A medical institution business access management method and system

Abstract

The present invention relates to a method for managing the business access of medical institutions. The method designs an audit operation based on a medical insurance business request and a review operation based on the online state of the target medical institution, with respect to the effective access period of the target medical institution from the moment the registration application is approved. Furthermore, with respect to the review operation, a distinction is made between categories with and without an expiration period, with respect to registration application information. The review frequency is dynamically adjusted. While the review frequency is reduced in response to specific detection situations, the review frequency is further adjusted in a timely manner taking into account changes in data status, thereby ensuring the timeliness and accuracy of the review operation and intelligently realizing active detection-based adjustment and detection-based feedback-based adjustment. Simultaneously, a corresponding system is designed, wherein an access server collaborates with the target medical institution and a medical insurance business server to perform business scheduling and execution, thereby optimizing the review and review work frequency of the medical institution business access management and improving work efficiency.

Description

TECHNICAL FIELD

[0001] The application relates to a medical institution business access management method and system, and belongs to the technical field of access auditing. BACKGROUND

[0002] A medical insurance department adopts a supervision mode of "application-auditing-access-periodic review" for business access management of medical institutions (including medical institutions, retail pharmacies, etc.), and the specific process comprises, in sequence, application condition review, on-site verification, agreement signing, and periodic review. The mode aims to guarantee the safety of medical insurance funds through access auditing and subsequent supervision, but technical defects still exist in actual operation.

[0003] In the existing periodic review link, the medical insurance department needs to periodically check the qualifications of a large number of designated institutions, service data sampling, and agreement performance evaluation, including manual data verification, on-site repeated verification, and paper material declaration. However, there are disadvantages such as low data processing efficiency, lack of dynamic monitoring, repeated consumption of resources, and significant response delay. SUMMARY

[0004] The technical problem to be solved by the application is to provide a medical institution business access management method, which considers the time limit category and the non-time limit category of the registration information, dynamically adjusts the review frequency, and improves the review efficiency.

[0005] The application adopts the following technical solution to solve the above technical problem: The application designs a medical institution business access management method for realizing the management of the medical insurance department on the related business qualification access of the target medical institution. Based on the registration information of the target medical institution passing the audit of the medical insurance department, the target medical institution obtains the unique identification code SN C , IP address IP C , and in combination with the SN C , IP C contained in the medical insurance business request sent by the target medical institution, within the preset effective access period from the time when the registration passes, the following steps A to D are executed for the target medical institution in real time; wherein the registration information contains the time limit category and the non-time limit category.

[0006] Step A. Determine whether the target medical institution sends a medical insurance business request to the medical insurance business server, if yes, go to step B; otherwise, further determine whether the target medical institution sends a heartbeat signal, if yes, go to step C, otherwise, go to step D.

[0007] Step B. According to the SN C , IP C, and judgment of the type of service request, and controlling the sending of the medical insurance service request to the medical insurance service server;

[0008] Step C. Based on the target medical institution's corresponding cumulative online time and primary review frequency, the registration application information is divided into categories with and without a statute of limitations, and the review frequency is dynamically adjusted to conduct a primary review of the target medical institution's corresponding registration application information;

[0009] Step D: When a target medical institution sends a medical insurance service request or a heartbeat signal, the target medical institution is triggered to execute a high-level review including the accumulated medical insurance service request information and registration declaration information.

[0010] As a preferred technical solution of the present invention: based on the target medical institution's registration declaration information being reviewed and approved by the medical insurance department, the following steps are performed to obtain the unique identification code SN corresponding to the target medical institution assigned by the medical insurance department. C 、IP address C ;

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

[0012] Step b. The target medical institution communicates with the medical insurance department by logging in with an account and sending its country code to the medical insurance department. The medical insurance department generates a security code corresponding to the target medical institution and associates the account, country code, and security code. The account, country code, and security code constitute the unique identification code SN corresponding to the target medical institution. C ;

[0013] The medical insurance department communicates with the superior medical insurance unit periodically to obtain a correspondence table between medical institutions and country codes. The medical insurance department verifies the country code of the medical institution based on the correspondence table. If an error is found in the country code, the medical institution's medical insurance business request will be terminated, and the medical insurance business server's response to the medical insurance business request will be terminated.

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

[0015] Step i. The target medical institution submits its registration application information online to the medical insurance department based on the Sufuban web authentication and legal person authentication. The medical insurance department conducts an online review. If the review fails, the medical institution will be notified of the failure. If the review passes, the process proceeds to step ii.

[0016] Step ii. Offline on-site verification is performed on the target medical institution by the medical insurance department, if the verification is passed, step iii is entered; if the verification is not passed, the target medical institution is fed back information that the audit is not passed;

[0017] Step iii. The target medical institution is publicized by the medical insurance department, if the publicization is passed, it means that the audit of the registration information of the target medical institution by the medical insurance department is passed, and the two designated institution codes of the corresponding basic medical insurance designated medical institution and basic medical insurance designated retail pharmacy, and the signing of the two designated institution agreement are assigned; if the publicization is not passed, the target medical institution is fed back information that the audit is not passed.

