JP2002117147A - Link system between nursing care insurance databases - Google Patents

Abstract

PROBLEM TO BE SOLVED: To construct the data link of electronic database between the computer databases, which have different specifications, of plural providers. SOLUTION: While using a program 400 for extraction capable of accessing a database 250 of a computer 200 on the providing side and transferring data to a removable data recording medium 300, required data are extracted from the database 250 and outputted to the removable recording medium 300 and the extracted data on this removable recording medium 300 are inputted to a database 150 of a computer 100 on the side of a requesting person.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a long-term care insurance database linking system that supports data linking between databases of computers of a plurality of companies having different specifications at an application software level in relation to long-term care insurance.

[0002] This kind of a long-term care insurance database linking system has not existed conventionally.

[0003]

2. Description of the Related Art In the long-term care insurance system, a long-term care service provided by a local government or the like as a welfare measure and a long-term care service provided as part of the elderly insurance are provided as one long-term care insurance. It is assumed that.

Hereinafter, an outline of the flow of providing care insurance services will be described. The insurers of the long-term care insurance system are municipalities, and the insured persons (users) are elderly persons 65 years or older (No. 1 insured persons) and middle-aged persons aged 45 years to 65 years old (No. 2 insured persons). ). Those who are 40 years old or older pay the long-term care insurance premium, and apply for qualification for a care-requiring person to the municipality in charge if they need care for any reason. The municipalities will examine the application for the qualification for requiring caregiver, certify the degree of care required (qualification for receiving care), and issue a long-term care insurance card, etc. according to the condition of the recipient.

[0005] The long-term care insurance card differs depending on the degree of care required,
"Section payment limit standard amount (points)" for visiting bureau services
(Maximum number of insurance points that can be used each month) and "Segment pay limit reference amount (days)" for short-term entrance service are described. The limit (number of days) of the short-term entrance service changes according to the limit management period.

Special measures for non-insurance burdens (transitional measures for low-income earners who have been receiving services for some time)
If there is a public expenditure, such as social security, public welfare, medical expenses, etc., the municipalities and welfare offices will notify the user of the public expenditure recipient number, benefit rate (public expenditure ratio), and self-pay. As for the public expense recipient number, for example, a special measure is notified only once, and a new number is notified every month for welfare.

[0007] The certified caregiver requests a care manager belonging to a home care support facility or the like, and prepares a care plan including a usage form / usage form separate table defined by a standard. get. If the user (care-requiring person) agrees on the care plan, the care manager issues a usage card / use-card separate sheet to the user (care-requiring person) and provides a certain format prescribed by the standard. Votes /
Create a separate form for the provision slip (a usage table / a document that separates the usage table for each business establishment) and send it to various nursing care service providers, such as a home service business operated by the private sector.

The nursing care service is provided with a six-digit nursing care code according to the content and the providing time, and a “point” is determined for each code.

[0009] The usage slip includes personal information such as an insurer number, an insurer name, a home care support provider name and an insured person number, an insured person name, a date of birth, a gender, and a state requiring nursing care. ing. Further, as the contents of the monthly plan, a provision time zone, a service content, a name of a service provider office, a monthly service plan and a record of actual results (date, number of times, total number of times) are described.

[0010] In the separate table of usage slips, "payment limit management by visit place classification / user burden calculation", "payment limit management by type",
"Short-term entrance section payment limit management / user burden calculation" is performed.

[0011] The contents of "visited office division supply limit management / user burden calculation" include the establishment name, establishment number, service content / type, service code, score, number of times, service score / amount, type supply limit standard. Calculates points exceeding the number, types within the payment limit standard, points exceeding the classification payment limit standard, points within the classification payment limit standard, points unit, user's burden (for insurance), and user's burden (full amount) .

In the "supply limit management by type", the service type, the type supply limit reference amount (point), the total points, and the points exceeding the type supply limit reference are calculated.

[0013] In the "short-term entrance division supply limit management / user-paid calculation", the number of days is managed by the division supply limit reference amount (days), and the establishment name, establishment number, service content / type, service code, Calculate points, days, number of days eligible for payment, unit price of points, points within category payment limit standard, user's burden (for insurance), number of days not covered, number of points not covered by benefit, and user's burden (for full burden).

The calculation is started by examining the contents of the nursing care service, the time zone, and the service code corresponding to the number of hours from the nursing care benefit unit number table, but the number of codes is very large. Sometimes, the code itself is wrong.

Regarding fraction processing 1. In the rounding process for calculating the number of units, each time a calculation of addition or subtraction (limited to calculation by multiplying by some ratio) is performed on the basic number of units, a rounding process (rounding off) after the decimal point is performed. In other words, the calculation is to continuously multiply the integer value by the ratio.

2. In the rounding process for converting money, any fraction less than one yen that occurs when converting the calculated number of units into a monetary amount is rounded down.

Calculation of Nursing Care Expenses Calculate by multiplying the unit set for each service / facility in the nursing care benefit unit table (designated home service, designated home care support, designated facility service, etc.) by the unit price of one unit for each region.

2. The unit price of nursing care benefits is basically 10 yen per unit in each region. Depending on the labor costs and depreciation costs in the region, the city can be classified into visiting city services, short-term entrance services, facility services, etc. Some departments add one unit price.

3. There is special area addition for remote islands,
The number of units corresponding to 15/100 of the predetermined number of units at a time can be added to the predetermined number of units. This is the number of units that are not subject to limit management.

4. When there is a public expenditure burden, the number of target units is calculated separately for each different rate (real public expenditure benefit rate) obtained by subtracting the priority insurance / public expense benefit rate from the public expense benefit rate.

5. Price (discount) can be set for each service office.

Further, when there is a change in the plan, the content must be reflected in the usage slip / use slip separate table.

As described above, the calculation of the usage slip / usage slip separate table is very complicated.

Exceeding the "classified supply limit reference amount (points)" of the visiting tsusho service and the "category supply limit reference amount (days)" of the short-term entrance service is not covered by the long-term care insurance. The fee for the nursing care service that is exceeded will be borne by the user 100%. Care managers must pay close attention to the management of the “segment pay limit” as the personal burden increases all at once.

This management is performed in the column of "Segment pay limit reference points" in the usage slip table (provided slip table), and the point of management is how many points are allocated to each service.

The nursing care service provider prepares an individual support plan describing specific nursing care content based on the provided slip / provided slip separate table, and presents the contract to the care-requiring person and makes a contract. After the contract, the care recipient receives benefits such as dispatch of helpers. Nursing care service providers provide services based on individual assistance plans.

If the service is not provided due to the convenience of the user, or if a request for a service not planned in the middle of the month is received by the care service provider, it is necessary to contact the care manager and review the plan. is there. In particular, it is important to confirm that it does not exceed the "classified payment limit (points)" for the visiting bureau service and the "classified payment limit (days)" for the short-term entrance service. In the unlikely event that the plan exceeds the “in-category payment limit reference amount”, it is necessary to notify the user because the burden on the user will increase.

Billing in the visiting bureau / short-term entrance service is performed on a monthly basis, the "points" for each care code are totaled, and the cost is calculated from the total. For 90% of the cases, a claim (claim) of the number of claims for long-term care insurance is attached to the claim reviewing organization (National Health Insurance Federation). The remaining 10% will be collected from the service user who is the recipient. Exceptionally, special measures 7%
Depending on the public expenditure such as social security and welfare, the burden ratio changes.
Except for user claims, the contact is the Federation of National Health Insurance Organizations.

In order for the care manager to prepare a receipt ("care benefit bill information"), it is necessary to receive notification of service performance data from the care service provider. In addition, this data is based on the
It is also necessary for management.

There are three methods for submitting a claim that a care service provider or a home care support facility must submit to the National Health Insurance Federation. This is an exchange after printing on paper, an exchange by carrying a removable recording medium such as a floppy (registered trademark) disk or an MO disk, and a data transfer using a communication line.

