CN106875030A - Commercial health insurance directly pays for intelligent recommendation system and method online - Google Patents
Commercial health insurance directly pays for intelligent recommendation system and method online Download PDFInfo
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- CN106875030A CN106875030A CN201611150732.4A CN201611150732A CN106875030A CN 106875030 A CN106875030 A CN 106875030A CN 201611150732 A CN201611150732 A CN 201611150732A CN 106875030 A CN106875030 A CN 106875030A
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
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- G—PHYSICS
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- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
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Abstract
Intelligent recommendation system and method are directly paid for online the invention discloses a kind of commercial health insurance, and the system includes healthy business insurance front platform, basic data module, Secure Access Modules, intelligent enquiry module and recommended engine module.Emphasis of the present invention solves user in the case where Duo Jiashangbao companies hold insurance, how to determine that corresponding Claims Resolution order compensates benefit to obtain the business guarantor of maximum on line.The present invention integrates the relevant information of Various Hospitalss and commercial insurance company, enable the patient to be done directly the reimbursement of commercial health insurance online at medical institutions end, if patient holds the health insurance of Duo Jiashangbao companies simultaneously, the system can recommend related Claims Resolution scheme according to corresponding intelligent algorithm to patient, so that the final compensation maximizing the benefits of patient.
Description
Technical field
The present invention relates to internet medical information technical field, intelligence is directly paid for online in particular to a kind of commercial health insurance
Commending system and method.
Background technology
Commercial health insurance is the important component of China's health security system, accelerates the development of commercial health insurance,
Be conducive to tamping multi-level health security system, meet the diversified health care demand of the people.At this stage, business health
The compensation of insurance mainly by artificial come what is completed under line, is wasted time and energy, if patient is same for patient and insurance institution
Shi Chiyou Duo Jia commercial insurance companies are (referred to as：Shang Bao companies) health insurance and when needing insurance company to be compensated, patient
Being required for expending bigger cost with Shang Bao companies could complete entirely to compensate flow, so both be unfavorable for that patient obtained business in time
The compensation of industry health insurance, is also unfavorable for that Shang Bao companies reduce the management of commercial health insurance and compensate cost.At present, Huan Zhe
In the case that Duo Jiashangbao companies hold commercial health insurance, how by Claims Resolution that these business insurances are determined on line sequentially,
Need badly and directly pay for passage online by getting through business insurance, so that patient directly obtains the class of best compensation benefit on line
Topic.
The content of the invention
For the above background, intelligent recommendation system, weight are directly paid for online the invention provides a kind of commercial health insurance
Point solves user in the case where Duo Jiashangbao companies hold insurance, how to determine corresponding Claims Resolution order to obtain most on line
Big business protects and compensates benefit.The present invention integrates the relevant information of Various Hospitalss and commercial insurance company, makes trouble
Person can online be done directly the reimbursement of commercial health insurance at medical institutions end, if patient holds Duo Jiashangbao companies simultaneously
Health insurance, the system can recommend related Claims Resolution scheme according to corresponding intelligent algorithm to patient, so that the final compensation of patient
Pay maximizing the benefits.
To achieve the above object, the commercial health insurance designed by the present invention directly pays for intelligent recommendation system online, and its is special
Part is, including healthy business insurance front platform, basic data module, Secure Access Modules, intelligent enquiry module and pushes away
Recommend engine modules；
The healthy business insurance front platform：For being docked with hospital information system, subscriber identity information and report are gathered
Pin cost information；
The basic data module：For the subscriber identity information and the information of submitting an expense account to be pre-processed and deposited
Storage；
The Secure Access Modules：For carrying out safety certification to the subscriber identity information and the information of submitting an expense account；
The intelligent enquiry module：For with commercial insurance company's system docking, according to the subscriber identity information and report
Insure information and the compensation amount of money of pin cost information collection commercial insurance company；
The recommended engine module：For insure information and the compensation amount of money according to commercial insurance company, obtain recommending report
Pin data.
Further, the intelligent enquiry module includes：
Identity is intelligently inquired about：Inquiry of insuring is carried out for the subscriber identity information to be distributed into commercial insurance company, and
Return and obtain the Query Result of insuring that commercial insurance company returns；
Reimbursement data query：For the information of submitting an expense account to be sent to insuring successively according to the order of permutation and combination
The commercial insurance company of information, the compensation amount of money for being returned, the compensation amount of money of each commercial insurance company is row where calculating
Arrange the basis of next commercial insurance company's claim data in the compensation order of combination, the compensation that each commercial insurance company is returned
The summation of the amount of money is paid as the compensation amount of money of the permutation and combination.
