Service for integration with the subsystems rs erzl and pump ais oms. Rules for file exchange of data in AIS OMS during information interaction of participants of compulsory medical insurance Implementation of MIS Medialog

To the order of MGFOMS

No. dated "___" _____________ 2016

REGULATIONS

FILE DATA EXCHANGE IN AIS OMS

during information interaction of participants of the obligatory health insurance

moscow

Version 1.5.3

Moscow City Fund of Compulsory Health Insurance
2016

3.1 Files of the MO report in the CMO 27

3.1.1 Reference books MO 27

5.1 "Number plate" of policies 160

5.2 "Stop List" policies 160

5.3 "Start List" of policies 163

Introduction. ten

1. Forms of reporting documentation on paper in the file exchange of data between the participants of the CHI system when coordinating bills for medical care provided to patients for the reporting period 11

1.1 Form of the passport of the MO account for the medical care provided to the insured health insurance company. 13

1.1.1 Instructions for filling out the MO account passport 14

1.2 Form of the Protocol of the HCI of acceptance of the bill of the HCI for medical care provided to the insured HCI for the reporting period. 16

1.2.1 Instructions for filling out the Protocol of acceptance of the CMO account MO 17

1.3 Form of the Passport of the MO bill for medical care provided during the reporting period to patients insured in the territory of another constituent entity of the Russian Federation (nonresident). 21

1.4 Form of the Protocol of acceptance for payment of the bill of the Ministry of Defense for medical care provided to the insured on the territory of another constituent entity of the Russian Federation, for the reporting period. 22

2. Rules for calculating the cost of medical care provided to patients for the reporting period 23

2.1 General Provisions for calculating the cost of medical care 23

3. Protocol for the exchange of data between the medical institution and the medical center when agreeing bills for medical care provided to insured patients 26

3.1 Files of the MO report in the CMO 27

3.1.1 Reference books MO 27

3.1.2 Files of MO reports on medical care provided to patients insured by HMO 30

3.2 Report of the health insurance organization in the MO on the result of automated control / examination of the personalized bills of the MO for medical care provided to the insured during the reporting period 41

4. Report of the HIO to MGFOMS on the accepted personalized accounts declared by the MO for the reporting period. 46

4.1 Report of the HIO in MGFOMS on the personalized accounts of the MO for the reporting period. 46

4.2. Report of CMO to MGFOMS on financial interaction with MO for the reporting period. 49

4.3. Report of the health insurance organization to MGFOMS on defects / violations identified by the health insurance organization in the paid bills of the medical organization during the medical and economic examination (planned, target) and examination of the quality of medical care (planned, target). 51

5. Report of the HCI to MGFOMS on the volume and cost of medical care accepted by the HCI for payment 52

5.1 Files of the HCO report in MGFOMS on the volume and cost of medical care accepted by the HCO for payment 52

5.2 The form of the HCO report on the volume and cost of medical care provided to the insured MC for the reporting period and accepted by the HCO for payment 56

6. Protocol for the exchange of data between the Ministry of Defense and the Moscow State Fund of Medical Insurance in coordinating bills for medical care provided to nonresident patients during the reporting period. 58

6.1 Report of the MO to MGFOMS on personalized bills for medical care provided to nonresident patients. 58

6.2 Report of MGFOMS in the MO on the result of automated control of personalized bills of the MO for medical care provided to nonresident patients for the reporting period 61

7. NSI AIS OMC - a list of reference books and codifiers AIS OMC 62

8. Description of error codes during format-logical and semantic control of patient registries and registries medical services. 82

8.1 Checking records of the file "Register of patients". Syntactic control of records and verification of encoded information 82

8.2 Identifying Duplicate Records 84

8.3 Checking the connectivity of the patient registry file with the patient registry file 84

8.4 Checking the correctness of determining the CMO - the payer 84

8.5 Checking records of files "Register of medical services for patients". Syntactic control 85

8.6 Identification of duplicate entries in the file "Register of medical services for patients". 87

8.7 Checking the compliance of the data provided in the records of the account file in coded form with the codifiers and reference books of the reference data in force in the reporting period 87

8.8 Checking the correct organization of the patient account 90

9. Regulation for determining the payer for medical care provided 107

File interchange rules for manufacturing orders compulsory medical insurance policies 112

1.General provisions on RS ERZL. 112

2. The structure, format and rules for filling in the files of the CMO report on applications for the production of CHI policies 115

3. Selecting the order formation algorithm 127

3.1 Algorithm (scenario) definitions when forming an application for policy making 127

3.2 Description of scenarios for the formation of applications for the production of policies and features of filling in application files 130

