Insurance payment assessment support program, insurance payment assessment support method, and information processing device

Abstract

To provide an insurance claim payment assessment support program capable of easily acquiring data for inquiries used in insurance claims payment assessment.SOLUTION: A cooperation server 10 is configured to receive a request from an insurance company terminal 30 to obtain inquiry data used in insurance claim payment assessment ((3) in Figure 7), acquire a piece of information for identifying a patient included in the acquisition request and a piece of information for identifying a medical practice for which the insurance payment request is included in the acquisition request from a medical institution server 40 that stores receipt data as query data corresponding data((4) to (6) in Figure 7), and transmit inquiry data to the insurance company terminal 30 ((7) in Figure 7).SELECTED DRAWING: Figure 7

Description

[Technical Field]

[0001] The present invention relates to an insurance payment assessment support program, an insurance payment assessment support method, and an information processing device. [Background technology]

[0002] Insurance such as medical insurance and accident insurance provides coverage to prepare for financial risks in the event of illness or injury. Insurance companies confirm the names of illnesses, surgeries, etc. declared by the policyholder (patient) in the insurance claim form, etc., based on the medical certificate issued by a doctor, and then determine whether to pay the insurance claim based on the terms and conditions at the time of the contract.

[0003] In order to pay insurance benefits according to the name of the injury, illness, surgery, etc., insurance companies often require the policyholder (patient) to submit a medical certificate issued by a doctor as evidence of the name of the injury, illness, surgery, etc. Currently, for illnesses covered by special provisions such as the three major diseases, insurance companies require the policyholder (patient) to submit a medical certificate in order to conduct an assessment called a "medical certificate assessment." On the other hand, for illnesses not covered by special provisions, insurance companies require the policyholder (patient) to submit a copy of the receipt from the medical institution and the receipt from the insurance pharmacy in order to conduct an assessment called a "simplified assessment."

[0004] In addition, in the past, a system was known that allowed policyholders to claim insurance benefits without a medical certificate, by deriving the name of the relevant injury or illness based on a medical statement prepared by the medical institution at the time of consultation, and determining whether or not to pay the insurance benefits (see Patent Document 1, etc.). [Prior art documents] [Patent documents]

[0005] [Patent Document 1] Patent Publication No. 2021-26738 Summary of the Invention [Problem to be solved by the invention]

[0006] However, in the system disclosed in Patent Document 1, the contract holder (patient) is required to submit image data of the medical statement from the contract holder's terminal or to submit the medical statement by mail, which is time-consuming for the contract holder.

[0007] In one aspect, the present invention aims to provide an insurance payment assessment support program, an insurance payment assessment support method, and an information processing device that enable easy acquisition of reference data to be used in insurance payment assessments. [Means for solving the problem]

[0008] In one aspect, the insurance payment assessment support program receives a request to acquire reference data used in insurance payment assessment, Every Information on medical treatments performed within a specified period is summarized. R Medical fee statement Used to create The storage unit for storing data is referred to, and the information for identifying the patient included in the acquisition request, the identification information of the medical department that performed the medical treatment that is the subject of the insurance payment claim included in the acquisition request, and the information of the treatment date are retrieved. Information about medical treatment as the query data, and transmits the query data to the sender of the acquisition request. In the memory unit, each piece of information about the medical procedure listed on the medical fee statement for each patient is linked to the identification information of the medical department that performed the medical procedure and information about the date of the procedure, which are not listed on the medical fee statement. [Effects of the Invention]

[0009] It is possible to easily obtain reference data to be used in insurance payment assessments. [Brief explanation of the drawings]

