CN113689209A - Medical insurance fund payment method - Google Patents

Medical insurance fund payment method Download PDF

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Publication number
CN113689209A
CN113689209A CN202110985833.8A CN202110985833A CN113689209A CN 113689209 A CN113689209 A CN 113689209A CN 202110985833 A CN202110985833 A CN 202110985833A CN 113689209 A CN113689209 A CN 113689209A
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medical
reimbursement
account
institution
medical insurance
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CN202110985833.8A
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Chinese (zh)
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王海涛
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Shanghai Digital Technology Center
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Shanghai Digital Technology Center
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    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q20/00—Payment architectures, schemes or protocols
    • G06Q20/22—Payment schemes or models
    • G06Q20/28—Pre-payment schemes, e.g. "pay before"
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q20/00—Payment architectures, schemes or protocols
    • G06Q20/08—Payment architectures
    • G06Q20/10—Payment architectures specially adapted for electronic funds transfer [EFT] systems; specially adapted for home banking systems
    • G06Q20/102—Bill distribution or payments
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08—Insurance

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  • Accounting & Taxation (AREA)
  • Finance (AREA)
  • Engineering & Computer Science (AREA)
  • Physics & Mathematics (AREA)
  • General Physics & Mathematics (AREA)
  • General Business, Economics & Management (AREA)
  • Theoretical Computer Science (AREA)
  • Strategic Management (AREA)
  • Development Economics (AREA)
  • Economics (AREA)
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  • Technology Law (AREA)
  • Medical Treatment And Welfare Office Work (AREA)
  • Financial Or Insurance-Related Operations Such As Payment And Settlement (AREA)

Abstract

The invention provides a medical insurance fund payment method which is applied to an intelligent contract executed by a block chain node and comprises the following steps: acquiring a list to be paid exceeding a payment period corresponding to a medical institution; determining the amount to be paid corresponding to the medical institution according to the list to be paid; controlling a medical institution prepaid account and/or a medical insurance fund account to pay to the medical institution account according to the amount to be paid and initiating a transaction for recording the payment state; and acquiring a reimbursement request of a medical institution, and responding to the reimbursement request according to a payment result of the medical insurance fund account to the medical institution account. The invention can simplify the operation of each user in the process of purchasing the medicine belt amount, reduce the operation difficulty and improve the working efficiency and the accuracy.

