Risk control method, risk control device and computer equipment

Abstract

The invention provides a risk control method, a risk control device and computer equipment, and relates to the technical field of online payment risk control. The method comprises the following steps: receiving a medical insurance payment trigger request of a target user for a target medical insurance consumption behavior sent by a target medical insurance payment terminal; determining an identity risk parameter of the target medical insurance consumption behavior according to the identity verification information; determining a consumption risk parameter of the target medical insurance consumption behavior according to the consumption information; according to the identity risk parameter and the consumption risk parameter, performing risk assessment by using a preset risk control model to obtain a risk assessment parameter of the target user for the target medical insurance consumption behavior; and if the risk assessment parameter satisfies a preset medical insurance risk control condition, executing a payment processing operation of the target user for the target medical insurance consumption behavior according to the consumption information. Therefore, the risk in the field of direct insurance payment claim settlement can be identified, and the risk and loss can be avoided for insurance companies and insurance units.

Description

Technical Field

[0001] The present invention relates to the technical field of online payment risk control, and in particular to a risk control method, a risk control device and a computer device. Background Art

[0002] With the vigorous development of e-commerce in my country, more and more netizens have accepted online payment, and third-party payment service agencies have emerged, promoting the development of e-commerce. As a supplement to the lack of credit system in my country, third-party payment has attracted attention from all parties, and the focus is on its risks. Therefore, risk control of third-party payment has become a top priority.

[0003] Among the related technologies, more emphasis is placed on online payments in industries such as e-commerce, and corresponding risk control rules are designed based on the characteristics of the traditional e-commerce industry. However, in the field of supplementary medical fund payment and claims, due to the characteristics of the industry, its risk control is also somewhat different, and there are very few corresponding risk control rules. Summary of the invention

[0004] The purpose of the present invention is to provide a risk control method, a risk control device and a computer device to address the deficiencies in the above-mentioned prior art, so as to identify risks in the field of direct insurance claims, avoid risks and losses for insurance companies and insured units, and at the same time, provide a compliant operation plan for insurance claims service companies.

[0005] To achieve the above purpose, the technical solution adopted in the embodiment of the present application is as follows:

[0006] In a first aspect, an embodiment of the present application provides a risk control method, comprising: receiving a medical insurance payment trigger request for a target medical insurance consumption behavior of a target user sent by a target medical insurance payment terminal, the medical insurance payment trigger request comprising: identity authentication information of the target user for the target medical insurance consumption behavior, and consumption information of the target medical insurance consumption behavior; determining the identity risk parameters of the target medical insurance consumption behavior based on the identity authentication information; determining the consumption risk parameters of the target medical insurance consumption behavior based on the consumption information; performing risk assessment using a preset risk control model based on the identity risk parameters and the consumption risk parameters to obtain the risk assessment parameters of the target user for the target medical insurance consumption behavior; if the risk assessment parameters meet the preset medical insurance risk control conditions, executing the payment processing operation of the target user for the target medical insurance consumption behavior based on the consumption information.

[0007] In one embodiment, the identity authentication information includes: current verification indication information and historical verification indication information before this consumption, the current verification indication information is used to indicate whether the target user has performed identity authentication for the target medical insurance consumption behavior, and the historical verification indication information is used to indicate whether the target user has performed identity authentication when the medical insurance is activated; determining the identity risk parameters of the target medical insurance consumption behavior based on the identity authentication information includes: determining a first identity risk parameter based on the current verification indication information, using a first preset identity authentication risk rule; determining a second identity risk parameter based on the historical verification indication information, using a second preset identity authentication risk rule; determining the identity risk parameter of the target medical insurance consumption behavior based on the first identity risk parameter and the second identity risk parameter.

[0008] In one embodiment, the consumption information includes: consumption amount, consumption location information, historical consumption times within a preset unit historical time period, and consumption detail information; determining the consumption risk parameters of the target medical insurance consumption behavior based on the consumption information includes: determining the consumption amount as a consumption amount risk parameter; determining the consumption location risk parameter based on the consumption location information using a preset consumption location assessment rule; determining the historical consumption times as a consumption times risk parameter; determining the consumption detail risk parameter based on the consumption detail information using a preset consumption detail assessment rule; the consumption risk parameters include: the consumption amount risk parameter, the consumption location risk parameter, the consumption times risk parameter, and the consumption detail risk parameter.

[0009] In one embodiment, before performing risk assessment using a preset risk control model according to the identity risk parameter and the consumption risk parameter to obtain the risk assessment parameters of the target user for the target medical insurance consumption behavior, the method further includes: obtaining a preset identity assessment coefficient, a preset consumption location coefficient, and a preset consumption detail coefficient; determining the consumption amount coefficient corresponding to the consumption amount risk parameter according to the consumption amount risk parameter; determining the consumption frequency coefficient corresponding to the consumption frequency risk parameter according to the consumption frequency risk parameter; constructing a first matrix for the target medical insurance consumption behavior according to the preset identity assessment coefficient, the consumption amount coefficient, the preset consumption location coefficient, the consumption frequency coefficient, and the preset consumption detail coefficient; constructing a second matrix for the target medical insurance consumption behavior according to the identity risk parameter, the consumption amount risk parameter, the consumption location risk parameter, the consumption frequency risk parameter, and the consumption detail risk parameter; performing risk assessment using a preset risk control model according to the identity risk parameter and the consumption risk parameter to obtain the risk assessment parameters of the target user for the target medical insurance consumption behavior, including: performing risk assessment using a preset risk control model according to the first matrix and the second matrix to obtain the risk assessment parameters of the target user for the target medical insurance consumption behavior.

[0010] In one embodiment, the consumption location risk parameter is determined based on the consumption location information using a preset consumption location assessment rule, including: determining whether the consumption location information is the preset consumption location information of the target user; if the consumption location information is the preset consumption location information, determining the consumption location risk parameter to be a first location risk parameter; if the consumption location information is not the preset consumption location information, and the target user does not have a medical insurance consumption record at the other locations in the preset unit historical time period, determining the consumption location risk parameter to be a second location risk parameter; if the consumption location information is not the preset consumption location information, and the target user has a medical insurance consumption record at the other locations in the preset unit historical time period, determining the consumption location risk parameter to be a third location risk parameter.

[0011] In one embodiment, the consumption detail risk parameter is determined based on the consumption detail information using a preset consumption detail evaluation rule, including: determining whether the consumption detail information is all preset conventional drug information; if the consumption detail information is all preset conventional drug information, determining the consumption detail risk parameter to be a first consumption detail risk parameter; if the consumption detail information includes preset unconventional drug information, calculating a second consumption detail risk parameter as the consumption detail risk parameter based on the quantity of all drugs in the consumption detail information.

[0012] In one embodiment, determining the consumption amount coefficient corresponding to the consumption amount risk parameter based on the consumption amount risk parameter includes: determining, based on the consumption amount risk parameter, a target consumption amount interval in which the consumption amount risk parameter is located from multiple preset consumption amount intervals, and determining the coefficient corresponding to the target consumption amount interval as the consumption amount coefficient; determining the consumption frequency coefficient corresponding to the consumption frequency risk parameter based on the consumption frequency risk parameter includes: determining, based on the consumption frequency risk parameter, a target consumption frequency interval in which the consumption frequency risk parameter is located from multiple preset consumption frequency intervals, and determining the coefficient corresponding to the target consumption frequency interval as the consumption frequency coefficient.

