A method for obtaining insurance claim materials, a business server and a system

Abstract

The present invention provides a method for obtaining insurance claim materials, a business server and a system, and relates to the field of computer technology. The present invention receives the insurance product information purchased by the target patient returned by the insurance server, compares the target patient's medical information with the insurance product information, determines whether the comparison result meets the prohibition claim conditions, and if not, determines the target claim material list based on the insurance product information and the designated claim material list, obtains the target claim material information corresponding to the target claim material list from the hospital server, and sends the target claim material information to the terminal device. By comparing the medical information with the insurance product information, it is determined whether the prohibition claim conditions are met. If not, the target claim material information is sent to the terminal device, and the target patient can view the electronic document and / or collection information of the target claim material on the terminal device, understand the types of materials required for insurance claims, and save the target patient's time.

Description

Technical Field

[0001] The present application relates to the field of computer technology, and in particular to a method for obtaining insurance claim materials, a business server and a system. Background Art

[0002] As people's living standards improve, their insurance awareness has also increased, and more and more people choose to buy medical insurance for themselves or their families.

[0003] Usually, when a patient goes to the hospital for treatment due to an illness, he or she first pays the medical expenses to the hospital and obtains claim materials from the hospital. After that, the patient submits the claim materials obtained from the hospital to the insurance company to apply for a claim.

[0004] However, after seeing a doctor, most patients are not clear about what materials are needed to make an insurance claim. It takes a lot of time for patients to consult relevant personnel to determine the materials needed for the claim, resulting in a bad experience for patients. Summary of the invention

[0005] The present invention provides a method for obtaining insurance claim materials, a business server and a system to solve the problem that after receiving medical treatment, patients are unclear about what materials are needed for insurance claims.

[0006] Some embodiments of the present invention provide the following technical solutions:

[0007] In a first aspect, a method for obtaining insurance claim materials is provided, which is applied to a business server, and the method includes:

[0008] Sending a first query request to an insurance server; the first query request includes identification information of a target patient;

[0009] receiving the insurance product information purchased by the target patient returned by the insurance server; the insurance product information is queried by the insurance server according to the identification information;

[0010] Comparing the target patient's medical information with the insurance product information to determine whether the comparison result meets the claim prohibition condition;

[0011] When the comparison result does not meet the claim prohibition condition, determining a target claim material list according to the insurance product information and a designated claim material list pre-stored in the business server;

[0012] The target claim material information corresponding to the target claim material list is obtained from the hospital server, and the target claim material information is sent to the terminal device; the target claim material information includes an electronic document of the target claim material and / or the collection information of the target claim material.

[0013] In a second aspect, a service server is provided, comprising:

[0014] A first query request sending module is configured to send a first query request to the insurance server; the first query request includes identification information of a target patient;

[0015] An insurance product information receiving module, configured to receive the insurance product information purchased by the target patient returned by the insurance server; the insurance product information is queried by the insurance server according to the identification information;

[0016] A claim condition judgment module is configured to compare the target patient's medical information with the insurance product information to determine whether the comparison result meets the claim prohibition condition;

[0017] a target claim material list determination module, configured to determine a target claim material list according to the insurance product information and a designated claim material list pre-stored in the business server when the comparison result does not meet the claim prohibition condition;

[0018] The target claim material information sending module is configured to obtain the target claim material information corresponding to the target claim material list from the hospital server and send the target claim material information to the terminal device; the target claim material information includes the electronic document of the target claim material and / or the collection information of the target claim material.

[0019] In a third aspect, a business server is provided, comprising a processor, a memory, and a computer program stored in the memory and executable on the processor, wherein the computer program implements the steps of the above-mentioned method for obtaining insurance claim materials when executed by the processor.

[0020] In a fourth aspect, a computer-readable medium is provided, on which a computer program is stored, and when the computer program is executed by a processor, the steps of the above-mentioned method for obtaining insurance claim materials are implemented.

[0021] In a fifth aspect, a system for obtaining insurance claim materials is provided, comprising a terminal device, a hospital server, an insurance server, and the above-mentioned business server;

[0022] Wherein, the terminal device is configured to receive target claim material information corresponding to the target claim material list sent by the business server, as well as the planned route and recommended time for collection when the comparison result does not meet the claim prohibition condition; receive item information that does not meet the claim condition sent by the business server when the comparison result meets the claim prohibition condition; receive preset claim material information sent by the business server when the insurance product information purchased by the target patient is not found; and send a claim request to the business server;

[0023] The hospital server is configured to send the medical information of the target patient to the business server; send the target claim material information corresponding to the target claim material list to the business server, or send the preset claim material information corresponding to the preset claim material list to the business server; and receive the second query request sent by the business server, and return the QR code or hospital floor plan corresponding to the in-hospital navigation system to the business server according to the second query request;

[0024] The insurance server is configured to receive a first query request sent by the business server, and return insurance product information or error information purchased by the target patient to the business server according to the first query request; and receive an electronic document of target claim materials sent by the business server.

[0025] Compared with the prior art, this application has the following advantages:

[0026] In an embodiment of the present application, a first query request is sent to an insurance server, the first query request includes identification information of a target patient, and insurance product information purchased by the target patient is returned by the insurance server. The insurance product information is queried by the insurance server based on the identification information. The target patient's medical information is compared with the insurance product information to determine whether the comparison result meets the claim prohibition condition. When the comparison result does not meet the claim prohibition condition, the target claim material list is determined based on the insurance product information and a designated claim material list pre-stored in the business server, the target claim material information corresponding to the target claim material list is obtained from the hospital server, and the target claim material information is sent to the terminal device. The target claim material information includes an electronic document of the target claim material and / or the collection information of the target claim material. By comparing the target patient's medical information with the insurance product information purchased by the target patient, it is determined whether the prohibited claim conditions are met. When the prohibited claim conditions are not met, the target claim material list is determined based on the insurance product information and the designated claim material list pre-stored in the business server, and the target claim material information corresponding to the target claim material list is sent to the terminal device. The target patient can view the electronic documents of the target claim materials and / or the collection information of the target claim materials on the terminal device, and timely understand the types of materials required for insurance claims without spending a lot of time consulting relevant personnel, saving the target patient's time and improving the target patient's experience. BRIEF DESCRIPTION OF THE DRAWINGS

[0027] In order to more clearly illustrate the embodiments of the present application or the technical solutions in the prior art, a brief introduction will be given below to the drawings required for use in the embodiments or the description of the prior art. 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.

[0028] Figure 1 A flowchart schematically shows a method for obtaining insurance claim materials according to an embodiment of the present application;

[0029] Figure 2 A flowchart schematically shows another method for obtaining insurance claim materials according to an embodiment of the present application;

[0030] Figure 3 A schematic diagram schematically shows various fields included in a field set file in an embodiment of the present application;

[0031] Figure 4 A schematic diagram schematically shows how to process insurance product information according to a target insurance field combination and compare the insurance product information to be compared with the medical consultation information obtained by the processing in an embodiment of the present application;

[0032] Figure 5 The structure block diagram of a service server according to an embodiment of the present application is schematically shown;

[0033] Figure 6 A schematic diagram schematically shows a system for acquiring insurance claim materials according to an embodiment of the present application;

[0034] Figure 7 A block diagram schematically shows a service server for executing the method according to the present application;

[0035] Figure 8 A storage unit for holding or carrying a program code for implementing the method according to the present application is schematically shown. DETAILED DESCRIPTION

[0036] In order to make the purpose, technical solution and advantages of the embodiments of the present application clearer, the technical solution in the embodiments of the present application will be clearly and completely described below in conjunction with the drawings 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.

[0037] Reference Figure 1 , shows a flow chart of a method for obtaining insurance claim materials in an embodiment of the present application, for example, applied to a business server, and specifically may include the following steps:

[0038] Step 101, sending a first query request to an insurance server; the first query request includes identification information of a target patient.

[0039] In an embodiment of the present application, when the business server receives a preset trigger operation, it sends a first query request to the insurance server. The first query request includes the identification information of the target patient. The insurance server receives the first query request sent by the business server, and based on the identification information in the first query request, queries whether the insurance server stores the insurance product information purchased by the target patient corresponding to the identification information, that is, determines whether the target patient has purchased insurance.

[0040] The identification information of the target patient includes the ID number of the target patient; the insurance server refers to the server corresponding to the insurance company.

[0041] For example, target patient A is hospitalized due to injuries in a car accident. When the business server receives a preset trigger operation, it sends a first query request to the insurance server corresponding to insurance company B.

[0042] Step 102, receiving the insurance product information purchased by the target patient returned by the insurance server; the insurance product information is queried by the insurance server according to the identification information.

[0043] In an embodiment of the present application, if the insurance server queries and finds that the insurance product information purchased by the target patient corresponding to the identification information is stored in the insurance server, the insurance product information purchased by the target patient is sent to the business server, and the business server receives the insurance product information purchased by the target patient returned by the insurance server.

[0044] For example, the insurance server corresponding to the insurance company B queries and stores the insurance product information purchased by the target patient A, and sends the insurance product information purchased by the target patient A to the business server.

