CN110009513A - For Claims Resolution method, apparatus, equipment and the readable storage medium storing program for executing of mutual insurance - Google Patents
For Claims Resolution method, apparatus, equipment and the readable storage medium storing program for executing of mutual insurance Download PDFInfo
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- CN110009513A CN110009513A CN201910122639.XA CN201910122639A CN110009513A CN 110009513 A CN110009513 A CN 110009513A CN 201910122639 A CN201910122639 A CN 201910122639A CN 110009513 A CN110009513 A CN 110009513A
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- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/04—Trading; Exchange, e.g. stocks, commodities, derivatives or currency exchange
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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
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Abstract
The invention discloses a kind of Claims Resolution method, apparatus, equipment and readable storage medium storing program for executing for mutual insurance, it is related to information technology field, target electronic case history and target is obtained in block chain to insure information, and whether Claims Resolution condition is met based on intelligent contract assessment target electronic case history, utilize the characteristic of block chain decentralization, it not only ensure that the safety of storage target electronic case history, also assure the transparency of evaluation process and process of settling a claim, confidentiality is preferable, data are avoided to be tampered, the risk that reduction fund is stolen.The described method includes: when receiving Claims Resolution request, according to the user identifier of Claims Resolution request, target electronic case history and target are obtained in block chain and is insured information；Determine insured items, the intelligent contract based on insured items assesses target electronic case history；If assessment target electronic case history meets Claims Resolution condition, amount for which loss settled is calculated；The Claims Resolution account for determining user identifier pays for the loss of cash or goods entrusted to one the monetary transmissions famous dictum that amount for which loss settled indicates family.
Description
Technical field
The present invention relates to information technology fields, more particularly to a kind of Claims Resolution method, apparatus, equipment for mutual insurance
And readable storage medium storing program for executing.
Background technique
With the continuous development of information technology, collaboration medical services that many mutual insurance tissues are realized by information technology
Also fast-developing therewith.Mutual insurance tissue does not have outside shareholder, is owned jointly by all insurers, therefore, mutual insurance group
It knits with following three unique advantages: first is that insurer is consistent with insuer's interest, can preferably realize and be with the benefit of client
Center effectively avoids the insurer from carrying on an improper business to cheat caused moral hazard with insurant.Second is that exhibition industry expense is lower, core
Calamity setting loss accuracy is higher, and operating cost can be effectively reduced.Third is that assets and surplus are all due to not having shareholder's profit pressure
For the welfare and guarantee of the insurer, the insurance kind for being conducive to insurer's long-term benefit can be developed.Mutual insurance group is woven in establishment
When, unit or individual with homogeneity risk guarantee demand become member by concluding tissue contract, and pay premium and formed mutually
Fund is helped, the loss caused by being occurred by accident of the fund to tissue contract engagement is born the responsibility to pay compensation, or is worked as and insured
People's die, injured or disabled, suffer diseases or while reaching the conditions such as the age of tissue contract engagement, time limit, undertake payment insurance money responsibility, and
When user requests to settle a claim, settle a claim according to the agreement of tissue contract.Since mutual insurance tissue does not have outside shareholder, by complete
Body insurer owns jointly, and therefore, insurer not only pays close attention to whether itself Claims Resolution is repaid, the Claims Resolution that supervision of also having the right occurs
Whether conjunction is advised.
In the related technology, the tissue contract of mutual insurance tissue and insurance capital are stored in such as SQL
In traditional database of (Structured Query Language, structured query language) etc., when being settled a claim, lead to
Tissue contract is often obtained in the database, is managed according to the fund that the regulation of tissue contract transfers the corresponding amount of money in the database
It pays for.
In the implementation of the present invention, inventor find the relevant technologies the prior art has at least the following problems:
The confidentiality of traditional database is poor, and there are the possibility that data are tampered, and is easy to generation fund and is stolen
The case where, it is most likely that cause insurer and organize layer between contradiction, it cannot be guaranteed that in tissue member interests.
Summary of the invention
In view of this, the present invention provides a kind of Claims Resolution method, apparatus, equipment and readable storage mediums for mutual insurance
Matter, main purpose are to solve that current confidentiality is poor, and there are the possibility that data are tampered, and are easy to generation fund and are stolen
The case where the problem of.
According to the present invention in a first aspect, providing a kind of Claims Resolution method for mutual insurance, this method comprises:
When the Claims Resolution for receiving user is requested, according to the user identifier that the Claims Resolution request carries, obtained in block chain
Target electronic case history and target is taken to insure information；
Determine the insured items target insured information includes, the intelligence based on the insured items in the block chain
Energy contract, assesses the target electronic case history, and the intelligence contract defines the Claims Resolution condition of the insured items；
Meet if the intelligent contract based on the insured items in the block chain assesses the target electronic case history
The Claims Resolution condition calculates amount for which loss settled then based on the intelligent contract；
Determine the Claims Resolution account of the user identifier instruction, the monetary transmissions that the amount for which loss settled is indicated to the Claims Resolution
Account.
In another embodiment, described when the Claims Resolution for receiving user is requested, it is carried according to the Claims Resolution request
User identifier obtains target electronic case history and target in block chain and insures before information, comprising:
The request of insuring for receiving the user extracts the insured items and user mark in the request of insuring
Know；
The target electronic case history for obtaining the user identifier instruction, determines the rule of insuring of the insured items, is based on institute
Rule of insuring is stated to audit the target electronic case history；
If the requirement that the target electronic case history meets the rule of insuring is audited, using the insured items as institute
It states target to insure information, the target is insured, and information is corresponding with the user identifier to be stored into the block chain；
If auditing the requirement that the target electronic case history does not meet the rule of insuring, failed regeneration response, by institute
It states failure response and is back to the user.
In another embodiment, the determination target is insured the insured items that information includes, and is insured based on described
Intelligent contract of the project in the block chain, assesses the target electronic case history, comprising:
Information reading is carried out to the target electronic case history, operation names and doctor are extracted in the target electronic case history
Treatment expense；
Based on the intelligent contract, whether the operation names and the medical expense are assessed in the insured items
In the range of Claims Resolution condition regulation.
