Objective：To explore the criteria of health insurance quality management in clinical departments of tertiary hospitals and provide references for the criteria. Methods： Self?designed questionnaires were used among staff of the government authorities， health insurance agencies， tertiary hospitals and health insurance associations. Data were analyzed by SPSS17.0. Results： Among the 238 objects， 90.34% objects thought there was no or almost no unified criteria of health insurance quality management in clinical departments of tertiary hospitals， 71.01% objects thought it was urgent to make a unified criteria. “Appropriate treatment” and “Incorruptible and self?discipline” were considered as the most important criteria. Conclusion： It is urgent to make unified criteria of health insurance quality management in clinical departments of tertiary hospitals.