[0045] Step 103, comparing the target patient's medical information with the insurance product information to determine whether the comparison result meets the claim prohibition conditions.

[0046] In an embodiment of the present application, the business server obtains the medical information of the target patient, and compares the medical information of the target patient with the insurance product information purchased by the target patient to determine whether the comparison result meets the conditions for prohibiting claims.

[0047] Step 104, when the comparison result does not meet the claim prohibition condition, determine the target claim material list based on the insurance product information and the designated claim material list pre-stored in the business server.

[0048] In an embodiment of the present application, when the comparison result does not meet the conditions for prohibiting claims, that is, the insurance product information purchased by the target patient does not fail to meet the claims conditions, the business server sends a first reminder message to the terminal device to remind the target patient that he or she can apply for an insurance claim, and remind the target patient whether he or she needs to obtain the target claim material information. When the terminal device receives the first confirmation operation of the target patient, the terminal device sends a request to obtain the target claim material information to the business server. The business server determines the designated claim material list pre-stored in the business server based on the request to obtain the target claim material information sent by the terminal device. The designated claim material list refers to the claim material list corresponding to the insurance type of the insurance product information stored in the business server, and the designated claim material list includes a material name corresponding to at least one claim material.

[0049] Then, the business server determines the target claim material list based on the insurance product information and the designated claim material list pre-stored in the business server. The target claim material list is the material list common to both the claim material list included in the insurance product information and the designated claim material list.

[0050] Step 105, obtain the target claim material information corresponding to the target claim material list from the hospital server, and send the target claim material information to the terminal device; the target claim material information includes the electronic document of the target claim material and / or the collection information of the target claim material.

[0051] In an embodiment of the present application, after determining the target claim materials list, the business server sends a first acquisition request to the hospital server. The first acquisition request includes the target claim materials list. The hospital server queries the target claim materials information corresponding to the target claim materials list stored in the hospital server based on the first acquisition request. The target claim materials information includes the electronic document of the target claim materials and / or the collection information of the target claim materials. Then, the hospital server sends the target claim materials information corresponding to the target claim materials list to the business server. The business server receives the target claim materials information sent by the hospital server and sends the target claim materials information to the terminal device.

[0052] The target patient can view the electronic document of the target claim materials and / or the collection information of the target claim materials on the terminal device. The target claim materials refer to the claim materials that the hospital needs to issue when the target patient applies for insurance claims, and the electronic document of the target claim materials refers to the specific content included in the electronic version of the target claim materials. The collection information of the target claim materials refers to the information required for the target patient to collect the target claim materials, such as the material name of the target claim materials, the collection location and other information.

[0053] Target patients can timely learn the types of materials required for insurance claims through the electronic documents of target claim materials and / or the collection information of target claim materials on the terminal device, without spending a lot of time consulting relevant personnel, thus saving the target patients' time and improving the target patients' experience.

[0054] When the business server sends an electronic document of the target claim materials to the terminal device, the target patient can directly apply for a claim based on the electronic document of the target claim materials; when the business server sends the collection information of the target claim materials to the terminal device, the target patient can also go to the hospital to collect the claim materials based on the collection information of the target claim materials and then apply for a claim.

[0055] It should be noted that the terminal device can be a mobile terminal designated by the target patient, such as a mobile phone held by the target patient, and the target patient can directly view the target claim material information on the mobile terminal; the terminal device can be an electronic device deployed in the hospital, and the target patient can view the target claim material information corresponding to the target patient by operating the electronic device deployed in the hospital and entering the corresponding identification information.

[0056] In addition, the business server and hospital server in the embodiment of the present application can be different servers or the same server.

[0057] In an optional implementation manner of the present application, after step 101, steps S106, S107, S108 and S109 are further included:

[0058] Step S106, receiving error information returned by the insurance server; the error information is generated by the insurance server after failing to query the insurance product information purchased by the target patient according to the identification information;

[0059] Step S107, determining a preset claim settlement material list pre-stored in the business server;

[0060] Step S108, obtaining preset claim material information corresponding to the preset claim material list from the hospital server; the preset claim material information includes an electronic document of the preset claim material and / or the collection information of the preset claim material;

[0061] Step S109: sending the preset claim material information to the terminal device.

[0062] In an embodiment of the present application, if the insurance server finds that the insurance product information purchased by the target patient corresponding to the identification information is not stored in the insurance server, an error message is generated and sent to the business server, and the business server receives the error message returned by the insurance server.

[0063] When the business server receives the error message returned by the insurance server, it determines that the target patient has not purchased insurance. The business server sends a second reminder message to the terminal device to remind the target patient that no insurance purchase record has been found, and reminds the target patient whether it needs to obtain the preset claim material information. When the terminal device receives the second confirmation operation of the target patient, the terminal device sends a request to obtain the preset claim material information to the business server. The business server determines the preset claim material list pre-stored in the business server based on the request to obtain the preset claim material information sent by the terminal device; the preset claim material list refers to the list of all claim material stored in the business server.

[0064] Then, the business server sends a second acquisition request to the hospital server, and the second acquisition request includes a list of preset claim materials pre-stored in the business server. The hospital server queries the preset claim materials information corresponding to the list of preset claim materials stored in the hospital server based on the second acquisition request, and sends the preset claim materials information to the business server. The preset claim materials information includes an electronic document of the preset claim materials and / or information on the collection of the preset claim materials; the preset claim materials refer to all claim materials that can be issued by the hospital.

[0065] After receiving the preset claim material information returned by the hospital server, the business server sends the preset claim material information to the terminal device.

[0066] Therefore, when the insurance server fails to query the insurance product information purchased by the target patient, the business server obtains the electronic documents of all claim materials that the hospital can issue and / or the collection information of all claim materials that the hospital can issue from the hospital server and sends it to the terminal device.

[0067] Optionally, after step 103, it also includes: when the comparison result meets the claim prohibition condition, sending project information that does not meet the claim conditions to the terminal device; the project information includes the project name that does not meet the claim conditions and the reason for not meeting the claim conditions.

[0068] In an embodiment of the present application, after comparing the target patient's medical information with the insurance product information, when the comparison result meets the prohibition of claims conditions, that is, the insurance product information purchased by the target patient does not meet the claims conditions, the project information that does not meet the claims conditions is sent to the terminal device, and the project information includes the name of the project that does not meet the claims conditions and the reason for not meeting the claims conditions.

[0069] For example, the scope of liability exemption information included in the insurance product information includes driving under the influence of alcohol, and the diagnosis results in the medical information of the target patient A include: complex trauma xx, and the alcohol content in the blood test results exceeds the standard. After comparing the insurance product information with the medical information of the target patient A, it is determined that the comparison result meets the conditions for prohibiting claims, and the project information that does not meet the claims conditions is sent to the terminal device. The project information includes that the name of the project that does not meet the claims conditions is the diagnosis result, and the reason for not meeting the claims conditions is that the diagnosis result falls within the scope included in the liability exemption information.

[0070] In an embodiment of the present application, by comparing the target patient's medical information with the insurance product information purchased by the target patient, it is determined whether the prohibited claim conditions are met. When the prohibited claim conditions are not met, the target claim material list is determined based on the insurance product information and the designated claim material list pre-stored in the business server, and the target claim material information corresponding to the target claim material list is sent to the terminal device. The target patient can view the electronic documents of the target claim materials and / or the collection information of the target claim materials on the terminal device, and timely understand the types of materials required for insurance claims without spending a lot of time consulting relevant personnel, thereby saving the target patient's time and improving the target patient's experience.

[0071] Reference Figure 2, shows a flowchart of another method for obtaining insurance claim materials in an embodiment of the present application, which is applied to a business server and may specifically include the following steps:

[0072] Step 201, regularly obtain the medical information of the target patient from the hospital server.

[0073] In an embodiment of the present application, the business server periodically sends a request for obtaining medical information to the hospital server, and the request for obtaining medical information includes identification information of the target patient. The hospital server queries the medical information of the target patient stored in the hospital server based on the identification information in the request for obtaining medical information sent by the business server. The hospital server sends the medical information of the target patient to the business server, thereby enabling the business server to periodically obtain the medical information of the target patient from the hospital server.

[0074] For example, the business server obtains the medical information of the target patient from the hospital server every 2 hours.

[0075] Step 202: When the medical information contains information that meets a preset trigger condition, a first query request is sent to an insurance server; the first query request includes identification information of a target patient.

[0076] In an embodiment of the present application, when the business server detects that the medical information of the target patient contains information that meets the preset trigger conditions, that is, the business server receives the preset trigger operation, it sends a first query request to the insurance server, and the first query request includes the identification information of the target patient. The insurance server receives the first query request sent by the business server, and based on the identification information in the first query request, queries whether the insurance server stores the insurance product information purchased by the target patient corresponding to the identification information.

[0077] For example, the diagnosis result in the medical information of target patient A is compared with the major disease information stored in the business server, and it is determined that target patient A suffers from a major disease, then it is detected that the target patient's medical information contains information that meets the preset trigger conditions; or, if the target patient A's medical information includes a doctor's discharge order for tomorrow, then the business server determines that it has detected that the target patient's medical information contains information that meets the preset trigger conditions.

