CN113095944A - Insurance business payment management system and method - Google Patents

Insurance business payment management system and method Download PDF

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Publication number
CN113095944A
CN113095944A CN202010022826.3A CN202010022826A CN113095944A CN 113095944 A CN113095944 A CN 113095944A CN 202010022826 A CN202010022826 A CN 202010022826A CN 113095944 A CN113095944 A CN 113095944A
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medical
insurance
information
medical insurance
control terminal
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范锋
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Shanghai Qijian Information Technology Co ltd
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Shanghai Qijian Information Technology Co ltd
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    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06QINFORMATION 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
    • G06Q40/00Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08Insurance
    • GPHYSICS
    • G16INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16HHEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H10/00ICT specially adapted for the handling or processing of patient-related medical or healthcare data
    • G16H10/60ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records

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  • Public Health (AREA)
  • Medical Informatics (AREA)
  • General Health & Medical Sciences (AREA)
  • Epidemiology (AREA)
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  • Medical Treatment And Welfare Office Work (AREA)
  • Financial Or Insurance-Related Operations Such As Payment And Settlement (AREA)

Abstract

The invention discloses a system and a method for managing insurance service payment, which relate to the technical field of insurance payment, and the system comprises: the system comprises a medical insurance card, a control terminal, an insurance monitoring terminal and a server; the medical insurance card is used for providing the individual with reimbursement of medical insurance; the control terminal is used for providing the medical institution with management of medical insurance; the insurance monitoring terminal is used for providing insurance mechanisms with insurance business monitoring; the server is used for completing the payment approval request; the control terminal is respectively in signal connection with the insurance monitoring terminal and the server; and the server is in signal connection with the insurance monitoring terminal.

Description

Insurance business payment management system and method
Technical Field
The invention relates to the technical field of insurance payment, in particular to an insurance service payment management system and method.
Background art
Insurance is a Chinese word, pinyin is b { hacek over (a) } o xi { hacek over (a) } n, English is instance or instaurance, and the intention is a reliable guarantee; the method is a guarantee mechanism, is a tool for planning life finance, is a basic means for risk management under market economic conditions, and is an important support for a financial system and a social security system.
Insurance means that the insurance applicant pays insurance premium to the insurance carrier according to contract agreement, and the insurance carrier undertakes the responsibility for compensating insurance premium for property loss caused by the occurrence of the accident possibly caused by the contract agreement, or undertakes the business insurance action for paying insurance premium when the insured dies, is damaged, has diseases or reaches the conditions of the age, the deadline and the like of the contract agreement.
From an economic perspective, insurance is a financial arrangement that amortizes the loss of accidents; from a legal perspective, insurance is a contractual act, being a contractual arrangement where one party agrees to compensate for the loss of the other; from the social perspective, insurance is an important component of the social and economic guarantee system, and is an exquisite stabilizer for social production and social life; from a risk management perspective, insurance is one method of risk management.
Generally, when a predetermined medical insurance beneficiary pays monthly or quarterly the medical insurance fee dialed by the medical insurance company respectively, the medical insurance card is issued by the medical insurance company in an offline manner. Various hospitals/clinics and medical institutions can use the medical insurance card to provide medical fees for the insured life to withhold medical treatment and prescription drugs according to the disease of the insured life.
In other words, in the current medical insurance system, when various hospitals/clinics and medical institutions which are in communication with the medical bureau treat a medical insurance beneficiary, part of medical fees which are issued for medical care are applied from a medical insurance company, and the difference in medical fees is borne by the medical insurance beneficiary by himself/herself, and if the medical insurance company uses as a financial resource, the medical insurance beneficiary needs to pay part of the medical fees according to medical fees which are regularly paid by a medical insurance card issued by the medical insurance company in addition to insurance fees which are individually distributed, whereby the economic burden of medical insurance beneficiary on medical care can be reduced, and a more efficient medical system can be established.
