CN110148004A - Drug price discrimination method, device, computer equipment and storage medium - Google Patents
Drug price discrimination method, device, computer equipment and storage medium Download PDFInfo
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- CN110148004A CN110148004A CN201910270815.4A CN201910270815A CN110148004A CN 110148004 A CN110148004 A CN 110148004A CN 201910270815 A CN201910270815 A CN 201910270815A CN 110148004 A CN110148004 A CN 110148004A
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- G—PHYSICS
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- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
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- G06Q30/02—Marketing; Price estimation or determination; Fundraising
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- G06Q30/02—Marketing; Price estimation or determination; Fundraising
- G06Q30/0283—Price estimation or determination
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- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
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Abstract
The embodiment of the invention discloses a kind of drug price discrimination method, device, computer equipment and storage mediums, wherein the described method includes: obtaining Historical medical's bill from presetting database and parsing to it；The pricing information of all drugs in Historical medical's bill is obtained according to parsing result；The corresponding price data collection of each drug is formed according to acquired pricing information；It is fitted using price data collection of the Gaussian distribution model to each drug, to obtain the reasonable price section of each drug according to fitting result；If receiving Claims Resolution request, the Claims Resolution drug price in current Claims Resolution bill is determined according to the current Claims Resolution bill in the Claims Resolution request, and identify to the Claims Resolution drug price in the current Claims Resolution bill according to the reasonable price section.A kind of the case where the present invention is based on detection models to provide drug price discrimination method, can be improved the distinguishing ability during settling a claim to fraud, prevents insurance company's monetary losses generation.
Description
Technical field
The present invention relates to field of computer technology more particularly to a kind of drug price discrimination methods, device, computer equipment
And storage medium.
Background technique
With the increase of the user volume of purchase medical insurance, insurance company is fine there is no one for medical Claims Resolution process
Identification Insurance Fraud behavior method, as long as traditional way be user from hospital obtain medical bills and it is related prove,
And only the major class for drug of settling a claim in medical bills is identified, just the amount of money in medical bills is carried out according to Claims Resolution ratio
It compensates, this Claims Resolution mode, which can not be effectively prevented from user, gains Claims Resolution using false bill by cheating, if not can avoid user's utilization
False bill gains Claims Resolution by cheating, it is easy to the case where leading to insurance company's monetary losses generation.
Summary of the invention
In view of this, the embodiment of the present invention provides a kind of drug price discrimination method, device, computer equipment and storage
The case where medium can be improved the distinguishing ability during settling a claim to fraud, prevent insurance company's monetary losses generation.
On the one hand, the embodiment of the invention provides a kind of drug price discrimination methods, this method comprises:
Historical medical's bill is obtained from presetting database and it is parsed；
The pricing information of all drugs in Historical medical's bill is obtained according to parsing result；
The corresponding price data collection of each drug is formed according to acquired pricing information；
It is fitted using price data collection of the Gaussian distribution model to each drug, to obtain each drug according to fitting result
Reasonable price section；
If receiving Claims Resolution request, determined in current Claims Resolution bill according to the current Claims Resolution bill in the Claims Resolution request
Claims Resolution drug price, and reflected according to the reasonable price section to the Claims Resolution drug price in the current Claims Resolution bill
Not.
On the other hand, the embodiment of the invention provides a kind of drug price identification device, described device includes:
Resolution unit, for obtaining Historical medical's bill from presetting database and being parsed to it；
Acquiring unit, for obtaining the pricing information of all drugs in Historical medical's bill according to parsing result；
Execution unit, for forming the corresponding price data collection of each drug according to acquired pricing information；
Fitting unit, for being fitted using price data collection of the Gaussian distribution model to each drug, according to fitting
As a result the reasonable price section of each drug is obtained；
Discriminating unit, if being worked as receiving Claims Resolution request according to the current Claims Resolution bill determination in the Claims Resolution request
Claims Resolution drug price in preceding Claims Resolution bill, and according to the reasonable price section to the Claims Resolution medicine in the current Claims Resolution bill
Product price is identified.
Another aspect the embodiment of the invention also provides a kind of computer equipment, including memory, processor and is stored in
On the memory and the computer program that can run on the processor, when the processor executes the computer program
Realize drug price discrimination method as described above.
