To order MGFOMS
№ from "___" _____________ 2016
REGULATIONS
File exchange of data in AIS OMS
with the information interaction of members of the mandatory medical insurance
moscow
Version 1.5.3.
Moscow City Mandatory Medical Insurance Fund
2016
3.1 Reports of the Ministry of Defense in the SMO 27
3.1.1 References MO 27
5.1 "Locker" policies 160
5.2 "Stop list" policies 160
5.3 "Start list" policies 163
Introduction 10
1. Forms of reporting documentation on paper with data exchange files between participants of the OMS system when agreeing with accounts for medical care, rendered to patients for the reporting period 11
1.1 Form of the passport of the account of MO for medical assistance rendered by the insured SMO. 13
1.1.1 Instructions for filling the passport account MO 14
1.2 Form of the SMO Protocol Acceptance of the Municipal Account for Medical Assistance Provided Insured by the SMO for a reporting period. sixteen
1.2.1 Instructions for filling the CM accounting protocol MO 17
1.3 Form of the passport of the account of MO for medical assistance rendered for the reporting period to patients insured in the other subject of the Russian Federation (non-resident). 21.
1.4 The form of the acceptance protocol for payment of the account of MO for medical care provided by the insured in the territory of another constituency 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 for the calculation of the cost of medical care 23
3. Data exchange protocol between MO and SMO when agreeing with accounts for medical assistance provided by insured patients 26
3.1 Reports of the Ministry of Defense in the SMO 27
3.1.1 References MO 27
3.1.2 MO report files for medical care provided to patients insured by the CMA 30
3.2 Report of the SMO in MO according to the result of automated control / examination of personalized accounts of MO for medical assistance rendered by the insured for the reporting period 41
4. Report of the SMO in the MGFOMS according to the accepted personalized accounts declared by MO for the reporting period. 46.
4.1 SMO Report in MGFOMS for personalized accounts MO for a reporting period. 46.
4.2. Report of the SMO in MGFOMS financial interaction With Mo for the reporting period. 49.
4.3. Report of the SMO in MGFOMS on defects / violations identified by the SMO in paid accounts of MO during medical and economic expertise (planned, targeted) and examination of medical care (planned, target). 51.
5. SMO report in MGFOMS for the volume and cost of medical care, adopted by WMO for payment 52
5.1 SMO report files in MGFOMS for the volume and cost of medical care, adopted by WMO for payment 52
5.2 Form of the SMO report on the volume and cost of medical care provided by the insured MO for the reporting period, and the adopted WMO for payment 56
6. The MO and MGFOMM data exchange protocol when agreeing for medical assistance rendered to non-resident patients during the reporting period. 58.
6.1 Report of MO in MGFOMS for personalized accounts for medical care provided by non-resident patients. 58.
6.2 Report of the MGFOMS in MO according to the result of automated control of personalized accounts of MO for medical care provided by non-resident patients for the reporting period 61
7. NSI AIS OMS - List of reference books and codifiers AIS OMS 62
8. Description of error codes in the format-logical and semantic control of registries of patients and registries of medical services. 82.
8.1 Checking the records of the "Patient Registry" file. Syntax control of records and checking coded information 82
8.2 Detection of duplicate records 84
8.3 Checking the connectedness of the registry file of patients with the registry file of medical services on patients 84
8.4 Checking the correctness of the definition of the SMO - Payer 84
8.5 Checking records of the "Register of Medical Services on Patients". Syntax control 85.
8.6 Detection of duplicate records of the "Register of Medical Services on Patients". 87.
8.7 Checking the compliance of the data given in the accounts file records in the coded form, codifiers and reference books of the NSI, in force in the reporting period 87
8.8 Checking the correctness of the organization of the patient's account 90
9. Regulations for the definition of the payer for medical assistance rendered 107
File interchange rules on applications for the manufacture of OMC Policy 112
1. Common provisions on RS Erzl. 112.
2. Structure, format and rules for filling out the FMO report files on applications for the manufacture of OMS policies. 115.
