CN109523398A

CN109523398A - The method and apparatus of drug reimbursement Information abnormity

Info

Publication number: CN109523398A
Application number: CN201811264702.5A
Authority: CN
Inventors: 张淦
Original assignee: Ping An Medical and Healthcare Management Co Ltd
Current assignee: Shenzhen Ping An Medical Health Technology Service Co Ltd
Priority date: 2018-10-27
Filing date: 2018-10-27
Publication date: 2019-03-26
Anticipated expiration: 2038-10-27
Also published as: CN109523398B

Abstract

The present invention provides the method and apparatus for determining drug reimbursement Information abnormity, wherein, method includes: to obtain the drug protection amount settlement request for being directed to target medicine, drug protection amount settlement request includes the weight information and height information of the identity information of preset state user, the corresponding reimbursement information of target medicine and preset state user, determines that compensation protection amount and accumulative reimbursement of the preset state user within the reimbursement period of target medicine are insured amount according to identity information and reimbursement information；Single dosage is determined according to weight information and height information and usage and dosage rule；The corresponding reimbursement thresholding of target medicine and reimbursement time limit are determined according to protection amount, drug Huimin rule, single dosage has been paid for, and reimbursement thresholding, which is greater than or equal to, has paid for protection amount；If insured amount settlement request meets reimbursement time limit, also, accumulative reimbursement protection amount is greater than reimbursement thresholding, it is determined that drug protection amount settlement request has abnormal, sending reimbursement abnormal prompt.Technical solution of the present invention can reduce insurance fraud behavior.

Description

The method and apparatus of drug reimbursement Information abnormity

Technical field

The present invention relates to medical fields, more particularly to the method for determining drug reimbursement Information abnormity.

Background technique

With the development of society and the continuous promotion of living standards of the people, people gradually start to receive miscellaneous insurance Project is especially valued by the people especially for ensureing the medical insurance of basic medical demand.Existing medical insurance is main There are two types of, the commercial medical insurance including the profitability that the social medical insurance established by state and society and enterprise are established.It is right For the user for having participated in medical insurance, when its illness, user can be produced disease according to the Claims Resolution rule of medical insurance Raw medical expense is submitted an expense account, to alleviate the economic pressures generated by illness to a certain extent.

In current commercial medical insurance Claims Resolution policy, for certain special drugs for being included in Claims Resolution range, usually By healthcare structure after the identity for having verified illness user and medical qualification, these special drugs needed for illness user are mentioned User is supplied, then again by medical institutions according to the drug for being supplied to illness user medical insurance machine corresponding with illness user Structure is settled a claim.Be likely to occur following problem in this way: due to certain drugs have it is certain give policy (such as buying one and geing one free), give Drug not can be carried out Claims Resolution, these medicines that medical institutions may will give when settling a claim to Medical Insurance Organizations really Product are also included in Claims Resolution range, i.e. insurance fraud behavior can additionally increase the Claims Resolution expenditure of Medical Insurance Organizations in this way.

Summary of the invention

The embodiment of the present invention provides the method and apparatus for determining drug reimbursement Information abnormity, and solution is led because of insurance fraud behavior The problem of increasing, is paid in the Claims Resolution of the Medical Insurance Organizations of cause.

In a first aspect, providing a kind of method of determining drug reimbursement Information abnormity, comprising:

The drug protection amount settlement request for being directed to target medicine is obtained, the drug protection amount settlement request includes that preset state is used Weight information and the height letter of the corresponding reimbursement information of the identity information at family, the target medicine and the preset state user Breath；

Determine the preset state user in institute according to the identity information of the preset state user and the reimbursement information It states the protection amount of compensation in the reimbursement period of target medicine and adds up reimbursement protection amount, it is described to have paid for the insured amount and described accumulative reimbursement protection amount It is the corresponding protection amount of the target medicine, the accumulative reimbursement for submitting an expense account the target medicine in the corresponding period in period is protected Volume is not reset；

The body surface face of the preset state user is determined according to the weight information of the preset state user and height information Product；

The usage and dosage rule of the target medicine is obtained, and according to the body surface area and usage and dosage rule Determine the corresponding single dosage of the preset state user；

Obtain the target medicine corresponding drug Huimin rule, and according to paid for insured amount, described drug Huimin rule with And the single dosage determines the corresponding reimbursement thresholding of the target medicine, the reimbursement thresholding be greater than or equal to it is described Pay for insured amount, the drug Huimin rule is to buy the quantity of the target medicine to reach corresponding number of preset paid drug period After amount, giving quantity is that the target medicine of corresponding quantity of preset free drug period gives preset state user, drug period For reflecting that user uses attainable treatment degree after drug；

The corresponding reimbursement time limit of the target medicine is determined according to the reimbursement thresholding and the drug Huimin rule, it is described Reimbursement time limit is less than or equal to the reimbursement period；

If the drug protection amount settlement request is within the reimbursement time limit corresponding time, also, the accumulative reimbursement Protection amount is greater than the reimbursement thresholding, it is determined that the drug protection amount settlement request has abnormal, sending reimbursement abnormal prompt.

In the embodiment of the present invention, time when by the accumulative reimbursement protection amount to target medicine and settling accounts judges, It can determine whether the accumulative compensation protection amount of the target medicine alreadys exceed the thresholding amount of reimbursement, and determine the time of clearing Whether in using the validity period of drug given, when the accumulative compensation protection amount of target medicine be more than the thresholding amount of reimbursement simultaneously And time of clearing when being in the validity period of drug given, illustrate that the reimbursement of this part may submit an expense account is the drug given Expense, issuing reimbursement abnormity prompt can make the personnel for being responsible for Claims Resolution notice this abnormal conditions, so as to the situation It is verified, prevents insurance fraud, it to a certain extent can be to avoid the additional Claims Resolution expenditure for increasing Medical Insurance Organizations.

With reference to first aspect, in one possible implementation, described to be believed according to the weight of the preset state user Breath and height information determine the body surface area of the preset state user, comprising: are believed according to the weight of the preset state user Breath, the height information and body surface area calculation formula determine the body surface area of the preset state user；Wherein, the body Surface area calculation formula are as follows: body surface area=a* height+b* weight-c, the unit of the height are centimetre the list of the weight Position for kilogram, a, b, c are constant.By being calculated using preset body surface area calculation formula, default shape can be determined The body surface area of state user.

With reference to first aspect, in one possible implementation, according to the body surface area and the usage and dosage Rule determine the corresponding single dosage of the preset state user comprise determining that in the usage and dosage rule with body surface Area is the unit dosage of medication unit；The product of the unit dosage and the body surface area is determined as described pre- If the corresponding single dosage of status user.It, can be true by determining the unit dosage and body surface area of target medicine Determine the dosage of user's first use target medicine.