[0078] Step 203, receiving the insurance product information purchased by the target patient returned by the insurance server; the insurance product information is queried by the insurance server according to the identification information.

[0079] This step is similar in principle to the above step 102 and will not be described again here.

[0080] Step 204: determine the information in the medical information that belongs to the same category as the category of any field included in the field set file as the medical information of the target patient.

[0081] In an embodiment of the present application, a field set file is constructed in advance based on the patient's personal basic information and the medical information when visiting the hospital, and the field set file is stored in the business server. The field set file includes at least one insurance type field, and an insurance field combination corresponding to each insurance type field, the insurance field combination includes an insurance liability field set, a liability exemption field set, and a claim material field set; wherein the insurance liability field set includes an insurance time field subset, an insurance content field subset, and a compensation method field subset, the insurance time field subset includes at least one insurance time field, the insurance content field subset includes at least one insurance content field, and the compensation method field subset includes at least one compensation method field; the liability exemption field set includes at least one liability exemption field; the claim material field set includes at least one claim material field.

[0082] By dividing the field set file into an insurance type field set, an insurance liability field set, a liability exemption field set and a claim material field set according to different field types, the subsequent maintenance cost of the field set file is reduced.

[0083] like Figure 3 As shown, the insurance type field set in the field set file is divided into a field subset that is not subjected to subsequent comparison and a field subset that is subjected to subsequent comparison. The field subset that is not subjected to subsequent comparison includes fields such as financial insurance and property insurance, and the field subset that is subjected to subsequent comparison includes fields such as major disease insurance, specific disease insurance and medical insurance. Major disease insurance, specific disease insurance and medical insurance are all insurance type fields included in the field set file.

[0084] The insurance liability field set in the field set file includes the insurance time field subset, the insurance content field subset and the compensation method field subset. The insurance time field subset includes at least one insurance time field, such as time-related fields such as the protection period and the disease waiting period; the insurance content field subset includes at least one insurance content field, such as the coverage scope fields such as the type of serious illness, hospitalization medical expenses, medical expenses, and drug expenses; the compensation method field subset includes at least one compensation method field, such as the number of compensations and the compensation amount.

[0085] The liability exemption field set in the field set file includes at least one liability exemption field, such as fields that do not meet the claim conditions, such as past medical history, genetic disease, drunk driving, suicide, plastic surgery, congenital disease, rehabilitation treatment and intentional killing.

[0086] The claim material field set in the field set file includes at least one claim material field, such as outpatient medical records, discharge summaries, disability assessment reports, original receipts for medical expenses, prescriptions, diagnosis certificates, expense details, and major disease diagnosis instructions, etc., which are claim material fields that can be issued by hospitals.

[0087] Among them, each insurance type field in the insurance type field set has a different mapping relationship with the insurance liability field set, the liability exemption field set and the claim material field set. Therefore, after determining the corresponding insurance type field according to the insurance product information, the insurance liability field set, the liability exemption field set and the claim material field set with a mapping relationship can be determined.

[0088] Each time after obtaining the medical information of the target patient, the business server determines the category to which each piece of information in the target patient's medical information belongs, and determines the information in the medical information that belongs to the same category as any field included in the field collection file as the target patient's medical information, and stores the medical information in the business server for subsequent comparison with the insurance product information.

[0089] For example, the coverage period and the disease waiting period both belong to time-related information. Therefore, the time-related information in the medical information is extracted to obtain the target patient's medical information, that is, the hospitalization time 2020-02-12 and the discharge time 2020-04-15 in the medical information are extracted; the drug cost belongs to drug-related information. Therefore, the drug-related information in the medical information is extracted to obtain the target patient's medical information, that is, the drug item xxx in the medical information and the corresponding cost of each drug item are extracted.

[0090] According to the above method, information belonging to the same category as the category of any field included in the field set file is extracted from the medical information to obtain the medical information of the target patient, such as Figure 4 As shown, the target patient's medical information includes: the target patient A is 44 years old, the target patient A's hospitalization time is 2020-02-12, the target patient A's discharge time is 2020-04-15, the diagnosis result is complex trauma xx, the cost items include drug items xxx and the corresponding costs of each drug item, etc., as well as the list of materials that the target patient A has received, which are: disability level certificate, cost details, hospitalization medical records, outpatient medical records, etc.

[0091] Step 205: extract a target insurance field combination corresponding to a target insurance type field matching the insurance type according to the insurance type in the insurance product information; the target insurance field combination includes a target insurance liability field set and a target liability exemption field set.

[0092] In an embodiment of the present application, after receiving the insurance product information purchased by the target patient returned by the insurance server, the insurance type in the insurance product information is obtained, the insurance type in the insurance product information is compared with the various insurance type fields included in the insurance type field set in the field set file, and the target insurance type field that matches the insurance type is determined; the target insurance type field is an insurance type field in the insurance type field set.

[0093] Then, according to the different mapping relationships between each insurance type field and the insurance liability field set, the liability exemption field set and the claim material field set, the target insurance liability field set and the target liability exemption field set corresponding to the target insurance type field are extracted. The target insurance liability field set refers to the set consisting of the insurance liability fields corresponding to the target insurance type field in the insurance liability field set included in the field set file, and the target liability exemption field set refers to the set consisting of the liability exemption fields corresponding to the target insurance type field in the liability exemption field set included in the field set file.

[0094] For example, the target insurance type field is medical insurance, such as Figure 4 As shown, the target insurance field combination corresponding to the target insurance type field includes a target insurance liability field set and a target liability exemption field set. The target insurance liability field set includes a target insurance time field subset, a target insurance content field subset, and a target compensation method field subset; the target insurance time field subset includes at least one target insurance time field, such as the effective date of the insurance; the target insurance content field subset includes at least one target insurance content field, such as hospitalization medical expenses, drug expenses, and medical expenses; the target compensation method field subset includes at least one target compensation method field, such as the compensation amount. The target liability exemption field set includes at least one target liability exemption field, such as plastic surgery and other fields.

[0095] Step 206: extract keywords included in each text information in the insurance product information.

[0096] In an embodiment of the present application, after receiving the insurance product information purchased by the target patient returned by the insurance server, the insurance product information is split into multiple text information, which can be a complete sentence to be segmented, and then the keywords included in each text information are extracted.

[0097] For example, keywords extracted from insurance product information include "effective time", "cosmetic surgery", etc.

[0098] Step 207, compare each of the keywords in the insurance product information with the various fields included in the target insurance liability field set and the various fields included in the target liability exemption field set, and determine a first keyword that matches any field in the target insurance liability field set and a second keyword that matches any field in the target liability exemption field set.

[0099] In an embodiment of the present application, after extracting the keywords included in each text information in the insurance product information, each keyword is compared with the various fields included in the target insurance liability field set and the various fields included in the target liability exemption field set, that is, the similarity between the keyword and the various fields included in the target insurance liability field set and the various fields included in the target liability exemption field set is calculated. When the similarity is greater than a threshold, it is determined that the keyword matches the field, and the keyword that matches any field in the target insurance liability field set is determined as the first keyword, and the keyword that matches any field in the target liability exemption field set is determined as the second keyword.

[0100] For example, if the keyword in the insurance product information is "effective time", which matches the field "coverage effective date" in the target insurance liability field set, "effective time" is determined as the first keyword; if the keyword in the insurance product information is "cosmetic surgery", which matches the field "plastic surgery" in the target liability exemption field set, "cosmetic surgery" is determined as the second keyword.

[0101] Step 208: extract insurance data corresponding to the first keyword from the insurance product information.

[0102] In an embodiment of the present application, after determining a first keyword that matches any field in a target insurance liability field set, insurance data corresponding to each first keyword is extracted from the insurance product information.

[0103] For example, the first keyword is "effective time", and the insurance data corresponding to "effective time" extracted from the insurance product information is 2020-01-04.

[0104] Step 209, generating first information to be compared based on the first target field in the target insurance liability field set that matches the first keyword and the insurance data, and using the second target field in the target liability exemption field set that matches the second keyword as the second information to be compared.

[0105] In an embodiment of the present application, after the insurance data corresponding to each first keyword is extracted, the first information to be compared is generated based on the first target field in the target insurance liability field set that matches the first keyword, and the insurance data corresponding to the first keyword, that is, the insurance data is written after the first target field to generate the first information to be compared in a specific format.

[0106] The second target field in the target liability exemption field set that matches the second keyword is directly used as the second information to be compared, that is, the second keyword in the insurance product information is converted into the second target field, so as to compare it with the target patient's medical information through the second target field.

[0107] For example, the first target field matched by the first keyword "Effective Time" is "Protection Effective Date", and the insurance data corresponding to the first keyword "Effective Time" is 2020-01-04, then the first information to be compared generated includes the protection effective date: 2020-01-04; the second target field matched by the second keyword "Cosmetic Surgery" is "Plastic Surgery", then the second target field "Plastic Surgery" is determined as the second information to be compared.

