Medical insurance settlement method and device, equipment and storage medium

Abstract

The embodiment of the invention provides a medical insurance settlement method and device, equipment and a storage medium, and the method comprises the steps: carrying out the task node configuration and rule configuration of medical insurance settlement RPA according to a geographic region corresponding to a to-be-settled medical insurance; wherein the task node configuration comprises configuration of task nodes needing to be executed in the medical insurance settlement process and configuration of parameters corresponding to the task nodes; the rule configuration comprises conversion rule configuration, reconciliation rule configuration and filing rule configuration; the conversion rule configuration is a rule for converting the medical insurance data into the claim insurance data; the reconciliation rule configuration is to configure a field needing reconciliation, a reconciliation statement header name corresponding to the field needing reconciliation and a reconciliation mode corresponding to the field needing reconciliation; the filing rule configuration is to configure filing fields of the medical images uploaded in batches; and triggering the RPA to settle the to-be-settled medical insurance according to the configured task node and rule.

Description

Technical Field

[0001] The present disclosure relates to the field of data processing technology, and in particular to a medical insurance settlement method, device, equipment and storage medium. Background Art

[0002] When making a claim for medical insurance, you can choose to make a claim through direct settlement. Direct settlement means that when the insured seeks medical treatment, the medical expenses are directly settled to the hospital, and the hospital and the insurance company settle the bill. The insured only needs to pay his or her own part of the expenses. In this settlement model, the medical expenses are paid by the medical institution, and the insurance company settles with the medical institution. The corresponding processing flow is usually that the medical insurance bureau provides structured original data, the medical institution provides a statement, and the insurance company settles with the medical institution based on the structured original data and the statement.

[0003] At present, the direct settlement model usually needs to be completed by relevant staff through manual operations, such as manually obtaining statements from medical institutions, which requires a lot of manpower. Summary of the invention

[0004] The embodiments of the present disclosure provide a medical insurance settlement method, apparatus, device and storage medium to solve the problem in the related art that direct settlement of medical insurance needs to be achieved by manual operations by relevant staff, resulting in a large amount of manpower consumption.

[0005] In a first aspect, an embodiment of the present disclosure provides a medical insurance settlement method, the method comprising: According to the geographical area corresponding to the medical insurance to be settled, the task node configuration and rule configuration of the medical insurance settlement robot process automation RPA are performed; wherein the task node configuration includes configuring the task nodes that need to be executed during the medical insurance settlement process, and configuring the parameters corresponding to each task node; the rule configuration includes conversion rule configuration, reconciliation rule configuration and filing rule configuration; the conversion rule configuration is to configure the rules for converting medical insurance data into claim insurance data; the reconciliation rule configuration is to configure the fields that need to be reconciled, the reconciliation statement header names corresponding to the fields that need to be reconciled, and the reconciliation methods corresponding to the fields that need to be reconciled; the filing rule configuration is to configure the filing fields of batch uploaded medical images; The RPA is triggered to settle the medical insurance to be settled according to the configured task nodes and rules.

[0006] In a second aspect, an embodiment of the present disclosure provides a medical insurance settlement device, the device comprising: A configuration module is used to configure task nodes and rules for the medical insurance settlement robot process automation RPA according to the geographical area corresponding to the medical insurance to be settled; wherein the task node configuration includes configuring the task nodes to be executed during the medical insurance settlement process, and configuring the parameters corresponding to each task node; the rule configuration includes conversion rule configuration, reconciliation rule configuration and filing rule configuration; the conversion rule configuration is to configure the rules for converting medical insurance data into claim insurance data; the reconciliation rule configuration is to configure the fields that need to be reconciled, the reconciliation statement header names corresponding to the fields that need to be reconciled, and the reconciliation methods corresponding to the fields that need to be reconciled; the filing rule configuration is to configure the filing fields of medical images uploaded in batches; The settlement module is used to trigger the RPA to settle the medical insurance to be settled according to the configured task nodes and rules.

[0007] In a third aspect, an embodiment of the present disclosure provides a medical insurance settlement device, comprising: a processor; and a memory configured to store computer executable instructions, wherein the computer executable instructions, when executed, enable the processor to implement the steps of the method described in the first aspect above.

[0008] In a fourth aspect, an embodiment of the present disclosure provides a computer-readable storage medium, wherein the computer-readable storage medium is used to store computer-executable instructions, and the computer-executable instructions implement the steps of the method described in the first aspect when executed by a processor.

[0009] In a fifth aspect, an embodiment of the present disclosure provides a computer program product, wherein the computer program product includes a computer program, and when the computer program is executed by a processor, the steps of the method described in the first aspect are implemented.

[0010] At least one of the above technical solutions provided by the embodiments of the present invention can achieve the following technical effects: In an embodiment of the present invention, task node configuration and rule configuration can be performed on RPA according to the settlement geographical area corresponding to the medical insurance to be settled, and after completing the task node configuration and rule configuration, RPA can be triggered to settle the medical insurance to be settled according to the configured task nodes and rules.

