CN110223740A - Medical insurance, which is closed the account, cooperates with check system and method - Google Patents
Medical insurance, which is closed the account, cooperates with check system and method Download PDFInfo
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- CN110223740A CN110223740A CN201810176051.8A CN201810176051A CN110223740A CN 110223740 A CN110223740 A CN 110223740A CN 201810176051 A CN201810176051 A CN 201810176051A CN 110223740 A CN110223740 A CN 110223740A
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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
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- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
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- G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
- G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
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Abstract
The present invention, which provides a kind of medical insurance and closes the account, cooperates with check system and method, and the method comprising the steps of: obtaining the medical information that patient generates during diagnosis and treatment from the HIS system of hospital's end server；Medical information is compressed and encrypts and hospital's end server will be back to；The medical information for obtaining patient from HIS system calculates the first medical insurance billing information as the first medical data；It is numbered according to the first medical insurance billing information with hospital and generates the first medical insurance checkout code；Medical encryption data is obtained from hospital's end server and decryption obtains the second medical data to calculate the second medical insurance billing information；It is numbered according to the second medical insurance billing information with hospital and generates the second medical insurance checkout code；When the first medical insurance checkout code is consistent with the second medical insurance checkout code, authorization hospital end server carries out medical insurance clearing to patient.The present invention realizes that hospital cooperates with reconciliation with region HI center, can not only prevent human error and hospital from covering and protect phenomenon, and can reduce the data storage capacity of region HI center.
Description
Technical field
The present invention relates to the technical field of medical information more particularly to a kind of medical insurance close the account cooperate with check system and
Method.
Background technique
The guarantee for implement of the basic medical insurance basic diagnosis and treatment demand of the people is for compensation labourer because disease risks are made
At economic loss and a social security system establishing, with the gradual perfection of basic medical insurance, people need health
That asks steps up, and meets the needs of particularly serious Disease, more and more insured medical insurances of people.But in medical insurance
While high speed development, medical insurance industry is also faced with the difficulties such as supervision is inadequate, regional development is unbalance, innovative deficiency
Topic.
Medical insurance in hospital information system (Hospital Information system, hereinafter referred to as HIS system) connects
Mouthful, function is that the essential information, diagnostic message, cost details of patient in hospital are uploaded to HI center, and by medical insurance
The heart returns to accurately every billing information, such as: total cost is submitted an expense account, bill payment expense, out-of-pocket expenses.Hospital
If it is accurate for settling accounts and submit an expense account all strictly according to the facts according to the checkout amount of money to charge；If hospital stealthily carries out checkout data
Working process, so that it may carry out set guarantor.Currently, existing medical insurance interface is arranged in the lane database of medical institutions, human error or
It is phenomena such as can modifying intentionally to the checkout amount of money, human error and medical institutions set guarantor can not be prevented.
Currently, in HI center when settling accounts medical insurance, it usually needs the medical information of each hospital to be uploaded to
HI center, therefore the server of HI center needs to store the medical information data of magnanimity, it is hard to the server of HI center
Part resource requirement is very high, such as needs the database and high performance processor of large storage capacity, could quickly handle sea
The medical insurance account settlement business of amount.However, medical insurance server medical insurance account settlement business be easy to cause blocking very with the surge of medical data
To paralysis, to influence normal medical insurance account settlement business.Further, since simultaneously compression processing is not encrypted to medical information,
Medical information is easy to be distorted by other people, to not can avoid the case where set is protected.
Summary of the invention
It closes the account the main purpose of the present invention is to provide a kind of medical insurance and cooperates with check system and method, can be realized doctor
Institute cooperates with reconciliation when carrying out medical insurance clearing with region HI center, not only mitigates the data storage capacity of region HI center,
And it prevents human error and hospital from covering and protects phenomenon.
