JP2009237721A - Payment information integration system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a payment information integration system for verifying the possibility of a payment by checking data of a medical certificate concerning an insurance policy with the content of the insurance. <P>SOLUTION: In the payment information integration system, a medical certificate related to a reason for payment is extracted from a medical certificate DB 131 using a medical term of a medical term DB 133, and the medical certificate, a keyword of a medical term and insurance policy information are associated with each other, and stored in a reason for payment storage part 135. Unverified ones of the insurance policies applicable to the selected reason for payment are displayed in a list, and when a specific insurance policy number is selected from the list, the policies related to the name of the insured person of the insurance policy number are displayed in a list. When a specific insurance policy number is further selected, a list of medical certificates corresponding to the insurance policy number is displayed. When a specific medical certificate is selected from the list, a verification content concerning the medical certificate of the insurance policy number, the information on a reason keyword, etc. are displayed, and the information on the insurance policy of the policy number is viewed. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a payment information integration system that extracts a payment reason from medical terms in a medical certificate and extracts insurance policy information corresponding to the payment reason. The present invention relates to a payment information integration system that makes it easy to verify the possibility.

In life insurance, there are 18 types of claims and benefits, 74 types of payments exist for these types, and there are contracts (guarantees) that differ for each customer.
Examples of insurance claims / benefits include a specific sickness insurance payment that pays a lump sum when diagnosed with three major illnesses, and an advanced disability insurance that is the same as the death insurance premium if a sickness or injury results in a specific disability Advanced disability insurance that pays for 5 days, hospitalization for 5 days or more, benefit for hospitalization for 60 days before the start of hospitalization or 120 days after discharge from the hospital for the purpose of treating the injury or illness that caused the hospitalization There are outpatient benefits that pay money, surgical benefits that are paid when a certain operation is performed due to illness or injury, and specific damage benefits that are paid when treated for specific damage due to an accident.

Looking at the past specific period, there are more than 2 million medical certificates for the entire contract to be verified, and there are more than 20 million information on the contract (insurance policy information).
In this way, it is possible to find a description related to the reason for payment without omission from the huge amount of information on the medical certificate, extract the relevant policy information from the contents of the contract / special contract information and payment information, and then pay for the extracted policy information. The work of verifying the possibility of this requires a lot of time and personnel.

  There is also a movement to digitize the above work, and as a prior art, Japanese Patent Application Laid-Open No. 2003-108771 “Document Data Input / Output Method, Apparatus for Implementing the Same, and Recording Medium Recording the Processing Program” (Patent Document 1).

  In Patent Document 1, in a document data input / output method for inputting a specific item in a document and performing a task corresponding to the document, a necessary input item is obtained when executing a task corresponding to the received document. Is displayed, necessary input items are input, and processing of the input work is executed.

Japanese Patent Laid-Open No. 2004-187012

  In this way, it is difficult to extract payment items from conventional insurance policy information and verify the possibility of payment, and even if a medical certificate is digitized, the reason for payment is extracted, and the corresponding policy information There is a problem that it is not possible to easily verify the payment target by extracting the information.

[Object of invention]
The present invention has been made in view of the above-mentioned circumstances, and extracts reasons for payment from medical certificate data based on medical terms, searches a list of insurance policy information corresponding to a specific reason for payment, and further identifies a specific policy. It is an object of the present invention to provide a payment information integration system capable of easily verifying the possibility of payment by displaying a list of related medical certificate information from numbers.

  The present invention for solving the problems of the above conventional example is a payment information integration system for verifying the possibility of payment for a medical certificate related to insurance policy information, and is accessed from a verifier's terminal device via a network. A payment information integration server that executes processing, and the payment information integration server stores a data group necessary for processing and a processing program, a control unit that reads the processing program and can execute the processing, A medical certificate text database for storing text data of a medical certificate corresponding to a security number, a medical term database for storing medical terms related to insurance payment reasons, and at least insured as a data group in the storage unit An insurance policy information database that stores the details of insurance contracts, including the name and special contract, as insurance policy information for each security number, and insurance , A payment database that stores the number of securities that have been paid and that does not fall under the payment reason, a payment reason storage unit that is generated for searching for payment reasons, and a verification result database that stores verification results As a function realization means realized by the control unit, the medical certificate text data in the medical certificate text database is searched with medical terms in the medical term database, and the medical certificate is specified for each security number in the payment reason storage unit Information associated with the searched keyword is stored in association with each other, the insurance policy information corresponding to the security number is read from the insurance policy information database, stored in the payment reason storage unit in association with the security number, and the paid database is referred to. Data that does not correspond to the payment reason is deleted from the payment reason storage unit, and the status of the specific payment reason is determined from the terminal device. When an instruction to search for unverified cases is input, it is determined whether there is a keyword related to a specific payment reason in the payment reason storage unit, and the policy information of the security number with the keyword is referred to. To determine whether or not a particular payment reason is applicable, and to extract the corresponding insurance policy case, and to extract the insurance policy information that is output as a search result list When a specific case is selected from the display means and the list display contents of the search result, the payment reason storage unit is referred to display and output a list of securities related to the insured name of the security number of the specific case. When a security number to be verified is selected from the securities list, a list of medical certificate cases related to the selected security number is displayed and output, and when a specific medical certificate case is selected from the list of medical certificate cases, Selected diagnosis The related insurance policy information extraction / display means for displaying the relevant keyword in the notice together with the payment reason and the special contract, and the result of the verification made based on the contents displayed and output by the related insurance policy information extraction / display means It has a payment possibility verification means to memorize | store in a verification result database, It is characterized by the above-mentioned.

