A method for comparing medical insurance data of an insured person

Abstract

The application provides a medical insurance data comparison method for an insured person, and relates to the technical field of medical insurance data processing. The medical insurance data comparison method for the insured person comprises the following steps: obtaining personnel information of a target insured person and a current comparison-authorized medical insurance data amount corresponding to a target terminal; determining a data screening level corresponding to the target insured person and a comparison-authorized rule based on the personnel information; determining a data screenable level corresponding to the target terminal based on the medical insurance data amount; determining target to-be-comparison-authorized data corresponding to the personnel information from the target terminal based on the data screening level and the data screenable level, and determining an authorized result based on the comparison-authorized rule, the personnel information and the target to-be-comparison-authorized data. The application can improve the comparison and verification efficiency of medical insurance data of people in an emergency or special group.

Description

Technical Field

[0001] This application relates to the field of medical insurance data processing technology, and in particular to a method, system, electronic device, and medium for comparing medical insurance data of insured persons. Background Technology

[0002] With the continuous improvement of medical insurance policies and the increasing number of insured persons, the corresponding medical insurance data volume is also becoming increasingly large. In the process of medical insurance reimbursement, it is necessary to compare and verify the corresponding medical insurance data from a large number of medical insurance data. This involves comparing and verifying the insured person's identity, medical practice, reimbursement rules, and reimbursement content. The conventional method of comparison and verification is to enter the insured person's basic information and compare it with the stored medical insurance data.

[0003] However, due to the massive amount of medical insurance data, using conventional comparison and verification methods to identify the target medical insurance data from a large amount of data can easily lead to delays in the comparison and verification process. This is especially true for insured individuals in urgent medical situations or those in special groups, where the efficiency of comparing and verifying medical insurance data is too low. Summary of the Invention

[0004] To improve the efficiency of comparing and verifying medical insurance data for people in urgent medical situations or special groups, this application provides a method, system, electronic device, and medium for comparing medical insurance data of insured persons.

[0005] This application provides a method for comparing medical insurance data of insured individuals, employing the following technical solution: A method for comparing medical insurance data of insured persons includes: obtaining the personnel information of the target insured person and the amount of medical insurance data currently being compared and approved for the target terminal; determining the data screening level and comparison and approval rules corresponding to the target insured person based on the personnel information; determining the data screening level corresponding to the target terminal based on the amount of medical insurance data; determining the target data to be compared and approved for the personnel information from the target terminal based on the data screening level and the data screening level; and determining the approval result based on the comparison and approval rules, the personnel information, and the target data to be compared and approved for the target terminal.

[0006] According to some embodiments, the above-mentioned determination of the data screening level and comparison and approval rules corresponding to the target insured person based on personnel information includes: determining the basic information, diagnostic information, medication purchase information and treatment information of the person based on personnel information; determining the pathological type and pathological stage based on diagnostic information, and determining the treatment stage based on treatment information; and determining the data screening level based on pathological type, pathological stage and treatment stage.

[0007] According to some embodiments, the aforementioned personnel information includes basic personnel information, diagnostic information, medication purchase information, and treatment information; the aforementioned determination of the data screening level and comparison approval rules corresponding to the target insured person based on the personnel information includes: screening out necessary basic information from the basic personnel information and screening out necessary diagnostic information from the diagnostic information; establishing matching rules for matching medication purchase information and treatment information, and establishing approval rules for necessary basic information to participate in the comparison and diagnostic information to participate in the comparison; and integrating the matching rules and approval rules to obtain the comparison approval rules.

[0008] According to some embodiments, the above-mentioned determination of the data filterability level corresponding to the target terminal based on the amount of medical insurance data includes: obtaining the total amount of filterable resources corresponding to the target terminal, and determining the remaining amount of filterable resources corresponding to the target terminal based on the amount of medical insurance data and the total amount of filterable resources; determining the data filterability level as the highest data filterability level when the remaining amount of filterable resources is within a first preset resource range; determining the data filterability level as the second highest data filterability level when the remaining amount of filterable resources is within a second preset resource range; and determining the data filterability level as the lowest data filterability level when the remaining amount of filterable resources is within a third preset resource range.

[0009] According to some embodiments, the aforementioned target terminals include multiple target terminals, each storing partial medical insurance data of the target insured individuals. Each target terminal has its corresponding data filtering level. The aforementioned process of determining the target data to be compared and approved corresponding to the personnel information from the target terminals based on the data filtering level and the data filtering capability level includes: determining multiple key pieces of information corresponding to the personnel information, wherein the multiple key pieces of information correspond to multiple target terminals; generating a data filtering postponement instruction when any data filtering level among the data filtering levels corresponding to the multiple target terminals is not less than the data filtering level, and determining the data filtering resource consumption of the key information corresponding to any target terminal at any data filtering level; sending the data filtering postponement instruction and the data filtering resource consumption to any target terminal, controlling any target terminal to stop executing the filtering task corresponding to the data filtering resource consumption; and generating a data filtering instruction upon receiving information indicating that the filtering task has stopped, and sending the data filtering instruction and the key information corresponding to any target terminal to any target terminal, controlling any target terminal to filter out the target data to be compared and approved corresponding to the key information corresponding to any target terminal.

