AIS oms coordinator connection diagram. Integration service with rs erzl and pumpais oms subsystems
Yu.P. BABAK, Head of Information Department of the Fund. THE CONCEPT OF A SINGLE AUTOMATED INFORMATION SYSTEM FOR MANAGING FINANCIAL RESOURCES OF COMPULSORY HEALTH INSURANCE IN MOSCOW
The financial model of compulsory health insurance largely determines the financial support of Moscow's health care. It links the revenue and expenditure parts, ensuring the integrity of the system, its balance.
Financing improvements CHI systems should be directed primarily to the rational use of available financial resources and their compliance with the volume of medical care provided.
It is natural that effective management economic resources Compulsory medical insurance is impossible without taking into account information about the income entering the system, the costs of treatment and its results, the health status of the population served in medical institutions.
For these purposes, from the first days of the creation of a system of mandatory health insurance in Moscow, a concept was developed for building a unified information management of economic resources based on modern automated technologies. It was based on the scheme for processing information flows necessary for the implementation of financial management, presented at the end of this material.
When forming the concept of creating an automated information system(AIS) the goal was to develop and implement it based on the use of modern software and hardware solutions, integrated information technologies that ensure high-quality and efficient implementation of the Federal Law of the Russian Federation "On health insurance of citizens in Russian Federation".
The main purpose of the AIS CHI is to promptly provide the management of the MGFOMS with reliable comprehensive information about the indicators and characteristics of the functioning of the CHI system in time to ensure the following functions:
- complete (sufficiently) and reliable control of the needs of the city's population in medical services;
- a rational approach to the formation of the city program of compulsory medical insurance of citizens;
- accounting for receipts and expenditures financial resources in the CHI system;
- calculation of tariffs for medical services in the CHI system;
- collection, storage, processing and provision of objective information to the management of MGFOMS, necessary for management financial resources systems;
- ensuring control over the volume and quality of treatment and expenditure of funds in the CHI system;
- automation of the processes of activity of the MGFOMS;
- formation of the necessary safety stock to maintain the life of the CHI system.
At the first stage of the implementation of the concept, the Fund developed and implemented two automated information subsystems for the revenue and expenditure parts of the Moscow Compulsory Medical Insurance.
At the second stage, it was planned, on the basis of the information received and processed in the expenditure and income subsystems, to create in the AS MGFOMS unified registers of taxpayers and insured persons, on the basis of which it was possible to keep personalized records of financial resources, both coming to the MHI in the form of insurance premiums and paid for the rendered in health care facilities.
At the third stage, it was planned to integrate the subsystems implemented at the first and second stages into a single automated information system for managing financial resources with the simultaneous creation of monitoring tools financial activities fund in the CHI system.
At the first stage of the implementation of the concept during 1994-1996. The Fund has carried out work during which two automated information subsystems for the revenue and expenditure parts of the OMS of Moscow were developed and implemented.
The first stage of the program
The automated information subsystem of profitable activity is implemented on the basis of the distribution of the database of taxpayers according to the territorial principle of dividing Moscow. It operates on two levels: at the lower level - each accounting and control department (UCD) has a local area network based on the Novell 4.0 operating system. At automated workplaces, the employees of the UCU carry out registration of the taxpayer, obtain a memorial order for the accounting and control department, receive calculations and acts of the payer's inspections, both cameral and documentary, bank statements. Data processing and storage are carried out in the DBMS Clipper.
At the top level, information on the activities of the UCU is monthly transmitted on magnetic media and entered on the workstations of the employees of the Insurance Premiums Department for subsequent processing in the Oracle DBMS and the formation of consolidated financial indicators of the activities of all UCUs. It should be noted that the automation of daily routine procedures has largely freed up the resources of the inspectors, providing additional time for the following functions:
- direct production contact with payers for office and documentary checks the correctness of payment of insurance premiums;
- conducting a more in-depth analysis of the financial performance of payers, using the possibilities of automated sampling and comparison of information from databases;
- control over arrears in the payment of insurance premiums and the application of financial sanctions against payers-debtors.
