Unified register of compulsory medical insurance insured persons. Integration service with RS ERZL and Pump AIS OMS subsystems

Document overview

Integration service - with RS ERZL and PUMP AIS OMS subsystems

IMPORTANT! On the reconciliation of the Unified Register of Insured Persons according to compulsory medical insurance in the

Compulsory health insurance policy

Nfi 144 from 29

Letter - FFOMS from N 3960

MGFIF reliable protection of the rights of Muscovites who have a compulsory medical insurance policy

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 the city of Moscow, using EMIAS

Registered in the regional segment of the unified register of insured persons of the city of Moscow

Order of the Territorial Compulsory Medical Insurance Fund

Unified register of insured persons compulsory medical insurance

Unified register of insured persons compulsory medical insurance Moscow

Obtaining a policy

Unified register of insured persons compulsory medical insurance Moscow

IV. maintaining the central segment of the unified register of insured persons

IV. maintaining the central segment of the unified register of insured persons

An error occurred.

Unified register of insured persons

Segments

The central segment of the unified register of insured persons maintains

The procedure for maintaining personalized records in the field of compulsory health insurance

I. General provisions

II. Organization of personalized accounting

III. Maintaining the regional segment of the unified register of insured persons

IV. Maintaining the central segment of the unified register of insured persons

V. The procedure for maintaining personalized records of information about medical care provided to insured persons

In accordance with Article 43 of the Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation” (Collected Legislation of the Russian Federation, 2010, No. 49, Art. 6422) I order:

Approve the attached Procedure for maintaining personalized records in the field of compulsory health insurance.

Registration No. 19742

1. This Procedure defines the rules for maintaining personalized records of information about each insured person in the field of compulsory health insurance, including:

1) organization of personalized accounting in the field of compulsory health insurance;

2) maintaining a unified register of insured persons;

3) maintaining personalized records of information about medical care provided to insured persons;

4) technology for information exchange when maintaining personalized records in the field of compulsory health insurance.

2. The goals of personalized accounting in the field of compulsory health insurance are:

1) creation of conditions to ensure guarantees of the rights of insured persons to free provision of medical care of adequate quality and volume within the framework of basic and territorial compulsory health insurance programs;

2) creating conditions for monitoring the use of compulsory health insurance funds;

3) determining the need for volumes of medical care in order to form basic and territorial compulsory health insurance programs.

3. Personalized accounting of information about insured persons is maintained in the form of a unified register of insured persons, which is a combination of its central and regional segments, and includes the collection, processing, transfer and storage of the following information about insured persons:

1) last name, first name, patronymic;

3) date of birth;

4) place of birth;

5) citizenship;

6) details of the identity document;

7) place of residence;

8) place of registration;

9) date of registration;

10) insurance number of an individual personal account (SNILS), adopted in accordance with the legislation of the Russian Federation on individual (personalized) accounting in the compulsory pension insurance system;

11) number of the compulsory health insurance policy of the insured person;

12) information about the medical insurance organization chosen by the insured person;

13) date of registration as an insured person;

14) status of the insured person (working, non-working).

4. Personalized recording of information about medical care provided to insured persons includes the collection, processing, transfer and storage of the following information:

1) number of the compulsory health insurance policy of the insured person;

2) the medical organization that provided the relevant services;

3) types of medical care provided;

4) conditions for providing medical care;

5) timing of medical care;

6) volumes of medical care provided;

7) the cost of medical care provided;

8) diagnosis;

9) profile of medical care;

10) medical services provided to the insured person and medications used;

11) applied medical and economic standards;

12) specialty of the medical worker who provided medical care;

13) the result of seeking medical help;

14) the results of monitoring of the volumes, timing, quality and conditions of medical care.

5. Information about the insured person and the medical care provided to him can be provided both in the form of documents in written form and in electronic form, subject to guarantees of their reliability (authenticity), protection from unauthorized access and distortion in accordance with the requirements established by the legislation of the Russian Federation on the protection of personal data. In this case, the legal force of the submitted documents is confirmed by an electronic digital signature in accordance with the legislation of the Russian Federation. The decision on the possibility of presenting information in electronic form is made jointly by the participants in the information exchange.

6. Insurance medical organizations and medical organizations store copies of paper documents and electronic archives containing personalized information about insured persons and the medical care provided to them, submitted to the territorial compulsory health insurance fund (hereinafter referred to as the territorial fund) for personalized accounting, according to the rules of the organization of the state archival affairs.

