Decision No. 4210/QD-BYT dated September 20, 2017 providing for output data standards and formats used in management, assessment and payment for medical services covered by health insurance fund

DECISION

PROVIDING FOR OUTPUT DATA STANDARDS AND FORMATS USED IN MANAGEMENT, ASSESSMENT AND PAYMENT FOR MEDICAL SERVICES COVERED BY HEALTH INSURANCE FUND

MINISTER OF HEALTH

Pursuant to the Government’s Decree No. 75/2017/ND-CP dated June 20, 2017 defining Functions, Tasks, Powers and Organizational Structure of Ministry of Health;

Pursuant to the Government’s Decree No. 166/2016/ND-CP dated December 24, 2016 providing for electronic transactions in social, health and unemployment insurance sectors;

Pursuant to the Government’s Resolution No. 36a/NQ-CP dated October 14, 2015 on E-government;

At the request of the Director of Health Insurance Department,

HEREBY DECIDES:

...

...

...

1. Table 1: General entries relating to medical services covered by health insurance fund;

2. Table 2: Entries relating to drugs covered by health insurance fund;

3. Table 3: Entries relating to medical technical services and medical supplies covered by health insurance fund;

4. Table 4: Entries relating to subclinical results;

5. Table 5: Entries relating to clinical progression;

6. Table 6: List of cost-based groups of medical services;

7. Table 7: List of Department’s codes;

8. Table 8: List of codes of accidents and injuries;

9. Table 9: List of codes of procurements and drug categories.

...

...

...

Article 2. Implementation

1. Health facilities shall assume responsibility to send data to the Portal for medical data of Ministry of Health at http://congdulieuyte.vn and the Portal for receipt of health insurance assessment-related information of the Vietnam Social Security Authority at https://gdbhyt.baohiemxahoi.gov.vn with respect of information in Table 1, Table 2 and Table 3 prescribed in Article 1 herein as of October 31, 2017.

2. Information in Table 4 and Table 5 prescribed in Article 1 herein shall be sent by health facilities as of April 01, 2018.

Article 3.This Decision shall come into force as from the date on which it is signed. Decision No. 2286/QD-BYT dated June 02, 2017 by Minister of Health providing for output data standards and formats used in management, assessment and payment for medical services covered by health insurance fund is abrogated.

Article 4.Chief of Office of Ministry of Health, Director of Health Insurance Department, Directors/ Directors General of Departments/Authorities affiliated to Ministry of Health, Directors of Departments of Health of provinces or central-affiliated cities, and heads of relevant agencies shall be responsible for implementation of this Decision./.

PP. MINISTER
DEPUTY MINISTER



Pham Le Tuan

...

...

...

(Enclosed with Decision No. 4210/QD-BYT dated September 20, 2017 by Minister of Health)

No.

Entry

Data type

Maximum length

Description

1

MA_LK

String

...

...

...

Unique treatment code (for data connection between table 1 and table 2-5 in each medical examination or treatment (PRIMARY KEY)).

2

STT

Numeric

10

Ordinal numbers starting at 1 in each data transmission.

3

MA_BN

String

...

...

...

Patient’s code granted by the health facility.

4

HO_TEN

String

255

Full name of patient

5

NGAY_SINH

String

...

...

...

Date of birth specified in the patient's health insurance card, including 8 characters: 4 characters of year + 2 characters of month + 2 characters of day (if day and month are unknown, default value is “0101”)   

6

GIOI_TINH

Numeric

1

Sex; Encoded (1: Male; 2: Female; 3: Unknown)

7

DIA_CHI

String

...

...

...

Address is recorded according to the address specified in the patient’s health insurance card or the patient’s current address, including: house number (if any); street (if any); commune/ward/town; urban or sub-urban district/provincial-affiliated town or city; province/centrally-affiliated city

8

MA_THE

String

n

- Code of health insurance card issued by the social security agency

- With regard to patients who do not have health insurance cards but are eligible to receive health insurance benefits, such as children or organ transplant patients, etc., provisional codes shall be recorded according to the following rule: Object code + code of health insurance benefits + province code + KT + 8 characters starting at 00000001 and ending at 99999999 according to the ascending ordinal numbers of patients.

E.g.:  TE101KT00000011 (This provisional code is granted to the 11^th child patient whose birth certificate/ certificate of live birth is granted by a competent authority of Hanoi City).

- While receiving treatment, if a patient is granted a new health insurance card with its code changed, the new code (comprising 15 characters) shall be added and separated from the existing one by a semicolon “;”  

...

...

...

MA_DKBD

String

n

Code of primary health facility, comprising 5 characters, as specified in the patient’s health insurance card.

