CN106530089A - Method and server for obtaining insurance claim settlement quota - Google Patents
Method and server for obtaining insurance claim settlement quota Download PDFInfo
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- CN106530089A CN106530089A CN201510585862.XA CN201510585862A CN106530089A CN 106530089 A CN106530089 A CN 106530089A CN 201510585862 A CN201510585862 A CN 201510585862A CN 106530089 A CN106530089 A CN 106530089A
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- 238000000034 method Methods 0.000 title claims abstract description 37
- 238000013507 mapping Methods 0.000 claims description 18
- 238000012502 risk assessment Methods 0.000 claims description 12
- 230000009286 beneficial effect Effects 0.000 abstract description 7
- 201000010099 disease Diseases 0.000 description 8
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 8
- 230000036541 health Effects 0.000 description 7
- 230000008569 process Effects 0.000 description 5
- 238000007689 inspection Methods 0.000 description 4
- 241001269238 Data Species 0.000 description 3
- 239000003814 drug Substances 0.000 description 3
- 238000010586 diagram Methods 0.000 description 2
- 230000003862 health status Effects 0.000 description 2
- 230000008901 benefit Effects 0.000 description 1
- 230000008859 change Effects 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
- 238000013461 design Methods 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 238000005516 engineering process Methods 0.000 description 1
- 241000411851 herbal medicine Species 0.000 description 1
- 230000006872 improvement Effects 0.000 description 1
- 238000009533 lab test Methods 0.000 description 1
- 210000000056 organ Anatomy 0.000 description 1
- 238000012545 processing Methods 0.000 description 1
- 238000012552 review Methods 0.000 description 1
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- 238000012360 testing method Methods 0.000 description 1
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Abstract
The invention discloses a method and server for obtaining an insurance claim settlement quota. The latest medical data corresponding to the last time an insurance user sees the doctor are obtained; historical medical data corresponding to a preset time length in which the insurance user sees the doctor are obtained; analyzing the obtained historical medical data, and determining a user claim settlement rule corresponding to the insurance user; and on the basis of the obtained latest medical data, according to the determined user claim settlement rule, a claim settlement quota corresponding to the insurance user is calculated, so that corresponding claim settlement is performed on the insurance user according to the claim settlement quota obtained by calculation. The method and server for obtaining the insurance claim settlement quota has the beneficial effect that the claim settlement amount of the insurance user is obtained according to the personal specific circumstance of the insurance user, the claim settlement risks are lowered, and the claim settlement amount is more targeted.
Description
Technical field
A kind of the present invention relates to settlement of insurance claim technical field, more particularly to acquisition of settlement of insurance claim amount
Method and server.
Background technology
With the continuous improvement and the continuous progress of ideology of people's living standard, more and more
People is provided with Insurance consciousness, and actively selects to buy the insurance of respective type, such as health insurance, wealth
Produce danger etc..For this insurance type of health insurance, at present, the insurance that the country has more than 100 is public
Department has founded health insurance this business.But, when the Claims Resolution amount of health insurance is calculated, deposit
In following problem：
In Claims Resolution, the different health status of the user that insures for difference are managed for most of insurance company
Pay for amount roughly the same；That is, for the different users that insures, it is impossible to according to the use of insuring
The corresponding concrete health status in family, calculates the Claims Resolution amount for the user that insures；Therefore, it is right
The risk control of health insurance is poor, and it is bad that this also consequently leads to that Claims Resolution rate is high, Claims Resolution number is big etc.
Consequence, the health insurance business of some insurance companies are even chronically at lossing state.
The content of the invention
In view of the foregoing, it is necessary to which a kind of acquisition methods of settlement of insurance claim amount and server are provided,
To the personal considerations according to the user that insures, the Claims Resolution number for the user that insures is obtained, reduced
Claims Resolution risk.
The invention discloses a kind of acquisition methods of settlement of insurance claim amount, comprise the following steps：
Obtain newest medical data corresponding when the user that insures seeks medical advice the last time；
Obtain the user that insures seek medical advice in preset duration corresponding to historical medical data；
The historical medical data that parsing is obtained, it is determined that the corresponding user's Claims Resolution of the user that insures
Rule；
According to the described newest medical data for obtaining, according to the user's Claims Resolution rule for determining, meter
Calculate the corresponding Claims Resolution amount of user of insuring, so as to according to calculated amount of settling a claim to described
The user that insures is settled a claim accordingly.
