A data management method and device based on risk control

Abstract

The embodiment of the present application discloses a data management method and device based on risk control, wherein the method includes: obtaining user information of a target user, creating a work order based on the user information, determining the target patient of the target user based on the first address of the target user in the work order and the second address of at least one patient in the patient information database, sending a patient accompanying task notification to the terminal corresponding to the target patient accompanying, receiving the patient accompanying data uploaded by the target patient accompanying, analyzing the diagnostic information in the patient accompanying data, and determining the claim result of the target user based on the analysis result of the diagnostic information. By adopting the embodiment of the present application, the whole process of data control can be realized, the validity of data in each link can be ensured, and the processing efficiency of each link of data management can be improved, thereby improving the processing efficiency of the entire data management process.

Description

Technical Field

[0001] The present application relates to the field of computer technology, and in particular to a data management method and device based on risk control. Background Art

[0002] At present, after the target user is suspected of having a serious illness or is diagnosed with a serious illness, he / she applies for a claim to the insurance company, and the insurance company then initiates the claim business according to the claim process set by itself. However, each link in the claims business is an interaction between people, which has low interaction efficiency and a long claim cycle. In addition, the insurance liability is currently assessed manually and the claim results are determined. The assessment cycle is long and the claim results are greatly affected by subjective factors, which may lead to inaccurate claim results. For the target users, there is still no system for full-process control of review, appointment, medical treatment, follow-up, and claims, and the validity of the data in each link cannot be guaranteed. Summary of the invention

[0003] The embodiments of the present application provide a data management method and device based on risk control, which can realize full-process data control and ensure the validity of data in each link. At the same time, it can improve the processing efficiency of each link of data management, thereby improving the processing efficiency of the entire data management process.

[0004] In a first aspect, an embodiment of the present application provides a data management method based on risk management, the method comprising:

[0005] Get the user information of the target user and create a work order based on the user information;

[0006] Determine a target accompanying patient of the target user according to the first address of the target user in the work order and the second address of at least one accompanying patient in the accompanying patient information database, and send a medical accompanying task notification to a terminal corresponding to the target accompanying patient, wherein the medical accompanying task notification is used to notify the target accompanying patient to upload medical accompanying data, wherein the medical accompanying data includes the diagnosis information of the target user;

[0007] Receiving the accompanying medical data uploaded by the target accompanying medical attendant, and analyzing the diagnostic information in the accompanying medical data;

[0008] The claim settlement result of the target user is determined based on the analysis result of the diagnostic information.

[0009] In combination with the first aspect, in a possible implementation, obtaining the insurance information of the target user includes: receiving a claim request from the target user, the claim request including a target image uploaded by the target user; and extracting user information of the target user from the target image.

[0010] In combination with the first aspect, in a possible implementation, the target accompanying attendant of the target user is determined based on the first address of the target user in the work order and the second address of at least one accompanying attendant in the accompanying attendant information database, including: obtaining the first address of the target user in the work order; obtaining the second address of at least one accompanying attendant in the accompanying attendant information database; calculating the distance between the second address of each accompanying attendant among the at least one accompanying attendant's second addresses and the first address of the target user; and determining the accompanying attendant corresponding to the second address among the second addresses of each accompanying attendant that has the smallest distance to the first address as the target accompanying attendant of the target user.

[0011] In combination with the first aspect, in a possible implementation, the claim result of the target user is determined based on the analysis result of the diagnostic information, including: if the analysis result of the diagnostic information is the first analysis result, the claim result of the target user is determined to be confirmed claim; if the analysis result of the diagnostic information is the second analysis result, the claim result of the target user is determined to be rejected claim.

[0012] In combination with the first aspect, in a possible implementation, after determining that the claim result of the target user is confirmed claim, the method also includes: creating a follow-up task based on the user information of the target user, and determining the target follow-up person for the target user; sending a follow-up task notification to the terminal corresponding to the target follow-up person, and the follow-up task notification is used to notify the target follow-up person to enter the follow-up record.

[0013] In a second aspect, an embodiment of the present application provides a data management device based on risk management and control, the device comprising:

[0014] An acquisition module is used to obtain user information of a target user;

[0015] A creation module is used to create a work order based on the user information;

[0016] A first determination module is used to determine a target patient escort of the target user according to a first address of the target user in the work order and a second address of at least one patient escort in a patient escort information database;

[0017] A sending module is used to send a medical companion task notification to a terminal corresponding to the target medical companion, wherein the medical companion task notification is used to notify the target medical companion to upload medical companion data, wherein the medical companion data includes the diagnosis information of the target user;

[0018] A receiving module, used for receiving the accompanying medical data uploaded by the target accompanying medical attendant;

[0019] An analysis module, used for analyzing the diagnostic information in the accompanying medical data;

[0020] The second determination module is used to determine the claim settlement result of the target user according to the analysis result of the diagnostic information.

[0021] In combination with the second aspect, in a possible implementation, the acquisition module is specifically used to: receive a claim request from a target user, the claim request including a target image uploaded by the target user; and extract user information of the target user from the target image.

[0022] In combination with the second aspect, in a possible implementation, the above-mentioned first determination module is specifically used to: obtain the first address of the target user in the work order; obtain the second address of at least one accompanying attendant in the accompanying attendant information database; calculate the distance between the second address of each accompanying attendant among the at least one accompanying attendant's second addresses and the first address of the target user; determine the accompanying attendant corresponding to the second address among the second addresses of each accompanying attendant that has the smallest distance from the first address as the target accompanying attendant of the target user.

