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: carrying out the character recognition of a to-be-audited medical fee list, and obtaining a to-be-audited medical insurance text; performing medical insurance item matching on a to-be-audited medical insurance item in the to-be-audited medical insurance text and a hospital expense list database to obtain a medical insurance item matching result; and if the to-be-audited medical insurance item is successfully matched with the hospital expense list database, determining a medical insurance level according to a medical insurance item matching result, and performing commercial insurance auditing on the to-be-audited medical insurance item according to the medical insurance level to obtain a commercial insurance auditing result. According to the embodiment of the invention, the to-be-audited medical insurance item in the to-be-audited medical insurance text is subjected to medical insurance item matching with the hospital expense list database, so that the medical insurance level of the to-be-audited medical insurance item can be effectively determined, and the to-be-audited medical insurance item can be automatically subjected to commercial insurance auditing based on the medical insurance level of the to-be-audited medical insurance item; therefore, commercial insurance auditing errors caused by large differences of medical insurance policies in various regions are prevented, 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] Obtaining a list of medical expenses to be reviewed, and performing character recognition on the list of medical expenses to be reviewed to obtain a medical insurance text to be reviewed;

[0007] Matching the medical insurance items to be reviewed in the medical insurance text to be reviewed with the hospital expense list database to obtain a medical insurance item matching result;

[0008] If the medical insurance item to be reviewed successfully matches the hospital expense list database, the medical insurance level is determined according to the matching result of the medical insurance item, and the medical insurance item to be reviewed is subject to commercial insurance review according to the medical insurance level to obtain the commercial insurance review result.

[0009] Preferably, the medical insurance items to be reviewed in the medical insurance text to be reviewed are matched with the hospital expense list database to obtain the medical insurance item matching results, including:

[0010] Perform entity recognition on the medical insurance item to be reviewed, and determine the name of the medical insurance to be reviewed in the medical insurance item to be reviewed according to the entity recognition result;

[0011] Match the name of the medical insurance to be reviewed with the historical medical insurance item information in the hospital expense list database;

[0012] If the medical insurance name to be reviewed successfully matches with any of the historical medical insurance names in the historical medical insurance item information, it is determined that the medical insurance item to be reviewed successfully matches with the hospital expense list database;

[0013] If the medical insurance name to be reviewed fails to match the historical medical insurance name in the historical medical insurance item information, it is determined that the medical insurance item to be reviewed fails to match the hospital expense list database.

[0014] Preferably, determining the medical insurance level according to the medical insurance item matching result includes:

[0015] The medical insurance type corresponding to the matched historical medical insurance name is obtained, and the medical insurance type is determined as the medical insurance level corresponding to the medical insurance item to be reviewed.

[0016] Preferably, character recognition is performed on the medical expense list to be reviewed to obtain the medical insurance text to be reviewed, including:

[0017] Binarizing the medical expense list to be reviewed to obtain a binary image, and denoising the binary image to obtain a denoised image;

[0018] Performing tilt correction on the denoised image to obtain a corrected image, and segmenting the text in the corrected image to obtain segmented paragraphs;

[0019] Performing character segmentation on the segmented paragraphs to obtain segmented characters, and performing character recognition on the segmented characters to obtain text characters;

[0020] The text characters are classified, and the medical insurance text to be reviewed is determined according to the character classification result.

[0021] Preferably, performing character recognition on the segmented characters to obtain text characters includes:

[0022] Obtaining the character contour of the segmented character, and performing zero-crossing detection on the character contour;

[0023] Performing contour screening on the character contour according to the zero-crossing detection result to obtain a screening contour, and performing connected domain processing on the screening contour to obtain a connected domain contour;

[0024] The contour similarity between the connected domain contour and the preset contour is calculated, and the character corresponding to the preset contour with the maximum contour similarity is determined as the text character of the segmented character.

[0025] Preferably, after matching the medical insurance items to be reviewed in the medical insurance document to be reviewed with the hospital expense list database and obtaining the medical insurance item matching result, the process further includes:

[0026] If the medical insurance item to be reviewed fails to match the hospital expense list database, the medical insurance item to be reviewed is matched with the medical insurance catalog to obtain the local medical insurance policy;

[0027] The medical insurance deduction ratio is determined according to the local medical insurance policy, and the commercial insurance review is conducted on the medical insurance items to be reviewed according to the medical insurance deduction ratio to obtain the commercial insurance review results.