[0013] In one embodiment, the method also includes: if the risk assessment parameters do not meet the preset medical insurance risk control conditions, sending a verification trigger indication for the target medical insurance consumption behavior to the target medical insurance payment terminal; if a confirmation operation for the target medical insurance consumption behavior is returned by the target medical insurance payment terminal, then executing the payment processing operation of the target user for the target medical insurance consumption behavior based on the consumption information.

[0014] In the second aspect, an embodiment of the present application also provides a risk control device, including: a receiving module, configured to receive a medical insurance payment trigger request for a target user's target medical insurance consumption behavior sent by a target medical insurance payment terminal, the medical insurance payment trigger request including: the identity authentication information of the target user for the target medical insurance consumption behavior, and the consumption information of the target medical insurance consumption behavior; a first determination module, configured to determine the identity risk parameters of the target medical insurance consumption behavior based on the identity authentication information; a second determination module, configured to determine the consumption risk parameters of the target medical insurance consumption behavior based on the consumption information; an evaluation module, configured to perform risk evaluation based on the identity risk parameters and the consumption risk parameters using a preset risk control model to obtain the risk assessment parameters of the target user for the target medical insurance consumption behavior; a processing module, configured to execute the payment processing operation of the target user for the target medical insurance consumption behavior based on the consumption information if the risk assessment parameters meet the preset medical insurance risk control conditions.

[0015] In one embodiment, the identity authentication information includes: current verification indication information and historical verification indication information before this consumption, the current verification indication information is used to indicate whether the target user has performed identity authentication for the target medical insurance consumption behavior, and the historical verification indication information is used to indicate whether the target user has performed identity authentication when the medical insurance is activated; the first determination module is configured to: determine the first identity risk parameter based on the current verification indication information, using the first preset identity authentication risk rule; determine the second identity risk parameter based on the historical verification indication information, using the second preset identity authentication risk rule; determine the identity risk parameter of the target medical insurance consumption behavior based on the first identity risk parameter and the second identity risk parameter.

[0016] In one embodiment, the consumption information includes: consumption amount, consumption location information, historical consumption times within a preset unit historical time period, and consumption detail information; the second determination module is configured to: determine the consumption amount as a consumption amount risk parameter; based on the consumption location information, use a preset consumption location assessment rule to determine the consumption location risk parameter; determine the historical consumption times as a consumption times risk parameter; based on the consumption detail information, use a preset consumption detail assessment rule to determine the consumption detail risk parameter; the consumption risk parameters include: the consumption amount risk parameter, the consumption location risk parameter, the consumption times risk parameter, and the consumption detail risk parameter.

[0017] In one embodiment, the risk control device also includes a preprocessing module, which is configured to obtain a preset identity assessment coefficient, a preset consumption location coefficient, and a preset consumption detail coefficient; determine the consumption amount coefficient corresponding to the consumption amount risk parameter based on the consumption amount risk parameter; determine the consumption frequency coefficient corresponding to the consumption frequency risk parameter based on the consumption frequency risk parameter; construct a first matrix for the target medical insurance consumption behavior based on the preset identity assessment coefficient, the consumption amount coefficient, the preset consumption location coefficient, the consumption frequency coefficient, and the preset consumption detail coefficient; construct a second matrix for the target medical insurance consumption behavior based on the identity risk parameter, the consumption amount risk parameter, the consumption location risk parameter, the consumption frequency risk parameter, and the consumption detail risk parameter; the assessment module is configured to: perform risk assessment using a preset risk control model based on the first matrix and the second matrix to obtain the risk assessment parameters of the target user for the target medical insurance consumption behavior.

[0018] In one embodiment, the second determination module is configured to: determine whether the consumption location information is the preset consumption location information of the target user; if the consumption location information is the preset consumption location information, determine the consumption location risk parameter to be the first location risk parameter; if the consumption location information is not the preset consumption location information, and the target user does not have any medical insurance consumption records at the other locations in the preset unit historical time period, determine the consumption location risk parameter to be the second location risk parameter; if the consumption location information is not the preset consumption location information, and the target user has any medical insurance consumption records at the other locations in the preset unit historical time period, determine the consumption location risk parameter to be the third location risk parameter.

[0019] In one embodiment, the second determination module is configured to: determine whether the consumption details information is all preset conventional drug information; if the consumption details information is all preset conventional drug information, determine that the consumption details risk parameter is the first consumption details risk parameter; if the consumption details information includes preset unconventional drug information, calculate the second consumption details risk parameter as the consumption details risk parameter based on the quantity of all drugs in the consumption details information.

[0020] In one embodiment, the second determination module is configured to: determine, according to the consumption amount risk parameter, a target consumption amount interval in which the consumption amount risk parameter is located from a plurality of preset consumption amount intervals, and determine a coefficient corresponding to the target consumption amount interval as the consumption amount coefficient; determining, according to the consumption frequency risk parameter, a consumption frequency coefficient corresponding to the consumption frequency risk parameter, comprises: determining, according to the consumption frequency risk parameter, a target consumption frequency interval in which the consumption frequency risk parameter is located from a plurality of preset consumption frequency intervals, and determining a coefficient corresponding to the target consumption frequency interval as the consumption frequency coefficient.

[0021] In one embodiment, the processing module is configured as follows: if the risk assessment parameters do not meet the preset medical insurance risk control conditions, then a verification trigger indication for the target medical insurance consumption behavior is sent to the target medical insurance payment terminal; if a confirmation operation for the target medical insurance consumption behavior is received from the target medical insurance payment terminal, then based on the consumption information, the payment processing operation of the target user for the target medical insurance consumption behavior is executed.

[0022] In a third aspect, an embodiment of the present application further provides a computer device, comprising: a processor, a storage medium and a bus, wherein the storage medium stores program instructions executable by the processor, and when the computer device is running, the processor communicates with the storage medium via the bus, and the processor executes the program instructions to perform the steps of any one of the above methods.

[0023] In a fourth aspect, an embodiment of the present application further provides a computer-readable storage medium, on which a computer program is stored, and when the computer program is executed by a processor, the steps of any one of the above methods are executed.

[0024] The beneficial effects of this application are: obtaining a preset risk control model through identity risk parameters and consumption risk parameters, and then using the preset risk control model for risk assessment to obtain the risk assessment parameters of the target user for the target medical insurance consumption behavior, and determining whether to execute the payment processing operation of the target user for the target medical insurance consumption behavior according to the risk assessment parameters, and executing the payment processing operation of the target user for the target medical insurance consumption behavior according to the consumption information when the risk assessment parameters meet the preset medical insurance risk control conditions. In this way, it is possible to identify risks in the field of direct insurance claims, avoid risks and losses for insurance companies and insured units, and at the same time, provide a compliant operation solution for insurance claims service companies. BRIEF DESCRIPTION OF THE DRAWINGS

[0025] In order to more clearly illustrate the technical solutions of the embodiments of the present invention, the drawings required for use in the embodiments are briefly introduced below. It should be understood that the following drawings only show certain embodiments of the present invention and therefore should not be regarded as limiting the scope. For ordinary technicians in this field, other related drawings can be obtained based on these drawings without creative work.

