CN114418559A - Automatic payment clearing method and system - Google Patents

Automatic payment clearing method and system Download PDF

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CN114418559A
CN114418559A CN202210056388.1A CN202210056388A CN114418559A CN 114418559 A CN114418559 A CN 114418559A CN 202210056388 A CN202210056388 A CN 202210056388A CN 114418559 A CN114418559 A CN 114418559A
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data
transaction
bill data
reconciliation
transaction bill
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何晓俊
罗娜
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Beijing Rongwei Zhongbang Electronic Technology Co ltd
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Beijing Rongwei Zhongbang Electronic Technology Co ltd
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    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06QINFORMATION 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
    • G06Q20/00Payment architectures, schemes or protocols
    • G06Q20/02Payment architectures, schemes or protocols involving a neutral party, e.g. certification authority, notary or trusted third party [TTP]
    • G06Q20/023Payment architectures, schemes or protocols involving a neutral party, e.g. certification authority, notary or trusted third party [TTP] the neutral party being a clearing house
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06QINFORMATION 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
    • G06Q20/00Payment architectures, schemes or protocols
    • G06Q20/08Payment architectures
    • G06Q20/085Payment architectures involving remote charge determination or related payment systems
    • G06Q20/0855Payment architectures involving remote charge determination or related payment systems involving a third party
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06QINFORMATION 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
    • G06Q40/00Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/12Accounting

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Abstract

The invention relates to an automatic payment clearing method and a clearing system, wherein the clearing method comprises the following steps: acquiring account checking authority of a user; periodically extracting transaction bill data of the third-party payment mechanism, the clearing platform and the HIS; carrying out standardized cleaning treatment on the three-party original transaction bill data; performing reconciliation operation related to fund state verification on the cleaned three-party transaction bill data; dividing the reconciliation result after medical reconciliation according to a preset type, and carrying out statistics and warehousing on bill detail data according to a classification result; and carrying out standardized filing processing on the data result after account checking and transmitting the data result back to the clearing platform end.

Description

Automatic payment clearing method and system
Technical Field
The invention relates to the technical field of automatic clearing of medical bills, in particular to an automatic payment clearing method and system.
Background
With the rise of the technology of internet and intelligent medical treatment, the rapid development of internet mobile terminals, self-service integrated payment is popular among more hospitals and patients, the patients use various payment modes such as a network platform based on the mobile terminal, a mobile phone App, a payment treasure, a WeChat and a self-service machine, the medical cost can be efficiently and quickly settled by the aid of the diversified payment modes, the pressure of a manual window is effectively relieved, and meanwhile, huge risks and challenges are brought to financial management of the hospitals by account checking of various payment channels.
However, the existing account checking means generally has the disadvantages of large risk of manual account checking errors, low accuracy and efficiency and long processing period; the payment modes are various, and account checking is difficult because data of each platform is not integrated; the service channels are various, different business numbers are correspondingly set, and the reconciliation standards of the third-party systems are not uniform.
Furthermore, on the one hand, due to the differences in understanding to the person skilled in the art; on the other hand, since the applicant has studied a great deal of literature and patents when making the present invention, but the disclosure is not limited thereto and the details and contents thereof are not listed in detail, it is by no means the present invention has these prior art features, but the present invention has all the features of the prior art, and the applicant reserves the right to increase the related prior art in the background.
Disclosure of Invention
Aiming at the defects of the prior art, the invention provides an automatic payment clearing method, aiming at solving at least one or more technical problems in the prior art.
To achieve the above object, the present invention provides an automated payment clearing system, comprising at least:
the login module is used for logging in the liquidation platform by a user;
the extraction module is used for acquiring transaction bill data from a third-party payment mechanism, a clearing platform and the HIS;
the cleaning module is used for cleaning the three-party transaction bill data;
and the calculation module is used for carrying out reconciliation calculation on the three-party transaction bill data after cleaning treatment.
Preferably, the payment clearing system of the present invention further comprises:
the query module is used for providing a data query function for the medical bill after account checking calculation;
the adjusting module is used for adjusting any link of data acquisition, cleaning and calculation in the reconciliation task according to a preset period;
the channel management module is used for providing functions of information maintenance of the payment channel, channel addition, deletion and modification and channel payment mode configuration;
the refund management module is used for providing the functions of refund of expenses and accounting record.
Preferably, the extraction module comprises:
the conversion unit is used for uniformly converting the file format of original transaction bill data from three parties;
the dividing unit is used for dividing the original transaction bill data into sections according to the custom file configuration path;
and the dump unit is used for storing the original transaction bill data configured based on the preset partition rule to a distributed file system of the clearing platform.
Preferably, the cleaning module comprises:
a cleaning unit for checking non-null, duplicate and error fields within the original transaction bill data to remove anomalous data;
and the standardization unit is used for at least carrying out standardization processing on the payment channel codes, the transaction units and the amount in the three-party original transaction bill data.
Preferably, the calculation module comprises:
the state verification unit is used for verifying the fund state of the same transaction bill in the third-party payment mechanism and the HIS, and the verification is completed by calling respective state inquiry interfaces of the two parties;
and the result dividing unit is used for classifying the reconciliation results subjected to medical reconciliation according to a preset type and counting and warehousing the bill detail data according to the classification results.