It is described computer-readable to deposit in another aspect, the embodiment of the invention also provides a kind of computer readable storage medium
Storage media is stored with one or more than one computer program, and the one or more computer program can be by one
Or more than one processor executes, to realize drug price discrimination method as described above.
The embodiment of the present invention provides a kind of drug price discrimination method, device, computer equipment and storage medium, wherein
Method includes: to obtain Historical medical's bill from presetting database and parse to it；According to parsing result obtain described in go through
The pricing information of all drugs in history medical bills；The corresponding price data of each drug is formed according to acquired pricing information
Collection；It is fitted using price data collection of the Gaussian distribution model to each drug, to obtain the conjunction of each drug according to fitting result
Manage price range；If receiving Claims Resolution request, current Claims Resolution bill is determined according to the current Claims Resolution bill in the Claims Resolution request
In Claims Resolution drug price, and according to the reasonable price section to it is described it is current Claims Resolution bill in Claims Resolution drug price carry out
Identify.The present invention is based on detection models to provide a kind of drug price discrimination method, can be improved during settling a claim to fraud
Distinguishing ability, the case where preventing insurance company's monetary losses generation.
Detailed description of the invention
Technical solution in order to illustrate the embodiments of the present invention more clearly, below will be to needed in embodiment description
Attached drawing is briefly described, it should be apparent that, drawings in the following description are some embodiments of the invention, general for this field
For logical technical staff, without creative efforts, it is also possible to obtain other drawings based on these drawings.
Fig. 1 is a kind of application scenarios schematic diagram of drug price discrimination method provided in an embodiment of the present invention；
Fig. 2 is a kind of schematic flow diagram of drug price discrimination method provided in an embodiment of the present invention；
Fig. 3 is a kind of another schematic flow diagram of drug price discrimination method provided in an embodiment of the present invention；
Fig. 4 is a kind of another schematic flow diagram of drug price discrimination method provided in an embodiment of the present invention；
Fig. 5 is a kind of another schematic flow diagram of drug price discrimination method provided in an embodiment of the present invention；
Fig. 6 is a kind of schematic block diagram of drug price identification device provided in an embodiment of the present invention；
Fig. 7 is a kind of another schematic block diagram of drug price identification device provided in an embodiment of the present invention；
Fig. 8 is a kind of another schematic block diagram of drug price identification device provided in an embodiment of the present invention；
Fig. 9 is a kind of another schematic block diagram of drug price identification device provided in an embodiment of the present invention；
Figure 10 is a kind of another schematic block diagram of drug price identification device provided in an embodiment of the present invention；
Figure 11 is a kind of structure composition schematic diagram of computer equipment provided in an embodiment of the present invention.
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 described embodiments are some of the embodiments of the present invention, instead of all the embodiments.Based on this hair
Embodiment in bright, every other implementation obtained by those of ordinary skill in the art without making creative efforts
Example, shall fall within the protection scope of the present invention.
It should be appreciated that ought use in this specification and in the appended claims, term " includes " and "comprising" instruction
Described feature, entirety, step, operation, the presence of element and/or component, but one or more of the other feature, whole is not precluded
Body, step, operation, the presence or addition of element, component and/or its set.
It is also understood that mesh of the term used in this description of the invention merely for the sake of description specific embodiment
And be not intended to limit the present invention.As description of the invention and it is used in the attached claims, unless on
Other situations are hereafter clearly indicated, otherwise " one " of singular, "one" and "the" are intended to include plural form.
It will be further appreciated that the present invention illustrate in mountain and the appended claims used in term "and/or"
Refer to any combination and all possible combinations of one or more of associated item listed, and including these combinations.
Fig. 1 and Fig. 2 are please referred to, Fig. 1 is a kind of application scenarios of drug price discrimination method provided in an embodiment of the present invention
Schematic diagram, Fig. 2 are a kind of flow diagram of drug price discrimination method provided in an embodiment of the present invention.The drug price identifies
Method is applied in server or terminal, wherein terminal can be smart phone, tablet computer, laptop, desktop computer,
Personal digital assistant and wearable device etc. have the electronic equipment of communication function.As an application, as shown in Figure 1, the drug
Price discrimination method is applied in server 10, which can be a server in Distributed Services platform, should
Server 10 executes Claims Resolution drug price and identifies instruction, and by identification result feedback in terminal 20.
It should be noted that only illustrate a terminal 20 in Fig. 1, in the actual operation process, server 10 can be with
Identification result is fed back in more terminals 20.
