Medicare service collaboration method, system and storage medium

Abstract

This invention relates to the field of data processing technology, applicable to question-and-answer scenarios in fintech and healthcare. It discloses a collaborative method, system, and storage medium for medical insurance services, comprising: acquiring a user's medical service fulfillment certificate and medical data through a medical hardware terminal; doubly encrypting the medical service fulfillment certificate through the medical hardware terminal and blockchain nodes in a blockchain network to obtain a fulfillment certificate hash value, and writing the fulfillment certificate hash value into the blockchain, where the blockchain nodes include edge computing nodes and insurance nodes; generating claim suggestions on the medical data using a preset method on the edge computing nodes to obtain a target claim suggestion result; sending the target claim suggestion result to the insurance node through the edge computing node; and executing the claim task through the insurance node based on the fulfillment certificate hash value and the target claim suggestion result in the blockchain. This invention can improve data security, thereby enhancing the security of medical insurance services.

Description

Technical Field

[0001] This invention relates to the field of data processing technology, applicable to the fields of financial technology and healthcare, and particularly to a method, system, and storage medium for collaborative medical insurance services. Background Technology

[0002] In processing insurance business, insurance companies often need to interact with other entities to exchange data. For example, in the context of fintech and healthcare-related health insurance, insurance companies need to calculate health insurance premiums based on medical data provided by hospitals and other medical institutions, as well as insurance data stored by the insurance company itself. However, medical data and insurance data belong to different entities (medical institutions and insurance companies). Currently, data from different entities is usually directly transmitted to one party, which poses a risk of data leakage and affects data security. Summary of the Invention

[0003] This invention provides a collaborative method, system, and storage medium for medical insurance services to address the technical problem of data leakage risks in the medical insurance service process, aiming to improve data security and thus enhance the security of medical insurance services.

[0004] Firstly, a collaborative method for medical insurance services is provided, including: obtaining users' medical treatment performance certificates and medical treatment data through medical hardware terminals; The medical service performance certificate is double-encrypted by the medical hardware terminal and the blockchain nodes in the blockchain network to obtain the performance certificate hash value, and the performance certificate hash value is written into the blockchain. The blockchain nodes include edge computing nodes and insurance nodes. On the edge computing node, a claim suggestion is generated from the medical data using a preset method to obtain the target claim suggestion result; The target claim suggestion result is sent to the insurance node through the edge computing node; The insurance node executes the claims settlement task based on the hash value of the performance certificate in the blockchain and the target claims settlement suggestion result.

[0005] In some embodiments, the medical data includes disease type; On the edge computing node, a claim suggestion is generated from the medical data using a preset method to obtain a target claim suggestion result, including: Based on the disease type in the medical data and the preset scope of claims-compliant diseases, a compliance judgment is made to obtain a compliance judgment result; If the compliance judgment result indicates that the disease type belongs to the category of claims-compliant diseases, the premium adjustment coefficient is calculated based on the medical data. The combination of the compliance assessment result and the premium adjustment coefficient is determined as the target claims recommendation result.

[0006] In some embodiments, after determining compliance based on the disease type in the medical data and a preset scope of compliant claims diseases, and obtaining a compliance determination result, the method further includes: If the compliance judgment result indicates that the user's disease type belongs to the category of compliant diseases for claims, the completeness of the materials is obtained by comparing the medical data with the preset list of claims materials. If the material integrity indicates that the medical data is incomplete, a material integrity prompt is generated based on the material integrity and sent to the user.

[0007] In some embodiments, determining the combination of the compliance assessment result and the premium adjustment factor as the target claims recommendation result includes: The combination of the compliance assessment result and the premium adjustment factor is determined as the initial claims recommendation result; The initial claim suggestion result is encrypted to obtain the target claim suggestion result.

[0008] In some embodiments, the medical hardware terminal has a first private key, and the blockchain node has a second private key; The process of doubly encrypting the medical service performance certificate through the medical hardware terminal and blockchain nodes in the blockchain network to obtain the performance certificate hash value includes: The medical hardware terminal performs a first digital signature on the medical treatment performance certificate based on the first private key to obtain an encrypted certificate signature. The blockchain node performs a second digital signature on the encrypted certificate signature based on the second private key to obtain the hash value of the performance certificate.

[0009] In some embodiments, executing the claims task through the insurance node based on the hash value of the performance certificate in the blockchain and the target claims recommendation result includes: The authenticity of the performance certificate hash value is verified by the insurance node to obtain the certificate verification result; In response to the verification result indicating that the hash value of the performance certificate is valid, the claims task is executed according to the target claims recommendation result.

[0010] In some embodiments, the medical hardware terminal has a first private key and a first public key corresponding to the first private key; the blockchain node is the insurance node, and the insurance node has a second private key and a second public key corresponding to the second private key; The process of verifying the authenticity of the performance certificate hash value through the insurance node to obtain the certificate verification result includes: Obtain the first public key of the medical hardware terminal, and perform digital signature verification on the target claim suggestion result based on the first public key and the second public key to obtain the claim suggestion verification result; If the verification result of the claim recommendation indicates that the verification is successful, the claim settlement will be carried out based on the compliance judgment result in the target claim recommendation result.

