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珠海首例全国跨省异地医保即时联网报销成功结算

2017-08-18 16:57:16   央广网

央广网珠海8月18日消息(记者郭翔宇 通讯员蓝尚如)日前,记者从珠海市人社局了解到,珠海市已顺利实现与人社部信息中心、广东省结算平台的联网对接,成功上线国家异地就医信息结算系统。目前,珠海除了市第二人民医院,还有市人民医院、市妇幼保健院、中大五院、遵义医学院第五附属(珠海)医院等五家医院已接入国家平台,珠海市首例异地医保跨省结算也于近日在市第二人民医院实现真实生产环境下的成功结算。

今年68岁的徐先生湖南岳阳人,退休前一直在湖南岳阳生活,退休后,他带着老伴到珠海与儿子一起来居住。徐先生来珠海已有12年了,5年前在珠海市第二人民医院泌尿外科做过尿道结石手术,去年年底在普外科做过阑尾切除手术。

今年6月份徐先生发现颈前有肿物,在家人的陪同下又来到该院就诊,于8月10日在该院接受了“甲状腺右叶及峡部切除术+甲状腺左叶部分切除术+喉返神经探查术”。据该院医保科负责人介绍,因徐先生的退休职工医保参保地在湖南岳阳,根据原有的规定,在珠海的住院费用需要自己先垫付,出院后再前往湖南老家社保局报销,不仅过程比较麻烦,还需等上几个月才能拿到报销款。适逢该院于7月25日正式接入国家系统平台,8月1日结算系统开始启用,徐先生这次手术的医保费用可以直接在医院结算。

当天徐先生康复出院,为了其能享受到跨省异地医保就医实时结报的福利,医院医保办和信息科工作人员已多次与珠海市社保中心沟通、协调,成功为徐先生在医院终端办理了跨省异地医保即时结算联网手续。通过国家医保结算平台,徐先生完成了住院医保费用的即时结报,医疗总费用是14260.28元,医保统筹基金即时结报10481.66元,徐先生实际支付3778.62元,成为珠海市首例享受异地医保跨省结算便利的患者。

记者了解到,跨省就医联网结算报销政策实施前,住院垫付资金较高,报销所需材料繁多,程序复杂,还要两地奔波,给患者带来了极大的不便。为了让来珠海就医的外地参保人员享受更加便捷的一站式住院结算,同时方便珠海市参保人赴省外就医住院费用实现直接结算,解决参保人异地住院费用报销“跑腿”、“垫资”等情况,市人社部门全力推进异地就医结算工作。在做好本地医保系统升级改造同时,主动联系珠海市各大医疗机构开展国家异地就医信息结算平台建设,完成作为就医地与珠海市的全流程模拟联调测试,顺利对接国家结算平台。此例真实生产环境下的跨省联网成功结算,标志着珠海市跨省医保联网结算报销正式开通,既缓解了患者的资金垫付压力,又省去了跑腿的辛苦,缩短了报销时间,真正实现了“让信息多跑路,让群众少跑腿”的惠民目标。

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