The contents of the receipt are, for example, as follows. 1. Nursing care service providing organization Form 1 (1): Nursing care benefit bill Form 1 (2): Nursing care benefit bill attached sheet Form 2 to 10: Nursing care benefit statement Home care support establishment Style 1 (1): Nursing care payment bill Form 1 (2): Nursing care payment bill Attachment Form 7: Nursing care payment statement Form 11 and 12: Nursing care payment benefit management Table In addition, style 1 (1): Nursing care benefit bill and style 1
(2): A separate nursing care benefit bill is to be submitted for each office code.

In the Federation of National Health Insurance Organizations, the contents of the receipts (“benefit management information” and “benefit care billing information”) from the home care support establishment (insured person name, care insurer number, care recipient number) The insurer's number, care code, score, etc.) are compared with the contents of the receipts from various care service providers ("care benefit billing information") (specialized as "totsugo"). ) And conduct a review. All paper submissions are entered and all data is digitized before collation.

Form 7 “Home care support care benefit payment statement” submitted by the home care support establishment (information on the user who created the care plan by the home care support establishment) and Form 11
Insurer number, insurer name, insured person number, insured person's name, insured person's name, visiting office classification pay limit, establishment name, establishment number, service type name, service Type code / benefit plan number of units and form 1
2 Insurer number, insurer name, insured person number, insured person name, short-term entrance payment limit reference amount, establishment name, establishment number, service type name in "benefit management form short-term entrance service payment management form" The service type code, the planned number of payment days, and the like are collated with the number of planned units for each service type in forms 2 to 10 submitted by the care service provider.

If the contents of the receipt are appropriate, the National Federation of National Health Insurance Organizations issues a payment decision notice to the home care support establishment and various care service providers by electronic or telephone or facsimile. In addition, to the applicable municipalities (insurers), the “benefit management information” and the “nursing care benefit bill information” are transmitted by electronic mail to claim the insurance money. Municipalities make payments to the Federation of National Health Insurance organizations. The National Health Insurance Federation pays the insurance money to home care support establishments and nursing care service providers.

As a result of the collation (matching), if there is a mismatch in the contents of the receipt, a “return” (notification) is sent to the home care support office and various nursing care service providers by electric or telephone or facsimile. Done. Home care support offices and various nursing care service providers will make amendments and re-claim along with bills from the following month.

[0036]

As described above, in the long-term care insurance system, municipalities (insurers), welfare offices,
Among care recipients (insured), home care support establishments, nursing care service providers, and the National Health Insurance Federation,
It is necessary to exchange various forms of documents with complicated score calculation such as usage slip / usage slip separate table, provided slip / provided slip separate table, and receipt, so that the burden of paperwork is very large.

Although a system for requesting long-term care insurance has already been developed, different systems are used when the home support business and the home service business are performed by different establishments or within the same establishment. In this case, since each system has different specifications, the exchange of data between both systems must be paper-based,
In fact, it is. In this case, since the data is not electronic data, it is necessary to re-enter the data, and the work is performed twice, resulting in poor work efficiency and a high error rate.

For the "different specifications", for example, the language in which the application software was developed is different, the item names of tables (data storage locations) are different, the arrangement of items is different, the data of each item is different. Data migration between different databases due to differences in types and properties (attributes: For example, if the data type on the import side is shorter than that on the export side, the character string at the end will be cut off). Cannot simply be done.

Common data items (insurer number, insurer name,
(Insured person number, insured person name, etc.), but the data entered independently at each business site may be incorrect.

The present invention was created in order to solve the above-mentioned problems, and currently has different specifications at the application software level for computer databases owned by a plurality of companies involved in long-term care insurance. Because of this, care insurance information can only be exchanged on a paper basis, and the operator has to re-enter the information manually, which requires two repetitions. To break down inconvenient and inefficient situations such as bad and high error rates, and to establish data linkage in electronic databases between computer databases of multiple vendors with different specifications. And

[0041]

The first aspect of the present invention relates to a long-term care insurance database linking system which supports data linking between databases of computers of a plurality of vendors having different specifications at an application software level in connection with the long-term care insurance. An inter-database cooperation system, which uses an extraction program capable of accessing the database of the requestee side computer and transferring data to a removable recording medium, accessing the database of the requestee side computer to obtain necessary data. Extract,
The extracted data is exported to the removable recording medium, the removable recording medium storing the extracted data is transferred from the requester computer to the requester computer, and the extracted data is transferred from the removable recording medium. The data is imported into a database of the requester's computer.

The operation according to the first invention is as follows. It is not necessary to ask where the extraction program is located. That is, the extraction program may be installed on the requestee computer, or may be stored in a removable recording medium, and the removable recording medium may be set in the drive of the requestee computer and read. It may be. Anyway, the extraction program is started on the requestee computer. This extraction program can access the database of the requestee computer and can transfer data to a removable recording medium.

The database of the computer of the requestee can be accessed by using the above-mentioned extraction program, and the data extracted from the database is exported to the removable recording medium by the access. As a result, the requester company can import the data existing in the database of the requestee computer into the removable recording medium. That is, a portable database has been created. The requester trader transfers the removable recording medium into which the extracted data has been fetched, to the requester computer which is its own computer, reads the extracted data from the removable recording medium, and imports the database of the requester computer. . There is no need to ask where the import program is located at this time. That is, a program for import may be installed on the requester's computer, or may be stored on a removable recording medium.

As described above, the data linkage is completed between the databases of the computers of a plurality of vendors having different specifications at the application software level in relation to the nursing care insurance via the removable recording medium.

The requester's side needs to provide information that is the care insurance information owned by the requestee's side and is not included in the care insurance information owned by the requester's side. In the past, when it was desired to acquire, it could only be acquired on a paper basis. In such a situation,
As in the present invention, by using the extraction program and the removable recording medium as mediation, the care insurance information required by the requester can be obtained from the requester through the electronic database. That is, the data required by the requester's company is exported from the database of the requestor's computer to the removable recording medium in the electronic database, and the extracted data from the removable recording medium is imported into the database of the requester's computer in the electronic database. can do.

As a result, it is possible to eliminate the necessity of re-input by manual operation of the operator as in the conventional case where the care insurance information is exchanged on a paper basis because the specifications are different at the application software level. it can. In other words, avoiding the trouble twice, with extremely high work efficiency, and with a greatly reduced error rate,
It becomes possible to establish data linkage between computer databases of a plurality of vendors having different specifications.

According to the second aspect of the present invention, in the first aspect of the present invention, the nursing care insurance database interoperating system according to the first aspect, wherein the extraction of the necessary data from the database of the requestee computer using the extracting program is performed. The requestee computer requests input of the identification code of the requester, authenticates the input identification code,
When a required condition is satisfied, extraction and export of required data from the database are permitted only to those corresponding to the identification code.

The operation according to the second invention is as follows. The requestee company will cooperate in contributing to the dissemination and enhancement of the long-term care insurance system by responding to requests for the acquisition of necessary data from the requester company as much as possible. However, it should be a minimum requirement that the requester be a genuine and reliable supplier. Therefore, when accessing the database of the requestee computer using the extraction program, the requestee computer requests that the identification code of the requester be input by the extraction program. In response to this request, the operator operates an input unit such as a keyboard to input the identification code of the requester. The requestee computer authenticates the identification code entered by the extraction program and, when it satisfies the required conditions, gives practical permission to the access. In other words, only for the data corresponding to the identification code, extraction of required data requested from the database of the requestee computer and execution of export to the removable recording medium are permitted. As a result, it is possible to share the care insurance information under a regular use situation without any fraud or unexpected privacy infringement.

According to the third aspect of the present invention, there is provided the nursing-care insurance database linking system according to the first and second aspects, wherein necessary data is extracted from a database of the requestee's computer and is extracted to the removable recording medium. Data export and import of the extracted data from the removable recording medium to the database of the requester computer are performed by CSV (Comma Separa).
(Ted Value) format.

The operation according to the third aspect of the invention is as follows. CSV means values separated by commas. This format is used to record data in a file. Data in one record is separated by commas and arranged on one line. It is used in spreadsheet software for personal computers and database software. The application software for the database of the requestee computer complies with the CSV format, and similarly, the application software for the database of the requester computer complies with the CSV format. The extraction program is also based on the CSV format. Therefore, even in the extraction of necessary data from the database of the requestee computer using the extraction program,
Regular compatibility is maintained by executing the processing conforming to the CSV format in both the export of the extracted data to the removable recording medium and the import of the extracted data from the removable recording medium to the database of the requester computer. It is possible to perform accurate processing as it is.

