CN108257023A - A kind of nursing gold compensates method and apparatus - Google Patents
A kind of nursing gold compensates method and apparatus Download PDFInfo
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- CN108257023A CN108257023A CN201710225202.XA CN201710225202A CN108257023A CN 108257023 A CN108257023 A CN 108257023A CN 201710225202 A CN201710225202 A CN 201710225202A CN 108257023 A CN108257023 A CN 108257023A
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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
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/08—Insurance
Abstract
The embodiment of the invention discloses a kind of golden compensation method of nursing, for solving the problems, such as that existing nursing gold application is relatively complicated, not convenient.Present invention method includes：Determine that the target for treating to compensate automatically nurses case, the target nursing case is to have completed to nurse gold compensation for the first time and nursed the Claims Resolution case of nursing declaration form that responsibility is in the term of validity；If present system time reaches the automatic of target nursing case and compensates the time, the compensation application of the target nursing case is automatically initiated；Target nursing case is audited according to preset auditing rule；Pass through if the target nursing case is audited, the automatic compensation time of the target nursing case next time is updated according to the nursing declaration form；Case is nursed to the target by the financial system of insurance company to carry out nursing golden payment processing.The embodiment of the present invention also provides a kind of nursing gold and compensates device.
Description
Technical field
The present invention relates to financial services industries more particularly to a kind of nursing gold to compensate method and apparatus.
Background technology
Nursing insurance refers to that cause nursing need using the activity of daily living obstacle arranged by insurance contract insures as payment
The insurance to provide safeguard is paid in gold bar part, the nursing for insurant, is one kind of health insurance.
At present, when carrying out nursing gold Claims Resolution for nursing insurance, need applicant regular (such as：Monthly) carry out compensation Shen
Please, it is relatively complicated to lead to nurse gold application, for the applicant there are impairment, often due to punctual hair
It rises and compensates application and lead to miss the application time limit so that nursing insurance does not play the guaranteeing role having.
Invention content
An embodiment of the present invention provides a kind of nursing gold to compensate method and apparatus, can improve the facility of nursing gold application
Property, and improve the Claims Resolution efficiency of nursing gold.
In a first aspect, a kind of golden compensation method of nursing is provided, including：
Determine that the target for treating to compensate automatically nurses case, target nursing case for completed to nurse for the first time gold compensation,
And nursing responsibility is in the Claims Resolution case of the nursing declaration form in the term of validity；
If present system time reaches the automatic of target nursing case and compensates the time, the target shield is automatically initiated
Manage the compensation application of case；
Target nursing case is audited according to preset auditing rule；
If the target nursing case audit passes through, updated one under the target nursing case according to the nursing declaration form
The secondary automatic compensation time；
Case is nursed to the target by the financial system of insurance company to carry out nursing golden payment processing.
Second aspect provides a kind of nursing gold and compensates device, including：
Target case determining module, for determining that the target for treating to compensate automatically nurses case, the target nursing case is
It has completed to nurse gold compensation for the first time and nursing responsibility is in the Claims Resolution case of the nursing declaration form in the term of validity；
Automatic application module, if reaching the automatic of target nursing case for present system time compensates the time,
Automatically initiate the compensation application of the target nursing case；
Case auditing module, for being audited according to preset auditing rule to target nursing case；
Time update module is compensated, if passing through for target nursing case audit, according to the nursing declaration form more
The automatic compensation time of the new target nursing case next time；
Case compensates module, carry out for passing through the financial system of insurance company to the target nursing case nursing gold to
Pay processing.
As can be seen from the above technical solutions, the embodiment of the present invention has the following advantages：
In the embodiment of the present invention, first, determine that the target for treating to compensate automatically nurses case, the target nursing case is
It completes nursing gold for the first time and compensates and nurse the Claims Resolution case of nursing declaration form that responsibility is in the term of validity；If present system time
It reaches the automatic of target nursing case and compensates the time, then automatically initiate the compensation application of the target nursing case；Then,
Target nursing case is audited according to preset auditing rule；If the target nursing case audit passes through, root
The automatic compensation time of the target nursing case next time is updated according to the nursing declaration form；Finally, pass through the wealth of insurance company
Business system carries out target nursing case to nurse golden payment processing.In this way, it is compensated and still for having completed to nurse gold for the first time
The Claims Resolution case of nursing declaration form before the deadline automatically initiates compensation application when can be reached compensating the time automatically, without
Applicant periodically goes to carry out compensation application, improves the convenience of nursing gold application；If in addition, automatically initiate mesh after compensation application
Mark nursing case audit passes through, you can carries out nursing golden payment processing by financial system, substantially increases the Claims Resolution of nursing gold
Efficiency, so as to improve the guaranteeing role that nursing insurance plays.