Referring to Fig. 2, Fig. 2 is a kind of schematic flow diagram of drug price discrimination method provided in an embodiment of the present invention.Such as
Shown in Fig. 2, this approach includes the following steps S101~S105.
S101 obtains Historical medical's bill from presetting database and parses to it.
In embodiments of the present invention, in the preset database, which can be with for Historical medical's bill storage
For oracle database, MySQL database etc., Historical medical's bill may include Hospitalized costs inventory, emergency treatment doctor
Treat statement of expense etc..Historical medical's bill is parsed, specially using default resolution rules to Historical medical's bill
It is analyzed to obtain the price of drug therein, the default resolution rules can be keyword-extraction rules, word segmentation regulation.
Further, as shown in figure 3, the step S101 includes step S202~S206.
S202 obtains Historical medical's bill from presetting database.
S204 extracts the keyword content in Historical medical's bill according to keyword-extraction rules, wherein the pass
Key word content includes the label content being labeled in Historical medical's bill.
In embodiments of the present invention, it before the keyword content for extracting Historical medical's bill, needs in advance to going through
Keyword content in history medical bills is marked, and specific labeling method can be determines keyword content described first
Storage form in Historical medical's bill, such as: keyword content is that the history is stored in the form of column or in the form of row
In medical bills, if keyword content is stored in Historical medical's bill in the form of column, the column name of each column is preset
Keyword content to be marked, if keyword content is stored in Historical medical's bill in the form of row, preset every
The row title of a line is to be marked keyword content；The keyword content, which is included in Historical medical's bill, to be marked
The label content of note, such as: the content of " project name ", " unit price " and " type " is labeled in Historical medical's bill
Deng.
S206 carries out word segmentation processing according to keyword content of the word segmentation regulation to extraction, each after obtaining word segmentation processing
Word segment.
In embodiments of the present invention, the word segmentation regulation can use the segmentation methods based on natural language processing technique,
Word segmentation processing is carried out according to keyword content of the word segmentation regulation to extraction, each word segment after obtaining word segmentation processing passes through
Using word segmentation regulation carry out word segmentation processing so that treated, word segment meets natural language, be between each word it is coherent,
Each word is complete, for example, being " Western medicine sodium chloride injection 4.46 " for keyword content, is divided by word segmentation regulation
Each word segment obtained after word processing is " Western medicine ", " sodium chloride injection ", " 4.46 ".
S102 obtains the pricing information of all drugs in Historical medical's bill according to parsing result.
In embodiments of the present invention, the parsing result includes each word segment, described to be obtained according to parsing result
Take the pricing information of all drugs in Historical medical's bill, comprising: according to the attribute information of the word segment to all
Word segment carries out Screening Treatment, to obtain all words that attribute information and preset attribute match from all word segments
Pricing information of the segment as all drugs in Historical medical's bill.The pricing information is in Historical medical's bill
Drug unit price, the attribute information of the pricing information of drug is the attribute containing my umber of beats word in Historical medical's bill, according to
The attribute is from the word segment for having the attribute is filtered out as drug in Historical medical's bill in all word segments
Pricing information.Specifically, the pricing information for a certain drug may include a kind of or more in Historical medical's bill
Kind.
S103 forms the corresponding price data collection of each drug according to acquired pricing information.
In embodiments of the present invention, each drug corresponds to multiple pricing information, and is made of multiple pricing information each
The price data collection of kind drug.
S104 is fitted, to be obtained according to fitting result using price data collection of the Gaussian distribution model to each drug
The reasonable price section of each drug.
In embodiments of the present invention, the Gaussian distribution model is specially gauss of distribution function, described to use Gaussian Profile
Model is fitted the price data collection of each drug, specifically: using gauss of distribution function to the price data collection of each drug
It is fitted, and obtains the reasonable price section of each drug according to fitting result, the reasonable price section refers to by each drug
The estimated price section of each drug that is constructed of price data collection, some can be needed to verify by reasonable price section
Price parameter carry out soundness verification, specifically judge whether price parameter to be verified falls in the obtained reasonable price of fitting
In section, to identify the reasonability of price parameter to be verified by reasonable price section.
Further, as shown in figure 4, the step S104 includes step S302~S306.
S302 calculates the mean value of the price data collection of each drug according to default gauss of distribution function.
S304 chooses the default confidence level of the price data collection of each drug.
