Notice of the office of the state medical security administration on doing a good job

Payment method management subsystem

Working notification function of dig / DRP module

Medical insurance office letter [2022] No. 19

Medical security bureaus of all provinces, autonomous regions, municipalities directly under the central government and Xinjiang production and Construction Corps:

In order to implement the three-year action plan for the reform of DRG / Dip payment mode (medical insurance Fa [2021] No. 48), accelerate the establishment of effective and efficient medical insurance payment mechanism, and promote the in-depth development of DRG / Dip payment mode reform, the National Medical Insurance Bureau has developed the basic version of DRG / Dip function module based on the national unified medical insurance information platform. The relevant matters are hereby notified as follows:

1、 Online schedule of basic version of DRG / Dip function module

From April 2022, select some provincial medical insurance information platforms for testing, and adjust relevant rules, parameters, transmission, use, security and other functions in accordance with relevant DRG / Dip technical specifications and in combination with local data; Before the end of June 2022, select some new areas to carry out DRG / Dip payment reform and try out the DRG / Dip function module of the national unified medical insurance information platform; By the end of November 2022, the DRG / Dip function module will be applied nationwide.

2、 Local demand management

DRG / Dip function modules are "basic constraints". Local governments should carry out landing applications in strict accordance with the requirements of making full use of existing function applications, matching according to individual needs, minimum requirements for customized development and national audit of differential needs, so as to ensure that local personalized development is flexible, safe, controllable and unified as a whole.

3、 Work arrangement during the transition period

Regions that have not completed the construction of DRG / Dip payment information system must use the DRG / Dip function module provided by the national unified medical insurance information platform, and shall not repeat the construction in any form and reason.

For regions that have completed the construction of DRG / Dip payment information system, the provincial medical insurance bureau shall set the transition period and formulate the transition plan. During this period, the original system shall be well connected with the provincial medical insurance information platform to ensure that the DRG / Dip grouping results and settlement rules can be imported into the provincial medical insurance information platform to realize DRG / Dip settlement. We should make full preparations for the conversion and use of the DRG / Dip function module of the national unified medical insurance information platform, strengthen the evaluation, and ensure that the function is applicable and easy to use.

Office of National Medical Security Bureau

April 11, 2022

Source: Office of National Medical Security Bureau