A cross-provincial medical insurance network settlement method and system

Abstract

The present invention relates to a method and system for cross-provincial and inter-regional medical insurance network settlement, the aforementioned method includes: responding to a first operation of a user; referencing a dynamic link library file in a central interface and a function for uploading and downloading medical data; calling a function interface for downloading medical insurance card related data, parsing the user specific information in the medical insurance card; when the user is a non-local patient, calling a non-local special medical insurance settlement function interface to perform a pre-settlement of expenses; uploading the pre-settlement information and the user's medical insurance information to the national medical insurance service platform for final medical insurance settlement. Based on the above method, the self-service registration machine reads the patient information by swiping the card, uses the patient information to call the platform interface, and realizes real-time interaction with the patient's insurance location through the national medical insurance platform. The patient enjoys the local medical insurance benefits in real time, and does not need to pay in full and then return to the location for reimbursement. The above operations are all implemented using a self-service machine, and no manual window operation is required.

Description

Technical Field

[0001] The present invention relates to the technical field of real-time online settlement, and in particular to a method and system for cross-provincial and inter-regional medical insurance online settlement. Background Art

[0002] Currently, self-service registration machines are restricted by card readers. Almost all of the card readers of self-service registration machines are modified by developers authorized by the local social security centers of various provinces and cities to obtain the medical insurance information of local people who pay social security.

[0003] Due to the special circumstances of some provinces and cities (such as Tianjin), almost all medical insurance cards in these provinces and cities are magnetic stripe cards, so existing card readers can directly read the card information from the magnetic stripe and then send it to the developer authorized by the social security center to connect to the national medical insurance platform and conduct real-time settlement. However, most medical insurance cards in other provinces and cities are chip cards, and ordinary card readers cannot parse chip cards. Local social security centers in some provinces and cities will modify and authorize specific card readers to parse the information of the chip in the local social security card and obtain the medical insurance information of the insured for real-time reimbursement. The way each province and city reads local social security cards is similar.

[0004] When a non-local patient registers and pays at the manual window with a card, the window operator manually selects the non-local identity based on the patient's medical insurance card, connects to the local medical insurance service platform through a computer, and then jumps to the national medical insurance server for data exchange, realizing real-time medical insurance settlement.

[0005] The window calls the medical insurance platform through an interface, pushes the patient's basic information to the medical insurance platform, and the platform returns the patient's insurance information. The window pushes the patient's insurance information and registration and payment data to the platform, and the platform returns the success status and reimbursement amount. The window completes the medical insurance interaction based on the information returned by the platform and prints the registration fee receipt.

[0006] Therefore, the existing self-service registration machine card reader can only obtain and parse the chip and magnetic stripe content of the local social security card, and can only retrieve the local medical insurance platform; secondly, the interface cannot independently select patients as out-of-town medical patients, and manual selection is required. Summary of the invention

[0007] The invention discloses an inter-provincial and inter-regional medical insurance network settlement system, aiming to solve the technical problems existing in the prior art.

[0008] The present invention adopts the following technical solutions:

[0009] In a first aspect, an embodiment of the present invention provides a method for cross-provincial and cross-regional medical insurance network settlement, comprising:

[0010] responding to a first operation of a user;

[0011] Reference the dynamic link library files in the center interface and the functions used to upload and download medical data;

[0012] Call the function interface to download the relevant data of the medical insurance card and parse the specific user information in the medical insurance card;

[0013] When the user is a non-local patient, the non-local outpatient special medical insurance settlement function interface is called to perform pre-settlement of expenses;

[0014] Upload the preliminary settlement information and the user's medical insurance information to the national medical insurance service platform for final medical insurance settlement.

[0015] In a possible implementation, the user's first operation includes: detecting and confirming that the user's medical insurance card has been inserted into the card slot of the self-service registration machine.

