JP2004252958A - System and method for payment of coinsurance amount in medical insurance such as health insurance - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a system for the payment of a medical insurance coinsurance amount that can defer payment without requesting a signature or an entry of a personal identification number. <P>SOLUTION: The system comprises an advancement institution 10 which advances a medical insurance coinsurance payment charged to an insured person 30 by a medical institution 20, a DB 11 in which participants in the advancement service are registered, and the medical institution 20 which inquires qualification information on the insured person 30 from an insurer 60 according to identification information on the insured person 30 read in from an IC card 31 with the identification information recorded with an IC card reader/writer 22 for reading in identification information, checks whether the insured person is registered as a participant in the service or not, and according to the check results, charges the advance of the medical insurance coinsurance payment charged to the insured person 30. The advancement institution 10 checks a medical insurance benefit decided by the insurer 60 to adjust the advance to the medical institution. <P>COPYRIGHT: (C)2004,JPO&NCIPI

Description

  The present invention relates to a payment system and a payment method for self-payment of medical insurance suitable for use when paying for self-pay of medical insurance by post-payment.

  In the conventional medical insurance system, each national is enrolled in medical insurance such as health insurance, mutual aid association, national health insurance, etc. and pays monthly insurance premiums. A certain percentage (70%, etc.) is paid from medical insurance (hereinafter, the medical expenses paid from the medical insurance are referred to as medical insurance insurance benefits). The remaining portion (30%, etc.) of medical expenses is paid directly by each individual (hereinafter, the medical expenses corresponding to the proportion are referred to as the self-payment of medical insurance).

  The medical expenses paid from the medical insurance are each insurance insurer (health insurance association) using the receipts (medical treatment (dispensing) remuneration statement) created for each item at each medical institution such as a hospital, clinic, pharmacy, etc. , Country, local government, etc.). In practice, the receipt is often sent from each medical institution to an examination / payment institution that is a public institution. Then, after the contents of the receipt are examined by a staff member with specialized knowledge, a claim is made to each insurer in a lump. Payment is made from the insurer to each medical institution through an examination and payment institution. In this case, the period from billing to payment is usually about two months.

On the other hand, the medical expenses for the self-payment are usually settled for each medical treatment per day. The insured person goes to the accounting department of the medical institution when the medical treatment is over, and pays with cash.
As described above, payment for medical insurance insurance benefits claimed by a receipt is generally made through an examination payment organization. On the other hand, in recent years, IT (Information Technology) is used in line with deregulation, and a system that exchanges billing / payment information by receipt between a medical institution and an insurer directly without going through an examination / payment institution. Has been built. For example, in an organization that mediates transmission / reception of a large amount of receipt information between a medical institution and an insurer, there is one that employs a mechanism for returning a receipt reserved by an insurer to the medical institution (for example, Patent Document 1). ). Alternatively, there is a medical institution and an insurer provided with a means for encrypting each information in order to prevent information leakage in an intermediary organization (for example, Patent Document 2).
In addition, there are products that use a business model based on factoring to shorten the time required for cashing credits to the examination and payment institution. A point to keep in mind when factoring is that not all of the receipts issued by medical institutions are assessed at their exact cost. In other words, if there is an inappropriate point in the contents of the receipt, the amount charged may be reduced or reserved. Therefore, in the products as described above, the medical fee claim right (medical fee claim) generated at each medical institution is not treated as a claim with 100% credit, but as a certain defect. Therefore, the receivable assignee usually discounts about 80% and cashes the medical treatment receivable. Then, one or two months later, when the payment amount is fixed by the examination and payment institution, the remaining portion of the claim is paid. Therefore, the ratio of cashing at the beginning is as low as about 80%, for example.

  The above-described techniques are mainly matters relating to the medical insurance insurance benefits charged using the receipt. On the other hand, as for the medical insurance self-payment, it is common that payment is made on a daily basis in cash as described above. Some medical institutions have made it possible to use credit cards and debit cards (for example, Patent Document 3). However, there has been no particular technical change in the check system for claims. For example, in the same way as in the case of receipt screening, if the payment from the medical institution is reduced for the medical insurance insurance benefits, the ratio is reflected in the medical insurance self-payments. No mechanism has been established.

In addition, when an insurer examines a receipt for medical insurance insurance benefits, it will be possible to conduct a more detailed examination if the insured can know the amount already paid by each insured. There is. Therefore, there was a request to obtain information about self-payment.
JP 2001-344337 A (page 3-4, FIG. 1) JP 2002-149813 A (page 4-5, FIG. 1) JP 2002-230156 A (pages 10-11, FIG. 11)

  As mentioned above, postpayment at the counter has not progressed much. This postpayment does not just eliminate the need for medical institutions and insured to prepare cash. For example, the following convenience improvement effects can be expected. That is, the waiting time at a medical institution is not only a waiting time before medical treatment but also a waiting time for accounting after medical treatment is a major factor. This is because, after receiving various examinations and medical treatments at various departments, it may take a relatively long time for the information to be collected for accounting, and the accounting process is complicated. Has been affected.

  On the other hand, unlike ordinary sales contracts, medical institutions rarely change the content of medical practice at the time of accounting, and rarely confirm the content in advance at the time of accounting. In other words, at the time of accounting, the medical practice has already been carried out, and the contents of the medicine are all confirmed (because the service of “medical treatment” is a comprehensive commission of “cure the disease”). In addition, the amount of remuneration is generally left to medical institutions on the spot. Therefore, if a mechanism is provided that allows you to make a postpay payment without the need to enter a signature or PIN, if both sides use the mechanism in advance, It is possible to leave the medical institution when the medical treatment is completed (or when the medicine is received) without performing accounting (without checking the amount). If such a mechanism is provided, the waiting time at the medical institution can be greatly reduced, the concentration of work at the medical institution can be avoided, and various problems relating to the handling of cash at the accounting window can be solved.

  Further, as described above, conventionally, a review mechanism for payment of self-pay as in the case of receipt review has not been established. Also, even if the amount of medical insurance benefits paid by the medical institution was reduced, it was difficult to reflect the proportion in the medical insurance self-payment. Furthermore, the insurer could not easily respond to the desire to obtain payment information for the self-pay by the insured.

  The present invention has been made in view of such circumstances, and provides a payment system and a payment method for self-payment of medical insurance that can be paid by postpay without requiring the input of a signature or a personal identification number. For one purpose.

  Another object of the present invention is to provide a medical insurance self-payment payment system and payment method capable of easily constructing a more appropriate examination system for payment of the medical insurance self-payment. The present invention further provides a payment system and a payment method for the self-payment of the medical insurance that can easily reflect the result of the receipt assessment of the medical insurance insurance benefit for the self-payment of the medical insurance. For other purposes. Another object of the present invention is to provide a payment system and payment method for self-payment of medical insurance that can easily provide the insurer with payment information for self-pay of medical insurance. .

