JP2022129452A - Insurance claim agency device, insurance claim agency system, insurance claim agency method, insurance claim agency program, and recording medium - Google Patents

Abstract

To provides an insurance claim agency device, an insurance claim agency system, an insurance claim agency method, a program, and a recording medium that make insurance claim procedures more efficient and enable smooth insurance claims.SOLUTION: In an insurance claim agency system, an insurance claim agency server includes: a reception unit that receives an insurance claim from a user terminal of a user of insurance claim agency services to a specific insurance company and acquires required billing items; a contract content acquisition unit that communicates with an insurance company system of a billing destination insurance company based on the required billing items to acquire contract contents related to the claim; a required document specifying unit that specifies documents required to be submitted to the insurance company when making the claim based on the required billing items and the contract contents; a document request transmitting unit that transmits to the outside a request for transmission of each of one or more required documents specified by the required document specifying unit; a document receiving unit that receives the required document from the outside; and a claim processing unit that transmits claim information including the required documents and the required billing items to the insurance company system and performs claim processing.SELECTED DRAWING: Figure 1

Description

The present invention relates to an insurance claim agency device, an insurance claim agency system, an insurance claim agency method, an insurance claim agency program, and a recording medium.

Techniques are known for providing a service for performing insurance claim procedures on behalf of an insured person to an insurance company.

For example, Cited Document 1 discloses a life insurance processing system that requests a hospital to issue a medical certificate and instructs the hospital to send the medical certificate regardless of whether the medical certificate is required.

JP 2002-56188

In an actual insurance claim, the required documents differ depending on the content of the contract and the content of the claim, and it is often difficult for the user to understand which documents are required. As a result, the user may have to prepare or send documents repeatedly due to lack of documents, and the problem is that the procedure for claiming insurance claims is complicated. In addition, there is a possibility that users and medical institutions will have to prepare unnecessary documents, and there have been problems such as inefficiencies in procedures related to insurance claims.

The present invention has been made in view of the above points, and realizes smooth insurance claims by reducing the labor burden on users and medical institutions involved in claiming insurance claims, streamlining insurance claim procedures. It is an object of the present invention to provide an insurance claim agency device, an insurance claim agency system, an insurance claim agency method, an insurance claim agency program, and a recording medium, which make it possible.

The insurance claim agency apparatus of the present invention accepts a claim for insurance against a specific insurance company from a user terminal used by a user of an insurance claim agency service, and collects necessary billing information indicating the items necessary for the claim. A contract content acquisition unit that acquires the contract content related to the claim by communicating between the reception unit that acquires the contract content and the insurance company system owned by the insurance company to which the claim is made based on the necessary claim items. a required document specifying unit for specifying, as required documents, documents to be submitted to the insurance company for the claim based on the required request items and the contract content; and one or more required documents specified by the required document specifying unit a document request transmitting unit that externally transmits a request for transmission of each of the one or more required documents when the document is specified; a document receiving unit that receives the required document from the external; and a billing processing unit that transmits billing information including the necessary items for billing to the insurance company system and performs billing processing.

The insurance claim agency system of the present invention includes a user terminal used by a user of the insurance claim agency service, an insurance company system owned by an insurance company, a medical institution terminal owned by a medical institution, and the user terminal. and an insurance claim agency device that performs insurance claim agency service by communicating with the insurance company system and the medical institution terminal, wherein the insurance claim agency device is a reception unit for receiving an insurance claim to a specific insurance company from a user terminal used by a user of the insurance claim agency service and acquiring necessary billing information indicating the necessary items for the claim; a contract content acquisition unit that acquires the contract content related to the claim by communicating with an insurance company system owned by the insurance company to which the claim is made based on the items; a required document specifying unit for specifying documents to be submitted to the insurance company as required documents based on the content of the request; a document request transmitting unit for transmitting a request for transmission of each of one or more required documents to the outside; a document receiving unit for receiving the required documents from the outside; and request information including the required items for request together with the required documents to the insurance company system to perform claim processing.

An insurance claim proxy method of the present invention is an insurance claim proxy method performed by an insurance claim proxy device, in which a reception unit receives a specific insurance claim from a user terminal used by a user of the insurance claim proxy service. a receiving step of receiving an insurance claim against a company and obtaining necessary billing items indicating items necessary for the claim; a contract content acquisition step of communicating with an insurance company system held by to acquire the contract content related to the claim; a required document specifying step of specifying documents that need to be submitted to the insurance company as required documents; a document request transmission step of transmitting to the outside a request for transmission of each of the required documents of; a document reception step of receiving the required documents from the outside by the document receiving unit; and a billing processing step of transmitting billing information including the billing necessary items to the insurance company system and performing billing processing.

An insurance claim agency program according to the present invention is an insurance claim agency program executed by an insurance claim agency device provided with a computer. a receiving step of receiving an insurance claim to a specific insurance company and obtaining necessary billing information indicating items necessary for said billing; a contract content acquisition step of communicating with an insurance company system to acquire the contract content related to the claim; a required document specifying step of specifying a certain document as a required document; and when one or more required documents are specified by the required document specifying unit, sending a request for transmission of each of the one or more required documents to the outside. A document request transmission step for transmission, a document reception step for receiving the necessary documents from the outside, and a billing processing step for transmitting billing information including the billing necessary items together with the necessary documents to the insurance company system for billing processing. and is characterized by executing

1 is a diagram showing the configuration of an insurance claim representation system 10 according to an embodiment; FIG. 1 is a functional block diagram showing the configuration of an insurance claim agency apparatus according to an embodiment; FIG. It is a figure which shows an example of the table which shows the user information which concerns on an Example. FIG. 4 is a diagram showing an example of billing requirements according to the embodiment; It is a figure which shows an example of the table which shows the transaction management information which concerns on an Example. 1 is a functional block diagram showing the configuration of an insurance company system according to an embodiment; FIG. It is a figure which shows an example of the table which shows the customer contract information which concerns on an Example. 4 is a flow chart showing an example of a routine executed by the insurance claim representation server device according to the embodiment; 4 is a flow chart showing an example of a routine executed by the insurance claim representation server device according to the embodiment; 4 is a flow chart showing an example of a subroutine executed by the insurance claim representation server device according to the embodiment; 4 is a flow chart showing an example of a routine executed by the insurance claim representation server device according to the embodiment; 4 is a flow chart showing an example of a routine executed by the insurance claim representation server device according to the embodiment; 4 is a flow chart showing an example of a routine executed by the insurance claim representation server device according to the embodiment; 1 is a functional block diagram showing the configuration of an insurance claim agency apparatus according to an embodiment; FIG.

Embodiments of the present invention will be described in detail below with reference to the accompanying drawings. In the following description and accompanying drawings, substantially the same or equivalent parts are denoted by the same reference numerals.

FIG. 1 is a diagram showing the configuration of an insurance claim agency system 10 according to an embodiment of the present invention. As shown in FIG. 1, the insurance claim agency system 10 includes an insurance claim agency server 11 as an insurance claim agency device, user terminals 13 (1) to (m) (m is a positive integer), and an insurance company. Systems 15(1) to (n) (n is a positive integer) and medical institution terminals 17(1) to (p) (p is a positive integer) are communicably connected via a network NW. It is a system that

In the insurance claim agency system 10, an insurance claim agency server 11 cooperates with an insurance company and a medical institution to provide insurance claims on behalf of a user of the insurance claim agency service who is an insured person. Conduct claims against specific insurance companies

The network NW can be constructed by Internet communication including wireless communication such as Wi-Fi (registered trademark) and wired communication. A communication protocol such as TCP/IP is used for communication between devices in the insurance claim agency system 10 .

The insurance claim proxy server 11 communicates with user terminals 13(1)-(m), insurance company systems 15(1)-(n), and medical institution terminals 17(1)-(p). It is a server device that performs processing for acting on behalf of a user to claim an insurance claim.

In this embodiment, for example, the insurance claim proxy server 11 acts as a WEB cloud service on the network NW to claim insurance.

User terminals 13(1) to 13(m) are one or a plurality of terminal devices used by users of the insurance claim service. In FIG. 1, each of the m terminal devices included in the user terminals 13(1) to 13(m) is shown connected to the network NW. The number m of terminals included in the user terminals 13(1) to (m) is, for example, the number of users.

