Circular No. 48/2017/TT-BYT dated December 28, 2017 of the Ministry of Health on prescribing transfer of electronic data used in management and payment of covered health care costs

THE MINISTRY OF HEALTH

Circular No.  48/2017/TT-BYT dated December 28, 2017 of the Ministry of Health on prescribing transfer of electronic data used in management and payment of covered health care costs

Pursuant to the Government's Decree No. 75/2017/ND-CP dated June 20, 2017, defining the functions, tasks, powers and organizational structure of the Ministry of Health;

Pursuant to the Government's Decree No. 166/2016/ND-CP dated December 24, 2016 that prescribes electronic transactions arising in the social security, health insurance and unemployment insurance sector;

Upon the request of the Director of the Health Insurance Department;

The Minister of Health hereby issues the Circular that prescribes transfer of electronic data used in management and payment of covered health care costs.

Chapter I

GENERAL PROVISIONS

Article 1. Scope of adjustment

This Circular shall deal with electronic data, electronic data formatting, processes, protocols and time of transfer of electronic data and responses sent on receipt of transferred electronic data for the purposes of management, verification and payment of health care costs covered by the health insurance plan.

Article 2. Definition

For the purposes of this Circular, terms used herein shall be construed as follows:

1. General nomenclature refers to general information about medical technology services, medicines, medical equipment, blood and other formulated products, names of illnesses, healthcare establishments and others related to healthcare activities which have already been encoded and divided into separate classification schedules (General nomenclature codes) approved by the Minister of Health and enforceable at healthcare establishments providing health insurance -covered medical services, and entities carrying out inspection and payment of covered medical costs across the nation.

2. Information technology infrastructure refers to a combination of computing devices (servers or workstations), peripheral devices, network connected devices, auxiliary devices, local networks, wide area networks, IT applications and other equipment.

3. XML refers to the abbreviation for the English phrase “eXtensible Markup Language" that means the markup language that can be extended and is created to share electronic data between different IT systems.

4. UTF-8 refers to the Unicode 8-bit transformation format.

Article 3. Principles of transfer and receipt of electronic data

1. Electronic data must conform to requirements set out herein.

2. Transfer and receipt of electronic data must ensure clarity, integrity, equality, safety, confidentiality, effectiveness and conform to laws on electronic transactions.

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 based on 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) 1^st protocol: Transfer carried out by using web service connections;

b) 2^nd protocol: Transfer carried out by synchronizing electronic data by using the server software;

c) 3^rd protocol: Transfer carried out by directly inputting data;

d) 4^th 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.