The present invention compensates by being gone on line under line authentication and medical expenditure, user is not only facilitated, while also carrying
The operating efficiency of Sheng Liao enterprises.
Further, the recommended engine module includes：
Storage reimbursement data：The compensation amount of money for storing each permutation and combination that the reimbursement data query is returned；
Historical data analysis：For according to user characteristics, system compensated insurance stroke count, system compensated insured amount,
User itself historical claim data computes weighted as claim, obtains history reimbursement sequentially；
Reimbursement sequential combination：For all commercial insurance companies for having the information of insuring to be carried out into permutation and combination, and filter out
Highest compensates permutation and combination, the optional reimbursement data acquisition system of the amount of money, and the optional reimbursement data acquisition system is to compensate the amount of money with highest
Difference less than it is default compensation the difference amount of money permutation and combination；
Recommend reimbursement data：Recommend to submit an expense account data for exporting, rule is：When the element of optional reimbursement data acquisition system is 1
When, highest is compensated the amount of money and corresponding permutation and combination as optimal reimbursement data, with reference to the middle unit of optional reimbursement data acquisition system
The compensation amount of money and corresponding permutation and combination of element, as recommendation reimbursement data；When the element of optional reimbursement data acquisition system is more than 1
When, highest is compensated the amount of money and corresponding permutation and combination as optimal reimbursement data, with reference to the middle unit of optional reimbursement data acquisition system
The compensation amount of money and corresponding permutation and combination of element are arranged according to history reimbursement order, in the lump as recommendation reimbursement data.
Storage reimbursement data, the historical behavior to user excavates, and behavior to user is predicted, so as to set up
The relation of user and content.
A kind of method for directly paying for intelligent recommendation system online for above-mentioned commercial health insurance, it is characterized in that, bag
Include following steps：
1) subscriber identity information is obtained with submit an expense account information, Secure Access Modules by healthy business insurance front platform
Data safety certification is carried out to the subscriber identity information and the information of submitting an expense account；
2) intelligent enquiry module is distributed to commercial insurance company's system after being authorized through user using the subscriber identity information
Carry out inquiry of insuring；
3) intelligent enquiry module obtains the Query Result of insuring that commercial insurance company's system is returned, and has filtered out the information of insuring
Commercial insurance company and information of insuring；
4) commercial insurance company for having the information of insuring and the information of insuring are carried out permutation and combination by intelligent enquiry module, and
The compensation amount of money is calculated according to the information of submitting an expense account successively, the arrangement of amount of money descending will be compensated, obtain recommending reimbursement data；Specifically
Step includes：
41) commercial insurance company's code that reimbursement data query will have the information of insuring carries out permutation and combination；
42) information of submitting an expense account is sent reimbursement data query the system of commercial insurance company into permutation and combination successively
System, the compensation amount of money for being returned, the compensation amount of money of each commercial insurance company be the compensation of permutation and combination where calculating sequentially
In next commercial insurance company's claim data basis, using each commercial insurance company return compensation the amount of money summation as
The compensation amount of money of the permutation and combination；
43) reimbursement sequential combination is compensated the amount of money and corresponding permutation and combination as optimal reimbursement data by highest, with reference to can
Pin data are applied for, obtains recommending reimbursement data；
5) reimbursement data are recommended to recommend to submit an expense account data is activation to user terminal by described.
Preferably, step 43) in, the calculating process of the optional reimbursement data is：
A) set and compensate the difference amount of money；
B) obtain and compensate the permutation and combination of the difference less than the compensation difference amount of money of the amount of money as optional reimbursement with highest
Data acquisition system；
C) if the element number in the optional reimbursement data acquisition system is 1, the compensation amount of money of the permutation and combination is described
Optional reimbursement data, if the number in the optional reimbursement data acquisition system is more than 1, go to step D)；
D) each element in the optional reimbursement data acquisition system is computed weighted, is gone through with the arrangement of weighted value descending
History reimbursement sequentially, and by each element according to history reimbursement order with it is corresponding compensation the amount of money together as the optional reimbursement number
According to.
