DB37/T 4379-2021 协议定点医疗机构医疗保障服务规范

ICS03.060

CCSA11

37

山东省地方标准

DB37/T4379—2021

协议定点医疗机构医疗保障服务规范

Standardformedicalsecurityserviceofdesignatedmedicalinstitution

2021-06-15发布2021-07-15实施

山东省市场监督管理局发布

DB37/T4379—2021

目次

前言.................................................................................II

1范围...............................................................................3

2规范性引用文件.....................................................................3

3术语和定义.........................................................................3

4基本要求...........................................................................3

4.1组织管理.......................................................................3

4.2人员配备与岗位设置.............................................................4

5医保服务窗口.......................................................................4

5.1设置与功能.....................................................................4

5.2标志与标识.....................................................................4

5.3设施设备.......................................................................5

5.4信息公开.......................................................................5

6人员要求...........................................................................5

6.1基本要求.......................................................................5

6.2管理人员.......................................................................5

6.3服务人员.......................................................................5

7医保服务...........................................................................6

7.1医保政策宣讲...................................................................6

7.2备案登记.......................................................................6

7.3医保审核.......................................................................6

8医保管理...........................................................................7

8.1医保政策、操作培训.............................................................7

8.2沟通与协调.....................................................................7

8.3医保信息数据维护...............................................................8

9服务保障...........................................................................8

9.1制度建设.......................................................................8

9.2医保资料文件管理...............................................................9

9.3突发事件管理...................................................................9

9.4信息安全管理...................................................................9

10监督与评价........................................................................9

10.1监督..........................................................................9

10.2投诉处理......................................................................9

10.3考核..........................................................................9

10.4评价..........................................................................9

参考文献.............................................................................10

I

DB37/T4379—2021

前言

本文件按照GB/T1.1—2020《标准化工作导则第1部分：标准化文件的结构和起草规则》的规定