The fourth to sixth inventions of the present application are directed to the first aspect.
The third invention is characterized in that remote access and data transmission / reception using a communication line are performed instead of using a removable recording medium.

The nursing-care insurance database linking system according to the fourth invention of the present application is a nursing-care insurance database linking system that supports data linking between databases of computers of a plurality of vendors having different specifications at the application software level in connection with care insurance. By using an extraction / transmission / reception program capable of accessing the database of the requestee side computer via a communication line and transmitting / receiving data via the communication line, connecting the communication line to the database of the requestee side computer. The data is transmitted via the communication line, and the data is transmitted to the database of the requester computer.

The operation of the fourth invention is as follows. It is not necessary to ask where this extraction / transmission / reception program exists. In other words, the extraction / transmission / reception program may be installed on the requester's computer, or may be installed on the requester's computer and the requester's computer can be remotely controlled via a communication line. May be. Further, the requestee computer may download the extraction / transmission / reception program from the requester computer via the communication line. The extraction / transmission / reception program is capable of accessing the database of the requestee's computer and of transmitting / receiving data via a communication line.

The database of the computer of the requestee can be accessed by using the above-mentioned extraction / transmission / reception program, and necessary data is extracted from the database by the access. Then, it is possible to transmit the extracted data to the requester's computer via the communication line by using the extraction / transmission / reception program,
The extracted data can be imported into the database of the requesting computer.

As described above, data cooperation is completed between the databases of computers of a plurality of vendors having different specifications at the application software level in connection with the nursing care insurance via the communication line.

The care insurance information owned by the requestor's side, which is not included in the care insurance information owned by the requester's side. In the past, when it was desired to acquire, it could only be acquired on a paper basis. In such a situation,
As in the present invention, by using the extraction / transmission / reception program and the communication line as mediation, care insurance information required by the requester can be obtained from the requestee in the electronic database. . That is, the data required by the requester's company can be extracted from the database of the requester's computer by the electronic database, transmitted through a communication line, and imported into the database of the requester's computer by the electronic database. .

As a result, it is possible to eliminate the necessity of re-input by manual operation of the operator as in the conventional case where the care insurance information is exchanged on a paper basis because the specifications are different at the application software level. it can. In other words, avoiding the trouble twice, with extremely high work efficiency, and with a greatly reduced error rate,
It becomes possible to establish data linkage between computer databases of a plurality of vendors having different specifications. The data linkage is automatic, remote and unattended via a communication line, and is extremely efficient.

According to a fifth aspect of the present invention, there is provided a system for coordinating between long-term care insurance databases according to the fourth aspect of the present invention, wherein necessary data is extracted from a database of the requested person's computer using the extraction / transmission / reception program. The requestee computer requests the input of the identification code of the requester, authenticates the input identification code, and when a required condition is satisfied, the computer is limited to the one corresponding to the identification code. And extracting and exporting necessary data from the database.

The operation of the fifth invention is as follows. The requestee company will cooperate in contributing to the dissemination and enhancement of the long-term care insurance system by responding to requests for the acquisition of necessary data from the requester company as much as possible. However, it should be a minimum requirement that the requester be a genuine and reliable supplier. In particular, since access through a communication line cannot be directly visually confirmed by a partner, it is necessary to pay maximum attention to unauthorized access and privacy infringement. Therefore,
For access to the requester's computer via the communication line using the transmission / reception program, the requestee's computer must use the extraction / transmission / reception program to enter the identification code of the requester's vendor. Request. In response to this request, the requesting operator operates input means such as a keyboard to input the identification code of the requester. This identification code is transmitted from the requesting computer to the requesting computer via the communication line. The requestee computer authenticates the identification code received via the communication line, and when it satisfies the required conditions,
Give practical permission for such access. That is, only the data corresponding to the identification code is allowed to extract required data requested from the database of the computer of the requestee and to execute data transmission via the communication line. As a result, it is possible to share the care insurance information under a regular use situation without any fraud or unexpected privacy infringement.

The care insurance database interworking system according to the sixth aspect of the present invention is the system according to the fourth or fifth aspect, wherein necessary data is extracted from the database of the requester's computer, and the extracted data is transferred to the database of the requester's computer. CSV data transmission and import of extracted data
(Comma Separated Value) format.

The operation according to the sixth aspect of the invention is as follows. The extraction / transmission / reception program also complies with the CSV format. Therefore, both in the extraction of the required data from the database of the requestee computer using the extraction / transmission / reception program and in the transmission of the extracted data through the communication line, the extraction of the data into the database of the requester computer Also in the data import, by executing a process conforming to the CSV format, it is possible to perform an accurate process while maintaining regular compatibility.

The nursing care insurance database inter-working system of the seventh invention of the present application as a more practical form,
In the sixth to sixth inventions, the requester-side computer is a computer of a home care support office related to nursing care insurance, the requestee-side computer is a computer of a municipality involved in nursing care insurance, and Items include insurer number, insurer name, insured person number, reading, name of insured person, gender, date of birth, address, telephone number, degree of nursing care, expiration date, notification of home service plan creation request Provision of nursing care services, such as, visiting office payment limit reference amount, limit application period (of visiting visitation supply limit reference amount), short-term entrance payment limit reference amount, (short-term entrance payment limit reference amount) It is characterized in that necessary items required for creating a receipt are set.

According to the seventh aspect of the invention, care insurance information can only be exchanged on a paper basis due to differences in specifications at the application software level between home care support establishments and municipalities. The home care support establishment, which is the requester's side, is involved in the nursing care insurance for one or more items arbitrarily selected from the above item group from the database of the computer of the municipality, which is the requester's side. Necessary information can be obtained in an electronic database, which eliminates the need for re-entry by manual operation of the operator, avoids the need for work twice, achieves extremely high work efficiency, and greatly reduces the error rate In this state, it is possible to build data linkage between the home care support establishment and the computer database of both municipalities. To become.

Here, the municipalities are public institutions such as government offices, and mean any one of a city, a ward, a town, and a village as a public organization. Alternatively, they may be combined. This is the same in the following.

The nursing care insurance database inter-working system of the eighth invention of the present invention as a more practical form,
In the sixth to sixth inventions, the requester-side computer is a computer of a long-term care service providing organization related to long-term care insurance, the requested-side computer is a computer of a municipality related to long-term care insurance, and the extracted data item Provision of nursing care services such as insurer number, insurer name, insured number, reading, insured name, gender, date of birth, address, telephone number, degree of nursing care, expiration date, etc. The required items required for the above are set.

According to the eighth aspect of the present invention, care insurance information can only be exchanged on a paper basis due to differences in specifications at the application software level. The nursing care service provider, which is a provider, provides one or more items arbitrarily selected from the above item group,
Necessary information on nursing care insurance can be obtained from the computer database of the municipality, which is the requestor's side, in an electronic database, thus eliminating the need for re-entry by operator's manual work. It will be possible to build data linkage between computer databases of both nursing care service providers and municipalities while avoiding the hassle, working extremely efficiently, and greatly reducing the error rate. .

The nursing care insurance database inter-working system according to the ninth aspect of the present invention as a more practical form
In the sixth to sixth inventions, the requester-side computer is a computer of a home care support establishment relating to care insurance, the requestee-side computer is a computer of a welfare office relating to care insurance, and the extracted data is As the items, required items required for providing a nursing care service and creating a receipt, such as a recipient name, a reading, a target period, and a burden ratio, are set.

According to the ninth aspect, the exchange of care insurance information can be performed only on a paper basis because the specifications are different at the application software level. The home care support establishment, which is the requester's side, is involved in nursing insurance for one or more items arbitrarily selected from the above-mentioned item group from the computer database of the welfare office, which is the requester's side. Necessary information can be obtained in an electronic database, which eliminates the need for re-entry by manual operation of the operator, avoids the need for work twice, achieves extremely high work efficiency, and greatly reduces the error rate In such a state, it is possible to build data linkage between the computer databases of both the home care support office and the welfare office. It becomes so that.