In another embodiment, if the intelligent contract assessment based on the insured items in the block chain
The target electronic case history meets the Claims Resolution condition, then based on the intelligent contract, calculates amount for which loss settled, comprising:
Meet if the intelligent contract based on the insured items in the block chain assesses the target electronic case history
The Claims Resolution condition determines at least one Claims Resolution section of the Claims Resolution condition then based on intelligent contract；
According to the medical expense that the target electronic case history includes, the doctor is determined at least one described Claims Resolution section
Target Claims Resolution section where treatment expense；
The corresponding target Claims Resolution coefficient in target Claims Resolution section is obtained, the target Claims Resolution coefficient and the medical treatment are calculated
The product of expense, using the product as amount for which loss settled.
In another embodiment, if the intelligent contract assessment based on the insured items in the block chain
The target electronic case history meets the Claims Resolution condition, then based on the intelligent contract, after calculating amount for which loss settled, comprising:
It determines and accesses other nodes of at least one of the block chain, the target electronic case history, the target are thrown
Breath information-preserving and the amount for which loss settled are broadcast at least one other node；
If receiving the confirmation response more than or equal to quantity threshold in preset duration, the user is managed
It pays for；
If not receiving the confirmation response more than or equal to quantity threshold in preset duration, above-mentioned basis is re-executed
The target electronic case history and the target are insured the process that information is settled a claim.
In another embodiment, the Claims Resolution account of the determination user identifier instruction, the amount for which loss settled is referred to
After the monetary transmissions shown to the Claims Resolution account, comprising:
Information is insured to the target electronic case history, the target and the amount for which loss settled arranges, and generates Claims Resolution
Record；
The Claims Resolution is recorded and is bound with the user identifier, and the Claims Resolution after binding is recorded and the use
Family mark is stored into the block chain.
In another embodiment, the method also includes:
It is not inconsistent if the intelligent contract based on the insured items in the block chain assesses the target electronic case history
The Claims Resolution condition is closed, then generates refusal Claims Resolution response, refusal Claims Resolution response is back to the user.
Second aspect according to the present invention, provides a kind of Claims Resolution device for mutual insurance, which includes:
Module is obtained, for requesting the user identifier carried according to the Claims Resolution when the Claims Resolution for receiving user is requested,
Target electronic case history and target is obtained in block chain to insure information；
Evaluation module, for determining the insured items target insured information includes, based on the insured items in institute
The intelligent contract in block chain is stated, the target electronic case history is assessed, the intelligence contract defines the item of insuring
Purpose Claims Resolution condition；
Computing module, if for assessing the target based on intelligent contract of the insured items in the block chain
Electronic health record meets the Claims Resolution condition, then based on the intelligent contract, calculates amount for which loss settled；
Transmission module, for determining the Claims Resolution account of the user identifier instruction, the currency that the amount for which loss settled is indicated
It is transmitted to the Claims Resolution account.
In another embodiment, described device includes:
Receiving module extracts the insured items in the request of insuring for receiving the request of insuring of the user
With the user identifier；
Auditing module determines the throwing of the insured items for obtaining the target electronic case history of the user identifier instruction
Rule is protected, the target electronic case history is audited based on the rule of insuring；
First memory module will if meeting the requirement of the rule of insuring for auditing the target electronic case history
The insured items is insured information as the target, and the target is insured, and information is corresponding with the user identifier to be stored to institute
It states in block chain；
First generation module, if not meeting the requirement of the rule of insuring for auditing the target electronic case history,
Failed regeneration response, is back to the user for the failure response.
In another embodiment, the evaluation module, comprising:
Reading unit is extracted in the target electronic case history for carrying out information reading to the target electronic case history
Operation names and medical expense；
Assessment unit, for based on the intelligent contract, assess the operation names and the medical expense whether
In the range of the Claims Resolution condition regulation of the insured items.
In another embodiment, the computing module, comprising:
First determination unit, if for based on the insured items in the block chain intelligent contract assessment described in
Target electronic case history meets the Claims Resolution condition, then based on intelligent contract, determines at least one Claims Resolution area of the Claims Resolution condition
Between；
Second determination unit, the medical expense for including according to the target electronic case history, at least one described reason
Pay for the target Claims Resolution section where determining the medical expense in section；
Computing unit calculates the target Claims Resolution for obtaining the corresponding target Claims Resolution coefficient in target Claims Resolution section
The product of coefficient and the medical expense, using the product as amount for which loss settled.
In another embodiment, described device further include:
Broadcast module accesses other nodes of at least one of the block chain for determining, by the target electronic disease
It goes through, the target insures information and the amount for which loss settled is broadcast at least one other node；
The computing module, if being also used to receive the confirmation response more than or equal to quantity threshold in preset duration,
Then settle a claim to the user；
The acquisition module, if the confirmation for being also used to not receive in preset duration more than or equal to quantity threshold is rung
It answers, then re-executes and above-mentioned insured the process that information settles a claim according to the target electronic case history and the target.
In another embodiment, described device further include:
Sorting module, for being carried out to insure information and the amount for which loss settled of the target electronic case history, the target
It arranges, generates Claims Resolution record；
Second memory module is bound for recording the Claims Resolution with the user identifier, and by the institute after binding
Claims Resolution record is stated to store with the user identifier into the block chain.
In another embodiment, described device further include:
Second generation module, if for based on the insured items in the block chain intelligent contract assessment described in
Target electronic case history does not meet the Claims Resolution condition, then generates refusal Claims Resolution response, and refusal Claims Resolution response is back to institute
State user.
The third aspect according to the present invention, provides a kind of equipment, including memory and processor, and the memory is stored with
The step of computer program, the processor realizes above-mentioned first aspect the method when executing the computer program.
Fourth aspect according to the present invention provides a kind of readable storage medium storing program for executing, is stored thereon with computer program, feature
It is, the computer program realizes method described in above-mentioned first aspect when being executed by processor the step of.
