JP2013210819A - Factoring device, factoring method, and program - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent a factoring company from suffering a loss.SOLUTION: A factoring device 300 acquires each credit information created at multiple business offices, through a network, and calculates an increase-decrease rate of the number of claims on the basis of the number of credit claims and the number of credit claims shown by the previously-acquired credit information with respect to each business office. Then, the device 300 evaluates a possibility that the credit information is illegal credit information, with respect to each business office, on the basis of the increase-decrease rate of the number of claims, transmits a result of evaluation of illegality to a factoring company through the network, and assists determination of a credit purchase amount.

Description

  The present invention relates to a factoring device, a factoring method, and a program.

  In recent years, as a method for SMEs or the like to raise funds, factoring is used in which advance payment is made on behalf of the receivable based on the credit of the receivable. For example, in the field of long-term care, the introduction of the long-term care insurance system has led private care service providers and social welfare corporations to carry out long-term care services that have been performed by the government. A system has been proposed in which a nursing care provider can easily raise funds by purchasing a paid nursing care fee as a claim by a factoring company and collecting a claim from the National Health Insurance Federation, which is a debtor.

  However, in the field of nursing care, the amount paid on the due date fluctuates depending on the examination results of the National Health Insurance Federation. Therefore, if the conventional factoring business is applied as it is, there is a risk that a factoring company may lose. Therefore, a factoring system that settles the balance of the accounts receivable presented by the operator up to the amount obtained by multiplying a certain amount by the amount in advance according to the advance payment of the purchase price of the accounts receivable. Is generally known (for example, Patent Document 1).

JP 2002-056199 A

  However, in the factoring system described in Patent Document 1, since the upper limit of the purchase price in the factoring company is determined according to the examination result of the National Health Insurance Federation based on the request two months before the claim for the nursing care fee, If fraudulent claims are made in the meantime, the factoring company may not be able to recover the receivables. Therefore, it cannot be said that it is still sufficient from the viewpoint of preventing the loss of the factoring company.

  The present invention has been made in view of the circumstances as described above, and an object of the present invention is to provide a factoring device, a factoring method, and a program capable of preventing a loss in a factoring company.

In order to achieve the above object, a factoring device according to the first aspect of the present invention provides:
A receivable information acquisition means for acquiring receivable information created at a plurality of establishments through a network;
Increase / decrease in the number of claims to be calculated for each establishment by the rate of increase / decrease in the number of claims of claims indicated by the claim information acquired by the claim information acquisition means with respect to the number of claims of claims indicated by the claim information previously acquired by the claim information acquisition means A ratio calculation means;
A fraud evaluation means for evaluating the possibility of the bond information being fraudulent bond information based on the increase / decrease ratio of the number of claims calculated by the number increase / decrease ratio calculation means;
An evaluation transmission means for transmitting the fraud evaluation result evaluated by the fraud evaluation means to a factoring company via a network, and supporting the determination of the purchase price of the bond;
It is characterized by providing.

An amount increase / decrease ratio calculating means for calculating an increase / decrease ratio of a claim amount indicated by the claim information acquired by the claim information acquisition means to a claim amount indicated by the claim information acquired by the claim information acquisition means last time; Prepared,
The fraud evaluation means may determine that the bond information is fraudulent bond information based on the increase / decrease ratio of the number of claims calculated by the number increase / decrease ratio calculation means and the increase / decrease ratio of the charge amount calculated by the amount increase / decrease ratio calculation means. Assessing each site according to predetermined criteria,
You may do it.

Among the plurality of establishments, designated cancellation information acquisition means for acquiring designated cancellation information indicating establishments where claims for claims are restricted, via a network;
The designated cancellation information acquired by the designated cancellation information acquisition means is transmitted to the factoring company via the network, and the designated cancellation information transmission means for supporting the determination of whether or not the bond is purchased,
May be further provided.

Plan information acquisition means for acquiring plan information indicating the number of plan units of services performed at the establishments created at the plurality of establishments, respectively, via a network;
A divergence rate calculating means for calculating a divergence rate between the planned unit number of the service indicated by the plan information acquired by the plan information acquiring means and the actual unit number of the service indicated by the claim information acquired by the claim information acquiring means;
A performance evaluation means for evaluating the performance of the plan for each establishment based on the deviation rate calculated by the deviation calculation means according to a predetermined definition;
The evaluation transmission means transmits the fraud evaluation result evaluated by the fraud evaluation means and the result evaluation result evaluated by the performance evaluation means to a factoring company via a network to assist in determining the purchase price of the bond. ,
You may do it.

