CN117557384A - Intelligent examination engine suitable for medical insurance payment with traditional Chinese medicine characteristics - Google Patents
Intelligent examination engine suitable for medical insurance payment with traditional Chinese medicine characteristics Download PDFInfo
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- 239000003814 drug Substances 0.000 title claims abstract description 382
- 229940079593 drug Drugs 0.000 claims abstract description 134
- 238000012550 audit Methods 0.000 claims abstract description 42
- 238000012377 drug delivery Methods 0.000 claims description 37
- 238000000034 method Methods 0.000 claims description 34
- 238000012384 transportation and delivery Methods 0.000 claims description 21
- 239000000463 material Substances 0.000 claims description 19
- 238000004891 communication Methods 0.000 claims description 8
- 238000012937 correction Methods 0.000 claims description 2
- 239000002552 dosage form Substances 0.000 claims description 2
- 230000006978 adaptation Effects 0.000 abstract description 2
- 238000007726 management method Methods 0.000 description 6
- 229940126680 traditional chinese medicines Drugs 0.000 description 5
- 230000036541 health Effects 0.000 description 4
- 230000009897 systematic effect Effects 0.000 description 3
- 230000009286 beneficial effect Effects 0.000 description 2
- 238000010586 diagram Methods 0.000 description 2
- 238000005259 measurement Methods 0.000 description 2
- 239000000178 monomer Substances 0.000 description 2
- 238000003672 processing method Methods 0.000 description 2
- 229940126673 western medicines Drugs 0.000 description 2
- 230000008859 change Effects 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 238000001647 drug administration Methods 0.000 description 1
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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
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/08—Insurance
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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
- G06Q20/30—Payment architectures, schemes or protocols characterised by the use of specific devices or networks
- G06Q20/32—Payment architectures, schemes or protocols characterised by the use of specific devices or networks using wireless devices
- G06Q20/322—Aspects of commerce using mobile devices [M-devices]
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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
- G06Q20/38—Payment protocols; Details thereof
- G06Q20/40—Authorisation, e.g. identification of payer or payee, verification of customer or shop credentials; Review and approval of payers, e.g. check credit lines or negative lists
- G06Q20/401—Transaction verification
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
- G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients
- G16H20/13—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients delivered from dispensers
Abstract
The utility model relates to a doctor's insurance payment intelligence audit engine that is fit for traditional chinese medical science characteristics, the doctor gets into audit engine through the network entry work number, the base of doctor at audit engine has been increased in the village and town, simultaneously, the doctor can log in audit engine through mobile device, this current situation that adaptation village and town doctor office is scattered, the doctor inquires patient's case history information through mobile device in the village and town doctor generates the charge list with case charge, the patient can pay the doctor in the village and town in the work number charge audit module according to charge list, the doctor in the county class hospital can pass through the equipment of going out and examine the monthly drug form with the current situation that the medicine is scattered in the month, the doctor is at the end of month to the medicine of the business through the work number charge audit module, the patient has been adapted to the current situation that the payment of the two-stage charge audit service site of the business to the business charge audit module of medicine to the business charge audit module.
Description
Technical Field
The application relates to the technical field of medical system expense settlement, in particular to an intelligent auditing engine for medical insurance payment, which is suitable for the characteristics of traditional Chinese medicine.
Background
The traditional Chinese medicine service still has the problem of not tightly abutting the patient. The most fundamental reason for these problems is the lack of a complete traditional Chinese medicine service network. When a complete traditional Chinese medicine service network is constructed, how to realize the settlement of medical expenses of the county middle hospitals and the village and town health departments, and the settlement of medical expenses of the village and town health departments and patients are key. The existing western medicine medical treatment charge management method with more problems is difficult to adapt to the medical treatment charge settlement working scene of the traditional Chinese medicine. Because traditional Chinese medicines are various in variety and various in combination form, and a systematic medicine management architecture is needed, an intelligent medical insurance payment auditing engine suitable for the characteristics of traditional Chinese medicine is needed, so that the intelligent medical insurance payment auditing engine is suitable for the working scene with the characteristics of traditional Chinese medicine, such as mailing and medicine sending of county-level middle hospitals, and charging by the urban health department.