[0018] As a preferred technical solution of the present application: based on the registration information of the target medical institution being audited by the medical insurance department and being passed, the following steps are executed to realize the target medical institution applying for obtaining the IP address IP C from the medical insurance department.

[0019] Step iv. The target medical institution applies for the IP address from the medical insurance department, if the audit of the medical insurance department is passed, the operator special line deployment is informed, and the target medical institution is allocated the IP address IP C , after the target medical institution is successfully networked according to the IP address IP C , step v is entered; if the audit of the medical insurance department is not passed, the IP address application of the target medical institution is terminated.

[0020] Step v. The target medical institution is on-site verified by the medical insurance department, if the verification is passed, the medical insurance department issues the access policy including access blocking, network strategy, routing strategy, security strategy to the target medical institution, and synchronizes the medical insurance associated database; if the verification is not passed, the IP address IP C of the target medical institution is recovered.

[0021] As a preferred technical solution of the present application: the step B includes the following steps B1 to B3.

[0022] Step B1. The SN C and IP C in the medical insurance business request sent by the target medical institution to the medical insurance business server are extracted, and it is judged whether it belongs to the SN C and IP C corresponding to the allocation of the medical insurance department, if yes, step B2 is entered; otherwise, the sending of the medical insurance business request and the response of the medical insurance business server to the medical insurance business request are terminated.

[0023] Step B2. Extract the service request type in the medical insurance service request, and determine whether it meets the target medical institution registration declaration success determined its corresponding business category range, yes, go to step B3; otherwise, terminate the sending of the medical insurance service request, and terminate the response of the medical insurance service server to the medical insurance service request;

[0024] Step B3. For the medical insurance service request, do not intervene, send to the medical insurance service server, respond to the medical insurance service request by the medical insurance service server, and return to the target medical institution, realize the direct communication between the target medical institution and the medical insurance service server.

[0025] As a preferred technical solution of the application: initialize the primary review frequency corresponding to the target medical institution, within the preset effective access period from the registration declaration pass time, for the target medical institution in the process of steps A to D, step C includes the following steps C1 to C8;

[0026] Step C1. If the primary review has been performed in the history time, determine whether there is a frequency reduction cutoff time point corresponding to the target medical institution later than the current time, yes, go to step C2; otherwise, go to step C3;

[0027] If the primary review has not been performed in the history time, select all time limit categories from the registration declaration information to form each current time limit category, and randomly select No time limit categories from the registration declaration information to form each current no time limit category, and then go to step C5; N represents the number of no time limit categories in the registration declaration information, a represents the preset proportion, Indicates the upward rounding operation;

[0028] Step C2. According to the preset secondary review frequency less than the primary review frequency, determine whether the online cumulative duration corresponding to the current time from the time of the last primary review reaches the period duration corresponding to the secondary review frequency, yes, randomly select No time limit categories from the registration declaration information to form each current no time limit category, and then go to step C6; otherwise, do not do anything;

[0029] Step C3. According to the primary review frequency, determine whether the online cumulative duration corresponding to the current time from the time of the last primary review reaches the period duration corresponding to the primary review frequency, yes, randomly select No time limit categories from the registration declaration information to form each current no time limit category, and then go to step C4; otherwise, do not do anything;

[0030] Step C4. Determine whether there is a time limit identifier in all time limit categories corresponding to the target medical institution that is in an expired state at the current time. If yes, select the time limit categories with time limits that are currently in an expired state, and form the current time limit categories with time limits, and then go to step C5; otherwise, go directly to step C6.

[0031] Step C5. Extract information of the target medical institution corresponding to each current time limit category with time limits, obtain the effective time limit in the current time limit category information with time limits, and determine whether there is a current time limit category information with time limits that is currently in an invalid state. If yes, terminate the communication between the target medical institution and the medical insurance business server, and then go 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 with time limits 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 go to step C6.

[0032] Step C6. Extract information of the target medical institution corresponding to each current time limit category without time limits, and determine whether there is current time limit category information without time limits that does not meet the requirements of the medical insurance department for auditing. If yes, terminate the communication between the target medical institution and the medical insurance business server, and then go to step C7; otherwise, do nothing and go to step C7.

[0033] Step C7. If the communication between the target medical institution and the medical insurance business server has been terminated, determine that the primary review is unqualified, and feed back the current time limit category information with time limits corresponding to the target medical institution that is currently in an invalid state to the target medical institution, or feed back the current time limit category information without time limits corresponding to the target medical institution that does not meet the requirements of the medical insurance department for auditing to the target medical institution.

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

[0035] Step C8. Determine whether the primary review is qualified for a continuous preset number of times. If yes, select the earliest expiration time in the time limit identifiers of all time limit categories corresponding to the target medical institution, and form the frequency reduction cutoff time point corresponding to the target medical institution; otherwise, do nothing.

[0036] As a preferred technical solution of the present application: the current time limit categories with time limits formed in step C1, the current time limit categories without time limits formed in step C2, the current time limit categories without time limits formed in steps C3 to C4, or the current time limit categories without time limits and the current time limit categories with time limits, are respectively sent to the target medical institution in a primary review inquiry message.

