Medical insurance settlement system, method and equipment based on micro-service architecture and medium

Abstract

The invention relates to the technical field of medical insurance settlement, in particular to a micro-service architecture-based medical insurance settlement system, method, device and medium, comprising a WeChat service access module, a business logic processing module and a data storage module, the WeChat service access module is used for docking with a WeChat platform and introducing a load balancing mechanism, and the business logic processing module is used for processing the data storage module; the response speed and stability of the medical insurance settlement system are improved, so that the medical insurance settlement efficiency is improved. And the business logic processing module is used for receiving the user request sent by the WeChat service access module, performing medical insurance settlement business processing based on the user request, determining medical insurance business information, and executing data interaction with the data storage module. In order to ensure the security and expandability of the data and meet the high requirement of the medical insurance settlement service on the data, the data storage module is used for storing the medical insurance service information and the multi-dimensional data in the medical insurance system and the hospital information system by using the distributed database.

Description

Technical Field

[0001] The present application relates to the technical field of medical insurance settlement, and in particular to a medical insurance settlement system, method, device and medium based on a microservice architecture. Background Art

[0002] In today's society, the medical security system, as an important part of the national social security system, is directly related to the health and well-being of the people and social stability. With the continuous advancement of medical technology and the aging of the population, the demand for medical care is growing. As a key link between medical institutions, patients and medical insurance institutions, the importance of medical insurance settlement is becoming increasingly prominent.

[0003] However, when faced with an increasingly complex medical environment and rapidly growing medical needs, traditional medical insurance settlement systems are unable to cope with high concurrency and large data processing requirements due to limited system processing capabilities, resulting in low medical insurance settlement efficiency.

[0004] Therefore, how to improve the efficiency of medical insurance settlement is an urgent problem to be solved by technical personnel in this field. Summary of the invention

[0005] The purpose of this application is to provide a medical insurance settlement system, method, device and medium based on a microservice architecture to solve at least one of the above technical problems.

[0006] The above invention objectives of the present application are achieved through the following technical solutions: In the first aspect, the present application provides a medical insurance settlement system based on a microservice architecture, which adopts the following technical solutions: A medical insurance settlement system based on microservice architecture, including: WeChat service access module, business logic processing module and data storage module, wherein: WeChat service access module, which is used to connect with the WeChat platform and introduce a load balancing mechanism to ensure that user requests received by the medical insurance settlement system through the WeChat platform are evenly distributed to multiple servers; A business logic processing module, used to receive the user request sent by the WeChat service access module, perform medical insurance settlement business processing based on the user request, determine medical insurance business information, and perform data interaction with the data storage module; The data storage module is used to utilize a distributed database to store the medical insurance business information, multi-dimensional data in the medical insurance system and the hospital information system.

[0007] By adopting the above technical solution, a medical insurance settlement system based on a microservice architecture includes a WeChat service access module, a business logic processing module and a data storage module. The medical insurance settlement system adopts a microservice architecture, splits the system into multiple small, independent service units, and each service unit runs in its independent process. The services communicate with each other using a lightweight communication mechanism, which improves the scalability, flexibility and maintainability of the medical insurance settlement system and realizes the high cohesion and low coupling of the medical insurance settlement system. The WeChat service access module is used to connect with the WeChat platform and introduce a load balancing mechanism to improve the response speed and stability of the medical insurance settlement system, thereby improving the efficiency of medical insurance settlement. The business logic processing module is used to receive user requests sent by the WeChat service access module, perform medical insurance settlement business processing based on user requests, determine medical insurance business information, and perform data interaction with the data storage module. In order to ensure the security and scalability of data and meet the high requirements of medical insurance settlement business for data, the data storage module is used to use a distributed database to store medical insurance business information, medical insurance system and multi-dimensional data in the hospital information system.

[0008] In a preferred example, the present application can be further configured as follows: the WeChat service access module is also used to: When the user request sent by the WeChat platform is detected, user identity authentication is performed based on the user request, and an identity authentication result is determined; When the identity authentication result is that the authentication is passed, the user request that has passed the authentication is sent to the business logic processing module; When the identity authentication result is a verification failure, the user request that failed the verification is rejected, and the user request is added to the request monitoring queue to ensure the accuracy and security of the user identity.

[0009] In a preferred example, the present application may be further configured as follows: when the business logic processing module performs the medical insurance settlement business processing based on the user request and determines the medical insurance business information, it is used to: Performing a request type analysis based on the user request to determine the user request type, wherein the user request type includes: a medical insurance settlement request; Performing user request analysis based on the user request type and the user request, and determining data to be processed and a business processing flow; Medical insurance settlement business processing is performed based on the data to be processed and the business processing flow to determine the medical insurance business information.

[0010] In a preferred example, the present application can be further configured as follows: when the user request type is the medical insurance settlement request, When performing user request analysis based on the user request type and the user request and determining the data to be processed and the business processing flow, the business logic processing module is used to: Performing a process analysis based on the user request type to determine the business processing process, wherein the business processing process includes: order processing, cost calculation, medical insurance policy application, and settlement processing; The data to be processed is determined based on the user request type and the user request, wherein the data to be processed includes: user information, medical service details, cost details, and medical insurance policy information.

[0011] In a preferred example, the present application may be further configured as follows: when the business logic processing module performs the medical insurance settlement business processing based on the data to be processed and the business processing flow and determines the medical insurance business information, it is used to: Perform order processing based on the user information, the medical service details and the fee details in the data to be processed to obtain a medical insurance settlement order; Calculate the cost based on the medical insurance settlement order to determine the medical insurance reimbursement cost and the out-of-pocket expense, and apply the medical insurance policy based on the medical insurance policy information, the medical insurance reimbursement cost and the out-of-pocket expense to determine the medical insurance settlement review result; When the medical insurance settlement audit result is passed, the medical insurance reimbursement expenses and the out-of-pocket expenses are determined as the medical insurance business information, and the medical insurance business information is sent to the WeChat platform through the WeChat service access module, and data is interacted with the data storage module according to the medical insurance business information to complete the medical insurance settlement operation.