7. After the expiration of the period established for storing copies of documents on paper and electronic media in a medical insurance organization, they are subject to destruction in accordance with the legislation of the Russian Federation on the basis of an act of their destruction, approved by the head of the medical insurance organization.

8. Information about the insured person and the medical care provided to him is classified as restricted information and is subject to protection in accordance with the legislation of the Russian Federation.

9. Information about each insured person specified in paragraph 3 of this Procedure is entered into the unified register of insured persons.

10. The regional segment of the unified register of insured persons is maintained by the territorial fund on the basis of information about insured persons provided by the medical insurance organization.

11. The medical insurance organization and the territorial fund, by orders, determine the employees admitted to work with the regional segment of the unified register of insured persons, and comply with the requirements of the legislation of the Russian Federation on the protection of personal data.

12. When entering information about an insured person into the regional segment of the unified register of insured persons, the insurance medical organization ensures the accuracy and correctness of the entered information and carries out checks to prevent the appearance of duplicate entries in the regional segment of the unified register of insured persons:

1) for the presence of repetitions of last name, first name, patronymic, date and place of birth;

2) for the presence of repetitions according to the data of the identity document;

3) correct indication of the gender of the insured person;

4) for the presence of repetitions by date of birth and address of registration at the place of residence;

5) for the presence of repetitions of last name, first name and patronymic and registration address at the place of residence;

6) for the presence of repetitions according to the insurance number of the individual personal account (SNILS).

13. In order to update the regional segment of the unified register of insured persons and enter information about insured persons into it, the insurance medical organization generates and transmits information files with changes in information about insured persons provided for in paragraph 3 of this Procedure (hereinafter referred to as files with changes) to the territorial fund as necessary, but at least once a day if there are changes in information about the insured persons, in accordance with the agreement on financial support for compulsory health insurance.

14. The territorial fund provides round-the-clock reception and processing of files with changes received from medical insurance organizations.

15. When processing files with changes in the territorial fund, format-logical control of data, identification of records in the regional segment of the unified register of insured persons, and entry of information about insured persons are carried out.

16. After processing files with changes in the territorial fund, files confirming and/or rejecting changes are generated, which are sent to the relevant insurance medical organizations to adjust information about insured persons.

17. The territorial body of the Pension Fund of the Russian Federation, quarterly no later than the 15th day of the second month following the reporting period, provides, in accordance with the Agreement on information exchange between the Pension Fund of the Russian Federation and the Federal Compulsory Medical Insurance Fund, information about working insured persons to the corresponding territorial fund persons for inclusion in the regional segment of the unified register of insured persons.

18. Territorial fund monthly on the basis of information on state registration of death provided by civil registry authorities in accordance with Article 12 of the Federal Law of November 15, 1997 No. 143-FZ “On Acts of Civil Status” (Collection of Legislation of the Russian Federation, 1997, No. 47, Art. 5340; 2003, Art. 1553; 2009, Art. 6154; , updates the regional segment of the unified register of insured persons, notifies medical insurance organizations on the territory of the constituent entity of the Russian Federation about this and sends information files with information on the state registration of death in the territory of the constituent entity of the Russian Federation for persons whose information is not available in the regional segment of the unified register of insured persons , to the Federal Compulsory Medical Insurance Fund (hereinafter referred to as the Federal Fund) to update the central segment of the unified register of insured persons.

19. The territorial fund quarterly updates the regional segment of the unified register of insured persons based on information about working insured persons and sends information files with information about working insured persons, information about which is not available in the regional segment of the unified register of insured persons, to the Federal Fund for updating the central segment of the unified register of insured persons.

20. The insurer for non-working citizens monthly, no later than the 5th day of each month, provides to the relevant territorial fund information about non-working insured persons, provided for in subparagraphs 1-10, 14 of paragraph 3 of this Procedure, in accordance with agreements on information exchange between territorial funds and policyholders for unemployed citizens in the constituent entities of the Russian Federation, and in the form approved by the Federal Fund and the Pension Fund of the Russian Federation.

21. The territorial fund updates the regional segment of the unified register of insured persons on the basis of information received from the Federal Fund from the central segment of the unified register of insured persons.

