CN109191317A - The Claims Resolution method, apparatus and server of business insurance - Google Patents
The Claims Resolution method, apparatus and server of business insurance Download PDFInfo
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- CN109191317A CN109191317A CN201811024060.1A CN201811024060A CN109191317A CN 109191317 A CN109191317 A CN 109191317A CN 201811024060 A CN201811024060 A CN 201811024060A CN 109191317 A CN109191317 A CN 109191317A
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Abstract
The present invention provides the Claims Resolution method, apparatus and server of a kind of business insurance, wherein this method comprises: the information of reporting a case to the security authorities of the user sent by the insurance information system that business insurance service platform receives commercial insurance company；And go out the medical treatment data of user from information extraction of reporting a case to the security authorities；The medical data of user corresponding with medical treatment data are filtered out from patient assessment's data of the medical information system of medical institutions again；Then medical data are standardized, obtain standardized data；Standardized data is sent to insurance information system, obtains compensating gold so that commercial insurance company settle a claim according to standardized data calculating and feeds back to user for gold is compensated.The present invention realizes the information sharing of medical institutions and commercial insurance company by business insurance service platform, using Claims Resolution mode with no paper on line, shortens the Claims Resolution period, reduces Claims Resolution cost, improve the experience sense of user.
Description
Technical field
The present invention relates to business insurance technical fields, more particularly, to a kind of Claims Resolution method, apparatus kimonos of business insurance
Business device.
Background technique
With the increasingly rejuvenation of the disease incidences trend such as osteoporosis, cardiovascular and cerebrovascular diseases, people increasingly pay attention to body
Health, be also increasingly ready buy business insurance, still, existing commercial insurance company when settling a claim to Insurance User,
Need Insurance User to provide a large amount of paper material and imaging material, data input then carried out to material, typing error rate compared with
Height also needs manually to be sampled audit, increases the Claims Resolution cost of commercial insurance company, and excessive cycle of settling a claim, user's body
It is poor to test sense.
Summary of the invention
In view of this, the purpose of the present invention is to provide the Claims Resolution method, apparatus and server of a kind of business insurance, with contracting
The short Claims Resolution period reduces Claims Resolution cost, improves user experience.
In a first aspect, the embodiment of the invention provides a kind of Claims Resolution methods of business insurance, wherein this method is applied to quotient
Industry insurance service platform, the business insurance service platform respectively with the medical information system of medical institutions and commercial insurance company
Insurance information system communication connection；This method comprises: receiving the information of reporting a case to the security authorities for the user that insurance information system is sent；It reports a case to the security authorities information
For the Claims Resolution information for meeting default Claims Resolution condition；Go out the medical treatment data of user from information extraction of reporting a case to the security authorities；Medical treatment data include user
It is a variety of in identity information, medical treatment hospital, Waiting time and medical treatment serial number；From patient assessment's data of medical information system
Filter out the medical data of user corresponding with medical treatment data；Medical data are standardized, standardized data is obtained；
Standardized data is sent to insurance information system, is obtained so that commercial insurance company carries out Claims Resolution accounting according to standardized data
It compensates gold and feeds back to user for gold is compensated.
With reference to first aspect, the embodiment of the invention provides the first possible embodiments of first aspect, wherein report
The generating process of case information, comprising: the Claims Resolution information of insurance information system reception user；Insurance information system is according to Claims Resolution information
It is audited, judges whether user is business insurance user；If user is business insurance user, insurance information system according to
The insurance responsibility information of the insurance products of family purchase judges whether user meets default Claims Resolution condition；If user meets default reason
Compensation condition, insurance information system will settle a claim information flag as information of reporting a case to the security authorities.
With reference to first aspect, the embodiment of the invention provides second of possible embodiments of first aspect, wherein just
It includes a variety of in medical archives, medical information, disbursement and sattlement information and receipt information for examining data.
With reference to first aspect, the embodiment of the invention provides the third possible embodiments of first aspect, wherein should
Method further include: receive the auditing result after commercial insurance company audits standardized data；When auditing result is first
When as a result, the step of standardized data is sent to insurance information system is executed；Wherein the first result is what user needed to settle a claim
As a result.
