{
  "format": "audit-dossier-v1",
  "generated_at": "2026-06-03T09:45:06Z",
  "question": "诊疗项目收费与目录限制如何交叉审核？ 的适用条件和例外情况是什么？ 的适用条件和例外情况是什么？ 需要补充核验哪些原始凭证？",
  "answer": "问题：诊疗项目收费与目录限制如何交叉审核？ 的适用条件和例外情况是什么？ 的适用条件和例外情况是什么？ 需要补充核验哪些原始凭证？\n当前回答由检索依据直接组成，未生成无引用结论。\n规则依据：\n- …人员 （11）应用场景：住院、门（急）诊、互联网诊疗、异地就医 （12）监管费用类型：基本医疗保险（含生育保险）基金 （13）监管环节：事前、事中、事后 （14）参保险种：基本医疗保险、生育保… [C3]\n风险案例依据：\n- …治疗（340100030）\"。需要注意的是，该治疗项⽬“含电极棒”，也就是“电极棒”不能 费啦。 3-2 → “中医定向透药疗法”透了个寂寞 ⾸先，明确⼀下什么是“中医定向透药疗法” 中医定向… [C1]\n- …现了医师的价值。 3-5 → 宫腔⼤部分⼿术、治疗项⽬都含“宫颈扩张” 经宫腔输卵管镜检查、分段诊断性刮宫术、⼦宫内膜活检术、经宫腔镜双侧输卵管插管通液术、宫内节育器放置 内节育器取出术等等，… [C2]",
  "confidence": "high",
  "confidence_label": "高",
  "fallback_used": true,
  "fallback_label": "检索直出",
  "review_gate": "可进入人工复核",
  "review_notice": "该导出为审计线索和人工复核底稿，不替代正式审计结论。",
  "review_checklist": [
    "核对引用片段是否完整覆盖问题。",
    "打开原文确认条款上下文。",
    "检查目录、规则、法规版本是否适用。",
    "确认是否还需 HIS 原始凭证补证。"
  ],
  "source_collections": [],
  "citation_count": 3,
  "basis_group_count": 2,
  "basis_groups": [
    {
      "evidence_type": "rule_basis",
      "title": "规则依据",
      "items": [
        {
          "citation_id": "C3",
          "chunk_id": "2f58fc69-f0f7-57e2-8e45-024e47d9ab87",
          "snippet": "…人员 （11）应用场景：住院、门（急）诊、互联网诊疗、异地就医 （12）监管费用类型：基本医疗保险（含生育保险）基金 （13）监管环节：事前、事中、事后 （14）参保险种：基本医疗保险、生育保…",
          "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/2f58fc69-f0f7-57e2-8e45-024e47d9ab87",
          "locator": {
            "type": "paragraph",
            "line_end": null,
            "line_start": null,
            "title_path": [],
            "page_number": 1,
            "source_path": "智能监管“两库”规则和知识点/医疗保障基金智能监管规则库、知识库（2025年版）.pdf",
            "window_count": 969,
            "window_index": 19,
            "article_number": null,
            "parent_article_number": null
          },
          "index_version_key": "full-rebuild-20260603085815",
          "source_package_version_key": "source-package-real-data-kimi-candidate-fixed-20260603T084631Z"
        }
      ]
    },
    {
      "evidence_type": "risk_case_basis",
      "title": "风险案例依据",
      "items": [
        {
          "citation_id": "C1",
          "chunk_id": "f64c7d7e-b880-56fe-8219-b137eefca2f4",
          "snippet": "…治疗（340100030）\"。需要注意的是，该治疗项⽬“含电极棒”，也就是“电极棒”不能 费啦。 3-2 → “中医定向透药疗法”透了个寂寞 ⾸先，明确⼀下什么是“中医定向透药疗法” 中医定向…",
          "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/f64c7d7e-b880-56fe-8219-b137eefca2f4",
          "locator": {
            "type": "paragraph",
            "line_end": null,
            "line_start": null,
            "title_path": [],
            "page_number": 12,
            "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
            "window_count": 3,
            "window_index": 1,
            "article_number": null,
            "parent_article_number": null
          },
          "index_version_key": "full-rebuild-20260603085815",
          "source_package_version_key": "source-package-real-data-kimi-candidate-fixed-20260603T084631Z"
        },
        {
          "citation_id": "C2",
          "chunk_id": "464cd9e7-9ed3-548e-9401-7f4ae684c03b",
          "snippet": "…现了医师的价值。 3-5 → 宫腔⼤部分⼿术、治疗项⽬都含“宫颈扩张” 经宫腔输卵管镜检查、分段诊断性刮宫术、⼦宫内膜活检术、经宫腔镜双侧输卵管插管通液术、宫内节育器放置 内节育器取出术等等，…",
          "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/464cd9e7-9ed3-548e-9401-7f4ae684c03b",
          "locator": {
            "type": "paragraph",
            "line_end": null,
            "line_start": null,
            "title_path": [],
            "page_number": 12,
            "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
            "window_count": 3,
            "window_index": 2,
            "article_number": null,
            "parent_article_number": null
          },
          "index_version_key": "full-rebuild-20260603085815",
          "source_package_version_key": "source-package-real-data-kimi-candidate-fixed-20260603T084631Z"
        }
      ]
    }
  ],
  "citations": [
    {
      "citation_id": "C1",
      "marker": "[C1]",
      "evidence_type": "risk_case_basis",
      "source_collection": "risk-negative-list",
      "chunk_id": "f64c7d7e-b880-56fe-8219-b137eefca2f4",
      "snippet": "…治疗（340100030）\"。需要注意的是，该治疗项⽬“含电极棒”，也就是“电极棒”不能 费啦。 3-2 → “中医定向透药疗法”透了个寂寞 ⾸先，明确⼀下什么是“中医定向透药疗法” 中医定向…",
      "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/f64c7d7e-b880-56fe-8219-b137eefca2f4",
      "locator": {
        "type": "paragraph",
        "line_end": null,
        "line_start": null,
        "title_path": [],
        "page_number": 12,
        "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
        "window_count": 3,
        "window_index": 1,
        "article_number": null,
        "parent_article_number": null
      },
      "index_version_key": "full-rebuild-20260603085815",