22. In case of violation of the terms established by the agreement on financial support of compulsory health insurance for the provision of data on insured persons, as well as information about changes in this data, the insurance medical organization is obliged to pay the territorial fund at its own expense a fine in the amount established by Part 10 of Article 38 of the Federal Law dated 29 November 2010 No. 326-FZ “On Compulsory Medical Insurance in the Russian Federation” (hereinafter referred to as the Federal Law “On Compulsory Medical Insurance in the Russian Federation”).

23. The territorial fund exercises general control over the regional segment of the unified register of insured persons. If errors and inconsistencies are detected, the territorial fund sends the relevant information to the medical insurance organization indicating the list of inconsistencies and the time frame for their correction.

24. When making changes to the regional segment of the unified register of insured persons, the territorial fund generates files with changes, which it sends to the Federal Fund to update the central segment of the unified register of insured persons as necessary, but at least once a day if there are changes in information about the insured faces.

The files with changes include all newly entered and changed information about insured persons since the last submission.

25. The Federal Fund provides round-the-clock reception and processing of files with changes from territorial funds.

26. When processing files with changes, a check is made to ensure that the insured person has a previously issued valid compulsory health insurance policy of a single sample in the central segment of the unified register of insured persons.

27. In the central segment of the unified register of insured persons, information files are processed with information on the state registration of death and information on the status of insured persons (working, non-working), sent by territorial funds for persons whose information is not available in their regional segments of the unified register of insured persons, the results of which are sent to the territorial funds at the place of insurance.

28. The Federal Fund maintains the central segment of the unified register of insured persons and provides general control over the updating and use of the unified register of insured persons.

29. Data exchange between medical insurance organizations, territorial funds and the Federal Fund for the purpose of maintaining personalized records of information about insured persons is carried out electronically via dedicated or open communication channels, including the Internet, using an electronic digital signature in accordance with the requirements established by the legislation of the Russian Federation on the protection of personal data.

30. Personalized records of information about medical care provided to insured persons are maintained electronically by medical organizations and medical insurance organizations operating in the compulsory health insurance system, and by territorial funds.

31. A medical organization, an insurance medical organization and a territorial fund, by order, determine the employees who are allowed to work with information about personalized records of medical care provided to insured persons, and ensure their confidentiality in accordance with the requirements of the legislation of the Russian Federation on the protection of personal data.

32. Medical organizations provide information on medical care provided to insured persons, provided for in subparagraphs 1 - 13 of paragraph 4 of this Procedure, to the territorial fund.

33. The territorial fund, within two working days, based on the regional segment of the unified register of insured persons, carries out automated processing of information received from medical organizations about medical care provided to insured persons.

34. At the stage of automated processing of information about personalized records of medical care provided to insured persons, the following is carried out in the territorial fund:

1) identification of the insured person according to the regional segment of the unified register of insured persons, determination of the medical insurance organization responsible for paying the bill;

2) identification of insured persons who received medical care outside the insurance territory and determination of their insurance territory;

3) sending electronically the results obtained in accordance with subparagraphs 1 and 2 of this paragraph to the medical organization that provided medical care to the insured persons.

35. Based on the results of automated processing of information about medical care provided to insured persons, carried out in accordance with paragraph 34 of this Procedure, a medical organization submits it to medical insurance organizations in the amount and within the time frame established by the contract for the provision and payment of medical care under compulsory health insurance.

36. After monitoring the volumes, timing, quality and conditions of providing medical care in accordance with Article 40 of the Federal Law “On Compulsory Medical Insurance in the Russian Federation”, the information specified in paragraph 4 of this Procedure in the form of information files is transferred by the insurance medical organization to medical organizations and territorial fund within the time limits stipulated by the agreement on financial support for compulsory health insurance.

37. In case of difficulties in determining the insurance territory of a person who received medical care outside the insurance territory, the territorial fund generates an electronic request to the central segment of the unified register of insured persons, where within 5 working days a check is carried out and a response is generated indicating the identified insurance territory and the current policy number of the insured person.

38. Data exchange between medical organizations, medical insurance organizations, territorial funds and the Federal Fund for the purpose of maintaining personalized records of information about medical care provided to insured persons is carried out electronically via dedicated or open communication channels, including the Internet, using electronic digital signatures in accordance with the requirements established by the legislation of the Russian Federation for the protection of personal data.

