Commercial insurance auditing method and system and storage medium

Abstract

The invention provides a commercial insurance auditing method and system and a storage medium, and the method comprises the steps: obtaining a hospital expense settlement list of a to-be-audited user and a to-be-audited commercial insurance text, and carrying out the character recognition of the hospital expense settlement list, and obtaining the total amount, injury and disease separation information and medical insurance deduction information; determining a deduction class of the injury and disease separation item according to the injury and disease separation information, and determining an injury and disease separation deduction amount according to a deduction proportion of the deduction class; and auditing the to-be-audited commercial insurance text according to the class B deduction amount, the class C deduction amount, the over-limit price deduction amount and the injury and disease separation deduction amount in the medical insurance deduction information to obtain a commercial insurance auditing result. According to the embodiment of the invention, the total amount, the injury and disease separation information and the medical insurance deduction information in the hospital expense settlement sheet are directly used for the to-be-audited commercial insurance text, the local medical insurance policy does not need to be concerned and relied on too much, the problem of inconsistent auditing caused by policy difference and update lag is reduced, and the accuracy of commercial insurance auditing is improved.

Description

Technical Field

[0001] The present invention relates to the field of smart medical technology, and in particular to a commercial insurance review method, system and storage medium. Background Art

[0002] At present, with the improvement of users' safety awareness, users gradually realize the importance of insurance, and more and more users join the ranks of purchasing commercial insurance. In the process of commercial insurance, the insurance company will enter the user's policy information, such as the information of the policyholder, the insured, the insurance period, the type of insurance, the insurance amount, the premium and medical insurance, etc. When a commercial insurance claim occurs, the commercial insurance report document needs to be reviewed first. After the review of the commercial insurance report document is completed, the insurance company will make a commercial insurance claim.

[0003] In the existing commercial insurance review process, commercial insurance documents are generally reviewed item by item manually based on local medical insurance policies. However, medical insurance policies vary greatly from place to place and are not updated in a timely manner, which makes the review process prone to errors and reduces the accuracy of commercial insurance reviews. Summary of the invention

[0004] The purpose of the embodiments of the present invention is to provide a commercial insurance review method, system and storage medium to solve the problem of low accuracy of commercial insurance review in the prior art.

[0005] The embodiment of the present invention is implemented as follows: a commercial insurance review method, the method comprising:

[0006] Obtain the hospital expense settlement form and commercial insurance text of the user to be reviewed, and perform character recognition on the hospital expense settlement form to obtain the total amount, injury and illness separation information, and medical insurance deduction information;

[0007] Determine the deduction category of the injury and illness separation item according to the injury and illness separation information, and determine the injury and illness separation deduction amount according to the deduction ratio of the deduction category;

[0008] The commercial insurance text to be reviewed is reviewed according to the Class B deduction amount, Class C deduction amount, over-price deduction amount and injury and illness separation deduction amount in the medical insurance deduction information to obtain the commercial insurance review result.

[0009] Preferably, the commercial insurance document to be reviewed is reviewed according to the Class B deduction amount, Class C deduction amount, over-limit deduction amount and injury and illness separation deduction amount in the medical insurance deduction information to obtain the commercial insurance review result, including:

[0010] Obtain the pending Class B amount, pending Class C amount, pending over-limit amount and pending injury and illness separation amount in the pending commercial insurance text;

[0011] Compare the Class B deduction amount with the Class B amount to be reviewed to obtain the Class B deduction review result, and compare the Class C deduction amount with the Class C amount to be reviewed to obtain the Class C deduction review result;

[0012] Compare the excess price deduction amount with the to-be-reviewed excess price amount to obtain an excess price deduction review result, and compare the injury and illness separation deduction amount with the to-be-reviewed injury and illness separation amount to obtain an injury and illness separation deduction review result;

[0013] Among them, the commercial insurance audit results include the audit results of Class B deductions, the audit results of Class C deductions, the audit results of over-price deductions and the audit results of injury and illness separation deductions.

[0014] Preferably, the commercial insurance document to be reviewed is reviewed according to the Class B deduction amount, Class C deduction amount, over-limit deduction amount and injury and illness separation deduction amount in the medical insurance deduction information, and after obtaining the commercial insurance review result, it also includes:

[0015] If any deduction audit result in the commercial insurance audit result fails to be compared, the deduction item corresponding to the deduction audit result is determined as an abnormal deduction item;

[0016] Matching the abnormal deduction items with the medical insurance catalog to obtain a target deduction ratio, and determining a target deduction amount based on the deduction amount of the abnormal deduction items and the target deduction ratio;

[0017] The commercial insurance document to be reviewed and the hospital expense settlement sheet are proofread according to the target deduction amount.

