Payment review information providing system, payment claim acceptance system, payment review information providing method, and computer program

Abstract

To provide an information service system for payment examination capable of easily and quickly making insurance payment claims.SOLUTION: An information service system 20 for payment examination is connected to a recording disclosure system 3 such as information services to provide information on medical practices and medicines described in a receipt issued by medical institutions, and connected to a request processing system 10 accepting insurance payment claims from a terminal 2 used by policyholders. The information service system 20 for payment examination comprises acquisition means 21, generating means 22, and information service means 23 for providing payment examination information to the request processing system 10, where the acquisition means acquires the information on medical practices and medicines from the recording disclosure system 3 such as information services when the providing of payment examination information is requested to be used for the insurance payment examination from the request processing system 10, and the generating means generates the payment examination information including at least any one of hospitalization information and hospitalization days information corresponding to the reason for insurance payment, information on treatment corresponding to the reason for insurance payment, information on medicines corresponding to the reason for insurance payment, and information on diseases corresponding to the reason for insurance payment.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention relates to a payment examination information providing system, a payment claim acceptance system, a payment examination information providing method, and a computer program. [Background technology]

[0002] Conventionally, a medical expense payment system has been known that includes a medical institution terminal for inputting medical data such as the type of treatment, an insurance company terminal, a financial institution terminal, a management center that manages the medical data input from the medical institution terminal, processes insurance payment with the insurance company terminal, and requests transfer to the financial institution terminal, and a communication network that interconnects these (Patent Document 1). In this technology, the management center is configured to generate insurance claim data based on the medical data of the policyholder (patient) and send it to the insurance company terminal. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] Japanese Patent Application Laid-Open No. 2004-126793 Summary of the Invention [Problem to be solved by the invention]

[0004] However, it is practically difficult to build a system at the private sector level that manages medical data, which is personal information of policyholders. Therefore, even at the time of filing this application, when filing a claim for insurance payment, the policyholder must inform the insurance company of, for example, the date of admission, the date of discharge, the name and date of surgery, etc., and prepare and submit documents such as a medical certificate, which results in a problem that the claim itself takes time. Furthermore, even if it is possible to file a claim for insurance payment online, it may be necessary to attach, for example, images of receipts, etc., which can make the procedure cumbersome.

[0005] In recent years, efforts are underway to create a system that will enable individuals to obtain and view their personal information online from the information provision record disclosure system (Mynaportal (registered trademark)), which was established based on the Act on the Use of Numbers to Identify Specific Individuals in Administrative Procedures (Act No. 27 of 2013) (My Number Act). As part of this, efforts are underway to create a system that will enable individuals, or businesses with the individual's consent, to obtain, view, and use information about medicines dispensed based on prescriptions from the information provision record disclosure system. Furthermore, there are plans to enable information about medical procedures, such as surgeries, performed at hospitals to be obtained from the information provision record disclosure system, thereby expanding the scope of personal information that can be viewed and used.

[0006] The present invention has been made in consideration of the above background, and aims to provide a payment review information providing system, a payment claim acceptance system, a payment review information providing method, and a computer program that enable insurance payment claims to be filed easily and quickly. [Means for solving the problem]

[0007] The payment examination information providing system for achieving the above-mentioned object is connected to an information provision etc. record disclosure system that provides information on medical procedures and information on pharmaceuticals that are written on receipts issued by medical institutions, and a claim processing system that accepts claims for insurance payment online from a terminal used by an insurance policyholder, and the payment examination information providing system comprises: an acquisition means that, when requested by the claim processing system to provide payment examination information that is information to be used for insurance payment examination, acquires at least one of information on medical procedures and information on pharmaceuticals from the information provision etc. record disclosure system for one insurance policyholder who has filed a claim for insurance payment; a generation means that generates payment examination information based on the information acquired by the acquisition means; and an information providing means that provides the claim processing system with the payment examination information generated by the generation means, and the generation means derives payment examination information from the medical procedure information acquired by the acquisition means according to the content of the insurance contract, by referring to a hospitalization master that stores a list of information on hospitalizations that are the reason for insurance payment, the processing is characterized by performing at least one of the following processes: a process of extracting information on hospitalization that corresponds to the reason for insurance payment, and generating payment review information including the extracted information on hospitalization and information on the number of days of hospitalization; a process of extracting information on treatment that corresponds to the reason for insurance payment from information on medical procedures acquired by the acquisition means by referring to a treatment master that stores a list of information on treatment that corresponds to the reason for insurance payment, and generating payment review information including the extracted information on treatment; a process of extracting information on medicines that correspond to the reason for insurance payment from information on medicines acquired by the acquisition means by referring to a medicine master that stores a list of information on medicines that correspond to the reason for insurance payment, and generating payment review information including the extracted information on medicines; and a process of acquiring information on the injury or illness that corresponds to the reason for insurance payment from information on medical procedures or medicines acquired by the acquisition means by referring to an injury or illness master that stores information on the injury or illness that corresponds to the reason for insurance payment in association with information on the medical procedures or medicines corresponding to the injury or illness that corresponds to the reason for insurance payment, and generating payment review information including the acquired information on the injury or illness.

[0008] With this system, when claiming insurance payments, the policyholder does not need to look up information on hospitalization, treatment, medicines, injuries, or illnesses, or obtain medical certificates or other documents from medical institutions, making insurance payments simple and quick.

[0009] In addition, when the provision of payment review information is requested by the claim processing system, and the period for which insurance payments are to be made is specified by operation of the one insurance policyholder, the generation means may be configured to generate payment review information corresponding to that period.

[0010] This allows payment review information to be provided only to the extent necessary.

[0011] In addition, when the provision of payment review information is requested by the claim processing system and the period for which insurance payments are to be made is specified by the operation of the one insurance policyholder, the acquisition means may be configured to acquire at least one of information regarding medical treatments and information regarding pharmaceuticals corresponding to that period from the information provision record disclosure system.

[0012] This makes it possible to prevent more information (personal information) than necessary from being obtained from the information provision etc. record disclosure system.

[0013] The injury / illness master may also be configured to include a first injury / illness master that stores a list that associates information on medical treatments or pharmaceuticals with information on injuries or illnesses, and a second injury / illness master that stores a list of information on injuries or illnesses that are grounds for insurance payment, selected from the information on injuries or illnesses stored in the first injury / illness master according to the contents of the insurance contract.

[0014] This allows the first injury / illness master to be commonly used regardless of the contents of the insurance contract.

[0015] In addition, the information on hospitalization included in the payment review information may be at least one of information on the name of the medical procedure corresponding to the hospitalization and information on the code corresponding to the medical procedure, the information on treatment included in the payment review information may be at least one of information on the name of the medical procedure corresponding to the treatment and information on the code corresponding to the medical procedure, the information on pharmaceuticals included in the payment review information may be at least one of information on the name of the pharmaceuticals and information on the code corresponding to the pharmaceutical, and the information on injury or illness included in the payment review information may be at least one of information on the name of the injury or illness and information on the code corresponding to the injury or illness.

[0016] In addition, the generation means may be configured to refer to the injury / illness master, and when it obtains information on an injury or illness that is a reason for insurance payment from the information on medical procedures or medicines obtained by the acquisition means, obtain information on the medical procedures or medicines corresponding to the injury or illness, and include the obtained information on the medical procedures or medicines in the payment review information.

[0017] This makes it possible to provide not only information on injuries and illnesses, but also information on medical treatments and medicines that are the basis for the illnesses.

[0018] In addition, the information on medical procedures included in the payment review information may be at least one of information on the name of the medical procedure and information on a code corresponding to the medical procedure, and the information on pharmaceuticals included in the payment review information may be at least one of information on the name of the pharmaceutical and information on a code corresponding to the pharmaceutical.

[0019] Furthermore, a payment claim acceptance system for achieving the above-mentioned object is a payment claim acceptance system connected to an information provision etc. record disclosure system that provides information on medical treatments and information on pharmaceuticals that are written on receipts issued by medical institutions, and comprises: a claim acceptance means that accepts claims for insurance payment online from a terminal used by an insurance policyholder; an acquisition means that, when the claim acceptance means accepts a claim for insurance payment, acquires at least one of information on medical treatments and information on pharmaceuticals from the information provision etc. record disclosure system for one insurance policyholder who has made a claim for insurance payment; a generation means that generates payment examination information, which is information to be used in examining insurance payment, based on the information acquired by the acquisition means; and a display means that displays the payment examination information generated by the generation means on the terminal, and the generation means, depending on the content of the insurance contract, The system is characterized by performing at least one of the following processes: a process of extracting information on hospitalization that corresponds to the reason for insurance payment from information on medical procedures acquired by the acquisition means, with reference to an admission master that stores a list of information on hospitalization that corresponds to the reason for insurance payment, and generating payment review information including the extracted information on hospitalization and information on the number of days of hospitalization; a process of extracting information on treatment that corresponds to the reason for insurance payment from information on medical procedures acquired by the acquisition means, with reference to a treatment master that stores a list of information on treatment that corresponds to the reason for insurance payment, and generating payment review information including the extracted information on treatment; a process of extracting information on medicines that correspond to the reason for insurance payment from information on medicines acquired by the acquisition means, with reference to a medicine master that stores a list of information on medicines that correspond to the reason for insurance payment, and generating payment review information including the extracted information on medicines; and a process of acquiring information on injury or illness that corresponds to the reason for insurance payment from information on medical procedures or medicines acquired by the acquisition means, with reference to an injury or illness master that stores information on injury or illness that corresponds to the reason for insurance payment in association with information on medical procedures or medicines corresponding to the injury or illness that corresponds to the reason for insurance payment, and generating payment review information including the acquired information on injury or illness.

[0020] With this system, when claiming insurance payments, the policyholder does not need to look up information on hospitalization, treatment, medicines, injuries, or illnesses, or obtain medical certificates or other documents from medical institutions, making insurance payments simple and quick.

[0021] The payment claim acceptance system may further comprise an approval acceptance means for accepting approval from the one insurance policyholder for the payment examination information displayed on the terminal.

