Abnormal expense automatic extraction system and method

An automatic extraction and cost technology, applied in data processing applications, instruments, resources, etc., can solve the problems of backward technical means, weak punishment and deterrence, insufficient auditors, etc., and achieve the effect of improving the technical level and improving work efficiency.

Inactive Publication Date: 2017-02-15
PING AN TECH (SHENZHEN) CO LTD
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  • Abstract
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  • Claims
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Problems solved by technology

[0003] Due to the huge amount of medical treatment of insured persons, wide distribution of medical service institutions, strong real-time medical insurance settlement, strong professional diagnosis and treatment, and relatively hidden medical violations, medical insurance supervision and anti-fraud work in various places are facing insufficient auditors, backward technical means, and punishment. Difficulties such as weak deterrence

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  • Abnormal expense automatic extraction system and method
  • Abnormal expense automatic extraction system and method
  • Abnormal expense automatic extraction system and method

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Embodiment Construction

[0012] refer to figure 1 As shown, it is a business framework diagram of a preferred embodiment of the automatic extraction system for abnormal expenses of the present invention. In this embodiment, the basic business process of the medical supervision is: the medical information of the insured person 3 generates case data through the settlement system of the medical institution 2 . The case data are transmitted to the medical insurance institution 1 on a regular basis or in real time. The medical insurance institution 1 can store the medical settlement data in the database 3, and use the abnormal fee automatic extraction system 10 to regularly classify, process, model, analyze and other operations on the case data, from the massive case data Quickly screen out a small amount of abnormal data to be checked.

[0013] The medical insurance institution 1 communicates with the medical institution 2 through a network, such as a local area network or the Internet.

[0014] The me...

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Abstract

An abnormal expense automatic extraction method comprises the steps of receiving all case data of various levels of medical mechanisms; extracting the case data of a specific single disease of one or more medical mechanisms from the above case data; processing the above extracted data; utilizing the multiple regression to establish a model for the above processed data; carrying out the residual analysis on the established model to analyze an abnormal value; and outputting the abnormal value. The present invention also provides an abnormal expense automatic extraction system. According to the present invention, the medical insurance expense can be monitored effectively, the working efficiency and the medical insurance expense management and control technical level are improved, the management and control of the single disease is realized, and an audit flow and a management system are helped to be standard.

Description

technical field [0001] The invention relates to the technical field of data supervision, in particular to an automatic extraction system and method for abnormal medical expenses. Background technique [0002] At present, medical insurance expenses for chronic diseases have accounted for a large part of national medical insurance expenditures. However, driven by interests, criminals have illegally obtained social security funds in some places, including using fake invoices and documents to defraud medical insurance funds; repeat Repeatedly prescribing medicines for medical visits; fraudulently using other people's medical certificates to seek medical treatment and purchase medicines; using medical insurance funds to pay for medical expenses, drugs, and medical services that are not covered by medical insurance; Medical expenses increase the expenditure of medical insurance funds; fake hospitalization to defraud medical insurance funds and so on. The above fraudulent and ille...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): G06Q10/06G06Q50/22
Inventor 顾彦丁睿
Owner PING AN TECH (SHENZHEN) CO LTD
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