CN113191908B - Method and device for processing claims settlement auditing - Google Patents
Method and device for processing claims settlement auditing Download PDFInfo
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Abstract
The embodiment of the specification provides a method and a device for processing the examination and verification of a claim, wherein the method for processing the examination and verification of the claim comprises the following steps: identifying claim application materials of a user, and extracting medical entities contained in text information obtained by identification to construct medical events; marking medical insurance details in the medical event and the user medical insurance data based on the disease map to obtain a structured medical event and a structured medical insurance event; adding a label obtained by processing medical insurance data in the user medical insurance data in a trusted space to the structured medical insurance event; and inputting the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to perform core claim processing, and outputting a core claim result.
Description
Technical Field
The present document relates to the field of data processing technologies, and in particular, to a method and an apparatus for processing claims.
Background
With the rapid development of internet technology, the processes of selling, after-sales, claiming and the like of insurance can be operated on line, and with the deep development of insurance service, the requirements on service experience, refund or claiming after user application are more and more emphasized, so that the user can conveniently and rapidly carry out refund and claiming treatment, and part of insurance cases begin to adopt an on-line auditing mode to audit investigation materials, and high-complexity medical cases, insurance claiming cases, engineering cases and the like of the cases cannot be realized.
Disclosure of Invention
One or more embodiments of the present specification provide a method of claim audit processing. The method for processing the claims comprises the following steps: and identifying claim application materials of the user, and extracting medical entities contained in the text information obtained by identification to construct medical events. And marking medical insurance details in the medical event and the user medical insurance data based on the disease map to obtain a structured medical event and a structured medical insurance event. And adding the label obtained by processing the medical insurance data in the user medical insurance data in the trusted space to the structured medical insurance event. And inputting the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to perform core claim processing, and outputting a core claim result.
One or more embodiments of the present disclosure provide an apparatus for processing claims audit, including: and the event construction module is configured to identify claim application materials of the user and extract medical entities contained in the text information obtained by identification to construct medical events. And the marking processing module is configured to perform marking processing on medical insurance details in the medical event and the user medical insurance data based on the disease map to obtain a structured medical event and a structured medical insurance event. And the label adding module is configured to add labels obtained by processing the medical insurance data in the user medical insurance data in a trusted space to the structured medical insurance event. And the core claim processing module is configured to input the structured medical event and the added structured medical insurance event into a core claim rule determined based on the insurance policy information of the user to perform core claim processing and output a core claim result.
One or more embodiments of the present specification provide a claims audit processing apparatus, including: a processor; and a memory configured to store computer-executable instructions that, when executed, cause the processor to: and identifying claim application materials of the user, and extracting medical entities contained in the text information obtained by identification to construct medical events. And marking medical insurance details in the medical event and the user medical insurance data based on the disease map to obtain a structured medical event and a structured medical insurance event. And adding the label obtained by processing the medical insurance data in the user medical insurance data in the trusted space to the structured medical insurance event. And inputting the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to perform core claim processing, and outputting a core claim result.
One or more embodiments of the present specification provide a storage medium storing computer-executable instructions that, when executed, implement the following: and identifying claim application materials of the user, and extracting medical entities contained in the text information obtained by identification to construct medical events. And marking medical insurance details in the medical event and the user medical insurance data based on the disease map to obtain a structured medical event and a structured medical insurance event. And adding the label obtained by processing the medical insurance data in the user medical insurance data in the trusted space to the structured medical insurance event. And inputting the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to perform core claim processing, and outputting a core claim result.
Drawings
For a clearer description of one or more embodiments of the present description or of the solutions of the prior art, the drawings that are needed in the description of the embodiments or of the prior art will be briefly described below, it being obvious that the drawings in the description that follow are only some of the embodiments described in the present description, from which other drawings can be obtained, without inventive faculty, for a person skilled in the art;
FIG. 1 is a process flow diagram of a method for claim audit processing provided in one or more embodiments of the present disclosure;
FIG. 2 is a process flow diagram of a method for claim audit processing applied to an insurance claim scene, provided in one or more embodiments of the present disclosure;
FIG. 3 is a schematic diagram of a claim audit processing device according to one or more embodiments of the present disclosure;
fig. 4 is a schematic structural diagram of a claim audit processing device according to one or more embodiments of the present disclosure.
Detailed Description
In order to enable a person skilled in the art to better understand the technical solutions in one or more embodiments of the present specification, the technical solutions in one or more embodiments of the present specification will be clearly and completely described below with reference to the drawings in one or more embodiments of the present specification, and it is obvious that the described embodiments are only some embodiments of the present specification, not all embodiments. All other embodiments, which can be made by one or more embodiments of the present disclosure without inventive effort, are intended to be within the scope of the present disclosure.
The embodiment of the claim auditing and processing method is as follows:
referring to fig. 1, a processing flow chart of a claim auditing processing method provided by the present embodiment is shown, and referring to fig. 2, a processing flow chart of a claim auditing processing method applied to an insurance claim scene is shown.
Referring to fig. 1, the method for processing claims audit provided in this embodiment specifically includes steps S102 to S108.
Step S102, identifying claim application materials of the user, and extracting medical entities contained in the text information obtained by identification to construct medical events.
