Medical institution business admission management method and system

Abstract

The invention relates to a medical institution service admission management method, aiming at an effective admission time limit of a target medical institution from a registration and declaration passing moment, designing an auditing operation based on a medical insurance service request and a re-checking operation based on an online state of the target medical institution, and aiming at the re-checking operation, providing a medical institution service admission management system. The method comprises the following steps of: distinguishing and considering registration and declaration information according to an aging period type and a non-aging period type, dynamically adjusting the re-checking frequency, reducing the re-checking frequency under a specific detection condition, considering the change of a data state, further adjusting the re-checking frequency in time, and ensuring the timeliness and accuracy of re-checking operation; active detection type adjustment and detection feedback type adjustment are intelligently realized; and meanwhile, a corresponding system is designed, so that the admission server cooperates with the target medical institution and the medical insurance service server to perform service scheduling execution, the working frequency of service admission management auditing and rechecking of the medical institution is optimized, and the working efficiency is improved.

Description

Technical Field

[0001] The present invention relates to a method and system for managing the business access of medical institutions, belonging to the technical field of access review. Background Art

[0002] The medical insurance department adopts a regulatory model of "application - review - access - regular review" for the business access management of medical institutions (including medical institutions, retail pharmacies, etc.). The specific process includes, in sequence: review of application conditions, on - site inspection, agreement signing, and regular review. This model aims to ensure the safety of medical insurance funds through access review and subsequent supervision, but there are still technical defects in actual operation.

[0003] In the existing regular review link, the medical insurance department needs to conduct periodic qualification verification, service data sampling, and agreement performance evaluation on a large number of designated institutions, including manual data verification, on - site repeated inspections, and paper material declarations. However, there are disadvantages such as low - efficient data processing, lack of dynamic monitoring, repeated resource consumption, and significant response delay. Summary of the Invention

[0004] The technical problem to be solved by the present invention is to provide a method for managing the business access of medical institutions, which considers the registration and declaration information according to the time - limit category and non - time - limit category, dynamically adjusts the review frequency, and improves the review work efficiency.

[0005] The present invention adopts the following technical solutions to solve the above - mentioned technical problems: The present invention designs a method for managing the business access of medical institutions, which is used to realize the management of the relevant business qualification access of the target medical institution by the medical insurance department. Based on the fact that the target medical institution passes the review of its registration and declaration information by the medical insurance department and obtains the unique identification code SN corresponding to the target medical institution allocated by the medical insurance department C and IP address IP C , combined with the medical insurance service request sent by the target medical institution containing SN C and IP C , within the preset effective access period starting from the moment of passing the registration and declaration, the following steps A to D are executed in real - time for the target medical institution:

[0006] Step A. Determine whether it is detected that the target medical institution sends a medical insurance service request to the medical insurance service server. If so, enter Step B; otherwise, further determine whether it is detected that the target medical institution sends a heartbeat signal. If so, enter Step C; otherwise, enter Step D;

[0007] Step B. Control the sending of the medical insurance service request to the medical insurance service server according to the judgment of SN C , IP C in the medical insurance service request and the type of service request.

[0008] Step C. Perform primary review of the registration and declaration information corresponding to the target medical institution according to the online cumulative duration and primary review frequency corresponding to the target medical institution.

[0009] Step D. Wait for detecting that the target medical institution sends a medical insurance service request or a heartbeat signal, and trigger the execution of a high-level review corresponding to the target medical institution, which includes cumulative medical insurance service request information and registration and declaration information.

[0010] As a preferred technical solution of the present invention: Based on the fact that the registration and declaration information of the target medical institution is reviewed and passed by the medical insurance department, then perform the following steps to obtain the unique identification code SN corresponding to the target medical institution assigned by the medical insurance department C and IP address IP C ;

[0011] Step a. The target medical institution applies to the superior medical insurance unit to obtain its corresponding country code, and applies to the medical insurance department to obtain its corresponding account number and IP address IP C , and then enter step b;

[0012] Step b. The target medical institution communicates with the medical insurance department in the account login mode, and sends its country code to the medical insurance department. The medical insurance department generates the security code corresponding to the target medical institution, associates the account number, country code, and security code, and forms the unique identification code SN corresponding to the target medical institution from the account number, country code, and security code C ;

[0013] The medical insurance department communicates with the superior medical insurance unit periodically to obtain the correspondence table of medical institutions and country codes. The medical insurance department checks the country codes of medical institutions according to the correspondence table. If a wrong country code is found, the sending of the medical insurance service request of the medical institution is terminated, and the response of the medical insurance service server to the medical insurance service request is terminated.

[0014] As a preferred technical solution of the present invention: Perform the following steps to complete the review of the registration and declaration information of the target medical institution by the medical insurance department;

[0015] Step . The target medical institution submits its registration and declaration information to the medical insurance department online based on the WEB authentication of Jiangsu Government Service APP and legal person authentication. The medical insurance department conducts online review. If the review fails, the information that the review fails is feedback to the target medical institution; if the review passes, enter step ;

[0016] Step . The medical insurance department conducts on-site verification of the target medical institution. If the verification passes, enter step ; If the verification fails, feedback the information of failed review to the target medical institution;

[0017] Step . The medical insurance department publicizes the target medical institution. If the publicity passes, it means that the medical insurance department has approved the registration application information of the target medical institution, and assigns the two - designated institution codes for the basic medical insurance designated medical institutions and basic medical insurance designated retail pharmacies, as well as signs the two - designated institution agreement; if the publicity fails, feedback the information of failed review to the target medical institution.

