JP2003233668A - Health insurance treatment billing system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a system which can decide whether a charge of a health insurance treatment sent from a medical institution to a health expenditure payment facility is adequate or not. <P>SOLUTION: A medical treatment bill issued from a medical institution such as hospitals or pharmacies to a user is sent from a user's terminal such as a mobile phone 4 to a health insurance association's terminal such as a health insurance association computer 600. The computer compares a health insurance treatment billing information sent from a health insurance treatment billing origin 1 and the medical treatment bill, and determines validity of the health insurance treatment billing. <P>COPYRIGHT: (C)2003,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical expense payment institution, which is carried out by a medical institution such as a health insurance association or an insurance company when the medical institution such as a hospital or a pharmacy is used. The present invention relates to an insurance medical treatment request system in which whether an insurance medical treatment request is valid or not is determined based on medical treatment detailed information from a user.

[0002]

2. Description of the Related Art Conventionally, medical insurance claims are unilaterally made from medical institutions to each medical expense payment institution as a share of the medical expense payment institution.
The actual situation is that, based on the insurance medical treatment request information from the medical institution, whether or not the insurance medical treatment request is valid is checked. At the time of checking, whether or not there is a contradiction in the insurance medical treatment request information and whether the user actually exists are checked.

[0003] On the other hand, the medical treatment detailed information is mailed to the user in the form of a medical expense notice and a cash benefit decision notice in a state of being summarized with a delay of several months.

[0004]

Therefore, under the circumstances as described above, at each medical expense payment institution, at the time of billing from the medical institution, the medical treatment detailed information and the insurance medical treatment billing information are collated in detail. Even if it is checked, the user cannot remember the details of the medical care item accurately, and therefore, in most cases, the amount unilaterally charged by the medical institution had to be accepted as it was. In other words,
Even if incorrect claims were made, many were still processed as legitimate.

Therefore, an object of the present invention is to easily and surely judge whether or not an insurance medical treatment request as a medical expense paying institution's share, which is made by the medical institution to the medical expense paying institution, is reasonable. It is to provide an insurance medical treatment billing system that can be performed.

[0006]

[Means for Solving the Problems] Basically, the above-mentioned purpose is for a user side to input medical treatment detailed information issued to a user from a medical institution and wirelessly or wiredly send it to a medical expense payment institution. At least a terminal device and a medical expense payment institution side terminal device for receiving medical treatment detailed information from the user side terminal device and performing a collation check between the medical treatment detailed information and insurance medical treatment billing information from a medical institution. Therefore, this is achieved by configuring the system.

[0007]

BEST MODE FOR CARRYING OUT THE INVENTION An embodiment of the present invention will be described below with reference to FIG.
~ It demonstrates by FIG.

First, an insurance medical treatment billing system according to the present invention will be described. FIG. 1 shows a schematic configuration of an example of the system. As shown in the figure, a hospital computer 101, a pharmacy computer 1
There is 02. Further, as the user side terminal device, there is, for example, a mobile phone 4 having a still image capturing / transmitting function. Further, as a terminal device installed in the health insurance association 3, there is a health insurance association computer 600. A user database 601 and an insurance claim database 602 are attached to the health insurance association computer 600.

In this embodiment, as shown in the figure, the insurance medical invoice source 1 and the health insurance association computer 600 are connected to the network 2.
Since it is possible to communicate via the network, it is possible to make an insurance medical treatment request through the line network 2. However, such a communication form is not always necessary, and the insurance medical treatment request from the insurance medical treatment request source 1 is not necessarily required. May be billed to the health insurance association 3 in writing. However, the line network 2 is essential for the mobile phone 4. Under such a system configuration, the health insurance association computer 60
On the 0 side, the medical treatment detailed information from the mobile phone 4 and the insurance medical treatment billing information from the insurance medical treatment billing source 1 are fetched.
The collation check between these pieces of information is performed on the health insurance association computer 600.

The present invention will be described in more detail with reference to FIG.
Shows an example of the format of the medical treatment statement in which the medical treatment statement information is described. The medical treatment statement 5 is issued by the insurance medical treatment requester 1. As shown in the figure, the entry items are, for example, "medical treatment date" indicating the date and time of use.
And "medical care / prescription drug" indicating the medical treatment content or prescription drug,
The “medical treatment amount” paid by the user at the counter, the “medical treatment name”, and the hospital name or the “hospital / pharmacy name” indicating the pharmacy name are listed.