Preferably, the historical medical data that the parsing is obtained, it is determined that the user couple that insures
The user's Claims Resolution rule answered, including：
Based on the historical medical data for obtaining, according to default risk analysis rule, analysis is simultaneously
Insure described in obtaining the medical-risk grade of user；
According to default Claims Resolution rule and the mapping relations of medical-risk grade, it is determined that the use of insuring
User's Claims Resolution rule corresponding to the medical-risk grade at family.
Preferably, the default risk analysis rule includes：
Each medical-risk grade corresponds to different risk factors respectively.
Preferably, it is described to obtain newest medical data corresponding when the user that insures seeks medical advice the last time；
Obtain the user that insures seek medical advice in preset duration corresponding to historical medical data, including：
The newest medical data and the historical medical data is obtained in real time；Or,
According to predetermined period, obtain in the predetermined period corresponding newest medical data and
The historical medical data.
Preferably, it is described to obtain newest medical data corresponding when the user that insures seeks medical advice the last time
The step of after, also include：
The described newest medical data that parsing is obtained is with the presence or absence of default excessive risk Claims Resolution factor；
If there is default excessive risk Claims Resolution factor, according to default excessive risk Claims Resolution factor and reason
The mapping relations of rule are paid for, it is determined that the user corresponding to the excessive risk Claims Resolution factor of the user that insures
Claims Resolution rule；
Regular, the corresponding Claims Resolution amount of user of insuring described in calculating according to the user's Claims Resolution for determining,
To be settled a claim to the user that insures accordingly according to calculated Claims Resolution amount.
Corresponding to a kind of above-described acquisition methods of settlement of insurance claim amount, present invention also offers
A kind of acquisition server of settlement of insurance claim amount, including：
Data acquisition module, for obtaining newest doctor corresponding when the user that insures seeks medical advice the last time
Treat data；Obtain the user that insures seek medical advice in preset duration corresponding to historical medical data；
Data resolution module, for parsing the historical medical data for obtaining, it is determined that described insure
The corresponding user's Claims Resolution rule of user；
Amount computing module, for according to the described newest medical data for obtaining, according to the institute for determining
State user's Claims Resolution rule, calculate described in insure the corresponding Claims Resolution amount of user, so as to according to calculating
To Claims Resolution amount the user that insures is settled a claim accordingly.
Preferably, the data resolution module includes：
Analytic unit, for based on the historical medical data for obtaining, according to default risk point
Analysis rule, analyzes and obtains the medical-risk grade of the user that insures；
Determining unit, for the mapping relations according to default Claims Resolution rule and medical-risk grade,
It is determined that the user's Claims Resolution rule corresponding to the medical-risk grade of the user that insures.
Preferably, the default risk analysis rule includes：
Each medical-risk grade corresponds to different risk factors respectively.
Preferably, the data acquisition module is used for：
The newest medical data and the historical medical data is obtained in real time；Or,
According to predetermined period, obtain in the predetermined period corresponding newest medical data and
The historical medical data.
Preferably, the acquisition server of the settlement of insurance claim amount also includes：
Risk parsing module, for parsing the described newest medical data for obtaining with the presence or absence of default
Excessive risk Claims Resolution factor；
Regular determining module, if for there is default excessive risk Claims Resolution factor, according to default
The mapping relations that excessive risk settles a claim factor with rule of settling a claim, it is determined that the excessive risk reason of the user that insures
User's Claims Resolution rule corresponding to compensation factor；
Wherein, the amount computing module is additionally operable to：
Regular, the corresponding Claims Resolution amount of user of insuring described in calculating according to the user's Claims Resolution for determining,
To be settled a claim to the user that insures accordingly according to calculated Claims Resolution amount.
The acquisition methods and server of settlement of insurance claim amount described above can reach following beneficial
Effect：
Corresponding newest medical data when being sought medical advice the last time by obtaining the user that insures；Obtain institute
State the user that insures to seek medical advice in preset duration corresponding historical medical data；It is described that parsing is obtained
Historical medical data, it is determined that the corresponding user's Claims Resolution rule of the user that insures；According to the institute for obtaining
Newest medical data is stated, regular according to the user's Claims Resolution for determining, insure described in calculating user couple
The Claims Resolution amount answered, to carry out accordingly to the user that insures according to calculated Claims Resolution amount
Claims Resolution；The reason for the user that insures is obtained with the personal concrete condition according to the user that insures
The beneficial effect of number is paid for, Claims Resolution risk is reduced so that Claims Resolution number has more specific aim.