  According to the present invention, in the payment information integration system, the related insurance policy information extraction / display means displays and outputs the insurance policy information corresponding to the security number with reference to the payment reason storage unit from the security number of the selected specific case. It is characterized by doing.

  In the above payment information integration system, the payment reason search means stores information specifying the medical certificate in the payment reason storage unit in association with the storage location of the text data of the medical certificate, When a specific medical certificate item is selected from the list of medical certificate items, the policy information extraction / display means accesses the storage location of the medical certificate text data so that the text data of the medical certificate can be viewed. An index is displayed and output.

  In the payment information integration system, the present invention provides a medical certificate image database for storing medical certificate image data corresponding to the security number as a data group in the storage unit, and the payment reason search means is provided in the payment reason storage unit. When storing the information to identify the medical certificate, the storage location of the image data of the medical certificate is associated and stored, and the related insurance policy information extraction / display means selects the specific medical certificate item from the list of medical certificate items Then, in order to make it possible to view the image data of the medical certificate, an index for accessing the storage location of the image data of the medical certificate is displayed and output.

  According to the present invention, in the payment information integration system, an instruction for the related insurance policy information extraction / display means to access the storage location of the text data of the medical certificate or the storage location of the image data of the medical certificate is displayed from the terminal device. When input, the data is read from the storage location in the medical certificate text database or the medical certificate image database, and displayed.

  In the payment information integrated system, the related insurance policy information extraction / display means reads the insurance policy information corresponding to the security number with reference to the payment reason storage unit from the security number of the selected specific case, The paid information in the insurance policy information is separately displayed and output.

  In the payment information integrated system, when the related insurance policy information extraction / display means inputs an instruction to start continuous processing of verification from the list display contents of the search results, the list display contents of the search results When you select an issue with a security number in order and the verification process for that issue ends, select the issue with the next security number in the list display contents of the search results, and the verification of all the issues displayed in the list ends. It is characterized by repeating the process.

  In the payment information integration system according to the present invention, the verification work is performed in a plurality of stages, and the result verified in the previous stage by the related insurance policy information extraction / display means is stored in the verification result database. In this case, the verification result in the previous stage is displayed on the display portion for inputting the verification result.

  In the payment information integration system, the subject insurance policy information extracting / displaying means is a list of search results, and when the insured has subscribed to a plurality of insurance policies, the representative insurance policy item The security number is displayed and output as a representative security number.

  According to the present invention, as a function realization means realized by the control unit, the payment reason search means performs a process of searching for medical certificate text data in the medical certificate text database by medical terms in the medical term database, and Stores information specifying the medical certificate for each policy number in the storage unit in association with the searched keyword, reads the policy information corresponding to the policy number from the policy information database, and stores the policy number in the payment reason storage unit The data that does not correspond to the payment reason is deleted from the payment reason storage unit by referring to the paid database, and the terminal device is instructed to search for a case whose status is unverified for a specific payment reason. Then, it is determined whether or not there is a keyword related to the specific payment reason in the payment reason storage unit, and the securities with the keyword Refers to the policy information of the issue, determines whether or not a specific payment reason is applicable, performs a process of extracting the case of the corresponding policy, and the target policy information extraction / display means is the extracted policy When the related insurance policy information extraction / display means selects a specific case from the list display contents of the search result, refer to the payment reason storage unit and specify the relevant case. Displays a list of securities related to the insured name of the case's securities number, and when a security number to be verified is selected from the list, displays a list of medical certificate cases related to the selected security number When a specific medical certificate item is selected from the list of medical certificate items, the corresponding keyword in the selected medical certificate is displayed and output together with the payment reason and the special contract, and the payment possibility verification means Since it is a payment information integration system that performs processing to store the verification results based on the contents displayed and output by the continuous insurance policy information extraction / display means in the verification result database, the possibility of payment can be easily verified effective.

  According to the present invention, when the related insurance policy information extraction / display unit inputs an instruction to access the storage location of the text data of the medical certificate displayed in the index or the storage location of the image data of the medical certificate, from the terminal device, The payment information integration system reads the data from the storage location in the medical certificate text database or medical certificate image database, displays it, and outputs it, so the text data or image data of the medical certificate can be viewed, and the possibility of payment can be verified more easily. There is an effect that can be done.