[0010] According to some embodiments, after determining multiple key information corresponding to personnel information, the above-mentioned determination of target data to be compared and approved corresponding to personnel information from target terminals based on data filtering level and data filterability level includes: generating data filtering instructions when the data filterability level corresponding to multiple target terminals is less than the data filtering level, and sending the data filtering instructions and multiple key information to their respective target terminals, controlling the target terminals to filter out the target data to be compared and approved corresponding to the multiple key information.

[0011] According to some embodiments, the aforementioned personnel information corresponds to necessary basic information, necessary diagnostic information, medication purchase information, and treatment information. The aforementioned determination of the approval result based on the comparison and approval rules, personnel information, and target data to be compared and approved includes: comparing the necessary basic information with the target data to be compared and approved, and comparing the necessary diagnostic information with the target data to be compared and approved, based on the approval rules contained in the comparison and approval rules; if the necessary basic information matches the target data to be compared and approved, and the necessary diagnostic information matches the historical diagnostic information contained in the target data to be approved, then matching the medication purchase information with the treatment information based on the matching rules contained in the comparison and approval rules; if the medication purchase information matches the treatment information, then generating an approval result for the matching of the medical insurance data of the target insured person.

[0012] This application provides a medical insurance data comparison system for insured individuals, employing the following technical solution: A medical insurance data comparison system for insured individuals includes: a data acquisition module, a rule determination module, a level determination module, and an approval result determination module. The data acquisition module acquires the personnel information of the target insured individual and the current amount of medical insurance data to be compared and approved corresponding to the target terminal. The rule determination module determines the data filtering level and comparison and approval rules corresponding to the target insured individual based on the personnel information. The level determination module determines the data filtering level corresponding to the target terminal based on the amount of medical insurance data. The approval result determination module determines the target data to be compared and approved corresponding to the personnel information from the target terminal based on the data filtering level and the data filtering level, and determines the approval result based on the comparison and approval rules, the personnel information, and the target data to be compared and approved.

[0013] According to some embodiments, the rule determination module described above is specifically used to: determine basic personnel information, diagnostic information, medication purchase information, and treatment information based on personnel information; determine pathological type and pathological stage based on diagnostic information, and determine treatment stage based on treatment information; and determine data screening level based on pathological type, pathological stage, and treatment stage.

[0014] According to some embodiments, the aforementioned personnel information corresponds to basic personnel information, diagnostic information, medication purchase information, and treatment information; the aforementioned rule determination module is specifically used for: filtering necessary basic information from the basic personnel information and filtering necessary diagnostic information from the diagnostic information; establishing matching rules for matching medication purchase information and treatment information, and establishing approval rules for the comparison of necessary basic information and diagnostic information; and integrating the matching rules and approval rules to obtain the comparison approval rules.

[0015] According to some embodiments, the aforementioned level determination module is specifically used for: obtaining the total screening resource quantity corresponding to the target terminal, and determining the remaining screening resource quantity corresponding to the target terminal based on the medical insurance data quantity and the total screening resource quantity; determining the data screening level as the highest data screening level when the remaining screening resource quantity is within a first preset resource quantity range; determining the data screening level as the second highest data screening level when the remaining screening resource quantity is within a second preset resource quantity range; and determining the data screening level as the lowest data screening level when the remaining screening resource quantity is within a third preset resource quantity range.

[0016] According to some embodiments, the aforementioned target terminal includes multiple target terminals, each storing partial medical insurance data of the target insured person. Each target terminal has its corresponding data filtering level. The aforementioned approval result determination module is specifically used for: determining multiple key pieces of information corresponding to the personnel information, wherein the multiple key pieces of information correspond to multiple target terminals; generating a data filtering postponement instruction when any data filtering level among the data filtering levels corresponding to the multiple target terminals is not less than the data filtering level, and determining the data filtering resource consumption of the key information corresponding to any target terminal at any data filtering level; sending the data filtering postponement instruction and the data filtering resource consumption to any target terminal, controlling the target terminal to stop executing the filtering task corresponding to the data filtering resource consumption; and generating a data filtering instruction when the filtering task is stopped, and sending the data filtering instruction and the key information corresponding to any target terminal to the target terminal, controlling the target terminal to filter out the target data to be compared and approved corresponding to the key information corresponding to the target terminal.

[0017] According to some embodiments, the above-mentioned approval result determination module is specifically used to: generate a data filtering instruction when the data filtering level corresponding to multiple target terminals is less than the data filtering level, and send the data filtering instruction and multiple key information to their respective target terminals, and control the target terminals to filter out the target data to be compared and approved corresponding to the multiple key information.

[0018] According to some embodiments, the aforementioned personnel information corresponds to necessary basic information, necessary diagnostic information, medication purchase information, and treatment information. The aforementioned approval result determination module is specifically used for: comparing the necessary basic information with the target data to be compared and approved based on the approval rules contained in the comparison approval rules; comparing the necessary diagnostic information with the target data to be compared and approved based on the matching rules contained in the comparison approval rules; when the necessary basic information matches the target data to be compared and approved, and the necessary diagnostic information matches the historical diagnostic information contained in the target data to be approved, matching the medication purchase information with the treatment information based on the matching rules contained in the comparison approval rules; and when the medication purchase information matches the treatment information, generating an approval result for the matching of the medical insurance data of the target insured person.

[0019] This application provides an electronic device that adopts the following technical solution: An electronic device comprising: processor; The memory stores a computer program, which, when executed by the processor, causes the processor to perform the aforementioned method for comparing the insured person's medical insurance data.

