CN114722063B - Updating method and device of medical insurance auditing system, electronic equipment and storage medium - Google Patents
Updating method and device of medical insurance auditing system, electronic equipment and storage medium Download PDFInfo
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Abstract
The disclosure discloses an updating method and device of a medical insurance auditing system, an electronic device and a storage medium, and the main technical scheme comprises the following steps: the preset medical insurance knowledge base and the preset engine configuration table are intensively deployed in the open service platform in a cluster mode, when the preset medical insurance knowledge base and/or the preset engine configuration table need to be updated, only the preset medical insurance knowledge base and the preset engine configuration table in the open service platform need to be updated, the medical insurance auditing system which accords with the current medical insurance reimbursement policy can be used when medical insurance data are audited, the problem that auditing is inaccurate or errors exist in auditing results due to untimely updating of the system is effectively solved, and auditing accuracy of the medical insurance data is improved.
Description
Technical Field
The present disclosure relates to the field of data processing technologies, and in particular, to an update method and apparatus for a medical insurance auditing system, an electronic device, and a storage medium.
Background
Currently, for medical insurance data auditing, a method of integrating a rule engine and related data into a third-party service system is generally adopted; when medical insurance data is audited, the medical insurance data is input into the third-party service system, and the third-party service system can call the rule engine through the local interface to complete auditing of the medical insurance data.
Although the method can complete the auditing work of the medical insurance data, when the rule engine is updated and the medical insurance reimbursement rule and/or reimbursement drugs change, the third-party business system may not be able to update correspondingly in time, thereby resulting in inaccurate medical insurance auditing result or errors.
Disclosure of Invention
The disclosure provides an updating method and device of a medical insurance auditing system, electronic equipment and a storage medium. The method mainly aims to solve the problem that when medical insurance data is stored in an own network under a third-party service system, the medical insurance data is not updated timely.
According to a first aspect of the present disclosure, an updating method of a medical insurance auditing system is provided, which includes:
detecting whether the preset medical insurance knowledge base and the preset engine configuration table are updated or not; the system comprises a preset medical insurance knowledge base and a preset engine configuration table, wherein the preset medical insurance knowledge base and the preset engine configuration table are centrally deployed in an open service platform in a cluster mode;
and if the update exists, updating the preset medical insurance knowledge base and the preset engine configuration table in the open service platform cluster respectively.
Optionally, the method further includes:
receiving request information of medical insurance data to be audited, wherein the request information comprises an authorization code of an open service platform and the medical insurance data to be audited;
identifying an authorization code in the request information, and determining a target service class corresponding to the authorization code;
and in the target service category, a first access interface is called based on a preset rule engine to audit the medical insurance data to be audited, wherein the first access interface is used for indicating to access the preset medical insurance knowledge base and/or the preset engine configuration table in the open service platform.
Optionally, the receiving the request information of the medical insurance data to be audited includes:
establishing a communication channel with a third-party service platform based on a second access interface of the open service platform;
and receiving the medical insurance data to be audited sent by the third-party service platform based on the communication channel.
Optionally, after the target service class calls a first access interface to audit the medical insurance data to be audited based on a preset rule engine, the method further includes:
and sending the determined auditing result to the third-party service platform through the communication channel.
Optionally, the method further includes:
receiving a downloading request aiming at offline examination, wherein the downloading request comprises an authorization code;
acquiring a Software Development Kit (SDK) of an authorized resource corresponding to the authorization code, wherein the SDK comprises a preset rule engine;
encrypting the preset medical insurance knowledge base and the preset engine configuration table;
and responding to the downloading request, and sending the encrypted data and the Software Development Kit (SDK).
Optionally, after the target service class calls a first access interface to audit the medical insurance data to be audited based on a preset rule engine, the method further includes:
carrying out violation analysis on the medical insurance auditing result based on a preset data analysis component;
and encrypting the violation analysis result by using the authorization code.
According to a second aspect of the present disclosure, there is provided an updating apparatus of a medical insurance auditing system, including:
the detection unit is used for detecting whether the preset medical insurance knowledge base and the preset engine configuration table are updated or not; the system comprises a preset medical insurance knowledge base and a preset engine configuration table, wherein the preset medical insurance knowledge base and the preset engine configuration table are intensively deployed in an open service platform in a cluster mode;
and the updating unit is used for respectively updating the preset medical insurance knowledge base and the preset engine configuration table in the open service platform cluster when the update is determined to exist.