Each of the user terminals 13 (1) to (m) has an input unit capable of accepting input operations by the user, and a display unit capable of displaying images such as various input screens or screens containing messages directed to the user. , and a communication unit that communicates with the insurance billing proxy server 11 .

In this embodiment, for example, each of the user terminals 13(1) to (m) is a smart phone possessed by the user. Each of the user terminals 13(1) to 13(m) is not limited to a smart phone, and may be a terminal device including other smart devices such as personal computers, tablets, and wearable devices.

For example, the terminal devices included in the user terminals 13(1) to 13(m) may be configured to allow input of biometric authentication information for user identity verification.

For example, the user sends information such as a name to the insurance claim representation system 10 via the user terminal 13(x) (x is an arbitrary positive integer) (hereinafter also simply referred to as "user terminal 13"). Register in advance. When it becomes necessary to claim an insurance claim, by applying for the use of the service of the insurance claim agency system 10, the insurance claim is requested to the insurance claim agency system 10 and sent to the insurance company. An insurance claim is made indirectly through the insurance claim agency system 10 .

For example, when the user makes an insurance claim, the user authenticates by entering an ID, password, etc. from the operation screen of the user terminal 13(x), and if the authentication is correct, the service menu can be accessed. , the service menu appears on the display screen. For example, when the user selects an insurance claim menu, an insurance claim screen is displayed, and it is possible to input items necessary for claiming insurance. When the user presses the claim button after entering the items necessary for the claim, the necessary claim items indicating the items necessary for the claim are transmitted to the insurance claim agency server 11, and the insurance claim is processed in the insurance claim agency system 10. The processing for acting as an agent for billing is started.

Insurance company systems 15 ( 1 ) to (n) are owned by one or more insurance companies with which the insurance claim representation system 10 has a contract, and are provided for executing information processing related to the insurance claim representation system 10 . It is a system that In each of the insurance company systems 15(1)-(n), the insurance claim proxy server 11 accesses the insurance company systems 15(1)-(n) to inquire about the details of the insurance contract and to make insurance claims on behalf of the user. It is configured to be able to provide an API (Application Programming Interface) for billing money.

For example, the number n of systems included in the insurance company systems 15(1) to (n) corresponds to the number of insurance companies (hereinafter also referred to as contracted insurance companies) that have contracts with the insurance claim agency system 10. is doing. FIG. 1 shows how each of n insurance company systems from insurance company system 15(1) to insurance company system 15(n) is connected to network NW.

Each of the insurance company systems 15(1) to (n) transmits information indicating the specified contract details to the insurance claim proxy server 11 in response to a contract content inquiry request from the insurance claim proxy server 11. do. In addition, each of insurance company systems 15(1)-(n) receives an insurance claim including information and attached documents necessary for claiming insurance from insurance claim agency server 11. FIG.

The medical institution terminals 17(1)-(p) are one or a plurality of terminal devices installed in medical institutions with which the insurance claim representation system 10 is affiliated (hereinafter also referred to as affiliated medical institutions). Medical institution terminals 17(1)-(p) are connected to a network NW.

Each of the medical institution terminals 17 (1) to (p) is a medical certificate/certificate of hospitalization, a certificate of hospitalization/hospitalization, a certificate of hospitalization, a certificate of hospitalization/outpatient, etc. (hereinafter simply referred to as "diagnostic certificate").

In this embodiment, for example, the number p of terminal devices included in the medical institution terminals 17(1) to (p) corresponds to the number of affiliated medical institutions. In FIG. 1, each of p terminal devices from a medical institution terminal 17(1) to a medical institution terminal 17(p) is shown connected to a network NW. One affiliated medical institution may have one terminal, or, for example, a plurality of medical institution terminals 17 may exist for each department or doctor.

Each of the medical institution terminals 17(1) to 17(p) has an input unit capable of accepting operation input, a screen indicating that there is a request to create a medical certificate, a screen necessary for creating and sending a medical certificate, etc. The terminal device includes a display unit that displays an image, and a communication unit that communicates with the insurance claim proxy server 11 via the network NW.

In this embodiment, for example, each of the medical institution terminals 17(1) to (p) is a tablet terminal. The terminal devices included in the medical institution terminals 17(1) to (p) are not limited to tablet terminals, and may be other terminal devices such as personal computers and smart phones.

Each of the medical institution terminals 17(1)-(p) receives a request for the preparation of a medical certificate from the insurance claim service server 11, and transmits the medical certificate prepared by the medical institution to the source of the request. . For example, when each of the medical institution terminals 17(1) to 17(p) receives a medical certificate creation request, a screen indicating that there is a medical certificate creation request is displayed. After that, for example, when the medical institution terminal 17 receives an operation for designating one of the medical certificate creation requests, a medical certificate data input screen is displayed on the display screen of the medical institution terminal 17 . When the doctor in charge enters the medical certificate data on the input screen and presses the send button, the created medical certificate is sent from the medical institution terminal 17 to the insurance claim proxy server 11 .

When the insurance claim proxy server 11 receives from the user terminal 13(x) information indicating items necessary for claiming insurance against a specific insurance company, it is necessary to submit the information to the specific insurance company for the claim. Identify the document as a required document.

When one or more required documents are specified, the insurance claim proxy server 11 transmits a request for transmission of each of the one or more required documents to the outside.

For example, when the insurance claim proxy server 11 specifies a medical certificate as a required document, the medical institution terminal 17 (x) (x is an arbitrary positive integer) of the medical institution that issues the medical certificate. Send information requesting creation and transmission.

For example, when a document to be prepared by the user is specified as a required document, the insurance claim proxy server 11 transmits information requesting transmission of the document to be prepared by the user to the user terminal 13 (x ). Upon receipt of the required documents requested from the medical institution terminal 17(x) or the user terminal 13(x), the insurance claim proxy server 11 sends the required documents together with the claim information necessary for claiming insurance claims to a specific insurance company. Submitting a claim to the insurance company system 15(x) on behalf of the user to that particular insurance company.

The configuration and functions of the insurance claim proxy server 11 will be described below with reference to FIGS. 2 to 5. FIG. FIG. 2 is a functional block diagram showing the configuration of the insurance claim proxy server 11. As shown in FIG.

The insurance billing proxy server 11 is controlled by a control unit (not shown). The control unit includes a CPU (Central Processing Unit) (not shown), a ROM (Read Only Memory) (not shown), a RAM (Random Access Memory) (not shown), etc., and functions as a computer. The CPU implements various functions by reading and executing various programs stored in the ROM or externally.

Further, the insurance claim proxy server 11 includes a storage unit (not shown). The storage unit is a storage device such as a hard disk, a flash memory, an SSD (Solid State Drive), or a RAM (Random Access Memory) that appropriately stores data necessary for processing of the control unit and data generated in the processing. The storage unit stores various programs executed by the control unit such as software for the insurance claim proxy server 11 to receive insurance claims and to transmit and receive information necessary for insurance claims. In addition, the storage unit stores various databases (DB) necessary for executing various programs for claiming insurance claims.

The communication unit 21 is a network adapter such as a NIC (Network Interface Card) for performing communication such as transmission and reception of data with the outside according to instructions from the control unit. The communication unit 21 includes, for example, the insurance claim proxy server 11, user terminals 13(1) to 13(m) which are external devices, and the insurance company system 15(1), which are necessary for the service of the insurance claim proxy system 10. ) to (n) and medical institution terminals 17(1) to (p).

For example, the communication unit 21 receives information regarding an insurance claim transmitted from the user terminal 13(x). In addition, the communication unit 21 receives information indicating the user's contract details from the insurance company system 15(x) (where x is an arbitrary positive integer), and sends it to the insurance company system 15(x). information. In addition, the communication unit 21 transmits information indicating a request to create a medical certificate to the medical institution terminal 17(x), and receives the medical certificate from the medical institution terminal 17(x).

A user information database (hereinafter also referred to as a user information DB) 23 is a database that stores information on users who use the insurance claim claim representation system 10 . The user information DB 23 stores personal information such as names and contact addresses for identifying users, and authentication information such as passwords.

