JR-T 0147-2016 保险公司参与社会医疗保险服务

ICS 03.060 A11 JR 中华人民共和国金融行业标准 JR/T 0147—2016 保险公司参与社会医疗保险服务数据交换规范 Data exchange specification for insurance companies to participate in social medical insurance services 2016 - 08 -10发布 2016 - 08 - 10实施中国保险监督管理委员会发布 JR/T 0147-2016 I 目次前言 ................................ ................................ ............ VI 引言 ................................ ................................ ........... VII 1 范围 ................................ ................................ .............. 1 2 规范性引用文件 ................................ ................................ .... 1 3 术语和定义 ................................ ................................ ........ 1 3.1 交易 transaction ................................ ............................. 1 3.2 消息 message ................................ ................................ . 2 3.3 请求消息 request message ................................ .................... 2 3.4 应答消息 response message ................................ ................... 2 3.5 请求方 requester ................................ ............................. 2 3.6 应答方 responsor ................................ ............................. 2 3.7 元素 element ................................ ................................ . 2 3.8 数据模型 data model ................................ ......................... 2 3.9 医疗机构 medical institutes ................................ ................. 2 3.10 健康档案 health record ................................ ...................... 3 3.11 统筹基金账户 risk pooling funds ................................ ............ 3 3.12 自费 private expenses ................................ ....................... 3 3.13 自付 coinsurance ................................ ............................. 3 3.14 国家药品编码 national drug codes ................................ ........... 3 3.15 医疗目录 Medical Catalog ................................ .................... 3 4 数据类型 ................................ ................................ .......... 3 4.1 字符型 String ................................ ................................ 3 4.2 数值型 Numeric ................................ ............................... 4 4.3 日期时间型 Date and Time ................................ ................... 4 4.4 标识符型 Identifier ................................ .......................... 4 4.5 布尔型 Boolean ................................ ............................... 4 4.6 货币型 Currency ................................ .............................. 4 4.7 计量型 Measure ................................ ............................... 4 4.8 枚举型 Enumeration ................................ ........................... 4 5 交易 ................................ ................................ .............. 5 5.1 交易说明 ................................ ................................ ...... 5 5.1.1 交易的模式 ................................ ................................ 5 5.1.2 批量处理 ................................ ................................ .. 5 5.1.3 交易安全性 ................................ ................................ 5 5.1.4 交易错误处理 ................................ .............................. 5 5.2 交易定义 ................................ ................................ ...... 5 JR/T 0147-2016 II 5.2.1 社保机构注册及变更交易 ................................ .................... 6 5.2.2 医疗机构信息上传交易 ................................ ...................... 6 5.2.3 医疗目录上传交易 ................................ .......................... 6 5.2.4 医疗目录限价自费比上传交易 ................................ ................ 7 5.2.5 疾病目录上传交易 ................................ .......................... 7 5.2.6 参保人信息上传交易 ................................ ........................ 7 5.2.7 就医登记交易 ................................