Optionally, the apparatus further comprises:
the first receiving unit is used for receiving request information of the medical insurance data to be audited, wherein the request information comprises an authorization code of the open service platform and the medical insurance data to be audited;
the identification unit is used for identifying the authorization code in the request information and determining the target service class corresponding to the authorization code;
an auditing unit, configured to invoke a first access interface based on a preset rule engine to audit the to-be-audited medical insurance data within the target service category, where the first access interface is used to instruct access to the preset medical insurance knowledge base and/or the preset engine configuration table in the open service platform
Optionally, the first receiving unit includes:
the establishing module is used for establishing a communication channel with a third-party service platform based on a second access interface of the open service platform;
and the receiving module is used for receiving the to-be-audited medical insurance data sent by the third-party service platform based on the communication channel.
Optionally, the apparatus further comprises:
and the first sending unit is used for calling a first access interface based on a preset rule engine to audit the medical insurance data to be audited in the target service category in the auditing unit, and then sending the determined auditing result to the third-party service platform through the communication channel.
Optionally, the apparatus further comprises:
a second receiving unit, configured to receive a download request for offline auditing, where the download request includes an authorization code;
the acquisition unit is used for acquiring a software development kit SDK of the authorized resource corresponding to the authorization code, wherein the software development kit SDK comprises a preset rule engine, the preset medical insurance knowledge base and the preset medical insurance rule base;
the first encryption unit is used for encrypting the preset medical insurance knowledge base and the preset engine configuration table;
and the second sending unit is used for responding to the downloading request and sending the encrypted data and the software development kit SDK.
Optionally, the apparatus further comprises:
the analysis unit is used for carrying out violation analysis on the medical insurance auditing result based on a preset data analysis component after the first access interface is called to audit the medical insurance data to be audited based on a preset rule engine in the target service class by the auditing unit;
and the second encryption unit is used for encrypting the violation analysis result by using the authorization code.
According to a third aspect of the present disclosure, there is provided an electronic device comprising:
at least one processor; and
a memory communicatively coupled to the at least one processor; wherein the content of the first and second substances,
the memory stores instructions executable by the at least one processor to enable the at least one processor to perform the method of the first aspect.
According to a fourth aspect of the present disclosure, there is provided a non-transitory computer readable storage medium having stored thereon computer instructions for causing the computer to perform the method of the aforementioned first aspect.
According to a fifth aspect of the present disclosure, there is provided a computer program product comprising a computer program which, when executed by a processor, implements the method as set forth in the preceding first aspect.
According to the updating method and device of the medical insurance auditing system, the electronic equipment and the storage medium, whether the preset medical insurance knowledge base and the preset engine configuration table are updated or not is detected; the system comprises a preset medical insurance knowledge base and a preset engine configuration table, wherein the preset medical insurance knowledge base and the preset engine configuration table are intensively deployed in an open service platform in a cluster mode, and if updating is determined to exist, the preset medical insurance knowledge base and the preset engine configuration table in the open service platform cluster are respectively updated. Compared with the prior art, the embodiment of the application has the advantages that the preset medical insurance knowledge base and the preset engine configuration table are intensively deployed in the open service platform in a cluster mode, when the preset medical insurance knowledge base and/or the preset engine configuration table need to be updated, the medical insurance auditing system which accords with the current medical insurance reimbursement policy can be used when medical insurance data is audited only by updating the preset medical insurance knowledge base and the preset engine configuration table in the open service platform, the problem of inaccurate auditing or error in auditing results caused by untimely updating of the system is effectively solved, and the auditing accuracy of the medical insurance data is improved.
It should be understood that the statements in this section do not necessarily identify key or critical features of the embodiments of the present application, nor do they limit the scope of the present application. Other features of the present application will become apparent from the following description.
Drawings
The drawings are included to provide a better understanding of the present solution and are not to be construed as limiting the present disclosure. Wherein:
fig. 1 is a schematic flowchart of an updating method of a medical insurance auditing system according to an embodiment of the present disclosure;
fig. 2 is a schematic flow chart of an auditing method for medical insurance data according to an embodiment of the present disclosure;
fig. 3 is a schematic flow chart of an auditing method for medical insurance data in an offline environment according to an embodiment of the present disclosure;
fig. 4 is a schematic flowchart of a method for analyzing a medical insurance audit result in violation according to an embodiment of the present disclosure;
fig. 5 is a schematic structural diagram of an updating apparatus of a medical insurance auditing system according to an embodiment of the present disclosure;
fig. 6 is a schematic structural diagram of an updating apparatus of another medical insurance auditing system according to an embodiment of the present disclosure;
fig. 7 is a schematic block diagram of an example electronic device 600 provided by embodiments of the present disclosure.