[0108] According to the above method, based on the target insurance liability field set and the target liability exemption field set, the corresponding information can be extracted from the insurance product information, and the following information can be generated: Figure 4 The insurance product information to be compared is shown, and the insurance product information to be compared includes the first information to be compared and the second information to be compared. Among them, the first information to be compared includes: the effective date of the insurance is 2020-01-04, the end date of the insurance is 2021-01-04, the waiting period for the disease is 90 days for the first insurance, the hospitalization medical expenses are xxxxxx, the drug expenses are xxxxxx, and the hospitalization medical expenses for major diseases are xxxxxx; the second information to be compared includes: plastic surgery and driving under the influence of alcohol.

[0109] By storing a field set file in a business server, based on the insurance type in the insurance product information purchased by the target patient, the target insurance liability field set and the target liability exemption field set in the field set file are determined, and based on the target insurance liability field set and the target liability exemption field set, corresponding information is extracted from the insurance product information to generate first information to be compared and second information to be compared, thereby retaining the medical-related information in the insurance product information that needs to be compared, removing some unnecessary information, and facilitating the subsequent comparison of the target patient's medical information with the first information to be compared and the second information to be compared, thereby reducing the amount of data during comparison.

[0110] Step 210, comparing the target patient's medical information with the first information to be compared and the second information to be compared, respectively, to determine whether the comparison result meets the claim prohibition condition.

[0111] In an embodiment of the present application, after obtaining the target patient's medical information, as well as the first information to be compared and the second information to be compared, the medical information is compared with the first information to be compared and the second information to be compared respectively to determine whether the comparison result meets the conditions for prohibiting claims.

[0112] Specifically, step 210 includes sub-step S2101, sub-step S2102 and sub-step S2103:

[0113] Sub-step S2101, comparing the first information to be compared with the information belonging to the same category in the medical information one by one, and determining whether there is information in the medical information that matches the second information to be compared;

[0114] Sub-step S2102, when the information belonging to the same category matches, and there is no information in the medical information that matches the second information to be compared, determining that the comparison result does not meet the claim prohibition condition;

[0115] Sub-step S2103, when the information belonging to the same category does not match, and / or there is information in the medical information that matches the second information to be compared, it is determined that the comparison result meets the claim prohibition condition.

[0116] In an embodiment of the present application, the category to which each information in the first information to be compared and the medical information belongs is first determined, the information belonging to the same category in the first information to be compared and the medical information is compared one by one, and it is determined whether there is information in the medical information that matches the second information to be compared.

[0117] When the first information to be compared and the information belonging to the same category in the medical information match, and there is no information in the medical information that matches the second information to be compared, it is determined that the comparison result does not meet the conditions for prohibiting claims.

[0118] When the information belonging to the same category in the first information to be compared and the medical information does not match, and / or there is information in the medical information that matches the second information to be compared, it is determined that the comparison result meets the conditions for prohibiting claims. Specifically, when the information belonging to the same category in the first information to be compared and the medical information does not match, it is determined that the comparison result meets the conditions for prohibiting claims; or, when there is information in the medical information that matches the second information to be compared, it is determined that the comparison result meets the conditions for prohibiting claims; or, when the information belonging to the same category in the first information to be compared and the medical information does not match, and there is information in the medical information that matches the second information to be compared, it is determined that the comparison result meets the conditions for prohibiting claims.

[0119] For example, the hospitalization time 2020-02-12 and the discharge time 2020-04-15 in the medical information both belong to time-related information, and the protection effective time 2020-01-04 and the protection deadline 2021-01-04 in the first information to be compared both belong to time-related information. The hospitalization time and discharge time are compared with the protection effective time and the protection deadline, and it is determined that the time period between the hospitalization time and the discharge time is after the protection effective time and before the protection deadline, that is, it is determined that the information belonging to the same category in the first information to be compared and the medical information matches, and accordingly, other information belonging to the same category also matches, and there is no information matching "drunk driving" or "plastic surgery" in the medical information, then it is determined that the comparison result does not meet the prohibited claims conditions.

[0120] Step 211, when the comparison result does not meet the claim prohibition condition, each of the keywords in the insurance product information is compared with each field included in the target claim material field set to determine a third keyword that matches any field in the target claim material field set.

[0121] In the embodiment of the present application, the target insurance field combination also includes a target claim material field set, that is, when executing step 205, the target claim material field set corresponding to the target insurance type field matching the insurance type is extracted according to the insurance type in the insurance product information. The target claim material field set refers to a set of claim material fields corresponding to the target insurance type field in the claim material field set included in the field set file.

[0122] like Figure 4 As shown, the target insurance field combination also includes a target claim material field set, and the target claim material field set includes at least one claim material field, such as expense details.

[0123] When the comparison result does not meet the claim prohibition conditions, the business server sends a first reminder message to the terminal device to remind the target patient that he can apply for an insurance claim, and remind the target patient whether he needs to obtain the target claim material information. When the terminal device receives the first confirmation operation of the target patient, the terminal device sends a request to obtain the target claim material information to the business server. The business server compares each keyword in the insurance product information with each field included in the target claim material field set based on the request to obtain the target claim material information sent by the terminal device, that is, calculates the similarity between the keyword and each field included in the target claim material field set. When the similarity is greater than the threshold, it is determined that the keyword matches the field, and the keyword that matches any field in the target claim material field set is determined as the third keyword.

[0124] For example, the keyword in the insurance product information is "cost details", which matches the field "cost details" in the target claim material field set, and "cost details" is determined as the third keyword.

[0125] It should be noted that the designated claim material list in the above-mentioned embodiment 1 also refers to each target claim material field included in the target claim material field set.

[0126] Step 212: determine the third target field in the target claim material field set that matches the third keyword as the target claim material list.

[0127] In an embodiment of the present application, after determining the third keyword that matches any field in the target claim material field set, the third target field in the target claim material field set that matches the third keyword is directly used as the target claim material list, that is, the third keyword in the insurance product information is converted into the third target field.

[0128] For example, if the third target field matched by the third keyword "expense details" is "expense details", the third target field "expense details" is determined as the target claim material list.

[0129] According to the above method, the third keyword can be extracted from the insurance product information based on the target claim material field set, and the third keyword can be converted into a third target field, thereby generating Figure 4 The target claim material list in the insurance product information to be compared is shown, and the target claim material list includes: hospitalization medical records, outpatient medical records, discharge summary, cost details and diagnosis certificate.

[0130] Step 213, obtaining the target claim material information corresponding to the target claim material list from the hospital server, and sending the target claim material information to the terminal device; the target claim material information includes the electronic document of the target claim material and / or the collection information of the target claim material.

[0131] This step is similar in principle to the above step 105 and will not be described again here.

[0132] Specifically, the target patient's medical information includes a list of materials received; step 213 includes sub-steps S2131, S2132, and S2133:

[0133] Sub-step S2131, determining the material list in the target claim material list that does not match the received material list as an unreceived material list;

[0134] Sub-step S2132, obtaining from the hospital server the electronic documents of the received materials corresponding to the received materials list, the electronic documents of the unreceived materials corresponding to the unreceived materials list, and the receipt information of the unreceived materials;

[0135] Sub-step S2133, sending the electronic document of the received materials and / or the receipt information of the received materials, as well as the electronic document of the unreceived materials and / or the receipt information of the unreceived materials to the terminal device.

[0136] In an embodiment of the present application, after determining the target claim material list, the business server compares the target claim material list with the received material list included in the medical information one by one, and determines the material list that does not match the received material list as the unreceived material list.

[0137] Then, the business server sends a first acquisition request to the hospital server. The first acquisition request specifically includes a list of received materials and a list of unreceived materials. Based on the first acquisition request, the hospital server queries the electronic documents of received materials corresponding to the received materials list, the electronic documents of unreceived materials corresponding to the unreceived materials list, and the receipt information of the unreceived materials stored in the hospital server. The hospital server sends the electronic documents of received materials corresponding to the received materials list, the electronic documents of unreceived materials corresponding to the unreceived materials list, and the receipt information of the unreceived materials to the business server.

[0138] Next, the business server sends the electronic document of the received materials and / or the receipt information of the received materials, and the electronic document of the unreceived materials and / or the receipt information of the unreceived materials to the terminal device. Specifically, the business server may send the electronic document of the received materials and the electronic document of the unreceived materials to the terminal device, or send the receipt information of the received materials and the receipt information of the unreceived materials to the terminal device, or send the electronic document of the received materials and the receipt information of the unreceived materials to the terminal device, etc.

[0139] Among them, the collection information of the collected materials includes: the material name of the collected materials and the first marking information of the collected materials, and the first marking information indicates that the collected materials have been collected; the collection information of the uncollected materials includes: the material name of the uncollected materials, the second marking information of the uncollected materials, and the collection time, collection location and collection precautions of the uncollected materials, and the second marking information indicates that the uncollected materials have not been collected.

[0140] like Figure 4As shown, the list of received materials includes disability level certificate, expense details, hospitalization medical records, and outpatient medical records, and the target claim material list includes hospitalization medical records, outpatient medical records, discharge summary, expense details, and diagnosis certificate. It is determined that the list of uncollected materials includes the discharge summary and diagnosis certificate. Then, the business server obtains the electronic documents of the received materials corresponding to the list of received materials, the electronic documents of the uncollected materials corresponding to the list of uncollected materials, and the collection information of the uncollected materials, and sends the electronic documents of the received materials and / or the collection information of the received materials, as well as the electronic documents of the uncollected materials and / or the collection information of the uncollected materials to the terminal device.

