Method and device for reviewing disease diagnosis information
A technology of disease diagnosis and diagnostic information, applied in the computer field, can solve the problems of low audit efficiency, low audit accuracy, affecting the timeliness and accuracy of medical insurance claims
Active Publication Date: 2019-10-25
PING AN TECH (SHENZHEN) CO LTD
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[0003] Based on this, it is necessary to provide a disease diagnosis information review method and device for the technical problems of low review efficiency and low review accuracy in the traditional disease diagnosis information review method, which affect the timeliness and accuracy of medical insurance claims.
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[0043] In order to make the object, technical solution and advantages of the present invention clearer, the present invention will be further described in detail below in conjunction with the accompanying drawings and embodiments. It should be understood that the specific embodiments described here are only used to explain the present invention, not to limit the present invention.
[0044] see figure 1 , a method for reviewing disease diagnosis information, comprising:
[0045] Step 102: Obtain the input policy number and disease name through the claim settlement business system, search the pre-stored diagnosis information database according to the input disease name, obtain the disease diagnosis path data corresponding to the input disease name from the disease diagnosis information database, disease diagnosis path The data includes a plurality of attribute labels, a label node corresponding to each attribute label, and a weight value of each label node.
[0046] Specifical...
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A disease diagnosis information review method and device, comprising: obtaining an inputted insurance policy number and disease name, and obtaining disease diagnosis path data which correspond to the inputted disease name and which comprise a plurality of attribute tags, a tag node corresponding to each attribute tag and the weight value of each tag node; obtaining the inputted tag node, obtaining a tag node in the disease diagnosis path data which is the same as the inputted tag node, and obtaining the weight value of said tag node; calculating a path review weight value as the product of the weight values of a plurality of inputted tag nodes; and when the path review weight value is greater than or equal to a preset path review weight threshold value, reading and processing claim payment rule data to obtain a claim payment numerical value, generating a claim payment instruction, and sending the same to a payment platform.
Description
technical field [0001] The invention relates to the field of computer technology, in particular to a method and device for reviewing disease diagnosis information. Background technique [0002] Generally, when medical insurance claims are reviewed, it is necessary to review whether the disease diagnosis information of the claim case is reasonable, so as to prevent criminals from defrauding insurance premiums through unreasonable diagnosis and illegally seeking profits. In the traditional medical insurance claims review process, whether the diagnostic information is manually reviewed is reasonable. This review method is labor-intensive and low-efficiency, which makes the time limit for claims longer, and the diagnosis filled by the doctor will have a lot of auxiliary descriptive language. Medical and insurance-based professionals identify diagnostic information, and different reviewers may have different understandings of the content of the same diagnostic information, making...
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IPC IPC(8): G06F16/00G06Q40/08
CPCG06Q40/08
Inventor 戴建云杨刚
Owner PING AN TECH (SHENZHEN) CO LTD