CN110517050A - A kind of medical insurance, which instead cheats to exchange, encodes digging system and method - Google Patents
A kind of medical insurance, which instead cheats to exchange, encodes digging system and method Download PDFInfo
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- CN110517050A CN110517050A CN201910741147.9A CN201910741147A CN110517050A CN 110517050 A CN110517050 A CN 110517050A CN 201910741147 A CN201910741147 A CN 201910741147A CN 110517050 A CN110517050 A CN 110517050A
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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
- G06Q30/00—Commerce
- G06Q30/018—Certifying business or products
- G06Q30/0185—Product, service or business identity fraud
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/08—Insurance
Abstract
It instead cheats to exchange the invention discloses a kind of medical insurance and encodes digging system and method, act on the first character type catalogue and the second character type catalogue, system includes that sequentially connected data input module, data scrubbing module, diversity factor Fraction Model module and excavation are exchanged coding module, method includes: the first character type catalogue and the second character type catalogue in S1. cleaning clearing detailed data, forms new the first character type catalogue and the second character type catalogue；S2. the diversity factor Fraction Model between the first character type catalogue and the second character type catalogue is established；S3. medical item coding scenarios of exchanging are excavated.Medical insurance settlement information detailed data amount is very big, cause analyse whether exist exchange coding scenarios when, it is difficult to carry out the analysis of efficiently and accurately, present invention excavation Cost of Medical Treatment project code method and system of exchanging efficiently solves the problems, such as this, and system and method has been used and cheated in upgrading synergy project medical insurance is counter at present.
Description
Technical field
It instead cheats to exchange the invention belongs to Data Management Analysis technical field more particularly to a kind of medical insurance and encodes digging system
And method.
Background technique
National medical insurance office issued " notification that medical insurance fund typical case is defrauded of in fraud about 8 ", notification in 2019
A lot of cases for being related to gaining medical insurance fund by the modes such as Cost of Medical Treatment project of exchanging by cheating.Designated medical organization, fixed point retail medicine
The means by drug of exchanging, instrument, diagnosis and treatment item such as shop and insurant, more note medical insurance Project Costs, it has also become maliciously deceive
Take one of the main means of medical insurance fund.In medical insurance settlement system database, the medical clearing detail record of each all can band
There are " hospital charge project name " and corresponding " the big directory name of medical insurance three " the two fields." hospital charge project name " is
It is used to record the medical used Cost of Medical Treatment project of patient inside each medical service organ." the big directory name of medical insurance three " packet
Basic medical insurance Drug catalogue, diagnosis and treatment item catalogue, medical services facility standard have been included, has been that country is protected for guarantee basic medical
The health operation of dangerous system is prepared, wherein Class A, Class B Cost of Medical Treatment project are be directly brought into allowable range or part
It is included in allowable range.Audit medical insurance fund with whether specification when, medical insurance settle accounts detail record data volume it is often non-
Chang great, leads to be difficult to analyze the big directory name of medical insurance three and whether hospital charge project name exchanges situation.Existing excavation string
Medical insurance can be settled accounts detailed data progress data mining by changing Cost of Medical Treatment project code method, this is domestic first for knowledge
The data analysing method and system for medical insurance charging item of not exchanging, and obtained typically exchange Class A, Class B Cost of Medical Treatment
Project code situation.But since the various regions quality of data is different, poor for some qualities of data area it is off-gauge but often
The medical item coding scenarios of exchanging seen, it is also necessary to carry out artificial treatment, be determined after medicine audit, constantly expand case model of exchanging
It encloses.CN107145587A discloses a kind of anti-fake system of medical insurance excavated based on big data, it includes following subsystem: data
It extracts, conversion, load subsystem, big data storage subsystem, data mining subsystem, rule base and knowledge base subsystem, reality
Shi Liuji Operator Systems and visual subsystem, the data pick-up, conversion, load subsystem and big data storage subsystem connect
It connects, big data storage subsystem is connect with data mining subsystem, data mining subsystem and rule base and knowledge base subsystem
Connection, rule base and knowledge base subsystem are connect with real-time streams subsystem, big data storage subsystem, rule base and knowledge base
System and real-time streams computing subsystem are connect with visual subsystem respectively again.Above system internal structure and dispatching algorithm are multiple
It is miscellaneous, it is not suitable for this case.