At the same time, the Fund, together with insurance medical organizations, carried out work on the creation and implementation of an automated information subsystem of the expenditure part, which made it possible to solve the problems of accounting for the insured, forming insurance payments for the medical care provided, funds for the management of medical care, accounting for the medical care provided to patients, and forming personal accounts of patients , formation of invoices for health facilities.
The developed and implemented subsystem consists of three levels. At the top level is the hardware-software complex MGFOMS, implemented according to the client-server scheme. The complex supports automated information technologies that generate insurance payments for HIOs, identify patients when providing them with medical care, mutual settlements between HMOs and other territorial CHI funds.
At the middle level of the subsystem, there are HIO hardware and software systems that automate information technologies developed by insurers to perform the following functions: processing invoices for patients, examination of the medical care provided, generation of accounts for settlements with other HMOs, as well as non-resident and unidentified patients with MGFOMS, support of consolidated registers of insured companies.
The lower level of the subsystem consists of HCI automated workstations that support information technologies created by HMOs according to the methodology and requirements of the Moscow State Commissariat for Health Insurance, allowing you to keep records of medical care provided to patients in HCIs, maintain patient registers, and generate personal invoices for medical care for payment to HMOs. The subsystem has uniform standards for data exchange between the three levels. The Fund has developed and implemented a unified regulatory and reference base. The exchange of information between levels is carried out on magnetic media.
The introduction of an automated information subsystem of the expenditure part made it possible to ensure the transition from payment for medical care provided on the basis of individual price lists to payment on the basis of uniform tariffs for medical services; creation of medical and economic standards for inpatient care; transition from a costly system of payment by invoices for medical care provided to payment based on per capita standards and personalized bills for patients.
Second stage of the program
At the second stage of the implementation of the concept, a single register of taxpayers and a single register of insured persons were created on the Fund's central server.
At the second stage of the implementation of the concept in 1996-1998. MGFOMS carried out work that made it possible to create a single register of taxpayers and a single register of insured people on the central server of the Fund.
In the automated information subsystem of income, the hardware and software complexes of the UCU were integrated with the hardware and software complex of the executive directorate based on the Faxnet communication network. This made it possible to combine incoming information about taxpayers into a single register of taxpayers. The register contains information on more than 500,000 registered legal entities and individuals who pay insurance premiums, allows you to receive and accumulate statistical data in retrospect for each taxpayer. On the basis of the Oracle-Express software product, an analytical module has been developed and implemented that processes incoming data on the flows of financial resources of the income subsystem, on their basis, models and forecasts about the receipt of financial resources are formed.
Based on the consolidated registers of the insured in the CMO, a unified register of the insured was created and is currently maintained on the central server of the MGFOMS, containing information about 8 million 690 thousand residents of Moscow insured in the compulsory medical insurance system. Its implementation makes it possible to ensure the formation of per capita standards for paying for medical care and funds for the management of HIOs, carrying out work on differentiating tariffs for medical services, calculating insurance payments in HMOs, and making mutual settlements between HMOs.
During the operation of the unified register of the insured, it turned out that information about them has low reliability. Therefore, during the period of work at the second stage, efforts were made to improve the software product that supports its maintenance. In particular, a function was implemented that ensures the inadmissibility of repetition in a single register of series and policy numbers of the insured. In order to increase the reliability of the unified register, a refinement was carried out, allowing to verify the data on the insured with the data coming from the Moscow registry offices on the deceased, who changed their surname, and newborns.
The measures taken made it possible to start work on the introduction of a plastic health insurance card with a new system of identification of the insured. The previously used coding system for compulsory medical insurance policies was limited to the serial number of the issued policy and information about the place of issue and the population group to which the insured belongs.