3. Selection of the application formation algorithm 127
3.1 Definitions of the algorithm (scenario) when forming an application for the manufacture of policy 127
3.2 Description of scenarios for the formation of applications for the manufacture of policies and the features of filling out files of applications 130
4. Rules for filling files such as
depending on the script (code) 136
5. MGFOMS reports to the EPZL 159 Database
5.1 "Locker" policies 160
5.2 "Stop list" policies 160
5.3 "Start list" policies 163
6. Additional Services AIS OMS on requests to RS and CA Erzl 165
6.1 Structure of requests to RS ERZL 166
6.2 Query Structure for CA ERZL 166
7. Procedure for forming a message file of the loading of 167
Adopted cuts and terms
| AIS OMS. | Automated Mandatory Medical Insurance Information System |
| Apk | Hardware and software complex |
| Bd | Database |
| VMP. | High-tech medical care |
| Sun. | Temporary certificate - a document confirming the execution of the policy and the certification of the right to free medical support |
| Document OMS. | Policy OMS old Sample, Polis of OMS of a single sample, temporary certificate of insuring OMS |
| Don | The document certifying the person of the insured person, on the basis of which the policy of the OMS is issued |
| Erzl | A single register of insured persons on OMS in the Russian Federation, the organization and support of which is carried out by FFOMS |
| ENP | The set number of the single sample. Is the identifier of the insured person in Yerzl |
| Zl | Face insured by OMS, received document OMS |
| Nonresident | Face insured for compulsory health insurance in another subject of the Russian Federation |
| IP | Information parcel |
| KSG | Clinical Statistical Group of Diseases - Specialized Medical Assistance in Inpatient Conditions and in day hospitals |
| MGFOMS | Moscow City Mandatory Medical Insurance Fund |
| MO | Medical organization of the OMS system |
| MO with PF. | Medical organization, the financing of which is carried out at the perverse principle |
| MO with G. | Medical organization exercising horizontal calculations from the means of per capita financing for medical assistance rendered in the areas of medical organizations to their attached population |
| Ms. | Medical standard - a set of medical and diagnostic technologies provided in the framework of the completed case of hospitalization in stationary conditions |
| MS IS. | Medical and Sociological Integral System - AIS Portal OMS |
| NMP | Emergency medical care |
| NSI | Regulatory background |
| OMS | Mandatory Medical Insurance |
| According to MO with a hospital type PF | Polyclinic compartment with attached population, which is a structural division of a medical organization of a hospital type |
| PPO | Application software |
| PPS | Application software |
| PF | Executive financing - a way of financing medical organizations providing primary health care on the standard for attached population |
| Patient Registry (Accounts) | The list of patients MO, who provided medical care for oMS program during the reporting period. The registry of patients, complemented by the tariff value of the medical services rendered to the patient of MO for the reporting period and registered in the service registry, determines the register of accounts |
| Register of services | A consolidated list of medical services rendered to patients according to the IMS program for the reporting period. The bundle with the register of patients is carried out according to the CHA document registered in the register of patients and the register of medical services |
| RS Erzl | Regional segment of Erzl |
| SMO | Insurance medical organization |
| SMP | Emergency |
| SP | Insurance |
| Insurer | SMO, registered the Document of the OMS of the Insured |
| Patient account | The tariff value of medical services (in units of accounting) rendered to the patient MO under the OMS program for the reporting period. The number of accounts of MO is determined by the number of patients treated in MO for the reporting period |
| PN | Attached population - a list of insured by OMS in Moscow attached to medical organizations providing primary health care |
| TFOMS | Territorial OMS Foundation |
| FLK. | Format-logical control |
| TPN | Territorial-attached population |
| FFOMS | Federal Fund of OMS |
| Tsapk. | Central hardware - Software complex AIS OMS |
| BVDP | Center for the issue and personalization of policies |
| Tsoi. | Center for processing information in the Ass |
| CA Erzl | The central segment of a single register of insured persons. |
| EP. | Electronic Polis |
Legislative I. regulations In the system of OMS
1. Federal Law of November 29, 2010 No. 326 - FZ "On Compulsory Medical Insurance in Russian Federation».
2. Rules of compulsory medical insurance approved by the Order of the Ministry of Health and Social Development of the Russian Federation of 28.02.2011 No. 158n.
3. The procedure for conducting a personalized accounting in the field of compulsory health insurance, approved by the Order of the Ministry of Health and Social Development of the Russian Federation of January 25, 2011 No. 25n.
4. General principles Building and functioning information systems and the procedure for information interaction in the field of compulsory medical insurance, approved by the order of the FFOMS of 04/07/2011 No. 79.
5. The procedure for organizing and conducting control of volumes, deadlines, quality and conditions for the provision of medical care on the OMS, approved by order of the FFOMS of 01.12.2010 No. 230.
6. Accounting for surgical operations as part of personalized accounting in the field of OMS (Ex. FFOMS dated 04/05/2012 No. 2194 / 21-4 / and)
7. The list of types of high-tech medical care provided at the expense of compulsory health insurance funds, approved by the Decree of the Government of Moscow dated December 24, 2015 No. 949-PP.
Guidelines for the organization of information interaction in AIS OMS:
8. Automated information system for compulsory medical insurance in Moscow. Interface of the universal postal gateway OMSGW, 2011.
9. Automated information system for compulsory medical insurance in Moscow. Protocol of information exchange with the regional and central segments of Yerzl, 2011.
