S6: _.fg42IBHXH-GDBVIv hu6ng din thuc hien

trich chuyen dfr lieu di~n ill

CQNG HOA xA HQI CHU NGHiA VI~T NAMI>Qcl~p - TV do - H~nh phuc

Ha N9i, ngay 23 thdng s nam 2018

uAo HIEM xX HQI VI~T NAM

Kinh giri:,., - Bao hiem xa hQi cac tinh, thanh ph6 true thuoc Trung uong;

S~ Y TE TiNH KON TUM ao hiem xa hQiBQQuoc phong; Bao hiem xa hQiCong an nhan dan.r K S· 6' Ik "tOLL (sau day goi chung la BHXH cac tinh)11"\EN ..t.of,.1 , ..

ICh i· NgaY;Jg:5..~~. 28/,12/2017 BQY tS da ban hanh Thong tu s6 48/20 17/TT-BYT quy, uvh.."· .... ; .... ·..oiruftriCh.. uyen dfr lieu di~n nr trong quan ly va thanh toan chi phi kham benh,dIU OSdSg:...... . KBCB) bao hiSm y tS (Thong tu s6 48), Bao hiem xa hQiVi~t Nam

dS nghi BHXH cac tinh nghiem tuc thuc hien cac quy dinh cua Thong tu s6 48,d6ng thai ph6i hQPchat che voi Sa Y ts va cac co sa ~CB bao hiSm y tS (BHYT)tren dia ban dS th6ng nhAt th\lc hi~n vi~c trich chuySn'dfr li~u di~n tu dSn C6ngtiSp nh~n dfr li~u H~ th6ng thong tin giam dinh BHYT cua BHXH Vi~t Nam(C6ng tiSp nh~n dfr li~u) nhu sau:

1. VS dfr li~u di~n tu do ca sa KBCB trich chuySn len C6ng tiSp nh~ dfrli~u dS quan ly, giam dinh va thanh toan BHYT

a) Dfr li~u di~n tu cac danh m\lc duQ'cl~p thea dinh dc;mgexcel g6m: danhm\lc dich V\l Icy thu~t, thu6c va v~t tu y tS da duQ'ccApthAm quySn phe duy~t sud\lllg va danh m\lCthu6c, v~t tuy tS dAuth~u, mua s~m tt;lidon vi; danh m\lc khoaphong thea Bang 7 QuySt dinh s6 4210/QD-BYT ngay 20/9/2017 cua BQY tS quydinh chuAnva dinh dc;mgdfr li~u d~u ra su d\lllg trong quan ly, giam dinh va thanhtoan BHYT (QuySt dinh s6 4210/QD-BYT); cac danh m\lc khac thea huang d~ncua BQY ts va Bao hiSm xa hQi Vi~t Nam (dfr li~u danh m\lc).

b) Dfr li~u h6 sa chi tiSt cua nguai b~nh BHYT duQ'c l~p thea dinh d~mgfile XML quy dinh tt;li QuySt dinh s6 4210/QD-BYT. Rieng thong tin vS rnagiuang, thong tin th~u va dfr li~u Bang 4, Bang 5 thea QuySt dinh 421O/QD-BYTth\lc hi~n thea huang d~ tt;liDiSm 6 Cong van s6 1677IBYT-BH ngay 28/3/2018cua BQY tS (dfr li~u chi tiSt).

c) Dfr li~u h6 sa t6ng hQP dS nghi thanh toan BHYT duQ'c l~p thea dinhdt;lngfile Excel g6m chi phi v~t tu y tS thea m~u 19IBHYT, chi phi thu6c theam~u 201BHYT, chi phi dich V\l ky thu~t thea m~u 211BHYT; Danh sach nguaib~nh BHYT kham chfra b~nh ngot;li tm dS nghi thanh toan thea m~u C79a-HD;Danh sach nguai b~nh BHYT kham chfra b~nh nQi trU dS nghi thanh toan thea "­m~u C80a-HD quy dinh tt;liQuySt dinh s6 917/QD-BHXH ngay 20/6/2016 cuaT6ng Giam d6c BHXH Vi~t Nam (dfr li~u t6ng hQ'P).