- While receiving treatment, if a patient is granted a new health insurance card with a change in code of primary health facility, the new code of primary health facility shall be added and separated from the existing one by a semicolon “;”

- In case of unavailability of a health insurance card, code of province/city + 000 shall be specified. E.g.: 01000 if the patient lives in Hanoi City.

10

GT_THE_TU

String

...

...

...

Effective date of the health insurance card, comprising 8 characters: 4 characters of year + 2 characters of month + 2 characters of day.

- While receiving treatment, if a patient is granted a new health insurance card with a change in its effective date, the new effective date shall be added and separated from the existing one by a semicolon “;”

- In case of unavailability of a health insurance card, the date on which the patient receives medical services (comprising 8 characters: 4 characters of year + 2 characters of month + 2 characters of day) shall be specified.  

11

GT.THE_DEN

String

n

Expiry date of the health insurance card, comprising 8 characters: 4 characters of year + 2 characters of month + 2 characters of day.

- While receiving treatment, if a patient is granted a new health insurance card with a change in its expiry date, the new expiry date shall be added and separated from the existing one by a semicolon “;”

...

...

...

12

MIEN_CUNG_CT

String

8

- Effective date of copayment exemption certificate granted by a social security agency, comprising 8 characters: 4 characters of year + 2 characters of month + 2 characters of day.

E.g.: If the patient is eligible for copayment exemption as from March 31, 2017, it is represented as 20170331

- In case of unavailability of copayment exemption certificate granted by a social security agency, this entry is left blank.

13

TEN_BENH

...

...

...

n

Medical diagnosis shall be sufficiently specified as shown in medical record.

14

MA_BENH

String

15

Code of major disease according to ICD 10 or code of disease in traditional medicine.

15

MA_BENHKHAC

...

...

...

255

Code of other disease (if any) according to ICD 10 or code of disease in traditional medicine. If a patient suffers from multiple health conditions, codes of diseases shall be separated by semicolons “;”

16

MA_LYDO_VVIEN

Numeric

1

Encoding of the object receiving medical services covered by health insurance fund (1: Appropriate referral; 2: Emergency case; 3: Inappropriate referral; 4: Unrestricted referral (i.e. receiving medical services at a health facility other than the registered one in the same province/city)

17

MA_NOI_CHUYEN

...

...

...

5

Code of health facility where the patient is referred to (this code is granted by the social security agency)

18

MA_TAI_NAN

Numeric

1

Accident/injury; using reference encoding specified in Table 8 (List of accidents and injuries) enclosed herewith.

19

NGAY_VAO

...

...

...

12

- Time when the patient receives medical services, comprising 12 characters: 4 characters of year + 2 characters of month + 2 characters of day + 2 characters of hour (24-hour format) + 2 characters of minute. E.g.: If a patient receives medical services at 15:20 PM on March 31, 2017, it is represented as 201703311520

20

NGAY_RA

String

12

- Time of discharge, comprising 12 characters: 4 characters of year + 2 characters of month + 2 characters of day + 2 characters of hour (24-hour format) + 2 characters of minute.

E.g.: If a patient is discharged from the hospital at 09:20 AM on April 05, 2017, it is represented as 201704050920;

- In case of outpatient treatment, date of finishing the outpatient treatment (the final date of using medicines or medical services as prescribed by physician) shall be specified; “0000” is default value for 2 characters of hour + 2 characters of minute.

...

...

...

21

SO_NGAY_DTRI

Numeric

3

Actual days of treatment

22

KET_QUA_DTRI

Numeric

1

...

...

...

23

TINH_TRANG_RV

Numeric

1

Discharging status; Encoded (1: Discharged; 2: Referred to other hospital; 3: Escaped from the hospital; 4: Discharged as requested by the patient)

24

NGAY_TTOAN

String

12

...

...

...

E.g.: If a patient is discharged from the hospital at 09:20 AM on April 05, 2017, it is represented as 201704050920;

- This entry shall be left blank when sending data to the target gateway if the patient has left the hospital but failed to make payment of medical expenses.  When the patient pays medical expenses or the health facility completes payment procedures (because the patient has escaped from the health facility without payment of medical expenses), the health facility shall provide additional information about the date of payment and send complete date to the target gateway or provide additional information about the date of payment directly on the target gateway.

25

T_THUOC

Numeric

15

Total amount of costs of drugs (including oxygen), fluid replacement, transfusion of blood and blood products (including costs of nucleic acid test (NAT), antibody test and platelet screening KIT), cost of blood transport and packaging cost (for oriental medicines) in XML2 file, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

26

T_VTYT

...

...

...