[0020] This application provides a computer-readable medium, which adopts the following technical solution: A computer-readable medium having a computer program stored thereon, which, when executed by a processor, causes the processor to perform the aforementioned method for comparing the medical insurance data of insured persons.

[0021] According to the embodiments provided in this application, based on the analysis and processing of the personnel information of the target insured persons, the data screening level and comparison and approval rules corresponding to the target insured persons are determined. Then, based on the amount of medical insurance data currently being compared and approved at the target terminal, the data screening level corresponding to the target terminal is determined. Based on the comparison and judgment of the data screening level and the data that can be screened, the target data to be compared and approved corresponding to the personnel information is determined from the target terminal using the comparison and approval results. Then, based on the comparison and approval rules, the personnel information and the target data to be compared and approved are quickly compared to determine the approval result. Thus, by establishing the data screening level and comparison and approval rules corresponding to the target insured persons, targeted data screening and comparison and approval are carried out, thereby improving the efficiency of medical insurance data comparison and verification for medical emergencies or special groups. Attached Figure Description

[0022] Figure 1 This is a block diagram illustrating the method for comparing medical insurance data of insured individuals according to an embodiment of this application; Figure 2 This is a block diagram of the medical insurance data comparison system for insured persons according to an embodiment of this application; Figure 3 This is a schematic diagram of an electronic device according to an embodiment of this application.

[0023] Explanation of reference numerals in the attached figures: 20: Medical insurance data comparison system for insured persons; 201: Data acquisition module; 202: Rule determination module; 203: Grade determination module; 204: Approval result determination module; 30: Electronic equipment; 301: Processor; 302: Bus; 303: Memory; 304: Transceiver. Detailed Implementation

[0024] The following is in conjunction with the appendix Figures 1-3 This application will be described in further detail.

[0025] To make the objectives, technical solutions, and advantages of the embodiments of this application clearer, the technical solutions of the embodiments of this application will be clearly and completely described below with reference to the accompanying drawings. Obviously, the described embodiments are only some embodiments of this application, not all embodiments. Based on the embodiments of this application, all other embodiments obtained by those skilled in the art without creative effort are within the scope of protection of this application.

[0026] This application provides a method for comparing medical insurance data of insured individuals, executed by an electronic device. This electronic device can be a server or a terminal device. The server can be a standalone physical server, a server cluster composed of multiple physical servers, a distributed device, or a cloud server providing cloud computing services. The terminal device can be a smartphone, tablet, laptop, desktop computer, etc., but is not limited to these. The terminal device and the server can be directly or indirectly connected via wired or wireless communication, and this embodiment of the invention does not impose any limitations.

[0027] Reference Figure 1 A method for comparing medical insurance data of insured persons includes steps S101, S102, S103 and S104, wherein, in S101, the personnel information of the target insured person and the amount of medical insurance data currently approved for comparison corresponding to the target terminal are obtained.

[0028] In some embodiments, the personnel information is the personal information of the target insured person and the summary information of the medical treatment information recorded during the medical treatment process; the target terminal is a device terminal that stores the medical insurance data of the insured person; the medical insurance data volume is the amount of medical insurance data of other insured persons participating in the comparison and verification in the target terminal at the current moment.

[0029] The electronic device obtains the personal information of the target insured person from the first operating terminal and the medical information of the target insured person from the second operating terminal, which is operated by the medical staff. The first operating terminal is the device terminal operated by the target insured person and the second operating terminal is the device terminal operated by the medical staff. The electronic device integrates the obtained personal information and medical information to obtain the personnel information of the target insured person.

[0030] In addition, while obtaining the personnel information of the target personnel, the electronic device generates a data acquisition instruction and sends the data acquisition instruction to the target terminal. The target terminal responds to the data acquisition instruction, filters out the medical insurance data of other insured persons currently participating in the comparison and verification in the target terminal, calculates the amount of medical insurance data of other insured persons, and sends the amount of medical insurance data to the electronic device.

[0031] S102, based on personnel information, determine the data screening level and comparison and approval rules corresponding to the target insured persons.

[0032] In some embodiments, the data screening level reflects the urgency of comparing and verifying the medical insurance data of the target insured persons; the comparison and verification rules are the rules for comparing and verifying the medical insurance data of the target insured persons.

[0033] The electronic device analyzes and processes the personal information and medical information contained in the personnel information to determine the basic personnel information, diagnostic information, medication purchase information, and treatment information of the target insured person. Subsequently, the electronic device determines the data screening level of the target insured person based on the diagnostic information and treatment information, and identifies necessary basic information from the basic personnel information and filters necessary diagnostic information from the diagnostic information. Then, the electronic device establishes matching rules for medication purchase information and treatment information, as well as approval rules for necessary basic information and necessary diagnostic information to participate in the comparison, and integrates the matching rules and approval rules to obtain the comparison approval rules.

[0034] S103, based on the amount of medical insurance data, determines the data filtering level corresponding to the target terminal.

[0035] In some embodiments, the data filtering level is a filtering level that reflects the target terminal's ability to compare and verify the medical insurance data of the target insured person when the target terminal is simultaneously comparing and verifying the medical insurance data of other insured persons.

[0036] The electronic device obtains the total screening resources of the target terminal, and determines the remaining screening resources in the target based on the amount of medical insurance data and the total screening resources. Then, the remaining screening resources are used as judgment information. If the remaining screening resources meet a specific range, the data screening level corresponding to the target terminal is determined to be the data screening level corresponding to the specific range.