Disclosure of Invention
In view of this, the present invention provides a system and a method for managing payment of insurance services, which have the advantages of high intelligent management degree, high security and high management efficiency.
In order to achieve the purpose, the invention adopts the following technical scheme:
an insurance service payment management system, the system comprising: the system comprises a medical insurance card, a control terminal, an insurance monitoring terminal and a server; the medical insurance card is used for providing the individual with reimbursement of medical insurance; the control terminal is used for providing the medical institution with management of medical insurance; the insurance monitoring terminal is used for providing insurance mechanisms with insurance business monitoring; the server is used for completing the payment approval request; the control terminal is respectively in signal connection with the insurance monitoring terminal and the server; and the server is in signal connection with the insurance monitoring terminal.
Further, the control terminal is used for reading the information in the medical insurance card and writing the latest updated diagnosis and treatment record information transmitted by the medical insurance management system, so as to use the access security information from the medical insurance card, read and transmit the latest diagnosis and treatment information about related medical insurance beneficiaries through a communication network when the insurance medical insurance payment and medical treatment are requested to be paid online according to the latest diagnosis and treatment information; the medical insurance management device is used for performing online access on the control terminal according to the access safety information of the medical insurance management system recorded in the medical insurance card so as to set whether to inquire the diagnosis and treatment record information or not, can receive the diagnosis and treatment record information from the control terminal, confirms payment permission of medical insurance payment and medical fees, and transmits the latest updated diagnosis and treatment record data recorded in the medical insurance card to the control terminal connected with the communication network.
Further, the insurance monitoring terminal includes: the consumption information base is used for storing the reimbursement receipt to be audited, which is generated by the insurer in the medical consumption process; the system comprises a retrieval unit, a verification unit and a verification unit, wherein the retrieval unit is used for acquiring a to-be-verified reimbursement document of a participant from a consumption information base, and the to-be-verified reimbursement document comprises visit registration information, prescription detail information and expense settlement information; the expense screening unit is used for receiving the reimbursement receipt to be audited, classifying a plurality of items of data in the prescription detail information, and then outputting the medical examination registration information, the expense settlement information and the classified prescription detail information; the analysis execution unit is used for acquiring the registration information of the doctor, the expense settlement information and the classified prescription detail information and automatically auditing all data in the prescription detail information; the human-computer interaction unit is used for displaying the registration information of the treatment, the expense settlement information and the prescription detail information, inputting parameters and threshold values corresponding to all data in the prescription detail information into the analysis execution unit, enabling the analysis execution unit to automatically carry out batch audit on the data according to the parameters and the threshold values, and adding suspicious data identifications or normal data identifications for all data according to the audit results; the human-computer interaction unit is also used for carrying out manual examination on information except for automatic examination; during manual examination, the analysis execution unit calls corresponding professional knowledge according to the visit registration information, the prescription detail information and the expense settlement information; and the analysis execution unit calls the corresponding checked reimbursement bill according to the information in the reimbursement bill to be checked during manual checking, and stores the checked reimbursement bill in the historical information base.
Further, the server is a payment approval server for confirming the payment approval to the relevant medical institution in response to the payment approval request from the medical insurance management apparatus; and an information database for storing the medical insurance-related information of the medical insurance beneficiary recorded on the medical insurance card and the medical history information including all the medical information of the medical insurance beneficiary recorded thereon.
Further, the control terminal further comprises a signature approval input component for transmitting the signature of the health care beneficiary to the health care management system so that the health care beneficiary receiving diagnosis and treatment can confirm the details of the diagnosis and treatment result; and the medical insurance management means of the medical insurance management system must record the treatment information and confirm the payment approval based on the signature of the medical insurance beneficiary transmitted from the control terminal.
Further, the medical insurance card: recording medical insurance related data configured for medical insurance beneficiaries; access security information to access the medical insurance management system online, and related information fields regarding personal medical insurance of one or more medical insurance beneficiaries able to use the medical insurance card; and a medical record information field in which the newly updated medical record information is recorded.