  In order to solve the above-mentioned problem, the present invention comprises a target insured person registration means for registering a target person of a service for changing the payment of the medical insurance self-payment to the insured person of the medical insurance requested from a medical institution, Reading means for reading the identification information from the storage means in which the identification information of the insurer is recorded, first confirmation means for confirming the medical insurance guarantee status of the insured person based on the read identification information, and the read identification Based on the confirmation results of the second confirmation means and the first and second confirmation means for confirming whether the insured person is the insured person registered by the target insured person registration means based on the information A reimbursement requesting means for requesting payment of the insured person's self-payment, and a reimbursement payment determining means for processing the amount charged by the reimbursement requesting means, Confirm the amount of medical insurance insurance benefits for the medical institution of the insured determined by the insured of the insured of the insured person and adjust the amount of reimbursement payment to the medical institution based on the insurance benefit As the reimbursement amount of the reimbursement payment amount to the insured person based on the reimbursement payment amount adjustment means, the reimbursement request amount of the medical insurance self-payment from the medical institution, and the medical insurance insurance benefit amount Insured claim amount determining means for determining the claim amount is provided.

Further, the present invention provides the insured claim amount determination means for the insured person with an amount obtained by reducing the medical insurance self-payment in accordance with a rate of receipt assessment of the medical insurance insurance benefit by the insurer. The billing amount is determined as a reimbursement amount for the advance payment amount.
Further, according to the present invention, the first confirmation means accesses the database in which the insurer of the insured's medical insurance manages the qualification information of each insured person via the communication line, so that the insured It is characterized by confirming the medical insurance guarantee status.
Further, according to the present invention, the reimbursement requesting means intends to receive a payment renewal service for the confirmation result of the first and second confirmation means and the insured for the medical insurance self-payment. Whether or not to charge is determined based on the confirmation result about whether or not. In the present invention, the insured claim amount determining means satisfies the condition that the medical insurance self-payment for the insured is subject to special payments such as additional benefits, high medical expenses, etc. from the insurer of the medical insurance. If it is determined that the condition is satisfied, the payment is requested from the invoiced party on behalf of the insured person, and the insured person is corrected based on the requested amount. The determined amount is determined as a billing amount as a compensation amount.

  In addition, the present invention provides a target insured person registration process for registering a target person of a service for changing the payment of the medical insurance self-payment to the insured person of the medical insurance requested by the medical institution, and identification information of the insured person A reading process of reading the identification information from the storage means storing the first information, a first confirmation process of confirming the medical insurance guarantee status of the insured person based on the read identification information, and the reading process based on the read identification information Based on the second confirmation process for confirming whether or not the insured person is an insured person registered in the target insured person registration process, and the confirmation results in the first and second confirmation processes, A reimbursement request process for requesting the insured's self-pay reimbursement payment, a reimbursement determination process for paying the invoiced amount in the reimbursement request process, and the insured's medical care Protection A reimbursement payment adjustment process for confirming a medical insurance insurance benefit for the medical institution of the insured determined by the insurer and adjusting an advance payment for the medical institution based on the insurance benefit; and The insured person who determines the amount to be invoiced as the reimbursement amount of the reimbursement payment to the insured person based on the reimbursement amount of the medical insurance self-payment from the medical institution and the medical insurance insurance benefit And a billing amount determination process.

  In addition, the present invention provides a target insured person registration process for registering a target person of a service for changing the payment of the medical insurance self-payment to the insured person of the medical insurance requested by the medical institution, and identification information of the insured person A reading process of reading the identification information from the storage means storing the first information, a first confirmation process of confirming the medical insurance guarantee status of the insured person based on the read identification information, and the reading process based on the read identification information Based on the second confirmation process for confirming whether or not the insured person is an insured person registered in the target insured person registration process, and the confirmation results in the first and second confirmation processes, A reimbursement request process for requesting the insured's self-pay reimbursement payment, a reimbursement determination process for paying the invoiced amount in the reimbursement request process, and the insured's medical care Protection A reimbursement payment adjustment process for confirming a medical insurance insurance benefit for the medical institution of the insured determined by the insurer and adjusting an advance payment for the medical institution based on the insurance benefit; and Insured for determining the amount of reimbursement for reimbursement payment for the insured person based on the reimbursement amount paid by the medical institution for the self-payment of the medical insurance and the medical insurance insurance benefit It is a payment program for self-payment of medical insurance, characterized in that it includes a description for causing one or a plurality of computers to execute a person claim amount determination process.

  In addition, the present invention includes a target insured person registration means for registering a target person of a service for changing the payment of medical insurance self-payment to a medical insurance person insured requested by a medical institution, and the insured person Payment incentive confirmation means for confirming whether or not there is an intention to receive the payment replacement service for the self-payment of the medical insurance, and the insured who has confirmed that the payment replacement confirmation means has the intention to receive the payment replacement service. Is included in a billing process target exclusion means for excluding the billing process target person.

  In addition, the present invention is claimed by the reimbursement requesting means for requesting payment for the self-payment of the medical insurance for the insured who is excluded from the claim processing target by the claim processing object exclusion means, and the reimbursement requesting means. It further comprises an advanced payment processing means for processing the amount charged.

  In addition, the present invention further comprises a service usage fee charging unit that charges the usage fee of the payment replacement service based on the usage status for the insured who is excluded from the claim processing target by the claim processing target exclusion unit. Features.

  In addition, the present invention includes a target insured person registration process for registering a target person of a service for changing the payment of the medical insurance self-payment to the insured person of the medical insurance requested by the medical institution, and the insured person Payment reconfirmation confirmation process for confirming whether or not there is a willingness to receive payment reimbursement service for the self-payment of the medical insurance, and the insured who has confirmed that the payment reimbursement confirmation means is willing to receive the reimbursement service Is included in a billing process exclusion process for excluding from the billing process target person.

  In addition, the present invention includes a target insured person registration process for registering a target person of a service for changing the payment of the medical insurance self-payment to the insured person of the medical insurance requested by the medical institution, and the insured person Payment reconfirmation confirmation process for confirming whether or not there is a willingness to receive payment reimbursement service for the self-payment of the medical insurance, and the insured who has confirmed that the payment reimbursement confirmation means is willing to receive the reimbursement service Is a payment program for the self-payment of medical insurance, characterized in that it includes a description for causing one or a plurality of computers to execute a billing process exclusion process for excluding a billing process target person.

  According to the present invention, the reading means that reads the identification information from the storage means that recorded the identification information of the insured person, and the first status that confirms the medical insurance guarantee status of the insured person based on the read identification information. Confirmation means, second confirmation means for confirming whether the insured person is registered by the target insured person registration means based on the read identification information, first and second Based on the confirmation result of the confirmation means, there is provided a replacement payment requesting means for requesting payment for the self-payment of the medical insurance to the insured person, so double confirmation means by the first and second confirmation means By confirming that the insured person is a valid target for the reimbursement service for the self-payment of the medical insurance, for example, it is possible to pay by postpay without requiring the input of a signature or PIN There is an effect that kill.