The filtering of optional data acquisition system is carried out according to difference is compensated, the scope of recommendation order can be reduced, so as to mitigate use
The selection difficulty at family.
Preferably, the step 1) in obtain subscriber identity information and submit an expense account after information, basic data module according to
Commercial insurance company require, the information of submitting an expense account is filled a vacancy, is replaced, data merge, data split, data loading and
Abnormality processing.
Because the data of hospital information system transmission are unified, but the data that Ge Shangbao companies need are each inconsistent,
So processing to meet the different demands of each system by the differentiation that the system can carry out data.
Preferably, the step D) in the claim of ranking operation include that user characteristics, system have compensated insurance stroke count, system
Insured amount, user itself historical claim data are compensated.
Reimbursement result is computed weighted according to historical data so that result is more close to the users demand.
Advantages of the present invention includes：
1) patient can just know oneself in the case where Duo Jiashangbao companies hold commercial health insurance on direct-on-line
In the situation of insuring of Duo Jiashangbao companies, and the reimbursement of system intelligent recommendation can be just obtained on line sequentially, this avoid
Patient travels to and fro between Duo Jia insurance companies to submit an expense account, time saving and energy saving, while also ensuring that patient can obtain the compensation effect of maximum
Benefit；
2) medical institutions and commercial health insurance company are integrated, has been broken between medical institutions and Shang Bao companies
Barrier, on the premise of safe and efficient, insurance company is obtained the compensation demand of patient in time, and accelerate whole compensation
Flow, while also allow for Shang Bao companies knows reimbursement situation of the patient in other Shang Bao companies in time, it is unnecessary to reduce some
Business protect compensate expenditure；
3) at medical institutions end, for patient provides the channel that commercial health insurance is directly paid for online, reduce further trouble
The medical treatment cost of person, optimizes the procedure in hospital of patient.
Brief description of the drawings
Fig. 1 is the structured flowchart that commercial health insurance of the present invention directly pays for intelligent recommendation system online.
Fig. 2 is the flow chart that commercial health insurance of the present invention directly pays for intelligent recommendation method online.
Wherein：Healthy business insurance front platform 1, basic data module 2, Secure Access Modules 3, intelligent enquiry module 4,
Identity intelligently inquiry 41, submits an expense account data query 42, recommended engine module 5, storage reimbursement data 51, historical data analysis 52, report
Pin sequential combination 53, recommends reimbursement data 54, hospital information system 6, commercial insurance company's system 7.
Specific embodiment
Below in conjunction with the drawings and specific embodiments, the present invention is described in further detail.
As depicted in figs. 1 and 2, a kind of commercial health insurance of the invention directly pays for intelligent recommendation system, including healthy business online
Industry insurance front platform 1, basic data module 2, Secure Access Modules 3, intelligent enquiry module 4 and recommended engine module 5.This hair
It is bright based on computer and communication network realization JavaEE platform, by call HTTP interface ask with hospital HIS system and
Commercial insurance company's system communication connection.
Healthy business insurance front platform 1：For being docked with hospital information system 6, subscriber identity information and reimbursement are gathered
Cost information.Healthy business insurance front platform 1 can be realized by the PC installed in hospital.
Basic data module 2：For subscriber identity information and the information of submitting an expense account to be pre-processed and stored.
Secure Access Modules 3：For carrying out safety certification to subscriber identity information and the information of submitting an expense account.
Intelligent enquiry module 4：For being docked with commercial insurance company system 7, according to subscriber identity information and submit an expense account
Insure information and the compensation amount of money of information gathering commercial insurance company.
Intelligent enquiry module 4 includes identity intelligently inquiry 41 and reimbursement data query 42.
Identity intelligently inquiry 41：Inquiry of insuring is carried out for subscriber identity information to be distributed into commercial insurance company, and is returned
Return and obtain the Query Result of insuring that commercial insurance company returns；
Reimbursement data query 42：For the information of submitting an expense account to be sent to letter of insuring successively according to the order of permutation and combination
The commercial insurance company of breath, the compensation amount of money for being returned, the compensation amount of money of each commercial insurance company is arrangement where calculating
The basis of next commercial insurance company's claim data, the compensation that each commercial insurance company is returned in the compensation order of combination
The summation of the amount of money as the permutation and combination the compensation amount of money.
Recommended engine module 5：For insure information and the compensation amount of money according to commercial insurance company, obtain recommending reimbursement number
According to.