[0141] Of course, in actual use, the names of the materials that the hospital can issue for claim materials include: outpatient medical records, prescriptions, discharge summaries, diagnosis certificates, original receipts for medical expenses, detailed lists of expenses during hospitalization, extended hospitalization application forms, major disease diagnosis instructions, disability assessment reports, etc.; Collection precautions refer to the content that needs to be paid attention to when collecting the target claim materials. For example, if a prescription requires invoice information, when the target claim materials sent by the business server to the terminal device include a prescription, it will send the collection precautions to the terminal device accordingly to remind the target patient to determine whether the current prescription should be exchanged for an invoice.

[0142] It should be noted that if when comparing the target patient's medical information with the first information to be compared and the second information to be compared, it is determined that the comparison result does not meet the prohibition conditions for claims, but the medical information includes medical items or drug types that are not within the scope of claims, then when the business server sends the target claim material information, it will send a prompt message to the terminal device to remind the target patient of the medical items or drug types that are not within the scope of claims.

[0143] Furthermore, after step 213, the method further includes steps S31 and S32:

[0144] Step S31, generating a collection planning path according to the target location of the target patient and the collection location of the uncollected materials;

[0145] Step S32: sending the collection planning path to the terminal device.

[0146] In the embodiment of the present application, when the business server sends the target claim material information to the terminal device, it will also send a third reminder message to the terminal device accordingly, and use the third reminder message to remind the target patient whether he needs to check the collection planning path for the uncollected materials. When the terminal device receives the third confirmation operation of the target patient, the terminal device sends a request to obtain the collection planning path to the business server. The business server receives the request to obtain the collection planning path sent by the terminal device, and generates the collection planning path according to the target location of the target patient and the collection location of the uncollected materials. The collection location specifically includes the corresponding building number, floor, room number and other information when the uncollected materials are collected.

[0147] The target location of the target patient may be the current location of the target patient or the ward location of the target patient when the patient is hospitalized. When the target location of the target patient is the current location of the target patient, the terminal device may carry the current location information of the target patient in the acquisition request for obtaining the planned path when sending the acquisition request for obtaining the planned path to the business server; when the target location of the target patient is the ward location of the target patient when the patient is hospitalized, the business server may extract the ward location from the medical information of the target patient.

[0148] After generating the collection planning path, the business server sends the collection planning path to the terminal device. The target patient can view the collection planning path of the uncollected materials on the terminal device and collect the corresponding uncollected materials based on the collection planning path. Each uncollected material has its own corresponding collection planning path.

[0149] The collection planning path is generated through the business server and sent to the terminal device, providing target patients with better quality and more humane services, thereby improving the service quality and medical experience of target patients.

[0150] Specifically, step S32 includes sub-step S321, sub-step S322, sub-step S323, sub-step S324 and sub-step S325:

[0151] Sub-step S321, sending a second query request to the hospital server;

[0152] Sub-step S322, receiving a QR code corresponding to the in-hospital navigation system returned by the hospital server, and adding the planned route to the QR code; the QR code is obtained by the hospital server after finding out that the hospital has an in-hospital navigation system according to the second query request;

[0153] Sub-step S323, sending the QR code with the planned route added thereto to the terminal device;

[0154] or,

[0155] Sub-step S324, receiving a hospital floor plan returned by the hospital server, and marking the planned route for collection in the hospital floor plan; the hospital floor plan is obtained by the hospital server after failing to find out that the hospital has an in-hospital navigation system according to the second query request;

[0156] Sub-step S325, sending the hospital floor plan with the planned route marked thereon to the terminal device.

[0157] In an embodiment of the present application, after generating the collection planning path, the business server sends a second query request to the hospital server. The hospital server queries whether the hospital corresponding to the hospital server has an in-hospital navigation system based on the second query request. If the hospital server finds that the hospital has an in-hospital navigation system, it obtains the QR code corresponding to the in-hospital navigation system and sends the QR code corresponding to the in-hospital navigation system to the business server. The business server receives the QR code corresponding to the in-hospital navigation system returned by the hospital server, and the business server adds the collection planning path to the QR code corresponding to the in-hospital navigation system, and then sends the QR code with the added collection planning path to the terminal device.

[0158] If the terminal device is a mobile terminal designated by the target patient, the target patient uses the mobile terminal to identify the QR code with the collection planning path added, and the mobile terminal connects to the in-hospital navigation system; if the terminal device is an electronic device deployed in the hospital, the target patient can use the mobile terminal held to scan the QR code displayed on the terminal device, and the mobile terminal connects to the in-hospital navigation system. After the mobile terminal is connected to the in-hospital navigation system, the collection planning path of each uncollected material will be displayed on the mobile terminal page, and the corresponding uncollected materials will be collected based on the displayed collection planning path.

[0159] However, if the hospital server does not find that the hospital has an in-hospital navigation system according to the second query request, the hospital server obtains the hospital floor plan and sends the hospital floor plan to the business server. The business server receives the hospital floor plan returned by the hospital server, and marks the collection planning path in the hospital floor plan. The business server then sends the hospital floor plan marked with the collection planning path to the terminal device, and also sends the text navigation information corresponding to the collection planning path to the terminal device.

[0160] After the target patient receives the corresponding uncollected materials according to the QR code with the collection plan path added or the hospital floor plan marked with the collection plan path, the target patient performs the collection confirmation operation on the terminal device, and the terminal device sends the collection information of the corresponding materials to the business server, and the business server saves the collection record of the corresponding materials.

[0161] Furthermore, after step 213, the method further includes steps S33 and S34:

[0162] Step S33, generating a recommended collection time according to the collection time of the uncollected materials and the target time corresponding to the target patient; the target time includes the treatment time and / or the discharge time;

[0163] Step S34, sending the recommended collection time to the terminal device.

[0164] In an embodiment of the present application, when the business server sends the target claim material information to the terminal device, it will also send a fourth reminder message to the terminal device accordingly. The fourth reminder message is used to remind the target patient whether he needs to check the recommended collection time for the uncollected materials. When the terminal device receives the fourth confirmation operation of the target patient, the terminal device sends a request to obtain the recommended collection time to the business server. The business server receives the request to obtain the recommended collection time sent by the terminal device, and then extracts the target time corresponding to the target patient from the medical information of the target patient, where the target time includes the treatment time and / or discharge time, and generates the recommended collection time based on the collection time of the uncollected materials and the target time corresponding to the target patient.

[0165] After generating the recommended collection time, the business server sends the recommended collection time to the terminal device. The target patient can view the recommended collection time for the uncollected materials on the terminal device, and collect the corresponding uncollected materials based on the recommended collection time, thereby improving the collection efficiency of the target patient and avoiding the need to go to the corresponding collection location multiple times to collect materials due to time mismatch.

[0166] Furthermore, after step 213, the method further includes steps S35 and S36:

[0167] Step S35, receiving a claim settlement request sent by the terminal device;

[0168] Step S36: according to the claim settlement request, sending the electronic document of the target claim settlement material to the insurance server to apply for claim settlement.

[0169] In an embodiment of the present application, when the business server sends the target claim materials information to the terminal device, it will also send a fifth reminder message to the terminal device accordingly. The fifth reminder message is used to remind the target patient whether the electronic document of the target claim materials needs to be uploaded to the insurance server to make a claim application. When the terminal device receives the fifth confirmation operation of the target patient, the terminal device sends a claim request to the business server. The business server receives the claim request sent by the terminal device, and based on the claim request, sends the electronic document of the target claim materials to the insurance server to make a claim application.

[0170] The insurance company's corresponding insurance server provides an upload entrance for claim materials. Target patients can upload electronic documents of claim materials to the insurance server with one click through terminal devices and business servers, thereby reducing consumable costs and reducing waiting time for collection.

[0171] In an embodiment of the present application, by comparing the target patient's medical information with the insurance product information purchased by the target patient, it is determined whether the prohibited claim conditions are met. When the prohibited claim conditions are not met, the target claim material list is determined based on the insurance product information and the designated claim material list pre-stored in the business server, and the target claim material information corresponding to the target claim material list is sent to the terminal device. The target patient can view the electronic documents of the target claim materials and / or the collection information of the target claim materials on the terminal device, and timely understand the types of materials required for insurance claims without spending a lot of time consulting relevant personnel, thereby saving the target patient's time and improving the target patient's experience.

[0172] Reference Figure 5 , shows a structural block diagram of a business server in an embodiment of the present application.

[0173] The service server 500 of the embodiment of the present application includes:

[0174] A first query request sending module 501 is configured to send a first query request to an insurance server; the first query request includes identification information of a target patient;

[0175] The insurance product information receiving module 502 is configured to receive the insurance product information purchased by the target patient returned by the insurance server; the insurance product information is queried by the insurance server according to the identification information;

[0176] The claim condition judgment module 503 is configured to compare the target patient's medical information with the insurance product information to determine whether the comparison result meets the claim prohibition condition;

[0177] The target claim material list determination module 504 is configured to determine the target claim material list according to the insurance product information and the designated claim material list pre-stored in the business server when the comparison result does not meet the claim prohibition condition;

[0178] The target claim material information sending module 505 is configured to obtain the target claim material information corresponding to the target claim material list from the hospital server and send the target claim material information to the terminal device; the target claim material information includes the electronic document of the target claim material and / or the collection information of the target claim material.