  Moreover, since the reimbursement request means requests the insured person to pay for the self-payment of the medical insurance, it is possible to easily provide the insurer with payment information for the self-pay of the medical insurance. There is an effect that can be done.

  In addition, the amount that the insured claim amount determining means reduced the medical insurance self-payment according to the rate of receipt assessment for the medical insurance insurance benefit by the insurer as the reimbursement amount for the reimbursement payment for the insured Therefore, it is possible to easily reflect the result of the receipt assessment for the medical insurance insurance benefit for the medical insurance self-payment.

  In addition, the first confirmation means accesses the database in which the insured person's medical insurance insurer manages the qualification information of each insured person via the communication line, so that the insured person's medical insurance Since the guarantee status is confirmed, the qualification of the insured can be directly confirmed based on the latest information.

  In addition, the reimbursement requesting means confirms the confirmation results of the first and second confirming means and whether or not the insured is willing to receive a payment reimbursement service for the medical insurance self-payment. Therefore, it is possible to flexibly cope with the case where the insured does not want to pay by postpay.

  In addition, whether the insured claim amount determination means satisfies the condition that the medical insurance self-payment for the insured person receives special payments such as additional benefits and high medical expenses from the insurer of the medical insurance If it is determined that the condition is satisfied, the payment request is made to the invoiced party on behalf of the insured person, and the insured person is provided with the amount corrected based on the requested amount. Since the invoiced amount is determined as a compensation amount, the procedure taken by the insured can be simplified.

In addition, according to the present invention, a person who is subject to a service for changing the payment of the medical insurance self-payment to the insured person of the medical insurance requested from the medical institution is registered, and the insured person Whether or not there is an intention to receive the payment replacement service, and the insured person who has confirmed that the payment replacement confirmation means is willing to receive the payment replacement service is excluded from the claims processing person.
Therefore, by using the payment renewal service, the insured can return without waiting for the settlement of the accounting after reception, and the effect of improving the convenience for the patient can be obtained.

In addition, according to the present invention, for the insured who is excluded from the person to be billed, a request for payment for the self-payment of the medical insurance is received, and the billed amount is billed.
Therefore, in order to reimburse the patient's receivables for a certain period of time, offset a part of the receivables later, and charge the user together with the service usage fee, the handling of cash is reduced (the service called “medical care” (This is a comprehensive delegation of “cure the disease”).

In addition, the present invention charges the usage fee for the payment replacement service based on the number of times of use for the insured who is excluded from the billing target.
Therefore, regardless of the amount of debt to be reimbursed, the user can know the service fee if the number of times the service is used, and the convenience can be improved.

  Hereinafter, the best mode for carrying out the present invention will be described.

  Hereinafter, a first embodiment of a medical insurance payment system to which the present invention is applied will be described with reference to the drawings. FIG. 1 is a system diagram showing a configuration example of a medical expenses payment system 1 using medical insurance. The payment system 1 shown in FIG. 1 includes a cashless system 100 (hereinafter referred to as a cashless system 100) related to the self-payment of medical insurance, and a receipt direct billing and settlement system 200.

  The cashless system 100 is a system that provides a function for paying the self-payment of medical insurance by postpay. The cashless system 100 is realized with the minimum configuration of the payment reimbursement organization 10, one or a plurality of medical institutions 20, and a plurality of IC cards 31 carried by a plurality of insured persons 30. In addition, both or one of the credit company 40 and the insurance company 50 can be included as components.

  On the other hand, the receipt direct billing / settlement system 200 includes a payment advancement institution 10, one or more medical institutions 20, one or more insurers 60, and a virtual branch office 70 of a financial institution. Of these, the virtual branch 70 of the financial institution can be omitted or changed to another non-virtual financial institution.

  In the payment system 1 according to the present embodiment, the reimbursement organization 10 replaces the claim for medical fee benefits (medical fee receivables) obtained by each medical institution 20 performing medical care on each insured person 30. Or you are going to buy it. However, it is assumed that medical receivables for self-payment of medical insurance are basically replaced, and medical receivables for insurance benefits are both replaced and purchased. The payment advance institution 10 provides cash to the medical institution 20 as the advance or purchase price at the time of the advance or purchase. On the other hand, the payment bureau 10 asks each insured person 30 or each insurer 60 for a cash benefit as a claim for reimbursement or purchase. Each insured person 30 pays the payment reimbursement organization 10 by transferring cash to a bank account (not shown) or by providing cash through the credit company 40 or the insurance company 50. On the other hand, each insurer pays by transferring cash to a bank account (not shown) or by transferring cash to a virtual branch 70 of a financial institution installed in the cyber space.

  The payment reimbursement organization 10 is a system composed of a computer and its peripheral devices, and particularly has a billing information DB (database) 11 inside. The payment reimbursement organization 10 communicates with computers constituting the medical institution 20, the credit company 40, the insurance company 50, the insurer 60, and the virtual branch 70 via a communication line such as the Internet, a wired or wireless public network, and a dedicated line. Connected as possible.

  In the billing information DB 11, registration information including identification information of the medical institution 20, the insured person 30 and the insurer 60 registered as using the system 1, and transmission / reception between the medical institution 20 and the insurer 60 Electronically received receipt information is recorded. In the billing information DB 11, billing information for reimbursement between the payment institution 10 and each medical institution 20, information on the amount repaid, and reimbursement between the payment institution 10 and each insured person 30. Information on the amount requested as a payment request and information on the amount paid are recorded. The billing information DB 11 further includes information on the amount billed for direct receipt between the payment reimbursement organization 10 and each medical institution 20, information on the amount repaid or purchased for the bill, and the payment organization 10 Information on the amount billed or the amount billed for the direct receipt bill as a reimbursement request and the various master data used in the receipt examination are recorded.

  The medical institution 20 is a system composed of a computer and its peripheral devices. In this case, the medical institution 20 includes a computer terminal 21 having a display, a keyboard, a mouse, and the like, and an IC card reader / writer 22 connected to the terminal 21.

  The insured person 30 is an insured person (person or family member) who is enrolled in medical insurance by the insurer 60, and carries an IC card 31 used as an insured person card (insurance card) of the medical insurance. . The IC card 31 is a flat plate made of synthetic resin on which a semiconductor device comprising a storage means (memory) and its control device is mounted, and the storage means has an insured card that is unique information for each insured card. Identifier (identification information; symbol / number of insured card), one or more insured names, insurer names, codes indicating the type of insurance, and the like are recorded.

