江西重新修订医保信用管理办法 D级定点药店将列入重点整治对象

Core Viewpoint - The Jiangxi Provincial Medical Insurance Bureau has issued the "Interim Measures for Medical Security Credit Management" to enhance the credit management system for medical insurance, with Yichun and Fuzhou designated as pilot cities for this initiative [2][8]. Group 1: Credit Management Framework - The revised management measures clarify the subjects of credit evaluation, including nine types of entities, and focus on the management of medical insurance payment qualification for designated medical institutions [9]. - The credit evaluation method will implement dynamic management within a rating cycle, with unified evaluation rules established by the provincial medical insurance bureau [3][9]. - The management measures include a tiered management approach, allowing for the suspension or termination of medical insurance payment qualifications for entities identified as untrustworthy [3][9]. Group 2: Penalties and Incentives - For entities rated as D-level, the medical insurance administrative department will implement several measures, including mandatory rectification, public disclosure of untrustworthy information, and increased monitoring frequency [10]. - Entities rated A will receive public recognition, credit file documentation, and potential rewards in internal performance evaluations, while B-rated entities will be managed normally [11]. - C and D-rated entities may face suspension of their medical insurance payment qualifications and will be subject to administrative penalties for non-compliance with medical insurance registration and payment obligations [11][12].