[0179] Optionally, the business server stores a field set file, the field set file including at least one insurance type field and an insurance field combination corresponding to each insurance type field; the insurance field combination includes an insurance liability field set, a liability exemption field set and a claim material field set;

[0180] The insurance liability field set includes an insurance time field subset, an insurance content field subset and a compensation method field subset, wherein the insurance time field subset includes at least one insurance time field, the insurance content field subset includes at least one insurance content field, and the compensation method field subset includes at least one compensation method field;

[0181] The liability exemption field set includes at least one liability exemption field; the claim material field set includes at least one claim material field.

[0182] Optionally, the claim settlement condition judgment module 503 includes:

[0183] A target insurance field combination extraction submodule is configured to extract a target insurance field combination corresponding to a target insurance type field matching the insurance type according to the insurance type in the insurance product information; the target insurance field combination includes a target insurance liability field set and a target liability exemption field set;

[0184] A keyword extraction submodule, configured to extract keywords included in each text information in the insurance product information;

[0185] A keyword comparison submodule is configured to compare each keyword in the insurance product information with each field included in the target insurance liability field set and each field included in the target liability exemption field set, and determine a first keyword that matches any field in the target insurance liability field set and a second keyword that matches any field in the target liability exemption field set;

[0186] An insurance data extraction submodule, configured to extract insurance data corresponding to the first keyword from the insurance product information;

[0187] a submodule for generating information to be compared, configured to generate first information to be compared according to a first target field in the target insurance liability field set that matches the first keyword and the insurance data, and to use a second target field in the target liability exemption field set that matches the second keyword as second information to be compared;

[0188] The claim condition judgment submodule is configured to compare the medical information of the target patient with the first information to be compared and the second information to be compared respectively, and determine whether the comparison result meets the claim prohibition condition.

[0189] Optionally, the claim settlement condition judgment submodule includes:

[0190] an information comparison unit, configured to compare the first information to be compared with the information belonging to the same category in the medical information one by one, and determine whether there is information in the medical information that matches the second information to be compared;

[0191] The first claim condition judgment unit is configured to determine that the comparison result does not meet the claim prohibition condition when the information belonging to the same category matches and there is no information matching the second information to be compared in the medical information;

[0192] The second judgment unit for claim conditions is configured to determine that the comparison result meets the claim prohibition condition when the information belonging to the same category does not match and / or there is information in the medical information that matches the second information to be compared.

[0193] Optionally, the target insurance field combination includes a target claim material field set; the target claim material list determination module 504 includes:

[0194] A third keyword determination submodule is configured to, when the comparison result does not meet the claim prohibition condition, compare each of the keywords in the insurance product information with each field included in the target claim material field set, and determine a third keyword that matches any field in the target claim material field set;

[0195] The target claim material list determination submodule is configured to determine the third target field in the target claim material field set that matches the third keyword as the target claim material list.

[0196] Optionally, the business server 500 further includes:

[0197] A medical information acquisition module is configured to periodically acquire the medical information of the target patient from a hospital server;

[0198] When the medical information contains information that meets the preset trigger condition, the first query request sending module 501 is executed.

[0199] Optionally, the business server 500 further includes:

[0200] The medical information determination module is configured to determine the information in the medical information that belongs to the same category as the category of any field included in the field set file as the medical information of the target patient.

[0201] Optionally, the medical treatment information of the target patient includes a list of materials received; the target claim material information sending module 505 includes:

[0202] The uncollected material list determination submodule is configured to determine the material list in the target claim settlement material list that does not match the collected material list as the uncollected material list;

[0203] The target claim material information acquisition submodule is configured to acquire, from the hospital server, the electronic documents of the received materials corresponding to the received materials list, the electronic documents of the unreceived materials corresponding to the unreceived materials list, and the receipt information of the unreceived materials;

[0204] The target claim settlement material information sending submodule is configured to send the electronic document of the received materials and / or the receiving information of the received materials, and the electronic document of the unreceived materials and / or the receiving information of the unreceived materials to the terminal device;

[0205] Among them, the collection information of the collected materials includes: the material name of the collected materials and the first marking information of the collected materials, and the first marking information indicates that the collected materials have been collected; the collection information of the uncollected materials includes: the material name of the uncollected materials, the second marking information of the uncollected materials, and the collection time, collection location and collection precautions of the uncollected materials, and the second marking information indicates that the uncollected materials have not been collected.

[0206] Optionally, the business server 500 further includes:

[0207] A collection planning path generation module is configured to generate a collection planning path according to the target position of the target patient and the collection location of the uncollected materials;

[0208] The collection planning path sending module is configured to send the collection planning path to the terminal device.

[0209] Optionally, the module for receiving the planned path and sending it includes:

[0210] A second query request sending submodule is configured to send a second query request to the hospital server;

[0211] The receiving planning path adding submodule is configured to receive the QR code corresponding to the in-hospital navigation system returned by the hospital server, and add the receiving planning path to the QR code; the QR code is obtained by the hospital server after finding out that the hospital has an in-hospital navigation system according to the second query request;

[0212] A QR code sending submodule is configured to send the QR code with the collection planning path added thereto to the terminal device;

[0213] Alternatively, the collection planning path marking submodule is configured to receive a hospital floor plan display map returned by the hospital server, and mark the collection planning path in the hospital floor plan display map; the hospital floor plan display map is obtained by the hospital server after failing to find out that the hospital has an in-hospital navigation system according to the second query request;

[0214] The hospital floor plan display map sending submodule is configured to send the hospital floor plan display map marked with the collection planning path to the terminal device.

[0215] Optionally, the business server 500 further includes:

[0216] A collection recommended time generation module is configured to generate a collection recommended time according to the collection time of the uncollected materials and the target time corresponding to the target patient; the target time includes the treatment time and / or the discharge time;

[0217] The recommended collection time sending module is configured to send the recommended collection time to the terminal device.

[0218] Optionally, the business server 500 further includes:

[0219] A claim settlement request receiving module, configured to receive a claim settlement request sent by the terminal device;

[0220] The electronic document sending module is configured to send the electronic document of the target claim materials to the insurance server according to the claim request to make a claim application.

[0221] Optionally, the business server 500 further includes:

[0222] an error information receiving module, configured to receive error information returned by the insurance server; the error information is generated by the insurance server after failing to query the insurance product information purchased by the target patient according to the identification information;

[0223] A preset claim materials list determination module is configured to determine a preset claim materials list pre-stored in the business server;

[0224] A preset claim material information acquisition module is configured to acquire preset claim material information corresponding to the preset claim material list from the hospital server; the preset claim material information includes an electronic document of the preset claim material and / or collection information of the preset claim material;

[0225] The preset claim material information sending module is configured to send the preset claim material information to the terminal device.

[0226] Optionally, the business server 500 further includes:

[0227] The project information sending module is configured to send project information that does not meet the claim conditions to the terminal device when the comparison result meets the claim prohibition condition; the project information includes the project name that does not meet the claim conditions and the reason for not meeting the claim conditions.

[0228] In an embodiment of the present application, by comparing the target patient's medical information with the insurance product information purchased by the target patient, it is determined whether the prohibited claim conditions are met. When the prohibited claim conditions are not met, the target claim material list is determined based on the insurance product information and the designated claim material list pre-stored in the business server, and the target claim material information corresponding to the target claim material list is sent to the terminal device. The target patient can view the electronic documents of the target claim materials and / or the collection information of the target claim materials on the terminal device, and timely understand the types of materials required for insurance claims without spending a lot of time consulting relevant personnel, thereby saving the target patient's time and improving the target patient's experience.

[0229] Correspondingly, an embodiment of the present application also provides a business server, including a processor, a memory, and a computer program stored in the memory and executable on the processor, wherein the computer program implements the steps of the above-mentioned method for obtaining insurance claim materials when executed by the processor.

[0230] An embodiment of the present application also provides a computer-readable medium, on which a computer program is stored. When the computer program is executed by a processor, the steps of the above-mentioned method for obtaining insurance claim materials are implemented.

[0231] Reference Figure 6 , showing a schematic diagram of a system for acquiring insurance claim materials according to an embodiment of the present application.

[0232] The embodiment of the present application also provides a system for obtaining insurance claim materials, including a terminal device 601, a hospital server 602, an insurance server 603, and the above-mentioned business server 500.

[0233] Among them, the terminal device 601 is configured to receive the target claim material information corresponding to the target claim material list sent by the business server, as well as the planned route and recommended time for collection when the comparison result does not meet the claim prohibition condition; receive the project information that does not meet the claim conditions sent by the business server when the comparison result meets the claim prohibition condition; receive the preset claim material information sent by the business server when the insurance product information purchased by the target patient is not found; and send a claim request to the business server.