  In the present system 1, the credit company 40 is a system comprising a computer and its peripheral devices, and is charged as a compensation from the payment reimbursement organization 10 to the payment reimbursement organization 10 on behalf of the insured person 30. Used to pay the amount. It is assumed that each insured person 30 and the credit company 40 have a credit agreement in advance, and that the payment institution 10 is registered to make payment through the credit company 40.

  In addition, the insurance company 50 is a system composed of a computer and its peripheral devices, and in this case, an insurance contract is concluded with the insured person 30 to guarantee the self-payment of medical insurance. To do. That is, the insured person 30 pays a predetermined premium every month (or yearly), while the insurance company 50 receives the insured person 30 when payment for the self-payment of the medical insurance is required. Compensate and pay the payment on behalf of the insurer 30.

  The insurer 60 is a system composed of a computer and its peripheral devices, and particularly has a qualification DB 61 inside. The qualification DB 61 is a database that records the latest qualification information regarding each insured person 30, 30, 30,. In the qualification DB 61, as information indicating the qualification of each insured person 30 as an insured person, an identifier of the insured person (identification information; a symbol / number of the insured person), one or more The name of the insured person, a code indicating the current type of insurance, medical history information at each medical institution 20, insurance payment amount, and the like are recorded.

  The virtual branch office 70 of a financial institution is a system composed of a computer and its peripheral devices. Specifically, it is one branch of a financial institution (such as a bank) virtually existing on the Internet. The branch has a plurality of accounts, and contractors, balances, authentication information, and the like of each account are recorded in the account DB 71, respectively. In this system 1, each payment institution 10, each medical institution 20, 20, 20,..., And each insurer 60, 60, 60,... Has one or more accounts in the same virtual branch 70. doing. Then, the money transfer between the payment institution 10, each medical institution 20, 20, 20,..., And each insurer 60, 60, 60,. Is done by.

  The configuration shown in FIG. 1 is an example of an embodiment of the present invention, and can be changed as appropriate. For example, the payment advancement organization 10 may be configured by being distributed in a plurality of locations, or may be configured integrally with the virtual branch office 70 of the financial institution. In addition, the separation between the cashless system 100 and the direct receipt billing / settlement system 200 is not particularly strict, and both systems can be regarded as including respective components.

  The payment reimbursement institution 10, the medical institution 20, the credit company 40, the insurance company 50, the insurer 60, and the virtual branch 70 include a computer and its peripheral devices, and one or a plurality of programs executed on the computer. Composed. The program can be distributed via a computer-readable recording medium or a communication line.

  Next, the basic operation of the cashless system 100 shown in FIG. 1 will be described with reference to FIG. 2, the same reference numerals are used for the same components as those in FIG. 1. In the figure, hatched thick arrows indicate “money flow”, and white thick arrows indicate “information flow”. In FIG. 2, it is assumed that the medical institution 20, the payment replacement institution 10, and the insurer 60 are connected via the communication network 2. In this example, it is assumed that all the insured persons 30 of the insurer 60 are registered as users of the cashless system by the payment reimbursement organization 10.

  Now, it is assumed that an insured person 30 who wants to receive the medical institution 20 has submitted an IC card 31 (insured person card) to the reception of the medical institution 20. Assume that the person in charge of the reception inserts the IC card 31 into the IC card insertion port of the IC card reader / writer 22 and further performs a predetermined operation on the computer terminal 21. Then, the computer terminal 21 reads identification information of the IC card 31 recorded on the IC card 31. Next, the computer terminal 21 makes a qualification confirmation request to the insurer 60 using the read identification information as key information (S10).

  The insurer 60 confirms the health qualification status of the insured person 30 identified by the key information received in the qualification DB 61. If it is confirmed that the insurance is valid, the qualification data indicating that the insurance qualification is guaranteed (data indicating the contents of the insurance and in this case, the user of the cashless system 100) Data) is returned as qualification approval information (S11). If the qualification is approved (S11), the computer terminal 21 transfers qualification data indicating that to a receipt information management / accounting processing computer (not shown) in the medical institution 20 (S12).

  When the insured person 30 finishes the medical treatment for the day, the insured person 30 moves to the reception of the accounting. Here, it is assumed that the insured 30 desires a cashless accounting process. The account acceptor reads the IC card 31 of the insured person 30 with an IC card reader connected to an account terminal (not shown), and the qualification is approved at the time of reception on the screen of the terminal. Confirm that the user is a registered user of the cashless system 100. Then, the fact that the cashless system 100 is used for accounting (cashless handling) is recorded in the receipt information management / accounting computer in the medical institution 20 (S13). When it is recorded that the cashless treatment is performed, there is no matter that the insured person 30 has to confirm in the subsequent processing, so that the insured person 30 can leave the medical institution 20 here. However, the intention to use the cashless system 100 may be confirmed at the end of the consultation.

  At the medical institution 20, after the end of the medical examination time of the day, as the accounting data for the day, the amount charged for the self-pay for medical insurance treated as a cashless system is transmitted together with the receipt claim information (S 14). The payment reimbursement organization 10 receives the accounting data, stores it in the billing information DB 11, and manages it (S15). The accounting data received here is collected and managed for each medical institution 20 (in this case, for each hospital), for example, as shown in FIG. In the example shown in FIG. 3, each insured person 30 is identified by “name” and “insured person symbol / number”, together with “medical date”, “insurer name”, “self-payment”. Information such as “ratio”, “total amount”, and “self-paid amount” is also recorded. Then, the payment amount corresponding to the billing amount for one month is collectively paid in advance on a predetermined day of each month (S16).

  Next, the payment reimbursement institution 10 bills each insured person 30 as a reimbursement for reimbursement (S17). At the time of billing (S17), each insured person 30 confirms the contents of the payment notice / confirmation sent from the payment reimbursement organization 10 (S18). FIG. 4 is a diagram illustrating an example of a payment notification / confirmation document. Each payment notice / confirmation in FIG. 4 includes “insured person symbol / number” as identification information, “date of medical examination”, “medical institution name”, “invoiced amount” corresponding to each insured person 30. "And" total self-payment amount "are shown. Further, a more detailed content description can be attached to the payment notice / confirmation. And when there is no problem in the contents of the claim, the amount charged is paid from each insured person 30 and the amount of replacement is collected (S19).

  Next, the payment reimbursement organization 10 also provides the insurer 60 with billing information for the self-pay (S20). Further, after two months, the insurer 60 receives receipt data (data indicating the assessment result of the receipt request). Check the examination results, and ask the medical institution 20 to return the self-pay portion for the necessary assessments for changes and corrections. Actually, it will be adjusted for the next month. At the same time, additional benefits and high medical expenses are settled (S21).

  Next, another example of the processing procedure of the cashless system 100 shown in FIG. 1 will be described with reference to FIGS. As shown in FIG. 5, first, the insured 30 performs a participation application procedure for the cashless system 100 (S101). Upon receipt of the application for participation, the payment institution 10 updates and accumulates the insured card information of the insured person 30 participating in the cashless system 100 as the billing information database 11 (S102).