4. Rules for filling in files like
depending on the scenario (code) 136

5. Reports of MGFOMS to the HIO according to the RS database ERZL 159

5.1 "Number plate" of policies 160

5.2 "Stop List" policies 160

5.3 "Start List" of policies 163

6. Additional AIS OMC services upon requests to RS and CA ERZL 165

6.1 Structure of requests to RS ERZL 166

6.2 Structure of requests to the CA ERZL 166

7. The procedure for generating a message file on the result of loading 167

Accepted abbreviations and terms

Legislative and regulatory documents in the CHI system

1. the federal law dated November 29, 2010 No. 326 - FZ "On compulsory health insurance in the Russian Federation".

2. The rules of compulsory health insurance approved by the order of the Ministry of Health and social development RF dated February 28, 2011 No. 158n.

3. The procedure for maintaining personalized records in the field of compulsory health insurance, approved by order of the Ministry of Health and Social Development of the Russian Federation of 25.01.2011 No. 29n.

4. General principles the construction and operation of information systems and the procedure for information interaction in the field of compulsory health insurance, approved by order of the FFOMS dated 07.04.2011 No. 79.

5. The procedure for organizing and monitoring the volumes, terms, quality and conditions for the provision of medical care under the compulsory medical insurance, approved by order of the FFOMS dated 01.12.2010 No. 230.

6. Accounting surgical operations within the framework of personified accounting in the field of compulsory medical insurance (outgoing FFOMS dated 05.04.2012 No. 2194 / 21-4 / and)

7. The list of types of high-tech medical care provided at the expense of compulsory medical insurance funds was approved by the Moscow Government Decree No. 949-PP dated 24.12.2015.

Guidelines for the organization of information interaction in the AIS OMS:

8. Automated information system of compulsory medical insurance in Moscow. OMSGW Universal Mail Gateway Interface, 2011.

9. Automated information system of compulsory medical insurance in Moscow. Protocol of information exchange with regional and central segments of ERZL, 2011.

10. Automated information system of compulsory medical insurance in Moscow. Information exchange protocol for the transfer of reference information in the corporate network, 2011.

11. Instructions for accounting for medical care provided in a 24-hour hospital and in day hospitals (outside the per capita financing system) for compulsory medical insurance (Appendix 3 to the Tariff Agreement for 2016 dated 25.12.2015).

12. The procedure for information interaction between participants of compulsory health insurance in the automated information system of compulsory health insurance in Moscow, approved by order of MGFOMS dated 01.12.2011 No. 192.

13. Regulations for maintaining in the AIS CHI information on the attachment of insured persons to medical organizations in Moscow, version 1.1 of 20.11.2015.

14. Procedure for calculation and transfer financial resources for per capita financing to medical organizations in Moscow providing primary health care on an outpatient basis to the assigned population for 2016 (Appendix 12 to the Tariff Agreement for 2016 of December 25, 2015).

17. Guidelines for registration in the AIS CHI of the first stage of clinical examination of the adult population and staying in inpatient institutions for orphans and children in difficult life situations (version 1.7, 2016).

18. Methodological recommendations for taking into account the second stage of clinical examination of the adult population and children-orphans and children in difficult life situations in the AIS CHI (version 1.7, 2016).

19. Methodological recommendations for the registration in the AIS of the CHI of the medical examination of orphans and children left without parental care, including those adopted (adopted), taken under guardianship (guardianship), into a foster or foster family ( version 1.2, 2016).

20. Regulations for the reception and transmission of data on medical care provided for emergency indications to patients not identified in the CHI system, during information interaction in the AIS OMC participants CHI systems (version1.4 from26.04.16).

Integration with the subsystems RS ERZL and PUMP AIS OMS in accordance with the order of MGFOMS No. 27 dated January 30, 2017 and order No. 04-03-04 / 867 dated January 23, 2018.

From January 23, 2018, by order of the MOSCOW CITY FUND OF MANDATORY MEDICAL INSURANCE (hereinafter MGFOMS) No. 04-03-04 / 867 "On ensuring information interaction of participants in the Moscow compulsory health insurance system", all medical organizations must, starting from accounts for January 2018, bills for provided by OMS medical help to form only with the use of the subsystem of PERSONAL ACCOUNTING OF MEDICAL CARE OF THE AUTOMATED INFORMATION SYSTEM OF COMPULSORY HEALTH INSURANCE (hereinafter PUMP AIS OMS).