[0023] In combination with the second aspect, in a possible implementation, the above-mentioned second determination module is specifically used to: if the analysis result of the diagnostic information is the first analysis result, determine that the claim result of the target user is confirmed claim; if the analysis result of the diagnostic information is the second analysis result, determine that the claim result of the target user is rejected claim.

[0024] In combination with the second aspect, in a possible implementation, the above-mentioned creation module is also used to create a new follow-up task based on the user information of the target user after determining that the claim result of the target user is confirmed claim; the above-mentioned first determination module is also used to determine the target follow-up person of the target user; the above-mentioned sending module is also used to send a follow-up task notification to the terminal corresponding to the target follow-up person, and the follow-up task notification is used to notify the target follow-up person to enter the follow-up record.

[0025] In a third aspect, an embodiment of the present application provides a server comprising a processor, an input device, an output device and a memory, wherein the processor, input device, output device and memory are interconnected, wherein the memory is used to store a computer program that supports a terminal to execute the above method, and the computer program comprises program instructions, and the processor is configured to call the program instructions to execute the data management method based on risk control of the above first aspect.

[0026] In a fourth aspect, an embodiment of the present application provides a computer-readable storage medium, which stores a computer program, and the computer program includes program instructions, which, when executed by a processor, enable the processor to execute the risk control-based data management method of the first aspect mentioned above.

[0027] The embodiment of the present application obtains user information of the target user, creates a work order according to the user information, determines the target accompanying patient of the target user according to the first address of the target user in the work order and the second address of at least one accompanying patient in the accompanying patient information database, sends an accompanying patient task notification to the terminal corresponding to the target accompanying patient, and the accompanying patient task notification is used to notify the target accompanying patient to upload accompanying patient data, wherein the accompanying patient data includes the diagnosis information of the target user, receives the accompanying patient data uploaded by the target accompanying patient, analyzes the diagnosis information in the accompanying patient data, and determines the claim result of the target user according to the analysis result of the diagnosis information, thereby realizing full-process data control, ensuring the validity of data in each link, and at the same time improving the processing efficiency of each link of data management, thereby improving the processing efficiency of the entire data management process. BRIEF DESCRIPTION OF THE DRAWINGS

[0028] In order to more clearly illustrate the technical solutions of the embodiments of the present application, the drawings required for use in the description of the embodiments will be briefly introduced below. Obviously, the drawings described below are some embodiments of the present application. For ordinary technicians in this field, other drawings can be obtained based on these drawings without paying any creative work.

[0029] Figure 1 It is a schematic diagram of a system architecture in a medical claims scenario provided by an embodiment of the present application;

[0030] Figure 2 is a schematic flow chart of a data management method based on risk control provided in an embodiment of the present application;

[0031] Figure 3 is another schematic flow chart of a data management method based on risk management provided in an embodiment of the present application;

[0032] Figure 4 is a schematic block diagram of a data management device based on risk management provided in an embodiment of the present application;

[0033] Figure 5 It is a schematic block diagram of a server provided in an embodiment of the present application. DETAILED DESCRIPTION

[0034] The following will be combined with the drawings in the embodiments of the present application to clearly and completely describe the technical solutions in the embodiments of the present application. Obviously, the described embodiments are part of the embodiments of the present application, not all of the embodiments. Based on the embodiments in the present application, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of this application.

[0035] It should be understood that the terms "first", "second", etc. in the specification and claims of the present application and the drawings are used to distinguish different objects rather than to describe a specific order. In addition, the terms "including" and "having" and any variations thereof are intended to cover non-exclusive inclusions. For example, a process, method, system, product or device that includes a series of steps or units is not limited to the listed steps or units, but may optionally include steps or units that are not listed, or may optionally include other steps or units that are inherent to these processes, methods, products or devices.

[0036] It should also be understood that reference to an "embodiment" herein means that a particular feature, structure, or characteristic described in conjunction with the embodiment may be included in at least one embodiment of the present application. The presentation of the phrase at various locations in the specification does not necessarily refer to the same embodiment, nor is it an independent or alternative embodiment that is mutually exclusive with other embodiments. It is explicitly and implicitly understood by those skilled in the art that the embodiments described herein may be combined with other embodiments.

[0037] It should be further understood that the term “and / or” used in the specification and appended claims refers to any combination and all possible combinations of one or more of the associated listed items, and includes these combinations.