[0018] Preferably, proofreading the commercial insurance document to be reviewed and the hospital expense settlement form according to the target deduction amount includes:

[0019] Obtain the deduction amount of the abnormal deduction item in the commercial insurance document to be reviewed and the hospital expense settlement form, and obtain the deduction amount to be compared and the settlement deduction amount;

[0020] If the target deduction amount is different from the deduction amount to be compared, the abnormal deduction item is marked as an error in the commercial insurance document to be reviewed;

[0021] If the target deduction amount is different from the settlement deduction amount, the medical insurance deduction information is updated according to the settlement deduction amount.

[0022] Preferably, character recognition is performed on the hospital expense settlement form to obtain the total amount, injury and illness separation information, and medical insurance deduction information, including:

[0023] Binarizing the hospital expense settlement form to obtain a binary image, and denoising the binary image to obtain a denoised image;

[0024] Performing tilt correction on the denoised image to obtain a corrected image, and segmenting the text in the corrected image to obtain segmented paragraphs;

[0025] Performing character segmentation on the segmented paragraphs to obtain segmented characters, and performing character recognition on the segmented characters to obtain text characters;

[0026] The text characters are classified, and the total amount, the injury and illness separation information and the medical insurance deduction information are determined according to the character classification results.

[0027] Preferably, performing character recognition on the segmented characters to obtain text characters includes:

[0028] Obtaining a character contour of the segmented character, and calculating a contour similarity between the character contour and a preset contour;

[0029] The character corresponding to the preset contour with the maximum contour similarity is determined as the text character of the segmented character.

[0030] Preferably, before obtaining the hospital expense settlement sheet of the user to be reviewed and the commercial insurance text to be reviewed, the method further includes:

[0031] If the hospital expense settlement sheet is not obtained, then the Class B deduction items, Class C deduction items, injury and illness separation items, and over-limit price deduction items in the commercial insurance document to be reviewed are obtained;

[0032] Matching the Class B deduction items, the Class C deduction items, the injury and illness separation items, and the over-price deduction items with the medical insurance catalog to obtain the medical insurance deduction ratio;

[0033] Determine the Class B deduction amount, the Class C deduction amount, the over-limit price deduction amount and the injury and illness separation deduction amount according to the medical insurance deduction ratio and the item amounts of the Class B deduction items, the Class C deduction items, the injury and illness separation items and the over-limit price deduction items;

[0034] The commercial insurance text to be reviewed is reviewed based on the Class B deduction amount, the Class C deduction amount, the over-limit price deduction amount and the injury and illness separation deduction amount to obtain the commercial insurance review result.

[0035] Another object of an embodiment of the present invention is to provide a commercial insurance review system, the system comprising:

[0036] The character recognition module is used for the text segmentation module to obtain the hospital expense settlement form of the user to be reviewed and the commercial insurance text to be reviewed, and perform character recognition on the hospital expense settlement form to obtain the total amount, injury and illness separation information and medical insurance deduction information;

[0037] An injury and illness separation module, used to determine the deduction category of the injury and illness separation item according to the injury and illness separation information, and determine the injury and illness separation deduction amount according to the deduction ratio of the deduction category;

[0038] The commercial insurance review module is used to review the commercial insurance text to be reviewed according to the Class B deduction amount, Class C deduction amount, over-limit price deduction amount and injury and illness separation deduction amount in the medical insurance deduction information to obtain the commercial insurance review result.

[0039] Preferably, the commercial insurance review module is also used to:

[0040] Obtain the pending Class B amount, pending Class C amount, pending over-limit amount and pending injury and illness separation amount in the pending commercial insurance text;

[0041] Compare the Class B deduction amount with the Class B amount to be reviewed to obtain the Class B deduction review result, and compare the Class C deduction amount with the Class C amount to be reviewed to obtain the Class C deduction review result;

[0042] Compare the excess price deduction amount with the to-be-reviewed excess price amount to obtain an excess price deduction review result, and compare the injury and illness separation deduction amount with the to-be-reviewed injury and illness separation amount to obtain an injury and illness separation deduction review result;

[0043] Among them, the commercial insurance audit results include the audit results of Class B deductions, the audit results of Class C deductions, the audit results of over-price deductions and the audit results of injury and illness separation deductions.