[0018] As a preferred technical solution of the present invention: Based on the fact that the registration application information of the target medical institution has been approved by the medical insurance department, perform the following steps to enable the target medical institution to apply to the medical insurance department to obtain the IP address IP C ;

[0019] Step . The target medical institution connects to the medical insurance department to apply for an IP address. If the medical insurance department approves, it notifies the operator for dedicated line deployment and assigns the IP address IP to the target medical institution C , and after the target medical institution successfully connects to the network based on the IP address IP C , enter step ; If the medical insurance department's review fails, terminate the IP address application of the target medical institution;

[0020] Step . The medical insurance department conducts on - site verification of the target medical institution. If the verification passes, the medical insurance department issues access policies including access blocking, network policies, routing policies, and security policies to the target medical institution, and synchronizes the medical insurance associated database; if the verification fails, recycle the IP address IP of the target medical institution C .

[0021] As a preferred technical solution of the present invention: The following steps B1 to B3 are included in step B;

[0022] Step B1. Extract the SN C , IP C in the medical insurance service request sent by the target medical institution to the medical insurance service server, and determine whether they are assigned by the medical insurance department and the SN C corresponds to the IP C . If so, enter step B2; otherwise, terminate the sending of this medical insurance service request and the response of the medical insurance service server to this medical insurance service request;

[0023] Step B2. Extract the service request type in this medical insurance service request, and determine whether it meets the corresponding service category range determined when the target medical institution's registration and declaration are successful. If so, proceed to Step B3; otherwise, terminate the sending of this medical insurance service request and the response of the medical insurance service server to this medical insurance service request.

[0024] Step B3. Do not intervene with this medical insurance service request, send it to the medical insurance service server, and let the medical insurance service server respond to this medical insurance service request and return to the target medical institution, realizing direct communication between the target medical institution and the medical insurance service server.

[0025] As a preferred technical solution of the present invention: Based on the registration and declaration information including a time-limited category and a non-time-limited category, and initializing the primary review frequency corresponding to the target medical institution, within a preset effective access period starting from the moment when the registration and declaration are passed, when the processes of Steps A to D are executed in real time for the target medical institution, Step C includes the following Steps C1 to C8;

[0026] Step C1. If a primary review has been executed in historical time, determine whether there is a downscaling cut-off time point corresponding to the target medical institution that is later than the current moment. If so, proceed to Step C2; otherwise, proceed to Step C3;

[0027] If a primary review has not been executed in historical time, select all the time-limited categories from the registration and declaration information to form each current time-limited category, and randomly select non-time-limited categories from the registration and declaration information to form each current non-time-limited category, and then proceed to Step C5; represents the number of non-time-limited categories in the registration and declaration information, represents the preset ratio, represents the ceiling operation;

[0028] Step C2. According to a preset secondary review frequency that is less than the primary review frequency, determine whether the online cumulative duration corresponding to the time from the last execution of the primary review to the current moment reaches the cycle duration corresponding to the secondary review frequency. If so, randomly select non-time-limited categories from the registration and declaration information to form each current non-time-limited category, and then proceed to Step C6; otherwise, do not perform any processing;

[0029] Step C3. According to the primary review frequency, determine whether the online cumulative duration corresponding to the time from the last execution of the primary review to the current moment reaches the cycle duration corresponding to the primary review frequency. If so, randomly select non-time-limited categories from the registration and declaration information to form each current non-time-limited category, and then proceed to Step C4; otherwise, do not perform any processing;

[0030] Step C4. Determine whether there is a time limit identifier in all the time limit categories corresponding to the target medical institution that is in an expired state at the current moment. If so, select the time limit categories corresponding to each of the currently expired time limit identifiers to form each current time limit category, and then proceed to Step C5; otherwise, directly proceed to Step C6.

[0031] Step C5. Extract the information corresponding to each current time limit category of the target medical institution, obtain the effective time limit in the information of each current time limit category, and determine whether there is current time limit category information in an invalid state. If so, terminate the communication between the target medical institution and the medical insurance service server, and then proceed to Step C6; otherwise, for each current time limit category corresponding to the target medical institution, use the effective time limit in the current time limit category information corresponding to the target medical institution to form or update the time limit identifier of the current time limit category corresponding to the target medical institution, and then proceed to Step C6.

[0032] Step C6. Extract the information corresponding to each current non-time limit category of the target medical institution, and determine whether there is current non-time limit category information that does not meet the review requirements of the medical insurance department. If so, terminate the communication between the target medical institution and the medical insurance service server, and then proceed to Step C7; otherwise, do nothing and proceed to Step C7.

[0033] Step C7. If the communication between the target medical institution and the medical insurance service server has been terminated, determine that the primary review is unqualified, and feedback to the target medical institution the current time limit category information in an invalid state corresponding to it, or feedback to the target medical institution the current non-time limit category information that does not meet the review requirements of the medical insurance department.

[0034] If the communication between the target medical institution and the medical insurance service server has not been terminated, determine that the primary review is qualified, and proceed to Step C8.

[0035] Step C8. Determine whether the primary review has been qualified for a preset number of consecutive times. If so, select the earliest expiration time among the time limit identifiers of all the time limit categories corresponding to the target medical institution to form the down-frequency cut-off time point corresponding to the target medical institution; otherwise, do nothing.