[0234] The hospital server 602 is configured to send the medical information of the target patient to the business server; send the target claim material information corresponding to the target claim material list to the business server, or send the preset claim material information corresponding to the preset claim material list to the business server; and receive a second query request sent by the business server, and return a QR code or a hospital floor plan corresponding to the in-hospital navigation system to the business server according to the second query request.

[0235] The insurance server 603 is configured to receive a first query request sent by the business server, and return insurance product information or error information purchased by the target patient to the business server according to the first query request; and receive an electronic document of target claim materials sent by the business server.

[0236] In the embodiment of the present application, a database is deployed in the hospital server 602, and the medical information of each patient is stored in the database. The business server 500 periodically sends a request for obtaining medical information to the hospital server 602. The hospital server 602 queries the medical information of the target patient based on the request for obtaining medical information, and sends the medical information of the target patient to the business server 500.

[0237] Correspondingly, the insurance server 603 also stores various insurance product information, such as insurance product information 1, insurance product information 2 to insurance product information n. When the business server 500 detects that the medical information of the target patient contains information of a preset trigger condition, it sends a first query request to the insurance server 603. The insurance server 603 receives the first query request sent by the business server 500, and queries whether the insurance product information purchased by the target patient is stored in the insurance server according to the first query request. When the insurance server 603 queries the insurance product information purchased by the target patient, it returns the insurance product information purchased by the target patient to the business server 500. When the insurance server 603 does not query the insurance product information purchased by the target patient, it returns an error message to the business server 500.

[0238] In addition, the business server 500 will extract the medical information from the target patient's medical information. When the business server 500 receives the insurance product information purchased by the target patient, the business server 500 will compare the target patient's medical information with the insurance product information to determine whether the comparison result meets the conditions for prohibiting claims.

[0239] When the comparison result does not meet the claim prohibition conditions, the business server 500 determines the target claim material list based on the insurance product information and the designated claim material list pre-stored in the business server; then, the business server 500 sends a first acquisition request to the hospital server 602, and the hospital server 602 queries the target claim material information corresponding to the target claim material list based on the first acquisition request, and sends the target claim material information corresponding to the target claim material list to the business server 500, and then, the business server 500 sends the target claim material information to the terminal device 601, and the terminal device 601 receives the target claim material information sent by the business server 500.

[0240] In addition, the business server 500 will also generate a collection planning path based on the target location of the target patient and the collection location of the uncollected materials. Then, the business server 500 sends a second query request to the hospital server 602. The hospital server 602 receives the second query request sent by the business server 500, and queries whether the hospital corresponding to the hospital server has an in-hospital navigation system based on the second query request. If so, the hospital server 602 returns the QR code corresponding to the in-hospital navigation system to the business server 500. If not, the hospital server 602 returns the hospital floor plan to the business server 500. The business server 500 adds the collection planning path to the QR code, or marks the collection planning path in the hospital floor plan, and sends the QR code with the collection planning path added or the hospital floor plan marked with the collection planning path to the terminal device 601. The terminal device 601 receives the QR code with the collection planning path added or the hospital floor plan marked with the collection planning path. In addition, the business server 500 will generate a recommended collection time based on the collection time of the uncollected materials and the target time corresponding to the target patient, and send the recommended collection time to the terminal device 601. The terminal device 601 receives the recommended collection time sent by the business server 500.

[0241] When the comparison result meets the conditions prohibiting claim settlement, the business server 500 sends the project information that does not meet the claim settlement conditions to the terminal device 601, and the terminal device 601 receives the project information that does not meet the claim settlement conditions sent by the business server.

[0242] However, when the business server 500 receives an error message returned by the insurance server 603, it determines the preset claim materials information pre-stored in the business server 500, and the business server 500 sends a second acquisition request to the hospital server 602. The hospital server 602 queries the preset claim materials information corresponding to the preset claim materials list according to the second acquisition request, and sends the preset claim materials information to the business server 500. Then, the business server 500 sends the preset claim materials information to the terminal device 601, and the terminal device 601 receives the preset claim materials information sent by the business server 500.

[0243] The target patient can also apply for a claim through the terminal device 601 and the business server 500. First, the terminal device 601 sends a claim request to the business server 500. Based on the claim request, the business server 500 sends an electronic document of the target claim materials to the insurance server 603. The insurance server 603 receives the electronic document of the target claim materials sent by the business server 500 to review the insurance claim.

[0244] In an embodiment of the present application, by comparing the target patient's medical information with the insurance product information purchased by the target patient, it is determined whether the prohibited claim conditions are met. When the prohibited claim conditions are not met, the target claim material list is determined based on the insurance product information and the designated claim material list pre-stored in the business server, and the target claim material information corresponding to the target claim material list is sent to the terminal device. The target patient can view the electronic documents of the target claim materials and / or the collection information of the target claim materials on the terminal device, and timely understand the types of materials required for insurance claims without spending a lot of time consulting relevant personnel, thereby saving the target patient's time and improving the target patient's experience.

[0245] As for the device embodiment, since it is basically similar to the method embodiment, the description is relatively simple, and the relevant parts can be referred to the partial description of the method embodiment.

[0246] The device embodiments described above are merely illustrative, wherein the units described as separate components may or may not be physically separated, and the components displayed as units may or may not be physical units, that is, they may be located in one place, or they may be distributed on multiple network units. Some or all of the modules may be selected according to actual needs to achieve the purpose of the scheme of this embodiment. Ordinary technicians in this field can understand and implement it without paying creative labor.

[0247] The various component embodiments of the present application can be implemented in hardware, or in software modules running on one or more processors, or in a combination thereof. It should be understood by those skilled in the art that a microprocessor or digital signal processor (DSP) can be used in practice to implement some or all functions of some or all components in the computing processing device according to the embodiment of the present application. The application can also be implemented as a device or apparatus program (e.g., computer program and computer program product) for executing part or all of the methods described herein. Such a program implementing the present application can be stored on a computer-readable medium, or can have the form of one or more signals. Such a signal can be downloaded from an Internet website, or provided on a carrier signal, or provided in any other form.

[0248] For example, Figure 7 A business server that can implement the method according to the present application is shown. The business server conventionally includes a processor 710 and a computer program product or computer-readable medium in the form of a memory 720. The memory 720 can be an electronic memory such as a flash memory, an EEPROM (electrically erasable programmable read-only memory), an EPROM, a hard disk or a ROM. The memory 720 has a storage space 730 for a program code 731 for executing any method step in the above method. For example, the storage space 730 for the program code may include individual program codes 731 for implementing various steps in the above method, respectively. These program codes can be read from or written to one or more computer program products. These computer program products include program code carriers such as a hard disk, a compact disk (CD), a memory card or a floppy disk. Such a computer program product is usually as shown in reference Figure 8 The portable or fixed storage unit. The storage unit may have Figure 7 The storage unit may be a storage segment, storage space, etc. similarly arranged in the memory 720 in the business server. The program code may be compressed, for example, in an appropriate form. Typically, the storage unit includes a computer readable code 731', i.e., a code that can be read by a processor such as 710, which, when run by the business server, causes the business server to perform the various steps in the method described above.

[0249] The term "one embodiment", "embodiment" or "one or more embodiments" herein means that a particular feature, structure or characteristic described in conjunction with the embodiment is included in at least one embodiment of the present application. In addition, please note that the examples of the term "in one embodiment" here do not necessarily all refer to the same embodiment.

[0250] In the description provided herein, a large number of specific details are described. However, it is understood that the embodiments of the present application can be practiced without these specific details. In some instances, well-known methods, structures and techniques are not shown in detail so as not to obscure the understanding of this description.

[0251] In the claims, any reference signs placed between brackets shall not be construed as limiting the claims. The word "comprising" does not exclude the presence of elements or steps not listed in the claims. The word "a" or "an" preceding an element does not exclude the presence of a plurality of such elements. The present application may be implemented by means of hardware comprising several different elements and by means of a suitably programmed computer. In a unit claim enumerating several means, several of these means may be embodied by the same item of hardware. The use of the words first, second, and third etc. does not indicate any order. These words may be interpreted as names.

[0252] Finally, it should be noted that the above embodiments are only used to illustrate the technical solutions of the present application, rather than to limit it. Although the present application has been described in detail with reference to the aforementioned embodiments, those skilled in the art should understand that they can still modify the technical solutions described in the aforementioned embodiments, or make equivalent replacements for some of the technical features therein. However, these modifications or replacements do not deviate the essence of the corresponding technical solutions from the spirit and scope of the technical solutions of the embodiments of the present application.

