CN111461899A - Quick claim settlement system and method for business insurance and cloud business insurance platform - Google Patents
Quick claim settlement system and method for business insurance and cloud business insurance platform Download PDFInfo
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Abstract
The invention provides a quick claims settlement system, a quick claims settlement method and a cloud claims settlement platform for a business insurance, wherein the system comprises a pre-service system for the business insurance, the cloud services platform and the claims settlement system for the business insurance; the cloud business insurance platform is used for receiving the business insurance registration request and determining a target business insurance settlement and claim system according to the identity information and the application information in the business insurance registration request; the target merchant insurance claim settlement system is used for auditing the insurance information to complete merchant insurance registration; the cloud business insurance platform is used for receiving a business insurance claim application; sending a data extraction instruction to a target merchant insurance preposition service system according to the identity information and the application information; the target merchant insurance prepositive service system extracts the claim settlement related data according to the instruction and sends the claim settlement related data to the cloud merchant insurance platform; the cloud merchant insurance platform is used for standardizing the claim settlement data to obtain standard claim settlement data; and the target trader insurance claim settlement system generates a claim settlement result according to the standard claim settlement data. The invention realizes the service of one-key quick claim settlement for patients, solves the problems of difficult claim settlement and slow claim settlement for the patients under the condition of ensuring the merchants, and provides more convenient and efficient service for the patients.
Description
Technical Field
The invention relates to the technical field of commercial insurance, in particular to a quick claim settlement system and method for a merchant insurance and a cloud merchant insurance platform.
Background
With the increasing trend of diseases such as cardiovascular and cerebrovascular diseases, diabetes, osteoporosis and the like, more and more people are aware of the importance of health, the awareness of health care is continuously improved, and the willingness to purchase commercial health insurance is continuously increased. Along with the increase of the commercial health insurance purchased by the user, when the user needs to settle a claim in the hospitalizing process, the existing claim settling mode adopts a post-paying mode and an off-line manual auditing mode, and the patient needs to prepare various paper materials, so that the method is not environment-friendly, and on the other hand, the required materials are various and are easy to miss, and the number of butted departments is large, so that the patient needs to spend a large amount of energy to manually reimburse, and the auditing period is long.
Disclosure of Invention
The invention aims to provide a quick claims settlement system and method for a merchant insurance and a cloud merchant insurance platform, which realize the one-key quick claims settlement service for patients, solve the problems of difficult and slow claims settlement for the past merchant insurance patients and provide more convenient and efficient services for the patients.
The technical scheme provided by the invention is as follows:
the invention provides a quick claim settlement system for a merchant insurance, which comprises a plurality of medical institution terminals, a cloud merchant insurance platform and a plurality of merchant insurance claim settlement systems; the plurality of medical institution terminals respectively comprise a medical institution information system corresponding to a pre-insurance service system, and the cloud platform is respectively in communication connection with the pre-insurance service systems and the plurality of pre-insurance claim settlement systems of a plurality of different medical institutions;
the cloud business insurance platform receives a business insurance registration request of a target medical institution, wherein the business insurance registration request comprises identity information of a business insurance user, insurance application information, a medical institution for treatment and initial time for treatment;
the cloud business insurance platform determines a target business insurance claim system according to the identity information and the application information in the business insurance registration request, wherein the target business insurance claim system is any one of the plurality of business insurance claim systems;
the target merchant insurance claim settlement system receives the merchant insurance registration request and the insurance information, verifies the insurance information, and completes merchant insurance registration according to the merchant insurance registration request if the verification is passed;
the cloud business insurance platform receives a business insurance claim application, wherein the business insurance claim application comprises identity information, insurance application information and information acquisition authorization of a business insurance user;
the cloud business insurance platform calls the corresponding business insurance registration request according to the identity information and the application information of the business insurance claims, and acquires the medical institution for treatment and the initial time for treatment in the business insurance registration request;
the cloud merchant insurance platform determines a target merchant insurance preposition service system according to the medical institution for treatment, generates a data extraction instruction by combining the identity information, the initial time for treatment and the information acquisition authorization, and sends the data extraction instruction to the target merchant insurance preposition service system of a target medical institution terminal, wherein the target merchant insurance preposition service system is any one of the merchant insurance preposition service systems of the different medical institutions;
the target merchant insurance preposition service system extracts the medical data of the corresponding merchant insurance user of the corresponding medical institution according to the data extraction instruction;
the cloud business insurance platform determines the target business insurance and administration system according to the identity information and the application information in the business insurance and administration application, extracts corresponding claim settlement data in the medical data according to the application information, and standardizes the claim settlement data according to the business insurance reimbursement requirement of the target business insurance and administration system to obtain standard claim settlement data;
and the target trader insurance claim settlement system generates a claim settlement result according to the standard claim settlement data and the insurance information.
Further, the method also comprises the following steps:
the medical institution terminal acquires user registration operation to generate the merchant insurance registration request; forwarding the merchant insurance registration request to the cloud merchant insurance platform through a corresponding merchant insurance pre-positioned service system;
after the medical institution settlement is completed, the medical institution terminal acquires user claim settlement operation to generate the application of the insurance claim settlement; and forwarding the underwriting claims application to the cloud underwriting platform through a corresponding underwriting pre-service system.