It is provided by the invention a kind of for the Claims Resolution method, apparatus of mutual insurance, equipment and can by above-mentioned technical proposal
Storage medium is read, compared with current tissue contract and insurance capital are stored in the mode of traditional database, the present invention exists
User's request is when settling a claim, and obtains target electronic case history in block chain and target is insured information, and based on block chain
Whether intelligent contract assessment target electronic case history meets Claims Resolution condition, manages in the case where meeting Claims Resolution condition user
It pays for, using the characteristic of block chain decentralization, not only ensure that the safety of storage target electronic case history, it is ensured that assessed
The transparency of journey and process of settling a claim, confidentiality is preferable, avoids data from being tampered, the risk that reduction fund is stolen.
The above description is only an overview of the technical scheme of the present invention, in order to better understand the technical means of the present invention,
And it can be implemented in accordance with the contents of the specification, and in order to allow above and other objects of the present invention, feature and advantage can
It is clearer and more comprehensible, the followings are specific embodiments of the present invention.
Detailed description of the invention
By reading the following detailed description of the preferred embodiment, various other advantages and benefits are common for this field
Technical staff will become clear.The drawings are only for the purpose of illustrating a preferred embodiment, and is not considered as to the present invention
Limitation.And throughout the drawings, the same reference numbers will be used to refer to the same parts.In the accompanying drawings:
Fig. 1 shows a kind of Claims Resolution method flow schematic diagram for mutual insurance provided in an embodiment of the present invention；
Fig. 2A shows a kind of Claims Resolution method flow schematic diagram for mutual insurance provided in an embodiment of the present invention；
Fig. 2 B shows a kind of Claims Resolution method flow schematic diagram for mutual insurance provided in an embodiment of the present invention；
Fig. 3 A shows a kind of structural schematic diagram of Claims Resolution device for mutual insurance provided in an embodiment of the present invention；
Fig. 3 B shows a kind of structural schematic diagram of Claims Resolution device for mutual insurance provided in an embodiment of the present invention；
Fig. 3 C shows a kind of structural schematic diagram of Claims Resolution device for mutual insurance provided in an embodiment of the present invention；
Fig. 3 D shows a kind of structural schematic diagram of Claims Resolution device for mutual insurance provided in an embodiment of the present invention；
Fig. 3 E shows a kind of structural schematic diagram of Claims Resolution device for mutual insurance provided in an embodiment of the present invention；
Fig. 3 F shows a kind of structural schematic diagram of Claims Resolution device for mutual insurance provided in an embodiment of the present invention；
Fig. 3 G shows a kind of structural schematic diagram of Claims Resolution device for mutual insurance provided in an embodiment of the present invention；
Fig. 4 shows a kind of apparatus structure schematic diagram of computer equipment provided in an embodiment of the present invention.
Specific embodiment
The exemplary embodiment that the present invention will be described in more detail below with reference to accompanying drawings.Although showing the present invention in attached drawing
Exemplary embodiment, it being understood, however, that may be realized in various forms the present invention without should be by embodiments set forth here
It is limited.It is to be able to thoroughly understand the present invention on the contrary, providing these embodiments, and can be by the scope of the present invention
It is fully disclosed to those skilled in the art.
The embodiment of the invention provides a kind of Claims Resolution methods for mutual insurance, can request to settle a claim in user
When, target electronic case history and target are obtained in block chain and is insured information, and the intelligent contract based on block chain assesses target
Whether electronic health record meets Claims Resolution condition, settles a claim in the case where meeting Claims Resolution condition to user, is gone using block chain
The characteristic of the heart not only ensure that the safety of storage target electronic case history, it is ensured that evaluation process and Claims Resolution process
The transparency, it is preferable to have reached confidentiality, avoids data from being tampered, reduces the purpose for stealing risk of fund, as shown in Figure 1, should
Method includes:
101, it when the Claims Resolution for receiving user is requested, according to the user identifier that Claims Resolution request carries, is obtained in block chain
Target electronic case history and target is taken to insure information.
In embodiments of the present invention, it is insured due to that can have a large amount of user, so that being stored in block chain a large amount of
Electronic health record and information of insuring, therefore, in order to get the electronic health record of user itself, so that it is determined that whether user can be with
It settles a claim, user identifier can be carried in Claims Resolution request, in this way, when the Claims Resolution for receiving user is requested, it can be according to reason
The user identifier that request carries is paid for, target electronic case history and target are obtained in block chain and is insured information.
102, insured items target insured information includes is determined, the intelligent contract based on insured items in block chain,
Target electronic case history is assessed, intelligent contract defines the Claims Resolution condition of insured items.
In embodiments of the present invention, since the condition that different insured items is settled a claim all is different, and intelligence is closed
The Claims Resolution condition of each insured items is described in about, therefore, is getting target electronic case history and target is insured after information,
Insured items target insured information includes, and the intelligent contract based on insured items in block chain are determined, to target electronic
Case history is assessed, so that it is determined that whether the target electronic case history of user meets the condition of Claims Resolution.
If the intelligent contract assessment target electronic case history 103, based on insured items in block chain meets Claims Resolution condition,
Then based on intelligent contract, amount for which loss settled is calculated.
In embodiments of the present invention, if the intelligent contract based on insured items in block chain assesses target electronic case history
Meet Claims Resolution condition, then it represents that can settle a claim to user at this time, amount for which loss settled can be calculated based on intelligent contract.
104, the Claims Resolution account for determining user identifier instruction pays for the loss of cash or goods entrusted to one the monetary transmissions famous dictum that amount for which loss settled indicates family.
In embodiments of the present invention, after amount for which loss settled has been calculated, the Claims Resolution of user identifier instruction can be determined
Account pays for the loss of cash or goods entrusted to one the monetary transmissions famous dictum that amount for which loss settled indicates family, to realize the Claims Resolution to user.
Method provided in an embodiment of the present invention can obtain target electricity when user requests to settle a claim in block chain
Sub- case history and target are insured information, and whether the assessment of the intelligent contract based on block chain target electronic case history meets Claims Resolution item
Part settles a claim to user in the case where meeting Claims Resolution condition, using the characteristic of block chain decentralization, not only ensure that and deposits
Store up the safety of target electronic case history, it is ensured that the transparency of evaluation process and process of settling a claim, confidentiality is preferable, avoid counting
According to being tampered, the risk that reduction fund is stolen.