After the participants of the mutual aid and the common aid project or the medical insurance project submit the claim application, the insurer or the mutual aid provider needs to conduct public assessment investigation to determine whether the participants have evidence of fact that the participants are not paid in advance of joining in accordance with health notification and the like, wherein investigation paths and suggestions need to be given by analyzing according to the claim application materials and the like of the participants. In the method for processing the claim settlement, in the process of performing the claim settlement processing on the insurance claim settlement case, starting from claim settlement application materials submitted by users, identifying text information contained in the claim settlement application materials and further extracting medical entities contained in the claim settlement application materials to construct medical events, respectively constructing structural medical events of the claim settlement application materials and structural medical insurance events of the medical insurance data in combination with the medical insurance data of the users, taking the structural medical events as input and running a claim settlement rule determined based on the insurance policy information of the users to perform verification on the claim settlement application materials and the medical insurance data of the users, and finally outputting a claim settlement result with positive evidence to assist operation staff to perform dispatching decisions and perform single-point dispatching according to the positive evidence so as to improve the claim settlement efficiency and investigation efficiency.
The claim settlement materials in this embodiment include medical related image materials submitted by the user in the process of applying for the claim settlement for the mutually-assisted and the medical insurance project, and the image materials can be obtained by photographing or scanning the related materials such as hospitalized materials, visiting materials, examination sheets and the like of the user. For example, the user is used as a participant of a mutual aid and common aid project or a medical insurance project, applies for insurance claims after sick consultation, and photographs all materials relevant to hospitalization and consultation in the claims application process to obtain claim application materials composed of photographs.
In the specific implementation, in the process of identifying the claim application material of the user, OCR (Optical Character Recognition ) is adopted to identify the medical photos contained in the claim application material, so that the text information of each medical photo in the claim application material is obtained. However, the information carried in different medical photos is different, and the importance degree or the credibility degree of the information is also different, for example, the discharge report material and the diagnosis information carried in the pathological diagnosis material are strong credible medical information, and the credibility degree of the diagnosis information carried in the diagnosis result of the clinic development is lower, so that the credibility degree of the medical information of the user extracted from the claim application material is higher, thereby improving the accuracy of subsequent claim processing, in the process of identifying the claim application material, the credibility degree of each medical photo is firstly determined according to the material type of at least one medical photo contained in the claim application material; and performing OCR (optical character recognition) on each medical photo according to the credibility to obtain text information of each medical photo.
For example, for the strongly trusted discharge report material and pathological diagnosis material in the claim application material submitted by the paramedics of the mutual aid project or the medical insurance project, the photographs of the discharge report material and the pathological diagnosis material are identified by adopting OCR so as to obtain text information of the discharge report material and the pathological diagnosis material; and identifying text information of the outpatient diagnosis result in a fuzzy adaptation mode for the outpatient diagnosis result of which the claim application material is not strong and credible.
On the basis of the text information for identifying the claim application material, extracting the medical entity included in the text information to construct a medical event, and in order to improve the accuracy of extracting the medical entity, in an optional implementation manner provided in this embodiment, the medical entity included in the text information is extracted and the medical event is constructed in the following manner:
inputting the text information into a text recognition model for text recognition processing to obtain medical information of the user;
extracting entity keywords of the medical entity from the medical information, and constructing the medical event according to the entity keywords;
wherein the medical entity comprises at least one of: hospital identification, time information, and disease type (or disease name).
For example, text information obtained by OCR recognition of a photograph of a discharge report material of a user is input into a text recognition model for recognition processing, medical information corresponding to the text information is output, medical entities such as hospital identification, time information, disease types and the like are extracted from the output medical information, and finally medical events carried in the discharge report material are constructed by using the extracted medical entities as follows:
medical event 1: disease 1, a hospital, xx year x1 month xx day-xx year xx month x2 day;
medical event 2: disease 2, a hospital, xx year x1 month xx day-xx year xx month x2 day.
In practical application, in the claim application material submitted by the user, certain correlation may exist between medical events carried by photos of different materials, for example, the hospital report material and the medical event carried by the pathological diagnosis material in the claim application material submitted by the user are medical events for the same disease, for this, in an optional implementation manner provided in this embodiment, after the medical events are constructed, and before the following marking process by using a disease map, the medical events of the same disease or the same disease type are fused, and in the fusion process, specifically, first, in the medical events of each medical photo, one or more medical events with the same disease type (or disease name) are determined; the fusion is performed on the same one or more medical events that contain the disease category (or disease name).
And step S104, marking the medical insurance details in the medical event and the user medical insurance data based on the disease map to obtain a structured medical event and a structured medical insurance event.
The disease map in this embodiment is a map constructed according to health notification information (such as health notification) in the participation process of the mutual aid project or the medical insurance project and diseases recorded in a policy or an application agreement, and aims to detect a pre-verification process for medical events carried in claim application materials of users through the disease map, and to perform corresponding marking on the medical events according to the result of the pre-verification process, so as to serve as a basis for one aspect of subsequent claim processing.
It should be noted that, in this embodiment, the user medical insurance data is introduced based on the claim settlement application material submitted by the user, so as to promote the comprehensiveness and accuracy of the claim settlement audit, and the processing of the medical insurance data including the medical insurance details in the user medical insurance data is similar to the processing of the medical event, and the marking processing is performed on the medical insurance details by using the disease map, so as to be used as the basis of another aspect of the follow-up claim processing. The user medical insurance data comprise user medical insurance seeking data, hospitalization data and the like, and particularly can be obtained through an interface provided by a third party mechanism or a medical insurance mechanism.
The structured medical event refers to data information of the medical event formed according to a preset data format or structure; the structured medical insurance event refers to data information of the medical insurance event formed according to a preset data format or structure.