[0010] [Figure 1] 1 is a diagram illustrating a schematic configuration of an insurance payment assessment system according to an embodiment. [Figure 2] FIG. 2(a) is a diagram showing the hardware configuration of the link server, and FIG. 2(b) is a diagram showing the hardware configuration of the insurance company terminal and the medical institution server. [Figure 3] FIG. 2 is a functional block diagram of a link server, an insurance company server, and a medical institution server. [Figure 4] 10 is a flowchart showing a process of a cooperation server. [Figure 5] FIG. 10 is a diagram showing an example of a hospitalization, surgery, and outpatient status report. [Figure 6] FIG. 10 is a diagram showing an example of a medical receipt. [Figure 7] FIG. 1 is a diagram illustrating an overview of an embodiment. [Figure 8] FIG. DETAILED DESCRIPTION OF THE INVENTION

[0011] An embodiment of an insurance payment assessment system will be described in detail below with reference to FIGS. 1 to 7. The insurance payment assessment system of this embodiment is a system that supports insurance payment assessment work at an insurance company. Payment assessments include a "medical certificate assessment" when the policyholder's illness is one of the three major illnesses covered by a special contract, and a "simplified assessment" when the illness is other than the three major illnesses. The insurance payment assessment system of this embodiment provides reference data as evidence required for payment assessment to a terminal used by an insurance company employee when the employee performs a simplified assessment.

[0012] Fig. 1 shows a schematic configuration of an insurance payment assessment system 100 according to one embodiment. As shown in Fig. 1, the insurance payment assessment system 100 includes a linkage server 10 as an information processing device, an insurance company terminal 30, and a medical institution server 40. The insurance company terminal 30 is connected to a network N1 such as the Internet, and the medical institution server 40 is connected to a network N2 such as a regional medical network. Note that each of the networks N1 and N2 uses SSL (Secure Sockets Layer) or VPN (Virtual Private Network), which greatly reduces the possibility of information leakage or interception.

[0013] The linking server 10 is connected to both the networks N1 and N2, and performs data exchange between the insurance company terminal 30 and the medical institution server 40. More specifically, when the linking server 10 receives a request from the insurance company terminal 30 to acquire reference data to be used for simplified assessment, the linking server 10 requests the reference data from the medical institution server 40 and transmits the reference data received from the medical institution server 40 to the insurance company terminal 30.

[0014] FIG. 2(a) shows the hardware configuration of link server 10. Link server 10 includes a central processing unit (CPU) 90, a read-only memory (ROM) 92, a random access memory (RAM) 94, storage (a hard disk drive (HDD) or a solid state drive (SSD)) 96, a network interface 97, and a portable storage medium drive 99. These components of link server 10 are connected to a bus 98. In link server 10, the CPU 90 executes a program (including an insurance claim payment assessment support program) stored in ROM 92 or storage 96, or a program read from a portable storage medium 91 by the portable storage medium drive 99, thereby realizing the functions of the components shown in FIG. 3. The functions of the components of link server 10 shown in FIG. 3 may be realized by an integrated circuit such as an application specific integrated circuit (ASIC) or a field programmable gate array (FPGA). Details of the components of FIG. 3 will be described later.

[0015] Returning to Figure 1, the insurance company terminal 30 is a terminal used by an insurance company employee, and has the function of sending a request to the linked server 10 to obtain reference data to be used for simplified appraisals, and receiving and displaying reference data from the linked server 10.

[0016] The insurance company terminal 30 has a hardware configuration as shown in Fig. 2(b). Specifically, the insurance company terminal 30 includes a CPU 190, a ROM 192, a RAM 194, a storage 196, a network interface 197, a display unit 193, an input unit 195, and a portable storage medium drive 199 capable of reading data stored in the portable storage medium 191. The display unit 193 includes a liquid crystal display or the like, and the input unit 195 includes a keyboard, a mouse, a touch panel, or the like. These components of the insurance company terminal 30 are connected to a bus 198. In the insurance company terminal 30, the CPU 190 executes a program to realize the functions of the components shown in Fig. 3.

