Medical insurance navigation terminology - from a professional translation company

降本增效

reduce costs and increase efficiency

门诊

outpatient service

门慢人群

the group with chronic diseases covered by medical insurance

门慢人群

outpatient-specified NCD group

违规汇总

violation summary

达标

up-to-standard

身份验证

identity authentication

身份核验

identity verification

费用转移

expense transfer

费用初审

preliminary review of expenses

费用分担

cost sharing

诚信管理

integrity management

营养摄入

nutrition intake

自费

self-paying

脑卒中

cerebral stroke

肺炎

pneumonia

网上审核

online review

绩效评价

performance evaluation

绩效考核体系

performance appraisal system

绩效工资

performance-related pay

统一身份认证

unified identity authentication

经办机构终审

final review by responsible agency

线下经办

offline processing

线上服务

online service

线上处方

online prescription

纳入医保范围内的

included in medical insurance

精准化、便捷化

accuracy and convenience

筛查

identify

稽核计划制定

audit plan formulation

稽核监控

audit and monitoring

稽核全流程管理

whole-process audit management,

社保卡鉴权

social security card authentication

病种

disease types

病患转移

patient transfer

病例审核

medical record review

疾病防控

disease prevention and control

电子社保卡

electronic social security card

电子病历

electronic medical records

生物特征识别技术

biometric recognition technology

生物特征识别技术

biometric recognition technologies

现场稽核

on-site audit

现场核查

on-site verification

流感疫苗接种

influenza vaccination

水电煤缴费

utiity payment

欺诈和浪费

fraud and waste

模型验证

model validation

模型调优

model tuning

模型分析

model analysis

标签画像

label portraits

智能审核子系统

Intelligent Review Subsystem

智慧就医

intelligent medical treatment

数据管理

data management

数据清洗

data cleaning

数据标准

data standards

数据挖掘

data mining

数据分析服务

Data Analysis Service

支付管理

payment management

支付标准制定

payment standard setting

控费

expense control

成本管理

cost management

慢病肾病

chronic renal disease

慢病

NCD

慢特病资格库

qualified Special NCDs database

慢特病

Special NCDs

循证医学

evidence-based medicine

建模

modelling

床日

bed day

并发症

complication

家庭医生签约

family doctor contract

家庭医生

family doctors

审核人员

reviewers

学科建设

discipline development

大病保险

critical illness insurance

多样性、高风险性、不易比较

diversity, high risk and difficulty in comparison

基层支付制度改革

grassroot payment reform

商保商城

commercial insurance supermarket

可评估性

evaluability

反馈确认

feedback confirmation

参保人

the insured

协议网签

online agreements signing

协议管理

agreement management

医院支付制度改革

Hospital Payment Reform

医疗资源投入

medical resource investment

医疗行为

medical activities

医疗网络

medical network

医疗保障经费

medical security funds

医疗不足风险管理

medical insufficient risk management

医师培训计划

physician training plan

医务人员

hospital staff

医保缴费

medical insurance payment

医保移动支付

medical insurance mobile payment

医保查询

medical insurance inquiry

医保支付范围

coverage of medical insurance

医保医师

Medical Insurance Doctors

医保

medical insurance

分级诊疗

tiered diagnosis and treatment

冠心病

coronary heart disease

免疫

immunization

健康画像

healthy portrait

健康档案

health records

信用卡还款

credit card repayment

信息维护

information maintenance

保本微利

protecting the principal while gaining a small profit

以“疾病治疗”为核心

disease treatment-centered

以“健康管理”为中心

health management-centered

付费测算

payment calculation

人工稽核服务

Munual Audit Service

亚健康人群

people with sub-health conditions

事后人工审核服务

Ex Post Munual Review Service

临床医学

clinical medicine

个账购买

individual account purchase

两定单位

“two designated units” (designated medical institutions and pharmacies for medical insurance)

专家复审

expert review

一体化风控服务

Integrated Risk Control Service

“最多跑一次”

“One Visit at Most”

PBM

PBM (Pharmacy Benefit Management)

DRGs分组算法

DRG grouping algorithm

DRGs

DRGs (Diagnosis Related Groups)

BI

BI (Business Intelligence)

省内外异地实时联网结算系统

interprovincial real-time networking and settlement system

医疗卫生制度

healthcare system

医疗健康

health care

异地就医直接结算

Real-time site-off settlement 

基本药物

essential medicine

药品电子监管码

drug electronic supervision code

耗材

consumable

大病保险

serious disease insurance

病案

medical records

“最多跑一次”

“simplify the onsite procedures to one visit”

定点医疗机构

designated medical institutions

业务经办

business handling

骗保

insurance fraud

无监督学习算法

unsupervised learning algorithm

神经网络

neural network

挂床住院

counterfeit hospitalization

分级诊疗

hierarchical diagnosis and treatment 

事前

ex-ante

事中

ongoing

事后

ex-post

医保

Medical insurance

在线就医服务

Online medical service

查询

Inquiry

线上诊间结算

Online clinic settlement

慢病

Chronic disease

重疾

Serious illness

个账活化

Individual account activation

远程会诊

Remote consulting

双向转诊

Two-way referral

精算能力

Actuarial ability

医疗保障

Medical security

多周期

Multi-cycle

咨询

Consulting

长护保险

Long-term care insurance

大病保险

Major illness insurance

慢病保险

Chronic disease insurance

精算

Actuarial science

疾病谱

Disease spectrum

避险机制

Risk aversion mechanism

电子社保卡

electronic social security cards

综合柜员制

comprehensive counter system

公共服务事项目录

catalogue of public service items

免填单业务

table-free business

信息安全等级保护制度

information security level protection system

政府采购

government procurement

拓展经费保障渠道

expand funding channels

创新应用试点

innovative pilots

总体谋划、分步实施

overall planning and step-by-step implementation

市级集中

Municipal Centralization

业务经办一体化

integration of business handling

业务流程标准化

standardization of business process

系统数据集中化

centralization of system data

稽核监管规范化

standardization of audit supervision

市县需求差异化

differentiation of needs between cities and counties

基于DRG的绩效评估管理

DRG-based performance evaluation management

人均赔付金额

per capita compensation amount

三医联动

the reform of medical care, medical insurance and pharmaceutical industry