Ten payment queries tied to records and applicable rules
Real sources · Illustrative request · Sample version
Customer question
Hypothetical commission: a mainland China hospital receives ten payment queries on one clinical topic.
What separately supports medical necessity and payment eligibility?
The 2026 implementing rules address necessary care and payment policies. General guidance does not replace local rules applicable on the service date.
Payment-response evidence matrix
| Check / stage | Chart content |
|---|---|
| Clinical context then | Locate original notes, orders and reports |
| Medical necessity | Link contemporaneous standards and patient context |
| Payment conditions | Check national/provincial/pooling-area items, standards and dates |
Jurisdiction: mainland China. No real records or payment determination. Article 11 of the 2026 rules is the reference.
Analysis excerpt
| Check | Finding / sample content | Use |
|---|---|---|
| Query 07 | Necessity does not establish payment eligibility | Locate clinical and payment bases separately |
| Original records | Missing originals remain flagged | Request missing originals; never reconstruct fiction |
| Professional review | Disputed points remain pending | Deliver response after one review round |
Delivery manifest
| File | Format | Contents |
|---|---|---|
| Ten-query response table | XLSX | Queries, responses, original locations and pending items |
| Clinical and payment-rule index | XLSX | Versions, jurisdiction, applicable dates and rule mapping |
| Reviewed response memorandum | One topic, agreed 100 pages and one professional review |
This is an illustrative formal delivery manifest. This pack supplies an HTML report, CSV tables and a source register. Agree formal formats, quantities and scope in the quote.
Acceptance criteria
- Each agreed query is addressed with source locations. Medical records are not fabricated retrospectively.
Sources
- 国家医保局 · 基金使用监督管理条例实施细则，2026
https://www.nhsa.gov.cn/art/2026/2/13/art_173_19681.html