FIG. 3 is a diagram showing an example of user information stored in the user information DB 23 as a table TB1. As shown in FIG. 3, the user information DB 23 stores a user ID assigned to each user, a password for authentication when accessing the insurance claims claim representation system 10, a name for specifying the user, Gender, date of birth, address and telephone number are associated and stored.

Further, as shown in FIG. 3, even if information such as credit card information when the user pays the usage fee for the service provided by the insurance claim representation system 10 is further associated with the user ID of the user. good.

For example, when the user first uses the insurance claim representation system 10, the user sends personal information such as the user's name and information such as a password necessary for authentication to the user terminal 13 as shown in the table TB1. Enter in the displayed input screen. For example, when the user presses a send button after that, the entered information is sent to the insurance claim proxy server 11 .

In the insurance claim proxy server 11, the information transmitted from the user terminal 13 is received via the communication unit 21, and the user ID is assigned by the control unit and stored in the user information DB 23, thereby completing the user registration. done.

The user information DB 23 may store biometric information such as fingerprints and veins as information for authentication in addition to or instead of passwords.

The authentication unit 25 is a functional unit that authenticates the identity of the user when the user uses the insurance claim representation system 10 to make an insurance claim. The authentication unit 25 authenticates a user based on user information registered in advance and stored in the user information DB 23 .

For example, when a user's user ID and password are input via the user terminal 13(x), the authentication unit 25 checks against the ID and password stored in the user information DB 23, If they do not match, it is determined that the authentication is not possible. For example, the authentication unit 25 notifies the user terminal 13(x) of the authentication result via the communication unit 21 .

For example, the authentication unit 25 cooperates with the eKYC (electric Know Your Customer) service that uses the face image of the user and an identification document with a face photo such as a driver's license or passport to perform more rigorous identity verification. you can go Further, the authentication unit 25 may perform authentication using biometric information such as fingerprints and veins.

The common processing unit 27 is a functional unit that functions as a reception unit that performs reception processing for receiving insurance claims from users. In the reception process, the common processing unit 27 receives, via the communication unit 21, the necessary billing information indicating the necessary items for claiming the insurance money that the user has input and transmitted via the user terminal 13(x). do.

FIG. 4 is a diagram showing an example of billing requirements transmitted from the user terminal 13(x) to the insurance billing proxy server 11. As shown in FIG. As shown in FIG. 4, the required claim items include personal information such as user ID, name, address, telephone number, insurance company name, insurance policy number, reason for claim, medical institution information, and insurance payment destination. and other insurance claim information. In addition, the items required for a claim may include items that may or may not be necessary depending on the reason for the claim, such as driver's license information that is required when the claim is related to a traffic accident.

The billing requirements may include items other than those shown in FIG. 4, such as details of treatment and number of days of hospitalization. For example, all of the items provided in the insurance claim form prescribed by a plurality of insurance companies contracted by the insurance claim agency system 10 may be included in the billing requirements.

When the common processing unit 27 receives the necessary billing items in the reception processing, it determines whether or not all the information necessary for processing the proxy billing for the insurance claims is complete. The necessary information includes, for example, the name, insurance company name, and insurance policy number, which are essential items for the insurance claim agency server 11 to cooperate with the insurance company to act as an insurance claimant.

In addition to the reception process described above, the common processing unit 27 has a function of collectively performing communications such as multiple transmissions to the same destination or transmissions of overlapping content to the same destination. Here, in the insurance claim proxy server 11, when acting on behalf of insurance claims, predetermined processing is performed separately for each insurance company from the viewpoint of personal information protection and handling of customer information of each insurance company. done by the region. Each of the per-insurer processing areas are designed to be inaccessible to each other.

For processing for each insurance company, the common processing unit 27 transmits the necessary billing information to the processing area for each insurance company based on the information specifying the insurance company included in the necessary billing information. For example, when the contents to be notified to the user overlap in the processing for each insurance company, the common processing unit 27 collectively notifies the overlapping contents at one time.

As a result, for example, information requesting the same document is transmitted to the same user many times, and it is possible to prevent the user from repeatedly transmitting the document. Therefore, the service provision areas 29(1) to 29(n) (where n is a positive integer) that can reduce the burden on the user are a plurality of processing areas provided for each of a plurality of insurance companies. That is, service providing areas 29(x) (x is an arbitrary positive integer) (hereinafter also simply referred to as "service providing areas 29") are provided by the number n of contracted insurance companies. Each of service provision areas 29(1)-29(n) corresponds to each of insurance company systems 15(1)-15(n).

Each of the service providing areas 29(1) to 29(n) is independent from each other, that is, completely separated from each other so as not to be accessible from the viewpoint of personal information protection and handling of customer information of each insurance company. there is For example, the service providing areas 29(1) to 29(n) do not allow other service providing areas 29 to access information used for processing in one service providing area 29 and information created by the processing. Designed to be impossible. Therefore, it becomes impossible to transfer personal information between insurance companies or to transfer information such as confidential information within a company, thereby realizing high security.

For example, in the insurance claims agency system 10, information used for processing related to insurance claims and information created by the processing are handled in accordance with the guidelines of the Center for Financial Industry Information Systems (FISC). Further, in the insurance claim agency system 10, for example, the design of the service provision area 29 is designed according to the guidelines of FISC.

Each of the service providing areas 29(1) to 29(n) includes a contract content acquiring unit 31, a detailed examination processing unit 33, a required document identifying unit 35, a required document requesting unit 37, a billing processing unit 39, a transaction management database (hereinafter referred to as transaction management DB) 41 and a criterion database (hereinafter referred to as a criterion DB) 43 .

For example, the common processing unit 27 provides a service provision area 29 corresponding to the insurance company corresponding to the name of the insurance company described in the required billing items, that is, the insurance company to which the user who has entered the required billing items is billed. (x) to send the billing requirements;

Upon receiving the necessary billing items from the common processing unit 27, the contract content acquisition unit 31 communicates with the insurance company system 15(x) owned by the billing destination insurance company related to the request based on the necessary billing items. Communicate to acquire the contractual content of the claim, that is, the contractual content that serves as the basis for the claim. For example, the contract content acquisition unit 31 transmits information indicating a request for transmission of the contract content to the insurance company system 15(x), and sends information indicating the requested contract content to the insurance company system 15(x) as a response to the request. (x).

For example, the information indicative of the contract content request includes the insurance policy number included in the billing requirements. For example, the insurance company system 15(x) transmits information indicating contract details corresponding to the insurance policy number to the insurance company system 15(x).

The scrutinization processing unit 33 judges the validity of the required billing items based on the contract details. For example, the scrutinization processing unit 33 compares the necessary billing items with the contract content based on the insurance policy number included in the necessary billing items, and determines the degree of matching of the items that should match. Confirm the existence of the described contract. For example, the scrutinization processing unit 33 determines the degree of matching by comparing the name in the necessary items for billing and the name of the contractor in the contract details.

After the scrutinization of the required claim items by the scrutinization processing unit 33, the required document identification unit 35 selects documents that need to be submitted to a specific insurance company for claiming the insurance money, based on the required claim items and contract details. Identify as

For example, the required document specifying unit 35 calculates the payment amount of the insurance claim related to the claim based on the required claim items and the contract details, and determines whether or not the medical certificate is necessary based on the calculated payment amount. For example, the required document specifying unit 35 specifies a medical certificate as a required document when the insurance payment amount is equal to or greater than a predetermined amount. Further, for example, when the insurance payment amount is equal to or less than a predetermined amount, the required document specifying unit 35 determines that a medical certificate is unnecessary. For example, when the required document identifying unit 35 determines that a medical certificate is unnecessary, it specifies a copy of a receipt from a medical institution as the required document.

For example, the destination of the request for transmission of the required document (hereinafter also referred to as "request destination") is predetermined for each required document according to the attribute of the required document. For example, each of the required documents may be associated with a request destination in advance and stored in the determination criteria DB 43, for example.

For example, for the medical certificate, the medical institution terminal 17 of the medical institution where the user received treatment is determined as the request destination. The medical institution terminal 17 is specified based on billing requirements for each billing.