Description

Medical insurance fund payment method
Technical Field
The invention relates to the technical field of intelligent contracts, in particular to a medical insurance fund payment method.
Background
In the process of purchasing the medicine with the quantity, the medical insurance bureau generally plans the purchasing requirements of a plurality of medical institutions, then docks the purchasing requirements to the corresponding medical institutions, and the medical institutions pay the corresponding price after supplying the purchasing requirements. However, in the payment process of the price, the medical institution fails to pay the price due to various reasons, and in this case, the medical insurance bureau needs to pay the price in advance. In the above process, since the whole business process involves numerous users, interaction between two different roles is required, which results in a complex and error-prone whole process.
Disclosure of Invention
The medical insurance fund payment method provided by the invention can simplify the operation of each user in the medicine tape amount purchasing process, reduce the operation difficulty and improve the working efficiency and accuracy.
The invention provides a medical insurance fund payment method which is applied to an intelligent contract executed by a block chain node and comprises the following steps:
acquiring a list to be paid exceeding a payment period corresponding to a medical institution;
determining the amount to be paid corresponding to the medical institution according to the list to be paid;
controlling a medical institution prepaid account and/or a medical insurance fund account to pay to the medical institution account according to the amount to be paid and initiating a transaction for recording the payment state;
and acquiring a reimbursement request of a medical institution, and responding to the reimbursement request according to a payment result of the medical insurance fund account to the medical institution account.
Optionally, controlling payment of a medical institution prepaid account and/or a medical insurance fund account to the medical institution account in accordance with the amount to be paid comprises:
and when the amount to be paid is smaller than the balance of the prepaid fee account, controlling the prepaid fee account of the medical institution to pay to the medical institution account.
Optionally, controlling payment of a medical institution prepaid account and/or a medical insurance fund account to the medical institution account in accordance with the amount to be paid comprises:
when the amount to be paid is larger than the balance of the prepaid fee account, controlling the prepaid fee account of the medical institution to pay to the medical institution account;
obtaining the amount which cannot be paid successfully in the amounts to be paid; and controlling the medical insurance fund account to pay to the medical institution account.
Optionally, the obtaining a reimbursement request of a medical institution and responding to the reimbursement request according to the payment result of the medical insurance fund account to the medical institution account includes:
acquiring the reimbursement amount of the reimbursement request;
determining a difference between the reimbursement amount and a payment amount of the medical insurance fund to the medical institution account;
and controlling a medical insurance fund account to pay to the medical institution according to the difference.
Optionally, obtaining the reimbursement amount of the reimbursement request includes:
responding to the reimbursement request, and sending a reimbursement request list to a medical insurance institution;
and acquiring a reimbursement confirmation list confirmed by the medical insurance institution according to the reimbursement request list, and determining the reimbursement amount.
Optionally, the obtaining of the reimbursement confirmation list confirmed by the medical insurance institution according to the reimbursement request list includes:
acquiring an reimbursement confirmation item selected by the medical insurance institution in the reimbursement request list;
and determining a reimbursement confirmation list according to the reimbursement confirmation items.
Optionally, determining the reimbursement confirmation list according to the reimbursement confirmation item includes:
obtaining the unselected reimbursement request items in the reimbursement request list;
and forming a new reimbursement request list according to the unselected reimbursement request items, and sending the new reimbursement request list to the medical institution.
Optionally, sending an reimbursement request list to the medical insurance institution in response to the reimbursement request comprises:
and responding to the reimbursement request, and sending a plurality of reimbursement request lists to the medical insurance institution.
Optionally, the obtaining of the reimbursement confirmation list confirmed by the medical insurance institution according to the reimbursement request list includes:
and acquiring a partial reimbursement confirmation list selected by the medical insurance institution in the reimbursement request lists.
In the technical scheme provided by the invention, the list to be paid of the medical institution is monitored, and when the list to be paid exceeds a preset period and cannot be paid, the intelligent contract controls the medical insurance fund account and the medical institution account to pay to the medical institution so as to ensure the rights and interests of the medical institution. After the payment is completed, since the medical institution usually needs to perform medical reimbursement and other processes to the medical insurance institution, the payment part of the medical insurance fund is deducted by the intelligent contract in the medical insurance reimbursement process. Therefore, the payment of the price of the bill to be paid and the filling process of the medical insurance fund can be finished without manual intervention. In the technical scheme provided by the invention, as the intelligent contract is stored and executed on the blockchain, anyone cannot tamper with the intelligent contract, and therefore, a trust basis of a multi-party business process is provided. Meanwhile, data in the service execution process is stored on the block chain, so that the traceability and the non-tamper property of the flow data can be ensured.
Drawings
FIG. 1 is a flow chart of a method for payment of medical insurance funds in accordance with an embodiment of the present invention;
FIG. 2 is a flow chart of a reimbursement process for a payment method for medical insurance funds according to another embodiment of the present invention;
FIG. 3 is a flow chart of reimbursement amount determination for a method of payment for a medical insurance fund according to another embodiment of the present invention;