[0036] As a preferred technical solution of the present invention: each current time-limited category and each current non-time-limited category formed in step C1, each current non-time-limited category formed in step C2, each current non-time-limited category formed in steps C3 to C4, or each current non-time-limited category and each current time-limited category are respectively sent to the target medical institution in a primary review inquiry message;

[0037] In step C5, the target medical institution receives the primary review inquiry message, extracts the information of each current time-limited category corresponding to the target medical institution in the primary review inquiry message respectively, and combines the unique identification code SN corresponding to the target medical institution C with the IP address IP C , constructs a primary review response message for return; then first judges whether the SN C , IP C in the primary review response message belong to those allocated by the medical insurance department and SN C corresponds to IP C . If so, continue to execute the judgment on the information of each current time-limited category corresponding to the target medical institution respectively; otherwise, terminate the communication between the target medical institution and the medical insurance business server, and then enter step C6;

[0038] In step C6, the target medical institution receives the primary review inquiry message, extracts the information of each current non-time-limited category corresponding to the target medical institution in the primary review inquiry message respectively, and combines the unique identification code SN corresponding to the target medical institution C with the IP address IP C , constructs a primary review response message for return; then first judges whether the SN C , IP C in the primary review response message belong to those allocated by the medical insurance department and SN C corresponds to IP C . If so, continue to execute the judgment on the information of each current non-time-limited category corresponding to the target medical institution respectively; otherwise, terminate the communication between the target medical institution and the medical insurance business server, and then enter step C7.

[0039] As a preferred technical solution of the present invention: step D includes the following steps D1 to D3;

[0040] Step D1. Wait until it is detected that the target medical institution sends a medical insurance service request or a heartbeat signal, and trigger to enter step D2;

[0041] Step D2. Perform an audit on accumulating the information of each medical insurance business request for the target medical institution. If the audit is qualified, proceed to Step D3; if the audit is unqualified, terminate the communication between the target medical institution and the medical insurance business server.

[0042] Step D3. Perform a primary review of the registration and declaration information corresponding to the target medical institution.

[0043] Correspondingly, the technical problem to be solved by the present invention is to provide a system for the medical institution business access management method, which collaborates with the access server, the target medical institution, and the medical insurance business server to perform business scheduling and execution, improving work efficiency.

[0044] The present invention adopts the following technical solutions to solve the above technical problems: The present invention designs a system for the medical institution business access management method, including an access server. Among them, the target medical institution and the medical insurance business server are directly connected and communicate through the main communication link, and the access server accesses the main communication link between the target medical institution and the medical insurance business server through the branch communication link.

[0045] Based on the access server detecting in Step A that the target medical institution sends a medical insurance business request to the medical insurance business server through the main communication link, in Step B, the access server copies the medical insurance business request from the main communication link and analyzes the SN C , IP C , and the type of business request in this medical insurance business request, and then the access server controls the sending of this medical insurance business request to the medical insurance business server.

[0046] Based on the access server detecting in Step A that the target medical institution sends a heartbeat signal, in Steps C1 to C4 of Step C, the access server constructs a primary review inquiry message and sends it to the target medical institution; in Steps C5 and C6, the primary review response message constructed by the target medical institution is returned to the access server, and the access server performs the judgments in Steps C5 and C6, as well as the operations in Steps C7 to C8, to control the communication between the target medical institution and the medical insurance business server.

[0047] Based on the access server not detecting the medical insurance business request or heartbeat signal sent by the target medical institution in Step A, in Step D, when the access server detects the medical insurance business request or heartbeat signal sent by the target medical institution, it triggers the access server and the target medical institution to interact and perform a senior review.

[0048] As a preferred technical solution of the present invention: the access server accumulatively detects and stores the number of times the target medical institution sends and completes medical insurance business requests to the medical insurance business server; in the step D2, the access server sends an instruction to the target medical institution to inquire about the number of times the target medical institution sends and completes medical insurance business requests to the medical insurance business server. The target medical institution receives the instruction, queries its internal log file to obtain the result, and feeds it back to the access server. The access server determines whether the result from the target medical institution is consistent with the number stored in the access server. If it is, the audit is qualified and step D3 is entered; otherwise, the audit is unqualified and the communication between the target medical institution and the medical insurance business server is terminated.

[0049] The medical insurance department includes an online handling server and an IP allocation server. Among them, the online handling server communicates with the target medical institution and the IP allocation server respectively; the target medical institution creates registration application information and sends it to the online handling server. The online handling server receives the registration application information and conducts an audit. Based on the audit passing, the online handling server constructs the unique identification code SN corresponding to the target medical institution C and sends the audit passing result to the IP allocation server. The IP allocation server allocates the IP address IP corresponding to the target medical institution C and returns it to the online handling server. Finally, the online handling server sends the unique identification code SN corresponding to the target medical institution C , IP address IP C to the target medical institution and the access server.

[0050] For the medical institution business access management method and system of the present invention, compared with the prior art by adopting the above technical solutions, the following technical effects are achieved:

[0051] The medical institution business access management method designed by the present invention designs an audit operation based on medical insurance business requests and a review operation based on the online status of the target medical institution for the effective access period of the target medical institution since the moment of successful registration application. And for the review operation, considering the registration application information in terms of time-limited categories and non-time-limited categories, dynamically adjusting the review frequency. While reducing the review frequency in specific detection situations, considering the change of data status, further adjusting the review frequency in a timely manner to ensure the timeliness and accuracy of the review operation, and intelligently realizing active detection-based adjustment and detection feedback-based adjustment; at the same time, designing a corresponding system, using the access server to cooperate with the target medical institution and the medical insurance business server to execute business scheduling, optimizing the review and review work frequencies of medical institution business access management, and improving work efficiency. Description of the Drawings

[0052] Figure 1It is the flowchart for the medical insurance department to review the registration and declaration information of the target medical institution in the design of the present invention;