Second aspect, the embodiment of the invention also provides a kind of Claims Resolution methods of business insurance, wherein this method is applied to
The insurance information system of commercial insurance company, insurance information system and business insurance service platform communicate to connect；This method comprises:
The information of reporting a case to the security authorities of user is sent to business insurance service platform；So that business insurance service platform handle to information of reporting a case to the security authorities
To the standardized data of user；Information of reporting a case to the security authorities is to meet the Claims Resolution information of default Claims Resolution condition；Receive business insurance service platform
The standardized data of transmission；Claims Resolution accounting is carried out according to standardized data to obtain compensating gold, will be compensated gold and is fed back to user.
In conjunction with second aspect, the embodiment of the invention provides the first possible embodiments of second aspect, wherein to
The information of reporting a case to the security authorities that business insurance service platform sends user includes: to receive the Claims Resolution information of user；Claims Resolution information is audited,
Judge whether user is business insurance user；If user is business insurance user, according to the guarantor of the insurance products of user's purchase
Dangerous information responsible judges whether user meets default Claims Resolution condition；If user meets default Claims Resolution condition, by information mark of settling a claim
It is denoted as information of reporting a case to the security authorities.
In conjunction with the first possible embodiment of second aspect, the embodiment of the invention provides second of second aspect
Possible embodiment, wherein after the step of receiving the Claims Resolution information of user, this method further include: use identifying code or electricity
The mode of son signature verifies and confirms Claims Resolution information.
The third aspect, the embodiment of the invention also provides a kind of Claims Resolution devices of business insurance, wherein the device is set to
Business insurance service platform, the business insurance service platform respectively with the medical information system of medical institutions and commercial insurance company
Insurance information system communication connection；The device includes: information receiving module of reporting a case to the security authorities, for receiving insurance information system transmission
The information of reporting a case to the security authorities of user；Information of reporting a case to the security authorities is to meet the Claims Resolution information of default Claims Resolution condition；Medical treatment data extraction module is used for from report
Case information extraction goes out the medical treatment data of user；Medical treatment data include subscriber identity information, medical treatment hospital, Waiting time and stream of seeing a doctor
It is a variety of in water number；Medical data screening module, for filtering out and seeing a doctor from patient assessment's data of medical information system
The medical data of the corresponding user of data；Data processing module is standardized for being standardized to medical data
Data；Data transmission blocks, for standardized data to be sent to insurance information system, so that commercial insurance company is according to standard
Change data carry out Claims Resolution accounting and obtain compensating gold and compensation gold is fed back to user.
In conjunction with the third aspect, the embodiment of the invention provides the first possible embodiments of the third aspect, wherein just
It includes a variety of in medical archives, medical information, disbursement and sattlement information and receipt information for examining data.
Fourth aspect, the embodiment of the invention also provides a kind of servers, wherein including processor and machine readable storage
Medium, machine readable storage medium are stored with the machine-executable instruction that can be executed by processor, and processor executes machine can
It executes instruction to realize method described in above-mentioned first aspect and second aspect.
The embodiment of the present invention bring it is following the utility model has the advantages that
The embodiment of the invention provides the Claims Resolution method, apparatus and server of a kind of business insurance, by business insurance service
The information of reporting a case to the security authorities for the user that the insurance information system that platform receives commercial insurance company is sent；And go out user from information extraction of reporting a case to the security authorities
Medical treatment data；Use corresponding with medical treatment data is filtered out from patient assessment's data of the medical information system of medical institutions again
The medical data at family；Then medical data are standardized, obtain standardized data；Standardized data is sent to guarantor
Dangerous information system obtains compensation gold and feeds back compensation gold so that commercial insurance company settle a claim according to standardized data calculating
To user.The present invention realizes the information sharing of medical institutions and commercial insurance company by business insurance service platform, using line
Upper with no paper Claims Resolution mode, shortens the Claims Resolution period, reduces Claims Resolution cost, improve the experience sense of user.
Other features and advantages of the present invention will illustrate in the following description, alternatively, Partial Feature and advantage can be with
Deduce from specification or unambiguously determine, or by implementing above-mentioned technology of the invention it can be learnt that.
To enable the above objects, features and advantages of the present invention to be clearer and more comprehensible, better embodiment is cited below particularly, and match
Appended attached drawing is closed, is described in detail below.