Preferably, the present invention provides an automated payment clearing method, the method comprising:
acquiring account checking authority of a user;
periodically extracting transaction bill data of the third-party payment mechanism, the clearing platform and the HIS;
carrying out standardized cleaning treatment on the three-party original transaction bill data;
performing reconciliation operation related to fund state verification on the cleaned three-party transaction bill data;
dividing the reconciliation result after medical reconciliation according to a preset type, and carrying out statistics and warehousing on bill detail data according to a classification result;
and carrying out standardized filing processing on the data result after account checking and transmitting the data result back to the clearing platform end.
Preferably, the payment clearing method further comprises:
before at least one or more medical bill data to be checked is acquired from a third-party payment mechanism, a clearing platform and an HIS (subscriber identity system) regularly, whether first transaction bill data exist in a priority processing queue or not is inquired and confirmed;
when at least one item of first transaction bill data exists in the pre-prioritization queue, the reconciliation tasks related to the first transaction bill data are executed in sequence. For the medical bill data needing to be preferentially checked, the medical bill data can be inserted into the execution sequence of the timing checking task at any time to be processed in time without modifying the bill storage time or waiting for the end of the current task, so that the problem that the medical bill data needing to be preferentially checked cannot be processed in time due to the fact that the quantity of the acquired medical bill data to be processed is too large and the required time is too long can be effectively avoided.
Preferably, when at least one item of first transaction bill data does not exist in the priority-oriented processing queue, second transaction bill data is obtained from the three-party database according to the execution logic of the timing reconciliation task, and the reconciliation task related to the second transaction bill data is executed in sequence. When at least one item of first transaction bill data does not exist in the pre-prioritization processing queue, the fact that no medical bill data needing to be executed with priority for the reconciliation task exists currently means that the system can still execute the subsequent reconciliation task related to the second transaction bill data which is not executed with priority according to the execution logic of the scheduled timing reconciliation task, namely the original requirements for the reconciliation task do not need to be changed, and the consistency and the timely effectiveness of the reconciliation task are ensured.
Preferably, before executing the reconciliation task related to any of the second transaction billing data, the method further comprises:
determining whether the second transaction billing data has an indicator that characterizes having been preferentially processed;
and if the transaction bill data exists, returning the inquiry and confirming whether the first transaction bill data exists in the priority processing queue, otherwise, sequentially executing a reconciliation task related to the second transaction bill data. According to the invention, part of the medical bill data to be preferentially processed can be inserted into the execution sequence of the timing reconciliation task in real time, so that the second transaction bill data has the possibility of being specified as the first transaction bill data which needs to be preferentially processed and exists in the queue to be preferentially processed, and the repeated reconciliation work of the medical bill data can be avoided by confirming whether the second transaction bill data has the indication mark, so that the processing efficiency of the reconciliation work is improved, and the resource consumption caused by the repeated reconciliation is reduced.
Preferably, after the execution of the reconciliation task related to any of the second transaction billing data, the method further comprises:
judging whether the second transaction bill data is the last data to be processed;
and returning to the inquiry and confirming whether the first transaction bill data exists in the queue to be processed preferentially or not when the second transaction bill data is not the last data to be checked. The automatic payment clearing method and the system solve the problems of low account checking efficiency and poor accuracy of manual account checking. The system can adapt to bill data formats from different payment channels, so that the system can uniformly and effectively analyze and reconcile different bill data to realize in-hospital reconcile reconciliation; secondly, the method and the device can automatically acquire the bill data, automatically reconcile the account and generate a reconciled account statistical result, so that the probability of the occurrence of the unilateral account is greatly reduced, and related users can conveniently and quickly check the detailed account data of the reconciled account and the abnormal account, thereby responding in time; in addition, for the medical bill data needing to be preferentially checked, the medical bill data needing to be preferentially checked can be inserted into the execution sequence of the timing account checking task at any time to be processed in time, so that the situation that the medical bill data needing to be preferentially checked cannot be processed in time due to the fact that the quantity of the acquired medical bill data to be processed is too large and the required time is too long can be avoided, and the medical bill data needing to be preferentially processed usually relates to a plurality of services of follow-up medical insurance reimbursement and cancellation, and therefore on the premise that timeliness and accuracy of the account checking work are guaranteed through the clearing method, smooth development of other follow-up medical service services can be guaranteed.
Drawings
Fig. 1 is a block diagram of a payment clearing system according to a preferred embodiment of the present invention.
List of reference numerals
1: an extraction module; 2: a cleaning module; 3: a calculation module; 4: a query module; 5: and an adjusting module.
Detailed Description
The following detailed description is made with reference to the accompanying drawings.