In a more practical form, the care insurance database inter-working system according to the tenth aspect of the present invention is the system according to the first to third aspects, wherein the requester's computer is a care service providing organization related to care insurance. Computer, wherein the requestee side computer is a computer of a welfare office involved in nursing care insurance, and as items of the extracted data, recipient name, reading, payer number,
It is characterized by setting necessary items required for providing nursing care services and creating a claim, such as public fund recipient number, public fund number, target period, benefit rate (public expense burden ratio), user burden, etc. I do.

According to the tenth aspect, since care insurance information can only be exchanged on a paper basis due to differences in specifications at the application software level, a request is made between a care service provider and a welfare office. The nursing care service providing organization, which is the client's side, needs one or more items arbitrarily selected from the above item group from the computer database of the welfare office, which is the requestee's side, for the necessary care insurance. Information can be acquired in an electronic database, thus eliminating the need for re-entry by manual operation of the operator, avoiding the need for work twice, achieving extremely high work efficiency, and greatly reducing the error rate. Build data linkage between computer databases of both nursing service providers and welfare offices Door will be able to.

In the eleventh aspect of the present invention as a more practical form, the care insurance database interlinking system according to the first to sixth aspects of the present invention, wherein the requester's computer is a care service providing organization related to care insurance. A computer of the home care support establishment related to the care insurance, and various data items (insurer number, insurer Nursing care services such as name, insured number, reading, name of insured, gender, date of birth, address, telephone number, degree of need for nursing care, expiration date, recipient's name, reading, subject period, burden ratio, etc.) It is characterized in that the necessary items required for providing and providing a claim have been set.

According to the eleventh invention, care insurance information can only be exchanged on a paper basis due to differences in specifications at the application software level between the care service provider and the home care support establishment. The nursing care service provider, which is the requester's side, provides one or more items arbitrarily selected from the above item group from the database of the home care support establishment, which is the requester's side, from the database of the care insurance. Necessary information related to the electronic database can be obtained,
This eliminates the need for operator re-entry due to manual work, avoids the need for work twice, achieves extremely high work efficiency, and greatly reduces the rate of errors. It is possible to establish data linkage between the computer databases of both places.

A more practical form of the care insurance database interworking system according to the twelfth invention is the home care support establishment according to the first to sixth inventions, wherein the requester's computer is related to care insurance. The computer of the requestee side is a computer of a care service provider related to nursing care insurance, and as the items of the extracted data, an insurer number, an insurer name, an insured number, an insured name, Gender, date of birth, state of need for nursing care, home care support business establishment name, person in charge, visiting office payment limit reference amount, limit application period (of visitation office payment limit reference amount), short-term entrance payment limit standard Amount, limit application period (of the short-term entrance payment limit reference amount), number of days of short-term entrance until the previous month, creation date, notification date, provision time zone, service content, service matters Provision of nursing care services such as the name of the business establishment, monthly service plan and record of actual results (date, number of times, total number of times), number of public expenditures, number of units subject to public expenditure, number of recipients of public expenditure, benefit rate (public expenditure ratio) It is characterized in that necessary items required for creating a receipt are set.

According to the twelfth aspect, since care insurance information can only be exchanged on a paper basis conventionally because specifications are different at the application software level, the home care support office and the care service provider can exchange information. The home care support establishment, which is the requester's side, provides one or more items arbitrarily selected from the above group of items from the database of the care service provider's computer, which is the requester's side, from the database of the care insurance. Necessary information related to the electronic database can be obtained,
This eliminates the need for operator re-entry due to manual work, avoids the need for work twice, provides extremely high work efficiency, and significantly reduces the rate of errors. It becomes possible to establish data linkage between the computer databases of both institutions.

In the nursing care insurance database cooperation system according to the thirteenth aspect of the present invention, in the first to twelfth aspects of the present invention, the requester's computer includes data originally stored in the database of the requester's computer. The data is compared with the extracted data imported from the requested computer to the database of the requested computer, and the result of the comparison is displayed.

The operation according to the thirteenth aspect is as follows. As described above, any data relating to the nursing care insurance system that was not in the database of the requester computer but in the database of the requestee computer was transmitted via a communication line, even through a removable recording medium. By importing the requester computer into the database of the requester computer, two pieces of care insurance information having different specifications are prepared in the database of the requester computer. As a result, it is possible to eliminate the necessity of re-input by manual operation of the operator as in the conventional case. However, the present invention is not limited to this, and the database of the requester's computer originally stored the data. The care insurance information is automatically collated with the care insurance information taken from the database of the requestee's computer. Then, the matching result is displayed on a display.

Thus, for example, in preparing a claim that must be submitted to the National Health Insurance Federation,
Incorrect data can be checked in advance,
If there is incorrect data, it can be corrected and a claim can be created. This is true even when the home care support facility creates a receipt by referring to the data obtained from the care service provider by the method of the present invention from the care service provider, or vice versa. This is also effective in the case where a claim is created with reference to data obtained by the method of the present invention. However, it is not necessarily required that either of the traders perform the above-described collation processing, and at least one of the traders may perform the above-described verification processing. Both claims are submitted to the Federation of National Health Insurance Organizations, where they are collated (matched). If there is a discrepancy between the two claims, the claim will be refunded. By providing the service provider with verification of mutual care insurance information in advance, the possibility of inconsistency in the verification by the above-mentioned Federation of National Health Insurance Associations, that is, the possibility of returning a claim, is greatly reduced. be able to. Therefore, it is possible to eliminate the trouble of returning the receipt twice, and it is possible to significantly improve the efficiency of the work related to the nursing care insurance.

[0078]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, a specific embodiment of a system for linking care insurance databases according to the present invention will be described in detail with reference to the drawings.

(Embodiment 1) In Embodiment 1, the requester's computer and the requestee's computer are related by using a removable recording medium as an intermediary.

FIG. 1 is a block diagram showing a basic configuration of a system for linking care insurance databases according to the first embodiment of the present invention. In FIG. 1, reference numeral 100 denotes a requester-side computer, and 150 denotes a requester-side computer 10.
Reference numeral 0 denotes a care insurance information database, reference numeral 200 denotes a requestee computer, reference numeral 250 denotes a care insurance information database in the requestee computer 200, reference numeral 300 denotes a removable recording medium, and reference numeral 400 denotes an extraction program. Here, the database 150 related to the care insurance information of the requester computer 100 and the database 25 related to the care insurance information of the requestee computer 200.
0 is different from the specification at the application software level.

Thus, the nursing-care insurance database cooperation system of the present invention supports data cooperation between the databases 150 and 250 of two computers having different specifications at the application software level. For this purpose, in the first embodiment, the extraction program 40 that can access the database 250 of the requestee-side computer 200 for data linkage and can transfer data to the removable recording medium 300
0 is prepared. There is no restriction on the location of the extraction program 400, and the removable recording medium 300
May be stored in advance, or may be installed in the requestee side computer 200.

As for the removable recording medium 300,
The requester's company owns it, and the operator (staff / employee) of the requester's company carries it when going to the business site of the requested company.

[0099] As companies involved in the nursing care insurance system, there are a nursing care service provider, a home care support establishment, a municipality, a welfare office, and a federation of national health insurance organizations. There are the following combinations.

Between the home care support establishment and the municipalities, the home care support establishment becomes the requester-side trader, and the municipalities become the requestee-side trader. Between the nursing care service provider and the municipality, the nursing care service provider becomes the requester company and the municipality becomes the requester company. Between the home care support establishment and the welfare office, the home care support establishment becomes the requester's company, and the welfare office becomes the requestee's company.
Between the care service provider and the welfare office, the care service provider becomes the requester's business, and the welfare office becomes the requestee's business. Either the care service provider or the home care support establishment can be the requester and the requestee.

FIG. 2 is a block diagram showing a general outline of a computer system constructing a database. This may apply to the requester-side computer 100 as well as to the requestee-side computer 200.