Claims

1. A method for obtaining insurance claim materials, characterized in that: Applied to a business server, the method comprises: Sending a first query request to an insurance server; the first query request includes identification information of a target patient; receiving the insurance product information purchased by the target patient returned by the insurance server; the insurance product information is queried by the insurance server according to the identification information; Comparing the target patient's medical information with the insurance product information to determine whether the comparison result meets the claim prohibition condition; When the comparison result does not meet the claim prohibition condition, determining a target claim material list according to the insurance product information and a designated claim material list pre-stored in the business server; Obtaining target claim material information corresponding to the target claim material list from the hospital server, and sending the target claim material information to the terminal device; the target claim material information includes an electronic document of the target claim material and / or receipt information of the target claim material; Generate a collection planning path according to the target location of the target patient and the collection location of the uncollected materials; Sending the planned route to the terminal device; The step of sending the receiving planned path to the terminal device includes: Sending a second query request to the hospital server; receiving a QR code corresponding to the in-hospital navigation system returned by the hospital server, and adding the planned route to the QR code; the QR code is obtained by the hospital server after finding out that the hospital has an in-hospital navigation system according to the second query request; The QR code with the planned route for collection added thereto is sent to the terminal device.

2. The method according to claim 1, characterized in that The business server stores a field set file, the field set file including at least one insurance type field and an insurance field combination corresponding to each insurance type field; the insurance field combination includes an insurance liability field set, a liability exemption field set and a claim material field set; The insurance liability field set includes an insurance time field subset, an insurance content field subset and a compensation method field subset, wherein the insurance time field subset includes at least one insurance time field, the insurance content field subset includes at least one insurance content field, and the compensation method field subset includes at least one compensation method field; The liability exemption field set includes at least one liability exemption field; the claim material field set includes at least one claim material field.

3. The method according to claim 2, characterized in that The step of comparing the target patient's medical information with the insurance product information to determine whether the comparison result meets the claim prohibition condition includes: According to the insurance type in the insurance product information, extract a target insurance field combination corresponding to a target insurance type field matching the insurance type; the target insurance field combination includes a target insurance liability field set and a target liability exemption field set; Extracting keywords included in each text information in the insurance product information; Compare each of the keywords in the insurance product information with each field included in the target insurance liability field set and each field included in the target liability exemption field set, and determine a first keyword that matches any field in the target insurance liability field set and a second keyword that matches any field in the target liability exemption field set; extracting insurance data corresponding to the first keyword from the insurance product information; Generate first information to be compared based on the first target field in the target insurance liability field set that matches the first keyword and the insurance data, and use the second target field in the target liability exemption field set that matches the second keyword as second information to be compared; The medical information of the target patient is compared with the first information to be compared and the second information to be compared respectively to determine whether the comparison result meets the conditions for prohibiting claims.

4. The method according to claim 3, characterized in that The step of comparing the target patient's medical information with the first information to be compared and the second information to be compared respectively, and determining whether the comparison result meets the claim prohibition condition, comprises: Compare the first information to be compared with the information belonging to the same category in the medical information one by one, and determine whether there is information in the medical information that matches the second information to be compared; When the information belonging to the same category matches, and there is no information in the medical information that matches the second information to be compared, determining that the comparison result does not meet the claim prohibition condition; When the information belonging to the same category does not match, and / or there is information in the medical information that matches the second information to be compared, it is determined that the comparison result meets the claim prohibition condition.

5. The method according to claim 3, characterized in that: The target insurance field combination includes a target claim material field set; when the comparison result does not meet the claim prohibition condition, the step of determining the target claim material list according to the insurance product information and the designated claim material list pre-stored in the business server includes: When the comparison result does not meet the claim prohibition condition, each of the keywords in the insurance product information is compared with each field included in the target claim material field set to determine a third keyword that matches any field in the target claim material field set; The third target field in the target claim material field set that matches the third keyword is determined as the target claim material list.

6. The method according to claim 2, characterized in that Before the step of sending the first query request to the insurance server, the method further includes: Obtaining the medical information of the target patient from the hospital server at regular intervals; When the medical information contains information that meets the preset trigger condition, the step of sending a first query request to the insurance server is executed.

7. The method according to claim 6, characterized in that Before the step of comparing the target patient's medical information with the insurance product information to determine whether the comparison result meets the claim prohibition condition, the step further includes: Information in the medical information that belongs to the same category as the category of any field included in the field set file is determined as the medical information of the target patient.

8. The method according to claim 1, characterized in that The medical information of the target patient includes a list of materials received; the step of obtaining target claim material information corresponding to the target claim material list from the hospital server and sending the target claim material information to the terminal device includes: Determine the material list in the target claim material list that does not match the received material list as the unreceived material list; Obtaining from the hospital server the electronic document of the received materials corresponding to the received materials list, the electronic document of the unreceived materials corresponding to the unreceived materials list, and the receipt information of the unreceived materials; Sending the electronic document of the received materials and / or the receiving information of the received materials, and the electronic document of the unreceived materials and / or the receiving information of the unreceived materials to the terminal device; Among them, the collection information of the collected materials includes: the material name of the collected materials and the first marking information of the collected materials, and the first marking information indicates that the collected materials have been collected; the collection information of the uncollected materials includes: the material name of the uncollected materials, the second marking information of the uncollected materials, and the collection time, collection location and collection precautions of the uncollected materials, and the second marking information indicates that the uncollected materials have not been collected.

9. The method according to claim 8, characterized in that After the step of obtaining the target claim material information corresponding to the target claim material list from the hospital server and sending the target claim material information to the terminal device, the method further includes: Generate a recommended collection time according to the collection time of the uncollected materials and the target time corresponding to the target patient; the target time includes the treatment time and / or the discharge time; The recommended pickup time is sent to the terminal device.

10. The method according to claim 1, characterized in that After the step of obtaining the target claim material information corresponding to the target claim material list from the hospital server and sending the target claim material information to the terminal device, the method further includes: receiving a claim settlement request sent by the terminal device; According to the claim settlement request, an electronic document of the target claim settlement material is sent to the insurance server to apply for a claim settlement.

11. The method according to claim 1, characterized in that: After the step of sending the first query request to the insurance server, the method further includes: receiving error information returned by the insurance server; the error information is generated by the insurance server after failing to query the insurance product information purchased by the target patient according to the identification information; Determining a preset list of claims materials pre-stored in the business server; Acquire preset claim material information corresponding to the preset claim material list from the hospital server; the preset claim material information includes an electronic document of the preset claim material and / or receipt information of the preset claim material; The preset claim settlement material information is sent to the terminal device.

12. The method according to claim 1, characterized in that After the step of comparing the target patient's medical information with the insurance product information to determine whether the comparison result meets the claim prohibition condition, the method further includes: When the comparison result meets the claim prohibition condition, the project information that does not meet the claim conditions is sent to the terminal device; the project information includes the project name that does not meet the claim conditions and the reason why it does not meet the claim conditions.

13. A business server, characterized in that: include: A first query request sending module, configured to send a first query request to the insurance server; The first query request includes identification information of a target patient; An insurance product information receiving module, configured to receive the insurance product information purchased by the target patient returned by the insurance server; The insurance product information is queried by the insurance server according to the identification information; A claim condition judgment module is configured to compare the target patient's medical information with the insurance product information to determine whether the comparison result meets the claim prohibition condition; a target claim material list determination module, configured to determine a target claim material list according to the insurance product information and a designated claim material list pre-stored in the business server when the comparison result does not meet the claim prohibition condition; A target claim material information sending module is configured to obtain target claim material information corresponding to the target claim material list from the hospital server, and send the target claim material information to the terminal device; The target claim material information includes an electronic document of the target claim material and / or the collection information of the target claim material; The target claim material information sending module is further configured to generate a pick-up planning path according to the target location of the target patient and the pick-up location of the uncollected materials, and send the pick-up planning path to the terminal device; The step of sending the receiving planned path to the terminal device includes: Sending a second query request to the hospital server; receiving a QR code corresponding to the in-hospital navigation system returned by the hospital server, and adding the planned route to the QR code; the QR code is obtained by the hospital server after finding out that the hospital has an in-hospital navigation system according to the second query request; The QR code with the planned route for collection added thereto is sent to the terminal device.

14. A business server, characterized in that: The invention comprises a processor, a memory and a computer program stored in the memory and executable on the processor, wherein when the computer program is executed by the processor, the steps of the method for obtaining insurance claim materials as described in any one of claims 1 to 12 are implemented.

15. A computer readable medium, characterized in that The computer readable medium stores a computer program, and when the computer program is executed by a processor, the steps of the method for obtaining insurance claim materials according to any one of claims 1 to 12 are implemented.

16. A system for obtaining insurance claim materials, characterized in that: comprising a terminal device, a hospital server, an insurance server, and a business server as claimed in claim 13; Wherein, the terminal device is configured to receive target claim material information corresponding to the target claim material list sent by the business server, as well as the planned route and recommended time for collection when the comparison result does not meet the claim prohibition condition; receive item information that does not meet the claim condition sent by the business server when the comparison result meets the claim prohibition condition; receive preset claim material information sent by the business server when the insurance product information purchased by the target patient is not found; and send a claim request to the business server; The hospital server is configured to send the medical information of the target patient to the business server; send the target claim material information corresponding to the target claim material list to the business server, or send the preset claim material information corresponding to the preset claim material list to the business server; and receive the second query request sent by the business server, and return the QR code or hospital floor plan corresponding to the in-hospital navigation system to the business server according to the second query request; The insurance server is configured to receive a first query request sent by the business server, and return insurance product information or error information purchased by the target patient to the business server according to the first query request; and receive an electronic document of target claim materials sent by the business server.

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