  According to the present invention, when the related insurance policy information extracting / displaying unit inputs an instruction to start continuous processing of verification from the list display content of the search result, the security number is sequentially displayed in the list display content of the search result. When a matter is selected and the verification process for that matter is completed, the matter with the next security number is selected in the list display contents of the search results, and the process is repeated until all of the cases displayed in the list are verified. Since the payment information integration system is used, verification work can be automated for a plurality of cases, and the possibility of payment can be verified more easily.

  According to the present invention, the verification work is performed in a plurality of stages, and when the related insurance policy information extraction / display means verifies the result verified in the previous stage in the verification result database, the verification result Since the above-mentioned payment information integration system displays the verification result in the previous stage on the display part for inputting, there is an effect that the previous verification result can be referred to and the possibility of payment can be verified more easily.

Embodiments of the present invention will be described with reference to the drawings.
[Outline of the embodiment]
The payment information integration system according to the embodiment of the present invention extracts a medical certificate corresponding to a payment reason (with a possibility of payment) from medical texts from a large amount of medical text data, When the medical certificate is associated with the customer's contract information (insurance policy information), an unverified list is displayed with the corresponding policy for the selected reason, and when a specific policy number is selected from the list, A list of related securities is displayed by the insured name of the security number, and when a specific security number is selected, a list of medical certificates corresponding to the security number is displayed, and a specific medical certificate is selected from among them. Then, the contents of verification regarding the certificate of the security number and information on the reason keyword are displayed, and further, the insurance policy information of the security number can be browsed, and the payment possibility can be easily verified. And quickly, One in which multi-faceted verification can be a do not comprehensively leakage in the range.

[Entire system: Fig. 1]
A payment information integration system (this system) according to an embodiment of the present invention will be described with reference to FIG. FIG. 1 is a configuration block diagram of a payment information integration system according to an embodiment of the present invention.
As shown in FIG. 1, this system basically includes a payment information integration server 1, a network 2, and a plurality of user computers (user PCs) 3 connected to the payment information integration server 1 via the network 2. Has been.

[Internal configuration of payment information integration server]
The payment information integration server 1 is realized by a computer device.
The internal configuration of the payment information integration server 1 includes a control unit 11, a main memory 12, a storage unit 13, and an interface unit 14.

[Internal components of payment information integration server: Fig. 2]
Next, each part of the internal configuration of the payment information integration server 1 will be described with reference to FIG. FIG. 2 is a diagram showing the relationship between the function realization means of the payment information integration server and the DB group.

[Storage unit 13]
The storage unit 13 stores data and processing programs necessary for processing.
Specifically, as necessary data groups, a medical certificate text DB (database) 131 for storing text data such as a medical certificate, a medical certificate image DB 132 for storing image data such as a medical certificate, and medical terms related to payment reasons Medical term DB 133 for storing insurance policy information DB 134 for storing insurance policy information, payment reason storage unit 135 prepared for facilitating verification, verification result DB 136 for storing verification results, and information on already paid securities numbers. A prepaid DB 137 for storing is provided.

  Further, the storage unit 13 stores, as processing programs, a payment reason search processing program, a target insurance policy information extraction / display processing program, a related insurance policy information detection / display processing program, a payability verification processing program, and the like.

[Main memory 12]
The main memory 12 is a work memory, and is loaded with the processing program and can be executed.
[Control unit 11]
The control unit 11 reads a processing program stored in the storage unit 13 and develops it in the main memory 12 so that the processing can be executed.

  The control unit 11 provides a function realization unit that can be executed by loading a processing program from the storage unit 13 into the main memory 12, and specifically includes a payment reason search unit 111, target insurance policy information, and the like. The extraction / display unit 112, the related insurance policy information detection / display unit 113, the payability verification unit 114, and the like can be realized.

[User PC3]
The user PC 3 is a computer used by the verifier to verify the possibility of payment. The user PC 3 accesses the payment information integration server 1 and verifies the possibility of payment for the insurance policy information corresponding to the payment reason. The verification result is input.
Since the user PC 3 is a computer device, the user PC 3 has an internal configuration similar to that of the payment information integration server 1, and is further connected to a display device, an input device, and the like.

[Contents of various databases]
[Diagnostics text DB 131: FIG. 3]
The medical certificate text DB 131 stores information such as a medical certificate in a text format, and as shown in FIG. 3, "date of completion", "relationship", "page number of recorded medical certificate screen", "medical certificate name" Data is set for items such as “description contents of medical certificate”, “remarks column of medical certificate”, and “memo field”, and is stored for each security number.
FIG. 3 is a diagram showing an outline of the medical certificate text DB.
The medical certificate text DB 131 is accessed by the payment reason search means 111 described later and collated with the medical term keyword in the medical term DB 133.

