Social security card-based medical insurance in-diagnosis settlement system and method

Abstract

The invention provides a social security card-based medical insurance in-diagnosis settlement system and method. The system comprises a medical insurance settlement service module used for obtaining personal information and providing outpatient, hospitalization and outpatient coordination settlement services, a medical insurance settlement routing module used for sending municipal medical insurance, provincial medical insurance and remote medical insurance settlement information and returning settlement results, a medical insurance management service module used for enabling medical insuranceto correspond to a basic medical insurance drug directory, a diagnosis and treatment item directory and medical service facility standards, and a medical insurance security management module used forverifying an identity of an accessed designated medical institution, monitoring a system terminal of the designated medical institution and controlling a medical insurance service calling mode. Through the system and the method, for the problems of single medical insurance settlement mode, overcrowding at settlement windows, and the like at present, the settlement of terminal systems such as an outpatient department, a laboratory, a nurse station and the like can be realized based on conventional window settlement, and full connection between a hospital information system and a medical insurance business system is realized.

Description

technical field [0001] The invention relates to the technical field of medical insurance information, in particular to a medical insurance inter-diagnosis settlement system and method based on a social security card. Background technique [0002] Medical insurance settlement is an important part of the medical insurance service and medical service process. It mainly provides online settlement services for medical expenses for insured persons according to the medical insurance reimbursement policy. At present, the whole country has basically realized the network settlement service in designated hospitals, including medical treatment, industrial injury and maternity insurance expenses, which brings great convenience to the insured. [0003] In order to ensure the security of settlement, designated hospitals need to install encrypted cards and configure settlement software. Therefore, most of the currently implemented medical insurance network settlements in designated hospital...

AI Technical Summary

Problems solved by technology

However, the medical insurance fee still needs to be settled at the payment window, which brings a lot of inconvenience to the insured patients

The technical reason for this problem is that the system deployment mode of encrypted cards and settlement software makes it impossible to fully connect the medical insurance settlement system and the hospital information system (mainly the HIS system), and the settlement service can only be authorized to a proprietary client

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