Medical insurance case filing auditing method and device executed by computer

A medical insurance and computer technology, applied in the computer field, can solve problems such as difficulty in dealing with a large number of user reports, easy misjudgment, and easy omission of key items, so as to reduce the risk of manual audit misjudgment, save manpower, and improve audit accuracy sexual effect

Active Publication Date: 2020-03-06
ALIPAY (HANGZHOU) INFORMATION TECH CO LTD
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  • Application Information

AI Technical Summary

Problems solved by technology

With the increase of medical insurance users, it is increasingly difficult to deal with a large number of user reports in the manual review process in the case filing and review process. On the one hand, it requires a lot of labor costs. Misjudgments are prone to occur in the case of limited manpower

Method used

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  • Medical insurance case filing auditing method and device executed by computer
  • Medical insurance case filing auditing method and device executed by computer
  • Medical insurance case filing auditing method and device executed by computer

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Embodiment Construction

[0049] The solutions provided in this specification will be described below in conjunction with the accompanying drawings.

[0050] figure 1 A schematic diagram of an implementation scenario according to an embodiment is shown. Such as figure 1As shown, this implementation scenario involves the filing and review of medical insurance, and the review process is carried out by a computer. In the embodiment of this manual, the medical knowledge map is used to provide more judgment basis for filing and reviewing. Among them, case filing review: in medical insurance claims, review the materials submitted by users, and file a case for materials that meet the standards as a result of the review; medical knowledge map: a knowledge map based on medical knowledge. refer to figure 1 , the medical knowledge graph contains nodes and connection edges between nodes. Each node corresponds to medical entities such as hospitals, diseases, operations, and departments. Each connection edge ref...

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Abstract

The embodiment of the invention provides a medical insurance case filing auditing method and device executed by a computer. The method comprises the steps of obtaining medical related text materials submitted by a user; according to a preset medical entity type, performing medical entity extraction on the text material to obtain each target medical entity; linking each extracted target medical entity to a pre-established medical knowledge graph, the medical knowledge graph comprising a plurality of nodes and connecting edges between the nodes, the nodes correspond to the medical entities and having standard names of the medical entities, and the connecting edges showing the incidence relation between the medical entities corresponding to the two connected nodes; and according to the targetmedical entities in the medical knowledge graph and the association relationships of the target medical entities indicated by the medical knowledge graph, outputting a result of whether case filing is carried out or not. Manpower can be saved, and auditing accuracy can be improved.

Description

technical field [0001] One or more embodiments of this specification relate to the field of computers, and in particular to a computer-executed medical insurance filing review method and device. Background technique [0002] In medical insurance claims, it is necessary to review the materials submitted by the user, and file a case for the materials that meet the standards as a result of the review. [0003] Most of the traditional solutions adopt the method of manual review, and judge whether the case can be filed according to the business definition review strategy for the credential materials submitted by the user. With the increase of medical insurance users, it is increasingly difficult to deal with a large number of user reports in the manual review process in the case filing and review process. On the one hand, it requires a lot of labor costs. Misjudgment is prone to occur in the case of limited manpower. [0004] Therefore, it is desired to provide a computer-execu...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): G06Q40/08G06K9/00G06F16/35G06F16/36
CPCG06Q40/08G06F16/35G06F16/367G06V30/413
Inventor 刘阳阳
Owner ALIPAY (HANGZHOU) INFORMATION TECH CO LTD
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