A claim settlement amount reconciliation verification method and system based on cascading logic

Abstract

The application discloses a kind of based on cascade logic's claim amount check and verify method and system, method includes: obtaining the multiple amount fields of the claim case to be verified and the inherent arithmetic operation relationship between each amount field, according to inherent arithmetic operation relationship formation cascade check directed graph, analysis is carried out to cascade check directed graph, generate the cascade depth coding indicating the conduction topological hierarchy of each node, according to cascade depth coding, the relationship of current node and upstream node is analyzed, obtains the deviation propagation factor indicating the influence degree of upstream node to current node amount;The scheme improves the checking ability from single-point detection to chainwise cause and effect tracking level, not only analyzes the deviation of amount, but also can track the path of conduction, and identify root cause node and deviation type, reduce the difficulty of auditing, guarantee the effect of claim amount check and verify.

Description

Technical Field

[0001] This invention relates to the field of monetary analysis technology, specifically to a method and system for verifying the reconciliation of claims amounts based on cascaded logic. Background Technology

[0002] Currently, when verifying insurance claim amounts, the steps of single amount verification, expense deduction verification, and total amount calculation verification are completed in a fixed order. After each verification step is completed, only the final verification result of normal or abnormal is output. However, the above verification methods still have the following drawbacks: Since most of the anomalies in the claim amount are not due to a single field calculation error, but rather a chain of anomalies caused by the progressive transmission and layering of numerical deviations in the verification process, the existing verification methods lack the ability to trace the cascading logical path and make it difficult to analyze the causal relationship between each verification node. When a deviation in amount occurs, effective verification and tracing cannot be performed, which increases the difficulty of auditing. Summary of the Invention

[0003] To address the shortcomings of existing technologies, this invention provides a method and system for verifying the reconciliation of claim amounts based on cascaded logic, thus solving the aforementioned problems.

[0004] The above-mentioned technical objective of the present invention is achieved through the following technical solution: A method for verifying the reconciliation of claim amounts based on cascading logic, comprising: Step S1: Obtain multiple amount fields of the claim case to be verified and the inherent arithmetic operation relationship between each amount field. Form a cascade verification directed graph based on the inherent arithmetic operation relationship. Analyze the cascade verification directed graph to generate a cascade depth code representing the transmission topology level of each node. Step S2: Based on the cascaded deep coding, analyze the relationship between the current node and the upstream node to obtain the deviation propagation factor, which represents the degree of influence of the upstream node on the amount of the current node. Step S3: Obtain the original claim amount of the claim case to be verified, calculate the verification claim amount according to the cascaded verification directed graph, traverse the cascaded verification directed graph in reverse, and then calculate the cumulative deviation path value and reverse tracing identifier of each upstream node by combining the deviation propagation factor. Step S4: Based on the reverse tracing identifier and the cumulative deviation path value of each node, find the candidate nodes, identify the candidate nodes, obtain the root cause node and deviation type, and generate the reconciliation verification result.

[0005] Furthermore, a cascaded verification directed graph is formed based on inherent arithmetic operations, including: All amount fields in the claims to be verified are used as nodes. For the inherent arithmetic operations between amount fields, they are transformed into directed edges. After merging the directed edges corresponding to all inherent arithmetic operations, a cascaded verification directed graph is formed. The inherent arithmetic operations are addition, subtraction, multiplication, and division.

[0006] Furthermore, the cascaded check directed graph is analyzed to generate a cascaded depth code representing the propagation topology level of each node, including: For each node in the cascaded check directed graph, set the cascade depth code corresponding to all nodes with an in-degree of 0 to 0. Then, perform topological sorting on the cascaded check directed graph and process each node in topological order: for the current node, its cascade depth code is equal to the maximum value of the cascade depth codes of all its direct upstream nodes plus 1, which gives the cascade depth code representing the topological hierarchy of each node.

[0007] Furthermore, in-degree includes: for each node, the number of all its corresponding upstream nodes is the in-degree of that node.

