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Medical claim payment refusing method and apparatus, terminal device and storage medium

A billing and billing technology, applied in the field of terminal equipment and storage media, medical claims refusal methods, and devices, can solve problems such as claims processing methods, and achieve the effect of improving accuracy and processing efficiency

Inactive Publication Date: 2018-02-09
PING AN TECH (SHENZHEN) CO LTD
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

[0003] Embodiments of the present invention provide a medical claim refusal method, device, terminal equipment, and storage medium method to solve the problems existing in the claim processing method of manually reviewing duplicate bills and refusal of payment

Method used

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  • Medical claim payment refusing method and apparatus, terminal device and storage medium
  • Medical claim payment refusing method and apparatus, terminal device and storage medium
  • Medical claim payment refusing method and apparatus, terminal device and storage medium

Examples

Experimental program
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Embodiment 1

[0027] figure 1 A flow chart showing the method for rejecting payment of medical claims in this embodiment. The medical claim refusal method is applied in the claim settlement system of an insurance institution, and is used to improve the claim settlement processing efficiency of medical insurance and save labor costs. Such as figure 1 As shown, the medical claim refusal method includes the following steps:

[0028] S10: Obtain a claim settlement application request, where the claim settlement application request includes a case ID and current billing information, and the current billing information includes at least one current item information.

[0029] Wherein, the claim settlement application request refers to a request for making the claim settlement system perform claim settlement processing. A case ID is an identifier used to uniquely identify a case. The case ID includes but is not limited to the case number of the case to which the claim application belongs. Throug...

Embodiment 2

[0088] Figure 6 A functional block diagram of a medical claim refusal device corresponding to the medical claim refusal method in Embodiment 1 is shown. Such as Figure 6 As shown, the medical claim rejection device includes a claim application request acquisition module 10 , a historical bill information acquisition module 20 , a same bill judgment module 30 and a first payment denial information output module 40 . Among them, the implementation functions of the claim application request acquisition module 10, the historical bill information acquisition module 20, the same bill judgment module 30 and the first payment denial information output module 40 correspond to the corresponding steps of the medical claim rejection method in the embodiment. .

[0089] The claim settlement application request module 10 is configured to obtain a claim settlement application request. The claim settlement application request includes a case ID and current bill information, and the curren...

Embodiment 3

[0118] This embodiment provides a computer-readable storage medium, on which a computer program is stored. When the computer program is executed by a processor, the medical claim refusal method in Embodiment 1 is implemented. In order to avoid repetition, details are not repeated here. . Alternatively, when the computer program is executed by the processor, the functions of the various modules / units in the medical claim rejection device in Embodiment 2 are implemented. To avoid repetition, details are not repeated here.

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Abstract

The invention discloses a medical claim payment refusing method and apparatus, a terminal device and a storage medium. The medical claim payment refusing method comprises the steps of obtaining a claim application request, wherein the claim application request comprises a case ID and current bill information, and the current bill information comprises at least one piece of current item information; based on the case ID, obtaining historical bill information corresponding to the case ID, wherein the historical bill information comprises at least one piece of historical item information; based on the at least one piece of the current item information and the at least one piece of the historical item information, judging whether the current bill information and the historical bill informationcorrespond to a same bill or not; and if the current bill information and the historical bill information correspond to the same bill, outputting payment refusing information. According to the medical claim automatic payment refusing method, whether a current bill and a historical bill corresponding to the case ID are the same bill or not can be judged; the claim application request where the same bill is located is subjected to automatic payment refusing; the accuracy of case claiming is improved; and the processing efficiency of the claim application request is improved.

Description

technical field [0001] The present invention relates to the field of medical claims, in particular to a medical claim refusal method, device, terminal equipment and storage medium. Background technique [0002] Medical insurance is a type of insurance established based on economic losses caused by disease risks. In the process of medical insurance claims, the policyholder submits a claim application request to the business personnel of the insurance institution, and attaches the corresponding medical bill. The business personnel review the claim application request and the corresponding medical bill. When the historical bill of claim is repeated, the claim application request will be rejected to avoid property loss to the insurance institution. This method of manually reviewing duplicate bills and rejecting payment takes a lot of time in the review process with low accuracy and high labor costs. Contents of the invention [0003] Embodiments of the present invention prov...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): G06Q40/08G06F17/30G06K9/68G06N3/04G06N3/08
CPCG06F16/90344G06N3/08G06Q40/08G06V30/248G06V30/10G06N3/045
Inventor 梁效栋戴建云
Owner PING AN TECH (SHENZHEN) CO LTD
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