With reference to first aspect, in one possible implementation, the basis has paid for insured amount, the described drug Huimin rule And the single dosage determines that the corresponding reimbursement thresholding of the target medicine includes: true according to the drug Huimin rule The fixed paid drug period；Determine that the target medicine is corresponding according to the paid drug period and the single dosage Paid Quantity of drugs；Determine that the first expense, first expense are the target medicine pair that quantity is the paid Quantity of drugs The drug total cost answered；According to it is described paid for it is insured amount the corresponding reimbursement thresholding of the target medicine is determined with first total value, The corresponding reimbursement door of the target medicine is limited to N times of the first expense, and N is the positive integer more than or equal to 0.Paid Quantity of drugs Quantity for the drug for needing expense to buy buys the drug institute of the quantity of drug of the needs expense by determining Need expense and paid for protection amount, can determine and pay for reimbursement thresholding corresponding to protection amount.

With reference to first aspect, in one possible implementation, described according to the reimbursement thresholding and the drug favour People's rule determines that the corresponding reimbursement time limit of the target medicine includes: to determine the paid drug according to the drug Huimin rule Period and the free drug period；Determine that the target medicine period is corresponding using duration, the target medicine period is quantity For the sum of the paid drug period and free drug period；The mesh is determined according to the reimbursement thresholding and the use duration The corresponding reimbursement time limit of drug is marked, the reimbursement time limit is M times using duration, and M is the positive integer more than or equal to 1. By the period and the period for the drug given of the drug that the needs that determining Huimin rule defines are bought, determine that two kinds of periods are corresponding Total duration, in conjunction with the duration and paid for protection amount and can determine the corresponding reimbursement time limit of the target medicine.

With reference to first aspect, in one possible implementation, after the sending reimbursement abnormal prompt further include: root The prompt duration of the reimbursement abnormal prompt is determined according to the insured amount settlement request and the reimbursement time limit；Passing through the time After period of the length for the prompt duration, the reimbursement abnormal prompt is unlocked.By continue for one section in prompt Reimbursement abnormal prompt is released after duration, can make the available reimbursement of drug in normally Claims Resolution range.

With reference to first aspect, in one possible implementation, the method also includes: determine in the reimbursement period The corresponding maximum compensation amount of the interior target medicine；If the accumulative reimbursement is insured amount to be greater than the maximum compensation amount, Freeze or refuse the drug protection amount settlement request.It, can be to avoid mistake by determining maximum amount of the drug in a reimbursement Degree reimbursement, to prevent insurance fraud behavior.

With reference to first aspect, in one possible implementation, determination target within the reimbursement period The corresponding maximum amount of compensating of drug includes: according to the usage and dosage rule, single dosage and the drug Huimin Rule determines the corresponding paid Quantity of drugs of maximum of the target medicine described within the reimbursement period；It is that the maximum has by quantity The corresponding drug total amount of target medicine for repaying Quantity of drugs is determined as maximum of the target medicine within the reimbursement period Compensate amount.By determining that the amount of money corresponding to maximum Quantity of drugs with compensation and the drug by the quantity is determined as maximum compensation volume Degree guarantees the available reimbursement of drug in normally Claims Resolution range under the premise of avoiding excessively submitting an expense account.

With reference to first aspect, in one possible implementation, described according to the usage and dosage rule, single medication Dosage and the drug Huimin rule determine the corresponding maximum paid drug number of the target medicine described within the reimbursement period Amount includes: to determine the target medicine within the reimbursement period according to the single dosage and the usage and dosage rule Corresponding drug total quantity；It is determined according to the drug total quantity and the drug Huimin rule described within the reimbursement period The corresponding paid Quantity of drugs of maximum of target medicine.

Second aspect provides a kind of device of determining drug reimbursement Information abnormity, comprising:

Request module, for obtaining the drug protection amount settlement request for being directed to target medicine, the drug protection amount clearing Request includes identity information, the corresponding reimbursement information of the target medicine and the preset state user of preset state user Weight information and height information；

Protection amount compensates determining module, according to the identity information of the preset state user and reimbursement information determination Compensation protection amount and accumulative reimbursement of the preset state user within the reimbursement period of the target medicine are insured amount, it is described paid for it is insured amount and The accumulative reimbursement protection amount is the corresponding protection amount of the target medicine, the target in the corresponding period in reimbursement period The accumulative reimbursement protection amount of drug is not reset；

Body surface area determining module, for according to the weight information of the preset state user and height information determination The body surface area of preset state user；

Dosage determining module, for obtaining the usage and dosage rule of the target medicine, and according to the body surface face The long-pending and described usage and dosage rule determines the corresponding single dosage of the preset state user；

Thresholding amount determining module for obtaining the corresponding drug Huimin rule of the target medicine, and is protected according to having paid for Volume, drug Huimin rule and the single dosage determine the corresponding reimbursement thresholding of the target medicine, the report Pin thresholding be greater than or equal to it is described paid for protection amount, the drug Huimin rule is to buy the quantity of the target medicine to reach default Corresponding quantity of paid drug period after, give target medicine that quantity is corresponding quantity of preset free drug period to Preset state user, the drug period is for reflecting that user uses attainable treatment degree after drug；

Reimbursement time limit determining module, for determining the target medicine according to the reimbursement thresholding and the drug Huimin rule The corresponding reimbursement time limit of product, the reimbursement time limit are less than or equal to the reimbursement period；

Abnormal determining module, if for the drug protection amount settlement request within the reimbursement time limit corresponding time, Also, the accumulative reimbursement is insured amount to be greater than the reimbursement thresholding, it is determined that the drug protection amount settlement request has abnormal, sending Submit an expense account abnormal prompt.

The third aspect, provides another device for determining drug reimbursement Information abnormity, including processor, memory and logical Believe interface, the processor, memory and communication interface are connected with each other, wherein the communication interface is for receiving or sending number According to the device that the memory is used to store determining drug reimbursement Information abnormity executes the application code of the above method, institute State the method that processor is configured for executing above-mentioned first aspect.

Fourth aspect provides a kind of computer storage medium, and the computer storage medium is stored with computer program, institute Stating computer program includes program instruction, and described program instruction makes the processor execute above-mentioned first when being executed by a processor The method of aspect.

In the embodiment of the present invention, by judge currently submit an expense account whether be the drug given expense, be to give in determination Drug expenditure when, then issue abnormal prompt, can make be responsible for Claims Resolution personnel notice this abnormal conditions, so as to right The situation is verified, and insurance fraud is prevented, to a certain extent can be to avoid the additional Claims Resolution expenditure for increasing Medical Insurance Organizations.

Detailed description of the invention

It to describe the technical solutions in the embodiments of the present invention more clearly, below will be to needed in the embodiment Attached drawing is briefly described, it should be apparent that, drawings in the following description are only some embodiments of the invention, for ability For the those of ordinary skill of domain, without creative efforts, it can also be obtained according to these attached drawings other attached Figure.

Fig. 1 is a kind of flow diagram of the method for determining drug reimbursement Information abnormity that inventive embodiments provide；

Fig. 2 is the flow diagram of another method for determining drug reimbursement Information abnormity provided in an embodiment of the present invention；

Fig. 3 is a kind of composed structure signal of the device of determining drug reimbursement Information abnormity provided in an embodiment of the present invention Figure；

Fig. 4 is the composed structure signal of another device for determining drug reimbursement Information abnormity provided in an embodiment of the present invention Figure.

