical institution with referral qualification shall issue the "Henan Provincial Basic Medical Insurance Referral Form" and apply for registration and filing according to the regulations. If the same disease process is hospitalized in the same designated medical institution for many times (including cross-year hospitalization), the second and subsequent referral forms will not be issued, and the relevant disease diagnosis certificate and the original referral form (valid for one year) shall be applied for registration and filing according to the regulations.

2) The registration and filing procedures for non-local referral personnel are valid for one hospitalization cycle (valid at the time), and one hospitalization cycle shall not exceed 3 months in principle. If you still need to continue to be hospitalized for more than 3 months**, you should apply for an extension of registration and filing procedures in accordance with the regulations.

3) When seeking medical treatment in other places, you must choose the designated medical institution for medical insurance in the place of medical treatment, and give priority to the designated medical institution for direct settlement. For medical expenses incurred in non-direct settlement designated medical institutions, the medical insurance designated certificate confirmed by the medical insurance agency at the place of medical treatment shall be provided for reimbursement (to be cancelled after the establishment of the national medical insurance designated medical institution information database).

4) For medical expenses that fail to go through the filing procedures in accordance with the regulations and are hospitalized in designated medical institutions under medical insurance, the reimbursement shall be handled according to the existing regulations of the insured place.

5) In order to ensure the direct settlement of inpatient medical expenses for medical treatment in other places, please bring your social security card when seeking medical treatment.