国家医保局印发通知：今年底前所有统筹地区均需开展即时结算

Core Points - The core viewpoint of the article is that the reform of the medical insurance fund's instant settlement system is expected to enhance the operational management mechanism of the medical insurance fund, thereby improving settlement efficiency [1] Group 1: Reform Objectives - The National Healthcare Security Administration has issued a notice to promote the instant settlement reform, requiring all coordinated areas to implement it by the end of 2025 [1] - By the end of 2026, it is expected that instant settlement funds will account for over 80% of the local medical insurance fund's monthly settlement funds [1] - The proportion of designated medical institutions with instant settlement capabilities is also targeted to reach 80% by the end of 2026 [1] Group 2: Mechanism Enhancements - The notice emphasizes the need to strengthen the construction of the instant settlement mechanism, including standardizing the fund disbursement mechanism and enhancing audit and supervision mechanisms [1] - A risk warning mechanism is to be established to ensure better management of the medical insurance fund [1] Group 3: Settlement Process Improvements - Provincial medical insurance departments are instructed to guide designated medical institutions to submit medical expense claims by the 10th of the following month [1] - Localities are encouraged to further standardize the instant settlement process and utilize information technology to enhance efficiency and reduce settlement cycles [1] - The goal is to disburse settlement funds within 20 working days after the claim submission deadline, aiming for completion by the end of the following month [1]