Recommended engine module 5 includes storage reimbursement data 51, historical data analysis 52, reimbursement sequential combination 53 and recommends report
Pin data 54.
Storage reimbursement data 51：The compensation amount of money for storing each permutation and combination that reimbursement data query 42 is returned；
Historical data analysis 52：Insurance money has been compensated for having compensated insurance stroke count, system according to user characteristics, system
Volume, user itself historical claim data compute weighted as claim, obtain history reimbursement sequentially；
Reimbursement sequential combination 53：Permutation and combination for all commercial insurance companies for having the information of insuring to be carried out limit,
And permutation and combination, optional reimbursement data acquisition system that highest compensates the amount of money are filtered out, optional reimbursement data acquisition system is to be compensated with highest
Permutation and combination of the difference of the amount of money less than the default compensation difference amount of money；
Recommend reimbursement data 54：Recommend to submit an expense account data for exporting, rule is：When the element of optional reimbursement data acquisition system is
When 1, highest is compensated the amount of money and corresponding permutation and combination as optimal reimbursement data, with reference to the middle unit of optional reimbursement data acquisition system
The compensation amount of money and corresponding permutation and combination of element, as recommendation reimbursement data；When the element of optional reimbursement data acquisition system is more than 1
When, highest is compensated the amount of money and corresponding permutation and combination as optimal reimbursement data, with reference to the middle unit of optional reimbursement data acquisition system
The compensation amount of money and corresponding permutation and combination of element are arranged according to history reimbursement order, in the lump as recommendation reimbursement data.
Based on said system, a kind of commercial health insurance of the invention directly pays for intelligent recommendation method online, comprises the following steps：
1) subscriber identity information and information of submitting an expense account are obtained by user terminal, and to subscriber identity information and is submitted an expense account
Information carries out data safety certification；User terminal can be healthy business insurance front platform 1, healthy business insurance front platform 1
Can be realized by PC.Subscriber identity information and report that healthy business insurance front platform 1 is collected from hospital information system 6
Pin cost information is stored to basic data module 2, and basic data module 2 is required according to commercial insurance company, to letter of submitting an expense account
Breath is filled a vacancy, is replaced, data merge, data split, data are loaded and abnormality processing.Secure Access Modules 3 are to user identity
Information and the information of submitting an expense account carry out authenticity verification and safety certification, and Secure Access Modules 3 are using Inter Milan algorithm to system industry
Business data carry out the operations such as encryption and decryption, signature and sign test, it is ensured that availability of data, integrality and confidentiality, it is to avoid exist in data
Increase in transmission and exchange process, change, the problems such as losing and reveal.
2) by healthy business insurance front platform 1 and user mutual, after being authorized through user, intelligently inquiry 41 will be used identity
Commercial insurance company's system 7 that all the system that family identity information are distributed to are accessed insure inquiry (by distributed message
Transmission is completed).
3) intelligently inquiry 41 obtains the Query Result of insuring that commercial insurance company's system 7 is returned to identity, has filtered out and has insured
The commercial insurance company of information and information of insuring；
4) commercial insurance company and the information of insuring that will have the information of insuring carry out permutation and combination, permutation and combination storage is arrived and is divided
In cloth message queue, each arrangement in lining up is considered as a calculating theme, is then processed by distributed message and lined up
In each calculate theme, calculated successively according to the information of submitting an expense account each calculate theme compensation amount of money, will compensate gold
Volume descending is arranged, and obtains recommending reimbursement data.Specific steps include：
41) reimbursement sequential combination 53 will have commercial insurance company's code of the information of insuring to carry out the permutation and combination of limit；
42) information of submitting an expense account is sent reimbursement data query 42 the commercial insurance company's system into permutation and combination successively
7, by the compensation amount of money for calling the budget and balance interface of commercial insurance company's system 7 to be returned, it is stored in storage reimbursement data
In 51.The compensation amount of money of each commercial insurance company is next business insurance public affairs in the compensation order for calculate place permutation and combination
The basis of claim data is taken charge of, the compensation of summation as the permutation and combination of the compensation amount of money that each commercial insurance company is returned is golden
Volume；
43) recommend reimbursement data 54 that highest is compensated the amount of money and corresponding permutation and combination as optimal reimbursement data, with reference to
Optional reimbursement data, obtain recommending reimbursement data.