[0037] S104, based on the data filtering level and the data filterable level, determine the target data to be compared and verified corresponding to the personnel information from the target terminal, and determine the verification result based on the comparison and verification rules, personnel information and target data to be compared and verified.

[0038] In some embodiments, the target data to be compared and verified is the medical insurance data stored in the target terminal corresponding to the target insured person, used for medical insurance data comparison and verification; the verification result is information reflecting whether the medical insurance data of the target insured person is accurate.

[0039] The electronic device uses data filtering level and data screenable level as the basis for judgment. When a preset specific relationship is met between the data filtering level and the data screenable level, the electronic device generates a corresponding data filtering instruction and sends it to the target terminal that stores the medical insurance data of the target insured person. The target terminal responds to the data filtering instruction and sends the target insured person's target data to be compared and verified to the electronic device. Based on the comparison and verification rules, the electronic device compares and analyzes the target comparison and verification data and the personnel information to determine the verification result. Thus, by establishing a data filtering level and comparison and verification rules corresponding to the target insured person, targeted data filtering and comparison verification are carried out, thereby improving the efficiency of medical insurance data comparison and verification for medical emergencies or special groups.

[0040] In some embodiments, the approval result may be an approval result where the medical insurance data of the target insured person does not match, or an approval result where the medical insurance data of the target insured person matches. In addition, if the approval result is an approval result where the medical insurance data of the target insured person does not match, the approval result may also include data on the mismatch between the personnel information and the target data to be compared and approved.

[0041] In some embodiments, after determining the comparison and approval result, the electronic device sends the comparison and approval result to the first operating terminal and the second operating terminal for display, so that the target insured person and the obligated person can obtain the comparison and approval result.

[0042] Step S102: Based on personnel information, determine the data screening level and comparison and approval rules corresponding to the target insured persons, including: based on personnel information, determine the basic information, diagnosis information, medication purchase information and treatment information of the personnel; based on diagnosis information, determine the pathology type and pathology stage, and based on treatment information, determine the treatment stage; based on pathology type, pathology stage and treatment stage, determine the data screening level.

[0043] In some embodiments, the electronic device analyzes the personal information contained in the personnel information to determine the basic personnel information of the target insured person, wherein the basic personnel information includes name, gender, age, and residence information, etc.; at the same time, the electronic device analyzes the medical information contained in the personnel information to determine the diagnosis information, medication purchase information, and treatment information of the target insured person. Subsequently, the electronic device analyzes the diagnosis information to determine the pathological type and pathological stage of the target insured person, and analyzes the treatment information to determine the current disease stage of the target insured person, and determines the corresponding treatment stage based on the current disease stage.

[0044] The pathological type, pathological stage, and treatment stage can subjectively reflect the urgency of the target insured person's illness. Based on these factors, the data screening level for the target insured person can be determined. Specifically, the electronic device compares the pathological type with a preset pathological type-treatment difficulty level database to determine the corresponding pathological type level. A higher pathological type level indicates a higher risk of the target insured person contracting the disease. The electronic device also compares the pathological stage with a preset pathological stage-pathological level data table, and the treatment stage with a preset treatment stage, to determine the corresponding pathological level and treatment level. Finally, the electronic device sums the pathological type level, pathological level, and treatment level to determine the total level, which is then used as the data screening level. A higher pathological level indicates a greater impact of the disease on the target insured person, and a higher treatment level also indicates a greater impact of the disease.

[0045] Step S102: Based on personnel information, determine the data screening level and comparison approval rules corresponding to the target insured persons, including: screening out necessary basic information from personnel basic information and screening out necessary diagnostic information from diagnostic information; establishing matching rules for matching drug purchase information and treatment information, and establishing approval rules for necessary basic information to participate in the comparison and diagnostic information to participate in the comparison; integrating the matching rules and approval rules to obtain the comparison approval rules.

[0046] In some embodiments, the matching rule is a matching rule used to maintain logical consistency between drug purchase information and treatment information in dimensions such as time, disease, and drug dosage; the approval rule is an approval rule used to cross-validate necessary basic information and diagnostic information in dimensions such as compliance of medical insurance reimbursement status, rationality of treatment pathway, and timeliness of expense occurrence.

[0047] The electronic device filters out essential basic information from the basic personnel information to identify the true identity of the target insured person. This essential basic information includes name, gender, and age. Simultaneously, it filters out essential diagnostic information from the diagnostic information to identify the target insured person's condition. This essential diagnostic information consists of key fields, such as disease name and disease details. Subsequently, the electronic device establishes matching rules for medication purchase and treatment information, as well as rules for subsequent medical insurance data comparison and verification of the essential basic information and diagnostic information. Finally, the electronic device integrates these matching and verification rules to obtain the corresponding comparison and verification rules for the target insured person.

[0048] Step S103, based on the amount of medical insurance data, determines the data filterability level corresponding to the target terminal, including: obtaining the total filterability resource amount corresponding to the target terminal, and determining the remaining filterability resource amount corresponding to the target terminal based on the amount of medical insurance data and the total filterability resource amount; if the remaining filterability resource amount is within a first preset resource amount range, determining the data filterability level as the highest data filterability level; if the remaining filterability resource amount is within a second preset resource amount range, determining the data filterability level as the second highest data filterability level; if the remaining filterability resource amount is within a third preset resource amount range, determining the data filterability level as the lowest data filterability level.