The embodiment of the invention provides a kind of Claims Resolution methods for mutual insurance, can request to settle a claim in user
When, target electronic case history and target are obtained in block chain and is insured information, and the intelligent contract based on block chain assesses target
Whether electronic health record meets Claims Resolution condition, settles a claim in the case where meeting Claims Resolution condition to user, is gone using block chain
The characteristic of the heart not only ensure that the safety of storage target electronic case history, it is ensured that evaluation process and Claims Resolution process
The transparency, it is preferable to have reached confidentiality, avoids data from being tampered, reduces the purpose for stealing risk of fund, as shown in Figure 2 A, should
Method includes:
201, the request of insuring for receiving user extracts insured items and user identifier in request of insuring.
In embodiments of the present invention, it was recognized by the inventor that in mutual insurance project, usually, mutual insurance project
In can be arranged one in each terminal for being related to for storing the database of relevant information and data that relevant user is insured,
For example, the information of insuring of user, fund of project etc. are stored in database, and these databases are usually all such as SQL
Traditional database.During practical application, the risk that traditional database is stolen and distorts there are data, this just very may be used
The information that can be stolen or insure there is a situation where the fund in database is tampered generation, to compromise mutual insurance project
The basic interests of middle client, it is easy to cause the internal contradictions between client.In embodiments of the present invention, it is contemplated that block chain tool
There is the characteristic of decentralization, so that block chain in storing data and information, can not only guarantee the safety of data and information
Property, it can also be ensured that the transparency of the operation of data and information, therefore, Claims Resolution system of the present invention, using block
Chain stores the electronic health record of user, and the intelligent contract based on block chain executes the process of Claims Resolution, so that each be made to access to
The process that terminal in block chain can clearly settle a claim very much.
Wherein, electronic health record is uploaded in the block chain of Claims Resolution system by the hospital for having upload qualification.Claims Resolution system can
To support client, the terminal of hospital that can download the client, and the electronic health record of user is uploaded into famous dictum in the client
In compensation system, in this way, when Claims Resolution system receive hospital upload electronic health record when, in order to by the electronic health record of each user into
Row is distinguished, and makes only user itself that can inquire in block chain itself electronic health record, to guarantee the safety of electronic health record
Property, it needs to extract the user identifier of user in electronic health record, stores user identifier is corresponding with the electronic health record to block chain
In, so that subsequent user identifier of only holding can just inquire electronic health record.In general, it can be extracted in electronic health record
The user identifier as user such as address name, ID card No., medical insurance account of user, and after user identifier has been determined,
User identifier is showed into user, so that user is subsequent can to realize the sequence of operations such as insure, settle a claim based on the user identifier.
It should be noted that due to being stored with an identical block chain in the terminal of each access Claims Resolution system, it is every in order to guarantee
The consistency of data in block chain in a terminal, when complete electronic health record is stored into block chain after, need the electricity
Sub- case history and user identifier are synchronized to other terminals, so that other terminals store the electronic health record and user identifier to certainly
In the block chain of body.
By executing the above process, a large amount of electronic health record can be included in system block chain of settling a claim, and in subsequent base
It settles a claim in the electronic health record to user.Due to only can just enjoy Claims Resolution system in the user that Claims Resolution system China National Investment & Guaranty Corp. is crossed
Therefore entrance of insuring can be set, and be stored in the electricity in block chain based on user in the Claims Resolution of system in the client for system of settling a claim
Sub- case history assesses the request of insuring of user, and after assessment is insured and requested successfully, completes insuring for user, is generated for user and insures
Information, to be settled a claim subsequent based on the information of insuring for user.Wherein, when detect user triggering insure entrance when,
Display is insured the page, show in the page of insuring the offer of Claims Resolution system it is a variety of can insured items and user identifier input
Frame, and after detecting that user confirms the page of insuring, confirmation receives the request of insuring of user, and obtains user's selection
Insured items and user's input user identifier, so as to it is subsequent based on the insured items and user identifier be that user carries out
It insures.
202, the target electronic case history for obtaining user identifier instruction, determines the rule of insuring of insured items, based on rule of insuring
Then target electronic case history is audited, if target electronic case history meets the requirement for rule of insuring, executes following step
203；If target electronic case history does not meet the requirement for rule of insuring, following step 204 is executed.
In embodiments of the present invention, since insured items is with rule of insuring, for example, having the user of fixed illness
Can insure, the age reaches standard can insure or work to specify work post that can insure, therefore, receiving user
Request of insuring, after getting the user identifier and insured items of user, firstly, according to user identifier, obtain user identifier
The target electronic case history of instruction；It is then determined that the rule of insuring for the insured items that user's request is insured, and it is based on the rule of insuring
Then, the target electronic case history got is audited, judges whether target electronic case history meets the specified by rules of insuring
Range, so that it is determined that whether the user can insure.For example, set the insured items that user selects as A, the rule of insuring of A
Middle regulation can insure A with the user of illness 1 and illness 2, in this way, if in the target electronic case history of user including illness 1,
Then indicate that the target electronic case history of the user meets the requirement for rule of insuring；If in the target electronic case history of user only including disease
Disease 3, then it represents that the target electronic case history of the user does not meet the requirement for rule of insuring.
By the above process, the audit to target electronic case history can be realized, so that it is determined that whether user can insure
Its insured items selected.If target electronic case history meets the requirement for rule of insuring, then it represents that the user is can to select it
What the insured items selected was insured, namely execute the process in following step 203；It insures if target electronic case history is not met
The requirement of rule, then it represents that the user is cannot to insure to the insured items that it is selected, and user needs to reselect
Insured items, namely execute the process in following step 204.
If 203, target electronic case history meets the requirement for rule of insuring, insure information using insured items as target,
Target is insured, and information is corresponding with user identifier to be stored into block chain.
In embodiments of the present invention, if target electronic case history meets the requirement for rule of insuring, then it represents that user can throw
The product of insuring of its selection is protected, therefore, is insured information using the insured items as the target of the user, and the target is insured letter
Cease store into block chain corresponding with user identifier.
