Regulations for information interaction in the AIS OMS of participants in compulsory medical insurance in Moscow using web services
Participants of compulsory medical insurance of the city of Moscow are:
— MGFOMS;
— medical organizations operating in the field of CHI;
— insurance medical organizations operating in the field of CHI;
The main task of information interaction in the AIS OMS of participants in compulsory medical insurance in Moscow is the exchange of data between participants in the MHI in order to coordinate bills for medical care provided to patients during the reporting period.
The exchange of data between the participants of the MHI system includes the interchange using the web services of the subsystem PUMP AIS OMS, IS MO and IS SMO:
- between MGFOMS, MO when coordinating the register of invoices for payment for medical care provided to insured persons under the compulsory medical insurance program, based on the personalized register of patients submitted by the MO and the associated register of medical services (in accounting units) provided to patients of the MO for the reporting period;
- between the Moscow Region and the MGFOMS when coordinating invoices for payment for medical care provided to citizens insured outside the constituent entity of the Russian Federation in whose territory a compulsory medical insurance policy was issued (nonresident citizens), based on the personalized register of nonresident citizens and the associated register of medical services submitted by the Moscow Region (in accounting units) rendered to the patients of medical organizations during the reporting period;
- between MSFHIMS, MO, HMOs on the report on personalized registers of MO patients insured by HMOs, and related registries of medical services provided by the MO, declared by the MO for the reporting period and accepted by the HMO for payment based on the results of the IEC;
- between MGFOMS, MO, SMO on regulatory and reference information necessary for the formation of personalized accounting in the field of compulsory medical insurance;
- between the Ministry of Defense and the MGFOMS (data processing center of the AIS OMS) and between the CMO and the MGFOMS when making inquiries to the ERZL RS in order to identify a treated person in the ERZL RS for the period of medical care and to identify the payer for the medical care provided to him;
- between MO, SMO and MGFOMS when updating information on attaching the insured to medical organizations that carry out medical activities in the city of Moscow [12]. Participates parameter (MO attachment) as part of the register of patients and the register of medical services.
Data exchange in the AIS OMC is carried out through web services, the format and structure of which are given in this document. The formation of medical register accounts is carried out by means of the PUMP AIS OMS subsystem based on the data entered from the primary medical reporting statistical forms (TAP and the Card of the retired from the Hospital). TAP creation time (f66) is no more than 24 hours from the moment the service is provided (excluding holidays and weekends). The reconciliation of register accounts of the MGFOMS is carried out by transferring data in the subsystem of the PUMP AIS OMS. Transfer-acceptance of reporting is confirmed by documentation on paper containing the attributes of the transferred reports and individual total indicators of personalized MO accounts calculated according to the tariff.
Medical organizations, which are financed according to the per capita funding standard for attached persons, form register accounts using the PUMP AIS CHI subsystem on a monthly basis, regardless of the presence or absence of medical services rendered in the reporting period. In cases where there are no medical services rendered in the reporting period, a zero invoice is sent to the payer. Payment is made in accordance with the calculated value of the per capita funding standard for attached persons.