Medical expense abnormity monitoring method, monitoring server and storage medium

Abstract

The invention discloses a medical expense abnormity monitoring method, a server and a storage medium, and the method comprises the steps: receiving medical data sent by a medical institution server, the medical data comprising insurer identifications and medical reimbursement fees of insurers corresponding to the insurer identifications in a preset accounting period; Searching the insured time corresponding to the insured person identifier according to pre-stored insured information; performing Calculating to obtain actual accounting time according to the preset accounting period and the insured time; performing Calculating to obtain an average reimbursement limit according to a preset medical reimbursement limit and the preset accounting period; Obtaining an actual reimbursement limit according to the actual accounting time and the average reimbursement limit; Judging whether the medical reimbursement cost is greater than an actual reimbursement limit or not; And if the medical reimbursement cost is greater than the actual reimbursement limit, setting an abnormal identifier and associating the abnormal identifier with the insurer identifier. According to the invention, medical cost abnormal behaviors can be conveniently and rapidly identified based on the neural network, and medical cost is monitored.

Description

technical field [0001] The invention relates to the technical field of insurance monitoring, in particular to a monitoring method for abnormal medical expenses, a monitoring server and a computer-readable storage medium. Background technique [0002] Residents participate in social medical insurance (hereinafter referred to as medical insurance) to guarantee basic living. In the existing social medical insurance operating rules, in order to prevent the insured from abusing medical insurance resources, a reimbursement limit is set for each insured person for each hospitalization and each year of hospitalization, and some insured persons use the reimbursement limit to count the natural year. Units, even if the insured person obtains the medical insurance reimbursement qualification in the middle of the year or at the end of the year, he can still be reimbursed according to the annual reimbursement limit. Malicious insured persons use methods such as deliberately prescribing m...

AI Technical Summary

Problems solved by technology

[0003] The main purpose of the present invention is to provide a monitoring method for abnormal medical expenses, a monitoring server and a computer-readable storage medium, aiming to solve the problem of large workload and low accuracy of manually checking abnormal medical expenses due to the huge medical insurance reimbursement data technical problem

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