10. Automated information system for compulsory medical insurance in Moscow. Information exchange protocol for the transfer of regulatory information in the corporate network, 2011.
11. Instructions for the accounting of medical care provided in a round-the-clock hospital and in day hospitals (outside the per capita financing system) on mandatory health insurance (Annex 3 to the 2016 tariff agreement of 25.12.2015).
12. The procedure for information interaction between participants in compulsory medical insurance in an automated information system of compulsory medical insurance in Moscow, approved by order of the MGFOMS of 01.12.2011.№ 192.
13. Regulations on the AIS of the OMS of information on the attachment of insured persons to the medical organizations of Moscow, version 1.1 of 20.11.2015.
14. ORDER OF CALCULATION AND LIST financial means For perverse financing to medical organizations in Moscow, providing primary health care on outpatient conditions to the attached to the population for 2016 (Appendix 12 to the tariff agreement for 2016 of 25.12.2015).
17. Methodical recommendations for accounting in the AIS of the OMC of the first stage of the rechasery of the adult population and staying in stationary institutions of orphans and children in difficult life situations (version 1.7, 2016).
18. Methodical recommendations for accounting in the AIS of the OMS of the second stage of the recolacation of the adult population and staying in the stationary institutions of orphans and children in difficult life situations (version 1.7, 2016).
19. Methodical recommendations for accounting in AIS OMS dispensarization of orphans and children left without parental care, including adopted (adopted) adopted under custody (guardianship) in a reception or patronage family ( version 1.2, 2016).
20. Rules of receiving data on medical care data provided on emergency testimony to patients not identified in the OMS system, with information interaction in AIS OMC participants of the OMS system (version1.4 from26.04.16).
Yu.P. Babak, Head of the Fund Information Management. Concept of the Unified Automated Information System of Financial Resources of Mandatory Medical Insurance of Moscow
The financial model of the OMS largely determines the financial support of Moscow health. It links the profitable and consumables, ensuring the integrity of the system, its balance.
Improving the financing of the OMS system should be directed primarily to the rational use of the existing financial resources and their compliance with the volume of medical care provided.
Naturally, effective management economic resources The OMS is impossible without taking into account information on income in the system, spending on the treatment and its results, the state of health of the population, which is served in medical institutions.
For these purposes, from the first days of the creation of a compulsory health insurance system in Moscow, the concept of building a single information management of economic resources based on modern automated technologies was developed. Its basis was the scheme for processing the information flows necessary for the implementation of financial management, presented at the end of this material.
When forming the concept of creating an automated information system (AIS), a goal was set to develop and implement on the basis of the use of modern software and technical solutions, comprehensive information technologies that ensure the qualitative and efficient implementation of the Federal Law of the Russian Federation "On Medical Insurance of Citizens in the Russian Federation".
The main purpose of the AIS OMS is an operational presentation of the management of the MGFOMs of reliable comprehensive information on indicators and characteristics of the functioning of the OMS system in a time section to ensure the following functions:
- full (sufficiently) and reliable control of the needs of the city's population in medical services;
- a rational approach to the formation of the urban program of compulsory medical insurance of citizens;
- accounting for the receipt and consumption of financial resources in the OMS system;
- calculation of tariffs by medical services in the OMS system;
- collection, storage, processing and provision by the management of the MGFOMS objective information necessary to manage the financial resources of the system;
- ensuring control of the volume and quality of treatment and spending of funds in the OMS system;
- automation of MHFOM operation processes;
- formation of the necessary insurance stock to maintain the vital activity of the OMS system.
At the first stage of the implementation of the concept of the Foundation, the Foundation has developed and implemented two automated information subsystems of the income and consumable part of the OMS of Moscow.
At the second stage, it was planned on the basis of the information received and processed in the expenditure and revenue subsystems to create a unified taxpayers and insured registers, on the basis of which a personalized accounting of funds could be conducted in OMS in the form of insurance premiums and paid for the rendered In the LPU medical care.
At the third stage, the integration of subsystems implemented at the first and second stages was planned, into a single automated information system for managing financial resources with simultaneous creation of means for monitoring financial activities Foundation in the system of OMS.
At the first stage of the implementation of the Concept during 1994-1996. The Foundation carried out work during which two automated information subsystems of the income and expenditure parts of Moscow were developed and implemented.
First stage of the program
The automated information subsystem of income activities is implemented on the basis of the distribution of the database on taxpayers on the territorial principle of Moscow division. It operates on two levels: at the lower level - a local computing network on the Novell 4.0 operating system has been created in each accounting and control control (CDE). On automated workplaces, the staff of the UCU register the taxpayer, receiving a memorial order for the accounting and control department, obtaining calculations and acts of checks of the payer, both cameral and documentary, diversity bank statements. Processing and storage of data are carried out in the CLiRrer DBMS.
