JP2002015059A - Medical expense transaction method - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a method for realizing early encashment of medical expense in order to solve a problem that procedures of billing and payment for medical expense between an operator, a medical expense transaction dealer and an assurer are conducted on the basis of actual spots of accounts conventionally, at times, resulting in the delay of office work handling and the irregular and long cash receipt term for the operator, thus hindering the operator's management. SOLUTION: A medical expense-billing machine, a medical expense transaction device, a medical expense benefits processing unit, and a dealer information providing device are connected through a computer network. The office work handling from billing to receipt of the medical expense is mechanically performed to shorten the handling term. In addition, the operator can select any one of factoring method, financing method and cash receipt method for encashment, so that the management can be set right and conducted smoothly.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical treatment business processing system between a business operator and a medical treatment business operator and an insurer, and more particularly to a computer and a network for selecting a payment system for a business operator. The present invention relates to a medical expenses business processing method for performing early payment.

[0002]

2. Description of the Related Art Conventionally, there are 50 large and small billing organizations (medical treatment business processing companies) between a medical treatment cost provider (business operator) and each insurer.
The business operator prepares a medical treatment bill and requests a report from the requesting organization via a document or a floppy (registered trademark) desk. Invoices for medical treatment were collected and prepared for each insurer, and documents were sent to the insurer as a whole. Then, the insurer makes an insurance examination and then provides medical expenses to the claiming organizations, and the medical expenses are paid to the business via the claiming organizations. But,
The period of paperwork in the above-mentioned claim groups varies greatly among individuals and often over a long period of time, and insurers also have large variations in individual payment periods depending on the type of insurance and the district in charge.

[0003]

As described above, paperwork from billing to payment has not been carried out smoothly, and as a result, the following problems have occurred. 1. The period from billing to payment by a medical treatment company (Judo rehabilitation clinic, a daily necessities company for the physically handicapped, an acupuncturist, masseur, other medical treatment company, care company, etc.) is irregular and For 2.5 to 10 months. 2. Since the reimbursement service provider requires a long period of time to deposit the billed amount, it may be a factor of deteriorating the cash flow. 3. Due to the incomplete flow of billing and payment of medical expenses, there was a case where improper billing was required to improve business performance. 4. Since the self-examination within the billing organization is manually performed only on the actual bill, the work efficiency is low. 5. Computers for issuing bills (medical care billing machines) are sold by several companies and are not compatible with each other. In addition, it did not have an automatic examination function and was merely a bill issuing machine. 6. Even in the billing organization, there are various models, and there is no mutual compatibility. The present invention provides a medical treatment expense business processing method that solves the above-mentioned problems.

[0004]

In view of the above, the present inventor has solved the above problem by the following method as a result of construction of a method based on research and operation experiments. In the present invention, the medical treatment expenses business processing mainly includes the medical treatment expenses business processing, but includes a part of the processing of insurance premiums, and a person involved in the business is referred to as a medical treatment expenses business operator or simply a business operator. Also, an application form for providing medical expenses or insurance premiums is called a bill or a claim, and furthermore, treating the claim as a claim is called a deemed claim. (1) As a facility for medical expenses provider, means for inputting medical expenses billing material, first automatic examination means to be executed with support from medical expenses business processing device, and preparation of medical expenses bill and , A means for transferring to a processing company, and a reimbursement bill invoicing machine for checking whether there is a payment from the insurer to the reimbursement business processing company, Means for supporting the first-stage automatic examination of the medical expenses provider, means for receiving the medical expenses bill and checking the result of the first automatic examination, examination of the contents of the documents for checking for inadequate documents, and detailed examination of the amount of the charges And second means of automatic examination having each means of return of failed examinations, each means of confirmation of seal of medical treatment provider, printing deviation of receipt, signature of patient, etc., ranking of company, and suspension of processing work. Execute each means A tertiary automatic examination device having an information input means from company data recording means and external industry information Searching Authority because the results of the third-order automatic examination means comprises a printer for display and printing to view,

A factoring-based calculation processing means for paying in accordance with a contract with the business operator based on the examination result passed through the above, purchasing the entire reimbursement bill as a receivable and paying the reimbursement business operator immediately. A reimbursement bill is regarded as a receivable, a pledge is set for the receivable, and a loan-type calculation processing means is provided for lending to the reimbursement company immediately, and payment is immediately made to the reimbursement company after receiving payment from the insurer. An operating fund unit having a calculation processing means of a depositing method, having said calculation processing means and a path for depositing and paying, and having an operating means of funds; and an insurance fund after said third automatic examination means. Means for preparing and issuing a bill to the insurer, means for sending out the bill to the insurer, means for confirming the deposit from the insurer and depositing it into the funding department, By search And means for notifying the notification,