In an optional implementation manner provided in this embodiment, the marking processing of the medical event based on the disease map is implemented in the following manner: searching for the presence or absence of a disease category in the disease profile based on the disease category in the medical event; if yes, marking a disease label corresponding to the disease type in the medical event to obtain the structured medical event; if not, the processing is not needed.
For example, for medical event 1: and searching whether the disease 1 exists in the disease map or not in the disease 1, A hospital, xx is carried out on xx-xx, and if the disease 1 exists in the disease map and the disease 1 corresponds to health notification information and is ensured to be excluded, marking the medical event 1 in a specific marking mode, namely writing a label of the disease 1 in the medical event, and subsequently, making a core-claim decision of a positive core-claim result according to the label in the process of inputting the medical event 1 into a core-claim rule for core-claim processing.
Similarly, marking the medical insurance details in the user medical insurance data based on the disease map is realized by adopting the following modes:
searching for the presence or absence of the disease category in the disease profile according to the disease category recorded in the medical insurance details;
and if so, marking a disease label corresponding to the disease type in the medical insurance event of the medical insurance details to obtain the structured medical insurance event.
And step S106, adding the label obtained by processing the medical insurance data in the trusted space in the user medical insurance data to the structured medical insurance event.
In the specific implementation, relevant data information related to user privacy may exist in the user medical insurance data of the user, which is acquired through an interface provided by a third party mechanism or a medical insurance mechanism, and the user privacy information is not limited to the identity information of the user, but also includes disease information which is not allowed to be known by others without authorization of the user; in order to protect the data privacy of the user and avoid the leakage of the user privacy, in this embodiment, the marking process is performed on the medical insurance data of the user in the trusted space, and the tag obtained by the processing is added to the structured medical insurance data, and in a specific optional implementation manner provided in this embodiment, the adding the tag obtained by processing the medical insurance data in the medical insurance data of the user in the trusted space to the structured medical insurance event includes:
According to a preset matching rule, matching processing is carried out on medical insurance data containing user privacy data in the medical insurance data in the trusted space, and a disease label of the medical insurance data to be processed is obtained; the trusted space is configured on a trusted medium or a trusted device;
and adding the disease label to the structured medical insurance event, and blurring medical insurance data containing user privacy data in the medical insurance data and outputting the medical insurance data from the trusted space.
And S108, inputting the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to carry out core claim processing, and outputting a core claim result.
The core claim rule in this embodiment refers to an executable rule for performing a claim audit on a medical event and a medical insurance event, specifically, in a core claim processing process, after loading the core claim rule, inputting the structured medical event and the added structured medical insurance event into the core claim rule, and operating the core claim rule to perform core claim processing, and outputting a corresponding core claim result, where the core claim result includes that a core claim passes and a core claim fails, and the core claim passes through a claim settlement application material indicating a user and user medical insurance data satisfy a payment condition, that is: negative core claim results; in contrast, the core claim fails to satisfy the claims condition by indicating that the claim application material of the user and the user medical insurance data do not satisfy the claims condition, namely: positive results of the claim.
Before the processing of the claim, the claim rule of the subsequent claim processing is determined by combining the policy information of the user, and in the process of determining the claim rule according to the policy information of the user, firstly, the insurance product of the medical policy corresponding to the policy information is determined; the core claim rules are then determined based on the insurance product and loaded.
In an optional implementation manner provided in this embodiment, inputting the structured medical event and the added structured medical insurance event into a claim rule determined based on the policy information of the user to perform claim processing, and outputting a claim result, where the method includes:
inputting the structured medical event and the added structured medical insurance event into a health notification claim rule to perform first claim processing to obtain a first claim result;
if the first core claim result is that the core claim fails, outputting a positive core claim result carrying an event identifier;
if the first core claim result is that the core claim passes, inputting the structured medical event and the added structured medical insurance event into a policy range core claim rule to carry out a second core claim result;
if the second core claim result is that the core claim fails, outputting a positive core claim result carrying an event identifier;
If the second core claim result is that the core claim passes, outputting a prompt for the passing of the core claim.
On the basis, in order to facilitate the auditor to make a dispatching decision, and avoid the problems of low efficiency and waste of manpower and material resources existing in the whole-path investigation by the auditor, in an alternative implementation manner provided by the embodiment, under the condition that the core claim result is a positive core claim result, a corresponding positive evidence material is obtained according to the positive core claim result, further, a claim settlement investigation node is determined based on the positive evidence material, and investigation reminding information of the claim settlement investigation node is generated, so that the auditor is helped to make a single dispatching decision, and the investigation efficiency of the investigator is improved.
The following further describes the claim auditing method provided in this embodiment, referring to fig. 2, by taking an application of the claim auditing method provided in this embodiment to an insurance claim scene as an example, and specifically includes steps S202 to S222.
Step S202, determining the credibility of each medical photo according to the material type of at least one medical photo contained in the claim application material of the user.
And step S204, performing OCR (optical character recognition) on each medical picture according to the credibility to obtain text information of each medical picture.
Step S206, inputting the text information into the text recognition model for text recognition processing, and outputting the medical information of the user.
Step S208, extracting entity keywords of the medical entity from the medical information, and constructing the medical event according to the entity keywords. The medical entity comprises three kinds of diseases or disease names and hospital identification and time information.
Step S210, fusing the medical events containing the same disease type or disease name according to the disease type and/or disease name contained in the medical events.
