CONG HOAXA HQICHlJ NGHiA YI~T NAMDQct,p - T\t do - H,nh pluieHa N(1ir ttgiryJ 8 thang 3ndm 20] 8s6;~6ffIBYT -BH

V/v huang ,d$ giw quyet met 86vAn d~ v~ ung dung eNTf trongquan ly KCB va thanh roan BHYT

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Luu h" ..'o sCI SO:'I"""'I'IiBIICt"III~":l1:1> !. , , , II:'IA • • • ~ ,A t ~ ,. ~', r , inh h h"" ,. he 'h'~. gun quyet mot so wang, mac trOllS qua tnnn t uc 'wn tin lQC " pa

trong ,quan Ij khatu b~nh, chua ij~nh>(KBCB) va thanh toan chi phi KBCB baoh ·~ ;. (B'UVT k" h/;' ,1. "" h";\, , N'''' • , '" I:;10m y te' ii~ ), sau "hI tong Qba:t VOlBao 'Jem xa hQl Vl~t Nam, B9 YitehU'<1u~!d~;ncac.a.anvi th\lc hi~n IDQtS& nQi d.Qug:,sau:

L ve vi¢c !ra cUu thong ti.ll the BHYT

.. Sa Y tS cac tinh, thanh ph5 tnrc thuQc, trung uong;- Cac Benh vi~n, Vi~n c,6 giuong b~nh true thu9c B<)Y t~;- Cac cO'sa kham benh, chua b~nh tbuQc cac B¢, nganh,

(Scm aay gOi chung lit cac don vi}

sa Y TE rlNH iON TL1fDEJrlNS6;£/.J i.'::i

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~ ~~o hi~tn x~ h<)i,(BHXI;) Vi~t Nam ~acung ~§p cac cang ~\l tr~ CUll ~1nCOIlg tlep nb~ (ala ChI https,:llgdbhyt~baohiemxah()l.goV.vnl) hO(;lC Cong thopgtin di~n tu (dia chi https:!/baohie11lxahoi.gov,vn) ho~c tra c(ru trllC ti&p thong C]juac4c ham giao di~n l~p trlnh (rng dVng - API (Application Programmin:sInterface) theo Cong van s6 366IBHXH~CNTT ngay 31101/2018, de co ]scrKBCB thvc hi~h tra cfru thong tin the BHYT khi don ti~p nguCti c6 the BH YTu@nKBGBb~ngm9t trong cac ·cong09 nay~Rieng cae d6i tuqng Quan nhan,Con.g an nhan dan, Co yeu (Cac the BllYr co rna ail tU:(JJ1gQN, CA, C~'):truang hqp tra Clm b~ng cae cona, C\l neu b.,en.ma khong co thong tin the BHYrthl chi ki@m tra the BHYT va giiy to' tOy than c6 ann d8 t111)'cbi~n KBGS t~e()qui·dinh. i

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CAc CQ .s6 KBGB Stl d1,Jng thong tin tra CUll b~g m~t ttong Cae cong cl;lltrac\(runoi tren eua ccr quan BHXH i~k,thai di8$ ngllbi b~nh d~n KBCB 131'11cal sodS xac dinh KBCB d6i vai nguai b~nh theo ch~ d9 BI-IYT ho~c khong thea ~hS. """ ,.' ," ,'. _., ' ''-_.~ .. X "10: ~' ~, '" ,I., , "' '. ,- __ ,"' ,-t, :,' ,10 " ,_f"'_' J ,-<19BHYT. Trllang hgp ~l thOl dt¢'m ngl1crl b~nh ,den KBCB ma ket qua tra cU1ljcoth8ng bao the BHIT b~t thoi h'.ln sil d\log tbi co so KBCB thl,lC hl¢o KBGB p6ivai ngueri d6 khong thea ch~ dQBHYT va giai thkh d~ ngucri b~nh ho~c t~Rnnhan uguai b¢nh bi~L Truang hClP t;ti tl1ai dibm nguoi b~Ilh d~n KBCB 111a ;k~tqua tra ctm co thong bao the BHYT con th(yi h(;U1StY dl;mg va hgp l~ thi cd saKBCB tht,l'c hi~n KECB d6i v6i nguOi do thea ch§ u{>HHYT. CO'quan BHfCHclij,ll tmch fihi,em t.ru:ac pn.apluft v~ ti:nh ehfnh xae eua thong tin tren H~ th8ng.!