At the top level - information about the activities of the CD monthly on magnetic media is transmitted and introduced on Arms of insurance premiums for subsequent processing in Oracle DBMS and the formation of consolidated financial indicators of the activities of all the uku. It should be noted that the automation of everyday routine procedures has largely released the resources of inspectors by providing additional time to perform the following functions:
- direct production contact with payers for cameral and documentary checks the correctness of payment of insurance premiums;
- carrying out a more in-depth analysis of the financial indicators of payers using the capabilities of an automated sample and comparing information from databases;
- conduct control over overdue debts on the payment of insurance premiums and the application of financial sanctions to debtor payers.
In parallel, the Foundation together with the insurance medical organizations carried out work on the creation and implementation of the automated information subsystem of the expenditure part, which made it possible to solve the tasks of accounting for insured, the formation of insurance payments for the medical assistance provided, funds for the conduct of the work of the SMO, accounting for medical care for patients, the formation of personal accounts of patients , forming invoices on the LPU.
The developed and implemented subsystem consists of three levels. At the top level there is a Hardware-software complex MGFOMS, implemented according to the client-server scheme. The complex supports automated information technologies that implement insurance payments for the SMO, identifying patients when providing them with medical care, mutual settlements between the SMO, other territorial OMS funds.
At the average level of the subsystem, the SMO hardware and software complexes that automate information technologies developed by insurers, to perform the following functions: Processing of accounts for patients, examination of medical care provided, the formation of accounts for settlements with other SMOs, as well as non-resident and unidentified patients with MGFOMS, Support for consolidated registers of insured companies.
The lower level of the subsystem consists of automated workplaces of LPU supporting information technologies created by the SMO on the methodology and the requirements of the MGFOMS, allowing to keep records of medical care to patients in the LPU, maintain patient registers, form personal accounts for rendered medical assistance to pay for the SMO. The subsystem has unified data exchange standards between three levels. The Fund has developed and implemented a single regulatory reference base. The exchange of information between levels is carried out on magnetic media.
The introduction of an automated information subsystem of the expenditure part made it possible to ensure the transition from payment for medical assistance provided on the basis of individual price list for payment based on uniform tariffs for medical services; creation of medical and economic standards for inpatient assistance; The transition from the cost system of payment on invoice for personal care for payments based on per capita standards and personalized accounts for patients.
Second stage of the program
At the second stage of the implementation of the concept on the central server of the Fund, a single register of taxpayers and a single register of the insured was created.
At the second stage of the implementation of the concept in 1996-1998. MGFOMS carried out works that have made a single register of taxpayers on the central server of the Foundation and a single register of the insured.
In the automated information subsystem, income was integrating hardware software complexes Cook with a hardware and software package of the executive directorate based on the Communication Network Faxnet. This made it possible to combine incoming information on taxpayers into a single register of taxpayers. The register contains information about more than 500 thousand registered legal and individuals who pay insurance premiums, allows to obtain and accumulate statistical data in retrospect for each taxpayer. Based software Product Oracle-Express developed and implemented an analytical module that makes the processing of incoming data on the streams of financial resources of the income subsystem, they are based on models and forecasts for the receipt of funds.
On the basis of the consolidated registers of the insured in the SMO, the Unified Register of Insured, containing information on 8 million 690 thousand inhabitants of Moscow, insured in the OMS residents, was maintained and relevantly supported on the MHFOM central server. Its implementation makes it possible to ensure the formation of per capita standards for payment of medical care and funds for the conduct of the CM, carrying out work on the differentiation of tariffs for medical services, the implementation of the calculations of insurance payments in the SMO, carrying out mutual settlements between the SMO.
During the operation of a single register of the insured, it was revealed that information about them has low reliability. Therefore, during the work at the second stage, efforts were made to improve the software product supporting its support. In particular, a function was implemented to ensure the inadmissibility of repetition in a single register of the series and numbers of the policies of the insured. In order to increase the reliability of a single register, a refinement has been completed, allowing to impose data on the insured with the data coming from Moscow's regulations on the dead, who have changed the name of the newborn.
The measures taken made it possible to start work on the implementation of a plastic health insurance card with new system Identification of the insured. The previously used coding system of OMS policies was limited to the sequence number of the issued policy and information about the place of issuance and group to which the insured.
However, the development of the OMS system showed the inconsistency of such an approach to the formation of the central database, to which the systems for the development of basic financial indicators and medical care systems. Therefore, at the second stage, under the Pharmaceutical Insurance Experiment, a new insured codifier was developed, which allows it to determine the floor and age according to it, the place of formation of the codifier, the category of the beneficiary, on which medication can be obtained for free or discount. A function is implemented on the basis of a single register that allows you to automatically form the formation of the codifier on the insured. Based on the codifier, the design of plastic medical insurance cards has been developed, and their release has begun.