[0022] Furthermore, a payment review information providing method for achieving the above-mentioned object is a payment review information providing method by a payment review information providing system connected to an information provision etc. record disclosure system that provides information on medical treatments and information on pharmaceuticals that are written on receipts issued by medical institutions, and a claim processing system that accepts claims for insurance payment online from a terminal used by an insurance policyholder, and the method includes the following steps: an acquisition step of acquiring, when the claim processing system requests the provision of payment review information that is information to be used for reviewing insurance payment, at least one of information on medical treatments and information on pharmaceuticals from the information provision etc. record disclosure system for one insurance policyholder who has filed a claim for insurance payment; a generation step of generating payment review information based on the information acquired in the acquisition step; and an information provision step of providing the payment review information generated in the generation step to the claim processing system, wherein the generation step refers to an admission master that stores a list of information on hospitalizations that are the reason for insurance payment according to the content of the insurance contract, and the information obtained in the acquisition step is provided to the claim processing system. The method is characterized by executing at least one of the following processes: extracting information on hospitalization that corresponds to the reason for insurance payment from the information on medical procedures obtained in the acquisition step, and generating payment review information including the extracted information on hospitalization and information on the number of days of hospitalization; extracting information on treatment that corresponds to the reason for insurance payment from the information on medical procedures obtained in the acquisition step by referring to a treatment master that stores a list of information on treatments that correspond to the reason for insurance payment, and generating payment review information including the extracted information on treatment; extracting information on medicines that correspond to the reason for insurance payment from the information on medicines obtained in the acquisition step by referring to a medicine master that stores a list of information on medicines that correspond to the reason for insurance payment, and generating payment review information including the extracted information on medicines; and referencing an injury / illness master that stores information on the injury / illness that corresponds to the reason for insurance payment in association with information on medical procedures or medicines corresponding to the injury / illness that corresponds to the reason for insurance payment, acquiring information on the injury / illness that corresponds to the reason for insurance payment from the information on medical procedures or medicines obtained in the acquisition step, and generating payment review information including the acquired information on the injury / illness.

[0023] This method eliminates the need for the policyholder to research information on hospitalization, treatment, medication, injuries, and illnesses, or to obtain medical certificates and other documents from medical institutions when filing a claim, making it easier and faster to file a claim.

[0024] Furthermore, a computer program for achieving the above-mentioned object is a computer program that causes a computer connected to an information provision etc. record disclosure system that provides information on medical treatments and information on pharmaceuticals that are written on receipts issued by medical institutions, and a claim processing system that accepts claims for insurance payment online from a terminal used by an insurance policyholder, to function as a payment examination information providing system, and causes the computer to function as: an acquisition means that, when requested by the claim processing system to provide payment examination information that is information to be used for insurance payment examination, acquires at least one of information on medical treatments and information on pharmaceuticals from the information provision etc. record disclosure system for one insurance policyholder who has filed a claim for insurance payment; a generation means that generates payment examination information based on the information acquired by the acquisition means; and an information providing means that provides the claim processing system with the payment examination information generated by the generation means, and the generation means refers to a hospitalization master that stores a list of information on hospitalizations that are grounds for insurance payment according to the content of the insurance contract, and The device is characterized by performing at least one of the following processes: extracting information on hospitalization that corresponds to the reason for insurance payment from the information on medical treatment acquired by the acquisition means, and generating payment review information including the extracted information on hospitalization and information on the number of days of hospitalization; extracting information on treatment that corresponds to the reason for insurance payment from the information on medical treatment acquired by the acquisition means by referring to a treatment master that stores a list of information on treatment that corresponds to the reason for insurance payment, and generating payment review information including the extracted information on treatment; extracting information on medicine that corresponds to the reason for insurance payment from the information on medicine acquired by the acquisition means by referring to a medicine master that stores a list of information on medicines that correspond to the reason for insurance payment, and generating payment review information including the extracted information on medicines; and referencing an injury / illness master that stores information on injury / illness that corresponds to the reason for insurance payment in association with information on medical treatments or medicines corresponding to the injury / illness that corresponds to the reason for insurance payment, acquiring information on injury / illness that corresponds to the reason for insurance payment from the information on medical treatments or medicines acquired by the acquisition means, and generating payment review information including the acquired information on injury / illness.

[0025] With this kind of program, when claiming insurance payments, the policyholder does not need to look up information on hospitalization, treatment, medication, injuries or illnesses, or obtain medical certificates or other documents from medical institutions, making insurance payment claims simple and quick. [Effects of the Invention]

[0026] According to the present invention, insurance claims can be filed easily and quickly. [Brief explanation of the drawings]

[0027] [Figure 1] 1 is a diagram showing a payment claim acceptance system, a terminal used by an insurance policyholder, and an information provision record disclosure system according to an embodiment. [Figure 2] FIG. 10 is a diagram illustrating an example of an admission master. [Figure 3] FIG. 10 is a diagram illustrating an example of a treatment master. [Figure 4] FIG. 10 is a diagram illustrating an example of a medicine master. [Figure 5] FIG. 10 is a diagram illustrating an example of the first illness master data. [Figure 6] FIG. 10 is a diagram illustrating an example of a second illness master. [Figure 7] FIG. 10 is a diagram illustrating an example of a hospitalization information generation process. [Figure 8] FIG. 10 is a diagram illustrating an example of treatment information generation processing. [Figure 9] FIG. 10 is a diagram illustrating an example of a drug information generation process. [Figure 10] FIG. 10 is a diagram illustrating an example of injury / illness information generation processing. [Figure 11] This is a flowchart explaining an example of the operation of the payment claim acceptance system, the terminal used by the insurance policyholder, and the information provision record disclosure system, and shows a case where the insurance policyholder has registered as a user of the information provision record disclosure system. [Figure 12]This is a flowchart explaining an example of the operation of the payment claim acceptance system, the terminal used by the insurance policyholder, and the information provision record disclosure system, and shows a case where the insurance policyholder has not registered as a user of the information provision record disclosure system. [Figure 13] 13 is a flowchart following FIG. 11 or 12 illustrating an example of the operation of the payment claim acceptance system, the terminal used by the insurance policyholder, and the information provision record disclosure system. [Figure 14] 1A shows an example of a login screen displayed on a terminal used by an insurance policyholder, and FIG. 1B shows an example of an insurance claim screen. [Figure 15] FIG. 10A shows an example of a payment period input screen displayed on a terminal used by an insurance policyholder, and FIG. 10B shows an example of a user registration confirmation screen. [Figure 16] 10A shows an example of a consent confirmation screen for obtaining medical information, and FIG. 10B shows an example of a password entry screen, both of which are displayed on a terminal used by an insurance policyholder. [Figure 17] Figure (a) shows an example of a screen displaying the completion of reading of the personal identification number card on the terminal used by the insurance policyholder, and Figure (b) shows an example of a screen displaying the user registration. [Figure 18] FIG. 1(a) shows an example of a user registration consent confirmation screen displayed on the terminal used by the insurance policyholder, and FIG. 1(b) shows an example of a user registration completion notification screen. [Figure 19] FIG. 10A shows an example of a medical information acquisition completion notification screen displayed on a terminal used by an insurance policyholder, and FIG. 10B shows a first example of an information content confirmation screen. [Figure 20] FIG. 10A shows a second example of an information content confirmation screen displayed on a terminal used by an insurance policyholder, and FIG. 10B shows a third example of an information content confirmation screen. [Figure 21] FIG. 10 is a diagram showing an example of an insurance claim acceptance completion screen displayed on the terminal used by the policyholder. DETAILED DESCRIPTION OF THE INVENTION

[0028] Next, an embodiment of the present invention will be described in detail with reference to the accompanying drawings. As shown in Fig. 1, a payment claim acceptance system 1 according to an embodiment is a system for accepting insurance payment claims online. The payment claim acceptance system 1 is connected to a terminal 2 used by an insurance policyholder and an information provision record disclosure system 3 via a network such as the Internet.

[0029] The terminal used by the policyholder (hereinafter also referred to as "policyholder's terminal") 2 is, for example, a smartphone.

[0030] The Information Provision, etc. Record Disclosure System 3 is an information provision, etc. record disclosure system established based on the Act on the Use of Numbers to Identify Specific Individuals in Administrative Procedures (Act No. 27 of 2013), and is also known as My Number Portal. When the Information Provision, etc. Record Disclosure System 3 receives an online request for information from an individual or a business operator with the individual's consent, it requests information from an information provider at an administrative agency or other such institution and obtains information held by the information provider from the information provider. The Information Provision, etc. Record Disclosure System 3 then provides the information obtained from the information provider to the individual or other such entity online.

[0031] The Information Provision and Record Disclosure System (hereinafter referred to as "My Number Portal")3 can provide information on medical procedures and pharmaceuticals listed on prescriptions issued by medical institutions such as hospitals, clinics, and pharmacies. Information on medical procedures and pharmaceuticals is stored in an online eligibility confirmation system managed by the Social Insurance Medical Fee Payment Fund and the National Health Insurance Association (hereinafter referred to as "Payment Fund and National Health Insurance Association"), which is the information provider.

[0032] In more detail, hospitals, clinics, etc. create medical receipts containing information on medical procedures such as surgery, treatment, and hospitalization, as well as information on the medicines used in connection with the medical procedures, and pharmacies create dispensing receipts containing information on the medicines dispensed based on prescriptions. Medical institutions such as hospitals, clinics, and pharmacies then send the created receipts (receipt data) to the online billing system managed by the Payment Fund and the National Health Insurance Association by the specified deadline of the month following the month of treatment or dispensing. The information on medical procedures and medicines contained in the receipt data sent to the online billing system is registered and stored in the online eligibility verification system.

[0033] In addition, hospitals, clinics, etc. issue electronic prescriptions and register them in the electronic prescription management service managed by the electronic prescription management service operator. Pharmacies then obtain the registered electronic prescriptions, dispense medication, and register the dispensed electronic prescriptions in the electronic prescription management service. Information about the medicines included in the dispensed electronic prescriptions is registered and stored in the online eligibility verification system.

[0034] When My Number Portal 3 receives an information acquisition request from the payment claim acceptance system 1, it requests the online qualification confirmation system to provide information, and acquires information on medical procedures and information on pharmaceuticals from the online qualification confirmation system. Then, My Number Portal 3 provides the information on medical procedures and information on pharmaceuticals acquired from the online qualification confirmation system to the payment claim acceptance system 1.

[0035] Information regarding medical procedures (hereinafter referred to as "medical procedure information") includes, for example, the name of the public health insurance subscriber, date of birth, gender classification, year and month of treatment, code of the medical institution that performed the medical procedure, name of the medical institution that performed the medical procedure, date of treatment (date of treatment or date of implementation), date of admission, date of discharge, medical procedure code, name of the medical procedure, number of times, fee schedule classification number, etc.

[0036] When based on medical prescriptions, information related to pharmaceuticals (hereinafter referred to as "pharmaceutical information") includes, for example, the name of the public health insurance subscriber, date of birth, gender classification, year and month of treatment, code of the medical institution where the pharmaceutical was used, name of the medical institution where the pharmaceutical was used, date of treatment (date of treatment or date of administration), pharmaceutical code, name of the pharmaceutical, amount used, number of times used, drug price standard code, etc.