In order to achieve the above object, a factoring method according to a second aspect of the present invention includes:
Receivable information acquisition step for acquiring receivable information created at a plurality of establishments through a network,
Increase / decrease in the number of claims to be calculated for each establishment by the rate of increase / decrease in the number of claims for claims indicated by the claim information acquired in the claim information acquisition step with respect to the number of claims for claims indicated by the claim information acquired last time in the claim information acquisition step A percentage calculation step;
A fraud evaluation step for evaluating the possibility of the bond information being fraudulent bond information based on the increase / decrease ratio of the number of claims calculated in the number increase / decrease ratio calculation step;
Sending the fraud evaluation result evaluated in the fraud evaluation step to a factoring company via a network, and an evaluation transmission step for supporting the determination of the purchase price of the bond,
It is characterized by providing.

In order to achieve the above object, a program according to the third aspect of the present invention provides:
Computer
Receivable information acquisition means for acquiring receivable information created at multiple establishments via the network,
Increase / decrease in the number of claims to be calculated for each establishment by the rate of increase / decrease in the number of claims of claims indicated by the claim information acquired by the claim information acquisition means with respect to the number of claims of claims indicated by the claim information previously acquired by the claim information acquisition means Percentage calculation means,
A fraud evaluation means for evaluating, for each establishment, the possibility that the bond information is fraudulent bond information based on the increase / decrease ratio of the number of claims calculated by the number increase / decrease ratio calculation means;
An evaluation transmission means for transmitting the fraud evaluation result evaluated by the fraud evaluation means to a factoring company via a network and supporting the determination of the purchase price of the bond;
It is made to function as.

  According to the present invention, it is possible to prevent a loss from occurring in a factoring company.

It is a block diagram which shows an example of the factoring system which concerns on embodiment of this invention. It is a figure which shows the structural example of establishment DB. It is a figure which shows an example of the nursing care benefit expense description. It is a figure which shows the example of determination of evaluation. It is a figure which shows an example of a payment management slip. It is a figure which shows an example of service classification performance evaluation list information. It is a figure which shows an example of the performance evaluation list according to nursing care establishment. It is a flowchart which shows one procedure of the process of the factoring apparatus in the factoring system which concerns on embodiment of this invention.

  In the present embodiment, an example is shown in which the factoring apparatus of the present invention is applied to a factoring system that is communicably connected to a computer of a nursing care establishment or a computer of a factoring company via a network.

  As shown in FIG. 1, the factoring system 10 includes a plurality of office computers 100, a long-term care insurance claim device 200, a factoring device 300, and a plurality of factoring company computers 400, which can communicate with each other. It is connected to the.

  The office computer 100 is a general computer installed in a nursing care office, and includes a storage unit 110, a control unit 120, an input unit 130, a communication unit 140, and a system bus 150 that interconnects them. And. The business office computer 100 creates a long-term care benefit statement showing a bill for claiming a long-term care insurance and a benefit management slip indicating a plan of a long-term care service performed at the long-term care business, and the long-term care insurance via the network. A function of transmitting to the billing apparatus 200 is provided.

  The storage unit 110 includes a hard disk, a memory, and the like, and stores application programs. The application program is software having a function of executing a work executed on the office computer 100 by a user of the office.

  The control unit 120 includes a CPU (Central Processing Unit) and the like. The control unit 120 operates according to the application program stored in the storage unit 110 and executes processing according to the application program.

  The input unit 130 includes a keyboard, a mouse, a camera, a microphone, and the like, and is a device for inputting data. By the input operation to the input unit 130 by the user of the care establishment,

  The communication unit 140 has a serial interface or an analog interface for receiving an analog signal. The communication unit 140 communicates with the care insurance claim device 200 under the control of the control unit 120.

  The long-term care insurance claiming device 200 has a function of acquiring a long-term care benefit statement and a benefit management slip transmitted from the office computer 100, and transmitting them to the National Health Insurance Federation (not shown) and a function of transmitting them to the factoring device 300. .

  The long-term care insurance claim apparatus 200 is a general computer, and includes a storage unit 210, a control unit 220, an input unit 230, a communication unit 240, and a system bus 250 that interconnects them.

  The storage unit 210 includes a hard disk, a memory, and the like, and stores application programs. The application program is a program in which a series of processes for realizing a function of transmitting a nursing care benefit expense statement and a benefit management slip is described.

  The control unit 220 includes a CPU and the like. The control unit 220 operates according to the application program stored in the storage unit 210 and executes processing according to the application program.

  The input unit 230 includes a keyboard, a mouse, a camera, a microphone, and the like, and is a device for inputting data.

  The communication unit 240 has a serial interface or an analog interface for receiving an analog signal. The communication unit 240 communicates with the factoring device 300 and a National Health Insurance computer under the control of the control unit 220.

  The factoring device 300 is a general computer, and includes a storage unit 310, a control unit 320, an input unit 330, a communication unit 340, and a system bus 350 that connects these components to each other. The factoring device 300 is connected to a computer of a prefecture (not shown) via a network.