Further, the method also comprises the following steps:
the system also comprises a mobile terminal; the mobile terminal is in communication connection with the cloud commerce and insurance platform;
the mobile terminal acquires user registration operation to generate the merchant insurance registration request and sends the merchant insurance registration request to the cloud merchant insurance platform;
and after settlement of the medical institution is completed, the mobile terminal acquires user claim settlement operation to generate the application of the business insurance claim, and sends the application of the business insurance claim to the cloud business insurance platform.
Further, the method also comprises the following steps:
and the cloud underwriting platform associates the underwriting registration request with the corresponding underwriting application to generate an underwriting record of the underwriting user.
Further, the method also comprises the following steps:
and the cloud business insurance platform receives and stores the claim settlement result of the target business insurance claim system, and associates the claim settlement result with the corresponding business insurance claim application in the business insurance claim record.
The invention also provides a quick claims settlement method for the merchant insurance, which comprises the following steps:
receiving a merchant insurance registration request, wherein the merchant insurance registration request comprises identity information, insurance application information, a medical institution for treatment and initial time for treatment of a merchant insurance user;
determining a target merchant insurance claim system according to the identity information and the application information in the merchant insurance registration request, and auditing the application information through the target merchant insurance claim system to complete merchant insurance registration;
receiving a business insurance claim application, wherein the business insurance claim application comprises identity information, insurance information and information acquisition authorization of a business insurance user;
calling the corresponding merchant insurance registration request according to the identity information and the application information of the merchant insurance claim and claim, and acquiring a medical institution for treatment and initial time for treatment in the merchant insurance registration request;
determining a target merchant insurance preposition service system according to the medical institution, generating a data extraction instruction by combining the identity information, the initial time of the medical visit and the information acquisition authorization, and sending the data extraction instruction to the target merchant insurance preposition service system of the target medical institution terminal;
extracting medical data of a corresponding merchant insurance user of a corresponding medical institution through the target merchant insurance preposition service system according to the data extraction instruction;
determining a target merchant insurance claim system according to the identity information and the application information in the merchant insurance claim application, extracting corresponding claim data in the medical data according to the application information, and standardizing the claim data according to the merchant insurance reimbursement requirement of the target merchant insurance claim system to obtain standard claim data;
and generating a claim settlement result according to the standard claim settlement data and the application information through the target trader claim guarantee system.
Further, generating a claim settlement result according to the standard claim settlement data and the application information by the target trader insurance claim system further comprises:
and associating the merchant insurance registration request with the corresponding merchant insurance claim application to generate a merchant insurance claim record of the merchant insurance user.
Further, associating the underwriting registration request with the corresponding underwriting application, and generating an underwriting record of the underwriting user further includes:
and associating the claim settlement result with a corresponding application of the business insurance claim in the business insurance claim record.
The invention also provides a cloud business insurance platform which is in communication connection with the business insurance preposition service systems and the business insurance claim settlement systems of a plurality of medical institutions, and comprises the following components:
the system comprises a receiving module, a service information acquisition module and a service information acquisition module, wherein the receiving module is used for receiving a service registration request which comprises identity information, insurance application information, a medical institution and initial time of treatment of a service user;
the processing module is used for determining a target merchant insurance claim system according to the identity information and the application information received by the receiving module, and auditing the application information through the target merchant insurance claim system to complete merchant insurance registration, wherein the target merchant insurance claim system is any one of the plurality of merchant insurance claim systems;
the receiving module is used for receiving a business insurance claim application, wherein the business insurance claim application comprises identity information, insurance application information and information acquisition authorization of a business insurance user;
the calling module calls the corresponding merchant insurance registration request according to the identity information and the application information of the merchant insurance claim and claim received by the receiving module;
the processing module is used for acquiring the medical care medical institution and the initial time of medical care in the merchant insurance registration request obtained by the calling module, determining a target merchant insurance pre-service system according to the medical care medical institution, generating a data extraction instruction by combining the identity information, the initial time of medical care and the information acquisition authorization, and sending the data extraction instruction to the target merchant insurance pre-service system of the target medical institution terminal; the target merchant insurance preposition service system is any one of merchant insurance preposition service systems of a plurality of medical institutions;
the receiving module is used for receiving the medical data of the corresponding merchant insurance user of the corresponding medical institution, which is extracted by the target merchant insurance prepositive service system according to the data extraction instruction;
the processing module is used for determining the target merchant insurance claim system according to the identity information and the application information in the merchant insurance claim application received by the receiving module, and extracting corresponding claim data in the medical data received by the receiving module according to the application information;
the processing module is used for standardizing the claim settlement data obtained by the calling module according to the merchant insurance reimbursement requirement of the target merchant insurance claim system to obtain standard claim settlement data;
and the processing module generates a claim settlement result according to the standard claim settlement data and the application information through the target merchant insurance claim settlement system.
Further, the method also comprises the following steps:
the processing module is used for correlating the merchant insurance registration request with the corresponding merchant insurance claim application to generate a merchant insurance claim record of the merchant insurance user;
and the processing module is used for associating the claim settlement result with the corresponding application of the business insurance claim in the business insurance claim record.
Through the rapid claims settlement system and method for the merchant insurance and the cloud merchant insurance platform, at least the following technical effects are realized:
1. according to the invention, the service of one-key quick claim settlement of the patient is realized, the problems of difficult and slow claim settlement of the patient by the conventional merchant are solved, and more convenient and efficient service is provided for the patient.
2. In the invention, the claim settlement auditing is carried out through the business insurance claim settlement system, so that the investment of manpower and material resources of insurance companies is reduced, and the problems of low manual auditing speed, low efficiency and high error rate are solved.