[0037] Furthermore, when the pharmaceutical information is based on a prescription, it may include, for example, the name of the public health insurance subscriber, date of birth, gender classification, month and year of medical treatment, code of the medical institution (pharmacy, etc.) that dispensed the medicine, name of the medical institution that dispensed the medicine, code of the medical institution (hospital, clinic, etc.) that issued the prescription, name of the medical institution that issued the prescription, dispensing date (date of medical treatment, date of dispensing, or date of implementation), date of issuance of the prescription, name of usage, special instructions, pharmaceutical code, name of the pharmaceutical, unit, amount used, single dose, number of times dispensed, pharmaceutical price standard code, etc.

[0038] The payment claim reception system 1 is configured to include a claim processing system 10 and a payment examination information providing system 20. As an example, the claim processing system 10 is a server managed by an insurance company, and the payment examination information providing system 20 is a server managed by a business that provides a service that provides information to insurance companies.

[0039] The claim processing system 10 is a system that accepts claims for insurance payment online from a terminal 2 used by an insurance policyholder. The claim processing system 10 is made up of a computer equipped with a CPU, RAM, ROM, etc. (not shown) and a storage device 19, and is connected to the insurance policyholder's terminal 2 and a payment examination information providing system 20 via a network.

[0040] The billing processing system 10 comprises a billing acceptance means 11, a payment examination information acquisition means 12, an approval acceptance means 13, and a display means 14. The billing processing system 10 realizes each means by loading a computer program stored in a ROM or storage device 19 into RAM and executing it. In other words, the computer program causes a computer connected to the terminal 2 and the payment examination information providing system 20 to function as the billing processing system 10. Specifically, the computer program causes the computer to function as the billing acceptance means 11, the payment examination information acquisition means 12, the approval acceptance means 13, and the display means 14.

[0041] The claim acceptance means 11 accepts claims for insurance payment online from the terminal 2 used by the policyholder. When the claim acceptance means 11 accepts a claim for insurance payment from the terminal 2 of the policyholder, it causes the display means 14 to display on the terminal 2 of the policyholder a screen (see FIG. 15(b)) that prompts the policyholder to confirm whether or not he or she has registered as a user to use My Number Portal 3.

[0042] If the policyholder operates the terminal 2 and selects to register as a user of My Number Portal 3, the claim acceptance means 11 requests My Number Portal 3 via the payment review information providing system 20 to use the linked service.

[0043] If the policyholder operates the terminal 2 and selects that he / she has not registered as a user of My Number Portal 3 (is unregistered), the claim acceptance means 11 causes the display means 14 to display on the terminal 2 of the policyholder a screen (see FIG. 17(b)) notifying the policyholder that he / she will register as a user of My Number Portal 3. Then, if the policyholder operates the terminal 2 and requests user registration of My Number Portal 3, the claim acceptance means 11 requests user registration from My Number Portal 3 via the payment examination information providing system 20.

[0044] In addition, when the insured person operates the terminal 2 (see Figure 15(a)) to specify the period for which insurance payments are to be made (hereinafter also referred to as the "payment period") when making a claim for insurance payments, the claim acceptance means 11 accepts information on the payment period along with the claim for insurance payments.

[0045] The payment examination information acquisition means 12 acquires payment examination information generated by a generation means 22, which will be described later, from the payment examination information providing system 20. The payment examination information is information used by the insurance company to review insurance payment, and includes, for example, information on hospitalization, information on treatment such as surgery and procedures, information on medicines administered or prescribed (dispensed) for treatment, information on injuries and illnesses, etc.

[0046] When the payment review information acquisition means 12 receives information from Mynaportal 3 via the payment review information providing system 20 that identity verification of the policyholder has been completed or information that user registration of the policyholder has been completed, it requests the payment review information providing system 20 to provide payment review information. At this time, if the claim acceptance means 11 has accepted information on the payment target period, the payment review information acquisition means 12 provides the information on the payment target period to the payment review information providing system 20. When payment review information is provided from the payment review information providing system 20, the payment review information acquisition means 12 acquires the provided payment review information.

[0047] The approval receiving means 13 causes the display means 14 to display on the policyholder's terminal 2 a screen (see Figures 19(b), 20(a), and (b)) that allows the policyholder to confirm the payment review information acquired by the payment review information acquisition means 12, and receives approval from a policyholder who has filed a claim for insurance payment for the payment review information displayed on the terminal 2. When the approval receiving means 13 receives approval from the policyholder, it causes the display means 14 to display on the policyholder's terminal 2 a screen (see Figure 21) that notifies the policyholder that acceptance of the insurance payment claim has been completed.

[0048] The display means 14 displays a predetermined screen, such as a screen that allows the policyholder to confirm the payment examination information, on the display DSP of the terminal 2 of the policyholder.

[0049] The payment examination information providing system 20 is a system that provides payment examination information to be used for examining insurance payment to the claim processing system 10. The payment examination information providing system 20 is made up of a computer equipped with a CPU, RAM, ROM, etc. (not shown) and a storage device 29, and is connected to the My Number Portal 3 and the claim processing system 10 via a network.

[0050] The storage device 29 stores an admission master, a treatment master, a medication master, and an injury / illness master.

[0051] As shown in Figure 2, the hospitalization master is configured as a table that stores a list of information on hospitalizations that qualify for insurance payment. The hospitalization master stores information on medical procedures in association with hospitalization flags. In this embodiment, the medical procedures are those listed in the medical medical procedure master established by the Ministry of Health, Labor and Welfare.

[0052] As an example, the information on the medical procedure includes information on the medical procedure code included in the medical procedure master, information on the name of the medical procedure (hereinafter also referred to as "medical procedure name"), and information on the fee schedule classification number. The hospitalization flag is a flag for determining whether the corresponding medical treatment is a hospitalization that is a reason for insurance payment.

[0053] The hospitalization master stores a hospitalization flag of "1" corresponding to a medical procedure that is determined to be a hospitalization that constitutes a reason for insurance payment, such as "acute general hospitalization fee 2 (night shift special hospitalization basic fee)," more specifically, a medical procedure that is determined to be a basic hospitalization fee for calculating the number of days of hospitalization. The hospitalization master also stores a hospitalization flag of "0" corresponding to a medical procedure that is determined not to be a reason for insurance payment, such as "specific time discharge deduction (general ward hospitalization basic fee)," more specifically, a medical procedure that is determined to be a secondary procedure such as an addition or deduction to the basic hospitalization fee. The hospitalization master sets the hospitalization flag according to the contents of the insurance contract, etc.

[0054] As shown in Figure 3, the treatment master is configured as a table that stores a list of information on treatments such as surgeries and procedures that qualify for insurance payment. The treatment master stores information on medical procedures listed in the medical procedure master in association with treatment applicable flags.

[0055] The medical procedure information includes, for example, information on the medical procedure code listed in the medical procedure master, information on the name of the medical procedure, and information on the fee schedule classification number. The treatment applicable flag is a flag for determining whether the corresponding medical procedure is a treatment that is eligible for insurance payment.

[0056] The treatment master stores a treatment applicable flag of "1" corresponding to a medical procedure that is determined to be a treatment that constitutes a reason for insurance payment, such as "spinal fixation, laminectomy, laminoplasty (laminoplasty)." The treatment master also stores a treatment applicable flag of "0" corresponding to a medical procedure that is determined not to be a treatment that constitutes a reason for insurance payment, such as "spinal cord evoked potential measurement surcharge (surgery of the brain, spine, spinal cord, or aortic aneurysm)." The treatment applicable flag is set in the treatment master according to the contents of the insurance contract, etc.

[0057] As shown in Figure 4, the drug master is configured as a table that stores a list of information on drugs that are eligible for insurance payment. In this embodiment, the drugs are those listed in the drug master established by the Ministry of Health, Labor and Welfare. The drug master stores information on drugs listed in the drug master, ATC code information, and therapeutic classification code information in association with each other.

[0058] For example, the information on the pharmaceutical product includes information on the pharmaceutical code listed in the pharmaceutical master, information on the name of the pharmaceutical product (hereinafter also referred to as "pharmaceutical product name"), and information on the drug price standard code. The ATC code is an ATC code of the Anatomical Therapeutic Classification System, and in this embodiment, a level 2 classification (for example, A02) is used as an example. The therapeutic category code is a three-digit therapeutic category code (therapeutic category number) of the Japanese Standard Product Classification (medical category 87 "Pharmaceuticals and related products").

[0059] For example, the drug master stores an ATC code "A02" and a therapeutic category code "232" corresponding to "Gastar D Tablets 20 mg." Also, the drug master stores an ATC code "L01" and a therapeutic category code "429" corresponding to "Opdivo Intravenous Infusion 20 mg."

[0060] 5 and 6, the injury / illness master is a master that stores information on an injury or illness that is a reason for insurance payment and information on medical treatments or medicines that correspond to the injury or illness that is a reason for insurance payment, in association with each other. In this embodiment, the injury / illness master is made up of a first injury / illness master shown in FIG. 5 and a second injury / illness master shown in FIG. 6.

[0061] As shown in FIG. 5, the first injury / illness master is configured as a table that stores a list in which information on medical treatments or medicines is associated with information on injuries or illnesses.

[0062] The medical procedure information includes, for example, medical procedure code information, medical procedure name information, and fee schedule classification number information, all of which are listed in the medical procedure master. The drug information includes, for example, drug code information, drug name information, and drug price standard code information, all of which are listed in the drug master.

[0063] The information on the injury or illness includes, for example, information on the injury or illness name code and the injury or illness name listed in the injury or illness name master established by the Ministry of Health, Labor and Welfare, and information on ICD10, which is the ICD code of the International Classification of Diseases, 10th Revision.

[0064] The first injury / illness master stores, for example, information on the injury / illness associated with the medical procedure "intracranial hematoma removal (performed via craniotomy) (intracerebral)," specifically, the injury / illness code "4369009," the injury / illness name "stroke," and the ICD10 code "I64." The first injury / illness master also stores, for example, information on the injury / illness associated with the pharmaceutical product "Novolin® injection 100 units / mL," specifically, the injury / illness code "2500013," the injury / illness name "diabetes," and the ICD10 code "E14."

[0065] Note that Figure 5 shows an example in which only one piece of injury / illness information is stored corresponding to one medical procedure or one medicine, but there are also cases in which multiple pieces of injury / illness information are stored corresponding to one medical procedure or one medicine.