To achieve the above object, the present invention, which provides a kind of medical insurance and closes the account, cooperates with check system, installs and runs on doctor
It protects in server, which is connect by communication network with one or more hospitals end server communication, the medical insurance knot
It includes computer program instructions that calculation expense, which cooperates with check system, which includes medical insurance database, is adapted for carrying out calculating
The processor of machine program instruction and the memory suitable for storing computer program instructions, the computer program instructions are by handling
Device loads and executes following steps: obtaining the medical treatment that patient generates during diagnosis and treatment from the HIS system of hospital's end server in real time
Information；The medical information of patient is subjected to compression and is encrypted to medical encryption data, and medical encryption data is back to hospital end
The medical data base of server；When medical insurance server receives the medical insurance settlement request of patient, settled accounts according to the medical insurance of patient
Request the medical information for obtaining patient from HIS system as the first medical data, and according to being stored in patient in medical insurance database
Medical insurance clearing standard and the first medical data calculate the first medical insurance billing information of patient；The first medical insurance of patient is settled accounts
Information is combined together and by hash algorithm encryption with hospital's number as the first medical insurance checkout code；From hospital's end server
Medical data base obtains the medical encryption data of patient, and medical encryption data is decrypted to obtain the second medical number of patient
According to；The second medical insurance billing information of patient is calculated according to the medical insurance clearing standard of patient and the second medical data；By the of patient
Two medical insurance billing informations are combined together and by hash algorithm encryption with hospital's number as the second medical insurance checkout code；Judge
Whether one medical insurance checkout code and the second medical insurance checkout code are consistent；When the first medical insurance checkout code is consistent with the second medical insurance checkout code,
It sends medical insurance clearing authorized order and medical insurance clearing is carried out to patient for hospital to hospital's end server.
Preferably, the computer program instructions also execute the following steps: the medical insurance knot according to patient by processor load
It calculates request and whether has medical insurance clearing qualification in medical insurance database lookup patient；When patient does not have medical insurance clearing qualification, eventually
Only patient's medical insurance clearing and feedback message to hospital's end server inform that patient does not have medical insurance clearing qualification.
Preferably, the computer program instructions are also executed the following steps: by processor load when the first medical insurance checkout code
When inconsistent with the second medical insurance checkout code, generate medical insurance clearing exception information and be sent to hospital's end server notice hospital operation
Personnel verify the medical information in HIS system；It is automatic to the first medical insurance billing information according to the second medical insurance billing information of patient
Data correction is carried out, and revised first medical insurance billing information is saved into the HIS system of hospital.
Preferably, the computer program instructions are also executed the following steps: by processor load when the first medical insurance checkout code
When inconsistent with the second medical insurance checkout code, the first medical insurance billing information of patient and two groups of expenses of the second medical insurance billing information are compared
With differences, and the two groups of expense variance items that will be present are marked；It is existing to there are such two groups of expense variances for multiplicating
The hospital of elephant terminates the hospital and carries out medical insurance clearing, which is included in the abnormal list in medical insurance database, and to region
HI center reminds the hospital that there are the operations that medical insurance set is protected.
Preferably, the medical information includes hospital's number, the personal essential information of patient, medical expense title, medical treatment
Fee Amount, medical expense generation time and operator's name information.
On the other hand, it closes the account the present invention also provides a kind of medical insurance and cooperates with method of calibration, be applied in medical insurance server,
The medical insurance server is connect by communication network with one or more hospitals end server communication, which includes medical insurance
Database, this method comprises the following steps: obtaining what patient generated during diagnosis and treatment from the HIS system of hospital's end server in real time
Medical information；The medical information of patient is subjected to compression and is encrypted to medical encryption data, and medical encryption data is back to doctor
The medical data base of institute's end server；When medical insurance server receives the medical insurance settlement request of patient, according to the medical insurance of patient
Settlement request obtains the medical information of patient as the first medical data from HIS system, and according to being stored in medical insurance database
The medical insurance clearing standard and the first medical data of patient calculates the first medical insurance billing information of patient；By the first medical insurance of patient
Billing information is combined together and by hash algorithm encryption with hospital's number as the first medical insurance checkout code；It is serviced from hospital end
The medical data base of device obtains the medical encryption data of patient, and medical encryption data is decrypted to obtain the second doctor of patient
Treat data；The second medical insurance billing information of patient is calculated according to the medical insurance clearing standard of patient and the second medical data；By patient
The second medical insurance billing information and hospital number be combined together and the second medical insurance checkout code become by hash algorithm encryption；Sentence
Whether disconnected first medical insurance checkout code and the second medical insurance checkout code are consistent；When the first medical insurance checkout code is consistent with the second medical insurance checkout code
When, medical insurance clearing authorized order is sent to hospital's end server, and medical insurance clearing are carried out to patient for hospital.
Preferably, it further includes following steps that the medical insurance, which closes the account and cooperates with method of calibration: according to the medical insurance knot of patient
It calculates request and whether has medical insurance clearing qualification in medical insurance database lookup patient；When patient does not have medical insurance clearing qualification, eventually
Only patient's medical insurance clearing and feedback message to hospital's end server inform that patient does not have medical insurance clearing qualification.