FIG. 4 is a flowchart of a reimbursement confirmation list for a method of payment of medical insurance funds according to another embodiment of the present invention;
FIG. 5 is a flowchart illustrating a method for reissuing a reimbursement request list according to another embodiment of the present invention.
Detailed Description
In order to make the objects, technical solutions and advantages of the embodiments of the present invention clearer, 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.
The embodiment of the invention provides a medical insurance fund payment method which is applied to an intelligent contract executed by a block chain node, and as shown in figure 1, the method comprises the following steps:
step 101, acquiring a list to be paid exceeding a payment period corresponding to a medical institution; in some embodiments, after receiving the medical product delivered by the medical institution, the medical institution needs to authenticate the received product, after authenticating the product, the price of the authenticated product should be paid within a certain period, and before completing the payment, a list of the product and the price which should be paid but are not paid is recorded as a to-be-paid list, and the list is consistent with the list when the medical institution authenticates the medical product. In this step, the list to be paid beyond the payment period is acquired, and since the list to be paid beyond the payment period indicates that the medical institution fails to complete payment within the specified period, intervention is required to ensure the rights and interests of the medical institution.
102, acquiring a list to be paid exceeding a payment period corresponding to a medical institution; in some embodiments, the intelligent contract determines the amount of the corresponding to-be-paid bill after obtaining the bill, so as to facilitate subsequent payment of the to-be-paid bill.
103, controlling a medical institution prepaid account and/or a medical insurance fund account to pay to the medical institution account and initiating a transaction for recording the payment state according to the amount to be paid; in some embodiments, the payment process includes three states, namely, payment from the medical institution prepaid account, payment from the medical insurance fund account, or payment from the medical institution prepaid account and the medical insurance fund account in combination. When the balance of the medical institution prepaid account is larger than the amount to be paid, the medical institution prepaid account carries out payment; when the medical institution prepaid account is 0, paying by the medical insurance fund; in other states, the medical institution prepaid account and the medical insurance fund account are jointly paid, but the balance of the medical insurance institution prepaid account is preferentially paid, and the medical insurance fund account is only used for supplementing insufficient balance. The transaction in the embodiment of the invention refers to the operation of adding, deleting, changing and searching data initiated on the block chain. The transaction in the step is to write data generated in the process that the intelligent contract controls the medical institution prepaid account and/or the medical insurance fund account to pay the medical institution account into the blockchain uplink for recording.
And 104, acquiring a reimbursement request of a medical institution, and responding to the reimbursement request according to a payment result of the medical insurance fund account to the medical institution account. In some embodiments, the intelligent contract determines an reimbursement request initiated by the medical institution, and when the medical insurance fund account has funded for the medical institution, the intelligent contract calculates a deducted reimbursement amount and a reimburseable amount, and sends the reimburseable amount to the medical insurance institution for approval.
In the technical scheme provided by the embodiment, the list to be paid of the medical institution is monitored, and when the list to be paid exceeds a preset period and cannot be paid, the intelligent contract controls the medical insurance fund account and the medical institution account to pay to the medical institution so as to ensure the rights and interests of the medical institution. After the payment is completed, since the medical institution usually needs to perform medical reimbursement and other processes to the medical insurance institution, the payment part of the medical insurance fund is deducted by the intelligent contract in the medical insurance reimbursement process. Therefore, the payment of the price of the bill to be paid and the filling process of the medical insurance fund can be finished without manual intervention. In the technical scheme provided by the embodiment, as the intelligent contract is stored and executed on the blockchain, anyone cannot tamper with the intelligent contract, and therefore, a trust basis of the multi-party business process is provided. Meanwhile, data in the service execution process is stored on the block chain, so that the traceability and the non-tamper property of the flow data can be ensured.
As an optional embodiment, controlling payment of a medical institution prepaid account and/or a medical insurance fund account to the medical institution account depending on the amount to be paid comprises:
and step 201, when the amount to be paid is smaller than the balance of the prepaid fee account, controlling the prepaid fee account of the medical institution to pay to the medical institution account. In some embodiments, the amount to be paid is less than the prepaid account balance, indicating that the prepaid account balance of the medical institution is capable of making a payment for the medical price, and thus controlling the prepaid account to make a payment to the medical institution.
As an optional embodiment, controlling payment of a medical institution prepaid account and/or a medical insurance fund account to the medical institution account depending on the amount to be paid comprises:
step 301, when the amount to be paid is larger than the balance of the prepaid account, controlling the prepaid account of the medical institution to pay to the medical institution account; in some embodiments, when the amount to be paid is greater than the prepaid account balance, it is indicated that the current prepaid account has the ability to pay the portion of the amount to be paid, and therefore, the amount to be paid is preferentially paid with the prepaid account.
Step 302, obtaining the amount which cannot be paid successfully in the amounts to be paid; and controlling the medical insurance fund account to pay to the medical institution account. In some embodiments, after the payment of the prepaid account, a portion of the amount to be paid is not paid, and the medical institution is paid by the medical insurance fund account in addition to the medical insurance fund account.