Disclosure of Invention
In order to solve the problem that the western medicine medical charge and payment management method is difficult to adapt to the medical charge settlement working scene of traditional Chinese medicine, the application provides a medical insurance charge intelligent auditing engine suitable for the characteristics of traditional Chinese medicine so as to adapt to the working scene with the characteristics of traditional Chinese medicine of mailing and medicine sending of county-level middle hospitals, and charge generation of village and town health departments.
The application relates to an intelligent examination engine for medical insurance payment, which is suitable for the characteristics of traditional Chinese medicine.
On one hand, the application provides an intelligent checking method suitable for medical insurance payment with the characteristics of traditional Chinese medicine, which comprises the following steps:
receiving a network access request sent by mobile equipment, analyzing the network access request to acquire a network access work number of the mobile equipment, and judging whether the network access work number is in a stored work number list;
if the network access work number is in the stored work number list, allowing the mobile equipment to access the network;
calling out history information of all cases of the network access number in the current month, and establishing a current month medication list of the network access number;
feeding back all case history information to the mobile device in units of each case;
receiving a selected case instruction sent by the mobile equipment, determining a selected case and feeding back case information of the selected case to the mobile equipment;
receiving a medicine selection instruction sent by the mobile equipment, determining the selected medicines, and importing the medicine retail price and the medicine metering of each selected medicine into a current month medicine table of a network access work number;
receiving a settlement medication expense instruction of the selected case sent by the mobile equipment, and generating a medication expense detail of the selected case;
receiving first payment information, verifying the first payment information, and deducting the amount of the fee in the medicine fee list;
establishing a current month ex-warehouse medicine table of the network access work number according to the current month medicine table of the network access work number;
receiving a medicine delivery instruction sent by delivery equipment, and checking delivery medicines and a delivery medicine table in the current month;
checking the current month delivery medicine table and the current month medicine table, and generating the delivery medicine cost detail of the network entry number according to the medicine price when delivering in the current month;
and receiving the second payment information, verifying the second payment information, and deducting the amount of the charge in the inventory charge detail.
On the other hand, the application provides a medical insurance payment intelligent auditing engine suitable for the characteristics of traditional Chinese medicine, and the medical insurance payment intelligent auditing engine suitable for the characteristics of traditional Chinese medicine is implemented by the medical insurance payment intelligent auditing method, and comprises the following steps:
a network access auditing module;
the medication list establishing module is connected with the network access auditing module;
the work number and medicine expense checking module is connected with the medicine table establishing module;
and the drug charge auditing module of the drug library is connected with the work number drug charge auditing module.
In yet another aspect, the present application provides an intelligent audit system for medical insurance payment adapted to the characteristics of traditional Chinese medicine, including:
the intelligent checking engine is suitable for medical insurance payment with the characteristics of traditional Chinese medicine;
each mobile device is in communication connection with the medical insurance payment intelligent auditing engine suitable for the traditional Chinese medicine characteristics;
the ex-warehouse equipment is in communication connection with the medical insurance payment intelligent auditing engine suitable for the characteristics of traditional Chinese medicine;
and the payment equipment is in communication connection with the medical insurance payment intelligent auditing engine which is suitable for the characteristics of traditional Chinese medicine.
The utility model relates to a doctor's insurance payment intelligence audit engine that is fit for traditional chinese medical science characteristics, the doctor gets into audit engine through the network work number, the base of doctor at audit engine has been increased in the village, simultaneously, the doctor can log in audit engine through mobile device in the village, this adaptation village doctor's scattered current situation in office place, the doctor inquires patient's case history information through mobile device in the village, and open medicine in audit engine according to patient's current situation, audit engine will select the medicine instruction, and audit medicine retail price, the medicine measurement, pay for case use expense generation medication expense detail, the patient can pay the doctor in the village in the work number medicine expense audit module according to the medicine expense detail, the doctor can be through the warehouse medicine expense audit module of the equipment of going out of warehouse and the medicine expense of current situation of the month in the county, the doctor is at the end of the month, pay for the doctor's medicine expense audit module through work number medicine expense audit module, patient pay for the work number medicine expense audit module and pay for the work number audit module to the work number audit module and pay for the work number audit module and pay the mode of medicine expense of the doctor to the doctor module and have adapted to the state of the medicine and pay for the medicine and have taken.
Drawings
Fig. 1 is a flowchart of a medical insurance payment intelligent auditing method suitable for the characteristics of traditional Chinese medicine according to an embodiment of the present application.