[0006] Further, means for confirming and re-claiming receivables;
A reimbursement service processing device configured by means of a long-term accounts receivable processing means, and having means for examining a bill from the recuperation service processor and paying the recuperation fee as equipment of the insurer, Medical expenses subsidy system medical treatment benefit payment payment processing device, National Health Insurance medical treatment cost payment payment processing device, Medical treatment benefit payment payment processing device of various mutual aid insurance, Medical treatment benefit payment payment processing device of union-managed insurance, Equipped with a medical treatment payment payment processor for government-managed insurance, a medical treatment payment payment processor for workers' compensation insurance, a premium payment processor for auto liability insurance, and a premium payment processor for long-term care insurance. As equipment, comprising a trader information providing device that provides trader information to the medical treatment cost processing company,
, The medical expenses invoice issuing machine of the medical expenses business operator, a medical expenses business processing apparatus of a medical expenses business processing company, a medical expenses payment payment or insurance premium payment processing apparatus of an insurer,
A medical reimbursement business processing method, wherein a computer network is connected to a company information providing device of an external industry information research organization, and a business receives reimbursement medical expenses from an insurer via a medical reimbursement business processor.

[0007] (2) As a facility of a medical treatment fee provider, a means for inputting medical treatment claim data, a first automatic examination means to be executed with assistance from a medical treatment cost operation processing device, and a medical treatment cost bill. A means for preparing and transferring to a processing provider, a reimbursement bill invoicing machine for confirming whether or not a reimbursement service processing provider has received payment from an insurer; As equipment, means for supporting the primary reimbursement of the medical expenses provider, means for receiving the medical reimbursement bill and checking the result of the primary automatic examination, and means for checking the contents of the documents for inadequate documents. Secondary automatic examination means with means for scrutinizing the amount of the claim and returning the part that failed the examination, means for confirming the stamping of the judo reduction teacher, confirming the misprint of the receipt and the patient's signature, ranking the business operator, and stopping the processing work And the respective means Tertiary automatic examination means having business data recording means for execution and information input means from an external industry information research organization; a display device for displaying the result of the tertiary automatic examination means; and a printer for printing. Prepared,

[0008] Based on the result of the examination passed above, payment is made under a contract with the business operator, the reimbursement bill is regarded as a receivable, the entire amount is purchased, and the reimbursement operator is paid immediately to the medical service operator. The reimbursement bill is regarded as a receivable, and the pledge is set for the receivable, and a loan-type calculation processing means for immediately lending to the reimbursement company is provided. An operating fund unit having a calculation processing means of a payment method to pay, and having the calculation processing means and a path of payment and payment, and having an operation means of funds; and further, after the third automatic examination means,
Means for preparing and issuing an invoice to the insurer, means for sending out the invoice to the insurer, means for confirming the payment from the insurer and depositing into the funding department, Means to be notified by search or by notification,

[0009] In addition, receivables confirmation and re-billing journal entry means,
A reimbursement service processing device configured by means of a long-term accounts receivable processing means, and having means for examining a bill from the recuperation service processor and paying the recuperation fee as equipment of the insurer, Medical expenses subsidy system medical treatment benefit payment payment processing device, National Health Insurance medical treatment cost payment payment processing device, Medical treatment benefit payment payment processing device of various mutual aid insurance, Medical treatment benefit payment payment processing device of union-managed insurance, Equipped with a medical treatment payment payment processor for government-managed insurance, a medical treatment payment payment processor for workers' compensation insurance, a premium payment processor for auto liability insurance, and a premium payment processor for long-term care insurance. As equipment, comprising a trader information providing device that provides trader information to the medical treatment cost processing company,
, The medical expenses invoice issuing machine of the medical expenses provider, the medical expenses business processing apparatus of the medical expenses business processor, the medical treatment expenses payment or insurance premium payment processing apparatus of the insurer, and an external industry information research organization Medical treatment business processing system, wherein the medical treatment business processing system is connected to a third party information providing device by a computer network, and the business operator receives the billed medical treatment cost from the insurer through the medical treatment business processing company.

[0010] (3) The calculation processing means in the factoring system of the calculation center of the reimbursement service processing business operator described in the item (1) comprises: a contracting means of a factoring system first performed between the processing operator and the business; Based on the means to make the claim that has been examined by the processing company an unrecognized claim, and from the amount charged for the claim, a business commission including the administrative processing cost and the processing period interest, and the discount rate including the business evaluation rank and risk factor Means for calculating the deducted amount as the purchase amount, means for issuing a command to pay the purchase amount to the business to the operation fund unit, and payment for the purchase amount from the funds by the payment processing means in the operation fund unit. The means to be implemented for the business operator, and the one, the processing company, after paying the purchase price, issues a bill to the insurer based on the examined receipt and insurance Medical expenses business processing system, characterized in that it comprises means for billing, a means of payment collection to the funds unit received a payment from the insurer to.