Description of the drawings
Fig. 1 is that a kind of flow process of embodiment of the acquisition methods of settlement of insurance claim amount of the present invention is illustrated
Figure；
During Fig. 2 is the acquisition methods of settlement of insurance claim amount of the present invention, step S30 in embodiment described in Fig. 1
A kind of embodiment schematic flow sheet；
Fig. 3 is that the flow process of the another embodiment of the acquisition methods of settlement of insurance claim amount of the present invention is shown
It is intended to；
Fig. 4 is a kind of block diagram of embodiment of the acquisition server of settlement of insurance claim amount of the present invention；
During Fig. 5 is the acquisition server of settlement of insurance claim amount of the present invention, parse in embodiment described in Fig. 4
Module
Fig. 6 is the block diagram of the another embodiment of the acquisition server of settlement of insurance claim amount of the present invention.
The realization of embodiment of the present invention purpose, functional characteristics and advantage will in conjunction with the embodiments, with reference to attached
Figure is described further.
Specific embodiment
Technical scheme is further illustrated below in conjunction with Figure of description and specific embodiment.
It should be appreciated that specific embodiment described herein is not used to limit only to explain the present invention
The fixed present invention.
It will be appreciated by those skilled in the art that the acquisition methods of settlement of insurance claim amount of the present invention and service
Keynote idea and design described by device, is not only used in this specific insurance species institute of health insurance
In corresponding scope of business field, naturally it is also possible to apply in other insurance type correspondences such as property insurance
The scope of business in, the specific embodiment party of the acquisition methods and server of settlement of insurance claim amount of the present invention
In formula, the concrete insurance type not being applied to is carried out exhaustive one by one.
Fig. 1 is refer to, Fig. 1 is a kind of embodiment of the acquisition methods of settlement of insurance claim amount of the present invention
Schematic flow sheet；As shown in figure 1, the acquisition methods of settlement of insurance claim amount of the present invention may be embodied as
Steps as described below S10-S40：
Step S10, acquisition are insured corresponding newest medical data when seeking medical advice the last time of user；
Step S20, obtain the user that insures seek medical advice in preset duration corresponding to Historical medical's number
According to；
In the embodiment of the present invention, when the user that insures seeks medical advice, hospital terminal is just by the user that insures
When this is sought medical advice, corresponding newest medical data is uploaded to hospital server.Due to the user that insures it is every
Secondary when seeking medical advice, the hospital terminal corresponding medical data of user of can insuring is uploaded to hospital services
Device, thus one, all of medical treatment when once seeking medical advice as of late of being sought medical advice from the user that insures first
Data have been maintained in hospital server.
Insurance server need acquisition insure user's corresponding medical data when, can be according to insuring
The characteristic information of user, obtains institute when the user that insures seeks medical advice the last time right from hospital server
The newest medical data answered；Simultaneously, it is also possible to obtain this and insure user such as 1 in the preset duration
Corresponding all historical medical datas of seeking medical advice in year.
Wherein, medical data described above is included but is not limited to：The medicine of purchase, disease name
Title, inspection project, hospital name of seeking medical advice, hospital department of seeking medical advice, whether be in hospital, length of stay with
And the corresponding analysis data of all kinds of results of laboratory test etc..
In one embodiment, insurance server from hospital server can obtain this in real time and insure
User's newest medical data corresponding when seeking medical advice the last time, and this insures user when default
Historical medical data corresponding to seeking medical advice in long.In one embodiment, insurance server can be by
According to predetermined period, the corresponding user that insures nearest in the predetermined period is obtained from hospital server
Secondary corresponding newest medical data when seeking medical advice, and the user that insures seeks medical advice in preset duration institute
Corresponding historical medical data.