Fig. 2 is a schematic structural diagram of a medical insurance payment intelligent auditing engine module suitable for the characteristics of traditional Chinese medicine according to an embodiment of the present application.
Fig. 3 is a schematic structural diagram of an intelligent checking system for medical insurance payment, which is suitable for the characteristics of traditional Chinese medicine and provided in an embodiment of the present application.
Reference numerals:
100-an intelligent auditing engine suitable for medical insurance payment with the characteristics of traditional Chinese medicine; 110-accessing to a network auditing module;
120-a medication list building module; 130-a work number and medicine expense auditing module; 140-checking the drug charge of the drug library;
200-a mobile device; 300-ex-warehouse equipment; 400-payment device.
Detailed Description
In order to make the objects, technical solutions and advantages of the present application more apparent, the present application will be further described in detail with reference to the accompanying drawings and examples. It should be understood that the specific embodiments described herein are for purposes of illustration only and are not intended to limit the present application.
The application provides an intelligent examination engine suitable for medical insurance payment with the characteristics of traditional Chinese medicine.
As shown in fig. 1, in an embodiment of the present application, a method for intelligently auditing medical insurance payment suitable for characteristics of traditional Chinese medicine includes:
s100, receiving a network access request sent by the mobile equipment, analyzing the network access request to acquire the network access work number of the mobile equipment, and judging whether the network access work number is in a stored work number list.
Specifically, a physician in a town logs in to the network number on a mobile device. The purpose of this step is to verify the legitimacy of the mobile device.
And S100a, if the network access work number is in the stored work number list, allowing the mobile equipment to access the network.
Specifically, the medical insurance payment intelligent auditing engine establishes a job number list in advance, and doctors in villages and towns with qualified medical science register in the medical insurance payment intelligent auditing engine in advance and are distributed with a network access job number, wherein the network access job number is stored in the job number list, and the network access job numbers stored in the job number list have legality.
Therefore, if the network access number is in the stored number list, the network access number is determined to be legal, and further the mobile equipment is determined to be legal.
S200, calling out history information of all cases of the network entry number in the current month, and establishing a current month medication list of the network entry number.
Specifically, each network entry number of each month only has one current month administration list. The current month dosage form contains the dosage of all cases.
And S300, feeding back all case history information to the mobile device in each case unit.
Specifically, the case history information may be case information of 3-5 months of all case histories.
S300a, receiving a selected case instruction sent by the mobile device, and feeding back case information of the selected case to the mobile device.
Specifically, the mobile device creates a selected case instruction and sends the selected case instruction to the medical insurance payment intelligent auditing engine, the selected case instruction is used for selecting one case as a selected case, and the selected case instruction is also used for acquiring case information of the selected case in a history period. The history period is freely selectable by the mobile device.
And after receiving the selected case instruction sent by the mobile device, the medical insurance payment intelligent auditing engine invokes case information of the selected case in the history period and sends the case information to the mobile device.
S400, receiving a selected case instruction sent by the mobile device, determining a selected case and feeding back case information of the selected case to the mobile device.
S400a, receiving a medicine selection instruction sent by the mobile equipment, determining the selected medicines, and importing the medicine retail price and the medicine measurement of each selected medicine into a current month medicine table of the network work number.
S400b, receiving a settlement medication expense instruction of the selected case sent by the mobile equipment, and generating a medication expense detail of the selected case.
S500, receiving the first payment information, verifying the first payment information, and deducting the amount of the fee in the medicine fee list.
S600, establishing a current month ex-warehouse medicine table of the network access work number according to the current month medicine table of the network access work number.
S700, receiving a medicine delivery instruction sent by delivery equipment, and checking delivery medicines and a delivery medicine table in the current month.
S700a, checking the current month drug delivery list and the current month drug delivery list, and generating the drug delivery cost details of the network access number according to the drug price when the current month is delivered.
S800, receiving the second payment information, verifying the second payment information, and deducting the cost amount in the drug library cost detail.
