Chapter II
TRANSFER OF ELECTRONIC DATA
Article 4. Input data and output data acquired in management and payment of health care costs covered by the health insurance plan
1. Electronic data used in management, assessment and payment of covered medical costs shall include input data and output data.
2. Input data and output data shall be established on the basis of and in strict compliance with regulations of the general nomenclature codes issued by the Minister of Health, and shall be required to ensure linkage and interconnectivity between electronic data for management, inspection and payment of covered medical costs.
3. Electronic data formatting:
a) XML shall be used to format electronic data while UTF-8 may be used to represent alphabetical letters in the Unicode character system.
b) Each XML file may contain one or multiple covered health check-up or treatment records each of which stores information about a patient’s health care visit even if such health care visit is made by a patient holding at least two health insurance cards.
Article 5. Protocols for transfer of electronic data
1. Protocols for transfer of electronic data shall comprise:
a) 1st protocol: Transfer carried out by using web service connections;
b) 2nd protocol: Transfer carried out by synchronizing electronic data by using the server software;
c) 3rd protocol: Transfer carried out by directly inputting data;
d) 4th protocol: Transfer carried out by transmitting FTP (File Transfer Protocol) files.
2. Health care establishments shall be accorded the discretionary power to decide on one of the protocols stated in paragraph 1 of this Article, but shall be required to ensure that transferred data are accurate and input data are identical to output data.
Article 6. Processes for sending of electronic data and responses sent on receipt of transferred electronic data for the purpose of management of covered costs
1. Time of sending of electronic data for the purpose of management of covered costs:
Health care establishments shall upload electronic data on the data receipt Portal of the Health Insurance Verification Information System administered by the Vietnam Social Security (hereinafter referred to as Health Insurance Verification Portal) immediately after an outpatient medical check-up and treatment visit or an inpatient health care stay, unless otherwise provided in Article 8 hereof.
2. Responses sent on receipt of transferred electronic data for the purpose of management of covered costs
a) Right after receipt of information from healthcare establishments carrying out verification of current status and information of the health insurance card held out by a contact patient, the Health Insurance Verification Portal shall be required to respond with information about the current status and details of that patient’s health insurance card, and provide a statement showing a full history of that patient’s health care visits that includes at least the following information: medical check-up and treatment time, primary diseases and secondary diseases (if any) specified in ICD-10 disease codes or traditional medicine classification codes of diseases, and description of his/her health care condition existing within 06 (six) latest months.
b) After receipt of electronic data containing a health care establishment’s information about end of a health check-up visit, or an outpatient or inpatient treatment visit, the Health Insurance Verification Portal shall inform that health care establishment of receipt of such electronic data.
3. Authentication of electronic date shall not be required for transfer of electronic data containing a health care establishment’s information about end of a health check-up visit, or an outpatient or inpatient treatment visit to the Health Insurance Verification Portal for the purpose of management of covered medical services.
Article 7. Processes for sending of electronic data and responses sent on receipt of transferred electronic data for the purpose of request for verification and payment of covered medical costs
1. Within the duration of 07 (seven) working days from the date of end of a patient’s health care visit, healthcare establishments shall be obliged to:
a) Carry out checking and comparison to adjust electronic data in the event of any deviation as compared with those existing in the reality and provide additional information in case of insufficient information or eliminate irrelevant information before sending out electronic data to request payment of covered medical costs;
b) Authenticate the electronic data sent as a request for inspection and payment of covered medical costs before the responsible or authorized person sends his/her data.
c) Send electronic data to the Health Data Receipt Portal of the Ministry of Health and the Health Insurance Information Verification Portal, unless otherwise prescribed in subparagraph d paragraph 1 of this Article.
d) Send electronic data indicating the request for verification and payment of covered medical costs that may be incurred at the end date of a month, quarter or year to the Health Data Receipt Portal of the Ministry of Health and the Health Insurance Information Verification Portal prior to the 5th day of the succeeding month.
2. Responses from the Health Data Receipt Portal of the Ministry of Health:
Right after receipt of electronic data from healthcare establishments, the Health Data Receipt Portal of the Ministry of Health must reply to them to give confirmation.
3. Responses from the Health Insurance Information Verification Portal:
a) Immediately after receipt of electronic data showing the request for verification and payment of covered medical costs from healthcare establishments, the Health Insurance Information Verification Portal shall be obliged to inform these healthcare establishments of whether such electronic data have been received;
b) Within the duration of 07 (seven) working days of receipt of electronic data used for requesting verification and payment of covered medical costs, the Health Insurance Information Verification Portal shall be obliged to inform in detail the results of verification of such electronic data;
c) In case of any alert or rejection, or both alert and rejection, of electric data the Health Insurance Information Verification Portal shall have the burden of clarifying the reason for such alert or rejection with respect to each detail of XML table and informing healthcare establishments for their knowledge and timely modification.
Article 8. Delay in transfer of electronic data required by the prescribed deadline
1. Transfer of electronic data used for management, verification and payment health care costs covered by the health insurance plan may be delayed in comparison with the date prescribed by this Circular if:
a) there is any act of god or force majeure resulting in the information technology infrastructure system’s failure to transfer or receive such electronic data.
b) the information technology infrastructure system’s failure to transfer or receive such electronic data is resulted from the fact that electricity or Internet connection is not available.
2. When acts of god or force majeure, referred to in subparagraph a paragraph 1 of this Article, occur on the side of the healthcare establishment that sends electronic data or on the side of the entity that receives electronic data, the party affected by such unexpected events shall promptly notify the other party of causes of its failure to transfer or receive electronic data. Notification shall be delivered by telephone or email or written documents. Transfer and receipt of electronic data shall resume promptly after any failure or defect is repaired or corrected.
3. If the cause specified in subparagraph b paragraph 1 of this Article is determined, the Head of a healthcare establishment and Head of a Social Security agency entering into a contract for provision of covered medical services with that healthcare establishment shall have the discretionary power to decide on the manner and time of sending of electronic data; the Head of that healthcare establishment and the head of a social security agency shall be responsible for reporting on that decision to the regulatory body having direct authority over these two entities.
Article 9. Data confidentiality and management
1. Sending, transferring, receiving, responding to, exchanging and managing electronic data as prescribed herein shall be secured and managed under laws on information technology, network security, health check-up, medical treatment and others.
2. In addition to complying with paragraph 1 of this Article, entities, organizations or individuals engaged in sending, transferring, receiving, responding to, exchanging and managing electronic data shall assume the following responsibilities:
a) Ensure safety, confidentiality, accuracy and integrity of electronic data and use electronic data assigned within the scope of their functions, duties and powers; collaborate with entities, organizations or individuals concerned in implementing necessary technical approaches to ensure authenticity of such electronic data, system security and safety;
b) Follow legislative regulations and procedures concerning protection of health information privacy in the network environment.
Tìm kiếm
Thông tư 48/2017/TT-BYT (Bản Word)