Managing and exploiting information on the health insurance appraisal information system

(Baonghean) -Vietnam Social Security has just issued Decision 1553/QD-BHXH dated September 28, 2017 promulgating Regulations on management and exploitation of information on the Health Insurance Assessment Information System.

Accordingly, information on the Health Insurance Appraisal Information System includes:

1. National shared information, including:

a) Information on the list of drugs, blood, medical supplies and technical services in the health insurance payment list issued by the Ministry of Health; drugs with registration numbers, declared and re-declared drugs announced by the Department of Drug Administration - Ministry of Health.

b) Information on the list of health examination and treatment facilities covered by health insurance, with codes issued by Vietnam Social Security.

c) Information of other relevant categories as prescribed by Vietnam Social Security.

2. Information shared across the province, including:

a) Data on drugs and medical supplies applicable to the entire province.

b) Technical service price list data is still valid and applicable to the whole province.

People do medical examination and treatment procedures using health insurance. Photo: Document

3. Information at each health insurance examination and treatment facility, including:

a) Data on technical services, drugs, and medical supplies in the approved list for use at medical examination and treatment facilities.

b) Data on medical staff and medical equipment used at medical examination and treatment facilities.

c) Data on application for payment of health insurance examination and treatment costs.

d) Data on appraisal results, advances, and settlement of health insurance medical examination and treatment costs.

d) Other data serving health insurance appraisal.

Information Management on the System is regulated as follows:

1. The information management unit has the right to update, edit, delete, and adjust information under its management responsibility, and is responsible for updating and adjusting information as soon as there are changes or new information arises.

2. The Information Technology Center manages all information on the System's reception portal.

3. Northern Regional Center for Health Insurance Assessment and Multi-line Payment: manages information on Health Insurance Assessment Software including:

a) Information on the categories specified in Points a and c, Clause 1, Article 2 of these regulations.

b) Information on medical examination and treatment data covered by health insurance nationwide.

4. The Health Insurance Policy Implementation Board manages information on the list of health insurance medical examination and treatment facilities specified in Point b Clause 1 Article 2 of these regulations.

5. The provincial Social Insurance manages information on the shared lists of the whole province, information of medical examination and treatment facilities on the Health Insurance Appraisal Software according to the provisions of Article 1 of the Health Insurance Appraisal Process issued with Decision No. 1456/QD-BHXH dated December 1, 2015 of the General Director of Vietnam Social Insurance, information on Health Insurance cards issued by the provincial Social Insurance, information on advances, funding for health examination and treatment under Health Insurance connected from other professional software of the Industry.

6. District Social Insurance manages information of health insurance examination and treatment facilities that are authorized to sign health insurance examination and treatment contracts on the Health Insurance Appraisal Software.

Health insurance examination at Nghe An Maternity and Pediatrics Hospital. Photo: Thanh Chung

7. Health insurance medical examination and treatment facilities

a) Manage information on drug lists, medical supplies, technical services, medical staff lists, departments and other lists of the unit sent to the System's receiving portal.

b) Manage the health insurance examination and treatment data information of the unit sent to the System's receiving portal.

During the process of exploiting information from the System: Health insurance medical examination and treatment facilities are entitled to exploit information from the System's reception portal, including:

a) Look up and export data from national shared catalogs, provincial shared catalogs, and unit shared catalogs.

b) Add, adjust, delete catalog data and medical examination and treatment data of the unit on the System's reception portal.

c) Look up health insurance card information, history of the last 6 medical examinations and treatments of people with health insurance cards who come to the unit for medical examination and treatment.

d) Send detailed data on health insurance payment requests to the Receiving Portal as soon as the patient finishes a medical examination, outpatient or inpatient treatment; Adjust, delete, and resend detailed data on health insurance payment requests that have not been sent to the Social Insurance agency for appraisal.

d) Send detailed payment request data to the appraiser within 24 hours from the time of payment; Data sent to the appraiser can only be replaced with the approval of the Social Insurance agency; Send summary data of monthly health insurance payment request within the first 5 days of the following month.

e) Send data on the list of drugs and medical supplies within 5 working days upon the winning bid or procurement results by other legal means or upon changes or adjustments to the list, prices of drugs, medical supplies, and technical services.

g) Look up and export appraisal results and reports on settlement of health insurance examination and treatment costs.

People do procedures for health examination and treatment under health insurance at Tuong Duong District Medical Center. Photo: Document

On the use of electronic signatures

1. Electronic signatures are integrated and used on the Health Insurance Appraisal Information System in accordance with legal regulations and when instructed by Vietnam Social Security.

2. The integrated electronic signature on the report must include: the digital signature of the head of the agency, unit (or authorized person) and the digital signature of the officer preparing the report or of the leader of the department, office, or division where the report is prepared.

3. Reports generated from the Health Insurance Appraisal Information System with integrated valid digital signatures have legal value and replace paper reports.

PV