[0008] Furthermore, based on cascaded deep coding, the relationship between the current node and upstream nodes is analyzed to obtain a deviation propagation factor representing the degree of influence of upstream nodes on the amount of the current node, including: For each current node, analyze its inherent operational relationship with its corresponding upstream node to obtain the relationship coefficient. Specifically: if the fixed operational relationship between the current node and its upstream node is addition, the relationship coefficient is 1; if the fixed operational relationship is subtraction, the relationship coefficient of the upstream node corresponding to the minuend is 1, and the relationship coefficient of the upstream node corresponding to the subtrahend is -1; if the fixed operational relationship is multiplication, the relationship coefficient is the fixed multiplier of the multiplication; if the fixed operational relationship is division, the relationship coefficient is the fixed divisor of the division.

[0009] Furthermore, based on cascaded deep coding, the relationship between the current node and upstream nodes is analyzed to obtain a deviation propagation factor representing the degree of influence of upstream nodes on the amount of the current node, which also includes: The concatenated depth coding value of the upstream node is compared with the concatenated depth coding value of the current node, and then the deviation propagation factor is calculated in conjunction with the relationship coefficient to obtain the degree of influence of the upstream node on the amount of the current node. The larger the absolute value of the deviation propagation factor, the greater the influence intensity, indicating that the upstream node is more sensitive to the deviation contribution of the downstream node.

[0010] Furthermore, the verification claim amount is calculated based on the cascaded verification directed graph, and the cascaded verification directed graph is traversed in reverse. Then, the deviation propagation factor is used to calculate the deviation cumulative path value and reverse tracing identifier of each upstream node, including: Based on the topological order of the cascaded verification directed graph and the original claim amount and inherent arithmetic operation relationship of each node, the verification claim amount of each node is calculated: for the inherent arithmetic operation relationship of addition, the verification claim amount of the node is equal to the sum of the original claim amounts of all its upstream nodes. For cases where the inherent arithmetic operation relationship is subtraction, the verified claim amount of this node is equal to the original claim amount upstream of the minuend minus the original claim amount upstream of the subtrahend. For nodes whose inherent arithmetic operations involve multiplication, the verified claim amount for that node is equal to the original claim amount of the upstream node multiplied by a fixed multiplier. For nodes whose inherent arithmetic operation relationship is division, the verification claim amount of this node is equal to the original claim amount of the upstream node divided by a fixed divisor. Calculate the difference between the original claim amount and the verified claim amount for each node to obtain the local deviation value of that node. Starting from the node with the largest concatenated depth encoding, traverse backwards along the directed edge direction to all upstream nodes. For the current node, multiply its local deviation value by the deviation propagation factor between that node and each direct upstream node to obtain the path deviation contribution received by the upstream node from the current node. The cumulative path deviation contribution received by each upstream node from all downstream nodes is summed and then added to the local deviation value of that upstream node to obtain the cumulative path deviation value of that upstream node.

[0011] Furthermore, the verification claim amount is calculated based on the cascaded verification directed graph, and the cascaded verification directed graph is traversed in reverse. Then, the deviation propagation factor is used to calculate the cumulative deviation path value and reverse tracing identifier for each upstream node. This also includes: During the reverse traversal, a reverse tracing identifier is generated for each upstream node. The reverse tracing identifier is encoded as a string and is in the format of current node number - upstream node number - deviation propagation factor. Each node is numbered according to its sequence number in the cascaded check directed graph.

[0012] Furthermore, based on the reverse tracing identifier and the cumulative deviation path value of each node, candidate nodes are identified and recognized to obtain the root cause node and deviation type, generating reconciliation verification results, including: For the current node, if it has multiple upstream nodes, the upstream node with the largest cumulative deviation path value is selected as the candidate node. If multiple upstream nodes have the same cumulative deviation path value, one of them is selected as the candidate node. Candidate nodes are identified to determine root cause nodes and deviation types; The identified root cause nodes are combined with their corresponding deviation types to generate the reconciliation verification results.