[0049] In some embodiments, the total screening resource amount is the maximum amount of medical insurance data that the target terminal can handle for screening within a preset unit time period; the remaining screening resource amount is the amount of medical insurance data that the target terminal has left for screening medical insurance data when screening the medical insurance data of other insured persons.

[0050] The electronic device generates a screening resource quantity acquisition instruction and sends it to the target terminal. The target terminal responds to the screening resource quantity acquisition instruction and sends the total screening resource quantity to the electronic device. At the same time, the electronic device determines the screening resource quantity currently in use by the target terminal based on the medical insurance data. Subsequently, the electronic device subtracts the total screening resource quantity from the screening resource quantity to obtain the remaining screening resource quantity for the target terminal.

[0051] The electronic device retrieves the first, second, and third preset resource ranges, and compares the remaining filtering resources with each of these ranges. If the electronic device determines that the remaining filtering resources are within the first preset resource range, it indicates that the target terminal has sufficient remaining filtering resources. When filtering the medical insurance data of the target insured person, it will not affect the filtering of medical insurance data of other insured persons or the filtering of medical insurance data of newly added insured persons. Therefore, the electronic device can directly filter the medical insurance data of the target insured person. Thus, the electronic device sets the data filtering level to the highest filtering level.

[0052] When the electronic device determines that the remaining screening resources are within the second preset resource range, it indicates that the remaining screening resources of the target terminal are relatively sufficient. When screening the medical insurance data of the target insured persons, it may affect the screening of the medical insurance data of newly added insured persons. At present, the medical insurance data of the target insured persons can be screened directly. Therefore, the electronic device determines the data screening level as the second highest data screening level.

[0053] If the electronic device determines that the remaining screening resources are within the third preset resource range, it indicates that the target terminal currently has insufficient remaining screening resources. When screening the medical insurance data of the target insured persons, it cannot promptly extract the medical insurance data of the target insured persons. Therefore, the electronic device sets the data screening level to the lowest data screening level.

[0054] In some embodiments, the first preset resource quantity range, the second preset resource quantity range, and the third preset resource quantity range can be set by a technician based on the total amount of resources screened for the target terminal, and the specific values ​​of the ranges are not specifically limited in this application embodiment.

[0055] In some embodiments, when the target terminal includes multiple target terminals, each of which stores partial medical insurance data of the target insured person, and each of the multiple target terminals has its corresponding data filterability level, step S104, based on the data filterability level and the data filterability level, determines the target data to be compared and approved corresponding to the personnel information from the target terminals. This includes: determining multiple key information corresponding to the personnel information, wherein the multiple key information corresponds to multiple target terminals; generating a data filtering postponement instruction when any data filterability level among the data filterability levels corresponding to the multiple target terminals is not less than the data filtering level, and determining the data filtering resource consumption of the key information corresponding to any target terminal at any data filterability level; sending the data filtering postponement instruction and the data filtering resource consumption to any target terminal, controlling any target terminal to stop executing the filtering task corresponding to the data filtering resource consumption; and generating a data filtering instruction when the filtering task is stopped, and sending the data filtering instruction and the key information corresponding to any target terminal to any target terminal, controlling any target terminal to filter out the target data to be compared and approved corresponding to the key information corresponding to any target terminal.

[0056] In some embodiments, key information refers to reference information used by the target terminal to filter the medical insurance data of the target insured persons stored in its own database. The key information may be index information, key feature information, etc. The data filtering pause instruction is an instruction used to control the target terminal to stop itself from filtering the medical insurance data of other insured persons. The data filtering resource consumption is the amount of resources consumed by any target terminal when filtering medical insurance data based on its corresponding key information. The filtering task is the task of any target terminal to filter the medical insurance data of other insured persons.

[0057] Depending on the data type, content, and confidentiality level, the medical insurance data of insured individuals will be stored in different target terminals. Therefore, when there are multiple target terminals, it is necessary to identify the target data to be compared and verified corresponding to the personnel information from multiple target terminals. When filtering the target data to be compared and verified corresponding to the personnel information stored in each target terminal, it is necessary to compare the data filterability level and the data screening level corresponding to each target terminal.

[0058] The electronic device first analyzes the personnel information to identify multiple key pieces of information corresponding to the personnel information. At the same time, the electronic device compares the data filtering level and the data filtering level corresponding to multiple target terminals. If the electronic device determines that the data filtering level of any data corresponding to any target terminal is not less than the data filtering level, it indicates that the data filtering resources of any target terminal cannot meet the requirements for filtering the medical insurance data of the target insured person. The electronic device then generates a data filtering postponement instruction and determines the data filtering resource consumption of the key information corresponding to that target terminal.

[0059] Subsequently, the electronic device sends a data filtering pause instruction and the data filtering resource consumption to any target terminal. Based on the data filtering pause instruction, the target terminal determines the data filtering resource consumption corresponding to the multiple filtering tasks it is currently executing. Then, the target terminal compares the data filtering resource consumption of the multiple tasks with the total data filtering resource consumption, determines the target task data filtering resource consumption that is the same as or greater than the total data filtering resource consumption, and takes the filtering task corresponding to the target task data filtering resource consumption as the target filtering task. Based on the data filtering pause instruction, the target terminal stops filtering for the target filtering task.

