National Health Insurance Act Article 63
The Insurer, in order to examine the item, quantity, and quality of the medical service of this Insurance provided by the contracted medical care institutions, shall appoint medical and pharmaceutical specialists who have clinical or relevant experiences to conduct the review, which shall be based on the approved payment; the review work shall be assigned to the relevant professional agency or group.A review of the medical services in the preceding paragraph shall be done before, during, and after the matter; sampling or case analysis will be the methods used.The Competent Authority shall establish the procedure and schedule for medical expense application and payment, as well as rules for reviewing medical services.The Insurer shall be responsible for drafting the contract items of Paragraph 1, the contracted institutions, qualifications of the group, selection, and revision of procedure, supervision, and relevant pertaining to rights and responsibilities and reporting these matters to the Competent Authority for approval.
中文原文 全民健康保險法第63條
保險人對於保險醫事服務機構辦理本保險之醫療服務項目、數量及品質，應遴聘具有臨床或相關經驗之醫藥專家進行審查，並據以核付費用；審查業務得委託相關專業機構、團體辦理之。
前項醫療服務之審查得採事前、事後及實地審查方式辦理，並得以抽樣或檔案分析方式為之。
醫療費用申報、核付程序與時程及醫療服務審查之辦法，由主管機關定之。
第一項得委託之項目、受委託機構、團體之資格條件、甄選與變更程序、監督及權利義務等有關事項之辦法，由保險人擬訂，報主管機關核定發布。
前項醫療服務之審查得採事前、事後及實地審查方式辦理，並得以抽樣或檔案分析方式為之。
醫療費用申報、核付程序與時程及醫療服務審查之辦法，由主管機關定之。
第一項得委託之項目、受委託機構、團體之資格條件、甄選與變更程序、監督及權利義務等有關事項之辦法，由保險人擬訂，報主管機關核定發布。