S306 determines each drug according to the mean value of the price data collection of each drug and the default confidence level
Reasonable price section.
Specifically, the default gauss of distribution function is a kind of widely used function in mathematical statistics, it is defined as follows,
If it is μ, standard variance σ that stochastic variable X, which obeys mean value,2The high phase distribution, be denoted as: X~N (μ, σ2), then the height of stochastic variable X
Phase distribution function are as follows:
For gauss of distribution function F (x), given stochastic variable X indicates each drug
Price data collection, the fitting of function approximation is carried out using gauss of distribution function F (x) to the price data collection of each drug, and is passed through
Normal distribution curve obtains the mean μ of price data collection.Reasonable price section for each drug is aobvious what is predefined
It is calculated under work property is horizontal, significance is commonly referred to as α, as previously mentioned, α can be set as 0.05 by most situations,
Then the default confidence level of each drug is (1- α) or 100 × (1- α) %.Then, if α=0.05, each drug it is pre-
It is then 0.95 or 95% that reliability, which is arranged, then, for presetting confidence level as 0.95 or the reasonable price section of 95% each drug
Calculation method it is as follows:Wherein, μ indicates the mean value of the price data collection of each drug, how many standard variance z indicates,
σ indicates that the standard variance of the price data collection of each drug, n indicate the quantity for the price data that price data is concentrated.
S105 determines current Claims Resolution account according to the current Claims Resolution bill in the Claims Resolution request if receiving Claims Resolution request
Claims Resolution drug price in list, and according to the reasonable price section to it is described it is current Claims Resolution bill in Claims Resolution drug price into
Row identifies.
In embodiments of the present invention, the Claims Resolution drug price is the unit price of Claims Resolution drug in current Claims Resolution bill, at this
In embodiment, need to determine currently settle a claim in Claims Resolution request the Claims Resolution drug unit price of bill, under normal circumstances, Ke Yi in advance
The unit price that each Claims Resolution drug is obtained in the monovalent column of drug of current Claims Resolution bill, according to the reasonable price section to being obtained
Each Claims Resolution drug unit price identified one by one, if respectively Claims Resolution drug unit price in the reasonable price section, judge
It is otherwise unfair price for reasonable price.Specifically, as shown in figure 5, described work as according to the reasonable price section to described
The step of Claims Resolution drug price in preceding Claims Resolution bill is identified specifically includes following steps S402~S406:S402, determines
Reasonable price section corresponding with the current Claims Resolution Claims Resolution drug of bill in Historical medical's bill；S404, described in judgement
Whether the Claims Resolution drug price in current Claims Resolution bill is in identified reasonable price section；S406, if the current reason
The Claims Resolution drug price in list of paying for the loss of cash or goods entrusted to one be not at determined by reasonable price section, determine the current reason in the Claims Resolution request
The Claims Resolution drug price for paying for the loss of cash or goods entrusted to one single is unreasonable.
It should be noted that according to the reasonable price section to it is described it is current Claims Resolution bill in Claims Resolution drug price into
Row identifies, if respectively the unit price of Claims Resolution drug is judged as reasonable price, is otherwise unreasonable valence in the reasonable price section
Lattice can be improved the distinguishing ability during settling a claim to fraud in practical applications, prevent insurance company's monetary losses
It happens.
As seen from the above, the embodiment of the present invention from presetting database by obtaining Historical medical's bill and solving to it
Analysis；The pricing information of all drugs in Historical medical's bill is obtained according to parsing result；According to acquired pricing information
Form the corresponding price data collection of each drug；It is fitted using price data collection of the Gaussian distribution model to each drug, with root
The reasonable price section of each drug is obtained according to fitting result；If receiving Claims Resolution request, according to current in the Claims Resolution request
Bill of settling a claim determines the Claims Resolution drug price in current Claims Resolution bill, and according to the reasonable price section to the current Claims Resolution
Claims Resolution drug price in bill is identified.The present invention is based on detection models to provide a kind of drug price discrimination method, can
The case where improving the distinguishing ability during settling a claim to fraud, preventing insurance company's monetary losses generation.
Referring to Fig. 6, a kind of corresponding above-mentioned drug price discrimination method, the embodiment of the present invention also propose a kind of drug price
Identification device, the device 100 include: resolution unit 101, acquiring unit 102, execution unit 103, fitting unit 104, identify list
Member 105.
