By Fineline Cube 
The National Healthcare Security Administration (NHSA) has announced a three‑phase, AI‑powered review pilot covering Beijing, Tianjin, Hebei, Liaoning, Zhejiang, Hunan, and Chongqing. The initiative – dubbed “local exploration, national evaluation” – aims to modernise claim adjudication, enhance fund sustainability, and standardise cost‑control rules across the country.
Pilot Scope and Objectives
- Designated Units – Medical insurance bureaus in Beijing, Tianjin, Hebei Province, Liaoning Province, Zhejiang Province, Hunan Province, and Chongqing Municipality.
- Goals
- Strengthen full‑process intelligent review capabilities.
- Create a “local exploration and innovation, national evaluation and promotion” model.
- Promote the safe, efficient, and sustainable operation of medical‑insurance funds.
Roll‑out Structure
| Phase | Period | Key Activities |
|---|---|---|
| Initiation | Oct 2025 – Nov 2025 | Baseline assessment, selection of pilot elements (functional optimisation, review models, intelligent reporting). |
| Advancement | Nov 2025 – Mar 2027 | Pilot provinces adopt AI and big‑data‑driven data governance; develop custom review rules. |
| Promotion | Apr 2017 – Dec 2017 | National deployment of proven knowledge and rules; build a nationwide intelligent review knowledge base. |
- Pilot Flexibility – Provinces may cherry‑pick components aligned with local circumstances.
- Technology Leveraging – Encouragement to use artificial intelligence (AI) and big data for enhanced data governance.
National Knowledge Base and Standardisation
- Intelligent Review Knowledge Base – NHSA will prioritise deployment of effective pilot rules on the national platform.
- Standardised Drug Knowledge Base – Nationwide, standardisation of medication‑compliance rules to unify cost‑review benchmarks.-Fineline Info & Tech