[0012] In a preferred example, the present application may be further configured as follows: the business logic processing module is also used to: Obtaining the medical insurance type, insurance information, health status and medical needs from the data storage module, and performing medical insurance policy analysis based on the medical insurance type and the insurance information to determine the medical insurance analysis details; Based on the health condition and the medical needs, project recommendations are made, recommended medical insurance projects are determined, and the medical insurance analysis details and the recommended medical insurance projects are sent to the WeChat platform through the WeChat service access module.

[0013] In the second aspect, the present application provides a medical insurance settlement method based on a microservice architecture, which adopts the following technical solutions: Connect with the WeChat platform and introduce a load balancing mechanism to ensure that user requests received by the medical insurance settlement system through the WeChat platform are evenly distributed to multiple servers; Receive a user request, perform medical insurance settlement business processing based on the user request, and determine medical insurance business information; A distributed database is used to store the medical insurance business information, the multi-dimensional data in the medical insurance system and the hospital information system.

[0014] In a third aspect, the present application provides an electronic device, which adopts the following technical solution: at least one processor; Memory; At least one application, wherein the at least one application is stored in a memory and configured to be executed by at least one processor, and the at least one application is configured to: execute the above-mentioned medical insurance settlement method based on microservice architecture.

[0015] In a fourth aspect, the present application provides a computer-readable storage medium, which adopts the following technical solution: A computer-readable storage medium stores a computer program, which, when executed in a computer, causes the computer to execute the above-mentioned medical insurance settlement method based on a microservice architecture.

[0016] In summary, the present application includes at least one of the following beneficial technical effects: The medical insurance settlement system based on microservice architecture includes WeChat service access module, business logic processing module and data storage module. The medical insurance settlement system adopts microservice architecture, splits the system into multiple small and independent service units, each service unit runs in its independent process, and uses lightweight communication mechanism to communicate with each other, which improves the scalability, flexibility and maintainability of the medical insurance settlement system and realizes the high cohesion and low coupling of the medical insurance settlement system. The WeChat service access module is used to connect with the WeChat platform and introduce the load balancing mechanism to improve the response speed and stability of the medical insurance settlement system, thereby improving the efficiency of medical insurance settlement. The business logic processing module is used to receive user requests sent by the WeChat service access module, process medical insurance settlement business based on user requests, determine medical insurance business information, and perform data interaction with the data storage module. In order to ensure the security and scalability of data and meet the high requirements of medical insurance settlement business for data, the data storage module is used to use a distributed database to store medical insurance business information, medical insurance system and multi-dimensional data in the hospital information system.

[0017] Request type analysis is performed based on user requests to determine the user request type. Then, user request analysis is performed based on the user request type and user request to determine the data to be processed and the business processing flow. User request analysis helps ensure the accuracy and completeness of the data to be processed. Selecting the appropriate business processing flow also helps to simplify the operation process and improve the degree of automation of business processing. Finally, medical insurance settlement business processing is performed based on the data to be processed and the business processing flow to determine the medical insurance business information. BRIEF DESCRIPTION OF THE DRAWINGS

[0018] Figure 1 This is a flowchart of a medical insurance settlement system based on a microservice architecture according to one embodiment of the present application; Figure 2 This is a structural diagram of a medical insurance settlement method based on a microservice architecture in one embodiment of the present application; Figure 3 It is a structural schematic diagram of an electronic device according to one embodiment of the present application. DETAILED DESCRIPTION

[0019] The following combination Figures 1 to 3 This application is described in further detail.

[0020] This specific embodiment is merely an explanation of the present application and is not a limitation of the present application. After reading this specification, a person skilled in the art may make non-creative modifications to the present embodiment as needed, but such modifications are protected by the patent law as long as they are within the scope of the present application.

[0021] In order to make the purpose, technical scheme and advantages of the embodiment of the present application clearer, the technical scheme in the embodiment of the present application will be clearly and completely described in conjunction with the drawings in the embodiment of the present application. Obviously, the described embodiment is a part of the embodiment of the present application, not all of the embodiments. Based on the embodiments in the present application, all other embodiments obtained by ordinary technicians in the field without creative work are within the scope of protection of the present application. It should be noted that in the optional embodiments of the present application, the object information and other related data involved, when the embodiments in the present application are applied to specific products or technologies, need to obtain the permission or consent of the object, and the collection, use and processing of the relevant data need to comply with the relevant laws, regulations and standards of the relevant countries and regions. In other words, if the data related to the object is involved in the embodiment of the present application, it needs to be obtained through the authorization and consent of the object, the authorization and consent of the relevant departments, and in accordance with the relevant laws, regulations and standards of the country and region. If personal information is involved in the embodiment, the acquisition of all personal information needs to obtain the consent of the individual. If sensitive information is involved, the separate consent of the information subject needs to be obtained, and the embodiment also needs to be implemented with the authorization and consent of the object.

[0022] In addition, the term "and / or" in this article is only a description of the association relationship of associated objects, indicating that there can be three relationships. For example, A and / or B can represent: A exists alone, A and B exist at the same time, and B exists alone. In addition, the character " / " in this article, unless otherwise specified, generally means that the associated objects before and after are in an "or" relationship.