Wherein, the resolution unit 101, for obtaining Historical medical's bill from presetting database and being solved to it
Analysis.
Acquiring unit 102, for obtaining the pricing information of all drugs in Historical medical's bill according to parsing result.
Execution unit 103, for forming the corresponding price data collection of each drug according to acquired pricing information.
Fitting unit 104, for being fitted using price data collection of the Gaussian distribution model to each drug, according to quasi-
Close the reasonable price section that result obtains each drug.
Discriminating unit 105, if being determined for receiving Claims Resolution request according to the current Claims Resolution bill in the Claims Resolution request
Claims Resolution drug price in current Claims Resolution bill, and according to the reasonable price section to the Claims Resolution in the current Claims Resolution bill
Drug price is identified.
As seen from the above, the embodiment of the present invention from presetting database by obtaining Historical medical's bill and solving to it
Analysis；The pricing information of all drugs in Historical medical's bill is obtained according to parsing result；According to acquired pricing information
Form the corresponding price data collection of each drug；It is fitted using price data collection of the Gaussian distribution model to each drug, with root
The reasonable price section of each drug is obtained according to fitting result；If receiving Claims Resolution request, according to current in the Claims Resolution request
Bill of settling a claim determines the Claims Resolution drug price in current Claims Resolution bill, and according to the reasonable price section to the current Claims Resolution
Claims Resolution drug price in bill is identified.The present invention is based on detection models to provide a kind of drug price discrimination method, can
The case where improving the distinguishing ability during settling a claim to fraud, preventing insurance company's monetary losses generation.
Referring to Fig. 7, the resolution unit 101, comprising:
Bill acquiring unit 101a, for obtaining Historical medical's bill from presetting database.
Extraction unit 101b, for being extracted according to keyword-extraction rules in the keyword in Historical medical's bill
Hold, wherein the keyword content includes the label content being labeled in Historical medical's bill.
Word segmentation processing unit 101c is obtained for carrying out word segmentation processing according to keyword content of the word segmentation regulation to extraction
Each word segment after word segmentation processing.
Referring to Fig. 8, the parsing result includes each word segment, the acquiring unit 102, comprising:
Subelement 102a is obtained, for carrying out at screening according to the attribute information of the word segment to all word segments
Reason is cured using obtaining all word segments that attribute information and preset attribute match from all word segments as the history
Treat the pricing information of all drugs in bill.
Referring to Fig. 9, the fitting unit 104, comprising:
Computing unit 104a calculates the equal of the price data collection of each drug for the default gauss of distribution function of basis
Value.
Selection unit 104b, the default confidence level of the price data collection for choosing each drug.
Determination unit 104c, for being determined according to the mean value and the default confidence level of the price data collection of each drug
The reasonable price section of each drug.
Referring to Fig. 10, the discriminating unit 105, comprising:
Reasonable price interval determination unit 105a, for determining the reason in Historical medical's bill with the current Claims Resolution bill
Pay for the corresponding reasonable price section of drug；
Judging unit 105b, for judging whether the Claims Resolution drug price in the current Claims Resolution bill is in identified
In reasonable price section；
Judging unit 105c, if for it is described it is current Claims Resolution bill in Claims Resolution drug price be not at determined by rationally
In price range, determine that the Claims Resolution drug price of the current Claims Resolution bill in the Claims Resolution request is unreasonable.
Above-mentioned drug price identification device and above-mentioned drug price discrimination method correspond, specific principle and process
It is identical as above-described embodiment the method, it repeats no more.
Above-mentioned drug price identification device can be implemented as a kind of form of computer program, and computer program can be such as
It is run in computer equipment shown in Figure 11.
Figure 11 is a kind of structure composition schematic diagram of computer equipment of the present invention.The equipment can be terminal, be also possible to
Server, wherein terminal can be smart phone, tablet computer, laptop, desktop computer, personal digital assistant and wear
Wear the electronic device that formula device etc. has communication function and speech voice input function.Server can be independent server, can also
To be server cluster that multiple servers form.Referring to Fig.1 1, which includes being connected by system bus 501
Processor 502, non-volatile memory medium 503, built-in storage 504 and the network interface 505 connect.Wherein, the computer equipment
500 non-volatile memory medium 503 can storage program area 5031 and computer program 5032,5032 quilt of computer program
When execution, processor 502 may make to execute a kind of drug price discrimination method.The processor 502 of the computer equipment 500 is used for
Calculating and control ability are provided, the operation of entire computer equipment 500 is supported.The built-in storage 504 is non-volatile memories Jie
The operation of computer program 5032 in matter 503, which provides environment, may make processor when the computer program is executed by processor
502 execute a kind of drug price discrimination method.The network interface 505 of computer equipment 500 is for carrying out network communication.This field
Technical staff is appreciated that structure shown in Figure 11, only the block diagram of part-structure relevant to application scheme, not
The restriction for the computer equipment being applied thereon to application scheme is constituted, specific computer equipment may include than in figure
Shown more or fewer components perhaps combine certain components or with different component layouts.