The invention provides an automated payment clearing system which can be used for automatic proofreading of medical bill data between an HIS and a third-party payment institution. Specifically, the liquidation system may include:
the extraction module 1 is used for acquiring transaction bill data from a third-party payment mechanism, a clearing platform and an HIS;
the cleaning module 2 is used for cleaning the three-party transaction bill data, and the cleaning comprises proofreading, duplicate removal and unification aiming at the three-party transaction bill data;
the calculation module 3 is used for carrying out reconciliation calculation on the three-party transaction bill data after cleaning treatment;
the query module 4 is used for providing a data query function for the medical bill after account checking calculation;
and the adjusting module 5 is used for adjusting any link of data acquisition, cleaning and calculation in the reconciliation task according to a preset period.
Preferably, in the present invention, the data scheduling module 5 is further configured to screen medical billing data satisfying the three-party reconciliation task, that is, when the data scheduling module 5 regularly detects that the medical billing data satisfying the three-party reconciliation task exists in the current time period, the reconciliation request is sent to the platform database to perform a corresponding reconciliation operation.
According to a preferred embodiment, the reconciliation calculation, namely the transaction record passing through the clearing platform of the invention is respectively checked with the bill of the third-party payment mechanism and the HIS bill, and at least when the information such as the transaction number, the transaction time, the transaction amount and the like in the bills of each party are consistent, the transaction result is considered to be successful, and the reconciliation result is recorded as a tie account; if not, the bill records should be recorded in doubt, and the related personnel are informed to carry out the treatment.
According to a preferred embodiment, the clearing system may further comprise:
the login module is used for logging in the payment clearing platform by a user;
the channel management module is used for providing functions of information maintenance aiming at the payment channel, channel addition, deletion and modification and channel payment mode configuration;
and the refund management module is used for providing the functions of expense refund and record of the HIS single-side account, the third-party payment mechanism single-side account and the abnormal bill.
According to a preferred embodiment, the data query functions include, but are not limited to, HIS historical billing queries, third party payment institution billing queries, reconciliation calendar queries, reconciliation result queries, abnormal billing information queries, abnormal billing processing records, and refund records, among others.
According to a preferred embodiment, the extraction module 1 may comprise:
the bill data extraction unit is used for acquiring transaction bill data from the third-party payment mechanism, the clearing platform and the HIS according to a preset sampling period;
the conversion unit is used for uniformly converting the file format of original transaction bill data from three parties;
the dividing unit is used for dividing the original transaction bill data into sections according to the custom file configuration path;
and the dump unit is used for storing the original transaction bill data configured based on the preset partition rule to a distributed file system of the clearing platform and establishing mapping between the data file and the database tool.
Preferably, the partitioned configuration of the original transaction billing data may be partitioned by information such as hospital number, transaction date, and/or payment channel.
According to a preferred embodiment, the cleaning module 2 may comprise:
the system comprises a cleaning unit, a data processing unit and a data processing unit, wherein the cleaning unit is used for cleaning original transaction bill data and checking information such as non-empty fields, repeated single numbers, payment channel codes and the like to remove abnormal data;
and the standardization unit is used for removing the difference fields in the three-party original transaction bill data, namely, at least carrying out standardization processing on information such as payment channel codes, transaction units, amount of money and the like.
According to a preferred embodiment, the data calculation module 3 may comprise:
the state verification unit is used for verifying the fund state of the same transaction bill in the third-party payment mechanism and the HIS, and the verification process can be completed by calling respective state inquiry interfaces of the third-party payment mechanism and the HIS;
and the result dividing unit is used for dividing the reconciliation result subjected to medical reconciliation into a flat type, a long type, a short type, a suspicion type and the like, and performing bill data statistics and bill detail data warehousing according to parameters such as bill generation date, payment channel codes, hospital numbers and the like.
According to a preferred embodiment, the query module 4 may comprise:
the first query unit is used for providing a financial data query function of the unilateral account;
the second query unit is used for providing an account data query function of the multilateral account;
based on the payment clearing system, the invention provides a payment clearing method, which comprises the following steps:
acquiring transaction bill data of a third-party payment mechanism, a clearing platform and an HIS;
performing field proofreading, duplicate removal and uniform cleaning treatment on the three-party transaction bill data;
carrying out reconciliation calculation on the three-party transaction bill data after cleaning treatment;
according to a preferred embodiment, the clearing method further comprises: providing the function of inquiring the reconciliation record and the detailed accounting information of the medical bill after the reconciliation calculation; and any link of data acquisition, cleaning, calculation and the like in the reconciliation task is periodically adjusted.
According to a preferred embodiment, the step of obtaining the three-party transaction billing data may comprise:
acquiring transaction bill data from a third-party payment mechanism, a clearing platform and an HIS according to a preset sampling period;
uniformly converting the file format of original transaction bill data from three parties;
partitioning the transaction bill data subjected to format conversion according to a custom file configuration path;
storing the original transaction bill data configured based on the preset partition rule to a distributed file system of a clearing platform, and establishing mapping between the data file and a database tool.
Preferably, the partitioned configuration of the original transaction billing data may be partitioned by information such as hospital number, transaction date, and/or payment channel.
According to a preferred embodiment, the step of performing the cleaning process on the three-party original bill data may include:
cleaning the three-party original transaction bill data, and checking information such as non-empty fields, repeated single numbers, payment channel codes and the like to remove abnormal data;
and (3) carrying out standardized difference processing on information such as payment channel codes, transaction units and money amount of the three-party original transaction bill data.
