Anhui issued an emergency notice: the new crown consultation expenses reimbursement ratio unified to 70 percent

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There is no starting line or reimbursement limit, and the reimbursement ratio is 70%; all designated medical institutions that have opened the basic medical insurance fund settlement service are temporarily included in the outpatient settlement of NICs; the medical category “NICs Outpatient (1102)” is unified to settle the outpatient expenses of NICs ……

On Dec. 29, Anhui Provincial Medical Security Bureau, Anhui Provincial Department of Finance and Anhui Provincial Health and Wellness Commission jointly issued an urgent notice on the outpatient treatment of new coronavirus infection, aiming to make every effort to protect health, prevent serious illness, protect people’s life safety and health to the greatest extent, and do a good job of outpatient treatment of new coronavirus infection for employees’ basic medical insurance and urban and rural residents’ basic medical insurance participants. (hereinafter referred to as “new coronary infection”) of the outpatient treatment and protection work.

The notice clarifies that the unification of the new coronary infection outpatient protection treatment. The medical expenses incurred by the insured persons with new coronavirus infection in the general outpatient (emergency) treatment in the co-ordination area, in accordance with the treatment plan for new coronavirus pneumonia and other regulations, are included in the scope of payment of the basic medical insurance co-ordination fund, with no starting line and reimbursement limit, and the reimbursement ratio is unified at 70%.

At the same time, the settlement level restriction of the fixed-point institution is abolished. The village health office (community health service station), township health center (community health service center), first-class hospital, second-class hospital, third-class hospital and other designated medical institutions that have opened the basic medical insurance fund settlement service in the coordination area are temporarily included in the outpatient settlement of the new crown infection, supporting the participants to obtain timely outpatient treatment and protection treatment.

For the settlement of outpatient expenses of NICs, the notice points out that Anhui Medical Insurance Information Center optimizes the settlement system module of Anhui Medical Insurance Information Platform and unifies the medical category of “NICs Outpatient (1102)” to settle the outpatient expenses of NICs. All designated medical institutions are required to select the four disease diagnosis codes of NICs for billing through the medical category of “NICs (1102)”. The medical insurance settlement system automatically determines the treatment algorithm according to the medical category and disease diagnosis, and realizes instant settlement and reimbursement through the network.

If a participant is temporarily out of town, visiting relatives, or visiting a designated medical institution that is not eligible for online settlement, or if the medical insurance settlement system needs to be suspended due to inter-year carryover (shutdown), or if the network fails to settle instantly on site, he or she can apply for manual reimbursement at the local medical insurance office with the relevant outpatient bills.

The notice requires that the medical insurance to pay for the outpatient expenses of the new crown infection, not included in the annual basic medical insurance general outpatient co-ordination budget, from the medical insurance current reserved risk fund or the balance of the fund in previous years, the implementation of separate statistics, separate settlement. The co-ordinated areas should be timely settlement of the medical insurance funds for the outpatient treatment of the new crown infection of the participants.

Also introduced, the “notice” implementation period from the date of issue to March 31, 2023.