JP2022166584A - Medical expense payment management system, medical expense payment management method, and program - Google Patents

Abstract

To provide a flexible insurance service in accordance with a contractor in preparing payment for medical expenses.SOLUTION: A medical expense payment management system is configured to: perform advanced transfer processing to transfer the amount of medical expenses of a contractor to a medical institution account, on the basis of a reception of medical expense bill information from a medical institution system; and collect the amount of medical expenses from a dedicated account of a financial institution that manages funds of the contractor after the processing to transfer the amount of medical expenses to the medical institution account. On the basis of a contract status information of the contractor on the advanced transfer processing, a determination is made as to whether to send a bill to an insurance company for a payment for insurance money corresponding to the amount of medical expenses paid by the advance transfer processing.SELECTED DRAWING: Figure 1

Description

The present invention relates to a medical fee payment management system, a medical fee payment management method, and a program.

Patients who receive treatment at a medical institution pay the medical fee at the accounting counter of the medical institution after the treatment. Patients are often kept waiting for a long time because it takes a long time to process medical fees at the accounting counter. In order to eliminate such inconvenience, a service has been started to pay for medical expenses. Patent Document 1 discloses a technique of a payment system that allows the self-payment of medical expenses to be deferred. By deferring the self-payment of the medical expenses, there is no need to exchange cash at the accounting counter.

The payment of medical fees as described above is often made in preparation for cases in which a large medical fee is billed after subscribing to medical insurance. In many cases, the payment of premiums for joining such medical insurance is non-refundable. Patent Document 2 discloses a technique for preparing for the payment of medical expenses.

Japanese Patent No. 4443946 Japanese Patent No. 6734329

Here, it is desired to provide flexible insurance services according to the policyholder when preparing for the payment of medical expenses.

SUMMARY OF THE INVENTION Accordingly, an object of the present invention is to provide a medical fee payment management system, a medical fee payment management method, and a program that solve the above-described problems.

According to the first aspect of the present invention, the medical fee payment management system performs advance transfer processing of the medical fee of the contractor to the account of the medical institution based on receipt of medical fee billing information from the medical institution system. processing means; medical fee collection processing means for collecting the medical fee from a dedicated account of a financial institution that manages the funds of the contractor after processing the transfer of the medical fee to the account of the medical institution; a claim presence/absence determining means for determining whether or not to make a claim to an insurance company for the insurance money corresponding to the medical expenses paid in advance by the reimbursement processing, based on the contract status information regarding the reimbursement processing.

The above-described medical expense payment management system includes insurance claim processing means for generating a payment claim to the insurance company for the insurance money corresponding to the medical expenses paid in advance by the reimbursement transfer process when it is determined that the payment claim will be made. , may be provided.

When it is determined that the billing is to be performed, the above-described medical fee payment management system selects a method of billing, whether the billing is to be performed using the medical statement information or the medical certificate issued by the medical institution. billing method determining means for determining.

In the medical expense payment management system described above, when the insurance claim processing means determines that the payment claim is to be made, the insurance claim processing means uses a method according to the determination result of the claim method to handle the medical expenses paid in advance by the reimbursement transfer process. and claim processing means for generating a claim to the insurance company for claims to be made.

In the medical expense payment management system described above, the billing presence/absence determination means determines whether or not the medical billing information includes the medical bill information, and the insurance money corresponding to the medical bill paid in advance by the payment transfer process. If the medical bill information is included, the insurance claim processing means determines whether or not to make a claim for payment to the insurance company, and if the medical bill information is included, the insurance money corresponding to the medical expenses paid in advance by the payment transfer process may generate a claim to the insurance company for

In the medical expense payment management system described above, the billing presence/absence determination means determines whether or not the insurance money corresponding to the medical expenses paid in advance by the payment transfer process is based on the contents of the medical bill information included in the medical billing information. It is determined whether or not to make a claim for payment to an insurance company, and the insurance claim processing means processes the insurance for the insurance money corresponding to the medical expenses paid in advance by the payment transfer process based on the contents of the medical bill information. When it is determined that the company will be billed for payment, a claim for payment of insurance money corresponding to the medical expenses paid in advance by the above-mentioned remittance processing may be generated.

The medical expense payment management described above comprises policyholder determination means for determining whether the policyholder is covered by insurance or not covered by insurance based on the contract status information of the policyholder, and the insurance claims processing means comprises , when the policyholder is an insurance-applied policyholder, a claim for payment to the insurance company of the insurance money corresponding to the medical expenses paid in advance by the payment transfer processing may be generated.

In the medical expense payment management system described above, the payment transfer processing means may determine whether or not to perform payment transfer processing of the medical expenses of the contractor to the account of the medical institution based on the reception of the medical expense billing information. .

The medical expense payment management system described above may include credit processing means for generating information regarding the transfer of credit for the medical fees based on the results of the remittance processing of the medical fees of the contractor to the account of the medical institution. .

According to the second aspect of the present invention, the medical fee payment management system performs advance transfer processing of paying the medical fees of the contractor to the account of the medical institution based on receipt of medical fee billing information from the medical institution system. a processing unit, a medical fee collection processing unit that collects the medical fee from a dedicated account of a financial institution that manages the funds of the contractor after processing the transfer of the medical fee to the medical institution account, and the medical fee billing information. a claim presence/absence determination unit that determines whether or not to make a claim to an insurance company for the insurance payment corresponding to the medical expenses paid in advance by the reimbursement transfer process, based on whether or not medical statement information is included in the medical treatment and an insurance claim processing unit that generates a claim for payment of insurance money corresponding to the medical expenses paid by the payment transfer process to the insurance company when detailed information is included.