Order of the Ministry of Health and Social Development of the Russian Federation dated January 25, 2011 No. 29n “On approval of the Procedure for maintaining personalized records in the field of compulsory health insurance”

Registration No. 19742

From January 1, 2011, the compulsory medical insurance system introduced personalized recording of information about each insured person. The procedure for its conduct is regulated.

It is envisaged to create a unified register of insured persons, consisting of central and regional segments. A list of data on citizens included in the register has been determined.

Regional segments are formed by the Federal Compulsory Compulsory Medical Insurance Fund based on information provided by medical insurance organizations. This is done at least once a day (if there are changes in the data). Information is received around the clock. For violation of these deadlines, a fine is imposed on insurers.

The territorial bodies of the Pension Fund of the Russian Federation submit quarterly data on working insured persons to the Federal Compulsory Compulsory Medical Insurance Fund for inclusion in the regional segment. Insurers of unemployed citizens submit information about them to the register on a monthly basis. In addition, the TFOMS updates the register monthly based on information about the state registration of death from the registry office. Data from the regional segment enters the central segment daily.

The register also contains information about medical care provided to insured persons. A list of them has been determined. Medical organizations submit this data to the Federal Compulsory Compulsory Medical Insurance Fund. There they are processed (the insured person is identified; the insurer responsible for paying the bill is determined; persons who received medical care outside the insurance territory are identified) and returned. After this, the information is sent to insurers. They check the volume, timing, quality and conditions of medical care. In the future, the data is transferred to medical organizations and the Federal Compulsory Medical Insurance Fund.

The exchange of information is carried out electronically via dedicated or open communication channels, including the Internet, using an electronic digital signature.

According to RINTECH General Director Sergei Kuptsov, “the creation of the ERZ was the next major step towards formalizing the budgetary component of the informatization of medicine. A unified database has been created, unified formats for interaction between systems have been developed, and unified requirements have been formulated. The issuance of electronic compulsory health insurance policies has begun, which will soon be combined with a universal electronic card. Such a systematic approach, developed in the process of creating new compulsory medical insurance policies, can become a “driver” for the development of informatization in medicine.”

The exchange of data between participants in the compulsory medical insurance system includes legally significant document flow using web services of the Personalized Accounting for Medical Care system - PUMP AIS Compulsory Medical Insurance, the information system of medical organizations - IS MO and the information system of medical insurance organizations - IS SMO when using the Regional Segment of the Unified Register of Insured Persons ( RS ERZL).

To renew insurance in Moscow in accordance with the federal law “On Compulsory Health Insurance in the Russian Federation” dated November 29, 2010 N 326-FZ, a citizen must submit an application to any insurance organization in Moscow to replace the old 1998 policy with a uniform policy.

In order to obtain a compulsory health insurance policy, the insured person submits a standard application to a health insurance organization (MCO) to select (or replace) an insurer. After this, the MCO transmits information about the insured person who submitted the application to the territorial fund, where, within 2 working days, a check is made against the unified register of insured persons to determine whether the insured person already has a valid policy. If confirming information is identified, the medical insurance organization that received the application sends a refusal to the insured person within 5 working days.

In the event of a change in the place of residence or place of stay of the 3JT MO, when registering a repeated application within a year (the date of the repeated application should not be previously registered in the PC ERZL), sends to the CMO an electronic copy of the application for attachment to the MO with the note “change of residence/stay” ZL" in the top field of the application.

After updating the data of the regional consolidated register of insured persons in accordance with paragraphs 3.1 - 3.4 of these Methodological Recommendations, each current SRH record must be assigned (aligned) with a unique single compulsory medical insurance policy number (USP) in accordance with the Rules for the formation of a single number of the compulsory medical insurance policy .

An 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 complete information about the owner of the policy with his signature, as well as the validity period of the document.

2.9. If the insured person, at the time of filing the application, was affiliated with a medical organization providing primary health care within the framework of the state guarantee program for the provision of free medical care to citizens that is not part of the public health care system of the city of Moscow, the medical organization that accepted the application shall interact 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 a citizen to select a medical organization when providing him with medical care within the framework of the program of state guarantees of free provision of medical care to citizens.”

The main excess is formed by the non-working population, which is due to 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 government bodies.