[0011] In some embodiments, the target claims recommendation result includes a compliance assessment result and a premium adjustment factor; The response to the document verification result indicating that the performance document hash value is valid, and the execution of the claims task based on the target claims recommendation result, includes: In response to the verification result indicating that the hash value of the performance certificate is valid, claims settlement is carried out based on the compliance judgment result; In response to the verification result indicating that the hash value of the performance certificate is valid, and the target claims recommendation result includes a premium adjustment coefficient, the user's initial premium is adjusted according to the premium adjustment coefficient.

[0012] Secondly, a medical insurance service collaboration system is provided, the medical insurance service collaboration system being used to perform the above method, the medical insurance service collaboration system comprising: A medical hardware terminal and at least two blockchain nodes in a blockchain network; the medical hardware terminal is communicatively connected to each of the blockchain nodes; the at least two blockchain nodes include an edge computing node and an insurance node.

[0013] Thirdly, a computer-readable storage medium is provided, which stores a computer program that, when executed by a processor, implements the steps of the above-described method.

[0014] In the aforementioned collaborative medical insurance service method, system, and storage medium, the medical treatment fulfillment certificate can be double-encrypted through medical hardware terminals and blockchain nodes in the blockchain network to obtain the certificate hash value, which is then written to the blockchain. This double encryption enhances the certificate's credibility, reduces the risk of forgery or tampering, and ensures the certificate reliably proves the user's genuine medical treatment. This reduces the risk of providing medical insurance services based on false medical data and improves data credibility. At edge computing nodes, a pre-defined method generates claim suggestions based on the medical data, yielding initial claim suggestion results. This allows for compliance judgment of the medical data directly at the medical edge node, sending only the judgment result (i.e., the target claim suggestion result) to the insurance node, rather than directly transmitting the original data from different entities to one party. This reduces the risk of data leakage and improves data security. The insurance node executes the claim task based on the fulfillment certificate hash value and the target claim suggestion result in the blockchain. This enables the insurance node to make decisions based on trusted medical treatment fulfillment certificates and claim suggestions, improving data credibility and security, thereby enhancing the security of medical insurance services. Attached Figure Description

[0015] To more clearly illustrate the technical solutions of the embodiments of the present invention, the drawings used in the description of the embodiments of the present invention will be briefly introduced below. Obviously, the drawings described below are only some embodiments of the present invention. For those skilled in the art, other drawings can be obtained based on these drawings without creative effort.

[0016] Figure 1 This is a schematic diagram of an application environment for a medical insurance service collaboration method according to an embodiment of the present invention; Figure 2 This is a flowchart illustrating a medical insurance service collaboration method according to an embodiment of the present invention; Figure 3 yes Figure 2 A schematic diagram of a specific implementation method for step S102; Figure 4 yes Figure 2 A schematic diagram of a specific implementation method for step S103; Figure 5 This is another flowchart illustrating the medical insurance service collaboration method in one embodiment of the present invention; Figure 6 yes Figure 4 A flowchart illustrating a specific implementation of step S303; Figure 7 yes Figure 2 A schematic diagram of a specific implementation of step S105; Figure 8 yes Figure 7 A schematic diagram of a specific implementation of step S601; Figure 9 yes Figure 7 A schematic diagram of a specific implementation method for step S602. Detailed Implementation

[0017] The technical solutions of the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings. Obviously, the described embodiments are only some, not all, of the embodiments of the present invention. Based on the embodiments of the present invention, all other embodiments obtained by those skilled in the art without creative effort are within the scope of protection of the present invention.

[0018] The medical insurance service collaboration method provided in this embodiment of the invention can be applied to, for example... Figure 1 In this application environment, the client communicates with the server via a network. The server can receive information such as the target claim settlement suggestion result and the hash value of the performance certificate from the client, and execute the claim settlement task based on the hash value of the performance certificate and the target claim settlement suggestion result. Then, the server can feed back the execution result of the claim settlement task to the client.

[0019] The client can be, but is not limited to, various personal computers, laptops, smartphones, tablets, and portable wearable devices. The server can be implemented using a standalone server or a server cluster consisting of multiple servers. For example, the client can be a medical hardware terminal, and the server can include blockchain nodes in a blockchain. The invention will now be described in detail through specific embodiments.

[0020] Please see Figure 2 As shown, Figure 2 A flowchart illustrating a collaborative medical insurance service method provided in an embodiment of the present invention includes the following steps: S101: Obtain the user's medical treatment fulfillment certificate and medical treatment data through medical hardware terminal; S102: The medical service performance certificate is double-encrypted through the medical hardware terminal and the blockchain nodes in the blockchain network to obtain the performance certificate hash value, and the performance certificate hash value is written into the blockchain. The blockchain nodes include edge computing nodes and insurance nodes. S103: On the edge computing node, claims suggestions are generated from medical data using a preset method to obtain the target claims suggestion result; S104: Send the target claim suggestion result to the insurance node through the edge computing node; S105: Execute the claims task through the insurance node based on the hash value of the performance certificate in the blockchain and the target claims suggestion result.