2. VS cach thuc tiSp nh~n dfr li~u di~n tu

a) CO's~ KBCB gui dfr lieu di~n tu tai Di@m 1 Cong van nay dSn C6ng tiSpnhan dfr lieu bang mot trong cac phirong thirc quy dinh tai DiSu 5 Thong tu s6 48(rieng phirong tlnrc truyen theo FTP sir dung d@giri len Cong dfr li~u cua BQY tS).NQi dung chi tiSt thuc hien theo Tai lieu huang d§n lien thong va d~c ta dfr lieu Hethong thong tin giam dinh BHYT ban hanh kern theo Quyet dinh s6 917/QD~BHXHngay 20/6/2016, Cong van s6 2723IBHXH-CSYT ngay 21/712016 va Congvan s6 4782IBHXH-CNTT ngay 27/10/2017 cua BHXH Vi~t Nam.

b) CO'sa KBCB giri dfr li~u danh muc cho co quan BHXH qua C6ng tiSpnhan dfr li~u l~n d~u hoac ngay sau khi co phat sinh moi ho~c co sir thay d6i, diSuchinh danh muc trong qua trinh thuc hien hop d6ng KBCB BHYT.

- - - - -- - - - -- -I:

- CO'quan BHXH thuc hien viec ap dung danh muc tren H~ thong thong tingiam dinh BHYT khi nh~n duQ'c van bim cua cO'sa KBCB d@lam can cu giamdinh, thailh tom BHYT, thong bao d@cO'sa KBCB diSu chlnh trong truOng hgpkhong dung danh m\lc dung chung theo quy dinh cua BQY tS.

c) Dfr li~u chi tiSt d@quan ly KBCB duQ'c cO'sa KBCB gui cho cO'quanBHXH theo quy dinh t~i DiSu 6 Thong tu s6 48.

- Dfr li~u chi tiSt dS nghi thanh toan BHYT duQ'ccO'sa KBCB xac th\lC vagui cho cO'quan BHXH theo quy dinh t~i DiSu 7 Thong tu s6 48, cO'sa KBCBth\lc hi~n vi~c gui dfr li~u dS nghi thanh toan ti:r C6ng tiSp nh~n thong qua chucnang "H6 sO'dS nghi thanh toan ->H6 sO'XML ->Danh sach dS nghi thanh toan" .Truac khi gui dfr li~u dS nghi thanh toan BHYT, cO'sa kham chfra b~nh co th@sud\lllg chuc nang "D6i chiSu h6 sO'''d@ki@mtra, diSu chinh, b6 sung thong tin ho~cgui l~i nSu dii li~u chua dung vai h6 sO',b~nh an cua ngum b~nh.

- D6i vai dii li~u dS nghi thanh toan trvc tiSp cac chi phi thuQc ph~m vi,quySn lQ'inguai b~nh dUQ'chuang: cO'quan BHXH huang d~n cO'sa KBCB guidii li~u chi tiSt ho~c, su d\lng chuc nang nh~p dii li~u tren C6ng tiSp nh~n lam cO'sa giam difJh, thanh-toan theo quy dinh.,.._' . - ~:.

d) Dii li~u tBng 'ii<iP:4Snghi thanh toan BHYT phat sinh trong thang duQ'ccO'sa KBCB l~p, gui len C6ng tiSp nh~n dfr li~u truac ngay mung 05 cua thangkS tiSp theo quy dinh t~i DiSu 7 Thong tu s6 48. CO'sa KBCB su d\lng chuc nang"H6 sO'dS nghi thanh toan -> D6i chiSu h6 sO'''d@ki@mtra tinh chinh xac cua diili~u chi tiSt va t6ng hgp.