Specifically, the physician in the village and town enters the medical insurance payment intelligent auditing engine through the network access work number, meanwhile, the physician in the village and town can log in the auditing engine through the mobile equipment, the physician in the village and town inquires the case history information of the patient through the mobile equipment, the drug is opened in the auditing engine according to the current situation of the patient, the auditing engine receives the selected drug instruction, the retail price and the drug metering of the drug are audited, the case drug cost is generated into a drug cost detail, the patient can pay to the physician in the village and town in the work number drug cost auditing module according to the drug cost detail, the drug library drug cost auditing module in the county level hospital can audit the monthly drug outlet table and the monthly drug administration table through the ex-warehouse equipment, the physician in the month end pays to the drug library drug cost auditing module through the work number drug cost auditing module, and the two-stage payment auditing mode of the patient to the drug library drug cost auditing module adapts to the current situation of scattered drug service sites in the village and town.
According to the medical insurance payment intelligent auditing method suitable for the traditional Chinese medicine characteristics, the doctors in the villages and towns enter the auditing engine through the network access work number, the base number of the doctors in the villages and towns in the auditing engine is increased, the doctors in the villages and towns can log in the auditing engine through mobile equipment, the current situation that the doctors in the villages and towns are scattered in offices is adapted, patients can pay the doctors in the work number and the drug fee auditing module according to the drug fee details, the drug library and drug fee auditing module in the county level hospitals can audit the monthly drug delivery table and the monthly drug delivery table through the ex-warehouse equipment, the doctors in the villages and towns pay the drug library and drug fee auditing module through the work number and drug fee auditing module, and the two-stage payment mode that the patients pay the drug fee auditing module pays the drug library and drug fee module adapts to the current situation that the drug management architecture of the rural traditional Chinese medicine service website is scattered.
In one embodiment of the present application, prior to step S100, a method for intelligent audit of medical insurance payment suitable for the characteristics of traditional Chinese medicine includes,
s100b, establishing a job number list.
And S100c, coding the medical certificate number of the registered doctor into a network access work number according to the registration information of the registered doctor in the medical auditing institution, and importing each network access work number into a work number list.
S100d, storing a job number list.
Specifically, the traditional Chinese medicine service network is generally formed by a unit of a county-level hospital, so that registered doctors generally receive network access numbers by a unit of a county-level hospital, and the network access numbers are stored in an audit engine database of the county-level hospital.
The job number list plays a role in managing doctors in registration in the county, provides a guarantee for the safety of the traditional Chinese medicine service, enables the registered doctors to enter the auditing engine only by using the network access job number, and increases the convenience of the traditional Chinese medicine service.
In one embodiment of the present application, prior to step S200, a method for intelligent audit of medical insurance payment suitable for the characteristics of traditional Chinese medicine includes,
and S200a, storing the medicine table of the current month at the end of the month.
And S200b, updating the medicine table of the current month at the beginning of the next month.
Specifically, the monthly medication list is updated at the beginning of each month, and the monthly medication list of the last month is stored for checking the medication details when the work number and drug fee checking module pays to the drug library and drug fee checking module.
The application relates to a method for updating a medicine table in the current month, which aims to increase the repayment efficiency of a medicine charge auditing module of a traditional Chinese medicine library of an auditing engine. And meanwhile, the method is convenient for doctors in villages and towns to count the business volume in the current month. The method for updating the current month medication list prevents the current month medication list from being mixed, and the method for updating the current month medication list also prevents doctors in villages and towns from forgetting related data
In an embodiment of the present application, S300 includes:
and S300b, storing all the case history information by taking the social security number of the patient as a unit, wherein each social security number corresponds to one piece of case history information.
S300c, receiving the social security number information and calling out all case history information of the social security number.
Specifically, the traditional Chinese medicine is different from western medicine in each taking period, and the traditional Chinese medicine needs to be taken according to the traditional taking type, metering and current state of a patient by a traditional Chinese medical practitioner, so that all case history information in social security number units needs to be taken, and the information is important when the traditional Chinese medical practitioner takes the medicine.
The method for calling the case history information is beneficial to the traditional Chinese medicine starting of the traditional Chinese medicine, and in a medicine table building module of the auditing engine, the traditional Chinese medicine can modify the medicine type, the metering and even the processing method of the traditional Chinese medicine. These contents are all closely related to calling the case history information method.
In an embodiment of the present application, before step S400a, the intelligent auditing method for medical insurance payment suitable for the characteristics of traditional Chinese medicine includes:
s400c, establishing a medicine category sub-list.
S400d, introducing the Chinese patent medicine tablets, the Chinese patent medicine medicaments and the Chinese medicinal materials into a medicine variety sub-list.
And S400e, inserting the medicine seed list into a current month medicine list of the network access work number.