15

Total amount of costs of medical supplies in XML3 file, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

27

T_TONGCHI

Numeric

15

Total costs of each medical examination or treatment which is total amount of money in XML2 and XML3 files, rounded to the nearest hundredth.  A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

28

T_BNTT

...

...

...

15

Total amount self-paid by the patient for medical services which are not covered by the health insurance fund in XML2 and XML3 files, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

29

T_BNCCT

Numeric

15

Total amount co-paid by the patient according to the health insurance coverage in XML2 and XML3 files, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

30

T_BHTT

...

...

...

15

Total amount of which payment request is submitted to the social security agency in XML2 and XML3 files, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

31

T_NGUONKHAC

Numeric

15

Total amount of the patient’s medical expenses covered by other financial sources in XML2 and XML3 files, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

32

T_NGOAIDS

...

...

...

15

Cost of non-capitated medical services, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

33

NAM_QT

Numeric

4

The year in which payment request for medical services is submitted to a social security agency.

34

THANG_QT

...

...

...

2

The month in which payment request for medical services is submitted to a social security agency.

35

MA_LOAI_KCB

Numeric

1

Encoded types of medical services (1: Medical examination; 2: Outpatient treatment; 3: Inpatient treatment)

- In case of long-term treatment of a chronic disease, XML file shall be sent every month (between the first day and the last day of each month).

- In case of outpatient treatment of other diseases, only XML file shall be sent upon the completion of a treatment.

...

...

...

MA_KHOA

String

15

Department's code; if a patient receives treatment at multiple departments, code of the department that consolidates the patient’s medical records shall be specified.

37

MA_CSKCB

String

5

Code of health facility where the patient receives treatment ( this code is granted by the social security agency)

...

...

...

MA_KHUVUC

String

2

Code of place of residence specified in the health insurance card, i.e. K1 or K2 or K3”

39

MA_PTTT_QT

String

255

International procedural code (according to ICD-9-CM Volume 3) (This entry must be specified upon the availability of reference table of international procedural codes and written directive promulgated by Ministry of Health). In case of multiple procedures, procedural codes shall be separated by semicolons (;)

...

...

...

CAN_NANG

Numeric

5

Only weights of patients who are children under 1 year of age are specified.  This entry reflects the body weight in kilograms (kg) of a child patient measured at the time of hospitalization.

This kilogram of body weight is represented by a decimal, rounded to the nearest hundredth. Decimal point is a dot (.).

E.g.: 5.75 kg.

Table 2: Entries relating to drugs covered by health insurance fund

(Enclosed with Decision No. 4210/QD-BYT dated September 20, 2017 by Minister of Health)

STT

...

...

...

Data type

Maximum length

Description

1

MA_LK

String

100

Unique treatment code (for data connection between table 1 and this table in each medical examination or treatment).

2

...

...

...

Numeric

6

Ordinal numbers starting at 1 in each data transmission.

3

MA_THUOC

String

255

- Code of active ingredient as specified in the Set of code lists used in medical examination and treatment, and payment of covered medical services (hereinafter referred to as “Set of code lists in healthcare sector”) promulgated by Ministry of Health;

- Code of oxygen: 40.17;

...

...

...

+ If antibody tests are done, 2 characters “KT” shall be added to the codes of blood and blood products, and separated by a dot “.”

+ If NAT tests are done, 3 characters “NAT” shall be added to the codes of blood and blood products, and separated by a dot “.”

+ If both antibody test and NAT test are done, 5 characters “KTNAT” shall be added to the codes of blood and blood products, and separated by a dot “.”

- Cost of blood transport shall be specified as “VM.XXXXX”, in which "XXXXX" is the code of the health facility providing blood; - Packaging cost for oriental medicines shall be specified as “BB.XXXXX”, in which "XXXXX" is the code of the health facility that requests for payment.

4

MA_NHOM

Numeric

2

Used to classify and sort medical expenses into corresponding sections (referred to Table 6 enclosed herewith)

...

...

...

TEN_THUOC

String

1024

It must be the drug name granted registration number by the Drug Administration of Vietnam or Traditional Medicine Administration of Vietnam

6

DON_VI_TINH

String

50

- Smallest unit of drug as announced by the Drug Administration of Vietnam or the Traditional Medicine Administration of Vietnam;

...

...

...

7

HAM_LUONG

String

1024

Concentration of drug granted registration number by the Drug Administration of Vietnam or the Traditional Medicine Administration of Vietnam; if drugs contain multiple active ingredients, concentration of each active ingredient shall be specified and separated from each other by a semicolon (;)

- In case of traditional ingredients or family medicines without concentrations, this entry shall be left blank or filled with drug weight (if available).