  The storage unit 310 includes a hard disk, a memory, and the like, and stores a business establishment DB and a program. As shown in FIG. 2, the business establishment DB is a table in which business establishment numbers determined for each business establishment and business establishment names are associated with each other. Returning to FIG. 1, in the storage unit 310, the nursing care benefit expense statement and the benefit management slip transmitted from the nursing care insurance claim apparatus 200 are stored in association with each other on a monthly basis. Furthermore, although not shown in the figure, the storage unit 310 stores the number of charges increased / decreased and the amount of increase / decrease in the amount of bill calculated by the function of the billing comparison unit 321 to be described later. The determination result determined by the result determination unit 322 is stored on a monthly basis.

  The control unit 320 includes a CPU and the like. The control unit 220 operates according to the program stored in the storage unit 210 and executes processing according to the program. The control unit 320 includes, as main functional units provided by the program, a billing comparison unit 321, a billing comparison result determination unit 322, a designated cancellation information acquisition unit 323, a performance comparison unit 324, and a performance comparison result determination unit 325. And a transmission unit 326.

  The claim comparison unit 321 sends the long-term care benefit expense statement as shown in FIG. 3 transmitted from the long-term care insurance claim device 200, and the long-term care benefit cost transmitted from the previous long-term care insurance claim device 200 and stored in the storage unit 310. Compared with the description, the increase / decrease ratio of the number of claims and the increase / decrease ratio of the charge amount are calculated. Regarding the increase / decrease rate of the number of claims, for example, the value in the third column (identification number) in the third column of the nursing care benefit statement acquired this time is the value in the ninth column (the current number of claims) and the previous time Based on the value in the ninth column (the previous number of claims) in the row where the value in the third column of the acquired nursing care benefit statement is “7111,” the number of claims increase / decrease ratio is calculated.

  Specifically, by subtracting the previous number of claims from the current number of claims, calculate the subtracted value of the number of claims, divide the subtracted number of claims by the previous number of claims, and multiply by 100. Calculate the rate of increase or decrease in the number of claims. If the sign of the calculated increase / decrease rate of the number of claims is negative, the increase / decrease rate of the number of claims indicates a decrease rate of the number of claims.

  On the other hand, regarding the increase / decrease rate of the invoiced amount, for example, the value (insurance invoice amount) in the 12th column of the row where the value (identification number) in the third column of the nursing care benefit statement acquired this time is “7111” Total value (current invoice amount) of the value in the 13th column (invoiced for public expenses), the value in the 19th column (invoiced amount for specified resident public expenses), and the value in the 20th column (invoiced amount for specified resident insurance) (Insurance Claim Amount), 13th Column Value (Public Expense Charge), and 19th Column Value (Specified Resident Public Expense Claim Amount) for the row where the value in the third column of the acquired nursing care benefit statement is “7111” ) And the total value (previous charge amount) of the 20th column value (specific resident insurance claim amount), the charge amount increase / decrease ratio for each establishment is calculated. Specifically, the billing amount increase / decrease ratio is calculated by calculating the billing amount subtraction value obtained by subtracting the previous summation value from the current summation value, dividing the billing amount subtraction value by the previous billing amount and multiplying by 100. Is calculated. The billing amount increase / decrease rate indicates a billing amount decrease rate if the sign of the calculated billing amount increase / decrease rate is negative, and if it is positive, it indicates a billing amount increase rate.

  The billing comparison result determination unit 322 determines one of three predetermined evaluations based on the billing number increase / decrease rate and the billing amount increase / decrease rate calculated by the billing comparison unit 321, The number and the evaluation result are associated with each other (evaluation information) and stored in the storage unit 310 for each office. In this embodiment, for example, as shown in FIG. 4, three-stage evaluations such as “A evaluation”, “B evaluation”, and “C evaluation” are preset. This indicates that there is a high possibility of fraudulent charges in the order of “A evaluation”, “B evaluation”, and “C evaluation”. “A evaluation” is assigned a value such that the absolute value of the increase / decrease rate of the number of claims is 3 or less and the absolute value of the increase / decrease rate of the charge amount is 5 or less. The “B evaluation” is assigned a value such that the absolute value of the increase / decrease rate of the number of claims is 4 to 10 and the absolute value of the increase / decrease rate of the charge amount is 6 to 15. A value such as an absolute value of the billing number increase / decrease ratio of 11 or more, or an absolute value of the billing amount increase / decrease ratio of 16 or more is assigned to “C evaluation”.

  The designated revocation information acquisition unit 323 obtains designated revocation information from a prefectural computer or the like via a network. The designated revocation information is information indicating a list of care providers that have been canceled by the care providers in accordance with the audit guidance network in each prefecture.