[0016] In a possible implementation, the dynamic link library file includes:

[0017] Billing DDL files are used to calculate the costs and expenses of various hospital operations;

[0018] Synchronize DDL files to synchronize and update data of various subsystems within the hospital to ensure data consistency and accuracy;

[0019] HIS system-related DDL files are used to integrate with the HIS system to achieve data sharing and exchange functions.

[0020] In a possible implementation, functions for uploading and downloading medical data are defined in the dynamic link library file.

[0021] In a possible implementation, the step of calling a function interface for downloading medical insurance card related data and parsing the user specific information in the medical insurance card further specifically includes:

[0022] Call the function interface to download the medical insurance card related data and receive the message returned by the interface function;

[0023] Parse the program execution status in the returned message. When the program execution status is successful, continue to parse the user's specific information in the returned message.

[0024] In a possible implementation, when the user is a non-local patient, the non-local outpatient special medical insurance settlement function interface is called to perform the pre-settlement step, which also includes:

[0025] Based on the user's specific information, determine whether the user is a non-local patient. When the current user is determined to be a non-local patient, call the non-local outpatient special medical insurance settlement function interface, upload the International Classification of Disease Diagnosis code defined in the national service interface dictionary, and obtain the medical treatment sequence number;

[0026] Call the off-site special medical insurance settlement function interface, upload the medical treatment sequence number and fee segmentation information, and receive the message returned by the interface function;

[0027] Parse the program execution status in the returned message. When the program execution status is successful, continue the pre-settlement operation.

[0028] In a possible implementation manner, the step of uploading the preliminary settlement information and the user's medical insurance information to the national medical insurance service platform for final medical insurance settlement further includes:

[0029] Call the off-site special medical insurance settlement function interface to upload the preliminary settlement information and the user's medical insurance information to the national medical insurance service platform for final medical insurance settlement.

[0030] In a second aspect, an embodiment of the present invention provides a cross-provincial and cross-regional medical insurance network settlement system, including:

[0031] A response module, used for responding to a first operation of a user;

[0032] Reference module, used to reference dynamic link library files in the center interface and functions for uploading and downloading medical data;

[0033] The parsing module is used to call the function interface for downloading the relevant data of the medical insurance card and parse the specific user information in the medical insurance card;

[0034] The pre-settlement module is used to call the out-of-town special medical insurance settlement function interface for pre-settlement when the user is a out-of-town patient;

[0035] The medical insurance settlement module is used to upload the preliminary settlement information and the user's medical insurance information to the national medical insurance service platform for final medical insurance settlement.

[0036] In a third aspect, an embodiment of the present invention provides an electronic device, including:

[0037] one or more processors;

[0038] A memory for storing one or more programs;

[0039] When the one or more programs are executed by the one or more processors, the one or more processors implement the cross-provincial and cross-regional medical insurance network settlement method as described in any of the above items.

[0040] In the fourth aspect, an embodiment of the present invention provides a readable storage medium, which stores a cross-provincial and cross-regional medical insurance online settlement program. When the cross-provincial and cross-regional medical insurance online settlement program is executed by a processor, it can implement the cross-provincial and cross-regional medical insurance online settlement method as described in any of the above items.

[0041] The technical solution adopted by the present invention can achieve the following beneficial effects:

[0042] The present invention provides a cross-provincial and cross-regional medical insurance network settlement method, which reads patient information by swiping a card, uses the patient information to call the platform interface, and realizes real-time interaction with the patient's insurance location through the national medical insurance platform. The patient enjoys local medical insurance benefits in real time, and does not need to pay in full and then return to the location for reimbursement. The above operations are all realized by self-service machines, and no manual window operation is required, which reduces the pressure of manual windows and the waiting time for patients to queue up for payment, saves patients more time to communicate with doctors, and increases patients' medical experience. At the same time, the standard prescription information can be uploaded to the national platform in combination with actual conditions, such as national drug codes, routes of administration, frequency of use, dosage units, etc.