[0011] It can be seen that the embodiment of the present invention can realize automated real-time settlement of medical insurance through RPA. Since the task nodes and their corresponding parameters can be configured when configuring RPA, direct settlement of medical insurance can be realized automatically according to demand. In addition, the embodiment of the present invention can also configure the conversion rules, reconciliation rules and filing rules when configuring RPA, so that the original medical insurance data can be automatically converted into the claim data used in the settlement, and the reconciliation function and medical image filing can be automatically realized without manual reconciliation, thereby saving manpower and effectively solving the problem that a large amount of manpower is required to be consumed in the related technology because the direct settlement of medical insurance needs to be realized by the relevant staff through manual operation. In addition, since the automatic settlement of medical insurance can be realized without manual participation, the customer information will not be seen by the relevant personnel during the settlement process of medical insurance, so that the privacy and security of customer information can be effectively protected. It can also effectively avoid the occurrence of settlement errors caused by the mistakes of relevant personnel, and effectively improve the accuracy and efficiency of medical insurance settlement.

[0012] In addition, the embodiment of the present invention also takes into account the situation that business rules in different places may be different, and further combines the settlement geographical area corresponding to the medical insurance to be settled, and proposes different rule configurations and task node configurations according to different settlement geographical areas, so as to effectively adapt to the rules of different regions and effectively improve the flexibility and adaptability of automated medical insurance direct settlement. BRIEF DESCRIPTION OF THE DRAWINGS

[0013] In order to more clearly illustrate one or more embodiments of the present disclosure or the technical solutions in the prior art, the drawings required for use in the embodiments or the prior art descriptions are briefly introduced below. Obviously, the drawings described below are only some embodiments recorded in the present disclosure. For those of ordinary skill in the art, other drawings can be obtained based on these drawings without creative labor. Figure 1 One of the flowcharts of the medical insurance settlement method provided by one embodiment of the present invention; Figure 2 A second flowchart of a medical insurance settlement method provided by an embodiment of the present invention; Figure 3 A schematic diagram of the module composition of a medical insurance settlement device 300 provided in one embodiment of the present invention; Figure 4 A schematic diagram of the hardware structure of a medical insurance settlement device provided in one embodiment of the present invention. DETAILED DESCRIPTION

[0014] In order to make the technical parties in this technical field better understand the technical aspects of one or more embodiments of the present disclosure, and to make the purpose, technical solutions and advantages of the present invention clearer, the technical solutions of the present invention will be clearly and completely described below in combination with the specific embodiments of the present invention and the corresponding drawings. Obviously, the described embodiments are only part of the embodiments of the present invention, not all of the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without making creative work are within the scope of protection of the present invention.

[0015] The technical solutions provided by various embodiments of the present invention are described in detail below in conjunction with the accompanying drawings.

[0016] See also Figure 1 , Figure 1 One of the flow charts of the medical insurance settlement method provided by one embodiment of the present invention is as follows: Figure 1 As shown, the method comprises the following steps: Step 102: According to the geographical area corresponding to the medical insurance to be settled, perform task node configuration and rule configuration on the medical insurance settlement RPA; wherein the task node configuration includes configuring the task nodes that need to be executed during the medical insurance settlement process, and configuring the parameters corresponding to each task node; the rule configuration includes conversion rule configuration, reconciliation rule configuration and filing rule configuration; the conversion rule configuration is to configure the rules for converting medical insurance data into claim insurance data; the reconciliation rule configuration is to configure the fields that need to be reconciled, the name of the statement header corresponding to the fields that need to be reconciled, and the reconciliation method corresponding to the fields that need to be reconciled; the filing rule configuration is to configure the filing fields of the medical images uploaded in batches.

[0017] Step 104: Trigger RPA to settle the medical insurance to be settled according to the configured task nodes and rules.

[0018] In the embodiment of the present invention, after the medical insurance to be settled is determined, the geographical area corresponding to the medical insurance to be settled may be obtained first.

[0019] Considering that different geographical areas may have different corresponding social security policies and business processing rules, resulting in different data formats and corresponding medical insurance direct settlement processes, the embodiment of the present invention can first determine the geographical area corresponding to the medical insurance to be settled, and configure the task nodes and rules of the medical insurance settlement RPA (Robotic Process Automation) according to the determined geographical area.

[0020] The geographical area corresponding to the medical insurance to be settled may be the area where the medical treatment corresponding to the medical insurance occurs, or may be the settlement area corresponding to the medical insurance, which is not limited in the embodiment of the present invention.

[0021] Then, the task nodes and rules of the medical insurance settlement RPA can be configured according to the geographical area corresponding to the medical insurance to be settled.

[0022] Among them, the task node configuration may include configuring the task nodes that need to be executed during the medical insurance settlement process, and configuring the parameters corresponding to each task node.

[0023] In one embodiment of the invention, the task nodes that need to be executed during the medical insurance settlement process may include at least one of the following: logging into the medical insurance claims system, downloading medical insurance data, converting the medical insurance data into claim insurance data according to the configured conversion rules, improving the medical insurance payee information, importing the converted claim insurance data and the improved medical insurance payee information into the settlement system, reconciling the corresponding statements of the medical insurance to be settled according to the configured reconciliation rules, filing the batch uploaded medical images according to the configured filing rules, reviewing the medical insurance claims, and making claims for the medical insurance payees.