For example, for each document to be prepared by the user, the user terminal 13 is determined as the request destination. For example, for some of the documents to be prepared by the user, the institution that issues the documents may be the request destination. For example, when the required documents are family register-related documents, the request destination may be a terminal device owned by the national government or a local government that issues the required documents. For example, if the reason for the request is an accident and documents related to the accident are required documents, a terminal device owned by a police station or a safe driving center may be specified as a request destination for the required documents. In particular, when the required document is a traffic accident certificate, the terminal device owned by the safe driving center may be determined as the destination of the request.

For example, the required document identifying unit 35 identifies the required document based on a comparison between the contract content portion of the required billing items and the item corresponding to the contract content portion.

For example, if the user changes his or her surname after contracting the insurance, only the surname will be different when comparing the policyholder name in the contract details and the name in the required billing information. In this case, a document such as a copy of family register is identified as the required document.

Further, for example, the required document specifying unit 35 may determine the document to be prepared by the user based on a comparison between the insurance content in the contract details and the request reason in the request request items. For example, if the reason for the claim is related to a traffic accident and the content of the security includes a security related to a traffic accident, the traffic accident certificate is specified as the required document because it is covered by the security.

In this way, since the required documents are specified by the required document specifying unit 35, the user does not have to judge what the required documents are, and it is difficult to understand what the required documents are, and the user cannot find the required documents again and again. You can avoid situations where you have to add and submit Therefore, the burden on the user is reduced.

The required document requesting unit 37 functions as a document request transmitting unit that executes a document request transmitting step of transmitting to the outside a request for transmission of each required document specified by the required document specifying unit 35 . For example, when a medical certificate is identified as a required document, the required document requesting unit 37 transmits a request for transmission of the medical certificate to the medical institution terminal 17 .

For example, when the medical institution terminal 17 (x) receives a request to send a medical certificate, the doctor of the medical institution prepares a medical certificate for each insurance company and sends the request to the service providing area 29 ( Send the medical certificate to x).

As described above, the required document requesting unit 37 is separately provided for each insurance company, so it is possible to deal with cases where the format of the medical certificate, such as a file format, differs for each insurance company. For example, information indicating the format of the medical certificate conforming to the format prescribed by the insurance company is sent along with the request, and a request is made to create the medical certificate in that format. For example, each of the service providing areas 29(1) to 29(n) may store in advance the format of the medical certificate for each insurance company.

Further, the required document requesting unit 37 transmits a request for transmission of the required document to the user terminal 13 when the document to be prepared by the user is included in the required document.

Further, for example, the required document requesting section 37 may transmit a request for transmission of the required document to the common processing section 27 .

In addition, when a plurality of requests are made from one user in parallel, the common processing unit 27 collects the required documents from the same request destination in different request processing and requests the required documents all at once. can be done.

For example, when a user makes an insurance claim with a plurality of insurance companies, if the required documents are duplicated among the plurality of insurance companies, that is, the plurality of service provision areas 29(x) specify the same document as the required document. case is conceivable. In such a case, the common processing unit 27 does not send a request for required documents for each billing process, but aggregates the information indicating the request for required documents from the service providing area 29 and sends a request for the required documents. By transmitting the aggregated information once to the user terminal 13, for example, it is possible to prevent multiple requests from being transmitted to the request destination. Further, even if the required documents are different among a plurality of insurance companies, not only the same documents, but also the information indicating requests for a plurality of required documents are aggregated and sent to the user terminal 13 in one transmission. can do. Therefore, the request for necessary documents is not sent to the user multiple times for each request, and the burden on the user can be reduced.

Further, the required document requesting section 37 functions as a document receiving section that executes a document receiving step of receiving the requested required document from the request destination of the required document.

For example, as described above, when the common processing unit 27 collectively transmits requests for a plurality of claims for documents that need to be submitted for claims to each of a plurality of insurance companies, the required documents from the requesting party are commonly processed. A unit 27 may collectively receive and supply the requested documents to each of the service provision areas (x).

The claim processing unit 39 performs insurance claim processing by transmitting claim information including necessary billing items together with the necessary documents received as a result of the request from the necessary document request unit 37 to the insurance company system 15(x).

For example, the billing processing unit 39 generates billing information necessary for claiming insurance money based on billing requirements and contract details. For example, the billing processing unit 39 generates information in a format determined for each insurance company or information in a common format as billing information. For example, the claim processing unit 39 may create an insurance claim in a format determined for each insurance company, use it as claim information, and transmit the claim information together with necessary documents to the insurance company system 15(x). .

In this manner, the billing information in the format determined for each insurance company can be generated in the billing processing unit 39 of the service providing area 29(x) for each insurance company. For example, it becomes unnecessary for the user to create an insurance claim form corresponding to the format of each insurance company, thus reducing the burden on the user.

Also, the claim processing unit 39 receives the result of examination by the insurance company. Also, the claim processing unit 39 may receive a notification of the completion of insurance payment from the insurance company.

The transaction management DB 41 is a database for managing transaction status for each insurance company. When the insurance claim proxy server 11 accepts an insurance claim for a specific insurance company, it is recorded in the transaction management DB of the service provision area 29(x) corresponding to the specific insurance company, and is recorded as the procedure progresses. , is updated in association with information indicating the progress.

FIG. 5 is a diagram showing an example of transaction management information stored in the transaction management DB 41 as a table TB2. As shown in FIG. 5, a "transaction number" is attached to each request, and information necessary for the request such as "user ID", "insurance policy number", and "reason for request" is described. Also, the billing status such as "Medical certificate preparation requested", "Billing examination requested", etc., indicating the progress status, is displayed on the transaction number. are described in association with each other.

For example, information indicating billing status may be displayable on the display screen of the user terminal 13(x). For example, the user can check the progress of the procedure for the insurance claim made by the user via the user terminal 13(x).

For example, the "claim status" is determined to be subject to payment as a result of examination by the insurance company, and when the insurance company completes payment of the insurance claim to the user, the claim status is updated to "payment completed". stored for a certain period of time.

The criteria DB 43 is a database that stores criteria for required documents for each insurance company. For example, the determination criteria DB 43 stores determination criteria for specifying necessary documents for each condition such as insurance type and treatment content.

For example, regarding whether or not a medical certificate is necessary, in addition to the type of insurance, the determination criteria based on the insurance payment amount are stored in the determination criteria DB 43 . For example, the criterion DB 43 stores conditions determined by an insurance company as criteria for determining the necessity of documents to be prepared by the user.

An example of the configuration and function of each part of the insurance company system 15(x) owned by each contracted insurance company and the content of the database will be described below with reference to FIGS. 6 and 7. FIG. FIG. 6 is a functional block diagram showing the configuration of the insurance company system 15(x).

The insurance company system 15(x) is controlled by a controller (not shown). The control unit includes a CPU (Central Processing Unit) (not shown), a ROM (Read Only Memory) (not shown), a RAM (Random Access Memory) (not shown), etc., and functions as a computer. The CPU implements various functions by reading and executing various programs stored in the ROM or externally.

The insurance company system 15(x) also includes a storage unit (not shown). The storage unit is a storage device such as a hard disk, a flash memory, an SSD (Solid State Drive), or a RAM (Random Access Memory) that appropriately stores data necessary for processing of the control unit and data generated in the processing. The storage unit stores various programs executed by the control unit, such as software for the insurance company system 15 to receive insurance claims and transmit examination results. In addition, the storage unit stores a database (DB) that records contract details with customers.

The communication unit 51 is a network adapter such as a NIC (Network Interface Card) for performing communication such as transmission and reception of data with the outside according to instructions from the control unit. The communication unit 51 performs communication such as transmission of contract information and reception of information to the effect that an insurance claim is made, for example, with the insurance claim proxy server 11 .

A customer contract information database (customer contract information DB) 53 stores personal information of a customer who has an insurance contract with an insurance company held by the insurance company system 15(x) in association with the details of the customer's insurance contract. It is a database that

FIG. 7 is a diagram showing an example of customer contract information stored in the customer contract information DB 53 as a table TB3. As shown in FIG. 7, in table TB3, items such as insurance type, insurance policy number (insurance policy No.), contract date, contract period, coverage details, etc. are associated with each customer ID. For example, in addition to the information shown in FIG. 7, the customer contract information may include information such as the contractor's name and recipient.

The authentication unit 55 is a functional unit for authenticating access from outside the insurance company system 15(x). For example, the authentication unit 55 is set to permit access from the insurance claim proxy server 11 when the authentication is performed correctly.