[0028] Preferably, after conducting a commercial insurance review on the medical insurance item to be reviewed according to the medical insurance deduction ratio and obtaining the commercial insurance review result, the process further includes:

[0029] If the commercial insurance review result is passed, the medical insurance type of the medical insurance item to be reviewed is determined according to the medical insurance deduction ratio, and the medical insurance item to be reviewed and the medical insurance type of the medical insurance item to be reviewed are stored in the hospital expense list database accordingly.

[0030] Another object of an embodiment of the present invention is to provide a commercial insurance review system, the system comprising:

[0031] A character recognition module is used to obtain a list of medical expenses to be reviewed, and perform character recognition on the list of medical expenses to be reviewed to obtain a medical insurance text to be reviewed;

[0032] A medical insurance matching module, used to match the medical insurance items to be reviewed in the medical insurance text to be reviewed with the hospital expense list database to obtain a medical insurance item matching result;

[0033] The commercial insurance review module is used to determine the medical insurance level according to the matching result of the medical insurance item if the medical insurance item to be reviewed is successfully matched with the hospital expense list database, and to conduct a commercial insurance review on the medical insurance item to be reviewed according to the medical insurance level to obtain the commercial insurance review result.

[0034] Preferably, the medical insurance matching module is also used for:

[0035] Perform entity recognition on the medical insurance item to be reviewed, and determine the name of the medical insurance to be reviewed in the medical insurance item to be reviewed according to the entity recognition result;

[0036] Match the name of the medical insurance to be reviewed with the historical medical insurance item information in the hospital expense list database;

[0037] If the medical insurance name to be reviewed successfully matches with any of the historical medical insurance names in the historical medical insurance item information, it is determined that the medical insurance item to be reviewed successfully matches with the hospital expense list database;

[0038] If the medical insurance name to be reviewed fails to match the historical medical insurance name in the historical medical insurance item information, it is determined that the medical insurance item to be reviewed fails to match the hospital expense list database.

[0039] The embodiments of the present invention can effectively obtain the medical insurance text to be reviewed in the medical expense list to be reviewed by performing character recognition on the medical expense list to be reviewed, and can effectively determine the medical insurance level of the medical insurance item to be reviewed by matching the medical insurance items to be reviewed in the medical insurance text to be reviewed with the medical insurance items in the hospital expense list database, and can automatically perform commercial insurance review on the medical insurance item to be reviewed based on the medical insurance level of the medical insurance item to be reviewed, without the need to manually review the medical insurance items to be reviewed item by item, thereby preventing commercial insurance review errors caused by large differences in medical insurance policies from different regions and improving the accuracy of commercial insurance review. BRIEF DESCRIPTION OF THE DRAWINGS

[0040] Figure 1 is a flow chart of a commercial insurance review method provided by a first embodiment of the present invention;

[0041] Figure 2 is a structural diagram of a commercial insurance review system provided by a second embodiment of the present invention;

[0042] Figure 3 is a specific implementation diagram of the commercial insurance review system provided by the second embodiment of the present invention;

[0043] Figure 4 It is a schematic diagram of the structure of a terminal device provided in the third embodiment of the present invention. DETAILED DESCRIPTION

[0044] 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.

[0045] In order to illustrate the technical solution of the present invention, a specific embodiment is provided below for illustration.

[0046] Embodiment 1

[0047] 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:

[0048] Step S10, obtaining a list of medical expenses to be reviewed, and performing character recognition on the list of medical expenses to be reviewed to obtain a medical insurance text to be reviewed;

[0049] Among them, by performing character recognition on the medical expense list to be reviewed, the medical insurance text to be reviewed in the medical expense list to be reviewed can be effectively obtained. The medical insurance text to be reviewed includes the medical insurance items to be reviewed and the medical insurance deduction amounts corresponding to the medical insurance items to be reviewed.

[0050] Optionally, character recognition is performed on the medical expense list to be reviewed to obtain a medical insurance text to be reviewed, including:

[0051] Binarizing the medical expense list to be reviewed to obtain a binary image, and denoising the binary image to obtain a denoised image; wherein, by binarizing the medical expense list to be reviewed, the medical expense list to be reviewed can be effectively converted into a grayscale image, and by denoising the binary image to remove noise points in the binary image, the image quality of the binary image is improved;

[0052] 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;

[0053] 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;

[0054] The text characters are classified, and the medical insurance text to be reviewed is determined based on the character classification results; wherein, entity recognition is performed on the text characters, the medical insurance target characters are determined based on the entity types of the text characters, and the text sentences corresponding to the medical insurance target characters are combined to obtain the medical insurance text to be reviewed.