  The result comparison unit 324 compares the care benefit cost statement as shown in FIG. 3 transmitted from the care insurance claim apparatus 200 with the benefit management slip as shown in FIG. The deviation rate is calculated for each care service of the care provider. The divergence rate is, for example, the value in the 13th column of the row (total information record) in which the value (record type code) in the 4th column of the care benefit expense statement transmitted from the care insurance claiming device 200 is “10”. The actual unit number obtained by subtracting (the number of units not subject to limit management) from the value in the 16th column (total number of insurance units) is calculated from the value in the 5th column (service provision month) of the total information record and the current nursing care insurance claim device 200. The value of the fourth column (target month) of the sent benefit management slip, the value of the sixth column (establishment number) of the summary information record, the value of the 18th column (establishment number) of the benefit management slip, and the summary information The value in the seventh column of the record (insurer number listed on the certificate) and the value in the fifth column of the benefit management slip (insurer number), the value in the eighth column of the summary information record (insured number) and the benefits management slip 11th column value (insured number The value in the 21st column (planning unit) of the benefit management slip in the row in which the value in the 9th column (service type code) in the total information record and the value in the 20th column (service type code) in the benefit management slip all match Calculate by dividing by (number). Since care is performed by combining a plurality of services, service contents at a plurality of business establishments as well as a single business establishment are listed in the benefit management slip. In addition, the number of service units is shown on the benefit management slip. Also, the divergence rate is calculated in units of service at the establishment.

  For example, in the case of the illustrated example, as shown in FIG. 3, the total number of insurance units in the aggregate information record is “3988” and the number of units not subject to limit management is “653”. “3335”. On the other hand, as shown in FIG. 5, the number of planned units shown in the row of the benefit management slip that matches the above items of the total information record is “3335”. Therefore, in this example, the deviation rate is “1”.

  Then, a calculation result list in which the calculated divergence rate is associated with the service provision date, the establishment number, the insured number, and the service type code is generated and stored in the storage unit 310.

  The performance comparison result determination unit 325 determines the performance evaluation for the plan based on the calculation result list generated by the performance comparison unit 324. For example, when the average divergence rate is “1” or less, A evaluation is given, and when it exceeds “1”, B evaluation is given. Then, the result comparison result determination unit 325 creates service type result evaluation list information indicating a list of evaluations for each care service type of the care provider and a result evaluation list for each care facility, and stores the information in the storage unit 310. In addition, A evaluation has shown that possibility that the fraudulent claim is not performed is higher than B evaluation (Hereafter, A evaluation and B evaluation are the same).

  Specifically, the result comparison result determination unit 325 aggregates the divergence rate of the lines where the service provision date and the establishment number in the calculation result list are common to each service type code, and the number of lines where the service type code is common. The average value for each service type code is calculated by dividing the total value. When the average value is “1” or less, the evaluation result is determined as A evaluation, and when it exceeds “1”, the evaluation result is determined, and the evaluation result is associated with the establishment number and the service type code. The service type performance evaluation list information as shown in FIG. 6 is generated and stored in the storage unit 310.

  Subsequently, the result comparison result determination unit 325 generates a care facility-based result evaluation list according to the evaluation indicated in the service type result evaluation list information and stores it in the storage unit 310. Specifically, the result comparison result determination unit 325 sets the B evaluation if there is even one B evaluation among the evaluation results having the same establishment number in the service type result evaluation list information, and if only the A evaluation is provided. As A evaluation, the evaluation result according to establishment is determined. Then, the determined evaluation result is associated with the establishment number, and a result evaluation list for each care establishment as shown in FIG. 7 is generated.

  The transmission unit 326 includes the evaluation information determined by the billing comparison result determination unit 322, the specified cancellation information acquired by the specified cancellation information acquisition unit 323, and the service type actual evaluation list information generated by the actual comparison result determination unit 325. And a list of performance evaluations by nursing care establishment and (various information) are transmitted to the factoring company computer 400 via the communication unit 340 described later. As a result, the factoring company determines whether or not to pay, the upper limit amount, etc., based on the acquired various information.

  The input unit 330 includes a keyboard, a mouse, a camera, a microphone, and the like, and is a device for inputting data.

  The communication unit 340 has a serial interface or an analog interface for receiving an analog signal. The communication unit 340 communicates with prefecture computers and factoring company computers 400 under the control of the control unit 320.

  The factoring company computer 400 is a general computer installed in a financial institution such as a bank, for example. The storage unit 410, the control unit 420, the input unit 430, and the communication unit 440 are connected to each other. System bus 450. The factoring company computer 400 is a computer of an institution that purchases, as a claim, a care fee charged to the National Health Insurance Federation by the care establishment based on the claim of the care establishment, and based on various information transmitted from the factoring device 300, Whether to buy or not, and the purchase price.

  The storage unit 410 includes a hard disk, a memory, and the like, and stores application programs. The application program is software having a function of performing a task executed by the user of the factoring company on the factoring company computer 400.

  The control unit 420 includes a CPU (Central Processing Unit) and the like. The control unit 420 operates according to the application program stored in the storage unit 410 and executes processing according to the application program.