According to the third aspect of the present invention, the medical fee payment management system performs advance transfer processing of paying the medical fees of the contractor to the account of the medical institution based on receipt of medical fee billing information from the medical institution system. a processing unit, a medical fee collection processing unit that collects the medical fee from a dedicated account of a financial institution that manages the funds of the contractor after processing the transfer of the medical fee to the medical institution account, and the medical fee billing information. a claim presence/absence determination unit that determines whether or not to make a claim for insurance payment corresponding to the medical expenses paid in advance by the above-mentioned reimbursement processing based on the content of the medical statement information included in the medical statement information; If it is determined to make a claim to the insurance company for the insurance money corresponding to the medical expenses paid in advance by the said payment transfer process based on the above, the insurance money corresponding to the medical treatment expenses paid in advance by the said payment transfer process will be sent to the insurance company. and a claims processor for generating a claim for.

According to the fourth aspect of the present invention, the medical fee payment management system performs advance transfer processing of the medical fee of the contractor to the account of the medical institution based on the receipt of medical fee billing information from the medical institution system. a processing unit, a policyholder determination unit that determines whether the policyholder is an insurance-applied policyholder or a non-insurance policyholder based on the contract status information of the policyholder, A medical fee collection processing unit that collects the medical expenses from a dedicated account of a financial institution that manages the funds of the person, and when the contractor is the insurance covered contractor, the medical expenses paid by the above-mentioned reimbursement transfer process. a claims processor for generating a corresponding claim for payment to an insurance company.

According to a fifth aspect of the present invention, the medical fee payment management method performs a payment transfer process for the contractor's medical fees to the medical institution account based on receipt of medical fee billing information from the medical institution system, and After processing the transfer of the medical fee to the medical institution account, the medical fee is collected from the dedicated account of the financial institution that manages the funds of the contractor, and based on the contract status information regarding the payment transfer processing of the contractor, It is determined whether or not to make a claim for payment to the insurance company for the insurance money corresponding to the medical expenses paid in advance by the payment transfer process.

According to the sixth aspect of the present invention, the program instructs the computer of the medical fee payment management system to remit the contractor's medical fee to the medical institution account based on the reception of the medical fee billing information from the medical institution system. payment transfer processing means for processing, medical fee collection processing means for collecting the medical fee from a dedicated account of a financial institution that manages the funds of the contractor after processing the transfer of the medical fee to the medical institution account, and the contract function as claim presence/absence determination means for determining whether or not to make a claim to an insurance company for insurance claims corresponding to medical expenses paid in advance by said payment transfer process, based on contract status information relating to said payment transfer process of said person. Let

According to the present invention, it is possible to provide flexible insurance services according to the policyholder when preparing for payment of medical fees.

1 is a diagram showing the configuration of a medical fee payment management system according to one embodiment of the present invention; FIG. It is a figure which shows the process outline|summary of the medical expenses payment management system by one Embodiment of this invention. It is a figure which shows the hardware constitutions of each apparatus contained in the medical expenses payment management system by one Embodiment of this invention. 1 is a functional block diagram of a medical fee payment management server and a financial institution server according to one embodiment of the present invention; FIG. 1 is a first diagram showing a processing flow of a medical fee payment management system according to one embodiment of the present invention; FIG. FIG. 4 is a second diagram showing the processing flow of the medical fee payment management system according to one embodiment of the present invention; 1 is a diagram illustrating an overview of loan processing according to one embodiment of the present invention; FIG. FIG. 11 is a third diagram showing the processing flow of the medical fee payment management system according to one embodiment of the present invention; FIG. 10 is a fourth diagram showing the processing flow of the medical fee payment management system according to one embodiment of the present invention; FIG. 10 is a fifth diagram showing the processing flow of the medical fee payment management system according to one embodiment of the present invention; FIG. 4 illustrates a first management server and a second management server according to one embodiment of the present invention; FIG. 10 is a sixth diagram showing the processing flow of the medical fee payment management system according to one embodiment of the present invention;

A medical fee payment management system according to an embodiment of the present invention will be described below with reference to the drawings.
FIG. 1 is a diagram showing the configuration of a medical fee payment management system according to the same embodiment.
As shown in FIG. 1, the medical fee payment management system 100 includes a medical fee payment management server 1, a financial institution server 2, a medical institution server 3, and an insurance company server 4, which are connected via a communication network. The medical fee payment management server 1 is a computer operated by a company that uses the medical fee payment management system 100 to provide main services to patients who are contractors. The financial institution server 2 is a computer operated by a financial institution. The medical institution server 3 is a computer operated by a medical institution. The insurance company server 4 is a computer operated by an insurance company. The medical fee payment management system 100 may include at least a medical fee payment management server. A terminal device used by a user may be connected to each server for communication.

FIG. 2 is a diagram showing an outline of processing of the medical fee payment management system according to this embodiment.
The medical fee payment management service according to this embodiment is provided by a service provider company that operates the medical fee payment management server 1 . (1) Contractors who are potential patients make a contract for the service with the service provider. Under this contract, the contractor can receive medical expense payment management services. (2) The contractor who receives the medical expense payment management service opens at least a health account in a financial institution, and instructs the monthly transfer of a predetermined accumulated amount to the health account. The monthly reserve amount may be freely determined by the contractor. Alternatively, the contractor may instruct the financial institution to transfer a large amount of accumulated funds to the health account at once. The health account is a dedicated account necessary for receiving the medical expense payment management service. The contractor may open a separate ordinary account at a financial institution and transfer the reserve funds from this ordinary account to the health account. This health account allows a financial institution to lend the balance of the difference when the contractant's medical expenses notified from an external device such as the medical expenses payment management server 1 become higher than the balance of the health account. It may be an account with a loan function.