[0043] Based on the above method, the hospital, on the basis of the existing information system, uses the functions encapsulated in the dynamic link library interface to connect to the medical insurance center to complete the medical data management and fee settlement of medical insurance patients. BRIEF DESCRIPTION OF THE DRAWINGS

[0044] In order to more clearly illustrate the technical solutions of the embodiments of the present invention, the following briefly introduces the drawings required for describing the embodiments, which constitute a part of the present invention. The exemplary embodiments of the present invention and their descriptions explain the present invention and do not constitute improper limitations on the present invention. In the drawings:

[0045] Figure 1 A flow chart of a method for cross-provincial and cross-regional medical insurance network settlement provided by an embodiment of the present invention;

[0046] Figure 2 A structural block diagram of a cross-provincial medical insurance network settlement system provided by an embodiment of the present invention;

[0047] Figure 3 A structural block diagram of an electronic device provided by an embodiment of the present invention. DETAILED DESCRIPTION

[0048] In order to make the purpose, technical solution and advantages of the present invention clearer, the technical solution of the present invention will be clearly and completely described below in conjunction with the specific embodiments of the present invention and the corresponding drawings. In the description of the present invention, it should be noted that the term "or" is usually used in the sense of including "and / or", unless the content clearly indicates otherwise.

[0049] Obviously, the described embodiments are only some embodiments of the present invention, not all embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of the present invention.

[0050] In the existing technology, out-of-town patients cannot directly use the self-service registration machine to realize self-service registration and payment, and need to go to the manual window to handle it. When registering and paying at the manual window, they need to connect to the local medical insurance service platform through a computer to jump to the national medical insurance server, call the medical insurance platform through the interface to complete data interaction, and complete the medical insurance interaction and registration fee receipt printing according to the information returned by the platform. The steps are cumbersome.

[0051] Specifically, when patients seek medical treatment in another province, if they want to complete the settlement in a different place, they need to register online in advance. After the registration is successful, they can choose a designated medical institution in another place according to their needs. Only then can they use the card to complete the registration and settlement of medical treatment in another place.

[0052] To solve the above problems, an embodiment of the present invention provides a cross-provincial medical insurance network settlement method, comprising the following steps:

[0053] Step 110: responding to a first operation of the user.

[0054] In one embodiment of the present invention, the user's first operation includes: detecting and confirming that the user's medical insurance card has been inserted into the card slot of the self-service registration machine for cross-provincial medical treatment, and that the medical insurance card is normally identified and can be successfully read.

[0055] Specifically, the timing of the first operation includes when the patient registers, when he / she is admitted to the hospital, when he / she is discharged from the hospital, and when he / she is settled in the outpatient department.

[0056] The medical insurance card described in this embodiment is not limited to a magnetic stripe medical insurance card (that is, the case in Tianjin) or a chip-type medical insurance card (the case in most other provinces and cities). Preferably, the medical insurance card is a chip-type medical insurance card.

[0057] Step 120, reference the dynamic link library file in the central interface and the functions for uploading and downloading medical data.

[0058] Specifically, the central interface refers to an integrated platform that connects various subsystems and modules in the registration machine system. It can integrate all subsystems together to achieve data sharing and interaction. The role of the central interface is to achieve information sharing and collaborative work between various subsystems, so that the performance and efficiency of the entire system are improved.

[0059] Specifically, the central interface can help hospital managers better understand the patient's medical conditions and connect the data of various modules such as outpatient, inpatient, and examination modules, so that doctors and hospital managers can more conveniently view and manage patients' medical information and provide better medical services to patients.

[0060] In one embodiment of the present invention, the dynamic link library files and functions are all referenced from the central interface standard, and the dynamic link library files include nybreckoning.dll, nybreckoningsy.dll and yhybreckoning_his.dll; the functions used for uploading and downloading medical data include DataDown_rs, DataDown_sp, DataDown_yb, DataDown_mts, DataDown_mtd, DataDown_czys, DataDown_czyd, DataDown_cmts, DataDown_cmtd, DataDown_smzs, DataDown_card, DataDown_smzd, DataDown_gzys, DataDown_gzyd, DataUpload, DataDown_sp1, etc.