An insurance service payment management method, the method performing the steps of: step 1: the medical insurance card is used for providing the individual with reimbursement for medical insurance; step 2: the control terminal is provided for medical institutions to manage medical insurance; and step 3: the insurance monitoring terminal is used for monitoring insurance business provided for an insurance mechanism; and 4, step 4: server, completing payment approval request; the control terminal is respectively in signal connection with the insurance monitoring terminal and the server; and the server is in signal connection with the insurance monitoring terminal.
Further, the control terminal is used for reading the information in the medical insurance card and writing the latest updated diagnosis and treatment record information transmitted by the medical insurance management system, so as to use the access security information from the medical insurance card, read and transmit the latest diagnosis and treatment information about related medical insurance beneficiaries through a communication network when the insurance medical insurance payment and medical treatment are requested to be paid online according to the latest diagnosis and treatment information; the medical insurance management device is used for performing online access on the control terminal according to the access safety information of the medical insurance management system recorded in the medical insurance card so as to set whether to inquire the diagnosis and treatment record information or not, can receive the diagnosis and treatment record information from the control terminal, confirms payment permission of medical insurance payment and medical fees, and transmits the latest updated diagnosis and treatment record data recorded in the medical insurance card to the control terminal connected with the communication network.
Compared with the prior art, the invention has the following beneficial effects: the insurance business payment management system and method have the advantages of high management intelligence degree, high safety and high management efficiency. Whether violation occurs in the insurance reimbursement process is monitored through the insurance monitoring terminal, and the management efficiency and safety are improved.
Drawings
The invention is described in further detail below with reference to the following figures and detailed description:
fig. 1 is a schematic system structure diagram of an insurance service payment management system disclosed in an embodiment of the present invention.
Fig. 2 is a schematic flow chart of a method of insurance service payment management disclosed in the embodiment of the present invention.
Detailed Description
The following description of the embodiments of the present invention is provided for illustrative purposes, and other advantages and effects of the present invention will become apparent to those skilled in the art from the present disclosure.
Please refer to fig. 1. It should be understood that the structures, ratios, sizes, and the like shown in the drawings and described in the specification are only used for matching with the disclosure of the specification, so as to be understood and read by those skilled in the art, and are not used to limit the conditions of the present invention, so that the present invention has no technical significance. In addition, the terms such as "upper", "lower", "left", "right", "middle" and "one" used in the present specification are for clarity of description, and are not intended to limit the scope of the present invention, and changes or modifications in the relative relationship may be made without substantial technical changes and modifications.
Example 1
An insurance service payment management system, the system comprising: the system comprises a medical insurance card, a control terminal, an insurance monitoring terminal and a server; the medical insurance card is used for providing the individual with reimbursement of medical insurance; the control terminal is used for providing the medical institution with management of medical insurance; the insurance monitoring terminal is used for providing insurance mechanisms with insurance business monitoring; the server is used for completing the payment approval request; the control terminal is respectively in signal connection with the insurance monitoring terminal and the server; and the server is in signal connection with the insurance monitoring terminal.
Specifically, in the current medical insurance system, there is a problem in that although medical services are generally available and medical histories of patients who are not treated may be used by hospitals/clinics or medical institutions with drug offices attached thereto or excessive medical fees may be illegally requested by the same institutions by administering unnecessary treatments or adding improper prescriptions, it is difficult to exactly check detailed medical fees in the part of the medical insurance company, and excessive application of medical fees or full payment of the excessively requested medical fees by the medical insurance company may occur, resulting in a long-lasting loss in the part of the medical insurance company and causing medical insurance beneficiaries to regularly pay increased medical fees for the loss.