Description of the drawings
It to describe the technical solutions in the embodiments of the present invention more clearly, below will be to embodiment or description of the prior art
Needed in attached drawing be briefly described, it should be apparent that, the accompanying drawings in the following description be only the present invention some
Embodiment, for those of ordinary skill in the art, without having to pay creative labor, can also be according to these
Attached drawing obtains other attached drawings.
Fig. 1 is a kind of golden compensation method one embodiment flow chart of nursing in the embodiment of the present invention；
Fig. 2 is that a kind of flow for nursing gold compensation method and step 104 under an application scenarios is shown in the embodiment of the present invention
It is intended to；
Fig. 3 calculates described this required compensation of target nursing case for gold compensation method of nursing a kind of in the embodiment of the present invention
Nursing gold step schematic diagram；
Fig. 4 is that a kind of gold compensation method of nursing generates the single flow diagram of Claims Resolution batch in the embodiment of the present invention；
Fig. 5 is a kind of flow diagram nursed gold and compensate method and step 403 in Fig. 4 corresponding embodiments；
Fig. 6 is that a kind of nursing gold compensates first example structure figure of device in the embodiment of the present invention；
Fig. 7 is that a kind of nursing gold compensates second example structure figure of device in the embodiment of the present invention；
Fig. 8 is that a kind of nursing gold compensates device third example structure figure in the embodiment of the present invention.
Specific embodiment
An embodiment of the present invention provides a kind of nursing gold to compensate method and apparatus, for solving existing nursing gold application more
The problem of cumbersome, not convenient.
In order to make the invention's purpose, features and advantages of the invention more obvious and easy to understand, below in conjunction with the present invention
Attached drawing in embodiment is clearly and completely described the technical solution in the embodiment of the present invention, it is clear that disclosed below
Embodiment be only part of the embodiment of the present invention, and not all embodiment.Based on the embodiments of the present invention, this field
All other embodiment that those of ordinary skill is obtained without making creative work, belongs to protection of the present invention
Range.
Referring to Fig. 1, a kind of golden compensation method one embodiment of nursing includes in the embodiment of the present invention：
101st, determine that the target for treating to compensate automatically nurses case, the target nursing case is has completed to nurse golden compensation for the first time
Pay and nurse the Claims Resolution case of nursing declaration form that responsibility is in the term of validity；
In the present embodiment, predominantly those have been completed to nurse gold compensation for the first time and have nursed the shield that responsibility is in the term of validity
The Claims Resolution case of declaration form is managed, i.e., described target nursing case compensates application to automatically initiate nursing gold.It is understood that consider
To the property of nursing insurance, when the event arranged on nursing declaration form occurs for insurant, such as after heavy disease is made a definite diagnosis, applicant needs
Nursing gold, which compensates request, for the first time is proposed to the nursing declaration form, and relevant Claims Resolution material is submitted to complete nursing gold for the first time and is compensated
Request.It after completing to compensate for the first time, is usually compensated by stages due to nursing insurance, such as monthly compensates primary, phase
Applicant in the prior art is needed monthly actively to carry out the primary nursing gold applied for operation and can just obtain of that month compensation, this implementation
The compensation application of target nursing case can be carried out in example for applicant automatically, so as to improve the facility of nursing gold application
Property.
Particularly, in practical applications, the gold of the nursing for the first time compensation request for nursing declaration form can also be by automatic mode
It realizes.It is docked for example, the system of insurance company can carry out data with medical system, when insurant is after certain hospital makes a definite diagnosis,
Medical system is by the system made a definite diagnosis information and be sent to insurance company of the insurant, if the system detection of insurance company finds to be somebody's turn to do
The information of making a definite diagnosis of insurant meets it and nurses the Claims Resolution of declaration form when requiring, and the system of insurance company can be insured for this automatically
Human hair plays nursing gold and compensates application.This for Du Gu old man, without insurants such as patients family members for, its Shen can be exempted
The hardship that please be settled a claim substantially increases the serve nursing of insurant.
It should be noted that the Claims Resolution case for nursing declaration form, since nursing declaration form is respectively provided with the term of validity, such as arrange
Nursing is compensated 1 year, 2 years or 5 years etc., and when current time exceeds the term of validity, which then no longer has Claims Resolution effect
Power.Therefore, after confirming the nursing declaration form still in the term of validity, it just can determine that the Claims Resolution case as institute in the present embodiment
The target nursing case said.
102nd, whether detection present system time reaches the automatic of target nursing case and compensates the time, if so, holding
Row step 103, if it is not, then continuing to detect；
In the present embodiment, target nurses case when carrying out nursing gold compensation for the first time, and system can provide certainly for applicant
The dynamic option for compensating application, if applicant has chosen the option, system is held automatically in subsequent processing target nursing case
The nursing gold of row the present embodiment compensates method.When applicant chooses the option of automatic compensation application, applicant can voluntarily set
It is fixed automatic to compensate the time, for example, be set as monthly carrying out within 1st it is automatic compensate application, then target nursing case next month is automatic
The compensation time is next month 1.Particularly, if applicant does not set the specific automatic compensation time, system can be the mesh
Mark nursing case sets a default time as the automatic compensation time.