[0061] Specifically, the role of DDL files is to provide the modules or services required by the program, as well as to optimize and enhance the program. Among them, nybreckoning.dll is a billing DDL file, which is used to calculate the costs and expenses of various hospital businesses; nybreckoningsy.dll is a synchronization DDL file, which is used to synchronize and update the data of various subsystems within the hospital to ensure the consistency and accuracy of the data; yhybreckoning_his.dll is a DDL file related to the HIS system, which is used to integrate with the HIS system (hospital information management system) to realize data sharing and exchange and other functions.

[0062] Specifically, the DataDown_rs function is used to download personnel-related data, the DataDown_sp function is used to download drug-related data, the DataDown_yb function is used to download medical insurance-related data, the DataDown_mts function is used to download clinic-related data, the DataDown_mtd function is used to download clinic-specific detailed data, the DataDown_czys function is used to download operating doctor-related data, the DataDown_czyd function is used to download operating doctor's diagnosis, treatment and other records of patients, the DataDown_cmts function is used to download operating nurse-related data, the DataDown_cmtd function is used to download operating nurse's treatment records of patients, the DataDown_card function is used to download medical card-related data, the DataDown_mzydjs function is used to download outpatient doctor settlement-related data, the DataDown_smzs function is used to download scanning doctor-related data, the DataDown_smzd function is used to download scanning doctor's diagnosis records of patients, the DataDown_gzys function is used to download working doctor-related data, the DataDown_gzyd function is used to download working doctor's treatment records of patients, the DataUpload function is used to upload data to the database, and the DataDown_sp1 function is used to download drug price information. Specifically, the aforementioned function is defined in the dynamic link library file.

[0063] In one embodiment of the present invention, the aforementioned dynamic link library file and function are declared.

[0064] Step 130, call the function interface for downloading medical insurance card related data and parse the user specific information in the medical insurance card.

[0065] In one embodiment of the present invention, step 130 also specifically includes: calling a function interface (i.e., DataDown_card function) for downloading medical insurance card related data, and receiving a message returned by the interface function; parsing the program execution status in the returned message. When the program execution status is successful, it means that the medical insurance card can be parsed normally, and then continue to parse the specific information of the user in the returned message.

[0066] Specifically, the user's specific information includes identity number, name, age, gender, unit name, personal code, crowd category, verification code, card swiping type, electronic certificate authorization, real-person authentication business serial number, QR code value + line separator + information end character and other specific information.

[0067] Step 140, when the user is a non-local patient, the non-local outpatient special medical insurance settlement function interface is called to perform pre-settlement of expenses.

[0068] In one embodiment of the present invention, step 140 further specifically includes:

[0069] Based on the user's specific information, determine whether the user is a non-local patient. When the current user is determined to be a non-local patient, call the non-local outpatient special medical insurance settlement function interface (that is, DataDown_mzydjs function), upload the International Classification of Disease Diagnosis code defined in the national service interface dictionary, and obtain the medical treatment sequence number;

[0070] Call the off-site special medical insurance settlement function interface, upload the medical treatment sequence number and fee segmentation information, and receive the message returned by the interface function;

[0071] Parse the program execution status in the returned message. When the program execution status is successful, continue the pre-settlement operation.

[0072] Specifically, the International Classification of Diseases (ICD) was developed by the WHO. It is a system that classifies diseases according to their etiology, pathology, clinical manifestations, and anatomical location, and represents them in a coding method. The 11th edition (ICD-11 for short) was released in 2018. The latest version of ICD-11 has established its foundation component (ICD-11 Foundation component) at the content level, with a total of 54,000 entities such as diseases, injuries, external causes, signs and symptoms. According to specific needs, the required content can be extracted from the foundation component to form a subset. ICD-11-mortality and morbidity statistics (ICD-11-MMS) is a subset extracted from the foundation component. It is a disease classification and code used to calculate mortality and morbidity, and is also the version currently compiled by my country.