[0026] Figure 1 A schematic diagram of a risk control method provided in an embodiment of the present application;

[0027] Figure 2 A schematic diagram of a risk control method provided in an embodiment of the present application;

[0028] Figure 3 A schematic diagram of a risk control method provided in an embodiment of the present application;

[0029] Figure 4 A schematic diagram of a risk control method provided in an embodiment of the present application;

[0030] Figure 5 A schematic diagram of a risk control method provided in an embodiment of the present application;

[0031] Figure 6A schematic diagram of a risk control method provided in an embodiment of the present application;

[0032] Figure 7 A schematic diagram of a risk control method provided in an embodiment of the present application;

[0033] Figure 8 A schematic diagram of the structure of a risk control device provided in an embodiment of the present application;

[0034] Fig. 9 A schematic diagram of the structure of a computer device provided in an embodiment of the present application. DETAILED DESCRIPTION

[0035] In order to make the purpose, technical solutions and advantages of the embodiments of the present invention clearer, the technical solutions in the embodiments of the present invention will be clearly and completely described below in conjunction with the drawings in the embodiments of the present invention. Obviously, the described embodiments are only part of the embodiments of the present invention, not all of the embodiments.

[0036] Therefore, the following detailed description of the embodiments of the present application provided in the accompanying drawings is not intended to limit the scope of the present application for which protection is sought, but merely represents selected embodiments of the present application. Based on the embodiments in the present application, all other embodiments obtained by ordinary technicians in the field without creative work are within the scope of protection of the present application.

[0037] In the description of the present application, it should be noted that if the terms "upper", "lower", etc. appear, the orientation or position relationship indicated is based on the orientation or position relationship shown in the drawings, or is the orientation or position relationship in which the product of the application is usually placed when used. It is only for the convenience of describing the present application and simplifying the description, and does not indicate or imply that the device or element referred to must have a specific orientation, be constructed and operated in a specific orientation, and therefore cannot be understood as a limitation on the present application.

[0038] In addition, the terms "first", "second", etc. in the specification and claims of the present invention and the above-mentioned drawings are used to distinguish similar objects, and are not necessarily used to describe a specific order or sequence. It should be understood that the data used in this way can be interchanged where appropriate, so that the embodiments of the present invention described herein can be implemented in an order other than those illustrated or described herein. In addition, the terms "including" and "having" and any variations thereof are intended to cover non-exclusive inclusions, for example, a process, method, system, product or device that includes a series of steps or units is not necessarily limited to those steps or units that are clearly listed, but may include other steps or units that are not clearly listed or inherent to these processes, methods, products or devices.

[0039] It should be noted that, in the absence of conflict, the features in the embodiments of the present application may be combined with each other.

[0040] Figure 1 A flow chart of a risk control method provided in an embodiment of the present application; Figure 1 As shown, the method includes:

[0041] Step 110: Receive a medical insurance payment trigger request for a target medical insurance consumption behavior from a target user sent by a target medical insurance payment terminal.

[0042] Among them, the medical insurance payment trigger request includes: the identity authentication information of the target user for the target medical insurance consumption behavior, and the consumption information of the target medical insurance consumption behavior.

[0043] The target medical insurance payment terminal may be a terminal device that can use a medical insurance code and / or a medical insurance card, wherein the terminal device may be, for example, a smart phone, a personal digital assistant (PDA), a laptop computer, a server, a desktop computer, or any other computing device with networking capabilities, but is not limited thereto.

[0044] A risk control method provided in an embodiment of the present application is applied to a server, wherein the server can be an independent physical server, a server cluster or a distributed system composed of multiple physical servers, or a cloud server that provides basic cloud computing services such as cloud services, cloud databases, cloud computing, cloud functions, cloud storage, network services, cloud communications, middleware services, domain name services, security services, content delivery networks (CDNs), and big data and artificial intelligence platforms.

[0045] The medical insurance payment trigger request is triggered by the target user swiping the medical insurance code or using the medical insurance card to the server through the terminal device.

[0046] Step 120: Determine the identity risk parameters of the target medical insurance consumption behavior based on the identity verification information.

[0047] Among them, identity authentication information is the information generated by the target user through different identity authentication methods on his terminal device, such as: mobile phone number, face information, license information, ID card number, address information, etc.

[0048] The identity risk parameter is the risk parameter corresponding to different identity authentication methods, which is used to characterize the degree of risk. Generally, the more secure the identity authentication method is, the smaller the identity risk parameter is. For example, the identity risk parameter of face authentication is less than the identity risk parameter of mobile phone number authentication method and less than the identity risk parameter of license authentication method.

[0049] Step 130: Determine consumption risk parameters of the target medical insurance consumption behavior based on the consumption information.

[0050] Among them, consumption information includes information related to consumption, such as: consumption amount, consumption location, consumption frequency, consumption details, etc.

[0051] The consumption risk parameter is the consumption risk coefficient corresponding to different consumption information; generally, the more the consumption information conforms to common sense, the smaller the consumption risk parameter; for example: the smaller the consumption amount, the smaller the consumption risk parameter; the closer the consumption location is to a common location, the smaller the consumption risk parameter; the closer the drugs included in the consumption details are to conventional drugs, the smaller the consumption risk parameter.

[0052] Step 140: Based on the identity risk parameters and the consumption risk parameters, a preset risk control model is used to perform risk assessment to obtain risk assessment parameters for the target user's target medical insurance consumption behavior.

[0053] Among them, this step can obtain a preset risk control model based on identity risk parameters and consumption risk parameters, and then use the preset risk control model to perform risk assessment to obtain risk assessment parameters for target users' target medical insurance consumption behavior.

[0054] The larger the risk assessment parameter is, the greater the risk of the target user's target medical insurance consumption behavior is; the smaller the risk assessment parameter is, the smaller the risk of the target user's target medical insurance consumption behavior is.

[0055] Step 150: If the risk assessment parameters meet the preset medical insurance risk control conditions, the payment processing operation of the target user for the target medical insurance consumption behavior is executed according to the consumption information.

[0056] Among them, the preset medical insurance risk control condition can be that the risk assessment parameter is less than the preset risk assessment parameter threshold. The preset risk assessment parameter threshold can be set based on experience or by referring to relevant literature, and is not limited here.

[0057] If the risk assessment parameter is less than the preset risk assessment parameter threshold, it means that the risk of the target user's target medical insurance consumption behavior this time is controllable and safe; if the risk assessment parameter is greater than the preset risk assessment parameter threshold, it means that the risk of the target user's target medical insurance consumption behavior this time is uncontrollable and unsafe.

[0058] The risk control method provided in the embodiment of the present application firstly receives a medical insurance payment trigger request for a target medical insurance consumption behavior of a target user sent by a target medical insurance payment terminal; secondly, determines the identity risk parameter of the target medical insurance consumption behavior according to the identity authentication information; thirdly, determines the consumption risk parameter of the target medical insurance consumption behavior according to the consumption information; then, based on the identity risk parameter and the consumption risk parameter, a preset risk control model is used to perform risk assessment to obtain the risk assessment parameter of the target user for the target medical insurance consumption behavior; finally, if the risk assessment parameter meets the preset medical insurance risk control condition, the payment processing operation of the target user for the target medical insurance consumption behavior is executed according to the consumption information. The preset risk control model is obtained by the identity risk parameter and the consumption risk parameter, and then the preset risk control model is used to perform risk assessment to obtain the risk assessment parameter of the target user for the target medical insurance consumption behavior, and whether to execute the payment processing operation of the target user for the target medical insurance consumption behavior is determined according to the risk assessment parameter, and when the risk assessment parameter meets the preset medical insurance risk control condition, the payment processing operation of the target user for the target medical insurance consumption behavior is executed according to the consumption information. In this way, risks in the field of direct insurance claims can be identified, helping insurance companies and policyholders avoid risks and losses. At the same time, a compliance operation solution can be provided for insurance claims service companies.