Preferably, it further includes following steps that the medical insurance, which closes the account and cooperates with method of calibration: when the first medical insurance checkout code
When inconsistent with the second medical insurance checkout code, generate medical insurance clearing exception information and be sent to hospital's end server notice hospital operation
Personnel verify the medical information in HIS system；It is automatic to the first medical insurance billing information according to the second medical insurance billing information of patient
Data correction is carried out, and revised first medical insurance billing information is saved into the HIS system of hospital.
Preferably, it further includes following steps that the medical insurance, which closes the account and cooperates with method of calibration: when the first medical insurance checkout code
When inconsistent with the second medical insurance checkout code, the first medical insurance billing information of patient and two groups of expenses of the second medical insurance billing information are compared
With differences, and the two groups of expense variance items that will be present are marked；It is existing to there are such two groups of expense variances for multiplicating
The hospital of elephant terminates the hospital and carries out medical insurance clearing, which is included in the abnormal list in medical insurance database, and to region
HI center reminds the hospital that there are the operations that medical insurance set is protected.
Preferably, the medical information includes hospital's number, the personal essential information of patient, medical expense title, medical treatment
Fee Amount, medical expense generation time and operator's name information.
Compared to the prior art, medical insurance of the present invention, which is closed the account, cooperates with check system and method to utilize medical data base
Medical encryption data and HIS system in medical data generate respectively the first medical insurance checkout code and the second medical insurance settle accounts code, and
The consistency of two groups of medical insurance checkout codes is compared, when two groups of medical insurance checkout codes are inconsistent, hospital's billing information is carried out
Disbursement and sattlement is carried out after data correction, is reduced the artificial medical insurance that participates in and is submitted an expense account process, has reached hospital and region HI center
It carries out cooperateing with the effect of reconciliation when medical insurance clearing, to prevent human error or can repair the checkout amount of money intentionally
The generation for phenomena such as changing, preventing human error and medical institutions set guarantor.In addition, the present invention encrypts the medical information of patient
It compresses and disperses in the medical data base for being stored in each hospital, the data for alleviating the medical insurance server of region HI center are deposited
Reserves, and medical insurance expense clearing speed can be accelerated, to ensure that the normal operation of medical insurance account settlement business.
Detailed description of the invention
Fig. 1 is that medical insurance of the present invention closes the account and cooperates with the application environment schematic diagram of check system preferred embodiment；
Fig. 2 is that the medical insurance of Fig. 1 closes the account and cooperates with the functional block diagram of check system；
Fig. 3 is that medical insurance of the present invention closes the account and cooperates with the flow chart of the preferred embodiment of method of calibration；
The embodiments will be further described with reference to the accompanying drawings for the realization, the function and the advantages of the object of the present invention.
Specific embodiment
It is of the invention to reach the technical means and efficacy that predetermined goal of the invention is taken further to illustrate, below in conjunction with
Attached drawing and preferred embodiment, to a specific embodiment of the invention, structure, feature and its effect, detailed description are as follows.It should manage
Solution, the specific embodiments described herein are merely illustrative of the present invention, is not intended to limit the present invention.
Shown in referring to Fig.1, Fig. 1 is that medical insurance of the present invention closes the account and cooperates with the application environment of the preferred embodiment of check system
Schematic diagram.In the present embodiment, the medical insurance, which is closed the account, cooperates with check system 10 to install and operates in medical insurance server 1, should
Medical insurance server 1 carries out information communication by communication network 3 and one or more hospitals end server 2, such as cures from each
Institute's end server 2 receives medical information of the patient during hospital's diagnosis and treatment.The communication network 3 can for Wi-Fi (such as
The telecommunication networks such as GPRS, WIFI, Bluetooth) or interconnection world-wide web (such as the networks such as Internet).
The medical insurance server 1 is that a kind of mass computing in region HI center (such as area medical mechanism) is arranged
Machine, server, cloud platform server etc. have the cloud computing device of data processing and communication function.The medical insurance server 1 is used
In receiving medical information of the patient sent from hospital's end server 2 during hospital's diagnosis and treatment, by the medical information of patient into
Row ciphered compressed is at medical encryption data and is back to hospital's end server 2 and is saved, and generates medical insurance clearing authorization and refer to
It enables and is sent to hospital's end server 2 to authorize hospital to carry out medical insurance clearing for patient.