(3) Under the above contract, the financial institution will transfer the reserve money to the health account of the contractor every month. The account from which the reserve money is transferred may be the regular account of the financial institution of the contractor who opened the health account, or may be an account of another financial institution. The service provider provides the medical expense payment management service when the balance of the health account is equal to or greater than the predetermined service maintenance balance. The financial institution may apply a higher interest rate than the interest rate applied to other accounts to calculate the interest rate for the reserve fund managed in the health account based on the above contract.

(4) The service providing company instructs the collection of the monthly membership fee as consideration for the provision of the medical fee payment management service. Thereby, it is possible to instruct the transfer of the monthly membership fee from the health account or ordinary account to the account of the service provider company. (5) The service provider instructs the insurance company to pay a predetermined amount of the monthly membership fee to the insurance company on behalf of the policyholder. At this time, the service company may input to the medical expense payment management server 1 an instruction to collectively pay the insurance premiums of a plurality of policyholders to the insurance company. The medical fee payment management server 1 transfers insurance premiums to the insurance company account to the financial institution server 2 . An insurance contract is made between an insurance company and a service provider. An insurance contract is a contract of insurance money that is paid from an insurance company to a service provider that pays for the medical expenses when the medical expenses of the policyholder are higher than a predetermined amount. The service provider provides a service to pay the policyholder as a solatium for the insurance money. An insurance contract may be directly between the policyholder and the insurance company. In this case as well, if the service provider detects that the medical fees of the contractor who has a contract with the insurance company for this service is higher than a predetermined amount, the service provider will reimburse the medical fees paid to the medical institution. you can go Alternatively, the service provider company may reimburse the medical expenses paid to the medical institution even if the medical expenses of the contractor who has made a contract for this service with the insurance company are less than a predetermined amount.

(6) After signing the contract according to (1) above, the contractor will have a medical examination at a medical institution where this service can be used. (7) If the patient who received medical treatment is a contractor, the medical institution will directly bill the service provider for the medical expenses. (8) When a medical institution requests a medical fee, the service provider issues a payment instruction to cover the medical fee. As a result, the service provider company can transfer the medical fee from its own account to the account of the medical institution, and pay the medical fee for the contractor who becomes the patient. (9) At a later date, the service providing company instructs the financial institution to collect the medical fees paid in advance. As a result, the financial institution server transfers the medical fee from the account of the contractor to the account of the service provider company.

(10) The balance managed by the health account is reduced by being used as medical expenses. The financial institution automatically makes loans so that the balance of the health account maintains the basic balance (basic balance > service maintenance balance). (11) If the medical fee is more than a predetermined high amount, the service provider instructs the financial institution to pay a predetermined solatium. As a result, the financial institution transfers the solatium from the account of the service provider to the subscriber's health account or ordinary account. The insurance contract entered into by the service provider with the insurance company is ``performance cost insurance''. For this reason, the service provider pays in advance (before receipt of the insurance money) as a solatium for loss due to the decrease in the health account balance of the policyholder. As described above, the service provider company may instruct the financial institution to pay a predetermined solatium even if the medical fee is not equal to or greater than the predetermined high amount. As a result, the financial institution transfers the solatium from the account of the service provider to the subscriber's health account or ordinary account. The service provider may pay all or part of the loss due to the reduction in the policyholder's health account balance prior to receipt of the insurance benefit.

(12) The service provider makes a claim for insurance benefits corresponding to the solatium based on the contract with the insurance company. (13) The insurance company instructs the financial institution to pay the insurance benefit based on the insurance claim. As a result, the insurance money is transferred from the account of the insurance company to the account of the service provider company. Alternatively, depending on the contract between the insurance company and the policyholder, the insurance company may instruct the financial institution to pay the insurance benefit to the policyholder's account based on the insurance benefit request from the service provider. In this case, the insurance money is transferred from the account of the insurance company to the account of the policyholder. (14) The insurance company notifies the service provider that the insurance payment has been completed. Note that the service provider company may issue the medical fee payment instruction (8) based on the contract status of the contractor regarding the reimbursement process when issuing the medical fee payment instruction (8) for the rebuilding described above. . In addition, the service provider determines whether or not to make a claim (12) to the insurance company for the insurance money corresponding to the medical expenses paid in advance by the payment transfer process, based on the contract status of the policyholder. you can For example, the service provider determines whether the information indicating the contract status is a general contract (ordinary contract) or a specific contract, the type of insurance, or the amount of medical expenses, and whether or not to make a claim for insurance benefits to the insurance company. can be determined. When the service provider company determines to make an insurance claim, the service provider may make an insurance claim (12).

When the contractor contracts for the medical expense payment management service, the contractor can receive services such as payment of medical expenses and payment of condolence money through the processing described above. In addition, when contracting the medical expense payment management service, the contractor can automatically deposit a specified amount in the health account every month. The contractor can cancel the contract of the medical expense payment management service in the future, and in this case, the amount accumulated in the health account can be transferred to another account of the contractor and used. In addition, since the interest rate of the health account is higher than the interest rate of other accounts, by saving money in the health account, it is possible to receive services equivalent to or better than the savings type medical insurance. In addition, the service provider company can provide flexible insurance services according to the contract status of the contractor to prepare for the payment of medical expenses.

FIG. 3 is a diagram showing the hardware configuration of each device included in the medical fee payment management system.
As shown in this figure, the medical fee payment management server 1, the financial institution server 2, the medical institution server 3, and the insurance company server 4 include a CPU (Central Processing Unit) 101, a ROM (Read Only Memory) 102, a RAM (Random Access Memory) 103, database 104, communication module 105, and other hardware.