Detailed description of the invention
It, below will be to specific in order to illustrate more clearly of the specific embodiment of the invention or technical solution in the prior art
Embodiment or attached drawing needed to be used in the description of the prior art be briefly described, it should be apparent that, it is described below
Attached drawing is some embodiments of the present invention, for those of ordinary skill in the art, before not making the creative labor
It puts, is also possible to obtain other drawings based on these drawings.
Fig. 1 is a kind of flow chart of the Claims Resolution method of business insurance provided in an embodiment of the present invention；
Fig. 2 is a kind of communication structure schematic diagram of business insurance service platform provided in an embodiment of the present invention；
Fig. 3 is the flow chart of the Claims Resolution method of another business insurance provided in an embodiment of the present invention；
Fig. 4 is the flow chart of the Claims Resolution method of the third business insurance provided in an embodiment of the present invention；
Fig. 5 is a kind of structural schematic diagram of the Claims Resolution device of business insurance provided in an embodiment of the present invention.
Specific embodiment
In order to make the object, technical scheme and advantages of the embodiment of the invention clearer, below in conjunction with attached drawing to the present invention
Technical solution be clearly and completely described, it is clear that described embodiments are some of the embodiments of the present invention, rather than
Whole embodiments.Based on the embodiments of the present invention, those of ordinary skill in the art are not making creative work premise
Under every other embodiment obtained, shall fall within the protection scope of the present invention.
Currently, commercial insurance company when settling a claim to Insurance User, needs Insurance User to provide a large amount of, complicated doctors
The paper materials such as diagnosis, payment receipt or imaging material are treated to apply for Claims Resolution service, the material of submission is such as encountered in application process
Expect incomplete or material deficiency, needs to arrive acquisition again and submission that medical hospital carries out data repeatedly, application formality is cumbersome, Claims Resolution
Material is complicated, excessive cycle of settling a claim.What the Claims Resolution that commercial insurance company receives patient needed to submit Insurance User after applying
Material carries out the typing again of digitization information, brings TPA (Third Party Administrator, the third party tube of great number
Reason person) expenditure, the risk of higher data input mistake is existed simultaneously, needs manually to be sampled audit to the data of typing,
Claims Resolution cost and processing timeliness are considerably increased, this is based on, a kind of Claims Resolution method of business insurance provided in an embodiment of the present invention,
Device and server can be applied in the scene for needing to carry out user business insurance Claims Resolution.
For the Claims Resolution convenient for understanding the present embodiment, first to a kind of business insurance disclosed in the embodiment of the present invention
Method describes in detail.
A kind of flow chart of the Claims Resolution method of business insurance shown in Figure 1, this method are applied to business insurance service
Platform, a kind of communication structure schematic diagram of business insurance service platform shown in Figure 2, business insurance service platform difference
It is communicated to connect with the medical information system of medical institutions and the insurance information system of commercial insurance company；
This method comprises:
Step S102 receives the information of reporting a case to the security authorities for the user that insurance information system is sent；Information of reporting a case to the security authorities is to meet default Claims Resolution
The Claims Resolution information of condition；
When user needs commercial insurance company to settle a claim, can by scan the commercial insurance company two dimensional code or
The wechat public platform for paying close attention to the commercial insurance company uploads Claims Resolution information, or the artificial cabinet face for passing through the commercial insurance company
Claims Resolution information is sent to the commercial insurance company.
Commercial insurance company judges whether the user meets after receiving the Claims Resolution information of user, according to the Claims Resolution information
The condition fast settled a claim, quick Claims Resolution are quickly settled a claim to user by the way of with no paper on line, if met, are recognized
Meet default Claims Resolution condition for the Claims Resolution information, is letter of reporting a case to the security authorities by the Claims Resolution information flag using the compensation process fast settled a claim
Breath, is sent to business insurance service platform, if do not met, using mode of settling a claim under traditional line.
Step S104 goes out the medical treatment data of user from information extraction of reporting a case to the security authorities；
Since the medical treatment record of user may more than once, business insurance service platform is in the information of reporting a case to the security authorities for receiving user
Afterwards, the medical treatment data of user are extracted from information of reporting a case to the security authorities, when medical treatment data include subscriber identity information, medical treatment hospital, see a doctor
Between and the medical treatments information such as medical treatment serial number.