[0059] The following is an example explanation of the process of determining the identity risk parameters of the target medical insurance consumption behavior in the above embodiment. Figure 2 The following is a flow chart of the risk control method provided in the embodiment of the present application. Figure 2 As shown, the identity verification information includes: current verification indication information and historical verification indication information before this consumption, the current verification indication information is used to indicate whether the target user has done identity verification for the target medical insurance consumption behavior, and the historical verification indication information is used to indicate whether the target user has done identity verification when the medical insurance is activated. The above step 120 may further include the following steps 210 to 230:

[0060] Step 210: Determine a first identity risk parameter based on the current verification instruction information and using a first preset identity verification risk rule.

[0061] Among them, the current verification instruction information refers to the identity verification required during the payment process of the target medical insurance consumption behavior, such as: face verification, verification code verification, etc.

[0062] The first preset identity authentication risk rule is used to explain the determination rule of the first identity risk parameter corresponding to the current authentication indication information, for example: the identity risk parameter corresponding to face authentication takes a fixed value less than 0.1, the identity risk parameter corresponding to face authentication always takes 0, etc. Generally, the first identity risk parameter is less than or equal to 1.

[0063] Step 220: Determine a second identity risk parameter based on the historical verification indication information and using a second preset identity verification risk rule.

[0064] Among them, the historical verification indication information refers to the identity authentication performed before payment of the target medical insurance consumption behavior, such as: mobile phone number verification and license verification performed when binding the mobile phone number during activation.

[0065] The second preset identity authentication risk rule is used to explain the determination rule of the second identity risk parameter corresponding to the historical verification indication information, for example: the identity risk parameter corresponding to the mobile phone number verification done by binding the mobile phone number during activation takes a fixed value less than 0.2-0.3, and the identity risk parameter corresponding to the license verification takes a fixed value between 0.4-0.6, etc. Generally, the second identity risk parameter is less than or equal to 1.

[0066] Step 230: Determine the identity risk parameter of the target medical insurance consumption behavior based on the first identity risk parameter and the second identity risk parameter.

[0067] Among them, the first identity risk parameter can be used as the identity risk parameter of the target medical insurance consumption behavior, the second identity risk parameter can be used as the identity risk parameter of the target medical insurance consumption behavior, or the first identity risk parameter and the second identity risk parameter can be used as the identity risk parameters of the target medical insurance consumption behavior, depending on the identity authentication method actually performed by the target user.

[0068] It should be noted that, in actual operation, step 210 and step 220 are performed in no particular order.

[0069] The risk control method provided in the embodiment of the present application determines the first identity risk parameter by using the first preset identity authentication risk rule according to the current verification indication information; determines the second identity risk parameter by using the second preset identity authentication risk rule according to the historical verification indication information; determines the identity risk parameter of the target medical insurance consumption behavior according to the first identity risk parameter and the second identity risk parameter. Based on the current verification indication information and the historical verification indication information, the identity risk parameter of the target medical insurance consumption behavior is determined from different dimensions. In this way, the accuracy of risk identification can be improved from the identity dimension.

[0070] The following is an example explanation of the process of determining the consumption risk parameters of the target medical insurance consumption behavior in the above embodiment. Figure 3 The following is a flow chart of the risk control method provided in the embodiment of the present application. Figure 3 As shown, the consumption information includes: consumption amount, consumption location information, historical consumption times within a preset unit historical time period, and consumption details information. The above step 130 may further include the following steps 310 to 340:

[0071] Step 310: Determine the consumption amount as the consumption amount risk parameter.

[0072] For example, if the consumption amount is 1,000 yuan, the corresponding consumption amount risk parameter is 1,000; if the consumption amount is 10,000 yuan, the corresponding consumption amount risk parameter is 10,000.

[0073] Step 320: Determine the consumption location risk parameters based on the consumption location information and using preset consumption location assessment rules.

[0074] Among them, consumption location information refers to the location where the target medical insurance consumption behavior occurs.

[0075] The preset consumption location assessment rules are used to explain the determination rules of the consumption location risk parameters corresponding to the consumption location information; generally, the closer the consumption location is to the common location, the smaller the consumption location risk parameter is; for example: if the consumption location is a common location, the consumption location risk parameter is always 0; if the consumption location is not a common location and there are no other consumption locations on the same day, the consumption location risk parameter takes a fixed value between 0.4-0.6; if the consumption location is not a common location and there are other consumption locations on the same day, the consumption location risk parameter takes a fixed value between 0.9-1. Generally, the consumption location risk parameter is less than or equal to 1.

[0076] Step 330: Determine the historical consumption frequency as the consumption frequency risk parameter.

[0077] For example, if the number of historical consumption times is 2, the corresponding consumption times risk parameter is 2; if the number of historical consumption times is 5 yuan, the corresponding consumption times risk parameter is 5.

[0078] Step 340: Determine the consumption detail risk parameters based on the consumption detail information using the preset consumption detail assessment rules.

[0079] Among them, consumption risk parameters include: consumption amount risk parameters, consumption location risk parameters, consumption frequency risk parameters and consumption detail risk parameters.

[0080] Among them, consumption details information refers to the drug information targeted by the target medical insurance consumption behavior.

[0081] The preset consumption detail assessment rules are used to explain the rules for determining the consumption detail risk parameters corresponding to the consumption detail information; generally, the closer the drugs included in the consumption details are to conventional drugs, the smaller the corresponding consumption detail risk parameters are; for example: if the drugs targeted by the target medical insurance consumption behavior are all conventional drugs, then the corresponding consumption detail risk parameters are always 0; if the drugs targeted by the target medical insurance consumption behavior include precious tonic drugs, large medical devices or other uncommon drugs, then the consumption detail risk parameter values ​​are determined according to the quantity of drugs purchased.

[0082] It should be noted that, in actual operation, steps 310 to 340 are performed in no particular order.

[0083] The risk control method provided in the embodiment of the present application determines the consumption amount as the consumption amount risk parameter; according to the consumption location information, the consumption location risk parameter is determined by using the preset consumption location assessment rule; the historical consumption times are determined as the consumption times risk parameter; according to the consumption detail information, the consumption detail risk parameter is determined by using the preset consumption detail assessment rule. The consumption risk parameter is determined from multiple dimensions such as the consumption amount, consumption location information, historical consumption times, and consumption detail information. In this way, the accuracy of risk identification can be improved from the consumption dimension.

[0084] In one embodiment, the risk control model is obtained by a matrix obtained by each coefficient and a matrix obtained by each risk parameter. Figure 4 As shown, before the above step 140, a risk control method provided in an embodiment of the present application may further include the following steps 410 to 450:

[0085] Step 410: Obtain a preset identity assessment coefficient, a preset consumption location coefficient, and a preset consumption detail coefficient.

[0086] Among them, the preset identity assessment coefficient, the preset consumption location coefficient and the preset consumption detail coefficient can be set according to experience or according to referenced literature, and are not limited here.

[0087] For example, the preset identity assessment coefficient may be constantly set to 10; the preset consumption location coefficient may be constantly set to 10; and the preset consumption details coefficient may be constantly set to 5.

[0088] Step 420: Determine the consumption amount coefficient corresponding to the consumption amount risk parameter according to the consumption amount risk parameter.