(4) The calculation processing means in the financing method of the calculation center of the medical treatment fee processing business operator described in (1) is:
A contracting means of a financing method first performed between a processing company and a business entity, a means for setting a receivable without recognizing the examined claim examined by the processing company, a means for setting a pledge of the receivable, Means for calculating, as a loan amount, a deduction amount obtained by subtracting a business consignment fee including an administrative processing cost and a processing period interest and a discount rate including a business evaluation rank, a risk factor and a pledge right evaluation from a set amount; Means for issuing a command to pay the loan amount to the business operator to the operation fund department, means for executing the payment of the loan amount from the fund by the payment processing means in the operation fund section to the business operator, and the business operator receiving the loan If the loan amount to be repaid within the repayment date of the contract is executed, when the loan amount is received and collected and the operating funds department is repaid, Return If the loan amount is not repaid within the due date and the loan amount is not repaid, the processor will apply the pledge priority repayment, and when the pledge priority repayment is applied, the processing of the reviewed receipt will be performed when the loan is not repaid Means for making a claim to the insurer, and means for receiving payment from the insurer and depositing and collecting money in the operating fund unit.

(5) The calculation processing means in the payment method of the calculation center of the medical treatment service processing business operator described in the item (1) is:
First, a contracting means of a payment method performed between the processing company and the business entity, and a means for preparing a medical treatment bill after collecting a predetermined business consignment commission by the examined receipt examined by the processing company. , A means for issuing to an insurer, a means for receiving an insurer's payment, and a means for depositing in the operation fund section, and a means for processing in the operation fund section and paying a medical treatment fee to a business operator. Processing method. (6) In the medical treatment expenses business processing method described in (1),
There is a means by which the business operator can call the medical treatment cost processing business processing device with the medical treatment cost invoice issuing machine at any time to check whether or not there is payment from the insurer who has requested the medical treatment cost business processing company through the network. A medical expenses business processing method characterized by the following.

[0013]

Embodiments of the present invention will be described with reference to the drawings. FIG. 1 is a block diagram showing an outline of a computer and a network constituting the present method. In the figure, 1 is a medical expenses bill issuing machine, 2 is a printer, 3 is a network, 4 is a medical expenses business processing device, 5 is a printer, 6
Is an image data display 7 is a business record file, 8
Denotes a provider information providing device, 9 denotes a medical treatment fee payment processing device, 30 denotes a calculation center, 101 denotes a business operator, 102 denotes a medical treatment business operator, 103 denotes an external investigation organization, and 104 denotes an insurer. The reimbursement bill issuing machine 1 is a client / server provided at each business operator, and is provided in the software of the reimbursement bill (recept) issuing machine and the calculation center of the reimbursement business processing company. The medical treatment service processing device (business processing device) 4 which is a database application communication / server is connected to a computer network (network) 3, and the software of the server is linked via the network 3. After the first screening (automatic screening), a claim is issued. Then, this data is transmitted to the business processing device 4 via the network 3.

The business processing device 4 includes a communication means for communication with the outside via a network, a means for supporting and confirming the first examination, a second automatic examination means, a third automatic examination means, and a medical treatment payment. The operation calculation processing means of the operation fund section, the attached company record file 7, and the printer 5
, An image data display 6, and a means for creating a medical treatment bill for each insurer, a calculation processing means for each contract processing method, a medical treatment claim, and a delivery means for payment. , Means for confirming payment and notifying the operator, means for paying medical expenses to the operator, and means for processing receivables, etc. ing.

The trader information providing device 8 is located at an external research organization, and provides the latest information of each of the above businesses to the medical treatment cost processing trader via the network 3. Further, the medical treatment fee payment processing device 9 is arranged in the insurer, and accepts medical treatment bills and pays medical treatment expenses with a medical treatment business processing company via the network 3. . The computer network (network) 3 includes a WAN (Wide Area Network), CAN (City Area Network), LAN
A communication network such as a (local area network) may be used, and the Internet may be adopted as a method.

The details of the flow of the medical expenses business processing system will be described below with reference to the drawings. FIG. 2 is a block diagram showing the configuration of the operator equipment of this system. In the figure, 11 is a judo reduction teacher,
12 is a volunteer group mainly for the daily necessities of persons with disabilities, 13 is an acupuncturist and masseur, 14 is a nursing care provider,
15 is a medical treatment provider, 16 is a medical treatment, 17 is a medical treatment record, 18 is a billing material input, 19 is a primary automatic examination function, 20 is an examination item, a cause of injury, a long-term reason, a proximity part, and a billing part. 21 is bill creation, 22 is bill transfer,
Reference numeral 23 denotes a payment confirmation, and reference numerals 24, 25, and 26 denote network connection lines. As shown in the figure, after performing the treatment 16, the business operator 101 performs the treatment record creation 17 by the medical treatment cost invoicing machine 1, inputs the billing material 18, and
The next automatic examination 19 is executed by examination means. This means is compatible with each model connected to the network connection line 24 via the software in the medical treatment bill issuing machine 1 and the network 3 from the medical treatment business processing device (business processing device) 4. This is executed by the primary automatic examination support software (31) having the property. Examination item 20 is to collate and determine whether the cause of injury, long-term reason, proximity site, requested site, etc., meet the examination criteria.

After the above-mentioned examination is completed, a reimbursement bill is prepared 21 in a predetermined format which differs depending on the type of insurance, and the bill is transferred 22 to the reimbursement business processing device 4 from the network connection line 25 via the network 3. . The above operations are the same as those of any of the factoring method, the financing method, and the deposit method described later. Further, the business operator 101 calls the payment confirmation means 43 of the medical treatment cost business processing device 4 with the medical treatment cost invoicing machine 1 from time to time through the network 3 to determine whether or not there is a payment from the insurer 104 who requested. You can check the current situation. Therefore, especially in the case of the above-mentioned payment method, a payment schedule can be scheduled in advance.