103rd, the compensation application of the target nursing case is automatically initiated；
It is automatic to send out if present system time reaches the automatic of target nursing case and compensates the time in the present embodiment
Play the compensation application of the target nursing case.
104th, target nursing case is audited according to preset auditing rule, if audit does not pass through, performed
Step 105, if audit passes through, step 106 is performed；
In the present embodiment, in order to avoid the processing of this compensation application and other process flows of target nursing case are sent out
Raw conflict is obscured, and needs to audit target nursing case according to preset auditing rule.It it is understood that should
The type that auditing rule can nurse the corresponding nursing declaration form of case according to the target is set, such as the nursing for weight disease
Different auditing rules can be set separately from for the nursing declaration form of endowment in declaration form.It, can be first according to the mesh before audit
The type of the corresponding nursing declaration form of mark nursing case gets corresponding auditing rule, in the auditing rule that basis is got to this
Target nursing case carries out audit processing.
Further, as shown in Fig. 2, above-mentioned steps 104 can include：
201st, it detects in the corresponding nursing declaration form of the target nursing case and whether there is other reasons in state of transferring accounts
It pays in case or the nursing declaration form and whether there is the other pleas not completed in addition to the target nurses case,
If so, performing step 202, if being no, step 203 is performed；
202nd, determine that the target nursing case audit does not pass through；
203rd, determine that the target nursing case audit passes through.
For above-mentioned steps 201~203, in an application scenarios, above-mentioned auditing rule can be set as the target
There cannot be other Claims Resolution cases in state of transferring accounts in the corresponding nursing declaration form of nursing case and cannot exist except described
The other pleas not completed except target nursing case.Therefore, it detects in the corresponding nursing declaration form of target nursing case
With the presence or absence of this two classes case, if so, determining that target nursing case audit does not pass through, if being no, the target is just determined
Nursing case audit passes through.
105th, target nursing case is handled according to default flow；
In the present embodiment, when the target nursing case audit it is obstructed out-of-date, then the target is protected according to default flow
Reason case is handled.Specifically, the compensation application of target nursing case can be initiated again after a certain time interval,
For example, obstructed out-of-date in target nursing case audit, setting again attempted to compensate target nursing case after 3 minutes
Application；Alternatively, target nursing case can also be cancelled in this compensation application, and the mesh is updated according to the nursing declaration form
The automatic compensation time of mark nursing case next time waits for and reaches the automatic compensation time of target nursing case next time.
It is understood that for the audit of target nursing case not by the case of, the default flow can there are many
Setting means, so as to adjust the specific processing mode to target nursing case according to actual use situation, to this
Embodiment is not construed as limiting.
106th, the automatic compensation time of the target nursing case next time is updated according to the nursing declaration form；
After target nursing case audit passes through, can determine substantially target nursing case this compensate application can be with
It winds up the case, therefore, can be automatically initiated to ensure to compensate application next time, need to update the target according to the nursing declaration form
Nurse the automatic compensation time of case next time.Specifically, if agreement nursing gold is monthly compensated once in the nursing declaration form, under
The primary time of compensating automatically compensates the time equal to this plus a calendar month automatically；If agreement nursing gold in the nursing declaration form
Quarterly compensate primary, then next time automatic compensates the time and be equal to this and automatic compensate the time that time adds a season；
Etc..As it can be seen that the newer automatic compensation time next time is mainly specific in target nursing case correspondence nursing declaration form
Depending on agreement.
107th, case is nursed to the target by the financial system of insurance company to carry out nursing golden payment processing.
It, can be by the financial system of insurance company to the target nursing case after target nursing case audit passes through
Part carries out nursing golden payment processing.It is understood that for most of target nursing case, the nursing of each issue of payment
Gold is identical, such as pays 1000 yuan each issue.Therefore, after audit passes through, you can the financial system of declaration insurance company,
Financial system is directly paid with reference to the nursing gold that the target nursing case last time is paid.
Particularly, due to partly cause, for example, it is last compensate application failure, it is last compensate application audit not by or
Person is last to initiate to compensate application etc. not successfully, it is possible to target nursing case be caused not paid there are more phases and nurse gold
Situation.For example, target nursing case is completed to nurse for the first time after gold compensates, due to be in danger acknowledge a debt family change the problem of, cause
The nursing gold of two months continuous later (monthly 1 phase, totally 2 phase) pays failure.At this point, when third month carries out nursing golden payment
When, this month, will ought to be together paid the nursing gold of 3 phases to the people that is in danger, it is therefore desirable to calculate described this institute of target nursing case
The nursing gold that need to be compensated；Then, the nursing gold being calculated is committed to the financial system of insurance company so that the wealth
The business system payment nursing gold.