  On the other hand, the medical institution 20 reads the identifier of the insured person included in the IC card 31 submitted by the insured person 30 at each visit (S103). Next, a request for qualification examination and insured card information is transmitted to the insurer 60 based on the insured's identifier (S104).

  On the other hand, the insurer 60 updates and accumulates the insured identifier, qualification information, and insured card information as the qualification database 61 (S105). Here, when a request for qualification examination and insured card information is received (S104), the accumulated qualification information and insured card information are confirmed (S106). Next, the qualification examination result and the insured person information are transmitted to the referral source medical institution 20 (S107).

  When the medical institution 20 receives the qualification examination result and the insured card information (S107), the medical institution 20 displays the qualification examination result and the insured person card information on the screen (S108). Next, a request for cashless handling availability information is transmitted to the payment reimbursement organization 10 based on the insured card information of the insured person (S109).

  The payment bureau 10 confirms whether the insured person 30 participates in the cashless system 100 based on the insured person's card information of the insured person (S110). Then, the cashless system participation information is transmitted to the referral medical institution 20 (S111).

  The medical institution 20 receives the cashless system participation information (S112), and stores the insured identifier, the insured card information, and the cashless system participation information in the terminal 21 (S113).

  Next, as shown in FIG. 6, the medical institution 20 confirms the intention of cashless treatment from the insured person at the end of the medical examination, reads the identifier of the insured person ID contained in the IC card 31, and A cashless mark is added to the stored information, and the information is stored again in the terminal 21 (S114). After the accounting of the insured person 30 is confirmed, the identifier of the insured person card included in the IC card 31 is read, information is called by a cashless mark, and the settlement amount for self-pay is input or transferred from the accounting system (S115). ). Next, the insured person's card information treated as cashless, the billing details, etc. are transmitted to the payment reimbursement organization 10 (S116).

  The payment reimbursement organization 10 receives and accumulates payment requests for the self-pay from the medical institution 20 (S117). Next, the process after step S118 and the process after step S124 are executed in parallel.

  In the processing after step S118, first, the payment request information for each medical institution accumulated by the medical institution 20 accumulated for a certain period is totaled for each medical institution to determine the advance payment amount (S118). Next, processing for determining the settlement / adjustment amount by sharing information with the insurer 60 is performed (S119).

  Here, the processing content of step S119 or step S125 described later will be described with reference to FIG. In the process of determining the settlement / adjustment amount by sharing information with the insurer (S119, S125), first, as shown in FIG. A process of transmitting the additional benefit requested to the insurer and data for high-cost medical expenses) to the insurer 60 is performed (S201). In the insurer 60, the settlement data for each insured person is utilized for insurance benefit examination (receipt examination), payment of additional benefits, and high medical expenses (S202). Next, the insurer 60 pays the paying institution 10 the medical cost data for each insured person determined by the insurance benefit screening (receipt screening) and the additional benefits and high medical expenses data determined by the insurer to pay. Is transmitted (S203). Next, the payment reimbursement organization 10 based on the medical expenses data for each insured determined by the insurance benefits screening (receipt screening) and the additional benefits and high medical expenses data determined by the insurer to pay. Then, the settlement / adjustment amount of the self-pay that has already been paid in advance is determined (S204).

  When the settlement / adjustment amount is determined as described above, as shown in FIG. 7, the payment advance organization 10 determines the settlement amount (advance payment amount−adjustment / adjustment amount) to each medical institution 20. The specification is transmitted or sent (S120). Here, the medical institution 20 confirms the settlement contents (details) from the payment reimbursement organization 10 (S121). On the other hand, the payment advance institution 10 performs a process of transferring the settlement amount to the account of each medical institution 20 (S122). Then, in the medical institution 20, payment is made from the payment reimbursement institution 10 (S123).

  On the other hand, in step S124, the payment reimbursement organization 10 sorts the payment request information for each self-payment from each medical institution 20 accumulated for a certain period, and considers additional benefits and high-cost medical treatment costs. Then, the amount charged by the advance payment to the insured and the insurer is determined (S124). Next, as shown in FIG. 8, a process for determining the settlement / adjustment amount by sharing information with the insurer 60 is performed (S125).

  When the process shown in FIG. 9 (S125) is performed as described above, the payment bureau 10 pays the insured person 30 (including the credit company 40 and the insurance company 50) and the insurer 60 (repaid payment). (Invoice amount-settlement / adjustment amount) is determined, and the description is transmitted or sent (S126).

  The insured person 30 confirms the content of the bill (details) from the payment reimbursement organization 10 (S127). If there is no problem in the confirmation, the billing amount is withdrawn from the account of each insured person 30 as it is (S128). Then, the payment reimbursement organization 10 receives deposits from each insured person 30 (including the credit company 40 and the insurance company 50) and the insurer 60 (S129).

  On the other hand, the insurance company 50 confirms the content of the bill (details) transmitted from the payment reimbursement organization 10 (S130). The insurance company 50 transfers the amount charged (collected as an insurance premium from each individual) (S131). Then, in step 129, a payment process for the payment reimbursement organization 10 is performed.

  In addition, the credit company 40 confirms the billing contents (details) transmitted from the payment reimbursement organization 10 (S132). Then, the credit company 40 performs a process of transferring the bill amount (S133). Here, in step 129, payment processing for the payment advancement organization 10 is performed. Further, after notifying each individual of the contents of the bill, the credit company 40 collects the payment from each insured person 30 (S134).

  Further, the insurer 60 confirms the content of the bill (details) from the payment reimbursement organization 10 (S135). If there is no problem as a result of the confirmation, the insurer 60 transfers the bill amount as it is (S136).

  Next, an example of the processing procedure of the receipt direct billing / settlement system 200 shown in FIG. 1 will be described with reference to FIG. The example shown in FIG. 10 is a case where the payment reimbursement organization 10 purchases a receipt from each medical institution 20. First, the medical institution 20 transmits a billing receipt desired to be purchased by the payment reimbursement organization 10 to the payment renewal organization 10 (S301). The payment reimbursement organization 10 compares the past number of months with the previous month for the total number of receipts, the number of consultation days, and the number of medical treatments, and confirms that the average value is within a certain range (S302).

  Next, the payment reimbursement institution 10 collates with the master table of the rules for medical treatment managed in the billing information DB 11 or the like, and assesses the amount of money corresponding to an error in the rules or an appropriate amount of violation for the problematic receipt ( S303). Next, the assessment ratio is multiplied by a qualification error rate (probability of performing medical care for unqualified) and a risk rate (predetermined safety rate) (S304). The purchase ratio is automatically calculated by the above procedure and the purchase amount is determined (S305). And the process which transfers the purchase amount to the medical institution 20 is performed (S306). Thus, the purchase amount is paid from the payment institution 10 to the medical institution 20 (S307).

