Skip to content
go to content
HOME > >FAQ

FAQ

archives search 검색 시작일 선택 달력 검색 마지막일 선택 달력 돋보기 아이콘
questionWhat are the IT services available for the public and for healthcare providers?
answer

The HIRA website provides various services including medical fee verification and access to quality assessment results. HIRA's mobile application, free of charge, provides up-to-date health information and healthcare institution information to help patients choose hospitals and pharmacies. Additionally, HIRA offers a providers portal and claim submission portal, where claims can be electronically submitted and results can be accessed more conveniently.

questionWhat are the difference between KPIS and DUR?
answer

The Korea Pharmaceutical Information Service (KPIS) assigns a 13-digit standard code (KD code) to all drugs in Korea's pharmaceutical market. The KPIS’s primary goal is to manage the import, production, distribution, and consumption of pharmaceuticals.

Drug Utilization Review (DUR) is a system that provides real-time information on drug safety. DUR minimizes and prevents the unsafe use of drugs by reviewing prescriptions and comparing them to the national safety standards at the time of prescribing and dispensing. The DUR is connected to the HIRA system and returns review results with real-time administration history within 0.5 seconds.

questionHow does HIRA utilize its data?
answer

The data from providers sent to HIRA is used primarily for claims review and quality assessment services. The Data Warehouse (DW) is where the data is stored, and it is used for governmental pol

questionWhat is HIRA's role in resource management and benefit decision making with regard to pharmaceuticals and new medical technology?
answer

HIRA collects and manages the information reported by healthcare providers about their facilities, equipment, and workforce status to assist with resource management. HIRA also reviews the clinical validity and cost-effectiveness of new healthcare technology after safety and efficacy approval by the Ministry of Health and Welfare. The results are sent to the Ministry, and the Minister makes decisions on benefit coverage. For new drugs, HIRA reviews the coverage decision, NHIS negotiates the price with pharmaceutical companies for covered drugs, and final confirmation of those decisions is made by the Minister. For generic drugs, the price is determined by HIRA according to a pre-determined formula.

questionWhat is HIRA's quality assessment?
answer

HIRA's quality assessment functions to prevent the overuse, underuse, and misuse of healthcare services by providers. At the same time, it aims to reducing the variability of quality between individual healthcare providers, ultimately resulting in more stable and consistent healthcare nationwide. In doing so, HIRA has also implemented a pay-for-performance system called the Value Incentive Program (VIP) which has led providers to take more steps toward quality improvement.

questionWhat is HIRA's claims review?
answer

The objective of HIRA’s claims review is to prevent waste, improve public health, and keep healthcare costs affordable. Claims review is conducted to verify that healthcare services provided are clinically valid and cost-effective, and that claimed costs are accurately calculated according to NHI benefit criteria. The claims review process consists of a self-precheck of providers, an electronic check-up, an electronic review, and finally a detailed review performed by HIRA staff and committees of experts.

questionWhat is HIRA?
answer

Korea's National Health Insurance system (NHI) operates under 3 major acting bodies: The Ministry of Health and Welfare (MoHW), The National Health Insurance Service (NHIS), and The Health Insurance Review and Assessment Service (HIRA). The MoHW oversees the overall NHI system and supervises NHIS and HIRA. NHIS is in charge of eligibility management and insurance contribution collection. HIRA is responsible for claims review, setting terms for benefits, and healthcare quality assessment. Operation and management of the NHI was separated and divided between these two agencies in order to ensure independence, fairness, and objectivity.

1