Step S106 filters out user corresponding with medical treatment data just from patient assessment's data of medical information system
Examine data；
Business insurance service platform filters out user from patient assessment's data of medical system according to subscriber identity information
History go to a doctor data, the letter such as specific medical treatment hospital, Waiting time and medical treatment serial number provided according to user in information of reporting a case to the security authorities
Breath filters out the medical data that user needs commercial insurance company to settle a claim, which includes medical archives, medical treatment letter
It is a variety of in breath, disbursement and sattlement information and receipt information.
Step S108 is standardized medical data, obtains standardized data；
Since Different hospital uses different HIS (Hospital Information System, hospital information system) systems
System, causes Different hospital data structure and medical data to have differences, and off-gauge medical data increase the tired of follow-up checks
Difficulty needs loss adjuster's medical expertise with higher, increases the investment of Claims Resolution human cost, it is therefore desirable to medical number
According to being standardized, standardized data is obtained, subsequent loss department is carried out according to standardized data convenient for commercial insurance company
Reason improves Claims Resolution efficiency, reduces Claims Resolution cost.
Standardized data is sent to insurance information system by step S110, so that commercial insurance company is according to normalized number
According to carry out Claims Resolution calculate obtain compensate gold and by compensate gold feed back to user.
Commercial insurance company is after the standardized data for receiving the transmission of business insurance service platform, according to the normalized number
It is audited according to the information of reporting a case to the security authorities to user, when auditing result is the first result, which is to need to carry out user
Claims Resolution, carries out Claims Resolution accounting according to standardized data, obtains compensating gold, will compensate gold and feeds back to user, Claims Resolution processing is completed, such as
Fruit auditing result shows that the information of reporting a case to the security authorities is unsatisfactory for the condition of Claims Resolution, which is informed user, Claims Resolution processing is completed.
By compensate gold feed back to user can be directly by compensate gold go to the account of user, and inform user Claims Resolution it is complete
At, can also by compensate gold the amount of money inform user, after user confirms that the compensation amount of money is errorless, then by compensate gold go to user's account
Family.
A kind of Claims Resolution method of business insurance provided in an embodiment of the present invention receives business by business insurance service platform and protects
The information of reporting a case to the security authorities for the user that the insurance information system of dangerous company is sent；And go out the medical treatment data of user from information extraction of reporting a case to the security authorities；Again
The medical data of user corresponding with medical treatment data are filtered out from patient assessment's data of the medical information system of medical institutions；
Then medical data are standardized, obtain standardized data；Standardized data is sent to insurance information system, with
Make commercial insurance company according to standardized data carry out Claims Resolution calculate obtain compensate gold and by compensate gold feed back to user.The present invention
Embodiment realizes the information sharing of medical institutions and commercial insurance company by business insurance service platform, using with no paper on line
Claims Resolution mode, shorten Claims Resolution the period, reduce Claims Resolution cost, improve the experience sense of user.
The embodiment of the invention also provides the Claims Resolution methods of another business insurance, as shown in figure 3, this method is in Fig. 1 institute
It is realized on the basis of the embodiment of the method shown, wherein this method is applied to the insurance information system of commercial insurance company, the insurance
Information system and business insurance service platform communicate to connect；
This method comprises:
Step S302 sends the information of reporting a case to the security authorities of user to business insurance service platform；So that business insurance service platform pair
Information of reporting a case to the security authorities is handled to obtain the standardized data of user；Information of reporting a case to the security authorities is to meet the Claims Resolution information of default Claims Resolution condition；
When user needs commercial insurance company to settle a claim, Claims Resolution information, business insurance are sent to commercial insurance company
Company verifies and confirms the Claims Resolution information by the way of identifying code and/or electronic signature, whether judges the Claims Resolution information
It is that commercial insurance company is sent to by user, if it is what is sent by user, by commercial insurance company according to reason
It pays for information and judges whether the user is business insurance user, if it is business insurance user, according to the use in insurance information system
The insurance responsibility information of the insurance products of family purchase judges whether the user meets the condition fast settled a claim, if met,
Think that the Claims Resolution information meets default Claims Resolution condition, is marked as information of reporting a case to the security authorities, and be sent to business insurance service platform.