[0013] Furthermore, a claims amount reconciliation and verification system based on cascaded logic, applied to the above method, includes: The cascaded analysis unit is used to obtain multiple amount fields of the claim to be verified and the inherent arithmetic operation relationship between each amount field. Based on the inherent arithmetic operation relationship, a cascaded verification directed graph is formed. The cascaded verification directed graph is analyzed to generate a cascaded depth code representing the transmission topology level of each node. The deviation calculation unit is used to analyze the relationship between the current node and the upstream node based on the cascaded depth coding, and obtain the deviation propagation factor representing the degree of influence of the upstream node on the amount of the current node. The amount tracing unit is used to obtain the original claim amount of the claim case to be verified, calculate the verified claim amount according to the cascaded verification directed graph, traverse the cascaded verification directed graph in reverse, and then calculate the cumulative deviation path value and reverse tracing identifier code of each upstream node in combination with the deviation propagation factor. The cross-checking unit is used to find candidate nodes based on the reverse tracing identifier and the cumulative deviation path value of each node, identify the candidate nodes, obtain the root cause node and deviation type, and generate cross-checking results.

[0014] In summary, the present invention has the following main beneficial effects: Step S1 constructs a cascaded verification directed graph and generates cascaded depth coding, transforming the originally implicit monetary dependencies into an explicit cascaded verification directed graph. At the same time, the topological hierarchical coding accurately reflects the hierarchical position of each monetary node in the transmission path. Step S2 assigns corresponding relationship coefficients to the inherent arithmetic operations between each current node and its upstream nodes, and further analyzes them to obtain the deviation propagation factor. The deviation propagation factor not only reflects the amplification or reduction effect brought about by the fixed multiplier or divisor in multiplication or division, but also reflects the dilution effect of the hierarchical distance on error propagation through the reciprocal of the depth difference. Thus, it achieves a differentiated and accurate reflection of the intensity of cross-level influence, avoiding the blindness of treating all upstream nodes equally in traditional methods.

[0015] Step S3 calculates the verification claim amount node by node in the cascaded verification directed graph and inherent operational relationships, and compares it with the original claim amount to obtain the local deviation value. Then, along the reverse traversal path, the local deviation value of each node is calculated with the corresponding deviation propagation factor to obtain the cumulative deviation path value. The cumulative deviation path value integrates its own local deviation and the path deviation contribution of all downstream nodes, which can fully reflect the total error carrying capacity of the node in the entire cascade. At the same time, during the reverse traversal process, a reverse tracing identification code containing the node number, upstream node number and deviation propagation factor is generated for each upstream node, forming a traceability chain of error propagation. Step S4 filters candidate nodes based on the cumulative deviation path value, and determines the root cause node and deviation type by comparing the absolute value of the local deviation of the candidate node with the absolute value of the contribution sum of all downstream nodes, generating the reconciliation verification result. This solution improves the verification capability from single-point detection to the chain cause-effect tracing level. It not only analyzes the deviation of the amount, but also tracks the propagation path and identifies the root cause node and deviation type, reducing the difficulty of auditing and ensuring the effectiveness of the reconciliation verification of the claim amount. Attached Figure Description

[0016] Figure 1 This is a flowchart illustrating the steps of the claim amount reconciliation and verification method based on cascaded logic of the present invention. Figure 2 This is a block diagram of the claims amount reconciliation and verification system based on cascaded logic of the present invention. 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 embodiments of the present invention, and not all embodiments. 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] refer to Figure 1 and Figure 2 A method for verifying the reconciliation of claim amounts based on cascading logic, comprising: Step S1: Obtain multiple amount fields of the claim case to be verified and the inherent arithmetic operation relationship between each amount field. Form a cascade verification directed graph based on the inherent arithmetic operation relationship. Analyze the cascade verification directed graph to generate a cascade depth code representing the transmission topology level of each node. Step S2: Based on the cascaded deep coding, analyze the relationship between the current node and the upstream node to obtain the deviation propagation factor, which represents the degree of influence of the upstream node on the amount of the current node. Step S3: Obtain the original claim amount of the claim case to be verified, calculate the verification claim amount according to the cascaded verification directed graph, traverse the cascaded verification directed graph in reverse, and then calculate the cumulative deviation path value and reverse tracing identifier of each upstream node by combining the deviation propagation factor. Step S4: Based on the reverse tracing identifier and the cumulative deviation path value of each node, find the candidate nodes, identify the candidate nodes, obtain the root cause node and deviation type, and generate the reconciliation verification result.

