By Fineline Cube 
China’s National Healthcare Security Administration (NHSA) has issued the “Interim Administrative Rules for Instant Settlement of Basic Medical Insurance Funds,” introducing a new payment method for disbursing medical insurance funds to designated medical institutions. This initiative aligns with the requirements of basic medical insurance fund budget management and medical expense settlement management.
Key Innovations
- Accelerated Settlement Times
The new rules focus on reducing the time it takes to settle accounts, enhancing the efficiency of fund disbursement. - Item-by-Item Payment
The rules promote the declaration and allocation of funds for each individual medical expense, ensuring more precise fund management. - Monthly Pre-payment
Designated medical institutions will receive monthly advance payments to improve cash flow and reduce financial pressure.
Applicability
These rules apply to instant settlement work conducted by medical insurance departments at all levels with designated medical institutions. They cover both employee medical insurance funds (including maternity insurance) and urban and rural resident medical insurance funds.
Implementation Objectives
The primary goals of these new rules are to increase the efficiency of instant settlement by streamlining processes such as uploading settlement lists and conducting intelligent reviews. This will result in shorter times for expense reconciliation, application approval, and fund allocation.
Monthly Pre-payment Details
For monthly pre-payments, a certain percentage of medical insurance funds will be pre-allocated to designated institutions each month. Deductions and performance evaluations will be conducted concurrently and tied to the annual settlement. In cases of accelerated or item-by-item payments, monthly pre-payments may not be necessary.
Settlement Process
When an insured person settles their bill at a designated medical institution, the medical insurance information platform will calculate their benefits, including fund payments and personal contributions, and transmit the settlement information back to the institution. Local authorities will determine the appropriate instant settlement payment ratio based on the current year’s medical insurance fund budget and previous years’ expenditures.
Effective Date
These rules are effective as of the date of their issuance, marking a significant step toward improving the management and efficiency of medical insurance fund disbursement in China.-Fineline Info & Tech