According to a preferred embodiment, the reconciliation calculation of the cleaned bill data specifically comprises: the medical reconciliation result is divided into types of flat, long, short and in doubt, and the like, and the bill detail data is put into storage for the division basis including but not limited to bill generation date, payment channel code, hospital number and other bill information.
According to a preferred embodiment, before performing the reconciliation calculation, the method further comprises: and regularly screening the medical bill data meeting the three-party reconciliation task, and sending a reconciliation request to the platform database to execute corresponding reconciliation operation when detecting that the medical bill data meeting the three-party reconciliation task exists in the current time period.
According to a preferred embodiment, the step of reconciliation may specifically comprise: when medical bill data meeting the three-party reconciliation task is found based on the timing task, the fund state of a bill to be reconciled is verified through respective inquiry interfaces of a third-party payment mechanism and the HIS, and if the fund states of the third-party payment mechanism and the HIS are inconsistent, the current transaction is judged to be a unilateral account or an abnormal bill.
Particularly, if the hospital grants the related authority, the clearing platform can automatically process the unilateral account or the abnormal bill and deliver the processing result to the account responsible person in a mail or short message mode, otherwise, the related responsible person is informed to automatically process the unilateral account or the abnormal bill in the mail or short message mode.
Further, the checking result of the bilateral bill information may be based on the data of the HIS, for example, if the transaction bills with the same mark are found in the third-party payment mechanism database, it may be determined whether the transaction bills are the same transaction through a plurality of related identifiers in the transaction bills, such as a bill generation time period, a serial number, and the like, when the transaction bills are the same order, it may be determined whether the amounts in the transaction bills of both parties are the same, and if the amounts are the same, the transaction bills are settled, otherwise, the transaction bills are abnormal transactions, and the reconciliation result is recorded in the database.
According to a preferred embodiment, the transaction bill, which is partially present in the third party payment authority database but not found in the HIS database, is determined to be of the withdrawn transaction type. Specifically, if a so-called revocation transaction bill exists in the clearing platform database and a corresponding transaction history can be found in the third-party payment institution database, and if the transaction is submitted on the current day and revoked on the current day or revoked on the next day, the transaction bill and the revocation transaction are determined as a tie account.
Further, for the transaction bills existing in the third-party payment agency database but not existing in the HIS database, if the revocation transaction record does not exist, the transaction bills are determined as the unilateral bills.
According to a preferred embodiment, the step of querying the reconciliation record and the detailed accounting information of the medical bill after the reconciliation calculation can comprise the following steps: and inquiring the accounting data of the historical transaction bill, wherein the historical transaction bill can comprise a unilateral account order and a multilateral account order. For example, while viewing accounting data records of a unilateral ledger order through a clearing platform, transaction data within a particular period (yesterday, last week or last month, etc.) may be viewed. And the mode of financial data inquiry can be selected according to bill generation time, courtyards, transaction types, payment platforms, order serial numbers, business types and the like.
According to a preferred embodiment, the specific workflow of the payment clearing method of the invention is as follows:
acquiring user authority through a login module;
starting a timing task to obtain transaction bill data from a third party payment authority, a clearing platform and the HIS;
uniformly converting the file format of original transaction bill data from three parties;
partitioning the transaction bill data subjected to format conversion according to a custom file configuration path;
storing original transaction bill data configured based on a preset partition rule to a distributed file system of a clearing platform, and establishing mapping between a data file and a database tool;
cleaning the three-party original transaction bill data, and checking information such as non-empty fields, repeated single numbers, payment channel codes and the like to remove abnormal data;
the method comprises the following steps of carrying out standardized difference processing on information such as payment channel codes, transaction units, amount and the like of three-party original transaction bill data;
the method comprises the steps of dividing the transaction types of bill data after data cleaning, respectively storing the bill data of different transaction types into different file paths, and mapping the bill data into a database tool;
the clearing platform screens medical bill data meeting the three-party reconciliation task in any time period based on the regular retrieval task, and sends a reconciliation request to the platform database when a corresponding reconciliation task exists;
performing classification of types such as tie, long, short and suspicion on the reconciliation result subjected to medical reconciliation, and counting and warehousing the bill detail data by taking the bill generation date, the payment channel code, the hospital number and other bill information as a classification basis;
and inquiring the checked data result according to the information of the courtyard transfer party, the payment channel, the transaction date and the like, carrying out standardized filing treatment on the data result and transferring the data result back to the platform end.
According to a preferred embodiment, when an account checking process is executed, firstly, medical bill data with account checking conditions are detected and obtained, an account checking request is sent to a platform database to perform account checking operation on normal transaction bills and/or abnormal transaction bills, in the account checking process, whether information such as serial numbers, transaction time and transaction amounts of the same transaction bills in a third-party payment mechanism and an HIS (subscriber identity system) are consistent or not can be judged, if so, the account checking data result is filed, a distributed file system is input, and meanwhile, a partition mapping database is established; if not, entering a long process; and if the judgment basis is that the bill data exists in the third-party payment mechanism and the bill data does not exist in the HIS, the short-payment process is started, and if the judgment basis is that the bill data exists in the third-party payment mechanism and the bill data does not exist in the HIS, the account checking data result is filed, the account checking data result is input into a distributed file system, and a partition mapping database is established.