[0060] After any target terminal stops the target screening task, it generates screening task stop information and sends the screening task stop information to the electronic device. Upon receiving the screening task stop information, the electronic device generates a data screening instruction and sends the data screening instruction and the key information corresponding to any target terminal to that target terminal, thereby controlling any target terminal to screen out the target data to be compared and approved corresponding to its key information.

[0061] In some embodiments, after determining multiple key pieces of information corresponding to personnel information, target data to be compared and approved corresponding to personnel information is determined from target terminals based on data filtering level and data filterability level. This includes: generating a data filtering instruction when the data filterability level corresponding to multiple target terminals is less than the data filtering level, and sending the data filtering instruction and multiple key pieces of information to their respective target terminals, thereby controlling the target terminals to filter out the target data to be compared and approved corresponding to the multiple key pieces of information.

[0062] In some embodiments, if the electronic device determines that the data filtering level corresponding to multiple target terminals is less than the data filtering level, it indicates that all target terminals used to store the medical insurance data of the target insured persons currently meet the requirement of prioritizing the filtering of the medical insurance data of the target insured persons. Therefore, the electronic device sends the generated data filtering instruction to multiple target terminals, and at the same time sends multiple key information to their respective target terminals, thereby controlling the multiple target terminals to filter out their respective target data to be compared and approved.

[0063] In some embodiments, when the personnel information corresponds to necessary basic information, necessary diagnostic information, medication purchase information, and treatment information, step S104, based on the comparison approval rules, personnel information, and target data to be compared and approved, determines the approval result, including: comparing the necessary basic information with the target data to be compared and approved, and comparing the necessary diagnostic information with the target data to be compared and approved, based on the approval rules contained in the comparison approval rules; when the necessary basic information matches the target data to be compared and approved, and the necessary diagnostic information matches the historical diagnostic information contained in the target data to be approved, matching the medication purchase information with the treatment information based on the matching rules contained in the comparison approval rules; when the medication purchase information matches the treatment information, generating an approval result for the matching of the medical insurance data of the target insured person.

[0064] In some embodiments, if the electronic device determines that the necessary basic information matches the target data to be compared and verified, and that the necessary diagnostic information matches the historical diagnostic information contained in the target data to be verified, it indicates that the identity and medical condition of the target insured person are genuine. Subsequently, the electronic device matches the drug purchase information and treatment information, and if it determines that the drug purchase information matches the treatment information, it indicates that the drug reimbursement of the target insured person is genuine. Then, the electronic device generates the verification result of the medical insurance data matching of the target insured person.

[0065] This application provides a medical insurance data comparison system for insured individuals, employing the following technical solution: Reference Figure 2A medical insurance data comparison system 20 for insured individuals includes: a data acquisition module 201, a rule determination module 202, a level determination module 203, and an approval result determination module 204. The data acquisition module 201 acquires the personnel information of the target insured individual and the current amount of medical insurance data to be compared and approved corresponding to the target terminal. The rule determination module 202 determines the data filtering level and comparison and approval rules corresponding to the target insured individual based on the personnel information. The level determination module 203 determines the data filtering level corresponding to the target terminal based on the amount of medical insurance data. The approval result determination module 204 determines the target data to be compared and approved corresponding to the personnel information from the target terminal based on the data filtering level and the data filtering level, and determines the approval result based on the comparison and approval rules, the personnel information, and the target data to be compared and approved.

[0066] In some embodiments, the rule determination module 202 described above is specifically used to: determine basic personnel information, diagnostic information, medication purchase information, and treatment information based on personnel information; determine pathological type and pathological stage based on diagnostic information, and determine treatment stage based on treatment information; and determine data screening level based on pathological type, pathological stage, and treatment stage.

[0067] In some embodiments, the aforementioned personnel information includes basic personnel information, diagnostic information, medication purchase information, and treatment information; the aforementioned rule determination module 202 is specifically used for: filtering necessary basic information from the basic personnel information and filtering necessary diagnostic information from the diagnostic information; establishing matching rules for matching medication purchase information and treatment information, and establishing approval rules for the comparison of necessary basic information and the comparison of diagnostic information; and integrating the matching rules and approval rules to obtain the comparison approval rules.

[0068] In some embodiments, the grade determination module 203 described above is specifically used to: obtain the total screening resource quantity corresponding to the target terminal, and determine the remaining screening resource quantity corresponding to the target terminal based on the medical insurance data quantity and the total screening resource quantity; if the remaining screening resource quantity is within a first preset resource quantity range, determine the data screening level as the highest data screening level; if the remaining screening resource quantity is within a second preset resource quantity range, determine the data screening level as the second highest data screening level; if the remaining screening resource quantity is within a third preset resource quantity range, determine the data screening level as the lowest data screening level.

[0069] In some embodiments, the target terminal includes multiple target terminals, each storing partial medical insurance data of the target insured person. Each target terminal has its corresponding data filtering level. The approval result determination module 204 is specifically used to: determine multiple key information corresponding to the personnel information, wherein the multiple key information corresponds to multiple target terminals; when any data filtering level among the data filtering levels corresponding to the multiple target terminals is not less than the data filtering level, generate a data filtering postponement instruction, and determine the data filtering resource consumption of the key information corresponding to any target terminal at any data filtering level; send the data filtering postponement instruction and the data filtering resource consumption to any target terminal, controlling the target terminal to stop executing the filtering task corresponding to the data filtering resource consumption; when the filtering task stop information is obtained, generate a data filtering instruction, and send the data filtering instruction and the key information corresponding to any target terminal to any target terminal, controlling the target terminal to filter out the target data to be compared and approved corresponding to the key information corresponding to the target terminal.