[0023] The embodiments of the present application are further described in detail below in conjunction with the drawings in the specification.

[0024] The embodiment of the present application provides a medical insurance settlement system based on a microservice architecture, including: a WeChat service access module 101, a business logic processing module 102 and a data storage module 103. The medical insurance settlement system adopts a microservice architecture, which aims to split large applications into a series of small, autonomous services to improve the scalability, flexibility and maintainability of the medical insurance settlement system, and realize the high cohesion and low coupling of the medical insurance settlement system. The WeChat service access module 101 is used to connect with the WeChat platform and introduce a load balancing mechanism to ensure that the user requests received by the medical insurance settlement system through the WeChat platform are evenly distributed to multiple servers; the business logic processing module 102 is used to receive the user request sent by the WeChat service access module 101, perform medical insurance settlement business processing based on the user request, determine the medical insurance business information, and perform data interaction with the data storage module 103; the data storage module 103 is used to use a distributed database to store medical insurance business information, medical insurance system and multi-dimensional data in the hospital information system. The introduction of a load balancing mechanism in the WeChat service access module 101 improves the response speed and stability of the medical insurance settlement system, thereby improving the efficiency of medical insurance settlement.

[0025] A medical insurance settlement system based on microservice architecture, such as Figure 1 As shown, the system includes a WeChat service access module 101, a business logic processing module 102 and a data storage module 103, wherein: The WeChat service access module 101 is used to connect with the WeChat platform and introduce a load balancing mechanism to ensure that the user requests received by the medical insurance settlement system through the WeChat platform are evenly distributed to multiple servers; For the embodiment of the present application, the medical insurance settlement system adopts a microservice architecture, splitting the system into multiple small, independent service units, each service unit running in its independent process, and using a lightweight communication mechanism to communicate between services, thereby improving the scalability, flexibility and maintainability of the medical insurance settlement system, and achieving high cohesion and low coupling of the medical insurance settlement system. Therefore, a WeChat service access module 101 is designed in the medical insurance settlement system for docking with the WeChat platform, that is, the platform can be docked through an API interface, and is responsible for receiving user requests sent by the WeChat platform and performing preliminary processing, which can be used to implement WeChat-related authentication and authorization logic to ensure the security and legitimacy of user requests. In order to improve the response speed and stability of the medical insurance settlement system, reduce the waiting time of users and the risk of system crash, a load balancing mechanism is introduced in the WeChat service access module 101, and the WeChat service access module 101 is deployed on multiple servers to form a server cluster, and Nginx is deployed at the front end of the server cluster as a load balancer, which is responsible for evenly distributing the received WeChat platform requests to the back-end servers. Among them, Nginx supports multiple load balancing algorithms, such as Round Robin, Least Connections, IP Hash, etc. The introduction of the load balancing mechanism in the WeChat service access module 101 improves the response speed and stability of the medical insurance settlement system, thereby improving the efficiency of medical insurance settlement.

[0026] The business logic processing module 102 is used to receive the user request sent by the WeChat service access module 101, perform medical insurance settlement business processing based on the user request, determine the medical insurance business information, and perform data interaction with the data storage module 103; For the embodiment of the present application, in the medical insurance settlement system using the microservice architecture, a business logic processing module 102 is also provided, and the business logic processing module 102 will receive the user request sent by the WeChat service access module 101, parse the user request, and perform business processing according to the medical insurance policy and rules to determine the medical insurance business information. Of course, during the processing of the business logic processing module 102, the business logic processing module 102 will interact with the data storage module 103 to obtain the necessary medical insurance policy information and user information, or store the medical insurance business information corresponding to the processing result in the data storage module 103 for subsequent query and statistics. The medical insurance settlement business includes, but is not limited to: payment information query, medical insurance online authorization, payment information detail upload, medical settlement information viewing, online payment, and payment result query. Of course, it can also include other medical insurance settlement businesses, which are no longer limited in the embodiment of the present application.

[0027] The data storage module 103 is used to store medical insurance business information, medical insurance system and multi-dimensional data in the hospital information system using a distributed database.

[0028] For the embodiment of the present application, a data storage module 103 is also provided in the medical insurance settlement system adopting the microservice architecture. The data storage module 103 is the core part of the medical insurance settlement system and is responsible for storing and managing medical insurance business information, multi-dimensional data in the medical insurance system and the hospital information system. In order to ensure the security and scalability of the data and meet the high requirements of the medical insurance settlement business for data, the data storage module 103 adopts distributed database technology.

[0029] Specifically, according to the business requirements and data characteristics of the medical insurance settlement system, select a suitable distributed database. For example, you can choose a distributed relational database or NoSQL database that supports high concurrency, high availability and data consistency. Then, configure the distributed database, including the number of database nodes, storage capacity, network topology, etc., to ensure that the database can support the business requirements of the medical insurance settlement system and has sufficient redundancy and fault tolerance. Furthermore, according to factors such as data access frequency, business logic and data source, the medical insurance business information, medical insurance system and hospital information system multi-dimensional data are reasonably partitioned and sharded, which helps to improve data access efficiency and reduce database load.

[0030] It can be seen that in the embodiment of the present application, the medical insurance settlement system based on the microservice architecture includes a WeChat service access module 101, a business logic processing module 102 and a data storage module 103. The medical insurance settlement system adopts a microservice architecture, splits the system into multiple small, independent service units, and each service unit runs in its independent process. The services communicate with each other using a lightweight communication mechanism, which improves the scalability, flexibility and maintainability of the medical insurance settlement system and realizes the high cohesion and low coupling of the medical insurance settlement system. The WeChat service access module 101 is used to connect with the WeChat platform and introduce a load balancing mechanism to improve the response speed and stability of the medical insurance settlement system, thereby improving the efficiency of medical insurance settlement. The business logic processing module 102 is used to receive user requests sent by the WeChat service access module 101, perform medical insurance settlement business processing based on user requests, determine medical insurance business information, and perform data interaction with the data storage module 103. In order to ensure the security and scalability of data and meet the high requirements of the medical insurance settlement business for data, the data storage module 103 is used to use a distributed database to store medical insurance business information, medical insurance system and multi-dimensional data in the hospital information system.