FIG. 3 is a block diagram showing the configuration of the calculation center of the medical treatment service provider according to the present system. First, a medical treatment cost operation processing method and operations of the present invention will be described. The method includes a factoring method, in which the claim amount is regarded as a claim and the entire amount is purchased, a factoring method, a claim in which the claim amount is regarded as a claim, a pledge is set for the claim, and a loan is provided. There are three types of methods, paying and depositing, and the contracting business operator and the processing company select, decide, and contract with each other as to which method should be used to execute the medical treatment cost processing business. In this calculation center, the above-mentioned method is executed by the medical treatment cost operation processing device. Further, the factoring method is a method in which the medical treatment bill (recept) is regarded as a receivable and cashed and paid before the due date (before payment).
This includes early reimbursement.

In the figure, 30 is a calculation center, 31 is a primary automatic examination support, 32 is a reception / primary automatic examination check means, 33 is a secondary automatic examination means, and 34 is an examination item (document defect check). , Request contents examination
35 is the third automatic examination means, 36
Is an examination item (confirmation of seal of stamping of judo reduction teacher, misprint of receipt, confirmation of patient's signature, etc.) 37 is an examination item (ranking of business operator / stop processing) 38 is a business data record file,
39 is an image data display, 40 is a print, 41
Means for invoicing and issuing to the insurer, 42 for billing, 43 for payment confirmation means, 44 and 45 for network connection lines,
46 is a deposit to the operating fund department, 47 is a deposit route, 48 is a means for confirming and reclaiming accounts receivable, 49 is a long-term accounts receivable processing means, 50 is an operating funds section, 51 is a factoring method calculation processing means, and 52 is a loan. Method calculation processing means, 53 is a payment method calculation processing means, 54 is a long-term accounts receivable payment path, 55
Is the payment, 56 is the payment route to the business, 57, 58,
Reference numeral 59 denotes a network connection line.

As shown in the figure, the first automatic examination support software is provided via the network connection line 57 to the first automatic examination means 1 of the medical expenses bill issuing machine 1 of the business 101.
9 Then, the data of the invoice after the first automatic examination (FIG. 2) is inputted to the reception / first automatic examination check means 32 of the business processing device 4 via the network 3, and after the check, the second automatic examination is performed. It is sent to the examination means 33 and the examination items 34 are checked (document insufficiency check, claim contents examination / requested amount examination / return for unsuccessful examinations). Will be reviewed further. In this examination, first, examination item 3 by image
6. Confirmation of the stamping of the Judo reduction teacher's seal, the deviation of the receipt printing, the signature of the patient, etc., is confirmed by comparing the image data recorded in the company data recording file 38 by means such as pattern matching. The examination item 37 is determined based on the history data of each company stored in the company data record file 38 and the latest information on the industry (described later) sent from the network connection line 45.
(Company ranking and processing business suspension) is performed automatically. Then, the receipt that passed the above-mentioned examination is displayed on the image data display 39 or printed out.
0 is set. The above is the examination process of the medical treatment bill (recept) performed by the medical treatment business operator 102. When the above steps are completed, one of the factoring method, the financing method, and the payment method, which has been contracted (described later), is selected and executed. Therefore, the business can receive the medical treatment fee at an early stage according to the selected method.

Next, as an example, the process after the above-mentioned examination process will be described with reference to FIG. Medical treatment business operator 102
(Processing company), based on the completed claim,
The billing and issuing means 41 creates and issues a prescribed medical treatment bill to each insurer in the business processing device 4,
2 network connection line 59 and network 3
Is connected to the medical treatment cost benefit payment processing device 9 of the insurer 104 (FIG. 4).

FIG. 4 is a block diagram showing the configuration of an insurer (medical treatment expenses / benefit payment) of this system and equipment of an external research organization. In the figure, 60 is a network connection line for payment, 61
Is a medical treatment subsidy payment system for medical expenses payments, 6
2 is the national health insurance medical expenses payment payment processor, 63
Is a reimbursement benefit payment processor for various mutual aid insurances, 64 is a reimbursement benefit payment processor for union-managed insurance, 65 is a reimbursement benefit payment processor for government-managed insurance, and 66 is a recuperation benefit payment for workers' compensation insurance. A payment processing device, 67 and 68 are network connection lines, 84 is a care payment payment processing device for long-term care insurance, and 85 is a insurance payment payment processing device for auto liability insurance. The billing network connection line 59
(FIG. 3) and each insurer 10 via network 3
The data of the medical treatment cost invoice inputted into the medical treatment cost payment processing device 9 (including the insurance premium payment processing device) of No. 4 are the medical treatment cost payment processing devices 61 to 6 described above.
6, or after being examined by the insurance payment payment processing devices 84 and 85, the payment amount for medical expenses (including insurance premiums) is determined, and the payment network connection line 60 is connected via the network connection line 67 and the network 3. Then, it is sent to the insurer deposit connection line 44 in FIG. 3 described above, is input to the deposit confirmation means 43 of the business processing device 4, and is sent from the deposit 46 to the operational fund unit to the operational fund unit 50.