[0066] Furthermore, in this embodiment, if there is no information on an illness or injury corresponding to a medical procedure, such as a treatment for nutritional supplementation or a medicine, the master storage area does not store information on the illness name code, the illness name, or the ICD10 information. For example, for the medicine "Otsuka Saline Injection 20mL," the corresponding storage area does not store information on the illness name code, the illness name, or the ICD10 information. For convenience, in the drawings, storage areas with no information stored are represented by "-."

[0067] As shown in Fig. 6, the second injury / illness master is configured as a table that stores a list of information on injuries / illnesses that qualify as reasons for insurance payment, selected from the information on injuries / illnesses stored in the first injury / illness master according to the details of the insurance contract. In this embodiment, the second injury / illness master stores information on illnesses that qualify as reasons for insurance payment, in association with information on classification codes for classifying the illnesses that qualify as reasons for insurance payment into predetermined groups.

[0068] The information on the illness includes information on the illness name code, information on the illness name (disease name), and information on the ICD10, similar to the first illness master.

[0069] In this embodiment, as an example, diseases that qualify as reasons for insurance payment are classified into seven groups: classification code "01" is "malignant neoplasms," classification code "02" is "diabetes," classification code "03" is "heart disease," classification code "04" is "hypertensive diseases," classification code "05" is "cerebrovascular diseases," classification code "06" is "urogenital diseases," and classification code "07" is "circulatory system diseases."

[0070] The second injury / illness master stores information on classification codes from "01" to "07" in association with information on illnesses that fall under one or more insurance payment reasons belonging to each classification. An example of an illness that falls under an insurance payment reason belonging to classification code "01" (malignant neoplasm) is "lip cancer." An example of an illness that falls under an insurance payment reason belonging to classification code "02" (diabetes) is "diabetes." An example of an illness that falls under an insurance payment reason belonging to classification code "03" (heart disease) is "angina pectoris."

[0071] An example of a disease that corresponds to a reason for insurance payment belonging to classification code "04" (hypertensive disease) is "hypertension." An example of a disease that corresponds to a reason for insurance payment belonging to classification code "05" (cerebrovascular disease) is "stroke." An example of a disease that corresponds to a reason for insurance payment belonging to classification code "06" (urogenital system disease) is "nephritis." An example of a disease that corresponds to a reason for insurance payment belonging to classification code "07" (circulatory system disease) is "polyarteritis nodosa."

[0072] As shown in FIG. 1, the payment examination information provision system 20 includes an acquisition means 21, a generation means 22, and an information provision means 23. The payment examination information provision system 20 realizes each means by loading a computer program stored in a ROM or storage device 29 into RAM and executing the program. In other words, the computer program causes a computer connected to the My Number Portal 3 and the billing processing system 10 to function as the payment examination information provision system 20. Specifically, the computer program causes the computer to function as the acquisition means 21, the generation means 22, and the information provision means 23.

[0073] When the acquisition means 21 is requested to provide payment review information by the claim processing system 10, it acquires medical treatment information and pharmaceutical information for one policyholder who has filed a claim for insurance payment from My Number Portal 3. In detail, when the claim acceptance means 11 of the claim processing system 10 accepts a claim for insurance payment from the policyholder's terminal 2 and the acquisition means 21 is requested to provide payment review information by the payment review information acquisition means 12, the acquisition means 21 acquires medical treatment information and pharmaceutical information from My Number Portal 3 through API integration.

[0074] The medical procedure information acquired by the acquisition means 21 includes information on the medical procedure code and medical procedure name for each medical procedure. Furthermore, the medical procedure information acquired by the acquisition means 21 includes information on the date of treatment or the date of admission and the date of discharge for each medical procedure. Note that the information on the date of admission and the date of discharge acquired by the acquisition means 21 is not limited to information indicating the date of admission or the date of discharge itself, but may be information from which the date of admission and the length of hospitalization can be calculated, for example, information on the date of treatment on the first day of the medical procedure (hospitalization) and the number of times the medical procedure was performed corresponding to the number of days of hospitalization.

[0075] The pharmaceutical information acquired by the acquisition unit 21 includes information on the pharmaceutical code and pharmaceutical name for each pharmaceutical, as well as the date of medical treatment or the date of dispensing.

[0076] The generating means 22 generates payment examination information based on the information acquired by the acquiring means 21. In detail, the generating means 22 executes at least one of a hospitalization information generating process, a treatment information generating process, a medication information generating process, and an injury / illness information generating process in accordance with the content of the insurance contract of a policyholder who has filed a claim for insurance payment, based on the information acquired by the acquiring means 21, to generate payment examination information.

[0077] The hospitalization information generation process refers to the hospitalization master as shown in Figure 2, extracts information on hospitalizations that are grounds for insurance payment from the medical procedure information acquired by the acquisition means 21, and generates payment examination information that includes the extracted hospitalization information and information on the number of days of hospitalization. The hospitalization information that the generation means 22 includes in the payment examination information is information on the name of the medical procedure corresponding to the hospitalization and information on the code corresponding to the medical procedure. Here, in this embodiment, the code corresponding to the medical procedure is the medical procedure code and the fee schedule classification number.

[0078] As an example, as shown in Fig. 7(a), it is assumed that the acquisition means 21 acquires, as medical procedure information, information such as the name of the medical institution, date of treatment, number of times, medical procedure code, and name of medical procedure for each medical procedure from the My Number Portal 3. Here, if the medical procedure is hospitalization, the date of treatment corresponds to the date of the first day of hospitalization (date of hospitalization), and the number of times corresponds to the number of days of hospitalization.

[0079] In the hospitalization information generation process, the generation means 22 refers to the hospitalization master (Fig. 2), and first adds a fee schedule classification number and a hospitalization flag corresponding to the medical procedure code or medical procedure name for each medical procedure, as shown in Fig. 7(b). Next, the generation means 22 extracts hospitalization information ("acute general hospitalization fee 2 (night shift special hospitalization basic fee)") as shown in Fig. 7(c) by excluding records other than those with a hospitalization flag of "1" (records with a hospitalization flag of "0"), which indicate hospitalization that corresponds to the reason for insurance payment, from the multiple records shown in Fig. 7(b).

[0080] Then, as shown in Figure 7(d), the generating means 22 acquires information on the number of days of hospitalization and information on hospitalization, specifically, information on the medical procedure code, medical procedure name, and fee schedule classification number, as information to be included in the payment examination information. Note that the information on the number of days of hospitalization may also include information on the date of admission and the date of discharge, calculated from information on the date of medical treatment and the number of times.

[0081] The treatment information generation process refers to the treatment master as shown in Figure 3, extracts information on treatments that are subject to insurance payment reasons from the medical procedure information acquired by the acquisition means 21, and generates payment examination information that includes the extracted treatment information. The treatment information that the generation means 22 includes in the payment examination information is information on the name of the medical procedure that corresponds to the treatment and information on the code that corresponds to the medical procedure.

[0082] As an example, as shown in Figure 8(a), assume that the acquisition means 21 acquires information such as the name of the medical institution, the date of treatment, the medical treatment code, and the name of the medical treatment for each medical treatment from the My Number Portal 3 as medical treatment information.

[0083] In the treatment information generation process, the generation means 22 refers to the treatment master (Fig. 3), and first adds a fee schedule classification number and a treatment applicable flag corresponding to the medical procedure code or medical procedure name for each medical procedure, as shown in Fig. 8(b). Next, the generation means 22 extracts treatment information ("spinal fixation, laminectomy, laminoplasty (laminoplasty)") as shown in Fig. 8(c) by excluding records other than those with a treatment applicable flag of "1" (records with a treatment applicable flag of "0"), which indicate treatments that qualify for insurance payment, from the multiple records shown in Fig. 8(b).

[0084] Then, as shown in Figure 8(d), the generation means 22 acquires information to be included in the payment review information, such as the date of medical treatment and information on the treatment, specifically, the medical treatment code, medical treatment name, and fee schedule classification number.

[0085] The drug information generation process refers to the drug master as shown in Figure 4, extracts information on drugs that correspond to the reason for insurance payment from the drug information acquired by the acquisition means 21, and generates payment examination information that includes the extracted drug information. The drug information that the generation means 22 includes in the payment examination information is information on the name of the drug and information on the code corresponding to the drug. The codes corresponding to the drug here are the drug code, drug price standard code, ATC code, and therapeutic classification code.

[0086] As an example, as shown in Figure 9(a), the acquisition means 21 acquires information such as the name of the medical institution, the date of treatment or dispensing, the drug code, and the drug name for each drug from the My Number Portal 3 as pharmaceutical information.

[0087] In the drug information generation process, the generation means 22 refers to the drug master (Figure 4) and first adds, for each drug, a drug price standard code, ATC code, and therapeutic classification code corresponding to the drug code or drug name, as shown in Figure 9(b).

[0088] Next, the generating means 22 excludes, from the plurality of records shown in FIG. 9(b), records other than the records of the pharmaceuticals corresponding to the reason for insurance payment. Pharmaceuticals corresponding to the reason for insurance payment are set according to the contents of the insurance contract, etc. As an example, in this embodiment, the generating means 22 determines that pharmaceuticals having an ATC code of any of "L01," "L02," "L03," and "L04" are pharmaceuticals corresponding to the reason for insurance payment. The generating means 22 excludes, from the plurality of records shown in FIG. 9(b), records other than the records having an ATC code of "L01," "L02," "L03," or "L04" that indicate pharmaceuticals corresponding to the reason for insurance payment (in FIG. 9(b), records having an ATC code of "A03" or "N02"), thereby extracting pharmaceutical information ("Opdivo Intravenous Infusion 20 mg") as shown in FIG. 9(c).

[0089] Then, as shown in Figure 9(d), the generation means 22 acquires information on the date of medical treatment or dispensing date, and information on the pharmaceutical product, specifically, the pharmaceutical product code, pharmaceutical product name, drug price standard code, ATC code, and therapeutic classification code, as information to be included in the payment review information.

[0090] The injury / illness information generation process refers to the injury / illness master data as shown in Figures 5 and 6, acquires information on the injury / illness that corresponds to the reason for insurance payment from the medical treatment or pharmaceutical information acquired by the acquisition means 21, and generates payment examination information including the acquired injury / illness information. The injury / illness information that the generation means 22 includes in the payment examination information is information on the name of the injury / illness and information on the code corresponding to the injury / illness. Here, in this embodiment, the code corresponding to the injury / illness is the injury / illness name code and ICD10.

[0091] In addition, when the generation means 22 acquires information on an injury or illness that is a reason for insurance payment from the information on medical treatment or medicine acquired by the acquisition means 21 by referring to the injury or illness master, the generation means 22 acquires information on the medical treatment or medicine corresponding to the injury or illness, and includes the acquired information on the medical treatment or medicine in the payment review information.