FIG. 4 is a functional block diagram of a medical fee payment management server and a financial institution server.
The medical fee payment management server 1 executes a medical fee payment management program stored in advance. As a result, the medical fee payment management server 1 includes a control unit 11, a membership fee processing unit 12, an insurance premium management unit 13, an out-of-pocket payment processing unit 14, a medical fee collection processing unit 15, an insurance payment processing unit 16, and a service maintenance determination unit. 17 and a notification unit 18 are provided.
The control unit 11 controls other functional units.
The membership fee processing unit 12 instructs collection of the monthly membership fee necessary for providing the service.
The insurance premium management unit 13 performs processing related to insurance contracts when providing services.
The reimbursement processing unit 14 performs remittance processing and the like for reimbursement of medical expenses.
The medical fee collection processing unit 15 performs medical fee collection processing.
The insurance money transfer processing unit 16 performs transfer processing and the like when paying the insurance money as a solatium to the policyholder.
The service maintenance determination unit 17 performs processing for determining whether or not to suspend the service of medical fee payment management based on whether the balance of the health account is the service maintenance balance.
The notification unit 18 performs various notifications.

The financial institution server 2 executes various processing programs. As a result, the financial institution server 2 has the functions of a control unit 21 , an accumulation processing unit 22 , a transfer processing unit 23 , a balance confirmation unit 24 , a loan processing unit 25 , an interest rate management unit 26 and a notification unit 27 .
A control unit 21 controls other functional units.
The reserve processing unit 22 performs reserve processing, temporary reserve funds, condolence money, etc., from the ordinary account or the like to the health account for each contractor. In addition to monthly reserves, deposits to health accounts include temporary reserves, condolence money, and high-cost medical care expenses.
The transfer processing unit 23 performs transfer processing based on instructions from other devices.
The balance confirmation unit 24 confirms the balance for each contractor.
The loan processing unit 25 automatically performs loan processing when the balance of the health account for each contractor is less than a predetermined basic balance.
The interest rate management unit 26 calculates the interest rate on the balance of the health account by using the interest rate on the balance of the health account that is higher than that of other accounts. The interest rate is, for example, the interest rate applied to the balance of the health account. In still other examples, high interest rates may not be applied to health account balances.
The notification unit 27 makes various notifications to a predetermined device.

For convenience of explanation, the medical fee payment management server 1, the financial institution server 2, the medical institution server 3, and the insurance company server 4 are explained as a single server. You may make it unite and process each server.

FIG. 5 is the first diagram showing the processing flow of the medical fee payment management system.
Next, the processing flow of the medical fee payment management system will be explained step by step.
First, the financial institution server 2 stores information such as the ordinary account number, the health account number, the monthly reserve amount, and the transfer date for the reserve in association with the account ID corresponding to the contractor. Then, the reserve processing unit 22 of the financial institution server 2 performs processing to transfer the reserve amount from the contractor's ordinary account to the health account at a predetermined time on the day indicated by the transfer date. As a result, the accumulated amount of each policyholder is transferred to the health account of the policyholder.

On the other hand, the medical expense payment management server 1 also stores contractor information such as contractor ID, financial institution information, health account number, contractor name, contractor address, etc. for each contractor. Based on the contractor information, the membership fee processing unit 12 of the medical fee payment management server 1 sends monthly membership fee collection instruction information including the health account number of each contractor, the financial institution information of these accounts, the account number of the service provider company, etc. Generate. The membership fee processing unit 12 transmits monthly membership fee collection instruction information to the financial institution server 2 (step S101).

When financial institution servers 2 of a plurality of financial institutions are included in the medical fee payment management system 100, the membership fee processing unit 12 transmits membership fee collection instruction information to the corresponding financial institution server 2 according to the financial institution information. Similarly, when the medical fee payment management server 1 transmits other information to the financial institution server 2, the information is transmitted to different financial institution servers 2 based on the financial institution used by the contractor. Description is omitted.

The transfer processing unit 23 of the financial institution server 2, based on the membership fee collection instruction information, transfers a predetermined amount of membership fee from the account number of the contractor who is the transfer source indicated by the information to the account number of the service provider company which is the transfer destination. conduct. As a result, the monthly membership fee, which is the consideration for providing the service, is paid from the contractor to the service providing company.

The insurance premium management unit 13 of the medical fee payment management server 1 pays a predetermined amount of the monthly fee to the insurance company as an insurance premium. In this case, the insurance premium management unit 13 calculates the total insurance premium for all policyholders who maintain the service. The amount of monthly membership fees and insurance premiums may vary depending on the service level, which is one aspect of contract conditions of the contractor. For example, depending on the service level, the amount of insurance money and the provision of other services may differ. In the contract conditions of this embodiment, the contractor may be classified into either a general member or a specific member according to his/her own contract. For example, a general member can receive a service for reimbursement of medical expenses provided by a service provider company, regardless of whether the member receives a medical examination as an outpatient or is hospitalized. Also, for example, a specific member can receive a service for reimbursement of medical expenses provided by a service provider company only when he or she receives a medical examination at an outpatient clinic. There may be differences in insurance premiums for general members and specific members, and monthly membership fees for receiving services. The premium management unit 13 further generates premium payment instruction information including the calculated total premium. The insurance premium payment instruction information includes the account number of the insurance company account as the transfer destination, and the account number of the service provider company as the transfer source. The membership fee processing unit 12 transmits insurance premium payment instruction information to the financial institution server 2 (step S102). The transfer processing unit 23 of the financial institution server 2 transfers the insurance premium from the account number of the service providing company, which is the transfer source, to the account number of the insurance company account based on the insurance premium payment instruction information.