Medical events are built up of disease categories or disease names, hospital identification, and time information.
Step S212, if the disease type or the disease name contained in the medical event exists in the disease map, the corresponding disease label is marked in the medical event, and the structured medical event is obtained.
In step S214, the user medical insurance data of the user is obtained through a medical insurance data interface provided by the third party institution or the medical insurance institution.
The user medical insurance data consists of medical insurance data related to the privacy of the user data and medical insurance lists not related to the privacy of the user data.
Step S216, if the disease type or the disease name recorded in the medical insurance list exists in the disease map, marking the corresponding disease label in the medical insurance event of the medical insurance list, and obtaining the structured medical insurance event.
Step S218, the label obtained by processing the medical insurance data in the trusted space is added to the structured medical insurance event.
And step S220, inputting the structured medical event and the structured medical insurance event into a core claim rule determined based on the insurance policy information of the user to carry out core claim processing, and outputting a positive core claim result carrying an event identifier.
Step S222, determining the claim investigation node and generating investigation reminding information of the claim investigation node according to the positive evidence material determined based on the event identification.
The embodiment of the claim auditing and processing device provided in the specification is as follows:
in the foregoing embodiments, a method for processing an audit of a claim is provided, and a device for processing an audit of a claim is provided corresponding to the method, which is described below with reference to the accompanying drawings.
Referring to fig. 3, a schematic diagram of an apparatus for auditing and processing claims according to the present embodiment is shown.
Since the apparatus embodiments correspond to the method embodiments, the description is relatively simple, and the relevant portions should be referred to the corresponding descriptions of the method embodiments provided above. The device embodiments described below are merely illustrative.
The embodiment provides a claim auditing processing apparatus, including:
an event construction module 302 configured to identify claim application materials of the user and extract medical entities contained in the text information obtained by the identification to construct medical events;
a marking module 304 configured to perform marking processing on medical insurance details in the medical event and the user medical insurance data based on the disease map, to obtain a structured medical event and a structured medical insurance event;
a tag adding module 306 configured to add a tag obtained by processing medical insurance data in a trusted space in the user medical insurance data to the structured medical insurance event;
and a core claim processing module 308 configured to input the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to perform core claim processing, and output a core claim result.
Optionally, the event construction module 302 includes:
a confidence level determination sub-module configured to determine a confidence level of each medical photograph according to a material type of at least one medical photograph contained in the claim application material;
and the OCR recognition sub-module is configured to perform OCR recognition on each medical photo according to the credibility degree to obtain text information of each medical photo.
Optionally, the event construction module 302 includes:
the text recognition processing sub-module is configured to input the text information into a text recognition model for text recognition processing and output the medical information of the user;
a medical event construction sub-module configured to extract entity keywords of the medical entity from the medical information and construct the medical event according to the entity keywords;
wherein the medical entity comprises at least one of: hospital identification, time information, and disease type.
The embodiment of the claim auditing processing equipment provided in the specification is as follows:
in response to the foregoing description of a method for processing an claim audit, one or more embodiments of the present disclosure further provide an apparatus for processing an claim audit, where the apparatus for processing an claim audit is configured to execute the foregoing method for processing an claim audit, and fig. 4 is a schematic structural diagram of an apparatus for processing an claim audit provided by one or more embodiments of the present disclosure.
The device for processing the claim auditing includes:
as shown in FIG. 4, the claims audit processing device may vary widely in configuration or performance, may include one or more processors 401 and memory 402, and may have one or more stored applications or data stored in the memory 402. Wherein the memory 402 may be transient storage or persistent storage. The application program stored in the memory 402 may include one or more modules (not shown), each of which may include a series of computer-executable instructions in the claims audit processing device. Still further, the processor 401 may be configured to communicate with the memory 402 and execute a series of computer executable instructions in the memory 402 on the claim audit processing device. The claims audit processing device may also include one or more power supplies 403, one or more wired or wireless network interfaces 404, one or more input/output interfaces 405, one or more keyboards 406, and the like.
In a specific embodiment, the claim audit processing apparatus includes a memory, and one or more programs, wherein the one or more programs are stored in the memory, and the one or more programs may include one or more modules, and each module may include a series of computer-executable instructions for the claim audit processing apparatus, and configured to be executed by the one or more processors, the one or more programs including computer-executable instructions for:
identifying claim application materials of a user, and extracting medical entities contained in text information obtained by identification to construct medical events;
marking medical insurance details in the medical event and the user medical insurance data based on the disease map to obtain a structured medical event and a structured medical insurance event;
adding a label obtained by processing medical insurance data in the user medical insurance data in a trusted space to the structured medical insurance event;
and inputting the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to perform core claim processing, and outputting a core claim result.
Optionally, the identifying claim application material of the user includes:
determining the credibility of each medical photo according to the material type of at least one medical photo contained in the claim application material;
and performing OCR (optical character recognition) on each medical photo according to the credibility to obtain text information of each medical photo.
Optionally, the extracting identifies a medical entity included in the obtained text information to construct a medical event, including:
inputting the text information into a text recognition model for text recognition processing, and outputting the medical information of the user;
extracting entity keywords of the medical entity from the medical information, and constructing the medical event according to the entity keywords;
wherein the medical entity comprises at least one of: hospital identification, time information, and disease type.
Optionally, the medical event is marked based on the disease map, which is implemented in the following manner:
searching for the presence or absence of a disease category in the disease profile based on the disease category in the medical event;
if yes, marking a disease label corresponding to the disease type in the medical event to obtain the structured medical event.