According to a preferred embodiment, the prior art generally processes medical bill data sequentially according to the saving or generation time of transaction bill data when medical bill data is acquired and checked through a timing reconciliation task, and often does not have the capability of priority processing in case of rapid increase of data volume. For the medical bill data needing urgent or preferential processing, such as the bill of the money of partial large-volume or urgent medical assistance services (such as medical service items of examination and examination, operation, drug purchase and postoperative rehabilitation) or the medical bill which needs preferential processing and is designated by other people, if the corresponding medical bill data is to be obtained and checked by the timed reconciliation task preferentially, the warehousing time of the bill data is generally required to be modified, and thus the original authenticity of the data is damaged, and the corresponding medical bill data needing preferential processing can be started only after the execution of the current checking task is finished, and further, the medical bill data needing preferential processing generally relates to a plurality of services of subsequent medical insurance reimbursement, so that the execution logic of the original timed reconciliation task is not influenced and the authenticity of the original medical bill data is not changed, the method is characterized in that the method comprises the steps of carrying out priority check processing on part of medical bill data needing emergency processing so as to adapt to the actual requirements of medical account checking work and ensure the timeliness and accuracy of the account checking work, wherein the medical account checking work is closely related to medical insurance reimbursement work, and particularly, information such as transaction types, bill amounts and the like has great influence on reimbursement limits, so that the priority check processing on the emergency medical bill data is beneficial to ensuring the development of other subsequent medical service businesses.
For ease of understanding, a reconciliation processing method for high-priority medical bill data is described in detail in connection with the payment clearing system of the present invention. Specifically, at least one or more medical bill data to be checked are acquired from the third-party payment mechanism, the settlement platform and the HIS periodically by the bill data extraction unit, and before the one or more medical bill data to be checked are acquired by the bill data extraction unit, the inquiry module 4 will inquire and confirm whether the first transaction bill data cached in the queue to be processed preferentially exists or not. Specifically, the first transaction billing data in the present invention refers to medical billing data inserted into the queue to be prioritized in advance and/or in real time, or medical billing data manually designated to be prioritized.
According to a preferred embodiment, when the first transaction bill data exists in the pre-priority processing queue is inquired and confirmed through the inquiry module 4, the cleaning module 2 performs proofreading, duplicate removal and uniform cleaning processing on the three-party original medical bill data corresponding to the first transaction bill data, and then the calculation module 3 performs reconciliation calculation on the cleaned medical bill data. Preferably, when the first transaction bill data in the priority processing queue is queried and confirmed through the query module 4, the calculation module 3 performs priority check processing on the first transaction bill data in the priority processing queue preferentially, and may loop the query and check processing on the first transaction bill data until the reconciliation task on the first transaction bill data in the priority processing queue is completely executed.
According to a preferred embodiment, when the inquiry module 4 inquires and confirms that the first transaction bill data does not exist in the pre-priority processing queue, the bill data extraction unit sequentially acquires one or more second transaction bill data to be checked from the third-party payment mechanism, the clearing platform and the HIS according to a preset sampling period, the cleaning module 2 performs checking, duplicate removal and uniform cleaning on the three-party primary medical bill data corresponding to the second transaction bill data, and the calculation module 3 performs account checking calculation on the cleaned medical bill data.
According to a preferred embodiment, when the first transaction bill data does not exist in the pre-prioritization queue, one or more medical bills in the original bill data set can be subjected to reconciliation in sequence according to the execution logic of the task of regularly extracting the medical bill data, and when the medical bill data needing to be preferentially checked is related, the medical bills to be prioritized can be inserted into the pre-prioritization queue without changing the execution order of the timed sampling and reconciliation tasks. When there is no medical bill data in the queue to be processed in priority, the medical bill can be continuously checked in sequence according to the execution logic of the original account checking task.
According to a preferred embodiment, after the calculation module 3 performs the checking process on any one of the second transaction bill data, it is determined whether the currently processed second transaction bill data is the last bill data to be checked acquired in the current timing task, and if not, the step of "inquiring and confirming whether the first transaction bill data exists in the queue to be processed preferentially by the inquiry module 4" needs to be returned. Preferably, after checking the three-party bill data corresponding to the second transaction bill data each time, it is determined whether the current reconciliation task is the last task in the current timing task, and if not, before executing the checking task for the next second transaction bill data, the reconciliation task returns to the priority-like processing queue to determine whether the first transaction bill data exists, so as to ensure that the first transaction bill data inserted into the priority-like processing queue in real time after the timing checking task for the medical bill data is started can be processed in time. The medical bill data needing to be preferentially checked can be inserted into the execution sequence of the timing account checking task at any time to be processed in time without modifying the bill storage time or waiting for the end of the current task, so that the medical bill data needing to be preferentially checked can not be processed in time due to the fact that the quantity of the acquired medical bill data to be processed is too much and the required time is too long.