[0031] Furthermore, in order to prevent unauthorized access and potential security threats and protect sensitive data and user privacy in the medical insurance settlement system, in the embodiment of the present application, the WeChat service access module 101 is also used to: When a user request sent by the WeChat platform is detected, user identity authentication is performed based on the user request, and the identity authentication result is determined; When the identity authentication result is that the authentication is passed, the authenticated user request is sent to the business logic processing module 102; When the identity authentication result is a verification failure, the user request that failed the verification will be rejected and the user request will be added to the request monitoring queue to ensure the accuracy and security of the user identity.

[0032] For the embodiment of the present application, in the medical insurance settlement system based on the microservice architecture, the WeChat service access module 101 assumes the important responsibilities of connecting with the WeChat platform and preliminarily processing user requests. For user requests initiated by users through the WeChat platform, user identity authentication is a core link. By verifying the identity of the accessing user, unauthorized access and potential security threats can be prevented, thereby protecting sensitive data and user privacy in the medical insurance settlement system.

[0033] Therefore, when a user request sent by the WeChat platform is detected, the WeChat service access module 101 first parses the user request, extracts key information in the user request, such as user ID, request type, request parameters, etc., and extracts information related to user identity authentication from the parsed request, such as login credentials provided by the user (such as WeChat OpenID, Session Key, etc.) or other identity authentication identifiers. Then, according to the identity authentication strategy set by the medical insurance settlement system, the identity authentication information provided by the user is verified to determine whether the user has the right to perform the currently requested operation. The identity authentication strategy can be: interacting with the API provided by the WeChat platform to verify the validity of the user login credentials; of course, the correctness of the user identity information can also be checked according to the user database pre-set by the medical insurance settlement system. Then, according to the application result of the identity authentication strategy, the identity authentication result is determined; if the identity authentication information extracted from the user request matches the information recorded by the system, and the user has the corresponding authority, the identity authentication result is determined to be passed; otherwise, the identity authentication result is determined to be failed.

[0034] Furthermore, when the identity authentication result is verification passed, it indicates that the user is a legitimate user and has the right to access and operate the relevant services of the medical insurance settlement system. Therefore, the WeChat service access module 101 will encapsulate the user request that has passed the verification, including all parameters of the user request and the identity authentication result, and send the encapsulated information to the business logic processing module 102 for further processing. When the identity authentication result is verification failure, it indicates that the user may be an illegal user, or the provided identity authentication information is incorrect. The WeChat service access module 101 will reject the user request that failed the verification and will not send it to the business logic processing module 102. At the same time, in order to ensure the accuracy and security of the user identity, the WeChat service access module 101 will add the user request that failed the verification to the request monitoring queue, which is used to record all user requests that failed the verification for subsequent auditing and troubleshooting. For each user request added to the request monitoring queue, the WeChat service access module 101 will record detailed log information, including request time, user ID (if available), request type, identity authentication result, etc.

[0035] It can be seen that in the embodiment of the present application, when a user request sent by the WeChat platform is detected, user identity authentication is performed based on the user request to determine the identity authentication result. When the identity authentication result is that the authentication is passed, the user request that has passed the authentication is sent to the business logic processing module 102. When the identity authentication result is that the authentication fails, the user request that failed the authentication is rejected, and the user request is added to the request monitoring queue to ensure the accuracy and security of the user identity. By verifying the identity of the accessing user, unauthorized access and potential security threats can be prevented, thereby protecting sensitive data and user privacy in the medical insurance settlement system.

[0036] Furthermore, in order to ensure the accuracy and completeness of the data to be processed and improve the degree of automation of business processing, in the embodiment of the present application, the business logic processing module 102, when performing medical insurance settlement business processing based on user requests and determining medical insurance business information, is used to: Performing a request type analysis based on the user request to determine the user request type, wherein the user request type includes: medical insurance settlement request; Perform user request analysis based on user request type and user request to determine the data to be processed and the business processing flow; Carry out medical insurance settlement business processing based on the data to be processed and the business processing flow to determine the medical insurance business information.

[0037] For the embodiment of the present application, in the process of executing the medical insurance settlement business processing, the user request type is analyzed to quickly determine the user request type, so that the business logic processing module 102 can accurately locate the data to be processed and the most appropriate business processing flow. This helps to ensure the accuracy and completeness of the data to be processed, and the selection of the appropriate business processing flow also helps to simplify the operation process and improve the degree of automation of business processing.

[0038] Specifically, preprocessing is performed based on the user request to obtain the preprocessed user request, wherein the preprocessing includes but is not limited to: parsing the request body, extracting key information, and checking the legitimacy of the request. Then, the business logic processing module 102 matches the request through a preset keyword library to identify the request type, wherein the preset keyword library includes identifiers of various request types, such as "settlement", "query", "modification", etc. However, when the keyword match is insufficient and the request type cannot be determined, the business logic processing module 102 can use pattern recognition technology to perform further request type analysis, that is, by analyzing the URL structure, request parameters, request body format and other features of the request, the system can identify the category to which the request belongs. For user request types, they include but are not limited to: medical insurance settlement request, payment information query request, medical insurance online authorization request, medical settlement information viewing request, and paid result query request.