In the present embodiment, the medical insurance server 1 is include but are not limited to, and medical insurance, which is closed the account, cooperates with check system
10, suitable for storing the memory 11 of a plurality of computer program instructions, the processor 12 for executing various computer program instructions, communicating
Unit 13 and medical insurance database 14.The memory 11 can be a kind of read only memory ROM, and random access memory ram, electricity can
Flash memory EEPROM, flash memory FLASH, disk or CD etc..The processor 12 is a kind of central processing unit
(CPU), microcontroller (MCU), data processing chip or information process unit having data processing function.The communication
Unit 13 be a kind of wired or wireless communication interface with remote communicating function, for example, support GSM, GPRS, WCDMA,
The communication interface of the mechanicss of communication such as CDMA, WIFI, bluetooth (Bluetooth).The medical insurance database 14 is for storing patient's
The doctor of essential information (including information such as personal name, identification card number, age, gender, home address, telephone numbers) and patient
Protect clearing standard (such as the medical insurance amount of money, grade of insuring, medical insurance clearing information such as project and the amount of money).
In the present embodiment, hospital end server 2 is mainframe computer, the server, cloud in a kind of setting hospital
Platform Server etc. has the cloud computing device of data processing and communication function.Each hospital is arranged a hospital end and services
Device 2, each hospital's end server 2 are include but are not limited to, HIS system (medical institutions' information system) 21 and medical number
According to library 22.The HIS system 21 is for managing the medical information that each patient generates during the hospitalize, the medical treatment
When information includes hospital's number, the generation of the personal essential information of patient, medical expense title, the medical expense amount of money, medical expense
Between and the information such as operator's name.The medical data base 22 controls patient in hospital for saving the medical insurance server 1
The medical information encryption generated during treatment and compressed medical encryption data.
As shown in Fig. 2, Fig. 2 is that medical insurance of the present invention closes the account and cooperates with the functional block diagram of check system.In the present embodiment
In, the medical insurance, which is closed the account, cooperates with check system 10 to be made of the program module that various computer program instructions form, including
But it is not limited to, medical information acquisition module 101, medical information processing module 102, the first medical insurance settlement module 103, second doctor
Protect settlement module 104 and medical insurance correction verification module 105.The so-called module of the present invention refers to that one kind can be by medical insurance server
1 processor 12 executes and can complete the series of computation machine program instruction section of fixed function, is stored in medical insurance service
In the memory 11 of device 1, the concrete function of each module is illustrated below in conjunction with Fig. 1 and Fig. 3.
Refering to what is shown in Fig. 3, being that medical insurance of the present invention closes the account and cooperates with the flow chart of the preferred embodiment of method of calibration.At this
In embodiment, the medical insurance, which is closed the account, cooperates with the various method and steps of method of calibration to realize by computer software programs,
The computer software programs are stored in computer readable storage medium (such as medical insurance server in the form of computer program instructions
1 memory 11) in, computer readable storage medium may include: read-only memory, random access memory, disk or CD etc.,
The computer program instructions can be loaded by processor (such as processor 12 of medical insurance server 1) and execute following steps
S31 to step S41.
Step S31 obtains the medical information that patient generates during hospital's diagnosis and treatment from the HIS system of hospital in real time；Specifically
Ground, medical information acquisition module 101 acquire patient from the HIS system 21 of each hospital end server 2 by communication unit 13 and exist
The medical information generated during diagnosis and treatment, the medical information include hospital's number, the personal essential information of patient, medical expense name
The information such as title, the medical expense amount of money, medical expense generation time and operator's name.
The medical information of patient is carried out compression and is encrypted to medical encryption data, and medical encryption data is returned by step S32
Reach the medical data base of hospital；Specifically, medical information processing module 102 using Encryption Algorithm by the medical information of patient into
Row compression is encrypted to medical encryption data, and medical encryption data is back to hospital's end server 2 and is stored in medical data
In library 21.In the present embodiment, the Encryption Algorithm includes, but are not limited to data encryption standard algorithm (Data
Encryption Standard, DES), Advanced Encryption Standardalgorithm (Advanced Encryption Standard, AES) with
And RSA public key algorithm etc..Medical information is carried out ciphered compressed by medical information processing module 102 and dispersed by the present invention
It is stored in the medical data base 22 of each hospital, not only alleviates the data storage of the medical insurance server 1 of region HI center
Amount guarantees the normal operation of medical insurance account settlement business, and can prevent each to accelerate medical insurance expense clearing speed
Situation caused by the medical data in HIS system 21 in hospital is artificially distorted or made mistakes etc. occur, prevent human error and
The generation for phenomena such as medical institutions' set is protected.