[0017] The medical institution server 40 is connected to user terminals used by medical professionals, such as doctors, working at the medical institution via a LAN (Local Area Network) or the like. The medical institution server 10 is an information processing device that manages data on medical fee statements (referred to as "receipts") created on user terminals in a receipt database 46 (see FIG. 3). A receipt is a document such as that shown in FIG. 6 and is issued monthly. The receipt includes the patient's name, date of birth, name of illness or injury, start date of treatment, outcome (recovery, death, discontinuation), information about the treatment, and information about hospitalization. Note that the receipt database 46 may also store information not listed on the receipt. For example, the receipt database 46 stores information on the medical department that performed each treatment listed on the receipt and date information linked to the receipt. Note that receipts may be either fee-for-service receipts or Diagnosis Procedure Combination (DPC) receipts that comply with the DPC system. The DPC system is a comprehensive medical fee payment system that uses a method (comprehensive payment method) to calculate hospital medical fees based on a fixed daily fee determined by the disease and treatment content (diagnosis group classification).The DPC system was introduced by the Ministry of Health, Labor and Welfare with the aim of standardizing the quality of medical care.

[0018] As an example, the medical institution server 40 has the same hardware configuration (FIG. 2(b)) as the insurance company terminal 30. In the medical institution server 40, the CPU 190 executes a program to realize the functions of each unit shown in FIG. 3. Note that the functions of each unit of the medical institution server 40 in FIG. 3 may be realized by an integrated circuit such as an ASIC or FPGA.

[0019] FIG. 3 shows a functional block diagram of the insurance company terminal 30, the link server 10, and the medical institution server 40.

[0020] (Functions of the insurance company terminal 30) As shown in FIG. 3, the insurance company terminal 30 has an acquisition request sending unit 32 and an inquiry data receiving unit 34. When an insurance company representative performs a "simple assessment," the representative inputs a request to acquire inquiry data. When making this acquisition request, the representative inputs predetermined information (information identifying the policyholder (patient) and information identifying the medical treatment in question). The information identifying the patient includes patient identification information (such as a patient ID). The information identifying the medical treatment in question includes medical institution identification information (such as a hospital code), medical department identification information (such as a medical department code), and information on the date of medical treatment. The insurance company representative inputs the predetermined information into the insurance company terminal 30 by referring to the "Hospitalization, Surgery, and Outpatient Status Report" (see FIG. 5) written by the policyholder (patient) and submitted by the policyholder.

[0021] When a request to acquire reference data (including the above-mentioned predetermined information) is input from the insurance company's person in charge, the acquisition request transmission unit 32 transmits the request to acquire reference data to the link server 10.

[0022] When query data is transmitted from the link server 10 , the query data receiving unit 34 receives the query data and displays it on the display unit 193 .

[0023] (Regarding the functions of the linked server 10) As shown in Figure 3, the linked server 10 has an acquisition request receiving unit 12 as a receiving unit, a medical institution identification unit 14, a query data request unit 16, a query data acquisition unit 18, an insurance company identification unit 20, and a query data transmission unit 22 as a transmitting unit.

[0024] The acquisition request receiving unit 12 receives an acquisition request transmitted from the acquisition request transmitting unit 32 of the insurance company terminal 30. The medical institution specifying unit 14 checks the medical institution identification information (such as a hospital code) included in the acquisition request and identifies which medical institution server 40 the query data should be requested from. The query data requesting unit 16 executes a process to request the query data from the medical institution server 40 specified by the medical institution specifying unit 14. At this time, the query data requesting unit 16 transmits to the medical institution server 40 the patient identification information (such as a patient ID), medical department identification information (medical department code), and information on the date of medical treatment included in the acquisition request.

[0025] The query data acquisition unit 18 acquires query data transmitted from the medical institution server 40. The insurance company identification unit 20 identifies to which insurance company terminal 30 the acquired query data should be sent. Specifically, the insurance company identification unit 20 identifies which patient the acquired query data belongs to, and identifies the insurance company terminal 30 that most recently transmitted a request to acquire query data for that patient. The query data transmission unit 22 transmits the query data to the insurance company terminal 30 identified by the insurance company identification unit 20.