Detailed Description
Exemplary embodiments of the present disclosure are described below with reference to the accompanying drawings, in which various details of the embodiments of the disclosure are included to assist understanding, and which are to be considered as merely exemplary. Accordingly, those of ordinary skill in the art will recognize that various changes and modifications of the embodiments described herein can be made without departing from the scope and spirit of the disclosure. Also, descriptions of well-known functions and constructions are omitted in the following description for clarity and conciseness.
An update method, an update apparatus, an electronic device, and a storage medium of a medical insurance audit system according to an embodiment of the present disclosure are described below with reference to the drawings.
Fig. 1 is a schematic flow chart of an updating method of a medical insurance auditing system according to an embodiment of the present disclosure.
As shown in fig. 1, the method comprises the following steps:
Because the medical insurance reimbursement policy can change frequently, the types of medical insurance reimbursement medicines, reimbursement diagnostic items and medical service facilities can change, the calculation logic of the preset engine can also change, the content in the preset knowledge base needs to be updated, the preset engine configuration table needs to be updated, and when the medical insurance audit system is updated, various modes are provided, such as: the updating is carried out manually, the system automatically detects and updates the updating information, and the updating mode is not limited in the embodiment of the application.
The medical insurance auditing system may detect whether at least one of the preset medical insurance knowledge base and the preset engine configuration table needs to be updated at preset time intervals or within a specified time period, for example, the time intervals may be set to 12 hours, or to 21:00, detecting; the embodiment of the present application does not limit the manner of detecting the update. When the updated information is not detected, the detection is continued at preset time intervals, and when the updated information is detected, step 102 is executed. The preset medical insurance knowledge base comprises: a basic medical insurance medicine catalog, a diagnosis and treatment item catalog, a medical service facility catalog and medical insurance reimbursement policies in a planning area; the preset engine configuration table includes engine calculation logic.
And step 102, if the update is determined to exist, updating the preset medical insurance knowledge base and the preset engine configuration table in the open service platform cluster respectively.
The medical insurance reimbursement policy is only executed after a set date, and part of functions of the medical insurance auditing system cannot be used when the medical insurance auditing system updates information, so that the medical insurance auditing system cannot be updated immediately after detecting the updated information, and the medical insurance reimbursement policy is selected to be updated in non-working time according to the effective date of the medical insurance auditing policy; for example: when the medical insurance auditing system detects the updated information, the updated medical insurance reimbursement policy is determined to be implemented in the tomorrow, and the system can complete updating before tomorrow working time (such as 1.
As another implementation manner of the embodiment of the present application, in order to determine timeliness of updating of the medical insurance auditing system, when the preset medical insurance knowledge base and the preset engine configuration table are updated, the update is performed in real time, and a specific update time is not limited in the embodiment of the present application.
According to the updating method of the medical insurance auditing system, whether the preset medical insurance knowledge base and the preset engine configuration table are updated or not is detected; the system comprises a preset medical insurance knowledge base and a preset engine configuration table, wherein the preset medical insurance knowledge base and the preset engine configuration table are intensively deployed in an open service platform in a cluster mode, and if updating is determined to exist, the preset medical insurance knowledge base and the preset engine configuration table in the open service platform cluster are respectively updated. Compared with the prior art, the embodiment of the application has the advantages that the preset medical insurance knowledge base and the preset engine configuration table are centrally deployed in the open service platform in a cluster mode, when the preset medical insurance knowledge base and/or the preset engine configuration table need to be updated, the medical insurance auditing system which accords with the current medical insurance reimbursement policy can be used when auditing the medical insurance data to be audited only by updating the preset medical insurance knowledge base and the preset engine configuration table in the open service platform, the problem of inaccurate auditing or error in auditing results caused by untimely updating of the system is effectively solved, and the auditing accuracy of the medical insurance data is improved.
An embodiment of the present application further provides an auditing method for medical insurance data, as shown in fig. 2, fig. 2 is a schematic flow diagram of an auditing method for medical insurance data provided in an embodiment of the present application.
The authorization code comprises user authority, and the authorization code can determine the available service window and viewable resource condition of the current user. Because the medical insurance reimbursement policies in different overall areas are different, and the reimbursement ratios of hospitals in different levels are also different, the method and the system adopt the micro-service style to design the open service platform, divide service windows according to the overall areas, hospital levels and service categories, confirm the service window corresponding to the user permission in the authorization code mode, and realize accurate service.
