Latest procedures for payment of health insurance-covered medical care at the health insurance-covered medical care providers in Vietnam

Latest procedures for payment of health insurance-covered medical care at the health insurance-covered medical care providers in Vietnam

The Appendix attached to Decision 1003/QD-BHXH in 2024 has detailed the procedure for processing payment of health insurance-covered medical care at the health insurance-covered medical care providers in Vietnam as follows:

Implementation

Step 1. Preparation and submission of documents

- Within 7 working days (from the date of completion of medical examination and treatment for the patient), the health insurance medical facility must send electronic data requesting the payment of health insurance medical examination and treatment costs to the Data Reception Portal of the Health Insurance Assessment Information System of Vietnam Social Security (hereinafter referred to as the Health Insurance Assessment Information Portal). Data arising in the last days of the month, quarter, or year must be sent to the Health Insurance Assessment Information Portal before the 5th of the following month.

- Within the first 15 days of each month, the health insurance medical facility will compile a Summary of medical examination and treatment costs for health insurance participants (Form C79-HD) of the previous month and send it to the social insurance agency.

- Within the first 15 days of each quarter, the health insurance medical facility will send a Quarterly Settlement Report of health insurance medical examination and treatment costs of the previous quarter to the social insurance agency.

Step 2. The social insurance agency will receive the documents and process them according to regulations.

Method of Implementation

- The health insurance medical facility submits documents online or directly at the social insurance agency or via public postal services (and simultaneously sends the payment request data to the Health Insurance Assessment Information Portal according to the regulations in Circular 48/2017/TT-BYT).

- Conduct the signing of the cost settlement minutes for health insurance medical examination and treatment at the headquarters of the social insurance agency or at the medical facility.

Components of the Documents:

Summary of health insurance medical examination and treatment costs according to Form C79-HD issued with Circular 102/2018/TT-BTC.

Number of document sets: 1 set along with electronic data

Processing Time: No later than 40 days from the date the social insurance agency receives the complete valid documents.

Subjects of Administrative Procedures: Health insurance medical facilities

Implementing Agency: Provincial/District Social Insurance as decentralized

Results of Administrative Procedures

- Settlement minutes of health insurance medical examination and treatment costs signed between the social insurance agency and the medical facility (Form C82-HD);

- The social insurance agency transfers the funds to the medical facility.

Fees and Charges: None

More details can be found in Decision 1003/QD-BHXH of 2024, which comes into force in Vietnam from July 16, 2024.

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