During practical application, since in the case where target electronic case history meets and insures rule, user can pass through
Payment insures to insured items to realize, therefore, Claims Resolution system can also receive the fund of insuring of user, in this way, may be used also
It is also stored using the insured amount for the fund of insuring for being paid user as target information of insuring.Furthermore, it is contemplated that user
Target electronic case history in include user information be not very perfect, and hence it is also possible to require user input address name, use
The details such as family age and user's gender, and also it is used as target to insure information these details, the embodiment of the present invention
Content that information includes is insured without specifically limiting to target.
If 204, target electronic case history does not meet the requirement for rule of insuring, failure response is returned in failed regeneration response
It is back to user.
In embodiments of the present invention, if target electronic case history does not meet the requirement for rule of insuring, then it represents that user is current
It is at this moment cannot the insure product of insuring of its selection just needs failed regeneration to respond, and the failure response of generation is returned to
User needs to re-start and insure so that user knows currently to insure unsuccessfully.
And during practical application, in order to make user after receiving failure response, it could be aware that failure of insuring
Reason can carry the key point that rule of insuring is not met in target electronic case history as failure cause, and in failure response
The failure cause, so that user can be concerned about the failure cause of this failure of insuring.
The process in 201 to step 204, user can insure in Claims Resolution system through the above steps, buy
The insured items of oneself selection is insured.Since the main purpose insured is to guarantee that user can enjoy insured items institute
Bring interests, therefore, user, can be during successive treatments, according to the reality for the treatment of after the success of Claims Resolution system China National Investment & Guaranty Corp.
Border procedure request is settled a claim, referring to fig. 2 B, this method comprises:
205, it when the Claims Resolution for receiving user is requested, according to the user identifier that Claims Resolution request carries, is obtained in block chain
Target electronic case history and target is taken to insure information.
In embodiments of the present invention, only holding user identifier just due to the electronic health record stored in block chain can inquire
And get, namely only user itself has the permission for accessing own electronic case history, therefore, when user settles a claim
When, it needs to authorize Claims Resolution system, allows Claims Resolution system to access the electronic health record of oneself and audited.In order to realize pair
Claims Resolution system is authorized, and the user identifier of oneself can be supplied to Claims Resolution system by user, so that the system of settling a claim is mentioned according to user
The user identifier of confession carries out the extraction of electronic health record in block chain.Wherein, user can carry user's mark in Claims Resolution request
Know, in this way, after Claims Resolution system receives the Claims Resolution request of user user identifier can be extracted in Claims Resolution request, and be based on using
Family mark, gets target electronic case history in block chain.
Due to when settling a claim to user, it is also necessary to insure which project with reference to user, and insured according to user
Project settle a claim, therefore, it is also desirable to be insured information according to the target that user identifier gets the user.Through the above steps
201 to process shown in step 204, and the information of insuring of user is also stored in block chain known to us, therefore, can be with
Based on the user identifier, the target that the user is obtained in block chain is insured information, and subsequent based on the target got electricity
Sub- case history and target information of insuring settle a claim to user.
206, insured items target insured information includes is determined, the intelligent contract based on insured items in block chain,
Target electronic case history is assessed, if the intelligent contract assessment target electronic case history symbol based on insured items in block chain
Condition is rationally paid for, then executes following step 207 to step 210；If the intelligent contract based on insured items in block chain is commented
Estimate target electronic case history and meet Claims Resolution condition, then executes following step 211.
In embodiments of the present invention, after the target for having got user insures information and target electronic case history,
To determine insured items target insured information includes, intelligent contract based on insured items in block chain, to target electronic
Case history is assessed, so that it is determined that whether user's present case can settle a claim.Wherein, it has been included in intelligent contract more
The Claims Resolution condition of a project, Claims Resolution condition specifically include the operation names that can settle a claim, at least one Claims Resolution section and each Claims Resolution
The corresponding Claims Resolution coefficient in section.The hand carried out during sick due to will record user in the target electronic case history of user
Therefore art title and medical expense after getting target electronic case history, carry out information reading to target electronic case history,
Operation names and medical expense are extracted in target electronic case history, and are used to really according to the operation names and payment for medical care got
It is fixed whether to settle a claim to user or specific amount for which loss settled.
Specifically, first when assessing target electronic case history in the intelligent contract based on insured items in block chain
First, intelligent contract can determine whether the Claims Resolution condition of insured items；Then, the intelligence contract pass through the operation names that will acquire and
Medical expense is compared with range as defined in Claims Resolution condition, to whether assess operation names and medical expense in item of insuring
Purpose is settled a claim in the range of condition regulation.It should be noted that only operation names and medical expense have been all satisfied Claims Resolution item
When part, can just it settle a claim.For example, the operation names of settling a claim for setting the Claims Resolution condition of project A in intelligent contract include operation
X, perform the operation Y and operation Z, and Claims Resolution section includes [500~1000], [1000~2000], [2000~5000], if user's
The operation names that user is got in target electronic case history are X, and medical expense 3000 can then determine the operation names of user
In the range of can settle a claim operation names, medical expense Claims Resolution section [2000~5000] in, therefore, can to the user into
Row Claims Resolution；If the operation names for getting user in the target electronic case history of user are N, medical expense 3000 then may be used
To determine the operation names of user not in the range of can settle a claim operation names, even if the medical expense of user is in Claims Resolution section
It is interior, and it is unsatisfactory for Claims Resolution condition.
By executing the above process, target electronic disease can be assessed based on intelligent contract of the insured items in block chain
It goes through and whether meets Claims Resolution condition, if the intelligent contract assessment target electronic case history based on insured items in block chain meets reason
Compensation condition, then it represents that can settle a claim at this time to user, namely execute following step 207 to the process in step 210；If
Intelligent contract assessment target electronic case history based on insured items in block chain meets Claims Resolution condition, then it represents that user is current
Situation is unsatisfactory for Claims Resolution condition, can not temporarily settle a claim, namely executes the process in following step 211.
If the intelligent contract assessment target electronic case history 207, based on insured items in block chain meets Claims Resolution condition,
Then based on intelligent contract, at least one Claims Resolution section of the Claims Resolution condition is determined.