Drawings
The above features, technical features, advantages, and implementations of a quick claims settlement system and method for an underwriting platform will be further described in the following detailed description of preferred embodiments with reference to the accompanying drawings.
FIG. 1 is a schematic structural diagram of an embodiment of a rapid claims settlement system for underwriting according to the present invention;
FIG. 2 is a flow chart of one embodiment of a method for rapid claims settlement for underwriting according to the present invention;
fig. 3 is a schematic structural diagram of an embodiment of a cloud commerce and insurance platform of the present invention.
Description of the drawings:
100 quick claims settlement system for merchant insurance
110 medical institution terminal 111 target merchant insurance preposition service system
120 cloud merchant insurance platform 121 receiving module 122 processing module 123 calling module
130 trader insurance claim system 131 target trader insurance claim system
Detailed Description
In the following description, for purposes of explanation and not limitation, specific details are set forth, such as particular system structures, techniques, etc. in order to provide a thorough understanding of the embodiments of the present application. However, it will be apparent to one skilled in the art that the present application may be practiced in other embodiments that depart from these specific details. In other instances, detailed descriptions of well-known systems, devices, circuits, and methods are omitted so as not to obscure the description of the present application with unnecessary detail.
It will be understood that the terms "comprises" and/or "comprising," when used in this specification and the appended claims, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof.
For the sake of simplicity, the drawings only schematically show the parts relevant to the present invention, and they do not represent the actual structure as a product. In addition, in order to make the drawings concise and understandable, components having the same structure or function in some of the drawings are only schematically depicted, or only one of them is labeled. In this document, "one" means not only "only one" but also a case of "more than one".
It should be further understood that the term "and/or" as used in this specification and the appended claims refers to and includes any and all possible combinations of one or more of the associated listed items.
In particular implementations, the terminal devices described in embodiments of the present application include, but are not limited to, other portable devices such as mobile phones, laptop computers, family computers, or tablet computers having touch sensitive surfaces (e.g., touch screen displays and/or touch pads). It should also be understood that in some embodiments the terminal device is not a portable communication device, but is a desktop computer having a touch-sensitive surface (e.g., a touch screen display and/or touchpad).
In the discussion that follows, a terminal device that includes a display and a touch-sensitive surface is described. However, it should be understood that the terminal device may include one or more other physical user interface devices such as a physical keyboard, mouse, and/or joystick.
The terminal device supports various applications, such as one or more of the following: a drawing application, a presentation application, a network creation application, a word processing application, a disc burning application, a spreadsheet application, a gaming application, a telephone application, a video conferencing application, an email application, an instant messaging application, an exercise support application, a photo management application, a digital camera application, a digital video camera application, a Web browsing application, a digital music player application, and/or a digital video player application.
Various applications that may be executed on the terminal device may use at least one common physical user interface device, such as a touch-sensitive surface. One or more functions of the touch-sensitive surface and corresponding information displayed on the terminal can be adjusted and/or changed between applications and/or within respective applications. In this way, a common physical architecture (e.g., touch-sensitive surface) of the terminal can support various applications with user interfaces that are intuitive and transparent to the user.
In addition, in the description of the present application, the terms "first", "second", and the like are used only for distinguishing the description, and are not intended to indicate or imply relative importance.
In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the following description will be made with reference to the accompanying drawings. It is obvious that the drawings in the following description are only some examples of the invention, and that for a person skilled in the art, other drawings and embodiments can be derived from them without inventive effort.
In an embodiment of the present invention, as shown in fig. 1, an underwriting fast claims settlement system 100 includes a plurality of medical institution terminals 110, a cloud underwriting platform 120, and a plurality of underwriting systems 130; the medical institution terminals 110 respectively comprise a medical institution information system corresponding to a pre-service system of the merchant, and the cloud merchant platform 120 is respectively in communication connection with the pre-service systems of the merchant and the merchant insurance claim settlement systems 130 of different medical institutions;
the cloud underwriting platform 120 receives an underwriting registration request of a target medical institution, wherein the underwriting registration request comprises identity information of underwriting users, insurance application information, medical institution for treatment and initial time for treatment;
the cloud insurance platform 120 determines a target merchant insurance claim system 131 according to the identity information and the application information in the merchant insurance registration request, wherein the target merchant insurance claim system 131 is any one of the plurality of merchant insurance claim systems 130;
the target merchant insurance claim settlement system 131 receives the merchant insurance registration request and the insurance information, verifies the insurance information, and completes merchant insurance registration according to the merchant insurance registration request if the verification is passed;
the cloud underwriting platform 120 receives an underwriting application, which includes identity information of underwriting users, insurance information and information acquisition authorization;
the cloud insurance platform 120 calls the corresponding insurance registration request according to the identity information and the application information of the insurance claim and claim application, and acquires the medical institution for treatment and the initial time for treatment in the insurance registration request;
the cloud business insurance platform 120 determines a target business insurance pre-service system 111 according to the medical institution, generates a data extraction instruction by combining the identity information, the initial time of the medical visit and the information acquisition authorization, and sends the data extraction instruction to the target business insurance pre-service system 111 of the target medical institution terminal 110, wherein the target business insurance pre-service system 111 is any one of the business insurance pre-service systems of a plurality of different medical institutions;
the target merchant insurance pre-service system 111 extracts medical data of a corresponding merchant insurance user of a corresponding medical institution according to the data extraction instruction;
the cloud insurance platform 120 determines the target merchant insurance claim system 131 according to the identity information and the application information in the merchant insurance claim application, extracts corresponding claim data in the medical data according to the application information, and standardizes the claim data according to the merchant insurance reimbursement requirement of the target merchant insurance claim system 131 to obtain standard claim data;
the target trader insurance claim settlement system 131 generates a claim settlement result according to the standard claim settlement data and the insurance information.