Optionally, marking the medical insurance details in the user medical insurance data based on the disease map, and implementing the following modes:
searching for the presence or absence of the disease category in the disease profile according to the disease category recorded in the medical insurance details;
and if so, marking a disease label corresponding to the disease type in the medical insurance event of the medical insurance details to obtain the structured medical insurance event.
Optionally, the adding the label obtained by processing the medical insurance data in the trusted space to the structured medical insurance event includes:
according to a preset matching rule, matching processing is carried out on medical insurance data containing user privacy data in the medical insurance data in the trusted space, and a disease label of the medical insurance data to be processed is obtained; the trusted space is configured in a trusted medium;
and adding the disease label to the structured medical insurance event, and blurring medical insurance data containing user privacy data in the medical insurance data and outputting the medical insurance data from the trusted space.
Optionally, inputting the structured medical event and the added structured medical insurance event into a claim rule determined based on the policy information of the user to perform claim processing, and outputting a claim result, including:
Inputting the structured medical event and the added structured medical insurance event into a health notification claim rule to perform first claim processing to obtain a first claim result;
if the first core claim result is that the core claim passes, inputting the structured medical event and the added structured medical insurance event into a policy range core claim rule to carry out a second core claim result;
if the second core claim result is that the core claim fails, outputting a positive core claim result carrying an event identifier;
if the first core claim result is that the core claim fails, outputting a positive core claim result carrying the event identification.
Optionally, the inputting the structured medical event and the added structured medical insurance event into the claim rule determined based on the policy information of the user to perform claim processing, and before the outputting the claim result flow, further includes:
determining an insurance product to which the medical policy corresponding to the policy information belongs;
and determining the core claim rule based on the insurance product, and loading the core claim rule.
An embodiment of a storage medium provided in the present specification is as follows:
in response to the foregoing description of a method for processing claims, one or more embodiments of the present disclosure further provide a storage medium based on the same technical concept.
The storage medium provided in this embodiment is configured to store computer executable instructions, where the computer executable instructions when executed implement the following procedures:
identifying claim application materials of a user, and extracting medical entities contained in text information obtained by identification to construct medical events;
marking medical insurance details in the medical event and the user medical insurance data based on the disease map to obtain a structured medical event and a structured medical insurance event;
adding a label obtained by processing medical insurance data in the user medical insurance data in a trusted space to the structured medical insurance event;
and inputting the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to perform core claim processing, and outputting a core claim result.
Optionally, the identifying claim application material of the user includes:
determining the credibility of each medical photo according to the material type of at least one medical photo contained in the claim application material;
and performing OCR (optical character recognition) on each medical photo according to the credibility to obtain text information of each medical photo.
Optionally, the extracting identifies a medical entity included in the obtained text information to construct a medical event, including:
Inputting the text information into a text recognition model for text recognition processing, and outputting the medical information of the user;
extracting entity keywords of the medical entity from the medical information, and constructing the medical event according to the entity keywords;
wherein the medical entity comprises at least one of: hospital identification, time information, and disease type.
Optionally, the medical event is marked based on the disease map, which is implemented in the following manner:
searching for the presence or absence of a disease category in the disease profile based on the disease category in the medical event;
if yes, marking a disease label corresponding to the disease type in the medical event to obtain the structured medical event.
Optionally, marking the medical insurance details in the user medical insurance data based on the disease map, and implementing the following modes:
searching for the presence or absence of the disease category in the disease profile according to the disease category recorded in the medical insurance details;
and if so, marking a disease label corresponding to the disease type in the medical insurance event of the medical insurance details to obtain the structured medical insurance event.
Optionally, the adding the label obtained by processing the medical insurance data in the trusted space to the structured medical insurance event includes:
according to a preset matching rule, matching processing is carried out on medical insurance data containing user privacy data in the medical insurance data in the trusted space, and a disease label of the medical insurance data to be processed is obtained; the trusted space is configured in a trusted medium;
and adding the disease label to the structured medical insurance event, and blurring medical insurance data containing user privacy data in the medical insurance data and outputting the medical insurance data from the trusted space.
Optionally, inputting the structured medical event and the added structured medical insurance event into a claim rule determined based on the policy information of the user to perform claim processing, and outputting a claim result, including:
inputting the structured medical event and the added structured medical insurance event into a health notification claim rule to perform first claim processing to obtain a first claim result;
if the first core claim result is that the core claim passes, inputting the structured medical event and the added structured medical insurance event into a policy range core claim rule to carry out a second core claim result;
If the second core claim result is that the core claim fails, outputting a positive core claim result carrying an event identifier;
if the first core claim result is that the core claim fails, outputting a positive core claim result carrying the event identification.
Optionally, the inputting the structured medical event and the added structured medical insurance event into the claim rule determined based on the policy information of the user to perform claim processing, and before the outputting the claim result flow, further includes:
determining an insurance product to which the medical policy corresponding to the policy information belongs;
and determining the core claim rule based on the insurance product, and loading the core claim rule.
It should be noted that, in the present specification, the embodiment about the storage medium and the embodiment about the method for auditing the claims in the present specification are based on the same inventive concept, so that the specific implementation of this embodiment may refer to the implementation of the corresponding method, and the repetition is omitted.