It is also assumed that the contractor has undergone a medical examination at a prescribed medical institution. Then, in this medical institution, the medical institution server 3 determines whether the patient ID input by the operator is associated with the contractor's ID of the medical expense payment management service. When the patient's ID is associated with the ID of the contractor of the medical fee payment management service, the medical institution server 3 outputs a determination input screen for whether or not to receive the medical fee payment management service to the monitor. Note that medical institutions may include hospitals, pharmacies, and the like. When a person in charge of a hospital accounts for a contractor's payment, or when a person in charge of a pharmacy accounts for a contractor's payment, the person in charge becomes an operator and accesses the medical institution server 3 from a terminal device. The medical institution server 3 acquires the patient ID from the terminal device based on the operator's operation, and if the patient ID is linked to the ID of the contractor of the medical fee payment management service, the medical institution server 3 starts the medical fee payment management service. A judgment input screen for accepting or not is output to the monitor.

When the operator confirms the patient's intention and determines that the patient will receive the medical expense payment management service, the operator uses the determination input screen output to the monitor of the medical institution server 3 to instruct the start of the service. Then, the medical institution server 3 generates medical billing information including the contract ID of the contractor, the medical expenses, the medical institution ID, the statement of medical expenses, and the like. The medical institution server 3 transmits medical fee billing information to the medical fee payment management server 1 .

The medical fee payment management server 1 receives the medical fee billing information (step S103). Then, the reimbursement processing unit 14 of the medical fee payment management server 1 reads information such as the medical fee, contract ID, medical institution ID, medical fee statement data, etc. included in the medical fee billing information. The reimbursement processing unit 14 reads information indicating whether the service can be maintained or not recorded in a database or the like in association with the contract ID. If the contract ID is associated with information indicating that the service can be maintained, the reimbursement processing unit 14 determines that medical expenses will be reimbursed. The reimbursement processing unit 14 may determine whether or not to reimburse medical expenses through other processing. For example, the payment transfer processing unit 14 reads the membership type recorded in a database or the like in association with the contract ID. Membership types are classified into general members and specific members. The payment transfer processing unit 14 also reads the type of medical treatment included in the medical fee statement data. The type of medical care is classified into either outpatient or inpatient. When the member type is general member, the reimbursement transfer processing unit 14 determines that medical expenses should be reimbursed regardless of whether the type of medical treatment is outpatient or inpatient. When the member type is a specific member, the payment transfer processing unit 14 judges that medical expenses should be paid only when the type of medical care is outpatient. The processing of this payment transfer processing unit 14 is an example of processing for determining whether or not to perform the payment transfer processing based on the contract status information regarding the payment transfer processing of the contractor.

The payment transfer processing unit 14 reads the account number of the medical institution account corresponding to the medical institution ID from a database or the like. The payment transfer processing unit 14 reads the account number of the service provider company and the account number of the medical institution account corresponding to the medical institution ID from a database or the like. The reimbursement processing unit 14 generates medical fee payment instruction information including at least the medical fee, the account number of the service provider company that is the source of the transfer, and the account number of the medical institution account that is the destination of the transfer (step S104). The reimbursement processing unit 14 transmits medical fee payment instruction information to the financial institution server 2 (step S105). As a result of reading the information indicating whether the service can be maintained or not recorded in the database or the like in association with the contract ID, the reimbursement processing unit 14 reads the information indicating that the service cannot be maintained. is determined to be discontinued. In this case, the payment transfer processing unit 14 instructs the notification unit 18 to notify that the service cannot be maintained. The notification unit 18 reads the network address of the patient (contractor) from a database or the like based on the contract ID, and notifies the network address of information indicating that the service cannot be maintained. As a result, the contractor transfers an amount such that the balance of the health account exceeds the service maintenance balance. The balance confirmation unit 24 of the financial institution server 2 reads the balance of the contractor's health account and notifies the medical fee payment management server 1 of it. As a result, the service maintenance determining unit 17 of the medical fee payment management server 1 determines whether or not the service can be maintained by the processing shown in FIG. 8 below. Details will be described later with reference to FIG.

The financial institution server 2 receives the medical fee payment instruction information. The transfer processing unit 23 performs transfer processing using the account number of the transfer source, the account number of the transfer destination, and the transfer amount, which is the medical fee, included in the medical fee payment instruction information. That is, the transfer processing unit 23 performs a transfer process of subtracting the medical fee from the balance of the account indicated by the account number of the service provider company and adding the medical fee to the balance of the account number of the medical institution account. As a result, the service provider company can make advance payments for the medical expenses to the medical institution. Note that the interest rate management unit 26 of the financial institution server 2 may calculate the interest rate on the balance of the health account using a higher interest rate than other accounts such as the ordinary account.

The medical fee collection processing unit 15 of the medical fee payment management server 1 issues a medical fee collection instruction on a predetermined day of the next month in response to a medical fee payment instruction for one month issued by a predetermined day of the previous month. The medical fee collection processing unit 15 totals the medical fees based on the medical fee billing information for one month up to a predetermined day of the previous month (step S106). The medical fee collection processing unit 15 records a plurality of pairs of medical fee billing information and medical fee payment instruction information in a database, and generates corresponding medical fee collection instruction information based on the information (step S107). ). In the medical fee collection instruction information, based on a pair of medical fee billing information and medical fee payment instruction information for one month up to a predetermined day in the previous month, the contractor's health account corresponding to the contract ID to be the transfer source. , the account number of the service provider company to which the payment is to be transferred, and the total medical expenses. The medical fee collection processing unit 15 transmits medical fee collection instruction information to the financial institution server 2 (step S108). The transfer processing unit 23 of the financial institution server 2, based on the medical fee collection instruction information, subtracts the medical fee from the balance of the account number of the contractor's health account corresponding to the contract ID that is the transfer source, and transfers the medical fee to the service that will be the transfer destination. Perform transfer processing to add medical expenses to the balance of the account number of the provider company. As a result, the service provider company can collect the medical expenses paid by the service provider company. The financial institution server 2 repeats the above processing for each contractor.