The CMO monthly, within the period established by these Regulations, sends to MGFFOMS an individual entrepreneur with the appropriate message code and an attached archive file (zip), which includes a file register of APs attached to the MO 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 health insurance company (electronic version of the text document - Appendix 2) in pdf format. IP message codes:

An insured person can have only one compulsory health insurance policy. When seeking help from a medical institution, the insured citizen is required to present an insurance policy. Payment for medical services provided (under the compulsory medical insurance program) is borne by the medical insurance company that issued the compulsory medical insurance policy to this person.

According to the law on compulsory health insurance (CHI) in the Russian Federation, all citizens of the country have the right to medical care in any place and in any institution. Not so long ago, identifying a patient from out of town was not easy. Medical care was sometimes provided without understanding whether the person existed in the compulsory medical insurance database or not. Each territory had its own procedures and features of health insurance, its own registers of attached citizens.

You can view 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 health insurance policy is a document that no one but you can use! Instead of a barcode, the policy has a chip built into it, like a bank card; it will contain your personal signature and photograph, which makes it impossible for others to use your personal data!

The medical insurance organization transfers files with changes to the territorial fund as necessary, but at least once a day if there are changes in information about the insured persons, in accordance with the agreement on financial support for compulsory health insurance. The Territorial Fund provides round-the-clock reception and processing of files with changes received from medical insurance organizations.

ERZL about unidentified. 2 5.6 Linking records. 2 APPENDIX 1. STRUCTURE OF DIRECTORIES.. 2 APPENDIX 2. Rules and restrictions when working with attachments 2 APPENDIX 3. Format and logical control.. 2 LIST OF ABBREVIATIONS and DEFINITIONS Abbreviation Definition AIS - Automated information system AIS Compulsory Medical Insurance MGFOMS - Automated information system for compulsory medical insurance of the Moscow City Compulsory Medical Insurance Fund AWP - Automated workplace AS - Automated DB system - Database VS - Temporary certificate GOZNAK Federal State Unitary Enterprise "Goznak" VHI - Voluntary medical insurance DPFS - Document confirming the fact of insurance (compulsory medical insurance policy, temporary certificate ) DUDL - Identity document EMIAS - Unified Medical Information Analytical System of the city.

Main processes: 1) receiving information about APs from MO/SMO and entering them into the RS ERZL; 2) receiving, recording and executing applications from health insurance companies for the production of compulsory medical insurance policies; interaction with GOZNAK; accounting of manufactured compulsory medical insurance policies, including their status; 3) accounting for the attachment of APs to medical organizations in Moscow, including maintaining a register of scanned documents of APs’ applications for attachment to the Moscow Region; 4) registration of newborns born in Moscow; 5) registration of unidentified persons who received medical care in the Moscow Region.
Moscow; 6) accounting of non-resident APs (third-party TFOMS) who received medical care in the Moscow Municipality; 7) recording of data on the AP, such as: - address of the AP; — contact details of the AP; — AP citizenship; — social status, disability, benefits for APs; — information about the AP’s identity documents; — SNILS ZL; — information about compulsory medical insurance policies for APs, incl.

Project Summary

A highly loaded system that actually operates in 24x365 mode;
Fault-tolerant, geographically distributed infrastructure of more than 150 servers and more than 200 virtual machines, ensuring uninterrupted operation of GIS CHI application systems at sites in the regions of the Russian Federation;
Hundreds of thousands of transactions per record per day, and at the moment of loading information about the working population or data reconciliations, two to three tens of millions per day;
Millions of read requests (search and determination of insurance affiliation) per day as usual;
Terabytes of data with optimized access to operational storage;
Geographically distributed data bus;
Service and technical support in all regions of the Russian Federation.

UKL - Unique personality code in the AIS Compulsory Medical Insurance MGFOMS UEK - Universal electronic card Full name - Last name First name Patronymic FLC - Format-logical control FFOMS - Federal Compulsory Health Insurance Fund CS - Central segment of the CS ERZL Central segment of the unified register of insured persons ECMP - Expertise of the quality of medical care HTTPS - Hypertext Transfer Transport Protocol Security - a secure protocol for transferring hypertext information SOAP - Simple Object Access Protocol - a protocol for exchanging structured messages in a distributed computing environment UTF-8 Unicode Transformation Format, 8-bit - Unicode transformation format, 8 -bit WSDL - Web Services Description Language - a web services description language based on XML XML - eXtensible Markup Language - extensible markup language 1.