It is optional reimbursement data calculating process be：
A) set and compensate the difference amount of money, the compensation difference amount of money is initial by being manually specified, and the later stage is trained by great amount of samples
Obtain.
B) recommend reimbursement data 54 to obtain the difference for compensating the amount of money with highest to make less than the permutation and combination for compensating the difference amount of money
It is optional reimbursement data acquisition system；
C) if the element number in optional reimbursement data acquisition system is 1, the compensation amount of money of the permutation and combination is optional reimbursement
Data, if the number in optional reimbursement data acquisition system is more than 1, go to step D)；
D) historical data analysis 52 compute weighted to each element in optional reimbursement data acquisition system, with weighted value descending
Arrangement obtains history reimbursement sequentially, and by each element according to history reimbursement order with the corresponding compensation amount of money together as can apply for
Pin data.The claim of ranking operation includes that user characteristics, system have compensated insurance stroke count, system and compensated insured amount, user
Itself historical claim data.
5) recommending reimbursement data 54 will recommend reimbursement data is activation to user terminal, and offer to hospital is called by api interface
Information system 6, final decision-making is made by user.
First embodiment of the invention comprises the following steps：
1) subscriber identity information is obtained：Zhang, passport NO.：341230xxxxxxxx4532, carries out data encryption treatment
And information is transmitted separately to Shang Bao companies.
2) Shang Bao companies response message is obtained, the client for congratulating that so-and-so is Shang Bao companies A, Shang Bao company B is learnt.
3) Shang Bao companies are carried out into permutation and combination, and so-and-so medical (1182.6 yuan) rows of pressing of detailed and medical total cost will be congratulated
Row are transferred sequentially to Ge Jia insurance companies, carry out Claims Resolution calculating.
4) obtaining Claims Resolution result is：
A) order 1：Shang Bao companies A settles a claim 946.08 yuan, and Shang Bao companies B settles a claim 189.22 yuan, settles a claim 1135.3 yuan altogether.
B) order 2：Shang Bao companies B settles a claim 827.86 yuan, and Shang Bao companies A settles a claim 319.26 yuan, settles a claim 1147.12 altogether
Unit.
5) because Claims Resolution result only has two kinds of situations, so directly Claims Resolution result is returned.
Comprise the following steps in second embodiment of the invention：
6) subscriber identity information is obtained：So-and-so is congratulated, passport NO.：420300xxxxxxxx4210, is carried out at data encryption
Manage and information is transmitted separately to all Shang Bao companies.
7) Shang Bao companies response message is obtained, learns that it is client, the Shang Bao companies of Shang Bao companies A, Shang Bao company B to congratulate so-and-so
The client of C.
8) Shang Bao companies are carried out into permutation and combination, and so-and-so medical detailed and medical total cost (3016.82 yuan) will be congratulated to press
Put in order (ABC, ACB, BAC, BCA, CAB, CBA) pass to Ge Jia insurance companies, carry out Claims Resolution calculating.
9) obtaining Claims Resolution result is：
A) order 1：Shang Bao companies A settles a claim 2413.46 yuan, and Shang Bao companies B settles a claim 452.69 yuan, Shang Bao companies C Claims Resolutions
116.60 yuan, settle a claim 2982.75 yuan altogether.
B) order 2：Shang Bao companies A settles a claim 2413.46 yuan, and Shang Bao companies C settles a claim 490.02 yuan, Shang Bao companies B Claims Resolutions
49.86 yuan, settle a claim 2953.34 yuan altogether.
C) order 3：Shang Bao companies B settles a claim 2111.77 yuan, and Shang Bao companies A settles a claim 709.04 yuan, Shang Bao companies C Claims Resolutions
169.9 yuan, settle a claim 2990.71 yuan altogether.
D) order 4：Shang Bao companies B settles a claim 2111.77 yuan, and Shang Bao companies C settles a claim 804.54 yuan, Shang Bao companies A Claims Resolutions
76.56 yuan, settle a claim 2992.87 yuan altogether.
E) order 5：Shang Bao companies C settles a claim 2564.29 yuan, and Shang Bao companies A settles a claim 336.02 yuan, Shang Bao companies B Claims Resolutions
76.4 yuan, settle a claim 2976.71 yuan altogether.
F) order 6：Shang Bao companies C settles a claim 2564.29 yuan, and Shang Bao companies B settles a claim 336.02 yuan, Shang Bao companies A Claims Resolutions
76.4 yuan, settle a claim 2976.71 yuan altogether.