[0039] Then, based on the user request type and the user request, the user request analysis is performed to determine the data to be processed and the business processing flow, wherein the business logic processing module 102 pre-stores the correspondence between the user request type and the data type, and the correspondence between the user request type and the business processing flow, and at the same time, the requesting user information is marked in the user request, so that the business processing flow can be quickly and accurately screened out, and the data to be processed corresponding to the requesting user and the data type can be selected. Then, based on the data to be processed and the business processing flow, the medical insurance settlement business processing is performed to determine the medical insurance business information. For the medical insurance settlement business processing, a series of processing can be performed on the data to be processed according to the business processing flow to obtain the medical insurance business information.

[0040] It can be seen that in the embodiment of the present application, a request type analysis is performed based on the user request to determine the user request type, and then a user request analysis is performed based on the user request type and the user request to determine the data to be processed and the business processing flow. User request analysis helps to ensure the accuracy and completeness of the data to be processed, and selecting an appropriate business processing flow also helps to simplify the operating process and improve the degree of automation of business processing. Finally, medical insurance settlement business processing is performed based on the data to be processed and the business processing flow to determine the medical insurance business information.

[0041] Furthermore, in order to provide a more convenient and efficient medical insurance settlement service and improve user satisfaction and loyalty, in the embodiment of the present application, when the user request type is a medical insurance settlement request, When performing user request analysis based on user request type and user request and determining data to be processed and business processing flow, the business logic processing module 102 is used to: Conduct process analysis based on user request types to determine the business processing flow, which includes: order processing, cost calculation, medical insurance policy application, and settlement processing; Data is read based on the user request type and user request to determine the data to be processed, where the data to be processed includes: user information, medical service details, cost details, and medical insurance policy information.

[0042] For the embodiment of the present application, the business logic processing module 102 pre-stores the correspondence between the user request type and the business processing flow. When the user request type is a medical insurance settlement request, a process analysis is performed based on the user request type and the above correspondence to quickly and accurately determine the business processing flow corresponding to the medical insurance settlement request. For the business processing flow of the medical insurance settlement request, the business processing flow includes: order processing, cost calculation, medical insurance policy application, and settlement processing, wherein order processing is used to receive and analyze the medical insurance settlement request proposed by the user, verify the user's identity and medical insurance qualification, generate and initialize the medical insurance settlement order, and provide basic data support for subsequent processes; cost calculation is used to calculate the total cost of the patient according to the service details in the order, apply the preset cost calculation rules, and preliminarily divide the medical insurance reimbursement costs and out-of-pocket expenses according to the medical insurance policy; medical insurance policy application is used to retrieve and verify the medical insurance policy applicable to the current patient, accurately calculate the amount to be paid by the medical insurance pooling fund according to the policy information, and update the medical insurance payment part information in the order; settlement processing is used to interact with the payment system to complete the payment of the medical insurance fund and the deduction of the patient's out-of-pocket part.

[0043] At the same time, the business logic processing module 102 pre-stores the corresponding relationship between the user request type and the data type, so the data type to be read corresponding to the medical insurance settlement request can be quickly and accurately determined, and data can be read based on the user request and the data type to be read to determine the data to be processed, which includes: user information, medical service details, cost details, and medical insurance policy information. User information mainly describes the patient's identity, medical insurance status, contact information and other basic information, which is the basic data for processing medical insurance settlement requests; medical service details record the specific medical service items, time, location and medical institutions providing services received by the patient, which is an important basis for cost calculation and medical insurance policy application; cost details list in detail the various expenses incurred in the process of receiving medical services, including drug fees, medical treatment fees, examination fees, etc., which is the basis for calculating the total cost of the patient and the medical insurance payment part; medical insurance policy information contains key information such as medical insurance policy terms, reimbursement ratios, deductible standards, and caps applicable to the current patient, which is the basis for accurately calculating the amount of medical insurance payment. The data to be processed together constitute the key information required in the medical insurance settlement processing process, providing strong support for accurately and efficiently processing medical insurance settlement requests. Through fast and accurate business processing procedures and data reading, the business logic processing module 102 can provide users with more convenient and efficient medical insurance settlement services, thereby improving user satisfaction and loyalty.

[0044] It can be seen that in the embodiment of the present application, a process analysis is performed based on the user request type to determine the business processing process, wherein the business processing process includes: order processing, cost calculation, medical insurance policy application, and settlement processing. Then, data reading is performed based on the user request type and user request to determine the data to be processed, wherein the data to be processed includes: user information, medical service details, cost details, and medical insurance policy information. Through fast and accurate business processing flow and data reading, the business logic processing module 102 can provide users with more convenient and efficient medical insurance settlement services, thereby improving user satisfaction and loyalty.

[0045] Furthermore, in order to ensure the accuracy of medical insurance reimbursement expenses and out-of-pocket expenses, in the embodiment of the present application, the business logic processing module 102 performs medical insurance settlement business processing based on the data to be processed and the business processing flow to determine the medical insurance business information, and is used to: Process the order based on the user information, medical service details and cost details in the data to be processed, and obtain the medical insurance settlement order; Calculate costs based on medical insurance settlement orders, determine medical insurance reimbursement costs and out-of-pocket expenses, apply medical insurance policies based on medical insurance policy information, medical insurance reimbursement costs and out-of-pocket expenses, and determine medical insurance settlement review results; When the medical insurance settlement audit result is passed, the medical insurance reimbursement expenses and out-of-pocket expenses are determined as medical insurance business information, and the medical insurance business information is sent to the WeChat platform through the WeChat service access module 101, and data is interacted with the data storage module 103 according to the medical insurance business information to complete the medical insurance settlement operation.