According to a preferred embodiment, after the calculation module 3 performs the reconciliation process on any of the first transaction billing data, a first indicator indicating that the medical billing data has been processed preferentially is generated synchronously. Preferably, the first indication mark may be generated, for example, in the form of a key-value pair, for example, with the mark of the first transaction bill data as a primary key and the check time of the first transaction bill data as the value of the primary key of the key-value pair.
According to a preferred embodiment, when the query module 4 queries and confirms that the first transaction bill data exists in the pre-prioritized queue, the first indication mark corresponding to the first transaction bill data can be obtained from the database through the mark of the first transaction bill data, so as to accurately know when the first transaction bill data is subjected to the accounting check.
According to a preferred embodiment, before the calculation module 3 performs the checking process on any second transaction bill data, it is determined whether the second transaction bill data has the corresponding second indication mark indicating that the second transaction bill data has been processed preferentially, and the corresponding bill data checking operation is performed only when there is no corresponding second indication mark, and if so, the above-mentioned step of "inquiring and confirming whether the first transaction bill data exists in the queue to be processed preferentially by the inquiry module 4" is returned. Preferably, if the second transaction bill data has the corresponding second indication mark, it indicates that the second transaction bill data has been processed preferentially, and therefore, the second transaction bill data does not need to be processed repeatedly according to the execution logic of the original timing reconciliation task, because part of the medical bill data to be processed preferentially can be inserted into the execution sequence of the timing reconciliation task in real time, so that the second transaction bill data has the possibility of being specified as the first transaction bill data which needs to be processed preferentially and exists in the queue to be processed preferentially, and therefore, the repeated reconciliation work on the medical bill data can be avoided by confirming whether the indication mark exists in the second transaction bill data, the processing efficiency of the reconciliation work is improved, and the resource consumption caused by the repeated reconciliation is reduced.
According to a preferred embodiment, the related account checking personnel or the user can search out the medical bill data needing to be processed preferentially according to a certain query condition through the terminal equipment, the terminal equipment generates a selection instruction according to the corresponding search condition and sends the selection instruction to the server, and the server obtains the medical bill data needing to be processed preferentially from the database according to the search condition contained in the selection instruction and inserts the medical bill data into the treatment queue to be processed preferentially.
According to a preferred embodiment, the data repository of the payment clearing system of the present invention stores a large amount of medical transaction billing information, and the medical transaction billing database can be constructed in such a manner that the medical billing classifier is configured to perform classification on the medical transaction billing data repository in compliance with preset medical breakdown classification rules (e.g., based on the clinically issued disease diagnosis code ICD-10 and surgical operation classification code ICD-9-CM-3, or classification rules formed by classification codes autonomously compiled by the institution) to obtain a plurality of classification data, the classification of the medical billing classifier is performed based on the classification data to find abnormal medical billing attribute information in the classification data, the medical billing evaluator is configured to perform the scoring of the abnormal medical billing attribute information of each of the classification data, and when the score is lower than a set threshold value, early warning information is formed. The abnormal medical bill data at least comprises bill information of a single-side bill generated in the account checking process, and the medical bill processor is configured to compare first bill information generated by the HIS with second bill information generated by a third-party payment mechanism so as to evaluate the bill information into the medical bill information of the single-side bill generated under the condition that the amounts of the two sides are not matched. The abnormal medical bill attribute information is at least one attribute information related to all the abnormal medical bill information generated in each classified data counted, summarized and summarized by the medical bill counter, and in this embodiment, the attribute information is the number of the abnormal medical bill information. Wherein the classified data refers to a combination of a plurality of billing information having at least one same label attribute, and in this embodiment, the same label attribute is set to conform to the attribute expressed in the category of diagnosis breakdown and/or surgery breakdown as guided by the medical item management scheme of "Diagnosis Related Group (DRG)", wherein the amount of the medical billing information in each classified data is the same in the processing flow of the medical billing processor within at least the first billing information included therein.
According to a preferred embodiment, the medical subdivision classification rule is configured as a list of diagnosis subdivision items and/or surgery subdivision items divided in a predetermined coding, wherein each code represents a subdivided diagnosis or surgery item, and the items represented by each code are uniform at least in the billing amount. When the abnormal medical bill attribute information is set to be the quantity of the abnormal medical bill attribute information, the grade of the abnormal medical bill attribute information by the medical bill evaluator is selected to judge whether the quantity of the abnormal medical bill attribute information in the classified data is smaller than a preset threshold value or not based on a preset quantity related threshold value, and when the quantity of the abnormal medical bill attribute information in the classified data is smaller than the preset threshold value, early warning information is formed and provided for a user.
According to a preferred embodiment, the warning information is used to alert the user that the classified data of the attribute information of the current abnormal medical bill has a larger number of abnormal medical bills, indicating that the subdivided item has a larger probability of generating an abnormal medical bill, for example, because the standard pricing of the item in the system is unclear, or a gray space for the administering physician to set the price at will when issuing a bill to the patient, or a situation that the amount of the bill is intentionally changed, which is partly related to a violation. The user, which may be a HIS system administrator, may investigate the billing situation of the diagnosis and treatment or surgery segmentation project to which the relevant classification data belongs after receiving the early warning information, optimize or manage the billing situation of the project, correct the segmentation project in which the abnormality occurs by using the reduced number of abnormal bills (i.e., the increased tie-out data) as an improvement index, so that the DRG management scheme of the institution can participate in the project management of the hospital with higher standard and better health.