[0038] One application scenario of the embodiment of the present application may be medical claims. In the medical claims scenario, the target user may refer to the insured, and the user information may include the insured's insurance information and basic information. The basic information may include the handling area, name, gender, age, ID number, contact information, contact address, etc. The insurance information may include the policy number, primary insurance code, insured unit, insurance period, etc. Figure 1 As shown, Figure 1A schematic diagram of a system architecture in a medical claims scenario provided in an embodiment of the present application. Among them, terminal 1 can be used to represent the terminal corresponding to the insured, and terminal 2 can be used to represent the terminal corresponding to the target accompanying doctor. (1) The insured can enter his or her user information through terminal 1. (2) Terminal 1 can send the user information entered by the insured to the server. (3) After receiving the user information of the insured, the server can create a work order based on the user information, and the work order can include the work order type, basic information, insurance information, etc. of the insured. (4) The server can then determine the target accompanying doctor of the insured based on the first address of the insured in the work order. (5) The server can send an accompanying task notification to terminal 2. (6) After receiving the accompanying task notification, terminal 2 can output the accompanying task notification. (7) After accompanying the insured to the doctor, the target accompanying doctor uploads the accompanying data through terminal 2, and the accompanying data can include the diagnosis information of the insured. (8) Terminal 2 can then send the accompanying data uploaded by the insured to the server. (9) The server can receive the accompanying medical data sent by terminal 2, and can analyze the diagnostic information in the accompanying medical data. (10) The server then determines the claim result for the insured based on the analysis result of the diagnostic information. (11) The server can push the claim result to terminal 1 so that the insured can view the claim result in a timely manner. The embodiment of the present application reduces the links of human interaction by interacting with terminal 1 and terminal 2 multiple times, realizes the whole process control of data, ensures the validity of data in each link, and improves the processing efficiency of the entire data management process.

[0039] The following will be combined Figures 2 to 5 , the data management method and device based on risk control provided in the embodiments of the present application are described.

[0040] See also Figure 2 , is a schematic flow chart of a data management method based on risk control provided by an embodiment of the present application. Figure 2 As shown, the data management method based on risk control may include the following steps:

[0041] S201, obtaining user information of a target user, and creating a work order according to the user information.

[0042] In some feasible implementations, the target user can input user information on the first terminal, and the user information may include basic information and insurance information of the target user. The server may obtain the user information on the first terminal, and may create a work order for the target user based on the user information. Among them, the first terminal may be used to represent the terminal corresponding to the target user. The basic information may include the handling area, name, gender, age, ID number, contact information, contact address, etc.; the insurance information may include the policy number, primary insurance code, insured unit, insurance period, etc. The work order may include work order information (such as work order type), insurance information, basic information, etc.

[0043] In some feasible implementations, the server may obtain the basic information input by the target user on the first terminal and the insurance data uploaded by the target user. The server may detect the data format of the insurance data. When the data format of the insurance data is an image data format, the server may use optical character recognition (OCR) to convert the insurance data in the image data format into insurance data in a text data format, and may extract the insurance information of the target user from the insurance data in the text data format. The server may then create a work order for the target user based on the basic information and insurance information of the target user.

[0044] In some feasible implementations, the server can obtain the basic information input by the target user on the first terminal, and can extract the ID number in the basic information, retrieve the insurance information corresponding to the ID number in the insurance policy database, and obtain the insurance information corresponding to the ID number. The server can then create a work order for the target user based on the basic information and insurance information of the target user.

[0045] S202, determining a target accompanying person for the target user according to a first address of the target user in the work order and a second address of at least one accompanying person in an accompanying person information database, and sending an accompanying task notification to a terminal corresponding to the target accompanying person.

[0046] In some feasible implementations, after creating the work order of the target user, the server can obtain the first address of the target user in the work order. The first address can be the contact address in the basic information of the user information. The server can obtain the second address of at least one accompanying doctor in the accompanying doctor information database, and can push the accompanying doctor associated with the second address within the target area of ​​the first address to the first terminal. The target user can select his own accompanying doctor through the first terminal, and the server can obtain the accompanying doctor selected by the target user through the first terminal, and determine the accompanying doctor selected by the target user as the target accompanying doctor of the target user. After determining the target accompanying doctor, the server can create a new accompanying doctor task, and can send an accompanying doctor task notification to the terminal corresponding to the target accompanying doctor. The accompanying doctor task notification can be used to notify the target accompanying doctor to assist the target user in making an appointment with a specialist and accompany the target user to see a doctor, and upload the accompanying doctor data after the doctor is over. Among them, the second address can be the contact address of the accompanying doctor. The first address can be the contact address of the target user.

[0047] For example, the first address of the target user is address 1, the target area is the same administrative district, and the second addresses belonging to the same administrative district as address 1 are address 3, address 4, and address 6. The server pushes the accompanying doctor P3 associated with address 3, the accompanying doctor P4 associated with address 4, and the accompanying doctor P6 associated with address 6 to the first terminal. Assuming that the accompanying doctor selected by the target user on the first terminal is P6, the server obtains the accompanying doctor P6 selected by the target user through the first terminal, and determines the accompanying doctor P6 selected by the target user as the target accompanying doctor of the target user. The server creates a new accompanying task and sends an accompanying task notification to the terminal corresponding to the target accompanying doctor P6.