  The input unit 430 includes a keyboard, a mouse, a camera, a microphone, and the like, and is a device for inputting data.

  The communication unit 440 has a serial interface or an analog interface for receiving an analog signal. The communication unit 440 communicates with the factoring device 300 under the control of the control unit 420.

  The above is the configuration of the factoring system 10. Next, the overall operation of the factoring system 10 will be described focusing on the operation of the factoring device 300. First, the flow of insurance claims will be briefly explained.

  Under the Nursing Care Insurance System, National Health Insurance 40 pays 90% of the compensation for nursing care services provided by Nursing Care Service Provider 20 to users who are covered by Nursing Care Insurance, and the user bears the remaining 10%. It is supposed to be. In order to receive 90% of the insurance benefits from the National Health Insurance Federation, the nursing care facility provides a detailed statement of the nursing care benefits as a detailed description of the contents of the provided nursing care services, a benefit management slip indicating the plan of the nursing care services to be provided, etc. Submit to the National Health Insurance Federation as a claim for nursing care receivables. The National Health Insurance Federation examines the details of the nursing care benefit statement submitted and the benefits management slip, and provides insurance benefits only for those that pass the examination. It usually takes a little less than two months from submitting the long-term care benefit statement and the benefit management slip until insurance benefits are actually provided.

  The factoring business takes care care receivables held by the nursing care service establishment by the factoring company and prepays 70 to 80% of the purchased funds to the nursing care service establishment before the due date of the claim. This service supports the funding of service establishments. In the long-term care insurance system, only the amount that passed the examination is paid by the National Health Insurance Federation, so there is a possibility that the amount according to the Nursing Care Expense Statement submitted by the Long-Term Care Service Office may not be paid by the National Health Insurance Federation. Therefore, in order to prevent loss of the factoring company, the upper limit of the prepayment is suppressed to 70 to 80% of the purchase amount of the receivable.

  Nursing care receivables are public institutions with high creditworthiness by the debtor (National Health Insurance Federation), so the debtor risk is close to zero, and there are few concerns about debt collection, but the process of creating the billing information is artificial. If there is a mistake or a fraudulent claim based on malicious intent, payment of the amount corresponding to the billing information may not be received from the National Health Insurance Federation. In addition, since the upper limit of the purchase amount of receivables is determined based on the past examination results of the National Health Insurance Federation, it will be determined based on information less than two months ago, which will prevent damage to the factoring company. From the point of view, it was still not enough.

  Therefore, the factoring device 300 according to the present embodiment operates to avoid the risk of the factoring company by performing a predetermined evaluation based on the latest information and providing the evaluation information to the factoring company. Each time the factoring device 300 acquires the long-term care benefit statement and the benefit management slip from the long-term care insurance claim device 200 after the long-term care benefit bill and the benefit management slip are transmitted from the office computer 100 to the long-term care insurance billing device 200. In addition, the factoring apparatus 300 starts processing. The factoring device 300 compares the care benefit expense statement transmitted last time with the care benefit expense statement sent this time to determine the evaluation, the care benefit expense statement sent this time, A performance evaluation process for evaluating whether or not a nursing care service as planned is performed based on the benefit management slip, and a designated cancellation information acquisition process for acquiring designated cancellation information are executed.

  First, the factoring device 300 executes a specification evaluation determination process. As shown in FIG. 8, the factoring device 300 transmits the long-term care benefit statement transmitted from the long-term care insurance claim device 200 by the function of the claim comparison unit 321, transmitted from the previous long-term care insurance claim device 200 to the storage unit 310. An increase / decrease ratio of the number of claims is calculated in comparison with the stored nursing care benefit statement (step S101). Subsequently, the factoring device 300 compares the care benefit expense statement transmitted from the care insurance claim device 200 with the care benefit expense statement transmitted from the previous care insurance claim device 200 and stored in the storage unit 310. The charge amount increase / decrease ratio is calculated (step S102).

  Then, the function of the claim comparison result determination unit 322 determines whether or not the calculated absolute value of the increase / decrease rate of the number of claims is 3 or less (step S103). When it is determined that it is 3 or less (step S103; Yes), it is determined whether or not the absolute value of the billing amount increase / decrease ratio is 5 or less (step S104). When it determines with it being 5 or less (step S104; Yes), an evaluation result is determined as A evaluation (step S105). On the other hand, if it is determined in step S103 that 3 is exceeded (step S103; No), or if it is determined in step S104 that it exceeds 5 (step S104; No), the absolute value of the number of claims increase / decrease ratio is It is determined whether it is 4 to 10 (step S106). When it is determined that it is 4 to 10 (step S106; Yes), it is determined whether or not the absolute value of the billing amount increase / decrease ratio is 6 to 15 (step S107). When it determines with it being 6-15 (step S107; Yes), an evaluation result is determined as B evaluation (step S108). On the other hand, if it is determined in step S106 that it exceeds 10 (step S106; No), or if it is determined that it exceeds 15 in step S107 (step S107; No), the evaluation result is determined as C evaluation (step S107). S109).