[0089] Among them, the consumption amount risk parameter (consumption amount) can be segmented so that the consumption amount risk parameters (consumption amount) of different segments have different consumption amount coefficients. In this way, the number of changes in the consumption amount coefficient can be reduced and the amount of calculation can be reduced.

[0090] Step 430: Determine the consumption frequency coefficient corresponding to the consumption frequency risk parameter according to the consumption frequency risk parameter.

[0091] Among them, the consumption frequency risk parameter (consumption frequency) can be segmented so that the consumption frequency risk parameters (consumption frequency) of different segments have different consumption frequency coefficients. In this way, the number of changes in the consumption frequency coefficient can be reduced and the amount of calculation can be reduced.

[0092] Step 440: construct a first matrix for the target medical insurance consumption behavior based on the preset identity assessment coefficient, the consumption amount coefficient, the preset consumption location coefficient, the consumption frequency coefficient, and the preset consumption detail coefficient.

[0093] Among them, the first matrix is ​​composed of a preset identity assessment coefficient, a consumption amount coefficient, a preset consumption location coefficient, a consumption frequency coefficient, and a preset consumption detail coefficient.

[0094] Exemplarily, the first matrix is ​​as follows:

[0095] [abcde]

[0096] Among them, a represents the preset identity assessment coefficient; b represents the consumption amount coefficient; c represents the preset consumption location coefficient; d represents the consumption frequency coefficient; and e represents the preset consumption details coefficient.

[0097] Step 450: construct a second matrix for the target medical insurance consumption behavior based on the identity risk parameter, the consumption amount risk parameter, the consumption location risk parameter, the consumption frequency risk parameter, and the consumption detail risk parameter.

[0098] Among them, the second matrix is ​​composed of identity risk parameters, consumption amount risk parameters, consumption location risk parameters, consumption frequency risk parameters, and consumption detail risk parameters.

[0099] Exemplarily, the second matrix is ​​as follows:

[0100]

[0101] Among them, mcard represents the identity risk parameter; amount represents the consumption amount risk parameter; position represents the consumption location risk parameter; times represents the consumption frequency risk parameter; detail represents the consumption detail risk parameter.

[0102] It should be noted that, in actual operation, steps 410 to 440 are performed in no particular order.

[0103] Furthermore, the above step 140 may further include the following steps:

[0104] According to the first matrix and the second matrix, a preset risk control model is used to perform risk assessment to obtain risk assessment parameters for target users' target medical insurance consumption behaviors.

[0105] Among them, this step obtains a preset risk control model through the first matrix and the second matrix, and then uses the preset risk control model to perform risk assessment to obtain risk assessment parameters for target users' target medical insurance consumption behavior.

[0106] Exemplarily, the preset risk control model is as follows:

[0107]

[0108] Among them, a represents the preset identity assessment coefficient; b represents the consumption amount coefficient; c represents the preset consumption location coefficient; d represents the consumption frequency coefficient; e represents the preset consumption detail coefficient; mcard represents the identity risk parameter; amount represents the consumption amount risk parameter; position represents the consumption location risk parameter; times represents the consumption frequency risk parameter; detail represents the consumption detail risk parameter.

[0109] The risk control method provided in the embodiment of the present application obtains a preset identity assessment coefficient, a preset consumption location coefficient, and a preset consumption detail coefficient; according to the consumption amount risk parameter, determines the consumption amount coefficient corresponding to the consumption amount risk parameter; according to the consumption frequency risk parameter, determines the consumption frequency coefficient corresponding to the consumption frequency risk parameter; according to the preset identity assessment coefficient, consumption amount coefficient, preset consumption location coefficient, consumption frequency coefficient, and preset consumption detail coefficient, constructs a first matrix for the target medical insurance consumption behavior; according to the identity risk parameter, consumption amount risk parameter, consumption location risk parameter, consumption frequency risk parameter, and consumption detail risk parameter, constructs a second matrix for the target medical insurance consumption behavior; according to the first matrix and the second matrix, uses a preset risk control model to perform risk assessment, and obtains the risk assessment parameters of the target user for the target medical insurance consumption behavior. Based on the preset identity assessment coefficient, consumption amount coefficient, preset consumption location coefficient, consumption frequency coefficient, and preset consumption detail coefficient, construct a first matrix, based on the identity risk parameter, consumption amount risk parameter, consumption location risk parameter, consumption frequency risk parameter, and consumption detail risk parameter, construct a second matrix, based on the first matrix and the second matrix, construct a preset risk control model, and then use the preset risk control model to perform risk assessment, and obtain the risk assessment parameters of the target user for the target medical insurance consumption behavior. In this way, risks in the field of direct insurance claims can be comprehensively identified from various dimensions, helping insurance companies and insured units to avoid risks and losses.

[0110] The following is an example explanation of the process of determining the consumption location risk parameter in the above embodiment. Figure 5 The following is a flow chart of the risk control method provided in the embodiment of the present application. Figure 5 As shown, the above step 320 may further include the following steps 510 to 540:

[0111] Step 510: Determine whether the consumption location information is the preset consumption location information of the target user.

[0112] Among them, the preset consumption location information can be the location information of the above-mentioned common locations, that is, the common locations of the target user's medical insurance consumption behavior.

[0113] Exemplarily, the preset consumption location may be a pharmacy, community hospital, hospital, etc. near the target user's residence.

[0114] In actual operation, the consumption location information is compared with the preset consumption location information to determine whether the consumption location information is the preset consumption location information of the target user.

[0115] Step 520: If the consumption location information is the preset consumption location information, determine that the consumption location risk parameter is the first location risk parameter.

[0116] Among them, when the consumption location information is the preset consumption location information, the consumption location risk is low, the consumption location risk parameter is low, and the corresponding first location risk parameter value is small. Generally, the closer the consumption location is to the common location, the smaller the consumption location risk parameter is.

[0117] Exemplarily, the consumption location information is preset consumption location information, and the corresponding first location risk parameter is always 0.

[0118] Step 530: If the consumption location information is not the preset consumption location information, and the target user does not have any medical insurance consumption records at other locations in the preset unit historical time period, then the consumption location risk parameter is determined to be the second location risk parameter.

[0119] Among them, when the consumption location information is not the preset consumption location information, and the target user has no medical insurance consumption records at other locations in the preset unit historical time period, the consumption location risk is high, the consumption location risk parameter is high, and the corresponding second location risk parameter value is large.

[0120] Exemplarily, the consumption location information is not the preset consumption location information, and the target user has no medical insurance consumption records at other locations in the preset unit historical time period, and the corresponding second location risk parameter takes a value of 0.5.

[0121] Step 540: If the consumption location information is not the preset consumption location information, and the target user has medical insurance consumption records at other locations in the preset unit historical time period, then the consumption location risk parameter is determined to be a third location risk parameter.

[0122] Among them, when the consumption location information is not the preset consumption location information, and the target user has medical insurance consumption records at other locations in the preset unit historical time period, the consumption location risk is high, the consumption location risk parameter is high, and the corresponding third location risk parameter value is large.

[0123] Exemplarily, the consumption location information is not the preset consumption location information, and the target user has medical insurance consumption records at other locations in the preset unit historical time period, and the corresponding third location risk parameter takes the value of 1.

[0124] It should be noted that, in actual operation, steps 520 to 540 are performed in no particular order.

