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Claim settlement reference information generation method and device

A technology of reference information and disease information, applied in the field of data processing, can solve problems such as manual review errors

Pending Publication Date: 2020-04-24
TAIKANG LIFE INSURANCE CO LTD
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

Since the photos of medical records uploaded by patients can reach dozens of pages, it is not easy for medical reviewers to accurately extract the most relevant data information for prescription medical review from the complicated picture information and to assist reviewers in decision-making, and there may be artificial Audit errors

Method used

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  • Claim settlement reference information generation method and device
  • Claim settlement reference information generation method and device
  • Claim settlement reference information generation method and device

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Embodiment Construction

[0053] In order to make the above objects, features and advantages of the present invention more comprehensible, the present invention will be further described in detail below in conjunction with the accompanying drawings and specific embodiments.

[0054] refer to figure 1 , which shows a flow chart of the steps of an embodiment of a method for generating claim settlement reference information according to the present invention. The method is applied to a server, and the server communicates with the user terminal and the input terminal respectively. The method may specifically include the following steps:

[0055] Step 101, receiving medical record data sent by the user terminal;

[0056]The claim settlement review process of special drug insurance requires both the applicant (such as a patient) to provide medical records and professional review personnel to conduct review. In order to realize the claim settlement review process of special drug insurance online, the claim re...

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Abstract

The embodiment of the invention provides a claim settlement reference information generation method and device. The method is applied to a server, and comprises the steps of receiving medical record data transmitted by a user terminal; sending the medical record data to an input terminal, and receiving prescription data sent by the input terminal based on the medical record data, wherein the prescription data comprises disease information, targeted drug information, target information and a target detection result; judging whether a preset special drug insurance claim settlement condition is met or not according to the disease information, the targeted drug information, the target information and the target detection result; and generating claim settlement reference information according to a judgment result. According to the embodiment of the invention, the prescription data can be collected online, whether the special drug insurance claim settlement condition is met or not is automatically judged according to the prescription data, manual judgment is not needed, and the probability of auditing errors is reduced.

Description

technical field [0001] The present invention relates to the technical field of data processing, in particular to a claim settlement reference information generation method and a claim settlement reference information generation device. Background technique [0002] Special drug insurance refers to medical insurance for the cost of malignant tumor drugs. Special drug insurance allows patients to obtain claims for commonly used targeted drugs for lung cancer, breast cancer, liver cancer, gastric cancer, colorectal cancer, kidney cancer, leukemia and other cancers. [0003] At present, the claims review of special drug insurance is mainly carried out manually. Professionals with a doctor's license and clinical experience will conduct prescription review based on prescription information, medical knowledge and clinical experience and determine whether to grant compensation. Since the photos of medical records uploaded by patients can reach dozens of pages, it is not easy for med...

Claims

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Application Information

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IPC IPC(8): G16H10/60G16H70/40G06Q40/08
CPCG16H10/60G16H70/40G06Q40/08
Inventor 陈沛胡德婷张子豪
Owner TAIKANG LIFE INSURANCE CO LTD
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