According to the above-described processing, a contractor who has made a contract for a medical expense payment management service provided by a service provider company can open a dedicated account called a health account at a financial institution, and can accumulate a monthly reserve in this health account. Then, the patient can receive the service of reimbursement for medical expenses based on the balance of the health account, and can enjoy the merit of shortening the waiting time during accounting procedures at the medical institution.

In addition, since the accumulated amount is transferred to the health account every month, if you do not receive medical care at a medical institution, you can accumulate the balance of the health account for high medical expenses that may occur in the future, or cancel the service. It can be used for other purposes.

Also, if the interest rate given to the balance of the health account is higher than that of other accounts, the money can be managed more profitably by saving money in the health account compared to depositing money in other accounts.

FIG. 6 is a second diagram showing the processing flow of the medical fee payment management system.
FIG. 7 is a diagram showing an outline of loan processing.
The financial institution server 2 constantly monitors whether the health account balance is less than a predetermined basic balance. Note that the basic balance is a larger value than the service maintenance balance. Specifically, the balance confirmation unit 24 reads the balance of the contractor's health account (step S201). The balance confirmation unit 24 outputs the contractor ID, the account number of the contractor's health account, and the balance of the health account to the loan processing unit 25 . The loan processing unit 25 compares the balance of the health account with the amount set as the basic balance (step S202). If the balance of the health account is less than the basic balance (Fig. 7(a)), the loan processing unit 25 determines that the contract is automatically loaned (step S203). The loan processing unit 25 calculates the loan amount indicating the difference between the current balance of the health account and the basic balance recommended as the balance of the health account (step S204). The loan processing unit 25 generates loan transfer processing information indicating the loan amount and the account number of the health account (step S205). The loan processing unit 25 outputs the loan transfer processing information to the transfer processing unit 23 . The transfer processing unit 23 adds the loan amount to the balance of the account number of the health account included in the loan transfer processing information and subtracts the loan amount from the predetermined loan pool account of the financial institution (Fig. 7(b)). (Step S206). When lending, the loan processing unit 25 transmits a request to the medical expense payment management server 1 to determine whether or not the loan can be made, and as a result, only when it receives determination result information indicating that the loan is possible from the medical expense payment management server 1. You may make it loan processing of loan money.

With the above process, if the health account balance falls below the basic balance due to the collection of large medical expenses, the contractor can enjoy automatic loan service. As a result, it is possible to reduce the shortage of the balance in the use of the service for reimbursement of medical expenses using the health account.

FIG. 8 is a third diagram showing the processing flow of the medical fee payment management system.
The medical fee payment management server 1 determines whether or not to stop the medical fee payment management service, including the process of transferring the medical fee to the medical institution account of the contractor, based on whether or not the balance of the health account is the service maintenance balance. judge.

Specifically, the financial institution server 2 constantly monitors whether or not the balance of the subscriber's health account is less than the service maintenance balance. Incidentally, as shown in FIG. 7, the service maintenance balance is an amount smaller than the basic balance. Specifically, the balance confirmation unit 24 reads the balance of the contractor's health account. The balance confirmation unit 24 outputs the contractor ID, the account number of the contractor's health account, and the balance of the health account to the accumulation processing unit 22 . The accumulation processing unit 22 compares the balance of the health account with the amount set as the service maintenance balance. If the health account balance is less than the service maintenance balance, the accumulation processing unit 22 transmits service maintenance determination information to the medical expense payment management server 1 . The service maintenance determination information includes the subscriber ID and the balance of the subscriber's health account.

The service maintenance determination unit 17 of the medical fee payment management server 1 acquires service maintenance determination information (step S301). If the health account balance is less than the service maintenance balance, the service maintenance determination unit 17 determines that the service cannot be maintained based on the subscriber ID and the balance of the health account included in the service maintenance determination information (step S302). Note that the financial institution server 2 instead of the medical fee payment management server 1 may determine whether the service cannot be maintained. In this case, the notification unit 27 of the financial institution server 2 notifies the medical fee payment management server 1 that the service cannot be maintained. The service maintenance determining unit 17 of the medical fee payment management server 1 associates the information indicating that the service cannot be maintained with the contractor ID and registers it in a database or the like (step S303). As a result, the medical expense reimbursement service is stopped based on the receipt of the medical expense billing information for the contractor.

FIG. 9 is a fourth diagram showing the processing flow of the medical fee payment management system.
The medical fee payment management server 1 provides insurance for part of the membership fee for the service collected from the health account when the amount indicated by the medical fee billing information exceeds a predetermined amount while the service to the contractor is being maintained. Transfer processing of the insurance amount from the insurance company based on the payment of the premium to the insurance company is performed to the health account of the policyholder for whom the amount indicated in the medical fee claim information exceeds a predetermined amount. The processing will be described below.

The insurance payment transfer processing unit 16 of the medical fee payment management server 1 acquires the medical fee billing information received from the medical institution server 3 in the above-described processing from the payment transfer processing unit 14 that has completed the medical fee payment processing. The insurance money transfer processing unit 16 reads the medical fee included in the medical fee billing information (step S401). The insurance money transfer processing unit 16 determines whether or not the medical fee is equal to or higher than a predetermined high amount (step S402). When the medical fee is equal to or greater than a predetermined high amount, the insurance money transfer processing unit 16 determines to transfer the solatium to the health account that can be specified based on the medical fee claim information and to make an insurance claim ( step S403).