In FIG. 2, reference numeral 10 denotes a server constituted by a computer such as a dedicated server or a personal computer, and 50 denotes a client constituted by a computer such as a personal computer.

Reference numeral 1 as a component of the server 10
2 is a microprocessor, 14 is a database management system (DBMS), 16 is a group of various databases, 18
Is the insured database in database group 14,
20 is a plan group (use slip / use slip separate table) table group, 22
Is a performance table, 24 is a public expense setting table, 26 is a communication control device, 28 is an input / output interface, 30 is an input device such as a keyboard and mouse as peripheral components, 32 is a display device such as a CRT, and 34 is a display device such as a CRT. Printer,
36 is an external storage device such as a hard disk, and 38 is a removable recording medium drive.

Reference numeral 52 as a component of the client 50 denotes a microprocessor, 54 denotes a communication control device,
Reference numeral 6 denotes an input / output interface. Reference numeral 58 denotes an input device such as a keyboard and mouse, 60 denotes a display device such as a CRT, 62 denotes an external storage device such as a hard disk, and 64 denotes a removable recording medium drive.

The client 50 and the server 10 are LA
Transmission path 6 such as N (local area network)
6 are connected. A plurality of clients 50 may be connected to the server 10.

This computer system has a server 1
Although a client / server type database composed of a client 0 and a client 50 is constructed, it is not always necessary to do so, and a small-scale business establishment may be constituted by a stand-alone personal computer. Also, even in the case of the client / server type database system, the illustrated one is merely an example, and the configuration is arbitrary.

[0091] To supplementally explain, the insured person database 18 is a database for storing personal information of each insured person. The plan document table group 20 is a table group for storing information of usage slips / use slip separate tables. The performance table 22 is a table that stores service provision performance. The public expense setting table 24 is a table that stores information on public expense settings.

The input devices 30 and 58 are connected to the display device 3.
Devices such as a keyboard and a mouse for inputting data through the input area on the display screen and giving instructions to the computer through the display screen in the display screens 2 and 60. The display devices 32 and 60 are devices for displaying information such as user information and usage slip / use slip separate tables, and displaying an area for inputting data, buttons for giving instructions to a computer, and the like. The printer 34 is a printing device for outputting various forms and the like. The external storage devices 36 and 62 are relatively large-capacity hard disks and the like, and the removable recording medium drives 38 and 64 are magnetic disks such as floppy disks, magneto-optical disks such as MO and MD, and CD-RWs.
It is a drive for reading and writing by setting an optical disk such as a DVD-RAM or other removable recording medium 300. An application program (AP) and a graphical user interface (GU) are stored on a main storage device in the microprocessor 52 of the client 50.
I), a program part of the communication control unit and the like are stored. When there is no client 50, the server 10 has all functions.

Next, the operation of the nursing-care insurance database inter-linkage system according to the first embodiment configured as described above will be described.

As a preparation for data linkage, it is necessary to create an extraction program 400 corresponding to the specifications of the database 250 of the requestee computer 200 in advance. When creating the extraction program 400, the database 25 of the requestee computer 200 is used.
For 0, it is necessary to analyze the item names and properties (characteristics) of the table (data storage location).

In analyzing the database, SQL (Structured Query La), which is a database language for a relational database, is used.
nguage) and ODBC (Open DataBas)
e Connectivity), ADO (Active
eX Data Object), Link (connection) and the like are used.

Here, the ODBC will be supplementarily described.
ODBC is an application programming interface (API) for connecting to an SQL database server and has become a standard protocol for databases between different systems. In other words, ODB
C defines an interface between the client software and a database management system (DBMS). The driver group created based on ODBC is O
It is called a DBC driver and absorbs differences between OS, DBMS, and network, and provides a single interface to DBMS. The ODBC driver is provided by each DBMS vendor. All ODBC-compatible software can access its DBMS using the provided ODBC driver.

As described above, the database 250 of the computer 200 of the requestee is analyzed in advance.
The extraction program 400 is created based on the analysis result. The creation is based on the CSV format. The extraction program 400 is stored in the removable recording medium 300.

When the extraction program 400 is prepared,
Next, we move on to the practice of the long-term care insurance system.

The operator (staff / employee) at the requester's company needs certain data for care insurance information, and the necessary data is stored in the database 150 of the requester's computer 100 (the database group 16 in FIG. 2). If the data does not exist, it goes to the business site (requestee company) that owns the necessary data. At this time, the operator carries the removable recording medium 300. This removable recording medium 300
Stores an extraction program 400 in advance.

The operator of the requester company obtains the permission of the requester company and brings the removable recording medium 300
To the removable recording medium drive 6 of the client 50.
4 or the removable recording medium drive 38 of the server 10, and the extraction program 400 is started by a required operation from the input devices 58 and 30. In addition, if there is permission of the requestee side company, the removable recording medium 3
00 may be installed in the external storage devices 62 and 36 such as a hard disk, and thereafter, the extraction program 400 may be started from the external storage devices 62 and 36. In this case, the removable recording medium 300 includes the extraction program 40
It is possible to use one without zero. The extraction program 400 may be activated by an operator of the requestee's company. However, the requestee computer 20
0 in the external storage devices 62 and 36
When security is installed, security measures such as strict management of passwords are required. When the extraction program 400 is installed in the external storage devices 62 and 36 of the requestee computer 200, high-speed processing is possible. However, the capacity of the external storage devices 62 and 36 is compressed. Extracting program 400 to external storage device 6
Whether to run at 2, 36 or to run at the removable recording medium 300 depends on conditions and discussions.

In any case, by starting the extraction program 400, the database 250 of the requestee computer 200 can be accessed. Then, the data extracted from the database 250 by the access is exported to the removable recording medium 300. This allows the operator of the requester to
The necessary data existing in the database 250 of the requestee computer 200 is stored in the removable recording medium 300.
Can be captured. Thus, a portable database is created on the removable recording medium 300.

In the structure of the extraction program 400, it may be necessary to perform filtering for extracting necessary data. For example, in the case of a social insurance office, filtering is performed using the insured person's name and telephone number. In other cases, filtering is performed using the establishment code of the home care support establishment.

In the initial stage of the above access, the requestee computer 200 may request the input of the identification code of the requester company. In this case, the operator of the requester enters the identification code of his or her business from the input devices 30 and 58. The requestee computer 200 authenticates the input identification code, and if required conditions are satisfied, permits extraction and export of necessary data limited to those corresponding to the identification code.

[0104] The operator of the requester trader circulates to another office as necessary and takes in further necessary data into the removable recording medium 300. After completing the operation of loading the necessary data into the removable recording medium 300, the operator returns to the establishment of the requester's company to which he / she belongs, and removes the removable recording medium 300 loaded with the necessary data carried by the requester's computer. 100, the extracted data is read from the removable recording medium 300 and imported into the database 150 of the requester computer 100 (corresponding to the database group 16 in FIG. 2). I do.

Extraction of necessary data from the database 250 of the requestee computer 200, export of the extracted data to the removable recording medium 300, and extraction of the extracted data from the removable recording medium 300 to the database 150 of the requestor computer 100. Importing data is CSV (Comma Separated V)
execute) in accordance with the format.

The requestee side computer 20 as described above
Nursing care insurance information obtained by copying in the electronic database from the database 250 of No. 0 is always transferred to the database 150 of the requester's computer 100 in a correct state as long as the original data has no error. It is possible to eliminate the necessity of re-input by manual operation of the operator as in the conventional case where the care insurance information is exchanged. That is, data cooperation can be established between computer databases of a plurality of vendors having different specifications in a state where work is avoided twice, the work efficiency is extremely high, and the error rate is greatly reduced.

(Embodiment 2) In Embodiment 2, a requester's computer and a requestee's computer are connected via a communication line, and data transfer of extracted data is performed via the communication line. is there.

FIG. 3 is a block diagram showing a basic configuration of a care insurance database inter-working system according to the second embodiment of the present invention. In FIG. 3, reference numeral 100 denotes the requester computer, and 150 denotes the requester computer 10.
Reference numeral 0 denotes a care insurance information database, reference numeral 200 denotes a requestee computer, reference numeral 250 denotes a care insurance information database in the requestee computer 200, reference numeral 500 denotes a communication line, and reference numeral 600 denotes an extraction / transmission / reception program.
As in the first embodiment, the requester-side computer 1
The database 150 related to the care insurance information of 00 and the database 250 related to the care insurance information of the requestee computer 200 have different specifications at the application software level.

