a) Tra cfru, kat xuat dit lieu danh muc dung chung town qu6c, danh muc diing chung tai tinh, danh muc dung chung tai don vi. b) B6 sung, dien chinh, xoa du lieu danh muc va du lieu kham[r]
(1)BAO HIEM XA HOI VIET NAM CONG HOA XA HOI CHU NGHIA VIET NAM Doc rap - Tty - Hanh pink
s :-M3/QD-Bi-DcH Ha Noi, a21? thong 3 nom 2017
QUYET DINH
Ban hanh Quy dinh ye quan 1ST, khai thic
thong tin tren He thong thong tin giam dinh bao hiem y te TONG GIAM DOC BAO HIEM XA HOI VIET NAM Can cir Lu# Giao dich dien ;
Can cir Nghi quyet s6 36a/NQ-CP 14/10/2015 dia Chinh phit ve Chinh phis dien
Can cir Nghi dinh s6 166/2016/ND-CP 24/12/2016 ctia Chinh phu quy Binh ve giao dich dien to rinh vgc bao hiem xa hOi, bao hiem y te va bao hiem that nghiep;
Can cu Nghi dinh so 01/2016/ND-CP 05/01/2016 cua Chinh phu quy dinh chirc nang, nhiem vu, quyen han va ca cau t6 chirc ctla Bao hiem xa hOi Viet Nam;
Can cir Quyet dinh s6 1399/QD-BBXH 22/12/2014 cila 1.6ng Giam d6c Bao hiem xa hOi Viet Nam ban hanh quy dinh N4' to chirc thine hien bao hiem y to kham benh, china benh;
Can cu Quyet dinh s6 1456/QD-BHXH 01/12/2015 cila T6ng Giam d6c Bao hiem xa hOi Viet Nam ban hanh quy trinh giam dinh bao hiem y te;
Theo de nghi cua Giam d6c Trung tam Giam dinh bao hiem y to va Thanh town da tuyen khu vgc phia Bac,
QUYET DINH:
Dieu Ban ,hanh kern then Quyet dinh Quy dinh quan 1)"7, khai thac thOng tin tren He thong thong tin giam dinh bao hiem y te
Dieu Quyet dinh có hi'eu luc k'e tin k3', ban hanh
Dieu Giam d6c Trung tam Giam Binh bao hiem y to va Thanh town da tuyen khu vuc phia Bac, Chanh Van phong Bao hiem xa" hOi Viet Nam, Thit twang cac don vi trgc thuOc Bao hiem xa hOi Viet Nam, Giam doc Bao hiem xa hOi cac tinh, phi!) trine thuOc Trung gang, Giam doe Bao hiem xa hcii BO Quoc phong, Giam doc Bao hiem xa hOi Cong an nhan dan, cac dan vi, to chirc có thgc hien kham benh, chaa benh bao hiem y to chiu trach nhiem thi hanh Quyet clinh nay./
Noi nhOn: - Nhu Dieu 3;
- Hei long Quan lY BHXH Viet Nam; - Van pkong Chinh phii;
- BO Y te, BO Tai ehinh;
- UBND cac tinh, true thuOe Trung uang; - Cue Kiem soot TTHC, VPCP;
- Tong Giam doe, cac Pho Icing Giam doe;
- Sor Y to cac tinh, phO true thuOc Trung uang; - Cac benh vien, vien c6 gitromg berth thuee BO Y te; - Cac Cue: Quan y BQP, Y te BO CA, Y t.6 Bo GTVT; - BHXH BO QuOe phong, BHXH Cong an nhan dan; - Cac don vi true thuOc BHXH Viet Nam;
- COng '1 11)1 IIIIXEI Via Nam, - Ltru: VT, GDB (5b) A
KT TONG GIAM DOC
(2)BAO HIEM xA HOI VIET NAM CONG HOA XA HOI CHID NGHIA VIET NAM Dec lap - Tty - Hanh phut
QUY DINH
Ve quan 1ST, khai thic thong tin teen
He thong thong tin giam dinh bao hiem y to
(Ban hanh kem theo Quyit dinh sa.453.TD-BHX1-1 ngaya?thang9 nam 2017 cfia Ring Giam dac BHXH Viet Nam)
Dieu Quy dinh chung 1 Pham vi dieu chinh
Van,ban quy dinh ve quan khai thac thong tin tai C6ng tip nhan va Ph'n mem giam dinh cila He thong thong tin giam dinh bao hiem y te