[0026] (Functions of medical institution server 40) 3, the medical institution server 40 includes a request receiving unit 42 and a data extracting unit 44. As described above, the medical institution server 40 manages data on medical receipts in the medical receipt DB 46.

[0027] When the request receiving unit 42 receives a request to obtain query data from the query data request unit 16 of the linked server 10, it receives the request and notifies the data extraction unit 44 of the information contained in the request (patient identification information, medical department identification information, and information on the date of treatment).

[0028] When the data extraction unit 44 receives a notification from the request receiving unit 42, it refers to the medical receipt DB 46 and identifies the medical receipt data corresponding to the patient's identification information. Furthermore, the data extraction unit 44 extracts data corresponding to the medical department's identification information and the date of medical treatment from the acquired medical receipt data, and sets the extracted data as query data. The data extraction unit 44 transmits the query data to the link server 10.

[0029] (Regarding the processing of the linkage server 10) Next, the processing of the link server 10 will be described in detail with reference to the flowchart of FIG.

[0030] 4 starts, first, in step S10, the acquisition request receiving unit 12 waits until a request to acquire query data is received. When the acquisition request transmitting unit 32 of the insurance company terminal 30 transmits the information entered by the insurance company's staff (patient identification information, medical institution identification information, medical department information, and consultation date information) together with the acquisition request, the acquisition request receiving unit 12 proceeds to step S12.

[0031] In step S12, the acquisition request receiving unit 12 receives the acquisition request and notifies the medical institution specifying unit 14 of the request.

[0032] Next, in step S14, the medical institution specifying unit 14 specifies the medical institution requesting the reference data from the medical institution identification information included in the acquisition request, and notifies the reference data request unit 16 of the same.

[0033] Next, in step S16, the inquiry data request unit 16 transmits the information included in the acquisition request (patient identification information, medical department information, and consultation date information) to the medical institution server 40 of the medical institution identified by the medical institution identification unit 14. As a result, the inquiry data request unit 16 requests the medical institution server 40 for inquiry data for simplified assessment.

[0034] In the medical institution server 40, the request receiving unit 42 notifies the data extraction unit 44 of the patient's identification information, medical department information, and treatment date information. The data extraction unit 44 then references the medical receipt DB 46 to identify medical receipt data corresponding to the patient's identification information. Because a medical receipt is a document that lists all medical procedures for one month, if a patient visits the hospital for multiple illnesses, it is difficult to determine the medical procedures and treatment points that are the subject of an insurance claim just by looking at the medical receipt. In contrast, in this embodiment, as described above, the medical receipt DB 46 stores data for each medical procedure listed on the medical receipt in association with medical department identification information and treatment date information. Therefore, the data extraction unit 44 extracts data corresponding to the medical department identification information and treatment date information from the medical receipt data corresponding to the patient's identification information as reference data to be used for simplified assessment. The data extraction unit 44 then transmits the extracted reference data to the linkage server 10.

[0035] After step S16, in step S18, the query data acquisition unit 18 waits until the query data is transmitted from the medical institution server 40. Therefore, when the query data is transmitted from the data extraction unit 44, the query data acquisition unit 18 proceeds to step S20 and acquires the query data.

[0036] Next, in step S22, the insurance company identification unit 20 identifies which insurance company the query data should be sent to. In this case, the insurance company identification unit 20 identifies the insurance company terminal 30 that has sent the request to acquire query data for the patient, based on the patient's identification information contained in the query data. The insurance company identification unit 20 notifies the query data transmission unit 22 of the information of the identified insurance company terminal 30.

[0037] Next, in step S24, the inquiry data sending unit 22 sends the inquiry data to the identified insurance company terminal 30. In the insurance company terminal 30, the inquiry data receiving unit 34 receives the inquiry data and displays the inquiry data on the display unit 193 of the insurance company terminal 30. This allows the insurance company staff member to use the inquiry data as evidence to make an assessment (simplified assessment) of the payment of insurance money to the policyholder (patient).