In particular, each time a patient goes to a doctor and asks for a medical examination, an institution usually gives a plurality of examination/test items, and each item generally needs to be reserved and then executed according to corresponding requirements, but the execution places and time of each examination/test item are often different, the waiting intervals between the examination/test items are from several hours to several days, and finally, the waiting time is often as long as one month to obtain a still fuzzy examination conclusion. In order to clarify the fuzzy examination conclusion, the patient often has to go to other hospitals to repeat the above operations, and particularly, the high-quality third hospital faces the service of repeatedly providing repeated diagnoses and treatment for the patient. Resulting in the waste of high-quality diagnosis and treatment resources. In this case, medical resources of all hospitals in one area are integrated, so that a patient can complete each predetermined flow project in an optimal or better route or strategy in a predetermined diagnosis and treatment flow, in this case, it is more likely that the patient performs preliminary diagnosis and treatment in a hospital a, CT photography needs to be performed after the diagnosis and treatment is completed, in the case that the number of people in line in CT departments of the hospital a is large, and the queuing time is long, the patient is guided to a hospital b, in which the number of people in line in corresponding departments is small, to perform CT photography, in this step, an account item related to the preliminary diagnosis and treatment is generated in the hospital a, an account item related to the CT photography is generated in the hospital b, and so on, in the diagnosis and treatment flow of the patient, a plurality of account items related to a plurality of hospitals may be generated, after the diagnosis and treatment of the patient are finished, a unified central server is responsible for summarizing all link account items and measuring and calculating a total diagnosis and treatment bill to be sent to the patient, and after the patient pays to a bank account associated with the central server, the central server is responsible for distributing the total amount paid by the patient to a corresponding hospital based on the amount in the link account items and the hospital.
According to a preferred embodiment, the above solution is a currently advocated hospital solution, but it has a problem that the execution levels of different diagnosis and treatment links of hospitals in the same area, for example, the same city, are different, and particularly, the amount of bills in the links concerned by the present invention is different, and the amount of bills is not generally hooked with the overall comprehensive level of the hospital, for example, the first hospital is the third hospital, and patients habitually consider that all diagnosis and treatment items in the first hospital are the best and the charge is the most reasonable, as a result, most of patients in the city will rush into the first hospital to perform diagnosis and treatment in all links, resulting in that the hospitals with higher grades in the city are always full of patients, not only causing the patients to waste a lot of time in waiting time in line, but also not ensuring that the patients obtain equivalent diagnosis and treatment services at the most reasonable price, because a more highly rated hospital generally requires more capital to maintain the operation of the hospital, the cost may be unnecessarily distributed to each clinical item, resulting in a higher charge for the same clinical link in the first hospital relative to other hospitals, and even a higher than standard charge for the item, or a repeat of the item. Meanwhile, the second hospital with a lower grade actually reaches the specified standard in the same diagnosis and treatment link, and the charge is relatively more reasonable, but because reasonable patient guidance is lacked, the resources of the same diagnosis and treatment link of the second hospital are not well utilized, and a large amount of waste is caused. In this case, how to guide the patient's overall diagnosis and treatment process more optimally by using the link billing amount as a guide becomes a problem to be solved.
In the above scheme provided by this embodiment, the classification data is equal to the set of the link billing information, and the abnormal billing information is evaluated after the classification data is counted, so that the automatic evaluation of the quality of the same diagnosis and treatment link of each hospital is actually realized in terms of link billing amount, and it can be very directly obtained which hospital generates less abnormal billing information in which link, which indicates that the hospital has higher execution capacity in the link, and if the patient is guided to the link of the hospital to diagnose, not only is a large amount of queuing time wasted due to the inertia of the patient guided by the hospital rating in the past avoided, but also the patient can complete diagnosis and treatment of the link with relatively more reasonable billing amount (because the hospital generates less abnormal billing information in the item, which indicates that the hospital has more strict price standard and price control execution capacity in the item), saving medical expenses of patients. In addition, the system can also promote certain revenues for hospitals with fewer patients.
According to a preferred embodiment, the scheme is actually based on the effect that basic reconciliation is carried out to obtain abnormal bill information so as to carry out reconciliation in hospitals to protect benefits, the optimization of patient full-flow diagnosis and treatment guidance based on abnormal bill guidance related to the bill amount of each link of each hospital is realized, and in the configuration scheme of the hospital, the scheme makes a great contribution to the optimization of the patient guidance flow. The patient guide based on the protection of the medical expenditure of the patient can improve the diagnosis and treatment efficiency of the patient, reasonably realize the redistribution of regional medical resources, and provide solid data support for improving weak links related to the bill amount of a single hospital.
According to a preferred embodiment, the various elements of the automated payment clearing system described above may be implemented in whole or at least in part by software, hardware, and combinations thereof. The units can be embedded in a hardware form or independent from a processor in the computer device, and can also be stored in a memory in the computer device in a software form, so that the processor can call and execute operations corresponding to the units.