2 D6i Wang dp dung
a) Trung tam Cong nghe th6ng tin, Trung tam Giam dinh bao hiem y to (BHYT) va Thanh toan da tuyen khu vuc phia BL, Trung tam Giam dinh BHYT va Thanh toan da tuyen khu vuc phia Nam, Ban Thkrc hien chinh sach BHYT, Ban Thuc hien chinh sach bao hiem xa h6i,,Ban Dugc va Vat tu y te, Vu Tai chinh Ke toan, Vu Ke hoach va D'au tu, Vu Kim toan not bO, Vu Thanh tra Kiem tra (sau day goi chung la cac don vi nghiep vu cua BHXH Viet Nam)
b) Bao hiem xa hOi cac tinh, ph6 true thuOc Trung ucmg, Bao hiem xa hOi B6 Qu6c pheng,,Bao hiem hOi Cong an nhan clan (sau day goi chung la BHXLI tinh), Bao hiem xa hOi the quan, huyen, pho, thi xa true thu6c tinh (sau day goi chung la BHXH huyen)
c) Cac ca so kham benh, china benh BHYT
d) Cac ca quan, don vi, t6 chi.rc va ca nhan có lien quan den kham benh, chfra benh BHYT
Dieu Thong tin tren He thOng thong tin giam dinh BHYT 1 Thong tin dung chung toan qu6c, bao
a) Thong tin danh muc thu6c, mau, vat tu y to va dich vu ky thuat
danh muc toan BHYT Be Y to ban hanh; thuo'c cap se dang 14r, thu6c
ke khai, ke khai lai Cuc Quan 1y Dugc - Bo Y to ding b6
b) Thong tin danh muc CAC ca s& kham benh, chira Nnh BHYT BHXH
Viet Nam cap ma
c) Thong tin dm cac danh muc khac có lien quan BHXH Viet Nam quy dinh Thong tin dung chung toan tinh, bao g6m:
(3)b) Du lieu bang gia Bich vu ky thuat hileu luc ap dung chung toan tinh Thong tin tai timg ca so kham benh, chfra benh BHYT, bao
a) Da lieu dich vu ky thu4t, thu6c, vat to y to danh muc dugc phe duyat sir dung tai ca kham benh, chfra benh
b) DCz lieu n1 'Ian vier y te, trang fiat bi y to sir' dung tai co so kham benh, chug benh c) Du lieu hO so' de nghi toan chi phi kham benh, chita benh BHYT d) Du lieu kat qua giam dinh, tam img, quyat toan chi phi kham benh, chfra benh BHYT
d) Cac du lieu khac phuc vu giam clinh BHYT Di&I Quan 1ST thong tin teen He tilling
1 Dan vi quan VT thong tin dugc quyan cap nhat, sira, xoa, dieu chinh cac
thong tin thuOc trach nhiam quan 1T, có trach nhiam cap nhat, diau chinh cac
thOng tin có thay doi hoc phat sinh
2 Trung tam Cong ngha thong tin quan lT toan bO thong tin trail Cong flap nhan cua He thong
3 Trung tam Giam dinh BHYT va town da tuyan khu vuc phia BA.c: quan 13',7 thong tin Phan mam giam dinh BHYT bao g;S'm:
a) Thong tin cac danh muc quy dinh tai Diem a va c Khoan 1, Dieu quy dinh'nay
b) Thong tin du lieu kham benh, chita benh BHYT tren pham vi toan qu'6c
4 Ban Thuc hian chinh sach BHYT quan VT thong tin danh muc co si:r
kham benh, chirra benh BHYT quy dinh tai Diem b Khoan Dieu quy dinh
5 BHXH tinh quan 1ST thong tin cac danh muc clang chung toan tinh, thong
tin cila cac ca kham benh, chaa benh tren Phan main giam dinh BHYT theo quy
dinh tai Dieu Quy trinh giam dinh BHYT ban hanh kern theo Quyat dinh so
1456/QD-BHXH 01/12/2015 cua 'Ding Giam d6c BHXH Viet Nam, th6ng tin