[0046] For the embodiment of the present application, data verification is performed based on the user information, medical service details and cost details in the data to be processed to ensure the completeness and accuracy of the data to be processed, and the data to be processed after data verification is used for order processing to generate a medical insurance settlement order. Then, the cost details are extracted from the medical insurance settlement order, including the cost of various medical services, drug costs, examination costs, etc., and key information such as the medical insurance type and medical insurance status in the user information are extracted at the same time. According to the medical insurance policy information, it is determined whether each expense falls within the scope of medical insurance payment. For expenses that fall within the scope of medical insurance payment, the reimbursement ratio specified in the medical insurance policy is calculated. Then, all medical insurance reimbursement expenses are added together to obtain the medical insurance reimbursement expenses, and the total medical insurance reimbursement expenses are subtracted from the total expenses to obtain the out-of-pocket expenses.

[0047] Then, the business logic processing module 102 pre-sets a medical insurance settlement review mechanism, that is, the medical insurance settlement review mechanism can check whether the result of the cost calculation is accurate according to the medical insurance policy information. The medical insurance settlement review mechanism can be automatically calculated or manually reviewed and calculated by the business logic processing module. The specific implementation method of the medical insurance settlement review is no longer limited in the embodiment of the present application, and the user can set it according to the needs. According to the accuracy of the cost calculation and the compliance of the medical insurance policy application, the medical insurance settlement review result is determined, wherein the medical insurance settlement review result includes: review passed and review failed. Through accurate cost calculation and medical insurance policy application, the accuracy of medical insurance reimbursement expenses and self-paid expenses is ensured, and economic losses caused by calculation errors or improper policy understanding are avoided. Furthermore, when the medical insurance settlement review result is reviewed and passed, the medical insurance reimbursement expenses and self-paid expenses are determined as medical insurance business information, and the medical insurance business information is sent to the WeChat platform through the WeChat service access module 101, and data is interacted with the data storage module 103 according to the medical insurance business information to complete the medical insurance settlement operation. The business logic processing module 102 can process medical insurance settlement requests in real time, quickly generate medical insurance settlement orders and cost calculation results, and improve the efficiency of medical insurance settlement.

[0048] It can be seen that in the embodiment of the present application, order processing is performed based on the user information, medical service details and cost details in the data to be processed to obtain a medical insurance settlement order. Then, based on the medical insurance settlement order, the cost calculation is performed to determine the medical insurance reimbursement costs and out-of-pocket expenses, and the medical insurance policy is applied based on the medical insurance policy information, the medical insurance reimbursement costs and out-of-pocket expenses to determine the medical insurance settlement review result. Through accurate cost calculation and medical insurance policy application, the accuracy of medical insurance reimbursement costs and out-of-pocket expenses is ensured, and economic losses caused by calculation errors or improper policy understanding are avoided. When the medical insurance settlement review result is approved, the medical insurance reimbursement costs and out-of-pocket expenses are determined as medical insurance business information, and the medical insurance business information is sent to the WeChat platform through the WeChat service access module 101, and data interaction is performed with the data storage module 103 according to the medical insurance business information to complete the medical insurance settlement operation.

[0049] Furthermore, in order to enhance user satisfaction and trust and help users better understand and choose medical insurance items that suit them, in the embodiment of the present application, the business logic processing module 102 is also used to: Obtain the medical insurance type, insurance information, health status and medical needs from the data storage module 103, and perform medical insurance policy analysis based on the medical insurance type and insurance information to determine the medical insurance analysis details; Project recommendations are made based on health conditions and medical needs, recommended medical insurance projects are determined, and medical insurance analysis details and recommended medical insurance projects are sent to the WeChat platform through the WeChat service access module 101.

[0050] For the embodiment of the present application, a database including various medical insurance policies is pre-constructed in the business logic processing module 102. These medical insurance policies include but are not limited to: reimbursement ratio, reimbursement scope, deductible, ceiling, special disease reimbursement policy, etc. At the same time, in order to ensure the timeliness and accuracy of the policy database, it is necessary to update it regularly to reflect the latest changes in medical insurance policies. Therefore, according to the medical insurance type and insurance information, the corresponding policy terms are matched from the medical insurance policy database, and the matched policy terms are analyzed in detail. The analysis dimensions include but are not limited to: specific items of reimbursement scope, calculation method of reimbursement ratio, specific values ​​of deductible and ceiling, etc. Then, the analysis results of the policy terms are recorded as medical insurance analysis details. Personalized medical insurance policy analysis not only improves the accuracy of the policy, but also enhances user satisfaction and trust.

[0051] On the other hand, a database including various medical insurance projects is pre-built in the business logic processing module 102. Medical insurance projects include but are not limited to basic medical insurance, supplementary medical insurance, commercial health insurance, medical assistance, etc. In order to ensure the comprehensiveness and timeliness of the medical insurance project library, it covers medical security needs at different levels and is regularly updated to reflect the latest changes in medical insurance policies. Furthermore, according to the individual's health status and medical needs, the corresponding medical insurance projects are matched from the medical insurance project library. In the process of matching medical insurance projects, the key terms such as the coverage, reimbursement ratio, deductible, and capping of the medical insurance projects are considered to ensure that the recommended medical insurance projects can meet the actual needs of the individuals. Then, according to the matching results, a recommended medical insurance project containing key information such as the name of the recommended medical insurance project, the coverage, reimbursement ratio, deductible, and capping is generated. The intelligent recommendation method not only improves the pertinence of medical insurance services, but also helps users better understand and choose medical insurance projects that suit them. Finally, the medical insurance analysis details and recommended medical insurance projects are sent to the WeChat platform through the WeChat service access module 101.

