DB5101/T 63-2019 成都市医疗保障运行分析指标体系规范
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DB5101/T 63-2019
成都市医疗保障运行分析指标体系规范
2019-09-26实施
2019-08-26发布 目 次 前 言..........................................................................................................................................................1 1 范围.................................................................................................................................................................1 2 规范性引用文件.............................................................................................................................................1 3 术语和定义.....................................................................................................................................................1 4 医疗保障运行模型.........................................................................................................................................1 5 指标体系架构.................................................................................................................................................2 5.1 指标体系构建基本原则.........................................................................................................................2 5.2 总体架构.................................................................................................................................................3 6 指标体系.........................................................................................................................................................5 6.1 参保征缴类.............................................................................................................................................5 6.2 医保扩面类.............................................................................................................................................7 6.3 基金财务类.............................................................................................................................................8 6.4 医疗管理评价类...................................................................................................................................10 6.5 医疗费用支付构成类...........................................................................................................................15 6.6 定点医药机构类...................................................................................................................................18 6.7 稽核监督类...........................................................................................................................................19 6.8 经办机构类...........................................................................................................................................23 6.9 医保智能审核类...................................................................................................................................23 6.10 在线监控类.........................................................................................................................................27 6.11 在线预警类.........................................................................................................................................30 6.12 运行分析类.........................................................................................................................................31 6.13 支持医改类.........................................................................................................................................32 6.14 扩展类.................................................................................................................................................33 7 医保决策辅助...............................................................................................................................................36 7.1 概述.......................................................................................................................................................36 7.2 基本功能要求.......................................................................................................................................36 7.3 主要内容...............................................................................................................................................36 8 指标体系维护...............................................................................................................................................37 8.1 概述.......................................................................................................................................................37 8.2 指标的管理...........................................................................................................................................37 8.3 维护流程...............................................................................................................................................37 附录 A（规范性附录） 代码集......................................................................................................................39 附录 B（规范性附录） 数据项描述方法与规则......................................................................................... 43 参 考 文 献.................................................................................................................................................45 本标准按照GB/T 1.1-2009给出的规则起草。 本标准由成都市医疗保障局提出并归口。
DB5101/T 63-2019
成都市医疗保障运行分析指标体系规范
2019-09-26实施
2019-08-26发布 目 次 前 言..........................................................................................................................................................1 1 范围.................................................................................................................................................................1 2 规范性引用文件.............................................................................................................................................1 3 术语和定义.....................................................................................................................................................1 4 医疗保障运行模型.........................................................................................................................................1 5 指标体系架构.................................................................................................................................................2 5.1 指标体系构建基本原则.........................................................................................................................2 5.2 总体架构.................................................................................................................................................3 6 指标体系.........................................................................................................................................................5 6.1 参保征缴类.............................................................................................................................................5 6.2 医保扩面类.............................................................................................................................................7 6.3 基金财务类.............................................................................................................................................8 6.4 医疗管理评价类...................................................................................................................................10 6.5 医疗费用支付构成类...........................................................................................................................15 6.6 定点医药机构类...................................................................................................................................18 6.7 稽核监督类...........................................................................................................................................19 6.8 经办机构类...........................................................................................................................................23 6.9 医保智能审核类...................................................................................................................................23 6.10 在线监控类.........................................................................................................................................27 6.11 在线预警类.........................................................................................................................................30 6.12 运行分析类.........................................................................................................................................31 6.13 支持医改类.........................................................................................................................................32 6.14 扩展类.................................................................................................................................................33 7 医保决策辅助...............................................................................................................................................36 7.1 概述.......................................................................................................................................................36 7.2 基本功能要求.......................................................................................................................................36 7.3 主要内容...............................................................................................................................................36 8 指标体系维护...............................................................................................................................................37 8.1 概述.......................................................................................................................................................37 8.2 指标的管理...........................................................................................................................................37 8.3 维护流程...............................................................................................................................................37 附录 A（规范性附录） 代码集......................................................................................................................39 附录 B（规范性附录） 数据项描述方法与规则......................................................................................... 43 参 考 文 献.................................................................................................................................................45 本标准按照GB/T 1.1-2009给出的规则起草。 本标准由成都市医疗保障局提出并归口。
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