Specifically, the traditional Chinese medicine is relatively complex in types, and the classification of Chinese patent medicine tablets and Chinese patent medicine medicaments is similar to that of western medicines, but the classification of Chinese medicinal materials is very complex, and the classification method comprises, but is not limited to, the growth period, the production place information, the storage age and the processing method of single Chinese medicinal materials, which cause different prices of the same Chinese medicinal materials.
The medicine category list is favorable for a middle doctor to select traditional Chinese medicines meeting requirements, and when the middle doctor selects the traditional Chinese medicines, an auditing engine can automatically acquire prices of the corresponding traditional Chinese medicines, and the traditional Chinese medicine price data can be displayed in a medicine cost detail so as to be used for a work number medicine cost auditing module to check the cost amount.
In an embodiment of the present application, after step S400b, the intelligent audit method for medical insurance payment suitable for the characteristics of traditional Chinese medicine includes:
s400f, judging whether the selected medicine belongs to the types of the traditional Chinese medicine materials, wherein the sub-classification of each type of the traditional Chinese medicine materials comprises treatment types, and each treatment type has different treatment type prices.
S400g, if the medicine belongs to the category of the traditional Chinese medicine, the treatment type price and the medicine price of the traditional Chinese medicine are imported into the medicine' S current month medicine table.
Specifically, in the field of traditional Chinese medicine pharmacy, firstly traditional Chinese medicine monomers are processed, which is one aspect affecting the price of traditional Chinese medicines, when a plurality of traditional Chinese medicine monomers are combined into a pair of medicines, the work number medicine fee checking module also needs to collect treatment fees according to treatment types, for example, 2 yuan per serving is collected when the treatment types are grinding, 5 yuan per serving is collected when the treatment types are decocting with slow fire for 6 hours, and 3 yuan per serving is collected when the treatment types are decocting with strong fire for 2 hours.
The method for judging and selecting the medicine types is beneficial to a middle doctor to select proper treatment types according to needs, meanwhile, an auditing engine can automatically acquire the price of the corresponding treatment types, and treatment type charging data can be displayed in the medication expense detail so as to be used for a work number and medicine expense auditing module to check the expense amount.
In an embodiment of the present application, S700 includes:
s710, judging whether the drug in the warehouse is consistent with the drug list in the warehouse in the current month.
S720, switching to an early warning state if the drug delivery is not consistent with the drug delivery table in the current month.
And S730, feeding back the early warning state to the library equipment, and calling the current month medication list of the network work number.
And S740, synchronously refreshing the drug taking table in the current month and the drug taking table in the current month, and judging whether the drug taken out of the warehouse is consistent with the drug taking table in the current month or not again.
And S750, if the drug delivery table accords with the drug delivery table in the current month, eliminating the early warning state and switching to the conventional state.
And S760, if the drug delivery is not consistent with the drug delivery table in the current month, switching to an early warning state, popping up a correction window of the drug delivery device, and prompting the drug delivery device to correct.
Specifically, when the drug delivery table does not coincide with the drug delivery table in the month, there are two possibilities that the traditional Chinese medicine is increased or decreased after the traditional Chinese medicine is specifically selected by a middle doctor, and the drug record is not synchronous with the data of the drug delivery table in the month, so that the drug delivery table in the month does not coincide with the drug delivery table in the month due to the fact that the data is not timely refreshed, the drug delivery table in the month is refreshed, and the drug delivery table in the month is also refreshed when the drug delivery table in the month is refreshed, and the auditing engine compares the refreshed drug delivery table in the month with the drug delivery table in the month to ensure that the drug delivery table in the month is the latest data, and the other situation is that the staff responsible for delivering the drug is wrong, the staff responsible for delivering the drug is required to manually correct the drug delivery table in the month, and the wrong drug delivery table is replaced. It is worth mentioning that the traditional Chinese medicine materials in the traditional Chinese medicine warehouse are packaged according to weight, the packaged traditional Chinese medicine materials have information codes on the shells, and the traditional Chinese medicine materials need to scan the information codes before being delivered out of the warehouse.
According to the early warning method for the drug materials in the ex-warehouse, whether the drug materials in the ex-warehouse are consistent with the drug materials in the ex-warehouse in the current month or not is judged, so that the drug materials in the ex-warehouse are prevented from mistakes, the safety of traditional Chinese medicine service is improved, and meanwhile, the actual drug materials in the ex-warehouse, the drug materials in the ex-warehouse in the current month and the drug materials in the current month are correspondingly ensured.