The contract content inquiry receiving unit 57 is a functional unit that receives and responds to a request for the content of the insurance contract from the insurance billing proxy server 11 . For example, when the contract content inquiry receiving unit 57 receives information indicating a request for contract content from the contract content acquisition unit 31 in the service provision area 29(x) of the insurance claim proxy server 11, the contract content inquiry receiving unit 57 responds to the contract content request. , to the service providing area 29(x) that is the source of the request.

For example, the contract details inquiry reception unit 57 transmits information including contract details corresponding to the insurance policy number included in the request for contract details to the sender of the request for the contract details, thereby obtaining the contract details. Respond to requests.

The insurance claim acceptance/response unit 59 is a functional unit that accepts an insurance claim from the insurance claim agency server 11 and responds with an examination result. For example, when the insurance claim acceptance/response unit 59 receives the claim information transmitted together with the necessary documents from the claim processing unit 39 in the service provision area 29(x) of the insurance claim proxy server 11, it accepts the insurance claim. .

Also, for example, the insurance claim acceptance/response unit 59 transmits the result of examination by the insurance company, which is the billing destination of the insurance claim, to the claim processing unit 39 of the service providing area 29(x).

As described above, the insurance claim proxy server 11 in the insurance claim proxy system 10 accepts an insurance claim to a specific insurance company from a user terminal used by a user of the insurance claim proxy service. Communication between the reception unit that acquires the necessary billing items indicating the items necessary for the claim and the insurance company system owned by the insurance company to which the claim is made based on the necessary billing items and a contract content acquisition unit that acquires the contract content related to the billing.

Further, the insurance claim proxy server 11 includes a required document specifying unit for specifying, as required documents, documents that must be submitted to the insurance company for the claim, based on the required claim items and the contract details, and A document request transmission unit that transmits a request to the outside to request transmission, a document reception unit that receives necessary documents from the outside, and a claim information including necessary items for claim together with the required documents are sent to the insurance company system to process the claim. and a billing processor.

With such a configuration, according to the insurance claim agency system 10 including the insurance claim agency server 11, necessary documents for claiming insurance against a specific insurance company can be prepared in advance based on the necessary billing items and contract details. A request for transmission of each of the required documents may be identified and externally transmitted to receive the identified required documents. Then, by sending the billing information necessary for billing together with the necessary documents to the insurance company system on behalf of the user, the insurance bill can be billed on behalf of the user.

According to the insurance claim proxy server 11, the required document specifying unit specifies the documents required for claiming the insurance, and the required document requesting unit requests the medical institution or the user. Therefore, there is no need for the user to judge what the required documents are. In addition, since the request for the necessary documents is notified to the place where the documents should be prepared as described above, it is possible to prevent the documents from becoming insufficient and the user to add and submit the missing documents many times. It is possible to prevent medical institutions and users from preparing unnecessary documents. Therefore, the burden on users and medical institutions is reduced.

In addition, according to the insurance claim agency system 10 including the insurance claim agency server 11, all processing related to insurance claims can be advanced by sending and receiving electronic data, and a paperless system can be realized. Therefore, it is possible to reduce the labor of the user to print out the document, fill it out, sign or seal it, and to efficiently proceed with the procedure for claiming the insurance money.

Therefore, according to the insurance claim agency system 10 including the insurance claim agency server 11 of the present embodiment, the labor burden on the user, the medical institution, etc. involved in the insurance claim is reduced, and the insurance claim procedure is made more efficient. , an insurance claim agency device, an insurance claim agency system, an insurance claim agency method, an insurance claim agency program, and a recording medium that enable smooth insurance claims.

Furthermore, according to this embodiment, a plurality of service providing areas are provided independently of each other as processing areas individually corresponding to each insurance company, so insurance claims can be made with a plurality of insurance companies as billing destinations. Even in this case, high security can be maintained. In addition, each of the plurality of service provision areas can correspond to different regulations for each insurance company, and the insurance claims can be efficiently processed.

In addition, in this embodiment, when the user makes an insurance claim to a plurality of insurance companies, the information indicating the requests for necessary documents to be submitted to the plurality of insurance companies is aggregated and transmitted for each of the same request destinations. be able to. Therefore, even if insurance claims are made to a plurality of insurance companies, the effort borne by the user, the medical institution, etc. can be reduced. The same is true for multiple different insurance claims with the same insurance company.

The insurance claim proxy method executed by the insurance claim proxy server 11 when the insurance claim proxy system 10 performs the insurance claim proxy will be described with reference to FIGS. 8 to 13. FIG. The insurance claim proxy method is implemented by the insurance claim proxy server 11 executing an insurance claim proxy program.

FIG. 8 is a flow chart showing a common processing routine RT1, which is an example of a routine executed by the common processing unit 27 of the insurance claim representation server 11. As shown in FIG. For example, the common processing unit 27 starts the common processing routine RT1 when the power of the insurance claim representation server 11 is turned on.

After starting the common processing routine RT1, the common processing unit 27 waits for reception of necessary billing items from the user terminal 13(x) (step S101).

After executing step S101, the common processing unit 27 determines whether or not necessary items for billing have been received (S102). In step S102, the common processing unit 27 determines that the necessary billing items have been received when the necessary billing items such as those shown in FIG.

In step S102, the common processing unit 27 functions as a reception unit that executes a reception step of receiving an insurance claim from a user terminal to a specific insurance company and acquiring necessary billing information indicating items necessary for the claim. do.

As described above, for example, after the user authenticates via the user terminal 13(x), when the user enters the items necessary for claiming on the input screen of the insurance claim menu and presses the claim button, the necessary Required billing items indicating matters are sent to the insurance claim billing agency server 11 .

For example, the user may upload an image of a receipt from a medical institution when entering billing requirements. That is, an image such as a receipt from a medical institution may be attached to the required billing information. As a result, for example, if the only required documents are copies of receipts from medical institutions, the user does not have to submit the documents after sending the required billing items.

When the common processing unit 27 determines that the necessary items for billing have been received in step S102 (step S102: YES), it determines whether or not the necessary information is complete (step S103). In step S103, for example, it is determined whether or not information has been input with respect to predetermined items included in the necessary items for billing. For example, items that are required in the process of proxy processing of insurance claims, such as an insurance policy number required to inquire about contract details, are set in advance as predetermined items.

When the common processing unit 27 determines in step S103 that the necessary information is not complete (step S103: NO), the user terminal 13(x) sends information indicating a request for re-input to the user. It transmits (step S104).

When the common processing unit 27 determines in step S103 that the necessary information is complete (step S103: YES), it transmits necessary billing items to the service providing area 29(x) (step S105). In step S105, for example, the common processing unit 27 transmits the necessary billing information to the service providing area 29(x) corresponding to the insurance company to which the bill is to be sent, which is included in the necessary billing information.

Further, in step S105, for example, if there are a plurality of billing insurance companies included in the necessary billing items, the necessary billing items are sent to the service providing area 29(x) corresponding to each of the plurality of insurance companies. to send.

After executing step S105, the common processing unit 27 ends the common processing routine RT1 and newly starts the next common processing routine RT1.

FIG. 9 is a flow chart showing a service providing routine RT2, which is an example of a routine executed by each of the service providing areas 29(1) to 29(n) of the insurance claim representation server 11. FIG. For example, the service providing area 29(x) (where x is an arbitrary positive integer) starts the service providing routine RT2 when the power of the insurance claim representation server 11 is turned on.

When the service providing area 29(x) starts the service providing routine RT2, it determines whether or not it has received billing requirements from the common processing unit 27 (step S201). In step S201, for example, when the service providing area 29(x) receives the billing necessary items addressed to the service providing area 29(x) in step S105 (see FIG. 8) of the common processing routine RT1, , determines that the billing requirements have been received.

If the service providing area 29(x) determines in step S201 that the necessary billing information has not been received (step S201: NO), it repeats step S201 and determines again whether or not the necessary billing information has been received. .

When the contract content acquisition unit 31 of the service providing area 29(x) determines that the necessary billing items have been received in step S201 (step S201: YES), based on the necessary billing items, the insurance of the corresponding insurance company Communicate with the company system 15(x) to acquire the contract content related to the billing (hereinafter also referred to as "main billing") based on the necessary billing items (contract content acquisition step) (step S202).