Specific embodiment

Following will be combined with the drawings in the embodiments of the present invention, and technical solution in the embodiment of the present invention carries out clear, complete Site preparation description, it is clear that the described embodiment is only a part of the embodiment of the present invention, instead of all the embodiments.Based on this Embodiment in invention, every other reality obtained by those of ordinary skill in the art without making creative efforts Example is applied, shall fall within the protection scope of the present invention.

The technical solution of the embodiment of the present invention is suitable for usage and dosage rule drug related with the body surface area of user Submit an expense account the detection of Information abnormity.

Before introducing the scheme of the embodiment of the present invention, first introduce the present embodiments relate to several concepts.

1, the concept in period is submitted an expense account

The reimbursement period refers to that the protection amount compensated within its corresponding period is accumulated, also, right by its After the period answered, the period reset to the protection amount is needed.In some possible implementations, the reimbursement period can be should The insurance period of the corresponding medical insurance of drug.For example, the insurance period of the corresponding medical insurance of the drug is 1 year, then submit an expense account Period is 1 year.

2, drug Huimin rule

(such as social security office defends for the manufacturer or related medical management organization that the corresponding drug Huimin rule of drug is manufacture drug Students management department etc.) for what the drug was formulated some preferential give medicine rule.Such as it buys one and present one, buy and three give one, buy five and give Three, etc..Wherein, drug Huimin rule can be to give unit with Quantity of drugs, be to give unit and refer to give with Quantity of drugs The drug sent by drug sell when measurement unit as unit of.For example, using bottle as measurement unit when drug is sold, then drug Huimin Rule gives one bottle to buy three bottles, buys five bottles and gives one bottle；For another example, using box as measurement unit when drug is sold, then drug Huimin is regular It can be to buy five boxes to give three boxes, buy five boxes and give box, etc..Drug Huimin rule can also be to give unit with the drug period, Unit is given with drug refer to refer to that the drug given with the drug period corresponding to the drug is single with the medication cycle of drug Position, the drug period is a period of time that can reflect using treatment degree attainable after drug.For example, can be reached using drug To treatment degree indicate that then drug Huimin rule is to buy for three periods and give a period with the period, bought for five periods and give a period；Again Such as, it is indicated using the attainable treatment degree of drug with the course for the treatment of, then drug Huimin rule is to buy five courses for the treatment of to give three courses for the treatment of, buys one The course for the treatment of gives course for the treatment of, etc..

2, the concept of thresholding and reimbursement time limit is submitted an expense account

Reimbursement door be limited to according to the usage and dosage rule of drug and drug give that rule determines for measuring accumulative compensation Pay it is insured amount whether reasonable expense thresholding.Reimbursement time limit is corresponding with reimbursement thresholding, and reimbursement time limit is the usage and dosage according to drug The period for giving the validity period for distinguishing the drug given that rule determines of rule and drug.When reimbursement time limit is corresponding Between the time span of section be less than or equal to the time span of reimbursement corresponding period in period.The reimbursement time limit corresponding time is report The initial time in pin period begins to pass through the time reached after the corresponding duration of the reimbursement time limit.

It illustrates to be illustrated to reimbursement thresholding and reimbursement time limit.Assuming that the rule of giving of drug is sent one week to buy the period Phase, according to a cycle when it is 2 months a length of, a cycle uses two box drugs, and the unit price of a box drug is 500 yuan.Then report Pin thresholding is the integral multiple that the expense of the drug of user at one's own expense is needed when user reaches the standard for giving drug, as (500*2) * 3*1, (500*2) * 3*2, (500*2) * 3*3, etc..Reimbursement time limit is corresponding with reimbursement thresholding, and reimbursement door, which is limited to reach, to be given The integral multiple for the time that the drug for needing the drug of user at one's own expense and increasing to send when drug can use, as 1*2* (3+1) * 1,2* 2* (3+1), etc..

It is a kind of process signal of the method for determining drug reimbursement Information abnormity that inventive embodiments provide referring to Fig. 1, Fig. 1 Figure, as shown, this method comprises:

S101, obtains the drug protection amount settlement request for being directed to target medicine, and the drug protection amount settlement request includes default The identity information of status user, the target medicine it is corresponding reimbursement information and the preset state user weight information and Height information.

Here, drug protection amount settlement request is the settlement request that healthcare structure is initiated, can be by receiving medical institutions The drug protection amount settlement request that checkout apparatus issues is to getting the drug protection amount settlement request, wherein medical institutions can be with Have for medical insurance fixed hospital, medical insurance fixed point pharmacy etc. and sells the qualification of drug to illness user and have with Medical Insurance Organizations The mechanism of cooperative relationship.

Target medicine is the drug defined in medical insurance clause in Claims Resolution range, that is, needs Medical Insurance Organizations will Its corresponding cost transfer to medical institutions account drug.

Preset state user refers to that illness needs to buy the user of the target medicine.The identity information of preset state user be with The relevant information of the personal identification for showing preset state user of preset state user's unique match.The preset state The identity information of user can for the ID card No. of preset state user, preset state user fingerprint feature information, The face feature information, etc. of preset state user.

Here, the weight information and height information of preset state user includes the height information and weight information of user.

S102 determines the preset state user according to the identity information of the preset state user and the reimbursement information The protection amount of compensation and accumulative reimbursement within the reimbursement period of the target medicine is insured amount, described to have paid for the insured amount and accumulative reimbursement Protection amount is the corresponding protection amount of the target medicine.

Here, the protection amount that the reimbursement period of target medicine compensates within its corresponding period is accumulated, also, In the period for after its corresponding period, needing to reset the protection amount.The reimbursement period is the corresponding doctor of the target medicine Treat the insurance period of insurance.For example, the insurance period of the corresponding medical insurance of the target medicine is 1 year, then the report of target medicine Selling the period is 1 year.

The insured amount expense to have compensated since the initial time in the reimbursement period for the target medicine is paid for, just Under reason condition (be not present insurance fraud behavior), this paid for it is insured amount be equal to can also be considered as preset state user within the reimbursement period Buy the expense that the target medicine has been spent.

In the specific implementation, can determine that the compensation within the reimbursement period is protected according to the identity information of preset state user Then volume determines the corresponding reimbursed sum of reimbursement information, which has been paid for protection amount with this With the accumulative reimbursement protection amount being determined as within the reimbursement period.

It in one possible implementation, can be each to preset shape according to the identity information of each preset state user State user individually creates one and compensates information to the drug of the various drugs of preset state user for storing to have compensated User compensates information data table.It can determine according to the identity information of preset state user and believe with the identity of preset state user It ceases corresponding user and compensates information data table, it is corresponding then to obtain the target medicine from user compensation information data table It pays for insured amount, determines it as within the reimbursement period of the target medicine that the preset state user is corresponding to have paid for protection amount.

For example, current one shares 10000 users and compensates information data tables, respectively user compensate information data table 1~ 10000, user compensates information data table 1~10000 and respectively corresponds identity information 1~10000, the identity of preset state user Information is identity information 100, then user corresponding with identity information 100 is compensated information data table 100 and be determined as the default shape The corresponding user of state user compensates information data table.It is as shown in table 1 that user compensates information data table 100:

Claims Resolution drug	Protection amount is paid for
		Drug 1	Protection amount 1 is paid for
Drug 2	Protection amount 2 is paid for
		…	…

Table 1

Assuming that target medicine is drug 2, it is determined that the corresponding protection amount 2 of having paid for of drug 2 is in the reimbursement of target medicine week The preset state user is corresponding in phase has paid for protection amount.