[0073] Specifically, ICD-11-MMS defines two codes, stem codes and extension codes, as well as pre-coordination and post-coordination coding.

[0074] In one embodiment of the present invention, the uploaded International Classification of Diseases code may be the Mente code M00500.

[0075] Specifically, the medical treatment sequence number is the medical treatment voucher sequence number of this medical treatment transaction, which will be uploaded to the national medical insurance server as a voucher in subsequent registration and payment transactions to facilitate the other party to verify the legitimacy.

[0076] Specifically, the cost segmentation information includes detailed input time, medical institution project code, serial number, hospital code, medical insurance catalog code, hospital service item name, self-pay ratio, dosage form, specifications, unit price, quantity, incurred amount, declared amount, full self-paid amount, increased amount, surgical cost mark, cumulative increased mark, statistical code, increased drug mark, dosage, usage, approval number, number of days of medication, single dosage, department code, physician code, person in charge, handling time and other information.

[0077] Step 150, upload the pre-settlement information and the user's medical insurance information to the national medical insurance service platform for final medical insurance settlement.

[0078] Specifically, the DataDown_mzydjs function interface is called to pass the medical sequence number, document number, emergency identification, main diagnosis code, department number, department name, physician code, diagnosis description, cost occurrence time, person in charge, secondary disease diagnosis code, electronic receipt code, electronic receipt number, registration number, personal code, hospital code, community code, social security prescription serial number, medical category + information end character to the national medical insurance service, and receive the program execution status, program execution information, actual collection and deductible amount, total medical insurance payment amount, basic medical insurance pooling fund payment amount, civil servant medical assistance fund, supplementary medical insurance fund, major disease supplementary medical insurance fund (large medical assistance fund), disabled persons medical insurance fund, and civil servant medical assistance fund. Government subsidy funds, other fund payments, personal cash payments, personal account payments, personal account balances, insurance types, full advance payment marks, registration numbers, amount of drug expenses incurred, amount of drug expenses reported, amount of examination fees incurred, amount of examination fees reported, amount of treatment expenses incurred, amount of treatment expenses reported, amount of surgical fees incurred, amount of surgical fees reported, amount of bed fees incurred, amount of bed fees reported, amount of medical materials incurred, amount of medical materials reported, other amounts incurred, other reported amounts, amount of whole blood transfusion incurred, amount of whole blood transfusion reported, amount of component blood transfusion incurred, amount of component blood transfusion reported, amount incurred, reported amount, increased amount, out-of-pocket amount, center transaction time and other information are uploaded to the national medical insurance service platform for the final medical insurance settlement.

[0079] In the above embodiment, when patients from other places seek medical treatment across provinces, they can enjoy local medical insurance benefits and make real-time settlement at the self-service registration machine even if they do not go through the manual window. Based on the above method, the hospital uses the function encapsulated in the dynamic link library interface to connect to the medical insurance center on the basis of the existing information system to complete the medical data management of medical insurance patients. When the insured person goes to the hospital for medical treatment, the hospital information system can call the function encapsulated in the dynamic link library interface, obtain the basic information of the insured patient through the network, determine whether the insured patient is insured, and whether the medical treatment has been registered in the local medical insurance-related department, and issue a confirmation letter for hospitalization treatment to the medical insurance center, and also save the information of the insured patient in the designated medical institution information system. The hospital information system then manages the hospital expenses incurred during the hospitalization. When the patient is discharged from the hospital, the hospital information system calls the function encapsulated in the dynamic link library interface to settle the patient's hospitalization expenses, calculates the personal payment amount, the overall application amount and the medical assistance application amount of the insured patient, and uploads it to the medical insurance center database through the network to complete the management of the patient's hospitalization expenses. For outpatient payments, the hospital information system also uses the functions encapsulated in the dynamic link library interface to process payments, so as to achieve real-time processing of personal accounts and outpatient special fund payments.