[0037] In the step C5, the target medical institution receives the primary review inquiry message, extracts information about the current time-limited categories corresponding to the target medical institution respectively in the primary review inquiry message, and combines the unique identification code SN C and the IP address IP C to construct a primary review response message for return. Then, it is firstly judged whether the SN C and the IP C in the primary review response message belong to the allocation of the medical insurance department and the SN C corresponds to the IP C . If yes, the judgment about the information about the current time-limited categories corresponding to the target medical institution respectively is continued to be executed. If no, the communication between the target medical institution and the medical insurance service server is terminated, and then the step C6 is entered. C C C C C C

[0038] In the step C6, the target medical institution receives the primary review inquiry message, extracts information about the current non-time-limited categories corresponding to the target medical institution respectively in the primary review inquiry message, and combines the unique identification code SN C and the IP address IP C to construct a primary review response message for return. Then, it is firstly judged whether the SN C and the IP C in the primary review response message belong to the allocation of the medical insurance department and the SN C corresponds to the IP C . If yes, the judgment about the information about the current non-time-limited categories corresponding to the target medical institution respectively is continued to be executed. If no, the communication between the target medical institution and the medical insurance service server is terminated, and then the step C7 is entered.

[0039] As a preferred technical solution of the present application, the step D comprises the following steps D1 to D3.

[0040] Step D1. After detecting that the target medical institution sends a medical insurance service request or a heartbeat signal, it is triggered to enter the step D2.

[0041] Step D2. The audit about the accumulation of each medical insurance service request information is executed for the target medical institution. If the audit is qualified, the step D3 is entered. If the audit is not qualified, the communication between the target medical institution and the medical insurance service server is terminated.

[0042] Step D3. The primary review of the registered declaration information corresponding to the target medical institution is executed.

[0043] As a preferred technical solution of the present application, the time-limited category in the registered declaration information is a time-limited service qualification certificate.

[0044] Corresponding to the above, the technical problem to be solved by the present application is also to provide a medical institution business access management method system to improve work efficiency by cooperating with the target medical institution and the medical insurance business server to perform business scheduling execution through the access server.

[0045] In order to solve the above technical problems, the present application adopts the following technical scheme: the present application designs a medical institution business access management method system, which comprises an access server, wherein the target medical institution and the medical insurance business server are directly connected in communication through a main communication link, and the access server accesses the main communication link between the target medical institution and the medical insurance business server through a branch communication link.

[0046] Based on the detection of the access server 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, the access server in step B copies the medical insurance business request from the main communication link and analyzes the SN C , IP C , and the type of the business request, and then controls the sending of the medical insurance business request to the medical insurance business server by the access server;

[0047] Based on the detection of the access server in step A that the target medical institution sends a heartbeat signal, in steps C1 to C4 of step C of the present application, 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 judgment in steps C5 and C6 and the operations in steps C7 to C8 to control the communication between the target medical institution and the medical insurance business server;

[0048] Based on the detection of the access server in step A that the target medical institution sends a medical insurance business request or a heartbeat signal, in step D of the present application, when the access server detects that the target medical institution sends a medical insurance business request or a heartbeat signal, the access server triggers the interaction with the target medical institution to perform a high-level review.

[0049] As a preferred technical scheme of the present application: based on the cumulative detection and storage of the number of times that the target medical institution sends and completes a medical insurance business request to the medical insurance business server by the access server; in step D2, the access server sends an instruction to the target medical institution to inquire about the number of times that the target medical institution sends and completes a medical insurance business request to the medical insurance business server, the target medical institution receives the instruction, queries its internal log file, obtains the result, and feeds back to the access server, and the access server judges whether the result from the target medical institution is consistent with the number of times stored in the access server memory, if yes, 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.

[0050] As a preferred technical solution of the present invention: the medical insurance department includes an online server and an IP allocation server, wherein the online server communicates with the target medical institution and the IP allocation server respectively; the target medical institution creates registration declaration information and sends it to the online server, which receives the registration declaration information and reviews it. Based on the review, the online server constructs a unique identification code SN corresponding to the target medical institution. C The result of the review will be sent to the IP allocation server, which will allocate the IP address of the target medical institution. C , and returns it to the online server, and finally the online server will send the unique identification code SN corresponding to the target medical institution C 、IP address C Sent to the target medical institution and access server.