The work carried out made it possible to proceed to the implementation of the program to ensure the population of Moscow by plastic medical insurance cards. Within the framework of this program, it is planned at the first stage of the concept to replace the policies of the OMI of the 1994 sample policy on the OMC policy of 1998. In the insured to workable age; On the second - in the insured population of the retirement age and on the third - at the workable population.
In 1997, the Fund was developed and implemented a program for the modernization of computing equipment and software installed in the LPU at the first stage of the implementation of the Concept. The main purpose of the program was to conduct preparatory work necessary to integrate the created automated information subsystem of the expenditure part of the financial model of the OMS into a single AIS OMS, which was planned to be implemented in the third stage.
In order to transition to the LPU on the MGFOMS single software, under the modernization program, a competition held a single software for the accounting of medical care and its payment within the framework of the OMS system. For its conduct, uniforms were formed technical requirements, the implementation of which provided the transition of all 598 LPUs currently working in the OMS system, from various SMO software systems to a single basic software.
Based on the software that won the competition, MGFOMS under the modernization program in 1997-1998. Completed the work on creating a Pi-Lotto project of a single automated OMS information system.
Materials obtained as a result of work on pilot project, It is possible to draw conclusions about the possibility of integrating all software and technical complexes of the OMS subjects into a single automated information system with its further propagation on the LPU, which are not included in the OMS system, in order to build a single health information space of Moscow.
Third stage of the program
Currently, MGFOMS has begun to implement the third stage of the concept, the main task of which is to create a unified automated information system for managing financial resources of Moscow.
To do this, it is necessary to implement the following:
- in all LPU, combine autonomous arms to local computing networks that have access to a single communication network;
- create a single communication network that transmits information in in electronic format about the medical care provided to the population of Moscow and the payment of medical services from the LPU in MGFOMS and the SMO;
- based on AIS MEFOMS Create a hardware and software complex that ensures the management of the communications network;
- to replace the policies of the OMS of the Sample 1994 on the Policy of the OMS of the Sample 1998 in order to introduce a new individual number of the insured;
- ensure the introduction of the mechanized reading of the individual number of the insured for all types of medical documents into all types of discharged;
- form and maintain a single database of personalized data provided to medical care to the population of Moscow and its payment from the MHC;
- perform work on the interaction of a single taxpayer register, a single register of the insured, a single database of personalized data;
- monitor the financial activities of the OMS and the provision of medical care;
- combine automated technology of processing information flows of financial resources OMS shown in the scheme in unified system Data processing.
Programs will allow you to create a single automated information system for managing financial resources of OMS. The introduction of the system will be able to lead the MHFOM management to conduct operational control over the state of financial support of the OMS system; increase it economic efficiency; automated collection, storage and processing of financial streams; create prerequisites for a comprehensive solution to issues related to financial resources management; Increase the possibilities of adopting informed objective management decisions.
Integration with the subsystems of the RS Erosl and PMP AIS OMS in line with the order of the Ministry of Education and Science No. 27 dated January 30, 2011 and Order No. 04-03-04 / 867 of January 23, 2018
From January 23, 2018 by order of the Moscow City Foundation of Mandatory Medical Insurance (hereinafter referred to as MEFOM) No. 04-03-04 / 867 "On ensuring the information interaction of participants in the Moscow OMS system", all medical organizations must start with accounts for January 2018 rendered to Medical OMS Assistance to form only using the subsystem of personalized medical care for the automated information system of compulsory medical insurance (hereinafter referred to as AIS OMS).
To do this, it is necessary to fulfill the complex of organizational and technical measures related to the receipt of a medical organization (hereinafter referred to as MO) to subsystems to subsystems. Regional segment of a single register of insured persons (hereinafter referred to as RG ERZL) and PPM (order MGFOMS No. 27 of 01/30/2017).
In the MedWork Medical Information System, an integration module of interaction with PC subsystems Yerzl and Pump AIS MHF MHFOM is developed. The developed integration module allows you to exchange data from PC ERZL and PPP in real time. The information exchange will be carried out in accordance with the requirements of the MGFOMS set forth in the technical documentation on the PC subsystem ERZL and PPMP (Appendix No. 2 to the Order of the Ministry of Education and Science No. 27 of January 30, 2017).