  After executing any one of steps S105, S108, and S109, the factoring apparatus 300 associates the determined evaluation result with the establishment number and stores it as evaluation information in the storage unit 310 (step S110).

  Next, the factoring device 300 executes a performance evaluation process. The factoring device 300 uses the function of the performance comparison unit 324 to compare the nursing care benefit cost statement transmitted from the nursing care insurance claim device 200 with the benefit management slip, and to determine the rate of difference between the nursing care plan and the nursing care result. It calculates for every care service of a person (Step S111). Then, a calculation result list in which the calculated divergence rate is associated with the service provision date, the establishment number, the insured number, and the service type code is generated (step S112) and stored in the storage unit 310.

  Subsequently, the factoring device 300 aggregates the divergence rates of the lines having the same service provision date and establishment number in the calculation result list by service type code by the function of the result comparison result determination unit 325 (step S113). Then, the average value for each service type code is calculated by dividing the total value by the number of rows with the same service type code (step S114), and it is determined whether or not it is equal to or less than “1” (step S115). ). When it determines with it being "1" or less (step S115; Yes), it determines as A evaluation (step S116). On the other hand, when it determines with exceeding "1" (step S115; No), it determines as B evaluation (step S117). Then, service type performance evaluation list information is generated in association with the establishment number and service type code determined in step S116 or S117 (step S118) and stored in the storage unit 310.

  Next, the factoring apparatus 300 sets the B evaluation if there is at least one B evaluation among the evaluation results having the same establishment number in the service type performance evaluation list information, and determines the A evaluation if only the A evaluation is performed. The evaluation result for each place is determined (step S119). Then, the evaluation result for each business establishment is associated with the business establishment number, and a performance evaluation list for each care establishment is generated (step S120) and stored in the storage unit 310.

  Thereafter, designated cancellation information acquisition processing is executed. The factoring device 300 acquires specified cancellation information from a computer in a prefecture or the like via a network by the function of the specified cancellation information acquisition unit 323 (step S121), and stores it in the storage unit 310.

  Then, the factoring device 300 includes the evaluation information stored in the storage unit 310 by the specification evaluation determination process, the service type result evaluation list information stored in the storage unit 310 by the result evaluation process, and the result evaluation list for each care establishment, designated The designated revocation information stored in the storage unit 310 by the revocation information acquisition process (various information) is transmitted to the factoring company computer 400 via the communication unit 340 (step S122), and the process ends.

  The factoring company computer 400 obtains the evaluation information, the service type performance evaluation list information, the nursing care establishment performance evaluation list, and the designated cancellation information transmitted from the factoring device 300, and based on these information, whether or not the receivable has been purchased or purchased. Determine the amount of money. For example, for claims from establishments listed in the designated cancellation information, do not purchase receivables. For establishments with a B rating in the list of performance evaluations by nursing care establishment, evaluation information, service type performance evaluation The upper limit amount may be determined based on the list information.

  The above is the operation centering on the factoring device 300 in the factoring system 10. As described above, the factoring device 300 according to the present embodiment compares the most recent long-term care benefit expense specifications with the specification evaluation determination process and provides the evaluation result to the factoring company. Even when billed. It is possible to prevent loss in the factoring company. In addition, according to the factoring device 300 according to the present embodiment, the National Health Insurance Federation, such as whether or not the nursing care service is performed as planned based on the nursing care benefit expense statement and the benefit management slip by the performance evaluation process. It is possible to perform a simplified screening and to provide a factoring company with service type performance evaluation list information indicating a screening result and a performance evaluation list for each care establishment. Therefore, the factoring company can determine the upper limit of the purchase amount of the bond based on information with higher reliability. Furthermore, since the factoring device 300 according to the present embodiment provides the designated revocation information to the factoring company, it is possible not to purchase the receivable in response to the request from the care provider that has been canceled. .

(Modification)
The present invention is not limited to the above-described embodiment, and various modifications and applications are possible. In the above embodiment, based on the fact that the factoring device 300 has acquired the long-term care benefit statement and the benefit management slip from the long-term care insurance claim device 200, the detailed statement evaluation determination processing, the performance evaluation processing, and the designated cancellation information acquisition processing Although an example in which each process is executed in order is shown, this is an example. Each of the specification evaluation determination process, the performance evaluation process, and the designated cancellation information acquisition process may be executed in parallel. In addition, for example, the statement evaluation determination process and the performance evaluation process are executed every time the care benefit cost statement and the benefit management slip are acquired, and the designated cancellation information acquisition process is executed every predetermined period. It may be. Also, the timing for transmitting various information to the factoring company computer does not have to be transmitted at the same time, and may be transmitted in the order of generation or acquisition.