  The medical certificate includes "General Medical Certificate", "Treatment Content Report", "Hospital Situation Report", "Hospital Certificate", "Hospital Situation Report", "Specific Disease Diagnosis Certificate", "General Disability Diagnosis Certificate", "Nursing Care" Dedicated medical certificate, death certificate, death notice, etc.

[Diagnostic image DB 132: FIG. 4]
In the medical certificate image DB 132, as shown in FIG. 4, the medical certificate image image is stored for each security number using the image recording date and the document name as an index. In FIG. 4, the medical certificate image DB 132 does not store the image data itself, but stores the address of the storage location of the image data to link with the image data.
FIG. 4 is a diagram showing an outline of the medical certificate image DB.
The payment reason search means 111 accesses the medical certificate image DB 132, associates it with the medical certificate text data, and can select and view the medical certificate of the text and image data as shown in FIG.

[Medical terminology DB 133]
The medical term DB 133 is a medical term related to payment reasons such as disease name, name of operation, treatment method, physical condition, etc. (about 19,000 words with synonyms added to basic terms about 4,500). -Grouped in terms of benefit types and payment reasons, and medical terms are stored in association with one or more payment reasons.

The types of insurance claims / benefits are “Death Insurance (Death)”, “Advanced Disability Insurance (High Impairment)”, “Disability Insurance (Disability)”, “Specified Sickness Insurance”, “Specified Intractable Disease Benefit (Intractable Disease)” For example, in the case of “Advanced Disability Insurance”, the reason for payment is defined in the terms and conditions in terms of the status of “loss of binocular vision,” “loss of language function,” “continuous life-long care”, etc. In accordance with the above, it becomes “things that leave significant disabilities in the central nervous system / mental organs or the chest and abdominal organs and require constant care throughout life”. “Oshime” etc.
The medical term DB 133 is accessed by the payment reason search means 111 described later, and is used for batch processing using medical term keywords.

[Insurance policy information DB 134: FIG. 5]
The insurance policy information DB 134 stores the contents of the insurance contract for each customer for each security number. Specifically, as shown in FIG. 5, the policy number, the expiration date, the insurance name, the insured person name, the contract Information on the name, responsibility opening date (responsibility start date), contract date, expiration date, reduction date, reason for extinction, payment, special contract details (including target special contract) is stored.
FIG. 5 is a diagram showing an outline of the insurance policy information DB.
The insurance policy information DB 134 is accessed by the payment reason search means 111 described later, and necessary information is stored in the payment reason storage unit 135.

[Payment Reason Storage Unit 135: FIG. 6]
In the payment reason storage unit 135, a payment reason search unit (to be described later) performs a batch search for the data in the medical certificate text DB 131 using the term keyword in the medical term DB 134, and further refers to the insurance policy information DB 134 for insurance. Store securities information.

The payment reason storage unit 135 will be described with reference to FIG. FIG. 6 is a diagram showing an outline of information storage in the payment reason storage unit.
As shown in FIG. 6, the payment reason storage 135 includes a medical certificate number, a date of completion, a medical certificate type name (information for specifying a medical certificate), and a keyword of a medical term corresponding to the medical certificate for which batch search processing has been performed. In addition, as security information corresponding to the security number, the expiration date, insurance name, insured name, contractor name, responsibility release date (responsibility start date), contract date, expiration date, reduction date, Information on extinction reasons, payment, and special contract details (insurance policy information) is stored.

  Although not shown in the figure, the payment reason storage unit 135 uses the payment reason search unit 111 to store the text data storage address of the medical certificate text DB 131 in the medical certificate text DB 131 and the medical certificate image DB 132. The storage address of the medical certificate image data is stored in association with each other.

[Verification result DB 136: FIG. 7]
The verification result DB 136 stores the result when the payability of the insurance policy is verified. As shown in FIG. 7, for each security number, the keyword “ Information such as “applicable” or “non-applicable”, valid period, status of determination result, verifier, etc. is stored.
FIG. 7 is a diagram showing an outline of the verification result DB.
The verification result is set in the verification result DB 136 by the payable verification unit 114.

[Prepaid DB137]
The paid-in DB 137 stores insurance numbers, payments, etc. (paid-on) and securities numbers that do not correspond to the reason for payment. The paid-in DB 137 is used to exclude data stored in the payment reason storage unit 135 that is no longer a payment reason due to payment.
Therefore, even if it is already paid, the securities number is not registered in this paid DB 137 for securities that may fall under the reason for payment.

[Various processing means]
Next, various processing means realized by the control unit 11 reading and operating various processing programs will be described.
[Payment Reason Search Means 111: FIGS. 8 and 9]
The processing operation of the payment reason search means 111 will be described with reference to FIG. FIG. 8 is a flowchart showing a data setting process in the payment reason storage unit of the payment reason search means.
As shown in FIG. 8, the payment reason search means 111 first performs a batch search on the text data in the medical certificate text DB 131 with terms in the medical term DB 133 (S1), and specifies information (securities number, The completion date and the medical certificate type name) and the corresponding medical term keyword are associated with each other and stored in the payment reason storage unit 135 (S2).