[0053] Figure 2 It is the flowchart for the medical insurance department to assign the unique identification code and IP address corresponding to the target medical institution in the design of the present invention;

[0054] Figure 3 It is the specific flowchart for the medical insurance department to assign the IP address corresponding to the target medical institution in the design of the present invention;

[0055] Figure 4 It is the main flowchart of the business access management method for medical institutions in the design of the present invention;

[0056] Figure 5 It is the flowchart of step B in the business access management method for medical institutions in the design of the present invention;

[0057] Figure 6 It is the flowchart of step C in the business access management method for medical institutions in the design of the present invention;

[0058] Figure 7 It is the flowchart of step D in the business access management method for medical institutions in the design of the present invention;

[0059] Figure 8 It is the system schematic diagram of the business access management method for medical institutions in the design of the present invention. Specific embodiments

[0060] The following further elaborates on the specific embodiments of the present invention in conjunction with the accompanying drawings of the specification.

[0061] The present invention designs a business access management method and system for medical institutions, which is used to realize the management of the access of relevant business qualifications of target medical institutions by the medical insurance department. In practical applications, as Figure 8 shown, the designed system includes an access server. Among them, the target medical institution is directly connected to the medical insurance business server through a main communication link, and the access server is connected to the main communication link between the target medical institution and the medical insurance business server through a branch communication link; the medical insurance department includes an online service server and an IP allocation server, and the online service server communicates with the target medical institution and the IP allocation server respectively.

[0062] First, as Figure 1 shown, perform the following steps to step , and complete the review of the registration and declaration information of the target medical institution by the medical insurance department.

[0063] Step . The target medical institution submits its registration application information online to the online handling server of the medical insurance department based on the Jiangsu Government Affairs Service WEB authentication (the web page of the public service hall) and legal person authentication. The online handling server of the medical insurance department conducts online review. If the review fails, it will feedback the information of failed review to the target medical institution; if the review passes, it will enter step .

[0064] Step . The medical insurance department conducts on-site verification of the target medical institution offline. If the verification passes, it will enter step ; if the verification fails, it will feedback the information of failed review to the target medical institution.

[0065] Step . The medical insurance department publicizes the target medical institution. If the publicity passes, it means that the medical insurance department has passed the review of the registration application information of the target medical institution, and assigns the corresponding two-institution codes for basic medical insurance designated medical institutions and basic medical insurance designated retail pharmacies, as well as signs the two-institution agreement; if the publicity fails, it will feedback the information of failed review to the target medical institution.

[0066] Then, based on the fact that the registration application information of the target medical institution has passed the review by the medical insurance department, as Figure 2 shown, execute the following steps a to b to obtain the unique identification code SN corresponding to the target medical institution assigned by the medical insurance department C , IP address IP C .

[0067] Step a. The target medical institution applies to the superior unit of the medical insurance for the corresponding country code, and applies to the medical insurance department for the corresponding account number and IP address IP C , and then enters step b.

[0068] In practical applications, for the application and acquisition of the IP address IP in the above step a C , specifically as Figure 3 shown, the following steps are designed and implemented to step to achieve.

[0069] Step . The target medical institution connects to the medical insurance department to apply for an IP address. If the medical insurance department's review passes, it will notify the operator for dedicated line deployment, and the IP allocation server will assign the IP address IP to the target medical institution C . After the target medical institution successfully connects to the network based on the IP address IP C , it will return the IP address IP C to the online handling server and enter step ; If the medical insurance department's review fails, the IP address application of the target medical institution will be terminated.

[0070] The above steps In the review by the medical insurance department involved in the above steps, that is, before the access of the two designated institutions, the medical insurance department will conduct an assessment and review of the target medical institution (information technology), including but not limited to network security management systems, network topologies, dedicated computers, barcode scanners, real-name management devices, traceability codes, printers, antivirus software, etc. All must be qualified, otherwise access is prohibited.

[0071] Step . The medical insurance department conducts on-site verification of the target medical institution. If the verification passes, the medical insurance department issues access policies including access blocking, network policies, routing policies, and security policies to the target medical institution, and synchronizes the medical insurance associated databases (such as the basic information database, business database, etc.); if the verification fails, the IP address of the target medical institution will be C reclaimed. In actual application, when it comes to changing the operator, the institution network connection application process steps to step .

[0072] Step b. The target medical institution communicates with the online handling server of the medical insurance department in an account login manner, and sends its country code to the online handling server of the medical insurance department. The online handling server of the medical insurance department generates the security code corresponding to the target medical institution, associates the account, country code, and security code, and the unique identification code SN corresponding to the target medical institution is composed of the account, country code, and security code. C .

[0073] In actual application, the medical insurance department communicates with the superior medical insurance unit periodically to obtain the correspondence table between medical institutions and country codes. The medical insurance department checks the country codes of medical institutions according to the correspondence table. If a wrong country code is found, the sending of the medical insurance business request of the medical institution will be terminated, and the response of the medical insurance business server to the medical insurance business request will also be terminated.

[0074] Finally, after the target medical institution obtains the corresponding unique identification code SN C and IP address IP C , for the medical insurance business request sent by the target medical institution containing SN C and IP C , within the preset effective access period starting from the moment when the target medical institution's registration and declaration pass, as Figure 4 shown, the following steps A to D are executed in real time for the target medical institution.

[0075] Step A. The access server determines whether it detects that the target medical institution sends a medical insurance service request to the medical insurance service server via the primary communication link. If so, it proceeds to Step B; otherwise, the access server further determines whether it detects a heartbeat signal sent by the target medical institution. If so, it proceeds to Step C; otherwise, it proceeds to Step D.