Step S33 judges whether the medical insurance settlement request for receiving patient；Specifically, the first medical insurance settlement module 103 is logical
Cross whether monitoring medical insurance server 1 receives patient's medical insurance settlement request to judge whether patient carries out medical insurance clearing.Work as medical insurance
When server 1 receives patient's medical insurance settlement request of the transmission of hospital's end server 2, the first medical insurance settlement module 103, which determines, to be suffered from
Person needs to carry out medical insurance clearing.If medical insurance server 1 receives the medical insurance settlement request of patient, process turns to step S34；If doctor
The medical insurance settlement request that server 1 is not received by patient is protected, then process terminates.In the present embodiment, mould is settled accounts in the first medical insurance
Whether block 103 searches patient in medical insurance database 14 also according to the medical insurance settlement request (identification card number including patient) of patient
Has medical insurance clearing qualification.When patient does not have medical insurance clearing qualification, patient's medical insurance clearing and feedback message are terminated to hospital
End server 2 informs that patient does not have medical insurance clearing qualification；When patient has medical insurance clearing qualification, process continues step S34.
Step S34 obtains the medical information of patient as the from the HIS system of hospital according to the medical insurance settlement request of patient
One medical data, and believed according to the first medical insurance checkout that the medical insurance clearing standard of patient and the first medical data calculate patient
Breath；Specifically, the first medical insurance settlement module 103 obtains patient from the HIS system 21 of hospital according to the medical insurance settlement request of patient
Medical information as the first medical data, and the medical insurance clearing standard of patient and the first medical data calculate the first of patient
Medical insurance billing information.In the present embodiment, the medical insurance clearing standard of the patient is the doctor by Medical Insurance Organizations according to patient
It treats the medical expense loan standard that underwriting standard is calculated simultaneously to be stored in medical insurance database 14, including the medical insurance amount of money, insures
The information such as project and the amount of money are settled accounts in grade, medical insurance.The first medical insurance billing information includes that patient generates during hospitalize
Medical expense title, the medical expense amount of money, the medical insurances detail such as medical expense generation time.
The first medical insurance billing information of patient and hospital's number are combined together and are added by hash algorithm by step S35
It is close to become the first medical insurance checkout code；Specifically, the first medical insurance settlement module 103 parses hospital's volume from the medical information of patient
Number, and the first medical insurance billing information of patient and hospital's number are combined together and the first doctor is become by hash algorithm encryption
Protect checkout code.In the present embodiment, the hospital numbers the unique identifying number of each hospital for identification.The hash algorithm
It is the safety that FIPS is authenticated for the secure hash algorithm (Secure Hash Algorithm, be abbreviated as SHA) of the prior art
Hashing algorithm, a kind of can calculate are arrived corresponding to a digital massage, the fixed character string (also known as eap-message digest) of length
Algorithm.The first medical insurance billing information of patient and hospital's number are combined together and are encrypted using hash algorithm by the present invention
For the prior art, the present embodiment does not do specifically repeat herein.
Step S36 obtains the medical encryption data of patient from the medical data base of hospital's end server, and encrypts to medical treatment
Data are decrypted to obtain the second medical data of patient；Specifically, the second medical insurance settlement module 104 is from hospital's end server 2
Medical data base 22 obtain the medical encryption data of patient, and the medical encryption data of patient is solved using decipherment algorithm
Close the second medical data for obtaining patient.In the present embodiment, the decipherment algorithm is the inverse enciphering and deciphering algorithm of Encryption Algorithm, because
This can correctly restore the medical information of patient.May artificially be distorted due to the medical information of HIS system 21 in hospital or
Fault causes mistake, therefore the present invention is restored using the medical encryption data in the medical data base 22 of hospital's end server 2
Accuracy of the medical data of patient as verification medical information out, so that reaching prevents human error or intentionally can be to doctor
The generation for phenomena such as protecting the checkout amount of money to modify, preventing human error and medical institutions set guarantor.
Step S37 settles accounts according to the second medical insurance that the medical insurance clearing standard of patient and the second medical data calculate patient
Information；Specifically, the second medical insurance settlement module 104 calculates patient according to the medical insurance clearing standard and the second medical data of patient
The second medical insurance billing information.In the present embodiment, the second medical insurance billing information also includes patient during hospitalize
The medical insurances details such as the medical expense title of generation, the medical expense amount of money, medical expense generation time.