10) maximum 4 (BCA) that put in order that submit an expense account are obtained, reimbursed sum is：2992.87 yuan.Other results are made
It is optional amount of money set.
11) because optional amount of money set element is more than 1, so needs are screened according to the rule of default.
A) compensate the compensation difference between the amount of money with maximum and carry out first round filtering according to pre-setting first.
B) secondly computed weighted according to historical data.Stroke count, the compensation amount of money and user are compensated according to insurance company certainly
The historical data of body carries out condition filter.
12) most maximum reimbursement result responds to client with filter result at last.Note：Filter result is not necessarily can selected works
Reimbursed sum is maximum in conjunction puts in order.
Above in association with most preferred embodiment, invention has been described, but the invention is not limited in implementation disclosed above
Example, and modification, equivalent combinations that various essence of the invention are carried out should be covered.
The content not being described in detail in this specification belongs to prior art known to professional and technical personnel in the field.
Claims (7)
1. a kind of commercial health insurance directly pays for intelligent recommendation system online, it is characterised in that：Including horizontalization before healthy business insurance
Platform (1), basic data module (2), Secure Access Modules (3), intelligent enquiry module (4) and recommended engine module (5)；
The healthy business insurance front platform (1)：For being docked with hospital information system (6), collection subscriber identity information and
Submit an expense account information；
The basic data module (2)：For the subscriber identity information and the information of submitting an expense account to be pre-processed and stored；
The Secure Access Modules (3)：For carrying out safety certification to the subscriber identity information and the information of submitting an expense account；
The intelligent enquiry module (4)：For being docked with commercial insurance company's system (7), according to the subscriber identity information and
Submit an expense account information gathering commercial insurance company insure information and compensate the amount of money；
The recommended engine module (5)：For insure information and the compensation amount of money according to commercial insurance company, obtain recommending reimbursement
Data.
2. commercial health insurance according to claim 1 directly pays for intelligent recommendation system online, it is characterised in that：The intelligence
Enquiry module (4) includes：
Identity intelligently inquiry (41)：Inquiry of insuring is carried out for the subscriber identity information to be distributed into commercial insurance company, and
Return and obtain the Query Result of insuring that commercial insurance company returns；
Reimbursement data query (42)：For the information of submitting an expense account to be sent to insuring successively according to the order of permutation and combination
The commercial insurance company of information, the compensation amount of money for being returned, the compensation amount of money of each commercial insurance company is row where calculating
Arrange the basis of next commercial insurance company's claim data in the compensation order of combination, the compensation that each commercial insurance company is returned
The summation of the amount of money is paid as the compensation amount of money of the permutation and combination.
3. commercial health insurance according to claim 2 directly pays for intelligent recommendation system online, it is characterised in that：The recommendation
Engine modules (5) include：
Storage reimbursement data (51)：Compensation gold for storing each permutation and combination that reimbursement data query (42) returns
Volume；
Historical data analysis (52)：For according to user characteristics, system compensated insurance stroke count, system compensated insured amount,
User itself historical claim data computes weighted as claim, obtains history reimbursement sequentially；
Reimbursement sequential combination (53)：For all commercial insurance companies for having the information of insuring to be carried out into permutation and combination, and filter out
Highest compensates permutation and combination, the optional reimbursement data acquisition system of the amount of money, and the optional reimbursement data acquisition system is to compensate the amount of money with highest
Difference less than it is default compensation the difference amount of money permutation and combination；
Recommend reimbursement data (54)：Recommend to submit an expense account data for exporting, rule is：When the element of optional reimbursement data acquisition system is 1
When, highest is compensated the amount of money and corresponding permutation and combination as optimal reimbursement data, with reference to the middle unit of optional reimbursement data acquisition system
The compensation amount of money and corresponding permutation and combination of element, as recommendation reimbursement data；When the element of optional reimbursement data acquisition system is more than 1
When, highest is compensated the amount of money and corresponding permutation and combination as optimal reimbursement data, with reference to the middle unit of optional reimbursement data acquisition system
The compensation amount of money and corresponding permutation and combination of element are arranged according to history reimbursement order, in the lump as recommendation reimbursement data.