[0024] Among them, when the task nodes that need to be executed during the medical insurance settlement process include logging into the medical insurance claims system, when configuring parameters for the task nodes, the login account and login password can be configured for the task nodes that log into the medical insurance claims system; when the task nodes that need to be executed during the medical insurance settlement process include downloading medical insurance data, when configuring parameters for the task nodes, the location, file name, and generation time of the medical insurance data to be downloaded can be configured for the task nodes that download medical insurance data; when the task nodes that need to be executed during the medical insurance settlement process include medical insurance claims review, when configuring parameters for the task nodes, the conditions for passing the review can be configured for the task nodes for medical insurance claims review.

[0025] In one example, the display interface corresponding to the RPA may provide a list of selectable task nodes so that the configuration personnel can configure the task nodes through the list. For different task nodes, the display interface corresponding to the RPA may provide a corresponding list of selectable parameters, or provide a blank box for the configuration personnel to configure the parameters by filling in the parameters, which is not limited in this example.

[0026] The embodiment of the present invention can also configure the rules for the medical insurance settlement RPA, wherein the rule configuration may include conversion rule configuration, reconciliation rule configuration, and filing rule configuration. The conversion rule configuration may be to configure the rules for converting medical insurance data into claim insurance data; the reconciliation rule configuration may be to configure the fields that need to be reconciled, the name of the reconciliation statement header corresponding to the fields that need to be reconciled, and the reconciliation method corresponding to the fields that need to be reconciled; and the filing rule configuration may be to configure the filing fields of the batch uploaded medical images. Among them, the filing fields may include the image name, the user name in the image, the user ID number in the image, the medical institution number in the image, etc. These filing fields may be extracted after processing each uploaded medical image through OCR (Optical Character Recognition) technology.

[0027] In one example, the task nodes that need to be executed during the medical insurance settlement process may include: converting medical insurance data into claim insurance data according to the configured conversion rules. When configuring the conversion rules for converting medical insurance data into claim insurance data, a medical insurance data template and a claim insurance data template can be obtained, and the conversion relationship between the first field in the medical insurance data template and the second field in the claim insurance data template can be configured.

[0028] After completing the task node configuration and conversion rule configuration, you can trigger RPA to settle the medical insurance to be settled according to the configured task nodes and rules.

[0029] Among them, when triggering RPA to settle the medical insurance to be settled, it can be automatically triggered based on a preset time point or time period, or it can be manually triggered by relevant personnel as needed. The embodiment of the present invention does not limit this.

[0030] After completing the task node configuration and rule configuration of RPA, RPA can link the task nodes and rules according to the configured task nodes and rules to automatically execute the automatic settlement task of medical claims corresponding to the determined geographical area.

[0031] In one example, if Figure 2As shown, the task nodes that need to be executed during the configured medical insurance settlement process may include the following task nodes: log in to the medical insurance claims system, download medical insurance data, convert medical insurance data into claims insurance data according to the configured conversion rules, complete the medical insurance payee information, import the converted claims insurance data and the complete medical insurance payee information into the settlement system, reconcile the corresponding statements of the medical insurance to be settled according to the configured reconciliation rules, file the batch uploaded medical images according to the configured filing rules, review medical insurance claims, and make claims for medical insurance payees. The process of RPA automatically executing claims tasks can be: First, log in to the medical insurance claims system according to the configured login account and password. After successful login, re-download the medical insurance data with the specified file location, specified time period and specified file name from the medical insurance claims system according to the configured location, file name and generation time parameters of the medical insurance data to be downloaded. Convert the downloaded medical insurance data into claim insurance data according to the configured conversion rules.

[0032] During the conversion, the task node that converts the medical insurance data into the claim insurance data according to the configured conversion rule can convert the medical insurance data into the claim insurance data according to the conversion relationship between the first field in the medical insurance data template and the second field in the claim insurance data template. The converted claim insurance data can be a claim case list, that is, it can include a data list required for the claim case.

[0033] Then, the payee information can be improved as needed, for example, personal payee information can be supplemented. When supplementing, it can be automatically filled in according to the existing payee information. For example, if the payee has previously entered complete information and the corresponding personal image, after obtaining the payee's image, the complete information corresponding to the payee can be obtained according to the payee's image and automatically filled in.