[0052] It can be seen that in the embodiment of the present application, the medical insurance policy is parsed based on the medical insurance type and the insurance information, and the details of the medical insurance parsing are determined. The personalized medical insurance policy parsing not only improves the accuracy of the policy, but also enhances the user's satisfaction and trust. Project recommendations are made based on health conditions and medical needs, and recommended medical insurance projects are determined. The intelligent recommendation method not only improves the pertinence of medical insurance services, but also helps users better understand and choose medical insurance projects that suit them. Finally, the medical insurance parsing details and recommended medical insurance projects are sent to the WeChat platform through the WeChat service access module 101.

[0053] The above embodiment introduces a medical insurance settlement system based on a microservice architecture from the perspective of a device. The following embodiment introduces a medical insurance settlement method based on a microservice architecture from the perspective of a method flow. For details, please refer to the following embodiment.

[0054] The present application embodiment provides a medical insurance settlement method based on a microservice architecture, which is executed by an electronic device, such as Figure 2 As shown, the method includes step S201, step S202, and step S203, wherein: Step S201: connecting with the WeChat platform and introducing a load balancing mechanism to ensure that user requests received by the medical insurance settlement system through the WeChat platform are evenly distributed to multiple servers; Step S202: receiving a user request, performing medical insurance settlement business processing based on the user request, and determining medical insurance business information; Step S203: Utilize a distributed database to store medical insurance business information, medical insurance systems, and multi-dimensional data in hospital information systems.

[0055] It can be seen that in the embodiment of the present application, the connection with the WeChat platform and the introduction of a load balancing mechanism improve the response speed and stability of the medical insurance settlement system, thereby improving the efficiency of medical insurance settlement. Then, the user request sent by the WeChat service access module 101 is received, the medical insurance settlement business is processed based on the user request, the medical insurance business information is determined, and data interaction is performed with the data storage module 103. In order to ensure the security and scalability of the data and meet the high requirements of the medical insurance settlement business for data, a distributed database is used to store medical insurance business information, medical insurance systems, and multi-dimensional data in hospital information systems.

[0056] Technical personnel in the relevant field can clearly understand that, for the convenience and conciseness of description, the specific working process of the medical insurance settlement method based on microservice architecture described above can refer to the corresponding process in the aforementioned method embodiment, and will not be repeated here.

[0057] An electronic device is provided in an embodiment of the present application, such as Figure 3 As shown, Figure 3 The electronic device 300 shown includes: a processor 301 and a memory 303. The processor 301 and the memory 303 are connected, such as through a bus 302. Optionally, the electronic device 300 may also include a transceiver 304. It should be noted that in actual applications, the transceiver 304 is not limited to one, and the structure of the electronic device 300 does not constitute a limitation on the embodiments of the present application.

[0058] The processor 301 may be a CPU (Central Processing Unit), a general-purpose processor, a DSP (Digital Signal Processor), an ASIC (Application Specific Integrated Circuit), an FPGA (Field Programmable Gate Array) or other programmable logic devices, transistor logic devices, hardware components or any combination thereof. It may implement or execute various exemplary logic blocks, modules and circuits described in conjunction with the disclosure of this application. The processor 301 may also be a combination that implements computing functions, such as a combination of one or more microprocessors, a combination of a DSP and a microprocessor, etc.

[0059] The bus 302 may include a path to transmit information between the above components. The bus 302 may be a PCI (Peripheral Component Interconnect) bus or an EISA (Extended Industry Standard Architecture) bus. The bus 302 may be divided into an address bus, a data bus, a control bus, etc. For ease of representation, Figure 3 Only one thick line is used in the diagram, but it does not mean that there is only one bus or only one type of bus.

[0060] The memory 303 may be a ROM (Read Only Memory) or other types of static storage devices that can store static information and instructions, a RAM (Random Access Memory) or other types of dynamic storage devices that can store information and instructions, or an EEPROM (Electrically Erasable Programmable Read Only Memory), a CD-ROM (Compact Disc Read Only Memory) or other optical disk storage, optical disk storage (including compressed optical disk, laser disk, optical disk, digital versatile disk, Blu-ray disk, etc.), a magnetic disk storage medium or other magnetic storage device, or any other medium that can be used to carry or store the desired program code in the form of instructions or data structures and can be accessed by a computer, but is not limited thereto.

[0061] The memory 303 is used to store the application code for executing the solution of the present application, and the execution is controlled by the processor 301. The processor 301 is used to execute the application code stored in the memory 303 to implement the contents shown in the above method embodiment.

[0062] The electronic devices include, but are not limited to, mobile terminals such as mobile phones, laptop computers, digital broadcast receivers, PDAs (personal digital assistants), PADs (tablet computers), PMPs (portable multimedia players), vehicle-mounted terminals (such as vehicle-mounted navigation terminals), and fixed terminals such as digital TVs, desktop computers, etc. It can also be a server, etc. Figure 3 The electronic device shown is merely an example and should not bring any limitation to the functions and scope of use of the embodiments of the present application.

[0063] An embodiment of the present application provides a computer-readable storage medium, on which a computer program is stored. When the computer-readable storage medium is run on a computer, the computer can execute the corresponding content in the aforementioned method embodiment.

[0064] The embodiment of the present application provides a computer program product, which includes a computer program, which implements the method in any of the above embodiments when executed by a processor. Compared with the related art, the embodiment of the present application is connected to the WeChat platform and introduces a load balancing mechanism, which improves the response speed and stability of the medical insurance settlement system, thereby improving the efficiency of medical insurance settlement. Then, the user request sent by the WeChat service access module 101 is received, the medical insurance settlement business is processed based on the user request, the medical insurance business information is determined, and data interaction is performed with the data storage module 103. In order to ensure the security and scalability of the data and meet the high requirements of the medical insurance settlement business for data, a distributed database is used to store medical insurance business information, medical insurance systems, and multi-dimensional data in hospital information systems.