4. a kind of commercial health insurance for described in any claim in claims 1 to 3 directly pays for intelligent recommendation system online
The method of system, it is characterised in that：Comprise the following steps：
1) subscriber identity information is obtained with submit an expense account information, Secure Access Modules by healthy business insurance front platform (1)
(3) data safety certification is carried out to the subscriber identity information and the information of submitting an expense account；
2) intelligent enquiry module (4) is distributed to commercial insurance company's system after being authorized through user using the subscriber identity information
(7) inquiry of insuring is carried out；
3) intelligent enquiry module (4) obtains the Query Result of insuring that commercial insurance company's system (7) returns, and has filtered out letter of insuring
The commercial insurance company of breath and information of insuring；
4) commercial insurance company for having the information of insuring and the information of insuring are carried out permutation and combination by intelligent enquiry module (4), and
The compensation amount of money is calculated according to the information of submitting an expense account successively, the arrangement of amount of money descending will be compensated, obtain recommending reimbursement data；Specifically
Step includes：
41) commercial insurance company's code that reimbursement data query (42) will have the information of insuring carries out permutation and combination；
42) information of submitting an expense account is sent the system of commercial insurance company into permutation and combination successively for reimbursement data query (42)
System (7), the compensation amount of money for being returned, the compensation amount of money of each commercial insurance company is that the compensation of permutation and combination where calculating is suitable
The basis of next commercial insurance company's claim data in sequence, the summation of the compensation amount of money that each commercial insurance company is returned is made
It is the compensation amount of money of the permutation and combination；
43) highest is compensated the amount of money and corresponding permutation and combination as optimal reimbursement data for reimbursement sequential combination (53), with reference to can
Pin data are applied for, obtains recommending reimbursement data；
5) reimbursement data (54) is recommended to recommend to submit an expense account data is activation to user terminal by described.
5. commercial health insurance according to claim 4 directly pays for intelligent recommendation method online, it is characterised in that：Step 43)
In, the calculating process of the optional reimbursement data is：
A) set and compensate the difference amount of money,
B) obtain and compensate the permutation and combination of the difference less than the compensation difference amount of money of the amount of money as optional reimbursement data with highest
Set；
C) if the element number in the optional reimbursement data acquisition system is 1, the compensation amount of money of the permutation and combination is described optional
Reimbursement data, if the number in the optional reimbursement data acquisition system is more than 1, go to step D)；
D) each element in the optional reimbursement data acquisition system is computed weighted, history report is obtained with the arrangement of weighted value descending
Pin sequentially, and by each element according to history reimbursement order with it is corresponding compensation the amount of money together as the optional reimbursement data.
6. commercial health insurance according to claim 4 directly pays for intelligent recommendation method online, it is characterised in that：The step
1) after subscriber identity information and information of submitting an expense account are obtained in, basic data module (2) is required to institute according to commercial insurance company
State the information of submitting an expense account filled a vacancy, replaced, data merge, data split, data loading and abnormality processing.
7. commercial health insurance according to claim 5 directly pays for intelligent recommendation method online, it is characterised in that：The step
D the claim of ranking operation includes that user characteristics, system have compensated insurance stroke count, system and compensated insured amount, user itself in)
Historical claim data.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201611150732.4A CN106875030B (en) | 2016-12-14 | 2016-12-14 | Intelligent online direct claim recommendation system and method for business health insurance |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201611150732.4A CN106875030B (en) | 2016-12-14 | 2016-12-14 | Intelligent online direct claim recommendation system and method for business health insurance |