However, the development of the MHI system has shown the inconsistency of such an approach to the formation of a central database, which is based on both the system for developing the main financial indicators and the medical care accounting system. Therefore, at the second stage, as part of an experiment on pharmaceutical insurance, a new codifier of the insured was developed, which allows, based on his data, to determine the sex and age, the place where the codifier was formed, the category of privilege under which you can receive medicines free of charge or at a discount. On the basis of the unified register, a function has been implemented that allows you to automatically generate a codifier for the insured. On the basis of the codifier, the design of plastic health insurance cards has been developed, and their issuance has begun.
The work carried out made it possible to proceed to the implementation of a program to provide the population of Moscow plastic cards medical insurance. Within the framework of this program, it is planned to carry out the replacement of policies at the first stage of the concept OMS sample 1994 for compulsory medical insurance policies of the 1998 model for insured persons up to working age; on the second - among the insured population of retirement age and on the third - among the able-bodied population.
In 1997, the Fund developed and implemented a program to modernize the computer hardware and software installed in health care facilities at the first stage of the concept implementation. The main goal of the program was to carry out the preparatory work necessary to integrate the created automated information subsystem of the expenditure part of the financial model of compulsory medical insurance into single AIS OMS, the implementation of which was planned to be carried out at the third stage.
In order to transfer health care facilities to a single software, the MGFOMS, as part of the modernization program, held a competition for a single software for accounting for medical care and paying for it within the CHI system. For its implementation, unified technical requirements, the implementation of which ensured the transition of all 598 health care facilities currently operating in the compulsory health insurance system from various HMO software systems to a single basic software.
Based on the software that won the competition, MGFOMS within the framework of the modernization program in 1997-1998. completed work on the creation of a pilot project for a unified automated information system for compulsory medical insurance.
Materials obtained as a result of work on pilot project, allow us to draw conclusions about the possibility of integrating all the software and hardware complexes of compulsory health insurance entities into a single automated information system with its further distribution to health facilities that are not included in the compulsory medical insurance system in order to build a single information space for healthcare in Moscow.
Third stage of the program
At present, the MGFOMS has begun to implement the third stage of the concept, the main task of which is to create a unified automated information system for managing the financial resources of the Moscow OMS.
To do this, you need to implement the following:
- in all healthcare facilities to combine autonomous workstations into local computer networks with access to a single communication network;
- to create a unified communication network that will ensure the transfer of information in electronic form about the medical care provided to the population of Moscow and payment for medical services from medical facilities to the Moscow State Medical and Social Insurance Fund and SMOs;
- on the basis of AIS MGFOMS to create a hardware and software complex that provides management of the communication network;
- to replace the CHI policies of the 1994 model with the CHI policies of the 1998 model in order to introduce a new individual number of the insured;
- to ensure the introduction in medical facilities of mechanized reading of the individual number of the insured for all types of issued medical documents;
- to form and maintain a unified database of personalized data on medical care provided to the population of Moscow and its payment from compulsory medical insurance funds;
- perform work on the interaction of the unified register of taxpayers, the unified register of the insured, the unified database of personalized data;
- monitor the financial activities of CHI and the provision of medical care;
- combine automated technologies for processing information flows of CHI financial resources, shown in the diagram, into single system data processing.
The implementation of the programs will make it possible to create a unified automated information system for managing the financial resources of the CHI. The introduction of the system will enable the management of the MGFOMS to carry out operational control over the state of the financial support of the compulsory medical insurance system; increase its economic efficiency; automated collection, storage and processing of data on financial flows; create prerequisites for a comprehensive solution of issues related to the management of financial resources; increase the possibility of making informed objective management decisions.
7. NSI AIS OMS - a list of directories and codifiers AIS OMS Directory "AIS OMS Subscribers" - "sprabo хх.dbf"
The directory is designed to provide automated exchange of information in the AIS OMC and is used when sending and receiving information packages for various purposes, as well as to control the operation of the corporate network.
Classification objects in the Directory are AIS OMS subscribers.