Example 2
On the basis of the above embodiment, the control terminal is a card read/write device for reading information in the medical insurance card, writing the latest updated medical record information transmitted by the medical insurance management system, using the access security information from the medical insurance card, reading and transmitting the latest medical information about the relevant medical insurance beneficiary through the communication network when the insurance medical insurance payment and medical payment is requested online according to the latest medical information; the medical insurance management device is used for performing online access on the control terminal according to the access safety information of the medical insurance management system recorded in the medical insurance card so as to set whether to inquire the diagnosis and treatment record information or not, can receive the diagnosis and treatment record information from the control terminal, confirms payment permission of medical insurance payment and medical fees, and transmits the latest updated diagnosis and treatment record data recorded in the medical insurance card to the control terminal connected with the communication network.
Example 3
On the basis of the above embodiment, the insurance monitoring terminal includes: the consumption information base is used for storing the reimbursement receipt to be audited, which is generated by the insurer in the medical consumption process; the system comprises a retrieval unit, a verification unit and a verification unit, wherein the retrieval unit is used for acquiring a to-be-verified reimbursement document of a participant from a consumption information base, and the to-be-verified reimbursement document comprises visit registration information, prescription detail information and expense settlement information; the expense screening unit is used for receiving the reimbursement receipt to be audited, classifying a plurality of items of data in the prescription detail information, and then outputting the medical examination registration information, the expense settlement information and the classified prescription detail information; the analysis execution unit is used for acquiring the registration information of the doctor, the expense settlement information and the classified prescription detail information and automatically auditing all data in the prescription detail information; the human-computer interaction unit is used for displaying the registration information of the treatment, the expense settlement information and the prescription detail information, inputting parameters and threshold values corresponding to all data in the prescription detail information into the analysis execution unit, enabling the analysis execution unit to automatically carry out batch audit on the data according to the parameters and the threshold values, and adding suspicious data identifications or normal data identifications for all data according to the audit results; the human-computer interaction unit is also used for carrying out manual examination on information except for automatic examination; during manual examination, the analysis execution unit calls corresponding professional knowledge according to the visit registration information, the prescription detail information and the expense settlement information; and the analysis execution unit calls the corresponding checked reimbursement bill according to the information in the reimbursement bill to be checked during manual checking, and stores the checked reimbursement bill in the historical information base.
Specifically, in order to maintain the integrity of the basic medical insurance fund and protect the insured person from fully enjoying the basic medical insurance treatment, the medical management department makes a definite responsibility regulation for the behaviors of the responsible persons such as medical institutions, doctors, the insured persons and the like which violate the basic medical insurance regulation so as to prevent the responsible persons from cheating the medical insurance fund, for example, in the medical insurance settlement document, the opened medicine belongs to the contraindicated medicine of the insured person or is not the medicine for treating the diseases suffered by the insured person; the ginseng security people continuously handle a plurality of admissions in the same department of the same hospital, and the like. In the prior art, the auditing, checking and the like of the medical insurance reimbursement documents are manual auditing, namely auditors check the reimbursement documents one by one, the auditing speed and the auditing quality are low, illegal reimbursement document data are easily omitted, and then a large number of suspicious behaviors such as fraud, abuse, waste and the like occur, so that the medical insurance fund is lost.
Example 4
On the basis of the above embodiment, the server is a payment approval server for confirming the payment approval to the relevant medical institution in response to the payment approval request from the medical insurance management apparatus; and an information database for storing the medical insurance-related information of the medical insurance beneficiary recorded on the medical insurance card and the medical history information including all the medical information of the medical insurance beneficiary recorded thereon.
Example 5
On the basis of the above embodiment, the control terminal further comprises a signature approval input component for transmitting the signature of the health care beneficiary to the health care management system so that the health care beneficiary receiving the diagnosis and treatment can confirm the details of the diagnosis and treatment result; and the medical insurance management means of the medical insurance management system must record the treatment information and confirm the payment approval based on the signature of the medical insurance beneficiary transmitted from the control terminal.