[0034] After the image of the payee is completed, the converted claim insurance data and the completed medical insurance payee information can be imported into the settlement system. The import process can be automatically executed by RPA. Then, the reconciliation process can be performed on the corresponding statement of the medical insurance to be settled according to the configured reconciliation rules. When performing the reconciliation process, the task node in RPA that performs the reconciliation process on the corresponding statement of the medical insurance to be settled according to the configured reconciliation rules can obtain the target header name of the statement of the medical insurance to be settled, and match the target header name with the configured statement header name corresponding to the field that needs to be reconciled. If the match is successful, the statement corresponding to the target header name is reconciled according to the reconciliation method corresponding to the field that needs to be reconciled that matches the target header name. That is, first obtain the target header name from the statement of the medical insurance to be settled. This step can be achieved by OCR technology. Then, the target header name can be matched with the statement header name corresponding to the pre-configured field that needs to be reconciled. If the match is successful, it means that the statement corresponding to the target header name is the file that needs to be reconciled, and the statement corresponding to the target header name can be reconciled. When performing the reconciliation process, the fields included in the statement can be reconciled. When reconciling, you can also obtain the corresponding supporting materials of the statement for filing, such as obtaining the corresponding medical images of the statement for filing. Among them, the medical image can be automatically selected from the multiple uploaded medical images according to the pre-set medical image categories that need to be filed. Medical images can be uploaded in batches. When filing, these batch uploaded medical images can be filed according to the configured filing rules. You can first perform OCR recognition and matching on each medical image separately, and extract the content of the filing field corresponding to each medical image, such as the user's name, ID number, etc. in the medical image. Then, store the extracted content in correspondence with the medical image to achieve the filing of the batch uploaded medical images.

[0035] After completing the reconciliation process, you can conduct a medical insurance claim review to determine whether the medical insurance to be settled meets the configured review conditions. This process can also be called a pre-claim review, which can review the pre-process of the settled medical insurance, such as compliance review, risk review, etc. The embodiment of the present invention does not limit this. When conducting a pre-claim review, you can switch the pre-claim review account to implement the pre-claim review. After logging in to the pre-claim review account, you can select the pre-claim review conditions from the query area, and after the review is passed, make a claim for the medical insurance payee.

[0036] In the claims process, you can Figure 2As shown, first switch to the case processing account, and submit claims based on the configured limit selection, such as claims less than 200. Then, you can switch to the claims verification account and make claims to the medical insurance payee through the submitted claims.

[0037] In an embodiment of the present invention, RPA can log in to the medical insurance claims system and download medical insurance data from the medical insurance claims system, wherein the medical insurance data in the medical insurance claims system may be uploaded by medical insurance office personnel, and the file name of the medical insurance data may be renamed when uploading, and the file name may include: the organization identification of the uploading organization, the file type, the corresponding medical insurance type, and the time when the file was obtained. For example, the naming rule is "uploader's organization code_file type_insurance type_file acquisition time". The statement used by RPA for reconciliation and the medical images corresponding to the statement may be uploaded by a medical institution, and the file names of the statement and the medical images may also be renamed when uploading, and the file name may also include: the organization identification of the uploading organization, the file type, the corresponding medical insurance type, and the time when the file was obtained.

[0038] In an embodiment of the present invention, task node configuration and rule configuration can be performed on RPA according to the settlement geographical area corresponding to the medical insurance to be settled, and after completing the task node configuration and rule configuration, RPA can be triggered to settle the medical insurance to be settled according to the configured task nodes and rules.

[0039] The embodiments of the present invention can realize automatic settlement of medical insurance through RPA, without much modification of the original software system and with small workload. It can also support flexible adjustment of the online progress and the rules corresponding to each processing node by configuring rules and switches.

[0040] It can be seen that the embodiment of the present invention can realize automated real-time settlement of medical insurance through RPA. Since the task nodes and their corresponding parameters can be configured when configuring RPA, direct settlement of medical insurance can be realized automatically according to demand. In addition, the embodiment of the present invention can also configure the conversion rules, reconciliation rules and filing rules when configuring RPA, so that the original medical insurance data can be automatically converted into the claim data used in the settlement, and the reconciliation function and medical image filing can be automatically realized without manual reconciliation, thereby saving manpower and effectively solving the problem that a large amount of manpower is required to be consumed in the related technology because the direct settlement of medical insurance needs to be realized by the relevant staff through manual operation. In addition, since the automatic settlement of medical insurance can be realized without manual participation, the customer information will not be seen by the relevant personnel during the settlement process of medical insurance, so that the privacy and security of customer information can be effectively protected. It can also effectively avoid the occurrence of settlement errors caused by the mistakes of relevant personnel, and effectively improve the accuracy and efficiency of medical insurance settlement.

[0041] In addition, the embodiment of the present invention also takes into account the situation that business rules in different places may be different, and further combines the settlement geographical area corresponding to the medical insurance to be settled, and proposes different rule configurations and task node configurations according to different settlement geographical areas, so as to effectively adapt to the rules of different regions and effectively improve the flexibility and adaptability of automated medical insurance direct settlement.

[0042] Corresponding to the above medical insurance settlement method, the embodiment of the present invention further provides a medical insurance settlement device, Figure 3 A schematic diagram of the module composition of the medical insurance settlement device 300 provided in an embodiment of the present invention is shown in FIG. Figure 3 As shown, the medical insurance settlement device 300 includes: Configuration module 301 is used to configure task nodes and rules for the medical insurance settlement robot process automation RPA according to the geographical area corresponding to the medical insurance to be settled; wherein the task node configuration includes configuring the task nodes to be executed during the medical insurance settlement process, and configuring the parameters corresponding to each task node; the rule configuration includes conversion rule configuration, reconciliation rule configuration and filing rule configuration; the conversion rule configuration is to configure the rules for converting medical insurance data into claim insurance data; the reconciliation rule configuration is to configure the fields that need to be reconciled, the reconciliation statement header names corresponding to the fields that need to be reconciled, and the reconciliation methods corresponding to the fields that need to be reconciled; The settlement module 302 is used to trigger the RPA to settle the medical insurance to be settled according to the configured task nodes and rules.

