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央广网沈阳8月6日消息(记者徐志强)今年5月,铁岭市被辽宁省里列入第二批开展跨省异地就医直接结算的城市,要求在今年8月10日前完成相关准备工作。接到任务后,铁岭市医保局领导高度重视,相关工作人员从6月24日开始筹备,出台相关政策。工作人员加班加点,通过层层测试,最终通过验收,完成了整个系统的改造,于7月14日正式开放,提前完成了任务。
在跨省异地就医直接结算工作开展以前,跨省异地居住的铁岭市参保人员如果在居住地产生住院医疗费,需要参保人先自行垫付,然后再跑回铁岭办理结算,这期间来回奔波两地比较麻烦,如果手续拿不全还要白跑。这项工作开展以后,跨省异地居住的铁岭市参保人员就方便了很多。目前,天津、吉林、北京等跨省异地居住的全市参保人已经有7人在异地就医时进行了直接结算。工作人员表示,除西藏自治区外,铁岭市与全国32个省区市全部联网,全市参加城镇基本医疗保险的跨省异地居住人员都可以实现异地就医直接结算。
除了铁岭市的参保人去外面看病,来铁岭市居住的跨省异地参保人也可以享受这项政策。7月25日,一名内蒙古呼伦贝尔市的参保患者在铁岭市中心医院也成功完成了异地就医直接结算。目前,铁岭市中心医院、铁岭市中医院、铁岭县医院、清河区医院、铁煤集团总医院、开原市中心医院都可以完成跨省异地居住人员就医直接结算工作,以后还会逐渐开放所有的医院。
按照有关规定,异地居住人员在居住地发生的住院医疗费用,执行居住地基本医疗保险规定的药品、诊疗和服务设施目录支付范围、标准及相关支付政策;执行参保地基本医疗保险规定的统筹基金起付标准、年龄段自付比例、年度内统筹基金最高支付限额、大额补充医疗保险等相关政策规定。需要特别注意的是,执行居住地支付政策造成与铁岭市结算金额不一致时,超出部分不追回、低于部分不补偿。
工作人员提醒,在铁岭市范围内参保的跨省异地居住人员,事先需要到所属医保局进行备案登记,工作人员会把这些信息上传到平台,之后,这些人员在居住地产生住院医疗费用才能进行直接结算。目前,全市已有834人办理了异地就医备案。
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