In embodiments of the present invention, if the intelligent contract based on insured items in block chain assesses target electronic case history
Meet Claims Resolution condition, then it represents that can settle a claim to user at this time, continue to be calculated as the amount for which loss settled that user settles a claim.By
In each Claims Resolution project can be arranged Claims Resolution section, and the corresponding Claims Resolution coefficient in each Claims Resolution section be it is different, therefore,
Need to determine at least one Claims Resolution section of the Claims Resolution condition based on intelligent contract, and in the payment for medical care of subsequent determining user
Which, with specifically in Claims Resolution section, settle a claim to be based on the corresponding Claims Resolution coefficient in Claims Resolution section.
208, the medical expense for including according to target electronic case history determines medical expense institute at least one Claims Resolution section
Target settle a claim section, obtain the corresponding target in target Claims Resolution section and settle a claim coefficient, calculate target Claims Resolution coefficient and payment for medical care
Product, using product as amount for which loss settled.
In embodiments of the present invention, since each Claims Resolution section at least one Claims Resolution section of insured items can be right
A Claims Resolution coefficient is answered, therefore, the medical expense that can include according to target electronic case history first, at least one section of settling a claim
Target Claims Resolution section where middle determining medical expense；Then, the corresponding target Claims Resolution coefficient in target Claims Resolution section is obtained, is calculated
The product of target Claims Resolution coefficient and medical expense, using product as amount for which loss settled.For example, set Claims Resolution section include [500~
1000], [1000~2000], [2000~5000], corresponding Claims Resolution coefficient is respectively 0.5,0.6,0.8, then if user
Medical expense is 3000, then can determine that Claims Resolution section locating for medical expense is [2000~5000], corresponding Claims Resolution coefficient
It is 0.8, calculates 3000 × 0.8=2400 namely amount for which loss settled is 2400 yuan.
It should be noted that subsequent settled a claim based on amount for which loss settled due to having calculated amount for which loss settled,
In order to avoid other nodes accessed in Claims Resolution system have objection to amount for which loss settled, it is thus necessary to determine that in access block chain at least
Target electronic case history, target are insured information and amount for which loss settled are broadcast at least one other node, made by one other node
The available current initiation reason of pending Claims Resolution of other nodes and the process of calculating are obtained, and when other nodes are agreed to carry out
When Claims Resolution, it just will continue to settle a claim.There can be delay in view of carrying out information transmission between sometimes node, and can have one
A little fraud nodes interfere the execution of result, therefore, preset duration and quantity threshold can be set, in this way, if
The confirmation response more than or equal to quantity threshold is received in preset duration, it is determined that other nodes are to the amount for which loss settled that this is obtained
Certainly, it can settle a claim to user；If the confirmation response more than or equal to quantity threshold is not received in preset duration,
The amount for which loss settled then indicated is not approved by everybody, may calculate and mistake occurs, at this point, just needing to re-execute
It states and is insured the process that information settles a claim according to target electronic case history and target.
209, the Claims Resolution account for determining user identifier instruction pays for the loss of cash or goods entrusted to one the monetary transmissions famous dictum that amount for which loss settled indicates family.
In embodiments of the present invention, after amount for which loss settled has been calculated, the Claims Resolution of user identifier instruction can be determined
Account, by the monetary transmissions of amount for which loss settled instruction into the Claims Resolution account, to complete the Claims Resolution to user.
210, information is insured to target electronic case history, target and amount for which loss settled arranges, generate Claims Resolution record, will manage
It pays for record to be bound with user identifier, and the Claims Resolution record after binding is stored with user identifier into block chain.
, can be evidence-based when in embodiments of the present invention, in order to make the subsequent process to Claims Resolution generate query, it completes
After the Claims Resolution of user, the information that can insure to target electronic case history, target and amount for which loss settled are arranged, and generate Claims Resolution note
Claims Resolution record is bound with user identifier, and the Claims Resolution record after binding is stored with user identifier into block chain by record,
To which the Claims Resolution to be recorded to the foundation as subsequent investigation.
If the intelligent contract assessment target electronic case history 211, based on insured items in block chain does not meet Claims Resolution item
Part then generates refusal Claims Resolution response, and refusal Claims Resolution response is back to user.
In embodiments of the present invention, if the intelligent contract based on insured items in block chain assesses target electronic case history
Not meeting Claims Resolution condition, then it represents that user's present case is unsatisfactory for Claims Resolution condition, can not temporarily settle a claim, therefore,
Refusal Claims Resolution response is generated, refusal Claims Resolution response is back to user.
During practical application, generate refuse Claims Resolution response when, can not based on target electronic case history determination
The reason of being settled a claim, for example, operation names are not in the range of can settle a claim operation names or medical expense is not or not Claims Resolution area
In etc., and the reason is carried in refusal Claims Resolution response, so that user can know cannot achieve Claims Resolution why.
It should be noted that implementation process of the present invention is so that a block chain to be arranged in Claims Resolution system and stores all
Information and data instance be illustrated, and during practical application, can be set two or multiple block chains
Different data and information are stored respectively.For example, two block chains can be set, respectively medical block chain and insurance block
Chain, wherein medical block chain is for storing whether electronic medical records, verifying electronic health record can settle a claim；Insure block chain to use
It insures record, Claims Resolution record, information of insuring etc. in storage.The embodiment of the present invention is to the number of the block chain of setting without specific
It limits.
Method provided in an embodiment of the present invention obtains target electronic disease when user's request is settled a claim in block chain
It goes through and target is insured information, and whether the assessment of the intelligent contract based on block chain target electronic case history meets Claims Resolution condition,
It settles a claim in the case where meeting Claims Resolution condition to user, using the characteristic of block chain decentralization, not only ensure that storage mesh
Mark the safety of electronic health record, it is ensured that the transparency of evaluation process and process of settling a claim, confidentiality is preferable, avoid data quilt
It distorts, the risk that reduction fund is stolen.
Further, the specific implementation as Fig. 1 the method, the embodiment of the invention provides one kind to be directed to mutual insurance
Claims Resolution device, as shown in Figure 3A, described device include: obtain module 301, evaluation module 302, computing module 303 and transmission
Module 304.