  On the other hand, the payment bureau 10 transmits a billing receipt to the insurer 60 as the bill of the payment bureau 10 (billing based on the purchased receivable) (S308). The insurer 60 checks the claim receipt (S309). Next, the payment consent amount and the return receipt (a receipt with incomplete description) are transmitted to the payment reimbursement organization 10 (S310). Here, the payment reimbursement organization 10 receives the payment consent amount information and the return receipt from the insurer 60 (S311).

  Next, the insurer 60 performs a process of transferring the payment consent amount to the payment reimbursement organization 10 (S312). Here, in the payment reimbursement organization 10, payment is made by the insurer 60 (S313).

  Next, the payment reimbursement institution 10 makes an additional payment to the medical institution 20 according to the volume determined by the deposit amount (S314). In the medical institution 20, the payment amount is received from the payment reimbursement institution 10 (S315).

  Next, another example of the processing procedure of the direct receipt billing / settlement system 200 will be described with reference to FIG. The example shown in FIG. 11 is a case where the payment reimbursement organization 10 repays a receipt from each medical institution 20. First, the medical institution 20 transmits a claim receipt to the insurer 60 and the payment institution 10 (S401). The insurer 60 receives the claim receipt (S402) and examines the claim receipt (S403).

  On the other hand, the payment reimbursement organization 10 compares the past months with the previous month for the total number of receipts, the number of consultation days, and the number of medical treatments, and confirms that the average value is within a certain range (S404). . Furthermore, it collates with a master table of a predetermined medical treatment rule recorded in the billing information DB 11 and the like, and assesses the amount of money corresponding to an error in the rule or an appropriate amount of violation for a problematic receipt (S405). Next, a process of multiplying the assessed amount by the qualification error rate and the risk rate is performed (S406). By these processes, the rate of advance payment is automatically calculated, and the advance payment amount is determined (S407).

  The payment advance institution 10 performs a process of transferring the advance payment amount to the medical institution 20 (S408). In the medical institution 20, the amount of the advance payment is received from the payment advance institution 10 (S409).

  On the other hand, the insurer 60 transmits the payment consent amount information and the return receipt to the medical institution 20, and the payment consent amount is transmitted to the payment institution (S410). The medical institution 20 receives the payment consent amount information and the return receipt from the insurer 60 (S411).

  On the other hand, the payment bureau 10 receives information on the payment agreement amount from the insurer 60 (S412). Further, a process of transferring the amount (remaining amount) obtained by subtracting the amount already paid in advance from the amount deposited by the insurer 60 to the medical institution 20 is performed (S413). In the medical institution 20, the balance is paid from the payment reimbursement institution 10 (S414).

  Next, referring to FIG. 12, an example of a receipt review by the insurer 60 (step S309 in FIG. 10 or step S403 in FIG. 11) and a method for calculating a purchase (or replacement) ratio by the payment transfer organization 10 (FIG. 10). Steps S303 to S305 and Steps S405 to S407) will be described. FIG. 12 is a diagram showing an example of a receipt. The receipt shown in FIG. 12 has four description defects indicated by circles (1) to (4).

  For example, Maru (1) “Specific Disease Treatment Guidance Fee” has a score of 225 points (Maru (1)), and it is allowed only twice a month in the provisions of medical fees. In addition, the daily usage of Maru (2) “Diabetes treatment F” is “up to 0.3 mg at a time” and “up to 3 times a day”. It should be a “lock”. Further, the proper purpose of use of the “oral preparation (including an antidepressant) G” is not described in the “injury name” described in Mal (3). Essentially unnecessary drugs are prescribed. From “Mal (4)” and above, the “claim point” should be “2896”. That is, the sum of “948 points” for the part of Maru (1) (225 points), the part of Maru (2) (700 points), and the part of Maru (3) (23 points) is considered surplus.

  Although the above determination is a detailed determination, the purchase (advancement) ratio in the payment advancement institution 10 of the present embodiment is determined by setting an original “evaluation level”. For example, level A ... is not allowed. Level AB ... May be recognized for reasons. Level B ... There is a high possibility of being recognized. Level C: An evaluation is made according to a four-stage classification, such as most are recognized, and the ratio is determined.

  In this case, in the above example, the evaluation is made such that Mull (1) = A, Mull (2) == AB, Mull (3) = B. Therefore, Mal (1) is a “matter that is not paid”, but Mal (2) is “may be paid in some cases”, and Mal (3) is subject to indications (or A decision is made that it will be “paid” (as it is likely to be accepted as it is small). Therefore, it is considered that there is a possibility of “about 3619 to 3000 points” as the evaluation of this receipt, and this possibility becomes the “evaluation rate (90%, etc.)” and the final reception evaluation is performed. These evaluations are further calculated and corrected according to original evaluation criteria determined by analysis of experience values and past data.

  The main functions in the embodiment shown in FIG. 1 are collectively shown in FIG. That is, as functions realized by the computer terminal 21 or the like of the medical institution 20, the identification information reading function F 21 of the IC card 31 and the guarantee status confirmation function (first confirmation means) F 22 for confirming the qualification of the insured person 30. , A registered insured person confirmation function (second confirmation means) F23 for confirming the cashless system use registration of the insured person 30, a reimbursement request function F24 for claiming the self-payment of the medical insurance, and a medical insurance There is a payment request function F25 for claiming insurance benefits. Further, as a function realized by the computer of the payment institution 10, the insured person registration function F11 for registering the insured person 30 to use the cashless system and the charge information from the medical institution 20 are accumulated and managed. Billing amount detail storage function F12, insured person billing amount determination function F13 for determining the billing amount for the insured person 30, and a payment for determining and paying the advance payment for the medical insurance self-payment Advance payment amount determination function F14, payment amount determination function F15 for determining the advance payment amount or purchase payment amount at a predetermined ratio based on the billing amount details and other information and processing the payment to the billing medical institution And an advanced payment adjustment function F16 for adjusting the payment amount to the medical institution 20 in accordance with the receipt assessment for the insurance benefit. In FIG. 13, the functions that make a pair for the self-payment and the insurance benefit are shown surrounded by a chain line.

Hereinafter, a second embodiment of a medical insurance payment system to which the present invention is applied will be described with reference to the drawings. The medical insurance payment system of this embodiment is different from that of the first embodiment in that the system provides a payment replacement service to the user (patient) so that the patient can return without waiting for the settlement of the account after the consultation. In other words, the fixed fee system is charged once as a service fee for shortening the waiting time.
FIG. 14 shows the flow of communication between a medical institution and a patient when the payment renewal service is not used. As shown in FIG. 14, when a medical practice is provided in a medical institution (step S500), a claim for medical examination is generated in the medical institution, and at the same time, a patient who has received the medical examination has a debt for medical care. Occurs (step S501).
The amount of debt is determined only after the accounting process is performed in the medical institution (step S502) and the amount of medical fee is determined (step S503). Accordingly, during this time (steps S502 to S504), the patient is kept waiting at the medical institution until the billing process is completed.
The patient confirms the confirmed billing amount (step S505), and the debt is finally paid when the payment is completed.