Specifically, specifically may be used as shown in figure 3, calculating the golden step of this required nursing compensated of target nursing case
To include：
301st, determine that the time determines that the target is nursed according to the responsibility of the present system time and the nursing declaration form
Current desired total compensation number of case；
302nd, according to current desired total single treatment gold calculating compensated number and the nursing declaration form and made an appointment
Current desired total nursing gold of the target nursing case；
303rd, the difference of nursing gold that current desired total nursing gold and the nursing declaration form have been compensated is calculated, is obtained described
This required nursing gold compensated of target nursing case.
For above-mentioned steps 301, current desired total formula for compensating number can be expressed as min [(T-T0)/k, Pmax-
P], wherein, T represents present system time namely adjustment day；T0 represents the generation day of the event of nursing declaration form agreement, i.e. responsibility
Determine the time, if for example, nursing declaration form agreement is weight disease, T0 represents that weight disease makes a definite diagnosis day；K represents the shield of nursing declaration form agreement
The interval by stages that reason gold is compensated, if nursing declaration form agreement monthly compensates primary, k ≈ 30.So as to which (T-T0)/k can be calculated
It obtains the nursing declaration form and has the required number compensated altogether until responsibility determines the time to currently adjustment day.In addition, Pmax is represented
The total degree that nursing declaration form can be compensated, P represents the number that the nursing declaration form has been compensated so far, therefore Pmax-P represents to be somebody's turn to do
It nurses the maximum of declaration form current residual and compensates number.By formula min [(T-T0)/k, Pmax-P] it is found that current desired total compensation
Number takes current desired total compensation number of the smaller value as target nursing case from the number of the two.
For step 302, in the present embodiment, each nursing gold that nursing declaration form is made an appointment is equal, therefore, the mesh
Current desired total nursing gold of mark nursing case=current desired total compensation number * single treatments gold.
For step 303, record has target nursing case to correspond to the nursing gold that nursing declaration form has been compensated in financial system,
Therefore, this required nursing gold compensated=current desired total nursing is golden-nursing gold compensated of the target nursing case, i.e.,
It can obtain this value of nursing gold that ought to be compensated.It is understood that by this present embodiment, the nursing of compensation needed for this
Gold is calculated according to the computational methods of above-mentioned steps 301~303, which directly closes with present system time
Therefore connection, if nursing declaration form agreement is monthly to compensate primary nursing gold, is compensated even if having carried out multiple nursing gold in this month
Application, this system can only pay corresponding nursing gold when this month compensating application for the first time, and for remaining additional compensation Shen
Please, even if this required value of nursing gold compensated for applying successfully, being finally calculated also can be 0, so that wealth will not be caused
The error or loss of business system substantially increase the stability and reliability of this method.
Further, in the present embodiment, after paying nursing gold every time, insurance company is required to provide corresponding batch
Applicant is singly supplied to or the people that is in danger, therefore, in order to improve batch single formation efficiency when nursing gold is compensated, as shown in figure 4, institute
Stating the golden compensation method of nursing can also include：
401st, after target nursing case audit passes through, judge whether that the target nurses case upper one
Corresponding Claims Resolution batch is single when secondary nursing gold is compensated, if so, step 402 is performed, if it is not, then performing step 403；
402nd, when once nursing gold is compensated on described the target nursing case is added on the basis of corresponding Claims Resolution batch list
This nursing gold of part compensates corresponding liability clause and related compensation information, generates described this nursing gold of target nursing case
It is single to compensate corresponding Claims Resolution batch；
403rd, all previous nursing gold of the target nursing case is adjusted again compensates corresponding liability clause and related compensation
It is single to generate the corresponding Claims Resolution batch of the golden compensation of this nursing of the target nursing case for information.
For step 401, it is to be understood that being compensated due to this nursing gold can regard what last nursing gold was compensated as
Follow-up or supplement, therefore, for this corresponding Claims Resolution batch list, can also be single in upper primary corresponding Claims Resolution batch
On the basis of modify to obtain.It is thus possible to first judge whether that the target nursing case is compensated in upper primary nursing gold
When corresponding Claims Resolution batch it is single, if in the presence of step 402 is performed, it is corresponding singly to generate this using last corresponding Claims Resolution batch
Claims Resolution batch is single；If being not present, step 403 is performed, needs to rearrange and generates this nursing gold and compensate corresponding Claims Resolution batch
It is single.