In further embodiments, further comprising:
the medical institution terminal acquires user registration operation to generate the merchant insurance registration request; forwarding the merchant insurance registration request to the cloud merchant insurance platform through a corresponding merchant insurance pre-positioned service system;
after the medical institution settlement is completed, the medical institution terminal acquires user claim settlement operation to generate the application of the insurance claim settlement; and forwarding the underwriting claims application to the cloud underwriting platform through a corresponding underwriting pre-service system.
The system also comprises a mobile terminal; the mobile terminal is in communication connection with the cloud commerce and insurance platform;
the mobile terminal acquires user registration operation to generate the merchant insurance registration request and sends the merchant insurance registration request to the cloud merchant insurance platform;
and after settlement of the medical institution is completed, the mobile terminal acquires user claim settlement operation to generate the application of the business insurance claim, and sends the application of the business insurance claim to the cloud business insurance platform.
Specifically, in this embodiment, the quick claims settlement system for the medical insurance includes a plurality of medical institution terminals, a cloud medical insurance platform and a plurality of the claims settlement system for the medical insurance, the medical institution terminals respectively include their own medical institution information systems corresponding to the pre-service system for the medical insurance, and the cloud medical insurance platform is in communication connection with the plurality of the claims settlement systems for the medical insurance. That is to say, the cloud business insurance platform is connected with the business insurance settlement system of each insurance company, and is connected with the business insurance pre-service system corresponding to each medical institution information system, and then the business insurance pre-service system corresponding to each medical institution information system is connected with the medical institution terminal of each medical institution. Each business insurance claim system has a respective data processing mode, and in the whole business insurance claim process, the cloud business insurance platform serves as a docking platform for each business insurance claim system, so that data from other terminals such as medical terminals can be converted into data which can be directly recognized and called by each business insurance claim system, and flow faults caused by problems of data formats and the like are avoided.
When a merchant insured user visits a medical institution, namely before all medical actions occur, the merchant insured registration is needed.
The method comprises the steps that a business insurance user carries out user registration operation through a medical institution terminal, and inputs own identity information and insurance information, wherein the identity information comprises but is not limited to name, gender, mobile phone number, identity card number and the like, and at least comprises identity card number, social insurance number and the like, and the identity information of the user can be uniquely determined. The insurance information is the business insurance information which is applied by the user and requires business insurance claim settlement in the visit, and includes but is not limited to insurance companies, insurance types, insurance amount, insurance years and the like.
The medical institution terminal acquires the user registration operation to generate a merchant insurance registration request, the merchant insurance registration request comprises identity information of a merchant insurance user, a medical institution for treatment and initial time for treatment, the medical institution for treatment can identify according to an identification number of the medical institution terminal used for registration, and the identification number can also be input by the user. And then the medical institution terminal forwards the merchant insurance registration request to a cloud merchant insurance platform through a merchant insurance preposition service system of the medical institution terminal.
In addition, the merchant insurance user can also initiate a merchant insurance registration request through the mobile terminal. The mobile terminal is associated with the cloud business insurance platform, for example, a business insurance claim APP corresponding to the cloud business insurance platform is installed in the mobile terminal, and the user passes identity authentication on the business insurance claim APP. The user inputs own identity information, insurance information and medical institutions for treatment through the mobile terminal, initiates a merchant insurance registration request, and obtains the initial time for treatment in the merchant insurance registration request according to the mode. The mobile terminal directly sends the merchant insurance registration request to the cloud merchant insurance platform.
The cloud business insurance platform receives a business insurance registration request from the business insurance pre-service system or the mobile terminal, and determines a target business insurance claim system according to the identity information and the application information in the business insurance registration request, namely the business insurance claim system corresponding to the business insurance claim when the business insurance user applies the insurance before. The target merchant insurance claim system is any one of a plurality of merchant insurance claim systems in butt joint with the cloud merchant insurance platform.
The cloud business insurance platform sends the business insurance registration request to the target business insurance claim system, and the target business insurance claim system checks the insurance application information in the business insurance registration request, for example, identifies whether effective business insurance exists or not, and if the check is passed, the business insurance registration is finished. The target merchant insurance claim settlement system sends the audit result to the cloud merchant insurance platform, the cloud merchant insurance platform stores the audit result, the audit result is synchronously returned to the medical institution terminal or the mobile terminal through the cloud merchant insurance platform, the audit result is timely sent to the user, if the audit result does not pass, the user is timely notified, the user can conveniently process the audit result, and the final claim settlement failure is avoided. And if the audit result of the merchant insurance registration does not pass, the user cannot initiate a merchant insurance claim application subsequently.
After the merchant insurance registration is successful, the user visits a doctor. After all the doctor seeing actions are finished, the user uses own funds and medical institutions to settle accounts, namely the user pays in advance. After the settlement between the user and the medical institution is finished, the claim settlement application is further initiated, and the user needs to authorize the system to call the medical data of the user while the application is initiated.