In step S202, for example, if the billing destination insurance company for this billing is "insurance company A", the contract details acquisition unit 31 in the service provision area (A) for insurance company A requests transmission of the contract details. to insurance company system (A) of insurance company A. For example, the information requesting the content of the contract includes information indicating an insurance policy number.

As a reply to the request, information indicating the content of the contract is transmitted from the insurance company system (A) to the service provision area (A) of the insurance claim proxy server 11 . For example, in step S202, the contract content corresponding to the insurance policy number specified by the request sent by the contract content acquisition unit 31 is transmitted.

After step S202 is executed, the scrutinization processing unit 33 of the service providing area 29(x) determines whether or not the degree of matching between the necessary billing items and the contract content is equal to or greater than a predetermined value (step S203). In step S203, for example, the scrutinization processing unit 33, on the premise that the insurance policy numbers of the necessary billing items and the contract details match, if predetermined items other than the insurance policy numbers match, degree is equal to or greater than a predetermined value. Further, for example, in step S203, when items other than the insurance policy number match at least a predetermined number, it is determined that the degree of matching is at least a predetermined number.

When the detailed examination processing unit 33 determines in step S203 that the degree of matching between the necessary billing items and the contract content is not equal to or greater than a predetermined value (step S203: NO), it uses the information requesting re-input of the necessary billing items. After transmission to the user terminal 13(x) (step S204), the process returns to step S201 to determine again whether or not the necessary billing items have been received.

When the scrutinization processing unit 33 determines in step S203 that the degree of matching between the required billing items and the contract details is equal to or greater than a predetermined value (step S203: YES), the content of items common to the required billing items and the contract details is It is determined whether or not there is a complete match (step S205). For example, in step S205, the scrutinization processing unit 33 determines whether or not the common items such as the name included in the required billing items completely match.

When the detailed examination processing unit 33 determines that they do not completely match in step S205 (step S205: NO), it transmits a confirmation request to the user terminal 13(x) (step S206). For example, in step S206, if only the surname of the contractor's name is different, the close examination processing unit 33 sends a message requesting confirmation of whether or not the name needs to be corrected, and sends a message to the user terminal. 13(x) display screen.

After executing step S206, the scrutinization processing unit 33 determines whether or not the procedure can proceed without correction (step S207). In step S207, for example, in step S206, it is determined whether or not an input indicating that correction is unnecessary has been received via the user terminal 13(x).

If it is determined in step S207 that the procedure cannot proceed without correction (step S207: NO), the service providing area 29(x) transmits a re-entry request to the user terminal 13(x) (step S208 ), the process returns to step S201 to determine again whether or not the necessary billing information has been received.

If it is determined in step S205 that there is a complete match (step S205: YES), or if it is determined in step S207 that the required document identification unit 35 of the service provision area 29(x) can proceed with the procedure without correction, If so (step S207: YES), the amount of insurance money to be paid for this claim is calculated based on the necessary billing items and contract details (step S209). In step S209, for example, the required document specifying unit 35 calculates the amount of insurance payment based on the number of days of hospitalization.

After execution of step S209, the required document identifying unit 35 identifies the required documents that need to be submitted to the insurance company in making the claim (required document identifying step) (step S210 ).

In step S210, for example, the required document specifying unit 35 specifies required documents based on the amount of insurance payout calculated in step S209 in addition to the required billing items and contract details. In step S210, for example, the required document identifying unit 35 determines whether or not a medical certificate is required based on the amount of the insurance payment. do.

In step S210, for example, the required document identification unit 35 identifies the required document based on a comparison between a predetermined item of the required items for billing and a portion corresponding to the predetermined item of the contract details. For example, the required document specifying unit 35 specifies documents to be prepared by the user as required documents based on the request reason included in the required request items. In step S210, for example, if the reason for claim is a traffic accident, a traffic accident certificate is identified as the required document. In step S210, for example, if there is a change of surname after the contract of insurance has been made, a document such as a copy of the family register is identified as the required document.

Further, in step S210, the required document specifying unit 35 may refer to the criteria DB 43 and specify the required documents according to the required document criteria of the corresponding insurance company.

After executing step S210, the service providing area 29(x) executes a necessary document acquisition subroutine (step S211). In step S211, the required document requesting unit 37 requests a medical certificate from the medical institution when the required documents include a medical certificate. Further, when the required documents include documents that the user should prepare, the required document requesting unit 37 performs a process of requesting the documents from the user.

For example, the necessary document requesting unit 37 of the service provision area 29(A) of the insurance company A requests the medical institution to prepare a medical certificate in the specified format of the insurance company A.

After executing step S211, the claim processing unit 39 of the service providing area 29(x) creates insurance claim information (step S212). In step S212, for example, the claim processing unit 39 creates insurance claim information by combining the claim information including the necessary items for claim and the required documents.

After executing step S212, the claim processing unit 39 transmits the insurance claim information to the corresponding insurance company system 15(x) (step S213). When the insurance claim information is transmitted by executing step S213, the necessary documents and the information necessary for the claim are transmitted to the insurance company system of the insurance company to which the claim is made (claim processing step). an insurance claim will be made against

For example, when step S213 is executed, the billing status of the main bill in the transaction management DB 41 of the service provision area 29(x) is updated and stored as "under examination request".

After executing step S213, the service providing region 29(x) terminates the service providing routine RT2 and newly starts the next service providing routine RT2.

In addition, for example, in step S205 of the service providing routine RT2, communication is performed with the medical institution terminal 17(x), and the information on the medical institution included in the billing requirements and the information received from the medical institution terminal 17(x) are transmitted. The correctness of the content of the necessary claim items may be determined by determining whether or not they match. For example, if the billing requirements do not match the information from the medical institution, the information from the medical institution may be prioritized, and an inquiry message may be sent to the user terminal 13(x).

Communication between the service providing area 29(x) and the user terminal 13(x) in steps S204 and S206 to S208 may be performed via the common processing unit 27. FIG.

After executing step S213, the service providing area 29(x) receives the examination result from the insurance company system 15(x) and notifies the user of the examination result by transmitting it to the user terminal 13(x). may For example, when it is determined that the payment is applicable, the insurance company pays the insurance money to the user. When the payment of the insurance claim is completed, the service providing area 29(x) may receive a notification of payment completion from the insurance company system 15(x) and transmit it to the user terminal 13(x). Further, the service providing area 29(x) may update the "billing status" of the transaction management DB to "payment completed" when receiving the notification of payment completion.

After completing the service providing routine RT2 for one claim, when the payment of the insurance claim is completed, the service providing area 29(x) or the common processing unit 27 sends a request for payment of the service charge to the user terminal. 13(x). For example, when submitting a medical certificate for claiming an insurance claim, the insurance claim proxy server 11 performs processing to pay the cost of creating the medical certificate to the medical institution, and the amount of the service usage fee including the cost of creating the medical certificate is sent to the user terminal. 13(x). For example, even when the payment of the service fee is completed, the insurance claim proxy server 11 may store the fact that the payment of the service fee has been completed and the amount of the payment in the transaction management DB.

FIG. 10 is a flow chart showing the required document acquisition subroutine RT3, which is an example of a subroutine executed in step S211 of the service providing routine RT2.

Upon starting the required document acquisition subroutine RT3, the required document requesting unit 37 of the service providing area 29(x) determines whether or not the required documents determined in step S210 include a medical certificate issued by a medical institution (step S301).

When the required document requesting unit 37 determines in step S301 that a medical certificate is included, it transmits information requesting the creation of a medical certificate to the medical institution terminal 17(x) designated as the request destination (step S302). ).

In step S302, the required document requesting unit 37 functions as a document request transmitting unit that transmits a request for transmitting a medical certificate to the terminal of the medical institution.

After execution of step S302, or when it is determined in step S301 that the medical certificate is not included (step S301: NO), the required document requesting unit 37 determines whether the required documents include documents to be prepared by the user. is determined (step S303).

When the required document request unit 37 determines in step S303 that the document to be prepared by the user is included in the required documents (step S303: YES), the required document request unit 37 sends a request for transmission of the document to be prepared by the user to the user. It is transmitted to the terminal 13(x) (step S304).