[0044] The embodiment of the present invention directly uses the total amount, injury and illness separation information and medical insurance deduction information in the hospital expense settlement form to review the commercial insurance text, without paying too much attention to and relying on local medical insurance policies, reducing the problem of inconsistent reviews caused by policy differences and update lags, and improving the accuracy of commercial insurance reviews. BRIEF DESCRIPTION OF THE DRAWINGS

[0045] Figure 1 is a flow chart of a commercial insurance review method provided by a first embodiment of the present invention;

[0046] Figure 2 is a structural diagram of a commercial insurance review system provided by a second embodiment of the present invention;

[0047] Figure 3 It is a schematic diagram of the structure of a terminal device provided in the third embodiment of the present invention. DETAILED DESCRIPTION

[0048] In order to make the purpose, technical solution and advantages of the present invention more clearly understood, the present invention is further described in detail below in conjunction with the accompanying drawings and embodiments. It should be understood that the specific embodiments described herein are only used to explain the present invention and are not intended to limit the present invention.

[0049] In order to illustrate the technical solution of the present invention, a specific embodiment is provided below for illustration.

[0050] Embodiment 1

[0051] See also Figure 1 , is a flow chart of a commercial insurance review method provided by a first embodiment of the present invention. The commercial insurance review method can be applied to any device or system. The commercial insurance review method includes the steps of:

[0052] Step S10, obtaining the hospital expense settlement form of the user to be reviewed and the commercial insurance text to be reviewed, and performing character recognition on the hospital expense settlement form to obtain the total amount, injury and illness separation information and medical insurance deduction information;

[0053] Among them, by performing character recognition on the hospital expense settlement form, the total amount, injury and illness separation information, medical insurance deduction and other information in the hospital expense settlement form can be effectively extracted. The injury and illness separation information includes injury and illness separation items and the deduction categories corresponding to the injury and illness separation items. The deduction category can be Class A deduction, Class B deduction or Class C deduction. The medical insurance deduction information includes various deduction items and the corresponding deduction amounts.

[0054] Optionally, character recognition is performed on the hospital expense settlement form to obtain the total amount, injury and illness separation information, and medical insurance deduction information, including:

[0055] The hospital expense settlement form is binarized to obtain a binarized image, and the binarized image is denoised to obtain a denoised image; wherein, by binarizing the hospital expense settlement form, the hospital expense settlement form can be effectively converted into a grayscale image, and by denoising the binarized image, noise points in the binarized image are removed, thereby improving the image quality of the binarized image;

[0056] Performing tilt correction on the denoised image to obtain a corrected image, and segmenting the text in the corrected image to obtain segmented paragraphs; wherein, by performing tilt correction on the denoised image, segmentation operations in subsequent images are effectively facilitated;

[0057] Performing character segmentation on the segmented paragraphs to obtain segmented characters, and performing character recognition on the segmented characters to obtain text characters; wherein, by performing character segmentation on the segmented paragraphs, the recognition operation of the characters in the segmented paragraphs is facilitated;

[0058] The text characters are classified, and the total amount, the injury and illness separation information and the medical insurance deduction information are determined according to the character classification results; wherein, the text characters are matched with preset characters, and the total amount header, the injury and illness separation header and the medical insurance deduction header are determined according to the character matching results, the text characters corresponding to the total amount header are determined as the total amount, the text characters corresponding to the injury and illness separation header are determined as the injury and illness separation information, and the text characters corresponding to the medical insurance deduction header are determined as the medical insurance deduction information.

[0059] Further, character recognition is performed on the segmented characters to obtain text characters, including:

[0060] Obtaining the character contour of the segmented character, and calculating the contour similarity between the character contour and a preset contour; wherein the preset contour can be set according to requirements;

[0061] The character text corresponding to the preset contour with the maximum contour similarity is determined as the text character of the segmented character; wherein, by determining the character text corresponding to the preset contour with the maximum contour similarity as the text character of the segmented character, the character recognition effect of the segmented character is achieved.

[0062] Furthermore, before obtaining the hospital expense settlement form and commercial insurance text of the user to be reviewed, it also includes:

[0063] If the hospital expense settlement sheet is not obtained, then the Class B deduction items, Class C deduction items, injury and illness separation items, and over-limit price deduction items in the commercial insurance document to be reviewed are obtained;

[0064] Matching the Class B deduction items, the Class C deduction items, the injury and disease separation items, and the over-price deduction items with the medical insurance catalog to obtain the medical insurance deduction ratio; wherein, by matching the Class B deduction items, the Class C deduction items, the injury and disease separation items, and the over-price deduction items with the medical insurance catalog, the medical insurance deduction ratios corresponding to the Class B deduction items, the Class C deduction items, the injury and disease separation items, and the over-price deduction items can be effectively obtained;

[0065] Determine the Class B deduction amount, the Class C deduction amount, the over-limit price deduction amount and the injury and illness separation deduction amount according to the medical insurance deduction ratio and the item amounts of the Class B deduction items, the Class C deduction items, the injury and illness separation items and the over-limit price deduction items;

[0066] The commercial insurance text to be reviewed is reviewed based on the Class B deduction amount, the Class C deduction amount, the over-limit price deduction amount and the injury and illness separation deduction amount to obtain the commercial insurance review result.