Wherein, following operation is realized when the processor 502 executes the computer program:
Historical medical's bill is obtained from presetting database and it is parsed；
The pricing information of all drugs in Historical medical's bill is obtained according to parsing result；
The corresponding price data collection of each drug is formed according to acquired pricing information；
It is fitted using price data collection of the Gaussian distribution model to each drug, to obtain each drug according to fitting result
Reasonable price section；
If receiving Claims Resolution request, determined in current Claims Resolution bill according to the current Claims Resolution bill in the Claims Resolution request
Claims Resolution drug price, and reflected according to the reasonable price section to the Claims Resolution drug price in the current Claims Resolution bill
Not.
It is in one embodiment, described to obtain Historical medical's bill from presetting database and it is parsed, comprising:
Historical medical's bill is obtained from presetting database；
The keyword content in Historical medical's bill is extracted according to keyword-extraction rules, wherein the keyword
Content includes the label content being labeled in Historical medical's bill；
Word segmentation processing is carried out according to keyword content of the word segmentation regulation to extraction, each word piece after obtaining word segmentation processing
Section.
In one embodiment, the parsing result includes each word segment, described to be obtained according to parsing result
The pricing information of all drugs in Historical medical's bill, comprising:
Screening Treatment is carried out to all word segments according to the attribute information of the word segment, with from all word segments
All word segments that middle acquisition attribute information and preset attribute match are as all drugs in Historical medical's bill
Pricing information.
In one embodiment, described to be fitted using price data collection of the Gaussian distribution model to each drug, with root
The reasonable price section of each drug is obtained according to fitting result, comprising:
The mean value of the price data collection of each drug is calculated according to default gauss of distribution function；
Choose the default confidence level of the price data collection of each drug；
The reasonable of each drug is determined according to the mean value of the price data collection of each drug and the default confidence level
Price range.
In one embodiment, it is described according to the reasonable price section to it is described it is current Claims Resolution bill in Claims Resolution drug
Price is identified, comprising:
Determine reasonable price section corresponding with the current Claims Resolution Claims Resolution drug of bill in Historical medical's bill；
Judge whether the Claims Resolution drug price in the current Claims Resolution bill is in identified reasonable price section；
If the Claims Resolution drug price in the current Claims Resolution bill is not in identified reasonable price section, institute is determined
The Claims Resolution drug price for stating the current Claims Resolution bill in Claims Resolution request is unreasonable.
It will be understood by those skilled in the art that the embodiment of computer equipment shown in Figure 11 is not constituted to computer
The restriction of equipment specific composition, in other embodiments, computer equipment may include components more more or fewer than diagram, or
Person combines certain components or different component layouts.For example, in some embodiments, computer equipment only includes memory
And processor, in such embodiments, the structure and function of memory and processor are consistent with embodiment illustrated in fig. 11, herein
It repeats no more.
The present invention provides a kind of computer readable storage medium, computer-readable recording medium storage has one or one
A above computer program, the one or more computer program can be held by one or more than one processor
Row, to perform the steps of
Historical medical's bill is obtained from presetting database and it is parsed；
The pricing information of all drugs in Historical medical's bill is obtained according to parsing result；
The corresponding price data collection of each drug is formed according to acquired pricing information；
It is fitted using price data collection of the Gaussian distribution model to each drug, to obtain each drug according to fitting result
Reasonable price section；
If receiving Claims Resolution request, determined in current Claims Resolution bill according to the current Claims Resolution bill in the Claims Resolution request
Claims Resolution drug price, and reflected according to the reasonable price section to the Claims Resolution drug price in the current Claims Resolution bill
Not.