In step S304, the required document request section 37 of the service providing area 29(x) functions as a document request transmission section that transmits a request for transmission of documents to be prepared by the user to the terminal of the user.

When the required document requesting unit 37 determines in step S303 that the document to be prepared by the user is not included in the required documents (step S303: NO), it determines whether or not there is a document to be received (step S305). For example, when the required document requesting unit 37 requests a medical certificate from a medical institution in step S302, it determines that there is a document to be received in step S305. For example, if the required document requesting unit 37 determines in step S301 that the medical certificate is not included, it determines in step S305 that there is no document to be received.

After execution of step S304, or when it is determined that there is a document to be received in step S305 (step S305: YES), the required document requesting unit 37 waits for receipt of the requested document (step S306), and then It is determined whether or not the document has been received from the request destination (step S307).

In steps S306 and S307, the required document requesting unit 37 functions as a document receiving unit that receives required documents from the outside.

In step S307, for example, if there are a plurality of documents requested in step S302 or step S304, it is determined that the requested documents have been received when all of the requested documents have been received.

If the required document requesting unit 37 determines in step S307 that the requested document has not been received (step S307: NO), it returns to step S306 and waits again to receive the requested document.

If the required document requesting unit 37 determines in step S307 that the requested document has been received (step S307: YES), or if it determines in step S305 that there is no document to be received (step S305: NO), the required document requesting unit 37 Terminate the document acquisition subroutine RT3.

Note that steps S301 and S302 when the document request destination is the medical institution and steps S303 and S304 when the document request destination is the user may be executed in parallel, and are executed as separate routines. good too.

FIG. 11 is a flow chart showing a common processing routine RT4, which is a modification of the common processing routine RT1 (see FIG. 8) executed by the common processing unit 27. As shown in FIG.

In the common processing routine RT4, steps S101 to S105 proceed in the same manner as in the common processing routine RT1, so description thereof will be omitted.

The common processing unit 27 executes step S105 to transmit the billing necessary items to each of the one or more service providing areas 29(x) corresponding to the billing destination insurance company, and then (step S401). In step S401, for example, when there are a plurality of insurance companies to which billing is to be made, when information indicating the result of identifying the required documents is received from all the service providing areas 29(x) corresponding to each of the plurality of insurance companies. Then, it is determined that the identification result has been received.

When the common processing unit 27 determines in step S401 that the identification result of the required documents has not been received (step S401: NO), it repeats step S401 and determines again whether or not the identification result of the required documents has been received. do.

When the common processing unit 27 determines in step S401 that it has received the identification result of the required documents (step S401: YES), it executes the required document acquisition subroutine to receive the required documents from the external request destination (step S402). ).

In step S402, the common processing unit 27 executes a subroutine similar to the required document acquisition subroutine RT3 described with reference to FIG.

In step S402, for example, the common processing unit 27 requests a medical certificate from each of the one or more medical institution terminals 17(x) specified by the billing requirements, and then the one or more medical institution terminals 17(x). Receive a medical certificate from each of (x).

Further, in step S402, for example, the common processing unit 27 requests the user terminal 13(x) for one or more documents to be prepared by the user, and then the document sent from the user terminal 13(x). Receive one or more required documents.

After executing step S402, the common processing unit 27 transmits the received necessary documents to each of the corresponding service providing areas 29(x) (step S403).

In step S403, for example, if there are required documents for a plurality of insurance companies, the corresponding required documents are sent to each of the service provision areas 29(x) of the corresponding plurality of insurance companies.

After execution of step S403, or when it is determined in step S102 that the necessary items for billing have not been received (step S102: NO), the common processing unit 27 terminates the common processing routine RT4 and executes the next common processing routine RT4. Start fresh.

As described above, according to the common processing routine RT4, when a plurality of processes are progressing in parallel in a plurality of service providing areas for processing a plurality of claims to a plurality of insurance companies, in the plurality of processes For the specified plurality of necessary documents, requests for transmission of required documents can be aggregated and transmitted.

Therefore, for example, even when a user submits documents to be prepared to a plurality of insurance companies, the common processing unit 27 can collect and execute document requests to the user. For example, information requesting documents to be submitted to insurance company A and insurance company B is requested from the user once. Therefore, the user does not have to prepare and send documents multiple times. Therefore, the user's burden in claiming insurance money is reduced.

In addition, it is not limited to the case where the billing process for a plurality of insurance companies is proceeding in parallel. Can aggregate and send requests for required documents.

In addition, even if a plurality of billing processes are performed within a predetermined period in one service providing area, even if a plurality of required documents are specified, the common processing unit 27 aggregates them. You may submit a request for the required documents by

In step S402, the common processing unit 27 may acquire only the necessary documents to be requested from the user. In that case, each service providing area 29(x) may acquire the necessary documents to be requested from the medical institution.

12 and 13 show a service providing routine RT5 which is a modification of the service providing routine RT2 executed by each of the service providing areas 29(1) to 29(n) of the insurance claim representation server 11 described in FIG. It is a flow chart showing.

The service providing routine RT5 differs from the service providing routine RT2 in that the common processing unit 27 obtains the necessary documents from the service providing areas 29(1) to 29(n).

In the service providing routine RT5, steps S201 to S210 are performed in the same manner as in the service providing routine RT2, and therefore description thereof is omitted.

When the service providing area 29(x) executes step S210 to specify the required documents, it transmits the specified results of the required documents to the common processing unit 27 (step S501). In step S501, for example, the required document requesting section 37 of the service providing area 29(x) transmits information indicating required documents to the common processing section 27. FIG. The common processing unit 27 transmits information to the effect that the required documents are requested to each request destination of the required documents. In step S501, the common processing unit 27 functions as a document request transmission unit that externally transmits a request for transmission of each of one or more required documents.

After executing step S501, the service providing area 29(x) waits for the required documents (step S502), and then determines whether or not the required documents have been received from the common processing section 27 (step S503).

In step S503, for example, when the required document requesting unit 37 receives the required document transmitted from the common processing unit 27 to the service providing area 29(x) in step S403 of the common processing routine RT4 (FIG. 11) , it determines that the required documents have been received.

If the required document requesting unit 37 determines in step S503 that the required document has not been received (step S503: NO), it returns to step S502 and waits for the required document again.

If the required document requesting unit 37 determines in step S503 that the required documents have been received (step S503: YES), the billing processing unit 39 of the service providing area 29(x) performs the same operation as in step S212 of the service providing routine RT2. to create insurance claim information (step S504).

After that, the claim processing unit 39 transmits the insurance claim information to the corresponding insurance company system 15(x) in the same manner as in step S213 of the service providing routine RT2 (step S505).

After executing step S505, the service providing region 29(x) terminates the service providing routine RT5 and repeatedly executes the next service providing routine RT5.

For example, in the service providing routine RT5, the common processing unit 27 obtains documents to be prepared by the user from the user terminal 13(x), and the service providing area 29(x) obtains the medical certificate from the medical institution. It may be acquired. For example, in step S501, the identification result of the necessary documents is sent to the common processing section 27 only when documents to be prepared by the user are included. As a result, for example, when it is necessary to create a medical certificate in a format prescribed by an insurance company, the documents can be prepared efficiently.

[Modification]
With reference to FIG. 14, the configuration of an insurance claim proxy server 61, which is a modification of the insurance claim proxy server 11 of this embodiment, will be described. As shown in FIG. 14, the insurance claim proxy server 61 has a contract content DB 63 in each of the service provision areas 29(1) to 29(n) in addition to the same configuration as the insurance claim proxy server 11. is doing.

The contract content DB 63 is a database in which customer contract information of the insurance company corresponding to each service providing area 29(x) is stored. The contract content DB 63 stores the content of the insurance contract for each customer as shown in FIG. 7, for example.

For example, in the contract content DB 63, the contract information about the user of the insurance billing proxy server 61 is acquired in advance by the service providing area 29(x) and stored. For example, when a user is registered in the insurance claim proxy server 61, the name of the insurance company may also be entered, and the contract details of the user may be acquired from the insurance company system 15(x) of the corresponding insurance company. .

Further, for example, the contract content DB 63 may be synchronized with a database that stores customer contract information within the insurance company system 15(x). As a result, for example, the latest information can be held in the insurance claims billing proxy server 61 even when the contract details are updated.