[0051] The medical institution business access management method and system described in the present invention, using the above technical solution, has the following technical effects compared with the existing technology:

[0052] (1) The present invention designs a method for managing the business access of medical institutions. With respect to the effective access period of the target medical institution from the moment of passing the registration application, the present invention designs an audit operation based on the medical insurance business request and a review operation based on the online status of the target medical institution. In addition, with respect to the review operation, the registration application information is differentiated into categories with a time limit and categories without a time limit, and the review frequency is dynamically adjusted. While reducing the review frequency under specific detection conditions, the review frequency is further adjusted in time considering the change in data status to ensure the timeliness and accuracy of the review operation, and to intelligently realize active detection-based adjustment and detection feedback-based adjustment. At the same time, a corresponding system is designed to coordinate the target medical institution and the medical insurance business server with the access server to perform business scheduling and execution, thereby optimizing the review and review work frequency of the medical institution business access management and improving work efficiency. BRIEF DESCRIPTION OF THE DRAWINGS

[0053] Figure 1 This is a flowchart of the review of the registration and declaration information of the target medical institution by the medical insurance department in the design of the present invention;

[0054] Figure 2 This is a flow chart of the unique identification code and IP address corresponding to the target medical institution allocated by the medical insurance department in the design of the present invention;

[0055] Figure 3 This is a specific flow chart of the allocation of IP addresses corresponding to target medical institutions by the medical insurance department in the design of the present invention;

[0056] Figure 4is the main flow chart of the medical institution business access management method designed by the application;

[0057] Figure 5 is the flow chart of step B in the medical institution business access management method designed by the application;

[0058] Figure 6 is the flow chart of step C in the medical institution business access management method designed by the application;

[0059] Figure 7 is the flow chart of step D in the medical institution business access management method designed by the application;

[0060] Figure 8 is the system schematic diagram of the medical institution business access management method designed by the application. DETAILED DESCRIPTION

[0061] The specific embodiments of the application will be further described in detail below with reference to the accompanying drawings.

[0062] The application designs a medical institution business access management method and system, which is used to realize the management of the medical insurance department on the related business qualification access of the target medical institution. Figure 8 As shown in the figure, the designed system includes an access server, wherein the target medical institution and the medical insurance business server are directly connected in communication through a main communication link, and the access server accesses 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 a network management server and an IP allocation server, and the network management server communicates with the target medical institution and the IP allocation server respectively.

[0063] Firstly, as shown in the figure, the following steps i to iii are executed to complete the audit of the registration information of the target medical institution by the medical insurance department, and the registration information includes the time limit category and the non-time limit category. Figure 1 Step i. The target medical institution submits its registration information to the network management server of the medical insurance department online based on the Sufuwu WEB authentication (public service hall web page) and legal authentication, and the network management server of the medical insurance department performs online audit, and if the audit fails, the target medical institution is fed back the audit failure information; if the audit passes, step ii is entered.

[0064] Step ii. The medical insurance department performs offline on-site verification on the target medical institution, and if the verification passes, step iii is entered; if the verification fails, the target medical institution is fed back the audit failure information.

[0065]

[0066] ​Step iii. The target medical institution is announced by the medical insurance department. If the announcement is passed, it means that the medical insurance department passes the audit of the target medical institution's registration information, and assigns the corresponding basic medical insurance designated medical institution and basic medical insurance designated retail pharmacy two designated institution codes, and two designated institution agreement. If the announcement is not passed, the target medical institution is fed back the information that the audit is not passed.

[0067] Then, based on the fact that the target medical institution has passed the audit of its registration information by the medical insurance department, as shown in Figure 2 , the following steps a to b are executed to obtain the unique identification code SN C , IP address IP C assigned by the medical insurance department for the target medical institution.

[0068] Step a. The target medical institution applies to the medical insurance superior unit for the corresponding national code, and applies to the medical insurance department for the corresponding account and IP address IP C , and then enters step b.

[0069] In actual application, the application for IP address IP C in the above step a is specifically implemented as shown in Figure 3 , and the following steps iv to v are designed and executed.

[0070] Step iv. The target medical institution applies for IP address to the medical insurance department. If the medical insurance department passes the audit, the operator special line is deployed, and the IP address IP C is assigned to the target medical institution by the IP allocation server. After the target medical institution is successfully connected according to the IP address IP C , the IP address IP C is returned to the network management server, and step v is entered. If the medical insurance department does not pass the audit, the IP address application of the target medical institution is terminated.

[0071] The audit of the medical insurance department involved in the above step iv, namely, before the access of the two designated institutions, the medical insurance department will evaluate and audit the target medical institution (information technology) including but not limited to network security management system, network topology, special computer, bar code scanner, real-name system management equipment, traceability code, printer, antivirus software, etc. All must be qualified, otherwise access is prohibited.

[0072] Step v. The target medical institution is verified by the medical insurance department. If the verification is passed, the medical insurance department issues the access policy including access blocking, network policy, routing policy, security policy to the target medical institution, and synchronizes the medical insurance associated database (such as basic information database, business database, etc.). If the verification is not passed, the IP address IP CIn actual application, if the access strategy here involves changing the operator, it is necessary to go through steps iv to v of the institution network application process again.

[0073] Step b. The target medical institution communicates with the online server of the medical insurance department by logging in with an account, and sends its country code to the online server of the medical insurance department. The online server of the medical insurance department generates a security code corresponding to the target medical institution, and associates the account number, country code, and security code. The account number, country code, and security code constitute the unique identification code SN corresponding to the target medical institution. C .

[0074] In actual applications, the medical insurance department communicates with the superior medical insurance unit periodically to obtain a correspondence table between medical institutions and country codes. The medical insurance department verifies the country code of the medical institution based on the correspondence table. If an error is found in the country code, the medical institution's medical insurance business request will be terminated, and the medical insurance business server's response to the medical insurance business request will be terminated.