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MIS MEDWORK allows you to perform the following functions on the interaction with MGFOMS:
1. Maintaining a case of medical care (including maintaining the patient's main data, patient receipt planning, receiving reception and registration of acceptance documents)
1.1. At the stages of maintaining the main data of the patient and planning, the reception is made to the unambiguous identification of the evil, including non-residential, in the RS ERZL, identification or registration of newborns and non-subsided into the RS ERZL, with the assignment of appropriate identifiers and types of patients from PC Erosl.
1.2. This identifier is indicated in all the electronic documents of the PMI transmitted to the PMP, along with the patient type: 0 - evil, 1 - nonresident, 2 - newborn, 3- Unidentified.
2. Preparation of documents in MIS MO
2.1. Maintaining medical records to patients in all cases of medical care in this MO (in electronic weekend on-screen forms, as well as in paper forms requiring signatures of medical worker and printing MO)
3. Actualization of reference books in Pump:
3.1. Reference books of the structural divisions of MO (branches);
3.2. Directory of Medical Workers - MO employees;
3.3. Directory of Employment of Medical Workers of MO on the departments of MO according to a staffing schedule.
4. Filling out statistical medical / clinical information on the cases of medical care (for example, a form of an outpatient patient's coupon in volume according to the form No. 025-1 / y by order of the Ministry of Health of 12/15/2014 N 834n - Next TAP, statistical maps of retired from the hospital in the amount of According to forms No. 066 / y-02 and 066-1 / U-02, in accordance with the order of the Ministry of Health of Russia of December 30, 2002 No. 413, further form 066, other documents of primary medical statistics);
5. Daily transmission of new and edited documents of PMI from IIM MO in Pump (automatic mode):
5.1. PumpNE is subjected to FLC each transmitted document PM and returns the control result for each PMI in MIS MO (technically the result of the FLC is saved on the PMP server and is transmitted back to MO according to the automatically formed query from the MIS - on schedule or by the event of the completion of the FLC task the transmitted packet of PM) .
6. Obtaining a list of documents PMI (TAP / Form 066) for specified search conditions;
7. Calling an instance of the PMI document on the selected identifier;
8. Editing in MIK MO is incorrect for the results of the FLC documents of PMI during the period of open reporting period and making appropriate corrections in the induced copies of the PMI documents in PMP.
According to general Director "RINTEKH" Sergey Klekov, "the creation of ERZ has become another major step towards the formalization of the budget component of the informatization of medicine. Created single base, Unified system interaction formats have been developed, uniform requirements are formulated. The production of electronic compulsory medical insurance policies began, which will soon be combined with universal e-card. Such a systematic approach developed in the process of creating new OMS policies may become a "driver" of the development of informatization in medicine. "
Integration service - with PC subsystems Yerzl and Pump AIS OMS
Data exchange between participants in the OMS system includes a legally significant document management using web services of a personalized accounting system of medical care - PMP AIS OMS, information system of medical organizations - IS MO and an information system of insurance medical organizations - UMO uses the regional segment of the Unified Register of Insured Persons ( RS Erzl).
IMPORTANT! On the reconciliation - the unified registry of the insured - according to OMS in
For resuming insurance in Moscow in accordance with federal law "On compulsory medical insurance in the Russian Federation" of November 29, 2010 N 326-ФЗ, a citizen must apply to any insurance organization of Moscow on the replacement of the old policy of the 1998 sample policy on the Polis of a single sample.
Mandatory Medical Insurance Policy
In order to obtain a compulsory health insurance policy, the insured person submits a typical statement to the medical insurance organization (MSO) on the choice (or replacement) of the insurer. After that, MSO transfers information on the statement by the Insured Facial to the Territorial Fund, where within 2 working days it is checked according to a single register of insured persons. The fact of the existing policy has the insured person. When identifying confirming information, the insurance medical organization, which received a statement, sends a refusal to the insured person within 5 working days.
NFI 144 from 29
In the event of a change in the place of residence or the place of residence 3JT MO, when registering a re-statement during the year (the date of the re-application should not be previously registered in PC ERZL), sends an electronic copy of the application for the attachment to MO with a margin "Change of residence / stay Zl "in the top statement field.
Letter - FFOMS from N 3960
After actualization of data of the regional consolidated register of the insured persons under paragraphs 3.1 - 3.4 of these Methodical recommendations Each relevant recording of the SRP should be assigned (posed in compliance) a unique single number of the OMS (ENP) policy in accordance with the formation rules single number insurance medical Polisa. Mandatory health insurance.
MGFOMS Reliable protection of the rights of Muscovites having a policy of OMS
The electronic policy is a document that no one besides the owner will not be able to useWhat is due to the presence of a chip, personal signature and photographs of the insured. The document number is displayed on the front side. From the reverse side, complete information about the owner of the policy with his signature is posted, as well as the time of the document.