The sign of the classification is the "Mnemonic name of the subscriber" in conjunction with the "Type of the subscriber".
Directory structure
| Field name | Type | Size | Purpose |
| Abn_ID | Number | 6 | Subscriber ID |
| Abn_name | Symbol | 27 | Mnemonic name of the subscriber |
| Abn_type | Symbol | 1 | Subscriber type by code "tipaboXX" |
| Object_ID | Number | 6 | Object ID |
| Tip_answer | Symbol | 1 | Type of response to RS ERZL request by code "tipotvXX" |
| Status | Symbol | 1 | Subscriber status |
| Name | Symbol | 40 | Short name of the subscriber |
| Pilot | Symbol | 1 | Reserve |
The Abn_name parameter is used as the primary key when indexing the Directory data file.
“Subscriber type” codifier – “tipabo хх.dbf”
The AIS OMS subscriber type codifier is used as an auxiliary for the AIS OMS subscriber directory in order to determine the subscriber's responsibility as legal entity.
Explanations. A number of AIS OMS subscribers have more than one physically different workstation of a corporate network user. For unambiguity in the provision of reports on the MHI accounts of a legal entity of the MHI system, the subscriber type sets the only address at which data is exchanged between the legal entity, the CMO and the MGFOMS data center when data is exchanged via CHI account. The rest of the workstations of this legal entity are given the opportunity to access the AIS CHI databases without the right to provide reports on CHI accounts.
The elements of the set of objects included in the Codifier are the possible types of AIS OMS subscribers.
The sign of the classification is the name of the subscriber type.
Codifier Structure
| Field name | Type | Size | Purpose |
| Tip_ab | Symbol | 1 | Subscriber type code |
| Name_type | Symbol | 40 | Type name |
The Tip_ab parameter is used as the primary key when indexing the Codifier data file.
Codifier "Type of response to the request ERZ" - "tipotv xx.dbf"
The codifier of the type of responses to the request of RS ERZL is used as an auxiliary for the directory of AIS OMS subscribers in order to indicate the amount of data provided to various types of AIS OMS subscribers at the request of RS ERZL.
The elements of the set of objects included in the codifier are the types of responses to the request of RS ERZL ("0" - full, "1" - abbreviated).
A sign of classification is the name of the response type to the request. Establishes MGFOMS
Codifier Structure
| Field name | Type | Size | Purpose |
| Tip_answer | Symbol | 1 | Response type code (amount of data about the insured person) |
| Name_type | Symbol | 50 | Response Description |
The Tip_answer parameter is used as the primary key when indexing the Codifier data file.
Directory "Streets of Moscow" - "spr_ul xx.dbf"
The directory is designed to generate data on the Moscow address of an object (organization and individual) in the AIS OMC system. It is used in the subsystems of the AIS MHI for maintaining RS ERZL, in the formation of the Moscow address of the patient when registering and maintaining a personalized database on the accounts of patients treated under the Moscow city MHI program, in the NSI subsystems for maintaining databases on the objects of the MHI system (MO, SMO).
The elements of the set of objects included in the Directory are the streets of the city of Moscow according to the "All-Moscow street classifier", which is supported by the Service for Maintaining Citywide Classifiers (hereinafter referred to as SVOK).
A sign of classification is the name of the street.
Directory structure
As a primary key when indexing the data file of the Codifier, the Kod_fo parameter is used in conjunction with the relevance indicator (the Priznak parameter).
Codifier "Administrative-territorial districts of Moscow" - "admokr xx.dbf"
The codifier is intended to determine the administrative-territorial location of the CHI system object in Moscow. It is used in the AIS OMS as auxiliary information on the Moscow address of the object - in the subsystems of maintaining RS ERZL, elements of NSI OMS, in other subsystems of the AIS OMS, etc.
The objects of classification in the Codifier are the administrative-territorial formations (districts) of the city of Moscow. Conducted on the basis of the "All-Moscow classifier of territorial units of Moscow", which is supported by the SVOK.