[0125] The risk control method provided in the embodiment of the present application determines whether the consumption location information is the preset consumption location information of the target user; if the consumption location information is the preset consumption location information, the consumption location risk parameter is determined to be the first location risk parameter; if the consumption location information is not the preset consumption location information, and the target user does not have medical insurance consumption records at other locations in the preset unit historical time period, the consumption location risk parameter is determined to be the second location risk parameter; if the consumption location information is not the preset consumption location information, and the target user has medical insurance consumption records at other locations in the preset unit historical time period, the consumption location risk parameter is determined to be the third location risk parameter. Different consumption location risk parameters are determined based on different consumption location information. In this way, the risks in the insurance direct payment claims field can be more accurately identified from the consumption location dimension, so as to help insurance companies and insured units avoid risks and losses.

[0126] The following is an example explanation of the process of determining the consumption detail risk parameters in the above embodiment. Figure 6 The following is a flow chart of the risk control method provided in the embodiment of the present application. Figure 6 As shown, the above step 340 may further include the following steps 610 to 630:

[0127] Step 610: Determine whether the consumption details are all preset conventional drug information.

[0128] Among them, the conventional drug information may be the information of drugs commonly used by residents. In actual operation, it can be set according to experience or according to the referenced data, which is not limited here.

[0129] In actual operation, the consumption details information is compared with the preset conventional drug information to determine whether the consumption details information is the preset conventional drug information of the target user.

[0130] Step 620: If the consumption detail information is all preset conventional drug information, the consumption detail risk parameter is determined to be the first consumption detail risk parameter.

[0131] Among them, when the consumption details information are all preset conventional drug information, the consumption details risk is low, the consumption details risk parameter is small, and the corresponding first consumption details risk parameter value is small.

[0132] Exemplarily, the consumption details information are all preset conventional drug information, and the corresponding first consumption details risk parameter is always 0.

[0133] Step 630: If the consumption detail information includes preset non-conventional drug information, a second consumption detail risk parameter is calculated as the consumption detail risk parameter according to the quantity of all drugs in the consumption detail information.

[0134] The preset non-conventional drug information may be drug information other than drugs commonly used by residents. In actual operation, it may be set based on experience or based on referenced data, and is not limited here.

[0135] In actual operation, the consumption details information is compared with the preset unconventional drug information to determine whether the consumption details information is the preset unconventional drug information of the target user.

[0136] For example, if the consumption details include precious tonic drugs, large medical devices or other preset unconventional drug information, the corresponding second consumption details risk parameter value is The quantity of medicines purchased.

[0137] It should be noted that, in actual operation, step 620 and step 630 are performed in no particular order.

[0138] The risk control method provided in the embodiment of the present application determines whether the consumption details information are all preset conventional drug information; if the consumption details information are all preset conventional drug information, the consumption details risk parameter is determined to be the first consumption details risk parameter; if the consumption details information includes preset unconventional drug information, the second consumption details risk parameter is calculated as the consumption details risk parameter based on the quantity of all drugs in the consumption details information. Different consumption details risk parameters are determined based on different consumption details information. In this way, the risks in the insurance direct payment claims field can be more accurately identified from the consumption details dimension, so as to avoid risks and losses for insurance companies and insured units.

[0139] The following is an example to explain the process of determining the consumption amount coefficient in the above embodiment. The above step 420 may further include the following steps:

[0140] According to the consumption amount risk parameter, a target consumption amount interval in which the consumption amount risk parameter is located is determined from a plurality of preset consumption amount intervals, and a coefficient corresponding to the target consumption amount interval is determined as the consumption amount coefficient.

[0141] For example, the relationship between the consumption amount coefficient b and the consumption amount risk parameter amount is as follows:

[0142]

[0143] Correspondingly, the above step 430 may further include the following steps:

[0144] According to the consumption frequency risk parameter, a target consumption frequency interval in which the consumption frequency risk parameter is located is determined from a plurality of preset consumption frequency intervals, and a coefficient corresponding to the target consumption frequency interval is determined as the consumption frequency coefficient.

[0145] For example, the relationship between the consumption frequency coefficient d and the consumption frequency risk parameter times is as follows:

[0146]

[0147] The risk control method provided in the embodiment of the present application determines the target consumption amount interval where the consumption amount risk parameter is located from multiple preset consumption amount intervals according to the consumption amount risk parameter, and determines the coefficient corresponding to the target consumption amount interval as the consumption amount coefficient; determines the target consumption frequency interval where the consumption frequency risk parameter is located from multiple preset consumption frequency intervals according to the consumption frequency risk parameter, and determines the coefficient corresponding to the target consumption frequency interval as the consumption frequency coefficient. Different consumption amount coefficients and consumption frequency coefficients are determined based on different consumption amount intervals and consumption frequency intervals. In this way, the risks in the field of direct insurance claims can be identified more accurately from the consumption amount dimension and the consumption frequency dimension, so as to avoid risks and losses for insurance companies and insured units.

[0148] In one implementation, the risk control method provided in the embodiment of the present application also includes a situation where the risk assessment parameters do not meet the preset medical insurance risk control conditions; Figure 7 The following is a flow chart of the risk control method provided in the embodiment of the present application. Figure 7 As shown, the risk control method provided in the embodiment of the present application may further include the following steps 710 and 720:

[0149] Step 710: If the risk assessment parameters do not meet the preset medical insurance risk control conditions, a verification trigger instruction for the target medical insurance consumption behavior is sent to the target medical insurance payment terminal.

[0150] In actual operation, the verification trigger indication is used to indicate manual follow-up for verification.

[0151] After sending the verification trigger indication, manual follow-up verification can be performed in the background to further determine whether the risk assessment parameters determined by the risk control model are true. If not, that is, the risk assessment parameters meet the preset medical insurance risk control conditions, then continue to execute step 720; if true, that is, the risk assessment parameters do not meet the preset medical insurance risk control conditions, then block the target user's payment processing operation for the target medical insurance consumption behavior.

[0152] Step 720: If a confirmation operation for the target medical insurance consumption behavior is received from the target medical insurance payment terminal, the payment processing operation for the target medical insurance consumption behavior of the target user is executed according to the consumption information.

[0153] This step is to further determine whether the risk assessment parameters determined by the risk control model are true or not, that is, the risk assessment parameters meet the preset medical insurance risk control conditions. At this time, the target user makes payment for the target medical insurance consumption behavior.

[0154] The risk control method provided in the embodiment of the present application, if the risk assessment parameters do not meet the preset medical insurance risk control conditions, then send a verification trigger instruction for the target medical insurance consumption behavior to the target medical insurance payment terminal; if the confirmation operation for the target medical insurance consumption behavior returned by the target medical insurance payment terminal is received, then the payment processing operation of the target user for the target medical insurance consumption behavior is executed according to the consumption information. Through further manual verification, the risk identification in the field of insurance direct payment claims is further improved, and risks and losses are avoided for insurance companies and insured units.

[0155] After introducing the risk control method of the exemplary embodiment of the present disclosure, next, refer to Figure 8 The risk control device 800 according to the exemplary embodiment of the present disclosure will be described.

[0156] refer to Figure 8 As shown, the risk control device 800 includes: a receiving module 810, which is configured to receive a medical insurance payment trigger request for a target user's target medical insurance consumption behavior sent by a target medical insurance payment terminal, and the medical insurance payment trigger request includes: identity authentication information of the target user for the target medical insurance consumption behavior, and consumption information of the target medical insurance consumption behavior; a first determination module 820, which is configured to determine the identity risk parameters of the target medical insurance consumption behavior according to the identity authentication information; a second determination module 830, which is configured to determine the consumption risk parameters of the target medical insurance consumption behavior according to the consumption information; an evaluation module 840, which is configured to perform risk evaluation based on the identity risk parameters and the consumption risk parameters using a preset risk control model to obtain the risk evaluation parameters of the target user for the target medical insurance consumption behavior; a processing module 850, which is configured to execute the payment processing operation of the target user for the target medical insurance consumption behavior according to the consumption information if the risk assessment parameters meet the preset medical insurance risk control conditions.