The processed funds are processed by the operating fund processing unit 50, and the medical expenses are paid to the business 101 in FIG. 2 through the payment route 56 (for example, bank transfer) of the payment 55 to the business. In the above, at the time of the examination by the insurer 104, if there is a problem in the data of the medical treatment bill and it is determined that the payment is withheld or not eligible for payment, etc. 102
Is treated as long-term accounts receivable 49, and means for the company 101 is settled by reducing the amount paid for processing the following month. Further, the receivables confirming / reclaiming journaling means 48 creates and issues a bill 41 to each insurer 104 after reviewing and correcting it. Note that a business processing request from the business 101 to the medical treatment business processing company 102 is made on a monthly basis, and a bill for the previous month is made at the beginning of the month.

Further, the external industry information research organization 103 shown in FIG.
Is sent from the network connection line 45 in FIG. 3 to the third automatic examination means 35 via the network connection line 68 and the network 3, and together with the business data record file 38, It is used to rank business operators and stop processing operations 37. As described above, the entire configuration blocks have been described by connecting FIGS. 2, 3, and 4. Next, the factoring method for purchasing the entire amount by regarding the amount of the claim as a claim will be described with reference to the drawings.

FIG. 5 is a flowchart of the calculation processing means of the factoring system. In the figure, 70 is the assessed receipt, 71 is the deemed receivable, 72 is the billed amount,
73 is an outsourcing fee, 74 is a paperwork fee, 75 is a processing period interest, 76 is a discount rate, 77 is a business evaluation rank, 7
8 is a risk factor, 79 is a deduction amount, 80 is a purchase amount, 82 is a claim (payment application) to an insurer, 83 is an insurer payment (payment for medical expenses) 98 is deposit / collection, 105 is a factoring-type contract . The calculation processing means of the factoring method (purchase) firstly makes a contract of the factoring method between the processing company 102 and the business entity 101, and then examines the examined claim 7 examined by the processing company 102.
0 is regarded as a receivable 71, and the purchase amount is calculated based on the payment amount 72, a business consignment fee 73 including a business processing cost 74 and a processing period interest 75, and a discount rate 76 including a business evaluation rank 77 and a risk factor 78. The subtracted amount 79 is calculated as the purchase amount 80, and the purchase amount 8
A command to pay 0 to the business operator 101 is issued to the operation fund unit 50. Then, the operating fund unit 50 executes the payment 55 from the funds to the business operator 101 by the processing means.

In the above, the business evaluation rank 77 is:
For example, it is divided into 1 to 5 stages and determined in consideration of the business condition. The risk factor 78 also includes an unpredictable factor such as a sudden suspension or closure of the business 101. However, the discount rate is kept low because this method is originally intended for the convenience of business operators and to assist their management. As described above, the company 101 can achieve soundness and smooth management of the business by cashing the medical treatment costs at an early stage. In addition, the processing company 102 then performs the screening of the examined claim 7
0, the invoice is issued to the insurer 104, and the insurer 104
From the operating fund unit 50 after receiving payment.

FIG. 6 is a flowchart of the calculation processing means of the loan system. In the figure, 90 is a pledge setting, 91 is an outsourcing fee, 92 is a pledge evaluation, 93 is a discount rate, 94 is a loan amount, 95 is a loan amount payment, 96 is a loan amount due date repayment, 97 is a pledge release, Reference numeral 98 denotes deposit / collection, 106 denotes a loan-type contract, 107 denotes non-repayment of the loan amount due date, 108 denotes application of pledge priority repayment, and 109 denotes non-repayment of loan amount. The calculation processing means of the financing method (pledge setting) is the first
02 and a business 101, a loan-type contract 106 is made, then a pledge setting 90 is made as a receivable 71 without reference to the verified receipt 70 examined by the processing company 102. The outsourcing fee 91 including the processing period interest 75 and the loan amount 94 determined by the business evaluation rank 77, the risk factor 78 and the discount rate 93 including the pledge evaluation 92 are instructed to the investment fund unit 50, and the investment fund unit 50 Loan amount payment by processing means 95
Is performed on the business operator 101. In the above description, the pledge evaluation 92 is determined in consideration of the business state of the business 101.

When the borrower 101 executes the loan amount repayment 96 to be repaid within the contract repayment date, the loan amount is paid / collected 98 and repaid to the operating fund unit 50. . On the other hand, the company 101 who has received the loan
Not repaid within the repayment date of the contract and the loan amount is not repaid 107
, The processing company 102 applies pledge priority repayment 1
08, the examined claim 70 is processed by the treatment at the time of non-repayment of the loan 109, and a claim 82 (supply application) is made to the insurer described above, and an insurer payment 83 (supply of medical expenses) is received and collected 98. It is repaid to the operating fund unit 50. According to the above-mentioned financing method, the processing company 102 can further reduce the risk due to financing, and the business operator 101 can conveniently receive financing in a case where emergency funding is required.