[0080] In one embodiment of the present invention, a cross-provincial medical insurance network settlement system is also provided, the system comprising:

[0081] The response module 210 is configured to respond to a first operation of the user.

[0082] In one embodiment of the present invention, the response module 210 is configured to detect and confirm that the user's medical insurance card has been inserted into the card slot of the self-service registration machine for cross-provincial medical treatment, and that the medical insurance card is normally identified and can be successfully read.

[0083] The reference module 220 is used to reference the dynamic link library files in the central interface and the functions used for uploading and downloading medical data.

[0084] The parsing module 230 is used to call the function interface for downloading the medical insurance card related data and parse the user specific information in the medical insurance card.

[0085] In one embodiment of the present invention, the parsing module 230 is configured to call a function interface (i.e., DataDown_card function) for downloading medical insurance card related data, receive a message returned by the interface function, parse the program execution status in the returned message, and when the program execution status is successful, it means that the medical insurance card can be parsed normally, and then continue to parse the user's specific information in the returned message.

[0086] The pre-settlement module 240 is used to call the out-of-town special medical insurance settlement function interface to perform pre-settlement when the user is a out-of-town patient.

[0087] In one embodiment of the present invention, the pre-settlement module 240 is configured to determine whether the user is a non-local patient based on the user's specific information. When it is determined that the current user is a non-local patient, the non-local outpatient special medical insurance settlement function interface (that is, the DataDown_mzydjs function) is called to upload the International Disease Diagnosis Classification code defined in the national service interface dictionary to obtain the medical treatment sequence number; the non-local outpatient special medical insurance settlement function interface is called to upload the medical treatment sequence number and the fee segmentation information, and receive the message returned by the interface function; the program execution status in the returned message is parsed, and when the program execution status is successful, the pre-settlement operation continues.

[0088] The medical insurance settlement module 250 is used to upload the preliminary settlement information and the user's medical insurance information to the national medical insurance service platform for final medical insurance settlement.

[0089] Specifically, the functions further performed by the above modules are detailed in the above steps 110 to 150, which will not be repeated here.

[0090] like Figure 3 Corresponding to the inter-provincial and inter-regional medical insurance network settlement method provided in the above embodiment, an electronic device is provided in one embodiment of the present invention, the electronic device includes: a processor 310 and a memory 320. The memory 320 stores a computer program, and the computer program executes the above inter-provincial and inter-regional medical insurance network settlement method when it is run by the processor 310.

[0091] In one embodiment of the present invention, the electronic device further includes: a communication interface 330, and the processor 310, the communication interface 330 and the memory 320 are communicatively connected. The processor 310 is used to execute executable modules stored in the memory 320, such as computer programs.

[0092] The memory 320 may include a high-speed random access memory (RAM), and may also include a non-volatile memory, such as at least one disk memory. The communication connection between the system network element and at least one other network element is realized through at least one communication interface (which may be wired or wireless), and the Internet, wide area network, local area network, metropolitan area network, etc. may be used.

[0093] Among them, the memory 320 is used to store programs, and the processor 310 executes the program after receiving the execution instruction. The method executed by the device for flow process definition disclosed in any embodiment of the above-mentioned embodiments of the present invention can be applied to the processor 310, or implemented by the processor 310.

[0094] The processor 310 may be an integrated circuit chip with signal processing capabilities. In the implementation process, each step of the above method can be completed by the hardware integrated logic circuit or software instructions in the processor 310. The above processor 310 can be a general-purpose processor, including a central processing unit (CPU), a network processor (NP), etc. It can also be a digital signal processor (DSP), an application specific integrated circuit (ASIC), a field programmable gate array (FPGA), or other programmable logic devices, discrete gates or transistor logic devices, discrete hardware components. The methods, steps and logic block diagrams disclosed in the embodiments of the present invention can be implemented or executed. The general processor can be a microprocessor or the processor can also be any conventional processor, etc. The steps of the method disclosed in conjunction with the embodiments of the present invention can be directly embodied as a hardware decoding processor for execution, or a combination of hardware and software modules in the decoding processor for execution. The software module may be located in a mature storage medium in the art, such as a random access memory, a flash memory, a read-only memory, a programmable read-only memory, or an electrically erasable programmable memory, a register, etc. The storage medium is located in the memory 320, and the processor 310 reads the information in the memory 320 and completes the steps of the above method in combination with its hardware.