[0067] In this embodiment, when the hospital expense settlement statement is obtained, the review process shall be based on the hospital expense settlement statement. Even if there are errors in the character recognition of the hospital expense settlement statement, the review result of the hospital expense settlement statement can be used first to ensure the accuracy of the commercial insurance review result.

[0068] Step S20, determining the deduction category of the injury and illness separation item according to the injury and illness separation information, and determining the injury and illness separation deduction amount according to the deduction ratio of the deduction category;

[0069] Among them, the injury and illness separation items are matched with the deduction query table to obtain the deduction class. The deduction query table stores the correspondence between different injury and illness separation items and the corresponding deduction classes. The deduction ratio corresponding to the deduction class is queried, and the product between (1-deduction ratio) and the injury and illness separation amount in the injury and illness separation information is calculated to obtain the injury and illness separation deduction amount.

[0070] In this embodiment, the review result of injury-disease separation and over-scope medication will be deducted from the amount already deducted by Class B and Class C medical insurance, that is, the deduction ratio of injury-disease separation and over-scope medication is adjusted to "1-x%" (x is the ratio already reimbursed by medical insurance). For example:

[0071] Case 1 of separation of injury and illness: If the hospital expense settlement includes the item "wall motion analysis" and it is determined to be Class C, and 100% of the Class C amount has been deducted in the settlement, then there is no need to report the separation of injury and illness deduction for this item;

[0072] Case 2 of separation of injury and illness: If the hospital expense settlement statement includes the item of "left ventricular function measurement", which belongs to Class A, and Class A is reimbursed 100% in full in the settlement statement, then this item will be deducted 100% according to the rules of separation of injury and illness.

[0073] Step S30, reviewing the commercial insurance document to be reviewed according to the Class B deduction amount, Class C deduction amount, over-limit deduction amount and injury and illness separation deduction amount in the medical insurance deduction information to obtain the commercial insurance review result;

[0074] Among them, the commercial insurance text to be reviewed is reviewed through the Class B deduction amount, Class C deduction amount, over-price deduction amount and the injury and illness separation deduction amount in the medical insurance deduction information. There is no need to pay too much attention to and rely on local medical insurance policies, which reduces the inconsistency of audits caused by policy differences and update delays and improves the accuracy of commercial insurance audits.

[0075] Optionally, the commercial insurance document to be reviewed is reviewed according to the Class B deduction amount, Class C deduction amount, over-limit price deduction amount and injury and illness separation deduction amount in the medical insurance deduction information to obtain the commercial insurance review result, including:

[0076] Obtain the pending Class B amount, pending Class C amount, pending over-limit amount and pending injury and illness separation amount in the pending commercial insurance text;

[0077] Compare the Class B deduction amount with the Class B amount to be reviewed to obtain the Class B deduction review result, and compare the Class C deduction amount with the Class C amount to be reviewed to obtain the Class C deduction review result;

[0078] Compare the excess price deduction amount with the to-be-reviewed excess price amount to obtain an excess price deduction review result, and compare the injury and illness separation deduction amount with the to-be-reviewed injury and illness separation amount to obtain an injury and illness separation deduction review result;

[0079] Among them, the commercial insurance audit results include the audit results of Class B deductions, the audit results of Class C deductions, the audit results of over-price deductions and the audit results of injury and illness separation deductions.

[0080] Further, the commercial insurance document to be reviewed is reviewed according to the Class B deduction amount, Class C deduction amount, over-limit deduction amount and injury and illness separation deduction amount in the medical insurance deduction information, and after the commercial insurance review result is obtained, it also includes:

[0081] If any deduction audit result in the commercial insurance audit result fails to be compared, the deduction item corresponding to the deduction audit result is determined as an abnormal deduction item;

[0082] Matching the abnormal deduction items with the medical insurance catalog to obtain a target deduction ratio, and determining the target deduction amount according to the deduction amount of the abnormal deduction items and the target deduction ratio; wherein the product of the deduction amount of the normal deduction items and the target deduction ratio is calculated to obtain the target deduction amount;

[0083] The commercial insurance text to be reviewed and the hospital expense settlement statement are proofread according to the target deduction amount; wherein, the commercial insurance text to be reviewed and the hospital expense settlement statement are proofread according to the target deduction amount, which effectively improves the accuracy of character recognition of the hospital expense settlement statement and achieves the audit effect on the commercial insurance text to be reviewed.