In some cases, the information described on the medical statement 5 is also printed as a two-dimensional code 501 in a two-dimensional code in a blank space on the medical statement 5. There is. The two-dimensional code 501 is taken by the user as a still image with the mobile phone 4, and then transmitted to the health insurance association computer 600. However, if the two-dimensional code 501 is not printed on the medical statement 5, the medical statement 5 itself may be captured as a still image and then transmitted to the health insurance association computer 600.

As described above, the mobile phone 4 has a still image photographing function, and FIG. 3 shows an appearance of the mobile phone 4 as an example. As shown in the figure, in addition to the antenna unit 401, the display unit 402, the keyboard unit (telephone number and text input means) 405, a camera unit 404 is provided. Although the mobile phone 4 equipped with the camera unit 404 is currently in practical use, the camera unit 404 enables the two-dimensional code 501,
Alternatively, the medical treatment statement 5 itself is photographed.
Incidentally, the photographed two-dimensional code 501 is displayed as an image 403 on the display unit 402 for reference.

FIG. 4 also shows the health insurance association computer 6.
00 shows a data format in an example of a user database 601 attached to the H.00. As shown in the figure, in the user database 601, the two-dimensional code 501 transmitted from the user as image information is decoded and converted into text data, or the image information of the medical statement 5 itself is converted. It is converted into text data by image recognition and user database 60 is created for each user.
It is to be updated and registered as one record on one. One record is, for example, "use date", "user name",
It is composed of “hospital / pharmacy name”, “disease name”, “prescription drug name” and “window payment amount” as elements.

Also shown in FIG. 5 is the insurance claim database 60.
The data format in 2 is shown. The insurance claim database 602 is updated and registered as one record for each user, based on the insurance medical care claim detailed information directly and indirectly sent from the hospital computer 101 or the pharmacy computer 102. One record is, for example, "use date", "user name",
"Hospital / pharmacy name", "disease name", "prescription drug name", "window payment amount", "health insurance burden amount", and "total medical expenses" are elements.

FIG. 6 shows a flow of an example of the update registration process for the user database 601.
In this case, after the user first confirms whether or not the two-dimensional code 501 is printed on the medical treatment statement 5, the two-dimensional code 501 on the medical treatment statement 5 or the medical treatment statement 5 itself is carried. In addition to being photographed by the telephone 4, it is transmitted as image information to the health insurance association computer 600 via the network 2 (processes S1 to S).
3). On the other hand, in the health insurance association computer 600, the two-dimensional code 501 or the medical treatment statement 5 is received as image information and converted into text data by image recognition processing (processing S4, S5).
The two-dimensional code 501 converted into this text data,
Or, according to the medical treatment statement 5, the user database 601
In the above, the update registration of the user data has been performed (process S6).

FIG. 7 also illustrates the insurance claim database 602.
5 is a flow chart showing an example of an update registration process for. While the hospital / pharmacy issues the medical treatment statement 5 to the user, the insurance medical treatment statement is issued (process S10). The information on this insurance medical bill is the hospital computer 101 / pharmacy computer 102.
Is input to the health insurance association computer 600 via the network 2 (process S1).
1). The health care association computer 600 receives the insurance medical treatment bill detailed information from the line network 2. Based on the insurance medical treatment bill detailed information, the insurance bill database 602 updates and registers one record for each user. (Processes 12 and 13). Incidentally, there is a difference between the information on the medical treatment statement 5 and the insurance medical treatment statement detailed information, and the difference is required depending on the presence or absence of insurance claim data. Although the insurance claim data does not exist in the information on the medical treatment statement 5, it does exist in the insurance medical treatment statement information.

Finally, the health insurance association computer 600
The collation check processing in FIG.
Shows the flow in that example. As shown in the figure, at the time of the collation check, the collation check with the information on the insurance claim database 602 is performed with the date of use on the user database 601 and the user as keys (processes S20, 21). ). If the collation result is valid, the result such as the medical expense notice is transmitted to the user's mobile phone 4 (process S22). If the collation result is invalid, confirmation is made with respect to the insurance medical treatment invoicing source 1 (process S23).

[0018]

As described above, according to the present invention, whether or not an insurance medical treatment request from a medical institution to a medical expense paying institution as a medical expense paying institution's share is reasonable or not. It can be easily and surely determined.

[Brief description of drawings]

FIG. 1 is a diagram showing a system schematic configuration of an example of an insurance medical treatment billing system according to the present invention.