The foregoing describes specific embodiments of the present disclosure. Other embodiments are within the scope of the following claims. In some cases, the actions or steps recited in the claims can be performed in a different order than in the embodiments and still achieve desirable results. In addition, the processes depicted in the accompanying figures do not necessarily require the particular order shown, or sequential order, to achieve desirable results. In some embodiments, multitasking and parallel processing are also possible or may be advantageous.
In the 30 s of the 20 th century, improvements to one technology could clearly be distinguished as improvements in hardware (e.g., improvements to circuit structures such as diodes, transistors, switches, etc.) or software (improvements to the process flow). However, with the development of technology, many improvements of the current method flows can be regarded as direct improvements of hardware circuit structures. Designers almost always obtain corresponding hardware circuit structures by programming improved method flows into hardware circuits. Therefore, an improvement of a method flow cannot be said to be realized by a hardware entity module. For example, a programmable logic device (Programmable Logic Device, PLD) (e.g., field programmable gate array (Field Programmable Gate Array, FPGA)) is an integrated circuit whose logic function is determined by the programming of the device by a user. A designer programs to "integrate" a digital system onto a PLD without requiring the chip manufacturer to design and fabricate application-specific integrated circuit chips. Moreover, nowadays, instead of manually manufacturing integrated circuit chips, such programming is mostly implemented by using "logic compiler" software, which is similar to the software compiler used in program development and writing, and the original code before the compiling is also written in a specific programming language, which is called hardware description language (Hardware Description Language, HDL), but not just one of the hdds, but a plurality of kinds, such as ABEL (Advanced Boolean Expression Language), AHDL (Altera Hardware Description Language), confluence, CUPL (Cornell University Programming Language), HDCal, JHDL (Java Hardware Description Language), lava, lola, myHDL, PALASM, RHDL (Ruby Hardware Description Language), etc., VHDL (Very-High-Speed Integrated Circuit Hardware Description Language) and Verilog are currently most commonly used. It will also be apparent to those skilled in the art that a hardware circuit implementing the logic method flow can be readily obtained by merely slightly programming the method flow into an integrated circuit using several of the hardware description languages described above.
The controller may be implemented in any suitable manner, for example, the controller may take the form of, for example, a microprocessor or processor and a computer readable medium storing computer readable program code (e.g., software or firmware) executable by the (micro) processor, logic gates, switches, application specific integrated circuits (Application Specific Integrated Circuit, ASIC), programmable logic controllers, and embedded microcontrollers, examples of which include, but are not limited to, the following microcontrollers: ARC625D, atmel AT91SAM, microchip PIC18F26K20, and Silicone Labs C8051F320, the memory controller may also be implemented as part of the control logic of the memory. Those skilled in the art will also appreciate that, in addition to implementing the controller in a pure computer readable program code, it is well possible to implement the same functionality by logically programming the method steps such that the controller is in the form of logic gates, switches, application specific integrated circuits, programmable logic controllers, embedded microcontrollers, etc. Such a controller may thus be regarded as a kind of hardware component, and means for performing various functions included therein may also be regarded as structures within the hardware component. Or even means for achieving the various functions may be regarded as either software modules implementing the methods or structures within hardware components.
The system, apparatus, module or unit set forth in the above embodiments may be implemented in particular by a computer chip or entity, or by a product having a certain function. One typical implementation is a computer. In particular, the computer may be, for example, a personal computer, a laptop computer, a cellular telephone, a camera phone, a smart phone, a personal digital assistant, a media player, a navigation device, an email device, a game console, a tablet computer, a wearable device, or a combination of any of these devices.
For convenience of description, the above devices are described as being functionally divided into various units, respectively. Of course, the functions of each unit may be implemented in the same piece or pieces of software and/or hardware when implementing the embodiments of the present specification.
One skilled in the relevant art will recognize that one or more embodiments of the present description may be provided as a method, system, or computer program product. Accordingly, one or more embodiments of the present description may take the form of an entirely hardware embodiment, an entirely software embodiment or an embodiment combining software and hardware aspects. Furthermore, the present description can take the form of a computer program product on one or more computer-usable storage media (including, but not limited to, disk storage, CD-ROM, optical storage, etc.) having computer-usable program code embodied therein.
The present description is described with reference to flowchart illustrations and/or block diagrams of methods, apparatus (systems) and computer program products according to embodiments of the specification. It will be understood that each flow and/or block of the flowchart illustrations and/or block diagrams, and combinations of flows and/or blocks in the flowchart illustrations and/or block diagrams, can be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general purpose computer, special purpose computer, embedded processor, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.
These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the flowchart flow or flows and/or block diagram block or blocks.
These computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.
In one typical configuration, a computing device includes one or more processors (CPUs), input/output interfaces, network interfaces, and memory.
The memory may include volatile memory in a computer-readable medium, random Access Memory (RAM) and/or nonvolatile memory, such as Read Only Memory (ROM) or flash memory (flash RAM). Memory is an example of computer-readable media.
Computer readable media, including both non-transitory and non-transitory, removable and non-removable media, may implement information storage by any method or technology. The information may be computer readable instructions, data structures, modules of a program, or other data. Examples of storage media for a computer include, but are not limited to, phase change memory (PRAM), static Random Access Memory (SRAM), dynamic Random Access Memory (DRAM), other types of Random Access Memory (RAM), read Only Memory (ROM), electrically Erasable Programmable Read Only Memory (EEPROM), flash memory or other memory technology, compact disc read only memory (CD-ROM), digital Versatile Disks (DVD) or other optical storage, magnetic cassettes, magnetic disk storage or other magnetic storage devices, or any other non-transmission medium which can be used to store information that can be accessed by a computing device. Computer-readable media, as defined herein, does not include transitory computer-readable media (transmission media), such as modulated data signals and carrier waves.
