National Health Insurance Act Article 62
The contracted medical care institutions shall declare to the Insurer the points of the medical services rendered and the expense of drugs based on the Fee Schedule and Reference List for Medical Services as well as the drug dispensing items and fee schedule.The contracted medical care institutions shall declare the medical expenses in the preceding paragraph within the first day of the month following the treatment to six months. However, if there are unavoidable circumstances, another six months after the fact will be provided.The Insurer shall calculate the value of each point based on the budget allocated according to the preceding article and the total points of medical service as reviewed by the Insurer. The Insurer shall pay each contracted medical care institution according to the reviewed points.The drug expenses shall be paid to the contracted medical care institutions after being examined by the Insurer. In case the payment of expense exceeds the preset total of drug expense ratio target, exceeding the targeted amount, the Insurer shall adjust the drug dispensing items and fee schedule for the following year. The amount in excess shall be deducted from the budget for the medical benefit payment for the current season and the payment to contracted medical care institutions according to expenditure targets.
中文原文 全民健康保險法第62條
保險醫事服務機構應依據醫療服務給付項目及支付標準、藥物給付項目及支付標準，向保險人申報其所提供之醫療服務之點數及藥物費用。
前項費用之申報，應自保險醫事服務機構提供醫療服務之次月一日起六個月內為之。
但有不可抗力因素時，得於事實消滅後六個月內為之。
保險人應依前條分配後之醫療給付費用總額及經其審查後之醫療服務總點數，核算每點費用；並按各保險醫事服務機構經審查後之點數，核付其費用。
藥品費用經保險人審查後，核付各保險醫事服務機構，其支付之費用，超出預先設定之藥品費用分配比率目標時，超出目標之額度，保險人於次一年度修正藥物給付項目及支付標準；其超出部分，應自當季之醫療給付費用總額中扣除，並依支出目標調整核付各保險醫事服務機構之費用。
前項費用之申報，應自保險醫事服務機構提供醫療服務之次月一日起六個月內為之。
但有不可抗力因素時，得於事實消滅後六個月內為之。
保險人應依前條分配後之醫療給付費用總額及經其審查後之醫療服務總點數，核算每點費用；並按各保險醫事服務機構經審查後之點數，核付其費用。
藥品費用經保險人審查後，核付各保險醫事服務機構，其支付之費用，超出預先設定之藥品費用分配比率目標時，超出目標之額度，保險人於次一年度修正藥物給付項目及支付標準；其超出部分，應自當季之醫療給付費用總額中扣除，並依支出目標調整核付各保險醫事服務機構之費用。