At that time, the payment reason search means 111 stores the storage address of the text data of the medical certificate in the medical certificate text DB 131 and the storage address of the image data of the medical certificate in the medical certificate image DB 132 in association with each other.
This associated address is used in the display portion that allows the related insurance policy information detection / display means 113 to select and view the text data and image data of the medical certificate.

Then, the payment reason search means 111 determines whether or not the batch process has been completed for all the medical certificate texts (S3), and if not completed (in the case of No), the process returns to the process S1.
If batch processing has been completed for all the medical certificate texts (in the case of Yes), the payment reason search means 111 refers to the security number in the payment reason storage unit 135 and displays the corresponding insurance policy information in the insurance policy information DB 134. The insurance policy information is stored in the payment reason storage unit 135 (S4).

  Next, the data stored in the payment reason storage unit 135 is referred to the paid payment DB 137, and the data of the securities number that has been paid and does not correspond to the payment reason is deleted from the payment reason storage unit 135 (S5).

  Then, it is determined whether or not the processing for all the securities numbers has been completed (S6). If not completed (in the case of No), the process returns to the processing S4, and if completed (in the case of Yes), the payment is made. The process of setting data in the reason storage unit 135 is terminated. Then, based on the contents of the setting data in the payment reason storage unit 135, a case search for verification is performed.

  Next, the payment reason search means 111 displays and outputs a case search screen on the user PC 3 as an initial screen. The case search screen will be described with reference to FIG. FIG. 9 is a schematic diagram of the item search screen.

  In order to verify the possibility of payment, in the case search screen shown in FIG. The payment reason such as “Mouth” can be selected from the pull-down menu, and “Step 1 (not yet)” is selected from the pull-down menu as the verification status by reason. This “step 1 (not yet)” indicates an unverified state (status) that has not yet been verified in step 1.

  Here, the verification work is performed in two stages (steps 1 and 2). As for the verification status by reason, “step 1 (not yet)” indicates that step 1 is not verified, and “step 1 (completed)” indicates step 1 , Indicating that the guidance (guidance to the customer) is not required, “Step 1 (Hold)” is suspended in Step 1, “Step 2 (Not)” indicates unverified Step 2, and “ “Step 2 (Done)” ends in Step 2 and indicates that guidance is not required, “Step 2 (Hold)” indicates that it has been suspended in Step 2, “Billing Guidance Required” indicates guidance required, and “No Verification Required” "Indicates that it is not subject to verification.

  As described above, when the payment reason and the verification status “step 1 (not yet)” are selected from the pull-down menu on the case search screen of FIG. With reference to the payment reason storage unit 135, a process of extracting the insurance policy item to which the selected payment reason corresponds is performed.

Specifically, because the keyword related to the payment reason is stored in the medical term DB 133, the payment reason search means 111 reads the keyword related to the payment reason selected for the search from the medical term DB 133, and the keyword The payment reason storage unit 135 is searched for.
The payment reason search means 111 determines whether or not there is a keyword related to the payment reason in the payment reason storage unit 135, and when there is a related keyword, refers to the insurance policy information of the security number with the keyword. Then, it is determined whether or not the payment reason is the content of the insurance contract.
And the payment reason search means 111 will extract the case of the said insurance policy, if the payment reason corresponds to the contents of the insurance contract.

[Target insurance policy information extraction / display unit 112: FIG. 10]
The target insurance policy information extraction / display unit 112 is extracted by the payment reason search unit 111, and a list of insurance policies corresponding to the payment reason is displayed and output to the user PC 3 as a search result as shown in FIG. FIG. 10 is a schematic diagram of a search result list display screen.

In the search result list display screen, as shown in FIG. 10, the number (No.), representative securities number, number of separate units, insured name, date of birth, status symbol for each payment reason shown in FIG. 9, verification status Etc. are displayed.
The representative security number is a representative security number for a case of a representative insurance policy when the insured has joined a plurality of insurance policies.
The search result list may be displayed for a specific period (for example, a specific period with reference to the completion date).
The case of FIG. 10 is an example in which unverified information is extracted for the payment reason “failure”.

  The target insurance policy information extraction / display unit 112 refers to the verification result DB 136 when displaying the search result list, and if the verification status is registered for the payment reason corresponding to the security number, the status symbol, the verification status Is displayed and output to the user PC 3.

  The verification status is synonymous with the verification status according to the reason, and the status symbols are “Not yet” for “Step 1 (Not)”, “(1) Completed” for “Step 1 (Completed)”, “( 1) Keep ”is“ Step 1 (Stay) ”,“ (2) Not ”is“ Step 2 (Not) ”,“ (2) Done ”is“ Step 2 (Done) ”,“ (2) “Protect” indicates “Step 2 (Protect)”, “Guidance” indicates “Billing Guide Required”, and “-” indicates “No Verification Required”.

