The invention relates to the technical field of medical insurance intelligent auditing, and discloses a medical insurance medical document auditing method and
system based on a
knowledge graph. The method comprises the steps of obtaining evaluation index data and auditing results of an intelligent auditing
system in a hospital in different time periods before and after being online, and determining
knowledge graph nodes according to data changes; constructing a medical insurance auditing
knowledge graph based on the data of each time point and the logic dependency relationship between the nodes; calculating a
baseline level value and a change trend value of the evaluation index, and obtaining auditing influence coefficients of the node in different auditing links after the
system is online in combination with
graph node logic dependence; and screening nodes exceeding a preset threshold value according to the auditing
influence coefficient as nodes to be intervened, and generating an optimized knowledge graph for document auditing. According to the method, the knowledge graph is dynamically constructed by comparing the data before and after the system is online, and the node contribution is quantified by using the
influence coefficient to realize accurate optimization, so that the
adaptive capacity and the intervention efficiency of the auditing system are improved.