[0019] In one embodiment, forming a cascaded check directed graph based on inherent arithmetic operations includes: All amount fields in the claims to be verified are used as nodes. The amount fields are medical expenses, surgery fees, drug expenses, etc. For the inherent arithmetic operations between the amount fields, they are transformed into directed edges. Each amount field on the right side of the calculation formula points to the amount field on the left side, that is, from the dependent node to the dependent node. For example, total cost = medical expenses + surgery fees + drug expenses. These are formed into directed edges. After merging the directed edges corresponding to all inherent arithmetic operations, a cascaded verification directed graph is formed. For example, if the inherent arithmetic operation is total cost = medical expenses + surgery fees, then a directed edge is sent from the medical expense node and the surgery fee node to the total cost node. The inherent arithmetic operations are addition, subtraction, multiplication, and division.

[0020] In one embodiment, the cascaded check directed graph is analyzed to generate a cascaded depth code representing the topological hierarchy of each node, including: For each node in the cascaded check directed graph, set the cascade depth code corresponding to all nodes with an in-degree of 0 to 0. Then, perform topological sorting on the cascaded check directed graph and process each node in topological order: For the current node, its cascade depth code is equal to the maximum value of the cascade depth codes of all its direct upstream nodes plus 1. This gives the cascade depth code representing the topological level of each node. For example, if there are 3 nodes, node A has an in-degree of 0, node B's direct upstream is only A, so its depth is 1. Node C's direct upstream is only B, so its depth is 2. Therefore, the cascade depth code of C is 2.

[0021] In one embodiment, the in-degree includes: for each node, the number of all its corresponding upstream nodes is the in-degree of that node.

[0022] By treating all monetary fields in the claims case to be verified as nodes and constructing a cascaded verification directed graph based on inherent arithmetic operations, the dependency relationships of monetary amounts are understood by pointing from the dependent nodes to the dependent nodes. Furthermore, by performing topological sorting on the cascaded verification directed graph, a cascaded depth code representing the transmission topology level is generated for each node. This accurately reflects the hierarchical propagation path and superposition level of monetary deviations along the dependency chain. The verification process no longer processes individual or total monetary amounts in isolation, but possesses the ability to fully trace the cascaded logical path. When monetary deviations occur, the starting node and intermediate influencing nodes of the abnormal transmission can be quickly located based on the cascaded depth code, clearly restoring the causal relationships between each verification node, effectively reducing auditing difficulty and improving the traceability efficiency of claims verification.

[0023] In one embodiment, based on cascaded deep coding, the relationship between the current node and the upstream node is analyzed to obtain a deviation propagation factor representing the degree of influence of the upstream node on the amount of the current node, including: For each current node, analyze its inherent operational relationship with its corresponding upstream node to obtain the relationship coefficient. Specifically: if the fixed operational relationship between the current node and its upstream node is addition, the relationship coefficient is 1; if the fixed operational relationship is subtraction, the relationship coefficient of the upstream node corresponding to the minuend is 1, and the relationship coefficient of the upstream node corresponding to the subtrahend is -1; if the fixed operational relationship is multiplication, the relationship coefficient is the fixed multiplier of the multiplication, for example, reimbursement amount = total cost × reimbursement ratio, where the reimbursement ratio is the fixed multiplier, which is the relationship coefficient; if the fixed operational relationship is division, the relationship coefficient is the fixed divisor of the division, for example, per capita cost = total cost ÷ number of people, where the number of people is the fixed divisor, which is the relationship coefficient.