The historical medical data that step S30, parsing are obtained, it is determined that the user that insures is corresponding
User's Claims Resolution rule；
Seek medical advice in preset duration after corresponding historical medical data the user that insures is got,
The above-mentioned historical medical data being analyzed and acquired by, such as, in analyzing above-mentioned historical medical data, institute is right
The disease name of the user that insures for answering, searches the disease name pair according to the disease name of the user that insures
The kinds of Diseases answered, and then according to its kinds of Diseases, determine the corresponding death risk of its kinds of Diseases
Grade；According to the death risk grade for determining, death risk grade is searched corresponding with Claims Resolution rule
Mapping table, the corresponding user's Claims Resolution rule of user so that it is determined that this is insured.
It will be appreciated by those skilled in the art that when it is determined that the corresponding user's Claims Resolution of the user that insures is regular,
According to corresponding inspection project in its historical medical data and/or analysis data and/or can also be in hospital
Other historical medical datas such as number of days, determine the corresponding user's Claims Resolution rule of the user that insures.This
Inventive embodiments to according to the different content specifically included in historical medical data, come to should determine that throwing
The corresponding particular user Claims Resolution rule in warranty family does not carry out exhaustive one by one.
Step S40, according to the described newest medical data for obtaining, according to the user Claims Resolution for determining
Rule, calculate described in insure the corresponding Claims Resolution amount of user, so as to according to calculated Claims Resolution volume
Degree is settled a claim accordingly to the user that insures.
When according to historical medical data determine this insure corresponding to user user Claims Resolution rule when,
The user that insures according to obtaining newest medical data corresponding when seeking medical advice the last time, calculating should
The Claims Resolution amount insured corresponding to user, so as to according to calculated Claims Resolution amount, to the throwing
Settled a claim accordingly at warranty family.
In the embodiment of the present invention, described user's Claims Resolution rule is including but not limited to following several：
The repudiation of claims, part are compensated, normally compensate and turn manual review etc..
A kind of acquisition methods of settlement of insurance claim amount of the present invention, it is the last by obtaining the user that insures
Corresponding newest medical data when seeking medical advice；The user that insures described in obtaining seeks medical advice in preset duration institute
Corresponding historical medical data；The historical medical data that parsing is obtained, it is determined that the use of insuring
The corresponding user's Claims Resolution rule in family；According to the described newest medical data for obtaining, according to the institute for determining
State user's Claims Resolution rule, calculate described in insure the corresponding Claims Resolution amount of user, so as to according to calculating
To Claims Resolution amount the user that insures is settled a claim accordingly；With according to the individual of the user that insures
People's concrete condition come obtain for the user that insures Claims Resolution number beneficial effect, reduce Claims Resolution
Risk so that Claims Resolution number has more specific aim.
Based on the description of embodiment described in Fig. 1, for embodiment described in Fig. 1 in " step S30, solution
The historical medical data that analysis is obtained, it is determined that the corresponding user's Claims Resolution rule of the user that insures ",
Can also be realized by the technical scheme described by step S301-S302 in embodiment described in Fig. 2.
As shown in Fig. 2 in a kind of acquisition methods of settlement of insurance claim amount of the invention, implementing described in Fig. 1
In example, " historical medical data that step S30, parsing are obtained, it is determined that the user couple that insures
The user's Claims Resolution rule answered " may be embodied as：
Step S301, the historical medical data based on acquisition, advise according to default risk analysis
Then, analyze and obtain the medical-risk grade of the user that insures；
In the embodiment of the present invention, according to default risk analysis rule, to the Historical medical's number for obtaining
According to being analyzed, according to analysis result, the medical-risk grade corresponding to user of insuring is obtained.
In one embodiment, default risk analysis rule includes：
According to historical medical datas such as disease type, inspection project, the medicine of purchase, hospital stays
The distinguished corresponding weight of middle projects, calculates the above-mentioned Historical medical's number corresponding to user of insuring
According to corresponding total weighted value, and then the data area according to residing for total weighted value, obtain the use of insuring
Medical-risk grade corresponding to family.
In one embodiment, default risk analysis rule includes：
Pre-set the distinguished corresponding different risk factors of each medical-risk grade.Such as,
The corresponding risk factors of high medical-risk grade include：" in upper declaration form year, the non-detailed record of outpatient service
Enter and check the survey fees amount of money more than 2000 yuan of Claims Resolution request times more than 5 times ", " upper declaration form year
In degree, Claims Resolution request times of the drug expenditure amount of money more than 10000 yuan are more than 6 times in hospital " etc.；The traditional Chinese medical science
Treating the corresponding risk factors of risk class includes：" in upper declaration form year, length of stay is more than 20
It number of times of seeking medical advice is more than 2 times " etc..
