福建省-其他社会保障-全省参保人跨省已清算结算基金信息汇总信息

就医省系统定时下载三方对账成功明细，每月在指定时间点前，上传医药机构与就医地对账成功并且是就医省、国家平台、参保省三方对账成功的的数据（含结算信息和本次结算的审核扣款拒付信息），省系统获取费用清算信息，国家医保局生成清分数据后即可下载。下载后可以在省系统中进行对账或为财务提供汇总数据。

The Jiyiusheng Provincial Medical Insurance System regularly downloads the reconciliation details that have passed three-party verification. Before the specified deadline each month, it uploads the data that has successfully undergone reconciliation between medical institutions and the medical treatment location, as well as the three-party reconciliation among the Jiyiusheng system, the National Medical Insurance Platform, and the insured provinces. This data includes settlement information as well as the audit, deduction and rejection information for this settlement. The provincial system can obtain expense settlement information, which is downloadable after the National Healthcare Security Administration (NHSA) generates the clearing and allocation data. After downloading, the data can be used for reconciliation within the provincial system or provided to the finance department as aggregated data.

搜集汇总

背景与挑战

背景概述

该数据集汇总福建省参保人跨省就医的医保清算信息，包含就医省与医药机构对账成功的结算数据及审核扣款明细，用于省级系统对账及财务核算。数据由国家医保局统一清分后定期下发。