[0024] In one embodiment, based on cascaded deep coding, the relationship between the current node and the upstream node is analyzed to obtain a deviation propagation factor representing the degree of influence of the upstream node on the amount of the current node, and the method further includes: Dividing the relationship coefficient by the difference between the current node's concatenated deep coding and the upstream node's concatenated deep coding yields the deviation propagation factor, which indicates the degree of influence of the upstream node on the current node's amount. The larger the absolute value of the deviation propagation factor, the stronger the influence, indicating that the upstream node is more sensitive to the deviation contribution of the downstream node. For example, if the upstream node concatenation depth code is 2 and the current node concatenation depth code is 5, the difference is 3 and the relationship coefficient is 1, then the deviation propagation factor is 0.33. If the upstream node concatenation depth code is 0 and the current node concatenation depth code is 1, the difference is 1 and the relationship coefficient is 1, then the deviation propagation factor is 1, achieving complete transmission directly downstream. Among them, the cascaded depth coding reflects the hierarchical position of the amount node in the cascaded transmission path. When the upstream node error is aggregated through multiple layers, it will gradually be diluted due to the increase of the depth difference. The larger the layer spacing, the weaker the impact of the error on the current node. Multiplying the reciprocal of the depth difference with the relationship coefficient can simultaneously reflect the coefficient influence of arithmetic operations and the hierarchical dilution effect, avoiding the blindness of treating errors of different levels equally.

[0025] By analyzing the inherent arithmetic relationships between each current node and its upstream nodes, corresponding relationship coefficients are assigned for addition, subtraction, multiplication, and division. A deviation propagation factor is constructed by combining the difference in cascaded deep coding. This factor, calculated by dividing the relationship coefficient by the depth difference, simultaneously reflects the attenuation effect of arithmetic operations and hierarchical distance on error propagation. This allows the deviation propagation factor to accurately reflect the influence of each upstream node on the amount of the current node. A larger absolute value indicates a more sensitive deviation contribution from that upstream node. Therefore, when an anomaly occurs in the claim amount, this application can not only locate the source of the anomaly but also determine the transmission status of each upstream node based on the magnitude of the deviation propagation factor. It distinguishes between the differentiated effects of direct dependence and multi-level indirect transmission, avoiding the equivalent treatment of cross-level errors and improving the accuracy of verification and tracing.

[0026] In one embodiment, the verification claim amount is calculated based on the cascaded verification directed graph, and the cascaded verification directed graph is traversed in reverse. Then, the deviation cumulative path value and reverse tracing identifier of each upstream node are calculated in combination with the deviation propagation factor, including: Based on the topological order of the cascaded verification directed graph and the original claim amount and inherent arithmetic operation relationship of each node, the verification claim amount of each node is calculated: for the inherent arithmetic operation relationship of addition, the verification claim amount of the node is equal to the sum of the original claim amounts of all its upstream nodes. For cases where the inherent arithmetic operation relationship is subtraction, the verified claim amount of this node is equal to the original claim amount upstream of the minuend minus the original claim amount upstream of the subtrahend. For nodes whose inherent arithmetic operations involve multiplication, the verified claim amount for that node is equal to the original claim amount of the upstream node multiplied by a fixed multiplier. For nodes whose inherent arithmetic operation relationship is division, the verification claim amount of this node is equal to the original claim amount of the upstream node divided by a fixed divisor.

[0027] Calculate the difference between the original claim amount and the verified claim amount for each node to obtain the local deviation value of that node. Starting from the node with the largest concatenated depth encoding, traverse backwards along the directed edge direction to all upstream nodes. For the current node, multiply its local deviation value by the deviation propagation factor between that node and each direct upstream node to obtain the path deviation contribution received by the upstream node from the current node. The path deviation contribution received by each upstream node from all downstream nodes is accumulated, and then added to the local deviation value of the upstream node itself to obtain the cumulative path deviation value of the upstream node. The cumulative path deviation value reflects the total error at the node after topological weighting of all hierarchical errors during the downward propagation from the root node.

[0028] In one embodiment, the verification claim amount is calculated based on the cascaded verification directed graph, and the cascaded verification directed graph is traversed in reverse. Then, the deviation cumulative path value and reverse tracing identifier of each upstream node are calculated using the deviation propagation factor. The method also includes: During the reverse traversal, a reverse tracing identifier is generated for each upstream node. The reverse tracing identifier is encoded as a string and is in the format of current node number - upstream node number - deviation propagation factor. The number of each node is the sequence number of each node in the cascaded verification directed graph; For example, if node 1 is transmitted from node 2 through a deviation propagation factor of 0.3, then the reverse tracing identifier is 1-2-0.3. The reverse tracing identifier uniquely records which downstream nodes trace each upstream node, with what strength and direction of propagation. The deviation propagation factor is a real number representing unidirectional propagation. When the downstream deviation is positive, the path contribution received by the upstream node is also positive, and vice versa.