It can be that every kind of drug creates one according to the medicine information of every kind of drug in alternatively possible implementation Information data table is compensated to the drug of the compensation information of each preset state user for storing to have compensated.According to the target medicine Product can determine that the corresponding drug of the target medicine compensates information data table, then compensated from the drug obtained in information data table with The identity information of preset state user is corresponding to have paid for protection amount, is determined the reimbursement in the target medicine in the target medicine The preset state user is corresponding in period has paid for protection amount.

For example, the drug in Claims Resolution range has 1000 kinds, then drug compensates information data table one and shares 1000, respectively Information data table 1~1000 is compensated for drug, respectively corresponds drug 1~1000.Assuming that the target medicine is drug 125, then Drug corresponding with drug 125 compensates information data table 125 and is determined as the corresponding drug compensation information data table of the target medicine, It is as shown in table 2 that drug compensates information data table 125:

User	Protection amount is paid for
		User 1	Protection amount 1 is paid for
User 2	Protection amount 2 is paid for
		…	…

Table 2

Assuming that preset state user is user 1, it is determined that the corresponding protection amount 1 of having paid for of user 1 is in the report of the target medicine The preset state user is corresponding in the pin period has paid for protection amount.

S103 determines the body of the preset state user according to the weight information of the preset state user and height information Surface area.

In the embodiment of the present invention, body surface area can be obtained by the calculation formula of body surface area, wherein the meter of body surface area Calculating formula can be with are as follows: body surface area=0.0061* height information (unit: centimetre)+0.0128* weight information (unit: kilogram)- 0.1529。

S104, obtains the usage and dosage rule of the target medicine, and is used according to the body surface area and the usage Gauge then determines the corresponding single dosage of the preset state user.

Here, the usage and dosage rule of target medicine refer to the use interval of the target medicine and with body surface area be The unit dosage of medication unit.Wherein, the use interval of target medicine refers to twice using between the time of the drug Time interval, and refer to the unit bodies that the drug is intended for single use by the unit dosage of medication unit of body surface area The dosage of surface area.For example, target medicine is recombinant human vascular endothelial inhibin, recombinant human vascular endothelial inhibin is corresponding to be made With rule at 1-14 day for the treatment of cycle, daily medication was primary, continuous use 14 days, rest one week was further continued for next week Phase treatment.Its unit dosage using body surface area as medication unit is 7.5 milligrams of every body surface areas.

In the specific implementation, can be according to the body surface face of the target medicine corresponding unit dosage and preset state user Product determines that the corresponding single dosage of preset state user, the single dosage are equal to the unit dosage and the body The product of surface area.For example, target medicine is recombinant human vascular endothelial inhibin, the corresponding use of recombinant human vascular endothelial inhibin Dosage is 7.5 milligrams of every body surface areas, and the body surface area of preset state user is 0.8, it is determined that preset state user is corresponding Single dosage is 7.5*0.8=6 milligrams.

S105 obtains the corresponding drug Huimin rule of the target medicine, and advises according to insured amount, described drug Huimin has been paid for Then and the single dosage determines that the corresponding reimbursement thresholding of the target medicine, the reimbursement thresholding are greater than or equal to institute It states and has paid for protection amount, the drug Huimin rule is to buy the quantity of the target medicine to reach preset paid drug period corresponding Quantity after, giving quantity is that the target medicine of corresponding quantity of preset free drug period gives preset state user, drug Period is for reflecting that user uses attainable treatment degree after drug.

In the embodiment of the present invention, drug Huimin rule is to give unit with the drug period, is to give unit with the drug period Drug Huimin rule can be found in foregoing description.The paid drug period is when reaching this drug Huimin rule is corresponding to give standard The drug for needing user the to buy at one's own expense corresponding drug period.For example, drug Huimin rule is to buy three courses for the treatment of to send a course for the treatment of, then have Repaying the drug period is 3 courses for the treatment of.The free drug period be given when reaching this drug Huimin rule is corresponding to give standard to The drug at the family corresponding drug period.For example, drug Huimin rule is to buy three courses for the treatment of to send a course for the treatment of, then the free drug period is one A course for the treatment of.

In the embodiment of the present invention, according to having paid for, insured amount, drug Huimin is regular and single dosage determines target medicine Corresponding reimbursement thresholding can be with are as follows: determines the paid drug period according to drug Huimin rule；According to paid drug period and single Dosage determines the corresponding paid Quantity of drugs of target medicine；Determine that the first expense, the first expense are that quantity is paid drug The corresponding drug total cost of the target medicine of quantity；According to having paid for insured amount with the first expense and determined the corresponding reimbursement door of target medicine Limit, the corresponding reimbursement door of target medicine are limited to N times of the first expense, and N is the positive integer more than or equal to 1.

In one possible implementation, the case where it is to immobilize that each drug period is using the number of drug Under, it can be according to the rule of number, the target medicine in a target medicine corresponding drug period using the target medicine Lattice and the single dosage determine the quantity of the target medicine within a drug period, by the mesh in a drug period It marks the quantity of drug and the paid drug period product rounds up after counting and is determined as paid Quantity of drugs.

For example, target medicine is recombinant human vascular endothelial inhibin, the specification of recombinant human vascular endothelial inhibin is 15 millis Gram/, the paid drug period of recombinant human vascular endothelial inhibin were 3 periods, and a cycle uses 14 target medicines, single Dosage is 7.5*0.8=6 milligrams.Then determine one the drug period target medicine quantity be 14*6/15=5.6 Bottle, determines that the corresponding paid Quantity of drugs of target medicine isBottle.

In alternatively possible implementation, in the case where it is variable that each drug period is using the number of drug, It can determine that the number of target medicine target medicine in each drug period in the paid drug period determines respectively to be somebody's turn to do Target medicine within the paid drug period use the target medicine total degree, then according to the specification of the target medicine with And the single dosage determines the paid Quantity of drugs in the paid drug period.

For example, the target medicine is recombinant human vascular endothelial inhibin, the specification of recombinant human vascular endothelial inhibin is 15 Milligram/, the paid drug period of recombinant human vascular endothelial inhibin was 3 periods, and single dosage is 7.5*0.8=6 milli Gram, wherein first course for the treatment of is needed using 10 target medicines, and second course for the treatment of is needed using 14 drugs, third The course for the treatment of is needed using 12 drugs, it is determined that Quantity of drugs is with compensation

In the specific implementation, the unit price of the target medicine can be determined, by unit price and the paid drug number of the target medicine The product of amount is determined as the first expense, and N times of the first expense is then determined since N=1, by N times of the first expense and has paid for protection amount It is compared, has paid for N times of insured amount the first expense until finding to be greater than or equal to, this is greater than or equal to 1 and has paid for insured amount N times First expense is determined as the corresponding reimbursement thresholding of target medicine.For example, having paid for insured amount is 2000, determine that paid Quantity of drugs is 3, First expense is 500*3=1500.When N=1, N times of the first expense is 1500, since 1500 less than 2000, by N=2, when N=2 N times of the first expense is 3000, then is determined as the corresponding reimbursement thresholding of target medicine for 3000.