The authorization code is detected, the usable service window within the authorization range is detected, and the service category can be confirmed according to the usable service window, for example: when a doctor makes a prescription, the authorization code and prescription data information are sent to the open service platform together, and the open service platform can determine that the corresponding service window is a prescription audit window according to the information in the authorization code; when the medical insurance settlement data is audited, the authorization code and the prescription information are sent to the open service platform together, and the information in the authorization code of the service platform pattern is opened, so that the corresponding service window can be confirmed to be the medical insurance settlement data audit window; it should be noted that the application scenarios such as prescription making by a doctor and medical insurance settlement data auditing are exemplary illustrations, and the application scenarios of medical insurance auditing are not limited in the embodiment of the present application.
The preset rule engine audits the medical insurance data to be audited based on the information in the preset medical insurance knowledge base and the preset engine configuration table, wherein the auditing standard is different according to different target service types, for example: when the target service type is the prescription detection, the auditing rule is to audit whether the issued medicines correspond to the symptoms or not and whether the issued medicines have the selection of lower price of the same type or not; and when the target service type is medical insurance settlement data auditing, auditing the medical insurance reimbursement policy and hospital level in the overall area by the auditing service rule, and auditing whether reimbursement items and money amount meet the regulations.
As an extension to the above application embodiment, after the audit is completed, sending the determined audit result to the third-party service platform through the communication channel; the third-party service platform is a platform establishing a cooperative relationship with the open service platform, for example: hospital Information System (HIS), national medical insurance System, and the like, which are not limited in the embodiments of the present application.
As an implementation manner of the embodiment of the application, when the request information of the medical insurance data to be audited is received in step 201, the following method can be adopted, namely a communication channel with a third-party service platform is established based on a second access interface of the open service platform; and receiving the to-be-audited medical insurance data sent by the third-party service platform based on the communication channel.
The medical insurance data auditing method needs to be established under the condition of network intercommunication because the uploading and downloading of the medical insurance data are related, but in practical application, a part of hospitals do not have network conditions or a part of hospitals are unwilling to upload the medical insurance data to be audited; fig. 3 is a schematic flowchart of an auditing method of medical insurance data in an offline environment according to an embodiment of the present application, and as shown in fig. 3, the auditing method includes:
And the user sends a downloading request in the third platform and sends the downloading request to the open service platform through the second access interface, and the open service platform detects the authorization code in the downloading request and acquires the authorization condition of the authorization code.
The purpose of obtaining authorized resources is to: if all the contents in the preset medical insurance knowledge base and the preset engine configuration table are obtained, the downloaded data has overlarge internal memory and is inconvenient for users to download, and most of the downloaded data are not authorized to use and view due to the authority problem of the users, so that the incomplete data in the authority of the users are obtained according to the authority of different users and are used for the users to download; the Software Development Kit (SDK) includes a preset rule engine, and is configured to execute, based on the downloaded authorization data, an audit on the medical insurance data to be audited after the user completes downloading.
And 303, encrypting the preset medical insurance knowledge base and the preset engine configuration table.
In the open service platform, the preset medical insurance knowledge base and the preset engine configuration table are both stored in a local network under the open service platform, and when the medical insurance data to be audited is audited, the data in the preset medical insurance knowledge base and the preset engine configuration table are called in the local network under the open service platform for auditing, so that the risk of data information leakage does not exist. However, when the preset medical insurance knowledge base and the preset engine configuration table are downloaded, a non-full amount of the preset medical insurance knowledge base and the preset engine configuration table are stored in a network under a third-party service platform, and a risk of data information leakage exists, so that the preset medical insurance knowledge base and the preset engine configuration table need to be encrypted, and only a user is allowed to use data information therein based on a preset rule engine after downloading the data information to the local, but the user is not allowed to directly view the data information.
And step 304, responding to the downloading request, and sending the encrypted data and the software development kit SDK.
And allowing the user to download the encrypted data and the SDK to the local in response to the download request of the user so as to perform the examination and verification of the medical insurance data to be examined in an offline environment. The method solves the problem of medical insurance data auditing to be audited in an offline environment, and also solves the problem of data leakage of a hospital/open service platform.
Through the steps, auditing of medical insurance data to be audited can be completed, various conditions which do not conform to medical insurance reimbursement policies in the medical insurance data to be audited can be detected through auditing, and in order to facilitate visual observation of problems in the medical insurance reimbursement process, the embodiment of the application provides a method for violation analysis of medical insurance auditing results, and as shown in fig. 4, the method comprises the following steps:
and step 401, performing violation analysis on the medical insurance audit result based on a preset data analysis component.
After the medical insurance settlement data is audited, the open service platform records the audit result in the preset data analysis component, and the preset data analysis component analyzes the violation phenomenon according to different time intervals, for example, all medical insurance audit results are analyzed, medical insurance audit results in half years are analyzed, different hospitals are analyzed, and the like.