Example 6
On the basis of the above embodiment, the medical insurance card: recording medical insurance related data configured for medical insurance beneficiaries; access security information to access the medical insurance management system online, and related information fields regarding personal medical insurance of one or more medical insurance beneficiaries able to use the medical insurance card; and a medical record information field in which the newly updated medical record information is recorded.
Example 7
An insurance service payment management method, the method performing the steps of: step 1: the medical insurance card is used for providing the individual with reimbursement for medical insurance; step 2: the control terminal is provided for medical institutions to manage medical insurance; and step 3: the insurance monitoring terminal is used for monitoring insurance business provided for an insurance mechanism; and 4, step 4: a server for completing the payment approval request; the control terminal is respectively in signal connection with the insurance monitoring terminal and the server; and the server is in signal connection with the insurance monitoring terminal.
Specifically, when an entity (individual, business, or any type of organization) commits an offer for risk transfer to an "insurer" (also known as an "insurer", typically an insurance company, or a government agency), he (she, it) becomes the "insured", and the insurance contract formed by the set of offers and commitments is called an "insurance policy", or simply "policy". The legal document such as insurance policy usually contains insurance terms defining the conditions of occurrence of insurance accident and insurance responsibility, and also includes the amount of money to be paid by the insurer and who (beneficiary) to be paid by the money to be paid, in the course of insurance, once the insurance accident of terms agreement occurs. When a particular insured event occurs resulting in the loss of an insurance target, the beneficiary enjoys the right to claim a specified amount of claim funds to the insurer's claim policy.
In particular, an insurance benefit (also referred to as a "securable equity benefit" or a "securable benefit") refers to a legally recognized benefit that an applicant has with an insurance target. Often the applicant suffers an economic loss due to damage or loss of the insurance target, which gains in return for the preservation of the insurance target. Insurance benefits can only be established if they are legally recognized, economically determined rather than expected. Generally, the insurance benefits of property insurance exist when an insurance accident occurs, and the loss can be compensated; the insurance benefits of life insurance must exist at the time of making an insurance contract to prevent ethical risks.
Example 8
On the basis of the above embodiment, the control terminal is a card read/write device for reading information in the medical insurance card, writing the latest updated medical record information transmitted by the medical insurance management system, using the access security information from the medical insurance card, reading and transmitting the latest medical information about the relevant medical insurance beneficiary through the communication network when the insurance medical insurance payment and medical payment is requested online according to the latest medical information; the medical insurance management device is used for performing online access on the control terminal according to the access safety information of the medical insurance management system recorded in the medical insurance card so as to set whether to inquire the diagnosis and treatment record information or not, can receive the diagnosis and treatment record information from the control terminal, confirms payment permission of medical insurance payment and medical fees, and transmits the latest updated diagnosis and treatment record data recorded in the medical insurance card to the control terminal connected with the communication network.
It should be noted that, the system provided in the foregoing embodiment is only illustrated by dividing the functional units, and in practical applications, the functions may be distributed by different functional units according to needs, that is, the units or steps in the embodiments of the present invention are further decomposed or combined, for example, the units in the foregoing embodiment may be combined into one unit, or may be further decomposed into multiple sub-units, so as to complete all or part of the functions described above. The names of the units and steps involved in the embodiments of the present invention are only for distinguishing the units or steps, and are not to be construed as unduly limiting the present invention.
It can be clearly understood by those skilled in the art that, for convenience and brevity of description, the specific working processes and related descriptions of the storage unit and the processing unit described above may refer to the corresponding processes in the foregoing method embodiments, and are not described herein again.