S106, when determining the corresponding reimbursement of the target medicine according to the reimbursement thresholding and the drug Huimin rule Limit, the reimbursement time limit are less than or equal to the reimbursement period.

In the embodiment of the present invention, determine that the corresponding reimbursement time limit of target medicine can according to reimbursement thresholding and drug Huimin rule With are as follows: paid drug period and free drug period are determined according to drug Huimin rule；Determining the target medicine period corresponding makes With duration, the target medicine period is that quantity is the sum of paid drug period and free drug period；According to reimbursement thresholding and use Duration determines that the corresponding reimbursement time limit of target medicine, reimbursement time limit are using M times of duration, and M is just whole more than or equal to 1 Number.

In one possible implementation, it is fixed at the use interval of drug and each drug period uses drug In the case that number immobilizes, the target medicine period corresponding mode using duration can be determined according to usage and dosage rule Are as follows: according to the use for the number and the target medicine for using the target medicine in a target medicine corresponding drug period It is spaced and determines that a drug period is corresponding using duration, which is determined as target medicine The product period it is corresponding use duration.For example, using the number of the target medicine in a course for the treatment of is 2 times, which makes It is divided into 8 weeks with, the paid drug period is 2 courses for the treatment of, and the free drug period is 1 course for the treatment of, it is determined that a drug period pair A length of 2*8=16 weeks when the use answered, a length of 16* (2+1)=48 week when the corresponding use of target medicine period is determined.

It in alternatively possible implementation, is not fixed at the use interval of drug, alternatively, each drug period uses In the unfixed situation of the number of drug, when can determine respectively the corresponding use of each drug period according to usage and dosage rule It is long, each drug period corresponding be determined as the target medicine period using the sum of duration and corresponding use duration.For example, paid The drug period is 2 courses for the treatment of, and the free drug period is 1 course for the treatment of, wherein it is 5 weeks a length of when the corresponding use of first course for the treatment of, the 3 weeks a length of when the corresponding use of two courses for the treatment of, when third course for the treatment of corresponding use, is 1 week a length of, it is determined that the target medicine period A length of 9 weeks when corresponding use.

In the specific implementation, it is corresponding to calculate the target medicine period according to the usage and dosage rule of target medicine in advance The target medicine period corresponding duration is stored in advance duration, is determining that reimbursement door prescribes a time limit, is determining target medicine according to the duration The corresponding reimbursement time limit of product.

In the specific implementation, can determine that the reimbursement thresholding and quantity are the corresponding drug of the target medicine of paid Quantity of drugs The ratio of total cost (i.e. the first expense), is determined as the ratio for M, is determined as reimbursement time limit using duration for M times.

For example, reimbursement door is limited to 3000, quantity is that the corresponding drug total cost of target medicine of paid Quantity of drugs is 1500, it is determined that ratio 2 is then determined as reimbursement time limit using duration for 2 times.

S107, it is also, described accumulative if the drug protection amount settlement request is within the reimbursement time limit corresponding time Reimbursement is insured amount to be greater than the reimbursement thresholding, it is determined that the drug protection amount settlement request has exception, issues reimbursement abnormal prompt.

Here, insured amount settlement request refers to since the initial time in the reimbursement period within the reimbursement time limit corresponding time It is less than the reimbursement time limit to the time span between time when getting the drug protection amount settlement request.For example, the reimbursement period Initial time be 00:00:00 on January 1st, 2018, reimbursement time limit be 140 days, then the reimbursement time limit corresponding time be 2018 May 22 00:00:00, if drug protection amount settlement request be 00:00:00 on May 22nd, 2018 before get, the drug Insured amount settlement request meets reimbursement time limit, otherwise, is then unsatisfactory for reimbursement time limit.

In the specific implementation, report can be issued by prompting modes such as auditory tone cues, page pop-up prompt, distinguishing mark prompts Sell abnormal prompt.

In a further implementation, it is determining that the drug protection amount settlement request deposits when abnormal, can also extend, alternatively, temporarily Stop, alternatively, freezing the corresponding Claims Resolution operation of the drug protection amount settlement request.Wherein, Claims Resolution operation is that the reimbursement information is corresponding Reimbursed sum transfer initiate the drug protection amount settlement request medical institutions account in.

Optionally, if the drug protection amount settlement request is not within the reimbursement time limit corresponding time, alternatively, the accumulative report Pin is insured amount to be less than the reimbursement thresholding, then Claims Resolution operation is carried out according to normal process, by the corresponding reimbursement business of the reimbursement information Data are transferred into the business datum account of the corresponding medical institutions of drug protection amount settlement request, i.e., the reimbursement information is corresponding Reimbursed sum is transferred in the account for initiating the medical institutions of the drug protection amount settlement request.

In a further implementation, by the corresponding reimbursed sum of reimbursement information transfer initiate the drug protection amount clearing ask After in the account of the medical institutions asked, this can be paid for protection amount and be revised as the accumulative reimbursement protection amount.

In the embodiment of the present invention, reimbursement time limit when by the accumulative reimbursement protection amount to target medicine and settling accounts is sentenced It is disconnected, it can determine whether the accumulative compensation protection amount of the target medicine alreadys exceed the thresholding amount of reimbursement, and determine clearing Whether the time is in the validity period using the drug given, when the accumulative compensation protection amount of target medicine is more than the thresholding volume of reimbursement It spends and when time for settling accounts is in the validity period for the drug given, illustrate that the reimbursement of this part may submit an expense account is the medicine given The expense of product, issuing reimbursement abnormal prompt can make the personnel for being responsible for Claims Resolution notice this abnormal conditions, so as to this Situation is verified, and insurance fraud is prevented, to a certain extent can be to avoid the additional Claims Resolution expenditure for increasing Medical Insurance Organizations.

In some possible scenes, in the reimbursement period longer situation of target medicine, when preset state, user makes It when being finished the drug given, needs to continue drug purchase, the drug for continuing purchase can be submitted an expense account, and therefore, issue After submitting an expense account abnormal prompt, the reimbursement abnormal prompt can be released after a certain time, to facilitate preset state user can be with Continue to buy and normally submit an expense account.Referring to fig. 2, Fig. 2 is another determining drug reimbursement Information abnormity provided in an embodiment of the present invention Method flow diagram, as shown in the figure, which comprises

S201, obtains the drug protection amount settlement request for being directed to target medicine, and the drug protection amount settlement request includes default The identity information of status user, the target medicine it is corresponding reimbursement information and the preset state user weight information and Height information.

S202 determines the preset state user according to the identity information of the preset state user and the reimbursement information The protection amount of compensation and accumulative reimbursement within the reimbursement period of the target medicine is insured amount, described to have paid for the insured amount and accumulative reimbursement Protection amount is the corresponding protection amount of the target medicine.