[0076] Step B. The access server copies the medical insurance service request from the primary communication link and controls the sending of the medical insurance service request to the medical insurance service server based on the judgment of the SN C , IP C , and the type of service request in the medical insurance service request.

[0077] In practical applications, as Figure 5 shown, the above Step B is specifically executed as follows in Steps B1 to B3.

[0078] Step B1. The access server extracts the SN C , IP C in the medical insurance service request sent by the target medical institution to the medical insurance service server, and determines whether they are allocated by the medical insurance department and the SN C corresponds to the IP C . If so, it proceeds to Step B2; otherwise, it terminates the sending of the medical insurance service request and the response of the medical insurance service server to the medical insurance service request.

[0079] Step B2. The access server extracts the type of service request in the medical insurance service request and determines whether it meets the service category range corresponding to the target medical institution when the registration and declaration are successfully completed. If so, it proceeds to Step B3; otherwise, it terminates the sending of the medical insurance service request and the response of the medical insurance service server to the medical insurance service request.

[0080] Step B3. The access server does not intervene in the medical insurance service request, and the medical insurance service request is sent to the medical insurance service server. The medical insurance service server responds to the medical insurance service request and returns it to the target medical institution, realizing direct communication between the target medical institution and the medical insurance service server.

[0081] Step C. According to the online cumulative duration and the primary review frequency corresponding to the target medical institution, perform the primary review of the registration and declaration information corresponding to the target medical institution.

[0082] In practical applications, based on the fact that the registration and declaration information includes a time-limited category and a non-time-limited category, and the primary review frequency corresponding to the target medical institution is initialized, the above Step C is as Figure 6 shown, and is specifically designed and executed as follows in Steps C1 to C8 for the time-limited category such as a business qualification certificate with a time limit.

[0083] Step C1. If a primary review has been performed in the historical time, determine whether there is a frequency reduction cut-off time point corresponding to the target medical institution that is later than the current moment. If so, proceed to Step C2; otherwise, proceed to Step C3;

[0084] If a primary review has not been performed in the historical time, select all the time limit categories from the registration and declaration information to form each current time limit category, and randomly select categories without time limit categories from the registration and declaration information to form each current category without a time limit category. Then, the access server constructs a primary review inquiry message for each current time limit category and each current category without a time limit category, sends it to the target medical institution, and proceeds to Step C5; represents the number of categories without time limit categories in the registration and declaration information, represents a preset ratio, represents the ceiling operation.

[0085] Step C2. According to a preset secondary review frequency that is less than the primary review frequency, determine whether the online cumulative duration corresponding to the time from the last execution of the primary review to the current moment has reached the cycle duration corresponding to the secondary review frequency. If so, randomly select categories without time limit categories from the registration and declaration information to form each current category without a time limit category. Then, the access server constructs a primary review inquiry message and sends it to the target medical institution, and proceeds to Step C6; otherwise, do nothing.

[0086] Step C3. According to the primary review frequency, determine whether the online cumulative duration corresponding to the time from the last execution of the primary review to the current moment has reached the cycle duration corresponding to the primary review frequency. If so, randomly select categories without time limit categories from the registration and declaration information to form each current category without a time limit category. Then, the access server constructs a primary review inquiry message and sends it to the target medical institution, and proceeds to Step C4; otherwise, do nothing.

[0087] Step C4. Determine whether there is a time limit identifier in the time limit identifiers corresponding to all the time limit categories of the target medical institution that is in an expired state at the current moment. If so, select the time limit categories corresponding to the current expired time limit identifiers respectively to form each current time limit category. Then, the access server constructs a primary review inquiry message and sends it to the target medical institution, and proceeds to Step C5; otherwise, directly proceed to Step C6.

[0088] Step C5. The target medical institution receives the primary review inquiry message, extracts the information of each current time-limited category corresponding to the target medical institution in the primary review inquiry message currently, and combines it with the unique identification code SN corresponding to the target medical institution C and the IP address IP C , and the target medical institution constructs a primary review response message and returns it to the access server.

[0089] The access server determines the SN in the primary review response message C , IP C whether it belongs to the allocation by the medical insurance department, and SN C corresponds to IP C . If so, the access server obtains the valid time limit in the information of each current time-limited category, and further determines whether there is information of the current time-limited category that is currently in an invalid state. If so, the access server terminates the communication between the target medical institution and the medical insurance service server, and then enters Step C6; otherwise, the access server respectively constructs or updates the time limit identifier of the current time-limited category corresponding to the target medical institution with the valid time limit in the information of the current time-limited category corresponding to the target medical institution currently, and then enters Step C6.

[0090] If not, the access server terminates the communication between the target medical institution and the medical insurance service server, and then enters Step C6.

[0091] Step C6. The target medical institution receives the primary review inquiry message, extracts the information of each current non-time-limited category corresponding to the target medical institution in the primary review inquiry message currently, and combines it with the unique identification code SN corresponding to the target medical institution C and the IP address IP C , and the target medical institution constructs a primary review response message and returns it to the access server.

[0092] The access server determines the SN in the primary review response message C , IP C whether it belongs to the allocation by the medical insurance department, and SN C corresponds to IP C . If so, the access server further determines whether there is information of the current non-time-limited category that does not meet the review requirements of the medical insurance department. If so, the access server terminates the communication between the target medical institution and the medical insurance service server, and then enters Step C7; otherwise, the access server does not perform any processing and enters Step C7.

[0093] If not, the access server terminates the communication between the target medical institution and the medical insurance service server, and then enters Step C7.