[0021] The beneficial effects of this invention include, but are not limited to: Double encryption of medical service fulfillment certificates via medical hardware terminals and blockchain nodes in a blockchain network to obtain a hash value for the fulfillment certificate, which is then written into the blockchain. This double encryption enhances the credibility of the certificate, reduces the risk of forgery or tampering, and ensures that the fulfillment certificate reliably proves the user's genuine medical treatment, thereby reducing the risk of providing medical insurance services based on false medical data and improving data credibility. On edge computing nodes, a pre-defined method is used to generate claim suggestions from the medical data, obtaining initial claim suggestion results. This allows for compliance judgment of the medical data to be completed directly at the medical edge node, sending only the judgment result (i.e., the target claim suggestion result) to the insurance node, rather than directly transmitting the original data from different entities to one party, thereby reducing the risk of data leakage and improving data security. By having the insurance node execute the claim task based on the hash value of the fulfillment certificate and the target claim suggestion result in the blockchain, the insurance node can make decisions based on trusted medical service fulfillment certificates and claim suggestions, improving data credibility and security, and thus enhancing the security of medical insurance services.

[0022] In step S101 of some embodiments, the medical hardware terminal refers to equipment deployed in medical facilities such as hospitals and clinics. Specifically, after a user visits a clinic, the medical hardware terminal can generate a medical service fulfillment certificate by swiping the card. For example, in the field of medical insurance, the medical hardware terminal may include hardware terminals such as in-clinic Internet of Things (IoT) terminals and family doctor check-in devices. For example, users can check in on the medical hardware terminal by facial recognition, scanning a dynamic QR code, or using their medical insurance card, thereby generating a medical service fulfillment certificate. It should be noted that the medical service fulfillment certificate refers to the certificate used by insured persons (i.e., users) to prove their insured status, initiate medical insurance settlement, and complete expense reimbursement when seeking medical treatment. Specifically, the medical service fulfillment certificate may include information such as a physical medical insurance card, an electronic medical insurance code, or a barcode or QR code on the medical receipt. For example, after a patient completes an outpatient visit and checks in on the in-clinic IoT terminal, the doctor can operate the in-clinic IoT terminal to confirm the end of the treatment, and the in-clinic IoT terminal automatically generates a medical service fulfillment certificate containing information such as the patient's name, medical insurance number, visit time, and treatment summary. Medical records can include a user's medical history, laboratory reports, imaging reports, allergy history, surgical records, etc.

[0023] In step S102 of some embodiments, the performance certificate hash value is the hash value of the medical treatment performance certificate. Specifically, the performance certificate hash value can be a digital signature of the medical treatment performance certificate. For example, the user's medical treatment performance certificate can be encrypted using a first-layer symmetric encryption algorithm (such as AES, or Advanced Encryption Standard algorithm) using a medical hardware terminal to generate intermediate ciphertext. Then, the intermediate ciphertext can be signed using a second-layer asymmetric encryption algorithm (such as ECDSA, or Elliptic Curve Digital Signature Algorithm) by a blockchain node in the blockchain network to obtain the final performance certificate hash value. It should be noted that an immutable hash value is generated through double signature. Only when the hash value is verified will the insurance node execute tasks such as automatic claims processing or premium discounts. It should also be noted that the blockchain network can contain multiple blockchain nodes, such as edge computing nodes and insurance nodes. For example, in the medical insurance scenario in the healthcare field, edge computing nodes can specifically be IoT gateways inside hospitals, edge servers in regional health data centers, etc. Insurance nodes can be servers of insurance companies.

[0024] In step S103 of some embodiments, the target claim recommendation result refers to the insurance claim recommendation for the user. For example, the target claim recommendation result may include whether the user's medical treatment is within the scope of medical insurance coverage, the required claim materials, and the user's premium adjustment factor for the next year.

[0025] In step S104 of some embodiments, it should be noted that this application adopts a federated edge computing architecture, deploying a lightweight federated learning model on local edge computing nodes. Data does not need to leave the local node; the model only calculates the target claim recommendation result (e.g., whether the claim conditions are met, premium adjustment coefficient) and sends the target claim recommendation result to the insurance system, instead of using the traditional centralized data upload mode. In some embodiments, for example, the model deployed on the edge computing node can be a federated learning model. It should be noted that federated learning (FL) is a distributed machine learning technology that allows multiple participants (such as devices, nodes, etc.) to collaboratively train a machine learning model without sharing the original data. Specifically, each node (such as an insurance node) trains its local federated learning model on its local dataset.

[0026] In step S105 of some embodiments, the insurance node can be a node used to perform insurance services, or it can be a server or other equipment of an insurance company. For example, the claims task may include tasks such as claims settlement and premium adjustment. In some embodiments, such as in the medical insurance scenario in the healthcare field, after generating the target claims suggestion result, the insurance node can read the corresponding performance certificate hash value from the blockchain and compare it with the certificate in the user's currently submitted claims application. If the hash value matches successfully and the target claims suggestion result is "full reimbursement" or "partial reimbursement", the insurance node triggers the execution of the claims settlement task. In another embodiment, the claims task may also include initiating a manual review process. For example, when several target claims suggestion results include special claims suggestions (such as "large amount case, manual confirmation required"), the insurance node will generate a reminder message and send it to the claims review personnel for manual confirmation of whether to execute the claims task.

