CN112200687A - Special drug claims and accepts platform - Google Patents
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- CN112200687A CN112200687A CN202011178850.2A CN202011178850A CN112200687A CN 112200687 A CN112200687 A CN 112200687A CN 202011178850 A CN202011178850 A CN 202011178850A CN 112200687 A CN112200687 A CN 112200687A
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- G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
- G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients
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Abstract
The invention belongs to the field of drug insurance reimbursement, and particularly discloses a special drug claim receiving platform which comprises a mobile terminal and a background management terminal, wherein the mobile terminal is based on a WeChat public number and a small program, a patient can apply for claim and drug receiving through the platform, receive the drug after the application and the verification of the claim and the drug receiving can be carried out, and the whole process of claim and drug receiving can be checked in real time; the background management end has a background management function and is used for checking and managing orders of patients, efficiently configuring pharmacy medicines according to different claim settlement items, and enabling online and offline communication through signatures, two-dimensional codes and the like, so that the safety and the efficiency of all links are improved. The invention realizes the high-efficiency fusion of online and offline services, and helps patients to solve the problem of self-payment medical payment by assisting the patients through financial insurance means, and helps the patients to manage the medical payment more efficiently.
Description
Technical Field
The invention relates to the field of insurance reimbursement of medication, in particular to a special drug claim supporting platform.
Background
With the improvement of science and technology and the improvement of the research and development level of medicines, the number of special medicines (special medicines) in the market is increased, and the using amount of the special medicines is increased. Because special medicines are expensive and high in price, a certain economic burden is caused to patients with the special medicines, and in order to reduce the economic burden of the patients, the government or insurance company brings the medical cost of part of special-effect medicines into the medical insurance reimbursement range.
In the current commercial medical insurance claim policy, for some special drugs that fall under claim, the medical structure generally provides the special drugs required by the patient user to the user after verifying the identity and medical qualification of the patient user, and then the medical structure makes a claim for the drug provided to the patient user and the medical insurance structure corresponding to the patient user. The process of paying to special medicine among the prior art is comparatively loaded down with trivial details, and needs the user to come and go to places such as medical institution many times, leads to paying the progress slowly on the one hand, and on the other hand is owing to can't guarantee the full flow management and control and the flow of medicine and trace back, and the patient buys the medicine risk height.
Disclosure of Invention
The invention aims to provide a special drug claim receiving platform to solve the problems in the background technology.
In order to achieve the purpose, the invention provides the following technical scheme: a special drug claim payment supporting platform comprises a mobile terminal and a background management terminal, wherein the mobile terminal is based on a WeChat public number and a WeChat applet, a patient can submit a claim settlement and drug getting application to the platform through the WeChat public number and the WeChat applet and get the drug after the examination and verification are passed; the project application module carries out claims settlement and drug receiving application after the mobile terminal finishes registration, and comprises a claims settlement application submodule, a drug receiving application submodule and an information data acquisition module; the claim settlement application submodule is used for selecting applied medicines and uploading claim settlement data information through the information data acquisition module, and the claim settlement data information comprises claim settlement data and photos of the front side and the back side of the identity card.
Preferably, the medicine getting application sub-module is used for selecting the medicine getting modes of the user side, the medicine getting modes comprise in-hospital and out-of-hospital, and claim setting and medicine getting data is uploaded, and the claim setting and medicine getting data comprises prescriptions, influential reports and medical record reports.
Preferably, the background management end is used for checking and managing orders of patients, efficiently configuring pharmacy medicines according to different claim settlement items, and enabling online and offline communication through verification modes such as signature and two-dimensional codes, the background management end comprises an order checking and management module, a data collection module, a claim collection and drug collection data auditing module and a project distribution module, the order checking and management module is used for obtaining project applications sent by the mobile end, the project applications comprise claim settlement applications and drug collection applications, the integrity of the data of the applications is verified after the application is received, the order checking and management module can send an integrity deficiency warning to the mobile end when the integrity of the currently applied data is lower than a preset threshold value, the mobile end supplements the applied data, and verifies and checks the integrity again after the supplementation.
Preferably, the data collection module is used for collecting data after the application data check is passed, the data collection comprises collecting information of insurance and data information of insurance applicants, and the data collection is based on SpringBoot, MYSQL and big data technology; the claims collection and medicine taking data auditing module is used for collecting and auditing project application information and data information.
Preferably, the auditing process includes: matching the claim settlement items corresponding to the claim settlement information based on the claim settlement information in the claim settlement application, and configuring the medicine based on the data in the medicine picking application.