[0048] In some feasible implementations, after creating the work order of the target user, the server may send an address acquisition request to the first terminal of the target user. After receiving the address acquisition request sent by the server, the first terminal may call a global positioning system (GPS) module to obtain the geographical location of the first terminal. The first terminal may send the geographical location to the server. The server may receive the geographical location sent by the first terminal, and may determine a circular area with the geographical location as the center and a preset length as the radius. The server may obtain at least one second address in the database, and may detect whether the number of second addresses in the circular area among the at least one second address is greater than 1. When the number of second addresses in the circular area among the at least one second address is greater than 1, the server sends an accompanying medical order to the second terminals corresponding to all second addresses in the circular area. The accompanying medical attendant may receive the accompanying medical order through the second terminal, and the server determines the accompanying medical attendant who receives the accompanying medical order earliest as the target accompanying medical attendant of the insured. When the number of second addresses in the circular area among the at least one second address is equal to 1, the server may determine the accompanying medical attendant associated with the second address in the circular area as the target accompanying medical attendant of the target user. After determining the target accompanying attendant of the target user, the server may create a new accompanying task and send an accompanying task notification to the terminal corresponding to the target accompanying attendant. The accompanying task notification may be used to notify the target accompanying attendant to assist the target user in making an appointment with a specialist and to accompany the target user to see a doctor, and to upload the accompanying data after the visit. The second address may be the contact address of the accompanying attendant. The second terminal may be used to represent the terminal corresponding to the accompanying attendant. The accompanying data includes the diagnostic information of the target user, which may be the examination report of the target user.

[0049] For example, the geographical location located by GPS is address 1, and the preset length L=3 kilometers. The server determines a circular area with address 1 as the center and 3 kilometers as the radius. Assume that the second addresses in the circular area are address 7, address 5, address 9, and address 8 respectively. The server sends an accompanying order to terminal 7 corresponding to address 7, terminal 5 corresponding to address 5, terminal 9 corresponding to address 9, and terminal 8 corresponding to address 8 respectively. The accompanying attendants can choose whether to receive the accompanying order through their corresponding terminals. Assume that both accompanying attendants P5 and P9 have received the accompanying order, but accompanying attendant P5 received the accompanying order earlier than accompanying attendant P9, so the server determines accompanying attendant P5 as the target accompanying attendant, creates a new accompanying task, and sends an accompanying task notification to terminal 5 corresponding to the target accompanying attendant P5.

[0050] S203, receiving the accompanying medical data uploaded by the target accompanying medical attendant, and analyzing the diagnosis information in the accompanying medical data.

[0051] In some feasible implementations, the server may receive the accompanying diagnosis data uploaded by the target accompanying doctor, and may detect whether the data format of the accompanying diagnosis data belongs to the target format set. The target format set may include one or more data formats of ".pdf", ".doc", ".docx", ".jpg", ".png", ".tag", ".xls", and ".xlsx". When the data format of the accompanying diagnosis data belongs to the target format set, the server may detect whether the size of the accompanying diagnosis data exceeds a preset threshold. When the size of the accompanying diagnosis data does not exceed the preset threshold, the server may extract the diagnostic information in the accompanying diagnosis data, and may review and analyze the diagnostic information in the accompanying diagnosis data according to preset medical rules. When the data format of the accompanying diagnosis data does not belong to the target format set, a first prompt message is output, and the first prompt message may be used to prompt the target accompanying doctor to upload new accompanying diagnosis data whose data format belongs to the target format set. When the data format of the accompanying diagnosis data belongs to the target format set, and the size of the accompanying diagnosis data exceeds the preset threshold, a second prompt message is output, and the second prompt message may be used to prompt the target accompanying doctor to upload new accompanying diagnosis data whose data size does not exceed the preset threshold.

[0052] For example, if the target user is suspected of having cancer, after receiving the accompanying diagnosis data, the server will review and analyze the diagnostic information in the accompanying diagnosis data according to the preset medical rules to determine whether the target user is suitable for using cancer targeted drugs. For example, the semantic analysis of short text is used to determine whether there is a sentence with the meaning of "clear target" in the disease summary of the diagnostic information. If there is a sentence with the meaning of "clear target", it means that the target user is suitable for using cancer targeted drugs. If there is no sentence with the meaning of "clear target", it means that the target user is not suitable for using cancer targeted drugs.

[0053] S204: Determine the claim settlement result of the target user based on the analysis result of the diagnostic information.

[0054] In some feasible implementations, the server can determine the claim result for the target user based on the analysis result of the diagnostic information. If the analysis result of the diagnostic information is the first analysis result, indicating that the claim result of the target user is a confirmed claim, the server can determine that the target user is a first type of user, that is, a user to be claimed. If the analysis result of the diagnostic information is the second analysis result, indicating that the claim result of the target user is a rejected claim, the server can determine that the target user is a second type of user, that is, a non-claim user. The embodiment of the present application analyzes the diagnostic information to determine the claim result of the target user, thereby reducing the links of interaction between people, realizing full-process control of data, ensuring the validity of data in each link, and improving the processing efficiency of the entire data management process.

[0055] For example, taking the claim settlement of targeted cancer drugs as an example, when the analysis result of the above diagnostic information is suitable for the use of targeted cancer drugs, the server can output a result of confirming the claim settlement. If the analysis result of the above diagnostic information is not suitable for the use of targeted cancer drugs, the server can output a result of rejecting the claim settlement.

[0056] In an embodiment of the present application, the server obtains user information of the target user, creates a work order based on the user information, determines the target accompanying attendant of the target user based on the first address of the target user in the work order, and sends an accompanying task notification to the terminal corresponding to the target accompanying attendant, where the accompanying task notification is used to notify the target accompanying attendant to upload accompanying data, where the accompanying data includes the diagnosis information of the target user, receives the accompanying data uploaded by the target accompanying attendant, analyzes the diagnosis information in the accompanying data, and determines the claim result of the target user based on the analysis result of the diagnosis information, thereby realizing full-process data control, ensuring the validity of data in each link, and at the same time improving the processing efficiency of each link of data management, thereby improving the processing efficiency of the entire data management process.