[0084] Furthermore, the commercial insurance document to be reviewed and the hospital expense settlement sheet are proofread according to the target deduction amount, including:

[0085] Obtain the deduction amount of the abnormal deduction item in the commercial insurance document to be reviewed and the hospital expense settlement form, and obtain the deduction amount to be compared and the settlement deduction amount;

[0086] If the target deduction amount is different from the deduction amount to be compared, the abnormal deduction item is marked as an error in the commercial insurance text to be reviewed; wherein, if the target deduction amount is different from the deduction amount to be compared, it is determined that the commercial insurance information of the abnormal deduction item corresponding to the deduction amount to be compared is wrong;

[0087] If the target deduction amount is different from the settlement deduction amount, the medical insurance deduction information is updated according to the settlement deduction amount; wherein, updating the medical insurance deduction information by the settlement deduction amount effectively improves the accuracy of the medical insurance deduction information.

[0088] In this step, if there is a hospital expense settlement form, the audit results in the hospital expense settlement form can be compared with the Class B and C audit results to ensure consistency between the two. If the two are inconsistent, the results of the hospital expense settlement form can be used to verify and adjust the Class B and C audits, thereby improving the accuracy of the final audit.

[0089] In this embodiment, by directly using the total amount, injury and illness separation information and medical insurance deduction information in the hospital expense settlement form for the commercial insurance text to be reviewed, there is no need to pay too much attention to and rely on local medical insurance policies, which reduces the inconsistency of audits caused by policy differences and delayed updates, and improves the accuracy of commercial insurance audits. The hospital expense settlement form is the priority basis, and the Class B and C audits in the commercial insurance text to be reviewed are used as a reference to ensure that even if there are errors in the character recognition of the commercial insurance text to be reviewed, the accuracy of the audit can still be improved through two-way verification and complementary mechanisms. The data in the hospital expense settlement form has been reviewed by the medical insurance department and is authoritative, which further improves the accuracy of the commercial insurance audit and reduces the complexity of the audit, ensuring fast and accurate audit results.

[0090] Embodiment 2

[0091] See also Figure 2 , is a schematic diagram of the structure of a commercial insurance review system 100 provided in a second embodiment of the present invention, including:

[0092] The character recognition module 10 is used for the text segmentation module, which is used to obtain the hospital expense settlement form of the user to be reviewed and the commercial insurance text to be reviewed, and perform character recognition on the hospital expense settlement form to obtain the total amount, injury and illness separation information and medical insurance deduction information.

[0093] Optionally, the character recognition module 10 is further used to: perform binarization processing on the hospital expense settlement form to obtain a binarized image, and perform denoising processing on the binarized image to obtain a denoised image;

[0094] Performing tilt correction on the denoised image to obtain a corrected image, and segmenting the text in the corrected image to obtain segmented paragraphs;

[0095] Performing character segmentation on the segmented paragraphs to obtain segmented characters, and performing character recognition on the segmented characters to obtain text characters;

[0096] The text characters are classified, and the total amount, the injury and illness separation information and the medical insurance deduction information are determined according to the character classification results.

[0097] Furthermore, the character recognition module 10 is also used to: obtain the character contour of the segmented character, and calculate the contour similarity between the character contour and a preset contour;

[0098] The character corresponding to the preset contour with the maximum contour similarity is determined as the text character of the segmented character.

[0099] The injury and illness separation module 11 is used to determine the deduction category of the injury and illness separation item according to the injury and illness separation information, and determine the injury and illness separation deduction amount according to the deduction ratio of the deduction category.

[0100] The commercial insurance review module 12 is used to review the commercial insurance text to be reviewed according to the Class B deduction amount, Class C deduction amount, over-price deduction amount and injury and illness separation deduction amount in the medical insurance deduction information to obtain the commercial insurance review result.