The extraction / transmission / reception program 600 can access the database 250 of the requestee-side computer 200 via the communication line 500, and
00 enables data transmission and reception. The extraction / transmission / reception program 600 may be installed in the requester computer 100 or may be installed in the requestee computer 200. The installation may be performed directly on the spot or by download via the communication line 500.

As the communication line 500, a general public telephone network can be used. For the public telephone network,
It may be an analog telephone network or an ISDN (Integrated Services Digital Network). Alternatively, it may be a dedicated line or the Internet. Further, satellite communication may be used. The communication protocol may be any protocol as long as communication is possible.

FIG. 4 is a block diagram showing a general outline of a computer system constructing a database. This may apply to the requester-side computer 100 as well as to the requestee-side computer 200.
4, the same reference numerals as those in FIG. 2 of the first embodiment denote the same components, and a detailed description thereof will be omitted. In addition, items that have been described in the first embodiment and that are not described again in the second embodiment also apply to the second embodiment as they are, and a detailed description thereof will be omitted. The configuration of the second embodiment is different from that of the first embodiment as follows.

For connection to the communication line 500, a modem (modulator / demodulator), a terminal adapter, a line connection device (DSU), or a dial-up router is used. Here, these devices are collectively referred to as a communication unit. The server 10 includes a communication control device 26
In addition, a communication unit 40 is provided. The client 50 may be provided with a similar communication unit.

As in the case of the first embodiment, the database 25 of the
0 is analyzed, and an extraction / transmission / reception program 600 is created based on the analysis result. In its creation, CS
It shall conform to the V format. For this, there are remote maintenance software and the like. Specifically, software development is performed according to the actual situation of each business office. The extraction / transmission / reception program 600 is installed in the requester computer 100 and the requestee computer 200 in advance.

When the extraction / transmission / reception program 600 has been prepared, the operation proceeds to the care insurance system.

The operator (staff / employee) in the requester's company needs certain data for care insurance information, and the necessary data is stored in the database 150 of the requester's computer 100 (the database group 16 in FIG. 4). Does not exist, the access is made via the communication line 500 to the requestee computer 200 of the establishment (requestee company) that owns the necessary data. At this time, the extraction / transmission / reception program 600 is activated. Extraction / transmission / reception program 60
0 controls the communication unit 40 in the requester-side computer 100 and executes connection with the communication unit 40 in the other party's requestee-side computer 200 via the communication line 500. When the connection is permitted, the requester-side computer 100 and the requestee-side computer 200 are connected via the communication line 500 and are in a communicable state.

The requester computer 100 is connected to the communication line 5
The request of necessary data extraction and data transfer is made via 00. When the request is confirmed by the requestee computer 200, the requester computer 100 stops the request.

After confirmation, the requestee computer 200 starts its own extraction / transmission / reception program 600,
The requester computer 100 is requested to transmit the identification code of the requester company via the communication line 500. When the request is confirmed by the requester computer 100, the requestee computer 200 stops the request. After confirmation, the requester-side computer 100 transmits the identification code of its own office via the communication line 500.
The transmission of the identification code may be performed automatically by the extraction / transmission / reception program 600 or the operator may input the identification code from the input devices 30 and 58.

The requestee computer 200 authenticates the identification code received via the communication line 500, and if required conditions are satisfied, extracts and exports the necessary data limited to the one corresponding to the identification code. Allow If the result of the authentication indicates that the identification code is inconsistent, a request for retransmission or counting the number of retransmission requests for security, and if the number exceeds a predetermined number, forcibly terminate all subsequent processing. And perform the required processing.

When the result of the identification code authentication is affirmative, the requestee computer 200 extracts only necessary data from the database 250 to those corresponding to the identification code, and sets the communication unit 40 to Under control, the extracted data is transmitted to the requester's computer 100 on the other side via the communication line 500. That is, first, the requestee computer 200 transmits a message to the requester computer 100 to start data transmission. Requester computer 100
When receiving the message, it determines whether or not data can be received, and if possible, sends a message to the effect that the data can be received to the requestee computer 20.
Return to 0.

Upon receiving the message, the requestee computer 200 transmits the extracted data from the communication unit 40 to the communication unit 40 of the partner requester computer 100 via the communication line 500. The requester-side computer 100 sends a reception confirmation message every time the extracted data is received. The requester-side computer 100 sequentially imports the extracted data received from its own communication unit 40 via the communication line 500 into its own database 150.

Finally, a message to the effect that transmission of all extracted data has been completed is sent to the requestee computer 200.
To the requester computer 100, and a message indicating that all the extracted data has been received is returned from the requester computer 100 to the requestee computer 200. Then, the data transmission / reception is terminated, and the communication line 500 is disconnected.

In the above, the requestee side computer 2
Extraction of necessary data from the database 250
Data transmission and reception of the extracted data via the communication line 500,
And the database 15 of the requester computer 100
0 is imported to CSV (Comma
(Separated Value) format.

The requestee side computer 20 as described above
Nursing care insurance information obtained by data transmission / reception from the database 250 of the electronic mail from the electronic database 250 is always transferred to the database 150 of the requester computer 100 in a correct state as long as the original data has no error. Thus, it is possible to eliminate the necessity of re-input by the manual operation of the operator as in the conventional case where the care insurance information is exchanged. That is, data cooperation can be established between computer databases of a plurality of vendors having different specifications in a state where work is avoided twice, the work efficiency is extremely high, and the error rate is greatly reduced.

In the following, a specific description will be given according to the requester side trader and the requestee side trader.

(1) In the case where the requested party is a municipality: The requested party is a requested party or a care service provider.

Items to be transferred to the home care support establishment in the electronic database include the insurer number, insurer name, insured number, reading, insured name, gender, date of birth, address, and telephone number. , Degree of care required, expiration date, notification date of home service plan creation request
Necessary requirements for providing nursing care services and making receipts, such as the limit application period (of the visitor's office payment limit reference amount), the short-term entrance payment limit reference amount, and the limit application period (of the short-term entrance payment limit reference amount) Items.

Further, the name of the recipient of the special measures, the reading, the bearer number, the public expenses recipient number, the public expenses number, the target period, and the payment rate (special measures: 7%) are also notified.

Items to be passed to the care service provider in the electronic database include an insurer number, an insurer name,
The required items such as insured number, reading, name of insured person, gender, date of birth, address, telephone number, degree of need for nursing care, expiration date, etc. are necessary for providing nursing care services and creating a claim.

On the side of the home care support establishment, the information, telephone number and information from the welfare office in the provided slip / provided slip separate table are required. If you cannot receive the file from the home care support office, obtain the file from the municipality.

(2) When the requested party is a welfare office: The requested party is a requested party or a care service provider.

When there is a public expenditure such as a special measure (provisional measures for low-income earners who have been receiving services for a long time) or welfare, there is a notice to the user such as a public expenditure recipient number.
This public fund recipient number is notified every month that it is welfare.

The recipient name, reading, payer number, public expense recipient number, public expense number, target period, benefit rate (public expense share ratio), user burden, and the like are required.

Items to be delivered to the home care home support facility in the electronic database include items required for providing care services and creating a receipt, such as recipient name, reading, target period, and burden ratio. Items that are passed to the nursing care service provider in the electronic database include recipient name, reading, payer number, public expense recipient number, public expense number, target period, benefit rate (public expense burden ratio), user burden, etc. These are required items for providing nursing care services and creating a receipt.

It is more efficient to collect such information directly from the welfare office.

(3) In order to prepare an individual support plan at a care service providing organization, a provision slip / provided slip separate table (use slip / use slip separate table for each care service provider) is required. .

[0136] Also, the care service provider must enter the divisional payment limit reference amount in the separate form of the provision slip at the time of billing, and the numerical value is the same as the numerical value of the claim submitted from the home care support establishment. I have to do it.