For step 402, when upper primary nursing gold is compensated on the basis of corresponding Claims Resolution batch list, this can be added
The relevant information of nursing gold compensation compensates corresponding liability clause and related compensation information (such as including this nursing gold：It compensates
The amount of money compensates time etc.), you can it is single to generate the corresponding Claims Resolution batch of the golden compensation of this nursing of the target nursing case.It is general next
It says, the relevant information that this nursing gold of addition is compensated can be attached to behind the single information of last corresponding Claims Resolution batch.
For step 403, when single there is no the last Claims Resolution batch for nursing gold compensation, the present embodiment is adjusted described again
The all previous nursing gold of target nursing case compensates corresponding liability clause and related compensation information, generates the target nursing case
It is single that this nursing gold compensates corresponding Claims Resolution batch.Specifically, as shown in figure 5, above-mentioned steps 403 can include：
501st, the corresponding each nursing declaration form of the target nursing case is obtained；
502nd, it obtains in each nursing declaration form and each nurses the corresponding each liability clause of declaration form；
503rd, each liability clause according to the target nurses all previous nursing gold compensation interpretation of records of case corresponds to
Correlation compensates information；
504th, according to each liability clause and corresponding correlation arranged under obtained each nursing declaration form
It is single that compensation information generates the corresponding Claims Resolution batch of the golden compensation of this nursing of the target nursing case.
For above-mentioned steps 501~504, in the present embodiment, a target nursing case can correspond to one or more shields
Declaration form is managed, and one or more liability clauses can be corresponded on a nursing declaration form, different liability clauses can then correspond to not
Same compensation information.So as to, it is single in order to generate Claims Resolution batch that is complete and having levels, target nursing case pair can be obtained successively
The each nursing declaration form answered, often get one nursing declaration form after, then extract the nursing declaration form each liability clause and
The corresponding related compensation information of these liability clauses, until the liability clause under the nursing declaration form and all related compensation information
After the completion of extracting, then next nursing declaration form in each nursing declaration form is obtained, repeat said extracted step, Zhi Daosuo
Have nursing declaration form complete extraction until.
It is understood that above-mentioned related information of compensating can include the compensation situation of corresponding liability clause (such as just
Often compensate, waiting period is in danger, exempts premium, specially treated, etc.), compensate the amount of money, compensation date, etc..In addition, for step
Rapid 502, in the corresponding each liability clause of acquisition nursing declaration form, the different insurance kinds under the nursing declaration form can be first distinguished,
Obtain each liability clause under different insurance kinds.
For step 504, when sorting out all liability clauses under target nursing case and corresponding related compensate
After information, you can it is single to generate the corresponding Claims Resolution batch of the golden compensation of this nursing of the target nursing case.
It should be understood that the size of the serial number of each step is not meant to the priority of execution sequence, each process in above-described embodiment
Execution sequence should determine that the implementation process without coping with the embodiment of the present invention forms any limit with its function and internal logic
It is fixed.
In the present embodiment, first, determine that the target for treating to compensate automatically nurses case, the target nursing case is has completed
Nursing gold is compensated for the first time and nursing responsibility is in the Claims Resolution case of the nursing declaration form in the term of validity；If present system time reaches
The automatic of target nursing case compensates the time, then automatically initiates the compensation application of the target nursing case；Then, according to
Preset auditing rule audits target nursing case；If the target nursing case audit passes through, according to institute
It states nursing declaration form and updates the automatic compensation time of the target nursing case next time；Finally, it is by the finance of insurance company
System carries out target nursing case to nurse golden payment processing.In this way, for having completed to nurse gold compensation for the first time and still have
The Claims Resolution case of nursing declaration form in the effect phase automatically initiates compensation application, without application when can be reached compensating the time automatically
People periodically goes to carry out compensation application, improves the convenience of nursing gold application；In addition, if target is protected after automatically initiating compensation application
Reason case audit passes through, you can and it carries out nursing golden payment processing by financial system, substantially increases the Claims Resolution efficiency of nursing gold,
So as to improve the guaranteeing role that nursing insurance plays.
A kind of golden compensation method of nursing is essentially described above, and will compensate device to a kind of nursing gold below is retouched in detail
It states.
Fig. 6 shows that a kind of nursing gold compensates first example structure figure of device in the embodiment of the present invention.
In the present embodiment, a kind of nursing gold is compensated device and is included：
Target case determining module 601, for determining that the target for treating to compensate automatically nurses case, the target nurses case
To have completed to nurse the golden Claims Resolution case of nursing declaration form compensated and nursed responsibility and be in the term of validity for the first time；
Automatic application module 602, if reaching the automatic of target nursing case for present system time compensates the time,
Then automatically initiate the compensation application of the target nursing case；
Case auditing module 603, for being audited according to preset auditing rule to target nursing case；
Time update module 604 is compensated, if passing through for target nursing case audit, according to the nursing declaration form
Update the automatic compensation time of the target nursing case next time；
Case compensates module 605, and the financial system for passing through insurance company nurses target nursing case
Golden payment processing.