It is in one embodiment, described to obtain Historical medical's bill from presetting database and it is parsed, comprising:
Historical medical's bill is obtained from presetting database；
The keyword content in Historical medical's bill is extracted according to keyword-extraction rules, wherein the keyword
Content includes the label content being labeled in Historical medical's bill；
Word segmentation processing is carried out according to keyword content of the word segmentation regulation to extraction, each word piece after obtaining word segmentation processing
Section.
In one embodiment, the parsing result includes each word segment, described to be obtained according to parsing result
The pricing information of all drugs in Historical medical's bill, comprising:
Screening Treatment is carried out to all word segments according to the attribute information of the word segment, with from all word segments
All word segments that middle acquisition attribute information and preset attribute match are as all drugs in Historical medical's bill
Pricing information.
In one embodiment, described to be fitted using price data collection of the Gaussian distribution model to each drug, with root
The reasonable price section of each drug is obtained according to fitting result, comprising:
The mean value of the price data collection of each drug is calculated according to default gauss of distribution function；
Choose the default confidence level of the price data collection of each drug；
The reasonable of each drug is determined according to the mean value of the price data collection of each drug and the default confidence level
Price range.
In one embodiment, it is described according to the reasonable price section to it is described it is current Claims Resolution bill in Claims Resolution drug
Price is identified, comprising:
Determine reasonable price section corresponding with the current Claims Resolution Claims Resolution drug of bill in Historical medical's bill；
Judge whether the Claims Resolution drug price in the current Claims Resolution bill is in identified reasonable price section；
If the Claims Resolution drug price in the current Claims Resolution bill is not in identified reasonable price section, institute is determined
The Claims Resolution drug price for stating the current Claims Resolution bill in Claims Resolution request is unreasonable.
Present invention storage medium above-mentioned include: magnetic disk, CD, read-only memory (Read-Only Memory,
The various media that can store program code such as ROM).
Unit in all embodiments of the invention can pass through universal integrated circuit, such as CPU (Central
Processing Unit, central processing unit), or pass through ASIC (Application Specific Integrated
Circuit, specific integrated circuit) Lai Shixian.
Step in drug price discrimination method of the embodiment of the present invention can the adjustment of carry out sequence, merging according to actual needs
With delete.
Unit in drug price identification device of the embodiment of the present invention can be merged according to actual needs, divides and be deleted
Subtract.
The above description is merely a specific embodiment, but scope of protection of the present invention is not limited thereto, any
Those familiar with the art in the technical scope disclosed by the present invention, can readily occur in various equivalent modifications or replace
It changes, these modifications or substitutions should be covered by the protection scope of the present invention.Therefore, protection scope of the present invention should be with right
It is required that protection scope subject to.
Claims (10)
1. a kind of drug price discrimination method, which is characterized in that the described method includes:
Historical medical's bill is obtained from presetting database and it is parsed；
The pricing information of all drugs in Historical medical's bill is obtained according to parsing result；
The corresponding price data collection of each drug is formed according to acquired pricing information；
It is fitted using price data collection of the Gaussian distribution model to each drug, to obtain the conjunction of each drug according to fitting result
Manage price range；
If receiving Claims Resolution request, the Claims Resolution in current Claims Resolution bill is determined according to the current Claims Resolution bill in the Claims Resolution request
Drug price, and the Claims Resolution drug price in the current Claims Resolution bill is identified according to the reasonable price section.
2. the method as described in claim 1, which is characterized in that acquisition Historical medical's bill from presetting database is simultaneously right
It is parsed, comprising:
Historical medical's bill is obtained from presetting database；
The keyword content in Historical medical's bill is extracted according to keyword-extraction rules, wherein the keyword content
Including the label content being labeled in Historical medical's bill；
Word segmentation processing is carried out according to keyword content of the word segmentation regulation to extraction, each word segment after obtaining word segmentation processing.
3. method according to claim 2, which is characterized in that the parsing result includes each word segment, described
The pricing information of all drugs in Historical medical's bill is obtained according to parsing result, comprising:
Screening Treatment is carried out to all word segments according to the attribute information of the word segment, to obtain from all word segments
Price of all word segments for taking attribute information and preset attribute to match as all drugs in Historical medical's bill
Information.
4. the method as described in claim 1, which is characterized in that it is described using Gaussian distribution model to the price data of each drug
Collection is fitted, to obtain the reasonable price section of each drug according to fitting result, comprising:
The mean value of the price data collection of each drug is calculated according to default gauss of distribution function；
Choose the default confidence level of the price data collection of each drug；
The reasonable price of each drug is determined according to the mean value of the price data collection of each drug and the default confidence level
Section.