8

DUONG_DUNG

String

...

...

...

Code of administration route as specified in the Set of code lists in healthcare sector promulgated by Ministry of Health

9

LIEU_DUNG

String

255

Dose: quantity of medicine prescribed to be taken at one time * times of taking drug per day E.g.: Dose of “A” drug is 2 tablets each time and 2 times per day, it shall be represented as “2 tablets/time * 2 times/day”

10

SO_DANG_KY

String

...

...

...

Drug registration number issued by the Ministry of Health or the Drug Administration of Vietnam or the Traditional Medicine Administration of Vietnam (no space is added between characters)).

11

TT_THAU

String

25

Drug bid-related information, including: number of bid award decision, procurement, and drug category according to the list approved by the social security agency. Information shall be separated by semicolons (;). Codes procurements and drug categories are specified in Table 9.

E.g.: Drugs of category 2 of the Generic drug procurement are provided under the bid award decision No. 12/QD-SYT, this entry shall be represented as “12/QD-SYT;G1;N2”.

(in case of unavailability of a bid award decision, number of the official dispatch sent to the social security agency shall be specified)

12

...

...

...

Numeric

1

Code of scope of drug coverage. To be specific: (1): Drugs are covered by health insurance (i.e. they are in the list of drugs covered by health insurance); (2): Drugs are not covered by health insurance (i.e. they are not in the list of drugs covered by health insurance)

13

TYLE_TT

Numeric

3

Coinsurance by the health insurance fund and written as a percentage (%). This percentage is a positive whole number.

E.g.: If coinsurance percentage is 50%, the value of this entry shall be “50”. With regard to drugs for which coinsurance percentage is not provided for, the value of this entry shall be “100”. If drugs are not covered by health insurance, the value of this entry shall be “0”.

...

...

...

SO_LUONG

Numeric

10

Actual amount of drugs used, rounded to the nearest thousandth.  A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

15

DON_GIA

Numeric

15

- Unit price of drugs which is the unit price specified in the purchase invoice of the health facility, rounded to the nearest thousandth.  A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number. - In case of herbal ingredients, unit price plus damage costs as prescribed by the Ministry of Health shall be specified.

...

...

...

THANH_TIEN

Numeric

15

= SO_LUONG * DON_GIA, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

17

MUC_HUONG

Numeric

3

Coverage ratio in proportion to each type of medical expenses

...

...

...

E.g.: If a patient who is entitled to coverage ratio of 80% has received inpatient treatment by inappropriate referral to a central-level health facility (with coverage ratio of inappropriate referral case as 40%), the value of this entry shall be 32.

- In case a patient has received medical examination and treatment at an appropriate-level health facility with total medical expense less than 15% of the statutory pay rate, or the patient has received medical examination and treatment at a communal medical station, or the patient is eligible for copayment exemption in a year, the value of this entry shall be 100;

- In case a patient has received medical examination and treatment at an inappropriate-level health facility with total medical expense less than 15% of the statutory pay rate, the value of this entry shall be the coverage ratio of inappropriate referral case in corresponding with the professional and technical level of health facility.

18

T_NGUON KHAC

Numeric

15

Total amount of the patient’s medical expenses covered by other financial sources, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

19

...

...

...

Numeric

15

Total amount self-paid by the patient for medical services which are not covered by the health insurance fund, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

20

T_BHTT

Numeric

15

Total amount of which payment request is submitted to the social security agency according to the scope of coverage, rounded to the nearest hundredth.  A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

T_BHTT = (THANH_TIEN-T_BNTT-T_NGUONKHAC) x MUC_HUONG/100 x TYLE_TT/100

...

...

...

T_BNCCT

Numeric

15

Total amount co-paid by the patient according to the health insurance coverage, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

T_BNCCT = THANH_TIEN - T_NGUONKHAC - T_BNTT - T_BHTT

22

T_NGOAIDS

Numeric

15

...

...

...

23

MA_KHOA

String

15

Code of Department giving prescription to the patient (referred to Table 7 herein)

24

MA_BAC_SI

String

255

...

...

...

25

MA_BENH

String

255

Code of major disease (according to ICD 10) and/or code of disease in traditional medicine as diagnosed by traditional medicine doctor or physician; codes of other diseases shall be also added and separated by semicolons (;)

26

NGAY_YL

String

12

...

...

...

E.g.: Date of making physician order is at 15:20’ hrs., on March 31, 2017, it shall be represented as “201703311520”

27

MA_PTTT

Numeric

1

Code of payment method (0: Fee-for-service payment; 1: Capitation payment; 2: Payment of non-capitated medical services; 3: Diagnosis-related group (DRG)-based payment)

Notes:

- Symbol (*) is the multiplication sign (x).