Business insurance service platform extracts the medical treatment number of user after receiving the information of reporting a case to the security authorities of user from information of reporting a case to the security authorities
According to filtering out user from patient assessment's data of the medical information system of medical institutions according to medical treatment data and settle a claim
Medical data, and the data of going to a doctor are standardized, obtain standardized data, and the standardized data is sent to
Commercial insurance company.
Step S304 receives the standardized data that business insurance service platform is sent；
Commercial insurance company carries out after receiving standardized data according to report a case to the security authorities information of the standardized data to user
Audit, judges whether to settle a claim to the user.
Step S306 carries out Claims Resolution accounting according to standardized data and obtains compensating gold, will compensate gold and feeds back to user.
If above-mentioned auditing result demonstrates the need for settling a claim to the user, Claims Resolution accounting is carried out according to standardized data,
It obtains compensating gold, and feeds back to user for gold is compensated.
The embodiment of the present invention judges whether the Claims Resolution information of user meets according to default Claims Resolution condition by commercial insurance company
It reports a case to the security authorities information, if it is satisfied, being information of reporting a case to the security authorities by Claims Resolution information flag, and business insurance service platform is sent it to, by quotient
Industry insurance service platform handles the information of reporting a case to the security authorities to obtain standardized data, and commercial insurance company is according to the standard received
Change data to audit information of reporting a case to the security authorities, and judges whether to pay to user according to auditing result and compensate gold, and according to standard
Change data and calculate compensation gold, and feeds back to user for gold is compensated.By business insurance service platform, realize commercial insurance company with
The information sharing of medical institutions, so that commercial insurance company is when settling a claim to user, just by mode with no paper on line
The medical data that can get user avoid carrying out typing mistake caused by data input to material in the past, reduce TPA expenditure,
The Claims Resolution period is shortened, also avoids user from coming and going ceaselessly in commercial insurance company and medical institutions, improves the experience sense of user.
The embodiment of the invention also provides the Claims Resolution method of another business insurance, this method is shown in above-mentioned Fig. 1 to Fig. 3
It is realized on the basis of any means, as shown in figure 4, specific step is as follows for this method:
Step S402 sends Claims Resolution information from user to commercial insurance company；
Step S404, commercial insurance company verify Claims Resolution information by the way of identifying code and/or electronic signature
Confirmation；
Step S406, user respond to identifying code and/or sign electronically to commercial insurance company；
Step S408, commercial insurance company audit Claims Resolution condition, judge whether the user is business insurance user,
If so, step S410 is executed, if not, terminating；
Step S410 judges whether user meets default Claims Resolution according to the insurance responsibility information of the insurance products of user's purchase
Condition, if it is satisfied, step S412 is executed, if not, executing step S414；
Claims Resolution information flag is information of reporting a case to the security authorities by step S412, and the information that will report a case to the security authorities is sent to business insurance service platform；
Step S414 carries out Claims Resolution processing according to tradition Claims Resolution process；
Above-mentioned tradition Claims Resolution process refers to that user provides the paper material of business insurance companies mandate, quotient to commercial insurance company
Industry insurance company carries out data input to paper material, is audited according to typing information, is carried out according to auditing result to user
Claims Resolution.
Step S416, quotient protect the medical treatment data that service platform extracts user from the information of reporting a case to the security authorities received；
Step S418 goes out to use according to medical treatment data from patient assessment's data screening of the medical information system of medical institutions
The medical data at family；
Step S420, business insurance service platform are standardized medical data, the standardized data that will be obtained
It is sent to commercial insurance company；
Step S422, commercial insurance company audit information of reporting a case to the security authorities according to standardized data, judge that auditing result is
No is first as a result, if so, step S424 is executed, if it is not, terminating；
Step S424, commercial insurance company carry out Claims Resolution accounting according to standardized data, obtain compensating gold, and will compensate gold
Feed back to user.
The embodiment of the present invention passes through commercial insurance company with no paper on line by business insurance service platform
Mode obtains the medical data of user from medical institutions, to carry out Claims Resolution processing to user, user does not have to provide a large amount of paperys
Material improves user experience, and commercial insurance company directly can get the medical data of user, does not have to use information typing again
Mode, reduce Claims Resolution cost, shorten Claims Resolution the period.