5. the method as described in claim 1, which is characterized in that it is described according to the reasonable price section to the current Claims Resolution
Claims Resolution drug price in bill is identified, comprising:
Determine reasonable price section corresponding with the current Claims Resolution Claims Resolution drug of bill in Historical medical's bill；
Judge whether the Claims Resolution drug price in the current Claims Resolution bill is in identified reasonable price section；
If the Claims Resolution drug price in the current Claims Resolution bill is not in identified reasonable price section, the reason is determined
The Claims Resolution drug price for paying for the current Claims Resolution bill in request is unreasonable.
6. a kind of drug price identification device, which is characterized in that described device includes:
Resolution unit, for obtaining Historical medical's bill from presetting database and being parsed to it；
Acquiring unit, for obtaining the pricing information of all drugs in Historical medical's bill according to parsing result；
Execution unit, for forming the corresponding price data collection of each drug according to acquired pricing information；
Fitting unit, for being fitted using price data collection of the Gaussian distribution model to each drug, according to fitting result
Obtain the reasonable price section of each drug；
Discriminating unit, if determining current reason according to the current Claims Resolution bill in the Claims Resolution request for receiving Claims Resolution request
The Claims Resolution drug price paid for the loss of cash or goods entrusted to one in list, and according to the reasonable price section to the Claims Resolution drug valence in the current Claims Resolution bill
Lattice are identified.
7. device as claimed in claim 6, which is characterized in that the resolution unit, comprising:
Bill acquiring unit, for obtaining Historical medical's bill from presetting database；
Extraction unit, for extracting the keyword content in Historical medical's bill according to keyword-extraction rules, wherein institute
Stating keyword content includes the label content being labeled in Historical medical's bill；
Word segmentation processing unit obtains word segmentation processing for carrying out word segmentation processing according to keyword content of the word segmentation regulation to extraction
Each word segment afterwards.
8. device as claimed in claim 6, which is characterized in that the parsing result includes each word segment, described
Acquiring unit, comprising:
Obtain subelement, for carrying out Screening Treatment to all word segments according to the attribute information of the word segment, with from
All word segments that acquisition attribute information and preset attribute match in all word segments are as Historical medical's bill
In all drugs pricing information.
9. a kind of computer equipment, including memory, processor and it is stored on the memory and can be on the processor
The computer program of operation, which is characterized in that the processor realizes that claim 1-5 such as appoints when executing the computer program
Drug price discrimination method described in one.
10. a kind of computer readable storage medium, which is characterized in that the computer-readable recording medium storage have one or
More than one computer program, the one or more computer program can be by one or more than one processors
It executes, to realize drug price discrimination method as described in any one in claim 1-5.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201910270815.4A CN110148004A (en) | 2019-04-04 | 2019-04-04 | Drug price discrimination method, device, computer equipment and storage medium |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
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| CN201910270815.4A CN110148004A (en) | 2019-04-04 | 2019-04-04 | Drug price discrimination method, device, computer equipment and storage medium |
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| CN110148004A true CN110148004A (en) | 2019-08-20 |
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Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20080140599A1 (en) * | 2006-11-10 | 2008-06-12 | Debra Pacha | System and method for detecting healthcare insurance fraud |
| CN105488151A (en) * | 2015-11-27 | 2016-04-13 | 小米科技有限责任公司 | Reference document recommendation method and apparatus |
| CN107038669A (en) * | 2015-07-28 | 2017-08-11 | 平安科技（深圳）有限公司 | Abnormal settlement data warning system and method |
-
2019
- 2019-04-04 CN CN201910270815.4A patent/CN110148004A/en active Pending
Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20080140599A1 (en) * | 2006-11-10 | 2008-06-12 | Debra Pacha | System and method for detecting healthcare insurance fraud |
| CN107038669A (en) * | 2015-07-28 | 2017-08-11 | 平安科技（深圳）有限公司 | Abnormal settlement data warning system and method |
| CN105488151A (en) * | 2015-11-27 | 2016-04-13 | 小米科技有限责任公司 | Reference document recommendation method and apparatus |
Non-Patent Citations (1)
| Title |
|---|
| 吴剑: "基于离群点检测的医保欺诈检测研究" * |
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