[0095] In one embodiment of the present invention, a computer-readable storage medium is provided, wherein the computer-readable storage medium stores a computer program, and when the computer program is executed by a processor, the cross-provincial and cross-regional medical insurance network settlement method described in the above embodiment is executed.

[0096] It should be noted that the computer-readable medium shown in the present invention may be a computer-readable signal medium or a computer-readable storage medium or any combination of the above two. The computer-readable storage medium may be, for example, but not limited to, an electrical, magnetic, optical, electromagnetic, infrared, or semiconductor system, device or device, or any combination of the above. More specific examples of computer-readable storage media may include, but are not limited to: an electrical connection with one or more wires, a portable computer disk, a hard disk, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or flash memory), an optical fiber, a portable compact disk read-only memory (CD-ROM), an optical storage device, a magnetic storage device, or any suitable combination of the above. In the present invention, a computer-readable storage medium may be any tangible medium containing or storing a program that can be used by or in combination with an instruction execution system, device or device. In the present invention, a computer-readable signal medium may include a data signal propagated in a baseband or as part of a carrier wave, which carries a computer-readable program code. This propagated data signal may take a variety of forms, including but not limited to electromagnetic signals, optical signals, or any suitable combination of the above. Computer-readable signal media may also be any computer-readable medium other than computer-readable storage media, which may send, propagate or transmit a program for use by or in conjunction with an instruction execution system, apparatus or device. The program code contained on the computer-readable medium may be transmitted using any appropriate medium, including but not limited to: wireless, wire, optical cable, RF, etc., or any suitable combination of the above.

[0097] Those skilled in the art can clearly understand that, for the convenience and brevity of description, the specific working process of the system described above can refer to the corresponding process in the aforementioned embodiment, and will not be repeated here.

[0098] The cross-provincial and cross-regional medical insurance online settlement method, system, electronic device and computer program product provided in the embodiments of the present invention include a computer-readable storage medium storing program code. The instructions included in the program code can be used to execute the methods described in the previous method embodiments. The specific implementation can refer to the method embodiments and will not be repeated here.

[0099] Although example embodiments have been described herein with reference to the accompanying drawings, it should be understood that the above example embodiments are merely exemplary and are not intended to limit the scope of the present application to this. Those of ordinary skill in the art may make various changes and modifications therein without departing from the scope and spirit of the present application. All these changes and modifications are intended to be included within the scope of the present application as required by the appended claims.

[0100] 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.

[0101] Similarly, it should be understood that in order to streamline the present application and help understand one or more of the various inventive aspects, in the description of the exemplary embodiments of the present application, the various features of the present application are sometimes grouped together into a single embodiment, figure, or description thereof. However, the method of the present application should not be interpreted as reflecting the following intention: the claimed application requires more features than the features clearly stated in each claim. More specifically, as reflected in the corresponding claims, the inventive point is that the corresponding technical problem can be solved with features less than all the features of a single disclosed embodiment. Therefore, the claims following the specific embodiment are hereby explicitly incorporated into the specific embodiment, wherein each claim itself serves as a separate embodiment of the present application.

[0102] The embodiments of the present invention are described above in conjunction with the accompanying drawings, but the present invention is not limited to the above-mentioned specific implementation modes, which are merely illustrative rather than restrictive. Under the guidance of the present invention, ordinary technicians in this field can also make many forms without departing from the scope of protection of the present invention and the claims, all of which are within the protection of the present invention.