In one embodiment, described medical-risk grade is included but is not limited to：
High medical-risk grade, middle medical risk class, low medical-risk grade and without medical wind
Dangerous grade.
Step S302, according to default Claims Resolution rule and the mapping relations of medical-risk grade, it is determined that
User's Claims Resolution rule corresponding to the medical-risk grade of the user that insures.
After getting the corresponding medical-risk grade of user of insuring, according to default Claims Resolution rule
With the mapping relations of medical-risk grade, search corresponding to the medical-risk grade of the user that insures
User's Claims Resolution rule, so that it is determined that go out the user's reason corresponding to the medical-risk grade of the user that insures
Pay for rule.
In one embodiment, default Claims Resolution rule is included with the mapping relations of medical-risk grade
But it is not limited to：
High medical-risk grade correspondence：The repudiation of claims or part are compensated, and refuse in next declaration form year
Accept insurance absolutely；Middle medical risk class correspondence：Part is compensated or normal compensation, and next declaration form year
Degree additional premium；Low medical-risk grade and corresponded to without medical-risk grade respectively：It is normal to compensate,
And next declaration form year normally accepts insurance.
By above-mentioned embodiment, can be with Historical medical's number convenient, efficiently according to acquisition
According to determining the corresponding user's Claims Resolution rule of the user that insures, improve the efficiency of data processing.
Based on the description of embodiment described in Fig. 1, Fig. 2, the acquisition methods of settlement of insurance claim amount of the present invention
Can also realize by way of described in Fig. 3, Fig. 3 is the acquisition methods of settlement of insurance claim amount of the present invention
Another embodiment schematic flow sheet；As shown in figure 3, in the " step of embodiment described in Fig. 1
S10, acquisition insure corresponding newest medical data when seeking medical advice the last time of user " after, may be used also
To be embodied as steps as described below S120-S140：
The described newest medical data that step S120, parsing are obtained is managed with the presence or absence of default excessive risk
Compensation factor；
It is in the embodiment of the present invention, corresponding newest when getting the user that insures and seeking medical advice the last time
During medical data, directly parse in the newest medical data with the presence or absence of default excessive risk settle a claim because
Element.Different Claims Resolution companies can be set to above-mentioned excessive risk Claims Resolution factor according to actual conditions,
Such as, above-mentioned excessive risk Claims Resolution factor can be set as：" non-organ transfer operation expense responsibility payment is big
In 150,000 ", " the compensation expense of Chinese herbal medicine responsibility be more than 1000 yuan ", " in hospitalization cost, check inspection
The expense of testing accounts for more than 70% (containing) of total cost " etc..
If step S130, there is default excessive risk Claims Resolution factor, managed according to default excessive risk
The compensation factor mapping relations regular with Claims Resolution, it is determined that the excessive risk Claims Resolution factor institute of the user that insures
Corresponding user's Claims Resolution rule；
Step S140, calculating described in insure user correspondence regular according to the user's Claims Resolution for determining
Claims Resolution amount, so as to according to it is calculated Claims Resolution amount the user that insures is carried out accordingly
Claims Resolution.
If existed in above-mentioned user's newest medical data corresponding when seeking medical advice the last time of insuring
Excessive risk Claims Resolution factor set in advance, then according to default excessive risk Claims Resolution factor and Claims Resolution rule
Mapping relations, determine corresponding to the excessive risk Claims Resolution factor of the user that insures user Claims Resolution rule,
So as to according to the user's Claims Resolution rule for determining, calculate the Claims Resolution amount insured corresponding to user,
According to the Claims Resolution amount for calculating, to carry out corresponding Claims Resolution to the user that insures.
