Inner Mongolia Proposes Credit Evaluation Rules for Designated Medical Insurance Institutions — Credit Rating to Directly Affect Inspection Frequency

*Image source: Inner Mongolia Autonomous Region Medical Insurance Bureau

GoodNews Dental｜The Inner Mongolia Autonomous Region Medical Insurance Bureau recently issued a public notice soliciting feedback on three regulatory documents, including the Implementation Rules for Credit Evaluation of Designated Medical Insurance Institutions in Inner Mongolia Autonomous Region (Draft for Comment). The comment period closes on November 28, 2025.

The Implementation Rules specify that the credit evaluation cycle for designated medical institutions covers one full calendar year. Institutions start with a baseline score of 100 points, with scores reduced through a "deduction-based" system. Credit ratings are divided into four tiers from highest to lowest: Excellent (A ≥ 90), Good (90 > B ≥ 80), Poor (80 > C ≥ 65), and Bad (D < 65).

As previously reported by GoodNews Dental, the Inner Mongolia Autonomous Region Medical Insurance Bureau issued the Interim Measures for Medical Insurance Credit Management in Inner Mongolia in July 2025, establishing a tiered credit evaluation and dynamic oversight mechanism. The current Implementation Rules serve as the specific operational standards for credit evaluation of designated medical institutions under those interim measures.

The Implementation Rules require designated medical institutions to sign a credit commitment letter, conduct medical insurance training, and strengthen internal self-supervision. Medical insurance authorities at all levels are responsible — following a "tiered, localized" principle — for establishing credit files for designated institutions within their jurisdiction, and for managing the collection, entry, review, and revision of relevant information. Credit files include basic institutional information, records of trustworthy conduct, records of untrustworthy conduct, and other information to be included.

Regarding the aggregation of credit information: trustworthy records include commendations and awards related to integrity recognized through proper procedures by local governments and administrative departments at or above the banner/county level, records of compliance with laws, regulations, and service agreement terms, and verified reports of suspected insurance fraud. Untrustworthy records include administrative penalties imposed by medical insurance authorities at or above the county level for violations of medical insurance laws and regulations, breaches of medical insurance service agreements, and refusals to fulfill administrative penalty decisions.

The Implementation Rules establish a joint disciplinary list management system within the medical insurance sector. Designated medical institutions placed on the serious untrustworthy entity list for fraudulently obtaining medical insurance funds, or subject to judicial rulings for the same, will be directly included in the joint disciplinary list.

Regarding the application of ratings: designated institutions rated Excellent (Grade A) may, during the validity period of their credit rating, enjoy a range of incentives — including exemption from inspection upon renewal of their designated medical insurance agreement, waiver of routine periodic inspections, and a 2-point bonus added to their annual assessment score under the basic medical insurance designated institution agreement. Institutions rated Bad (Grade D) will have 2 points deducted from their annual assessment score, will be subject to routine supervision and inspection at twice the standard frequency, and may be designated as "seriously untrustworthy entities in the medical insurance sector" and added to the joint disciplinary list.

The Implementation Rules also establish a credit restoration mechanism. Untrustworthy designated institutions that meet the relevant criteria may apply to the medical insurance authority for credit restoration within the validity period of the untrustworthy record. Required materials include proof of institutional and individual identity, a credit restoration application form and commitment letter bearing the official seal and signed by the principal responsible person, and supporting documentation demonstrating correction and rectification of the violations.