医保管理工作制度.docxVIP

医保管理工作制度

目录

一、总则....................................................5

1.1制定目的.............................................6

1.2适用范围.............................................6

1.3基本原则.............................................7

二、组织机构与职责..........................................8

2.1组织架构.............................................8

2.2职责分工.............................................9

2.3工作流程............................................10

三、医保基金管理...........................................12

3.1基金筹集............................................12

3.1.1费用来源........................................13

3.1.2收缴程序........................................14

3.2基金支付............................................16

3.2.1支付范围........................................17

3.2.2支付标准........................................18

3.2.3支付程序........................................19

3.3基金监管............................................20

3.3.1监管内容........................................21

3.3.2监管措施........................................22

四、医保政策管理...........................................23

4.1政策制定............................................24

4.1.1政策制定程序....................................25

4.1.2政策内容........................................26

4.2政策执行............................................28

4.2.1执行方式........................................29

4.2.2执行监督........................................30

4.3政策评估............................................31

4.3.1评估方法........................................31

4.3.2评估结果运用....................................32

五、参保人员管理...........................................33

5.1参保登记............................................35

5.1.1登记条件........................................36

5.1.2登记程序........................................37

5.2参保信息管理........................................37

5.2.1信息采集........................................38

5.2.2信