Preferably, the project allocation module is used for matching case managers in the area according to the acquired mobile terminal positioning information after the medicine receiving application is passed, contacting the user with the mobile terminal through the case managers, and going to a designated hospital for confirmation diagnosis, wherein the confirmation diagnosis comprises uploading a confirmation diagnosis prescription, an image picture, adding order guide information and outpatient examination; the project distribution module is further used for distributing the pharmacy close to the geographical position of the user and sending an order application to the pharmacy, the pharmacy sends a medicine getting certificate to the background management terminal after confirming the order, the background management terminal sends the certificate to the mobile terminal, and the medicine getting certificate is a medicine getting two-dimensional code or a medicine getting receipt.
Preferably, the mobile terminal can go to a pharmacy to scan codes and check the sales through the acquired medicine taking voucher; uploading the signature, and uploading a medicine getting confirmation book, an insurance fund getting authorization book and a settlement bill of a patient by a pharmacy pharmacist, wherein the pharmacy pharmacist can set the self-payment amount of the user according to the medicine.
Compared with the prior art, the invention has the beneficial effects that:
the special drug claim payment supporting platform can provide a professional, safe and efficient drug direct payment management system for insurance drug users by connecting insurance companies, national pharmacies and drug purchasers, realizes efficient integration of online and offline services, and helps patients to solve self-payment medical payment problems and manage medical payment more efficiently by financial insurance means.
Drawings
FIG. 1 is a block diagram of a platform system of the present invention;
FIG. 2 is a block diagram of the user drug picking logic of the present invention;
FIG. 3 is a block diagram of the claim settlement process of the present invention;
FIG. 4 is a block diagram of a process for applying for picking up a drug.
In the figure: 1. a mobile terminal; 101. a user registration module; 102. a project application module; 102a, a claims application submodule; 102b, a medicine getting application submodule; 102c, an information data acquisition module; 2. a background management terminal; 201. an order checking and managing module; 202. a data collection module; 203. a claims collection and drug collection data auditing module; 204. and an item distribution module.
Detailed Description
The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
Referring to fig. 1-4, the present invention provides a technical solution: a special drug claim payment supporting platform comprises a mobile terminal 1 and a background management terminal 2, wherein the mobile terminal 1 is based on a WeChat public number and a WeChat applet, a patient can submit a claim settlement and drug collection application to the platform through the WeChat public number and the WeChat applet and receive drugs after the examination and verification are passed, the mobile terminal 1 comprises a user registration module 101 and a project application module 102 based on the WeChat public number and the WeChat applet, the user registration module 101 is used for performing user registration and binding when the mobile terminal 1 pays attention to the WeChat public number and starts the WeChat applet, and a user inputs a mobile phone number to the WeChat public number and the WeChat applet through the mobile terminal 1, performs identity verification through a verification code mode, perfects registration information and completes account registration; the project application module 102 applies for claim settlement and medicine getting after the mobile terminal completes registration, and the project application module 102 comprises a claim settlement application submodule 102a, a medicine getting application submodule 102b and an information data acquisition module 102 c; the claim settlement application submodule 102a is configured to select a drug to be applied, and upload claim settlement data information through the information data collection module 102c, where the claim settlement data information includes claim settlement data and photos of the front and back sides of the id card.
In this embodiment, after the user submits the application, the user may query various relevant information in the wechat public number, including information of the patient and the applicant, an uploaded detection report, information such as a medicine purchase invoice, a claim settlement application progress, a claim getting application progress order payment information, an insurance claim settlement progress, and a claim getting progress.
In this embodiment, the claim application sub-module 102b is configured to select a user prescription, the user prescription includes in-hospital and out-of-hospital, and upload claim data, the claim data includes a prescription, an influential report, and a medical record report.
In this embodiment, the back-end management terminal 2 is configured to check and manage orders of patients, efficiently configure pharmacy medicines according to different claim settlement items, and connect online and offline through verification methods such as signatures and two-dimensional codes, the back-end management terminal 2 includes an order checking and management module 201, a data collection module 202, a claim and medicine taking data verification module 203, and a item distribution module 204, the order checking and management module 201 is configured to obtain an item application issued by the mobile terminal 1, the item application includes a claim settlement application and a medicine taking application, and verifies integrity of data of the application after receiving, the order checking and management module 201 can send an insufficient integrity warning to the mobile terminal when integrity of the currently applied data is lower than a preset threshold, the mobile terminal supplements the applied data, and verifies and checks integrity again after supplementing. The data collection module 202 is used for collecting data after the application data check is passed, the data collection comprises collecting information of insurance and data information of insurance applicants, and the data collection is based on SpringBoot, MYSQL and big data technology; the claim and medicine taking data auditing module 203 is used for collecting and auditing project application information and data information.