d) D6i v6i truOng hQ'PcO'sa KBCB khong glii, gUi dii li~u ch~ (tm truOnghQ'Pquy dinh ~i DiSu 8 Thong tu s6 48), dii li~u chua dUQ'cchudn hoa theo quy dinhho~c cO'sa KBCB khong khai thac dii li~u d§n dSn chi dinh trung l~p ho~c chi dinhqua muc c~ thiSt, cO'quan BHXH t~m thm chua ch~p 'nh~ thanh toan chi phi nay,ph6i hQ'Pv6i cO'sa KBCB lam ro nguyen nhan, th6ng nh~t giai phap kh~c ph\lc.

BHXH tinh t6ng hQ'Pva thong bao v6i Sa Y tS va cac cO'sa KBCB tinhhinh lien thong dii li~u, ch~t luqng dii li~u, s6luqt, s6 chi KBCB phat sinh trongthang, d~c bi~t la cac bi@uhi~n, b~ng chUng co S\l b~t thuOng vS chi phi, t~n su~t

, ., .

KBCB, chi dinh, sir dung dich vu ky thuat, thuoc, v~t nr y tS qua mire cAnthiet dSdS nghi co So'KBCB kip thai kh~c phuc, diSu chinh.

3. VS viec phan h6i va tiSp nhen dfr lieu di~n tic tir CBng tiSp nhan dfr lieu

Thuc hien theo quy dinh tai Khoan 3 DiSu 7 Thong tu s6 48. Co quanBHXH thong bao va neu r6 ly do C\l thS chi tiSt dSn tirng ban ghi d6i voi dfr lieuco So' KBCB giri sai c§.utrue, sai logic cac tnrong thong tin, sai danh muc dungchung. Truong hop co sir chenh l~nh gitra ban gi§.y va di~n ill hoac chenh l~chgifra dfr li~u chi tiSt va dfr lieu t6ng hop, co quan BHXH thong bao dS co So'KBCBkip thai hieu chinh dfr lieu.

Viec thong bao, phan h6i thong tin gitra co quan BHXH va co So'KBCB thuchien b~ng van ban ho~c thu di~n illtheo dia chi email dii duQ'chai ben th6ng nh§.t.

4. VS vi~c t!;lmilng kinh phi KBCB theo dfr li~u di~n tu

Can cu dfr li~u gui len H~ th6ng thong tin giam dinh BHYT theo huang dant~i DiSm 5 Cong van s6 16771BYT-BH ngay 28/3/2018, truOng hqp chenh l~chv6i bao cao quySt toan cua co So' KBCB thi thong bao dS dan vi kiSm tra, diSuchinh.

Giam d6c BHXH cac tinh co trach nhi~m tf\}'ctiSp chi d!;lo,triSn khai th\lchi~n cac n9i dung huang dan t!;liCong van nay, kip thai bao cao Uy ban nhan dantinh, BHXH Vi~t Nam tinh hinh lien thong, trich chuySn dfr li~u theo quy dinh t!;liThong tu s6 48 va cac van ban huang dan th\lc hi~n. NSu co kho khan, vuang m~cbao cao v@Bao hiSm xii h9i Vi~t Nam (Trung tam giam dinh BHYT va Thanhtoan da tuySn khu V\l'C phia B~c) dS duQ'chuang dan giai quySt.lrNO'inh~n:- Nhu tren;- PTTg Vuong Dinh Hu~;- PTTg Vii Duc Dam;- CM tich HDQL BHXH VN; d8 bao cao- VPCP, BYT, BTC, BTTTT;- T6ng Giam d5c;- Oic Ph6 T6ng Giam d5c;- Sa Y tS cac tinh, TP ttvc thuQcTV;- Cac don vi: CSYT,TCKT, DVT, TTKT,KTNB,CNTT,GDN;- LUll: VT, GDB (5b)1---

KT. TONG GIAM DOCPHO TONG GIAM DOC

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