[0101] Optionally, the commercial insurance review module 12 is further used to: obtain the Class B amount to be reviewed, the Class C amount to be reviewed, the over-limit price amount to be reviewed, and the injury and illness separation amount to be reviewed in the commercial insurance text to be reviewed;

[0102] Compare the Class B deduction amount with the Class B amount to be reviewed to obtain the Class B deduction review result, and compare the Class C deduction amount with the Class C amount to be reviewed to obtain the Class C deduction review result;

[0103] Compare the excess price deduction amount with the to-be-reviewed excess price amount to obtain an excess price deduction review result, and compare the injury and illness separation deduction amount with the to-be-reviewed injury and illness separation amount to obtain an injury and illness separation deduction review result;

[0104] Among them, the commercial insurance audit results include the audit results of Class B deductions, the audit results of Class C deductions, the audit results of over-price deductions and the audit results of injury and illness separation deductions.

[0105] Furthermore, the commercial insurance review module 12 is further configured to: if any deduction review result in the commercial insurance review result fails to be compared, determine the deduction item corresponding to the deduction review result as an abnormal deduction item;

[0106] Matching the abnormal deduction items with the medical insurance catalog to obtain a target deduction ratio, and determining a target deduction amount based on the deduction amount of the abnormal deduction items and the target deduction ratio;

[0107] The commercial insurance document to be reviewed and the hospital expense settlement sheet are proofread according to the target deduction amount.

[0108] Furthermore, the commercial insurance review module 12 is also used to: obtain the deduction amount of the abnormal deduction item in the commercial insurance text to be reviewed and the hospital expense settlement form, and obtain the deduction amount to be compared and the settlement deduction amount;

[0109] If the target deduction amount is different from the deduction amount to be compared, the abnormal deduction item is marked as an error in the commercial insurance document to be reviewed;

[0110] If the target deduction amount is different from the settlement deduction amount, the medical insurance deduction information is updated according to the settlement deduction amount.

[0111] Preferably, the commercial insurance review module 12 is further used to: if the hospital expense settlement sheet is not obtained, obtain the Class B deduction items, Class C deduction items, injury and illness separation items and over-limit price deduction items in the commercial insurance text to be reviewed;

[0112] Matching the Class B deduction items, the Class C deduction items, the injury and illness separation items, and the over-price deduction items with the medical insurance catalog to obtain the medical insurance deduction ratio;

[0113] Determine the Class B deduction amount, the Class C deduction amount, the over-limit price deduction amount and the injury and illness separation deduction amount according to the medical insurance deduction ratio and the item amounts of the Class B deduction items, the Class C deduction items, the injury and illness separation items and the over-limit price deduction items;

[0114] The commercial insurance text to be reviewed is reviewed based on the Class B deduction amount, the Class C deduction amount, the over-limit price deduction amount and the injury and illness separation deduction amount to obtain the commercial insurance review result.

[0115] In this embodiment, by directly using the total amount, injury and illness separation information and medical insurance deduction information in the hospital expense settlement form for the commercial insurance text to be reviewed, there is no need to pay too much attention to and rely on local medical insurance policies, which reduces the inconsistency of audits caused by policy differences and delayed updates, and improves the accuracy of commercial insurance audits. The hospital expense settlement form is the priority basis, and the Class B and C audits in the commercial insurance text to be reviewed are used as a reference to ensure that even if there are errors in the character recognition of the commercial insurance text to be reviewed, the accuracy of the audit can still be improved through two-way verification and complementary mechanisms. The data in the hospital expense settlement form has been reviewed by the medical insurance department and is authoritative, which further improves the accuracy of the commercial insurance audit and reduces the complexity of the audit, ensuring fast and accurate audit results.

[0116] Embodiment 3

[0117] Figure 3 2 is a block diagram of a terminal device 2 provided in the third embodiment of the present application. Figure 3 As shown, the terminal device 2 of this embodiment includes: a processor 20, a memory 21, and a computer program 22 stored in the memory 21 and executable on the processor 20, such as a program of the commercial insurance review method. When the processor 20 executes the computer program 22, the steps in each embodiment of the commercial insurance review method described above are implemented.

[0118] Exemplarily, the computer program 22 may be divided into one or more modules, which are stored in the memory 21 and executed by the processor 20 to complete the present application. The one or more modules may be a series of computer program instruction segments capable of completing specific functions, which are used to describe the execution process of the computer program 22 in the terminal device 2. The terminal device may include, but is not limited to, a processor 20 and a memory 21.

[0119] The processor 20 may be a central processing unit (CPU), or other general-purpose processors, digital signal processors (DSP), application-specific integrated circuits (ASIC), field-programmable gate arrays (FPGA) or other programmable logic devices, discrete gate or transistor logic devices, discrete hardware components, etc. A general-purpose processor may be a microprocessor or any conventional processor, etc.