  In the above-described embodiment, an example in which one of three predetermined evaluations is determined based on the number-of-charges increase / decrease ratio or the charge amount increase / decrease ratio calculated by the claim comparison unit 321 has been described. This is an example. The predetermined evaluation may be 5 levels or 10 levels, may be arbitrary, and may be changeable. Further, statistical data of past examination results of National Health Insurance Federations may be acquired and evaluated based on the acquired statistical data. Moreover, although the example which determines an evaluation result based on the claim number increase / decrease ratio and the charge amount increase / decrease ratio has been shown in the above embodiment, the evaluation result is determined separately for the claim number increase / decrease ratio and the charge amount increase / decrease ratio. It may be.

  Moreover, in the said embodiment, although the function of the claim comparison result determination part 322 showed the example which determines an evaluation result based on the absolute value of the bill number increase / decrease ratio calculated this time and the absolute value of the charge amount increase / decrease ratio, This is an example. For example, memorize the number of claims increase / decrease ratio calculated in the past and the ratio of increase / decrease in charge amount, and the absolute value of the ratio of increase / decrease in the number of claims for the past three times and the amount of increase / decrease ratio of the charge amount both exceed 10. In the past, C evaluation, B evaluation when the absolute value for 3 times is 5 to 9, and A evaluation when the absolute value for 3 times are 1 to 4 are calculated in the past. The evaluation result may be calculated based on the increased / decreased charge number ratio or the charged amount increase / decrease ratio.

  In the above-described embodiment, an example in which designated cancellation information obtained from a computer in a prefecture is provided as it is to a factoring company is shown, but this is an example. The designated revocation information indicates a care provider that has been canceled by the prefecture, either by its establishment number or establishment name. Therefore, when the business location identification table in which the business location number and the business location name are associated with each other is stored in advance in the storage unit 310 and only the business location number is described in the designated cancellation information, the business location number is stored. If the establishment name is specified from the establishment identification table and only the establishment name is described in the designated revocation information, the establishment is identified from the establishment identification table based on the establishment name. Identify the number. Then, the establishment number and the establishment name may be associated with each other and provided to the factoring company.

  In the said embodiment, although the example which calculates the average value according to service kind code | cord | chord with the function of the performance comparison result determination part 325 was shown, this is an example. For example, with respect to all the deviation rates shown in the calculation result list generated by the performance comparison unit 324, if it is “1” or less, it is A evaluation, and if it exceeds “1”, it is B evaluation. Among the evaluations of the same service type code, if there is only one B evaluation, the B evaluation may be generated, and if all the A evaluations, the service type performance evaluation list information may be generated as the A evaluation. If the number of B evaluations is a predetermined number (for example, 4) or more, B evaluation may be generated, and if it is less than that number, service type performance evaluation list information may be generated as A evaluation.

  Moreover, in the said embodiment, in producing | generating the performance evaluation list according to nursing care establishment, if there is even one B evaluation among the evaluation results with the same establishment number of service type performance evaluation list information, it will be set as B evaluation. In the case of only A evaluation, an example of A evaluation is shown, but this is an example. For example, if the number of B evaluations indicated in the service type performance evaluation list information is equal to or greater than a predetermined number (for example, “4”), the evaluation of the nursing care establishment performance evaluation list is set as B evaluation, and less than that number If there is, A evaluation may be made. In addition, for example, the ratio of the B evaluation with respect to the total number of evaluations in the service type performance evaluation list information is calculated. If this ratio is less than a predetermined value, the evaluation of the performance evaluation list for each care establishment is set as the A evaluation. Otherwise, B evaluation may be used.

  In the above embodiment, the evaluation shown in the service type performance evaluation list information and the evaluation shown in the performance evaluation list for each care establishment are shown as two-stage evaluations of A evaluation and B evaluation. This is an example. The evaluation shown in the service type performance evaluation list information and the evaluation shown in the performance evaluation list for each nursing care facility do not have to be two-level evaluations, and are all three-level evaluations and five-level evaluations. Well, it is optional. Further, the evaluation stage may be different, such as evaluation in which one of the two stages and the other three stages. In this case, the evaluation stage may be an arbitrary stage.

  In the above-described embodiment, an example in which the nursing care benefit expense statement and the benefit management slip are transmitted from the nursing care insurance claiming device 200 to the factoring device 300 is shown as an example. The factoring device 300 may have the function of the long-term care insurance claim device 200. In this case, it is only necessary that the nursing care benefit statement and the benefit management slip are transmitted from the establishment computer 100 to the factoring device 300.

  Further, when the above-described functions are realized by sharing between an OS (Operating System) and an application, or by cooperation between the OS and the application, only a part other than the OS may be stored in the medium.