The sign of classification is the name of the administrative district.
Codifier Structure
| Field name | Type | Size | Purpose |
| cokr | Symbol | 2 | County code |
| Name_okr | Symbol | 40 | Name |
The parameter Cokr is used as the primary key when indexing the Codifier data file.
Codifier "Territory of the Russian Federation" - "territ xx.dbf"
The codifier is intended to determine the administrative-territorial location of the subject of the CHI system in the Russian Federation. It is used in the RS ERZL subsystem for maintaining a database of insured citizens in calculating the policy number of a single sample, in cooperation with the FFOMS for registering the policy of the insured and with the TsVDP for personalizing and issuing the policy. Also, when creating and maintaining a personalized database of accounts of patients treated in the Moscow Region under the Moscow City Compulsory Medical Insurance Program, registered at the place of insurance and residence in another constituent entity of the Russian Federation.
The object of classification in the codifier is the territorial entity of the Russian Federation.
A sign of classification is the name of the administrative-territorial formation of the Russian Federation.
Codifier Structure
| Field name | Type | Size | Purpose |
| C_t | Number | 3 | Territory code of insurance (residence) |
| Name_t | Symbol | 40 | Territory name |
| C_OKATO | Symbol | 5 | Territory code according to the All-Russian Classifier of Administrative-Territorial Entities of the Russian Federation (OKATO) |
The C_t parameter is used as the primary key when indexing the Codifier data file.
Codifier of countries and states - "COUNTRхх.dbf".
The codifier of countries and states is designed to automate the registration of the citizenship of the population insured under compulsory medical insurance. It is used in the AIS OMS subsystem for maintaining RS ERZL. Includes codes of the All-Russian classifier of countries and states: digital and three-letter.
The object of the codifier is a public entity.
A sign of classification is the short name of the country/state.
Codifier Structure
| Field name | Type | Size | Purpose |
| C_oksm | Number | 3 | Digital code of the country according to the All-Russian classifier of countries and states OKSM |
| Name | Symbol | 35 | Short name of the country/state |
| Code | Symbol | 2 | Country short name code |
| Alfa3 | Symbol | 3 | Letter country code according to OKSM |
Integration with the RS ERZL and PUMP AIS OMS subsystems in accordance with the order of the MGFOMS No. 27 of January 30, 2017 and the order No. 04-03-04/867 of January 23, 2018
From January 23, 2018, according to the order of the MOSCOW CITY FUND FOR MANDATORY HEALTH INSURANCE (hereinafter referred to as MGFOMS) No. 04-03-04 / 867 "On ensuring information interaction between participants in the compulsory medical insurance system in Moscow", all medical organizations must, starting with invoices for January 2018, invoices for provided by CHI medical help to form only using the subsystem of PERSONALIZED ACCOUNT OF MEDICAL CARE OF THE AUTOMATED INFORMATION SYSTEM OF COMPULSORY HEALTH INSURANCE (hereinafter PUMP AIS CHI).
To do this, it is necessary to carry out a set of organizational and technical measures related to obtaining a medical organization (hereinafter MO) access to the subsystems REGIONAL SEGMENT OF THE SINGLE REGISTER OF INSURED PERSONS (hereinafter WG ERZL) and PUMP (Order MGFOMS No. 27 of 01/30/2017).
In the MEDWORK MEDICAL INFORMATION SYSTEM, an integration module for interaction with the ERZL PC and PUMP AIS OMS MGFOMS subsystems has been developed. The developed integration module allows real-time data exchange with PC ERZL and PUMP. The information exchange will be carried out in accordance with the requirements of the MGFOMS set out in the technical documentation for the ERZL and PUMP PC subsystems (Appendix No. 2 to the order of the MGFOMS No. 27 dated 01/30/2017).
