商保结算

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上海:加强医保数据应用于商保结算
Bei Jing Shang Bao· 2025-08-06 11:59
Group 1 - The core viewpoint of the article is the issuance of measures to promote the high-quality development of commercial health insurance, which aims to support innovation in the biopharmaceutical industry [1] - The measures emphasize the enhancement of the application of medical insurance data in commercial insurance settlements, optimizing the synchronous settlement model between medical insurance and commercial insurance [1] - The initiative includes the collaboration with the "Shanghai Insurance Code" platform to improve direct compensation service processes and expand access to more medical institutions and commercial health insurance products [1] Group 2 - The measures aim for full coverage of secondary and tertiary hospitals and explore extending direct compensation services to special departments and international departments of hospitals [1] - The "Shanghai Insurance Code" will be improved to enhance its "one code for all compensation" functionality, utilizing blockchain technology to build an active compensation system between medical insurance and commercial insurance [1] - The initiative also focuses on ensuring the traceability of the entire process through authorized information, transaction records, and claims results being recorded on the blockchain, thereby increasing the transparency and efficiency of the claims service [1]