It should also be noted that the terms "comprises," "comprising," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. Without further limitation, an element defined by the phrase "comprising one … …" does not exclude the presence of other like elements in a process, method, article or apparatus that comprises the element.
One or more embodiments of the present specification may be described in the general context of computer-executable instructions, such as program modules, being executed by a computer. Generally, program modules include routines, programs, objects, components, data structures, etc. that perform particular tasks or implement particular abstract data types. One or more embodiments of the specification may also be practiced in distributed computing environments where tasks are performed by remote processing devices that are linked through a communications network. In a distributed computing environment, program modules may be located in both local and remote computer storage media including memory storage devices.
In this specification, each embodiment is described in a progressive manner, and identical and similar parts of each embodiment are all referred to each other, and each embodiment mainly describes differences from other embodiments. In particular, for system embodiments, since they are substantially similar to method embodiments, the description is relatively simple, as relevant to see a section of the description of method embodiments.
The foregoing description is by way of example only and is not intended to limit the present disclosure. Various modifications and changes may occur to those skilled in the art. Any modifications, equivalent substitutions, improvements, etc. that fall within the spirit and principles of the present document are intended to be included within the scope of the claims of the present document.
Claims (15)
1. A method for processing the examination and the verification of a claim comprises the following steps:
identifying claim application materials of a user, and extracting medical entities contained in text information obtained by identification to construct medical events;
based on a disease map of a medical insurance project, marking the disease types existing in the disease map in the disease types existing in the disease map of the medical event and the disease types existing in the disease map in medical insurance details in user medical insurance data to obtain a structured medical event and a structured medical insurance event;
Blurring processing is carried out on medical insurance data containing user privacy data in the user medical insurance data in a trusted space, and processing results are added to the structured medical insurance event;
and inputting the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to perform core claim processing, and outputting a core claim result.
2. The claim 1 claim audit processing method, the identifying claim application material for a user, comprising:
determining the credibility of each medical photo according to the material type of at least one medical photo contained in the claim application material;
and performing OCR (optical character recognition) on each medical photo according to the credibility to obtain text information of each medical photo.
3. The claim 1 wherein the extracting identifies medical entity-building medical event contained in the obtained text information comprises:
inputting the text information into a text recognition model for text recognition processing, and outputting the medical information of the user;
extracting entity keywords of the medical entity from the medical information, and constructing the medical event according to the entity keywords;
Wherein the medical entity comprises at least one of: hospital identification, time information, and disease type.
4. The claim 2 claim audit processing method, wherein after the steps of identifying claim application materials of a user and extracting medical entities included in text information obtained by identification to construct medical events are executed, and the medical insurance item-based disease pattern, the steps of marking disease types of the medical events existing in the disease pattern and medical insurance details in user medical insurance data existing in the disease pattern, and obtaining structured medical events and structured medical insurance events are executed, further include:
among the medical events of each medical photograph, one or more medical events containing the same disease type are determined;
the fusion of the disease categories contained with one or more medical events is performed.
5. The claim 1 claim audit processing method for marking the medical event based on the disease profile by:
searching for the presence or absence of a disease category in the disease profile based on the disease category in the medical event;
If yes, marking a disease label corresponding to the disease type in the medical event to obtain the structured medical event.
6. The claim 1 claim auditing method, based on the disease map, for marking medical insurance details in the user medical insurance data, implemented in the following manner:
searching for the presence or absence of the disease category in the disease profile according to the disease category recorded in the medical insurance details;
and if so, marking a disease label corresponding to the disease type in the medical insurance event of the medical insurance details to obtain the structured medical insurance event.
7. The claim 1 claim audit processing method, wherein the blurring processing is performed on the medical insurance data including the user privacy data in the user medical insurance data in the trusted space, and adding the processing result to the structured medical insurance event, includes:
according to a preset matching rule, matching processing is carried out on medical insurance data containing user privacy data in the user medical insurance data in the trusted space, and a disease label of the medical insurance data is obtained; the trusted space is configured in a trusted medium;
and adding the disease label to the structured medical insurance event, and blurring medical insurance data containing user privacy data in the user medical insurance data and outputting the medical insurance data from the trusted space.
8. The claim 1 claim auditing method, the inputting the structured medical event and the added structured medical insurance event into a claim rule determined based on the user's policy information for claim processing, outputting a claim result, comprising:
inputting the structured medical event and the added structured medical insurance event into a health notification claim rule to perform first claim processing to obtain a first claim result;
if the first core claim result is that the core claim passes, inputting the structured medical event and the added structured medical insurance event into a policy range core claim rule to carry out a second core claim result;
if the second core claim result is that the core claim fails, outputting a positive core claim result carrying an event identifier;
if the first core claim result is that the core claim fails, outputting a positive core claim result carrying the event identification.
9. The claim 1 claim auditing method, wherein the steps of inputting the structured medical event and the added structured medical insurance event into a claim rule determined based on the user's policy information to perform claim processing, and outputting a claim result are further performed before the step of executing the claim result comprises:
determining an insurance product to which the medical policy corresponding to the policy information belongs;
And determining the core claim rule based on the insurance product, and loading the core claim rule.