On the other hand, FIG. 15 shows a flow of exchanges between a medical institution and a patient, a payment advancement institution, and an insurer when a payment advancement service is used. As shown in FIG. 15, first, the patient makes a service use application at a payment reimbursement organization or a medical institution (step S510). The payment reimbursement organization accepts the service use application and performs the service use registration for the patient (step S511). In addition, when an application for use of a service provided by a payment institution is made through a medical institution, the payment institution performs service use registration for the patient based on the service use application accepted by the medical institution (step S513, S512).
In this way, by registering the use of the payment advancement service in advance or prior to use, the patient's declaration of use of the payment advancement service is received (step S520), and the qualification of the insured person is confirmed. (Step S521) After confirming whether the service can be used (Steps S522 and S523), the payment advancement organization starts providing the service to the registered patient (Step S524).
That is, when a medical practice is provided in a medical institution (step S525), a claim for medical care is generated in the medical institution, and at the same time, a debt for medical care is generated in a patient who has received the medical care (step S525). S526).
As in the case shown in FIG. 14, this debt amount is determined only after the accounting process is performed in the medical institution (step S502) and the medical fee amount is determined (step S528).
However, when using the payment renewal service, since it is confirmed on the medical insurance payment system that the billing process for the medical practice is performed collectively for each predetermined period, during this time (steps (S528 to S529)) There is no need to wait at the medical institution until the billing process is completed, and it is possible to leave the medical institution with the debt amount being uncertain (step S527).

That is, a person who is subject to a service for changing the payment of the medical insurance self-payment to the insured of the medical insurance requested by the medical institution is registered (step S512), and the insured person at the time of the medical examination receives the medical care It is confirmed whether or not there is an intention to receive a payment replacement service for the insurance self-payment, and an insured who has been confirmed to have an intention to receive the payment replacement service is excluded from the claims processing target person. Specifically, for example, a table of a billing process list for an insured person who uses the payment reimbursement service and a table of a billing process list for an insured person who does not use the payment reimbursement service are provided separately. In the system, basically, when the insured's claim record is managed on the table of the claim processing list for the insured who does not use the payment renewal service, and the confirmation result of the intention to use the service is input And deleting the invoiced claims record of the insured person from the billing process list table for the insured person who does not use the payment reimbursement service, and the insured person billing process list table for the payment reimbursement service. Just write it.
Therefore, by using the payment renewal service, the insured person can return without waiting for the settlement of the accounting after reception, and the convenience of the patient can be improved.
For the insured's self-pay portion of the insured who is excluded from this claim processing person, for example, the payment for the self-payment of the self-pay portion of the medical insurance is billed to the payment institution for a month, and Get paid.
Therefore, since the payment reimbursement organization reimburses the patient's receivables for a certain period of time and charges the service user to the receivables that have been transferred at a later date and charges the service user, the handling of cash can be reduced. An effect is obtained.

The usage fee for the payment renewal service is charged based on the number of uses, for example, as a compensation for eliminating the accounting waiting time. Then, for example, when the sum of the amount of receivables for one month (medical insurance self-payment + service usage fee) is confirmed (step S530), a billing process is performed (step S531), and the confirmed billing amount is set to the service user. (Step S531), and when the payment is completed, the debt is finally paid (step S532).
As in the first embodiment described above, a billing / receiving agency service (steps S540 to S548) for additional benefits or refunds for high-cost medical treatment is performed to offset part of the transferred receivables. Also good.
Then, the service user is billed together with the service usage fee for the portion of the transferred residual credit that offsets a portion of the transferred receivable (medical insurance self-payment) (step S550). In this case as well, the service user confirms the confirmed billing amount (step S551), and this debt is finally paid when the payment is completed (step S552).
With this configuration, collection from a service user by assigning a claim to a third party, reimbursement payment, a collection request, or the like is also possible based on a prior contract between related parties.
In addition to charging for the service user, the medical institution may be charged as a system basic usage fee for accounting service concentration avoidance and cash handling reduction services.

The above flow will be described with reference to a time-series flowchart shown in FIG. 16. When using the payment renewal service, the use of the payment renewal service is declared at the time of acceptance.
After the qualification of the insured person is confirmed at the hospital terminal, an inquiry is made as to whether or not the payment reimbursement service is available to the registration database of the payment reimbursement organization. When payment reimbursement service is used, there is no need to pay for the insured person after the checkup, so there is no waiting time for checkup, and it is possible to go home after confirming the end of the checkup.
As described above, according to the medical insurance payment system of the present embodiment, the target person of the service that replaces the payment of the medical insurance self-payment for the insured person of the medical insurance requested from the medical institution is registered, and The insured person confirms whether the insured is willing to receive the payment reimbursement service for the medical insurance self-payment, and confirms that the payment reimbursement confirmation means is willing to receive the payment renewal service. Are excluded from the charge processing person.
Therefore, by using the payment renewal service, the insured person can return without waiting for the settlement of the accounting after the medical examination, and the effect of improving the convenience for the patient can be obtained.

1 is a system diagram showing a configuration example of a payment system 1 (a cashless system 100 and a direct receipt / payment system 200 for a self-payment of medical insurance) as an embodiment of the present invention. FIG. 1 is a conceptual diagram showing a basic processing flow by the cashless system 100 of FIG. The figure which shows the accumulation example of accounting data in Figure 2 The figure which shows the example of the claim information with respect to the insured person 30 in FIG. Flowchart showing the flow of processing in the cashless system 100 of FIG. 1 (continued in FIG. 6) 1 is a flowchart showing the flow of processing in the cashless system 100 of FIG. 1 (continuation of FIG. 5 and continuation of FIG. 7). 1 is a flowchart showing the flow of processing in the cashless system 100 of FIG. 1 (continuation of FIG. 6 and continuation of FIG. 8). Flowchart showing the flow of processing in the cashless system 100 of FIG. 1 (continuation of FIG. 7) The flowchart which shows the processing content of step S119 of FIG. 7, and step S125 of FIG. Flowchart showing an example of processing by the receipt direct billing and settlement system 200 of FIG. 1 (in the case of purchase) Flowchart showing an example of processing by the direct receipt billing and settlement system 200 of FIG. 1 (in the case of advance payment) The figure which shows an example of the receipt for demonstrating the example of a receipt examination, and a purchase (advance payment) ratio evaluation example 1 is a block diagram showing an outline of main functions of the embodiment of the present invention shown in FIG. Normal medical institution-patient interaction flowchart Flow chart of medical institution-patient interaction when using payment renewal service 14 and 15 is a flowchart when the exchange between the medical institution and the patient is seen in time series.