If there is a change in the middle of the month (especially if the service provision result exceeds the category payment limit reference amount), the care manager issues a new provision sheet / provided table to the care service provider. , You have to notify the section payment limit reference amount. At that time, the creation history of the usage slip / use slip separate table and the provision slip / provide slip separate table is kept, and only the changed offer slip / provide slip separate table is exported (batch writing), and the file is sent to the care service provider. Notify such as handover.

At the home care support office, necessary data is extracted and exported (collectively written) in CSV format.

If the nursing care service provider has an import (collective import) function, this can be handled.

The required items are as follows.

[0141] 1. Offer form Insurer number, insurer name, insured person number, insured person name, date of birth, gender, nursing care status classification, home care support business establishment name, person in charge, visiting office payment limit reference amount , Limit application period (of the limit for the amount of visiting office payment limit), short-term entrance payment limit standard amount, limit application period (of the short-term entrance payment limit standard amount), number of days of short-term entrance until the previous month, date of creation, notification date. Also, as the monthly plan contents of the usage form, the provision time zone, service contents, service provider office name, monthly service plan and record of actual results (date, number of times, total number of times). Provision Sheet Separate Table a) In “Visit Office Division Payment Limit Management / User Burden Calculation”, the establishment name, establishment number, service content / type, service code, score, number of times, service score / amount, type payment limit standard Items that exceed points, points within the type payment limit standard, points exceeding the classification payment limit standard, points within the classification payment limit standard, points unit, user's burden (for insurance), user's burden (full amount) are required is there.

B) In the "supply limit management by type", items such as service type, type supply limit reference amount (point), total points, and points exceeding the type supply limit reference are required.

C) In the "short term entrance section pay limit management / user burden calculation", the section pay limit reference amount (day), the number of days used up to the previous month, the planned number of days used in this month, the number of days covered by insurance benefits,
The number of days exceeding the category payment limit standard, as well as the establishment name, establishment number, service content / type, service code, score,
Items such as the number of days, the number of days covered, the unit price of points, the points within the classification pay limit standard, the user's burden (for insurance), the number of days not covered, the number of points not covered by benefits, and the user's burden (for the full amount) are required.

At the same time, the telephone number and the public expense information (public expense share ratio) notified from the social insurance office are also exported. If the information is imported by the nursing care service provider, there is no need to enter a telephone number, and it is also possible to check the burden ratio of those who bear public expenses.

(4) The home care support business side extracts and exports necessary data from one or a plurality of care service providing organizations in order to finish the use slip and create a receipt.

The required items are: insurer number, insurer name, insured person number, insured person name, date of birth, gender, nursing care status classification, home care support business establishment name, person in charge, Visiting place payment limit reference amount, limit application period (of visitation place payment limit reference amount), short-term entrance payment limit reference amount, limit application period (of short-term entrance supply limit reference amount), short-term entrance use days until last month, Items related to provision slips, such as creation date, notification date, provision time zone, service contents, service provider establishment name, monthly service plan and record of actual results (date, number of times, total number of times).

There are also other items related to public expenditure, such as the number of public expenditures, the number of public expense target units, the public expenditure recipient number, and the benefit rate (public expenditure share ratio).

The extracted data is imported on the home care support establishment side. If the nursing care service provider side,
If the data exported from the home care support office is not used after being imported, a check is made as to whether or not the data other than the data relating to the service provision results match. Before returning the receipt from the nursing care service provider and home care support establishment to the Federation of National Health Insurance Organizations, check the box to return it.
And the likelihood of becoming

The following details are mentioned for reference.

The care insurance claim system for the home support office (care manager business support system) has the following functions.

A function for importing information from municipalities, a function for importing information from a welfare office, a function for creating and printing a separate table for use slips / use slips, and a function for creating and printing a separate table for use slips / provide slips. / Exporting function separate sheet data export function ・ Management function of "category payment limit reference amount" List of "category payment limit reference amount" for each user (screen display and printing function) Exceeding and exceeding "category payment limit reference amount" List of such cases (screen display and print function)-Import and check function of actual data-Display and print of imported result list (if there is mismatched data, display and print error information)-National Health Insurance Association Function to create a reception for the society Function to create “benefit management information” and “care benefit bill information” (display and print functions) ・ Nursing care service Data import function (list display and print function) and check function for care insurance card from the provider organization Data import function (list display and print function) and check function for public expenditure from the care service provider organization Care service provider organization Has a following function.

-Import function of information from municipalities-Import function of information from welfare office-Creation and printing function of provided slip / provided slip separate table-Import function of provided slip / provided separate sheet data-"Section supply" Management function of "limit payment amount" List of "category payment limit amount" by user (screen display and printing function) List of cases that exceed and are likely to exceed "category payment limit amount" (screen display and printing function)・ Result data import input function Result list display and printing ・ Receipt creation function to National Federation of Health Insurance Organizations Creation function of “care insurance benefit bill information” (display and printing function) ・ Nursing care from home support office Import function of insurance card data (list display and print function) and check function ・ Import of data related to public expenditure from home support office Door function (list display and printing function) and check function care manager, management of the division payment limit base amount, in other words, must be carried out the management of the user insurance available number of points. Cases that exceed or are likely to exceed the category payment limit are extracted and listed, and users who should pay attention are managed with priority. The data is also sent to the nursing care service provider, and the nursing care service provider is also in charge of the management. In each home care support establishment, for example, the remaining visit base payment limit reference amount is 1000
Enter criteria such as those who have lost points and those whose short-term entrance payment limit has been less than three days, and pick up those who fall under the criteria.

The items required for the priority management user list of the section pay limit reference amount are as follows.

[0154] The insured person number, insured person name, date of birth, gender, nursing care status classification, home care support business establishment name, person in charge, name of visiting office payment limit reference amount, Limit application period (of the tsusho payment limit reference amount), short-term entrance payment limit reference amount, limit application period (of short-term entrance payment limit reference amount), etc.

[0155] Also, from the table of usage slips, the service type, the type payment limit reference amount (point), the total points, the points exceeding the type payment limit standard, and the " Short-term entrance section payment limit management / user-paid calculation "section payment limit standard (days), the number of days of use up to the previous month, the planned number of days of use for this month, the number of days covered by insurance benefits, the number of days exceeding the category payment limit standard.

By the way, when the result data is received in the middle of the month, it is easier to manage the “segment pay limit reference amount” and rework the care plan according to the result.

There are items to be entered in duplicate (business number, insured person name, insured person number, insured person number, etc.). For this item, it is also possible to collate the data on the data extraction side with the data input on the data reception side.

[0158]

According to the present invention, it is possible to construct a data link between databases of computers of a plurality of vendors having different specifications at the application software level in relation to the nursing care insurance via a removable recording medium. In other words, the requester's side obtains, from the necessity, information that is the care insurance information owned by the requestee's side and is not included in the care insurance information owned by the requester's side. Whereas, in the past, it was possible to obtain only on a paper basis, but in the present invention, by using an extraction program and a removable recording medium as a medium, the requester's company becomes necessary. Information on the long-term care insurance to be obtained can be obtained from the requestor's company in the electronic database. As a result, it is possible to eliminate the necessity of re-input by manual operation of the operator as in the conventional case. In other words, avoiding the trouble twice, with extremely high work efficiency, and with a greatly reduced error rate,
Data linkage between computer databases of a plurality of vendors having different specifications can be established.

Further, according to the present invention, it is possible to establish a data link via a communication line between databases of computers of a plurality of vendors having different specifications at the application software level in connection with the nursing care insurance. In other words, the requester's side obtains, from the necessity, information that is the care insurance information owned by the requestee's side and is not included in the care insurance information owned by the requester's side. In the past, when it was desired to obtain the information, it could only be obtained on a paper basis.In contrast, the present invention requires the requester's company by using an extraction / transmission / reception program and a communication line as mediation. Can be obtained from the requestee's company through an electronic database. As a result, it is possible to eliminate the necessity of re-input by manual operation of the operator as in the conventional case. That is, data cooperation can be established between computer databases of a plurality of vendors having different specifications in a state where work is avoided twice, the work efficiency is extremely high, and the error rate is greatly reduced. Then, the data linkage is automatic, remote and unattended through a communication line, and can be extremely highly efficient.