[0157] In one embodiment, the identity authentication information includes: current verification indication information and historical verification indication information before this consumption, the current verification indication information is used to indicate whether the target user has performed identity authentication for the target medical insurance consumption behavior, and the historical verification indication information is used to indicate whether the target user has performed identity authentication when the medical insurance is activated; the first determination module 820 is configured to: determine the first identity risk parameter based on the current verification indication information, using the first preset identity authentication risk rule; determine the second identity risk parameter based on the historical verification indication information, using the second preset identity authentication risk rule; determine the identity risk parameter of the target medical insurance consumption behavior based on the first identity risk parameter and the second identity risk parameter.

[0158] In one embodiment, consumption information includes: consumption amount, consumption location information, historical consumption times within a preset unit historical time period, and consumption detail information; the second determination module 830 is configured to: determine the consumption amount as a consumption amount risk parameter; based on the consumption location information, use the preset consumption location assessment rules to determine the consumption location risk parameter; determine the historical consumption times as a consumption times risk parameter; based on the consumption detail information, use the preset consumption detail assessment rules to determine the consumption detail risk parameter; consumption risk parameters include: consumption amount risk parameter, consumption location risk parameter, consumption times risk parameter and consumption detail risk parameter.

[0159] In one embodiment, the risk control device 800 also includes a preprocessing module, which is configured to obtain a preset identity assessment coefficient, a preset consumption location coefficient, and a preset consumption detail coefficient; determine the consumption amount coefficient corresponding to the consumption amount risk parameter based on the consumption amount risk parameter; determine the consumption frequency coefficient corresponding to the consumption frequency risk parameter based on the consumption frequency risk parameter; construct a first matrix for the target medical insurance consumption behavior based on the preset identity assessment coefficient, the consumption amount coefficient, the preset consumption location coefficient, the consumption frequency coefficient, and the preset consumption detail coefficient; construct a second matrix for the target medical insurance consumption behavior based on the identity risk parameter, the consumption amount risk parameter, the consumption location risk parameter, the consumption frequency risk parameter, and the consumption detail risk parameter; the assessment module 840 is configured to: perform risk assessment using a preset risk control model based on the first matrix and the second matrix to obtain the risk assessment parameters of the target user for the target medical insurance consumption behavior.

[0160] In one embodiment, the second determination module 830 is configured to: determine whether the consumption location information is the preset consumption location information of the target user; if the consumption location information is the preset consumption location information, determine the consumption location risk parameter as the first location risk parameter; if the consumption location information is not the preset consumption location information, and the target user does not have medical insurance consumption records at other locations in the preset unit historical time period, determine the consumption location risk parameter as the second location risk parameter; if the consumption location information is not the preset consumption location information, and the target user has medical insurance consumption records at other locations in the preset unit historical time period, determine the consumption location risk parameter as the third location risk parameter.

[0161] In one embodiment, the second determination module 830 is configured to: determine whether the consumption details information is all preset conventional drug information; if the consumption details information is all preset conventional drug information, determine the consumption details risk parameter as the first consumption details risk parameter; if the consumption details information includes preset unconventional drug information, then calculate the second consumption details risk parameter as the consumption details risk parameter based on the quantity of all drugs in the consumption details information.

[0162] In one embodiment, the second determination module 830 is configured to: determine, based on the consumption amount risk parameter, a target consumption amount interval in which the consumption amount risk parameter is located from a plurality of preset consumption amount intervals, and determine a coefficient corresponding to the target consumption amount interval as the consumption amount coefficient; determine, based on the consumption frequency risk parameter, a consumption frequency coefficient corresponding to the consumption frequency risk parameter, including: determining, based on the consumption frequency risk parameter, a target consumption frequency interval in which the consumption frequency risk parameter is located from a plurality of preset consumption frequency intervals, and determining a coefficient corresponding to the target consumption frequency interval as the consumption frequency coefficient.

[0163] In one embodiment, the processing module 850 is configured as follows: if the risk assessment parameters do not meet the preset medical insurance risk control conditions, a verification trigger indication for the target medical insurance consumption behavior is sent to the target medical insurance payment terminal; if a confirmation operation for the target medical insurance consumption behavior is received from the target medical insurance payment terminal, the payment processing operation of the target user for the target medical insurance consumption behavior is executed based on the consumption information.

[0164] The above-mentioned device is used to execute the method provided by the aforementioned embodiment, and its implementation principle and technical effect are similar, which will not be repeated here.

[0165] The above modules may be one or more integrated circuits configured to implement the above methods, such as one or more application specific integrated circuits (ASICs), or one or more microprocessors, or one or more field programmable gate arrays (FPGAs). For another example, when a module is implemented in the form of a processing element scheduling program code, the processing element may be a general-purpose processor, such as a central processing unit (CPU) or other processor that can call program code. For another example, these modules may be integrated together and implemented in the form of a system-on-a-chip (SOC).

[0166] Fig. 9 A schematic diagram of a computer device provided in an embodiment of the present application. The device can be integrated into a terminal device or a chip of a terminal device. The terminal can be a computing device with data processing capabilities.

[0167] The device includes: a processor 901 , a storage medium 902 , and a bus 903 .

[0168] The storage medium 902 stores program instructions executable by the processor 901. When the computer device 900 is running, the processor 901 communicates with the storage medium 902 via the bus 903, and the processor 901 executes the program instructions to perform the above method embodiment. The specific implementation method and technical effect are similar and will not be repeated here.

[0169] Optionally, the present invention also provides a program product, such as a computer-readable storage medium, comprising a program, which is used to execute the above method embodiment when executed by a processor.

[0170] In the several embodiments provided by the present invention, it should be understood that the disclosed devices and methods can be implemented in other ways. For example, the device embodiments described above are only schematic, for example, the division of units is only a logical function division, and there may be other division methods in actual implementation, such as multiple units or components can be combined or integrated into another system, or some features can be ignored or not executed. Another point is that the mutual coupling or direct coupling or communication connection shown or discussed can be through some interfaces, indirect coupling or communication connection of devices or units, which can be electrical, mechanical or other forms.

[0171] The units described as separate components may or may not be physically separated, and the components shown as units may or may not be physical units, that is, they may be located in one place or distributed on multiple network units. Some or all of the units may be selected according to actual needs to achieve the purpose of the solution of this embodiment.

[0172] In addition, each functional unit in each embodiment of the present invention may be integrated into one processing unit, or each unit may exist physically separately, or two or more units may be integrated into one unit. The above-mentioned integrated unit may be implemented in the form of hardware or in the form of hardware plus software functional units.

[0173] The above-mentioned integrated unit implemented in the form of a software functional unit can be stored in a computer-readable storage medium. The above-mentioned software functional unit is stored in a storage medium, including a number of instructions for a computer device (which can be a personal computer, a server, or a network device, etc.) or a processor (English: processor) to perform some steps of the methods of various embodiments of the present invention. The aforementioned storage medium includes: U disk, mobile hard disk, read-only memory (English: Read-Only Memory, abbreviated: ROM), random access memory (English: Random Access Memory, abbreviated: RAM), disk or optical disk and other media that can store program codes.