Summary of the invention
Digging system and method are encoded in view of this, instead cheating to exchange the object of the present invention is to provide a kind of medical insurance, with solution
Deficiency certainly in the prior art.
In order to achieve the above object, the purpose of the present invention is be achieved through the following technical solutions:
On the one hand, a kind of medical insurance be provided instead cheat to exchange and encode digging system, wherein act on the first character type catalogue and
Second character type catalogue, including sequentially connected data input module, data scrubbing module, diversity factor Fraction Model module and digging
Coding module of exchanging is dug, the data input module is for receiving the first character type catalogue and the second character type catalogue
Title, the data scrubbing module include sequentially connected character conversion functionality block, character deletion functional block, character split function
Energy block, character ranking function block and data replacement function block, the diversity factor Fraction Model module is for establishing first word
Diversity factor Fraction Model between symbol type catalogue and the second character type catalogue, the coding module of exchanging that excavates includes data
Screening function block, data grouping functional block and data double check function block.
Above-mentioned medical insurance, which instead cheats to exchange, encodes digging system, wherein the diversity factor Fraction Model is based on first word
Levenstein distance between symbol type catalogue and the second character type catalogue is realized.
On the other hand, it a kind of medical insurance is provided instead cheats to exchange and encode method for digging, wherein it is realized based on such as above system,
Include:
S1. the first character type catalogue and the second character type catalogue in cleaning clearing detailed data, forms the first new word
Symbol type catalogue and the second character type catalogue；
S1.1 is respectively by the character in the first character type catalogue and the second character type catalogue in addition to Chinese, English, number
Be converted to space；
S1.2 will capitalize English respectively and be converted to small English in the first character type catalogue and the second character type catalogue；
S1.3 respectively removes the space of beginning and end in the first character type catalogue and the second character type catalogue；
First character type catalogue and the second character type catalogue are carried out character fractionation, shape by separator of space respectively by S1.4
At two character lists；
S1.5 will be split in the character lists formed after the first character type catalogue and the second character type directory characters respectively
Character is ranked up；
S1.6 is respectively by the character in the first character type catalogue and the second character type directory characters list after sequence with sky
Lattice form new the first character type catalogue and the second character type catalogue as connection, replace original the first character type catalogue and
Second character type catalogue；
S2. the clearing detailed data obtained after having operated to step S1, establishes the first character type catalogue and the second character
Diversity factor Fraction Model between type catalogue；
S2.1 calculates the Levenstein distance between the first character type catalogue and the second character type catalogue；
S2.2 calculates the Levenstein ratio between the first character type catalogue and the second character type catalogue, calculation formula are as follows:
S2.3 calculates the diversity factor score between the first character type catalogue and the second character type catalogue, and calculation formula is；
Diversity factor score=100* Levenstein ratio
S3. medical item coding scenarios of exchanging are excavated；
S3.1 screens medical treatment clearing detailed data, filters out the data that diversity factor score is less than empirical value；
S3.2 is grouped according to the first character type catalogue and the second character type catalogue, summarizes the medical expense amount of money；
S3.3 filters out the data that medical expense total amount is greater than empirical value；
S3.4 is screened according to Cost of Medical Treatment item types；
S3.5 checks the group of the first character type catalogue and the second character type catalogue, obtains medical item volume of exchanging
Code situation.
The beneficial effect of technical solution of the present invention includes:
Medical insurance settlement information detailed data amount is very big, cause analyse whether exist exchange coding scenarios when, be difficult into
The analysis of row efficiently and accurately, this excavation Cost of Medical Treatment project code method and system of exchanging efficiently solve the problems, such as this, mesh
Preceding system and method has been used and has been cheated in upgrading synergy project medical insurance is counter.
Detailed description of the invention
Fig. 1 is flow diagram of the present invention.
Specific embodiment
The present invention will be further explained below with reference to the attached drawings and specific examples, but not as the limitation of the invention.