va the BHYT BHXH tinh phat hanh, thong tin va tam irng, cap kinh phi chi
kham benh, chfra benh BHYT kat not tir cac phan mam nghiap vu khac cua Nganh
6 BHXH huyan quan VT thong tin dm cac co so kham benh, china benh
BHYT dugc phan cap 14.7 hap d6ng kham benh, chira benh BHYT teen PhAn mam giam dinh BHYT
7 Ca so kham benh, chira benh BHYT
a) Quan 15, thong tin danh muc thu6c, vat to y te, dich vu ky thuat, danh
muc nhan vien y te,,khoa phong va cac danh muc khac don vi gir' i len Cong
(4)b) Quan 1)% thOng tin da lieu kham banh, chira banh BHYT cua don vi giri len C6ng flap nhan dm He th6ng
Dieu Khai thic thong tin tir He thOng 1 Cac don vi nghiap vu thuOc BHXH Viet Nam
a) Dugc quyan tra ciru, kat xuat thong tin tin danh muc quy ta:c giam dinh ap dung tren He thong, danh muc dung chung toan quoc, danh muc dimg chung tai tinh; kat xuat cac biau mau ban hanh theo Quyat dinh so 1399/QD-BHXH, Quyat dinh so 982/QD-BHXH 13/7/2016 va viac ban hanh He th6ng chi tieu th6ng ke va the dO bao cao th6ng ke nganh BHXH da sir dung theo chirc Wang nhiam vu dugc giao; chiu trach nhiam ve bao mat, an toan cac thong tin khai thac tir He th6ng
b) Ban Thuc hien chinh sach BHYT, Ban Dugc va Vat t r y te, Trung tam Giarn dinh BHYT va toan da tuyen khu vuc phia Nam, Vu Thanh tra kiem tra, Vu Kim toan not bO: tra cuu dir lieu chi tit tai tong ca kham banh, chfra
banh, a nghi Trung tam Giam dinh BHYT va toan da tuyan khu-vgc phia
BL kat xuat du lieu chi tit tai cac ca s& kham benh, chaa banh BHYT theo Quyat dinh kiem tra, tra, kiem toan cua BHXH Viet Nam hoc thuc hien giam dinh chuyen de
c) Vu Tai chinh - Ke toan, Vu Kim toan not b0, Ban Thuc hien chinh sach BHYT: tra ciru thong tin va tarn img, toan chi phi KCB BHYT tren toan qu6c
d) Ban Thuc hien chinh sach BHXH: tra ciru lich sir kham b'enh, chaa banh BHYT cua cac twang hop da nghi huong cac the BHXH
2 BHXH tinh
a) Tra dm, kat xuat dir lieu danh muc dung chung toan qu6c, danh muc dimg chung tai tinh, danh muc sir di:mg tai ca so kham banh, chaa banh BHYT tren dia ban tinh
b) Thuc hien giam dinh din tir, xir 17 thong tin, ghi riNn kat qua giam dinh
ten du lieu din tir theo quy dinh ve phan cap 1(-)r7 kat va to chirc thuc hien hop
d'Ong kham banh, chfra banh BHYT va Quy trinh giam dinh ban hanh theo Quyat dinh s6 1456/QD-BHXH 01/12/2015 dia T6ng Giam d6c BHXH Viet Nam
c) Tra ciru, kat xuat din lieu tong hgp chi phi kham banh, chaa b'enh BHYT tren dia ban tinh va dir lieu da tuy'an di ngoai tinh
3 BHXH huyan
(5)b) Thuc hien giam dinh dien tit, xd Vi thong tin, ghi nhan kat qua giam dinh tren du lieu dien tir theo quy dinh ye phan cap 147 kat va t6 chirc thus hien hop ding kham benh, chita benh BHYT va Quy trinh giam dinh ban hanh theo Quyat dinh s6 1456/QD-BHXH 01/12/2015 cua T6ng Giam d6c BHXH Viet Nam
c) Tra cdu, kat xuat dir lieu tong hop chi phi kham benh, chila benh BHYT teen dia ban huyen