Those of skill in the art would appreciate that the various illustrative elements, method steps, and steps described in connection with the embodiments disclosed herein may be implemented as electronic hardware, computer software, or combinations of both, and that the software elements, method steps, and corresponding programs may be located in Random Access Memory (RAM), memory, Read Only Memory (ROM), electrically programmable ROM, electrically erasable programmable ROM, registers, hard disk, a removable disk, a CD-ROM, or any other form of storage medium known in the art. To clearly illustrate this interchangeability of electronic hardware and software, various illustrative components and steps have been described above generally in terms of their functionality. Whether such functionality is implemented as electronic hardware or software depends upon the particular application and design constraints imposed on the solution. Skilled artisans may implement the described functionality in varying ways for each particular application, but such implementation decisions should not be interpreted as causing a departure from the scope of the present invention.
The terms "first," "second," and the like are used for distinguishing between similar elements and not necessarily for describing or implying a particular order or sequence.
The terms "comprises," "comprising," or any other similar term are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus/unit.
So far, the technical solutions of the present invention have been described in connection with the preferred embodiments shown in the drawings, but it is easily understood by those skilled in the art that the scope of the present invention is obviously not limited to these specific embodiments. Equivalent changes or substitutions of related technical features can be made by those skilled in the art without departing from the principle of the invention, and the technical scheme after the changes or substitutions can fall into the protection scope of the invention.
The above description is only a preferred embodiment of the present invention, and is not intended to limit the scope of the present invention.
The foregoing embodiments are merely illustrative of the principles and utilities of the present invention and are not intended to limit the invention. Any person skilled in the art can modify or change the above-mentioned embodiments without departing from the spirit and scope of the present invention. Accordingly, it is intended that all equivalent modifications or changes which can be made by those skilled in the art without departing from the spirit and technical spirit of the present invention be covered by the claims of the present invention.

Claims (8)

1. An insurance service payment management system, the system comprising: the system comprises a medical insurance card, a control terminal, an insurance monitoring terminal and a server; the method is characterized in that: the medical insurance card is used for providing the individual with reimbursement of medical insurance; the control terminal is used for providing the medical institution with management of medical insurance; the insurance monitoring terminal is used for providing insurance mechanisms with insurance business monitoring; the server is used for completing the payment approval request; the control terminal is respectively in signal connection with the insurance monitoring terminal and the server; and the server is in signal connection with the insurance monitoring terminal.
2. The system of claim 1, wherein the control terminal is a card read/write device for reading information in the medical insurance card and writing the latest updated medical record information transmitted by the medical insurance management system for using the access security information from the medical insurance card to read and transmit the latest medical information about the relevant medical insurance beneficiary through the communication network when requesting to pay for insurance medical insurance payment and medical treatment based on the latest medical information online; the medical insurance management device is used for performing online access on the control terminal according to the access safety information of the medical insurance management system recorded in the medical insurance card so as to set whether to inquire the diagnosis and treatment record information or not, can receive the diagnosis and treatment record information from the control terminal, confirms payment permission of medical insurance payment and medical fees, and transmits the latest updated diagnosis and treatment record data recorded in the medical insurance card to the control terminal connected with the communication network.
3. The system of claim 2, wherein the insurance monitoring terminal comprises: the consumption information base is used for storing the reimbursement receipt to be audited, which is generated by the insurer in the medical consumption process; the system comprises a retrieval unit, a verification unit and a verification unit, wherein the retrieval unit is used for acquiring a to-be-verified reimbursement document of a participant from a consumption information base, and the to-be-verified reimbursement document comprises visit registration information, prescription detail information and expense settlement information; the expense screening unit is used for receiving the reimbursement receipt to be audited, classifying a plurality of items of data in the prescription detail information, and then outputting the medical examination registration information, the expense settlement information and the classified prescription detail information; the analysis execution unit is used for acquiring the registration information of the doctor, the expense settlement information and the classified prescription detail information and automatically auditing all data in the prescription detail information; the human-computer interaction unit is used for displaying the registration information of the treatment, the expense settlement information and the prescription detail information, inputting parameters and threshold values corresponding to all data in the prescription detail information into the analysis execution unit, enabling the analysis execution unit to automatically carry out batch audit on the data according to the parameters and the threshold values, and adding suspicious data identifications or normal data identifications for all data according to the audit results; the human-computer interaction unit is also used for carrying out manual examination on information except for automatic examination; during manual examination, the analysis execution unit calls corresponding professional knowledge according to the visit registration information, the prescription detail information and the expense settlement information; and the analysis execution unit calls the corresponding checked reimbursement bill according to the information in the reimbursement bill to be checked during manual checking, and stores the checked reimbursement bill in the historical information base.