FIG. 7 is a flowchart of the payment processing calculation means. In the figure, 110 is a contract of a deposit system, 1
11 is a bill for medical expenses, 112 is issued to the insurer, 11
3 indicates insurer payment, and 114 indicates deposit. The calculation processing means of this payment method firstly includes the processing company 102 and the business 10
1 and a contract 110 of the deposit system is made, and the insurer 1
This is a basic method in which the business 101 receives the payment from the company 04 via the processing company 102. As described above, in this method, each computer is connected by a computer network, and Since it is a method of delivering medical expenses through a company, the processing period is remarkably shortened as compared with the related art, and mechanical processing of business is enabled. Next, after collecting a predetermined business consignment fee 91 by the examined receipt 70 examined by the processing company 102, a medical treatment bill is created 111.
Claim 112 (supply application) to the insurer. Then, receiving the insurer payment 113 (supply of medical treatment expenses), the money is paid into the operation fund unit 50 as a deposit 114, and the medical treatment expenses are paid to the business 101 as a payment 55 therefrom.

[0030]

According to the present invention, the following excellent effects are exhibited. According to the invention of claims 1 and 2 of the present invention, a medical treatment cost invoice issuing machine of a medical treatment cost business operator, a medical treatment cost business processing device of a medical treatment business operator, and a medical treatment cost payment of an insurer. Since the processing device and the external industry information research organization's vendor information providing device is connected and processed by a computer network,
It is possible to perform the administrative processing from medical treatment billing to receipt mechanically, and the processing period is significantly shortened,
Businesses can cash their medical expenses at an early stage, and can improve the soundness and smoothness of management. There are three types of cashing: a factoring method, a financing method, and a depositing method, and the business operator can select an optimal method according to the situation. In addition, the medical treatment billing machine is equipped with a screening function to perform the first automatic examination with the support from the medical treatment bill processing device, and the function is improved. You can understand the flow of billing or payment of expenses. Then, the insurer can collectively receive the prescribed payment application, which has been pre-examined by the business operator and the processing company, online via the network, and receive subsequent medical treatment such as check, examination, and payment. It can be processed quickly by the gold payment processor. In addition, the payment of the medical treatment fee to the processing company can be made through the network, so that the work efficiency of the whole related affairs can be improved. (2) According to the invention of claim 3, after examining the medical expenses bill issued by the business operator, the medical expenses bill is regarded as a claim, the entire amount is purchased, and the medical expenses operator is paid immediately to the medical expenses operator by a factoring method. As a result, businesses can achieve soundness and smooth management by quickly cashing medical expenses.

According to the third and fourth aspects of the present invention, after the reimbursement service processor examines the reimbursement bill issued by the reimbursement service provider, the reimbursement bill is regarded as a claim, and The lending method is to set up a pledge right and provide immediate financing to the medical treatment provider, so that the processor can further reduce the risk of financing, and the provider can provide emergency financing in the event that it becomes necessary. , I can get a loan easily,
The soundness and smoothness of management can be achieved. 4, According to the invention of claim 5, the medical treatment expenses processing company,
After examining the reimbursement bill issued by the reimbursement provider, a reimbursement bill is created and transmitted to the insurer based on the reimbursement bill, and immediately after payment from the insurer, the reimbursement provider is contacted. The pay-in / pay-out method significantly shortens the processing time of the business compared to the past, enables the mechanical processing of the business, and greatly contributes to the soundness and smoothness of the management of the business. According to the invention of claim 6, the business operator calls the payment confirmation means of the medical treatment expenses business processing device with the medical treatment bill invoicing machine at any time through the network, and checks whether or not there is a payment from the insurer who requested. Since the present situation can be confirmed and the present situation is also reported from the processing company, it is possible to know the flow of payment, and in particular, in the case of the above-mentioned deposit system, it is possible to schedule a deposit in advance.

[Brief description of the drawings]

FIG. 1 is a block diagram showing a computer and a network constituting the present system.

FIG. 2 is a block diagram showing a configuration of a business facility of the present system.

FIG. 3 is a block diagram showing the configuration of a medical treatment cost processing company calculation center according to the present system.

FIG. 4 is a configuration block diagram of an insurer and an external research organization facility of the present system.

FIG. 5 is a flowchart of calculation processing means of a factoring method.

FIG. 6 is a flowchart of calculation processing means of a loan system.

FIG. 7 is a flowchart of a payment processing calculation means.