4 Co so kham benh, chda berth BHYT duac quyen khai thac cac thong tin tir C6ng tip nhan dm He thong, bao
a) Tra cfru, kat xuat dit lieu danh muc dung chung town qu6c, danh muc diing chung tai tinh, danh muc dung chung tai don vi
b) B6 sung, dien chinh, xoa du lieu danh muc va du lieu kham benh, chda benh cua don vi ten Cong tip nhan cua He th6ng
c) Tra cdu thong tin the BHYT, lich sir IL kham benh, chua benh gdn nhat cua nguZYi co the BHYT den kham benh, chua benh tai don vi
d) Gtiri dir lieu chi fiat de nghi town BHYT len C6ng tier, nhan nguad benh kat thitc lan kham benh, dot dieu tri ngoai tru hoSc not tru; Dive dieu chinh, xoa, giri lai du lieu chi tiet de nghi town BHYT chua giri ca quan BHXH giam dinh
d) Gui cid' lieu chi tit de nghi town sang giam dinh cham nhat 24 gio ke tir thoi diem town; Da lieu da gui giam Binh chi clugc thay the co sit chdp thuan cua cc quan BHXH; Giri cut lieu tong hop de nghi town BHYT hang thong d'au thong ke tiap
e) Giri du lieu danh muc thu6c, vat to y to vong lam viec co ket qua thau hoac mua sam bang cac hinh thirc hop phap Ichac hoSc co thay doi, dieu chinh danh muc, gia thuoc, vat to y te, dich vu ky thuat
g) Tra ciru, kat xuat thong bao kat qua giam dinh, bao cao guy& town chi phi kham benh, chua benh BHYT
5 Cac ca quan, don vi, to chdc va ca nhan c6 lien quan den kham benh, chua benh BHYT duac truy cap He th6ng thong tin giam dinh BHYT co yeu cau va duac Trung tarn Cong nghe thong tin cap tai khoan, phan quyen truy cap
Dieu Sir clung chit 147 dien tir
1 Chitk3'7dien tir dugc tich hop va sir dung tren He th6ng thong tin giam dinh BHYT theo dung cac quy dinh cua phap lust va co huong dan dm BHXH Viet Nam
2 Chit 1(3'7 dien tir tich hop tren bao cao phai g6m: chit 14/ s6 cua thii truing ca quan, don vi (hoac nguoi &roc uy quyen) va chit 147 so cua can b0 lap bao cao hoSc cua lanh ciao 130 phan, phong, ban nai lap bao cao
(6)3 , Bao cao ket xuat tir He th6ng thong tin giam dinh BHYT có tich hgp chit 147 so hop le có gia tri phap ly va thay the bao cao bang van ban giay
Dieu Trach nhiem t6 chirc thuc hien
1 Trach nhiem cua BHXH tinh
1.1 Giam d6c BHXH tinh c6 trach nhiem
a) T6 chirc thuc hien day du cac quy trinh nghiep vu giam dinh BHYT ten He thong theo huang clan oh BHXH Viet Nam; chiu trach nhiem ye ket qua cong tac giam dinh dien tir tai dia phuang dugc giao quan 15/
b) Dam bac, day du phuang tien, dieu kien lam viec, the d6 cho can b6 giam dinh theo quy dinh
c) Kip then bac, cao BHXH Viet Nam cac kho khan, vtrong,mat to chirc thuc hien giam dinh dien tir; kien nghi, de xuat huong giai quyet, khac phuc
1.2 Tnrang phong Cong nghe thong tin c6 trach nhiem
a) Quan ly tai khoan quan tri cua BHXH tinh; tao m&i, hely quyen truy cap He thong; quan 17 lich sir truy cap ciia nguoi dung thu6c BHXH tinh va BHXH huyen tren ca s& van ban de nghi cua cac phong, b6 phan nghiep vu lien quan