A kind of acquisition methods of settlement of insurance claim amount of the present invention, it is the last by obtaining the user that insures
Corresponding newest medical data when seeking medical advice；The described newest medical data that parsing is obtained whether there is
Default excessive risk Claims Resolution factor；If there is default excessive risk Claims Resolution factor, according to default
The mapping relations that excessive risk settles a claim factor with rule of settling a claim, it is determined that the excessive risk reason of the user that insures
User's Claims Resolution rule corresponding to compensation factor；According to the user's Claims Resolution rule for determining, institute is calculated
The corresponding Claims Resolution amount of the user that insures is stated, to insure to described according to calculated Claims Resolution amount
User is settled a claim accordingly；Obtain with the personal concrete condition according to the user that insures for being somebody's turn to do
Insure user Claims Resolution number beneficial effect, reduce Claims Resolution risk so that Claims Resolution number have more
Specific aim；Further, since carrying out the meter of Claims Resolution amount according only to the newest medical data of the user that insures
Calculate, this improves the computational efficiency of Claims Resolution amount, correspondingly saved and calculated Claims Resolution amount
Time cost.
Corresponding to the acquisition side of the settlement of insurance claim amount described by embodiment described in Fig. 1, Fig. 2 and Fig. 3
Method, present invention also offers a kind of acquisition server of settlement of insurance claim amount；In the embodiment of the present invention
The acquisition server of described settlement of insurance claim amount, possesses the insurance described in above-described embodiment
The repertoire of server.
As shown in figure 4, the acquisition server of settlement of insurance claim amount of the present invention includes：Data acquisition module
210th, data resolution module 220 and amount computing module 230.Wherein：
The data acquisition module 210, it is corresponding when the user that insures seeks medical advice the last time for obtaining
Newest medical data；Obtain the user that insures seek medical advice in preset duration corresponding to Historical medical
Data；
The data resolution module 220, for parsing the historical medical data for obtaining, determines institute
State the corresponding user's Claims Resolution rule of the user that insures；
Preferably, as shown in figure 5, the data resolution module 220 includes：
Analytic unit 221, for based on the historical medical data for obtaining, according to default risk
Analysis rule, analyzes and obtains the medical-risk grade of the user that insures；
Determining unit 222, closes for the mapping according to default Claims Resolution rule with medical-risk grade
System, it is determined that the user's Claims Resolution rule corresponding to the medical-risk grade of the user that insures.
Preferably, the default risk analysis rule includes：
Each medical-risk grade corresponds to different risk factors respectively.
The amount computing module 230, for according to the described newest medical data for obtaining, according to true
Fixed user's Claims Resolution rule, calculate described in insure the corresponding Claims Resolution amount of user, so as to according to
Calculated Claims Resolution amount is settled a claim accordingly to the user that insures.
Preferably, the data acquisition module 210 is used for：
The newest medical data and the historical medical data is obtained in real time；Or,
According to predetermined period, obtain in the predetermined period corresponding newest medical data and
The historical medical data.
A kind of acquisition server of settlement of insurance claim amount of the present invention, by obtaining the user nearest that insures
Secondary corresponding newest medical data when seeking medical advice；The user that insures described in obtaining seeks medical advice in preset duration
Corresponding historical medical data；The historical medical data that parsing is obtained, it is determined that described insure
The corresponding user's Claims Resolution rule of user；According to the described newest medical data for obtaining, according to what is determined
User's Claims Resolution is regular, and the corresponding Claims Resolution amount of user of insuring described in calculating, so as to according to calculating
The Claims Resolution amount for obtaining is settled a claim accordingly to the user that insures；Insure user's with basis
Personal concrete condition come obtain for the user that insures Claims Resolution number beneficial effect, reduce reason
Pay for risk so that Claims Resolution number has more specific aim.
Based on the description of embodiment described in Fig. 4, Fig. 5, the acquisition service of settlement of insurance claim amount of the present invention
Device can be constituted with the functional module described in Fig. 6, and Fig. 6 is the acquisition of settlement of insurance claim amount of the present invention
The schematic flow sheet of the another embodiment of server；As shown in fig. 6, settlement of insurance claim volume of the present invention
The acquisition server of degree includes：The data acquisition module 210, risk parsing module 310, rule
Determining module 320 and the amount computing module 230.Wherein：
The data acquisition module 210, it is corresponding when the user that insures seeks medical advice the last time for obtaining
Newest medical data；
Risk parsing module 310, for parsing the described newest medical data for obtaining with the presence or absence of default
Excessive risk Claims Resolution factor；
Regular determining module 320, if for there is default excessive risk Claims Resolution factor, according to default
Excessive risk Claims Resolution factor with Claims Resolution rule mapping relations, it is determined that the excessive risk of the user that insures
User's Claims Resolution rule corresponding to Claims Resolution factor；
Wherein, the amount computing module 230 is additionally operable to：
Regular, the corresponding Claims Resolution amount of user of insuring described in calculating according to the user's Claims Resolution for determining,
To be settled a claim to the user that insures accordingly according to calculated Claims Resolution amount.