In this embodiment, the process of auditing the claim reception data auditing module 203 includes: matching the claim settlement items corresponding to the claim settlement information based on the claim settlement information in the claim settlement application, and configuring the medicine based on the data in the medicine picking application.
In this embodiment, the item distribution module 204 is configured to match a case manager in the area according to the acquired location information of the mobile terminal 1 after the application of receiving the medication is passed, contact the user holding the mobile terminal 1 through the case manager and go to a designated hospital for confirmation, where the confirmation includes uploading a confirmation prescription, an image picture, adding order information, and performing outpatient examination; the project allocation module 204 is further configured to allocate a pharmacy close to the geographic location of the user, send an order application to the pharmacy, send a receipt for picking up the medicines to the background management terminal after the pharmacy confirms the order, and send the receipt to the mobile terminal by the background management terminal, where the receipt for picking up the medicines is a two-dimensional code for picking up the medicines or a receipt for picking up the medicines.
In this embodiment, a detailed process of the claim application is further provided:
s1: i claim for settlement;
s2: the user selects a corresponding insurance product to apply on the drug delivery through the claim settlement number given by the insurance company;
s3: the user fills in identity information, selects applied medicines, uploads the front and back sides of an insurance claim settlement data identity card and submits materials; if the user does not finish the quit, the data can be improved continuously through the claim settlement record page, and the data is submitted;
s4: the insurance specialist operator audits and submits the claim settlement application, if the audit is to be supplemented and removed, the materials need to be uploaded again in the claim record, and the application of receiving the drugs can be carried out if the materials pass; if the certificate does not pass, the insurance policy number is invalidated;
s5: the user receives the push information, and pushes and informs the user whether the claim application passes or whether claim data needs to be uploaded again according to the state of the claim application;
s6: the insurance specialist checks the claim settlement according to the claim settlement data uploaded by the user;
s7: the user can receive the medicines in the hospital and in the hospital outside without contacting the pharmacy for the user, and the user can match the nearby pharmacy according to the geographical position of the user outside the hospital)
S8: the user uploads the claims and the drug receiving data, the prescription, the imaging report, submits the examination result of the waiting drug receiving,
s9: the pharmacist specialist audits in the background,
s10: arranging an outpatient service, wherein a pharmacist specialist associates an allocation personal case manager of a user according to the area allocation user area with the user to confirm a diagnosis in a designated hospital, uploads a prescription for confirming the diagnosis, an image picture, adds guide information and performs outpatient service examination;
s11: the pharmacist specialist distributes similar drugstores according to the geographical position of the user, and after the pharmacy confirms the order, the user receives the two-dimensional code of the drug getting voucher;
s12: inquiring the drug taking application and the drug getting state; the user can check the state of the medicine getting application through the medicine application, and whether the data needs to be uploaded again can be inquired and seen through the medicine application page.
In this embodiment, the system is divided into a mobile terminal and a PC terminal (background management terminal), the mobile terminal is based on a wechat public account and a small program, a patient can apply for claim settlement and receive medicines through a platform, and receive medicines after the application and the verification pass, and the whole process of claim settlement and medicine reception can be checked in real time. The PC terminal has a background management function, city risk data (such as Suzhou, Hangzhou, Hunan and the like), audit claim settlement materials and the like are stored in the PC terminal, the PC terminal is used for checking and managing orders of patients, pharmacy medicines are efficiently configured according to different claim settlement items, online and offline communication is achieved through signatures, two-dimensional codes and the like, and safety and efficiency of all links are improved. The user searches pharmacy medicines on line, places orders for the medicines, applies for claims and obtains the medicines off line.
Moreover, the platform of the invention partially solves the problem of asymmetric information of insurance companies by controlling the whole process of medicines, reduces the medicine purchasing risk of patients, improves the accuracy of the insurance companies for acquiring the data of the patients, enables the subsequent patients to enjoy direct claim services, is more closely connected with the patients, and finally forms reciprocal effect.
Although embodiments of the present invention have been shown and described, it will be appreciated by those skilled in the art that changes, modifications, substitutions and alterations can be made in these embodiments without departing from the principles and spirit of the invention, the scope of which is defined in the appended claims and their equivalents.