[0043] Optionally, the task nodes that need to be executed during the medical insurance settlement process include at least one of the following: logging into the medical insurance claims system, downloading medical insurance data, converting the medical insurance data into claims insurance data according to the configured conversion rules, improving the medical insurance payee information, importing the converted claims insurance data and the improved medical insurance payee information into the settlement system, reconciling the corresponding statements of the medical insurance to be settled according to the configured reconciliation rules and filing the corresponding supporting materials of the statements, reviewing medical insurance claims, and making claims for medical insurance payees.

[0044] Optionally, configure the parameters corresponding to each task node, including: When the task node to be executed during the medical insurance settlement process includes logging into the medical insurance claim system, a login account and a login password are configured for the task node for logging into the medical insurance claim system; When the task node to be executed during the medical insurance settlement process includes downloading medical insurance data, the location, file name, and generation time of the medical insurance data to be downloaded are configured for the task node for downloading medical insurance data; When the task nodes to be executed during the medical insurance settlement process include medical insurance claim review, the conditions for passing the review are configured for the task nodes of the medical insurance claim review.

[0045] Optionally, the task nodes that need to be executed during the medical insurance settlement process include: converting the medical insurance data into claim insurance data according to the configured conversion rules; The configuration module 301 is used for: Obtain the medical insurance data template and the claim insurance data template; configuring a conversion relationship between a first field in the medical insurance data template and a second field in the claim insurance data template; The settlement module 302 is used for: When a task node that converts medical insurance data into claim insurance data according to a configured conversion rule executes a task, the medical insurance data is converted into claim insurance data according to a conversion relationship between the first field and the second field.

[0046] Optionally, the task nodes that need to be executed during the medical insurance settlement process include: reconciling the statement corresponding to the medical insurance to be settled according to the configured reconciliation rules; The settlement module 302 is used for: When executing a task at a task node that performs reconciliation processing on the statement of account corresponding to the medical insurance to be settled according to the configured reconciliation rules, obtain the target header name of the statement of account corresponding to the medical insurance to be settled, and match the target header name with the statement header name corresponding to the configured field that needs to be reconciled, and if the match is successful, perform reconciliation processing on the statement of account corresponding to the target header name according to the reconciliation method corresponding to the field that needs to be reconciled that matches the target header name; wherein the target header name is identified from the statement of account corresponding to the medical insurance to be settled based on optical character recognition (OCR) technology.

[0047] Optionally, the file names of the medical insurance data, the statement corresponding to the medical insurance to be settled, and the supporting materials corresponding to the statement include: the institution identification of the uploading institution, the file type, the corresponding medical insurance type, and the file acquisition time.

[0048] In an embodiment of the present invention, task node configuration and rule configuration can be performed on RPA according to the settlement geographical area corresponding to the medical insurance to be settled, and after completing the task node configuration and rule configuration, RPA can be triggered to settle the medical insurance to be settled according to the configured task nodes and rules.

[0049] It can be seen that the embodiment of the present invention can realize automated real-time settlement of medical insurance through RPA. Since the task nodes and their corresponding parameters can be configured when configuring RPA, direct settlement of medical insurance can be realized automatically according to demand. In addition, the embodiment of the present invention can also configure the conversion rules, reconciliation rules and filing rules when configuring RPA, so that the original medical insurance data can be automatically converted into the claim data used in the settlement, and the reconciliation function and medical image filing can be automatically realized without manual reconciliation, thereby saving manpower and effectively solving the problem that a large amount of manpower is required to be consumed in the related technology because the direct settlement of medical insurance needs to be realized by the relevant staff through manual operation. In addition, since the automatic settlement of medical insurance can be realized without manual participation, the customer information will not be seen by the relevant personnel during the settlement process of medical insurance, so that the privacy and security of customer information can be effectively protected. It can also effectively avoid the occurrence of settlement errors caused by the mistakes of relevant personnel, and effectively improve the accuracy and efficiency of medical insurance settlement.

[0050] In addition, the embodiment of the present invention also takes into account the situation that business rules in different places may be different, and further combines the settlement geographical area corresponding to the medical insurance to be settled, and proposes different rule configurations and task node configurations according to different settlement geographical areas, so as to effectively adapt to the rules of different regions and effectively improve the flexibility and adaptability of automated medical insurance direct settlement.

[0051] Corresponding to the above medical insurance settlement method, the embodiment of the present invention further provides a medical insurance settlement device, Figure 4 A schematic diagram of the hardware structure of a medical insurance settlement device provided in one embodiment of the present invention.

[0052] The medical insurance settlement device may be the terminal device or server provided in the above-mentioned embodiment for settling medical insurance.