In an embodiment of the present application, after step S700a, the intelligent audit method for medical insurance payment suitable for the characteristics of traditional Chinese medicine includes:
s700b, establishing a drug price list.
And S700c, receiving the medicine price information of each medicine, and importing the medicine price of each medicine into a medicine price table.
And S700d, when the medicine price is changed, receiving a medicine price change instruction, and updating the medicine price table.
Specifically, the price of the traditional Chinese medicine is not changed for years like western medicines, the price of the traditional Chinese medicine fluctuates due to factors such as climate of each year, so that the price list needs to be updated, and for the monthly work-number medicine fee checking module to pay for the medicine library medicine fee checking module, price difference can occur, for example, the price list is adjusted in a month seven, then the same traditional Chinese medicine tablets before and after the seventh number have two prices, and the checking cost of the work-number medicine fee checking module is inconsistent with the checking cost of the medicine library medicine fee checking module. When the time stamp is added, the original price table before the seventh is kept and time stamped. The work number medicine expense auditing module divides the current month medicine form into two parts according to the time stamp, the price is calculated according to the original medicine price form before the seventh, and the price is calculated according to the new medicine price form after the seventh. The drug charge auditing module of the drug library divides the drug table of the drug delivered in the current month into two parts according to the time stamp, the drug is priced according to the original drug price table before the seventh drug price table, and the drug is priced according to the new drug price table after the seventh drug price table. At this time, the auditing cost of the work number and drug expense auditing module is consistent with that of the drug expense auditing module of the drug library.
According to the method for processing the medicine price table, the medicine price is changed, and the time stamp and the original medicine price table are mapped, so that the auditing cost of the work number medicine fee auditing module is consistent with the auditing cost of the medicine library medicine fee auditing module.
As shown in fig. 2, in an embodiment of the present application, the medical insurance payment intelligent auditing engine suitable for the traditional Chinese medicine features executes a medical insurance payment intelligent auditing method suitable for the traditional Chinese medicine features, where the medical insurance payment intelligent auditing engine suitable for the traditional Chinese medicine features includes an access auditing module 110, a medication table establishing module 120, a job number and medication fee auditing module 130 and a medication library and medication fee auditing module 140.
The medication list establishing module 120 is connected with the network access auditing module 110. The job number and charge auditing module 130 is connected with the medication list establishing module 120. The drug library and drug fee auditing module 140 is connected 130 with the work number and drug fee auditing module.
Specifically, the network access auditing module 110 receives the network access request, parses the request, identifies the network access number, and verifies the network access number, and if the network access number is in the stored list of network access numbers, allows network access. The medication list creation module 120 selects the corresponding Chinese medicinal materials according to the current month medication list of the Chinese medicinal chemist, checks the medication cost, and charges the medication cost of the patient. The drug library charge auditing module 140 generates a drug library table of the current month against the drug table of the current month, and the drug library is carried out on the traditional Chinese medicine, and the drug charge is checked, and the drug charge is charged to the work number charge auditing module 130.
The intelligent medical insurance payment auditing engine suitable for the traditional Chinese medicine characteristics realizes a two-stage payment auditing mode that patients pay to the work-number medicine fee auditing module and the work-number medicine fee auditing module pay to the medicine library medicine fee auditing module, and adapts to the current situation that the traditional Chinese medicine service sites of villages and towns are scattered and have no systematic medicine management architecture.
The access audit module 110, medication form creation module 120, job number and pharmacy audit module 130 and the pharmacy inventory audit module 140 are numbered here for simplicity.
As shown in fig. 3, in an embodiment of the present application, the medical insurance payment intelligent auditing system suitable for the characteristics of traditional Chinese medicine includes an auditing engine 100, a plurality of mobile devices 200, a delivery device 300 and a payment device 400.
Each mobile device 200 is communicatively coupled to the medical insurance payment intelligent audit engine 100 adapted for the characteristics of traditional Chinese medicine. The ex-warehouse facility 300 is in communication with the medical insurance payment intelligent audit engine 100 adapted for the characteristics of traditional Chinese medicine. The payment device 400 is in communication with the medical insurance payment intelligent audit engine 100 adapted for the characteristics of traditional Chinese medicine.