The second medical insurance billing information of patient and hospital's number are combined together and are added by hash algorithm by step S38
It is close to become the second medical insurance checkout code；Specifically, the second medical insurance settlement module 104 is by the second medical insurance billing information of patient and hospital
Number is combined together and becomes the second medical insurance checkout code by hash algorithm encryption.Similarly, the present invention will using hash algorithm
The second medical insurance billing information of patient and hospital's number are combined together and be encrypted as the prior art, and the present embodiment is not done herein
Specifically repeat.
Step S39 judges whether the first medical insurance checkout code and the second medical insurance checkout code are consistent；Specifically, medical insurance school
Test module 105 using comparison algorithm will judge the first medical insurance checkout code and the second medical insurance settle accounts code it is whether consistent, verification two groups of marks
Whether consistent know code.The comparison algorithm is the whether identical algorithm of two character strings of comparison, simple and practical, for example including,
But it is not limited to, Equals method, Needleman-Wunsch algorithm, Smith-Waterman algorithm and LD algorithm
(Levenshtein Distance, LD).If the first medical insurance is settled accounts, code is consistent with the second medical insurance checkout code, and process executes step
S40；If the first medical insurance is settled accounts, code and the second medical insurance checkout code are inconsistent, and process executes step S41.
Step S40 sends medical insurance clearing authorized order to hospital's end server and carries out medical insurance clearing to patient for hospital；Tool
Body, medical insurance correction verification module 105 generates medical insurance clearing authorized order and is sent to the service of hospital end by communication unit 13
Device 2 come authorize hospital be patient carry out medical insurance clearing.
Step S41 generates medical insurance clearing exception information and is sent to hospital's end server notice hospital operation personnel and verifies
Medical information in HIS system；Specifically, medical insurance correction verification module 105 generates medical insurance clearing exception information and is sent to doctor
Institute's end server 2 notifies hospital operation personnel to verify and correct the medical information in HIS system 21.In the present embodiment, when
When one medical insurance checkout code and inconsistent the second medical insurance checkout code, medical insurance correction verification module 105 compares the first medical insurance knot of patient
Two groups of expense variance items of account information and the second medical insurance billing information, and the two groups of expense variance items that will be present are marked, example
Such as, expense variance item progress color is highlighted or the modes line flags such as font-weight is shown.Meanwhile medical insurance calibration mode
Block 105 carries out data correction to the first medical insurance billing information according to the second medical insurance billing information of patient automatically, and will be after amendment
The first medical insurance billing information save into the HIS system 14 of hospital.In addition, there is such abnormal phenomenon for multiplicating
Hospital, medical insurance correction verification module 105 terminates the hospital and carries out medical insurance clearing, and the hospital is included in medical insurance database 14
In abnormal list, and carry out reminding the hospital that there may be the improper operating conditions such as medical insurance set guarantor to region HI center.
Medical insurance provided by the embodiment of the present invention, which is closed the account, cooperates with check system and method using medical data base 22
Medical data in medical encryption data and HIS system 21 generates the first medical insurance checkout code and the second medical insurance checkout code respectively, and
The consistency of two groups of medical insurance checkout codes is compared, when two groups of medical insurance checkout codes are inconsistent, hospital's billing information is carried out
Disbursement and sattlement is carried out after data correction, is reduced the artificial medical insurance that participates in and is submitted an expense account process, has reached hospital and region HI center
It carries out cooperateing with the effect of reconciliation when medical insurance clearing, to prevent human error or can repair the checkout amount of money intentionally
The generation for phenomena such as changing, preventing human error and medical institutions set guarantor.In addition, the present invention encrypts the medical information of patient
It compresses and disperses to be stored in the medical data base 22 of each hospital, not only alleviate the medical insurance server 1 of region HI center
Data storage capacity, thus accelerate medical insurance expense clearing speed, guarantee medical insurance account settlement business normal operation, Er Qieke
Situation caused by prevent the medical data in the HIS system 21 in each hospital from artificially being distorted or being made mistakes etc. occurs, into one
Step prevents the generation of phenomena such as human error and medical institutions set guarantor.
It will be understood by those skilled in the art that all or part of the steps of various methods can pass through in above embodiment
Relative program instruction is completed, which can store in computer readable storage medium, and storage medium may include: read-only deposits
Reservoir, random access memory, disk or CD etc..