10. The claim 8 claim audit processing method further comprising:
obtaining a corresponding positive evidence material according to the positive core claim result;
and determining a claim investigation node based on the positive evidence material and generating investigation reminding information of the claim investigation node.
11. An apparatus for auditing and processing claims, comprising:
the event construction module is configured to identify claim application materials of the user and extract medical entities contained in the text information obtained by identification to construct medical events;
the marking processing module is configured to perform marking processing on the disease types existing in the disease patterns in the disease types existing in the disease patterns of the medical event and the medical insurance details in the user medical insurance data based on the disease patterns of the medical insurance projects to obtain a structured medical event and a structured medical insurance event;
the label adding module is configured to carry out fuzzification processing on medical insurance data containing user privacy data in the user medical insurance data in a trusted space, and add a processing result to the structured medical insurance event;
And the core claim processing module is configured to input the structured medical event and the added structured medical insurance event into a core claim rule determined based on the insurance policy information of the user to perform core claim processing and output a core claim result.
12. The claim 11 claim audit processing apparatus, the event construction module comprising:
a confidence level determination sub-module configured to determine a confidence level of each medical photograph according to a material type of at least one medical photograph contained in the claim application material;
and the OCR recognition sub-module is configured to perform OCR recognition on each medical photo according to the credibility degree to obtain text information of each medical photo.
13. The claim 11 claim audit processing apparatus, the event construction module comprising:
the text recognition processing sub-module is configured to input the text information into a text recognition model for text recognition processing and output the medical information of the user;
a medical event construction sub-module configured to extract entity keywords of the medical entity from the medical information and construct the medical event according to the entity keywords;
wherein the medical entity comprises at least one of: hospital identification, time information, and disease type.
14. An apparatus for processing claims, comprising:
a processor; and a memory configured to store computer-executable instructions that, when executed, cause the processor to:
identifying claim application materials of a user, and extracting medical entities contained in text information obtained by identification to construct medical events;
based on a disease map of a medical insurance project, marking the disease types existing in the disease map in the disease types existing in the disease map of the medical event and the disease types existing in the disease map in medical insurance details in user medical insurance data to obtain a structured medical event and a structured medical insurance event;
blurring processing is carried out on medical insurance data containing user privacy data in the user medical insurance data in a trusted space, and processing results are added to the structured medical insurance event;
and inputting the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to perform core claim processing, and outputting a core claim result.
15. A storage medium storing computer-executable instructions that when executed implement the following:
Identifying claim application materials of a user, and extracting medical entities contained in text information obtained by identification to construct medical events;
based on a disease map of a medical insurance project, marking the disease types existing in the disease map in the disease types existing in the disease map of the medical event and the disease types existing in the disease map in medical insurance details in user medical insurance data to obtain a structured medical event and a structured medical insurance event;
blurring processing is carried out on medical insurance data containing user privacy data in the user medical insurance data in a trusted space, and processing results are added to the structured medical insurance event;
and inputting the structured medical event and the added structured medical insurance event into a core claim rule determined based on the policy information of the user to perform core claim processing, and outputting a core claim result.
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| CN114372890B (en) * | 2022-01-12 | 2023-03-07 | 中国人民健康保险股份有限公司深圳分公司 | Insurance self-service claim settlement management method and system |
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Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN108305175A (en) * | 2017-12-30 | 2018-07-20 | 上海栈略数据技术有限公司 | Settlement of insurance claim air control assisted verification system based on intellectual medical knowledge mapping |
| CN108520465A (en) * | 2017-09-13 | 2018-09-11 | 平安科技（深圳）有限公司 | Medical insurance Claims Resolution method, apparatus, computer equipment and storage medium |
| CN109493285A (en) * | 2018-09-18 | 2019-03-19 | 阿里巴巴集团控股有限公司 | Image processing method, device, server and storage medium based on crowdsourcing |
| CN111626876A (en) * | 2020-05-27 | 2020-09-04 | 泰康保险集团股份有限公司 | Insurance auditing method, insurance auditing device, electronic equipment and storage medium |
| CN111986035A (en) * | 2020-08-31 | 2020-11-24 | 平安医疗健康管理股份有限公司 | Medical insurance service auditing method, device, equipment and storage medium |
| CN112182117A (en) * | 2020-09-25 | 2021-01-05 | 北京优全智汇信息技术有限公司 | Claims checking method and device |
-
2021
- 2021-05-13 CN CN202110523421.2A patent/CN113191908B/en active Active
Patent Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN108520465A (en) * | 2017-09-13 | 2018-09-11 | 平安科技（深圳）有限公司 | Medical insurance Claims Resolution method, apparatus, computer equipment and storage medium |
| CN108305175A (en) * | 2017-12-30 | 2018-07-20 | 上海栈略数据技术有限公司 | Settlement of insurance claim air control assisted verification system based on intellectual medical knowledge mapping |
| CN109493285A (en) * | 2018-09-18 | 2019-03-19 | 阿里巴巴集团控股有限公司 | Image processing method, device, server and storage medium based on crowdsourcing |
| CN111626876A (en) * | 2020-05-27 | 2020-09-04 | 泰康保险集团股份有限公司 | Insurance auditing method, insurance auditing device, electronic equipment and storage medium |
| CN111986035A (en) * | 2020-08-31 | 2020-11-24 | 平安医疗健康管理股份有限公司 | Medical insurance service auditing method, device, equipment and storage medium |
| CN112182117A (en) * | 2020-09-25 | 2021-01-05 | 北京优全智汇信息技术有限公司 | Claims checking method and device |
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