Fig. 7 shows that a kind of nursing gold compensates second example structure figure of device in the embodiment of the present invention.
As shown in fig. 7, further, the case, which compensates module 605, to be included：
Current total degree determination subelement 6051, for the responsibility according to the present system time and the nursing declaration form
Determine that the time determines current desired total compensation number of the target nursing case；
Current total nursing gold unit 6052, for pre- according to current desired total compensation number and the nursing declaration form
The single treatment gold first arranged calculates current desired total nursing gold of the target nursing case；
The golden computation subunit 6053 of this nursing, for having calculated current desired total nursing gold and the nursing declaration form
It is golden to obtain described this required nursing compensated of target nursing case for the difference of the nursing gold of compensation.
Unit 6054 is submitted, for the nursing gold being calculated to be committed to the financial system of insurance company so that
The financial system payment nursing gold.
Further, the case auditing module 603 can include：
Case detection unit 6031 is in for detecting to whether there is in the corresponding nursing declaration form of the target nursing case
It whether there is in the other Claims Resolution cases for state of transferring accounts or the nursing declaration form and do not completed in addition to the target nurses case
Other pleas；
Audit is not by unit 6032, if the testing result for the case detection unit 6031 is yes, it is determined that institute
Target nursing case audit is stated not pass through；
Audit is by unit 6033, if the testing result for the case detection unit 6031 is no, it is determined that institute
Target nursing case audit is stated to pass through.
Fig. 8 shows that a kind of nursing gold compensates device third example structure figure in the embodiment of the present invention.
As shown in figure 8, further, the nursing gold, which compensates device, to be included：
Judgment module 606 after passing through in target nursing case audit, judges whether the target shield
It is single to manage case corresponding Claims Resolution batch when upper primary nursing gold is compensated；
First single generation module 607, if the judging result for the judgment module 606 is yes, one on described
During secondary nursing gold compensation on the basis of corresponding batch list of settling a claim, it is corresponding to add the golden compensation of this nursing of the target nursing case
Liability clause and correlation compensate information, and it is single to generate the corresponding Claims Resolution batch of the golden compensation of this nursing of the target nursing case；
Second batch list generation module 608 if the judging result for the judgment module 606 is no, adjusts institute again
It states all previous nursing gold of target nursing case and compensates corresponding liability clause and related compensation information, generate the target nursing case
It is single that this nursing gold of part compensates corresponding Claims Resolution batch.
Further, the second batch list generation module 608 can include：
Declaration form acquiring unit 6081 is nursed, for obtaining the corresponding each nursing declaration form of the target nursing case；
Liability clause acquiring unit 6082, for obtaining, each to nurse declaration form corresponding each in each nursing declaration form
Liability clause；
Finish message unit 6083 is compensated, interpretation of records is compensated for nursing all previous nursing gold of case according to the target
Each liability clause corresponds to related compensation information；
Single generation unit 6084 is criticized, for according to each responsibility item arranged under obtained each nursing declaration form
Money and corresponding related compensation information generate the target nursing case, and this nurses the corresponding Claims Resolution batch list of gold compensation.
It is apparent to those skilled in the art that for convenience and simplicity of description, the system of foregoing description,
The specific work process of device and unit can refer to the corresponding process in preceding method embodiment, and details are not described herein.
In the above-described embodiments, it all emphasizes particularly on different fields to the description of each embodiment, is not described in detail or remembers in some embodiment
The part of load may refer to the associated description of other embodiments.
Those of ordinary skill in the art may realize that each embodiments described with reference to the embodiments described herein
Module, unit and/or method and step can be realized with the combination of electronic hardware or computer software and electronic hardware.This
A little functions are performed actually with hardware or software mode, specific application and design constraint depending on technical solution.Specially
Industry technical staff can realize described function to each specific application using distinct methods, but this realization is not
It is considered as beyond the scope of this invention.
In several embodiments provided herein, it should be understood that disclosed system, device and method can be with
It realizes by another way.For example, the apparatus embodiments described above are merely exemplary, for example, the unit
It divides, only a kind of division of logic function can have other dividing mode, such as multiple units or component in actual implementation
It may be combined or can be integrated into another system or some features can be ignored or does not perform.Another point, it is shown or
The mutual coupling, direct-coupling or communication connection discussed can be the indirect coupling by some interfaces, device or unit
It closes or communicates to connect, can be electrical, machinery or other forms.
The unit illustrated as separating component may or may not be physically separate, be shown as unit
The component shown may or may not be physical unit, you can be located at a place or can also be distributed to multiple
In network element.Some or all of unit therein can be selected according to the actual needs to realize the mesh of this embodiment scheme
's.