A kind of acquisition server of settlement of insurance claim amount of the present invention, by obtaining the user nearest that insures
Secondary corresponding newest medical data when seeking medical advice；Whether the described newest medical data that parsing is obtained is deposited
In default excessive risk Claims Resolution factor；If there is default excessive risk Claims Resolution factor, according to default
Excessive risk Claims Resolution factor with Claims Resolution rule mapping relations, it is determined that the excessive risk of the user that insures
User's Claims Resolution rule corresponding to Claims Resolution factor；According to the user's Claims Resolution rule for determining, calculate
The corresponding Claims Resolution amount of the user that insures, so as to according to calculated Claims Resolution amount to the throwing
Settled a claim accordingly at warranty family；It is directed to obtain with the personal concrete condition according to the user that insures
The beneficial effect of the Claims Resolution number of the user that insures, reduces Claims Resolution risk so that Claims Resolution number is more
Tool specific aim；Further, since carrying out amount of settling a claim according only to the newest medical data of the user that insures
Calculate, this improves the computational efficiency of Claims Resolution amount, correspondingly saved calculating Claims Resolution amount
Time cost.
It should be noted that herein, term " including ", "comprising" or its any other change
Body is intended to including for nonexcludability, so that process, method including a series of key elements,
Article or device not only include those key elements, but also including other key elements being not expressly set out,
Or also include the key element intrinsic for this process, method, article or device.Do not having
In the case of more restrictions, the key element limited by sentence "including a ...", it is not excluded that in bag
Also there is other identical element in the process, method, article or the device that include the key element.
The embodiments of the present invention are for illustration only, do not represent the quality of embodiment.
Through the above description of the embodiments, those skilled in the art can be understood that
Above-described embodiment method can add the mode of required general hardware platform to realize by software, certainly
Can also be by hardware, but the former is more preferably embodiment in many cases.Based on such reason
Solution, the part that technical scheme is substantially contributed to prior art in other words can be with
The form of software product is embodied, and the computer software product is stored in a storage medium (such as
ROM/RAM, magnetic disc, CD) in, use so that a station terminal equipment (can including some instructions
Being mobile phone, computer, server, or network equipment etc.) perform each embodiment of the invention
Described method.
The preferred embodiments of the present invention are the foregoing is only, its scope of the claims is not thereby limited, it is all
It is the equivalent structure or equivalent flow conversion made using description of the invention and accompanying drawing content, directly
Or other related technical fields are used in indirectly, the patent protection model of the present invention is included in the same manner
In enclosing.
Claims (10)
1. a kind of acquisition methods of settlement of insurance claim amount, it is characterised in that comprise the following steps：
Obtain newest medical data corresponding when the user that insures seeks medical advice the last time；
Obtain the user that insures seek medical advice in preset duration corresponding to historical medical data；
The historical medical data that parsing is obtained, it is determined that the corresponding user's Claims Resolution of the user that insures
Rule；
According to the described newest medical data for obtaining, according to the user's Claims Resolution rule for determining, meter
Calculate the corresponding Claims Resolution amount of user of insuring, so as to according to calculated amount of settling a claim to described
The user that insures is settled a claim accordingly.
2. the method for claim 1, it is characterised in that what the parsing was obtained described goes through
History medical data, it is determined that the corresponding user's Claims Resolution rule of the user that insures, including：
Based on the historical medical data for obtaining, according to default risk analysis rule, analysis is simultaneously
Insure described in obtaining the medical-risk grade of user；
According to default Claims Resolution rule and the mapping relations of medical-risk grade, it is determined that the use of insuring
User's Claims Resolution rule corresponding to the medical-risk grade at family.
3. method as claimed in claim 2, it is characterised in that the default risk analysis rule
Then include：
Each medical-risk grade corresponds to different risk factors respectively.