[Related insurance policy information detection / display means 113: FIGS. 11 to 13]
The related insurance policy information detection / display unit 113 will be described with reference to FIGS. FIG. 11 is a schematic diagram showing a list of securities related to a specific insured name, FIG. 12 is a schematic diagram showing a list of medical certificates to be verified, and FIG. 13 is related insurance policy information detection / display. It is a flowchart which shows the process of a means.

As shown in FIG. 11, the list of securities related to a specific insured name is displayed for each insured name. Status symbol for each payment reason such as “Overall” indicating the revalidation status, and “Death”, “High dysfunction”, “Disability”, “Intractable illness”, “Large care”, “Nursing”, “Malignant”, “Beta” Is done.
In addition, a column “Select” is provided at the left end so that securities information of a specific securities number can be selected from the securities list.

The related insurance policy information detecting / displaying means 113, when an instruction to start verification continuous processing is input on the search result list display screen of FIG. 10, selects items of the security number in order from the search result list (S11). Further, a list of related insurance policies is displayed and output to the user PC 3 as shown in FIG. 11 based on the insured name of the security number (S12).
When one verification process is completed, the verification continuous process automatically selects the cases with the securities numbers in the next order in the search result list and repeats until all the cases in the list are completed.

  In addition, instead of sequentially selecting cases with securities numbers in response to the instruction to start the continuous verification process, the name of the insured for the selected security number may be selected even if a case with any securities number is selected from the search result list. A list of securities related to can be displayed.

  Then, the related insurance policy information detection / display unit 113 determines whether or not the security number to be verified is selected from the related insurance policy list (S13), and if it is not selected (in the case of No), the determination The process S13 is repeated. If the certificate number to be verified is selected (in the case of Yes), a list of medical certificates corresponding to the selected security number is displayed as shown in the list of medical certificates to be verified in FIG. 12 (S14).

  As shown in FIG. 12, the list of medical certificates to be verified includes a security number including a medical certificate information for a selected security number as “original security number”, a type of medical certificate as “document”, A status symbol for the payment reason is displayed. For the status symbol, a character is displayed for a keyword hit for each payment reason, and the character indicates a re-verification status of the payment reason.

  Specifically, when a specific security number is selected from the search result list screen of FIG. 10, the related insurance policy information detection / display unit 113 refers to the payment reason storage unit 135 to insure the insurance number of the security number. FIG. 11 shows a list of insurance policies with which the contractor is contracted. Further, when a specific policy number is selected from the insurance policy list, a list of medical certificates related to the policy number is displayed as shown in FIG. To do. If the insured makes medical certificates many times, the data of a plurality of medical certificates will be associated with one security number.

  Then, when a specific medical certificate is selected from the displayed medical certificate list (S15), the related insurance policy information detection / display means 113 determines the date of completion of the medical certificate and the type of medical certificate collected for each security number. The name is displayed as an index, so that the text data of the medical certificate or the image data of the medical certificate can be browsed (display of the display portion that enables the selection and browsing of the text data and the medical certificate of the image data) (S16). At the same time, the contents of the security information of the selected security number are also displayed (display of the display portion of the insurance policy information) (S17).

Furthermore, the related insurance policy information detecting / displaying means 113 displays the hit (corresponding) keyword in the selected medical certificate together with the payment reason and the special contract (display of the reason keyword display part) (S18), and the verification is easy. To do.
The reason keyword display portion may be displayed before performing steps S16 and S17 when a specific medical certificate is selected.

Here, if text data or image data of a medical certificate is selected in a display portion where the medical data of text data and image data can be selected and viewed, those data are displayed on the screen.
In addition, the payment information for the selected security number (contents paid in the past), the category, the payment target, and the base date are displayed (display of the display portion of the payment information) (S19). ), The same payment can be confirmed.

The paid information is obtained by acquiring the information already paid from the insurance policy information by the related insurance policy information detecting / displaying unit 113 and displaying the display portion of the paid information.
As a result, all unverified insurance contracts and special contracts related to the insured name are extracted without omission, and information necessary for the verification is displayed in a viewable manner.

  Then, in a state where the display portion that allows setting of the verification contents of the selected security / medical certificate is displayed, the verification of Step 1 or Step 2 is performed, and the verification contents are set in the determination result column. In the judgment result column, the reason displayed in the reason keyword display is set to facilitate the setting of verification contents.

  That is, when a specific policy number is selected from FIG. 12, the related policy information detection / display means 113 displays the insurance policy information display part, text data, and image data diagnosis corresponding to the selected policy number. The display part that can be selected / viewed, the display part of the paid information, the display part that can set the verification contents of the selected securities / medical certificate, and the display part of the reason keyword are displayed and output to the user PC 3.