[0057] See also Figure 3 , is another schematic flow chart of a data management method based on risk control provided by an embodiment of the present application. Figure 3 As shown, the data management method based on risk control may include the following steps:

[0058] S301, receiving a claim settlement request from a target user.

[0059] S302, extracting user information of the target user from the target image included in the claim request.

[0060] S303, creating a work order according to the user information.

[0061] In some feasible implementations, the server may receive a claim request sent by a target user through a first terminal, and the claim request may include a target image uploaded by the target user. The server may use image recognition technology to extract the user information of the target user from the target image included in the claim request. The server may then create a work order for the target user based on the user information. Among them, the first terminal may be used to represent the terminal corresponding to the target user. The user information may include basic information and insurance information of the target user. Basic information may include handling area, name, gender, age, ID number, contact information, contact address, etc.; insurance information may include policy number, primary insurance code, insured unit, insurance period, etc. The work order may include work order information such as work order type, insurance information, basic information, etc.

[0062] S304, obtaining the first address of the target user in the work order.

[0063] S305: Obtain a second address of at least one accompanying person in the accompanying person information database.

[0064] S306: Calculate the distance between the second address of each of the at least one accompanying attendant and the first address of the target user.

[0065] S307: Determine the accompanying attendant whose second address is the shortest distance from the first address among the accompanying attendants as the target accompanying attendant of the target user.

[0066] In some feasible implementations, the server may obtain the first address of the target user in the above-mentioned work order, and the first address may be the contact address in the basic information of the target user. The server may obtain the second address of at least one accompanying attendant from the accompanying attendant information database, and may calculate the distance between the second address of each accompanying attendant in the second address of the at least one accompanying attendant and the first address of the target user. The second address may be the contact address of the accompanying attendant. The server may sort the distances between the second addresses of each accompanying attendant and the first address in ascending order to obtain a distance sequence, and may determine the second address corresponding to the minimum value in the distance sequence as the target address, and determine the accompanying attendant corresponding to the target address as the target accompanying attendant.

[0067] For example, the first address of the target user is address 1, the second address of the accompanying attendant A is address 3, the second address of the accompanying attendant B is address 5, the second address of the accompanying attendant C is address 11, the second address of the accompanying attendant D is address 9, and the second address of the accompanying attendant E is address 12. The server can calculate the distances between address 1 and address 3, address 5, address 11, address 9, and address 12 respectively. Assume that the distance between address 1 and address 3 is 3.6 kilometers, the distance between address 1 and address 5 is 2.7 kilometers, the distance between address 1 and address 11 is 1.8 kilometers, the distance between address 1 and address 9 is 5.9 kilometers, and the distance between address 1 and address 12 is 4.5 kilometers. The server sorts these distance values ​​from small to large, and obtains the distance sequence: 1.8, 2.7, 3.6, 4.5, 5.9. The server determines address 11 corresponding to the minimum value 1.8 in the distance sequence as the target address, and determines the accompanying attendant C corresponding to the target address as the target accompanying attendant.

[0068] S308, receiving the accompanying medical data uploaded by the target accompanying medical attendant, and analyzing the diagnosis information in the accompanying medical data.

[0069] In some feasible implementations, step S308 of the present application embodiment can refer to Figure 2 The implementation method of step S203 of the illustrated embodiment will not be described in detail here.

[0070] S309: If the analysis result of the diagnostic information is the first analysis result, determining the claim result of the target user is to confirm the claim.

[0071] S310: If the analysis result of the diagnostic information is the second analysis result, determining that the claim settlement result of the target user is a claim rejection.

[0072] In some feasible implementations, when the server detects that the analysis result of the above diagnostic information is the first analysis result, it means that the claim settlement result of the target user is confirmed claim settlement, and the server can determine that the above target user is a first type of user, that is, a user to be claimed. When the server detects that the analysis result of the above diagnostic information is the second analysis result, it means that the claim settlement result of the target user is rejected claim settlement, and the server can determine that the above target user is a second type of user, that is, a non-claim settlement user.

[0073] In some feasible implementations, after determining that the target user is a user to be compensated, the server may send a confirmation claim notice to the third terminal corresponding to the claims adjuster. The confirmation claim notice may be used to notify the claims adjuster to make a claim according to the determined claim result, which can improve the timeliness of the claim and improve the user experience. After determining that the target user is a non-claim user, the server may send a rejection claim notice to the third terminal corresponding to the claims adjuster. The rejection claim notice may carry a detailed reason for rejection, so that the claims adjuster can better communicate with the target user. For example, taking the claim settlement of cancer targeted drugs as an example, assuming that the analysis result of the above diagnostic information is not suitable for the use of cancer targeted drugs, the server determines that the target user is a non-claim user, outputs the result of the rejection claim, and sends a rejection claim notice to the third terminal corresponding to the claims adjuster. The reason for rejection in the rejection claim notice may be "Because your [name: Zhang San, ID number: 1234xxx890] target is unclear and not suitable for the use of targeted drugs, the company refuses to pay the cost of targeted drugs [Afatinib]". The claim rejection notice and / or claim confirmation notice may also be sent directly to the terminal corresponding to the policyholder, so that the policyholder can obtain the claim result in time. The claim rejection notice and / or claim confirmation notice may also be sent directly to the first terminal corresponding to the target user, so that the target user can obtain the claim result in time.