In this case, the insurance money transfer processing unit 16 of the medical fee payment management server 1 determines that the predetermined high amount of money is a solatium if the medical fee included in the medical fee claim information is equal to or greater than a predetermined high amount. Also, if the medical fee included in the medical fee claim information is less than a predetermined high amount, the insurance money transfer processing unit 16 determines that the medical fee is a solatium. The insurance money transfer processing unit 16 generates solatium payment information indicating the determined solatium amount. The solatium payment instruction information further includes information such as the account number of the payee's health account specified based on the contractor ID and the account number of the service provider company that made the transfer. The insurance money transfer processing unit 16 transmits the solatium payment instruction information to the financial institution server 2 (step S404).

The transfer processing unit 23 of the financial institution server 2 receives the solatium payment instruction information. Based on the solatium payment instruction information, the transfer processing unit 23 subtracts the solatium from the balance of the account number of the service providing company of the transfer source and adds the amount of the solatium to the balance of the account number of the payee's health account. As a result, the transfer processing unit 23 can pay the contractor a consolation money from the service provider company.

Then, the insurance payment processing unit 16 starts insurance payment claim processing according to the payment of the solatium. An insurance claim is based on an insurance contract between a service provider and an insurance company. An insurance contract is a contract that treats as an insured accident when medical expenses exceeding a predetermined amount of money are incurred. The insurance payment processing unit 16 generates insurance payment claim information (step S405). The insurance payment processing unit 16 transmits the insurance payment claim information to the insurance company server 4 (step S406). The insurance benefit claim information includes medical expenses, policyholder ID, medical institution ID received by the policyholder, account number of the service provider company, and the like.

Insurance company server 4 receives insurance claim information. The insurance company server 4 performs a predetermined examination process based on the insurance claim information. The insurance company server 4 generates insurance payment instruction information when the examination process is completed and insurance payment is determined. The insurance payment instruction information includes the insurance money, the account number of the insurance company account of the transfer source, the account number of the service provider company of the transfer destination, and the like. The insurance company server 4 transmits the generated insurance payment instruction information to the financial institution server 2 . The transfer processing unit 23 of the financial institution server 2 acquires the insurance payment instruction information. Based on the insurance payment instruction information, the transfer processing unit 23 of the financial institution server 2 subtracts the insurance payment from the balance of the account number of the insurance company account and adds the insurance payment to the account number of the service provider company. This completes the payment of the insurance money from the insurance company to the service provider company. When the payment is completed, the financial institution server 2 notifies the insurance company server 4 of the payment completion. When the insurance company server 4 completes transmission of the insurance payment instruction information and receives notification of payment completion, it generates insurance payment notification information. The insurance benefit notification information includes information such as the medical fee and policyholder ID included in the insurance benefit claim information. Insurance company server 4 transmits insurance benefit notification information to medical expense payment management server 1 .

The medical expense payment management server 1 receives the insurance benefit notification information (step S407). The insurance payment transfer processing unit 16 of the medical expense payment management server 1 performs insurance payment confirmation processing based on the reception of the insurance payment notification information (step S408). The insurance money transfer confirmation process is a judgment as to whether or not the account number of the service provider company has a money transfer corresponding to the insurance money included in the insurance money payment notification information.

With the above processing, the contractor who has made a contract for the medical expense payment management service can enjoy the service of automatically receiving payment of the solatium when the medical expense is high. The medical fee payment management server 1 may automatically perform the billing procedure for high-cost medical expenses when the medical fees are high according to the contract level of the contractor. High-cost medical expenses are benefits provided by, for example, the National Health Insurance Association, which is a public institution. For example, the medical expense payment management server 1 fills in necessary entry items of predetermined format data based on information on the contractor, medical expenses, information on the medical institution, etc. Generate a written high-cost medical care bill document. The medical expense payment management server 1 performs a process of transmitting or outputting the information of the high-cost medical expense bill document to a predetermined device. For example, the medical care fee payment management server 1 may output this high-cost medical care bill document to a printer for printing. Send the High-Cost Medical Care Claims Form to the High-Cost Medical Care Claims Desk. As a result, the contractor can receive public high-cost medical care benefits according to the contract level without the labor of creating and sending high-cost medical care bill documents when medical expenses are high.

It is difficult for individuals to predict their own health status in the future. For this reason, many people take out medical insurance to prepare for medical expenses in the event that they become seriously ill in the future. However, according to the medical expense payment management system described above, it is possible to prepare for future medical expenses by depositing own funds into a health account every month without subscribing to medical insurance. In many cases, medical insurance is a lump-sum payment and most of the premiums do not flow back to themselves, but the above-mentioned medical expense payment management system keeps the balance of the health account on hand and uses it for various necessary funds after retirement. be able to.

In other words, according to the medical expense payment management system described above, the account for general household living expenses and the medical expense payment account are clearly separated, and by accumulating an amount equivalent to the unpaid medical insurance premium each month, medical insurance does not cover In the unlikely event that medical expenses are high, including daily medical expenses, by setting up a dedicated account (health account) for medical expenses payment with insurance and borrowing functions, you will be able to worry about medical expenses for the rest of your life. It is possible to provide the technology to be resolved.

FIG. 10 is a fifth diagram showing the processing flow of the medical fee payment management system.
When the medical fee payment management server 1 receives the medical fee billing information from the medical institution server 3 while the service to the contractor is being maintained, the medical fee payment management server 1 receives insurance for a portion of the membership fee for the service collected from the health account. Based on the payment of the premium to the insurance company, the insurance money transfer process (benefit claim) from the insurance company is performed. The processing will be described below.