On approval of the Rules of Attachment and Accounting of Citizens Insured by OMS, to medical organizations of the State Health System of Moscow, providing primary health care and included in the register of medical organizations operating in the field of OMS of the city of Moscow, using EMIAS
2.9. In case the insured person at the time of filing the application had attached to a medical organization providing primary health care under the program state guarantees free provision Citizens of medical care, not included in the state health care system of the city of Moscow, a medical organization who adopted a statement, interacts with the specified medical organization in the manner determined in the order of the Ministry of Health and Social Development of the Russian Federation of May 26, 2012 N 406N "On Approval of the Selection Procedure A citizen of a medical organization when providing him with medical care under the program of state guarantees of free assistance to citizens of medical care. "
Registered in the regional segment of a single register of insured persons of the city of Moscow
The main excess is formed at the expense of the non-working population, which is associated with the complexity of working with this group - the lists of non-working residents of the Samara region there is no passport and visa service, nor in the registry offices, nor local self-government bodies.
Order of the Territorial Fund of Mandatory Medical Insurance G
The SMO monthly in the data established by these Rules, the period sends to the MGFOMS IP with the appropriate message code and the attached archive file (ZIP), which includes the ENG registry file attached to MO according to the statements during the reporting period (Table 3 of Annex 1 to this Regulation) structure DBF and the corresponding "summary report of information on attaching insured for _______", signed by the responsible representative of the SMO ( electronic version Text document - Appendix 2) in PDF format. IP messaging codes:
Unified register of insured persons OMS
Regional segments are formed by TFOMS based on information submitted by insurance hinds. This is done at least 1 time per day (if there are changes in data). Information is accepted around the clock. For violation of the specified deadlines for insurers, a fine is imposed.
The insured person can have only one policy of compulsory health insurance. Turning to help in medical institutionThe insured citizen is obliged to prevent the insurance policy. Payment for the medical services rendered (as part of the OMS program) assured medical company, issued the policy of the OMS to this person.
Single register of insured persons OMS Moscow
According to the law on compulsory health insurance (OMS) in the Russian Federation, all citizens of the country have the right to provide medical care anywhere in any institution. Not so long ago, identify the non-resident patient was not easy. Medical assistance was sometimes without understanding, there is a person in the base of OMS or not. Each territory had its own procedures and features of health insurance, their registers of attached citizens.
Obtaining polis
You can get acquainted with the list of documents necessary to obtain an electronic policy of compulsory health insurance here. What you need to know about the new electronic policy 1. The electronic policy of mandatory health insurance is a document that no one except you can use! Instead of barcode in the policy built-in chip, like bank card; It will be your personal signature and photography, which makes it impossible to use your personal data outsiders!
Single register of insured persons OMS Moscow
The insurance medical organization transmits files with changes to the territorial Fund as needed, but at least 1 time per day if there are changes in information about the insured persons, in accordance with the agreement on financial support for compulsory health insurance. The territorial fund provides round-the-clock mode of receiving and processing files with changes received from insurance medical organizations.
7. NSI AIS OMS - List of reference books and codifiers AIS OMS Handbook "Subscribers AIS OMS" - "SPRABO XX.DBF"
The directory is designed to provide automated information exchange in AIS OMS and is applied when sending and receiving information parcels of various purposes, as well as to control the work of the corporate network.
Classification objects in the directory are subscribers AIS OMS.
The sign of the classification is the "mnemonic name of the subscriber" together with the "Subscriber Type".
Structure of reference book
| Field name | A type | The size | Purpose |
| ABN_ID. | Numbers | 6 | Subscriber identifier |
| ABN_NAME. | Sim | 27 | Mnemonic name of the subscriber |
| ABN_TYPE. | Sim | 1 | Subscriber Type by Tipaboxx Codicator |
| Object_ ID | Numbers | 6 | Identifier object |
| Tip_otveta. | Sim | 1 | Type of response to the RS Request Yerzl by Tipotvxx Codicator |
| Status. | Sim | 1 | Subscriber status |
| Name. | Sim | 40 | Summary of the Subscriber |
| Pilot. | Sim | 1 | Reserve |
As a primary key, when indexing the directory data file, the ABN_NAME parameter is used.
Codifier "Subscriber Type" - "Tipabo xx.dbf"
The codifier of the subscribers of subscribers AIS OMS is used as a subsidiary for the directory of subscribers AIS OMS in order to determine the responsibility of the subscriber as legal entity.
Explanations. A number of subscribers AIS OMS have more than one physically different ARMA of the corporate network user. For unambiguing in the provision of reports on the accounts of the OMS legal entity, the OMS system of the subscriber type establishes the only address in which the mutualization of data is carried out between the legal entity, the SMO and the MGFOM Code with the interpretation of data on account OMS. The rest of the Armam of this legal entity provides the possibility of accessing the Databases of AIS OMS without the right to provide reports on the accounts of the OMS.