Table 3: Entries relating to medical technical services and medical supplies covered by health insurance fund

...

...

...

STT

Entry

Data type

Maximum length

Description

1

MA_LK

String

100

...

...

...

2

STT

Numeric

6

Ordinal numbers starting at 1 in each data transmission.

3

MA_DICH_VU

String

20

...

...

...

- Patient transport service shall be specified as VC.XXXXX, in which XXXXX is the code of initiating health facility.

- Code of hospital ranking-based cost of hospital bed is provided in the “Set of code lists in healthcare sector” promulgated by Ministry of Health;

4

MA_VAT_TU

String

255

- Code of medical supplies as specified in the “Set of code lists in healthcare sector” promulgated by Ministry of Health; only codes of medical supplies which are not included in the price of technical services are specified;

- With respect to medical supplies used in specific surgery or procedure and paid separately, code of surgery or procedure shall be added to <MA_DICH_VU> field  in front of <MA_VAT_TU> field of code of medical supplies;

- With respect to medical supplies which are not used in specific surgery or procedure, the <MA_DICH_VU> field  shall be left blank;

...

...

...

5

MA_NHOM

Numeric

2

Used to classify and sort medical expenses into corresponding sections (referred to Table 6 enclosed herewith)

Code of medical supplies applying payment ceiling or percentage is 11.

6

GOI_VTYT

String

...

...

...

Code of package of medical supplies used in each medical service (such as G1 for the first medical service, G2 for the second medical service, etc.) 

7

TEN_VAT_TU

String

1024

Name of medical supply

8

TEN_DICH_VU

String

...

...

...

Name of medical technical service or hospital bed;

In case of medical technical service or case requiring details about location and operation method or separation of different prices, detailed description shall be specified in the square brackets [ ] after the name of service.

9

DON_VI_TINH

String

50

Unit of calculation

10

PHAM_VI

...

...

...

1

Code of scope of medical supplies coverage (1: Medical supplies are covered by health insurance (i.e. they are in the list of medical supplies covered by health insurance); 2: Medical supplies are not covered by health insurance (i.e. they are not in the list of medical supplies covered by health insurance)

11

SO_LUONG

Numeric

10

Actual amount of medical supplies used, rounded to the nearest hundredth.  A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

12

DON_GIA

...

...

...

15

- Unit price of medical supplies which is the unit price specified in the purchase invoice of the health facility, rounded to the nearest thousandth.  A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

- In case of reused medical supplies, the unit price includes the cost of reprocessing of such reusable medical supplies as prescribed by the Ministry of Health. E.g.: When purchasing medical equipment with the unit price of VND 100,000 for use in two times with the reprocessing cost of VND 10,000, the unit price specified in this entry shall be VND 55,000.

13

TT_THAU

String

25

Information about bid award decision is specified according to the following format: XXXX.YY.Z (XXXX: Issued year of the bid award decision, YY: number of procurement, Z: number of bid award decision) (in case of unavailability of a bid award decision, number of the official dispatch sent to the social security agency shall be specified).

14

...

...

...

Numeric

3

Coinsurance written as a percentage (%) of medical technical services or medical supplies covered by the health insurance fund. This percentage is a positive whole number.

E.g.: If coinsurance percentage of medical technical services or medical supplies is 50%, the value of this entry shall be “50”. With regard to medical technical services or medical supplies for which coinsurance percentage is not provided for, the value of this entry shall be “100”. If medical technical services or medical supplies are not covered by health insurance, the value of this entry shall be “0”.

- With regard to hospital bed cost, in case a patient is transferred between two departments or more within one day:

+ code of hospital bed cost and unit price are unchanged, quantity is 0.5, coinsurance percentage is 100, if the patient is transferred between departments with highest and lowest hospital bed prices;  

+ code of hospital bed cost and unit price are unchanged, quantity is 0, if the patient is transferred to other departments (if any).

- In case a patient is transferred between two departments or more within one day and shares hospital beds with another patients:

+ if 02 patients share a hospital bed: code of hospital bed cost and unit price are unchanged, quantity is 0.5 and coinsurance percentage is 50;  

...

...

...

15

THANH_TIEN

Numeric

15

= SO_LUONG * DON_GIA, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

- In cases of special coinsurance percentages specified in the Appendix 01 enclosed herewith, THANH_TIEN = SO_LUONG * DON_GlA * TYLE_TT / 100, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

16

T_TRANTT

Numeric

...

...

...

Maximum costs of medical supplies as prescribed by the Ministry of Health. In case of unavailability of maximum costs, this entry shall be left blank.