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| CN107346475A (en) * | 2017-07-17 | 2017-11-14 | 太仓红码软件技术有限公司 | A kind of intelligent vehicle insurance appraisal procedure and its system based on data analysis |
| CN108053329A (en) * | 2018-01-19 | 2018-05-18 | 泰康保险集团股份有限公司 | For the information processing method of settlement of insurance claim, device, medium and electronic equipment |
| CN108335237A (en) * | 2017-06-22 | 2018-07-27 | 平安科技（深圳）有限公司 | It puts on record method, terminal and computer readable storage medium |
| CN109118374A (en) * | 2018-08-09 | 2019-01-01 | 辽宁万象联合医疗科技有限公司 | The method, apparatus and server of online application Claims Resolution |
| CN109272411A (en) * | 2018-09-03 | 2019-01-25 | 汇保医联信息科技有限公司 | The Claims Resolution method, apparatus and server of business insurance |
| CN109300053A (en) * | 2018-10-31 | 2019-02-01 | 平安医疗健康管理股份有限公司 | Intelligent recommendation method and Related product |
| CN109377388A (en) * | 2018-09-13 | 2019-02-22 | 平安医疗健康管理股份有限公司 | Medical insurance is insured method, apparatus, computer equipment and storage medium |
| WO2019052219A1 (en) * | 2017-09-13 | 2019-03-21 | 平安科技（深圳）有限公司 | Medical insurance claim method and apparatus, computer device and storage medium |
| CN109785095A (en) * | 2018-12-13 | 2019-05-21 | 平安医疗健康管理股份有限公司 | A kind of settlement method of medical expense, checkout apparatus and terminal device |
| CN109829829A (en) * | 2018-12-13 | 2019-05-31 | 平安科技（深圳）有限公司 | Intelligent recommendation method and relevant apparatus based on big data |
| CN111553798A (en) * | 2020-03-31 | 2020-08-18 | 万达信息股份有限公司 | System and method for direct claims of merchant and insurance |
| CN111652581A (en) * | 2020-05-29 | 2020-09-11 | 泰康保险集团股份有限公司 | Method and device for processing arithmetic data, storage medium and electronic equipment |
| CN111933239A (en) * | 2020-09-17 | 2020-11-13 | 泰康保险集团股份有限公司 | Data processing method, device, system and storage medium |
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| CN108335237A (en) * | 2017-06-22 | 2018-07-27 | 平安科技（深圳）有限公司 | It puts on record method, terminal and computer readable storage medium |
| WO2018233367A1 (en) * | 2017-06-22 | 2018-12-27 | 平安科技（深圳）有限公司 | Case registration method and apparatus, terminal, and computer readable storage medium |
| CN107346475A (en) * | 2017-07-17 | 2017-11-14 | 太仓红码软件技术有限公司 | A kind of intelligent vehicle insurance appraisal procedure and its system based on data analysis |
| WO2019052219A1 (en) * | 2017-09-13 | 2019-03-21 | 平安科技（深圳）有限公司 | Medical insurance claim method and apparatus, computer device and storage medium |
| CN108053329A (en) * | 2018-01-19 | 2018-05-18 | 泰康保险集团股份有限公司 | For the information processing method of settlement of insurance claim, device, medium and electronic equipment |
| CN109118374A (en) * | 2018-08-09 | 2019-01-01 | 辽宁万象联合医疗科技有限公司 | The method, apparatus and server of online application Claims Resolution |
| CN109272411A (en) * | 2018-09-03 | 2019-01-25 | 汇保医联信息科技有限公司 | The Claims Resolution method, apparatus and server of business insurance |
| CN109377388A (en) * | 2018-09-13 | 2019-02-22 | 平安医疗健康管理股份有限公司 | Medical insurance is insured method, apparatus, computer equipment and storage medium |
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| CN109300053A (en) * | 2018-10-31 | 2019-02-01 | 平安医疗健康管理股份有限公司 | Intelligent recommendation method and Related product |
| CN109785095A (en) * | 2018-12-13 | 2019-05-21 | 平安医疗健康管理股份有限公司 | A kind of settlement method of medical expense, checkout apparatus and terminal device |
| CN109829829A (en) * | 2018-12-13 | 2019-05-31 | 平安科技（深圳）有限公司 | Intelligent recommendation method and relevant apparatus based on big data |
| CN109829829B (en) * | 2018-12-13 | 2023-09-08 | 平安科技（深圳）有限公司 | Intelligent recommendation method and related device based on big data |
| CN111553798A (en) * | 2020-03-31 | 2020-08-18 | 万达信息股份有限公司 | System and method for direct claims of merchant and insurance |
| CN111652581A (en) * | 2020-05-29 | 2020-09-11 | 泰康保险集团股份有限公司 | Method and device for processing arithmetic data, storage medium and electronic equipment |
| CN111933239A (en) * | 2020-09-17 | 2020-11-13 | 泰康保险集团股份有限公司 | Data processing method, device, system and storage medium |
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Denomination of invention: Online direct compensation intelligent recommendation system and method for commercial health insurance Effective date of registration: 20220930 Granted publication date: 20201124 Pledgee: Wuhan area branch of Hubei pilot free trade zone of Bank of China Ltd. Pledgor: WUHAN MEDICAL UNION Co.,Ltd. Registration number: Y2022420000340 |