The medical institution terminal obtains a user claim settlement operation and generates a merchant insurance claim application, the merchant insurance claim application comprises identity information, insurance application information and information acquisition authorization of a merchant insurance user, medical data of the user can be extracted through the information acquisition authorization cloud merchant insurance platform, and then the medical institution terminal forwards a merchant insurance registration request to the cloud merchant insurance platform through the merchant insurance pre-service system.
In addition, the insurance provider user can also initiate an insurance claim application through the mobile terminal. The mobile terminal is associated with the cloud business insurance platform, for example, a business insurance claim APP corresponding to the cloud business insurance platform is installed in the mobile terminal, and the user passes identity authentication on the business insurance claim APP. The user inputs own identity information, insurance information and information acquisition authorization through the mobile terminal, a business insurance claim application is initiated, and the mobile terminal directly sends the business insurance claim application to the cloud business insurance platform.
The user can initiate a merchant insurance registration request and a merchant insurance claim settlement request through the mobile terminal via the cloud merchant insurance platform, the time and place limitation is avoided, and the operation is more convenient and faster.
The cloud business insurance platform receives a business insurance claim application from the business insurance pre-service system or the mobile terminal, and calls a corresponding business insurance registration request for completing application registration according to identity information of the business insurance claim application. The medical institution and the initial time of the visit in the request for registration of the merchant insurance are obtained. The cloud business insurance platform determines a target business insurance preposed service system corresponding to a target medical institution terminal of a business insurance user visiting medical institution according to the visiting medical institution, and generates a data extraction instruction aiming at the target business insurance preposed service system by combining identity information, visiting initial time and information acquisition authorization. The target medical institution terminal is a terminal of a medical institution for the business insurance user to see a doctor and is any one of a plurality of medical institution terminals, and the target business insurance pre-service system is a business insurance pre-service system corresponding to the target medical institution terminal.
The cloud merchant insurance platform sends the data extraction instruction to the target merchant insurance preposition service system, the target merchant insurance preposition service system extracts all medical data generated by the target user in the target medical institution in the target user target time period according to the data extraction instruction, and the user target time period is between the initial time of the visit and the settlement of the medical institution.
The different pre-service systems of the merchant insurance can be used for docking different medical institutions and extracting medical data of the docked medical institutions, and the standards, data processing modes and the like of the medical institutions are different, so that the pre-service systems of the merchant insurance can preliminarily standardize the medical data extracted according to the data extraction instruction according to the requirements of the cloud platform of the merchant insurance. And then, the target merchant insurance preposition service system directly sends the extracted medical data or the standardized medical data to the merchant insurance cloud platform.
The extracted medical data is subjected to standardized cleaning, redundant data is removed, and excessive data needing to be processed is avoided.
Since the target merchant insurance preposition service system extracts all medical data without screening, but contains a lot of data irrelevant to the merchant insurance reimbursement. The cloud business insurance platform firstly screens available claim settlement data from the medical data according to the application information in the business insurance claim settlement application, for example, screens corresponding details corresponding to items capable of carrying out claim settlement from the medical data according to medical items reimbursed by risk seeds applied by a user. Because the requirements of each merchant insurance claim system on claim file formats and the like are different, the cloud merchant insurance platform determines the target merchant insurance claim system according to the application information in the merchant insurance claim application, and standardizes the claim data according to the merchant insurance reimbursement requirement of the target merchant insurance claim system to obtain standard claim data, so that the target merchant insurance claim system can quickly identify the standard claim data.
And the target merchant insurance claim settlement system performs auditing calculation according to the standard claim settlement data and in combination with the application information to generate a claim settlement result, wherein the application information contains detailed information of the application insurance risk, so that the reimbursement quota can be calculated conveniently. And then the target merchant insurance claim settlement system sends the claim settlement result to the cloud merchant insurance platform for storage.
For differences such as data formats possibly existing between medical data of medical institutions and the business insurance claim system, the cloud business insurance platform is used for cleaning and converting, and the business insurance claim system is convenient to identify and rapidly process.
The invention realizes the service of one-key quick claim settlement for patients, solves the problems of difficult and slow claim settlement for the patients by the conventional merchant, and provides more convenient and efficient service for the patients. Through the means of realizing carrying out the merchant insurance registration, carrying out the claim settlement application afterwards, the system is automatic to extract medical data, need not user's collection by oneself, improves the efficiency of claim settlement.
Preferably, in a further embodiment of the present invention, further comprising: the cloud business insurance platform associates the business insurance registration request with the corresponding business insurance claim application to generate a business insurance claim record of the business insurance user;
and the cloud business insurance platform receives and stores the claim settlement result of the target business insurance claim system, and associates the claim settlement result with the corresponding business insurance claim application in the business insurance claim record.
Specifically, the cloud underwriting platform associates the underwriting registration request of the same underwriting user with the corresponding underwriting application, generates an underwriting claim record of the underwriting user, and facilitates later statistical analysis of big data. Because the application of the business insurance claim can be initiated only after the business insurance registration is successful, the adjacent business insurance registration request and the business insurance claim application are in corresponding relation. In addition, the audit result of the underwriting registration can be associated in the underwriting record, and the underwriting registration request which does not pass the audit does not have the corresponding application of the underwriting.
