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Similarity calculation method based on commercial medical insurance claim cases

A similarity calculation and medical insurance technology, applied in the fields of medical insurance and commercial insurance, to reduce labor costs, assist discovery, and improve service efficiency

Inactive Publication Date: 2016-08-17
陈杰
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  • Abstract
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  • Claims
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AI Technical Summary

Problems solved by technology

In this context, commercial insurance companies are faced with a "surge" in subsequent business volumes, and traditional manual inspection of all claims cases one by one to detect possible fraud cases has become unsustainable

Method used

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  • Similarity calculation method based on commercial medical insurance claim cases

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Embodiment Construction

[0028] The specific implementation manners of the present invention will be further described below in conjunction with the drawings and examples. The following examples are only used to illustrate the technical solution of the present invention more clearly, but not to limit the protection scope of the present invention.

[0029] Such as figure 1 As shown, the present invention describes a method for calculating similarity based on commercial medical insurance claims, which mainly includes the following steps:

[0030] S1. Discretization of attribute factors: calculate the sample distribution density of each age group, and divide the age into three segments at most according to the density distribution function and ensure the incremental continuity of each age group, while the sample size of each segment is basically balanced;

[0031] S2. Screening of the main attribute factors of claim cases: select attribute factors from the basic information of the accident person and ju...

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Abstract

The invention discloses a similarity calculation method based on commercial medical insurance claim cases. The method comprises the following steps that of 1 discretizing attribute factors, 2 screening main attribute factors of the claim cases, 3 building claim case standard templates and quantifying claim case weight values and 4 inspecting the standard rationality. According to the method, a traditional method which is adopted by commercial insurance companies and achieved through the step that all the claim cases are manually checked one by one to find possibly-existing fraud cases is abandoned, a traditional information technology and a data mining technology are combined, therefore, business personnel are more efficiently assisted in finding the fraud claim cases, the manual cost is reduced, and the service efficiency is improved; meanwhile, the mode of subjectively defining age segmentation points is abandoned in the aspect of sample age discretization processing, and the segmentation point range is determined according to an actual density distribution function of samples; in addition, the weight value of an initial template is determined by calculating the complexity, and differential calculation is conducted on all groups, so that the weight values of all the templates are optimized under all the accident conditions.

Description

technical field [0001] The invention relates to the technical fields of medical insurance and commercial insurance, in particular to a method for calculating similarity based on commercial medical insurance claims. Background technique [0002] In 2012, the State Council issued the "Notice on Printing and Distributing the Plan and Implementation Plan for Deepening the Reform of the Medical and Health System during the "Twelfth Five-Year Plan" Period", requiring active exploration and establishment of a protection mechanism for major and serious diseases, while increasing the maximum payment limit of basic medical insurance and the payment of high medical expenses On the basis of the proportion, coordinate basic medical insurance and commercial health insurance policies, and actively explore ways to use basic medical insurance funds to purchase commercial critical illness insurance or establish supplementary insurance to effectively improve the level of protection for major an...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): G06F19/00G06Q40/08G06Q50/18G06F17/30
CPCG06F19/328G06F16/3347G06Q40/08G06Q50/18
Inventor 陈杰
Owner 陈杰
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