Referring to shown in Fig. 1, the present invention, which provides a kind of medical insurance and instead cheats to exchange, encodes digging system, acts on the first character type
Catalogue and the second character type catalogue, including sequentially connected data input module, data scrubbing module, diversity factor fractional module pattern
Block and excavation are exchanged coding module, and data input module is used to receive the name of the first character type catalogue and the second character type catalogue
Claim, data scrubbing module includes sequentially connected character conversion functionality block, character deletion functional block, character fractionation functional block, word
Ranking function block and data replacement function block are accorded with, diversity factor Fraction Model module is for establishing the first character type catalogue and the second word
Diversity factor Fraction Model between symbol type catalogue, excavating coding module of exchanging includes data screening functional block, data grouping function
Block and data double check function block.
Preferably, diversity factor Fraction Model is based on the Levenstein between the first character type catalogue and the second character type catalogue
Distance is realized.
In addition, medical insurance of the present invention, which instead cheats to exchange, encodes method for digging based on such as above system realization, comprising:
S1. the first character type catalogue and the second character type catalogue in cleaning clearing detailed data, forms the first new word
Symbol type catalogue and the second character type catalogue；
S1.1 is respectively by the character in the first character type catalogue and the second character type catalogue in addition to Chinese, English, number
Be converted to space；
S1.2 will capitalize English respectively and be converted to small English in the first character type catalogue and the second character type catalogue；
S1.3 respectively removes the space of beginning and end in the first character type catalogue and the second character type catalogue；
First character type catalogue and the second character type catalogue are carried out character fractionation, shape by separator of space respectively by S1.4
At two character lists；
S1.5 will be split in the character lists formed after the first character type catalogue and the second character type directory characters respectively
Character is ranked up；
S1.6 is respectively by the character in the first character type catalogue and the second character type directory characters list after sequence with sky
Lattice form new the first character type catalogue and the second character type catalogue as connection, replace original the first character type catalogue and
Second character type catalogue；
S2. the clearing detailed data obtained after having operated to step S1, establishes the first character type catalogue and the second character
Diversity factor Fraction Model between type catalogue；
S2.1 calculates the Levenstein distance between the first character type catalogue and the second character type catalogue；
S2.2 calculates the Levenstein ratio between the first character type catalogue and the second character type catalogue, calculation formula are as follows:
S2.3 calculates the diversity factor score between the first character type catalogue and the second character type catalogue, and calculation formula is；
S3. medical item coding scenarios of exchanging are excavated；
S3.1 screens medical treatment clearing detailed data, filters out the data that diversity factor score is less than empirical value；
S3.2 is grouped according to the first character type catalogue and the second character type catalogue, summarizes the medical expense amount of money；
S3.3 filters out the data that medical expense total amount is greater than empirical value；
S3.4 is screened according to Cost of Medical Treatment item types；
S3.5 checks the group of the first character type catalogue and the second character type catalogue, obtains medical item volume of exchanging
Code situation.
In this case, the first character type catalogue is " hospital charge project name ", the second character type catalogue, that is, big mesh of medical insurance three
Record title.
When carrying out medical insurance fund fraud analysis of cases, Cost of Medical Treatment project code of exchanging is a kind of common insurance fraud row
For the meaning that this tool is encoded based on fuzzy matching algorithm and medical item establishes the big directory name of medical insurance three and hospital charge
The diversity factor Fraction Model of project name is exchanged situation for excavating Cost of Medical Treatment project in batches, scouts Cost of Medical Treatment mechanism string
The case for changing Cost of Medical Treatment project, be it is domestic it is first exchange the method and system of Cost of Medical Treatment project code for excavating medical insurance,
Typically exchange Class A, Class B Cost of Medical Treatment project code situation have been obtained, there is very big use value and meaning, it is subsequent also
The case of exchanging of the non-standard code in place is continuously replenished, with the accumulation of data, by all parts of the country exchanging encode case into
Row integration is significant.
The above is only preferred embodiments of the present invention, are not intended to limit the implementation manners and the protection scope of the present invention, right
For those skilled in the art, it should can appreciate that all with description of the invention
Diversity factor score=100* Levenstein ratio
And equivalent replacement made by diagramatic content and obviously change obtained scheme, this should all be included in
In the protection scope of invention.