Explanation of symbols

1 Payment System 10 Payment Advancement Institution 11 Billing Information DB (Database)
21 Computer terminal 22 IC card reader / writer 31 IC card 61 Qualification DB (database)
100 Cashless system for self-payment (cashless system)
200 Receipt direct billing and settlement system

Claims (12)

Target insured person registration means for registering a target person of a service for changing the payment of medical insurance self-payment for insured persons of medical insurance requested by a medical institution;
Reading means for reading the identification information from the storage means recording the identification information of the insured;
First confirmation means for confirming the medical insurance guarantee status of the insured person based on the read identification information;
Second confirmation means for confirming whether or not the insured person is registered by the target insured person registration means based on the read identification information;
Based on the confirmation results of the first and second confirmation means, a reimbursement requesting means for requesting payment for the self-payment of the medical insurance for the insured person,
A reimbursement amount determination means for processing the amount charged by the reimbursement request means;
Check the medical insurance insurance benefits for the medical institution of the insured determined by the insured's medical insurance insurer and adjust the advance payment amount for the medical institution based on the insurance benefits Reimbursement payment adjustment means,
The insured who determines the amount of reimbursement for the insured as a reimbursement amount based on the reimbursement amount of the medical insurance self-payment from the medical institution and the medical insurance insurance benefit A payment system for self-payment of medical insurance, comprising: a billing amount determining means. Reimbursement of reimbursement payment amount for the insured person by the insured claim amount determining means by reducing the medical insurance self-payment amount according to the rate of receipt assessment of the medical insurance insurance benefit by the insurer The payment system for self-pay of medical insurance according to claim 1, wherein the payment system is determined as a claim amount as a minute. The first confirmation means accesses the database in which the insured of the insured's medical insurance manages the qualification information of each insured through the communication line, thereby guaranteeing the insured's medical insurance. The payment system for self-pay of medical insurance according to claim 1 or 2, wherein the situation is confirmed. The reimbursement requesting means confirms the confirmation results of the first and second confirmation means and whether or not the insured is willing to receive payment reimbursement service for the medical insurance self-payment The payment system according to any one of claims 1 to 3, wherein whether or not to charge is determined based on the above. Whether or not the insured claim amount determination means satisfies the condition that the medical insurance self-payment for the insured person receives special payments such as additional benefits and high medical expenses from the insurer of the medical insurance. If it is determined that the condition is met, the payment request is made to the invoiced party on behalf of the insured, and the amount corrected for the insured based on the requested amount The payment system for medical insurance self-payment according to any one of claims 1 to 4, wherein the payment system is determined as a claim amount as a compensation amount. Insured person registration process for registering a person eligible for a service that replaces the payment of the medical insurance self-payment for the insured person of the medical insurance requested by the medical institution;
A reading process of reading the identification information from the storage means recording the identification information of the insured;
A first confirmation process for confirming the medical insurance guarantee status of the insured person based on the read identification information;
A second confirmation process for confirming whether the insured person is an insured person registered in the target insured person registration process based on the read identification information;
Based on the confirmation results in the first and second confirmation processes, a reimbursement request process for requesting payment for the insured's self-payment for the medical insurance,
An advance payment determination process to process payments for charges charged in the advance payment request process;
Check the medical insurance insurance benefits for the medical institution of the insured determined by the insured's medical insurance insurer and adjust the advance payment amount for the medical institution based on the insurance benefits The advance payment adjustment process,
The insured claim that determines the claim amount as the reimbursement amount of the reimbursement payment to the insured person based on the reimbursement payment amount of the medical insurance self-pay from the medical institution and the medical insurance insurance benefit amount A payment method for self-payment of medical insurance, characterized in that the method includes: Insured person registration process for registering a person eligible for a service that replaces the payment of the medical insurance self-payment for the insured person of the medical insurance requested by the medical institution;
A reading process of reading the identification information from the storage means recording the identification information of the insured;
A first confirmation process for confirming the medical insurance guarantee status of the insured person based on the read identification information;
A second confirmation process for confirming whether the insured person is an insured person registered in the target insured person registration process based on the read identification information;
Based on the confirmation results in the first and second confirmation processes, a reimbursement request process for requesting payment for the insured's self-payment for the medical insurance,
An advance payment determination process to process payments for charges charged in the advance payment request process;
Check the medical insurance insurance benefits for the medical institution of the insured determined by the insured's medical insurance insurer and adjust the advance payment amount for the medical institution based on the insurance benefits The advance payment adjustment process,
The insured who determines the amount of reimbursement for the insured as a reimbursement amount based on the reimbursement amount of the medical insurance self-payment from the medical institution and the medical insurance insurance benefit A payment program for self-payment of medical insurance, comprising a description for causing the claim amount determination process to be executed by one or more computers. Target insured person registration means for registering the target person of the service that replaces the payment of the medical insurance self-pay for the insured person of the medical insurance requested by the medical institution,
Payment repatriation confirmation means for confirming whether or not the insured is willing to receive payment reimbursement service for the medical insurance self-payment;
Payment for medical insurance self-payment, characterized in that it comprises claim processing object exclusion means for excluding insured persons who have confirmed that the payment replacement confirmation means is willing to receive payment replacement services. system. Reimbursement requesting means for requesting payment for medical insurance self-payment for the insured who is excluded from the claim processing target by the claim processing target exclusion means;
9. The payment system according to claim 8, further comprising: an advanced payment processing means for processing the amount charged by the advanced payment requesting means. 9. The service usage fee billing unit that charges the usage fee of the payment renewal service based on the number of times of use for the insured who is excluded from the billing target by the billing process exclusion unit. Payment system for self-payment of medical insurance described in 1. Insured person registration process for registering a person who is eligible for a service that replaces the payment of the medical insurance self-payment for the insured person of the medical insurance requested by the medical institution;
A payment renewal confirmation process for confirming whether the insured is willing to receive a payment reimbursement service for the medical insurance self-payment;
Payment for medical insurance self-payment, characterized in that it comprises a claim processing exclusion process for excluding insured persons who have confirmed that the payment replacement confirmation means is willing to receive a payment replacement service. Method. Insured person registration process for registering a person who is eligible for a service that replaces the payment of the medical insurance self-payment for the insured person of the medical insurance requested by the medical institution;
A payment renewal confirmation process for confirming whether the insured is willing to receive a payment reimbursement service for the medical insurance self-payment;
Including a description for causing one or a plurality of computers to execute a claim processing exclusion process for excluding an insured person who has confirmed that the payment replacement confirmation means intends to receive a payment replacement service from a charge processing person A payment program for the self-payment of medical insurance.

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