[Explanation of symbols]

1: Medical expenses bill issuing machine 2: Printer 3: Network 4: Medical expenses business processing device 5: Printer 6: Image data display 7: Business record file 8: Trader information providing device 9: Payment of medical expenses Processing equipment 11: Judo reduction teacher 12: Handicapped person daily necessities supplier Mainly volunteer group 13: Acupuncturist / massageist 14: Nursing care provider 15; Other medical expenses handling company 16: Treatment 17: Preparation of treatment record 18: Billing material Input 19: Primary automatic examination 20: Examination item, cause of injury, long-term reason, proximity part, billing part 21: Bill creation 22: Bill transfer 23: Payment confirmation 24, 25, 26: Network connection line 30: Calculation Center 31: First automatic examination support 32: Reception and first automatic examination check 33: Second automatic examination means 34: Examination items 35: Third automatic examination means 36: Judgment items (confirmation of Judo repositioning seal, confirmation of misprint on receipt, confirmation of patient signature, etc.) 37: Examination items (Company ranking / processing stoppage) 38: Business data record file 39: Image data display 40: Print 41: Billing / issuing means to insurer 42: Billing 43: Payment confirmation means 44, 45:
Network connection line 46; Deposit to operating fund department 47: Deposit route 48: Accounts receivable confirmation / reclaim journaling means 49: Long-term accounts receivable processing means 50; Operating fund part 51: Factoring method calculation processing means 52: Loan method calculation processing Means 53: Payment method calculation processing means 54: Long-term accounts receivable payment path 55: Purchase payment 56: Payment path to the business 57, 58: 59: Network connection line 60: Payment network connection line 61: Medical expenses subsidy system Reimbursement benefit payment processor 62: National health insurance recuperation benefit payment processor 63: Reimbursement benefit payment processor for various mutual aid insurances 64; Reimbursement benefit payment processor for union-managed insurance 65: Government Reimbursement benefit payment processing device 66 for insured insurance: Recuperation benefit payment processing device 67 for work injury insurance 8: Network connection line 70: Screened receipt 71: Deemed receivable 72: Invoiced amount 73: Outsourcing fee 74: Business processing expenses 75: Processing period interest 76: Discount rate 77: Business evaluation rank 78: Risk factor 79: Subtraction Amount 80: Purchase amount 82: Claim to insurer 83: Deposit /
Collection 84: Nursing care insurance premium payment processor 85: Automated liability insurance premium payment processor 90: Pledge setting 91: Business commission 92: Pledge evaluation 93: Discount rate 94: Loan amount 95: Loan amount payment 96 : Repayment of loan amount due date 97: Pledge release 98: Deposit / collection 101; Business operator 102: Medical treatment business operator 103: External research organization 104: Insurer 105: Factoring contract 106: Loan contract 107: Loan Non-repayment due date 108: Pledge priority repayment applied 109: Non-repayment of loan 110: Contract of payment method 111: Preparation of medical expenses bill 112: Request to insurer 113: Insurer payment 114: Payment

Claims (6)

