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Medical insurance supervision method, equipment and device and computer readable storage medium

A technology for medical insurance and regulatory procedures, applied in the medical insurance field, can solve the problems of difficult medical insurance supervision, regulatory loopholes, and low accuracy

Pending Publication Date: 2019-04-16
PING AN MEDICAL & HEALTHCARE MANAGEMENT CO LTD
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  • Abstract
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AI Technical Summary

Problems solved by technology

[0004] The main purpose of the present invention is to provide a medical insurance supervision method, which aims to solve the above-mentioned technical problems of high difficulty in medical insurance supervision, low accuracy, and easy occurrence of regulatory loopholes, so as to reduce the difficulty of medical insurance supervision and improve the accuracy and rigor of medical insurance supervision

Method used

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  • Medical insurance supervision method, equipment and device and computer readable storage medium
  • Medical insurance supervision method, equipment and device and computer readable storage medium
  • Medical insurance supervision method, equipment and device and computer readable storage medium

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Embodiment Construction

[0042] It should be understood that the specific embodiments described here are only used to explain the present invention, not to limit the present invention.

[0043] The main solution of the embodiment of the present invention is to analyze the medical consultation data of the insured based on the preset model, and extract the suspected abnormal cases.

[0044] Since medical insurance supervision is usually implemented manually in the existing technology, the supervision is difficult and requires a large number of specialized human resources, and the accuracy of manual supervision is low, and it is easy to produce regulatory loopholes.

[0045] The present invention provides a solution to analyze the medical data of the insured based on the preset model, and extract the suspected abnormal cases, so as to realize the automatic supervision of medical insurance expenses, reduce the difficulty of supervision, and improve the accuracy of supervision at the same time and rigor. ...

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Abstract

The invention discloses a medical insurance supervision method. The medical insurance supervision method is realized based on an intelligent decision. The medical insurance supervision method comprises the following steps: obtaining treatment data of an insured person; Extracting a preset field in the treatment data according to a preset model; And analyzing the preset field based on the preset model, and extracting suspected abnormal cases according to an analysis result. The invention further discloses medical insurance supervision equipment, a medical insurance supervision device and a computer readable storage medium. According to the technical scheme, the difficulty of medical insurance supervision is reduced, and the accuracy and the tightness of medical insurance supervision are improved.

Description

technical field [0001] The present invention relates to the technical field of medical insurance, in particular to a medical insurance supervision method, equipment, device and computer-readable storage medium. Background technique [0002] With the development of society and economy, the national medical insurance policy is gradually optimized, and more and more expenses incurred in the medical process can be reimbursed. However, in order to obtain more reimbursement, some insureds have violated regulations such as falsifying medical conditions, splitting expenses, and over-treatment, resulting in the loss of medical insurance funds. At present, medical insurance supervision mainly relies on manual review. However, due to factors such as large number of insured persons, huge medical data and strong specialization, manual supervision is very difficult. Not only does it require a large number of specialized human resources, but also the supervision Accuracy is also low, and ...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): G06Q40/08
CPCG06Q40/08
Inventor 陈明东黄越胥畅
Owner PING AN MEDICAL & HEALTHCARE MANAGEMENT CO LTD
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