[0092] The medical procedure information that the generating means 22 includes in the payment examination information is information on the name of the medical procedure and information on the code corresponding to the medical procedure, specifically, information on the medical procedure code and the fee schedule classification number. Also, the pharmaceutical information that the generating means 22 includes in the payment examination information is information on the name of the pharmaceutical and information on the code corresponding to the pharmaceutical. The codes corresponding to the pharmaceutical here are the pharmaceutical code and the drug price standard code.

[0093] As an example, as shown in Figure 10(a), the acquisition means 21 acquires information such as the name of the medical institution, date of treatment, medical procedure code, and name of the medical procedure for each medical procedure from My Number Portal 3 as medical procedure information, and also acquires information such as the name of the medical institution, date of treatment or dispensing date, drug code, and drug name for each drug as pharmaceutical information.

[0094] In the injury / illness information generation process, the generation means 22 refers to the first injury / illness master (Figure 5) and first, as shown in Figure 10(b), adds, for each medical procedure, the point table classification number, injury / illness name code, injury / illness name, and ICD10 corresponding to the medical procedure code or medical procedure name, and adds, for each pharmaceutical product, the drug price standard code, injury / illness name code, injury / illness name, and ICD10 corresponding to the pharmaceutical product code or pharmaceutical product name.

[0095] Next, the generating means 22 extracts information on medical procedures or medicines for which information on the injury or illness could be obtained, as shown in Figure 10(c), by excluding records for which the injury or illness name code, injury or illness name, and ICD10 could not be obtained from the multiple records shown in Figure 10(b). Next, the generating means 22 refers to the second injury or illness master (Figure 6) for the extracted medical procedures or medicines, and adds a classification code and classification, as shown in Figure 10(d).

[0096] Next, the generation means 22 excludes records from the multiple records shown in Figure 10(d) for which the classification code and classification could not be obtained, thereby obtaining information on the injury / illness (disease) that is the reason for insurance payment ("diabetes") and information on the medical treatment or pharmaceutical corresponding to the injury / illness (disease) ("Novolin R Injection 100 units / mL"), as shown in Figure 10(e).

[0097] Then, as shown in Figure 10(f), the generation means 22 acquires information to be included in the payment review information, such as the date of medical treatment or the date of dispensing, information on the medical treatment or drug (information on the medical treatment code, medical treatment name, and fee schedule classification number, or information on the drug code, drug name, and drug price standard code), and information on the injury or illness (information on the injury or illness name code, injury or illness name, ICD10, classification code, and classification).

[0098] When the generating means 22 executes two or more processes among the hospitalization information generation process, the treatment information generation process, the drug information generation process, and the injury / illness information generation process, the generating means 22 generates payment examination information including each piece of information extracted or acquired during each process. For example, the generating means 22 generates payment examination information including hospitalization information extracted during the hospitalization information generation process and treatment information extracted during the treatment information generation process. Also, for example, the generating means 22 generates payment examination information including drug information extracted during the drug information generation process and injury / illness information acquired during the injury / illness information generation process.

[0099] Furthermore, in this embodiment, when the provision of payment examination information is requested by the claim processing system 10, if a payment period for which insurance payments are to be made is specified by an operation of a policyholder making a claim for insurance payments, the generation means 22 generates payment examination information corresponding to the payment period. For example, if the payment period of "September to October 2021" is specified, the generation means 22 generates payment examination information including information on hospitalization, treatment, medicines, injuries and illnesses, etc. from September 1, 2021 to October 31, 2021.

[0100] The payment examination information providing system 20 may be configured such that the acquisition means 21 acquires, for one policyholder, medical procedure information and drug information for the entire period that the Mynaportal 3 can provide, and the generation means 22 generates payment examination information corresponding to the payment period (e.g., payment examination information for September to October 2021) based on the information for the entire period acquired by the acquisition means 21. The payment examination information providing system 20 may also be configured such that the acquisition means 21 acquires, for one policyholder, medical procedure information and drug information corresponding to the payment period (e.g., medical procedure information and drug information for September to October 2021) from the Mynaportal 3, and the generation means 22 generates payment examination information based on the information for the payment period acquired by the acquisition means 21.

[0101] In addition, the claim processing system 10 (payment claim acceptance system 1) may be configured so that, when the policyholder specifies the payment period, the policyholder can choose whether the information obtained from My Number Portal 3 is information for the entire period that My Number Portal 3 can provide, or information for the payment period.

[0102] The information providing means 23 provides the payment examination information generated by the generation means 22 to the claim processing system 10. In detail, the information providing means 23 provides the payment examination information to the payment examination information acquisition means 12 of the claim processing system 10 via a network.

[0103] Next, a payment claim acceptance method by the payment claim acceptance system 1 will be described, more specifically, a claim processing method by the claim processing system 10 and a payment examination information provision method by the payment examination information provision system 20. Specifically, an example of the operation of the payment claim acceptance system 1 (claim processing system 10 and payment examination information provision system 20), the terminal 2 used by the policyholder, and My Number Portal 3 will be described with reference to the flowcharts shown in Figures 11 to 13 and the screens displayed on the terminal 2 shown in Figures 14 to 21.

[0104] The terminal 2, in response to an operation by the policyholder who wishes to claim insurance, launches the insurance company's application software (app) or accesses the insurance company's website, and displays a login screen on the display DSP as shown in Fig. 14(a). When the policyholder presses the login button B1 and enters an ID, password, etc., the terminal 2 logs in to the payment claim acceptance system 1, or more specifically, the claim processing system 10, as shown in Fig. 11 (S101).

[0105] Next, the terminal 2 displays on the display DSP, in response to an operation by the policyholder, an insurance claim screen (see FIG. 14(b)) for claiming insurance payment for the insurance. When the policyholder presses the insurance claim button B2, the terminal 2 displays on the display DSP a payment period input screen (see FIG. 15(a)) for specifying the payment period. In the example screen shown in FIG. 15(a), the payment period is specified in months, but it may also be configured so that it can be specified in days, for example.

[0106] When specifying the payment period, the policyholder inputs the payment period and presses the "Next" button B21. This causes the terminal 2 to transmit information on the insurance payment claim and information on the payment period to the claim processing system 10 (S102). On the other hand, when not specifying the payment period, the policyholder presses the "Next" button B21 without inputting the payment period. This causes the terminal 2 to transmit information on the insurance payment claim to the claim processing system 10 (S102).

[0107] The claim processing system 10 accepts a claim for insurance payment from the terminal 2 (claim acceptance step) (S103). Next, the claim processing system 10 displays a user registration confirmation screen (see FIG. 15(b)) on the display DSP of the terminal 2 to confirm whether the policyholder has registered as a user of My Number Portal 3 (S104).

[0108] If the policyholder has registered as a user of My Number Portal 3, the policyholder can select the Registered button B3, which causes the terminal 2 to send information to the claim processing system 10 indicating that the policyholder has been registered (S105).

[0109] The billing processing system 10 transmits a request for use of the linked service to the MynaPortal 3 to the payment examination information providing system 20 (S106). The payment examination information providing system 20 transmits the request for use of the linked service to the MynaPortal 3 (S107).

[0110] My Number Portal 3 transmits a consent request for use of the linked service to Terminal 2 (S108). Terminal 2 displays a consent confirmation screen for obtaining medical information (see FIG. 16(a)) on the display DSP. When the policyholder presses the consent button B5, Terminal 2 transmits consent information to My Number Portal 3 (S109).

[0111] The My Number Portal 3 transmits a request for identity verification of the policyholder to the terminal 2 (S110). The terminal 2 displays a password entry screen (see FIG. 16(b)) on the display DSP to prompt the policyholder to enter the password for the electronic certificate for user authentication of the personal identification number card (hereinafter referred to as "My Number Card").

[0112] The policyholder enters his / her password and presses the "Next" button B6, then performs the reading operation of the My Number card MNC as shown in Figure 17(a). Once the reading is complete, the terminal 2 sends the information necessary for identity verification to the My Number Portal 3 (S111).

[0113] The Mynaportal 3 performs identity verification (S112), and when identity verification is complete, transmits a notification of identity verification completion to the payment examination information providing system 20 (S113). The payment examination information providing system 20 transmits a notification of identity verification completion to the claim processing system 10 (S114).

[0114] On the other hand, as shown in Figure 12, if the policyholder has not registered as a user of My Number Portal 3 and selects the Unregistered button B4 on the user registration confirmation screen (see Figure 15(b)) (S120), the claim processing system 10 will display on the display DSP of the terminal 2 a user registration implementation screen (see Figure 17(b)) notifying the user that user registration will be carried out (S121).

[0115] When the policyholder presses the user registration button B7, the terminal 2 sends a user registration request to the claim processing system 10 (S122). The claim processing system 10 sends a user registration request for My Number Portal 3 to the payment examination information providing system 20 (S123). The payment examination information providing system 20 sends the user registration request to My Number Portal 3 (S124).

[0116] My Number Portal 3 transmits a request for consent to user registration to Terminal 2 (S125). Terminal 2 displays a consent confirmation screen for user registration (see FIG. 18(a)) on the display DSP. When the policyholder presses the consent button B8, Terminal 2 transmits consent information to My Number Portal 3 (S126).

[0117] My Number Portal 3 sends a request to send information required for user registration to Terminal 2 (S127). Terminal 2 displays a password entry screen (see FIG. 16(b)) on the display DSP. The policyholder enters the password and presses the "Next" button B6, and then performs a reading operation on the My Number Card MNC. Once reading is complete, Terminal 2 sends the information required for user registration to My Number Portal 3 (S128).

[0118] My Number Portal 3 executes user registration (S129), and when user registration is complete, displays a user registration completion notification screen (see FIG. 18(b)) on the display DSP of terminal 2 notifying that user registration has been completed (S130). When the policyholder presses the "Next" button B9, My Number Portal 3 sends a consent request for use of the linked service to terminal 2 (S131). Terminal 2 displays a consent confirmation screen (see FIG. 16(a)) on the display DSP. When the policyholder presses the consent button B5, terminal 2 sends consent information to My Number Portal 3 (S132).

[0119] The MynaPortal 3 transmits a notification of completion of user registration to the payment examination information providing system 20 (S133). The payment examination information providing system 20 transmits a notification of completion of user registration of the MynaPortal 3 to the claim processing system 10 (S134).

[0120] When the payment review information providing system 20 sends a notification that user registration on My Number Portal 3 has been completed (Figure 12, S134) or a notification that identity verification has been completed (Figure 11, S114), the billing processing system 10 requests the payment review information providing system 20 to provide payment review information (S140), as shown in Figure 13.