The violation analysis results may visualize violation data, such as: the medical insurance reimbursement policy with higher violation rate can be displayed, and then the related personnel can be trained aiming at the medical insurance reimbursement policy, or the rationality of the medical insurance reimbursement policy can be investigated, so that the medical insurance policy is more perfect.
At step 402, the authorization code is used to encrypt the violation analysis result.
Since the violation analysis result relates to different third-party client information and is private data information, the violation analysis result is encrypted by using the authorization code and only authorized personnel are allowed to check the violation analysis result.
Corresponding to the updating method based on the medical insurance auditing system, the invention also provides an updating device based on the medical insurance auditing system. Since the device embodiment of the present invention corresponds to the method embodiment described above, details that are not disclosed in the device embodiment may refer to the method embodiment described above, and are not described again in the present invention.
Fig. 5 is a schematic structural diagram of an updating apparatus of a medical insurance auditing system according to an embodiment of the present disclosure, and as shown in fig. 5, the updating apparatus includes:
the detection unit 51 is used for detecting whether the preset medical insurance knowledge base and the preset engine configuration table are updated or not; the system comprises a preset medical insurance knowledge base and a preset engine configuration table, wherein the preset medical insurance knowledge base and the preset engine configuration table are centralized in an open service platform in a cluster mode;
an updating unit 52, configured to update the preset medical insurance knowledge base and the preset engine configuration table in the open service platform cluster, respectively, when it is determined that there is an update.
The updating device of the medical insurance auditing system provided by the disclosure detects whether the preset medical insurance knowledge base and the preset engine configuration table are updated or not; the system comprises a preset medical insurance knowledge base and a preset engine configuration table, wherein the preset medical insurance knowledge base and the preset engine configuration table are centrally deployed in an open service platform in a cluster mode, and if update is determined to exist, the preset medical insurance knowledge base and the preset engine configuration table in the open service platform cluster are respectively updated. Compared with the prior art, the embodiment of the application has the advantages that the preset medical insurance knowledge base and the preset engine configuration table are intensively deployed in the open service platform in a cluster mode, when the preset medical insurance knowledge base and/or the preset engine configuration table need to be updated, the medical insurance auditing system which accords with the current medical insurance reimbursement policy can be used when medical insurance data is audited only by updating the preset medical insurance knowledge base and the preset engine configuration table in the open service platform, the problem of inaccurate auditing or error in auditing results caused by untimely updating of the system is effectively solved, and the auditing accuracy of the medical insurance data is improved.
Further, in a possible implementation manner of this embodiment, as shown in fig. 6, the apparatus further includes:
the first receiving unit 53 is configured to receive request information of the medical insurance data to be audited, where the request information includes an authorization code of the open service platform and the medical insurance data to be audited;
an identifying unit 54, configured to identify an authorization code in the request information, and determine a target service category corresponding to the authorization code;
an auditing unit 55, configured to invoke, based on a preset rule engine, a first access interface to audit the to-be-audited medical insurance data within the target service class, where the first access interface is used to instruct to access the preset medical insurance knowledge base and/or the preset engine configuration table in the open service platform
Further, in a possible implementation manner of this embodiment, as shown in fig. 6, the first receiving unit 53 includes:
the establishing module 531 is configured to establish a communication channel with a third party service platform based on a second access interface of the open service platform;
the receiving module 532 is configured to receive the to-be-approved medical insurance data sent by the third-party service platform based on the communication channel.
Further, in a possible implementation manner of this embodiment, as shown in fig. 6, the apparatus further includes:
and a first sending unit 56, configured to, in the auditing unit 55, call a first access interface based on a preset rule engine to audit the to-be-audited medical insurance data in the target service class, and then send a determined auditing result to the third-party service platform through the communication channel.
Further, in a possible implementation manner of this embodiment, as shown in fig. 6, the apparatus further includes:
a second receiving unit 57, configured to receive a download request for offline audit, where the download request includes an authorization code;
an obtaining unit 58, configured to obtain a software development kit SDK of an authorized resource corresponding to the authorization code, where the software development kit SDK includes a preset rule engine, the preset medical insurance knowledge base, and the preset medical insurance rule base;
the first encryption unit 59 is configured to encrypt the preset medical insurance knowledge base and the preset engine configuration table;
a second sending unit 510, configured to send the encrypted data and the software development kit SDK in response to the download request.
Further, in a possible implementation manner of this embodiment, as shown in fig. 6, the apparatus further includes:
the analysis unit 511 is configured to, in the auditing unit, invoke, based on a preset rule engine, a first access interface to audit the to-be-audited medical insurance data in the target service class, and then perform violation analysis on a medical insurance audit result based on a preset data analysis component;
a second encrypting unit 512, configured to encrypt the violation analysis result using the authorization code.