S203 determines the body of the preset state user according to the weight information of the preset state user and height information Surface area.

S204, obtains the usage and dosage rule of the target medicine, and is used according to the body surface area and the usage Gauge then determines the corresponding single dosage of the preset state user.

S205 obtains the corresponding drug Huimin rule of the target medicine, and advises according to insured amount, described drug Huimin has been paid for Then and the single dosage determines that the corresponding reimbursement thresholding of the target medicine, the reimbursement thresholding are greater than or equal to institute It states and has paid for protection amount, the drug Huimin rule is to buy the quantity of the target medicine to reach preset paid drug period corresponding Quantity after, giving quantity is that the target medicine of corresponding quantity of preset free drug period gives preset state user, drug Period is for reflecting that user uses attainable treatment degree after drug.

S206, when determining the corresponding reimbursement of the target medicine according to the reimbursement thresholding and the drug Huimin rule Limit, the reimbursement time limit are less than or equal to the reimbursement period.

S207, it is also, described accumulative if the drug protection amount settlement request is within the reimbursement time limit corresponding time Reimbursement is insured amount to be greater than the reimbursement thresholding, it is determined that the drug protection amount settlement request has exception, issues reimbursement abnormal prompt.

Here, the specific implementation of step S201~S207 can refer to the description of step S101~S107, herein no longer It repeats.

S208 determines that the prompt of the reimbursement abnormal prompt continues according to the insured amount settlement request and the reimbursement time limit Duration.

In the embodiment of the present invention, determine that the prompt of reimbursement abnormal prompt is held according to drug protection amount settlement request and reimbursement time limit The mode of continuous duration are as follows: according between the initial time of time and the reimbursement period when getting the drug protection amount settlement request Duration, the difference between the reimbursement time limit and the duration is determined into the prompt duration.

For example, the initial time in reimbursement period is 00:00:00 on January 1st, 2018, reimbursement time limit is 140 days, is got The time of the drug protection amount settlement request is on 2 1st, 2018 00:00:00, it is determined that gets the drug protection amount settlement request When time and the reimbursement period initial time between when it is 31 days a length of, it is determined that prompt duration be 140-31= 109 days.

S209 unlocks the reimbursement and mentions extremely after passing through the period that time span is the prompt duration Show.

In the specific implementation, the reimbursement abnormity prompt can be released by modes such as removal abnormal marking, auditory tone cues.

In a further implementation, it can release and the corresponding Claims Resolution operation of drug protection amount settlement request is freezed, execute The drug protection amount settlement request and the corresponding reimbursement information of the target medicine is settled accounts, i.e., it is the reimbursement information is corresponding Reimbursed sum is transferred in the account for initiating the medical institutions of the drug protection amount settlement request.

In the embodiment of the present invention, determined drug protection amount settlement request there are exception and have issued reimbursement abnormal prompt it Afterwards, it determines that reimbursement abnormal prompt needs lasting duration, is continuing to have prompted to contact the abnormal prompt after the duration, may make The available normal reimbursement of drug in normal Claims Resolution range.

In some possible embodiments, it in above-mentioned embodiment of the method shown in fig. 1 or fig. 2, can also determine The corresponding maximum compensation amount of the target medicine in the reimbursement period；If the accumulative reimbursement is insured amount greater than the maximum compensation volume Degree, then freeze or refuse the drug protection amount settlement request.

In one possible implementation, determining that maximum within the reimbursement period of target medicine compensates amount can be with are as follows: Determine that maximum of the target medicine within the reimbursement period has according to usage and dosage rule, single dosage and drug Huimin rule Repay Quantity of drugs；The corresponding drug total cost of target medicine that quantity is maximum paid Quantity of drugs is determined as the target medicine Maximum compensation amount of the product within the reimbursement period.

Specifically, determine that target medicine is being reported according to usage and dosage rule, single dosage and drug Huimin rule Sell the concrete mode of the paid Quantity of drugs of maximum in the period are as follows: determine at this according to usage and dosage rule and single dosage Submit an expense account the corresponding drug total quantity of the target medicine in the period；According to the drug total quantity, the drug Huimin rule and the list Secondary dosage determines the corresponding paid Quantity of drugs of maximum of the target medicine within the reimbursement period.

In the specific implementation, can determine the use time of the target medicine within the reimbursement period according to the usage and dosage rule Number；The total quantity of the drug is determined according to the specification of the access times, the single dosage and the target medicine.

For example, the reimbursement period is 1 year, target medicine is injection infliximab, and target medicine is injection English husband It is divided between the anti-use in sharp Xidan 0 week, 2 weeks, 6 weeks, in (6+8) week, (6+16 weeks) ..., (6+8n) was all, the Xidan injection Ying Fuli Anti- single dosage is 250 milligrams, and the specification of injection infliximab is 100 milligrams/bottle, injection Ying Fulixi The drug Huimin rule of monoclonal antibody is to buy three courses for the treatment of to send a course for the treatment of, and each course for the treatment of uses the drug 1 time, then according to usage and dosage Rule, which determines, to be needed in 1 year using the injection infliximab to be 8 times, determines that maximum Quantity of drugs is 250*8/100= 20, maximum paid Quantity of drugs is [20/ (250*4/100)] *

By determining that the amount of money corresponding to maximum Quantity of drugs with compensation and the drug by the quantity is determined as maximum compensation volume Degree guarantees the available reimbursement of drug in normally Claims Resolution range under the premise of avoiding excessively submitting an expense account.

The method of inventive embodiments is described above, the device of inventive embodiments is described below.

It is a kind of composition knot of the device of determining drug reimbursement Information abnormity provided in an embodiment of the present invention referring to Fig. 3, Fig. 3 Structure schematic diagram, the device 30 include:

Request module 301, for obtaining the drug protection amount settlement request for being directed to target medicine, the drug protection amount knot The identity information that request includes preset state user, the corresponding reimbursement information of the target medicine and the preset state is calculated to use The weight information and height information at family；

Protection amount compensate determining module 302, for according to the preset state user identity information and the reimbursement information Determine that compensation protection amount and accumulative reimbursement of the preset state user within the reimbursement period of the target medicine are insured amount, it is described Paying for insured amount is the corresponding protection amount of the target medicine with the accumulative reimbursement protection amount, in the corresponding period in reimbursement period The accumulative reimbursement protection amount of the target medicine is not reset；

Body surface area determining module 303, for being determined according to the weight information and height information of the preset state user The body surface area of the preset state user；

Dosage determining module 304, for obtaining the usage and dosage rule of the target medicine, and according to the body surface Area and the usage and dosage rule determine the corresponding single dosage of the preset state user；

Thresholding amount determining module 305, for obtaining the target medicine corresponding drug Huimin rule, and according to having paid for The insured amount and described drug Huimin rule determines that the corresponding reimbursement thresholding of the target medicine, the reimbursement thresholding are greater than or equal to Described to have paid for protection amount, the drug Huimin rule is to buy the quantity of the target medicine to reach the preset paid drug period pair After the quantity answered, giving quantity is that the target medicine of corresponding quantity of preset free drug period gives preset state user, medicine The product period is for reflecting that user uses attainable treatment degree after drug；

Reimbursement time limit determining module 306, for determining the mesh according to the reimbursement thresholding and the drug Huimin rule The corresponding reimbursement time limit of drug is marked, the reimbursement time limit is less than or equal to the reimbursement period；

Abnormal determining module 307, if for the drug protection amount settlement request in the reimbursement time limit corresponding time It is interior, also, the accumulative reimbursement is insured amount greater than the reimbursement thresholding, it is determined that and there is exception in the drug protection amount settlement request, Issue reimbursement abnormal prompt.

