The invention discloses a medical insurance intelligent auditing and path recommending method and
system based on a large
language model, and particularly relates to the technical field of medical insurance auditing, and the method comprises the steps: S1, analyzing massive medical insurance policy documents through a first LLM, and generating a comprehensive confidence coefficient in combination with triple confidence coefficients of
semantics, context support degree and timeliness, after grading
processing, constructing a dynamically updated medical insurance rule
knowledge base; s2, converting free text medical advices of doctors into structured data by means of a second LLM, quantifying the integrity of the medical advices through field weights, and dynamically asking and complementing information in combination with constraint urgency; s3, associating the diagnosis and treatment scheme with the medical insurance information of the patient, matching rules in real time, and generating a color identifier for early warning violation; s4, recommending compliance alternative schemes in combination with the
medical knowledge graph, and sorting according to multi-dimensional scores such as medical insurance economy and the like; and S5, automatically extracting multi-
system data, and generating a standardized medical insurance
declaration report. The medical insurance
management efficiency is improved, the burden of
medical care and medical insurance departments is relieved, and reasonable use of medical insurance funds is guaranteed.