It should be noted that the foregoing explanations of the method embodiments also apply to the apparatus of this embodiment, and the principle is the same, and this embodiment is not limited.
The present disclosure also provides an electronic device, a readable storage medium, and a computer program product according to embodiments of the present disclosure.
FIG. 7 illustrates a schematic block diagram of an example electronic device 600 that can be used to implement embodiments of the present disclosure. Electronic devices are intended to represent various forms of digital computers, such as laptops, desktops, workstations, personal digital assistants, servers, blade servers, mainframes, and other appropriate computers. The electronic device may also represent various forms of mobile devices, such as personal digital processing, cellular phones, smart phones, wearable devices, and other similar computing devices. The components shown herein, their connections and relationships, and their functions, are meant to be examples only, and are not intended to limit implementations of the disclosure described and/or claimed herein.
As shown in fig. 7, the device 600 includes a computing unit 601, which can perform various appropriate actions and processes in accordance with a computer program stored in a ROM (Read-Only Memory) 602 or a computer program loaded from a storage unit 608 into a RAM (Random Access Memory) 603. In the RAM 603, various programs and data required for the operation of the device 600 can also be stored. The calculation unit 601, the ROM 602, and the RAM 603 are connected to each other via a bus 604. An I/O (Input/Output) interface 605 is also connected to the bus 604.
A number of components in the device 600 are connected to the I/O interface 605, including: an input unit 606 such as a keyboard, a mouse, or the like; an output unit 607 such as various types of displays, speakers, and the like; a storage unit 608, such as a magnetic disk, optical disk, or the like; and a communication unit 609 such as a network card, modem, wireless communication transceiver, etc. The communication unit 609 allows the device 600 to exchange information/data with other devices via a computer network such as the internet and/or various telecommunication networks.
The computing unit 601 may be a variety of general and/or special purpose processing components having processing and computing capabilities. Some examples of the computing Unit 601 include, but are not limited to, a CPU (Central Processing Unit), a GPU (graphics Processing Unit), various dedicated AI (Artificial Intelligence) computing chips, various computing Units running machine learning model algorithms, a DSP (Digital Signal Processor), and any suitable Processor, controller, microcontroller, and the like. The calculation unit 601 performs the respective methods and processes described above, such as the update method of the medical insurance audit system. For example, in some embodiments, the update method of the medical insurance audit system may be implemented as a computer software program tangibly embodied in a machine-readable medium, such as the storage unit 608. In some embodiments, part or all of the computer program may be loaded and/or installed onto the device 600 via the ROM 602 and/or the communication unit 609. When the computer program is loaded into the RAM 603 and executed by the computing unit 601, one or more steps of the method described above may be performed. Alternatively, in other embodiments, the computing unit 601 may be configured by any other suitable means (e.g. by means of firmware) to perform the update method of the aforementioned medical insurance audit system.
Various implementations of the systems and techniques described here above may be realized in digital electronic circuitry, integrated circuitry, FPGAs (Field Programmable Gate arrays), ASICs (Application-Specific Integrated circuits), ASSPs (Application Specific Standard products), SOCs (System On Chip, system On a Chip), CPLDs (Complex Programmable Logic devices), computer hardware, firmware, software, and/or combinations thereof. These various embodiments may include: implemented in one or more computer programs that are executable and/or interpretable on a programmable system including at least one programmable processor, which may be special or general purpose, receiving data and instructions from, and transmitting data and instructions to, a storage system, at least one input device, and at least one output device.
Program code for implementing the methods of the present disclosure may be written in any combination of one or more programming languages. These program codes may be provided to a processor or controller of a general purpose computer, special purpose computer, or other programmable data processing apparatus, such that the program codes, when executed by the processor or controller, cause the functions/operations specified in the flowchart and/or block diagram to be performed. The program code may execute entirely on the machine, partly on the machine, as a stand-alone software package partly on the machine and partly on a remote machine or entirely on the remote machine or server.
In the context of this disclosure, a machine-readable medium may be a tangible medium that can contain, or store a program for use by or in connection with an instruction execution system, apparatus, or device. The machine-readable medium may be a machine-readable signal medium or a machine-readable storage medium. A machine-readable medium may include, but is not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, or device, or any suitable combination of the foregoing. More specific examples of a machine-readable storage medium would include an electrical connection based on one or more wires, a portable computer diskette, a hard disk, a RAM, a ROM, an EPROM (Electrically Programmable Read-Only-Memory) or flash Memory, an optical fiber, a CD-ROM (Compact Disc Read-Only-Memory), an optical storage device, a magnetic storage device, or any suitable combination of the foregoing.