Specifically, the mobile device 200 includes a cell phone, tablet computer, etc., which can log into the device of the audit engine 100. The ex-warehouse facility 300 includes a code scanner and a computer and display communicatively coupled to the code scanner. The payment device 400 includes a POS machine, a social security card reading device, and a mobile phone having a third party payment function.
The intelligent checking system for medical insurance payment combining the traditional Chinese medicine characteristics can realize a two-stage payment checking mode of payment of a patient to a work-number medicine fee checking module and payment of the work-number medicine fee checking module to a medicine library medicine fee checking module on a hardware level, and the payment checking mode is suitable for the current situation that a traditional Chinese medicine service site in villages and towns has no systematic medicine management architecture at all.
For brevity, only in this embodiment, the medical insurance payment intelligent audit engine 100, the plurality of mobile devices 200, the delivery device 300 and the payment device 400 that are suitable for the characteristics of traditional Chinese medicine are numbered.
The technical features of the above embodiments may be combined arbitrarily, and the steps of the method are not limited to the execution sequence, so that all possible combinations of the technical features in the above embodiments are not described for brevity of description, however, as long as there is no contradiction between the combinations of the technical features, they should be considered as the scope of the description of the present specification.
The above examples only represent a few embodiments of the present application, which are described in more detail and are not to be construed as limiting the scope of the present application. It should be noted that it would be apparent to those skilled in the art that various modifications and improvements could be made without departing from the spirit of the present application, which would be within the scope of the present application. Accordingly, the scope of protection of the present application shall be subject to the appended claims.
Claims (10)
1. The intelligent auditing method for medical insurance payment suitable for the characteristics of traditional Chinese medicine is characterized by comprising the following steps:
receiving a network access request sent by mobile equipment, analyzing the network access request to acquire a network access work number of the mobile equipment, and judging whether the network access work number is in a stored work number list;
if the network access work number is in the stored work number list, allowing the mobile equipment to access the network;
calling out history information of all cases of the network access number in the current month, and establishing a current month medication list of the network access number;
feeding back all case history information to the mobile device in units of each case;
receiving a selected case instruction sent by the mobile equipment, determining a selected case and feeding back case information of the selected case to the mobile equipment;
receiving a medicine selection instruction sent by the mobile equipment, determining the selected medicines, and importing the medicine retail price and the medicine metering of each selected medicine into a current month medicine table of a network access work number;
receiving a settlement medication expense instruction of the selected case sent by the mobile equipment, and generating a medication expense detail of the selected case;
receiving first payment information, verifying the first payment information, and deducting the amount of the fee in the medicine fee list;
establishing a current month ex-warehouse medicine table of the network access work number according to the current month medicine table of the network access work number;
receiving a medicine delivery instruction sent by delivery equipment, and checking delivery medicines and a delivery medicine table in the current month;
checking the current month delivery medicine table and the current month medicine table, and generating the delivery medicine cost detail of the network entry number according to the medicine price when delivering in the current month;
and receiving the second payment information, verifying the second payment information, and deducting the amount of the charge in the inventory charge detail.
2. The intelligent auditing method for medical insurance payment according to claim 1, wherein the receiving the network access request sent by the mobile device, analyzing the network access request to obtain the network access number of the mobile device, and judging whether the network access number is before the stored number list, includes:
establishing a job number list;
according to the registration information of the registered doctor in the medical auditing institution, the medical certificate number of the registered doctor is encoded into a network access work number, and each network access work number is imported into a work number list;
a list of job numbers is stored.
3. The intelligent auditing method for medical insurance payment suitable for the characteristics of traditional Chinese medicine according to claim 1, which is characterized in that: the method for calling out the history information of all cases in the current month of the network entry number and establishing the current month medication list of the network entry number comprises the following steps:
storing the medicine table of the current month at the end of the month;
the current month dosage form is updated at the beginning of the next month.
4. The intelligent audit method for medical insurance payment according to claim 3, characterized in that the feeding back all case history information to the mobile device in units of each case includes:
storing all the case history information by taking a social security number as a unit, wherein each social security number corresponds to one case history information;
and receiving the social security number information and calling out all case history information of the social security number.