In addition, each functional unit in each embodiment of the present invention can be integrated in a processing unit, it can also
That each unit is individually physically present, can also two or more units integrate in a unit.Above-mentioned integrated list
The form that hardware had both may be used in member is realized, can also be realized in the form of SFU software functional unit.
If the integrated unit is realized in the form of SFU software functional unit and is independent product sale or uses
When, it can be stored in a computer read/write memory medium.Based on such understanding, technical scheme of the present invention is substantially
The part to contribute in other words to the prior art or all or part of the technical solution can be in the form of software products
It embodies, which is stored in a storage medium, is used including some instructions so that a computer
Equipment (can be personal computer, server or the network equipment etc.) performs the complete of each embodiment the method for the present invention
Portion or part steps.And aforementioned storage medium includes：USB flash disk, mobile hard disk, read-only memory (ROM, Read-Only
Memory), random access memory (RAM, Random Access Memory), magnetic disc or CD etc. are various can store journey
The medium of sequence code.
The above, the above embodiments are merely illustrative of the technical solutions of the present invention, rather than its limitations；Although with reference to before
Embodiment is stated the present invention is described in detail, it will be understood by those of ordinary skill in the art that：It still can be to preceding
The technical solution recorded in each embodiment is stated to modify or carry out equivalent replacement to which part technical characteristic；And these
Modification is replaced, the spirit and scope for various embodiments of the present invention technical solution that it does not separate the essence of the corresponding technical solution.
Claims (10)
- A kind of 1. golden compensation method of nursing, which is characterized in that including：Determine that the target for treating to compensate automatically nurses case, the target nursing case is has completed to nurse gold compensation for the first time and protect Reason responsibility is in the Claims Resolution case of the nursing declaration form in the term of validity；If present system time reaches the automatic of target nursing case and compensates the time, the target nursing case is automatically initiated The compensation application of part；Target nursing case is audited according to preset auditing rule；If the target nursing case audit passes through, according to the nursing declaration form update target nursing case next time It is automatic to compensate the time；Case is nursed to the target by the financial system of insurance company to carry out nursing golden payment processing.
- 2. the golden compensation method of nursing according to claim 1, which is characterized in that the financial system by insurance company Target nursing case nurse golden payment and handle including：Determine that the time determines working as the target nursing case according to the responsibility of the present system time and the nursing declaration form It is total needed for preceding to compensate number；According to current desired total single treatment gold calculating target compensated number and the nursing declaration form and made an appointment Nurse current desired total nursing gold of case；The difference of nursing gold that current desired total nursing gold and the nursing declaration form have been compensated is calculated, obtains the target nursing This required nursing gold compensated of case；The nursing gold being calculated is committed to the financial system of insurance company so that the financial system pays the shield Reason gold.
- 3. the golden compensation method of nursing according to claim 1, which is characterized in that it is described according to preset auditing rule to institute It states target nursing case and audit and include：Detect whether there is in the corresponding nursing declaration form of target nursing case other Claims Resolution cases in state of transferring accounts or The other pleas that whether there is in declaration form and do not completed in addition to the target nurses case are nursed described in person；If there are other Claims Resolution cases or described in state of transferring accounts in corresponding nurse of target nursing case in declaration form Nurse the other pleas for existing in declaration form and not completed in addition to the target nurses case, it is determined that the target nursing case Part audit does not pass through；If other Claims Resolution cases in state of transferring accounts, Huo Zhesuo is not present in target nursing case corresponding nurse in declaration form State the other pleas for being not present in nursing declaration form and not completed in addition to the target nurses case, it is determined that the target shield Reason case audit passes through.
- 4. the golden compensation method of nursing according to any one of claim 1 to 3, which is characterized in that the nursing gold is compensated Method further includes：After target nursing case audit passes through, judge whether the target nursing case in upper primary nursing gold Corresponding Claims Resolution batch is single during compensation；If when upper primary nursing gold is compensated, corresponding Claims Resolution batch is single there are target nursing case, once protected on described Reason gold on the basis of corresponding Claims Resolution batch list, adds described this nursing gold of target nursing case and compensates corresponding responsibility when compensating Clause and correlation compensate information, and it is single to generate the corresponding Claims Resolution batch of the golden compensation of this nursing of the target nursing case；If there is no target nursing case, when upper primary nursing gold is compensated, corresponding Claims Resolution batch is single, again described in adjustment The all previous nursing gold of target nursing case compensates corresponding liability clause and related compensation information, generates the target nursing case It is single that this nursing gold compensates corresponding Claims Resolution batch.