[0121] The payment examination information providing system 20 requests My Number Portal 3 to acquire medical information including medical treatment information and pharmaceutical information (S141). My Number Portal 3 acquires the medical information from the online eligibility confirmation system (S142) and provides the acquired medical information to the payment examination information providing system 20 (S143). The payment examination information providing system 20 acquires the medical information (acquisition step) (S144). In addition, My Number Portal 3 displays a medical information acquisition completion notification screen (see Figure 19(a)) on the display DSP of the terminal 2 to notify that acquisition of the medical information has been completed (S145).

[0122] The payment examination information providing system 20, which has acquired the medical information, generates payment examination information based on the information acquired in the acquisition step (generation step) (S151 to S152). In the generation step, at least one of hospitalization information generation processing, treatment information generation processing, drug information generation processing, and injury / illness information generation processing is executed according to the contents of the insurance contract signed by the policyholder, to generate payment examination information.

[0123] As mentioned above, the hospitalization information generation process refers to the hospitalization master (Figure 2), extracts information on hospitalizations that are grounds for insurance payment from the information on medical procedures acquired in the acquisition step, and generates payment review information that includes the extracted information on hospitalizations (information on the name of medical procedures, etc.) and information on the number of days of hospitalization.

[0124] In addition, the treatment information generation process refers to the treatment master (Figure 3), extracts information on treatments (surgery, procedures, etc.) that are grounds for insurance payment from the information on medical procedures acquired in the acquisition step, and generates payment review information that includes the extracted information on treatments (information such as the name of the medical procedure, fee schedule classification number, etc.).

[0125] In addition, the drug information generation process refers to the drug master (Figure 4), extracts information on drugs that are subject to the reason for insurance payment from the drug information acquired in the acquisition step, and generates payment review information that includes the extracted drug information (ATC code, therapeutic classification code, etc.).

[0126] In addition, the injury / illness information generation process refers to the first injury / illness master (Figure 5) and the second injury / illness master (Figure 6), acquires information on the injury / illness that corresponds to the reason for insurance payment from the information on medical treatment or medicine acquired in the acquisition step, and generates payment review information that includes the acquired information on the injury / illness (information such as the name of the injury / illness, ICD10, etc.).

[0127] In detail, in the generation step, first, depending on the content of the insurance contract, information on hospitalization, treatment, and medication is extracted based on the information acquired in the acquisition step, information on the injury or illness is acquired, and information on medical procedures and medications corresponding to the injury or illness is acquired (S151).

[0128] Thereafter, the payment examination information providing system 20 generates payment examination information including the extracted information and the acquired information (S152). If the policyholder has specified a payment period, the payment examination information providing system 20 generates payment examination information including information on hospitalization, treatment, medicines, injuries, illnesses, etc. during the payment period.

[0129] Then, the payment examination information providing system 20 provides the payment examination information generated in the generating step to the claim processing system 10 (information providing step) (S181).

[0130] The claim processing system 10 acquires the payment examination information (payment examination information acquisition step) (S182). After acquiring the payment examination information, the claim processing system 10 displays an information content confirmation screen on the display DSP of the terminal 2, which allows the policyholder to confirm the contents of the payment examination information (display step) (S183).

[0131] For example, if an insured person underwent treatment (surgery) that qualifies for insurance payment on October 1, 2021, such as "spinal fixation, laminectomy, laminoplasty (laminoplasty)," and was hospitalized for 12 days from September 30 to October 11, 2021, which qualifies for insurance payment, the claim processing system 10 will display an information content confirmation screen such as that shown in Figure 19(b) on the display DSP of terminal 2.

[0132] In addition, if the policyholder received the drug "Opdivo Intravenous Infusion 20mg" that is subject to the insurance payment reason on October 1, 2021, the claim processing system 10 will display an information content confirmation screen as shown in Figure 20(a) on the display DSP of terminal 2.

[0133] In addition, if the policyholder received prescriptions for the drug "Novolin R Injection 100 units / mL" for the illness (disease) "diabetes" that is the reason for insurance payment on October 1, 2021, the claim processing system 10 will display an information content confirmation screen such as that shown in Figure 20(b) on the display DSP of terminal 2.

[0134] In the examples shown in Figure 19(b) and Figures 20(a) and (b), the display DSP of terminal 2 displays the names of medical procedures and pharmaceuticals stored in the treatment master, pharmaceutical master, etc., but these names are based on the names listed in the medical procedure master and pharmaceutical master. Therefore, it may be difficult for the policyholder to understand at a glance what kind of medical procedures or pharmaceuticals they are.

[0135] Therefore, the payment claim reception system 1 may be configured to display on the display DSP of the terminal 2 names that are commonly used (common names) that are easy to understand even for those without medical knowledge, such as "spinal fixation, laminectomy, laminoplasty (laminoplasty)" in Figure 19(b) as "spinal surgery," "Opdivo IV infusion 20 mg" in Figure 20(a) as "anticancer drug," and "Novolin R injection 100 units / mL" in Figure 20(b) as "insulin preparation." In addition, the payment claim reception system 1 may be configured to display "spinal surgery" alongside "spinal fixation, laminectomy, laminoplasty (laminoplasty)" in Figure 19(b), to display "anticancer drug" alongside "Opdivo intravenous infusion 20 mg" in Figure 20(a), and to display "insulin preparation" alongside "Novolin R injection 100 units / mL" in Figure 20(b).

[0136] Such a configuration can be realized, for example, by including common names in the payment examination information. Specifically, the payment examination information providing system 20 has a common name master that stores information on medical procedures, etc., stored in a master in association with common names, and references this common name master to obtain common names and provide the payment examination information including the common names to the claim processing system 10. The common name master may be a treatment master or the like that stores information on common names in association with information on medical procedures, etc. In other words, the treatment master or the like may be configured as a common name master.

[0137] Furthermore, for example, the claim processing system 10 can have a conversion master that stores information on medical procedures, etc. included in the payment review information in association with information on common names, and by referring to this conversion master, convert the information on medical procedures, etc. obtained from the payment review information providing system 20 into common names and display the common names on terminal 2, or obtain common names from the information on medical procedures, etc. and display the obtained common names on terminal 2 together. The same applies to the names of injuries and illnesses.

[0138] When the policyholder checks the contents of the payment examination information by looking at the information content confirmation screen such as that shown in Figure 19(b) or Figures 20(a) and (b) and presses the OK button B10, the terminal 2 transmits payment examination information approval information to the claim processing system 10 (S184). The claim processing system 10 accepts the policyholder's approval of the payment examination information (approval acceptance step) (S185). Then, the claim processing system 10 displays an acceptance completion screen, such as that shown in Figure 21, on the display DSP of the terminal 2, notifying that acceptance of the insurance payment claim has been completed (S186).

[0139] After the acceptance of the insurance claim is completed, the insurance company conducts an insurance payment examination based on the payment examination information acquired by the claim processing system 10, and the insurance company notifies the policyholder of the examination results. The claim processing system 10 may be configured, for example, to include an examination means and a notification means (not shown), in which the examination means conducts an insurance payment examination based on the payment examination information provided by the payment examination information providing system 20, and the notification means notifies the policyholder of the examination results. The claim processing system 10 may also be configured, for example, to include an examination result receiving means and a notification means (not shown), in which the examination result receiving means receives input of the results of the payment examination conducted by the insurance company's examiner, and the notification means notifies the policyholder of the examination results.

[0140] According to the above-described embodiment, when claiming insurance payment, the policyholder does not need to look up information on hospitalization, treatment, medicines, injuries, or illnesses, or obtain documents such as medical certificates from medical institutions, which makes it possible to claim insurance payment easily and quickly.

[0141] Furthermore, if the policyholder specifies a payment period, payment examination information corresponding to the payment period is generated, so that payment examination information can be provided only to the required extent.

[0142] Furthermore, when generating payment review information corresponding to the payment period, if medical information corresponding to the payment period is obtained from My Number Portal 3, it is possible to prevent more medical information (personal information) than necessary from being obtained from My Number Portal 3.

[0143] Furthermore, since the injury / illness master consists of a first injury / illness master and a second injury / illness master, the first injury / illness master, which associates information on medical treatment or pharmaceuticals with information on injuries and illnesses, can be used in common regardless of the content of the insurance contract.

[0144] In addition, when information on an injury or illness that is grounds for insurance payment is obtained, information on the medical treatment or medication corresponding to that injury or illness is included in the payment review information, so that not only information on the injury or illness but also information on the medical treatment or medication that is the basis for that injury or illness can be provided.

[0145] Although the embodiment has been described above, the present invention can be practiced by appropriately modifying it as exemplified below.

[0146] In the above embodiment, when the injury / illness information obtained with reference to the first injury / illness master is also listed in the second injury / illness master, the injury / illness information is included in the payment examination information as information on the injury / illness that corresponds to the reason for insurance payment. However, for example, even if the injury / illness information obtained with reference to the first injury / illness master is not listed in the second injury / illness master, the injury / illness information obtained with reference to the first injury / illness master may be included in the payment examination information. Specifically, for example, the payment examination information may include information on treatment obtained with reference to the treatment master and information on the injury / illness corresponding to the treatment obtained with reference to the first injury / illness master. Furthermore, for example, the payment examination information may include information on pharmaceuticals obtained with reference to the pharmaceutical master and information on the injury / illness corresponding to the pharmaceutical obtained with reference to the first injury / illness master.

[0147] In the above embodiment, when information on an injury or illness that constitutes a reason for insurance payment is obtained, information on medical procedures and pharmaceuticals corresponding to the injury or illness is obtained, and the obtained information on medical procedures and pharmaceuticals is included in the payment review information. However, for example, the payment review information may not include information on medical procedures and pharmaceuticals corresponding to the injury or illness.

[0148] In the above embodiment, a medicine whose ATC code is a predetermined ATC code (any of "L01" to "L04") is determined to be a medicine that falls under the reason for insurance payment, but, for example, a medicine whose therapeutic category code is a predetermined therapeutic category code instead of an ATC code may be determined to be a medicine that falls under the reason for insurance payment. Also, a medicine whose ATC code is a predetermined ATC code and whose therapeutic category code is a predetermined therapeutic category code may be determined to be a medicine that falls under the reason for insurance payment.