The above is only a preferred embodiment of the present invention, is not intended to limit the scope of the invention, all to utilize this hair
Equivalent structure or equivalent flow shift made by bright specification and accompanying drawing content is applied directly or indirectly in other relevant skills
Art field, is included within the scope of the present invention.
Claims (10)
1. a kind of medical insurance, which is closed the account, cooperates with check system, install and run in medical insurance server, which passes through
Communication network is connect with one or more hospitals end server communication, which is characterized in that the medical insurance, which is closed the account, cooperates with verification system
System includes computer program instructions, which includes medical insurance database, the processing for being adapted for carrying out computer program instructions
Device and the memory suitable for storing computer program instructions, the computer program instructions are loaded by processor and are executed as follows
Step:
The medical information that patient generates during diagnosis and treatment is obtained from the HIS system of hospital's end server in real time；
The medical information of patient is subjected to compression and is encrypted to medical encryption data, and medical encryption data is back to hospital end clothes
The medical data base of business device；
When medical insurance server receives the medical insurance settlement request of patient, obtained according to the medical insurance settlement request of patient from HIS system
Take the medical information of patient as the first medical data, and according to be stored in patient in medical insurance database medical insurance clearing standard and
First medical data calculates the first medical insurance billing information of patient；
The first medical insurance billing information of patient and hospital's number are combined together and the first doctor is become by hash algorithm encryption
Protect checkout code；
The medical encryption data of patient is obtained from the medical data base of hospital's end server, and medical encryption data is decrypted
Obtain the second medical data of patient；
The second medical insurance billing information of patient is calculated according to the medical insurance clearing standard of patient and the second medical data；
The second medical insurance billing information of patient and hospital's number are combined together and the second doctor is become by hash algorithm encryption
Protect checkout code；
Judge whether the first medical insurance checkout code and the second medical insurance checkout code are consistent；
When the first medical insurance checkout code is consistent with the second medical insurance checkout code, sends medical insurance and settle accounts authorized order to hospital's end server
Medical insurance clearing are carried out to patient for hospital.
2. medical insurance as described in claim 1, which is closed the account, cooperates with check system, which is characterized in that the computer program instructions
It is also executed the following steps: by processor load
Whether has medical insurance clearing qualification in medical insurance database lookup patient according to the medical insurance settlement request of patient；
When patient does not have medical insurance clearing qualification, terminates patient's medical insurance clearing and feedback message is informed to hospital's end server and suffered from
Person does not have medical insurance clearing qualification.
3. medical insurance as described in claim 1, which is closed the account, cooperates with check system, which is characterized in that the computer program instructions
It is also executed the following steps: by processor load
When code and inconsistent the second medical insurance checkout code are settled accounts in the first medical insurance, generates medical insurance clearing exception information and be sent to hospital
Server notice hospital operation personnel are held to verify the medical information in HIS system；
Data correction is carried out automatically to the first medical insurance billing information according to the second medical insurance billing information of patient, and will be revised
First medical insurance billing information is saved into the HIS system of hospital.
4. medical insurance as described in claim 1, which is closed the account, cooperates with check system, which is characterized in that the computer program instructions
It is also executed the following steps: by processor load
When code and inconsistent the second medical insurance checkout code are settled accounts in the first medical insurance, the first medical insurance billing information and second of patient is compared
Two groups of expense variance items of medical insurance billing information, and the two groups of expense variance items that will be present are marked；
There is the hospital of such two groups of expense variance phenomenons for multiplicating, terminates the hospital and carry out medical insurance clearing, by the doctor
Institute is included in the abnormal list in medical insurance database, and reminds the hospital that there are the operations that medical insurance set is protected to region HI center.
5. cooperateing with check system as the described in any item medical insurances of Claims 1-4 are closed the account, which is characterized in that the medical treatment
When information includes hospital's number, the generation of the personal essential information of patient, medical expense title, the medical expense amount of money, medical expense
Between and operator's name information.