[0029] In one embodiment, candidate nodes are identified based on the reverse tracing identifier and the cumulative deviation path value of each node. These candidate nodes are then identified to obtain the root cause node and deviation type, generating a reconciliation verification result, including: For the current node, if it has multiple upstream nodes, the upstream node with the largest cumulative deviation path value is selected as the candidate node. If multiple upstream nodes have the same cumulative deviation path value, one of them is selected as the candidate node. Candidate nodes are identified to determine root cause nodes and deviation types. The identification rules are as follows: For all downstream nodes of the candidate node, the deviation propagation factor in the reverse tracing identifier code of the downstream node is multiplied by the local deviation value of the corresponding downstream node, and then the calculation results are accumulated to obtain the contribution sum value. If the absolute value of the local deviation value of the candidate node is greater than or equal to the absolute value of the contribution sum value, then the candidate node is the root cause node. Next, check whether the candidate root cause node has an upstream node, i.e., whether the in-degree is 0. If there is no upstream, the deviation type is input error, indicating that the amount filled in is abnormal. If there is an upstream node, the deviation type is "relationship error," which means that there is an anomaly in the computational relationship between the upstream node and the current node. If the absolute value of the local deviation value of the candidate node is less than the absolute value of the contribution value, then find the downstream node with the largest absolute value of the deviation propagation factor among all downstream nodes, and repeat the above identification process with this downstream node as a new candidate node. The maximum number of identifications according to the identification rules is 3. If the number of identifications exceeds 3, an alarm will be issued and manual intervention will be required. The identified root cause nodes are combined with their corresponding deviation types to generate the reconciliation verification results.

[0030] By calculating the verification claim amount for each node based on the topological order and inherent arithmetic operations of the cascaded verification directed graph, and comparing it with the original claim amount to obtain the local deviation value, the directed graph is traversed backwards starting from the node with the largest cascaded depth encoding. The local deviation value of each node is multiplied by the corresponding deviation propagation factor and accumulated layer by layer to obtain the cumulative deviation path value of each upstream node, thus reflecting the total error at each node after topological weighting of all levels of error. During the reverse traversal process, a reverse tracing identifier code containing the node number, upstream node number, and deviation propagation factor is generated for each upstream node. Candidate nodes are selected based on the cumulative deviation path value. By comparing the absolute value of the local deviation of the candidate node with the absolute value of the contribution and value of all downstream nodes, the root cause node can be determined and the deviation type can be identified, generating the final reconciliation verification result. This application realizes the leap from single-point anomaly detection to chain causal tracing, which can accurately reflect the cumulative contribution of errors at each level and provide a traceable and verifiable transmission evidence chain through the reverse tracing identifier code, reducing the complexity of manual auditing and ensuring the reconciliation verification of the claim amount.

[0031] In one embodiment, a claims amount reconciliation and verification system based on cascaded logic is applied to the above method, including: The cascaded analysis unit is used to obtain multiple amount fields of the claim to be verified and the inherent arithmetic operation relationship between each amount field. Based on the inherent arithmetic operation relationship, a cascaded verification directed graph is formed. The cascaded verification directed graph is analyzed to generate a cascaded depth code representing the transmission topology level of each node. The deviation calculation unit is used to analyze the relationship between the current node and the upstream node based on the cascaded depth coding, and obtain the deviation propagation factor representing the degree of influence of the upstream node on the amount of the current node. The amount tracing unit is used to obtain the original claim amount of the claim case to be verified, calculate the verified claim amount according to the cascaded verification directed graph, traverse the cascaded verification directed graph in reverse, and then calculate the cumulative deviation path value and reverse tracing identifier code of each upstream node in combination with the deviation propagation factor. The cross-checking unit is used to find candidate nodes based on the reverse tracing identifier and the cumulative deviation path value of each node, identify the candidate nodes, obtain the root cause node and deviation type, and generate cross-checking results.