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!Cherng tilll" B9 Y t~Ngay ,IcY: 28/03/201814.5[:33H,; tbong VOffice B9 Y Te

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Truang hgp 00 8\}' cf:>ky th:u~t'rna C<1$aKBCB khong tra .cUu duQ'cthong tip,cac co sa Kl)CB lienh~ ngay d~n cO'quanBHXH.l1oo ky hop d6ng ho~c qua T6~gdii M trQ' khach hang (s.3 di~n tho~ 1900.9696(8) d~ :ph6i hW xu I)' kip th~iTruong hop C(1 sb KBCB khoilg ]iSn h~,dU"Qcv6i CO' quan BHXH ho~cT6ng alaih6 trc !<huchhang thl co quan'BHXH c6 traoh llh!~mhru .toan b9 ljch su tra c~rl!c~a co S(J:KBCB, eo sa :&:BeB hru hlnh anh lai ira ctru va cung c~Pngay choBg!Yte,~qua dt~ ~h.Iem~l! q~octoali!zhy~@gl,naiLc(}m)~8kip thbi ph6i hop :'oi ~.~~Vl~tNaill glftrlquyet Neu do yeu to khach quan thl co quan BHXH khong tir d~Olthanh toan chi phf KBCB d6i vili trt!emg hop do. !

2. V~vl~c dlay d3'! thong n'n tren the BHYT;

,Baohi~m xa hQi Vi~t Maw dang tti1Jchi~n,c§p, d8i the BHYTtheo rna ~6an sinh X8: h~i, trong qua trinh ni soat, d6ng b¢ dil.li~u e6 mot s6 thong tin dugcC?Pnh?t,thay ct5ikhac vai thong tin tren the BHYT ma nguai b~nh su d~ngjdjKBCB, nhu: h9 vaten,ngay, tI:ang,nam $inb, rna the, mue hl,~(yng,thai h~n ~udl::mg,noli ding ky KBCB ban dau ... do v~y: i

- Tn.rCrnghqp 'thong tin tren the BHYT ho'o thong tin ki~m tra qua hJ.rnAPI ella c,a qu.an·BHXH cung cAp knee thong tin tra ctm t?i thbI di~rn 11gl1(yj bethe BHY! d~n,KBCB (kiu5n'gbaa g~m sal khil(; .thol1:g tin mtlc hutaJ:l~hgn ~tCd~mgthe BHY1) thi cae ccr sa KBCB chi ]~p 01 (mqt) Bang ke chi phf KB(f;Bban hanh kem theo Quy~t d:j.nh 8&. 3455lQD-BYT ngay 15/10/2013 ella aQtru&ng B9 Y tS va 01 (mQl) tile dfr li~udi~ll.tu, hl~u crunh thea thong tin d.a,iracUn lAn cu&i cung, dAng thai thong ban 'cho ng;~o-ib~nh hotic than. nhan lien Ih~ngay vai .oct quart BHXH dS thay d6i fhe ::SHYT phil hqp v6i thong tin da ddqccO'quan BHXH c~p nha.t;

- Trvang hgp trong thai gian di~u tri, nguai b~nh co thay d6j thong tin lheBHYT kbae v&i thong tin eta tra elm: CO'sa KBCB I~p bd sO"thanh toan dieothong tin va thong tin banh chinn, l1tuC hp:ang cua the BHYT da ki~m tra 'ticn~U'ai.co. t~eB~Y: d@n~am,b~nh; dAng tb6i l~pdu 1i9u.di~n~r thee .th~ngjti2eta gill ~ khl b~nh nhan dSn KBCB the.o dung quy alnh eua NgllJ dlnh, so105120 14/N!)-CP ngay 15/11/2014 cua Chfnh p.hu. CO"sa KBCB c6 tnkh nhi@mcung c~p dAy du hoa dan, chlifl'llgtu hgp ph,ap de ngucri b~nhlam th.Ll tvc th~nhtMm trvc ti.~Pvai co quanBHXH thea qtiy dinh; . J

J... r..., !- TruCynghQP nguai b~nh duge cap Giay chllyen tuyen sir d\mg trong n)3m

duang l1ch: co ghi.ma tile BHYT kbac ma the tra ciro tren h~ th6ng di~n fer)til!nguai dO.khong e§n xin cip l<;l:igi~y chuy~n tuy~n, cO' sa KBeB va cO' qtlanBHXfI co trach nhi~m ti~pIlh~l1} tht,rc hi~n dUng qui dinh nay, khang yeu t§.ungu(ri b~11h,phai xin cAp '1,;tigigy chuy~n tuY~l1. " .:

3. Do£ vai truang bqp the BHYT eua nguai b~nll gan h.et gia tri SLr d' ngkhi KBCB, ca sa KBee e6 traeh nhi~m thong bao eho nguai b~nh ho~c ,. annhan va CCI 'luau BHXH n<1iK>fhqp dOng KBCB 4a ngu(':ri b~h, duQ'cgia b~ theBHYT c6.gia tti srt dl}:nglien ~e. C(J qltiitfBHXH co trach n1:d~mthu ti~n.d."ng

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iBHYT cua ngubi benh (hose than nhan nguoi benh) ngay tai co so KBCB trongvong 05 (nam) ngay k~ nr ngay ti~p nh?ll dU'qc thong tin tir co so KBCB ho~cnguai benh d6 thv:c hien vi~ gia han the BHYT, Tnrong hop 'ngrroi b~nh thafngia BHYT l~n ti~p taeo bi chim (each qu~) nhung khong qua 05 (nam) ngly.", ""'- ;., '\. - h':'" .,,'~ ',. ," - ,--,"----- 'L:'t, ,._ ," .:» ,,", '''_.'~ ,!lam Vl~C ke nr ngay . et tha1 h"n,su' dung CUll tue BHYT tnroo thl thO'] gian eachqu~~gdo ~Uq,C tin.h1~thai gian ~6 tha:n gia ~H'~T hen tuc v~nguci ~~nhk~o1~phai tv ChI tra ChI phi KBCB etta nhung ugay each quang giua the Ian tnroc 'fathe lfuJ sau do. Truong h9'P d?c bi~t rna nguOi b9nh khong the n,r tham ~iaBHYT tiSp thi ca sa KBCB thollg boo va lh&ng tihdt v6i CO'qUailBHXH nai k)fhq,p d6ng KBCB dS giai quySt pb~n chj phi KBCB cua nguai b~nh do,. n~u k~6khan, vuOng Ill~C tW bao cao ccr quan quan Iy c§p tren trl,Ic ti~p.

I4. f)61 val chi p~f ~BCB rna ngua; b~nh chi t!~(bao g6m cun.g chi tra ~a

u.t·tra) thi t9i d6ng "So tieu nguQi b~nh tnl" trong Bieu m~u'OVBV, 02/BV cpaBangke chi phi KBCB cac ea sa KBeB ghi ro s6 tian nguai b~nh Cling chi lrcl,sa ti8n nguai 'b~nh tv tra (cho ca,hat truang h9'Pal' KBCB aung ~yin vaKB6;Bkhong dung tuyin) db xac dinh chinh xac quy&n l~i mien ClIng chi trn khi ngttajb~nh da tham gift BHYT diI 05 (:flam)nam lien tpc va co s6 ti~n CUng c~i tra ~u06 (sau) thung luong ca so ,6i y{ii cae truoog hgp KBGB du.ng tuyen. Contruoug hQ'P KB CB kbong dUng tuySn tm t6ng h~1J'eta tllS hi~ll 1'0dugc sf> ti~n

\, -"11· ~ q - - '\ .' b"" t... _._). '~ ...... J.11..·,.... . ;' x _ J._ l'~cung c, 1 tra cua ugual '.~nb, nhllng so tIen nay se Mlong aUGc tink de cap Glay1...,' nh' A t~t..,,· \" h" •. x~" kc'...1.. C.I. • 'v:nC'B' 'hinh' . J.cuung. ..~ l\,Uongctlng C l tra t~ongD:rull tal \)U"111.11•.. ' aC ca so .~' ...•...c· '. ,uabi~u miiu OIlBV; 02IBV th~o huang d§.tl tren va hoan thanh tnrac n&ayOI!6/2018 de d<ip (tng duqc y~u c~:unay. BHXH \li~tNam co tra.ch nhi~m diSucrunh cong thue tlnh ti~n ngmYi Penh ClIng chi tn~ va nguOi b~nh "t\rtni ttcn H~tl A.:' .. ';" h;l~ -*A ·A." . 1-'" 'I.. ' x: , ., I,long cong tiep nU~i ue tlep nh~ duQ'C di1 WU t.n.eo huang dan nay tn ngay01/6/2018. File XJvlL gui du li~u di¢n tu theo Quy~t dinh 56 4210JQfJ-,BKTnga;y 20'/9/2017 v6i MA_LYDO_VVIEN = 3 thi T_ENCeT # 0 et(mg vai so t~enngucri b~nh cung chi tra tren phcri;thanh toan.