17

MUC_HUONG

Numeric

3

Coverage ratio in proportion to each type of medical expenses.

- In case a patient has received medical services at an appropriate-level health facility, the coverage ratio shall be specified as 80, or 95 or 100. In case a patient has received medical services at an inappropriate-level health facility, the value of this entry shall be the coverage ratio multiplied by the coverage ratio of inappropriate referral case in corresponding with the professional and technical level of health facility;

- In case a patient has received medical examination and treatment at an appropriate-level health facility with total medical expense less than 15% of the statutory pay rate, or the patient has received medical examination and treatment at a communal medical station, or the patient is eligible for copayment exemption in a year, the value of this entry shall be 100;

- In case a patient has received medical examination and treatment at an inappropriate-level health facility with total medical expense less than 15% of the statutory pay rate, the value of this entry shall be the coverage ratio of inappropriate referral case in corresponding with the professional and technical level of health facility.

...

...

...

T_NGUONKHAC

Numeric

15

Total amount of the patient’s medical expenses covered by other financial sources, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

19

T_BNTT

Numeric

15

Total amount self-paid by the patient for medical services which are not covered by the health insurance fund, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

...

...

...

T_BHTT

Numeric

15

Total amount of which payment request is submitted to the social security agency according to the scope of coverage, rounded to the nearest hundredth.  A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

T_BHTT = (THANH_TIEN-T_BNTT-T_NGUONKHAC) x MUC_HUONG/100 x TYLE_TT/100

21

T_BNCCT

Numeric

15

...

...

...

T_BNCCT = THANHTIEN - T_NGUONKHAC - T_BNTT - T_BHTT

22

T_NGOAlDS

Numeric

15

T_NGOAlDS = T_BHTT, with respect to costs of non-capitated medical services, rounded to the nearest hundredth. A decimal point (“.”) shall be used to separate the whole numbers (or units) and the first decimal number.

23

MA_KHOA

String

...

...

...

Code of Department providing medical services (referred to Table 7)

24

MA_GIUONG

String

14

Code of hospital bed at each treatment department, comprising 4 characters and encoded as follows:

- For planned beds: H + the number of beds at such treatment department (numbered from 001)

- For extra beds: T + the number of beds at such treatment department (numbered from 001)

- For optional beds: C + the number of beds at such treatment department (numbered from 001)

...

...

...

* If a patient has been transferred between multiples beds, codes of beds shall be separated by semicolons (;)

25

MA_BAC_SI

String

255

- Code of physician who has examined and given orders to the patient (encoded according to number of practicing certificate)/ code of practicing certificate of medical examination and treatment practitioner

- With regard to a medical technical service, code of doctor or healthcare employee providing such technical service; if a medical service is provided by two healthcare employees or more, numbers of their practicing certificates shall be specified and separated by semicolons (;).

26

MA_BENH

...

...

...

255

Code of major disease (according to ICD 10) or code of disease in traditional medicine as diagnosed by traditional medicine doctor or physician. Codes of other diseases shall be also added and separated by semicolons (;)

27

NGAY_YL

String

12

Date of giving physician order (comprising 12 characters, according to the following format: yyyymmddHHmm = 4 characters of year + 2 characters of month + 2 characters of day + 2 characters of hour (24-hour format) + 2 characters of minute).

- For surgery, procedures and interventions: time of starting such surgery, procedure or intervention is specified.  

- For hospital beds: time of starting using hospital bed is specified

...

...

...

28

NGAY_KQ

String

12

Results release date (comprising 12 characters, according to the following format: yyyymmddHHmm = 4 characters of year + 2 characters of month + 2 characters of day + 2 characters of hour (24-hour format) + 2 characters of minute).

- For surgery, procedures and interventions: time of ending such surgery, procedure or intervention is specified.  

- For hospital beds: time of ending use of each type of hospital beds is specified.

E.g.: Result is released at 15:20’ hrs., on March 31, 2017, it shall be represented as “201703311520”

29

...

...

...

Numeric

1

Code of payment method (0: Fee-for-service payment; 1: Capitation payment; 2: Payment of non-capitated medical services; 3: Diagnosis-related group (DRG)-based payment)

Notes:

- In case medical supplies are used together with a specific medical technical service, code of medical service is specified in the entry 3 (MA_DICH_VU), and codes of medical supplies are specified in the entry 4 (MA_VAT_TU)

- Entry 15 (NGAY_YL):

+ With regard to date of using hospital beds, health facilities are required to specify date of giving physician orders according to the date of starting using or changing types of beds or bed prices, or sharing beds with other patients or transferring between departments.