[0055] Further, character recognition is performed on the segmented characters to obtain text characters, including:

[0056] Obtaining the character contour of the segmented character, and performing zero-crossing detection on the character contour; wherein, contour recognition is performed on the segmented character to obtain the character contour, and the accuracy of the character contour is effectively improved by performing zero-crossing detection on the character contour, and the contour width of the character contour is obtained, and the contour width is compared with a preset width range to achieve the zero-crossing detection effect of the character contour;

[0057] The character contour is subjected to contour screening according to the zero-crossing detection result to obtain a screening contour, and the screening contour is subjected to connected domain processing to obtain a connected domain contour; wherein, according to the comparison result between the contour width and the preset width range, the character contour whose contour width is not within the preset width range is deleted to achieve the contour screening effect of the contour width, and the accuracy of the connected domain contour is effectively improved by performing connected domain processing on the screening contour;

[0058] Calculate the contour similarity between the connected domain contour and the preset contour, and determine the character text corresponding to the preset contour with the maximum contour similarity 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 can be achieved.

[0059] Step S20, matching the medical insurance items to be reviewed in the medical insurance document to be reviewed with the hospital expense list database to obtain a medical insurance item matching result;

[0060] Among them, the hospital expense list database includes the verified hospital expense lists. The medical insurance items to be reviewed in the medical insurance text to be reviewed are matched with the medical insurance items in the hospital expense list database to detect whether there is historical review information corresponding to the medical insurance items to be reviewed in the hospital expense list database. If there is historical review information corresponding to the medical insurance items to be reviewed, the commercial insurance review can be directly carried out on the medical insurance items to be reviewed based on the medical insurance item matching results, without the need for manual intervention and policy reliance, thereby improving the accuracy and efficiency of the commercial insurance review.

[0061] Optionally, the medical insurance items to be reviewed in the medical insurance text to be reviewed are matched with the hospital expense list database to obtain the medical insurance item matching results, including:

[0062] Perform entity recognition on the medical insurance item to be reviewed, and determine the name of the medical insurance to be reviewed in the medical insurance item to be reviewed according to the entity recognition result; wherein, the entity type of the text vocabulary in the medical insurance item to be reviewed is determined according to the entity recognition result, the entity type of the text vocabulary is matched with the preset type, and the text vocabulary with successful matching is determined as the name of the medical insurance to be reviewed, and the preset type can be set according to the demand;

[0063] Match the name of the medical insurance to be reviewed with the historical medical insurance item information in the hospital expense list database; wherein, by matching the name of the medical insurance to be reviewed with the historical medical insurance item information in the hospital expense list database, it is detected whether the commercial insurance information corresponding to the medical insurance name to be reviewed has been reviewed in the historical medical insurance item information;

[0064] If the name of the medical insurance to be reviewed successfully matches the name of the historical medical insurance in any of the historical medical insurance item information, it is determined that the medical insurance item to be reviewed successfully matches the hospital expense list database;

[0065] If the medical insurance name to be reviewed and the historical medical insurance name in the historical medical insurance item information both fail to match, it is determined that the medical insurance item to be reviewed and the hospital expense list database fail to match; among them, if the medical insurance name to be reviewed and the historical medical insurance name in the historical medical insurance item information both fail to match, it is determined that the commercial insurance information corresponding to the medical insurance name to be reviewed has not been reviewed in the historical medical insurance item information.

[0066] Step S30: if the medical insurance item to be reviewed successfully matches the hospital expense list database, the medical insurance grade is determined according to the medical insurance item matching result, and the commercial insurance review is performed on the medical insurance item to be reviewed according to the medical insurance grade to obtain the commercial insurance review result;

[0067] Among them, if the medical insurance items to be reviewed are successfully matched with the hospital expense list database, the commercial insurance review can be directly conducted on the medical insurance items to be reviewed based on the hospital expense list database, without the need to manually review the medical insurance items one by one, thereby improving the efficiency of commercial insurance review. In this step, the medical insurance deduction ratio is determined based on the medical insurance level, the standard deduction amount is determined based on the medical insurance deduction ratio and the total amount of the medical insurance items to be reviewed, and the medical insurance deduction amount of the medical insurance items to be reviewed is compared with the standard deduction amount to obtain the commercial insurance review result.