To do this, it is imperative to perform a set of organizational and technical measures related to obtaining a medical organization (hereinafter MO) access to the REGIONAL SEGMENT OF THE UNIFIED REGISTER OF INSURED PERSONS (hereinafter RG ERZL) and PUMP (MGFOMS Order No. 27 dated 01.30.2017).

IN MEDICAL INFORMATION SYSTEM MedWork has developed an integration module for interaction with the PC ERZL and PUMP AIS OMS MGFOMS subsystems. The developed integration module allows for real-time data exchange with the EPZL PC and PUMP. Information exchange will be carried out in accordance with the requirements of MGFOMS, set out in the technical documentation for the PC ERZL and PUMP subsystems (Appendix No. 2 to MGFOMS order No. 27 dated 01/30/2017).

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MIS MedWork allows the MO to perform the following functions for interaction with MGFOMS:

1. Management of a case of medical care (including maintaining basic patient data, planning a patient's admission, conducting an admission and drawing up admission documents)

1.1. At the stages of Maintaining Basic Patient Data and Planning Admission, an unambiguous identification of APs, including nonresidents, in the RS URPL, identification or registration of newborns and unidentified in RS URPL, with the assignment of the corresponding identifiers and types of patients from the RS URPL is made

1.2. This identifier is indicated in all electronic documents of the PMI transmitted to the FMSP, 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 in all cases of medical care in a given medical organization (in electronic output screen forms, as well as in paper forms that require the signature of a medical worker and a seal of the medical organization)

3. Updating of MO directories in the PUMP:

3.1. Reference books of structural divisions of the Ministry of Defense (departments);

3.2. Directory of medical workers - employees of the Ministry of Defense;

3.3. Directory of employment of medical workers of the Ministry of Defense by departments of the Ministry of Defense according to the staffing table.

4. Filling in statistical medical / clinical information on cases of medical care (for example, the form of the Outpatient Patient's Ticket in the volume according to the form No. 025-1 / y according to the Order of the Ministry of Health of December 15, 2014 No. 834n - hereinafter TAP, statistical cards of those who left the hospital in volume 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 30.12.2002 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 transferred document to the MIS and returns the control result for each MIS to the MIS MO (technically, the FLC result is stored on the PUMP server and transmitted back to the MIS MO by an automatically generated request from the MIS - according to the schedule or upon the completion of the FLC task of the transmitted MIS package) ...

6. Getting a list of PMI documents (TAP / form 066) according to the specified search conditions;

7. Call a copy of the PMI document by the selected identifier;

8. Editing in the MIS MO of the incorrect PMI documents based on the results of the FLC during the open reporting period and making appropriate corrections to the summoned copies of the IUP documents in the FUMP.

application

to the order of MGFOMS

Description of 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 from 01.01.2001

Effective from 08.08.2016

Moscow

1 ......... GENERAL DESCRIPTION OF THE OPERATING PRINCIPLES OF WEB SERVICES RS ERZL AIS OMS 2

1.1 Purpose of the System .. 2

2 ......... Requirements for data exchange formats .. 2

3 ......... Order of interaction .. 2

3.1 General information. 2

3.2 Reading data from the RS EPZL .. 2

3.3 Data recording in RS EPZL .. 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

4.2 Access matrix. 2

4.3 Features of access to historical data. 2

5.1 Search for a PL and get its identifier current policy OMS .. 2

5.2 Simplified obtaining of the identifier of the current OMC policy. 2

5.3 Transfer of information to RS ERZL about nonresident insured persons. 2

5.4 Transfer of information to the RS ERPL about newborns. 2

5.5 Transfer of information to the RS ERZL about unidentified. 2

5.6 Linking records. 2

APPENDIX 1. STRUCTURE OF REFERENCES .. 2

APPENDIX 2. Rules and restrictions when working with attachments 2

APPENDIX 3. Format and logical control .. 2

LIST OF ABBREVIATIONS AND DEFINITIONS

1. GENERAL DESCRIPTION OF OPERATING PRINCIPLES OF WEB SERVICES RS ERZL AIS OMC

The work of AC clients with the System is based on the concept of synchronous request-response interaction. The asynchronous request mechanism is not used.

1.1 Purpose of the System

Regional segment Single register of insured persons is intended for collecting, storing, processing and providing data on persons insured in Moscow, as well as on persons who have sought medical help from medical organizations in Moscow.

MGFOMS, within the framework of its activities, maintains the RS ERZL, and also provides, within its competence, the protection of information constituting information of limited access.