FIG. 2 is a diagram showing a format example of a medical treatment statement in which medical treatment detailed information is described.

FIG. 3 is a diagram showing an appearance of an example of a mobile phone as a user-side terminal device.

FIG. 4 is a diagram showing a data format in an example of a user database attached to a health insurance association computer.

FIG. 5 is a diagram showing a data format in an example of an insurance claim database attached to a health insurance association computer.

FIG. 6 is a diagram showing a flow of an example of an update registration process for a user database.

FIG. 7 is a diagram showing a flow of an example of an update registration process for an insurance claim database.

FIG. 8 is a diagram showing a flow of an example of a collation check process in the health insurance association computer 3.

[Explanation of symbols]

1 ... Insurance requester, 2 ... line network, 3 ... health insurance association,
4 ... Mobile phone.

   ─────────────────────────────────────────────────── ─── Continued front page    (72) Inventor Takashi Yamauchi             456 Sakai, Nakai-cho, Ashigarakami-gun, Kanagawa Stock             Hitachi Information Technology Co., Ltd.             Within (72) Inventor Hideaki Ojima             456 Sakai, Nakai-cho, Ashigarakami-gun, Kanagawa Stock             Hitachi Information Technology Co., Ltd.             Within (72) Inventor Taichi Sugiyama             456 Sakai, Nakai-cho, Ashigarakami-gun, Kanagawa Stock             Hitachi Information Technology Co., Ltd.             Within (72) Inventor Yotaro Seguchi             456 Sakai, Nakai-cho, Ashigarakami-gun, Kanagawa Stock             Hitachi Information Technology Co., Ltd.             Within F term (reference) 5C062 AA02 AA17 AC41 AC55 AF00                       BA04

Claims (5)

[Claims] 1. A medical insurance claim system for determining the validity of an insurance medical claim when the medical institution is used, and the medical institution pays the medical expense paying institution to the medical expense paying institution from the medical institution. The user side terminal device which inputs the medical treatment detailed information issued to the user and transmits it to the medical expense payment institution by radio or wire, and the medical treatment detailed information from the user side terminal device are received, and the medical treatment is performed. An insurance medical treatment billing system comprising at least a medical expense payment institution side terminal device for performing a collation check between detailed information and insurance medical treatment billing information from a medical institution. 2. An insurance medical treatment billing system for determining the validity of an insurance medical treatment bill borne by a medical expenses paying institution from the medical institution when the medical institution is used. Image information of the user side terminal device that inputs the medical treatment statement information issued to the user as image information and transmits it to the medical expense payment organization wirelessly or by wire, and the medical treatment statement information from the user side terminal device And a medical fee payment institution side terminal device for checking the medical treatment specification information and the insurance medical treatment request information from the medical institution. 3. An insurance medical treatment billing system for determining the validity of an insurance medical treatment bill borne by a medical expenses paying institution when the medical institution uses the medical expenses paying institution. Image information of the user side terminal device that inputs the medical treatment statement information issued to the user as image information and transmits it to the medical expense payment organization wirelessly or by wire, and the medical treatment statement information from the user side terminal device And a character recognition of the image information, and at least a medical expense payment institution side terminal device for performing a collation check between the medical treatment detailed information and the insurance medical treatment request information from the medical institution. [Claim 4] An insurance medical treatment billing system for determining the validity of an insurance medical treatment bill borne by a medical expenses paying institution when the medical institution uses the medical expenses paying institution. Enter the two-dimensional coded medical treatment statement information issued to the user as image information, and
Alternatively, the user side terminal device which is transmitted to the medical expense payment institution by wire and the two-dimensional coded medical treatment detailed information from the user side terminal device are received as image information, the image information is decoded, and the medical treatment detailed information is received. And a medical bill payment institution side terminal device for performing a collation check with insurance medical bill request information from a medical institution. 5. An insurance medical treatment billing system for determining the validity of an insurance medical treatment bill borne by a medical expenses paying institution when the medical institution uses the medical institution billing system. The user side terminal device which inputs the medical treatment detailed information issued to the user and transmits it to the medical expense payment institution by radio or wire, and the medical treatment detailed information from the user side terminal device are received, and the medical treatment is performed. An insurance medical bill comprising at least a medical expense payment institution side terminal device for checking the detailed information and the insurance medical bill information from the medical institution and transmitting the result of the collation check to the user side terminal device. system.