[0027] In some embodiments, the insurance node can have a built-in smart contract to allocate funds based on medical service performance records and claim balances. For example, after claims settlement, a portion of the remaining claim resources (such as claim funds) can be allocated to the hospital's medical hardware terminals as service incentives for doctors or as a medical service fund. In another embodiment, the user's health management can be assessed based on their medical service data; if it is satisfactory, the user can receive a premium discount.

[0028] In some embodiments, such as Figure 3 As shown, the medical hardware terminal has a first private key, and the blockchain node has a second private key; In step S102, that is, by doubly encrypting the medical treatment fulfillment certificate through the medical hardware terminal and the blockchain node in the blockchain network to obtain the fulfillment certificate hash value, the following steps are included: S201: Through the medical hardware terminal, the medical treatment performance certificate is digitally signed based on the first private key to obtain the encrypted certificate signature; S202: Through the blockchain node, the encrypted certificate is digitally signed using the second private key to obtain the hash value of the performance certificate.

[0029] The advantage of this embodiment lies in the fact that the medical hardware terminal performs a first digital signature on the medical service fulfillment certificate using its first private key, resulting in an encrypted certificate signature. This allows the data source (the medical hardware terminal) to first complete the signature using its unique first private key, ensuring the authenticity and non-repudiation of the medical service fulfillment certificate's origin from a cryptographic perspective. Then, the encrypted certificate signature is further digitally signed using the second private key of a blockchain node, resulting in a fulfillment certificate hash value. This allows the blockchain network to re-sign the certificate already signed by the medical hardware terminal using its second private key, making the final generated fulfillment certificate hash value more reliable and tamper-proof, thereby improving data trustworthiness.

[0030] In step S201 of some embodiments, the encrypted credential signature is a digital signature obtained by encrypting the medical service fulfillment certificate with the first private key. Specifically, the first private key may be a unique identity key pre-stored in the security chip of the medical hardware terminal. For example, after a user completes their medical visit in the clinic, the medical hardware terminal (such as a clinic IoT terminal) first reads the medical service fulfillment certificate, and then calls the internal encryption module to use the first private key to perform asymmetric encryption on the hash value of the certificate data, thereby generating a digital signature, i.e., the encrypted credential signature.

[0031] In step S202 of some embodiments, the performance certificate hash value is a digital signature obtained by encrypting the encrypted certificate signature with the second private key. It should be noted that the encrypted certificate signature and the performance certificate hash value can not only prove that the medical treatment performance behavior does indeed originate from the designated legitimate hardware terminal, but also prevent the certificate from being forged or tampered with during transmission.

[0032] In some embodiments, such as Figure 4 As shown, the medical data includes disease types; In step S103, that is, on the edge computing node, a claim suggestion is generated from the medical data using a preset method to obtain the target claim suggestion result, which specifically includes the following steps: S301: Based on the disease types in the medical data and the preset scope of compliant diseases for claims, a compliance judgment is made to obtain the compliance judgment result; S302: If the compliance assessment result indicates that the disease type falls within the scope of claim-compliant diseases, the premium adjustment coefficient is calculated based on the medical data. S303: The combination of the compliance assessment result and the premium adjustment factor shall be determined as the target claims recommendation result.

[0033] The advantage of this embodiment lies in its compliance assessment, which is performed based on the disease type in the medical data and the preset scope of claim-compliant diseases. If the compliance assessment indicates that the disease type falls within the scope of claim-compliant diseases, the premium adjustment coefficient is calculated based on the medical data. This allows for compliance assessment of medical data to be completed directly at the medical edge node, sending only the assessment result (i.e., the target claim suggestion result) to the insurance node, rather than directly transmitting the original data from different entities to one party. This reduces the risk of data leakage and improves the data interaction security of medical insurance services.

[0034] In step S301 of some embodiments, the compliance judgment result is used to characterize whether the disease type falls within the scope of claim-compliant diseases. For example, assuming that the scope of claim-compliant diseases includes chronic diseases, and the disease type of the user's medical treatment recorded in the medical data is a chronic disease, then the compliance judgment result characterizes that the disease type falls within the scope of claim-compliant diseases.

[0035] In step S302 of some embodiments, the premium adjustment factor is a factor used to adjust the user's future (e.g., next year's) premium. The adjusted premium can be obtained by multiplying the premium adjustment factor by the user's current premium.