  It is also possible to superimpose a program on a carrier wave and distribute it via a communication network. For example, the program may be posted on a bulletin board (BBS, Bulletin Board System) on a communication network, and the program may be distributed via the network. Then, the above-described processing may be executed by starting these programs and executing them in the same manner as other application programs under the control of the operating system.

DESCRIPTION OF SYMBOLS 10 factoring system 100 establishment computer 110 memory | storage part 120 control part 130 input part 140 communication part 150 system bus 200 care insurance claim apparatus 210 memory | storage part 220 control part 230 input part 240 communication part 250 system bus 300 factoring apparatus 310 memory | storage part 320 control Unit 321 claim comparison unit 322 claim comparison result determination unit 323 designation cancellation information acquisition unit 324 result comparison unit 325 result comparison result determination unit 326 transmission unit 330 input unit 340 communication unit 350 system bus 400 factoring company computer 410 storage unit 420 control unit 430 Input unit 440 Communication unit 450 System bus

Claims (6)

A receivable information acquisition means for acquiring receivable information created at a plurality of establishments through a network;
Increase / decrease in the number of claims to be calculated for each establishment by the rate of increase / decrease in the number of claims of claims indicated by the claim information acquired by the claim information acquisition means with respect to the number of claims of claims indicated by the claim information previously acquired by the claim information acquisition means A ratio calculation means;
A fraud evaluation means for evaluating the possibility of the bond information being fraudulent bond information based on the increase / decrease ratio of the number of claims calculated by the number increase / decrease ratio calculation means;
An evaluation transmission means for transmitting the fraud evaluation result evaluated by the fraud evaluation means to a factoring company via a network, and supporting the determination of the purchase price of the bond;
A factoring device comprising: An amount increase / decrease ratio calculating means for calculating an increase / decrease ratio of a claim amount indicated by the claim information acquired by the claim information acquisition means to a claim amount indicated by the claim information acquired by the claim information acquisition means last time; Prepared,
The fraud evaluation means may determine that the bond information is fraudulent bond information based on the increase / decrease ratio of the number of claims calculated by the number increase / decrease ratio calculation means and the increase / decrease ratio of the charge amount calculated by the amount increase / decrease ratio calculation means. Assessing each site according to predetermined criteria,
The factoring apparatus according to claim 1, wherein: Among the plurality of establishments, designated cancellation information acquisition means for acquiring designated cancellation information indicating establishments where claims for claims are restricted, via a network;
The designated cancellation information acquired by the designated cancellation information acquisition means is transmitted to the factoring company via the network, and the designated cancellation information transmission means for supporting the determination of whether or not the bond is purchased,
The factoring device according to claim 1, further comprising: Plan information acquisition means for acquiring plan information indicating the number of plan units of services performed at the establishments created at the plurality of establishments, respectively, via a network;
A divergence rate calculating means for calculating a divergence rate between the planned unit number of the service indicated by the plan information acquired by the plan information acquiring means and the actual unit number of the service indicated by the claim information acquired by the claim information acquiring means;
A performance evaluation means for evaluating the performance of the plan for each establishment based on the deviation rate calculated by the deviation calculation means according to a predetermined definition;
The evaluation transmission means transmits the fraud evaluation result evaluated by the fraud evaluation means and the result evaluation result evaluated by the performance evaluation means to a factoring company via a network to assist in determining the purchase price of the bond. ,
The factoring device according to any one of claims 1 to 3, wherein the factoring device is provided. Receivable information acquisition step for acquiring receivable information created at a plurality of establishments through a network,
Increase / decrease in the number of claims to be calculated for each establishment by the rate of increase / decrease in the number of claims for claims indicated by the claim information acquired in the claim information acquisition step with respect to the number of claims for claims indicated by the claim information acquired last time in the claim information acquisition step A percentage calculation step;
A fraud evaluation step for evaluating the possibility of the bond information being fraudulent bond information based on the increase / decrease ratio of the number of claims calculated in the number increase / decrease ratio calculation step;
Sending the fraud evaluation result evaluated in the fraud evaluation step to a factoring company via a network, and an evaluation transmission step for supporting the determination of the purchase price of the bond,
A factoring method comprising: Computer
Receivable information acquisition means for acquiring receivable information created at multiple establishments via the network,
Increase / decrease in the number of claims to be calculated for each establishment by the rate of increase / decrease in the number of claims of claims indicated by the claim information acquired by the claim information acquisition means with respect to the number of claims of claims indicated by the claim information previously acquired by the claim information acquisition means Percentage calculation means,
A fraud evaluation means for evaluating, for each establishment, the possibility that the bond information is fraudulent bond information based on the increase / decrease ratio of the number of claims calculated by the number increase / decrease ratio calculation means;
An evaluation transmission means for transmitting the fraud evaluation result evaluated by the fraud evaluation means to a factoring company via a network and supporting the determination of the purchase price of the bond;
A program characterized by functioning as

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