[0149] In the above embodiment, the drug master is configured to store drug information in association with ATC code and therapeutic classification code information, but it may also be configured to store drug information in association with a flag (drug applicable flag) in the same way as the hospitalization master and treatment master of the above embodiment. The drug applicable flag is a flag for determining whether the corresponding drug is a drug that is subject to insurance payment, and can be set to, for example, "0" (not subject to insurance payment) or "1" (subject to insurance payment) depending on the content of the insurance contract, etc.

[0150] In the above embodiment, the second injury / illness master is configured as a table storing a list of information on illnesses that qualify for insurance payment reasons, but for example, the second injury / illness master may be configured as a table storing a list of information on injuries that qualify for insurance payment reasons.Furthermore, the second injury / illness master may be configured as a table storing both information on illnesses that qualify for insurance payment reasons and information on injuries that qualify for insurance payment reasons.

[0151] In the above embodiment, the injury / illness master data is composed of a first injury / illness master data and a second injury / illness master data, but for example, the injury / illness master data may be composed of the first injury / illness master data and the second injury / illness master data of the above embodiment combined into one data.

[0152] In the above embodiment, the payment examination information includes information on the date of medical treatment and the date of dispensing, but it may also be information on the year and month without including the day information, for example.

[0153] In the above embodiment, the medical procedure code and the fee schedule category number are exemplified as the code corresponding to the medical procedure, but for example, either the medical procedure code or the fee schedule category number may be used. Also, in the above embodiment, the information on the medical procedure such as hospitalization or treatment included in the payment examination information is both the information on the name of the medical procedure and the information on the code corresponding to the medical procedure, but for example, at least one of these may be used.

[0154] In the above embodiment, the drug code, NHI drug price standard code, ATC code, and therapeutic category code were exemplified as codes corresponding to drugs, but for example, any one of the drug code, NHI drug price standard code, ATC code, and therapeutic category code may be used. Furthermore, the code corresponding to a drug may be a YJ code (individual drug code). Furthermore, in the above embodiment, the information on a drug included in the payment examination information was both information on the name of the drug and information on the code corresponding to the drug, but for example, at least one of these may be used.

[0155] In the above embodiment, the injury / illness name code and ICD10 are exemplified as codes corresponding to the injury / illness, but for example, either the injury / illness name code or ICD10 may be used. Also, in the above embodiment, the injury / illness information included in the payment examination information is both information on the name of the injury / illness and information on the code corresponding to the injury / illness, but for example, at least one of these may be used.

[0156] If the payment examination information contains only code information and not name information, the billing processing system may have a master that stores the code information and name information in correspondence with each other, and the master may be referenced to convert the code to a name. The name here may be a name listed in the medical treatment procedure master or pharmaceutical master, or may be a general name that is easy to understand for those without medical knowledge.

[0157] In the above embodiment, the acquisition means 21 is configured to acquire both medical treatment information and pharmaceutical information from My Number Portal 3, but depending on the contents of the insurance contract, for example, the acquisition means may be configured to acquire only medical treatment information or only pharmaceutical information. The same applies to the acquisition step of the payment examination information provision method.

[0158] In the above embodiment, the acquisition means 21 is configured to acquire medical treatment information, etc. directly from My Number Portal 3, but for example, the acquisition means may be configured to acquire medical treatment information, etc. from My Number Portal via the claim processing system. In other words, the claim processing system may be configured to acquire medical treatment information, etc. from My Number Portal, and when requesting the payment review information providing system to provide payment review information, provide the medical treatment information, etc. acquired from My Number Portal to the payment review information providing system.

[0159] In the above embodiment, the payment claim acceptance system 1 is equipped with an approval acceptance means 13 and is configured to notify the policyholder that acceptance of the insurance payment claim has been completed after receiving approval from the policyholder for the payment review information displayed on the terminal 2. However, for example, the payment claim acceptance system may not be equipped with an approval acceptance means and may be configured to notify the policyholder that acceptance of the insurance payment claim has been completed in addition to displaying the payment review information on the policyholder's terminal.

[0160] In the above embodiment, the payment claim acceptance system 1 is configured to include a computer constituting the claim processing system 10 and a computer constituting the payment examination information providing system 20. However, for example, the payment claim acceptance system may be configured to include a computer having the functions of both the claim processing system and the payment examination information providing system. In this case, the payment claim acceptance system may be configured to include, for example, a claim acceptance means, an acquisition means, a generation means, and a display means. Furthermore, the payment claim acceptance method may be, for example, a method having a claim acceptance step, an acquisition step, a generation step, and a display step. Furthermore, the computer program may be a computer program that causes a computer connected to My Number Portal to function as a payment claim acceptance system, and may be configured to cause the computer to function, for example, as a claim acceptance means, an acquisition means, a generation means, and a display means.

[0161] In the above embodiment, a smartphone is exemplified as the terminal 2 used by the policyholder, but it may also be, for example, a tablet terminal, a personal computer, or the like.

[0162] In the above embodiment, a medical procedure listed in the medical procedure master is exemplified as a medical procedure, but in the present invention, the medical procedure may be, for example, a medical procedure listed in the dental medical procedure master defined by the Ministry of Health, Labor and Welfare, or a dispensing procedure listed in the pharmacy dispensing procedure master defined by the Ministry of Health, Labor and Welfare. Also, in the present invention, the medical procedure may include at least two of a medical procedure listed in the medical medical procedure master, a medical procedure listed in the dental medical procedure master, and a dispensing procedure listed in the pharmacy dispensing procedure master.

[0163] In the above embodiment, the pharmaceuticals are exemplified as pharmaceuticals listed in the pharmaceutical master, but in the present invention, the pharmaceuticals may be, for example, specific equipment listed in the specific equipment master established by the Ministry of Health, Labor and Welfare. In addition, in the present invention, the pharmaceuticals may include both pharmaceuticals listed in the pharmaceutical master and specific equipment listed in the specific equipment master.

[0164] Furthermore, the elements described in the above-described embodiment and modified examples may be implemented in any combination. [Explanation of symbols]

[0165] 1. Payment claim acceptance system 2. Terminal 3. Information Provision and Record Disclosure System (My Number Portal) 10. Billing Processing System 11. Claim acceptance method 13 Approval acceptance method 14 Display means 20 Payment Review Information System 21 Acquisition method 22 Generation means 23 Means of providing information

Claims

1. A payment review information providing system connected to an information provision record disclosure system that provides information on medical treatments and pharmaceuticals listed on receipts issued by medical institutions, a claim processing system that accepts insurance payment claims online from terminals used by insurance policyholders, and an acquisition means for acquiring, when the claim processing system requests the provision of payment review information, which is information to be used in reviewing insurance payment, from the information provision record disclosure system, at least one of information on medical treatments described on receipts issued by medical institutions and information on pharmaceuticals described on receipts issued by medical institutions, for one insurance policyholder who has filed a claim for insurance payment; A generating means for generating payment examination information based on the information acquired by the acquiring means; an information providing means for providing the payment examination information generated by the generating means to the claim processing system, The generating means, depending on the content of the insurance contract, a hospitalization information generation process that refers to a hospitalization master that stores a list of information on hospitalizations that qualify for insurance payment, extracts information on hospitalizations that qualify for insurance payment from the information on medical procedures acquired by the acquisition means, and generates payment examination information that includes the extracted information on hospitalizations and information on the number of days of hospitalization; a treatment information generation process that refers to a treatment master that stores a list of information on treatments that qualify for insurance payment, extracts information on treatments that qualify for insurance payment from the medical procedure information acquired by the acquisition means, and generates payment examination information that includes the extracted information on treatments; a drug information generation process that refers to a drug master that stores a list of information on drugs that are subject to insurance payment reasons, extracts information on drugs that are subject to insurance payment reasons from the drug information acquired by the acquisition means, and generates payment examination information that includes the extracted drug information; and, an injury / illness information generation process that refers to an injury / illness master that stores information on the injury / illness that is the reason for insurance payment and information on the medical treatment or medicine corresponding to the injury / illness that is the reason for insurance payment, acquires information on the injury / illness that is the reason for insurance payment from the information on the medical treatment or medicine acquired by the acquisition means, and generates payment examination information including the acquired information on the injury / illness; Execute at least one of In the hospitalization information generation process, the hospitalization master is referenced, and a process is executed to add a hospitalization flag indicating whether or not there is information on hospitalization that corresponds to the reason for insurance payment for each medical procedure, and medical procedures for which the added hospitalization flag is a value other than a predetermined value are excluded, thereby extracting information on hospitalization that corresponds to the reason for insurance payment, In the treatment information generation process, the treatment master is referenced, and a process is executed to add a treatment flag indicating whether or not information on treatment corresponding to the reason for insurance payment is present for each medical procedure, and by excluding medical procedures for which the added treatment flag is a value other than a predetermined value, information on treatment corresponding to the reason for insurance payment is extracted; In the drug information generation process, by referring to the drug master, a process is executed to add, for each drug, drug information that is not included in the drug information acquired by the acquisition means, and by excluding drugs whose added drug information is other than a predetermined value, information on drugs that correspond to the reason for insurance payment is extracted, The injury / illness information generation process refers to the injury / illness master, executes a process to add injury / illness information for each medical procedure or medicine, and obtains information on injuries / illnesses that are grounds for insurance payment by excluding medical procedures or medicines to which the specified injury / illness information has not been added.

2. The payment review information providing system described in claim 1, characterized in that when the claim processing system requests the provision of payment review information, and a period for which insurance payments are to be made is specified by the operation of the one insurance policyholder, the generation means generates payment review information corresponding to that period.

3. A payment review information provision system as described in claim 1 or claim 2, characterized in that when the claim processing system requests the provision of payment review information and the period for which insurance payment is to be made is specified by the operation of the one insurance policyholder, the acquisition means acquires at least one of information regarding medical treatment corresponding to the period and information regarding pharmaceuticals from the information provision record disclosure system.

4. The injury / illness master data includes: a first injury / illness master that stores a list in which information on medical treatments or medicines is associated with information on injuries and illnesses; a second injury / illness master that stores a list of injury / illness information that corresponds to a reason for insurance payment, selected from the injury / illness information stored in the first injury / illness master according to the content of the insurance contract; 4. The payment examination information providing system according to claim 1, wherein:

5. The hospitalization information to be included in the payment examination information is at least one of information on the name of the medical procedure corresponding to the hospitalization and information on the code corresponding to the medical procedure, The information on the treatment to be included in the payment examination information is at least one of information on the name of the medical procedure corresponding to the treatment and information on the code corresponding to the medical procedure, The information on pharmaceuticals to be included in the payment review information is at least one of information on the name of the pharmaceutical and information on the code corresponding to the pharmaceutical, The injury / illness information to be included in the payment review information is at least one of information on the name of the injury / illness and information on a code corresponding to the injury / illness.