Maintaining the RS ERPL includes the main and auxiliary processes.

Main processes:

1) receiving from the MO / CMO information about the AP and entering it into the RS ERZL;

2) acceptance, accounting and execution of HMS applications for the production of compulsory medical insurance policies; interaction with GOZNAK; accounting of the issued compulsory medical insurance policies, including their status;

3) accounting for the attachment of the AP to medical organizations in Moscow, including maintaining a register of scans of documents-statements of the AP on attachment to the MO;

4) registration of newborns born in Moscow;

5) registration of unidentified persons who received medical care in the Moscow region;

6) registration of nonresident ZL (third-party TFOMS) who received medical assistance in the Moscow region;

7) registration of data on AP, such as:

ZL address;

Contact details of the LP;

ZL citizenship;

Social status, disability, benefits of AP;

Information about the identity documents of the LP;

7. NSI AIS OMC - a list of reference books and codifiers AIS OMC Directory "Subscribers of AIS OMC" - "sprabo xx.dbf"

The reference book is intended to ensure the automated exchange of information in the AIS OMC and is used when sending and receiving information parcels for various purposes, as well as to control the work of the corporate network.

The objects of classification in the Directory are AIS OMC subscribers.

The classification feature is the "Subscriber's mnemonic name" in conjunction with the "Subscriber's type".

Directory structure

The Abn_name parameter is used as the primary key for indexing the Directory data file.
Codifier "Subscriber type" - "tipabo xx.dbf"

The codifier of the types of AIS OMC subscribers is used as an auxiliary for the directory of AIS OMC subscribers in order to determine the responsibility of the subscriber as legal entity.

Explanations. A number of AIS OMC subscribers have more than one physically different workstation of a corporate network user. For unambiguity in the provision of reports on OMC accounts of a legal entity of the system OMC type subscriber sets the only address at which the data exchange between the legal entity, the CMO and the MGFOMS data center is carried out when data is exchanged via oMS account... The rest of the AWPs of this legal entity are given the opportunity to access the OMS AIS databases without the right to provide reports on OMS accounts.

The elements of the set of objects included in the Codifier are the possible types of AIS OMC subscribers.

The classification feature is the name of the subscriber type.

Codifier structure

The codifier of the type of responses to the RS ERZL request is used as an auxiliary one for the directory of AIS OMC subscribers in order to designate the amount of data provided to various types of AIS OMC subscribers at the request of the RS ERZL RS.

The elements of the set of objects included in the codifier are the types of responses to the RS ERPL request ("0" - full, "1" - abbreviated).

The classification feature is the name of the type of response to the request. Establishes MGFOMS

Codifier structure

The reference book is designed to generate data on the Moscow address of the object (organization and natural person) in the AIS OMC system. It is used in the subsystems of the AIS CHI for maintaining the RS URZL, in the formation of the Moscow address of the patient when registering and maintaining a personalized database of the accounts of patients treated under the Moscow city CHI program, in the subsystems of the NSI for maintaining databases on the objects of the CHI system (MO, CMO).

The elements of the set of objects included in the Handbook are the streets of the city of Moscow according to the "All-Moscow Classifier of Streets", which is supported by the Service for Maintaining City-wide Classifiers (hereinafter SVOK).

The street name is a sign of classification.

Directory structure

The Kod_fo parameter in combination with the relevance attribute (Priznak parameter) is used as the primary key for indexing the Codifier data file.
Codifier "Administrative-territorial districts of Moscow" - "admokr хх.dbf"

The codifier is intended to determine the administrative-territorial location of the object of the CHI system in Moscow. It is used in the AIS OMC as auxiliary information at the Moscow address of the object - in the subsystems for maintaining the RS ERZL, elements of the NSI OMS, in other subsystems of the AIS OMS, etc.

The objects of classification in the Codifier are the administrative-territorial formations (okrugs) of the city of Moscow. It is conducted on the basis of the "Moscow Classifier of Territorial Units of Moscow", which is supported by SVOK.

The classification feature is the name of the administrative district.

Codifier structure

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, when interacting with the FFOMS for registering the insured's policy and with the CVDP for personalizing and issuing a policy. Also, in the formation and maintenance of a personalized database of accounts of patients treated in the Moscow Region under the Moscow City MHI 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.

The classification feature is the name of the administrative-territorial entity of the Russian Federation.

Codifier structure

The codifier of countries and states is designed to automate the registration of citizenship of the population insured under compulsory medical insurance. It is used in the AIS OMC 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 public education.

The classification feature is the short name of the country / state.

Codifier structure