[0068] Optionally, the medical insurance level is determined based on the matching result of the medical insurance item, including: obtaining the medical insurance type corresponding to the matched historical medical insurance name, and determining the medical insurance type as the medical insurance level corresponding to the medical insurance item to be reviewed. For example, if the medical insurance type corresponding to the historical medical insurance name is Class A, then Class A is determined as the medical insurance level of the medical insurance item to be reviewed.

[0069] Furthermore, after matching the medical insurance items to be reviewed in the medical insurance document to be reviewed with the hospital expense list database, and obtaining the medical insurance item matching result, the method further includes:

[0070] If the medical insurance item to be reviewed fails to match the hospital expense list database, the medical insurance item to be reviewed is matched with the medical insurance catalog to obtain the local medical insurance policy; wherein, the medical insurance item to be reviewed is matched with the medical insurance catalog to obtain the local medical insurance policy corresponding to the medical insurance item to be reviewed on the local medical insurance;

[0071] The medical insurance deduction ratio is determined according to the local medical insurance policy, and the medical insurance items to be reviewed are subject to commercial insurance review according to the medical insurance deduction ratio to obtain the commercial insurance review result; wherein, the product of the medical insurance deduction ratio and the total amount of the medical insurance items to be reviewed is calculated to obtain the standard deduction amount, and the medical insurance deduction amount of the medical insurance items to be reviewed is compared with the standard deduction amount to obtain the commercial insurance review result.

[0072] Furthermore, after the commercial insurance audit is performed on the medical insurance items to be reviewed according to the medical insurance deduction ratio and the commercial insurance audit result is obtained, it also includes: if the commercial insurance audit result is passed, the medical insurance type of the medical insurance item to be reviewed is determined according to the medical insurance deduction ratio, and the medical insurance item to be reviewed and the medical insurance type of the medical insurance item to be reviewed are stored in the hospital expense list database accordingly; wherein, by storing the medical insurance items to be reviewed and the medical insurance types that have passed the commercial insurance audit in the hospital expense list database accordingly, the subsequent commercial insurance audit operations of the same medical insurance items to be reviewed are facilitated.

[0073] In this embodiment, by performing character recognition on the medical expense list to be reviewed, the medical insurance text to be reviewed in the medical expense list to be reviewed can be effectively obtained. By matching the medical insurance items to be reviewed in the medical insurance text to be reviewed with the medical insurance items in the hospital expense list database, the medical insurance level of the medical insurance items to be reviewed can be effectively determined. Based on the medical insurance level of the medical insurance items to be reviewed, the medical insurance items to be reviewed can be automatically reviewed for commercial insurance, without the need to manually review the medical insurance items to be reviewed item by item, thereby preventing commercial insurance review errors caused by large differences in medical insurance policies in various places and improving the accuracy of commercial insurance review. In this embodiment, by continuously accumulating and improving the hospital expense list database, the list data can be automatically matched, the applicability of the review can be significantly improved, and the dependence on manual intervention and policies can be reduced. The hospital expense list database can make up for the situation where the medical insurance policy is not updated in a timely manner. During the review, the review is conducted based on the list data first, reducing the dependence on local medical insurance policies. In particular, when there is no medical insurance level A, B, or C in the list, the expense deduction rules can still be accurately judged, improving the accuracy and efficiency of the review.

[0074] Embodiment 2

[0075] 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:

[0076] The character recognition module 10 is used to obtain the medical expense list to be reviewed, and perform character recognition on the medical expense list to be reviewed to obtain the medical insurance text to be reviewed.

[0077] Optionally, the character recognition module 10 is further used to: perform binarization processing on the medical expense list to be reviewed to obtain a binarized image, and perform denoising processing on the binarized image to obtain a denoised image;

[0078] Performing tilt correction on the denoised image to obtain a corrected image, and segmenting the text in the corrected image to obtain segmented paragraphs;

[0079] Performing character segmentation on the segmented paragraphs to obtain segmented characters, and performing character recognition on the segmented characters to obtain text characters;

[0080] The text characters are classified, and the medical insurance text to be reviewed is determined according to the character classification result.

[0081] Furthermore, the character recognition module 10 is also used to: obtain the character contour of the segmented character, and perform zero-crossing detection on the character contour;

[0082] Performing contour screening on the character contour according to the zero-crossing detection result to obtain a screening contour, and performing connected domain processing on the screening contour to obtain a connected domain contour;

[0083] The contour similarity between the connected domain contour and the preset contour is calculated, and the character corresponding to the preset contour with the maximum contour similarity is determined as the text character of the segmented character.