[0120] The memory 21 may be an internal storage unit of the terminal device 2, such as a hard disk or memory of the terminal device 2. The memory 21 may also be an external storage device of the terminal device 2, such as a plug-in hard disk, a smart media card (SMC), a secure digital (SD) card, a flash card, etc. equipped on the terminal device 2. Further, the memory 21 may also include both an internal storage unit and an external storage device of the terminal device 2. The memory 21 is used to store the computer program and other programs and data required by the terminal device. The memory 21 may also be used to temporarily store data that has been output or is to be output.

[0121] In addition, each functional module in each embodiment of the present application can be integrated into one processing unit, or each unit can exist physically separately, or two or more units can be integrated into one unit. The above integrated unit can be implemented in the form of hardware or in the form of software functional unit.

[0122] If the integrated module is implemented in the form of a software functional unit and sold or used as an independent product, it can be stored in a computer-readable storage medium. Among them, the computer-readable storage medium can be non-volatile or volatile. Based on this understanding, the present application implements all or part of the processes in the above-mentioned embodiment method, and can also be completed by instructing the relevant hardware through a computer program. The computer program can be stored in a computer-readable storage medium, and the computer program can implement the steps of the above-mentioned various method embodiments when executed by the processor. Among them, the computer program includes computer program code, and the computer program code can be in source code form, object code form, executable file or some intermediate form. The computer-readable storage medium may include: any entity or device capable of carrying computer program code, recording medium, U disk, mobile hard disk, disk, optical disk, computer memory, read-only memory (ROM, Read-Only Memory), random access memory (RAM, Random Access Memory), electric carrier signal, telecommunication signal and software distribution medium, etc. It should be noted that the content contained in computer-readable storage media can be appropriately increased or decreased according to the requirements of legislation and patent practices in the jurisdiction. For example, in some jurisdictions, according to legislation and patent practices, computer-readable storage media do not include electrical carrier signals and telecommunication signals.

[0123] The embodiments described above are only used to illustrate the technical solutions of the present application, rather than to limit them. Although the present application has been described in detail with reference to the aforementioned embodiments, a person skilled in the art should understand that the technical solutions described in the aforementioned embodiments may still be modified, or some of the technical features may be replaced by equivalents. Such modifications or replacements do not deviate the essence of the corresponding technical solutions from the spirit and scope of the technical solutions of the embodiments of the present application, and should all be included in the protection scope of the present application.

Claims

1. A commercial insurance review method, characterized in that: The method comprises: Obtain the hospital expense settlement form and commercial insurance text of the user to be reviewed, and perform character recognition on the hospital expense settlement form to obtain the total amount, injury and illness separation information, and medical insurance deduction information; Determine the deduction category of the injury and illness separation item according to the injury and illness separation information, and determine the injury and illness separation deduction amount according to the deduction ratio of the deduction category; The commercial insurance text to be reviewed is reviewed according to the Class B deduction amount, Class C deduction amount, over-price deduction amount and injury and illness separation deduction amount in the medical insurance deduction information to obtain the commercial insurance review result.

2. The commercial insurance review method according to claim 1, characterized in that: The commercial insurance document to be reviewed is reviewed according to the Class B deduction amount, Class C deduction amount, over-limit price deduction amount and injury and illness separation deduction amount in the medical insurance deduction information to obtain the commercial insurance review result, including: Obtain the pending Class B amount, pending Class C amount, pending over-limit amount and pending injury and illness separation amount in the pending commercial insurance text; Compare the Class B deduction amount with the Class B amount to be reviewed to obtain the Class B deduction review result, and compare the Class C deduction amount with the Class C amount to be reviewed to obtain the Class C deduction review result; Compare the excess price deduction amount with the to-be-reviewed excess price amount to obtain an excess price deduction review result, and compare the injury and illness separation deduction amount with the to-be-reviewed injury and illness separation amount to obtain an injury and illness separation deduction review result; Among them, the commercial insurance audit results include the audit results of Class B deductions, the audit results of Class C deductions, the audit results of over-price deductions and the audit results of injury and illness separation deductions.

3. The commercial insurance review method according to claim 2, characterized in that: The commercial insurance document to be reviewed is reviewed according to the Class B deduction amount, Class C deduction amount, over-limit price deduction amount and injury and illness separation deduction amount in the medical insurance deduction information, and after the commercial insurance review result is obtained, it also includes: If any deduction audit result in the commercial insurance audit result fails to be compared, the deduction item corresponding to the deduction audit result is determined as an abnormal deduction item; Matching the abnormal deduction items with the medical insurance catalog to obtain a target deduction ratio, and determining a target deduction amount based on the deduction amount of the abnormal deduction items and the target deduction ratio; The commercial insurance document to be reviewed and the hospital expense settlement sheet are proofread according to the target deduction amount.

