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Suspicious behavior audit system and method in medical insurance reimbursement process

The invention discloses a suspicious behavior audit system in the medical insurance reimbursement process. The suspicious behavior audit system comprises a consumption information base, a retrieval unit, an expense screening unit, an analysis execution unit and a human-computer interaction unit. The retrieval unit can automatically obtain reimbursement bills to be audited from the consumption information base; multiple items of data in prescription detail information are classified through the expense screening unit; treatment registration information, expense settlement information and classified prescription detail information are displayed in the human-computer interaction unit so that audit staff can visually audit suspicious objects; meanwhile, parameters and threshold values corresponding to all the data in the prescription detail information are input into the analysis execution unit so that the analysis execution unit can conduct automatic audit on all the data in the prescription detail information; as a result, batch processing of multiple items of data is achieved, and manual audit time is greatly shortened; accordingly, by the aid of the audit system, medical insurance reimbursement bills can be audited efficiently, quickly and accurately.
Owner:PING AN MEDICAL & HEALTHCARE MANAGEMENT CO LTD +1
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