[0084] The medical insurance matching module 11 is used to match the medical insurance items to be reviewed in the medical insurance text to be reviewed with the hospital expense list database to obtain the medical insurance item matching results.

[0085] Optionally, the medical insurance matching module 11 is further used to: perform entity recognition on the medical insurance item to be reviewed, and determine the name of the medical insurance to be reviewed in the medical insurance item to be reviewed according to the entity recognition result;

[0086] Match the name of the medical insurance to be reviewed with the historical medical insurance item information in the hospital expense list database;

[0087] If the medical insurance name to be reviewed successfully matches with any of the historical medical insurance names in the historical medical insurance item information, it is determined that the medical insurance item to be reviewed successfully matches with the hospital expense list database;

[0088] If the medical insurance name to be reviewed fails to match the historical medical insurance name in the historical medical insurance item information, it is determined that the medical insurance item to be reviewed fails to match the hospital expense list database.

[0089] The commercial insurance review module 12 is used to determine the medical insurance level according to the matching result of the medical insurance item if the medical insurance item to be reviewed is successfully matched with the hospital expense list database, and to conduct a commercial insurance review on the medical insurance item to be reviewed according to the medical insurance level to obtain the commercial insurance review result.

[0090] Optionally, the commercial insurance review module 12 is further used to: obtain the medical insurance type corresponding to the matched historical medical insurance name, and determine the medical insurance type as the medical insurance level corresponding to the medical insurance item to be reviewed.

[0091] Furthermore, the commercial insurance review module 12 is also used for: if the medical insurance item to be reviewed fails to match the hospital expense list database, then matching the medical insurance item to be reviewed with the medical insurance catalog to obtain the local medical insurance policy;

[0092] The medical insurance deduction ratio is determined according to the local medical insurance policy, and the commercial insurance review is conducted on the medical insurance items to be reviewed according to the medical insurance deduction ratio to obtain the commercial insurance review results.

[0093] Furthermore, the commercial insurance review module 12 is also used to: if the commercial insurance review result is passed, determine the medical insurance type of the medical insurance item to be reviewed according to the medical insurance deduction ratio, and store the medical insurance item to be reviewed and the medical insurance type of the medical insurance item to be reviewed in the hospital expense list database accordingly.

[0094] See also Figure 3 , the verified hospital expense list will be manually reviewed again by auditors and medical insurance policy experts, and the hospital expense list that has passed the manual review will be input into the commercial insurance review system 100. The commercial insurance review system 100 will integrate the hospital expense list that has passed the manual review into the hospital expense list database. When there is no medical insurance grade A, B, or C in the medical expense list to be reviewed, the medical insurance grade is determined by matching the medical insurance name in the hospital expense list database directly by equal matching of the name, the medical insurance deduction ratio is determined based on the medical insurance grade, the standard deduction amount is determined based on the medical insurance deduction ratio and the total amount of the medical insurance items to be reviewed, and the medical insurance deduction amount of the medical insurance items to be reviewed is compared with the standard deduction amount to obtain the commercial insurance review result.

[0095] In this embodiment, by performing character recognition on the medical expense list to be reviewed, the medical insurance text to be reviewed in the medical expense list to be reviewed can be effectively obtained, and by matching the medical insurance items to be reviewed in the medical insurance text to be reviewed with the medical insurance items in the hospital expense list database, the medical insurance level of the medical insurance items to be reviewed can be effectively determined. Based on the medical insurance level of the medical insurance items to be reviewed, commercial insurance review can be automatically performed on the medical insurance items to be reviewed, and there is no need to manually review the medical insurance items to be reviewed item by item, thereby preventing commercial insurance review errors caused by large differences in medical insurance policies from place to place and improving the accuracy of commercial insurance review.

[0096] Embodiment 3

[0097] Figure 4 2 is a block diagram of a terminal device 2 provided in the third embodiment of the present application. Figure 4As 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.

[0098] 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.

[0099] 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.

[0100] 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.

[0101] 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.

[0102] 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.

[0103] 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: Obtaining a list of medical expenses to be reviewed, and performing character recognition on the list of medical expenses to be reviewed to obtain a medical insurance text to be reviewed; Matching the medical insurance items to be reviewed in the medical insurance text to be reviewed with the hospital expense list database to obtain a medical insurance item matching result; If the medical insurance item to be reviewed successfully matches the hospital expense list database, the medical insurance level is determined according to the matching result of the medical insurance item, and the medical insurance item to be reviewed is subject to commercial insurance review according to the medical insurance level to obtain the commercial insurance review result.