+ For medical supplies, date of conducting surgery, procedure or intervention with using medical supplies is specified so as to determine the payment ceiling for medical supplies in each use of technical services (if the cost of technical service does not include costs of medical supplies).

- Symbol (*) is the multiplication sign (x).

...

...

...

(Enclosed with Decision No. 4210/QD-BYT dated September 20, 2017 by Minister of Health)

STT

Entry

Data type

Maximum length

Description

1

MA_LK

...

...

...

100

Unique treatment code (for data connection between table 1 and this table in each medical examination or treatment).

2

STT

Numeric

6

Ordinal numbers starting at 1 in each data transmission

3

MA_DICH_VU

...

...

...

15

Code of subclinical service according to the “Set of code lists in healthcare sector” promulgated by Ministry of Health

4

MA_CHI_SO

String

50

Code of test index as specified in the “Set of code lists in healthcare sector” promulgated by Ministry of Health

5

TEN_CHI_SO

...

...

...

255

Name of test index as regulated by Ministry of Health

6

GIA_TRI

String

50

Index value (test result)

7

MA_MAY

...

...

...

50

Code of subclinical machinery (test machine, X-ray machine, ultrasound machine, etc.), provisionally specified according to the following format: XX.n.YYYYY.ZZZZZZ, in which:

- XX: Code of test machinery. E.g.: “HH” denotes hematology analyzer; "VS” denotes microbiology testing machine; “SH” denotes biochemistry analyzer; “SA” denotes ultrasound machine; "XQ" denotes X-ray machine; "CL" denotes CT Scanner; "MRI" denotes MRI equipment, etc.

- n: sign of source of funding for buying subclinical machinery (1: state budget; 2: private sector contribution; 3: other)

- YYYYY: Code of health facility

- ZZZZZZ: Serial number of subclinical machinery (the last 06 digits). If it consists of less than 6 digits, zeroes shall be added in the front.

8

MO_TA

String

...

...

...

Description written by result reader (This entry shall be left blank if test result description is unavailable)

9

KET_LUAN

String

1024

Conclusion announced by result reader (This entry shall be left blank if test result description is unavailable)

10

NGAY_KQ

String

...

...

...

Time of release of subclinical result (comprising 12 characters according to the following format: yyyymmddHHmm = 4 characters of year + 2 characters of month + 2 characters of day + 2 characters of hour (24-hour format) + 2 characters of minute) E.g.: Result is released at 15:20’ hrs., on March 31, 2017, it shall be represented as “201703311520”

Table 5: Entries relating to clinical progression

(Enclosed with Decision No. 4210/QD-BYT dated September 20, 2017 by Minister of Health)

STT

Entry

Data type

Maximum length

Description

1

...

...

...

String

100

Unique treatment code (for data connection between table 1 and this table in each medical examination or treatment).

2

STT

Numeric

6

Ordinal numbers starting at 1 in each data transmission

3

...

...

...

String

1024

Disease progression at each examination

4

HOI_CHAN

String

n

Medical consultation results (if any)

5

...

...

...

String

1024

Description of surgical procedure

6

NGAY_YL

String

12

Date of giving physician order (comprising 13 characters, according to the following format: yyyymmddHHmm = 4 characters of year + 2 characters of month + 2 characters of day + 2 characters of hour (24-hour format) + 2 characters of minute) E.g.: A physician order is given at 15:20’ hrs., on March 31, 2017, it shall be represented as “201503311520”

Table 6: List of cost-based groups of medical services

...

...

...

Code

Name of group of medical services

Note

1

Testing

2

Medical imaging

...

...

...

Function testing

4

Drugs in the list of drugs covered by health insurance

5

Drugs which are not in the list of drugs covered by health insurance

6

...

...

...

7

Blood and blood products

8

Surgery and procedures

9

Medical technical services for which payment is made according to coinsurance percentage

...

...

...

10

Medical supplies in the list of medical supplies covered by health insurance

11

Medical supplies for which payment is made according to coinsurance percentage

12

Transport

...

...

...

Medical examination

14

Days of day hospital bed

15

Days of inpatient hospital beds, including post-operative beds

Table 7: List of Department’s codes

...

...

...

STT

Name of department

Code

1

Outpatient Department

K01

2

Intensive Care Department

K02

...

...

...

General Medicine Department

K03

4

Cardiovascular Department

K04

5

Digestive Department

K05

6

...

...

...

K06

7

Department of Internal Urology

K07

8

Endocrinology Department

K08

9

Department of Allergy

...

...

...

10

Department of Clinical Hematology

K10

11

Infectious Disease Department

K11

12

Tuberculosis Department

K12

...