And (4) initiating a merchant insurance registration request, and defining a complete claim settlement flow after the merchant insurance registration request does not pass or a merchant insurance claim settlement application is initiated. In order to realize one-key claim of the merchant insurance user, the fact that the merchant insurance user inputs excessive information is avoided, meanwhile, medical data extraction errors are avoided, and only if all the merchant insurance claim records are complete claim processes, namely all merchant insurance registration requests do not pass or have corresponding merchant insurance claim applications, the next claim application can be carried out.
And after the cloud merchant insurance platform receives the new merchant insurance registration request, invoking the merchant insurance claim record of the merchant insurance user according to the identity information in the merchant insurance registration request. And if the records of the trade insurance claims are all complete claims processes, accepting a new trade insurance registration request and applying for new claims.
In this embodiment, the cloud business insurance platform generates the business insurance claim records of the business insurance users, so as to perform statistical analysis on the big data at a later stage, and strictly monitor the progress in the whole business insurance claim process.
The cloud business insurance platform receives and stores the claim settlement results of the target business insurance claim system, and associates the claim settlement results with the corresponding business insurance claim application in the business insurance claim records, so that the subsequent statistical analysis of the business insurance claim settlement is facilitated.
One embodiment of the present invention, as shown in fig. 2, is a method for fast claim settlement by underwriting, comprising:
receiving a merchant insurance registration request, wherein the merchant insurance registration request comprises identity information, insurance application information, a medical institution for treatment and initial time for treatment of a merchant insurance user;
determining a target merchant insurance claim system according to the identity information and the application information in the merchant insurance registration request, and auditing the application information through the target merchant insurance claim system to complete merchant insurance registration;
receiving a business insurance claim application, wherein the business insurance claim application comprises identity information, insurance information and information acquisition authorization of a business insurance user;
calling the corresponding merchant insurance registration request according to the identity information and the application information of the merchant insurance claim and claim, and acquiring a medical institution for treatment and initial time for treatment in the merchant insurance registration request;
determining a target merchant insurance preposition service system according to the medical institution, generating a data extraction instruction by combining the identity information, the initial time of the medical visit and the information acquisition authorization, and sending the data extraction instruction to the target merchant insurance preposition service system of the target medical institution terminal;
extracting medical data of a corresponding merchant insurance user of a corresponding medical institution through the target merchant insurance preposition service system according to the data extraction instruction;
determining a target merchant insurance claim system according to the identity information and the application information in the merchant insurance claim application, extracting corresponding claim data in the medical data according to the application information, and standardizing the claim data according to the merchant insurance reimbursement requirement of the target merchant insurance claim system to obtain standard claim data;
and generating a claim settlement result according to the standard claim settlement data and the application information through the target trader claim guarantee system.
Generating a claim settlement result according to the standard claim settlement data and the application information through the target trader insurance claim system, and then:
and associating the merchant insurance registration request with the corresponding merchant insurance claim application to generate a merchant insurance claim record of the merchant insurance user.
Associating the underwriting registration request with the corresponding underwriting application, and generating an underwriting record of the underwriting user further comprises:
and associating the claim settlement result with a corresponding application of the business insurance claim in the business insurance claim record.
The operation modes of the methods in this embodiment have been described in detail in the corresponding system embodiments, and thus are not described in detail.
In an embodiment of the present invention, as shown in fig. 3, a cloud underwriting platform 120, communicatively connected to underwriting pre-service systems and underwriting systems of a plurality of medical institutions, includes:
the receiving module 121 is configured to receive a merchant insurance registration request, where the merchant insurance registration request includes identity information of a merchant insurance user, insurance application information, a medical institution for treatment and initial time for treatment;
the processing module 122 determines a target business insurance claim system according to the identity information and the application information received by the receiving module 121, and verifies the application information through the target business insurance claim system to complete business insurance registration, wherein the target business insurance claim system is any one of the plurality of business insurance claim systems;
the receiving module 121 receives a business insurance claim application, where the business insurance claim application includes identity information, insurance application information, and information acquisition authorization of a business insurance user;
the calling module 123 calls the corresponding merchant insurance registration request according to the identity information and the application information of the merchant insurance claim and claim received by the receiving module 121;
the processing module 122 is configured to obtain a medical care medical institution and initial time of medical care in the medical care registration request obtained by the calling module 123, determine a target medical care pre-service system according to the medical care medical institution, generate a data extraction instruction by combining the identity information, the initial time of medical care and the information acquisition authorization, and send the data extraction instruction to the target medical care pre-service system of the target medical institution terminal; the target merchant insurance preposition service system is any one of merchant insurance preposition service systems of a plurality of medical institutions;
the receiving module 121 is configured to receive medical data of a corresponding merchant insurance user of a corresponding medical institution, which is extracted by the target merchant insurance pre-serving system according to the data extraction instruction;
the processing module 122 determines the target quotient insurance claim system according to the identity information and the application information in the quotient insurance claim application received by the receiving module 121, and extracts the claim data corresponding to the medical data received by the receiving module 121 according to the application information;
the processing module 122 is configured to standardize the claim settlement data obtained by the invoking module 123 according to the merchant insurance reimbursement requirement of the target merchant insurance claim system to obtain standard claim settlement data;
the processing module 122 generates a claim settlement result according to the standard claim settlement data and the application information through the target dealer insurance claim system.
Further comprising:
the processing module 122 associates the underwriting registration request with the corresponding underwriting application to generate an underwriting record of the underwriting user;
the processing module 122 associates the claim settlement result with the corresponding claim guarantee application in the claim guarantee record.
The operation modes of the methods in this embodiment have been described in detail in the corresponding system embodiments, and thus are not described in detail.
