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 an insurer identifier, disease information of an insurer, and a medical reimbursement expense of the insurer in a preset accounting period; Obtaining at least one reimbursement expense threshold value corresponding to the disease information according to a preset reimbursement expense threshold value table, and calculating a total reimbursement expense threshold value ofthe insurer according to the reimbursement expense threshold value; Judging whether the medical reimbursement cost is greater than the total reimbursement cost threshold; And when the medical reimbursement cost is greater than the total reimbursement cost threshold, setting an abnormal mark to be associated 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, each insured person has a reimbursement limit for each hospitalization and annual hospitalization, and some insured persons or medical institutions use the reimbursement limit to the greatest extent. , using methods such as deliberately prescribing more medicines and excessively arranging treatment to achieve the maximum reimbursement, resulting in excessive abuse of medical insurance resources. Staff need to check a large amount of reimbursement data to analyze and identify w...

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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