[0065] It should be understood that, although the steps in the flowchart of the accompanying drawings are displayed in sequence as indicated by the arrows, these steps are not necessarily executed in sequence in the order indicated by the arrows. Unless otherwise specified herein, there is no strict order restriction on the execution of these steps, and they can be executed in other orders. Moreover, at least a part of the steps in the flowchart of the accompanying drawings may include multiple sub-steps or multiple stages, and these sub-steps or stages are not necessarily executed at the same time, but can be executed at different times, and their execution order is not necessarily sequential, but can be executed in turn or alternately with other steps or at least a part of the sub-steps or stages of other steps.

[0066] The above are only some implementation methods of the present application. It should be pointed out that for ordinary technicians in this technical field, several improvements and modifications can be made without departing from the principles of the present application. These improvements and modifications should also be regarded as the scope of protection of the present application.

Claims

1. A medical insurance settlement system based on microservice architecture, characterized in that: include: WeChat service access module, business logic processing module and data storage module, including: WeChat service access module, which is used to connect with the WeChat platform and introduce a load balancing mechanism to ensure that user requests received by the medical insurance settlement system through the WeChat platform are evenly distributed to multiple servers; A business logic processing module, used to receive the user request sent by the WeChat service access module, perform medical insurance settlement business processing based on the user request, determine medical insurance business information, and perform data interaction with the data storage module; The data storage module is used to utilize a distributed database to store the medical insurance business information, multi-dimensional data in the medical insurance system and the hospital information system.

2. According to the microservice architecture-based medical insurance settlement system of claim 1, it is characterized in that: The WeChat service access module is also used for: When the user request sent by the WeChat platform is detected, user identity authentication is performed based on the user request, and an identity authentication result is determined; When the identity authentication result is that the authentication is passed, the user request that has passed the authentication is sent to the business logic processing module; When the identity authentication result is a verification failure, the user request that failed the verification is rejected, and the user request is added to the request monitoring queue to ensure the accuracy and security of the user identity.

3. The medical insurance settlement system based on microservice architecture according to claim 1 is characterized in that: When the business logic processing module performs the medical insurance settlement business processing based on the user request and determines the medical insurance business information, it is used to: Performing a request type analysis based on the user request to determine the user request type, wherein the user request type includes: a medical insurance settlement request; Performing user request analysis based on the user request type and the user request, and determining data to be processed and a business processing flow; Medical insurance settlement business processing is performed based on the data to be processed and the business processing flow to determine the medical insurance business information.

4. The medical insurance settlement system based on microservice architecture according to claim 3 is characterized in that: When the user request type is the medical insurance settlement request, When performing user request analysis based on the user request type and the user request and determining the data to be processed and the business processing flow, the business logic processing module is used to: Performing a process analysis based on the user request type to determine the business processing process, wherein the business processing process includes: order processing, cost calculation, medical insurance policy application, and settlement processing; The data to be processed is determined based on the user request type and the user request, wherein the data to be processed includes: user information, medical service details, cost details, and medical insurance policy information.

5. The medical insurance settlement system based on microservice architecture according to claim 4 is characterized in that: When the business logic processing module performs the medical insurance settlement business processing based on the data to be processed and the business processing flow and determines the medical insurance business information, it is used to: Perform order processing based on the user information, the medical service details and the fee details in the data to be processed to obtain a medical insurance settlement order; Calculate the cost based on the medical insurance settlement order to determine the medical insurance reimbursement cost and the out-of-pocket expense, and apply the medical insurance policy based on the medical insurance policy information, the medical insurance reimbursement cost and the out-of-pocket expense to determine the medical insurance settlement review result; When the medical insurance settlement audit result is passed, the medical insurance reimbursement expenses and the out-of-pocket expenses are determined as the medical insurance business information, and the medical insurance business information is sent to the WeChat platform through the WeChat service access module, and data is interacted with the data storage module according to the medical insurance business information to complete the medical insurance settlement operation.

6. The medical insurance settlement system based on microservice architecture according to claim 1 is characterized in that: The business logic processing module is also used to: Obtaining the medical insurance type, insurance information, health status and medical needs from the data storage module, and performing medical insurance policy analysis based on the medical insurance type and the insurance information to determine the medical insurance analysis details; Based on the health condition and the medical needs, project recommendations are made, recommended medical insurance projects are determined, and the medical insurance analysis details and the recommended medical insurance projects are sent to the WeChat platform through the WeChat service access module.

7. A medical insurance settlement method based on microservice architecture, characterized in that: include: Connect with the WeChat platform and introduce a load balancing mechanism to ensure that user requests received by the medical insurance settlement system through the WeChat platform are evenly distributed to multiple servers; Receive a user request, perform medical insurance settlement business processing based on the user request, and determine medical insurance business information; A distributed database is used to store the medical insurance business information, the multi-dimensional data in the medical insurance system and the hospital information system.

8. An electronic device, characterized in that: include: at least one processor; Memory; At least one application, wherein the at least one application is stored in a memory and configured to be executed by at least one processor, and the at least one application is configured to: execute the medical insurance settlement method based on microservice architecture as described in claim 7.

9. A computer-readable storage medium, characterized in that: A computer program is stored thereon, and when the computer program is executed in a computer, the computer is caused to execute the medical insurance settlement method based on microservice architecture as described in claim 7.

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