As an alternative embodiment, as shown in fig. 2, the obtaining a reimbursement request from a medical institution and responding to the reimbursement request according to the payment result from the medical insurance fund account to the medical institution account comprises:
step 401, obtaining the reimbursement amount of the reimbursement request; in some embodiments, the intelligent contract obtains the reimbursement amount corresponding to the reimbursement request, which is beneficial to calculating the amount to be deducted subsequently.
Step 402, determining a difference value between the reimbursement amount and a payment amount of the medical insurance fund to the medical institution account; in some embodiments, the payment amount of the medical insurance fund to the medical institution account is the amount to be deducted in the reimbursement process, so that the amount of reimbursement which can be obtained by the medical institution can be obtained through the calculation of the step.
And step 403, controlling a medical insurance fund account to pay to the medical institution according to the difference. In some embodiments, since the difference is an amount of money that the medical institution can obtain reimbursement, the medical insurance fund account is controlled to pay the medical institution an amount of money corresponding to the difference in this step, that is, reimbursement of the medical institution is completed.
As an alternative implementation, as shown in fig. 3, obtaining the reimbursement amount of the reimbursement request includes:
step 501, responding to the reimbursement request, and sending a reimbursement request list to a medical insurance institution; in some embodiments, in order to ensure accurate information in the reimbursement process of the medical institution, after the reimbursement request is sent by the medical institution, the corresponding list is sent to the medical insurance institution by the intelligent contract, and the medical insurance institution performs auditing and confirmation.
Step 502, obtaining a reimbursement confirmation list confirmed by the medical insurance institution according to the reimbursement request list, and determining the reimbursement amount. In some embodiments, the medical insurance institution can review the confirmed list to be a non-error list, and the reimbursement amount is formed according to the list without worrying about errors in the reimbursement amount.
As an alternative embodiment, as shown in fig. 4, acquiring an reimbursement confirmation list confirmed by the medical insurance institution according to the reimbursement request list includes:
step 601, acquiring reimbursement confirmation items selected by the medical insurance institution in the reimbursement request list; in some embodiments, the reimbursement list sent by the medical institution may have some unsatisfactory items, i.e. items that cannot be reimbursed, and in this step, the medical insurance institution is given a selected process to select and confirm the items in the reimbursement list. This approach enables reimburseable items in a single listing to be selected for confirmation directly, without resulting in a refusal reimbursement for the entire reimbursement listing for a partial reimbursement item.
Step 602, determining a reimbursement confirmation list according to the reimbursement confirmation items. In some embodiments, upon selection of an reimbursement confirmation entry by the medical insurance bureau, an reimbursement confirmation list is determined by the intelligent contract, i.e., all entries in the list are reimbursed.
As an alternative implementation, as shown in fig. 5, after determining the reimbursement confirmation list according to the reimbursement confirmation item, the method includes:
step 701, obtaining an unselected reimbursement request item in the reimbursement request list; in some embodiments, since the non-selected reimbursement request item means that the reimbursement program is not executed this time, the reimbursement request item is summarized and processed next to ensure that the medical institution has an opportunity to correct the reimbursement request item and reimburse the reimbursement request item.
Step 702, forming a new reimbursement request list according to the unselected reimbursement request items, and sending the new reimbursement request list to the medical institution. In some embodiments, a new reimbursement request list is formed and sent to the medical institution, and the medical institution may perform error correction again according to the reimbursement request list and initiate reimbursement again.
As an optional implementation manner, in response to the reimbursement request, sending a list of reimbursement requests to the medical insurance institution includes:
step 801, responding to the reimbursement request, sending a plurality of reimbursement request lists to the medical insurance institution. In some embodiments, the medical institution may trigger the sending of multiple reimbursement request lists by using one reimbursement request, which can simplify the operation of the user and eliminate the initiation of reimbursement requests for reimbursement lists one by one.
As an optional implementation manner, obtaining an reimbursement confirmation list confirmed by the medical insurance institution according to the reimbursement request list includes:
step 901, obtaining a partial reimbursement confirmation list selected by the medical insurance institution in the reimbursement request lists. In some embodiments, the medical insurance institution selects a plurality of reimbursement request lists, removes the unqualified reimbursement request lists, and confirms the unqualified reimbursement request lists as reimbursement confirmation lists so that the intelligent contract can perform payment control on the reimbursement confirmation lists.
It will be understood by those skilled in the art that all or part of the processes of the embodiments of the methods described above may be implemented by a computer program, which may be stored in a computer-readable storage medium, and when executed, may include the processes of the embodiments of the methods described above. The storage medium may be a magnetic disk, an optical disk, a Read-Only Memory (ROM), a Random Access Memory (RAM), or the like.
The above description is only for the specific embodiment of the present invention, but the scope of the present invention is not limited thereto, and any changes or substitutions that can be easily conceived by those skilled in the art within the technical scope of the present invention are included in the scope of the present invention. Therefore, the protection scope of the present invention shall be subject to the protection scope of the claims.