According to the present invention, the care insurance information originally stored in the database of the requester's computer is automatically compared with the care insurance information fetched from the database of the requestee's computer. Since the verification result is displayed on the display, for example, in the case of a home care support business or a care service provider in the preparation of a claim that must be submitted to the National Health Insurance Association Federation, incorrect data can be checked in advance. If there is incorrect data, a claim can be created after correcting the incorrect data. Both claims are individually submitted to the Federation of National Health Insurance Associations, where they are collated (matched). If there is a discrepancy between the two claims, the claim will be refunded. Alternatively, by providing the care service provider with verification of mutual care insurance information in advance,
The possibility of inconsistency in the collation at the aforementioned National Health Insurance Federation, that is, the possibility of returning the claim can be greatly reduced. Therefore, it is possible to eliminate the trouble of returning the receipt twice, and it is possible to significantly improve the efficiency of the work related to the nursing care insurance.

[Brief description of the drawings]

FIG. 1 is a block diagram showing a basic configuration of a system for linking care insurance databases according to a first embodiment of the present invention;

FIG. 2 is a block diagram showing a general outline of a computer system constructing a database in the first embodiment.

FIG. 3 is a block diagram illustrating a basic configuration of a system for linking care insurance databases according to a second embodiment of the present invention;

FIG. 4 is a block diagram showing a general outline of a computer system constructing a database in the second embodiment.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 10 ... Server 12 ... Microprocessor 14 ... Database management system (DBMS) 16 ... Various database groups 18 ... Insured person database 20 ... Plan (use sheet / use sheet separate table) table group 22 ... Result table 24 ... Public expense setting table 26 communication control device 28 input / output interface 30 input device such as keyboard and mouse 32 display device such as CRT 34 printer 36 external storage device such as hard disk 38 removable storage medium drive 40 communication unit 50 client 52 ... Microprocessor 54 ... Communication control device 56 ... I / O interface 58 ... Input device such as keyboard and mouse 60 ... Display device such as CRT 62 ... External storage device such as hard disk 64 ... Removable recording medium drive Reference numeral 6: transmission path 100: requester computer 150: database of care insurance information in the requester computer 200: requester computer 250: database of care insurance information in the requester computer 300: removable recording medium 400: extraction Program 500: Communication line 600: Extraction / transmission / reception program

Claims (13)

[Claims] 1. A long-term care insurance database linking system that supports data linking between databases of computers of a plurality of vendors having different specifications at an application software level in connection with long-term care insurance, and is capable of accessing a database of a requestee computer. Using an extraction program capable of transferring data to a removable recording medium, accessing the database of the requestee side computer to extract necessary data, exporting the extracted data to the removable recording medium, Transferring the removable recording medium storing the extracted data from the requester computer to the requester computer, and importing the extracted data from the removable recording medium into the database of the requester computer. Cooperation system between care insurance databases. 2. In extracting required data from a database of the requested-side computer using the extraction program, the requested-side computer requests an input of an identification code of a requesting side trader. 2. The method according to claim 1, wherein the input identification code is authenticated and, when a required condition is satisfied, extraction and export of necessary data from the database are permitted only to those corresponding to the identification code. Nursing insurance database link system described in. 3. Extraction of required data from a database of the requestor computer, export of the extracted data to the removable recording medium, and import of the extracted data from the removable recording medium to the database of the requester computer. To CSV (Comm
The nursing care insurance database inter-system according to claim 1 or 2, wherein the system is executed in accordance with a (Separated Value) format. 4. A care insurance database inter-working system for supporting data cooperation between databases of computers of a plurality of vendors having different specifications at an application software level in connection with care insurance, wherein a communication line is connected to a database of a computer of a requestee. Using an extraction / transmission / reception program that is accessible via the communication line and is capable of transmitting and receiving data via the communication line, extracts the necessary data by accessing the database of the requestee side computer via the communication line, A system for linking between care insurance databases, wherein the extracted data is transmitted through the communication line and imported into a database of a requester's computer. 5. In the extraction of required data from the database of the requestee computer using the extraction / transmission / reception program, the requestee computer requests input of an identification code of the requester trader. Certifying the input identification code, and permitting extraction and export of necessary data from the database only to those corresponding to the identification code when required conditions are satisfied. Item 4. The long-term care insurance database cooperation system according to item 4. 6. A method of extracting required data from the database of the requestee computer, transmitting and importing the extracted data to the database of the requester computer, and performing CSV (Comma Separated).
The system according to claim 4 or 5, wherein the system is executed in accordance with a (Value) format. 7. The requester's computer is a computer of a home care support establishment involved in nursing care insurance, the requested person's computer is a computer of a municipality involved in nursing care insurance, and the items of the extracted data are , Insurer number, insurer name, insured number, reading,
Insured person's name, gender, date of birth, address, telephone number, degree of nursing care, expiration date, notification date of home service plan creation request, the limit for visiting offices, the limit for visiting offices (the limit for visiting offices) The required items required for providing nursing care services and creating a claim, such as the amount application period, the short-term entrance payment limit reference amount, and the limit application period (of the short-term entrance payment limit reference amount) are set. The nursing care insurance database inter-system according to any one of claims 1 to 6. 8. The requester's computer is a computer of a care service provider related to care insurance,
The requestee side computer is a computer of a municipality involved in nursing care insurance, and as the items of the extracted data, an insurer number, an insurer name, an insured number, a reading,
Required items such as insured person's name, gender, date of birth, address, telephone number, degree of nursing care, expiration date, etc. required for providing nursing care service and creating a claim are set. The care insurance database cooperation system according to any one of claims 1 to 6. 9. The requester's computer is a computer of a home care support establishment involved in nursing care insurance, the requested person's computer is a computer of a welfare office involved in nursing care insurance, and the extracted data items are 7. Necessary items required for provision of a nursing care service and creation of a claim, such as a recipient name, a reading, a target period, and a burden ratio, have been set. Cooperation system between care insurance databases described in Crab. 10. The requester's computer is a computer of a care service provider related to nursing care insurance, and the requested person's computer is a computer of a welfare office related to nursing care insurance. Necessary requirements for providing nursing care services and creating receipts, such as recipient names, readings, payer numbers, public expense recipient numbers, public expense numbers, target periods, benefit rates (public expense burden ratios), and user burdens The nursing care insurance database inter-system according to any one of claims 1 to 6, wherein items are set. 11. The computer of the requester side is a computer of a care service provider related to the care insurance, the requestee side computer is a computer of a home care support establishment related to the care insurance, and the item of the extracted data. Various data items (insurer number, insurer name, insured number, reading, insured name, gender, date of birth, address,
(E.g., phone number, degree of nursing care, expiration date, recipient name, reading, target period, burden ratio, etc.), and other necessary items required for providing nursing care services and creating a claim. The care insurance database inter-linkage system according to any one of claims 1 to 6. 12. The requester's computer is a computer of a home care support establishment relating to care insurance,
The requestee side computer is a computer of a care service provider related to care insurance, and the extracted data items include an insurer number, an insurer name, an insured number, an insured name, gender, date of birth. , Nursing care status classification, home care support company establishment name, person in charge, visiting office payment limit reference amount, limit application period (for visiting office payment limit reference amount), short-term entrance payment limit reference amount, (short-term entrance Application period of the payment limit base amount, short-term admission days until the previous month,
Creation date, notification date, offer time zone, service content,
Record of nursing care services such as the name of the service business establishment, monthly service plan and record of actual results (date, number of times, total number of times), number of public expenditures, number of public expenditure units, number of public expenditure recipients, benefit rate (public expenditure share) The care insurance database inter-system according to any one of claims 1 to 6, wherein required items required for providing and creating a claim are set. 13. The requester's computer,
The data originally stored in the database of the requester computer is compared with the extracted data imported from the requester computer to the database of the requester computer, and the result of the comparison is displayed. The care insurance database inter-system linking system according to any one of claims 1 to 12, wherein the system is configured as described above.