4. The commercial insurance review method according to claim 3, characterized in that: Proofread the commercial insurance document to be reviewed and the hospital expense settlement form according to the target deduction amount, including: Obtain the deduction amount of the abnormal deduction item in the commercial insurance document to be reviewed and the hospital expense settlement form, and obtain the deduction amount to be compared and the settlement deduction amount; If the target deduction amount is different from the deduction amount to be compared, the abnormal deduction item is marked as an error in the commercial insurance document to be reviewed; If the target deduction amount is different from the settlement deduction amount, the medical insurance deduction information is updated according to the settlement deduction amount.

5. The commercial insurance review method according to claim 1, characterized in that: Perform character recognition on the hospital expense settlement form to obtain the total amount, injury and illness separation information, and medical insurance deduction information, including: Binarizing the hospital expense settlement form to obtain a binary image, and denoising the binary image to obtain a denoised image; Performing tilt correction on the denoised image to obtain a corrected image, and segmenting the text in the corrected image to obtain segmented paragraphs; Performing character segmentation on the segmented paragraphs to obtain segmented characters, and performing character recognition on the segmented characters to obtain text characters; The text characters are classified, and the total amount, the injury and illness separation information and the medical insurance deduction information are determined according to the character classification results.

6. The commercial insurance review method according to claim 5, characterized in that: Performing character recognition on the segmented characters to obtain text characters includes: Obtaining a character contour of the segmented character, and calculating a contour similarity between the character contour and a preset contour; The character corresponding to the preset contour with the maximum contour similarity is determined as the text character of the segmented character.

7. The commercial insurance review method according to claim 1, characterized in that: Before obtaining the hospital expense settlement form and commercial insurance text of the user to be reviewed, it also includes: If the hospital expense settlement sheet is not obtained, then the Class B deduction items, Class C deduction items, injury and illness separation items, and over-limit price deduction items in the commercial insurance document to be reviewed are obtained; Matching the Class B deduction items, the Class C deduction items, the injury and illness separation items, and the over-price deduction items with the medical insurance catalog to obtain the medical insurance deduction ratio; Determine the Class B deduction amount, the Class C deduction amount, the over-limit price deduction amount and the injury and illness separation deduction amount according to the medical insurance deduction ratio and the item amounts of the Class B deduction items, the Class C deduction items, the injury and illness separation items and the over-limit price deduction items; The commercial insurance text to be reviewed is reviewed based on the Class B deduction amount, the Class C deduction amount, the over-limit price deduction amount and the injury and illness separation deduction amount to obtain the commercial insurance review result.

8. A commercial insurance review system, characterized in that: The system comprises: The character recognition module is used for the text segmentation module to obtain the hospital expense settlement form of the user to be reviewed and the commercial insurance text to be reviewed, and perform character recognition on the hospital expense settlement form to obtain the total amount, injury and illness separation information and medical insurance deduction information; An injury and illness separation module, used to determine the deduction category of the injury and illness separation item according to the injury and illness separation information, and determine the injury and illness separation deduction amount according to the deduction ratio of the deduction category; The commercial insurance review module is used to review the commercial insurance text to be reviewed according to the Class B deduction amount, Class C deduction amount, over-limit price deduction amount and injury and illness separation deduction amount in the medical insurance deduction information to obtain the commercial insurance review result.

9. The commercial insurance review system according to claim 8, characterized in that: The commercial insurance review module is also used for: Obtain the pending Class B amount, pending Class C amount, pending over-limit amount and pending injury and illness separation amount in the pending commercial insurance text; Compare the Class B deduction amount with the Class B amount to be reviewed to obtain the Class B deduction review result, and compare the Class C deduction amount with the Class C amount to be reviewed to obtain the Class C deduction review result; Compare the excess price deduction amount with the to-be-reviewed excess price amount to obtain an excess price deduction review result, and compare the injury and illness separation deduction amount with the to-be-reviewed injury and illness separation amount to obtain an injury and illness separation deduction review result; Among them, the commercial insurance audit results include the audit results of Class B deductions, the audit results of Class C deductions, the audit results of over-price deductions and the audit results of injury and illness separation deductions.

10. A computer-readable storage medium storing a computer program, characterized in that: When the computer program is executed by a processor, the steps of the method according to any one of claims 1 to 7 are implemented.

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