[0075] Finally, obtain the corresponding unique identification code SN assigned by the medical insurance department at the target medical institution C 、IP address C After that, the medical insurance business request sent to the target medical institution includes SN C 、IP C , within the preset effective access period from the moment the target medical institution’s registration application is approved, if Figure 4 As shown, the following steps A to D are executed in real time for the target medical institution.

[0076] 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 main communication link. If so, it proceeds to step B; otherwise, the access server further determines whether it detects that the target medical institution sends a heartbeat signal. If so, it proceeds to step C, otherwise it proceeds to step D.

[0077] Step B: The admission server copies the medical insurance service request from the main communication link and, based on the SN in the medical insurance service request, C 、IP C , and determine the type of service request, and control the sending of the medical insurance service request to the medical insurance service server.

[0078] In practical applications, such as Figure 5 As shown, the above step B is designed to specifically perform the following steps B1 to B3.

[0079] Step B1. The access server extracts 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 is allocated by the medical insurance department and SN C with IP C Correspondingly, if yes, proceed to step B2; otherwise, terminate the sending of the medical insurance service request and terminate the medical insurance service server's response to the medical insurance service request.

[0080] Step B2. The access server extracts the business request type in the medical insurance business request and determines whether it meets the corresponding business category range determined when the target medical institution successfully registers and declares. If so, it proceeds to step B3; otherwise, it terminates the sending of the medical insurance business request and terminates the medical insurance business server's response to the medical insurance business request.

[0081] Step B3. The access server does not intervene in the medical insurance service request. The medical insurance service request is sent to the medical insurance service server, which 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.

[0082] Step C. Based on the cumulative online time and primary review frequency corresponding to the target medical institution, the registration declaration information is considered according to the categories with and without time limits, and the review frequency is dynamically adjusted to perform the primary review of the registration declaration information of the target medical institution.

[0083] In actual application, the primary review frequency corresponding to the target medical institution is initialized. The above step C is as follows Figure 6 As shown, the specific design executes the following steps C1 to C8, regarding categories with a time limit, such as business qualification certificates with a time limit.

[0084] Step C1. If the primary review has been performed historically, determine whether there is a frequency reduction cutoff time point corresponding to the target medical institution that is later than the current time. If so, proceed to step C2; otherwise, proceed to step C3;

[0085] If no primary review has been performed in the past, all time-limit categories are selected from the registration declaration information to form each current time-limit category, and at the same time, No limitation period categories, constitute each current no limitation period category, then the admission server constructs a primary review inquiry message for each current limitation period category and each current no limitation period category and sends it to the target medical institution, and enters step C5; N represents the number of no limitation period categories in the registration declaration information, a represents the preset ratio, Indicates a round-up operation.

[0086] Step C2. According to the preset secondary review frequency less than the primary review frequency, it is judged whether the online cumulative duration corresponding to the current time since the last time of performing the primary review reaches the period duration corresponding to the secondary review frequency. If yes, a random selection of the number of non-time limit categories in the registration declaration information is made to form each current non-time limit category, and then the primary review inquiry message is constructed by the access server and sent to the target medical institution, and step C6 is entered. If not, no processing is performed.

[0087] Step C3. According to the primary review frequency, it is judged whether the online cumulative duration corresponding to the current time since the last time of performing the primary review reaches the period duration corresponding to the primary review frequency. If yes, a random selection of the number of non-time limit categories in the registration declaration information is made to form each current non-time limit category, and then the primary review inquiry message is constructed by the access server and sent to the target medical institution, and step C4 is entered. If not, no processing is performed.

[0088] Step C4. It is judged whether there is a time limit identifier in the time limit identifiers of all the time limit categories corresponding to the target medical institution that is in an expired state at the current time. If yes, the time limit categories corresponding to the time limit identifiers in the expired state are selected to form each current time limit category, and then the primary review inquiry message is constructed by the access server and sent to the target medical institution, and step C5 is entered. If not, step C6 is directly entered.

[0089] Step C5. The target medical institution receives the primary review inquiry message, extracts the information of the current target medical institution corresponding to each current time limit category in the primary review inquiry message, and combines the unique identifier code SN C and the IP address IP C to construct the primary review response message and return it to the access server.

[0090] The access server judges whether the SN C and IP C in the primary review response message belong to the time limit categories allocated by the medical insurance department, and whether the SN C and IP C ​​If yes, the access server obtains the valid time limit in each current time-limited category information, and further determines whether there is current time-limited category information in invalid state. If yes, the access server terminates the communication between the target medical institution and the medical service server, and then enters step C6. If not, the access server respectively constructs or updates the time limit identifier of the current time-limited category corresponding to the target medical institution according to the valid time limit in the current time-limited category information corresponding to the target medical institution, and then enters step C6.

[0091] If not, the access server terminates the communication between the target medical institution and the medical service server, and then enters step C6.

[0092] Step C6. The target medical institution receives the primary review inquiry message, extracts the information corresponding to each current time-limited category in the primary review inquiry message, and combines the unique identification code SN C and the IP address IP C to construct a primary review response message and return it to the access server.