The acquisition module 301, the user for being carried according to the Claims Resolution request when the Claims Resolution for receiving user is requested
Mark obtains target electronic case history and target in block chain and insures information；
The evaluation module 302 is based on the insured items for determining the insured items target insured information includes
Intelligent contract in the block chain assesses the target electronic case history, and the intelligence contract defines the throwing
The Claims Resolution condition of guarantor's project；
The computing module 303, if for assessing institute based on intelligent contract of the insured items in the block chain
It states target electronic case history and meets the Claims Resolution condition, then based on the intelligent contract, calculate amount for which loss settled；
The transmission module 304 indicates the amount for which loss settled for determining the Claims Resolution account of the user identifier instruction
Monetary transmissions are to the Claims Resolution account.
In specific application scenarios, as shown in Figure 3B, the device further include: receiving module 305, auditing module 306, the
One memory module 307 and the first generation module 308.
The receiving module 305 is insured described in extraction in the request of insuring for receiving the request of insuring of the user
Project and the user identifier；
The auditing module 306 determines the insured items for obtaining the target electronic case history of the user identifier instruction
Rule of insuring, based on it is described insure rule the target electronic case history is audited；
First memory module 307, if meeting the requirement of the rule of insuring for auditing the target electronic case history,
It then insures information using the insured items as the target, the target is insured information storage corresponding with the user identifier
To in the block chain；
First generation module 308, if not meeting wanting for the rule of insuring for auditing the target electronic case history
It asks, then failed regeneration responds, and the failure response is back to the user.
In specific application scenarios, as shown in Figure 3 C, the evaluation module 302, comprising: reading unit 3021 and assessment are single
Member 3022.
The reading unit 3021, for carrying out information reading to the target electronic case history, in the target electronic case history
Middle extraction operation names and medical expense；
The assessment unit 3022, for assessing the operation names and the medical expense based on the intelligent contract
Whether in the range of the Claims Resolution condition of insured items regulation.
In specific application scenarios, as shown in Figure 3D, the computing module 303, comprising: the first determination unit 3031, the
Two determination units 3032 and computing unit 3033.
First determination unit 3031, if for being commented based on intelligent contract of the insured items in the block chain
Estimate the target electronic case history and meet the Claims Resolution condition, then based on intelligent contract, determines at least one of the Claims Resolution condition
Claims Resolution section；
Second determination unit 3032, the medical expense for including according to the target electronic case history, it is described at least
The target Claims Resolution section where the medical expense is determined in one Claims Resolution section；
The computing unit 3033 calculates the mesh for obtaining the corresponding target Claims Resolution coefficient in target Claims Resolution section
The product of mark Claims Resolution coefficient and the medical expense, using the product as amount for which loss settled.
In specific application scenarios, as shown in FIGURE 3 E, the device further include: broadcast module 309.
The broadcast module 309 accesses other nodes of at least one of the block chain for determining, by the target electricity
Sub- case history, the target insure information and the amount for which loss settled is broadcast at least one other node；
The computing module 303, if being also used to receive the confirmation response more than or equal to quantity threshold in preset duration,
Then settle a claim to the user；
The acquisition module 301, if the confirmation for being also used to not receive in preset duration more than or equal to quantity threshold is rung
It answers, then re-executes and above-mentioned insured the process that information settles a claim according to the target electronic case history and the target.
In specific application scenarios, as illustrated in Figure 3 F, the device further include: sorting module 310 and the second memory module
311。
The sorting module 310, for insuring information and the amount for which loss settled to the target electronic case history, the target
It is arranged, generates Claims Resolution record；
Second memory module 311 is bound for recording the Claims Resolution with the user identifier, and will be after binding
Claims Resolution record store into the block chain with the user identifier.
In specific application scenarios, as shown in Figure 3 G, the device further include: the second generation module 312.
Second generation module 312, if for being commented based on intelligent contract of the insured items in the block chain
Estimate the target electronic case history and do not meet the Claims Resolution condition, then generate refusal Claims Resolution response, refusal Claims Resolution response is returned
It is back to the user.
Device provided in an embodiment of the present invention obtains target electronic disease when user's request is settled a claim in block chain
It goes through and target is insured information, and whether the assessment of the intelligent contract based on block chain target electronic case history meets Claims Resolution condition,
It settles a claim in the case where meeting Claims Resolution condition to user, using the characteristic of block chain decentralization, not only ensure that storage mesh
Mark the safety of electronic health record, it is ensured that the transparency of evaluation process and process of settling a claim, confidentiality is preferable, avoid data quilt
It distorts, the risk that reduction fund is stolen.
It should be noted that each function involved by a kind of Claims Resolution device for mutual insurance provided in an embodiment of the present invention
Other corresponding descriptions of unit, can be with reference to the corresponding description in Fig. 1 and Fig. 2A to Fig. 2 B, and details are not described herein.
In the exemplary embodiment, referring to fig. 4, a kind of equipment is additionally provided, which includes communication bus, processing
Device, memory and communication interface, can also include, input/output interface and display equipment, wherein can between each functional unit
To complete mutual communication by bus.The memory is stored with computer program, processor, for executing institute on memory
The program of storage executes the Claims Resolution method for mutual insurance in above-described embodiment.
A kind of computer readable storage medium, is stored thereon with computer program, and the computer program is held by processor
The step of described Claims Resolution method for mutual insurance is realized when row.
Through the above description of the embodiments, those skilled in the art can be understood that the application can lead to
Hardware realization is crossed, the mode of necessary general hardware platform can also be added to realize by software.Based on this understanding, this Shen
Technical solution please can be embodied in the form of software products, which can store in a non-volatile memories
In medium (can be CD-ROM, USB flash disk, mobile hard disk etc.), including some instructions are used so that a computer equipment (can be
Personal computer, server or network equipment etc.) execute method described in each implement scene of the application.
It will be appreciated by those skilled in the art that the accompanying drawings are only schematic diagrams of a preferred implementation scenario, module in attached drawing or
Process is not necessarily implemented necessary to the application.