Claims (3)
1. a kind of medical insurance, which instead cheats to exchange, encodes digging system, which is characterized in that act on the first character type catalogue and the second word
Symbol type catalogue, including sequentially connected data input module, data scrubbing module, diversity factor Fraction Model module and excavation are exchanged
Coding module, the data input module are used to receive the name of the first character type catalogue and the second character type catalogue
Claim, the data scrubbing module includes sequentially connected character conversion functionality block, character deletion functional block, character fractionation function
Block, character ranking function block and data replacement function block, the diversity factor Fraction Model module is for establishing first character
Diversity factor Fraction Model between type catalogue and the second character type catalogue, the coding module of exchanging that excavates includes data sieve
Select functional block, data grouping functional block and data double check function block.
2. medical insurance as described in claim 1, which instead cheats to exchange, encodes digging system, which is characterized in that the diversity factor Fraction Model
It is realized based on the Levenstein distance between the first character type catalogue and the second character type catalogue.
3. a kind of medical insurance, which instead cheats to exchange, encodes method for digging, which is characterized in that real based on system as claimed in claim 1 or 2
It is existing, comprising:
S1. the first character type catalogue and the second character type catalogue in cleaning clearing detailed data, forms the first new character type
Catalogue and the second character type catalogue；
S1.1 respectively converts the character in the first character type catalogue and the second character type catalogue in addition to Chinese, English, number
For space；
S1.2 will capitalize English respectively and be converted to small English in the first character type catalogue and the second character type catalogue；
S1.3 respectively removes the space of beginning and end in the first character type catalogue and the second character type catalogue；
First character type catalogue and the second character type catalogue are carried out character fractionation by separator of space respectively by S1.4, are formed
Two character lists；
S1.5 will split the character in the character lists formed after the first character type catalogue and the second character type directory characters respectively
It is ranked up；
S1.6 is respectively made the character in the first character type catalogue and the second character type directory characters list after sequence with space
For connection, new the first character type catalogue and the second character type catalogue are formed, original the first character type catalogue and second is replaced
Character type catalogue；
S2. the clearing detailed data obtained after having operated to step S1, establishes the first character type catalogue and the second character type mesh
Diversity factor Fraction Model between record；
S2.1 calculates the Levenstein distance between the first character type catalogue and the second character type catalogue；
S2.2 calculates the Levenstein ratio between the first character type catalogue and the second character type catalogue, calculation formula are as follows:
Diversity factor score=100* Levenstein ratio
S2.3 calculates the diversity factor score between the first character type catalogue and the second character type catalogue, and calculation formula is；
S3. medical item coding scenarios of exchanging are excavated；
S3.1 screens medical treatment clearing detailed data, filters out the data that diversity factor score is less than empirical value；
S3.2 is grouped according to the first character type catalogue and the second character type catalogue, summarizes the medical expense amount of money；
S3.3 filters out the data that medical expense total amount is greater than empirical value；
S3.4 is screened according to Cost of Medical Treatment item types；
S3.5 checks the group of the first character type catalogue and the second character type catalogue, obtains medical item coding of exchanging
Situation.
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| CN201910741147.9A CN110517050A (en) | 2019-08-12 | 2019-08-12 | A kind of medical insurance, which instead cheats to exchange, encodes digging system and method |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN113468236A (en) * | 2021-06-03 | 2021-10-01 | 太平洋医疗健康管理有限公司 | Control method and device for matching standardized medical insurance catalogue |
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| CN109670173A (en) * | 2018-12-13 | 2019-04-23 | 平安医疗健康管理股份有限公司 | Submit an expense account the investigation method, identification server-side and storage medium of data |
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2019
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Patent Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN1317114A (en) * | 1998-07-10 | 2001-10-10 | 快速检索及传递公司 | Search system and method for retrieval of data, and use thereof in search engine |
| CN105320641A (en) * | 2014-07-30 | 2016-02-10 | 腾讯科技（深圳）有限公司 | Text checking method and user terminal |
| CN109636648A (en) * | 2018-12-13 | 2019-04-16 | 平安医疗健康管理股份有限公司 | Social security violation detection method, device, equipment and computer storage medium |
| CN109670173A (en) * | 2018-12-13 | 2019-04-23 | 平安医疗健康管理股份有限公司 | Submit an expense account the investigation method, identification server-side and storage medium of data |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN113468236A (en) * | 2021-06-03 | 2021-10-01 | 太平洋医疗健康管理有限公司 | Control method and device for matching standardized medical insurance catalogue |
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