When making changes to the regional segment of the unified register of insured persons, the territorial fund generates files with changes, which it sends to the Federal Fund to update the central segment of the unified register of insured persons as necessary, but at least once a day if there are changes in information about insured persons. The files with changes include all newly entered and changed information about insured persons since the last submission. 25. The Federal Fund provides round-the-clock reception and processing of files with changes from territorial funds.
26. When processing files with changes, a check is made to ensure that the insured person has a previously issued valid compulsory health insurance policy of a single sample in the central segment of the unified register of insured persons. 27.

The regional segments of the ERZ include specialized subsystems, in particular:

Software package of the territorial compulsory medical insurance fund;
Software package for medical insurance organizations;
Software package for medical organizations;
Subsystem for interaction with the system for issuing, personifying and delivering policies;
Subsystem for interaction with the personalized medical care accounting system;
A set of reference services ensuring the issuance of insurance certificates;
Administration subsystem for managing regional segments and ensuring information security.

Project results Today, new-style health insurance policies are issued using ERZ, while applications from territorial funds to issue policies are digitally signed.

When processing files with changes, a check is made to ensure that the insured person has a previously issued valid compulsory medical insurance policy of a single sample in the central segment of the unified register of insured persons. 27. In the central segment of the unified register of insured persons, information files are processed with information on the state registration of death and information on the status of insured persons (working, non-working), sent by territorial funds for persons whose information is not available in their regional segments of the unified register of insured persons, the results of which are sent to the territorial funds at the place of insurance. 28. The Federal Fund maintains the central segment of the unified register of insured persons and provides general control over the updating and use of the unified register of insured persons.

29.
Project IS ERZ Project objectives According to the law on compulsory health insurance (CHI) in the Russian Federation, all citizens of the country have the right to medical care anywhere and in any medical institution. Not so long ago, identifying a patient from out of town was not easy. Medical care was sometimes provided without understanding whether the person existed in the compulsory medical insurance database or not.

Each territory had its own procedures and features of health insurance, its own registers of attached citizens. Of course, this system had to be streamlined and the discussion on how this should be done, how to organize the exchange of information, was quite long.

Date of Birth

Previous full name, DR, UDL

Reason for error

(describe the error in detail and indicate previous data if there were changes in the AP)

Info

Appendix to the order of MGFIF No. 000 dated August 8, 2016 Description of the web services of the system of the Regional Segment of the Unified Register of Insured Persons of the Automated Information System of Compulsory Medical Insurance Version 2.0 dated 01/01/2001 To be put into effect from 08/08/2016 Moscow 2016 Contents 1…… ... GENERAL DESCRIPTION OF THE PRINCIPLES OF OPERATION OF WEB SERVICES RS ERZL AIS OMS 2 1.1 Purpose of the System..

2 2……… Requirements for data exchange formats.. 2 3……… Interaction order.. 2 3.1 General information. 2 3.2 Reading data from RS ERZL.. 2 3.3 Writing data to RS ERZL.. 2 3.4 List of data fields of the RS ERZL.. web service 2 3.5 Diagnostic codes and messages. 2 4……… Restrictions on access to certain methods for different categories of users.. 2 4.1 Users and categories of users. 2 4.2 Access Matrix. 2 4.3 Features of access to historical data.. 2 5………
GENERAL DESCRIPTION OF THE PRINCIPLES OF OPERATION OF RS ERZL AIS OMS WEB SERVICES Get the full text RS ERZL AIS OMS web services (hereinafter referred to as the System) are organized in the SOAP paradigm in accordance with the SOAP Version 1.2 specification using the “Client-Server” technology. The work of AS clients with the System is based on the concept of synchronous “request-response” interaction. The asynchronous request mechanism is not used. The regional segment of the Unified Register of Insured Persons is intended for collecting, storing, processing and providing data on persons insured in the city.

Moscow, as well as about persons who sought medical help from medical organizations in Moscow. MGFOMS, as part of its activities, conducts the RS ERZL, and also ensures, within its competence, the protection of information that constitutes restricted access information. Maintaining RS ERZL includes main and auxiliary processes.

Date edited: 27.11.2019

Maintaining the regional segment of the unified register of insured persons

9. Information about each insured person specified in paragraph 3 of this Procedure is entered into the unified register of insured persons.