[0094] Step C7. If the access server has terminated the communication between the target medical institution and the medical insurance business server, the access server determines that the primary review is unqualified and feeds back to the target medical institution the current time-limited category information corresponding to it that is currently in an invalid state, or feeds back to the target medical institution the current time-limited category information that does not meet the review requirements of the medical insurance department currently;

[0095] If the access server has not terminated the communication between the target medical institution and the medical insurance business server, the access server determines that the primary review is qualified and proceeds to Step C8.

[0096] Step C8. The access server determines whether the primary review has been qualified for a preset number of consecutive times. If so, the access server selects the earliest expiration time among the time limit identifiers of all the time-limited categories corresponding to the target medical institution to form the down-frequency cut-off time point corresponding to the target medical institution; otherwise, the access server does not perform any processing.

[0097] Step D. Wait for the access server to detect that the target medical institution sends a medical insurance business request or a heartbeat signal, trigger the interaction between the access server and the target medical institution, and perform a high-level review corresponding to the target medical institution that includes cumulative medical insurance business request information and registration and declaration information.

[0098] In practical applications, the above Step D is as Figure 7 shown, and the specific design is implemented as follows in Steps D1 to D3.

[0099] Step D1. Wait for the access server to detect that the target medical institution sends a medical insurance business request or a heartbeat signal, and trigger to enter Step D2.

[0100] Step D2. The access server performs a review on the cumulative medical insurance business request information for the target medical institution. If the review is qualified, it proceeds to Step D3; if the review is unqualified, the access server terminates the communication between the target medical institution and the medical insurance business server.

[0101] In practical applications, based on the access server's cumulative detection and storage of the number of times the target medical institution sends and completes medical insurance business requests to the medical insurance business server; then in the above Step D2, the specific design is that the access server sends an instruction to the target medical institution to inquire about the number of times the target medical institution sends and completes medical insurance business requests to the medical insurance business server. The target medical institution receives the instruction, queries its internal log file, obtains the result, and feeds it back to the access server. The access server determines whether the result from the target medical institution is consistent with the number stored in the access server. If so, the review is qualified and it proceeds to Step D3; otherwise, the review is unqualified and the communication between the target medical institution and the medical insurance business server is terminated.

[0102] Step D3. According to the design in Step C, the access server performs a primary review on the target medical institution corresponding to its registration and declaration information.

[0103] For the medical institution business access management method designed by the above technical solution, for the effective access period of the target medical institution since the moment of passing the registration and declaration, it designs the review operation based on the medical insurance business request and the review operation based on the online status of the target medical institution. And for the review operation, it differentiates and considers the registration and declaration information in terms of the time-limited category and the non-time-limited category, dynamically adjusts the review frequency, reduces the review frequency in specific detection situations, and at the same time considers the change of the data status, further adjusts the review frequency in a timely manner, ensuring the timeliness and accuracy of the review operation, and intelligently realizing the active detection type adjustment and the detection feedback type adjustment; at the same time, it designs the corresponding system to coordinate the target medical institution and the medical insurance business server by the access server to perform business scheduling and execution, optimize the review and review work frequencies of the medical institution business access management, and improve the work efficiency.

[0104] The embodiments of the present invention have been described in detail above in conjunction with the accompanying drawings. However, the present invention is not limited to the above embodiments. Within the scope of knowledge possessed by those of ordinary skill in the art, various changes can be made without departing from the gist of the present invention.

Claims

1. A business access management method for medical institutions, which is used to implement the management of the access of relevant business qualifications of target medical institutions by the medical insurance department, and is characterized in that: Based on the fact that the target medical institution has passed the review of its registration and declaration information by the medical insurance department and obtained the unique identification code SN corresponding to the target medical institution assigned by the medical insurance department C , IP address IP C , combined with the medical insurance service request sent by the target medical institution containing SN C , IP C , within the preset effective access period starting from the moment when the registration and declaration are passed, the following steps A to D are executed in real time for the target medical institution: Step A. Determine whether a medical insurance service request sent by the target medical institution to the medical insurance service server is detected. If yes, proceed to Step B; otherwise, further determine whether a heartbeat signal sent by the target medical institution is detected. If yes, proceed to Step C; otherwise, proceed to Step D; Step B. Control the sending of the medical insurance service request to the medical insurance service server based on the judgment of the SN C , IP C , and the service request type in the medical insurance service request; Step C. According to the online cumulative duration and the primary review frequency corresponding to the target medical institution, perform the primary review of the registration and declaration information corresponding to the target medical institution; Step D. Wait until a medical insurance service request or a heartbeat signal sent by the target medical institution is detected, and trigger the execution of the advanced review corresponding to the target medical institution, which includes the cumulative information of each medical insurance service request and the registration and declaration information; 2. The method for managing the business access of a medical institution according to claim 1, wherein: Based on the fact that the registration and declaration information of the target medical institution has been reviewed and passed by the medical insurance department, the following steps are then executed to obtain the unique identification code SN corresponding to the target medical institution assigned by the medical insurance department C , IP address IP C ; Step a. The target medical institution applies to the superior medical insurance unit for obtaining its corresponding national code, and applies to the medical insurance department for obtaining its corresponding account number and IP address IP, and then proceeds to Step b; C , and then proceeds to Step b; Step b. The target medical institution communicates with the medical insurance department in the account login mode, and sends its country code to the medical insurance department. The medical insurance department generates the security code corresponding to the target medical institution, associates the account, the country code, and the security code, and forms the unique identification code SN corresponding to the target medical institution with the account, the country code, and the security code C ; The medical insurance department communicates with the superior medical insurance unit periodically to obtain the correspondence table between medical institutions and country codes. The medical insurance department checks the country codes of medical institutions according to the correspondence table. If a wrong country code is found, the sending of the medical insurance service request of the medical institution and the response of the medical insurance service server to this medical insurance service request shall be terminated; 3. The method for managing the business access of a medical institution according to claim 1 or 2, characterized in that: Execute the following steps to complete the review of the registration and declaration information of the target medical institution by the medical insurance department; Step . Based on the Suzhou Government Service WEB authentication and legal person authentication, the target medical institution submits its registration application information online to the medical insurance department, and the medical insurance department conducts online review. If the review fails, the information of failed review will be fed back to the target medical institution; if the review passes, it will enter step ; Step . The medical insurance department conducts on-site verification of the target medical institutions offline. If the verification is passed, proceed to step ; If the verification fails, feedback the information that the review fails to the target medical institution; Step . The medical insurance department publicizes the target medical institutions. If the publicity is passed, it means that the medical insurance department has approved the registration and declaration information of the target medical institutions, and assigns the corresponding two-institution codes for basic medical insurance designated medical institutions and basic medical insurance designated retail pharmacies, as well as the signing of the two-institution agreement; if the publicity fails, the information of non-approval will be feedback to the target medical institutions.