[0038] In this embodiment, the query data request unit 16 and the query data acquisition unit 18 function as an acquisition unit that acquires prescription data corresponding to the acquisition request from the medical institution server 40 as query data.

[0039] FIG. 7 shows a schematic overview of this embodiment. As shown in FIG. 7, in this embodiment, (1) the policyholder (patient) submits a hospitalization, surgery, and outpatient status report (FIG. 5) to receive insurance payment. Next, (2) the insurance company representative, while viewing the hospitalization, surgery, and outpatient status report, inputs a request to acquire query data. (3) The insurance company terminal 30 transmits the input acquisition request to the link server 10. (4) The link server 10 receives the acquisition request (S12 in FIG. 4) and transmits a request to acquire query data to the medical institution server 40 that manages the medical receipt data. (5) The medical institution server 40 extracts data corresponding to the acquisition request as query data, and (6) transmits the query data to the link server 10, so that the link server 10 acquires the query data (S20 in FIG. 4). Then, (7) the link server 10 transmits the acquired query data to the insurance company terminal 30 (S24 in FIG. 4). As a result, (8) the display unit 193 of the insurance company terminal 30 displays the receipt data of the policyholder (patient) as inquiry data. Therefore, the insurance company staff can use the inquiry data as evidence to perform a simplified assessment. In this case, the policyholder (patient) does not need to submit the receipt (document) to the insurance company by mail or send the receipt electronic data to the insurance company terminal 30, thereby reducing the time and effort required of the policyholder (patient). While receipts issued by medical institutions and insurance pharmacies have traditionally been used for simplified assessments, receipts contain all the information listed on receipts, so there is no problem in using receipt data as evidence for simplified assessments. Furthermore, when requesting the acquisition of inquiry data ((2) in Figure 7), the insurance company staff inputs the identification information of the medical institution, as well as the identification information of the medical department and the date of treatment. Therefore, the medical institution server 40 can extract data on the medical treatment and disease name covered by the insurance as inquiry data, even if the receipt contains information on medical treatments for multiple injuries or illnesses.

[0040] In the above embodiment, the link server 10, upon acquiring query data from the medical institution server 40, transmits the acquired query data as is to the insurance company terminal 30. However, this is not limiting. For example, as shown in FIG. 8, the link server 10 may have the functionality of a report creation unit 24. The report creation unit 24 creates a hospitalization, surgery, and outpatient status report (see FIG. 5) based on the query data acquired by the query data acquisition unit 18. In this case, the query data transmission unit 22 transmits the query data as evidence to the insurance company terminal 30 along with the hospitalization, surgery, and outpatient status report created by the report creation unit 24. This eliminates the need for the policyholder (patient) to fill out the hospitalization, surgery, and outpatient status report, and allows the policyholder (patient) to simply provide the insurance company representative with information (such as the patient's identification information) necessary to acquire the query data. In the example of FIG. 8, the report creation unit 24 and the query data transmission unit 22 function as a creation unit that uses the query data to create a report necessary for payment assessment and transmits the created report to the insurance company terminal 30.

[0041] In the above embodiment, the linkage server 10 provides data on medical receipts as evidence when an insurance company performs a "simple assessment," but the present invention is not limited to this. For example, if it becomes possible to use data on medical receipts as evidence in the future for a "medical certificate assessment," the linkage server 10 may provide query data to the insurance company terminal 30 for the "medical certificate assessment" in the same manner as in the above embodiment.

[0042] In the above embodiment, a case where receipt data is transmitted as inquiry data to the insurance company terminal 30 has been described, but the present invention is not limited to this. If there is data that can be used as inquiry data (data created according to medical treatment), at least a part of the data may be provided as inquiry data to the insurance company terminal 30. An example of data that can be used as inquiry data is a survey file related to an impact assessment of the introduction of the DPC system.