The elements of the set of objects included in the codifier are possible types of subscribers of AIS OMS.
A sign of the classification is the name of the subscriber type.
Codifier structure
| Field name | A type | The size | Purpose |
| Tip_ab. | Sim | 1 | Subscriber type code |
| Name_tip. | Sim | 40 | Type type |
As a primary key, when indexing the codifier data file, the TIP_AB parameter is used.
Codifier "Answer Type to Request ERZ" - "Tipotv xx.dbf"
The response codifier to the RS ERZL request is used as a subsidiary for the directory of subscribers of AIS OMS for the purpose of denominating the amount of data provided by various types of subscribers of AIS OMS at the request of the RS ERZL.
The elements of the set of objects included in the codifier are the types of answers to the RS Request Erosl ("0" - complete, "1" - abbreviated).
A sign of the classification is the name of the type of response to the request. Installs MGFOMS
Codifier structure
| Field name | A type | The size | Purpose |
| Tip_otveta. | Sim | 1 | Answer type code (volume of insured data) |
| Name_tip. | Sim | 50 | Response description |
As a primary key, when indexing the codifier data file, the TIP_OTVETA parameter is used.
Directory "Streets of Moscow" - "SPR_UL XX.DBF"
The directory is designed to form data at the Moscow address of the object (organization and individual) In the system of AIS OMS. It is used in the subsystems of AIS OMS on the maintenance of the PC Erosl, in the formation of the Moscow address of the patient when making a personalized database on the accounts of patients treated in the Moscow City Program of OMS, in the subsystems of NSI on maintaining databases on the objects of the OMS system (MO, SMO).
The elements of the set of objects included in the reference book are the streets of the city of Moscow on the "General Student Classifier", the support of which is carried out by the management of citywide classifiers (hereinafter referred to as the SCO).
The sign of the classification is the name of the street.
Structure of reference book
As the primary key, when indexing the codifier data file, the kod_fo parameter is used together with a sign of relevance (PRIZNAK parameter).
Codifier "Administrative-territorial districts of Moscow" - "Admokr xx.dbf"
The codifier is designed to determine the administrative-territorial location of the OMS system in Moscow. It is used in the AIS of OMS as auxiliary information at the Moscow address of the object - in the subsystems of maintenance of the RS ERZL, elements of the NSI OMS, in other subsystems AIS OMS, etc.
The classification objects in the codifier are administrative and territorial education (district) of the city of Moscow. It is conducted on the basis of the "Muskoskovsky classifier of the territorial units of Moscow", the support of which carries out the SCO.
The sign of the classification is the name of the administrative district.
Codifier structure
| Field name | A type | The size | Purpose |
| Cokr. | Sim | 2 | District code |
| Name_okr. | Sim | 40 | Name |
As the primary key, when indexing the codifier data file, the COKR parameter is used.
The codifier of the "territory of the Russian Federation" - "Territ xx.dbf"
The codifier is intended to determine the administrative and territorial location of the subject of the OMS system in the Russian Federation. It is used in the PC subsystem of Erosl to maintain the database of insured citizens in the calculation of the number of the selected policy, when interacting with the FFOMS for registering the policy of the insured and from the CCDP for personalization and issuing the policy. Also, in the formation and conduct of a personalized database of patient accounts treated in MO on the Moscow City Program of the OMS, registered at the place of insurance and residence in another subject of the Russian Federation.
The object of classification in the codifier is the territorial formation of the Russian Federation.
The sign of the classification is the name of the administrative and territorial education of the Russian Federation.
Codifier structure
| Field name | A type | The size | Purpose |
| C_T. | Numbers | 3 | Code of Insurance Territory (residence) |
| Name_t. | Sim | 40 | Name of the territory |
| C_okato. | Sim | 5 | Territory code on the All-Russian Classifier of the Administrative and Territorial Educations of the Russian Federation (OKATO) |
As the primary key, when indexing the codifier data file, the C_t parameter is used.
Codificor countries and states - CountRh.dbf.
Codificors of countries and states is intended to automate the accounting of citizenship of the population insured by OMS. It is used in the subsystem of AIS OMS on the maintenance of the 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.
A sign of the classification is the brief name of the country / state.
Codifier structure
| Field name | A type | The size | Purpose |
| C_OKSM. | Numbers | 3 | Digital Code of the country in the All-Russian Classifier of the countries and states in Occm |
| Name. | Sim | 35 | Short name of the country / state |
| Code. | Sim | 2 | Code of the short name of the country |
| Ilfa3. | Sim | 3 | Country Code in Occm |