4. The method for managing the business access of a medical institution according to claim 2, characterized in that: Based on the fact that the registration and declaration information of the target medical institution has been reviewed and passed by the medical insurance department, the following steps are executed to enable the target medical institution to apply to the medical insurance department for obtaining the IP address IP C ; Step . The target medical institution connects to the medical insurance department to apply for an IP address. If the medical insurance department approves the application, it notifies the operator to deploy a dedicated line and assigns the IP address IP to the target medical institution C , and waits for the target medical institution to connect successfully based on the IP address IP C . After successful connection, proceed to step ; If the review by the medical insurance department fails, terminate the IP address application of the target medical institution; Step . The medical insurance department conducts on-site verification of the target medical institution. If the verification is passed, the medical insurance department issues access policies including access blocking, network policies, routing policies, and security policies to the target medical institution and synchronizes the medical insurance associated database; if the verification fails, the IP address IP of the target medical institution C will be recycled.

5. The method for managing the business access of a medical institution according to claim 1, wherein: The following steps B1 to B3 are included in Step B; Step B1. Extract the SN in the medical insurance service request sent by the target medical institution to the medical insurance service server C , IP C , and determine whether it belongs to the allocation by the medical insurance department, and whether the SN C corresponds to the IP C . If so, proceed to Step B2; otherwise, terminate the sending of the medical insurance service request and the response of the medical insurance service server to the medical insurance service request; Step B2. Extract the service request type in the medical insurance service request, and determine whether it meets the service category range corresponding to the target medical institution when the registration and declaration are successful. If yes, proceed to Step B3; Otherwise, terminate the sending of this medical insurance service request and the response of the medical insurance service server to this medical insurance service request; Step B3. Do not intervene in this medical insurance service request, send it to the medical insurance service server, and let the medical insurance service server respond to this medical insurance service request and return it to the target medical institution to realize the direct communication between the target medical institution and the medical insurance service server; 6. The business access management method of a medical institution according to claim 1, characterized in that: Based on the fact that the registration and declaration information includes a time-limited category and a non-time-limited category, and initializing the primary review frequency corresponding to the target medical institution, within the preset effective access period since the registration and declaration are passed, when Steps A to D are executed for the target medical institution in real time, Step C includes the following Steps C1 to C8; Step C1. If the primary review has been performed in the historical time, determine whether there is a down-frequency cut-off time point corresponding to the target medical institution that is later than the current time. If yes, proceed to Step C2; Otherwise, proceed to Step C3; If the primary review has not been performed in the historical time, all time limit categories are selected from the registration declaration information to form each current time limit category. At the same time, time limit-free categories are randomly selected from the registration declaration information to form each current time limit-free category, and then step C5 is entered; represents the number of time limit-free categories in the registration declaration information, represents a preset ratio, represents the ceiling operation; Step C2. According to a preset secondary review frequency that is less than the primary review frequency, determine whether the online cumulative duration corresponding to the current time since the last execution of the primary review reaches the cycle duration corresponding to the secondary review frequency. If so, randomly select non-time-limit categories from the registration and declaration information to form each current non-time-limit category, and then proceed to Step C6; otherwise, do nothing. Step C3. Determine whether the online cumulative duration corresponding to the current moment since the last execution of the primary review reaches the cycle duration corresponding to the primary review frequency according to the primary review frequency. If so, randomly select non-time-limit categories from the registration and declaration information to form each current non-time-limit category, and then proceed to Step C4; otherwise, do nothing. Step C4. Judge whether there is a time limit identifier in all the time-limited category time limit identifiers corresponding to the target medical institution that is in an expired state at the current time. If yes, select the time-limited categories corresponding to the current expired time limit identifiers respectively to form each current time-limited category, and then proceed to Step C5; Otherwise, directly proceed to Step C6; Step C5. Extract the information currently corresponding to each current time - limit category of the target medical institution, obtain the valid time limits in the information of each current time - limit category, and determine whether there is any information of the current time - limit category that is currently in an invalid state. If so, terminate the communication between the target medical institution and the medical insurance business server, and then proceed to Step C6; Otherwise, for each current time - limit category corresponding to the target medical institution, use the valid time limit in the information of the current time - limit category currently corresponding to the target medical institution to form or update the time - limit identifier of the current time - limit category corresponding to the target medical institution, and then proceed to Step C6; Step C6. Extract the information currently corresponding to each current non - time - limit category of the target medical institution, and determine whether there is any information of the current non - time - limit category that does not meet the review requirements of the medical insurance department. If so, terminate the communication between the target medical institution and the medical insurance business server, and then proceed to Step C7; otherwise, do nothing and proceed to Step C7; Step C7. If the communication between the target medical institution and the medical insurance business server has been terminated, then determine that the primary review is unqualified, and feedback to the target medical institution the information of the current time - limit category that is currently in an invalid state corresponding to it, or feedback to the target medical institution the information of the current non - time - limit category that does not meet the review requirements of the medical insurance department; If the communication between the target medical institution and the medical insurance business server has not been terminated, then determine that the primary review is qualified, and proceed to Step C8; Step C8. Determine whether the primary review has been qualified for a preset number of consecutive times. If so, select the earliest expiration time among the time - limit identifiers of all the time - limit categories corresponding to the target medical institution to form the down - frequency cut - off time point corresponding to the target medical institution; otherwise, do nothing.