[0074] In some feasible implementations, after determining the claim settlement result of the target user, the server may create a new return visit task according to the user information of the target user, and may determine the target return visitor of the target user. The server may send a return visit task notification to the fourth terminal corresponding to the target return visitor, and the return visit task notification may be used to notify the target return visitor to enter the return visit record. The return visit task may include the target user's basic information, diagnosis information, target accompanying doctor (such as the name, contact information, and identification of the accompanying doctor), etc.

[0075] In an embodiment of the present application, the server receives a claim settlement request from a target user, extracts user information of the target user from the target image included in the claim settlement request, creates a work order based on the user information, obtains the first address of the target user in the work order, obtains the second address of at least one accompanying doctor in the accompanying doctor information database, calculates the distance between the second address of each accompanying doctor and the first address of the target user, and then determines the accompanying doctor corresponding to the second address with the smallest distance from the first address among the second addresses of each accompanying doctor as the target accompanying doctor of the target user, receives the accompanying doctor data uploaded by the target accompanying doctor, and analyzes the diagnostic information in the accompanying doctor data. If the analysis result of the diagnostic information is the first analysis result, the claim settlement result of the target user is determined to be confirmed claim settlement; if the analysis result of the diagnostic information is the second analysis result, the claim settlement result of the target user is determined to be rejected claim settlement. The whole process of data control can be realized to ensure the validity of data in each link, and the processing efficiency of each link of data management can be improved at the same time, thereby improving the processing efficiency of the entire data management process.

[0076] See also Figure 4 , is a schematic block diagram of a data management device based on risk management provided by an embodiment of the present application. Figure 4 As shown, the data management device based on risk management in the embodiment of the present application includes:

[0077] An acquisition module 10 is used to acquire user information of a target user;

[0078] A creation module 20, used to create a work order according to the user information;

[0079] A first determination module 30 is used to determine a target patient escort of the target user according to a first address of the target user in the work order and a second address of at least one patient escort in a patient escort information database;

[0080] The sending module 40 is used to send a medical companion task notification to the terminal corresponding to the target medical companion, and the medical companion task notification is used to notify the target medical companion to upload medical companion data, and the medical companion data includes the diagnosis information of the target user;

[0081] The receiving module 50 is used to receive the accompanying medical data uploaded by the target accompanying medical attendant;

[0082] An analysis module 60 is used to analyze the diagnostic information in the accompanying diagnosis data;

[0083] The second determination module 70 is used to determine the claim settlement result of the target user according to the analysis result of the diagnostic information.

[0084] In some feasible implementations, the acquisition module 10 is specifically used for: receiving a claim settlement request from a target user, the claim settlement request including a target image uploaded by the target user; and extracting user information of the target user from the target image.

[0085] In some feasible implementations, the above-mentioned first determination module 30 is specifically used to: obtain the first address of the target user in the work order; obtain the second address of at least one accompanying attendant in the accompanying attendant information database; calculate the distance between the second address of each accompanying attendant among the at least one accompanying attendant's second addresses and the first address of the target user; determine the accompanying attendant corresponding to the second address with the smallest distance from the first address among the second addresses of each accompanying attendant as the target accompanying attendant of the target user.

[0086] In some feasible implementations, the above-mentioned second determination module 70 is specifically used to: if the analysis result of the diagnostic information is the first analysis result, determine that the claim result of the target user is confirmed claim; if the analysis result of the diagnostic information is the second analysis result, determine that the claim result of the target user is rejected claim.

[0087] In some feasible implementations, the creation module 20 is also used to create a new follow-up task based on the user information of the target user after determining that the claim result of the target user is confirmed claim; the first determination module 30 is also used to determine the target follow-up person of the target user; the sending module 40 is also used to send a follow-up task notification to the terminal corresponding to the target follow-up person, and the follow-up task notification is used to notify the target follow-up person to enter the follow-up record.

[0088] In a specific implementation, the above-mentioned data management device based on risk control can execute the above-mentioned Figure 2 or Figure 3 The implementation methods provided in each step of the implementation method provided implement the functions implemented in the above embodiments. For details, please refer to the above Figure 2 or Figure 3 The corresponding descriptions provided in each step of the method embodiment shown are not repeated here.

[0089] In an embodiment of the present application, a data management device based on risk control obtains user information of a target user, creates a work order based on the user information, determines a target accompanying patient of the target user based on a first address of the target user in the work order and a second address of at least one accompanying patient in an accompanying patient information database, sends an accompanying patient task notification to a terminal corresponding to the target accompanying patient, and the accompanying patient task notification is used to notify the target accompanying patient to upload accompanying patient data, wherein the accompanying patient data includes diagnosis information of the target user, receives the accompanying patient data uploaded by the target accompanying patient, analyzes the diagnosis information in the accompanying patient data, and determines a claim result of the target user based on the analysis result of the diagnosis information, thereby realizing full-process data control, ensuring the validity of data in each link, and improving the processing efficiency of each link of data management, thereby improving the processing efficiency of the entire data management process.

