Cancer Claims Review Support System

Abstract

This invention provides a cancer claims review assistance system to improve the problems of time-consuming interpretation of pathology reports and susceptibility to human experience. The system includes an input interface, a data storage module, a text recognition module, a processing module, and an output interface. The input interface receives the image of the pathology report corresponding to the claim case; the text recognition module recognizes the text in the report; the processing module generates cancer claims review assistance information based on the field settings and cancer interpretation reference data; and the output interface outputs this information for reference in cancer insurance or critical illness insurance claims review.

Claims

1. A cancer claims review assistance system, comprising: An input interface is configured to receive a pathology report image, wherein the pathology report image corresponds to a claim case; a data storage module is configured to store field setting data and cancer interpretation reference data, wherein the field setting data defines a plurality of claim review fields; a text recognition module is signal-connected to the input interface and configured to recognize a report text in the pathology report image; a processing module is signal-connected to the data storage module and the text recognition module, configured to determine whether the report text meets a preset report condition, and if the preset report condition is met, extract at least one key piece of information corresponding to the plurality of claim review fields from the report text according to the field setting data, and generate cancer claim review auxiliary information according to the at least one key piece of information and the cancer interpretation reference data; and an output interface is signal-connected to the processing module and configured to output the cancer claim review auxiliary information.

2. The cancer claim review assistance system as described in claim 1, wherein the plurality of claim review fields include a cancer name field, a cancer stage field, an in situ carcinoma determination field, a pathology report interpretation field, and a staging basis field.

3. The cancer claim review assistance system as described in claim 2, wherein the cancer claim review assistance information includes cancer name information, cancer stage information, carcinoma in situ judgment information, pathology report interpretation information, and staging basis information corresponding to the cancer name field, the cancer stage field, the carcinoma in situ judgment field, the pathology report interpretation field, and the staging basis field, respectively.

4. The cancer claims review assistance system as described in claim 3, wherein the output interface is further configured to output data source information, and the data source information includes a reference website name and a reference URL corresponding to the staging basis information.

5. The cancer claims review assistance system as described in claim 1, wherein the preset report conditions include pathology report identification information and claims review necessary information in the report text, and the claims review necessary information includes cancer type information, cancer stage information, pathological diagnosis information, tumor stage information, lymph node metastasis information, distant metastasis information, or a combination thereof, used to determine the payment conditions.

6. The cancer claim review assistance system as described in claim 1 or 5, wherein the processing module is further configured to generate an anomaly judgment result when the report text does not meet the preset report conditions, and the output interface outputs an input anomaly prompt information based on the anomaly judgment result.

7. The cancer claim review assistance system as described in claim 1, wherein the output interface outputs the cancer claim review assistance information in a table format, and the table format includes an item column and a content column.

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