According to the insurance claim proxy server 61, in step S202 (see FIG. 9) of the service providing routine RT2, when the contract content acquiring unit 31 of the service providing area 29(x) acquires the contract content, the insurance company system 15 There is no need to communicate with (x). The contract content acquisition unit 31 can acquire the contract content by referring to the contract content DB 63 in the service providing area 29(x). Therefore, it is possible to efficiently proceed with the processing for the insurance billing agency.

As described above in detail, according to the insurance claim agency system including the insurance claim agency apparatus of the present embodiment, contract details are acquired based on the required claim matters, and based on the required claim matters and the contract details, Identify the required documents, send a request for the transmission of the required documents to the user's external terminal or the system of the insurance company, receive the required documents from each requester, and obtain the claim information including the required billing items. By sending it to the insurance company system together with the document, it is possible to process the insurance claim on behalf of the user.

Therefore, an insurance claim agency device and an insurance claim agency system that reduce the labor burden on users, medical institutions, etc. involved in insurance claims, streamline insurance claim procedures, and realize smooth insurance claims. , an insurance claim agency method, an insurance claim agency program, and a recording medium.

In the above embodiment, an example in which a plurality of insurance companies have signed a contract has been described, but the present invention is not limited to this, and only one insurance company may make a contract.

In addition, in the above embodiment, an example in which insurance claims are made to a plurality of insurance companies has been described. can also The insurance claim agency device, the insurance claim agency system, the insurance claim agency method, the insurance claim agency program, and the recording medium of the present application can be used to make a single insurance claim even when making an insurance claim to one insurance company at a time. It can be applied in any case, even when claiming insurance claims against multiple insurance companies.

The configurations and routines in the above-described embodiments and modified examples are merely examples, and can be changed as appropriate according to usage and the like.

10 insurance claim agency system 11 insurance claim agency server 13 user terminal 15 insurance company system 17 medical institution terminal 21 communication unit 23 user information DB
25 Authentication unit 27 Common processing unit 29 Service provision area 31 Contract acquisition unit 33 Scrutiny processing unit 35 Required document identification unit 37 Required document request unit 39 Billing processing unit 41 Transaction management DB
43 Criteria DB

Claims (15)

a reception unit that receives an insurance claim to a specific insurance company from a user terminal used by a user of the insurance claim agency service and acquires necessary billing information indicating items necessary for the claim;
a contract content acquisition unit that acquires the contract content related to the claim by communicating with an insurance company system owned by the insurance company to which the claim is made, based on the necessary items for claim;
a required document specifying unit that specifies, as required documents, documents that need to be submitted to the insurance company for the claim based on the required claim items and the contract content;
a document request transmission unit configured to externally transmit a request for transmission of each of the one or more required documents when the one or more required documents are specified by the required document specifying unit;
a document receiving unit that receives the necessary documents from the outside;
a billing processing unit that transmits billing information including the billing necessary items together with the necessary documents to the insurance company system to perform billing;
and an insurance claim agency device. The required document specifying unit calculates the payment amount of the insurance claim related to the claim based on the required claim items and the contract details, and based on the calculated payment amount, a document issued by a medical institution 2. The insurance claim agency apparatus according to claim 1, wherein a certain medical certificate is specified as a required document. 3. The insurance claim agency apparatus according to claim 1, wherein said required document specifying unit specifies said required document based on criteria provided by an insurance company relating to said claim. 1 to 4, wherein the required document specifying unit specifies the required document based on a comparison between a predetermined item of the required billing matter and a portion corresponding to the predetermined item of the contract content. 4. The insurance claim agency apparatus according to any one of claims 3. When the required documents include a medical certificate to be issued by a medical institution, the document request transmission unit transmits a request for transmission of the medical certificate to a terminal owned by the medical institution. 5. The insurance claim agency apparatus according to any one of claims 1 to 4. The document request transmission unit transmits a request for transmission of the documents to be prepared by the user to the user terminal when the necessary documents include the documents to be prepared by the user. 6. The insurance claim agency apparatus according to any one of claims 1 to 5. 7. The insurance claim agency apparatus according to claim 1, wherein said claim processing unit prepares an insurance claim form based on said necessary items for claim and transmits it together with said necessary documents. . When a plurality of processes for a plurality of billing processes of the user are proceeding in parallel, the document request transmission unit transmits the plurality of required documents specified in the plurality of processes. 8. The insurance claim agency apparatus according to any one of claims 1 to 7, wherein the requested requests are aggregated and transmitted. The insurance claim agency apparatus has a plurality of service providing areas, which are mutually independent processing areas each including the contract content acquisition unit, the required document identification unit, and the claim processing unit, for each of the plurality of insurance companies. 8. An insurance claim agency apparatus according to any one of claims 1 to 7, characterized in that: 9. The insurance claim agency apparatus according to claim 8, wherein each of said service providing areas has said document request transmitting section and said document receiving section. When a plurality of processes for a plurality of billing processes of the user are proceeding in parallel, the document request transmission unit, among the plurality of required documents specified by the plurality of service provision areas, 11. The insurance claim agency apparatus according to claim 9, wherein, with respect to a plurality of necessary documents to which the requests for transmission have a common destination, the requests for transmission are aggregated and transmitted. A user terminal used by a user of an insurance claim service, an insurance company system owned by an insurance company, a medical institution terminal owned by a medical institution, the user terminal, the insurance company system, and the medical institution terminal and an insurance claim agency device that performs an insurance claim agency service by communicating with the insurance claim agency system,
The insurance claim agency device,
a reception unit that receives an insurance claim to a specific insurance company from a user terminal used by a user of the insurance claim agency service and acquires necessary billing information indicating items necessary for the claim;
a contract content acquisition unit that acquires the contract content related to the claim by communicating with an insurance company system owned by the insurance company to which the claim is made, based on the necessary items for claim;
a required document specifying unit that specifies, as required documents, documents that need to be submitted to the insurance company for the claim based on the required claim items and the contract content;
a document request transmission unit configured to externally transmit a request for transmission of each of the one or more required documents when the one or more required documents are specified by the required document specifying unit;
a document receiving unit that receives the necessary documents from the outside;
a billing processing unit that transmits billing information including the billing necessary items together with the necessary documents to the insurance company system to perform billing;
An insurance claim agency system characterized by comprising: An insurance claim agency method performed by an insurance claim agency device, comprising:
a reception step in which the reception unit receives an insurance claim from a user terminal used by a user of the insurance claim representation service to a specific insurance company and obtains necessary billing information indicating the necessary items for the claim;
A contract content acquisition step in which the contract content acquisition unit acquires the contract content related to the claim by communicating with an insurance company system owned by the insurance company to which the claim is made based on the required billing items. When,
a required document specifying step in which a required document specifying unit specifies, as required documents, documents that need to be submitted to the insurance company for the claim based on the required request items and the contract details;
a document request transmission step in which, when the one or more required documents are identified by the required document identification unit, the document request transmission unit externally transmits a request for transmission of each of the one or more required documents;
a document receiving step in which the document receiving unit receives the necessary documents from the outside;
a billing processing step in which the billing processing unit transmits billing information including the necessary items for billing together with the necessary documents to the insurance company system to perform billing;
An insurance claim agency method, comprising: An insurance claim agency program executed by an insurance claim agency device comprising a computer, wherein the computer:
a receiving step of receiving an insurance claim to a specific insurance company from a user terminal used by a user of the insurance claim agency service, and obtaining necessary billing information indicating items necessary for the claim;
a contract content acquisition step of communicating with an insurance company system owned by a billing destination insurance company related to the claim to acquire the contract content related to the claim, based on the claim necessary items;
a required document specifying step of specifying, as required documents, documents that need to be submitted to the insurance company for the claim, based on the required claim items and the contract content;
a document request transmission step of transmitting a request for transmission of each of the one or more required documents to the outside when one or more required documents are specified by the required document specifying unit;
a document receiving step of receiving the necessary documents from the outside;
a billing processing step of sending billing information including the billing necessary items together with the necessary documents to the insurance company system to perform billing;
An insurance claim agency program characterized by executing 15. A computer-readable recording medium storing the insurance claim agency program according to claim 14.

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