Any process or method descriptions, which are flow diagrams or otherwise described herein, may be understood to represent modules, segments, or portions of code which include one or more executable instructions for implementing specific logical functions or steps of the process, and alternate implementations are included within the scope of the preferred embodiment of the present invention in which functions may be executed out of order from that shown or discussed, including substantially concurrently or in reverse order, depending on the functionality involved, as would be understood by those reasonably skilled in the art of the embodiments of the present application.
It should be noted that the above-mentioned embodiments are exemplary, and that those skilled in the art, having benefit of the present disclosure, may devise various arrangements that are within the scope of the present disclosure and that fall within the scope of the invention. It should be understood by those skilled in the art that the present specification and figures are illustrative only and are not limiting upon the claims. The scope of the invention is defined by the claims and their equivalents. The present description contains several inventive concepts, such as "preferably", "according to a preferred embodiment" or "optionally", each indicating that the respective paragraph discloses a separate concept, the applicant reserves the right to submit divisional applications according to each inventive concept.

Claims (10)

1. An automated payment clearing system, comprising at least:
the login module is used for logging in the liquidation platform by a user;
the extraction module is used for acquiring transaction bill data from a third-party payment mechanism, a clearing platform and the HIS;
the cleaning module is used for cleaning the three-party transaction bill data;
and the calculation module is used for carrying out reconciliation calculation on the three-party transaction bill data after cleaning treatment.
2. A clearing system according to claim 1, further comprising:
the query module is used for providing a data query function for the medical bill after account checking calculation;
the adjusting module is used for adjusting any link of data acquisition, cleaning and calculation in the reconciliation task according to a preset period;
the channel management module is used for providing functions of information maintenance of the payment channel, channel addition, deletion and modification and channel payment mode configuration;
the refund management module is used for providing the functions of refund of expenses and accounting record.
3. A clearing system according to claim 1 or 2, wherein said extraction module comprises:
the conversion unit is used for uniformly converting the file format of original transaction bill data from three parties;
the dividing unit is used for dividing the original transaction bill data into sections according to the custom file configuration path;
and the dump unit is used for storing the original transaction bill data configured based on the preset partition rule to a distributed file system of the clearing platform.
4. A clearing system according to any of claims 1-3, wherein said cleaning module comprises:
a cleaning unit for checking non-null, duplicate and error fields within the original transaction bill data to remove anomalous data;
and the standardization unit is used for at least carrying out standardization processing on the payment channel codes, the transaction units and the amount in the three-party original transaction bill data.
5. A clearing system according to any of claims 1-4, wherein said calculation module comprises:
the state verification unit is used for verifying the fund state of the same transaction bill in the third-party payment mechanism and the HIS, and the verification is completed by calling respective state inquiry interfaces of the two parties;
and the result dividing unit is used for classifying the reconciliation results subjected to medical reconciliation according to a preset type and counting and warehousing the bill detail data according to the classification results.
6. An automated payment clearing method, comprising at least:
acquiring account checking authority of a user;
periodically extracting transaction bill data of the third-party payment mechanism, the clearing platform and the HIS;
carrying out standardized cleaning treatment on the three-party original transaction bill data;
performing reconciliation operation related to fund state verification on the cleaned three-party transaction bill data;
dividing the reconciliation result after medical reconciliation according to a preset type, and carrying out statistics and warehousing on bill detail data according to a classification result;
and carrying out standardized filing processing on the data result after account checking and transmitting the data result back to the clearing platform end.
7. The clearing method according to claim 6, further comprising:
before at least one or more medical bill data to be checked is acquired from a third-party payment mechanism, a clearing platform and an HIS (subscriber identity system) regularly, whether first transaction bill data exist in a priority processing queue or not is inquired and confirmed;
when at least one item of first transaction bill data exists in the pre-prioritization queue, the reconciliation tasks related to the first transaction bill data are executed in sequence.
8. A clearing method according to claim 6 or 7, characterized in that when at least one item of first transaction bill data does not exist in the pre-prioritization queue, second transaction bill data is obtained from a three-party database according to execution logic of a timing reconciliation task, and a reconciliation task related to the second transaction bill data is executed in turn.
9. A clearing method according to any of claims 6-8, further comprising, before performing a reconciliation task on any of said second transaction billing data:
determining whether the second transaction billing data has an indicator that characterizes having been preferentially processed;
and if the transaction bill data exists, returning the inquiry and confirming whether the first transaction bill data exists in the priority processing queue, otherwise, sequentially executing a reconciliation task related to the second transaction bill data.
10. A clearing method according to any of claims 6-9, further comprising after performing a reconciliation task relating to any of said second transaction billing data:
judging whether the second transaction bill data is the last data to be processed;
and returning to the inquiry and confirming whether the first transaction bill data exists in the queue to be processed preferentially or not when the second transaction bill data is not the last data to be checked.
CN202210056388.1A 2022-01-18 2022-01-18 Automatic payment clearing method and system Pending CN114418559A (en)

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