7. The method for managing the business access of a medical institution according to claim 6, wherein: Each of the current time - limit categories formed in Step C1 and each of the current non - time - limit categories, each of the current non - time - limit categories formed in Step C2, each of the current non - time - limit categories formed in Steps C3 to C4, or each of the current non - time - limit categories and each of the current time - limit categories are sent to the target medical institution in a primary review inquiry message respectively; In the step C5, the target medical institution receives the primary review inquiry message, extracts the information of each current time limit category in the primary review inquiry message corresponding to the target medical institution currently, and combines it with the unique identification code SN C corresponding to the IP address IP C , and constructs a primary review response message for return; Then, first, judge the SN in the primary review response message C , IP C whether they belong to those allocated by the medical insurance department, and whether the SN C corresponds to the IP C If so, continue to execute the judgment on the information of the target medical institution currently corresponding to each current time-limited category; Otherwise, terminate the communication between the target medical institution and the medical insurance business server, and then proceed to Step C6; In step C6, the target medical institution receives the primary review inquiry message, extracts the information of each current non-time-limited category in the primary review inquiry message corresponding to the target medical institution currently, and combines it with the unique identification code SN corresponding to the target medical institution C and the IP address IP C , and constructs a primary review response message for return; Then, first, determine the SN in the primary review response message C , IP C whether it belongs to the allocation by the medical insurance department, and whether the SN C corresponds to the IP C If so, continue to execute the judgment on the information of the target medical institution currently corresponding to each current non-time-limited category; Otherwise, terminate the communication between the target medical institution and the medical insurance business server, and then proceed to Step C7.

8. The method for managing the business access of a medical institution according to claim 6 or 7, characterized in that: Step D includes the following Steps D1 to D3; Step D1. Wait until a medical insurance business request or a heartbeat signal sent by the target medical institution is detected, and trigger the entry into Step D2; Step D2. Perform a review of accumulating the information of each medical insurance business request for the target medical institution. If the review is qualified, proceed to Step D3; if the review is unqualified, terminate the communication between the target medical institution and the medical insurance business server; Step D3. Perform a primary review of the registration and declaration information corresponding to the target medical institution.

9. A system for implementing the method for managing the business access of a medical institution according to claim 8, characterized in that: It includes an access server. Among them, the target medical institution communicates directly with the medical insurance business server through the main communication link, and the access server accesses the main communication link between the target medical institution and the medical insurance business server through the branch communication link; Based on the access server detecting in step A that the target medical institution sends a medical insurance service request to the medical insurance service server via the main communication link, in step B, the access server copies the medical insurance service request from the main communication link and analyzes the SN C , IP C , and the service request type in the medical insurance service request, and then the access server controls the sending of the medical insurance service request to the medical insurance service server; Based on the access server detecting the heartbeat signal sent by the target medical institution in step A, in steps C1 to C4 of step C, the access server constructs a primary review inquiry message and sends it to the target medical institution; in steps C5 and C6, the primary review response message constructed by the target medical institution is returned to the access server, and the access server executes the judgments in steps C5 and C6, as well as the operations in steps C7 to C8, to control the communication between the target medical institution and the medical insurance business server; Based on the access server not detecting the medical insurance business request or heartbeat signal sent by the target medical institution in step A, in step D, when the access server detects the medical insurance business request or heartbeat signal sent by the target medical institution, it triggers the access server and the target medical institution to interact and perform a high-level review.

10. The system of a medical institution business access management method according to claim 9, characterized in that: Based on the access server accumulating and storing the number of times the target medical institution sends and completes the medical insurance business request to the medical insurance business server; in step D2, the access server sends an instruction to the target medical institution to inquire about the number of times the target medical institution sends and completes the medical insurance business request to the medical insurance business server. The target medical institution receives this instruction, queries its internal log file, obtains the result, and feeds it back to the access server. The access server judges whether the result from the target medical institution is consistent with the number stored in the access server. If it is, the review is qualified and it enters step D3; otherwise, the review is unqualified and the communication between the target medical institution and the medical insurance business server is terminated; The medical insurance department includes an online processing server and an IP allocation server. Among them, the online processing server communicates with the target medical institutions and the IP allocation server respectively. The target medical institutions create registration and declaration information and send it to the online processing server. The online processing server receives the registration and declaration information and conducts an audit. Based on the successful audit, the online processing server constructs the unique identification code SN corresponding to the target medical institution C , and sends the result of successful audit to the IP allocation server. The IP allocation server allocates the IP address IP corresponding to the target medical institution C , and returns it to the online processing server. Finally, the online processing server sends the unique identification code SN C , IP address IP C to the target medical institution and the access server.

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