[0093] The access server determines whether the SN C and the IP C in the primary review response message belong to the allocation of the medical department, and whether the SN C corresponds to the IP C . If yes, the access server further determines whether there is current time-limited category information that does not meet the audit requirements of the medical department. If yes, the access server terminates the communication between the target medical institution and the medical service server, and then enters step C7. If not, the access server does not make any processing, and enters step C7.

[0094] If not, the access server terminates the communication between the target medical institution and the medical service server, and then enters step C7.

[0095] Step C7. If the access server has terminated the communication between the target medical institution and the medical service server, the access server determines that the primary review is unqualified, and feeds back the current time-limited category information in invalid state corresponding to the target medical institution, or feeds back the current time-limited category information that does not meet the audit requirements of the medical department corresponding to the target medical institution to the target medical institution.

[0096] If the access server has not terminated the communication between the target medical institution and the medical service server, the access server determines that the primary review is qualified, and enters step C8.

[0097] Step C8. The admission server determines whether the primary review is qualified continuously for a preset number of times. If yes, the admission server selects the earliest expiration time among all time limit identifiers corresponding to the target medical institution in each time limit category, and forms a frequency reduction cutoff time point corresponding to the target medical institution. If not, the admission server does not perform any processing.

[0098] Step D. When the admission server detects that the target medical institution sends a medical insurance business request or a heartbeat signal, the admission server triggers interaction with the target medical institution, and performs a senior review corresponding to the target medical institution, including cumulative medical insurance business request information and registration declaration information.

[0099] In actual application, as shown in step D above, the specific design and execution are as follows. Figure 7

[0100] Step D1. When the admission server detects that the target medical institution sends a medical insurance business request or a heartbeat signal, it triggers step D2.

[0101] Step D2. The admission server performs an audit on the cumulative medical insurance business request information of the target medical institution. If the audit is qualified, step D3 is entered. If the audit is not qualified, the admission server terminates the communication between the target medical institution and the medical insurance business server.

[0102] In actual application, based on the number of times the admission server accumulates and detects that the target medical institution sends and completes a medical insurance business request to the medical insurance business server, in step D2 above, the admission server sends an instruction to the target medical institution to inquire about the number of times the target medical institution sends and completes a medical insurance business request to the medical insurance business server. The target medical institution receives the instruction, queries its internal log file, obtains the result, and feeds back to the admission server. The admission server determines whether the result from the target medical institution is consistent with the number of times stored in the admission server. If yes, the audit is qualified, and step D3 is entered. If not, the audit is not qualified, and the communication between the target medical institution and the medical insurance business server is terminated.

[0103] Step D3. According to the design of step C, the admission server performs a primary review on the registration declaration information of the target medical institution.

[0104] ​The medical institution business access management method is designed for the valid access period of the target medical institution since the registration and declaration is passed, and the audit operation based on the medical insurance business request and the review operation based on the online state of the target medical institution are designed. For the review operation, the registration and declaration information is considered in the time limit category and the non-time limit category, and the review frequency is dynamically adjusted. In the specific detection condition, the review frequency is reduced, and the change of the data state is considered, and the review frequency is further adjusted in time to ensure the timeliness and accuracy of the review operation, and to intelligently realize the active detection type adjustment and the detection feedback type adjustment. At the same time, the corresponding system is designed to cooperate the access server, the target medical institution and the medical insurance business server to perform business scheduling, to optimize the medical institution business access management audit and review work frequency, and to improve the work efficiency.

[0105] The embodiments of the present application are described in detail above in combination with the drawings, but the present application is not limited to the above embodiments, and various changes can be made within the knowledge of those skilled in the art without departing from the purpose of the present application.

Claims

1. A method for managing the business access of a medical institution, used to enable the medical insurance department to manage the business qualifications of a target medical institution, characterized by: Based on the target medical institution's registration information being reviewed and approved by the medical insurance department, the medical insurance department will assign the target medical institution a unique identification code SN. C 、IP address C , combined with the medical insurance business request sent by the target medical institution, including SN C 、IP C , within the preset effective access period starting from the moment the registration application is approved, the following steps A to D are executed in real time for the target medical institution; wherein the registration application information includes a time-limited category and an indefinite-limited category; Step A. Determine whether the target medical institution sends a medical insurance service request to the medical insurance service server. If so, proceed to step B. Otherwise, further determine whether the target medical institution sends a heartbeat signal. If so, proceed to step C, otherwise proceed to step D. Step B. Based on the SN in the medical insurance business request C 、IP C , and judgment of the type of service request, and controlling the sending of the medical insurance service request to the medical insurance service server; Step C. Based on the target medical institution's corresponding cumulative online time and primary review frequency, the registration application information is divided into categories with and without a statute of limitations, and the review frequency is dynamically adjusted to conduct a primary review of the target medical institution's corresponding registration application information; Step D: When a target medical institution sends a medical insurance service request or a heartbeat signal, the target medical institution is triggered to execute a high-level review including the accumulated medical insurance service request information and registration declaration information.

