INSURER FUNCTION REINFORCEMENT SYSTEM RELEVANT TO FICTITIOUS REQUESTS AND REDUCED-POINT RETURN

摘要

PPROBLEM TO BE SOLVED: To request the refund of a medical payment collected by use of a fictitious or padded application and to assure the retrieval of the overpayment found to exist in the receipt after a point deduction appraisal. PSOLUTION: An actual oupatient record transmitted on the Internet by the general affairs section of each establishment is received and stored in a databank by the insurers' health insurance association. The record is referred to the post-appraisal receipt to come later from the paying foundation or the like. Upon finding a discrepancy in the number of medical institution-visiting days for which the institution is responsible, the receipt is returned to the institution with a request for the refund of previously-made payment or with a request for the submission of a corrected receipt. In other cases, the health insurance association or the like sends to the medical institution a post-appraisal point- deducted receipt with a written explanation of request for refund, prepares a refund notice on the basis of a signed refund agreement sent back from the medical institution and hands over the notice to the insured person, and the insured person shows the notice to the medical institution and is refunded the overpayment. PCOPYRIGHT: (C)2003,JPO