2. The commercial insurance review method according to claim 1, characterized in that: The medical insurance items to be reviewed in the medical insurance text to be reviewed are matched with the hospital expense list database to obtain the medical insurance item matching results, including: Perform entity recognition on the medical insurance item to be reviewed, and determine the name of the medical insurance to be reviewed in the medical insurance item to be reviewed according to the entity recognition result; Match the name of the medical insurance to be reviewed with the historical medical insurance item information in the hospital expense list database; If the name of the medical insurance to be reviewed successfully matches the name of the historical medical insurance in any of the historical medical insurance item information, it is determined that the medical insurance item to be reviewed successfully matches the hospital expense list database; If the medical insurance name to be reviewed fails to match the historical medical insurance name in the historical medical insurance item information, it is determined that the medical insurance item to be reviewed fails to match the hospital expense list database.

3. The commercial insurance review method according to claim 2, characterized in that: The medical insurance level is determined according to the matching results of the medical insurance items, including: The medical insurance type corresponding to the matched historical medical insurance name is obtained, and the medical insurance type is determined as the medical insurance level corresponding to the medical insurance item to be reviewed.

4. The commercial insurance review method according to claim 1, characterized in that: Perform character recognition on the medical expense list to be reviewed to obtain the medical insurance text to be reviewed, including: Binarizing the medical expense list to be reviewed 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 medical insurance text to be reviewed is determined according to the character classification result.

5. The commercial insurance review method according to claim 4, characterized in that: Performing character recognition on the segmented characters to obtain text characters includes: Obtaining the character contour of the segmented character, and performing zero-crossing detection on the character contour; Performing contour screening on the character contour according to the zero-crossing detection result to obtain a screening contour, and performing connected domain processing on the screening contour to obtain a connected domain contour; The contour similarity between the connected domain contour and the preset contour is calculated, and the character corresponding to the preset contour with the maximum contour similarity is determined as the text character of the segmented character.

6. The commercial insurance review method according to claim 1, characterized in that: After matching the medical insurance items to be reviewed in the medical insurance document to be reviewed with the hospital expense list database and obtaining the medical insurance item matching result, the method further includes: If the medical insurance item to be reviewed fails to match the hospital expense list database, the medical insurance item to be reviewed is matched with the medical insurance catalog to obtain the local medical insurance policy; The medical insurance deduction ratio is determined according to the local medical insurance policy, and the commercial insurance review is conducted on the medical insurance items to be reviewed according to the medical insurance deduction ratio to obtain the commercial insurance review results.

7. The commercial insurance review method according to claim 6, characterized in that: The commercial insurance review of the medical insurance item to be reviewed is performed according to the medical insurance deduction ratio, and after obtaining the commercial insurance review result, the method further includes: If the commercial insurance review result is passed, the medical insurance type of the medical insurance item to be reviewed is determined according to the medical insurance deduction ratio, and the medical insurance item to be reviewed and the medical insurance type of the medical insurance item to be reviewed are stored in the hospital expense list database accordingly.

8. A commercial insurance review system, characterized in that: The system comprises: A character recognition module is used to obtain a list of medical expenses to be reviewed, and perform character recognition on the list of medical expenses to be reviewed to obtain a medical insurance text to be reviewed; A medical insurance matching module, used to match the medical insurance items to be reviewed in the medical insurance text to be reviewed with the hospital expense list database to obtain a medical insurance item matching result; The commercial insurance review module is used to determine the medical insurance level according to the matching result of the medical insurance item if the medical insurance item to be reviewed is successfully matched with the hospital expense list database, and to conduct a commercial insurance review on the medical insurance item to be reviewed according to the medical insurance level to obtain the commercial insurance review result.

9. The commercial insurance review system according to claim 8, characterized in that: The medical insurance matching module is also used for: Perform entity recognition on the medical insurance item to be reviewed, and determine the name of the medical insurance to be reviewed in the medical insurance item to be reviewed according to the entity recognition result; Match the name of the medical insurance to be reviewed with the historical medical insurance item information in the hospital expense list database; If the name of the medical insurance to be reviewed successfully matches the name of the historical medical insurance in any of the historical medical insurance item information, it is determined that the medical insurance item to be reviewed successfully matches the hospital expense list database; If the medical insurance name to be reviewed fails to match the historical medical insurance name in the historical medical insurance item information, it is determined that the medical insurance item to be reviewed fails to match the hospital expense list database.

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.

Images