2. A method for managing access to medical institution services according to claim 1, characterized in that: Based on the target medical institution's registration information being reviewed and approved by the medical insurance department, the following steps are performed to obtain the unique identification code SN assigned by the medical insurance department to the target medical institution. C 、IP address C ; Step a. The target medical institution applies to the medical insurance superior unit to obtain its corresponding country code, and applies to the medical insurance department to obtain its corresponding account number and IP address. C , then go to step b; Step b. The target medical institution communicates with the medical insurance department by logging in with an account and sending its country code to the medical insurance department. The medical insurance department generates a security code corresponding to the target medical institution and associates the account, country code, and security code. The account, country code, and security code constitute the unique identification code SN corresponding to the target medical institution. C ; The medical insurance department communicates with the superior medical insurance unit periodically to obtain a correspondence table between medical institutions and country codes. The medical insurance department verifies the country code of the medical institution based on the correspondence table. If an error is found in the country code, the medical institution's medical insurance business request will be terminated, and the medical insurance business server's response to the medical insurance business request will be terminated.

3. A method for managing access to medical institution services according to claim 1 or 2, characterized in that: Perform the following steps to complete the medical insurance department's review of the target medical institution's registration information: Step i. The target medical institution submits its registration application information online to the medical insurance department based on the Sufuban web authentication and legal person authentication. The medical insurance department conducts an online review. If the review fails, the medical institution will be notified of the failure. If the review passes, the process proceeds to step ii. Step ii. The medical insurance department conducts an offline on-site verification of the target medical institution. If the verification passes, the process proceeds to step iii. If the verification fails, the medical institution is notified of the failure. Step iii. The medical insurance department shall make a public announcement of the target medical institution. If the announcement is passed, it means that the medical insurance department has approved the registration and declaration information of the target medical institution, and assigns the two designated institution codes of the corresponding basic medical insurance designated medical institution and basic medical insurance designated retail pharmacy, and signs an agreement between the two designated institutions; if the announcement is not passed, the failure information will be fed back to the target medical institution.

4. A method for managing access to medical institution services according to claim 2, characterized in that: Based on the target medical institution's registration information being reviewed and approved by the medical insurance department, perform the following steps to enable the target medical institution to apply to the medical insurance department for an IP address. C ; Step iv. 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 the dedicated line and allocates an IP address to the target medical institution. C , wait for the target medical institution to find the IP address C After the network connection is successful, proceed to step v; if the medical insurance department does not approve the application, the target medical institution's IP address application will be terminated; Step v. The medical insurance department conducts on-site verification of the target medical institution. If the verification is passed, the medical insurance department will issue access policies including access blocking, network policy, routing policy, and security policy to the target medical institution, and synchronize the medical insurance related database; if the verification fails, the IP address of the target medical institution will be C Recycling.

5. A method for managing access to medical institution services according to claim 1, characterized in that: The step B includes the following steps B1 to B3; 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 is allocated by the medical insurance department and SN C with IP C Correspondingly, if yes, proceed to step B2; otherwise, terminate the sending of the medical insurance service request and terminate the response of the medical insurance service server to the medical insurance service request; Step B2 extracts the business request type in the medical insurance business request and determines whether it meets the corresponding business category range determined when the target medical institution registration declaration is successful. If so, proceed to step B3; Otherwise, the sending of the medical insurance service request and the response of the medical insurance service server to the medical insurance service request are terminated; Step B3. No intervention is made on the medical insurance service request, and it 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.

6. A method for managing access to medical institution services according to claim 1, characterized in that: Initialize the primary review frequency corresponding to the target medical institution, and execute steps A to D for the target medical institution in real time within the preset effective access period from the time the registration application is approved. Step C includes the following steps C1 to C8; Step C1. If the primary review has been performed historically, determine whether there is a frequency reduction cutoff time point corresponding to the target medical institution that is later than the current time. If so, proceed to step C2. Otherwise, go to step C3; If no primary review has been performed in the past, all time-limit categories are selected from the registration declaration information to form each current time-limit category, and at the same time, No limitation period categories, constitute each current no limitation period category, and then enter step C5; N represents the number of no limitation period categories in the registration declaration information, a represents the preset ratio, Indicates rounding up operation; Step C2. Based on the preset secondary review frequency which is less than the primary review frequency, determine whether the online cumulative time corresponding to the last primary review to the current time has reached the cycle time corresponding to the secondary review frequency. If yes, randomly select No limitation period categories, forming each current no limitation period category, and then proceeding to step C6; otherwise, no processing is performed; Step C3. According to the primary review frequency, determine whether the online cumulative time corresponding to the last primary review to the current time has reached the cycle time corresponding to the primary review frequency. If yes, randomly select No limitation period categories, constitute each current no limitation period category, and then go to step C4; otherwise, no processing is performed; Step C4. Determine whether any of the time limit identifiers corresponding to the target medical institution's time limit categories are currently expired. If so, select the time limit categories corresponding to the currently expired time limit identifiers to form the current time limit categories, and then proceed to Step C5. Otherwise, go directly to step C6; Step C5. Extract the information corresponding to each current time limit category of the target medical institution, obtain the effective time period of each current time limit category information, and determine whether there is any current time limit category information that is currently invalid. 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, the time limit identifier of the current time limit category corresponding to the target medical institution is constructed or updated based on the valid time limit in the current time limit category information corresponding to the target medical institution, and then the process proceeds to step C6; Step C6. Extract the target medical institution's current information corresponding to each category with no statute of limitations, and determine whether any of the information 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 proceed to Step C7. Otherwise, do nothing, and proceed to Step C7. Step C7. If communication between the target medical institution and the medical insurance service server has been terminated, the primary review is determined to be unsatisfactory, and feedback is provided to the target medical institution regarding its currently invalidated category with a time limit, or information regarding its currently non-time limit category that does not meet the medical insurance department's review requirements. If the communication between the target medical institution and the medical insurance service server is not terminated, the primary review is determined to be qualified and the process proceeds to step C8; Step C8. Determine whether the primary review is qualified for the preset number of consecutive times. If so, select the earliest expiration time among all the time limit identifiers of each time limit category corresponding to the target medical institution to constitute the frequency reduction deadline corresponding to the target medical institution; otherwise, do nothing.