Corresponding to above method embodiment, a kind of structural schematic diagram of the Claims Resolution device of business insurance shown in Figure 5,
Wherein, the device be applied to business insurance service platform, business insurance service platform respectively with the medical information system of medical institutions
System and the insurance information system of commercial insurance company communicate to connect；The device includes:
It reports a case to the security authorities information receiving module 50, the information of reporting a case to the security authorities of the user for receiving insurance information system transmission；It reports a case to the security authorities information
For the Claims Resolution information for meeting default Claims Resolution condition；
Medical treatment data extraction module 51, for going out the medical treatment data of user from information extraction of reporting a case to the security authorities；Medical treatment data include using
It is a variety of in family identity information, medical treatment hospital, Waiting time and medical treatment serial number；
Medical data screening module 52, for being filtered out from patient assessment's data of medical information system and medical treatment data
The medical data of corresponding user；
Data processing module 53 obtains standardized data for being standardized to medical data；
Data transmission blocks 54, for standardized data to be sent to insurance information system, so that commercial insurance company's root
Settle a claim according to standardized data calculating and obtains compensating gold and feed back to user for gold is compensated.
In above-mentioned medical data screening module 52, data of going to a doctor include medical archives, medical information, disbursement and sattlement information and
It is a variety of in receipt information.
The Claims Resolution device of business insurance provided in an embodiment of the present invention, the Claims Resolution with business insurance provided by the above embodiment
Method technical characteristic having the same reaches identical technical effect so also can solve identical technical problem.
The embodiment of the invention also provides a kind of servers, wherein including processor and machine readable storage medium, machine
Readable storage medium storing program for executing is stored with the machine-executable instruction that can be executed by processor, processor execute machine-executable instruction with
Realize the Claims Resolution method for the business insurance that above method embodiment illustrates.
Processor may be a kind of IC chip, the processing capacity with signal.During realization, the above method
Each step can be completed by the instruction of the integrated logic circuit of the hardware in processor or software form.Above-mentioned processing
Device can be general processor, including central processing unit (Central Processing Unit, abbreviation CPU), network processing unit
(Network Processor, abbreviation NP) etc.；It can also be digital signal processor (Digital Signal
Processing, abbreviation DSP), specific integrated circuit (Application Specific Integrated Circuit, referred to as
ASIC), ready-made programmable gate array (Field-Programmable Gate Array, abbreviation FPGA) or other are programmable
Logical device, discrete gate or transistor logic, discrete hardware components.It may be implemented or execute in the embodiment of the present invention
Disclosed each method, step and logic diagram.General processor can be microprocessor or the processor is also possible to appoint
What conventional processor etc..The step of method in conjunction with disclosed in the embodiment of the present invention, can be embodied directly in hardware decoding processing
Device executes completion, or in decoding processor hardware and software module combination execute completion.Software module can be located at
Machine memory, flash memory, read-only memory, programmable read only memory or electrically erasable programmable memory, register etc. are originally
In the storage medium of field maturation.The storage medium is located at memory, and processor reads the information in memory, in conjunction with its hardware
The step of completing the method for previous embodiment.
The Claims Resolution method, apparatus and server of business insurance provided by the embodiment of the present invention and the computer journey of system
Sequence product, the computer readable storage medium including storing program code, before the instruction that program code includes can be used for execution
Method described in the embodiment of the method for face, specific implementation can be found in embodiment of the method, and details are not described herein.
It, can be with if the function is realized in the form of SFU software functional unit and when sold or used as an independent product
It is stored in a computer readable storage medium.Based on this understanding, technical solution of the present invention is substantially in other words
The part of the part that contributes to existing technology or the technical solution can be embodied in the form of software products, the meter
Calculation machine software product is stored in a storage medium, including some instructions are used so that a computer equipment (can be a
People's computer, server or network equipment etc.) it performs all or part of the steps of the method described in the various embodiments of the present invention.
And storage medium above-mentioned includes: that USB flash disk, mobile hard disk, read-only memory (ROM, Read-Only Memory), arbitrary access are deposited
The various media that can store program code such as reservoir (RAM, Random Access Memory), magnetic or disk.