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MIS MedWork allows medical organizations to perform the following functions of interaction with the MGFOMS:
1. Case management of medical care (including maintaining basic patient data, scheduling a patient's appointment, conducting an appointment and processing admission documents)
1.1. At the stages of Maintaining the patient’s basic data and Planning for admission, the unambiguous identification of APs, including those from other cities, is carried out in RS ERZL, identification or registration of newborns and those not identified in RS ERZL, with the assignment of appropriate identifiers and types of patients from RS ERZL.
1.2. This identifier is included in all electronic documents PMI transmitted to PUMP, together with the type of patient: 0 - ZL, 1 - Nonresident, 2 - Newborn, 3 - Unidentified.
2. Preparation of documents in MIS MO
2.1. Maintaining medical records for patients for all cases of medical care in this MO (in electronic output screen forms, as well as in paper forms that require the signature of a medical worker and the seal of the MO)
3. Updating MO directories in PUMP:
3.1. Reference books of structural subdivisions of the Moscow Region (departments);
3.2. Directory medical workers- employees of the Ministry of Defense;
3.3. Directory of employment of medical workers of the Moscow Region according to the departments of the Moscow Region according to the staffing table.
4. Filling in statistical medical / clinical information on cases of medical care (for example, the form of the Outpatient Coupon in the amount in accordance with the form No. 025-1 / y according to the Order of the Ministry of Health of 12.15. according to forms No. 066 / y-02 and 066-1 / y-02 in accordance with the Order of the Ministry of Health of Russia dated December 30, 2002 No. 413, - hereinafter form 066, other documents of primary medical statistics);
5. Daily transfer of new and edited PMI documents from MIS MO to PUMP (in automatic mode):
5.1. The PUMP subjects the FLC to each transmitted PMI document and returns the control result for each PMI to the MIS MO (technically, the FLC result is stored on the PUMP server and transmitted back to the MIS MO upon an automatically generated request from the MIS - according to a schedule or upon completion of the FLC task of the transmitted PMI package) .
6. Obtaining a list of PMI documents (TAP / form 066) according to the specified search conditions;
7. Calling a copy of the PMI document by the selected identifier;
8. Editing in the MIS MO of incorrect PMI documents based on the results of the FLC during the open period reporting period and making appropriate corrections to the called copies of the PMI documents in the PUMP.
According to CEO"RINTECH" by Sergey Kuptsov, "the creation of the ERZ was another major step towards the formalization of the budgetary component of informatization of medicine. Created single base, unified formats of system interaction have been developed, unified requirements have been formulated. The issuance of electronic compulsory health insurance policies has begun, which will soon be combined with universal electronic card. Such a systematic approach, developed in the process of creating new CHI policies, can become a “driver” for the development of informatization in medicine.”
Integration service - with subsystems RS ERZL and PUMP AIS OMS
The exchange of data between the participants of the MHI system includes a legally significant document flow using the web services of the Personalized Medical Care Accounting System - PUMP AIS OMS, the information system of medical organizations - IS MO and the information system of insurance medical organizations - IS SMO when using the Regional Segment of the Unified Register of Insured Persons ( RS ERZL).
IMPORTANT! On reconciliation - Unified register of the insured - for CHI in e
To renew insurance in Moscow in accordance with federal law“On Compulsory Medical Insurance in the Russian Federation” dated November 29, 2010 N 326-FZ, a citizen must submit an application to any insurance organization of Moscow on replacing the old policy of the 1998 model with a policy of a single sample.
Compulsory health insurance policy
In order to obtain a compulsory health insurance policy, the insured person submits a standard application to the health insurance organization (MCO) for the choice (or replacement) of the insurer. After that, the MSO transfers information about the insured person who submitted the application to the territorial fund, where, within 2 working days, the fact of having already current policy this insured person. Upon identification of supporting information, the insurance medical organization, which received the application, within 5 working days sends a refusal to the insured person.