5. The intelligent auditing method for medical insurance payment according to claim 1, wherein the steps of receiving the instruction of the selected medicine sent by the mobile device, determining the selected medicine and leading the medicine retail price and the medicine metering of each selected medicine into the current month medication list of the network entry number include:
establishing a drug category sub-list;
introducing the Chinese patent medicine tablets, the Chinese patent medicine medicaments and the Chinese medicinal materials into a medicine category list;
the list of drug categories is inserted into the current month medication list of the network entry number.
6. The intelligent auditing method for medical insurance payment according to claim 5, wherein after receiving the instruction of the selected medicine sent by the mobile device, determining the selected medicine and introducing the medicine retail price and the medicine metering of each selected medicine into the current month medication list of the network entry number, the method comprises the steps of:
judging whether the selected medicine belongs to the category of the traditional Chinese medicine materials; the sub-classification of each type of traditional Chinese medicine comprises treatment types, and each treatment type has different treatment type prices;
if the medicine belongs to the category of the traditional Chinese medicine, the treatment type price and the price of the traditional Chinese medicine are used as the current month medicine table for guiding the medicine.
7. The intelligent auditing method for medical insurance payment according to claim 1, wherein the receiving the drug delivery instruction sent by the delivery device checks the drug delivery and the drug delivery table in the current month, and includes:
judging whether the drug in the warehouse is consistent with the drug list in the warehouse in the current month;
if the drug delivery table does not accord with the drug delivery table in the current month, switching to an early warning state;
feeding back the early warning state to library equipment, and calling a current month medication list of the network work number;
synchronously refreshing the current month drug list and the current month drug list, and judging whether the drug to be stored is consistent with the current month drug list or not:
if the drug delivery table accords with the drug delivery table in the current month, eliminating the early warning state and switching to the conventional state;
if the drug delivery is not consistent with the drug delivery table in the current month, switching to an early warning state, popping up a correction window of the drug delivery device, and prompting the drug delivery device to correct.
8. The intelligent auditing method for medical insurance payment suitable for traditional Chinese medicine features according to claim 1, wherein before checking the current month delivery medicine table and the current month medicine table and generating the delivery medicine cost details of the network entry number according to the price of medicines delivered in the current month, the method comprises the following steps:
establishing a drug price table;
receiving the medicine price information of each medicine, and importing the medicine price of each medicine into a medicine price table;
when the medicine price is changed, a medicine price changing instruction is received, and the medicine price table is updated.
9. A medical insurance payment intelligent auditing engine suitable for the characteristics of traditional Chinese medicine, characterized in that the medical insurance payment intelligent auditing method suitable for the characteristics of traditional Chinese medicine according to any one of claims 1 to 9 is executed, and the medical insurance payment intelligent auditing engine suitable for the characteristics of traditional Chinese medicine comprises:
a network access auditing module;
the medication list establishing module is connected with the network access auditing module;
the work number and medicine expense checking module is connected with the medicine table establishing module;
and the drug charge auditing module of the drug library is connected with the work number drug charge auditing module.
10. The utility model provides a suitable doctor's insurance payment intelligence audit system of traditional chinese medical science characteristics which characterized in that includes:
the medical insurance payment intelligent auditing engine suitable for the characteristics of traditional Chinese medicine according to claim 9;
each mobile device is in communication connection with the medical insurance payment intelligent auditing engine suitable for the traditional Chinese medicine characteristics;
the ex-warehouse equipment is in communication connection with the medical insurance payment intelligent auditing engine suitable for the characteristics of traditional Chinese medicine;
and the payment equipment is in communication connection with the medical insurance payment intelligent auditing engine which is suitable for the characteristics of traditional Chinese medicine.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202311309803.0A CN117557384A (en) | 2023-10-08 | 2023-10-08 | Intelligent examination engine suitable for medical insurance payment with traditional Chinese medicine characteristics |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202311309803.0A CN117557384A (en) | 2023-10-08 | 2023-10-08 | Intelligent examination engine suitable for medical insurance payment with traditional Chinese medicine characteristics |
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| Publication Number | Publication Date |
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| CN117557384A true CN117557384A (en) | 2024-02-13 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN202311309803.0A Pending CN117557384A (en) | 2023-10-08 | 2023-10-08 | Intelligent examination engine suitable for medical insurance payment with traditional Chinese medicine characteristics |
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| Country | Link |
|---|---|
| CN (1) | CN117557384A (en) |
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2023
- 2023-10-08 CN CN202311309803.0A patent/CN117557384A/en active Pending
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