4. the method as described in claim 1 or 2 or 3, it is characterised in that the acquisition is insured use
Family the last time newest medical data corresponding when seeking medical advice；User insure when default described in obtaining
Historical medical data corresponding to seeking medical advice in long, including：
The newest medical data and the historical medical data is obtained in real time；Or,
According to predetermined period, obtain in the predetermined period corresponding newest medical data and
The historical medical data.
5. the method for claim 1, it is characterised in that the acquisition user that insures is nearest
When once seeking medical advice the step of corresponding newest medical data after, also include：
The described newest medical data that parsing is obtained is with the presence or absence of default excessive risk Claims Resolution factor；
If there is default excessive risk Claims Resolution factor, according to default excessive risk Claims Resolution factor and reason
The mapping relations of rule are paid for, it is determined that the user corresponding to the excessive risk Claims Resolution factor of the user that insures
Claims Resolution rule；
Regular, the corresponding Claims Resolution amount of user of insuring described in calculating according to the user's Claims Resolution for determining,
To be settled a claim to the user that insures accordingly according to calculated Claims Resolution amount.
6. a kind of acquisition server of settlement of insurance claim amount, it is characterised in that include：
Data acquisition module, for obtaining newest doctor corresponding when the user that insures seeks medical advice the last time
Treat data；Obtain the user that insures seek medical advice in preset duration corresponding to historical medical data；
Data resolution module, for parsing the historical medical data for obtaining, it is determined that described insure
The corresponding user's Claims Resolution rule of user；
Amount computing module, for according to the described newest medical data for obtaining, according to the institute for determining
State user's Claims Resolution rule, calculate described in insure the corresponding Claims Resolution amount of user, so as to according to calculating
To Claims Resolution amount the user that insures is settled a claim accordingly.
7. server as claimed in claim 6, it is characterised in that the data resolution module bag
Include：
Analytic unit, for based on the historical medical data for obtaining, according to default risk point
Analysis rule, analyzes and obtains the medical-risk grade of the user that insures；
Determining unit, for the mapping relations according to default Claims Resolution rule and medical-risk grade,
It is determined that the user's Claims Resolution rule corresponding to the medical-risk grade of the user that insures.
8. server as claimed in claim 7, it is characterised in that the default risk analysis
Rule includes：
Each medical-risk grade corresponds to different risk factors respectively.
9. the server as described in claim 6 or 7 or 8, it is characterised in that the data acquisition
Module is used for：
The newest medical data and the historical medical data is obtained in real time；Or,
According to predetermined period, obtain in the predetermined period corresponding newest medical data and
The historical medical data.
10. server as claimed in claim 6, it is characterised in that the settlement of insurance claim amount
Obtaining server also includes：
Risk parsing module, for parsing the described newest medical data for obtaining with the presence or absence of default
Excessive risk Claims Resolution factor；
Regular determining module, if for there is default excessive risk Claims Resolution factor, according to default
The mapping relations that excessive risk settles a claim factor with rule of settling a claim, it is determined that the excessive risk reason of the user that insures
User's Claims Resolution rule corresponding to compensation factor；
Wherein, the amount computing module is additionally operable to：
Regular, the corresponding Claims Resolution amount of user of insuring described in calculating according to the user's Claims Resolution for determining,
To be settled a claim to the user that insures accordingly according to calculated Claims Resolution amount.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510585862.XA CN106530089A (en) | 2015-09-15 | 2015-09-15 | Method and server for obtaining insurance claim settlement quota |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510585862.XA CN106530089A (en) | 2015-09-15 | 2015-09-15 | Method and server for obtaining insurance claim settlement quota |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN106530089A true CN106530089A (en) | 2017-03-22 |
Family
ID=58348616
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201510585862.XA Pending CN106530089A (en) | 2015-09-15 | 2015-09-15 | Method and server for obtaining insurance claim settlement quota |
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| Country | Link |
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| CN106897845A (en) * | 2017-04-11 | 2017-06-27 | 武汉华创欣网科技有限公司 | A kind of online accident solution of vehicle insurance and system |
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| CN107844947A (en) * | 2017-09-25 | 2018-03-27 | 平安科技（深圳）有限公司 | Method, apparatus, storage medium and the terminal of insured amount preposition verification |
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