Finally, it should be noted that embodiment described above, only a specific embodiment of the invention, to illustrate the present invention
Technical solution, rather than its limitations, scope of protection of the present invention is not limited thereto, although with reference to the foregoing embodiments to this hair
It is bright to be described in detail, those skilled in the art should understand that: anyone skilled in the art
In the technical scope disclosed by the present invention, it can still modify to technical solution documented by previous embodiment or can be light
It is readily conceivable that variation or equivalent replacement of some of the technical features；And these modifications, variation or replacement, do not make
The essence of corresponding technical solution is detached from the spirit and scope of technical solution of the embodiment of the present invention, should all cover in protection of the invention
Within the scope of.Therefore, protection scope of the present invention should be subject to the protection scope in claims.
Claims (10)
1. a kind of Claims Resolution method of business insurance, which is characterized in that the method is applied to business insurance service platform, the quotient
The industry insurance service platform insurance information system communication link with the medical information system of medical institutions and commercial insurance company respectively
It connects；The described method includes:
Receive the information of reporting a case to the security authorities for the user that the insurance information system is sent；The information of reporting a case to the security authorities is to meet default Claims Resolution condition
Claims Resolution information；
Go out the medical treatment data of the user from the information extraction of reporting a case to the security authorities；The medical treatment data include subscriber identity information, see a doctor
It is a variety of in hospital, Waiting time and medical treatment serial number；
The user corresponding with the medical treatment data is filtered out from patient assessment's data of the medical information system just
Examine data；
The medical data are standardized, standardized data is obtained；
The standardized data is sent to the insurance information system, so that the commercial insurance company is according to the standardization
Data carry out Claims Resolution accounting and obtain compensating gold and the compensation gold is fed back to the user.
2. the method according to claim 1, wherein the generating process of the information of reporting a case to the security authorities, comprising:
The insurance information system receives the Claims Resolution information of the user；
The insurance information system is audited according to the Claims Resolution information, judges whether the user is business insurance user；
If the user is business insurance user, the guarantor for the insurance products that the insurance information system is bought according to the user
Dangerous information responsible judges whether the user meets default Claims Resolution condition；
If the user meets default Claims Resolution condition, the Claims Resolution information flag is described report a case to the security authorities by the insurance information system
Information.
3. the method according to claim 1, wherein the medical data include medical archives, medical information, take
With a variety of in settlement information and receipt information.
4. the method according to claim 1, wherein the method also includes:
Receive the auditing result after the commercial insurance company audits the standardized data；
When the auditing result is the first result, execution is described to be sent to the insurance information system for the standardized data
The step of；Wherein first result is the result that user needs to settle a claim.
5. a kind of Claims Resolution method of business insurance, which is characterized in that the method is applied to the insurance information of commercial insurance company
System, the insurance information system and business insurance service platform communicate to connect；The described method includes:
The information of reporting a case to the security authorities of user is sent to the business insurance service platform；So that the business insurance service platform is to the report
Case information is handled to obtain the standardized data of the user；The information of reporting a case to the security authorities is the Claims Resolution letter for meeting default Claims Resolution condition
Breath；
Receive the standardized data that the business insurance service platform is sent；
Claims Resolution accounting is carried out according to the standardized data to obtain compensating gold, and the compensation gold is fed back into the user.
6. according to the method described in claim 5, it is characterized in that, described send user's to the business insurance service platform
Information of reporting a case to the security authorities includes:
Receive the Claims Resolution information of the user；
The Claims Resolution information is audited, judges whether the user is business insurance user；
If the user is business insurance user, institute is judged according to the insurance responsibility information of the insurance products of user purchase
State whether user meets default Claims Resolution condition；
It is the information of reporting a case to the security authorities by the Claims Resolution information flag if the user meets default Claims Resolution condition.
7. according to the method described in claim 6, it is characterized in that, the step of the Claims Resolution information for receiving the user it
Afterwards, the method also includes:
The Claims Resolution information is verified and confirmed by the way of identifying code and/or electronic signature.
