医保数据要素应用

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多层次医疗保障清分结算平台在重庆上线
Zhong Guo Xin Wen Wang· 2025-09-06 11:59
Core Insights - The event in Chongqing introduced the "Multi-level Medical Security Clearing and Settlement Platform" and "Medical Insurance Data Element Empowering Credit Finance" application scenarios, aimed at enhancing the accuracy of settlements and improving public access to medical services [1][3] Group 1: Multi-level Medical Security Clearing and Settlement Platform - The platform includes five key scenarios such as commercial insurance quick compensation and direct compensation, facilitating rapid online settlement of medical expenses for commercial health insurance [3] - Currently, 11 insurance companies, including Ping An Property & Casualty and Taikang Life, have applied for commercial insurance quick compensation, with the fastest settlement time reduced to one day [3] Group 2: Medical Insurance Data Empowering Credit Finance - This scenario creates a closed loop of "medical insurance characteristics - financial behavior - risk scoring," allowing for cross-referencing of patient information during identity verification [4] - The system can trigger real-time alerts for unusual medication purchases or frequent high-cost medical visits, enhancing banks' risk interception capabilities [4] - A pilot cooperation agreement was signed involving the Chongqing Medical Insurance Bureau and several major commercial health insurance companies to explore the application value of medical insurance data in the commercial health insurance sector [3][4]