[0043] In the above embodiment, the network to which the insurance company terminal 30 is connected is different from the network to which the medical institution server 40 is connected. However, this is not limited to this, and for example, the insurance company terminal 30 and the medical institution server 40 may be connected to the same network.

[0044] In the above embodiment, the medical institution server 40 manages the medical receipt data, but the present invention is not limited to this. For example, the linking server 10 may acquire medical receipt data from the medical institution server 40 or the like and manage the data in a storage unit of the linking server 10. In this case, when the linking server 10 acquires a request to acquire query data from the insurance company terminal 30, it may extract the medical receipt data corresponding to the acquisition request from the storage unit and transmit the data to the insurance company terminal 30.

[0045] The above processing functions can be realized by a computer. In this case, a program is provided that describes the processing contents of the functions that the processing device should have. By executing the program on a computer, the above processing functions are realized on the computer. The program that describes the processing contents can be recorded on a computer-readable storage medium (excluding carrier waves).

[0046] When distributing a program, it is sold in the form of a portable storage medium on which the program is recorded, such as a DVD (Digital Versatile Disc) or a CD-ROM (Compact Disc Read Only Memory).The program can also be stored in the storage device of a server computer and transferred from the server computer to other computers via a network.

[0047] A computer that executes a program stores, for example, a program recorded on a portable storage medium or a program transferred from a server computer in its own storage device. The computer then reads the program from its own storage device and executes processing in accordance with the program. Note that the computer can also read the program directly from a portable storage medium and execute processing in accordance with that program. The computer can also execute processing in accordance with the program received each time a program is transferred from the server computer.

[0048] The above-described embodiment is a preferred example of the present invention, but the present invention is not limited to this and can be modified in various ways without departing from the spirit of the present invention.

[0049] In addition, the following supplementary notes are disclosed in relation to the above-described embodiments. (Appendix 1) Receive a request to acquire reference data to be used in insurance payment assessment, acquires, as the inquiry data, data corresponding to information for identifying the patient included in the acquisition request and information for identifying the medical treatment for which the insurance payment claim is made included in the acquisition request from a storage unit that stores document data created in response to the medical treatment; transmitting the inquiry data to the sender of the acquisition request; An insurance payment assessment support program that causes a computer to execute processing. (Appendix 2) The insurance payment assessment support program described in Appendix 1, characterized in that the computer is further caused to execute a process of using the acquired inquiry data to create a report necessary for payment assessment and sending the created report to the sender. (Note 3) The assessment of the payment of the insurance claim is a simplified assessment conducted for illnesses other than those covered by the special contract. The insurance payment assessment support program described in Appendix 1 or 2, characterized in that in the acquisition process, data corresponding to information identifying the patient included in the acquisition request and information identifying the medical treatment that is the subject of the insurance payment claim included in the acquisition request is acquired as the inquiry data from the medical fee statement data stored in the memory unit. (Appendix 4) An insurance payment assessment support program as described in Appendix 3, characterized in that the information identifying the medical treatment that is the subject of the insurance payment claim includes identification information for the medical institution, identification information for the medical department, and information on the date of the treatment. (Appendix 5) Receive a request to acquire reference data to be used in insurance payment assessment, acquires, as the inquiry data, data corresponding to information for identifying the patient included in the acquisition request and information for identifying the medical treatment for which the insurance payment claim is made included in the acquisition request from a storage unit that stores document data created in response to the medical treatment; transmitting the inquiry data to the sender of the acquisition request; An insurance payment assessment support method characterized in that processing is executed by a computer. (Supplementary Note 6) A receiving unit that receives a request for acquisition of reference data used in insurance payment assessment; an acquisition unit that acquires, as the inquiry data, data corresponding to information identifying the patient included in the acquisition request and information identifying the medical treatment for which the insurance payment claim is made included in the acquisition request from a storage unit that stores document data created in response to the medical treatment; a transmission unit that transmits the inquiry data to a sender of the acquisition request; An information processing device comprising: (Appendix 7) The information processing device described in Appendix 6 further includes a creation unit that creates a report necessary for payment assessment using the inquiry data acquired by the acquisition unit and sends the created report to the sender. (Appendix 8) The assessment of the payment of the insurance claim is a simplified assessment made for illnesses other than those covered by the special contract. The information processing device described in Appendix 6 or 7, characterized in that the acquisition unit acquires, from the data of the medical fee statement stored in the memory unit, data corresponding to information identifying the patient included in the acquisition request and information identifying the medical procedure that is the subject of the insurance payment claim included in the acquisition request as the query data. (Appendix 9) An information processing device as described in Appendix 8, characterized in that the information identifying the medical treatment that is the subject of the insurance payment claim includes identification information of the medical institution, identification information of the medical department, and information on the date of the treatment. [Explanation of symbols]