Here, the contents of verification of the selected securities / medical certificate are the “major category” of the payment reason, “keyword” indicating whether the keyword is related, “validity period”, “judgment result”, “Verifier” or the like is displayed. In the “keyword” column, “applicable” is set if a specific keyword corresponding to the payment reason is applicable, and “non-applicable” is set otherwise.
The verifier refers to the displayed information and inputs the determination content in the “determination result” using a pull-down menu.
In addition, the reason keyword can be confirmed in the keyword column of the reason keyword display portion as to which keyword is verified for the payment reason to be verified. Thereby, the verification work of the verifier can be facilitated.

[Overall display contents: Fig. 14]
In order to make it easy to understand the entire display contents by the related insurance policy information detection / display means 113, an overview of the entire screen is shown in FIG. FIG. 14 is a schematic diagram showing the entire contents displayed by the related insurance policy information detecting / displaying means.
As shown in FIG. 14, the entire display contents are as follows: “Display section for a list of securities related to the name of the insured person”, “Display section for the list of medical certificates to be verified” at the bottom, "Display part that allows you to select and view medical certificates""Display part of paid information", "Display part of selected securities information" to the right, "Display part of judgment results" below them, and " “Reason keyword display part” is displayed.

[Display part that allows selecting and viewing medical certificates: Fig. 15]
Moreover, the display part which enables selection and browsing of the medical certificate of text data and image data is illustrated in FIG. FIG. 15 is a diagram showing a display portion that allows a medical certificate to be selected and viewed.
As shown in FIG. 15, the display portion that enables the selection / viewing of the medical certificate manages text data and microimage (microfilm image data) by securities number as a related document list. Linked with the date of completion and type of medical certificate. That is, when the date of completion and the type of medical certificate are clicked, text data or a micro image is read from the medical certificate text DB 131 or the medical certificate image DB 132 and displayed.

[Reason keyword display part: Fig. 16]
The display part of the reason keyword is illustrated in FIG. FIG. 16 is a diagram illustrating a display part of a reason keyword.
As shown in FIG. 16, when the “keyword” field is “applicable”, the reason keyword display portion is “major category”, “medium category”, “small category”, “ "Target special contract" and "Keyword" are displayed. Here, “major classification” is the payment reason that the verifier is responsible for, “small classification” is the item that may be applicable in the payment reason, and “target special contract” is the “selected securities information” Indicates the special contract code.

[Payability verification means 114]
The payability verification unit 114 refers to the contents displayed by the related insurance policy information detection / display unit 113 by referring to the reason keyword display part or the text data or image data of the medical certificate. Then, necessary information regarding the unverified payment reason is input to the display portion of the selected securities / medical certificate where the verification contents can be set, and when “registration” is instructed, the verification result is reflected in the verification result DB 136.

[Effect of the embodiment]
According to this system, medical certificates corresponding to the reason for payment (extractable payment) are extracted from a vast number of medical certificates, and the medical certificate and customer contract information (securities information) ), Search for unverified securities information for a specific payment reason, display a list of search results, and when a security number is selected from the search results, the security related to the insured name of that security number When a list is displayed and a specific security number is selected from the security list, a list of medical certificates related to the security number is displayed, and the payment possibility is verified from the information of the medical certificate displayed in the list. Therefore, there is an effect that comprehensive and multi-faceted verification can be performed comprehensively and easily without omissions accurately and quickly.

  The present invention extracts reasons for payment from medical certificate data based on medical terms, searches a list of insurance policy information corresponding to a specific payment reason, and lists related medical certificate information from a specific security number. It is suitable for a payment information integrated system that can be easily displayed and verified the possibility of payment.

1 is a configuration block diagram of a payment information integration system according to an embodiment of the present invention. It is a figure which shows the relationship between the function implementation means of a payment information integrated server, and DB group. It is a figure which shows the outline | summary of medical certificate text DB. It is a figure which shows the outline | summary of medical certificate image DB. It is a figure which shows the outline | summary of insurance policy information DB. It is a figure which shows the outline | summary of the information storage of a payment reason memory | storage part. It is a figure which shows the outline | summary of verification result DB. It is a flowchart which shows the data setting process to the payment reason memory | storage part of a payment reason search means. It is a schematic diagram of a case search screen. It is the schematic of a search result list display screen. It is a schematic diagram showing a list of securities related to a specific insured name. It is the schematic which shows the medical certificate list of verification object. It is a flowchart which shows the process of a related insurance policy information detection and display means. It is a schematic diagram which shows the whole display content by a related insurance policy information detection and display means. It is a figure which shows the display part which enables selection and browsing of a medical certificate. It is a figure which shows the display part of a reason keyword.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Payment information integrated server, 2 ... Network, 3 ... User PC, 11 ... Control part, 12 ... Main memory, 13 ... Memory | storage part, 14 ... Interface part, 111 ... Payment reason search means, 112 ... Target policy information extraction Display means 113: Related insurance policy information detection / display means 114 ... Payment possibility verification means 131 ... Medical certificate text DB 132: Medical certificate image DB 133: Medical term DB 134 134 Insurance policy information DB 135: Payment reason storage unit, 136: Verification result DB, 137: Prepaid DB