[0070] In some embodiments, the approval result determination module 204 described above is specifically used to: generate a data filtering instruction when the data filterability level corresponding to multiple target terminals is less than the data filtering level, and send the data filtering instruction and multiple key information to their respective target terminals, thereby controlling the target terminals to filter out the target data to be compared and approved corresponding to the multiple key information.

[0071] In some embodiments, the aforementioned personnel information corresponds to necessary basic information, necessary diagnostic information, medication purchase information, and treatment information. The aforementioned approval result determination module is specifically used for: comparing the necessary basic information with the target data to be compared and approved based on the approval rules contained in the comparison and approval rules; when the necessary basic information matches the target data to be compared and approved, and the necessary diagnostic information matches the historical diagnostic information contained in the target data to be approved, matching the medication purchase information with the treatment information based on the matching rules contained in the comparison and approval rules; and when the medication purchase information matches the treatment information, generating an approval result for the matching of the medical insurance data of the target insured person.

[0072] In some embodiments, the data acquisition module 201 may include logic circuits or be implemented by a central processing unit, digital signal processor, or field-programmable gate array (FPGA) included in an electronic device; the rule determination module 202 may include logic circuits or be implemented by a central processing unit, digital signal processor, or FPGA included in an electronic device; the grade determination module 203 may include logic circuits or be implemented by a central processing unit, digital signal processor, or FPGA included in an electronic device; and the approval result determination module 204 may include logic circuits or be implemented by a central processing unit, digital signal processor, or FPGA included in an electronic device.

[0073] Those skilled in the art will understand that, for the sake of convenience and brevity, the specific working processes of the systems, modules, and units described above can be referred to the corresponding processes in the foregoing method embodiments, and will not be repeated here.

[0074] This application discloses an electronic device, including: a processor; and a memory storing a computer program, which, when executed by the processor, causes the processor to perform the aforementioned method for comparing the medical insurance data of insured persons.

[0075] For example, refer to Figure 3 , Figure 3 The illustrated electronic device 30 includes a processor 301 and a memory 303. The processor 301 and the memory 303 are connected, for example, via a bus 302. Optionally, the electronic device 30 may also include a transceiver 304. It should be noted that in practical applications, the transceiver 304 is not limited to one type, and the structure of this electronic device 30 does not constitute a limitation on the embodiments of the present invention.

[0076] Processor 301 may be a CPU (Central Processing Unit), a general-purpose processor, a DSP (Digital Signal Processor), an ASIC (Application Specific Integrated Circuit), an FPGA (Field Programmable Gate Array), or other programmable logic devices, transistor logic devices, hardware components, or any combination thereof. It can implement or execute the various exemplary logic blocks, modules, and circuits described in this disclosure. Processor 301 may also be a combination that implements computational functions, such as a combination of one or more microprocessors, a combination of a DSP and a microprocessor, etc.

[0077] Bus 302 may include a pathway for transmitting information between the aforementioned components. Bus 302 may be a PCI (Peripheral Component Interconnect) bus or an EISA (Extended Industry Standard Architecture) bus, etc. Bus 302 can be divided into address bus, data bus, control bus, etc. For ease of representation, Figure 3 The bus is represented by a single thick line, but this does not mean that there is only one bus or one type of bus.

[0078] The memory 303 may be a ROM (Read Only Memory) or other type of static storage device capable of storing static information and instructions, RAM (Random Access Memory) or other type of dynamic storage device capable of storing information and instructions, or an EEPROM (Electrically Erasable Programmable Read Only Memory), CD-ROM (Compact Disc Read Only Memory) or other optical disc storage, optical disc storage (including compressed optical discs, laser discs, optical discs, digital universal optical discs, Blu-ray discs, etc.), magnetic disk media or other magnetic storage devices, or any other medium capable of carrying or storing desired program code in the form of instructions or data structures and accessible by a computer, but not limited thereto.

[0079] The memory 303 stores application code that executes the present invention and is controlled by the processor 301. The processor 301 executes the application code stored in the memory 303 to implement the content shown in the foregoing method embodiments.

[0080] Figure 3 The electronic device shown is merely an example and should not be construed as limiting the functionality and scope of use of the embodiments of the present invention.

[0081] This application discloses a computer-readable medium storing a computer program thereon. When the computer program is executed by a processor, the processor performs a method for comparing the medical insurance data of an insured person.

[0082] It should be understood that although the steps in the flowcharts of the accompanying figures are shown sequentially as indicated by the arrows, these steps are not necessarily executed in the order indicated by the arrows. Unless explicitly stated herein, there is no strict order restriction on the execution of these steps, and they can be executed in other orders. Moreover, at least some steps in the flowcharts of the accompanying figures may include multiple sub-steps or multiple stages. These sub-steps or stages are not necessarily completed at the same time, but can be executed at different times, and their execution order is not necessarily sequential, but can be performed alternately or in turn with other steps or at least some of the sub-steps or stages of other steps.

[0083] The above are only some embodiments of this application. It should be noted that for those skilled in the art, several improvements and modifications can be made without departing from the principle of this application, and these improvements and modifications should also be considered within the scope of protection of this application.