- 5. the golden compensation method of nursing according to claim 4, which is characterized in that described to adjust the target nursing case again The all previous nursing gold of part compensates corresponding liability clause and related compensation information, generates described this nursing gold of target nursing case Corresponding Claims Resolution batch is compensated singly to include：Obtain the corresponding each nursing declaration form of the target nursing case；It obtains in each nursing declaration form and each nurses the corresponding each liability clause of declaration form；Each liability clause according to the target nurses all previous nursing gold compensation interpretation of records of case corresponds to related compensate Information；According to each liability clause and corresponding related compensation information arranged under obtained each nursing declaration form It is single to generate the corresponding Claims Resolution batch of the golden compensation of this nursing of the target nursing case.
- 6. a kind of nursing gold compensates device, which is characterized in that including：Target case determining module, for determining that the target for treating to compensate automatically nurses case, the target nursing case is complete The Claims Resolution case for nursing declaration form that responsibility is in the term of validity is compensated and nurses into nursing gold for the first time；Automatic application module, if reaching the automatic of target nursing case for present system time compensates the time, automatically Initiate the compensation application of the target nursing case；Case auditing module, for being audited according to preset auditing rule to target nursing case；Time update module is compensated, if passing through for target nursing case audit, according to the nursing declaration form update institute State the automatic compensation time of target nursing case next time；Case compensates module, and the financial system for passing through insurance company to target nursing case nurse at golden payment Reason.
- 7. nursing gold according to claim 6 compensates device, which is characterized in that the case is compensated module and included：Current total degree determination unit, for determining that the time is true according to the responsibility of the present system time and the nursing declaration form Current desired total compensation number of the fixed target nursing case；The current golden unit of total nursing, for according to current desired total list compensated number and the nursing declaration form and made an appointment Secondary nursing gold calculates current desired total nursing gold of the target nursing case；The golden computing unit of this nursing, for calculating the nursing that current desired total nursing gold has been compensated with the nursing declaration form It is golden to obtain described this required nursing compensated of target nursing case for the difference of gold；Unit is submitted, for the nursing gold being calculated to be committed to the financial system of insurance company so that the finance The system payment nursing gold.
- 8. nursing gold according to claim 6 compensates device, which is characterized in that the case auditing module includes：Case detection unit whether there is for detecting in the corresponding nursing declaration form of the target nursing case in state of transferring accounts Other Claims Resolution cases or it is described nursing declaration form in whether there is except the target nurse case in addition to do not complete other Shens Tell case；Audit is not by unit, if the testing result for the case detection unit is yes, it is determined that the target nursing case Part audit does not pass through；Audit is by unit, if the testing result for the case detection unit is no, it is determined that the target nursing case Part audit passes through.
- 9. the nursing gold according to any one of claim 6 to 8 compensates device, which is characterized in that the nursing gold is compensated Device further includes：Judgment module after passing through in target nursing case audit, judges whether the target nursing case When upper primary nursing gold is compensated, corresponding Claims Resolution batch is single；First single generation module, if the judging result for the judgment module is yes, once nursing gold is paid on described When paying on the basis of corresponding Claims Resolution batch list, add described this nursing gold of target nursing case compensate corresponding liability clause with And correlation compensates information, and it is single to generate the corresponding Claims Resolution batch of the golden compensation of this nursing of the target nursing case；Second batch list generation module if the judging result for the judgment module is no, adjusts the target nursing again The all previous nursing gold of case compensates corresponding liability clause and related compensation information, and generating the target nursing case, this is nursed It is single that gold compensates corresponding Claims Resolution batch.
- 10. nursing gold according to claim 9 compensates device, which is characterized in that the second batch list generation module includes：Declaration form acquiring unit is nursed, for obtaining the corresponding each nursing declaration form of the target nursing case；Liability clause acquiring unit each nurses the corresponding each responsibility item of declaration form for obtaining in each nursing declaration form Money；Finish message unit is compensated, it is each described in all previous nursing gold compensation interpretation of records of case for being nursed according to the target Liability clause corresponds to related compensation information；Batch single generation unit, for according to each liability clause for arranging under obtained each nursing declaration form and right The related compensation information answered generates the target nursing case, and this nurses the corresponding Claims Resolution batch list of gold compensation.
Priority Applications (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201710225202.XA CN108257023A (en) | 2017-04-07 | 2017-04-07 | A kind of nursing gold compensates method and apparatus |
| PCT/CN2018/081826 WO2018184551A1 (en) | 2017-04-07 | 2018-04-04 | Method and device for paying for nursing fee |
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| Application Number | Priority Date | Filing Date | Title |
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| CN201710225202.XA CN108257023A (en) | 2017-04-07 | 2017-04-07 | A kind of nursing gold compensates method and apparatus |
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| CN108257023A true CN108257023A (en) | 2018-07-06 |
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| CN111127221A (en) * | 2019-11-21 | 2020-05-08 | 泰康保险集团股份有限公司 | Policy claim settlement method, policy claim settlement device, policy claim settlement medium and electronic equipment |
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| WO2018184551A1 (en) | 2018-10-11 |
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