b) Tham mtru cho Giam d6c BHXH tinh cac giai phap bao dam tien d6, chat lugng ket noi, lien thong dit lieu; cac bien phap bao dam an toan, bao mat thong tin khai thac tir He thong
1.3 Truong phong Giam dinh BHYT c6 trach nhiem
a) Tham muu cho Giam d6c BHXH tinh de b6 tri nhan ltrc vao cac 1)6 phan/nhom giam dinh de thuc hien giam dinh dien tir, xay dung ke hoach, n6i dung va giam sat ket qua thuc hien
b) Phan quyen khai that, xir VT thong tin cho can b6 thuc Phong Giam
dinh BHYT, b6 phan giam dinh thuc BHXH huyen theo dung them quyen, nhiem vu dugc giao
2 Trach nhiem cua cac co sa Icham benh, chita benh
a) Quan ly, bao mat cac tai khoan truy cap, bao mast cac thong tin khai that tir He th6ng
b) Lien thong dit lieu kip tiled, day du va chiu trach nhiem ve tinh chinh xac cua du lieu cat danh muc sir dung tai don vi, cid lieu dien tir de nghi toan BHYT
3 Trach nhiem ciia cat dcm vi tri c thu6c BHXH Viet Nam 3.1 Trung tam Cong nghe thong tin
a) Dam bao an toan hog dOng He th6ng, bao mat &I lieu kham benh, chita benh BHYT
(7)j Ph-giffUlnig Son
b) Quan 1Y tai khoan quan tri he thong cua BHXH Via Nam, tai khoan quan tri, tai khoan phan quyen ciia BHXLIcac tinh, tai khoan truy cap C6ng tiep nkan cua He thong tren ca so van ban de nghi cua cac don vi nghiep vu cua BHXH Via Nam; cap tai khoan cho cac dcm vi ngoai nganh theo chi dao cua BHXH Via Nam
c) Quan 1Y, giam sat viec xay dung co s& clit lieu dm He thong, lien thong voi cac co sg du lieu khaz cua BHXH Via Nam va cac don vi ngoai nganh; Tich hop cac img dung ve giao dich dien tit, chit kY so, the an sinh xa hOi dien
d) Sira di, b6 sung thong tin danh muc cac dan vi hanh chinh va cac danh muc khac c6 lien quan BHXH Via Nam quy dinh
3.2 Trung tam Giam dinh BHYT va town da tuyen khu v-krc phia Bac a) Quan ly, sir dung tai khoan phan quyen cUa Trung uang; phan quyen khai thac thong tin cho nguoi dung thuc cac don vi nghiep vu cua BHXH Via Nam ten phan mem giam dinh BHYT
b) Sda doi, bo sung, ngirng hieu luc th6ng tin tren danh muc clang chung tan quoc ve thuoc, vat to y te, dich vu ky thuat va cac danh muc Ichac; Cap nhat, di'eu chinh quy tAc ten phAn mem giam dinh BHYT
c) Phi hop vai cac don vi c6 lien quan to chirc huong dan, kiem tra viec thuc hien giam dinh dien tir ciia BHXH cac tinh
3.3 Thu tnrong cac don vi lien quan theo chirc nang nhiem vu dugc giao c6 trach nhiem to chirc thuc hien Quy dinh
4 Cac dan vi va ca nhan dugc quyen khai thac c6 trach nhiem thuc hien day du, nghiern tuc cac quy dinh cua phap lust, quy dinh, quy the cua BHXH Via Nam ve bao ve bi mat nha nu6c va bao dam an town thong tin theo Quyet dinh so 967/QE)-BHXH 20/6/2017 dn BI-IXH Viet Nam ve viec ban hanh Quy the bao ,clarn an town thong tin ung dung cong nghe thong tin cda nganh Bao him xa h6i
Dieu Dieu khoin thaw chieu
Tnrong hop cac van ban dugc clan chieu Quy dinh dugc thay the, sira doi, b6 sung thi thuc hien theo van ban thay the, sira di, b6 sung./ 4/
KT.TONG GIAM DOC PHO TONG GIA1VI DOC