[0036] In step S303 of some embodiments, the target claim recommendation result may include a compliance assessment result and a premium adjustment coefficient. It should be noted that the compliance assessment result indicates whether the user's medical treatment fulfillment behavior complies with the rules and requirements of medical insurance or commercial insurance, such as whether the treatment was conducted at a designated medical institution, whether the check-in was completed within the specified time, and whether the treatment items are covered by insurance. Specifically, the premium adjustment coefficient is a numerical factor (such as 0.9, 1.0, 1.2, etc.) used to adjust the user's premium amount upwards or downwards in subsequent premium calculations. For example, for a user who fulfills their obligations on time and all treatment items are compliant, the compliance assessment result is "compliant," and the premium adjustment coefficient is 0.85. Accordingly, the target claim recommendation result is {compliant, 0.85}. As another example, for a user who did not declare out-of-pocket items in advance during a medical treatment, the compliance assessment result is "non-compliant," and the premium adjustment coefficient is 1.2, that is, the target claim recommendation result is {non-compliant, 1.2}.

[0037] In some embodiments, such as Figure 5 As shown, after step S301, the medical insurance service collaboration method may further include the following steps: S401: If the compliance assessment result indicates that the user's disease type falls within the scope of compliant claims, the completeness of the materials is determined by comparing the medical data with the pre-set list of claims materials. S402: If the material integrity indicator is incomplete, generate a material integrity prompt based on the material integrity and send it to the user.

[0038] The advantage of this embodiment is that, when the compliance assessment indicates that the user's disease type falls within the scope of claim-compliant diseases, the completeness of the materials is determined by comparing the medical data with a pre-set list of claim materials. This allows for completeness verification of medical data entering subsequent processes at the data source, ensuring that it meets the basic requirements for claim processing. If the completeness of the materials indicates that the medical data is incomplete, a material completeness prompt is generated and sent to the user. This provides real-time feedback of the verification results to the user, guiding them to supplement or correct the data in a timely manner, thereby improving the reliability of medical insurance services.

[0039] In step S401 of some embodiments, material completeness can refer to the completeness of the materials in the medical data required to generate a claims recommendation. Specifically, the scope of eligible diseases for claims refers to the list of diseases that are pre-agreed upon in the insurance contract. For example, the scope of eligible diseases for claims may include critical illnesses or chronic diseases such as diabetes and hypertension. For example, medical data may include disease type, user identity, medical insurance certificates, etc. In some embodiments, medical data can be extracted from documents such as diagnostic certificates, laboratory reports, hospital admission records, and hospital expense lists.

[0040] In step S402 of some embodiments, the material completeness prompt is used to notify the user that materials are missing and remind the user to supplement the claim materials. The material completeness prompt can take the form of email, SMS, pop-up window, etc., and is not limited to these. The material completeness prompt can be used to notify the user of missing key documents, such as specific examination reports, complete medical records, etc.

[0041] In some embodiments, such as Figure 6 As shown, step S303, which involves determining the combination of the compliance assessment result and the premium adjustment coefficient as the target claims recommendation result, specifically includes the following steps: S501: The combination of the compliance assessment result and the premium adjustment factor shall be used as the initial claims recommendation result; S502: Encrypt the initial claim suggestion result to obtain the target claim suggestion result.

[0042] The advantage of this embodiment lies in determining the initial claim recommendation result by combining the compliance assessment result and the premium adjustment coefficient. This initial claim recommendation result is then encrypted to obtain the target claim recommendation result, thus providing encryption protection before data transmission. In this way, even if there are risks during data transmission, the encrypted data (i.e., the target claim recommendation result) will not be exposed in plaintext, thereby further enhancing the confidentiality of cross-node data interaction and improving the security of the medical insurance service collaboration process.

[0043] In step S501 of some embodiments, the initial claims recommendation result includes a compliance assessment result and a premium adjustment factor. It should be noted that the initial claims recommendation result is unencrypted data.

[0044] In step S502 of some embodiments, the initial claim recommendation result can be encrypted using an asymmetric encryption algorithm. In another embodiment, other encryption algorithms can also be used to encrypt the initial claim recommendation result, and this is not a limitation.

[0045] In some embodiments, such as Figure 7 As shown, step S105, which involves the insurance node executing the claims task based on the hash value of the performance certificate and the target claims suggestion result in the blockchain, specifically includes the following steps: S601: Verify the authenticity of the performance certificate hash value through the insurance node to obtain the certificate verification result; S602: In response to the verification result indicating that the performance document hash value is valid, execute the claims task based on the target claims recommendation result.

[0046] The advantage of this embodiment is that it verifies the authenticity of the performance certificate hash value through the insurance node, obtains the certificate verification result, and executes the claim task based on the target claim suggestion result when the certificate verification result indicates that the performance certificate hash value is valid. This ensures that the actual claim operation is triggered only after the authenticity of the medical treatment performance certificate is confirmed, thereby improving the reliability of the data on which the claim decision relies and ultimately enhancing the security of medical insurance services.

[0047] In step S601 of some embodiments, the credential verification result is used to characterize whether the performance credential hash value is authentic and valid. The performance credential hash value is written to the blockchain by blockchain nodes. In this case, the insurance node can directly obtain the credential verification result from the blockchain to verify its authenticity. In some embodiments, the insurance node can recalculate the hash value of the original medical performance credential submitted by the user and compare it byte-by-byte with the performance credential hash value already stored on the blockchain. For example, if the user submits a medical insurance settlement statement image, the insurance node can extract the key fields from the medical insurance settlement statement image and concatenate them into standard format credential data. Then, it can perform a hash operation on the credential data to obtain a new hash value and query the performance credential hash value in the corresponding block on the blockchain. If the two match, the credential verification result is authentic and valid. If they do not match, or if the corresponding hash value cannot be found on the chain, the result is invalid or tampered with.