8. a kind of Claims Resolution device of business insurance, which is characterized in that described device is set to business insurance service platform, the quotient
The industry insurance service platform insurance information system communication link with the medical information system of medical institutions and commercial insurance company respectively
It connects；Described device includes:
It reports a case to the security authorities information receiving module, for receiving the information of reporting a case to the security authorities for the user that the insurance information system is sent；The letter of reporting a case to the security authorities
Breath is the Claims Resolution information for meeting default Claims Resolution condition；
Medical treatment data extraction module, for going out the medical treatment data of the user from the information extraction of reporting a case to the security authorities；The medical treatment data
Including a variety of in subscriber identity information, medical treatment hospital, Waiting time and medical treatment serial number；
Medical data screening module, for being filtered out from patient assessment's data of the medical information system and the medical treatment number
According to the medical data of the corresponding user；
Data processing module obtains standardized data for being standardized to the medical data；
Data transmission blocks, for the standardized data to be sent to the insurance information system, so that the business insurance
Company settle a claim according to the standardized data calculating and obtains compensating gold and the compensation gold is fed back to the user.
9. device according to claim 8, which is characterized in that the medical data include medical archives, medical information, take
With a variety of in settlement information and receipt information.
10. a kind of server, which is characterized in that including processor and machine readable storage medium, the machine readable storage is situated between
Matter is stored with the machine-executable instruction that can be executed by the processor, and the processor executes the machine-executable instruction
To realize the described in any item methods of claim 1 to 7.
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| CN201811024060.1A CN109191317A (en) | 2018-09-03 | 2018-09-03 | The Claims Resolution method, apparatus and server of business insurance |
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| CN201811024060.1A CN109191317A (en) | 2018-09-03 | 2018-09-03 | The Claims Resolution method, apparatus and server of business insurance |
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Cited By (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111461899A (en) * | 2020-02-29 | 2020-07-28 | 万达信息股份有限公司 | Quick claim settlement system and method for business insurance and cloud business insurance platform |
| 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 |
| CN112308727A (en) * | 2020-11-30 | 2021-02-02 | 泰康保险集团股份有限公司 | Insurance claim settlement service processing method and device |
| CN113220712A (en) * | 2021-04-16 | 2021-08-06 | 新奥数能科技有限公司 | Method, device and equipment for generating energy enterprise project progress information table |
| CN113283850A (en) * | 2020-02-19 | 2021-08-20 | 北京沃东天骏信息技术有限公司 | Task auditing method, device and system |
| CN114723420A (en) * | 2022-06-07 | 2022-07-08 | 武汉金豆医疗数据科技有限公司 | Medical insurance, business and insurance integrated auditing method and device, electronic equipment and storage medium |
Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN106295151A (en) * | 2016-08-03 | 2017-01-04 | 合肥奇也信息科技有限公司 | A kind of medical care insurance is settled a claim system online |
| CN106295152A (en) * | 2016-08-03 | 2017-01-04 | 合肥奇也信息科技有限公司 | A kind of medical care insurance Claims Resolution management system |
| CN107220510A (en) * | 2017-06-08 | 2017-09-29 | 湖南暄程科技有限公司 | A kind of data managing method and system applied to medical industry |
| 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 |
| 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 |
-
2018
- 2018-09-03 CN CN201811024060.1A patent/CN109191317A/en active Pending
Patent Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN106295151A (en) * | 2016-08-03 | 2017-01-04 | 合肥奇也信息科技有限公司 | A kind of medical care insurance is settled a claim system online |
| CN106295152A (en) * | 2016-08-03 | 2017-01-04 | 合肥奇也信息科技有限公司 | A kind of medical care insurance Claims Resolution management system |
| CN107220510A (en) * | 2017-06-08 | 2017-09-29 | 湖南暄程科技有限公司 | A kind of data managing method and system applied to medical industry |
| 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 |
Cited By (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN113283850A (en) * | 2020-02-19 | 2021-08-20 | 北京沃东天骏信息技术有限公司 | Task auditing method, device and system |
| CN111461899A (en) * | 2020-02-29 | 2020-07-28 | 万达信息股份有限公司 | Quick claim settlement system and method for business insurance and cloud business insurance platform |
| 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 |
| CN112308727A (en) * | 2020-11-30 | 2021-02-02 | 泰康保险集团股份有限公司 | Insurance claim settlement service processing method and device |
| CN113220712A (en) * | 2021-04-16 | 2021-08-06 | 新奥数能科技有限公司 | Method, device and equipment for generating energy enterprise project progress information table |
| CN114723420A (en) * | 2022-06-07 | 2022-07-08 | 武汉金豆医疗数据科技有限公司 | Medical insurance, business and insurance integrated auditing method and device, electronic equipment and storage medium |
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