Nfi 144 from 29
In the event of a change in the place of residence or place of stay 3JT MO, when registering a re-application within a year (the date of the re-application should not be previously registered in RS ERZL), sends an electronic copy of the application for attachment to the MO with the note “change of residence / stay ZL" in the upper field of the application.
Letter - FFOMS from N 3960
After updating the data of the regional consolidated register of insured persons in accordance with paragraphs 3.1 - 3.4 of these Guidelines, each current record of the SRZ must be assigned (aligned) with a unique single number of the CHI policy (UNP) in accordance with the Rules for the formation of a single insurance number medical policy compulsory health insurance.
MGFOMS reliable protection of the rights of Muscovites with compulsory medical insurance policy
Electronic policy is a document that no one except the owner can use, which is due to the presence of a chip, personal signature and photograph of the insured. The document number is displayed on the front side. On the reverse side there is full information about the owner of the policy with his signature, as well as the validity period of the document.
On approval of the Regulations for attaching and registering citizens insured under compulsory medical insurance to medical organizations of the state healthcare system of the city of Moscow, providing primary health care and included in the register of medical organizations operating in the field of compulsory medical insurance in Moscow, using UMIAS
2.9. If the insured person at the time of application was attached to a medical organization providing primary health care under the program state guarantees free provision of medical care to citizens, not included in the state system health care of the city of Moscow, the medical organization that accepted the application interacts with the specified medical organization in the manner specified in the order of the Ministry of Health and Social Development of the Russian Federation dated May 26, 2012 N 406n "On approval of the procedure for choosing a medical organization by a citizen when providing him with medical care in within the framework of the program of state guarantees of free provision of medical care to citizens.
Registered in the regional segment of the unified register of insured persons of the city of Moscow
The main excess is formed at the expense of the non-working population, which is associated with the complexity of working with this group - there are no lists of non-working residents of the Samara region either in the passport and visa service, or in the registry office, or in local governments.
Order of the Territorial Compulsory Medical Insurance Fund g
On a monthly basis, within the period established by these Regulations, the CMO sends to the MGFOMS IP with the appropriate message code and an attached archive file (zip), which includes the register file of APs attached to the Ministry of Defense on applications during the reporting period (Table 3 of Appendix 1 to these Regulations) of the structure dbf and the corresponding "Summary report of information on the attachment of the insured for _______", signed by the responsible representative of the CMO ( electronic version text document - Appendix 2) in pdf format. IP message codes:
Unified register of insured persons OMS
Regional segments are formed by TFOMS on the basis of information provided by insurance medical organizations. This is done at least once a day (if there are changes in the data). Information is received around the clock. Penalties are imposed on the insurers for violating these deadlines.
An insured person may have only one compulsory health insurance policy. Asking for help in medical institution, the insured citizen is obliged to present an insurance policy. Payment for medical services rendered (within the framework of CHI programs) is covered by the insurance medical company, which issued compulsory medical insurance policy to this person.
Unified register of insured persons OMS Moscow
According to the law on compulsory health insurance (CMI) in the Russian Federation, all citizens of the country have the right to receive medical care anywhere and in any institution. Not so long ago, it was not easy to identify a non-resident patient. Health care sometimes turned out to be without understanding whether a person exists in the MHI database or not. Each territory had its own procedures and features of health insurance, its own registers of attached citizens.
Getting a policy
You can find the list of documents required to obtain an electronic compulsory health insurance policy here. What you need to know about the new electronic policy 1. An electronic compulsory medical insurance policy is a document that no one but you can use! Instead of a barcode, a chip is embedded in the policy, like bank card; it will contain your personal signature and photo, which makes it impossible for outsiders to use your personal data!
Unified register of insured persons OMS Moscow
The insurance medical organization transfers files with changes to the territorial fund as necessary, but at least 1 time per day if there are changes in the information about the insured persons, in accordance with the agreement on the financial provision of compulsory medical insurance. Territorial fund provides a round-the-clock mode for receiving and processing files with changes received from insurance medical organizations.