Claims

1. A cross-provincial medical insurance network settlement method, characterized in that: include: In response to a first operation of the user, the first operation of the user includes detecting and confirming that the user's medical insurance card has been inserted into the card slot of the self-service registration machine; The dynamic link library files in the reference center interface and the functions for uploading and downloading medical data, the dynamic link library files include billing DDL files, synchronization DDL files, and HIS system-related DDL files, wherein the billing DDL files are used to calculate the costs and expenses of various hospital businesses; the synchronization DDL files are used to synchronize and update the data of various subsystems within the hospital to ensure the consistency and accuracy of the data; the HIS system-related DDL files are used to integrate with the HIS system to realize data sharing and exchange functions; Call the function interface to download the medical insurance card related data, receive the message returned by the interface function, parse the program execution status in the returned message, and when the program execution status is successful, continue to parse the user's specific information in the returned message to obtain the user's specific information in the medical insurance card; Based on the user's specific information, determine whether the user is a non-local patient. If the user is a non-local patient, call the non-local outpatient special medical insurance settlement function interface, upload the International Classification of Disease Diagnosis code, obtain the medical treatment sequence number, call the non-local outpatient special medical insurance settlement function interface, upload the medical treatment sequence number and fee segmentation information, receive the message returned by the interface function, parse the program execution status in the returned message, and continue with the fee pre-settlement when the program execution status is successful; Call the off-site special medical insurance settlement function interface to upload the preliminary settlement information and the user's medical insurance information to the national medical insurance service platform for final medical insurance settlement.

2. The inter-provincial medical insurance network settlement method according to claim 1 is characterized in that: The functions for uploading and downloading medical data are defined in the dynamic link library file.

3. A cross-provincial medical insurance network settlement system, characterized by: include: A response module, used to respond to a first operation of the user, wherein the first operation of the user includes detecting and confirming that the user's medical insurance card has been inserted into the card slot of the self-service registration machine; A reference module is used to reference the dynamic link library files in the central interface and the functions for uploading and downloading medical data. The dynamic link library files include billing DDL files, synchronization DDL files, and HIS system-related DDL files. The billing DDL files are used to calculate the costs and expenses of various hospital businesses; the synchronization DDL files are used to synchronize and update the data of various subsystems within the hospital to ensure the consistency and accuracy of the data; the HIS system-related DDL files are used to integrate with the HIS system to realize data sharing and exchange functions; The parsing module is used to call the function interface for downloading the medical insurance card related data, receive the message returned by the interface function, parse the program execution status in the returned message, and when the program execution status is successful, continue to parse the user's specific information in the returned message to obtain the user's specific information in the medical insurance card; The pre-settlement module is used to determine whether the user is a non-local patient based on the user's specific information. When the user is a non-local patient, the non-local outpatient special medical insurance settlement function interface is called to upload the International Classification of Disease Diagnosis code, obtain the medical treatment sequence number, call the non-local outpatient special medical insurance settlement function interface, upload the medical treatment sequence number and fee segmentation information, receive the message returned by the interface function, parse the program execution status in the returned message, and continue the pre-settlement when the program execution status is successful; The medical insurance settlement module is used to call the off-site special medical insurance settlement function interface, upload the pre-settlement information and the user's medical insurance information to the national medical insurance service platform, and conduct the final medical insurance settlement.

4. An electronic device, characterized in that: include: one or more processors; A memory for storing one or more programs; When the one or more programs are executed by the one or more processors, the one or more processors implement the cross-provincial and cross-regional medical insurance network settlement method as described in claim 1 or 2.

5. A readable storage medium, characterized in that: The readable storage medium stores a cross-provincial and cross-regional medical insurance online settlement program. When the cross-provincial and cross-regional medical insurance online settlement program is executed by the processor, the cross-provincial and cross-regional medical insurance online settlement method as described in claim 1 or 2 can be implemented.

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