1) for the presence of repetitions of last name, first name, patronymic, date and place of birth;

2) for the presence of repetitions according to the data of the identity document;

3) correct indication of the gender of the insured person;

4) for the presence of repetitions by date of birth and address of registration at the place of residence;

5) for the presence of repetitions of last name, first name and patronymic and registration address at the place of residence;

6) for the presence of repetitions according to the insurance number of the individual personal account (SNILS).

The files with changes include all newly entered and changed information about insured persons since the last submission.

Instructions for working with the RS ERZ Yamalo-Nenets Autonomous Okrug

It is mandatory for every event or citizen’s appeal to the CMO to first make an RFQ at the ERZ CA.
Only based on the response from the CA ERZ and/or RS ERZ (web request), take further actions. Indicate the received data in the previous information.
The citizen must take copies and/or make scans of all documents required for compulsory medical insurance. Reason - clause 5 and clause 6 of the Order of the Ministry of Health and Social Development of the Russian Federation dated January 25, 2011 N 29n "On approval of the Procedure for maintaining personalized records in the field of compulsory health insurance."
If a CMO is being changed under a policy from another territory, it is necessary to send us an event about the CMO change with the data that the AP came with. If the ZSP arrived empty, it is necessary to clarify the data with which the ZP was registered in another territory. Only after changing the CMO(CA response) make changes about the AP if they are necessary.
Cancellation of the DPFS is carried out by the CMO based on the application of the AP.
The PVS for the first day will not include DPFS that are not included in the ERZ CA. The CMO is obliged to promptly make changes to the RS ERZ (CS ERZ) and process the sent protocols.
In the event-driven changes of the RS ERZThe CMO is obliged to:

Indicate the code of the medical insurance organization (parent), in accordance with the unified register of medical insurance organizations operating in the field of compulsory health insurance (F002.xml). Valid values are "83001", "83005" and "83008".
Be sure to fill in the Russian region code of the place of registration and the Russian region code of the place of residence. The Russian region code of the place of residence must belong to the Yamalo-Nenets Autonomous Okrug.

To add DPFS to the CA and RS, you must first complete the following steps:

1) Check if there were any errors in the event you sent and, if so, correct the specified error and repeat the event.

2) Check the registration sign, the validity period of the DPFS on the website. It is also necessary to check the notifications from the CA (Events sent to the CA by the fund), if there are no errors or the error “Deadlines for submission have been violated...”, then the aircraft has been added to the CA.

3) If an aircraft has been added to the CA, but the application has not been sent to GOZNAK, you must send event P010 for this aircraft, and it will be sent automatically.

Now let's talk more about the errors received from the CA.

“An attempt to significantly change the gender and age group of the insured person” occurs in connection with a change in the gender or age of the AP. It can also occur when the wrong gender or date of birth was indicated. It is necessary to check/correct the AP data and send P040. Then repeat the event.

“Error in the ENP facet “birthday and gender””, “The “month of birth” facet in the ENP is incorrectly calculated”, “The “year of birth” facet in the ENP is incorrectly calculated” occurs when age and gender were changed, but the ENP was not changed . This error may also occur if the DPFS was initially received for one date of birth or gender, and a duplicate is issued for another. It is necessary to check/correct the data on the AP and send P040. Then repeat the event.

“An error in the number or series and number of an identification document” occurs when the series or UDL number was indicated incorrectly, and can also occur when the type of document is incorrectly specified. It is necessary to correct and send P040. Then repeat the event.

"Error in SNILS check number" SNILS is specified incorrectly. It is necessary to correct and send P040. Then repeat the event.

“Invalid passport issue date” occurs when an expired passport is indicated, replacement periods are 14, 20 and 45 years. Then repeat the event.

“It is impossible to create an insured person with an insurance policy whose validity period is 0 days” occurs when the DPFS is added incorrectly to the RS. It is necessary to check the period of validity of the DPFS under the ZSP in the CA and/or RS, and you also need to make sure that in the RS this AP does not have insurance with a start date greater than the one you added. If the CA has insurance that belongs to another CMO, and the start date of which is higher than the one added, you need to cancel your aircraft and call the CMO whose DPFS was canceled because of you, so that they can restore their aircraft.

“Incorrect documents for a given citizen” occurs when documents of a foreign citizen are indicated, but citizenship is indicated in the Russian Federation, or vice versa, when documents of a citizen of the Russian Federation are indicated, but citizenship is indicated as foreign. This can also occur when there is a mismatch between age and document (for example, the birth certificate of an AP who is over 14 years old is affixed). It is necessary to check/correct the data and send P040. Then repeat the event.