[0174] The above is only a specific embodiment of the present invention, but the protection scope of the present invention is not limited thereto. Any person skilled in the art who is familiar with the technical field can easily think of changes or substitutions within the technical scope disclosed by the present invention, which should be included in the protection scope of the present invention. Therefore, the protection scope of the present invention should be based on the protection scope of the claims.

Claims

1. A risk control method, characterized in that: include: Receiving a medical insurance payment triggering request for a target medical insurance consumption behavior of a target user sent by a target medical insurance payment terminal, wherein the medical insurance payment triggering request includes: identity authentication information of the target user for the target medical insurance consumption behavior, and consumption information of the target medical insurance consumption behavior; Determining the identity risk parameter of the target medical insurance consumption behavior according to the identity verification information; Determining consumption risk parameters of the target medical insurance consumption behavior according to the consumption information; According to the identity risk parameter and the consumption risk parameter, a preset risk control model is used to perform risk assessment to obtain the risk assessment parameter of the target user for the target medical insurance consumption behavior; If the risk assessment parameters meet the preset medical insurance risk control conditions, the payment processing operation of the target user for the target medical insurance consumption behavior is executed according to the consumption information.

2. The method according to claim 1, characterized in that The identity verification information includes: current verification indication information and historical verification indication information before the current consumption, wherein the current verification indication information is used to indicate whether the target user has performed identity verification for the target medical insurance consumption behavior, and the historical verification indication information is used to indicate whether the target user has performed identity verification when the medical insurance was activated; Determining the identity risk parameter of the target medical insurance consumption behavior according to the identity verification information includes: Determine a first identity risk parameter using a first preset identity authentication risk rule according to the current verification instruction information; Determine a second identity risk parameter using a second preset identity authentication risk rule according to the historical authentication indication information; The identity risk parameter of the target medical insurance consumption behavior is determined according to the first identity risk parameter and the second identity risk parameter.

3. The method according to claim 1, characterized in that The consumption information includes: consumption amount, consumption location information, historical consumption times within a preset unit historical time period, and consumption details; Determining the consumption risk parameter of the target medical insurance consumption behavior according to the consumption information includes: Determining the consumption amount as a consumption amount risk parameter; According to the consumption location information, using a preset consumption location assessment rule to determine a consumption location risk parameter; Determining the historical consumption times as a consumption times risk parameter; According to the consumption detail information, the consumption detail risk parameters are determined using preset consumption detail assessment rules; the consumption risk parameters include: the consumption amount risk parameter, the consumption location risk parameter, the consumption frequency risk parameter and the consumption detail risk parameter.

4. The method according to claim 3, characterized in that Before performing risk assessment using a preset risk control model based on the identity risk parameter and the consumption risk parameter to obtain the risk assessment parameter of the target user for the target medical insurance consumption behavior, the method further includes: Obtaining a preset identity assessment coefficient, a preset consumption location coefficient, and a preset consumption detail coefficient; Determining a consumption amount coefficient corresponding to the consumption amount risk parameter according to the consumption amount risk parameter; Determining a consumption frequency coefficient corresponding to the consumption frequency risk parameter according to the consumption frequency risk parameter; Constructing a first matrix for the target medical insurance consumption behavior according to the preset identity assessment coefficient, the consumption amount coefficient, the preset consumption location coefficient, the consumption frequency coefficient, and the preset consumption detail coefficient; Constructing a second matrix for the target medical insurance consumption behavior according to the identity risk parameter, the consumption amount risk parameter, the consumption location risk parameter, the consumption frequency risk parameter, and the consumption detail risk parameter; The risk assessment is performed using a preset risk control model according to the identity risk parameter and the consumption risk parameter to obtain the risk assessment parameter of the target user for the target medical insurance consumption behavior, including: According to the first matrix and the second matrix, a preset risk control model is used to perform risk assessment to obtain risk assessment parameters of the target user for the target medical insurance consumption behavior.

5. The method according to claim 3, characterized in that: The step of determining the consumption location risk parameter based on the consumption location information and using a preset consumption location assessment rule includes: Determining whether the consumption location information is the preset consumption location information of the target user; If the consumption location information is the preset consumption location information, determining the consumption location risk parameter to be a first location risk parameter; If the consumption location information is not the preset consumption location information, and the target user does not have any medical insurance consumption record at the other location in the preset unit historical time period, then determining that the consumption location risk parameter is the second location risk parameter; If the consumption location information is not the preset consumption location information, and the target user has medical insurance consumption records at the other locations in the preset unit historical time period, then the consumption location risk parameter is determined to be a third location risk parameter.

6. The method according to claim 3, characterized in that The method of determining the consumption detail risk parameters based on the consumption detail information and using a preset consumption detail evaluation rule includes: Determine whether the consumption details are all preset conventional drug information; If the consumption detail information is all the preset conventional drug information, determining the consumption detail risk parameter as the first consumption detail risk parameter; If the consumption detail information includes preset unconventional drug information, a second consumption detail risk parameter is calculated as the consumption detail risk parameter according to the quantity of all drugs in the consumption detail information.

7. The method according to claim 4, characterized in that Determining the consumption amount coefficient corresponding to the consumption amount risk parameter according to the consumption amount risk parameter includes: According to the consumption amount risk parameter, determining a target consumption amount interval in which the consumption amount risk parameter is located from a plurality of preset consumption amount intervals, and determining a coefficient corresponding to the target consumption amount interval as the consumption amount coefficient; Determining the consumption frequency coefficient corresponding to the consumption frequency risk parameter according to the consumption frequency risk parameter includes: According to the consumption frequency risk parameter, a target consumption frequency interval in which the consumption frequency risk parameter is located is determined from a plurality of preset consumption frequency intervals, and a coefficient corresponding to the target consumption frequency interval is determined as the consumption frequency coefficient.

8. The method according to claim 1, characterized in that The method further comprises: If the risk assessment parameter does not meet the preset medical insurance risk control condition, a verification trigger instruction for the target medical insurance consumption behavior is sent to the target medical insurance payment terminal; If a confirmation operation for the target medical insurance consumption behavior returned by the target medical insurance payment terminal is received, the payment processing operation of the target user for the target medical insurance consumption behavior is executed according to the consumption information.

9. A risk control device, characterized in that: include: A receiving module is configured to receive a medical insurance payment triggering request for a target medical insurance consumption behavior of a target user sent by a target medical insurance payment terminal, wherein the medical insurance payment triggering request includes: identity authentication information of the target user for the target medical insurance consumption behavior, and consumption information of the target medical insurance consumption behavior; A first determination module is configured to determine the identity risk parameter of the target medical insurance consumption behavior according to the identity verification information; A second determination module is configured to determine a consumption risk parameter of the target medical insurance consumption behavior according to the consumption information; An evaluation module is configured to perform risk evaluation using a preset risk control model according to the identity risk parameter and the consumption risk parameter, and obtain a risk evaluation parameter of the target user for the target medical insurance consumption behavior; The processing module is configured to execute the payment processing operation of the target user for the target medical insurance consumption behavior according to the consumption information if the risk assessment parameter meets the preset medical insurance risk control condition.

10. A computer device, characterized in that: include: A processor, a storage medium and a bus, wherein the storage medium stores program instructions executable by the processor, and when the computer device is running, the processor and the storage medium communicate through the bus, and the processor executes the program instructions to perform the steps of the risk control method as described in any one of claims 1 to 5.

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