[0053] The medical insurance settlement device may have relatively large differences due to different configurations or performances, and may include one or more processors 401 and memory 402, and the memory 402 may store one or more storage applications or data. Among them, the memory 402 may be a temporary storage or a permanent storage. The application stored in the memory 402 may include one or more modules (not shown in the figure), and each module may include a series of computer executable instructions in the medical insurance settlement device. Furthermore, the processor 401 may be configured to communicate with the memory 402 to execute a series of computer executable instructions in the memory 402 on the medical insurance settlement device. The medical insurance settlement device may also include one or more power supplies 403, one or more wired or wireless network interfaces 404, one or more input and output interfaces 405, and one or more keyboards 406.

[0054] Specifically in this embodiment, the medical insurance settlement device includes a memory and one or more programs, wherein the one or more programs are stored in the memory, and the one or more programs may include one or more modules, and each module may include a series of computer executable instructions in the medical insurance settlement device, and is configured to be executed by one or more processors.

[0055] In an embodiment of the present invention, task node configuration and rule configuration can be performed on RPA according to the settlement geographical area corresponding to the medical insurance to be settled, and after completing the task node configuration and rule configuration, RPA can be triggered to settle the medical insurance to be settled according to the configured task nodes and rules.

[0056] It can be seen that the embodiment of the present invention can realize automated real-time settlement of medical insurance through RPA. Since the task nodes and their corresponding parameters can be configured when configuring RPA, direct settlement of medical insurance can be realized automatically according to demand. In addition, the embodiment of the present invention can also configure the conversion rules, reconciliation rules and filing rules when configuring RPA, so that the original medical insurance data can be automatically converted into the claim data used in the settlement, and the reconciliation function and medical image filing can be automatically realized without manual reconciliation, thereby saving manpower and effectively solving the problem that a large amount of manpower is required to be consumed in the related technology because the direct settlement of medical insurance needs to be realized by the relevant staff through manual operation. In addition, since the automatic settlement of medical insurance can be realized without manual participation, the customer information will not be seen by the relevant personnel during the settlement process of medical insurance, so that the privacy and security of customer information can be effectively protected. It can also effectively avoid the occurrence of settlement errors caused by the mistakes of relevant personnel, and effectively improve the accuracy and efficiency of medical insurance settlement.

[0057] In addition, the embodiment of the present invention also takes into account the situation that business rules in different places may be different, and further combines the settlement geographical area corresponding to the medical insurance to be settled, and proposes different rule configurations and task node configurations according to different settlement geographical areas, so as to effectively adapt to the rules of different regions and effectively improve the flexibility and adaptability of automated medical insurance direct settlement.

[0058] Another embodiment of the present disclosure further provides a computer-readable storage medium, wherein the computer-readable storage medium is used to store computer-executable instructions, and the computer-executable instructions implement the above process when executed by a processor.

[0059] The storage medium in the embodiment of the present disclosure can implement each process of the above-mentioned medical insurance settlement method embodiment and achieve the same effects and functions, which will not be repeated here.

[0060] Another embodiment of the present disclosure further provides a computer program product, which includes a computer program. When the computer program is executed by a processor, the above process is implemented.

[0061] The computer program product in the embodiment of the present disclosure can implement each process of the above-mentioned medical insurance settlement method embodiment and achieve the same effects and functions, which will not be repeated here.

[0062] In various embodiments of the present disclosure, the computer-readable storage medium includes a read-only memory (ROM), a random access memory (RAM), a magnetic disk or an optical disk, etc.

[0063] In the 1990s, it was very clear whether the improvement of a technology was hardware improvement (for example, improvement of the circuit structure of diodes, transistors, switches, etc.) or software improvement (improvement of the method flow). However, with the development of technology, many improvements of the method flow today can be regarded as direct improvements of the hardware circuit structure. Designers almost always obtain the corresponding hardware circuit structure by programming the improved method flow into the hardware circuit. Therefore, it cannot be said that the improvement of a method flow cannot be implemented with a hardware entity module. For example, a programmable logic device (PLD) (such as a field programmable gate array (FPGA)) is such an integrated circuit whose logical function is determined by the user's programming of the device. Designers can "integrate" a digital system on a PLD by programming themselves, without having to ask chip manufacturers to design and make dedicated integrated circuit chips. Moreover, nowadays, instead of manually making integrated circuit chips, this kind of programming is mostly implemented by "logic compiler" software, which is similar to the software compiler used when developing and writing programs, and the original code before compilation must also be written in a specific programming language, which is called hardware description language (HDL). There is not only one kind of HDL, but many kinds, such as ABEL (Advanced Boolean Expression Language), AHDL (Altera Hardware Description Language), Confluence, CUPL (Cornell University Programming Language), HDCal, JHDL (Java Hardware Description Language), Lava, Lola, MyHDL, PALASM, RHDL (Ruby Hardware Description Language), etc. The most commonly used ones are VHDL (Very-High-Speed ​​Integrated Circuit Hardware Description Language) and Verilog. Those skilled in the art should also know that it is only necessary to program the method flow slightly in the above-mentioned hardware description languages ​​and program it into the integrated circuit, and then it is easy to obtain the hardware circuit that implements the logic method flow.