Claims (9)

1. A medical insurance fund payment method is applied to an intelligent contract executed by a block chain node and comprises the following steps:
acquiring a list to be paid exceeding a payment period corresponding to a medical institution;
determining the amount to be paid corresponding to the medical institution according to the list to be paid;
controlling a medical institution prepaid account and/or a medical insurance fund account to pay to the medical institution account according to the amount to be paid and initiating a transaction for recording the payment state;
and acquiring a reimbursement request of a medical institution, and responding to the reimbursement request according to a payment result of the medical insurance fund account to the medical institution account.
2. The medical insurance fund payment method of claim 1, wherein controlling payment of a medical institution prepaid fund account and/or a medical insurance fund account to the medical institution account in accordance with the amount to be paid comprises:
and when the amount to be paid is smaller than the balance of the prepaid fee account, controlling the prepaid fee account of the medical institution to pay to the medical institution account.
3. The medical insurance fund payment method of claim 1, wherein controlling payment of a medical institution prepaid fund account and/or a medical insurance fund account to the medical institution account in accordance with the amount to be paid comprises:
when the amount to be paid is larger than the balance of the prepaid fee account, controlling the prepaid fee account of the medical institution to pay to the medical institution account;
obtaining the amount which cannot be paid successfully in the amounts to be paid; and controlling the medical insurance fund account to pay to the medical institution account.
4. The medical insurance fund payment method of claim 1, wherein obtaining a reimbursement request from a medical institution and responding to the reimbursement request based on payment from the medical insurance fund account to the medical institution account comprises:
acquiring the reimbursement amount of the reimbursement request;
determining a difference between the reimbursement amount and a payment amount of the medical insurance fund to the medical institution account;
and controlling a medical insurance fund account to pay to the medical institution according to the difference.
5. The medical insurance fund payment method of claim 4, wherein obtaining the reimbursement amount for the reimbursement request comprises:
responding to the reimbursement request, and sending a reimbursement request list to a medical insurance institution;
and acquiring a reimbursement confirmation list confirmed by the medical insurance institution according to the reimbursement request list, and determining the reimbursement amount.
6. The medical insurance fund payment method of claim 5, wherein obtaining an reimbursement confirmation list that the medical insurance institution confirms in accordance with the reimbursement request list comprises:
acquiring an reimbursement confirmation item selected by the medical insurance institution in the reimbursement request list;
and determining a reimbursement confirmation list according to the reimbursement confirmation items.
7. The medical insurance fund payment method of claim 5, wherein determining the reimbursement confirmation list based on the reimbursement confirmation items comprises:
obtaining the unselected reimbursement request items in the reimbursement request list;
and forming a new reimbursement request list according to the unselected reimbursement request items, and sending the new reimbursement request list to the medical institution.
8. The medical insurance fund payment method of claim 5, wherein sending a reimbursement request list to a medical insurance institution in response to the reimbursement request comprises:
and responding to the reimbursement request, and sending a plurality of reimbursement request lists to the medical insurance institution.
9. The medical insurance fund payment method of claim 8, wherein obtaining an reimbursement confirmation list that the medical insurance institution confirms in accordance with the reimbursement request list comprises:
and acquiring a partial reimbursement confirmation list selected by the medical insurance institution in the reimbursement request lists.
CN202110985833.8A 2021-08-29 2021-08-29 Medical insurance fund payment method Pending CN113689209A (en)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060116906A1 (en) * 2004-11-09 2006-06-01 Otterbach P D Health care cash management and accounts receivable factoring
CN109377387A (en) * 2018-09-10 2019-02-22 平安科技（深圳）有限公司 Medical insurance claims expense detection method, device, computer equipment and storage medium
CN112767185A (en) * 2021-01-28 2021-05-07 湖南大学 Reverse warranty financing method and device based on block chain and storage medium

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060116906A1 (en) * 2004-11-09 2006-06-01 Otterbach P D Health care cash management and accounts receivable factoring
CN109377387A (en) * 2018-09-10 2019-02-22 平安科技（深圳）有限公司 Medical insurance claims expense detection method, device, computer equipment and storage medium
CN112767185A (en) * 2021-01-28 2021-05-07 湖南大学 Reverse warranty financing method and device based on block chain and storage medium

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
陈文辉: "《我国城乡居民大病保险发展模式研究》", 中国经济出版社, pages: 110 *

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