...

...

Department of Dermatology

K13

14

Neurology Department

K14

15

Department of Mental Health

K15

16

...

...

...

K16

17

Department of Geriatrics

K17

18

Pediatrics Department

K18

19

General Surgery Department

...

...

...

20

Neurosurgery Department

K20

21

Thoracic Surgery Department

K21

22

Department of Digestive Surgery 

K22

...

...

...

Department of Urologic Surgery

K23

24

Trauma and Orthopedic Department

K24

25

Department of Burns

K25

26

...

...

...

K26

27

Department of Obstetrics

K27

28

ENT Department

K28

29

Department of Odontology

...

...

...

30

Department of Ophthalmology 

K30

31

Department of Physiotherapy and Rehabilitation

K31

32

Department of Nuclear Medicine

K32

...

...

...

Department of Oncology (radiation therapy)

K33

34

Blood Transfusion Department

K34

35

Department of Blood Purification

K35

36

...

...

...

K36

37

Department of Biochemistry

K37

38

Department of Microbiology

K38

39

Department of Medical Imaging

...

...

...

40

Department of Functional Tests

K40

41

Department of Endoscopy

K41

42

Department of Pathology

K42

...

...

...

Department of Infection Control

K43

44

Department of Pharmacy

K44

45

Department of Nutrition

K45

46

...

...

...

K46

47

Laboratory Department

K47

48

Department of Intensive Care

K48

49

Department of Poisoning Control

...

...

...

50

Respiratory Department

K50

Notes:

- Code of department begins with “K” character and 2 characters of ordinal numbers of department’s names as prescribed in the hospital statutes promulgated by Ministry of Health with amendments

- In case of inter-department, department’s code shall be specified according to the following format: Kxxyyzz..., in which xx is ordinal number of the first department, yy is ordinal number of the second department, zz is ordinal number of the third department, etc. according to the abovementioned list.

- In case a department in the abovementioned list is divided into smaller divisions, department's code is specified according to the following format: KXY.Z (In which, KXY is the primary department, Z is ordinal numbers ascending from 1 to n)

Department means a department or center of health facility.

Table 8: List of codes of accidents and injuries

...

...

...

Code

Name of group of medical services

Note

0

Unidentified

1

Traffic accidents

...

...

...

Occupational accidents

3

Underwater accidents

4

Burns

5

...

...

...

6

Suicide

7

Poisoning of various types

8

Other

...

...

...

Table 9: List of codes of procurements and drug categories

(Enclosed with Decision No. 4210/QD-BYT dated September 20, 2017 by Minister of Health)

I. Drugs of which contractor selection plan has been approved before July 01, 2016

Procurement

Procurement’s code

Drug category 

Code of drug category

Generic

G1

...

...

...

N1

G1

EU-GMP or PIC/s-GMP out of ICH or franchised drugs

N2

G1

GMP-WHO VN

N3

...

...

...

G1

Drugs having evidence of bioequivalence

N4

G1

Other

N5

Proprietary medicines

G2

...

...

...

N1

G2

Rare drugs

N2

Oriental medicine

G3

WHO-GMP VN

N1

...

...

...

G3

Other

N2

II. Drugs of which contractor selection plan has been approved as of July 01, 2016 under provisions of the Circular No. 11/2016/TT-BYT

Procurement

Procurement’s code

Drug category 

Code of drug category

Generic

...

...

...

Drugs manufactured by a manufacturing line that fulfill EU-GMP or PIC/s-GMP requirements in a country that is a member state of ICH or a plant in Australia

N1

G1

Drugs manufactured by a manufacturing line that fulfill WHO-GMP VN requirements granted certificates of free sales in Australia or a country that is a member state of ICH

N1

G1

Drugs manufactured by a manufacturing line that fulfill EU-GMP or PIC/s-GMP requirements but not in Australia or a country that is a member state of ICH

...

...

...

G1

Drugs manufactured by a manufacturing line that fulfill WHO-GMP VN requirements 

N3

G1

Drugs having evidence of bioequivalence 

N4

...

...

...

Other

N5

Original brand name drugs or equivalent drugs

G2

Original brand name drugs or equivalent drugs

N1

Traditional drugs/ herbal drugs

G3

Drugs manufactured by a manufacturing line that fulfill WHO-GMP VN requirements 

...

...

...

G3

Other

N2

Herbal ingredients

G4

Herbal ingredients farmed and harvested in accordance with GACP-WHO requirements

N1

...

...

...

Other

N2

Traditional ingredients

G5

Traditional ingredients processed by a qualified processing facility as announced by Traditional Medicine Administration

N1

G5

Other

...

...

...