Claims (9)

A payment information integration system that verifies the possibility of payment for a medical certificate related to insurance policy information,
Provided with a payment information integration server that is accessed via a network from a verifier's terminal device and executes processing,
The payment information integration server includes a storage unit that stores a data group necessary for processing and a processing program, and a control unit that can execute the processing by reading the processing program,
As a data group in the storage unit,
A medical certificate text database for storing medical certificate text data corresponding to the security number;
A medical term database that stores medical terms related to insurance payments;
An insurance policy information database that stores at least the name of the insured person and the insurance contract contents including the target special contract as insurance policy information for each security number;
A paid database that stores the number of securities and benefits that have not been paid due to payment of benefits and benefits,
A payment reason storage generated for the payment reason search;
A verification result database for storing the verification results;
As a function realizing means realized by the control unit,
The medical certificate text data in the medical certificate text database is searched by medical terms in the medical term database, and the information for specifying the medical certificate for each security number is associated with the searched keyword in the payment reason storage unit And stores the insurance policy information corresponding to the policy number from the policy information database, stores the policy information in the payment reason storage unit in association with the policy number, and corresponds to the payment reason with reference to the paid database. Data to be deleted is deleted from the payment reason storage unit, and an instruction to search for a case whose status is unverified for a specific payment reason is input from the terminal device, the specific payment reason is stored in the payment reason storage unit. It is determined whether or not there is a keyword related to the policy, and the identification is performed by referring to the policy information of the policy number with the keyword. Payment reason it is determined whether or not applicable, and the payment reason retrieval means for extracting the matter of the applicable insurance policy,
Target insurance policy information extracting / displaying means for displaying a list of the extracted insurance policy items as a search result;
When a specific case is selected from the list display contents of the search result, the list of securities related to the insured name of the security number of the specific case is displayed and output with reference to the payment reason storage unit. When a security number to be verified is selected from the list, a list of medical certificate cases related to the selected security number is displayed and output when a specific medical certificate case is selected from the list of medical certificate cases Related insurance policy information extraction / display means for displaying and outputting the relevant keyword in the medical certificate together with the payment reason and the special contract,
A payment information integration system, comprising: a payment possibility verification unit that stores a verification result based on contents displayed and output by the related insurance policy information extraction / display unit in the verification result database.   The related insurance policy information extracting / displaying unit displays and outputs the insurance policy information corresponding to the security number by referring to the payment reason storage unit from the selected security number of the specific case. Payment information integration system. The payment reason search means stores the information for identifying the medical certificate in the payment reason storage unit in association with the storage location of the text data of the medical certificate,
The related insurance policy information extraction / display means, when a specific medical certificate item is selected from the list of medical certificate items, accesses the storage location of the medical certificate text data so that the text data of the medical certificate can be viewed. 3. The payment information integration system according to claim 1, wherein an index to be displayed is output. As a data group in the storage unit, a medical certificate image database for storing medical certificate image data corresponding to the security number is provided,
The payment reason search means stores the information for specifying the medical certificate in the payment reason storage unit in association with the storage location of the image data of the medical certificate,
The related insurance policy information extraction / display means, when a specific medical certificate item is selected from the list of medical certificate items, accesses the storage location of the image data of the medical certificate so that the image data of the medical certificate can be viewed. 4. The payment information integration system according to claim 1, wherein an index to be displayed is output.   The related insurance policy information extraction / display means, when an instruction to access the storage location of the text data of the medical certificate displayed in the index or the storage location of the image data of the medical certificate is input from the terminal device, 5. The payment information integration system according to claim 3, wherein data is read from the storage location in the document image database and displayed.   The related insurance policy information extraction / display means reads the insurance policy information corresponding to the policy number by referring to the payment reason storage section from the security number of the selected specific case, and displays the paid information in the policy information separately. The payment information integration system according to claim 1, wherein the payment information integration system is output.   The related insurance policy information extraction / display means, when an instruction to start verification continuous processing is input from the list display contents of the search results, selects items of the security numbers in order in the search results list display contents, When the verification process of the case is completed, the case of the securities number of the next rank in the list display contents of the search result is selected, and the process is repeated until the verification of all the cases displayed in the list is completed. The payment information integration system according to any one of claims 1 to 6. Verification work is done in multiple stages,
The related insurance policy information extracting / displaying means displays the verification result in the previous stage on the display part for inputting the verification result when the result verified in the previous stage is stored in the verification result database. The payment information integration system according to any one of 1 to 7.   Target insurance policy information extraction / display means, when the insured has subscribed to multiple insurance policies in the list display of the search results, displays the security number as the representative security number for the representative insurance policy item The payment information integration system according to claim 1, wherein:

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