[0064] The controller may be implemented in any suitable manner, for example, the controller may take the form of a microprocessor or processor and a computer-readable medium storing a computer-readable program code (e.g., software or firmware) executable by the (micro)processor, a logic gate, a switch, an application-specific integrated circuit (ASIC), a programmable logic controller, and an embedded microcontroller, examples of which include but are not limited to the following microcontrollers: ARC 625D, Atmel AT91SAM, Microchip PIC18F26K20, and Silicone Labs C8051F320, and the memory controller may also be implemented as part of the control logic of the memory. It is also known to those skilled in the art that, in addition to implementing the controller in a purely computer-readable program code manner, the controller may be implemented in the form of a logic gate, a switch, an application-specific integrated circuit, a programmable logic controller, and an embedded microcontroller by logically programming the method steps. Therefore, such a controller may be considered as a hardware component, and the devices for implementing various functions included therein may also be considered as structures within the hardware component. Or even, the devices for implementing various functions may be considered as both software modules for implementing the method and structures within the hardware component.

[0065] The systems, devices, modules or units described in the above embodiments may be implemented by computer chips or entities, or by products with certain functions. A typical implementation device is a computer. Specifically, the computer may be, for example, a personal computer, a laptop computer, a cellular phone, a camera phone, a smart phone, a personal digital assistant, a media player, a navigation device, an email device, a game console, a tablet computer, a wearable device, or a combination of any of these devices.

[0066] For the convenience of description, the above devices are described in terms of functions and are divided into various units. Of course, when implementing the embodiments of the present disclosure, the functions of each unit can be implemented in the same or multiple software and / or hardware.

[0067] It should be understood by those skilled in the art that one or more embodiments of the present disclosure may be provided as a method, system or computer program product. Therefore, one or more embodiments of the present disclosure may take the form of a complete hardware embodiment, a complete software embodiment, or an embodiment combining software and hardware. Moreover, one or more embodiments of the present disclosure may take the form of a computer program product implemented on one or more computer-usable storage media (including but not limited to disk storage, CD-ROM, optical storage, etc.) containing computer-usable program code.

[0068] The present disclosure is described with reference to the flowcharts and / or block diagrams of the methods, devices (systems), and computer program products according to the embodiments of the present disclosure. It should be understood that each process and / or block in the flowchart and / or block diagram, as well as the combination of the processes and / or blocks in the flowchart and / or block diagram, can be implemented by computer program instructions. These computer program instructions can be provided to a processor of a general-purpose computer, a special-purpose computer, an embedded processor, or other programmable data processing device to generate a machine, so that the instructions executed by the processor of the computer or other programmable data processing device generate instructions for implementing the processes in the flowchart and / or block diagram. Figure 1 A process or multiple processes and / or boxes Figure 1 A device that provides the functions specified in a block or multiple blocks.

[0069] These computer program instructions may also be stored in a computer-readable memory capable of directing a computer or other programmable data processing device to operate in a specific manner, so that the instructions stored in the computer-readable memory produce an article of manufacture comprising an instruction device, which implements the process Figure 1 A process or multiple processes and / or boxes Figure 1 A function specified in one or more boxes.

[0070] These computer program instructions can also be loaded onto a computer or other programmable data processing device so that a series of operating steps are executed on the computer or other programmable device to produce a computer-implemented process, thereby providing instructions for implementing the process. Figure 1 A process or multiple processes and / or boxes Figure 1 The steps for the functions specified in one or more boxes.

[0071] It should also be noted that the terms "include", "comprises" or any other variations thereof are intended to cover non-exclusive inclusion, so that a process, method, commodity or device including a series of elements includes not only those elements, but also other elements not explicitly listed, or also includes elements inherent to such process, method, commodity or device. In the absence of more restrictions, the elements defined by the sentence "comprises a ..." do not exclude the existence of other identical elements in the process, method, commodity or device including the elements.

[0072] One or more embodiments of the present disclosure may be described in the general context of computer-executable instructions executed by a computer, such as program modules. Generally, program modules include routines, programs, objects, components, data structures, etc. that perform specific tasks or implement specific abstract data types. One or more embodiments of the present disclosure may also be practiced in distributed computing environments in which tasks are performed by remote processing devices connected through a communication network. In a distributed computing environment, program modules may be located in local and remote computer storage media, including storage devices.

[0073] Each embodiment in the present disclosure is described in a progressive manner, and the same or similar parts between the embodiments can be referred to each other, and each embodiment focuses on the differences from other embodiments. In particular, for the system embodiment, since it is basically similar to the method embodiment, the description is relatively simple, and the relevant parts can be referred to the partial description of the method embodiment.

[0074] The above description is only an embodiment of the present disclosure and is not intended to limit the present disclosure. For those skilled in the art, the present disclosure may have various modifications and variations. Any modification, equivalent substitution, improvement, etc. made within the spirit and principle of the present disclosure shall be included in the scope of the claims of the present disclosure.

