内蒙古“1+3”医保信用监管模式确保基金安全

Group 1 - The Inner Mongolia Autonomous Region has implemented the "1+3" medical insurance credit management model to enhance the safety of medical insurance funds [1] - The credit evaluation system categorizes three main entities: designated medical institutions, designated retail pharmacies, and insured individuals into four credit levels: Excellent (A≥90), Good (90>B≥80), Fair (80>C≥65), and Poor (D<65) [1] - The evaluation cycle is set for one calendar year, utilizing multiple data sources for credit assessment, including self-reported data, regular supervision by medical insurance departments, and shared data from social credit platforms [1] Group 2 - A standardized credit repair mechanism has been established, allowing entities with poor credit to apply for credit repair after correcting their behaviors and providing necessary documentation [2] - The medical insurance department will review and adjust credit records for those who meet the criteria for credit repair [2] - Entities disputing their credit evaluation results can file an appeal within a specified timeframe, with the medical insurance department required to respond within a designated working period [2]