      "source_package_version_key": "source-package-real-data-kimi-candidate-fixed-20260603T084631Z",
      "score": 0.8980487804878049,
      "metadata": {
        "locator": {
          "type": "paragraph",
          "line_end": null,
          "line_start": null,
          "title_path": [],
          "page_number": 12,
          "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
          "window_count": 3,
          "window_index": 1,
          "article_number": null,
          "parent_article_number": null
        },
        "line_end": null,
        "line_start": null,
        "row_number": null,
        "sheet_name": null,
        "title_path": [],
        "is_windowed": true,
        "page_number": 12,
        "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
        "article_number": null,
        "index_version_key": "full-rebuild-20260603085815",
        "source_collection": "risk-negative-list",
        "source_package_version_key": "source-package-real-data-kimi-candidate-fixed-20260603T084631Z"
      }
    },
    {
      "citation_id": "C2",
      "marker": "[C2]",
      "evidence_type": "risk_case_basis",
      "source_collection": "risk-negative-list",
      "chunk_id": "464cd9e7-9ed3-548e-9401-7f4ae684c03b",
      "snippet": "…现了医师的价值。 3-5 → 宫腔⼤部分⼿术、治疗项⽬都含“宫颈扩张” 经宫腔输卵管镜检查、分段诊断性刮宫术、⼦宫内膜活检术、经宫腔镜双侧输卵管插管通液术、宫内节育器放置 内节育器取出术等等，…",
      "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/464cd9e7-9ed3-548e-9401-7f4ae684c03b",
      "locator": {
        "type": "paragraph",
        "line_end": null,
        "line_start": null,
        "title_path": [],
        "page_number": 12,
        "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
        "window_count": 3,
        "window_index": 2,
        "article_number": null,
        "parent_article_number": null
      },
      "index_version_key": "full-rebuild-20260603085815",
      "source_package_version_key": "source-package-real-data-kimi-candidate-fixed-20260603T084631Z",
      "score": 0.7664454501122957,
      "metadata": {
        "locator": {
          "type": "paragraph",
          "line_end": null,
          "line_start": null,
          "title_path": [],
          "page_number": 12,
          "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
          "window_count": 3,
          "window_index": 2,
          "article_number": null,
          "parent_article_number": null
        },
        "line_end": null,
        "line_start": null,
        "row_number": null,
        "sheet_name": null,
        "title_path": [],
        "is_windowed": true,
        "page_number": 12,
        "source_path": "风险负面清单/医保负面清单整理_2024年2月.pdf",
        "article_number": null,
        "index_version_key": "full-rebuild-20260603085815",
        "source_collection": "risk-negative-list",
        "source_package_version_key": "source-package-real-data-kimi-candidate-fixed-20260603T084631Z"
      }
    },
    {
      "citation_id": "C3",
      "marker": "[C3]",
      "evidence_type": "rule_basis",
      "source_collection": "supervision-rules-knowledge",
      "chunk_id": "2f58fc69-f0f7-57e2-8e45-024e47d9ab87",
      "snippet": "…人员 （11）应用场景：住院、门（急）诊、互联网诊疗、异地就医 （12）监管费用类型：基本医疗保险（含生育保险）基金 （13）监管环节：事前、事中、事后 （14）参保险种：基本医疗保险、生育保…",
      "preview_url": "http://audit.lute-tlz-dddd.top/pages/preview/2f58fc69-f0f7-57e2-8e45-024e47d9ab87",
      "locator": {
        "type": "paragraph",
        "line_end": null,
        "line_start": null,
        "title_path": [],
        "page_number": 1,
        "source_path": "智能监管“两库”规则和知识点/医疗保障基金智能监管规则库、知识库（2025年版）.pdf",
        "window_count": 969,
        "window_index": 19,
        "article_number": null,
        "parent_article_number": null
      },
      "index_version_key": "full-rebuild-20260603085815",
      "source_package_version_key": "source-package-real-data-kimi-candidate-fixed-20260603T084631Z",
      "score": 0.7022526933802078,
      "metadata": {
        "locator": {
          "type": "paragraph",
          "line_end": null,
          "line_start": null,
          "title_path": [],
          "page_number": 1,
          "source_path": "智能监管“两库”规则和知识点/医疗保障基金智能监管规则库、知识库（2025年版）.pdf",
          "window_count": 969,
          "window_index": 19,
          "article_number": null,
          "parent_article_number": null
        },
        "line_end": null,
        "line_start": null,
        "row_number": null,
        "sheet_name": null,
        "title_path": [],
        "is_windowed": true,
        "page_number": 1,
        "source_path": "智能监管“两库”规则和知识点/医疗保障基金智能监管规则库、知识库（2025年版）.pdf",
        "article_number": null,
        "index_version_key": "full-rebuild-20260603085815",
        "source_collection": "supervision-rules-knowledge",
        "source_package_version_key": "source-package-real-data-kimi-candidate-fixed-20260603T084631Z"
      }
    }
  ]
}