Claims

1. A medical insurance settlement method, characterized in that: The method comprises: According to the geographical area corresponding to the medical insurance to be settled, the task node configuration and rule configuration of the medical insurance settlement robot process automation RPA are performed; wherein the task node configuration includes configuring the task nodes that need to be executed during the medical insurance settlement process, and configuring the parameters corresponding to each task node; the rule configuration includes conversion rule configuration, reconciliation rule configuration and filing rule configuration; the conversion rule configuration is to configure the rules for converting medical insurance data into claim insurance data; the reconciliation rule configuration is to configure the fields that need to be reconciled, the reconciliation statement header names corresponding to the fields that need to be reconciled, and the reconciliation methods corresponding to the fields that need to be reconciled; the filing rule configuration is to configure the filing fields of batch uploaded medical images; The RPA is triggered to settle the medical insurance to be settled according to the configured task nodes and rules.

2. The method according to claim 1, characterized in that The task nodes that need to be executed during the medical insurance settlement process include at least one of the following: logging into the medical insurance claims system, downloading medical insurance data, converting medical insurance data into claims insurance data according to the configured conversion rules, improving medical insurance payee information, importing the converted claims insurance data and the improved medical insurance payee information into the settlement system, reconciling the corresponding statements of the medical insurance to be settled according to the configured reconciliation rules, filing the batch uploaded medical images according to the configured filing rules, medical insurance claims review, and claims for medical insurance payees.

3. The method according to claim 2, characterized in that Configure the parameters corresponding to each task node, including: When the task node to be executed during the medical insurance settlement process includes logging into the medical insurance claim system, a login account and a login password are configured for the task node for logging into the medical insurance claim system; When the task node to be executed during the medical insurance settlement process includes downloading medical insurance data, the location, file name, and generation time of the medical insurance data to be downloaded are configured for the task node for downloading medical insurance data; When the task nodes to be executed during the medical insurance settlement process include medical insurance claim review, the conditions for passing the review are configured for the task nodes of the medical insurance claim review.

4. The method according to claim 2, characterized in that: The task nodes that need to be executed during the medical insurance settlement process include: converting medical insurance data into claim insurance data according to the configured conversion rules; Configure rules to convert medical insurance data into claims insurance data, including: Obtain the medical insurance data template and the claim insurance data template; configuring a conversion relationship between a first field in the medical insurance data template and a second field in the claim insurance data template; The settling of the medical insurance to be settled includes: When a task node that converts medical insurance data into claim insurance data according to a configured conversion rule executes a task, the medical insurance data is converted into claim insurance data according to a conversion relationship between the first field and the second field.

5. The method according to claim 1, characterized in that: The task nodes that need to be executed during the medical insurance settlement process include: reconciling the corresponding statements of the medical insurance to be settled according to the configured reconciliation rules; The settling of the medical insurance to be settled includes: When executing a task at a task node that performs reconciliation processing on the statement of account corresponding to the medical insurance to be settled according to the configured reconciliation rules, obtain the target header name of the statement of account corresponding to the medical insurance to be settled, and match the target header name with the statement header name corresponding to the configured field that needs to be reconciled, and if the match is successful, perform reconciliation processing on the statement of account corresponding to the target header name according to the reconciliation method corresponding to the field that needs to be reconciled that matches the target header name; wherein the target header name is identified from the statement of account corresponding to the medical insurance to be settled based on optical character recognition (OCR) technology.

6. The method according to claim 5, characterized in that The file names of the medical insurance data, the corresponding statements of the medical insurance to be settled, and the supporting materials corresponding to the statements include: the institution identification of the uploading institution, the file type, the corresponding medical insurance type, and the time when the file was obtained.

7. A medical insurance settlement device, characterized in that: The device comprises: A configuration module is used to configure task nodes and rules for the medical insurance settlement robot process automation RPA according to the geographical area corresponding to the medical insurance to be settled; wherein the task node configuration includes configuring the task nodes to be executed during the medical insurance settlement process, and configuring the parameters corresponding to each task node; the rule configuration includes conversion rule configuration, reconciliation rule configuration and filing rule configuration; the conversion rule configuration is to configure the rules for converting medical insurance data into claim insurance data; the reconciliation rule configuration is to configure the fields that need to be reconciled, the reconciliation statement header names corresponding to the fields that need to be reconciled, and the reconciliation methods corresponding to the fields that need to be reconciled; the filing rule configuration is to configure the filing fields of medical images uploaded in batches; The settlement module is used to trigger the RPA to settle the medical insurance to be settled according to the configured task nodes and rules.

8. A medical insurance settlement device, characterized in that: include: A memory, a processor, and a computer program stored in the memory and executable on the processor, wherein the computer program implements the steps of the method according to any one of claims 1 to 6 when executed by the processor.

9. A computer-readable storage medium, characterized in that: The computer-readable storage medium is used to store computer-executable instructions, and when the computer-executable instructions are executed by a processor, the steps of the method described in any one of claims 1 to 6 are implemented.

10. A computer program product, characterized in that The computer program product comprises a computer program, and when the computer program is executed by a processor, the steps of the method according to any one of claims 1 to 6 are implemented.

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