[0090] See also Figure 5 , is a schematic block diagram of a server provided by the present application. Figure 5 As shown, the server in the embodiment of the present application may include: one or more processors 501; one or more input devices 502, one or more output devices 503 and a memory 504. The processor 501, the input device 502, the output device 503 and the memory 504 are connected via a bus 505. The memory 504 is used to store a computer program, the computer program includes program instructions, and the processor 501 is used to execute the program instructions stored in the memory 504.

[0091] Among them, the processor 501 is configured to call the program instruction to execute and obtain the user information of the target user, create a work order according to the user information; determine the target accompanying doctor of the target user according to the first address of the target user in the work order and the second address of at least one accompanying doctor in the accompanying doctor information database. The output device 503 is used to send an accompanying doctor task notification to the terminal corresponding to the target accompanying doctor, and the accompanying doctor task notification is used to notify the target accompanying doctor to upload accompanying doctor data, and the accompanying doctor data includes the diagnosis information of the target user. The input device 502 is used to receive the accompanying doctor data uploaded by the target accompanying doctor. The processor 501 is also used to analyze the diagnosis information in the accompanying doctor data; according to the analysis result of the diagnosis information, determine the claim result of the target user.

[0092] It should be understood that in some feasible implementations, the processor 501 may be a central processing unit (CPU), and the processor may also be other general-purpose processors, digital signal processors (DSP), application specific integrated circuits (ASIC), field-programmable gate arrays (FPGA) or other programmable logic devices, discrete gate or transistor logic devices, discrete hardware components, etc. A general-purpose processor may be a microprocessor or the processor may also be any conventional processor, etc.

[0093] The input device 502 may include a touch pad, a microphone, a receiver, etc., and the output device 503 may include a display (LCD, etc.), a speaker, a transmitter, etc.

[0094] The memory 504 may include a read-only memory and a random access memory, and provide instructions and data to the processor 501. A portion of the memory 504 may also include a non-volatile random access memory. For example, the memory 504 may also store information about the device type.

[0095] In a specific implementation, the processor 501, input device 502, and output device 503 described in the embodiment of the present application can execute the implementation method described in the data management method based on risk control provided in the embodiment of the present application, and can also execute the implementation method of the data management device based on risk control described in the embodiment of the present application, which will not be repeated here.

[0096] The present application also provides a computer-readable storage medium storing a computer program, wherein the computer program includes program instructions, and when the program instructions are executed by a processor, Figure 2 or Figure 3 The data management method based on risk control is shown in the figure. For details, please refer to Figure 2 or Figure 3 The description of the illustrated embodiment will not be repeated here.

[0097] The above-mentioned computer-readable storage medium may be the data management device based on risk management or the internal storage unit of the electronic device described in any of the aforementioned embodiments, such as the hard disk or memory of the electronic device. The computer-readable storage medium may also be an external storage device of the electronic device, such as a plug-in hard disk, a smart memory card (smart media card, SMC), a secure digital (secure digital, SD) card, a flash card (flash card), etc. equipped on the electronic device. Furthermore, the computer-readable storage medium may also include both the internal storage unit of the electronic device and an external storage device. The computer-readable storage medium is used to store the computer program and other programs and data required by the electronic device. The computer-readable storage medium may also be used to temporarily store data that has been output or is to be output.

[0098] Those of ordinary skill in the art will appreciate that the units and algorithm steps of each example described in conjunction with the embodiments disclosed herein can be implemented in electronic hardware, computer software, or a combination of the two. In order to clearly illustrate the interchangeability of hardware and software, the composition and steps of each example have been generally described in terms of function in the above description. Whether these functions are performed in hardware or software depends on the specific application and design constraints of the technical solution. Professional and technical personnel can use different methods to implement the described functions for each specific application, but such implementation should not be considered to be beyond the scope of this application.

[0099] The present application is described with reference to the flowcharts and / or block diagrams of the methods, devices (terminals) and computer program products of the embodiments of the present application. It should be understood that each process and / or box in the flowchart and / or block diagram, as well as the combination of the processes and / or boxes in the flowchart and / or block diagram, can be implemented by computer program instructions. These computer program instructions can be provided to a processor of a general-purpose computer, a special-purpose computer, an embedded processor or other programmable data processing device to generate a machine, so that the instructions executed by the processor of the computer or other programmable data processing device generate instructions for implementing the processes in the flowchart and / or block diagram. Figure 1 A process or multiple processes and / or boxes Figure 1 A device that provides the functions specified in a block or multiple blocks.

[0100] These computer program instructions may also be stored in a computer-readable memory capable of directing a computer or other programmable data processing device to operate in a specific manner, so that the instructions stored in the computer-readable memory produce an article of manufacture comprising an instruction device, which implements the process Figure 1 A process or multiple processes and / or boxes Figure 1 A function specified in one or more boxes.

[0101] These computer program instructions can also be loaded onto a computer or other programmable data processing device so that a series of operating steps are executed on the computer or other programmable device to produce a computer-implemented process, thereby providing instructions for implementing the process. Figure 1 A process or multiple processes and / or boxes Figure 1 The steps for the functions specified in one or more boxes.

[0102] Although the present application has been described in conjunction with specific features and embodiments thereof, it is obvious that various modifications and combinations may be made thereto without departing from the spirit and scope of the present application. Accordingly, this specification and the drawings are merely exemplary illustrations of the present application as defined by the appended claims, and are deemed to have covered any and all modifications, variations, combinations or equivalents within the scope of the present application. Obviously, those skilled in the art may make various modifications and variations to the present application without departing from the spirit and scope of the present application. Thus, if these modifications and variations of the present application fall within the scope of the claims of the present application and their equivalents, the present application is also intended to include these modifications and variations.

