Insurance payment review assistance system

Abstract

This invention discloses an insurance reimbursement review assistance system to address the problem of insufficient review efficiency and consistency in medical reimbursement applications, where claims personnel must manually search for medical information and insurance policy reimbursement items. The system includes an input interface, a data storage module, a processing module, and an output interface. The processing module compares the textual information of the reimbursement application with a policy reimbursement item database and a medical reference database to generate medical information and multiple candidate reimbursement items, which are then displayed on the output interface for reference during insurance reimbursement review.

Claims

1. An insurance payment verification auxiliary system, comprising: An input interface configured to receive textual data corresponding to one of a claim; a data storage module storing a claim item database and a medical reference database, wherein the claim item database includes a plurality of insurance claim items; a processing module signal-connected to the input interface and the data storage module, configured to generate a plurality of candidate claim items based on the textual data and the claim item database, and to generate medical information corresponding to one of the claim, wherein each candidate claim item includes a claim item name and a suggested information; and an output interface signal-connected to the processing module, configured to display the medical information and the plurality of candidate claim items.

2. The insurance payment review assistance system as described in claim 1 further includes a text extraction module, signal-connected to the input interface and the processing module, wherein the input interface is further configured to receive a diagnostic report image, and the text extraction module is configured to extract the text data from the diagnostic report image.

3. The insurance payment review assistance system as described in claim 1, wherein the payment item database further includes item identification data, payment level data, applicable condition data, and comparison and correlation data corresponding to one of the plurality of insurance payment items.

4. The insurance payment review assistance system as described in claim 3, wherein the suggested information for each of the candidate payment items includes the item identification information, the payment level information, a judgment reason information and a suggestion degree information, and the plurality of candidate payment items are sorted according to the suggestion degree information.

5. The insurance payment review assistance system as described in claim 3 or 4, wherein the processing module is configured to generate judgment reasoning data corresponding to the plurality of candidate payment items based on the textual data, the applicable conditions data, and the comparative correlation data.

6. The insurance reimbursement review assistance system as described in claim 1, wherein the medical reference database includes multiple disease descriptions, surgical descriptions, treatment descriptions, and medical procedure descriptions.

7. The insurance reimbursement review assistance system as described in claim 1, wherein the medical reference database includes external medical reference materials obtained from an external medical information source, and the external medical information source is at least one of medical institution websites, health authority websites, and medical professional information websites.

8. The insurance payment review assistance system as described in claim 1, wherein the text data includes a first text field and a second text field, the first text field including a diagnosis or disease name, and the second text field including a doctor's instructions, a surgical procedure, a treatment, and / or a medical procedure.

9. The insurance payment review assistance system as described in claim 8, wherein the processing module is configured to obtain disease description information from the corresponding medical introduction information in the medical reference database based on the first text field information, and compare the second text field information with the payment item database to generate the plurality of candidate payment items.

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