[0048] In step S602 of some embodiments, performing a claims task based on the target claims recommendation result may include triggering claims settlement or discounting the user's premium.

[0049] In some embodiments, such as Figure 8 As shown, the medical hardware terminal has a first private key and a first public key corresponding to the first private key; the blockchain node is an insurance node, and the insurance node has a second private key and a second public key corresponding to the second private key; Step S601, which involves verifying the authenticity of the performance certificate hash value through the insurance node to obtain the certificate verification result, specifically includes the following steps: S701: Obtain the first public key of the medical hardware terminal, and perform digital signature verification on the target claim suggestion result based on the first public key and the second public key to obtain the claim suggestion verification result; S702: If the verification result of the claim recommendation indicates that the verification is successful, the claim settlement shall be carried out according to the compliance judgment result in the target claim recommendation result.

[0050] The advantage of this embodiment is that by obtaining the first public key of the medical hardware terminal and performing digital signature verification on the target claim suggestion result based on the first and second public keys, a claim suggestion verification result is obtained. This verifies that the data has not been tampered with and that its source is authentic. If the claim suggestion verification result indicates that the verification is successful, the claim settlement is carried out according to the compliance judgment result in the target claim suggestion result. This can improve the credibility of the data on which insurance business decisions such as claim settlement rely, thereby improving the reliability of medical insurance service collaboration.

[0051] In step S701 of some embodiments, the first public key refers to the public key of the medical hardware terminal, and the second public key refers to the public key of the insurance node. Specifically, the first public key can be publicly obtained from the blockchain or uploaded to the trusted certificate store of the insurance node through the medical hardware terminal. The second public key is the public key held by the insurance node itself, and the second public key can be broadcast in the blockchain network and stored by each node.

[0052] In step S702 of some embodiments, if both the first public key and the second public key are verified successfully, the claim suggestion verification result indicates that the verification is successful. In some embodiments, when verification is required, the first public key can be obtained from the blockchain, and the second public key can be obtained from the insurance node, and decryption verification can be performed sequentially. If both signatures are verified successfully, the claim suggestion verification result indicates that both signatures are valid, which means that the target claim suggestion result comes from a real terminal, has not been tampered with, and has been authorized by the insurance node.

[0053] In some embodiments, such as Figure 9 As shown, the target claims recommendation results include compliance assessment results and premium adjustment coefficients; In step S602, that is, when the verification result of the voucher indicates that the hash value of the performance voucher is valid, the claim settlement task is executed according to the target claim settlement suggestion result, which specifically includes the following steps: S801: In response to the document verification result indicating that the performance document hash value is valid, claims settlement is carried out based on the compliance judgment result; S802: In response to the certificate verification result indicating that the performance certificate hash value is valid and the target claims recommendation result includes the premium adjustment factor, adjust the user's initial premium according to the premium adjustment factor.

[0054] The advantage of this embodiment is that when the verification result indicates that the hash value of the performance certificate is valid, claims settlement is carried out based on the compliance judgment result, making the claims settlement operation safe and reliable. Furthermore, when the verification result indicates that the hash value of the performance certificate is valid and the target claims recommendation includes a premium adjustment factor, the user's initial premium is adjusted according to the premium adjustment factor. This allows for dynamic adjustment of the user's premium while ensuring the reliability of the data source, thereby improving the reliability of medical insurance services.

[0055] In some embodiments, after the insurance node verifies the authenticity of the performance certificate hash value, if it is authentic and valid, and the target claims recommendation result includes a premium adjustment coefficient, it can discount the user's premium for the next year based on the premium adjustment coefficient calculated by the edge computing node.

[0056] It should be understood that the sequence number of each step in the above embodiments does not imply the order of execution. The execution order of each process should be determined by its function and internal logic, and should not constitute any limitation on the implementation process of the embodiments of the present invention.

[0057] In one embodiment, a medical insurance service collaboration system is provided, which corresponds one-to-one with the medical insurance service collaboration method described in the above embodiments. The medical insurance service collaboration system includes a medical hardware terminal and at least two blockchain nodes in a blockchain network; the medical hardware terminal is communicatively connected to each blockchain node; the at least two blockchain nodes include an edge computing node and an insurance node.