5. Cae dan vi, BHXH c~icctp, cae ocrSf1KBeB thvc hi~n nghieUl tuc Fac~ " ' - , '" ' " , _,'. " _, ' "I '\ !qui djnh t~i Thong tu so 4812017m-BYT ng~y28/12/2017c~aB9 Y te ve t~ich

ch:uy@.ndu li~u di¢n tu phl,lc \flit quan 1y va g.iam djnh, thanh t08n chi phi KBCBBHYT (Sau duy viSt t~t lit Thong tv:.3648).. Thdpg nh~t t~Jn thQ:}su dvng dil JiQudi~n tir (dQ H~u qui dinh t~i.f)i~u 6 .Thong tu 53 48) do ..cu sa KBCB gm {lenCAng TiSp nh~n dlllj~u h.~ th&ng,til6ng tin giam di,nh BHYT cua BHXH 'fi~tNam (Sau day vi~t t~t la G8ng'iiip nh\U1dn H~u) him ca so:tsun tmg chi IphiKBCB .BHYI ella cac CQSQ .IQ3CB. Vi v~y, c.ftCco 56 KBCB ·cAu nghiem!tucthvc hi~n vi~c giri dfr 1i~u di~n tui ien C&ng tiep nh~ du li~u thuang 'A'Uyen,lient1,lcjtheo quy dinh t~ Thong tu s~ 48 va tv chiu fritCh nhi~m v~ vi~c khong d~9'ct:;un Lmg k.in.hphi KBeB neu kh6ng gtii d&y (tu dfr b¢u. .

6. Cae cO' so KECB clln nghiem tuc thvc hi~n quy drnh ch1l5n va dinhd1;logdrr li~u ddu ra sir d~mg trong quan ly, giam dinb va· thanh toan. c;hii phiKBCB BHYT ban hanb theoQuyetdinh s6 42tol@~BYT n!¢y20/9/2017 eua

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~Be) Y t~va cac van ban huang, dan thuc hl~n Quy~t djnh nay, Truong hop chuath];tc hi~;fi ng~yuUgo vi~p gui th;Qng tin lils:<ghiang (MA._ GILJONG), thong tinth~ll(TT~1lIAU) c~n chu uQng ph~i h~,vCri (1(Y quan BIlXFI:.d~th6ng qhfrt g1a;iphap xu tv. Ch~ nh~l,tnroc ngay 311S!20i,8, cac co sa KBCB phaihoan thi~nKong cac tnnrng thong tin: MA_GIUONG trong hang .XML3 va IT THA!Utrong 'hirng XML4, XM:L3d~ &cri dtrgc letl: c&ng tiSp nh?n dil H~u. lJ51vcri vi~c

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thuc hl~ll gfrl ali' He,l OLla bang 4 vlt hang 5 ban nanh thee Quyet o1nh ~o4210/Qr} ..BY'T, d6 nghi cac co sa KBCB triSn khai tlnrc hj~n thea k~ hoach \iabaa cao k@tqua thirc hj~n, d~ xuflt ki~n ngh], gUll phap trong truong h91) chua~~~ ,

Tin h9C hoa trcng quan 1)7 KBCB gHlm dinn va thanh tbifin BHYT iIiinhiem vi).quan trong ella nganh y t6 v<:lBHXH, gop ph&rn Ininh b~lChthong tin,d:ambac €iuy~n19iella cae ben.co lien quem) rHlug cao hi~u qua quaIl IYl Stf d~lfl.g.q~l.?..B.~Y·.T.~B9, y :6.yeu fc1iu.t12Lltt~uOn~,.ca~ d~.n vi ~n~hj~In tLW:0 C?AtI'C th~:ht~n, neu co kho khan, vuong mac lqp thul hac>cao B9 Y te (V v Bao hlem y t.~)va BHXH Vi~t Nam (Trung tim Cong Il~h~ thong til)) d~ dvrqc xem xct, ht~6hgd~n giui qtly~t.l~. .

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Ntii IIJil)n:- Nhu tren;- B9 tnr(mg(d~'bao cab);- Van ph6ngCllJnh phu, (dS b/e);- ijHXH Vi~tNam (d6 ph6ihQ'p);- eve KCB, e,l<:eNTT, Vv KHTC;_.'-lrtl: VT. BH.

KT. sO TRU'ONGTH((TRU'CJNG

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