An embodiment of the invention provides a computer-readable storage medium, on which a computer program is stored which, when being executed by a processor, carries out all or part of the method steps of the first embodiment.
All or part of the flow of the method according to the embodiments of the present invention may be implemented by a computer program, which may be stored in a computer-readable storage medium and used by a processor to implement the steps of the embodiments of the method. Wherein the computer program comprises computer program code, which may be in the form of source code, object code, an executable file or some intermediate form, etc. The computer-readable medium may include: any entity or device capable of carrying the computer program code, recording medium, usb disk, removable hard disk, magnetic disk, optical disk, computer Memory, Read-only Memory (ROM), Random Access Memory (RAM), electrical carrier wave signals, telecommunications signals, software distribution medium, etc. It should be noted that the computer readable medium may contain content that is subject to appropriate increase or decrease as required by legislation and patent practice in jurisdictions, for example, in some jurisdictions, computer readable media does not include electrical carrier signals and telecommunications signals as is required by legislation and patent practice.
An embodiment of the present invention further provides an electronic device, which includes a memory and a processor, wherein the memory stores a computer program running on the processor, and the processor executes the computer program to implement all or part of the method steps in the first embodiment.
The Processor may be a Central Processing Unit (CPU), other general purpose Processor, a Digital Signal Processor (DSP), an Application Specific Integrated Circuit (ASIC), an off-the-shelf Programmable Gate Array (FPGA) or other Programmable logic device, discrete Gate or transistor logic, discrete hardware components, etc. The general purpose processor may be a microprocessor or the processor may be any conventional processor or the like which is the control center for the computer device and which connects the various parts of the overall computer device using various interfaces and lines.
The memory may be used to store the computer programs and/or modules, and the processor may implement various functions of the computer device by running or executing the computer programs and/or modules stored in the memory and invoking data stored in the memory. The memory may mainly include a storage program area and a storage data area, wherein the storage program area may store an operating system, an application program required by at least one function (such as a sound playing function, an image playing function, etc.), and the like; the storage data area may store data (such as audio data, video data, etc.) created according to the use of the cellular phone, etc. In addition, the memory may include high speed random access memory, and may also include non-volatile memory, such as a hard disk, a memory, a plug-in hard disk, a Smart Media Card (SMC), a Secure Digital (SD) Card, a Flash memory Card (Flash Card), at least one magnetic disk storage device, a Flash memory device, or other volatile solid state storage device.
It should be noted that the above embodiments can be freely combined as necessary. The foregoing is only a preferred embodiment of the present invention, and it should be noted that, for those skilled in the art, various modifications and decorations can be made without departing from the principle of the present invention, and these modifications and decorations should also be regarded as the protection scope of the present invention.
Claims (10)
1. A rapid claims settlement system for a merchant insurance is characterized by comprising a plurality of medical institution terminals, a cloud merchant insurance platform and a plurality of merchant insurance claims settlement systems; the plurality of medical institution terminals respectively comprise a medical institution information system corresponding to a pre-insurance service system, and the cloud platform is respectively in communication connection with the pre-insurance service systems and the plurality of pre-insurance claim settlement systems of a plurality of different medical institutions;
the cloud business insurance platform receives a business insurance registration request of a target medical institution, wherein the business insurance registration request comprises identity information of a business insurance user, insurance application information, a medical institution for treatment and initial time for treatment;
the cloud business insurance platform determines a target business insurance claim system according to the identity information and the application information in the business insurance registration request, wherein the target business insurance claim system is any one of the plurality of business insurance claim systems;
the target merchant insurance claim settlement system receives the merchant insurance registration request, verifies the insurance application information in the merchant insurance registration request, and completes merchant insurance registration according to the merchant insurance registration request if verification is passed;
the cloud business insurance platform receives a business insurance claim application, wherein the business insurance claim application comprises identity information, insurance application information and information acquisition authorization of a business insurance user;
the cloud business insurance platform calls the corresponding business insurance registration request according to the identity information and the application information of the business insurance claims, and acquires the medical institution for treatment and the initial time for treatment in the business insurance registration request;
the cloud merchant insurance platform determines a target merchant insurance preposition service system according to the medical institution for treatment, generates a data extraction instruction by combining the identity information, the initial time for treatment and the information acquisition authorization, and sends the data extraction instruction to the target merchant insurance preposition service system of a target medical institution terminal, wherein the target merchant insurance preposition service system is any one of the merchant insurance preposition service systems of the different medical institutions;
the target merchant insurance preposition service system extracts the medical data of the corresponding merchant insurance user of the corresponding medical institution according to the data extraction instruction;
the cloud business insurance platform determines the target business insurance and administration system according to the identity information and the application information in the business insurance and administration application, extracts corresponding claim settlement data in the medical data according to the application information, and standardizes the claim settlement data according to the business insurance reimbursement requirement of the target business insurance and administration system to obtain standard claim settlement data;
and the target trader insurance claim settlement system generates a claim settlement result according to the standard claim settlement data and the insurance information.
2. The system of claim 1, further comprising:
the medical institution terminal acquires user registration operation to generate the merchant insurance registration request; forwarding the merchant insurance registration request to the cloud merchant insurance platform through a corresponding merchant insurance pre-positioned service system;
after the medical institution settlement is completed, the medical institution terminal acquires user claim settlement operation to generate the application of the insurance claim settlement; and forwarding the underwriting claims application to the cloud underwriting platform through a corresponding underwriting pre-service system.