7. A method for managing access to medical institution services according to claim 6, characterized in that: Each current statute of limitations category and each current no statute of limitations category formed in step C1, each current no statute of limitations category formed in step C2, each current no statute of limitations category formed in steps C3 to C4, or each current no statute of limitations category and each current statute of limitations category, are respectively sent to the target medical institution in the form of a primary review inquiry message; in step C5, the target medical institution receives the primary review inquiry message, extracts the information of each current statute of limitations category corresponding to the primary review inquiry message of the target medical institution, and combines it with the unique identification code SN corresponding to the target medical institution. C with IP address C , construct a primary review response message and return it; Then first determine the SN in the primary review response message C 、IP C Is it assigned by the medical insurance department and SN C with IP C Correspondingly, if yes, continue to judge the information of the target medical institution corresponding to each category with current statute of limitations; Otherwise, the communication between the target medical institution and the medical insurance service server is terminated, and then the process proceeds to step C6; In step C6, the target medical institution receives the primary review inquiry message, extracts the information of each category without statute of limitations in the primary review inquiry message corresponding to the target medical institution, and combines the unique identification code SN corresponding to the target medical institution. C with IP address C , construct a primary review response message and return it; Then first determine the SN in the primary review response message C 、IP C Is it assigned by the medical insurance department and SN C with IP C Correspondingly, if yes, continue to judge the information of the target medical institution corresponding to each category without statute of limitations; Otherwise, the communication between the target medical institution and the medical insurance service server is terminated, and then step C7 is entered.

8. A method for managing access to medical institution services according to claim 6 or 7, characterized in that: The step D includes the following steps D1 to D3; Step D1. When a target medical institution sends a medical insurance service request or a heartbeat signal, the process of step D2 is triggered. Step D2. Execute the audit of the cumulative medical insurance business request information 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; Step D3: Perform a preliminary review of the target medical institution's registration application information.

9. A method for managing access to medical institution services according to claim 6 or 7, characterized in that: The category with a time limit in the registration declaration information is the business qualification certificate with a time limit.

10. A system for implementing the medical institution business access management method according to claim 8, characterized in that: The access server includes a main communication link between the target medical institution and the medical insurance business server, wherein the target medical institution and the medical insurance business server are directly connected to each other for communication, and the access server is connected to the main communication link between the target medical institution and the medical insurance business server via a branch communication link; Based on the detection by the admission server in step A that the target medical institution sends a medical insurance service request to the medical insurance service server via the primary communication link, in step B the admission server copies the medical insurance service request from the primary communication link and analyzes the SN in the medical insurance service request. C 、IP C , and the type of service request, and then the admission server controls the sending of the medical insurance service request to the medical insurance service server; Based on the detection by the admission server of the heartbeat signal sent by the target medical institution in step A, in steps C1 to C4 of step C, the admission 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 admission server, and the admission server performs the judgment in steps C5 and C6, and 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 fact that the access server did not detect the medical insurance business request or heartbeat signal sent by the target medical institution in step A, in step D, the access server detects the medical insurance business request or heartbeat signal sent by the target medical institution, triggering the access server to interact with the target medical institution to perform advanced review.

11. The system of the medical institution business access management method according to claim 10, characterized in that: Based on the 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, the access server detects and stores the number of times; 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 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 the process goes to step D3; otherwise, the review is unqualified and the communication between the target medical institution and the medical insurance business server is terminated.

12. The system of the medical institution business access management method according to claim 10, characterized in that: The medical insurance department includes an online server and an IP allocation server, wherein the online server communicates with the target medical institution and the IP allocation server respectively; the target medical institution creates registration declaration information and sends it to the online server, which receives the registration declaration information and reviews it. Based on the review, the online server constructs a unique identification code SN corresponding to the target medical institution. C The result of the review will be sent to the IP allocation server, which will allocate the IP address of the target medical institution. C , and returns it to the online server, and finally the online server will send the unique identification code SN corresponding to the target medical institution C 、IP address C Sent to the target medical institution and access server.

Images