In a kind of possible design, the body surface area determining module 303 is specifically used for: being used according to the preset state Weight information, the height information and the body surface area calculation formula at family determine the body surface area of the preset state user；

Wherein, the body surface area calculation formula are as follows:

Body surface area=a* height+b* weight-c, the unit of the height is centimetre, and the unit of the weight is kilogram, A, b, c are constant.

In a kind of possible design, the dosage determining module 304 is specifically used for:

Determine in usage and dosage rule using body surface area as the unit dosage of medication unit；

The unit dosage and the product of the body surface area are determined as the corresponding single of the preset state user Dosage.

In a kind of possible design, the thresholding amount determining module 305 is specifically used for:

The paid drug period is determined according to the drug Huimin rule；

The corresponding paid drug of the target medicine is determined according to the paid drug period and the single dosage Quantity；

Determine that the first expense, first expense are the corresponding drug of target medicine that quantity is the paid Quantity of drugs Total cost；

Insured amount the corresponding reimbursement thresholding of the target medicine, the target are determined with first total value according to described paid for The corresponding reimbursement door of drug is limited to N times of the first expense, and N is the positive integer more than or equal to 0.

In a kind of possible design, the reimbursement time limit determining module 306 is specifically used for:

The paid drug period and the free drug period are determined according to the drug Huimin rule；

Determine that the target medicine period is corresponding using duration, the target medicine period is that quantity is the paid drug week The sum of phase and free drug period；

The corresponding reimbursement time limit of the target medicine, the reimbursement are determined according to the reimbursement thresholding and the use duration When be limited to M times using duration, M is the positive integer more than or equal to 1.

In a kind of possible design, described device 30 further include:

Duration determining module 308, for determining the report according to the insured amount settlement request and the reimbursement time limit Sell the prompt duration of abnormal prompt；

Abnormal prompt release module 309, for by time span be it is described prompt duration period after, Unlock the reimbursement abnormal prompt.

In a kind of possible design, described device 30 further include:

Maximum amount determining module 310, for determining the corresponding maximum compensation of the target medicine described within the reimbursement period Pay amount；

Request refusal module 311, if being greater than the maximum compensation amount for the accumulative reimbursement to be insured amount, freeze or Refuse the drug protection amount settlement request.

In a kind of possible design, the maximum amount determining module 310 is specifically used for:

It is determined according to the usage and dosage rule, single dosage and the drug Huimin rule in the reimbursement week The corresponding paid Quantity of drugs of maximum of the target medicine in phase；

The corresponding drug total amount of target medicine that quantity is the maximum paid Quantity of drugs is determined as the target Maximum compensation amount of the drug within the reimbursement period.In a kind of possible design, the maximum amount determining module 310 It is specifically used for:

The target medicine described within the reimbursement period is determined according to the single dosage and the usage and dosage rule The corresponding drug total quantity of product；

The target medicine within the reimbursement period is determined according to the drug total quantity and the drug Huimin rule The corresponding paid Quantity of drugs of maximum.

It should be noted that unmentioned content can be found in the description of embodiment of the method in the corresponding embodiment of Fig. 3, here It repeats no more.

In the embodiment of the present invention, determine that the device of drug reimbursement Information abnormity is insured amount by the accumulative reimbursement to target medicine And time when clearing is judged, can determine whether the accumulative compensation protection amount of the target medicine alreadys exceed the door of reimbursement Limit degree, and determine whether the time of clearing is in the validity period using the drug given, when the accumulative compensation of target medicine When paying in the insured amount validity period for being in the drug given more than the time of the thresholding amount submitted an expense account and clearing, illustrate that this part is reported What pin may be submitted an expense account is the expense for the drug given, and it is this that sending reimbursement abnormal prompt can be such that the personnel for being responsible for Claims Resolution notice Abnormal conditions prevent insurance fraud so as to verify the situation, can increase medical treatment guarantor to a certain extent to avoid additional The Claims Resolution of dangerous mechanism is paid.

Referring to fig. 4, Fig. 4 is the composition of another device for determining drug reimbursement Information abnormity provided in an embodiment of the present invention Structural schematic diagram, the device 40 include processor 401, memory 402 and communication interface 403.Processor 401 is connected to storage Device 402 and communication interface 403, such as processor 401 can be connected to memory 402 and communication interface 403 by bus.

Processor 401 is configured as that the device of the determining drug reimbursement Information abnormity is supported to execute described in Fig. 1 or Fig. 2 Determine corresponding function in the method for drug reimbursement Information abnormity.The processor 401 can be central processing unit (central Processing unit, CPU), network processing unit (network processor, NP), hardware chip or any combination thereof. Above-mentioned hardware chip can be specific integrated circuit (application specific integrated circuit, ASIC), Programmable logic device (programmable logic device, PLD) or combinations thereof.Above-mentioned PLD can be complex programmable Logical device (complex programmable logic device, CPLD), field programmable gate array (field- Programmable gate array, FPGA), Universal Array Logic (generic array logic, GAL) or its any group It closes.

402 memory of memory is for storing program code etc..Memory 402 may include volatile memory (volatile memory, VM), such as random access memory (random access memory, RAM)；Memory 402 It may include nonvolatile memory (non-volatile memory, NVM), such as read-only memory (read-only Memory, ROM), flash memory (flash memory), hard disk (hard disk drive, HDD) or solid state hard disk (solid-state drive, SSD)；Memory 402 can also include the combination of the memory of mentioned kind.The present invention is implemented In example, memory 402 is used to store the usage and dosage rule of target medicine, and the corresponding drug Huimin rule of target medicine has been paid for Protection amount etc..

The communication interface 403 is for sending or receiving data.

Processor 401 can call said program code to execute following operation:

The drug protection amount settlement request for being directed to target medicine is obtained by communication interface 403, the drug protection amount clearing are asked Ask the corresponding reimbursement information of identity information including preset state user, the target medicine and the preset state user Weight information and height information；

It should be noted that the realization of each operation can also correspond to referring to Fig.1 or the phase of embodiment of the method shown in Fig. 2 It should describe；The processor 401 can also cooperate other operations executed in above method embodiment with communication interface 403.

The embodiment of the present invention also provides a kind of computer storage medium, and the computer storage medium is stored with computer journey Sequence, the computer program include program instruction, and described program instruction executes the computer such as Method described in previous embodiment, the computer can be the one of the device of determination drug reimbursement Information abnormity mentioned above Part.For example, above-mentioned processor 401.