[0050] 10 Collaboration server (information processing device) 12 Acquisition request receiving unit (receiving unit) 16. Inquiry data request section (part of the acquisition section) 18 Inquiry data acquisition unit (part of acquisition unit) 22 Inquiry data transmission unit (transmission unit, part of creation unit) 24 Report Preparation Department (part of the Preparation Department) 40 Medical institution server (storage unit) 46 Receipt DB

Claims

1. Receive a request to acquire reference data to be used in insurance payment assessment; Refer to a storage unit that stores data used to create a medical fee statement that collectively lists information about medical procedures performed for each patient within a specified period, and acquire, as the inquiry data, information about the medical procedure that corresponds to the information that identifies the patient included in the acquisition request, the identification information of the medical department that performed the medical procedure that is the subject of the insurance payment claim included in the acquisition request, and the information about the date of the medical procedure; transmitting the inquiry data to the sender of the acquisition request; Have the computer execute the process, An insurance payment assessment support program characterized in that, in the memory unit, each piece of information about the medical procedure listed on each patient's medical fee statement is linked to the identification information of the medical department that performed the medical procedure and information about the date of the treatment, which are not listed on the medical fee statement.

2. The insurance payment assessment support program of claim 1, characterized in that the computer is further made to execute a process of using the acquired inquiry data to create a report necessary for payment assessment and sending the created report to the sender.

3. 3. The insurance payment assessment support program according to claim 1, wherein the insurance payment assessment is a simplified assessment carried out for illnesses other than those covered by special contracts.

4. Receive a request to acquire reference data to be used in insurance payment assessment; Refer to a storage unit that stores data used to create a medical fee statement that collectively lists information about medical procedures performed for each patient within a specified period, and acquire, as the inquiry data, information about the medical procedure that corresponds to the information that identifies the patient included in the acquisition request, the identification information of the medical department that performed the medical procedure that is the subject of the insurance payment claim included in the acquisition request, and the information about the date of the medical procedure; transmitting the inquiry data to the sender of the acquisition request; The computer executes the processing, An insurance payment assessment support method characterized in that, in the memory unit, each piece of information about the medical procedure listed on each patient's medical fee statement is linked to the identification information of the medical department that performed the medical procedure and information about the date of the treatment, which are not listed on the medical fee statement.

5. a receiving unit that receives a request to acquire reference data used in insurance payment assessment; an acquisition unit that refers to a storage unit that stores data used to create a medical fee statement that collectively lists information about medical procedures performed within a specified period for each patient, and acquires, as the inquiry data, information about the medical procedures that correspond to information identifying the patient included in the acquisition request, identification information of the medical department that performed the medical procedure that is the subject of the insurance payment claim included in the acquisition request, and information about the date of the medical procedure; a transmission unit that transmits the inquiry data to a sender of the acquisition request; Equipped with In the memory unit, an information processing device links each piece of information about the medical procedure listed on each patient's medical fee statement with the identification information of the medical department that performed the medical procedure and information about the date of the procedure, which are not listed on the medical fee statement.

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