[Claims] Claims: 1. As a facility of a medical expenses provider, a means for inputting medical expenses claim data, a first automatic examination means to be executed with assistance from a medical expenses business processing device, and a medical expenses bill created. And a means for transferring to a processing company, and a reimbursement bill invoicing machine for confirming whether or not a reimbursement business processing company has received payment from an insurer. Means for supporting the primary reimbursement service provider for the first automatic examination, means for receiving the reimbursement bill and checking the result of the first automatic examination, Second automatic examination means with means for scrutiny of amount and return for failed examinations, and means for confirming seals of medical expenses provider, confirming receipt printing deviation, patient signature, etc., ranking companies, and stopping processing operations And implement each means Tertiary automatic examination means having business data recording means for executing the data and information input means from an external industry information research organization, a display device for displaying the result of the tertiary automatic examination means, and a printer for printing. Prepare, make payment under the contract with the business based on the examination result passed above, purchase the full amount considering the medical treatment bill as a claim,
A calculating means of a factoring method for paying immediately to a medical expenses provider; a calculating method of a loan method for immediately lending to a medical expenses provider by setting a pledge on the receivables by treating the bill for medical expenses as a loan; An operating fund unit having a payment processing calculation means for immediately paying to the medical expenses provider after payment from the insurer, and having the calculation processing means and a payment and payment route, and having a fund management means; Means for preparing and issuing a bill to the insurer after the third automatic examination means, means for requesting the insurer to send the bill,
A means for confirming the deposit from the insurer and depositing it into the funding department; a means for notifying the deposit by a business search or by notification; a means for recognizing and reclaiming receivables; Medical expenses subsidy comprising a medical treatment expenses processing device constituted by processing means and each means, and having means for examining a bill from the medical treatment expenses processing company and paying medical expenses as equipment of an insurer. Reimbursement benefit payment processing device of the gold system, medical treatment benefit payment payment device of the National Health Insurance, medical treatment benefit payment payment device of various mutual aid insurances, medical treatment benefit payment payment device of the union-managed insurance, government-managed insurance Medical treatment benefit payment processing device, workers' compensation insurance payment payment processing device, auto liability insurance premium payment processing device, care insurance premium payment processing device, As equipment of the research organization, a medical treatment cost invoice issuing machine of the medical treatment business and a medical treatment business of the medical treatment business are provided with a business information providing device for providing business information to the medical treatment business. A processing device, an insurer's medical expenses benefit payment or insurance premium payment processing device,
A medical reimbursement business processing method, wherein a computer network is connected to a company information providing device of an external industry information research organization, and a business receives reimbursement medical expenses from an insurer via a medical reimbursement business processor. 2. As a facility for a medical expenses provider, a means for inputting medical expenses claim data, a first automatic examination means to be executed with support from the medical expenses business processing apparatus, and a medical expenses bill form. And a means for transferring to a processing company, and a reimbursement bill invoicing machine for confirming whether or not a reimbursement business processing company has received payment from an insurer. Means for supporting the primary reimbursement service provider for the first automatic examination, means for receiving the reimbursement bill and checking the result of the first automatic examination, Second automatic examination means with means for scrutiny of money and return of unsuccessful examinations, and means for confirmation of stamping of judo reduction teachers, confirmation of misprinting of receipts, patient signatures, etc., ranking of business operators, and suspension of processing operations , Execute each means Tertiary automatic examination means having business data recording means for inputting and information input means from an external industry information research organization,
A display device and a printer for displaying the result of the third automatic examination means, and a printer for printing, based on the examination result passed above, pays by contract with the business operator, the medical treatment bill is regarded as a claim Consider and buy the entire amount,
A calculating means of a factoring method for paying immediately to a medical expenses provider; a calculating method of a loan method for immediately lending to a medical expenses provider by setting a pledge on the receivables by treating the bill for medical expenses as a loan; An operating fund unit having a payment processing calculation means for immediately paying to the medical expenses provider after payment from the insurer, and having the calculation processing means and a payment and payment route, and having a fund management means; Means for preparing and issuing a bill to the insurer after the third automatic examination means, means for requesting the insurer to send the bill,
A means for confirming the deposit from the insurer and depositing it into the funding department; a means for notifying the deposit by a business search or by notification; a means for recognizing and reclaiming receivables; Medical expenses subsidy comprising a medical treatment expenses processing device constituted by processing means and each means, and having means for examining a bill from the medical treatment expenses processing company and paying medical expenses as equipment of an insurer. Reimbursement benefit payment processing device of the gold system, medical treatment benefit payment payment device of the National Health Insurance, medical treatment benefit payment payment device of various mutual aid insurances, medical treatment benefit payment payment device of the union-managed insurance, government-managed insurance Medical treatment benefit payment processing device, workers' compensation insurance payment payment processing device, auto liability insurance premium payment processing device, care insurance premium payment processing device, As equipment of the research organization, a medical treatment cost invoice issuing machine of the medical treatment business and a medical treatment business of the medical treatment business are provided with a business information providing device for providing business information to the medical treatment business. The processing device is connected to the insurer's medical treatment benefit payment or premium payment processing device and a company information providing device of an external industry information research organization via a computer network. A medical expenses business processing method characterized by receiving billed medical expenses from an insurer. 3. A contracting means of a factoring system which is first executed between a processing company and a business by a calculation processing means in a factoring system of a calculation center of a medical treatment cost business processing company according to claim 1. Subtracts the means of claiming the assessed claim judged in the above into a claim and the amount of the claim, and subtracts the outsourcing fee including the processing cost and the processing period interest, and the discount rate including the business evaluation rank and the risk factor. Means for calculating and processing the deducted amount as the purchase amount, means for issuing a command to pay the purchase amount to the business operator to the operation fund section, and payment processing means for payment of the purchase amount from the fund by the payment processing means in the operation fund section. After the payment of the purchase price, the processing company issues an invoice to the insurer based on the reviewed receipt and invoices the insurer. Requesting means and means for receiving payment from an insurer and depositing and collecting money in the operating fund unit. 4. The financing method of the reimbursement center of a reimbursement service processing business operator according to claim 1, wherein:
Means for making a claim that has been examined by a processing company into an unrecognized claim, means for setting a pledge of the claim, and a business consignment fee including business processing costs and processing period interest and a business Means for calculating a discount amount obtained by subtracting a discount rate including a risk assessment factor and a pledge right evaluation, and a credit amount as a loan amount;
Means for issuing a command for paying the loan amount to the business operator to the operation fund unit, means for executing the payment of the loan amount from the fund by the payment processing means in the operation fund unit to the business operator, and receiving the loan. If the operator makes a loan repayment within the contract due date,
Means in which the loan amount is received / collected and the Investment Funds Department is repaid, and, on the other hand, if the loaned company does not repay within the repayment date of the contract and the loan amount is Means for the processor to apply the pledge priority repayment, means for applying the pledge priority repayment, means for making a claim to the insurer by the processing means when the loan is not repaid, and means for paying from the insurer, A medical expenses business processing method, comprising means for receiving and collecting and receiving money in the operating fund unit. 5. A method according to claim 1, wherein the calculation processing means in the payment method of the calculation center of the medical treatment service processing business operator comprises:
Next, a means for preparing a medical treatment bill after collecting a prescribed business consignment fee, a means for issuing to the insurer, and a means for receiving the insurer's payment based on the assessed receipt examined by the processor, And a means for processing the money by the operation fund unit and paying the medical treatment fee to the business operator. 6. The medical treatment expenses business processing method according to claim 1, wherein the business operator requests the medical treatment expenses business operator to determine whether there is a deposit from the insurer through the network at any time. A reimbursement expense business processing method comprising means for calling and confirming a reimbursement expense processing business processing device by a certificate issuing machine.