Those of ordinary skill in the art will appreciate that realizing all or part of the process in above-described embodiment method, being can be with Relevant hardware is instructed to complete by computer program, the program can be stored in a computer-readable storage medium In, the program is when being executed, it may include such as the process of the embodiment of above-mentioned each method.Wherein, the storage medium can be magnetic Dish, CD, read-only memory (Read-Only Memory, ROM) or random access memory (Random Access Memory, RAM) etc..

The above disclosure is only the preferred embodiments of the present invention, cannot limit the right model of the present invention with this certainly It encloses, therefore equivalent changes made in accordance with the claims of the present invention, is still within the scope of the present invention.

Claims

1. a kind of method of determining drug reimbursement Information abnormity characterized by comprising

The drug protection amount settlement request for being directed to target medicine is obtained, the drug protection amount settlement request includes preset state user The corresponding reimbursement information of identity information, the target medicine and the weight information and height information of the preset state user；

Determine the preset state user in the mesh according to the identity information of the preset state user and the reimbursement information The protection amount of compensation submitted an expense account in the period and the accumulative reimbursement for marking drug are insured amount, and protection amount and the accumulative reimbursement protection amount of having paid for is The corresponding protection amount of the target medicine, the accumulative reimbursement protection amount of the target medicine is not in the corresponding period in reimbursement period It resets；

The body surface area of the preset state user is determined according to the weight information of the preset state user and height information；

The usage and dosage rule of the target medicine is obtained, and is determined according to the body surface area and the usage and dosage rule The corresponding single dosage of the preset state user；

Obtain the target medicine corresponding drug Huimin rule, and according to having paid for insured amount, the described drug Huimin rule and institute It states single dosage and determines that the corresponding reimbursement thresholding of the target medicine, the reimbursement thresholding have paid for guarantor more than or equal to described Volume, the drug Huimin rule are to buy the quantity of the target medicine to reach corresponding quantity of preset paid drug period Afterwards, it gives the target medicine that quantity is corresponding quantity of preset free drug period and gives preset state user, the drug period is used Attainable treatment degree after drug is used in reflection user；

The corresponding reimbursement time limit of the target medicine, the reimbursement are determined according to the reimbursement thresholding and the drug Huimin rule Time limit is less than or equal to the reimbursement period；

If the drug protection amount settlement request is within the reimbursement time limit corresponding time, also, the accumulative reimbursement is insured amount Greater than the reimbursement thresholding, it is determined that the drug protection amount settlement request has abnormal, sending reimbursement abnormal prompt.

2. the method according to claim 1, wherein the weight information according to the preset state user and Height information determines the body surface area of the preset state user, comprising:

It is determined according to the weight information, the height information and body surface area calculation formula of the preset state user described pre- If the body surface area of status user；

Wherein, the body surface area calculation formula are as follows:

Body surface area=a* height+b* weight-c, the unit of the height be centimetre, and the unit of the weight is kilogram a, b, c It is constant.

3. the method according to claim 1, wherein described according to the body surface area and the usage and dosage Rule determines that the corresponding single dosage of the preset state user includes:

The unit dosage and the product of the body surface area are determined as the corresponding single medication of the preset state user Dosage.

4. the method according to claim 1, wherein the basis paid for insured amount, the described drug Huimin rule with And the single dosage determines that the corresponding reimbursement thresholding of the target medicine includes:

The paid drug period is determined according to the drug Huimin rule；

The corresponding paid Quantity of drugs of the target medicine is determined according to the paid drug period and the single dosage；

Determine that the first expense, first expense are the total expense of the corresponding drug of target medicine that quantity is the paid Quantity of drugs With；

Insured amount the corresponding reimbursement thresholding of the target medicine, the target medicine are determined with first total value according to described paid for Corresponding reimbursement door is limited to N times of the first expense, and N is the positive integer more than or equal to 0.

5. the method according to claim 1, wherein described advise according to the reimbursement thresholding and the drug Huimin Then determine that the corresponding reimbursement time limit of the target medicine includes:

Determine that the target medicine period is corresponding using duration, the target medicine period is the paid drug period and free medicine The sum of product period；

The corresponding reimbursement time limit of the target medicine, the reimbursement time limit are determined according to the reimbursement thresholding and the use duration For M times using duration, M is the positive integer more than or equal to 1.

6. method according to claim 1-5, which is characterized in that also wrapped after the sending reimbursement abnormal prompt It includes:

The prompt duration of the reimbursement abnormal prompt is determined according to the insured amount settlement request and the reimbursement time limit；

After passing through the period that time span is the prompt duration, the reimbursement abnormal prompt is unlocked.

7. method according to claim 1-5, which is characterized in that the method also includes:

Determine the corresponding maximum compensation amount of the target medicine described within the reimbursement period；

If the accumulative reimbursement is insured amount to be greater than the maximum compensation amount, freezes or refuse the drug protection amount clearing and ask It asks.

8. a kind of device of determining drug reimbursement Information abnormity characterized by comprising

Request module, for obtaining the drug protection amount settlement request for being directed to target medicine, the drug protection amount settlement request The body of the corresponding reimbursement information of identity information, the target medicine including preset state user and the preset state user Weight information and height information；

Protection amount compensates determining module, is determined according to the identity information of the preset state user and the reimbursement information described default Compensation protection amount and accumulative reimbursement of the status user within the reimbursement period of the target medicine are insured amount, it is described paid for it is insured amount and described Accumulative reimbursement protection amount is the corresponding protection amount of the target medicine, the target medicine in the corresponding period in reimbursement period Accumulative reimbursement protection amount do not reset；

Body surface area determining module determines described default for the weight information and height information according to the preset state user The body surface area of status user；

Dosage determining module, for obtain the target medicine usage and dosage rule, and according to the body surface area with And the usage and dosage rule determines the corresponding single dosage of the preset state user；

Thresholding amount determining module, for obtaining the target medicine corresponding drug Huimin rule, and according to having paid for insured amount, institute It states drug Huimin rule and the single dosage determines the corresponding reimbursement thresholding of the target medicine, the reimbursement thresholding Protection amount has been paid for more than or equal to described, and the drug Huimin rule is to buy the quantity of the target medicine to reach preset paid After drug period corresponding quantity, target medicine that quantity is corresponding quantity of preset free drug period is given to default shape State user, the drug period is for reflecting that user uses attainable treatment degree after drug；

Reimbursement time limit determining module, for determining the target medicine pair according to the reimbursement thresholding and the drug Huimin rule The reimbursement time limit answered, the reimbursement time limit are less than or equal to the reimbursement period；

Abnormal determining module, if for the drug protection amount settlement request within the reimbursement time limit corresponding time, also, The accumulative reimbursement is insured amount to be greater than the reimbursement thresholding, it is determined that the drug protection amount settlement request has abnormal, sending reimbursement Abnormal prompt.

9. a kind of device of determining drug reimbursement Information abnormity, including processor, memory and communication interface, the processing Device, memory and communication interface are connected with each other, wherein the communication interface is used for transmission data, and the memory is for storing Program code, the processor execute the method according to claim 1 to 7 for calling said program code.

10. a kind of computer storage medium, which is characterized in that the computer storage medium is stored with computer program, described Computer program includes program instruction, and described program instruction makes the processor execute such as claim when being executed by a processor The described in any item methods of 1-7.