Article 70Medical Fees of Medical Institutions Providing Services Covered by Health Insurance
第七十条（保険医療機関等の診療報酬）
A Association of Medical Care Systems for the Elderly Aged 75 and older is to pay expenses related to benefits for medical treatment to medical institutions providing services covered by health insurance, etc., and the amount of expenses which a medical institution providing services covered by health insurance, etc. may claim from a Association of Medical Care Systems for the Elderly Aged 75 and older related to benefits for medical treatment is the amount calculated by deducting the amount of co-payment to be paid to the relevant medical institution providing services covered by health insurance, etc. with respect to the relevant benefits for medical treatment from the amount of expenses required for benefits for medical treatment calculated in accordance with the standards for calculation of the amount of expenses required for benefits for medical treatment set forth in paragraph (1) of the following Article.
後期高齢者医療広域連合は、療養の給付に関する費用を保険医療機関等に支払うものとし、保険医療機関等が療養の給付に関し後期高齢者医療広域連合に請求することができる費用の額は、次条第一項の療養の給付に要する費用の額の算定に関する基準により算定した療養の給付に要する費用の額から、当該療養の給付に関して当該保険医療機関等に支払われるべき一部負担金に相当する額を控除した額とする。
A Association of Medical Care Systems for the Elderly Aged 75 and older may, with the authorization of the prefectural governor, specify otherwise in a contract with a medical institution providing services covered by health insurance, etc. with regard to the expenses required for the benefits for medical treatment set forth in the preceding paragraph pertaining to the benefits for medical treatment provided at the medical institution providing services covered by health insurance, etc., within the scope of the amount calculated pursuant to the provisions of the same paragraph.
後期高齢者医療広域連合は、都道府県知事の認可を受け、保険医療機関等との契約により、当該保険医療機関等において行われる療養の給付に関する前項の療養の給付に要する費用につき、同項の規定により算定される額の範囲内において、別段の定めをすることができる。
When a medical institution providing services covered by health insurance, etc. requests payment of expenses related to benefits for medical treatment, the Association of Medical Care Systems for the Elderly Aged 75 and older is to make payment after conducting an examination in light of the standards for treatment and responsibility for benefits for medical treatment as set forth in paragraph (1) of the following Article, the standards for calculation of the amount of expenses required for benefits for medical treatment, and the provisions of the preceding paragraph.
後期高齢者医療広域連合は、保険医療機関等から療養の給付に関する費用の請求があつたときは、次条第一項の療養の給付の取扱い及び担当に関する基準並びに療養の給付に要する費用の額の算定に関する基準及び前項の定めに照らして審査した上、支払うものとする。
The Association of Medical Care Systems for the Elderly Aged 75 and older may entrust affairs concerning the examination and payment under the provisions of the preceding paragraph to the Organization or the NHI federation.
後期高齢者医療広域連合は、前項の規定による審査及び支払に関する事務を機構又は国保連合会に委託することができる。
A federation of national health insurance associations that is entrusted pursuant to the provisions of the preceding paragraph may entrust the affairs concerning the examination entrusted thereto, which pertain to the examination of medical bills specified by the Minister of Health, Labour and Welfare, to a corporation designated by the Minister of Health, Labour and Welfare as prescribed in Article 45, paragraph (6) of the National Health Insurance Act (hereinafter referred to as a "designated corporation").
前項の規定による委託を受けた国保連合会は、当該委託を受けた審査に関する事務のうち厚生労働大臣の定める診療報酬請求書の審査に係るものを、国民健康保険法第四十五条第六項に規定する厚生労働大臣が指定する法人（以下「指定法人」という。）に委託することができる。
A designated corporation that has been entrusted with the affairs concerning the review of medical bills specified by the Minister of Health, Labour and Welfare pursuant to the provisions of the preceding paragraph must have the review of the medical bills conducted by a person who satisfies the requirements specified by Order of the Ministry of Health, Labour and Welfare.
Beyond what is provided for in each of the preceding paragraphs, necessary matters concerning claims for expenses incurred in providing medical treatment at medical institutions providing services covered by health insurance, etc. are specified by Order of the Ministry of Health, Labour and Welfare.
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