[0058] In some embodiments, the medical insurance service collaboration system may include a primary healthcare service terminal module (i.e., the medical hardware terminal mentioned above), a federated edge computing node (i.e., the edge computing node mentioned above), a blockchain performance verification module, and an insurance intelligent risk control core module (i.e., the insurance node mentioned above). Specifically, the primary healthcare service terminal module is deployed in health service centers or clinics. The primary healthcare service terminal module may include an electronic health record (EHR) system, an Internet of Things (IoT) in-clinic check-in terminal, and a doctor's workstation, etc. The federated edge computing node is independently deployed on the medical institution's intranet and is physically isolated from the insurance core business system; the federated edge computing node is loaded with a federated learning model, which is used to receive data from the medical hardware terminal and combine it with a global model for local training. The blockchain performance verification module is used to connect to devices such as IoT in-clinic check-in terminals; when a user completes a chronic disease follow-up visit, the device generates a universally unique identifier (UUID), which is signed using an encryption algorithm and written to the blockchain to generate a verification hash. The insurance intelligent risk control core module is used to receive the performance certificate hash value and the claim suggestion result, automatically perform secondary verification, and trigger intelligent revenue sharing.

[0059] This invention provides a collaborative medical insurance service system. It employs dual encryption of medical service fulfillment certificates through medical hardware terminals and blockchain nodes in a blockchain network to obtain a hash value for the certificate, which is then written to the blockchain. This dual encryption enhances the credibility of the certificate, reduces the risk of forgery or tampering, and ensures that the certificate reliably proves the user's genuine medical treatment. This reduces the risk of providing medical insurance services based on false medical data and improves data credibility. At edge computing nodes, a pre-defined method generates claim suggestions from the medical data, resulting in an initial claim suggestion. This allows for compliance assessment of the medical data directly at the medical edge node, sending only the assessment result (i.e., the target claim suggestion) to the insurance node, rather than directly transmitting the original data from different entities to one party. This reduces the risk of data leakage and improves data security. The insurance node executes the claim task based on the hash value of the fulfillment certificate and the target claim suggestion in the blockchain. This enables the insurance node to make decisions based on reliable medical service fulfillment certificates and claim suggestions, improving data credibility and security, thereby enhancing the security of medical insurance services.

[0060] Specific limitations regarding the medical insurance service collaboration system can be found in the limitations of the intelligent question-answering method described above, and will not be repeated here. Each module in the aforementioned medical insurance service collaboration system can be implemented entirely or partially through software, hardware, or a combination thereof. These modules can be embedded in or independent of the processor in a computer device, or stored in the memory of a computer device as software, so that the processor can call and execute the corresponding operations of each module.

[0061] In one embodiment, a computer-readable storage medium is provided having a computer program stored thereon, the computer program performing the following steps when executed by a processor: Obtain users' medical treatment fulfillment certificates and medical treatment data through medical hardware terminals; The medical service performance certificate is double-encrypted by medical hardware terminal and blockchain nodes in the blockchain network to obtain the performance certificate hash value, and then the performance certificate hash value is written into the blockchain. The blockchain nodes include edge computing nodes and insurance nodes. On edge computing nodes, claims suggestions are generated from medical data using a preset method to obtain the target claims suggestion result; The target claim suggestion result is sent to the insurance node through the edge computing node; The insurance node executes the claims task based on the hash value of the performance certificate in the blockchain and the target claims recommendation result.

[0062] It should be noted that the functions or steps that can be implemented by the computer-readable storage medium or computer device described above can be referred to the relevant descriptions on the server side and client side in the foregoing method embodiments. To avoid repetition, they will not be described one by one here.

[0063] Those skilled in the art will understand that all or part of the processes in the methods of the above embodiments can be implemented by a computer program instructing related hardware. The computer program can be stored in a non-volatile computer-readable storage medium. When executed, the computer program can include the processes of the embodiments of the above methods. Any references to memory, storage, databases, or other media used in the embodiments provided in this application can include non-volatile and / or volatile memory. Non-volatile memory may include read-only memory (ROM), programmable ROM (PROM), electrically programmable ROM (EPROM), electrically erasable programmable ROM (EEPROM), or flash memory. Volatile memory may include random access memory (RAM) or external cache memory. By way of illustration and not limitation, RAM is available in a variety of forms, such as static RAM (SRAM), dynamic RAM (DRAM), synchronous DRAM (SDRAM), dual data rate SDRAM (DDRSDRAM), enhanced SDRAM (ESDRAM), synchronous link DRAM (SLDRAM), RAMbus direct RAM (RDRAM), direct memory bus dynamic RAM (DRDRAM), and memory bus dynamic RAM (RDRAM), etc.

[0064] Those skilled in the art will clearly understand that, for the sake of convenience and brevity, the above-described division of functional units and modules is used as an example. In practical applications, the above functions can be assigned to different functional units and modules as needed, that is, the internal structure of the device can be divided into different functional units or modules to complete all or part of the functions described above.

[0065] It should be noted that any AI models, software tools, or components not belonging to this company appearing in the embodiments of this application are merely illustrative examples and do not represent actual use. All user personal information involved in the embodiments of this application has been authorized (with the knowledge and consent) by the relevant parties or has been fully authorized by all parties, and the executing entity may obtain it through various legal and compliant means. The collection, storage, use, processing, transmission, provision, and disclosure of the information, data, and signals involved all comply with relevant laws and regulations and do not violate public order and good morals.