To provide for interaction with a user, the systems and techniques described here can be implemented on a computer having: a Display device (e.g., a CRT (Cathode Ray Tube) or LCD (Liquid Crystal Display) monitor) for displaying information to a user; and a keyboard and a pointing device (e.g., a mouse or a trackball) by which a user can provide input to the computer. Other kinds of devices may also be used to provide for interaction with a user; for example, feedback provided to the user can be any form of sensory feedback (e.g., visual feedback, auditory feedback, or tactile feedback); and input from the user may be received in any form, including acoustic, speech, or tactile input.
The systems and techniques described here can be implemented in a computing system that includes a back-end component (e.g., as a data server), or that includes a middleware component (e.g., an application server), or that includes a front-end component (e.g., a user computer having a graphical user interface or a web browser through which a user can interact with an implementation of the systems and techniques described here), or any combination of such back-end, middleware, or front-end components. The components of the system can be interconnected by any form or medium of digital data communication (e.g., a communication network). Examples of communication networks include: LAN (Local Area Network), WAN (Wide Area Network), internet, and blockchain Network.
The computer system may include clients and servers. A client and server are generally remote from each other and typically interact through a communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other. The Server can be a cloud Server, also called a cloud computing Server or a cloud host, and is a host product in a cloud computing service system, so as to solve the defects of high management difficulty and weak service expansibility in the traditional physical host and VPS service ("Virtual Private Server", or simply "VPS"). The server may also be a server of a distributed system, or a server incorporating a blockchain.
It should be noted that artificial intelligence is a subject for studying a computer to simulate some human thinking processes and intelligent behaviors (such as learning, reasoning, thinking, planning, etc.), and includes both hardware and software technologies. Artificial intelligence hardware technologies generally include technologies such as sensors, dedicated artificial intelligence chips, cloud computing, distributed storage, big data processing, and the like; the artificial intelligence software technology mainly comprises a computer vision technology, a voice recognition technology, a natural language processing technology, machine learning/deep learning, a big data processing technology, a knowledge map technology and the like.
It should be understood that various forms of the flows shown above, reordering, adding or deleting steps, may be used. For example, the steps described in the present disclosure may be executed in parallel, sequentially, or in different orders, as long as the desired results of the technical solutions disclosed in the present disclosure can be achieved, and the present disclosure is not limited herein.
The above detailed description should not be construed as limiting the scope of the disclosure. It should be understood by those skilled in the art that various modifications, combinations, sub-combinations and substitutions may be made in accordance with design requirements and other factors. Any modification, equivalent replacement, and improvement made within the spirit and principle of the present disclosure should be included in the protection scope of the present disclosure.
Claims (10)
1. An updating method of a medical insurance auditing system is characterized by comprising the following steps:
detecting whether the preset medical insurance knowledge base and the preset engine configuration table are updated or not; the system comprises a preset medical insurance knowledge base and a preset engine configuration table, wherein the preset medical insurance knowledge base and the preset engine configuration table are intensively deployed in an open service platform in a cluster mode;
if the update exists, updating the preset medical insurance knowledge base and the preset engine configuration table in the open service platform cluster respectively;
receiving request information of medical insurance data to be audited, wherein the request information comprises an authorization code of an open service platform and the medical insurance data to be audited;
identifying an authorization code in the request information, and determining a target service class corresponding to the authorization code;
in the target service category, a first access interface is called based on a preset rule engine to audit the medical insurance data to be audited, the first access interface is used for indicating to access the preset medical insurance knowledge base and/or the preset engine configuration table in the open service platform,
wherein, the receiving the request information of the medical insurance data to be audited includes:
establishing a communication channel with a third-party service platform based on a second access interface of the open service platform;
and receiving the medical insurance data to be audited sent by the third-party service platform based on the communication channel.
2. The method of claim 1, wherein after the auditing of the to-be-audited medical insurance data is performed within the target service class by invoking a first access interface based on a preset rules engine, the method further comprises:
and sending the determined auditing result to the third-party service platform through the communication channel.
3. The method of claim 1, further comprising:
receiving a downloading request aiming at offline examination, wherein the downloading request comprises an authorization code;
acquiring a Software Development Kit (SDK) of an authorized resource corresponding to the authorization code, wherein the SDK comprises a preset rule engine;
encrypting the preset medical insurance knowledge base and the preset engine configuration table;
and responding to the downloading request, and sending the encrypted data and the Software Development Kit (SDK).