5. The payment examination information providing system according to claim 1, wherein:

6. The payment review information providing system described in any one of claims 1 to 5, characterized in that the generation means, by referring to the injury or illness master, acquires information on the medical treatment or medicine corresponding to the injury or illness that is grounds for insurance payment from the information on the medical treatment or medicine acquired by the acquisition means, acquires information on the medical treatment or medicine corresponding to the injury or illness, and includes the acquired information on the medical treatment or medicine in the payment review information.

7. The information on the medical procedure to be included in the payment examination information is at least one of information on the name of the medical procedure and information on the code corresponding to the medical procedure, The information on pharmaceuticals to be included in the payment review information is at least one of the information on the name of the pharmaceutical and the information on the code corresponding to the pharmaceutical.

7. The payment examination information providing system according to claim 6.

8. A payment review information providing system as described in any one of claims 1 to 7, characterized in that it provides payment review information that includes common names by referring to a common name master that stores information on medical procedures, medicines, or illnesses that are grounds for insurance payment and information on common names, which are the commonly used names of medical procedures, medicines, or illnesses.

9. A payment claim acceptance system connected to an information provision record disclosure system that provides information on medical treatments and pharmaceuticals described in receipts issued by medical institutions, a claim acceptance means for accepting claims for insurance payment online from a terminal used by the policyholder; an acquisition means for acquiring, when the claim acceptance means accepts a claim for insurance payment, at least one of information on medical treatments described on receipts issued by medical institutions and information on medicines described on receipts issued by medical institutions from the information provision etc. record disclosure system for one insurance policyholder who has made a claim for insurance payment; a generating means for generating payment examination information, which is information to be used for examining insurance payment, based on the information acquired by the acquiring means; a display means for displaying the payment examination information generated by the generation means on the terminal; The generating means, depending on the content of the insurance contract, a hospitalization information generation process that refers to a hospitalization master that stores a list of information on hospitalizations that qualify for insurance payment, extracts information on hospitalizations that qualify for insurance payment from the information on medical procedures acquired by the acquisition means, and generates payment examination information that includes the extracted information on hospitalizations and information on the number of days of hospitalization; a treatment information generation process that refers to a treatment master that stores a list of information on treatments that qualify for insurance payment, extracts information on treatments that qualify for insurance payment from the medical procedure information acquired by the acquisition means, and generates payment examination information that includes the extracted information on treatments; a drug information generation process that refers to a drug master that stores a list of information on drugs that are subject to insurance payment reasons, extracts information on drugs that are subject to insurance payment reasons from the drug information acquired by the acquisition means, and generates payment examination information that includes the extracted drug information; and, an injury / illness information generation process that refers to an injury / illness master that stores information on the injury / illness that is the reason for insurance payment and information on the medical treatment or medicine corresponding to the injury / illness that is the reason for insurance payment, acquires information on the injury / illness that is the reason for insurance payment from the information on the medical treatment or medicine acquired by the acquisition means, and generates payment examination information including the acquired information on the injury / illness; Execute at least one of In the hospitalization information generation process, the hospitalization master is referenced, and a process is executed to add a hospitalization flag indicating whether or not there is information on hospitalization that corresponds to the reason for insurance payment for each medical procedure, and medical procedures for which the added hospitalization flag is a value other than a predetermined value are excluded, thereby extracting information on hospitalization that corresponds to the reason for insurance payment, In the treatment information generation process, the treatment master is referenced, and a process is executed to add a treatment flag indicating whether or not information on treatment corresponding to the reason for insurance payment is present for each medical procedure, and by excluding medical procedures for which the added treatment flag is a value other than a predetermined value, information on treatment corresponding to the reason for insurance payment is extracted; In the drug information generation process, by referring to the drug master, a process is executed to add, for each drug, drug information that is not included in the drug information acquired by the acquisition means, and by excluding drugs whose added drug information is other than a predetermined value, information on drugs that correspond to the reason for insurance payment is extracted, In the injury / illness information generation process, the injury / illness information is added for each medical procedure or medicine by referring to the injury / illness master, and by excluding medical procedures or medicines to which the specified injury / illness information has not been added, the payment claim acceptance system is characterized by obtaining information on injuries / illnesses that are grounds for insurance payment.

10. 10. The payment claim acceptance system according to claim 9, further comprising an approval acceptance means for accepting approval from said one insurance policyholder for the payment examination information displayed on said terminal.

11. A payment review information providing method using a payment review information providing system connected to an information provision record disclosure system that provides information on medical treatments and pharmaceuticals listed on receipts issued by medical institutions, a claim processing system that accepts insurance payment claims online from a terminal used by an insurance policyholder, and an acquisition step of acquiring, when the claim processing system requests the provision of payment review information, which is information to be used in reviewing insurance payment, at least one of information regarding medical treatments described on receipts issued by medical institutions and information regarding pharmaceuticals described on receipts issued by medical institutions from the information provision record disclosure system for one insurance policyholder who has filed a claim for insurance payment; a generating step of generating payment examination information based on the information acquired in the acquiring step; an information providing step of providing the payment examination information generated in the generating step to the claim processing system, In the generating step, depending on the content of the insurance contract, a hospitalization information generation process that refers to a hospitalization master that stores a list of information on hospitalizations that are subject to insurance payment reasons, extracts information on hospitalizations that are subject to insurance payment reasons from the information on medical procedures acquired in the acquisition step, and generates payment examination information that includes the extracted information on hospitalizations and information on the number of days of hospitalization; a treatment information generation process that refers to a treatment master that stores a list of information on treatments that qualify for insurance payment, extracts information on treatments that qualify for insurance payment from the information on medical procedures acquired in the acquisition step, and generates payment review information that includes the extracted information on treatments; A drug information generation process that refers to a drug master that stores a list of information on drugs that are subject to insurance payment reasons, extracts information on drugs that are subject to insurance payment reasons from the drug information acquired in the acquisition step, and generates payment examination information that includes the extracted drug information; and, an injury / illness information generation process that refers to an injury / illness master that stores information on the injury / illness that is the reason for insurance payment and information on the medical treatment or medicine corresponding to the injury / illness that is the reason for insurance payment, acquires information on the injury / illness that is the reason for insurance payment from the information on the medical treatment or medicine acquired in the acquisition step, and generates payment examination information including the acquired information on the injury / illness; Execute at least one of In the hospitalization information generation process, the hospitalization master is referenced, and a process is executed to add a hospitalization flag indicating whether or not there is information on hospitalization that corresponds to the reason for insurance payment for each medical procedure, and medical procedures for which the added hospitalization flag is a value other than a predetermined value are excluded, thereby extracting information on hospitalization that corresponds to the reason for insurance payment, In the treatment information generation process, the treatment master is referenced, and a process is executed to add a treatment flag indicating whether or not information on treatment corresponding to the reason for insurance payment is present for each medical procedure, and by excluding medical procedures for which the added treatment flag is a value other than a predetermined value, information on treatment corresponding to the reason for insurance payment is extracted; In the drug information generation process, by referring to the drug master, a process is executed to add drug information not included in the drug information acquired in the acquisition step for each drug, and by excluding drugs whose added drug information is other than a predetermined value, information on drugs corresponding to the reason for insurance payment is extracted, The injury / illness information generation process refers to the injury / illness master, executes a process to add injury / illness information for each medical procedure or medicine, and obtains information on injuries / illnesses that are grounds for insurance payment by excluding medical procedures or medicines to which the specified injury / illness information has not been added. This is a payment review information provision method characterized by the above.

12. A computer program that causes a computer connected to an information provision record disclosure system that provides information on medical treatments and pharmaceuticals listed on receipts issued by medical institutions, a claim processing system that accepts insurance payment claims online from a terminal used by an insurance policyholder, and the computer to function as a payment review information provision system, The computer an acquisition means for acquiring, when the claim processing system requests the provision of payment review information, which is information to be used in reviewing insurance payment, from the information provision record disclosure system, at least one of information on medical treatments described on receipts issued by medical institutions and information on pharmaceuticals described on receipts issued by medical institutions, for one insurance policyholder who has filed a claim for insurance payment; A generating means for generating payment examination information based on the information acquired by the acquiring means; The generating means functions as an information providing means for providing the payment examination information generated by the generating means to the claim processing system, The generating means, depending on the content of the insurance contract, a hospitalization information generation process that refers to a hospitalization master that stores a list of information on hospitalizations that qualify for insurance payment, extracts information on hospitalizations that qualify for insurance payment from the information on medical procedures acquired by the acquisition means, and generates payment examination information that includes the extracted information on hospitalizations and information on the number of days of hospitalization; a treatment information generation process that refers to a treatment master that stores a list of information on treatments that qualify for insurance payment, extracts information on treatments that qualify for insurance payment from the medical procedure information acquired by the acquisition means, and generates payment examination information that includes the extracted information on treatments; a drug information generation process that refers to a drug master that stores a list of information on drugs that are subject to insurance payment reasons, extracts information on drugs that are subject to insurance payment reasons from the drug information acquired by the acquisition means, and generates payment examination information that includes the extracted drug information; and, an injury / illness information generation process that refers to an injury / illness master that stores information on the injury / illness that is the reason for insurance payment and information on the medical treatment or medicine corresponding to the injury / illness that is the reason for insurance payment, acquires information on the injury / illness that is the reason for insurance payment from the information on the medical treatment or medicine acquired by the acquisition means, and generates payment examination information including the acquired information on the injury / illness; Execute at least one of In the hospitalization information generation process, the hospitalization master is referenced, and a process is executed to add a hospitalization flag indicating whether or not there is information on hospitalization that corresponds to the reason for insurance payment for each medical procedure, and medical procedures for which the added hospitalization flag is a value other than a predetermined value are excluded, thereby extracting information on hospitalization that corresponds to the reason for insurance payment, In the treatment information generation process, the treatment master is referenced, and a process is executed to add a treatment flag indicating whether or not information on treatment corresponding to the reason for insurance payment is present for each medical procedure, and by excluding medical procedures for which the added treatment flag is a value other than a predetermined value, information on treatment corresponding to the reason for insurance payment is extracted; In the drug information generation process, by referring to the drug master, a process is executed to add, for each drug, drug information that is not included in the drug information acquired by the acquisition means, and by excluding drugs whose added drug information is other than a predetermined value, information on drugs that correspond to the reason for insurance payment is extracted, The injury / illness information generation process refers to the injury / illness master, executes a process to add injury / illness information for each medical procedure or medicine, and obtains information on injuries / illnesses that are grounds for insurance payment by excluding medical procedures or medicines to which specified injury / illness information has not been added.

Images