[0066] The above embodiments are only used to illustrate the technical solutions of the present invention, and are not intended to limit it. Although the present invention has been described in detail with reference to the foregoing embodiments, those skilled in the art should understand that modifications can still be made to the technical solutions described in the foregoing embodiments, or equivalent substitutions can be made to some of the technical features. Such modifications or substitutions do not cause the essence of the corresponding technical solutions to deviate from the spirit and scope of the technical solutions of the embodiments of the present invention, and should all be included within the protection scope of the present invention.

Claims

1. A medical insurance service collaboration method, characterized by, include: Obtain users' medical treatment fulfillment certificates and medical treatment data through medical hardware terminals; The medical service performance certificate is double-encrypted by the medical hardware terminal and the blockchain nodes in the blockchain network to obtain the performance certificate hash value, and the performance certificate hash value is written into the blockchain. The blockchain nodes include edge computing nodes and insurance nodes. On the edge computing node, a claim suggestion is generated from the medical data using a preset method to obtain the target claim suggestion result; The target claim suggestion result is sent to the insurance node through the edge computing node; The insurance node executes the claims settlement task based on the hash value of the performance certificate in the blockchain and the target claims settlement suggestion result.

2. The method of claim 1, wherein, The medical data includes disease types; On the edge computing node, a claim suggestion is generated from the medical data using a preset method to obtain a target claim suggestion result, including: Based on the disease type in the medical data and the preset scope of claims-compliant diseases, a compliance judgment is made to obtain a compliance judgment result; If the compliance judgment result indicates that the disease type belongs to the category of claims-compliant diseases, the premium adjustment coefficient is calculated based on the medical data. The combination of the compliance assessment result and the premium adjustment coefficient is determined as the target claims recommendation result.

3. The method of claim 2, wherein, After determining compliance based on the disease type in the medical data and the preset scope of compliant claims diseases, and obtaining the compliance determination result, the method further includes: If the compliance judgment result indicates that the user's disease type belongs to the category of compliant diseases for claims, the completeness of the materials is obtained by comparing the medical data with the preset list of claims materials. If the material integrity indicates that the medical data is incomplete, a material integrity prompt is generated based on the material integrity and sent to the user.

4. The method of claim 2, wherein, The step of determining the combination of the compliance assessment result and the premium adjustment coefficient as the target claims recommendation result includes: The combination of the compliance assessment result and the premium adjustment factor is determined as the initial claims recommendation result; The initial claim suggestion result is encrypted to obtain the target claim suggestion result.

5. The method according to any one of claims 1 to 4, characterized in that, The medical hardware terminal has a first private key, and the blockchain node has a second private key; The process of doubly encrypting the medical service performance certificate through the medical hardware terminal and blockchain nodes in the blockchain network to obtain the performance certificate hash value includes: The medical hardware terminal performs a first digital signature on the medical treatment performance certificate based on the first private key to obtain an encrypted certificate signature. The blockchain node performs a second digital signature on the encrypted certificate signature based on the second private key to obtain the hash value of the performance certificate.

6. The method according to any one of claims 1 to 4, characterized in that, The process of executing the claims settlement task through the insurance node based on the hash value of the performance certificate in the blockchain and the target claims settlement suggestion result includes: The authenticity of the performance certificate hash value is verified by the insurance node to obtain the certificate verification result; In response to the verification result indicating that the hash value of the performance certificate is valid, the claims task is executed according to the target claims recommendation result.

7. The method of claim 6, wherein, The medical hardware terminal has a first private key and a first public key corresponding to the first private key; the blockchain node is the insurance node, and the insurance node has a second private key and a second public key corresponding to the second private key; The process of verifying the authenticity of the performance certificate hash value through the insurance node to obtain the certificate verification result includes: Obtain the first public key of the medical hardware terminal, and perform digital signature verification on the target claim suggestion result based on the first public key and the second public key to obtain the claim suggestion verification result; If the verification result of the claim recommendation indicates that the verification is successful, the claim settlement will be carried out based on the compliance judgment result in the target claim recommendation result.

8. The method of claim 6, wherein, The target claims recommendation results include compliance assessment results and premium adjustment coefficients; The response to the document verification result indicating that the performance document hash value is valid, and the execution of the claims task based on the target claims recommendation result, includes: In response to the verification result indicating that the hash value of the performance certificate is valid, claims settlement is carried out based on the compliance judgment result; In response to the verification result indicating that the hash value of the performance certificate is valid, and the target claims recommendation result includes a premium adjustment coefficient, the user's initial premium is adjusted according to the premium adjustment coefficient.

9. A medical insurance service coordination system characterized by, The medical insurance service collaboration system is used to perform the method according to any one of claims 1 to 7, and the medical insurance service collaboration system includes: A medical hardware terminal and at least two blockchain nodes in a blockchain network; the medical hardware terminal is communicatively connected to each of the blockchain nodes; the at least two blockchain nodes include an edge computing node and an insurance node.

10. A computer-readable storage medium storing a computer program, the computer program comprising instructions that, when executed by a computer, cause the computer to perform the method of any one of claims 1 to 9. When the computer program is executed by a processor, it implements the steps of the method as described in any one of claims 1 to 7.

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