6. a kind of medical insurance, which is closed the account, cooperates with method of calibration, it is applied in medical insurance server, which passes through communication network
Network is connect with one or more hospitals end server communication, which includes medical insurance database, which is characterized in that the party
Method includes the following steps:
The medical information that patient generates during diagnosis and treatment is obtained from the HIS system of hospital's end server in real time；
The medical information of patient is subjected to compression and is encrypted to medical encryption data, and medical encryption data is back to hospital end clothes
The medical data base of business device；
When medical insurance server receives the medical insurance settlement request of patient, obtained according to the medical insurance settlement request of patient from HIS system
Take the medical information of patient as the first medical data, and according to be stored in patient in medical insurance database medical insurance clearing standard and
First medical data calculates the first medical insurance billing information of patient；
The first medical insurance billing information of patient and hospital's number are combined together and the first doctor is become by hash algorithm encryption
Protect checkout code；
The medical encryption data of patient is obtained from the medical data base of hospital's end server, and medical encryption data is decrypted
Obtain the second medical data of patient；
The second medical insurance billing information of patient is calculated according to the medical insurance clearing standard of patient and the second medical data；
The second medical insurance billing information of patient and hospital's number are combined together and the second doctor is become by hash algorithm encryption
Protect checkout code；
Judge whether the first medical insurance checkout code and the second medical insurance checkout code are consistent；
When the first medical insurance checkout code is consistent with the second medical insurance checkout code, sends medical insurance and settle accounts authorized order to hospital's end server
Medical insurance clearing are carried out to patient for hospital.
7. medical insurance as claimed in claim 6, which is closed the account, cooperates with method of calibration, which is characterized in that this method further includes walking as follows
It is rapid:
Whether has medical insurance clearing qualification in medical insurance database lookup patient according to the medical insurance settlement request of patient；
When patient does not have medical insurance clearing qualification, terminates patient's medical insurance clearing and feedback message is informed to hospital's end server and suffered from
Person does not have medical insurance clearing qualification.
8. medical insurance as claimed in claim 6, which is closed the account, cooperates with method of calibration, which is characterized in that this method further includes walking as follows
It is rapid:
When code and inconsistent the second medical insurance checkout code are settled accounts in the first medical insurance, generates medical insurance clearing exception information and be sent to hospital
Server notice hospital operation personnel are held to verify the medical information in HIS system；
Data correction is carried out automatically to the first medical insurance billing information according to the second medical insurance billing information of patient, and will be revised
First medical insurance billing information is saved into the HIS system of hospital.
9. medical insurance as claimed in claim 6, which is closed the account, cooperates with method of calibration, which is characterized in that this method further includes walking as follows
It is rapid:
When code and inconsistent the second medical insurance checkout code are settled accounts in the first medical insurance, the first medical insurance billing information and second of patient is compared
Two groups of expense variance items of medical insurance billing information, and the two groups of expense variance items that will be present are marked；
There is the hospital of such two groups of expense variance phenomenons for multiplicating, terminates the hospital and carry out medical insurance clearing, by the doctor
Institute is included in the abnormal list in medical insurance database, and reminds the hospital that there are the operations that medical insurance set is protected to region HI center.
10. cooperateing with method of calibration as the described in any item medical insurances of claim 6 to 9 are closed the account, which is characterized in that the medical treatment
When information includes hospital's number, the generation of the personal essential information of patient, medical expense title, the medical expense amount of money, medical expense
Between and operator's name information.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201810176051.8A CN110223740A (en) | 2018-03-02 | 2018-03-02 | Medical insurance, which is closed the account, cooperates with check system and method |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201810176051.8A CN110223740A (en) | 2018-03-02 | 2018-03-02 | Medical insurance, which is closed the account, cooperates with check system and method |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN110223740A true CN110223740A (en) | 2019-09-10 |
Family
ID=67822106
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201810176051.8A Pending CN110223740A (en) | 2018-03-02 | 2018-03-02 | Medical insurance, which is closed the account, cooperates with check system and method |
Country Status (1)
| Country | Link |
|---|---|
| CN (1) | CN110223740A (en) |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112348500A (en) * | 2020-11-11 | 2021-02-09 | 武汉默联股份有限公司 | Closed-loop management method for medical payment |
| CN112667645A (en) * | 2021-01-22 | 2021-04-16 | 北京天健源达科技股份有限公司 | Method for processing sent medicine record |
-
2018
- 2018-03-02 CN CN201810176051.8A patent/CN110223740A/en active Pending
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112348500A (en) * | 2020-11-11 | 2021-02-09 | 武汉默联股份有限公司 | Closed-loop management method for medical payment |
| CN112667645A (en) * | 2021-01-22 | 2021-04-16 | 北京天健源达科技股份有限公司 | Method for processing sent medicine record |
| CN112667645B (en) * | 2021-01-22 | 2024-06-07 | 北京天健源达科技股份有限公司 | Method for processing issued records |
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Application publication date: 20190910 |
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| WD01 | Invention patent application deemed withdrawn after publication |