“Document parameters not specified or specified incorrectly” occurs if the UDL is not specified, or if the start or end date of validity of documents is incorrectly specified (Usually occurs when the expiration date of foreign documents is not filled in).

“The identity document of the insured person is not specified” occurs when the UDL is not specified, or the document was entered incorrectly into the database. We need to add the document to our database using event P040. Then repeat the event.

“It was not possible to uniquely identify the insured person” in the CA there are two non-united insurances that belong to one AP. To resolve this conflict it is necessary:

1) Clarify whether the insured person received the policy in another territory

2) Clarify whether the AP changed personal data.

3) It is necessary to check/correct the data and send P040 (If there were changes to the personal data).

4) Send the list in accordance with paragraph "Error handling RS ERZ" Instructions for working with RS ERZ.

“The start date of the policy being replaced is greater than the start date of the new one” is added by the DPFS with a start date less than that of the DPFS located in the CA. It is necessary to check the insurance documents that are in the CA against the RFQ and send us the changes with the correct dates. Then repeat the event.

“As part of the new data of the insured person, the UDL number is indicated, which, according to the CA data, is assigned to another insured person.” In the CA there is an AP with the same documents as your AP. It is necessary to check whether there were any data errors during the previous registration of your AP. It is also necessary to check the documents of your AP. If necessary, send p040. Then repeat the event.

“The information about the insurance affiliation is incorrectly specified in the in1 segment” Often occurs when the CMO sends events and indicates in the previous information data different from those contained in the CA (it is necessary to send in the previous information those that are returned at the request of the ZSP from the CA). Either when several aircraft are entered into the RS on the same day with the same onset of action, or a change is made to the QS and an aircraft with the same onset of action is added on the same day. It is impossible to issue BC and policies with the same period; the beginning of validity of the policy and BC can coincide only when the policy is issued. It is necessary to correct the start of the DPFS or issue a new DPFS and add it to the CA/RS.

“Unacceptable age of changes” means that this DPFS has expired and cannot be added to the CA. A new DPFS must be issued.

If the site shows the sign of registration with the CA, then you need to check the UPP and the date of issue of your DPFS and UPP, which is displayed on our website and, if necessary, change it at home and send the ZSP. After receiving a response to the RFQ, you should be marked with registration in the CA, and you can (should) send an application to GOZNAK. Do not forget to indicate the correct reason for re-registration of the DPFS.

P040 must be sent indicating previous and current data, including ENP.

In the DVIZIT field it is necessary to indicate the date of the insured person’s application (Application for choice(replacement) insurancemedicalorganizations, etc.).

When transmitting information about a temporary certificate in an event from the CMO, if the policy being produced has a limited validity period, the DSTOP field is used as the expiration date of the policy when sending the application to GOZNAK.

On the annulment of military personnel.

Based on part 3 of Art. 49.1 of the Federal Law of November 29, 2010 N 326-FZ and paragraph 10 of the Order of the Ministry of Health and Social Development of Russia of January 25, 2011 N 29n (as amended on December 8, 2016) “On approval of the Procedure for maintaining personalized records in the field of compulsory medical insurance” (Registered with the Ministry of Justice of Russia on February 8, 2016) .2011 N 19742), upon receipt of the corresponding application from the insured specified in part 1 of Art. 49.1 of the Federal Law of November 29, 2010 N 326-FZ or through its representative by an insurance medical organization (hereinafter referred to as the HMO), the HMO must cancel the compulsory medical insurance policy (event P02).

On sending letters regarding work with RS ERZ and CS ERZ.

Official letters (without personal data) should be sent to . Applications containing personal data must be sent via VipNet to the user "89 (TFOMS Yamalo-Nenets Autonomous Okrug) Administrator (VPN-2021)".

RS ERZ error handling

If it is impossible to process the IP protocol by an insurance medical organization, you must write a letter to the TFOMS Yamalo-Nenets Autonomous Okrug, describing the reason why independent processing is not possible, and also send personal data about the IP via a secure VipNet channel to the network node “89 (TFOMS Yamalo-Nenets Autonomous Okrug) Administrator” with indicating the subject of the letter “RSERZ”.

An example application for providing information about APs.