[0032] Although embodiments of the invention have been shown and described, it will be understood by those skilled in the art that various changes, modifications, substitutions and alterations can be made to these embodiments without departing from the principles and spirit of the invention, the scope of which is defined by the appended claims and their equivalents.

Claims

1. A method for verifying the reconciliation of claim amounts based on cascaded logic, characterized in that, include: Step S1: Obtain multiple amount fields of the claim case to be verified and the inherent arithmetic operation relationship between each amount field. Form a cascade verification directed graph based on the inherent arithmetic operation relationship. Analyze the cascade verification directed graph to generate a cascade depth code representing the transmission topology level of each node. Step S2: Based on the cascaded deep coding, analyze the relationship between the current node and the upstream node to obtain the deviation propagation factor, which represents the degree of influence of the upstream node on the amount of the current node. Step S3: Obtain the original claim amount of the claim case to be verified, calculate the verification claim amount according to the cascaded verification directed graph, traverse the cascaded verification directed graph in reverse, and then calculate the cumulative deviation path value and reverse tracing identifier of each upstream node by combining the deviation propagation factor. Step S4: Based on the reverse tracing identifier and the cumulative deviation path value of each node, find the candidate nodes, identify the candidate nodes, obtain the root cause node and deviation type, and generate the reconciliation verification result.

2. The method for verifying the reconciliation of claim amounts based on cascaded logic according to claim 1, characterized in that, A cascaded verification directed graph is formed based on inherent arithmetic operations, including: All amount fields in the claims to be verified are used as nodes. For the inherent arithmetic operations between amount fields, they are transformed into directed edges. After merging the directed edges corresponding to all inherent arithmetic operations, a cascaded verification directed graph is formed. The inherent arithmetic operations are addition, subtraction, multiplication, and division.

3. The method for verifying the reconciliation of claim amounts based on cascaded logic according to claim 2, characterized in that, The cascaded check directed graph is analyzed to generate a cascaded depth code representing the propagation topology level of each node, including: For each node in the cascaded check directed graph, set the cascade depth code corresponding to all nodes with an in-degree of 0 to 0. Then, perform topological sorting on the cascaded check directed graph and process each node in topological order: for the current node, its cascade depth code is equal to the maximum value of the cascade depth codes of all its direct upstream nodes plus 1, which gives the cascade depth code representing the topological hierarchy of each node.

4. The method for verifying the reconciliation of claim amounts based on cascaded logic according to claim 3, characterized in that, In-degree includes: For each node, the number of all its upstream nodes is the in-degree of that node.

5. The claim amount reconciliation verification method based on cascaded logic according to claim 3, characterized in that, Based on cascaded deep coding, the relationship between the current node and upstream nodes is analyzed to obtain a deviation propagation factor representing the degree of influence of upstream nodes on the amount of the current node, including: For each current node, analyze its inherent operational relationship with its corresponding upstream node to obtain the relationship coefficient. Specifically: if the fixed operational relationship between the current node and its upstream node is addition, the relationship coefficient is 1; if the fixed operational relationship is subtraction, the relationship coefficient of the upstream node corresponding to the minuend is 1, and the relationship coefficient of the upstream node corresponding to the subtrahend is -1; if the fixed operational relationship is multiplication, the relationship coefficient is the fixed multiplier of the multiplication; if the fixed operational relationship is division, the relationship coefficient is the fixed divisor of the division.

6. The method for verifying the reconciliation of claim amounts based on cascaded logic according to claim 5, characterized in that, Based on cascaded deep coding, the relationship between the current node and upstream nodes is analyzed to obtain a deviation propagation factor representing the degree of influence of upstream nodes on the amount of the current node. This also includes: The concatenated depth coding value of the upstream node is compared with the concatenated depth coding value of the current node, and then the deviation propagation factor is calculated in conjunction with the relationship coefficient to obtain the degree of influence of the upstream node on the amount of the current node. The larger the absolute value of the deviation propagation factor, the greater the influence intensity, indicating that the upstream node is more sensitive to the deviation contribution of the downstream node.