It will be appreciated by those skilled in the art that the module in device in implement scene can be described according to implement scene into
Row is distributed in the device of implement scene, can also be carried out corresponding change and is located at the one or more dresses for being different from this implement scene
In setting.The module of above-mentioned implement scene can be merged into a module, can also be further split into multiple submodule.
Above-mentioned the application serial number is for illustration only, does not represent the superiority and inferiority of implement scene.
Disclosed above is only several specific implementation scenes of the application, and still, the application is not limited to this, Ren Heben
What the technical staff in field can think variation should all fall into the protection scope of the application.
Claims (10)
1. a kind of Claims Resolution method for mutual insurance characterized by comprising
When the Claims Resolution for receiving user is requested, according to the user identifier that the Claims Resolution request carries, mesh is obtained in block chain
Mark electronic health record and target are insured information；
Determine that the insured items target insured information includes, the intelligence based on the insured items in the block chain are closed
About, the target electronic case history is assessed, the intelligence contract defines the Claims Resolution condition of the insured items；
If the intelligent contract assessment target electronic case history based on the insured items in the block chain meets described
Claims Resolution condition calculates amount for which loss settled then based on the intelligent contract；
Determine the Claims Resolution account of the user identifier instruction, the monetary transmissions that the amount for which loss settled is indicated to the Claims Resolution account
Family.
2. the method according to claim 1, wherein it is described when receive user Claims Resolution request when, according to institute
The user identifier that Claims Resolution request carries is stated, target electronic case history and target are obtained in block chain and is insured before information, comprising:
The request of insuring for receiving the user extracts the insured items and the user identifier in the request of insuring；
The target electronic case history for obtaining the user identifier instruction, determines the rule of insuring of the insured items, is based on the throwing
Rule is protected to audit the target electronic case history；
If the requirement that the target electronic case history meets the rule of insuring is audited, using the insured items as the mesh
Information of insuring is marked, the target is insured, and information is corresponding with the user identifier to be stored into the block chain；
If auditing the requirement that the target electronic case history does not meet the rule of insuring, failed regeneration response, by the mistake
It loses response and is back to the user.
3. the item of insuring that information the includes the method according to claim 1, wherein determination target is insured
Mesh, the intelligent contract based on the insured items in the block chain, assesses the target electronic case history, comprising:
Information reading is carried out to the target electronic case history, operation names and payment for medical care are extracted in the target electronic case history
With；
Based on the intelligent contract, assess the operation names and the medical expense whether the insured items Claims Resolution
In the range of condition regulation.
4. the method according to claim 1, wherein if described be based on the insured items in the block chain
In intelligent contract assess the target electronic case history and meet the Claims Resolution condition, then based on the intelligent contract, calculate Claims Resolution
The amount of money, comprising:
If the intelligent contract assessment target electronic case history based on the insured items in the block chain meets described
Claims Resolution condition determines at least one Claims Resolution section of the Claims Resolution condition then based on intelligent contract；
According to the medical expense that the target electronic case history includes, the payment for medical care is determined at least one described Claims Resolution section
With the target Claims Resolution section at place；
The corresponding target Claims Resolution coefficient in target Claims Resolution section is obtained, the target Claims Resolution coefficient and the medical expense are calculated
Product, using the product as amount for which loss settled.
5. the method according to claim 1, wherein if described be based on the insured items in the block chain
In intelligent contract assess the target electronic case history and meet the Claims Resolution condition, then based on the intelligent contract, calculate Claims Resolution
After the amount of money, comprising:
It determines and accesses other nodes of at least one of the block chain, the target electronic case history, the target are insured letter
Breath and the amount for which loss settled are broadcast at least one other node；
If receiving the confirmation response more than or equal to quantity threshold in preset duration, settle a claim to the user；
If not receiving the confirmation response more than or equal to quantity threshold in preset duration, re-execute above-mentioned according to
Target electronic case history and the target are insured the process that information is settled a claim.
6. the method according to claim 1, wherein the Claims Resolution account of determination user identifier instruction,
After the monetary transmissions that the amount for which loss settled is indicated to the Claims Resolution account, comprising:
Information is insured to the target electronic case history, the target and the amount for which loss settled arranges, and generates Claims Resolution record；
The Claims Resolution is recorded and is bound with the user identifier, and the Claims Resolution record after binding is marked with the user
Knowledge is stored into the block chain.
7. the method according to claim 1, wherein the method also includes:
If the intelligent contract based on the insured items in the block chain assesses the target electronic case history and does not meet institute
Claims Resolution condition is stated, then generates refusal Claims Resolution response, refusal Claims Resolution response is back to the user.
8. a kind of Claims Resolution device for mutual insurance characterized by comprising
Module is obtained, for the user identifier carried being requested according to the Claims Resolution, in area when the Claims Resolution for receiving user is requested
Target electronic case history and target is obtained in block chain to insure information；
Evaluation module, for determining the insured items target insured information includes, based on the insured items in the area
Intelligent contract in block chain assesses the target electronic case history, and the intelligence contract defines the insured items
Claims Resolution condition；
Computing module, if for assessing the target electronic based on intelligent contract of the insured items in the block chain
Case history meets the Claims Resolution condition, then based on the intelligent contract, calculates amount for which loss settled；
Transmission module, for determining the Claims Resolution account of the user identifier instruction, the monetary transmissions that the amount for which loss settled is indicated
To the Claims Resolution account.
9. a kind of equipment, including memory and processor, the memory are stored with computer program, which is characterized in that described
The step of processor realizes any one of claims 1 to 7 the method when executing the computer program.
10. a kind of readable storage medium storing program for executing, is stored thereon with computer program, which is characterized in that the computer program is processed
The step of device realizes method described in any one of claims 1 to 7 when executing.
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| CN201910122639.XA CN110009513A (en) | 2019-02-18 | 2019-02-18 | For Claims Resolution method, apparatus, equipment and the readable storage medium storing program for executing of mutual insurance |
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| CN201910122639.XA CN110009513A (en) | 2019-02-18 | 2019-02-18 | For Claims Resolution method, apparatus, equipment and the readable storage medium storing program for executing of mutual insurance |
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