4. The method of claim 1, wherein after the auditing of the to-be-audited medical insurance data is performed within the target service class by invoking a first access interface based on a preset rules engine, the method further comprises:
carrying out violation analysis on the medical insurance auditing result based on a preset data analysis component;
and encrypting the violation analysis result by using the authorization code.
5. An updating device of a medical insurance auditing system is characterized by comprising:
the detection unit is used for detecting whether the preset medical insurance knowledge base and the preset engine configuration table are updated or not; the system comprises a preset medical insurance knowledge base and a preset engine configuration table, wherein the preset medical insurance knowledge base and the preset engine configuration table are intensively deployed in an open service platform in a cluster mode;
the updating unit is used for respectively updating the preset medical insurance knowledge base and the preset engine configuration table in the open service platform cluster when the update is determined to exist;
the first receiving unit is used for receiving request information of the medical insurance data to be audited, wherein the request information comprises an authorization code of the open service platform and the medical insurance data to be audited;
a determining unit, configured to identify an authorization code in the request information, and determine a target service category corresponding to the authorization code;
the auditing unit is used for invoking a first access interface based on a preset rule engine to audit the medical insurance data to be audited in the target service category, and the first access interface is used for indicating to access the preset medical insurance knowledge base and/or the preset engine configuration table in the open service platform;
wherein the first receiving unit includes:
the establishing module is used for establishing a communication channel with a third-party service platform based on a second access interface of the open service platform;
and the receiving module is used for receiving the to-be-audited medical insurance data sent by the third-party service platform based on the communication channel.
6. The apparatus of claim 5, further comprising:
and the first sending unit is used for sending the determined auditing result to the third-party service platform through the communication channel after the auditing unit calls a first access interface to audit the medical insurance data to be audited based on a preset rule engine in the target service class.
7. The apparatus of claim 5, further comprising:
a second receiving unit, configured to receive a download request for offline auditing, where the download request includes an authorization code;
the acquisition unit is used for acquiring a Software Development Kit (SDK) of authorized resources corresponding to the authorization codes, and the SDK comprises a preset rule engine and a preset medical insurance knowledge base;
the first encryption unit is used for encrypting the preset medical insurance knowledge base and the preset engine configuration table;
and the second sending unit is used for responding to the downloading request and sending the encrypted data and the software development kit SDK.
8. The apparatus of claim 5, further comprising:
the analysis unit is used for carrying out violation analysis on the medical insurance auditing result based on a preset data analysis component after the auditing unit calls the first access interface to audit the medical insurance data to be audited based on a preset rule engine in the target service class;
and the second encryption unit is used for encrypting the violation analysis result by using the authorization code.
9. An electronic device, comprising:
at least one processor; and
a memory communicatively coupled to the at least one processor; wherein the content of the first and second substances,
the memory stores instructions executable by the at least one processor to enable the at least one processor to perform the method of any one of claims 1-4.
10. A non-transitory computer readable storage medium having stored thereon computer instructions for causing the computer to perform the method of any one of claims 1-4.
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| CN104820959A (en) * | 2015-04-29 | 2015-08-05 | 赵蒙海 | Medical knowledge base system based on data mining |
| EP3605376A1 (en) * | 2018-08-03 | 2020-02-05 | Siemens Healthcare GmbH | Blockchain-based distribution of medical data records |
| CN111125061A (en) * | 2019-12-18 | 2020-05-08 | 甘肃省卫生健康统计信息中心(西北人口信息中心) | Method for standardizing and promoting health medical big data |
| CN111598709B (en) * | 2020-06-29 | 2023-03-21 | 腾讯科技（深圳）有限公司 | Medical insurance data processing system, method, device, equipment and storage medium |
| CN112184426A (en) * | 2020-10-12 | 2021-01-05 | 深圳壹账通智能科技有限公司 | Data sharing method, system, server and computer readable storage medium |
| CN114202302A (en) * | 2021-11-05 | 2022-03-18 | 武汉金豆医疗数据科技有限公司 | Knowledge base construction and operation logic method and system applied to support medical insurance audit rules |
| CN114420240A (en) * | 2022-01-13 | 2022-04-29 | 袁方 | Prescription management system based on artificial intelligence, big data and block chain |
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Denomination of invention: Update methods and devices, electronic devices, and storage media for medical insurance review systems Effective date of registration: 20231101 Granted publication date: 20221101 Pledgee: Wuhan area branch of Hubei pilot free trade zone of Bank of China Ltd. Pledgor: WUHAN KINDO MEDICAL DATA TECHNOLOGY Co.,Ltd. Registration number: Y2023980063760 |