7. The method for verifying the reconciliation of claim amounts based on cascaded logic according to claim 6, characterized in that, The verification claim amount is calculated based on the cascaded verification directed graph. Then, the cascaded verification directed graph is traversed in reverse order. Finally, the deviation propagation factor is used to calculate the cumulative deviation path value and reverse tracing identifier for each upstream node, including: Based on the topological order of the cascaded verification directed graph and the original claim amount and inherent arithmetic operation relationship of each node, the verification claim amount of each node is calculated: for the inherent arithmetic operation relationship of addition, the verification claim amount of the node is equal to the sum of the original claim amounts of all its upstream nodes. For cases where the inherent arithmetic operation relationship is subtraction, the verified claim amount of this node is equal to the original claim amount upstream of the minuend minus the original claim amount upstream of the subtrahend. For nodes whose inherent arithmetic operations involve multiplication, the verified claim amount for that node is equal to the original claim amount of the upstream node multiplied by a fixed multiplier. For nodes whose inherent arithmetic operation relationship is division, the verification claim amount of this node is equal to the original claim amount of the upstream node divided by a fixed divisor. Calculate the difference between the original claim amount and the verified claim amount for each node to obtain the local deviation value of that node. Starting from the node with the largest concatenated depth encoding, traverse backwards along the directed edge direction to all upstream nodes. For the current node, multiply its local deviation value by the deviation propagation factor between that node and each direct upstream node to obtain the path deviation contribution received by the upstream node from the current node. The cumulative path deviation contribution received by each upstream node from all downstream nodes is summed and then added to the local deviation value of that upstream node to obtain the cumulative path deviation value of that upstream node.

8. The method for verifying the reconciliation of claim amounts based on cascaded logic according to claim 7, characterized in that, The verification claim amount is calculated based on the cascaded verification directed graph. The graph is then traversed in reverse order. The cumulative deviation path value and reverse tracing identifier for each upstream node are calculated using the deviation propagation factor. This also includes: During the reverse traversal, a reverse tracing identifier is generated for each upstream node. The reverse tracing identifier is encoded as a string and is in the format of current node number - upstream node number - deviation propagation factor. Each node is numbered according to its sequence number in the cascaded check directed graph.

9. A method for verifying the reconciliation of claim amounts based on cascaded logic according to claim 8, characterized in that, Based on the reverse tracing identifier and the cumulative deviation path value of each node, candidate nodes are identified and recognized to obtain the root cause node and deviation type, generating reconciliation verification results, including: For the current node, if it has multiple upstream nodes, the upstream node with the largest cumulative deviation path value is selected as the candidate node. If multiple upstream nodes have the same cumulative deviation path value, one of them is selected as the candidate node. Candidate nodes are identified to determine root cause nodes and deviation types; The identified root cause nodes are combined with their corresponding deviation types to generate the reconciliation verification results.

10. A claims amount reconciliation and verification system based on cascaded logic, applied in the method described in any one of claims 1-9, characterized in that, include: The cascaded analysis unit is used to obtain multiple amount fields of the claim to be verified and the inherent arithmetic operation relationship between each amount field. Based on the inherent arithmetic operation relationship, a cascaded verification directed graph is formed. The cascaded verification directed graph is analyzed to generate a cascaded depth code representing the transmission topology level of each node. The deviation calculation unit is used to analyze the relationship between the current node and the upstream node based on the cascaded depth coding, and obtain the deviation propagation factor representing the degree of influence of the upstream node on the amount of the current node; The amount tracing unit is used to obtain the original claim amount of the claim case to be verified, calculate the verified claim amount according to the cascaded verification directed graph, traverse the cascaded verification directed graph in reverse, and then calculate the cumulative deviation path value and reverse tracing identifier code of each upstream node in combination with the deviation propagation factor. The cross-checking unit is used to find candidate nodes based on the reverse tracing identifier and the cumulative deviation path value of each node, identify the candidate nodes, obtain the root cause node and deviation type, and generate cross-checking results.

Images