Claims

1. A method for comparing medical insurance data of insured individuals, characterized in that, include: Obtain the personnel information of the target insured persons and the amount of medical insurance data currently verified for comparison corresponding to the target terminal; Based on the personnel information, determine the data screening level and comparison and approval rules corresponding to the target insured persons; Based on the amount of medical insurance data, the data filtering level corresponding to the target terminal is determined; Based on the data filtering level and the data filterable level, target data to be compared and approved corresponding to the personnel information is determined from the target terminal, and the approval result is determined based on the comparison and approval rules, the personnel information and the target data to be compared and approved.

2. The method according to claim 1, characterized in that, The step of determining the data screening level and comparison and approval rules corresponding to the target insured person based on the personnel information includes: Based on the personnel information, determine the personnel's basic information, diagnostic information, medication purchase information, and treatment information; Based on the diagnostic information, the pathological type and pathological stage are determined, and based on the treatment information, the treatment stage is determined. The data screening level is determined based on the pathological type, pathological stage, and treatment stage.

3. The method according to claim 1, characterized in that, The personnel information includes basic personnel information, diagnostic information, medication purchase information, and treatment information; The step of determining the data screening level and comparison and approval rules corresponding to the target insured person based on the personnel information includes: Necessary basic information is selected from the basic personnel information, and necessary diagnostic information is selected from the diagnostic information; Establish matching rules for matching the drug purchase information and treatment information, and establish approval rules for the necessary basic information to participate in the comparison and the necessary diagnostic information to participate in the comparison; The matching rule and the approval rule are integrated to obtain the comparison approval rule.

4. The method according to claim 1, characterized in that, The step of determining the data filterability level corresponding to the target terminal based on the amount of medical insurance data includes: Obtain the total amount of screening resources corresponding to the target terminal, and determine the remaining amount of screening resources corresponding to the target terminal based on the amount of medical insurance data and the total amount of screening resources; If the remaining amount of filtering resources is within the first preset resource range, the data filtering level is determined to be the highest data filtering level. If the remaining amount of filtering resources is within the range of the second preset amount of resources, the data filtering level is determined to be the second highest data filtering level. If the remaining amount of filtering resources is within the third preset resource range, the data filtering level is determined to be the lowest data filtering level.

5. The method according to claim 1, characterized in that, The target terminal includes multiple target terminals, each storing a portion of the medical insurance data of the target insured person. Each target terminal has its corresponding data filtering level. The step of determining the target data for comparison and verification corresponding to the personnel information from the target terminal based on the data filtering level and the data filterable level includes: Determine multiple key pieces of information corresponding to the personnel information, wherein the multiple key pieces of information correspond to the multiple target terminals; If any data filterability level among the data filterability levels corresponding to the plurality of target terminals is not less than the data filterability level, a data filter postponement instruction is generated, and the data filter resource consumption of key information corresponding to any target terminal of any data filterability level is determined. The data filtering pause instruction and the data filtering resource consumption are sent to any of the target terminals to control any of the target terminals to stop executing the filtering task corresponding to the data filtering resource consumption; Upon receiving information indicating that the filtering task has stopped, a data filtering instruction is generated, and the data filtering instruction, along with the key information corresponding to any target terminal, is sent to the target terminal to control the target terminal to filter out the target data to be compared and approved that corresponds to the key information corresponding to the target terminal.

6. The method according to claim 5, characterized in that, After determining the multiple key pieces of information corresponding to the personnel information, the step of determining the target data to be compared and verified corresponding to the personnel information from the target terminal based on the data filtering level and the data filterability level includes: When the data filtering level corresponding to multiple target terminals is lower than the data filtering level, a data filtering instruction is generated, and the data filtering instruction and the multiple key information are sent to their respective target terminals to control the target terminals to filter out the target data to be compared and approved corresponding to the multiple key information.

7. The method according to claim 1, characterized in that, The personnel information includes necessary basic information, necessary diagnostic information, medication purchase information, and treatment information. The step of determining the approval result based on the comparison and approval rules, the personnel information, and the target data to be compared and approved includes: Based on the approval rules included in the comparison approval rules, the necessary basic information is compared with the target data to be compared and approved, and the necessary diagnostic information is compared with the target data to be compared and approved; If the necessary basic information matches the target data to be compared and approved, and the necessary diagnostic information matches the historical diagnostic information contained in the target data to be approved, the drug purchase information is matched with the treatment information based on the matching rules contained in the comparison and approval rules. If the drug purchase information matches the treatment information, an approval result for the matching of the target insured person's medical insurance data is generated.

8. A medical insurance data comparison system for insured individuals, characterized in that, include: The data acquisition module is used to acquire the personnel information of the target insured persons and the amount of medical insurance data currently compared and approved for the target terminal; The rule determination module is used to determine the data screening level and comparison and approval rules corresponding to the target insured person based on the personnel information; The grade determination module is used to determine the data filterability grade corresponding to the target terminal based on the amount of medical insurance data. The approval result determination module is used to determine the target data to be compared and approved corresponding to the personnel information from the target terminal based on the data filtering level and the data filterable level, and to determine the approval result based on the comparison and approval rules, the personnel information and the target data to be compared and approved.

9. An electronic device, characterized in that, include: processor; A memory storing a computer program that, when executed by the processor, causes the processor to perform the method as described in any one of claims 1-7.

10. A computer-readable medium having a computer program stored thereon, characterized in that, When the computer program is executed by a processor, the processor performs the method according to any one of claims 1-7.

Images