Claims

1. A data management method based on risk control, characterized in that: include: Obtaining basic information input by the target user on the first terminal, extracting the ID number from the basic information, retrieving the insurance information corresponding to the ID number from the insurance policy database, and creating a work order for the target user according to the basic information and the insurance information of the target user, wherein the basic information includes the handling area, name, gender, age, ID number, contact information, and contact address, the insurance information includes the insurance policy number, the main insurance code, the insured unit, and the insurance period, and the work order includes the work order type, the basic information, and the insurance information; Sending an address acquisition request to a first terminal of the target user, so that the first terminal calls a global positioning system module to acquire a geographic location of the first terminal; receiving the geographic location sent by the first terminal, and determining a circular area with the geographic location as the center and a preset length as the radius; Obtaining the first address of the target user in the work order, obtaining the second address of at least one accompanying patient in the accompanying patient information database, detecting whether the number of second addresses in the at least one second address within the circular area is greater than 1, and when the number of second addresses in the at least one second address within the circular area is greater than 1, calculating the distance between each second address in all second addresses within the circular area and the first address of the target user, and determining the accompanying patient corresponding to the second address with the smallest distance from the first address among the second addresses as the target accompanying patient of the target user; Create a new accompanying task, and send an accompanying task notification to the terminal corresponding to the target accompanying person, wherein the accompanying task notification is used to notify the target accompanying person to upload accompanying data, wherein the accompanying data includes the diagnosis information of the target user; Receiving the accompanying medical data uploaded by the target accompanying medical attendant, and analyzing the diagnostic information in the accompanying medical data; The claim settlement result of the target user is determined according to the analysis result of the diagnostic information.

2. The method according to claim 1, characterized in that Obtain the target user's insurance information, including: receiving a claim settlement request from a target user, wherein the claim settlement request includes a target image uploaded by the target user; The user information of the target user is extracted from the target image.

3. The method according to claim 1 or 2, characterized in that: Determining the claim settlement result of the target user according to the analysis result of the diagnostic information includes: If the analysis result of the diagnostic information is the first analysis result, determining the claim result of the target user is to confirm the claim; If the analysis result of the diagnostic information is the second analysis result, it is determined that the claim settlement result of the target user is a claim rejection.

4. The method according to claim 3, characterized in that After determining that the claim settlement result of the target user is confirmed claim settlement, the method further includes: Create a new return visit task according to the user information of the target user, and determine the target return visitor of the target user; A return visit task notification is sent to a terminal corresponding to the target return visit staff, wherein the return visit task notification is used to notify the target return visit staff to enter a return visit record.

5. A data management device based on risk control, characterized in that: include: An acquisition module, used to acquire basic information input by the target user on the first terminal, extract the ID number from the basic information, and retrieve the insurance information corresponding to the ID number from the insurance policy database; A creation module, used to create a work order for the target user according to the basic information and insurance information of the target user, wherein the basic information includes the handling area, name, gender, age, ID number, contact information, and contact address; the insurance information includes the policy number, primary insurance code, insured unit, and insurance period; and the work order includes the work order type, the basic information, and the insurance information; A sending module, configured to send an address acquisition request to a first terminal of the target user, so that the first terminal calls a global positioning system module to acquire a geographic location of the first terminal; A receiving module, configured to receive the geographic location sent by the first terminal, and determine a circular area with the geographic location as the center and a preset length as the radius; a first determination module, for obtaining the first address of the target user in the work order, obtaining the second address of at least one accompanying patient in an accompanying patient information database, detecting whether the number of second addresses in the at least one second address within the circular area is greater than 1, and when the number of second addresses in the at least one second address within the circular area is greater than 1, calculating the distance between each second address in all second addresses within the circular area and the first address of the target user, and determining the accompanying patient corresponding to the second address with the smallest distance from the first address among the second addresses as the target accompanying patient of the target user; The creation module is also used to create a new accompanying medical task; A sending module, used for sending a medical companion task notification to a terminal corresponding to the target medical companion, wherein the medical companion task notification is used for notifying the target medical companion to upload medical companion data, wherein the medical companion data includes the diagnosis information of the target user; A receiving module, used for receiving the accompanying medical data uploaded by the target accompanying medical attendant; An analysis module, used for analyzing the diagnosis information in the accompanying medical data; The second determination module is used to determine the claim settlement result of the target user according to the analysis result of the diagnostic information.

6. The device according to claim 5, characterized in that The acquisition module is specifically used for: receiving a claim settlement request from a target user, wherein the claim settlement request includes a target image uploaded by the target user; The user information of the target user is extracted from the target image.

7. A server, characterized in that: The method comprises a processor, an input device, an output device and a memory, wherein the processor, the input device, the output device and the memory are interconnected, wherein the memory is used to store a computer program, the computer program comprises program instructions, and the processor is configured to call the program instructions to execute the method according to any one of claims 1 to 4.

8. A computer-readable storage medium, characterized in that: The computer-readable storage medium stores a computer program, wherein the computer program includes program instructions, and when the program instructions are executed by a processor, the processor is caused to perform the method according to any one of claims 1 to 4.

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