Claims (7)
1. A special drug claim receiving platform is characterized by comprising a mobile terminal (1) and a background management terminal (2), wherein the mobile terminal (1) is based on a WeChat public number and a WeChat applet, a patient can submit a claim settlement and drug collection application to the platform through the WeChat public number and the WeChat applet and collect drugs after the examination and verification are passed, the mobile terminal (1) comprises a user registration module (101) and a project application module (102) based on the WeChat public number and the WeChat applet, the user registration module (101) is used for carrying out user registration and binding when the mobile terminal (1) pays attention to the WeChat public number and starts the WeChat applet, and a mobile phone number is input to the WeChat public number and the WeChat applet through the mobile terminal (1), identity verification is carried out through a verification code mode, registration information is perfected, and account registration is completed;
the project application module (102) carries out claims settlement and drug getting application after the mobile terminal finishes registration, and the project application module (102) comprises a claims settlement application submodule (102 a), a drug getting application submodule (102 b) and an information data acquisition module (102 c); the claim settlement application submodule (102 a) is used for selecting applied medicines and uploading claim settlement data information through the information data acquisition module (102 c), and the claim settlement data information comprises claim settlement data and photos of the front side and the back side of the identity card.
2. The special drug claims receiving platform of claim 1, wherein: the medicine getting application sub-module (102 b) is used for selecting the medicine getting modes of the user side, the medicine getting modes comprise in-hospital and out-of-hospital, and the claim medicine getting data is uploaded and comprises prescriptions, influential reports and medical record reports.
3. The special drug claims receiving platform of claim 1, wherein: the system comprises a background management end (2), a background management end (2) and a mobile end, wherein the background management end (2) is used for checking and managing orders of patients, efficiently configuring pharmacy medicines according to different claim settlement items, and enabling online and offline communication through verification modes such as signatures, two-dimensional codes and the like, the background management end (2) comprises an order checking and management module (201), a data collection module (202), a claim settlement and medicine receiving data verification module (203) and an item distribution module (204), the order checking and management module (201) is used for obtaining item applications sent by the mobile end (1), the item applications comprise claim settlement applications and medicine receiving applications, the integrity of the applied data is verified after receiving the application, the order checking and management module (201) can send an integrity deficiency warning to the mobile end when the integrity of the currently applied data is lower than a preset threshold value, and the mobile end supplements the applied data, and integrity verification and verification are performed again after replenishment.
4. The special drug claims bearing platform according to claim 3, wherein: the data collection module (202) is used for collecting data after the application data check is passed, the data collection comprises the collection of insurance information and insurance applicant data information, and the data collection is based on SpringBoot, MYSQL and big data technology; the claim and medicine taking data auditing module (203) is used for collecting and auditing project application information and data information.
5. The special drug claims receiving platform of claim 4, wherein: the auditing process comprises the following steps: matching the claim settlement items corresponding to the claim settlement information based on the claim settlement information in the claim settlement application, and configuring the medicine based on the data in the medicine picking application.
6. The special drug claims bearing platform according to claim 3, wherein: the project distribution module (204) is used for matching case managers in the area according to the acquired positioning information of the mobile terminal (1) after the medicine receiving application is passed, contacting the user holding the mobile terminal (1) through the case managers and going to a designated hospital for confirmation diagnosis, and the confirmation diagnosis comprises uploading a confirmation diagnosis prescription, an image picture, adding order guide information and outpatient examination; the project allocation module (204) is further used for allocating a pharmacy close to the geographical position of the user and sending an order application to the pharmacy, the pharmacy sends a medicine getting certificate to the background management terminal after confirming the order, the background management terminal sends the certificate to the mobile terminal, and the medicine getting certificate is a medicine getting two-dimensional code or a medicine getting receipt.
7. The special drug claims bearing platform according to claim 6, wherein: the mobile terminal (1) can go to a drugstore to scan codes and check the sales through the acquired medicine-taking voucher; uploading the signature, and uploading a medicine getting confirmation book, an insurance fund getting authorization book and a settlement bill of a patient by a pharmacy pharmacist, wherein the pharmacy pharmacist can set the self-payment amount of the user according to the medicine.
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CN113658011A (en) * | 2021-08-27 | 2021-11-16 | 上海镁信健康科技有限公司 | System based on intelligent claims settlement |
CN113689137A (en) * | 2021-09-06 | 2021-11-23 | 上海镁信健康科技有限公司 | Rapid communication method in medical insurance system |
CN113706316A (en) * | 2021-08-27 | 2021-11-26 | 上海镁信健康科技有限公司 | Insurance company-oriented special medicine claim service open platform |
CN114023417A (en) * | 2021-11-03 | 2022-02-08 | 上海镁信健康科技有限公司 | Medication rationality auditing system for on-line special-effect medicine |
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