4. The system of claim 3, wherein said server is a payment approval server for validating the payment approval to the relevant medical institution in response to a payment approval request from the medical insurance management apparatus; and an information database for storing the medical insurance-related information of the medical insurance beneficiary recorded on the medical insurance card and the medical history information including all the medical information of the medical insurance beneficiary recorded thereon.
5. The system of claim 4, wherein the control terminal further comprises a signature approval input component for transmitting the signature of the health care beneficiary to the health care management system so that the health care beneficiary receiving the diagnosis can confirm the details of the diagnosis result; and the medical insurance management means of the medical insurance management system must record the treatment information and confirm the payment approval based on the signature of the medical insurance beneficiary transmitted from the control terminal.
6. The system of claim 5, wherein the medical insurance card: recording medical insurance related data configured for medical insurance beneficiaries; access security information to access the medical insurance management system online, and related information fields regarding personal medical insurance of one or more medical insurance beneficiaries able to use the medical insurance card; and a medical record information field in which the newly updated medical record information is recorded.
7. An insurance service payment management method based on the system of one of claims 1 to 6, characterized in that the method performs the following steps: step 1: the medical insurance card is used for providing the individual with reimbursement for medical insurance; step 2: the control terminal is provided for medical institutions to manage medical insurance; and step 3: the insurance monitoring terminal is used for monitoring insurance business provided for an insurance mechanism; and 4, step 4: server, completing payment approval request; the control terminal is respectively in signal connection with the insurance monitoring terminal and the server; and the server is in signal connection with the insurance monitoring terminal.
8. The method of claim 7, wherein the control terminal is a card read/write device for reading information in the medical insurance card and writing the latest updated medical record information transmitted by the medical insurance management system for using the access security information from the medical insurance card to read and transmit the latest medical information about the relevant medical insurance beneficiary through the communication network when requesting to pay for insurance medical insurance payment and medical treatment based on the latest medical information online; the medical insurance management device is used for performing online access on the control terminal according to the access safety information of the medical insurance management system recorded in the medical insurance card so as to set whether to inquire the diagnosis and treatment record information or not, can receive the diagnosis and treatment record information from the control terminal, confirms payment permission of medical insurance payment and medical fees, and transmits the latest updated diagnosis and treatment record data recorded in the medical insurance card to the control terminal connected with the communication network.
CN202010022826.3A 2020-01-09 2020-01-09 Insurance business payment management system and method Pending CN113095944A (en)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN1489741A (en) * 2001-02-02 2004-04-14 ����ͨѶ�ɷ����޹�˾ System for managing medical insurance using information communication network
CN104134157A (en) * 2014-08-08 2014-11-05 平安养老保险股份有限公司 Suspicious behavior audit system and method in medical insurance reimbursement process
CN110009516A (en) * 2019-04-01 2019-07-12 太平洋医疗健康管理有限公司 Medical insurance intelligent checks method and system

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN1489741A (en) * 2001-02-02 2004-04-14 ����ͨѶ�ɷ����޹�˾ System for managing medical insurance using information communication network
CN104134157A (en) * 2014-08-08 2014-11-05 平安养老保险股份有限公司 Suspicious behavior audit system and method in medical insurance reimbursement process
CN110009516A (en) * 2019-04-01 2019-07-12 太平洋医疗健康管理有限公司 Medical insurance intelligent checks method and system

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