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Medical expense restriction rule generation method

A cost and medical technology, applied in the field of information processing, to achieve the effect of clear levels, scientific management and control, and clear categories

Pending Publication Date: 2017-09-01
杭州逸曜信息技术有限公司
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

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Problems solved by technology

However, there is currently no medical expense limitation rule generation method to solve

Method used

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Experimental program
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Embodiment 1

[0043] figure 1 It is a flowchart of the generation and application of the medical expense restriction rule provided in the first embodiment of the present invention. As shown in the figure, it includes the following steps:

[0044] Step 101: Receive first medical expense restriction information.

[0045] Among them, the first medical expense limit information source includes databases generated by policies and regulations of medical insurance, health, and price departments, including medical clinical knowledge, medical experience, etc. The policies and regulations issued by the medical insurance, health, and price departments refer to the policies and regulations issued by the Ministry of Human Resources and Social Security, the Health and Family Planning Commission, the Price Department, and the Medical Insurance Center that have a legal and binding effect. Mainly include the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog", the basi...

Embodiment 2

[0080] As it is currently in the golden age of medical insurance reform, the catalog, relevant management regulations, and payment methods are in a stage of constant exploration and adjustment. Therefore, the source of medical insurance control fees is often changed and supplemented. In the face of this situation, the method adopted by the medical insurance fee control software in the prior art is generally that there is a regulation, and a new rule engine is created based on this regulation, and the rule number is incremented in a direct order. This mode will quickly accumulate to more than hundreds of rules after being used for a period of time in the actual application process, and most of the rules have the problem of duplication and confusion. When the maintenance staff or customers get a new basis source change, when faced with such a complicated and irregular rule list, they often do not know which rule to add or modify, or whether it is true A new rule needs to be esta...

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PUM

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Abstract

The present invention relates to a method for generating medical expense limitation rules, comprising: step 1, receiving first medical expense limitation information; step 2, analyzing the first medical expense limitation information, extracting first limitation subject information and first limitation range information; step 3. Classify the first medical expense restriction information according to the first restriction subject information, and generate the first classification restriction information; Step 4, layer the first classification restriction information according to the first restriction range information, and create the first classification for each layer The limit information sets the cost information threshold range, and generates the first medical cost limit rule. The medical expense limitation rules generated by the method for generating medical expense limitation rules provided by the present invention have clear categories and clear layers, and can manage and control medical expenses reasonably and scientifically, thereby realizing cost reduction and efficiency increase of medical insurance expenses.

Description

Technical field [0001] The invention relates to an information processing method, in particular to a method for generating medical expense restriction rules. Background technique [0002] The social security system can effectively guarantee the basic survival and living needs of all members of the society, and is of great significance to safeguarding people's livelihood and building a harmonious society. At present, China’s social security system includes five major sectors: social welfare, special care placement, social assistance, housing security, and social insurance. Medical insurance is a part of social insurance. It is the most basic protection of the people’s right to life and health. It is closely related to everyone in the society, so it is an important part of the social security system. [0003] Since the new medical reform, Chinese people’s social security, medical care, and social assistance rights have been effectively safeguarded. With the universal medical insuran...

Claims

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Application Information

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IPC IPC(8): G06Q50/22G06Q50/26
CPCG06Q50/22G06Q50/26
Inventor 吕良忠黄向华吴越
Owner 杭州逸曜信息技术有限公司
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