3. The system for rapid claims settlement under underwriting of claim 1, further comprising a mobile terminal; the mobile terminal is in communication connection with the cloud commerce and insurance platform;
the mobile terminal acquires user registration operation to generate the merchant insurance registration request and sends the merchant insurance registration request to the cloud merchant insurance platform;
and after settlement of the medical institution is completed, the mobile terminal acquires user claim settlement operation to generate the application of the business insurance claim, and sends the application of the business insurance claim to the cloud business insurance platform.
4. The system of claim 1, further comprising:
and the cloud underwriting platform associates the underwriting registration request with the corresponding underwriting application to generate an underwriting record of the underwriting user.
5. The system of claim 4, further comprising:
and the cloud business insurance platform receives and stores the claim settlement result of the target business insurance claim system, and associates the claim settlement result with the corresponding business insurance claim application in the business insurance claim record.
6. A quick claims settlement method for a merchant insurance is characterized by comprising the following steps:
receiving a merchant insurance registration request, wherein the merchant insurance registration request comprises identity information, insurance application information, a medical institution for treatment and initial time for treatment of a merchant insurance user;
determining a target merchant insurance claim system according to the identity information and the application information in the merchant insurance registration request, and auditing the application information through the target merchant insurance claim system to complete merchant insurance registration;
receiving a business insurance claim application, wherein the business insurance claim application comprises identity information, insurance information and information acquisition authorization of a business insurance user;
calling the corresponding merchant insurance registration request according to the identity information and the application information of the merchant insurance claim and claim, and acquiring a medical institution for treatment and initial time for treatment in the merchant insurance registration request;
determining a target merchant insurance preposition service system according to the medical institution, generating a data extraction instruction by combining the identity information, the initial time of the medical visit and the information acquisition authorization, and sending the data extraction instruction to the target merchant insurance preposition service system of the target medical institution terminal;
extracting medical data of a corresponding merchant insurance user of a corresponding medical institution through the target merchant insurance preposition service system according to the data extraction instruction;
determining a target merchant insurance claim system according to the identity information and the application information in the merchant insurance claim application, extracting corresponding claim data in the medical data according to the application information, and standardizing the claim data according to the merchant insurance reimbursement requirement of the target merchant insurance claim system to obtain standard claim data;
and generating a claim settlement result according to the standard claim settlement data and the application information through the target trader claim guarantee system.
7. The method for rapid claims settlement by trader insurance according to claim 6, wherein the generating the claim settlement result by the target trader insurance claim system according to the standard claim settlement data and the application information further comprises:
and associating the merchant insurance registration request with the corresponding merchant insurance claim application to generate a merchant insurance claim record of the merchant insurance user.
8. The method for rapid claim settlement of the underwriting, according to claim 7, wherein the step of associating the request for registration of the underwriting with the corresponding application for the underwriting further comprises the step of, after generating the record of the underwriting for the underwriting user:
and associating the claim settlement result with a corresponding application of the business insurance claim in the business insurance claim record.
9. The utility model provides a cloud merchant protects platform which characterized in that, with the leading service system of the merchant of a plurality of medical institution, a plurality of merchant protects the claim system communication connection, include:
the system comprises a receiving module, a service information acquisition module and a service information acquisition module, wherein the receiving module is used for receiving a service registration request which comprises identity information, insurance application information, a medical institution and initial time of treatment of a service user;
the processing module is used for determining a target merchant insurance claim system according to the identity information and the application information received by the receiving module, and auditing the application information through the target merchant insurance claim system to complete merchant insurance registration, wherein the target merchant insurance claim system is any one of the plurality of merchant insurance claim systems;
the receiving module is used for receiving a business insurance claim application, wherein the business insurance claim application comprises identity information, insurance application information and information acquisition authorization of a business insurance user;
the calling module calls the corresponding merchant insurance registration request according to the identity information and the application information of the merchant insurance claim and claim received by the receiving module;
the processing module is used for acquiring the medical care medical institution and the initial time of medical care in the merchant insurance registration request obtained by the calling module, determining a target merchant insurance pre-service system according to the medical care medical institution, generating a data extraction instruction by combining the identity information, the initial time of medical care and the information acquisition authorization, and sending the data extraction instruction to the target merchant insurance pre-service system of the target medical institution terminal; the target merchant insurance preposition service system is any one of merchant insurance preposition service systems of a plurality of medical institutions;
the receiving module is used for receiving the medical data of the corresponding merchant insurance user of the corresponding medical institution, which is extracted by the target merchant insurance prepositive service system according to the data extraction instruction;
the processing module is used for determining the target merchant insurance claim system according to the identity information and the application information in the merchant insurance claim application received by the receiving module, and extracting corresponding claim data in the medical data received by the receiving module according to the application information;
the processing module is used for standardizing the claim settlement data obtained by the calling module according to the merchant insurance reimbursement requirement of the target merchant insurance claim system to obtain standard claim settlement data;
and the processing module generates a claim settlement result according to the standard claim settlement data and the application information through the target merchant insurance claim settlement system.
10. The cloud underwriting platform of claim 9, further comprising:
the processing module is used for correlating the merchant insurance registration request with the corresponding merchant insurance claim application to generate a merchant insurance claim record of the merchant insurance user;
and the processing module is used for associating the claim settlement result with the corresponding application of the business insurance claim in the business insurance claim record.
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