The insurance payment transfer processing unit 16 of the medical fee payment management server 1 acquires the medical fee billing information received from the medical institution server 3 in the above-described processing from the payment transfer processing unit 14 that has completed the medical fee payment processing (step S501). Based on the acquired medical billing information, the insurance money transfer processing unit 16 determines whether or not to make a claim (payment claim) for the insurance money to the insurance company (step S502). Specifically, the insurance money transfer processing unit 16 reads the contract ID and the medical fee statement data included in the medical billing information. The insurance money transfer processing unit 16 reads the membership type recorded in the database or the like in association with the contract ID. Membership types are classified into general members and specific members. The payment transfer processing unit 14 also reads the type of medical treatment included in the medical fee statement data. The type of medical care is classified into either outpatient or inpatient. When the membership type is a general member, the insurance payment processing unit 16 determines that the insurance payment is to be claimed to the insurance company regardless of whether the type of medical treatment is outpatient or inpatient. When the member type is a specific member, the reimbursement processing unit 14 determines that an insurance claim is to be made only when the medical treatment type is outpatient. The processing of this insurance money transfer processing unit 16 is based on the contract status information regarding the money transfer processing of the policyholder, and determines whether or not to make a claim to the insurance company for the insurance money corresponding to the medical expenses paid in advance by the money transfer processing. This is one aspect of the process of determining.

When the insurance money transfer processing unit 16 determines to make an insurance claim, it reads the medical fee included in the medical fee claim information (step S503). The insurance money transfer processing unit 16 determines whether or not the medical fee is equal to or higher than a predetermined high amount (step S504). When the medical fee is equal to or greater than a predetermined high amount, the insurance money transfer processing unit 16 determines to transfer the solatium to the health account that can be specified based on the medical fee claim information and to make an insurance claim ( step S505). Note that, if medical expenses are incurred, the insurance money transfer processing unit 16 transfers the solatium and claims for insurance claims, or only claims for insurance claims, even if the medical costs are not equal to or greater than a predetermined high amount. , may be determined to be performed.

In this case, the insurance money transfer processing unit 16 of the medical fee payment management server 1 determines that the predetermined high amount of money is a solatium if the medical fee included in the medical fee claim information is equal to or greater than a predetermined high amount. Also, if the medical fee included in the medical fee claim information is less than a predetermined high amount, the insurance money transfer processing unit 16 determines that the medical fee is a solatium. The insurance money transfer processing unit 16 generates solatium payment information indicating the determined solatium amount. The solatium payment instruction information further includes information such as the account number of the payee's health account specified based on the contractor ID and the account number of the service provider company that made the transfer. The insurance money transfer processing unit 16 transmits the solatium payment instruction information to the financial institution server 2 (step S506).

The transfer processing unit 23 of the financial institution server 2 receives the solatium payment instruction information. Based on the solatium payment instruction information, the transfer processing unit 23 subtracts the solatium from the balance of the account number of the service providing company of the transfer source and adds the amount of the solatium to the balance of the account number of the payee's health account. As a result, the transfer processing unit 23 can pay the contractor a consolation money from the service provider company.

Then, the insurance payment processing unit 16 starts insurance payment claim processing according to the payment of the solatium. The medical fee payment management server 1 does not have to issue the above-mentioned solatium payment instruction. In this case, the insurance payment processing unit 16 starts insurance payment claim processing according to the medical expenses. An insurance claim is based on an insurance contract between a service provider and an insurance company. An insurance contract is a contract that treats as an insured accident when medical expenses exceeding a predetermined amount of money are incurred. The insurance contract may be a contract that treats part or all of medical expenses as an insured accident when medical expenses are incurred. The insurance payment processing unit 16 generates insurance payment claim information (step S507). The insurance payment processing unit 16 transmits the insurance payment claim information to the insurance company server 4 (step S508). The insurance benefit claim information includes medical expenses, policyholder ID, medical institution ID received by the policyholder, the account number of the service provider company or the policyholder account number, and the like.

Insurance company server 4 receives insurance claim information. The insurance company server 4 performs a predetermined examination process based on the insurance claim information. The insurance company server 4 generates insurance payment instruction information when the examination process is completed and insurance payment is determined. The insurance payment instruction information includes the insurance money, the account number of the insurance company account from which the money is transferred, the account number of the service provider company to which the money is transferred, or the account number of the policyholder. The insurance company server 4 transmits the generated insurance payment instruction information to the financial institution server 2 . The transfer processing unit 23 of the financial institution server 2 acquires the insurance payment instruction information. The transfer processing unit 23 acquires the account number of the transfer source and the account number of the transfer destination based on the insurance payment instruction information. When the account number of the transfer destination is the account number of the service provider company, the transfer processing unit 23 subtracts the insurance amount from the balance of the account number of the insurance company account and adds the insurance amount to the account number of the service provider company. This completes the payment of the insurance money from the insurance company to the service provider company. Alternatively, if the transfer destination account number acquired based on the insurance payment instruction information is the account number of the policyholder, the transfer processing unit 23 subtracts the insurance money from the balance of the account number of the insurance company account, Add the insurance amount to the number. This completes the payment of the insurance money from the insurance company to the policyholder. When the payment is completed, the financial institution server 2 notifies the insurance company server 4 of the payment completion. When the insurance company server 4 completes transmission of the insurance payment instruction information and receives notification of payment completion, it generates insurance payment notification information. The insurance benefit notification information includes information such as the medical fee and policyholder ID included in the insurance benefit claim information. Insurance company server 4 transmits insurance benefit notification information to medical expense payment management server 1 .

The medical fee payment management server 1 receives the insurance benefit notification information (step S509). Upon receipt of the insurance benefit notification information, the insurance benefit transfer processing unit 16 of the medical expense payment management server 1 performs insurance benefit transfer confirmation processing (step S510). The insurance money transfer confirmation process is a judgment as to whether or not the account number of the service provider company has a money transfer corresponding to the insurance money included in the insurance money payment notification information.

In the processing of step S502 described above, if it is determined that an insurance claim (payment claim) for the insurance money is to be made to the insurance company, the medical expense payment management server 1 uses the medical statement information to make the insurance claim. Alternatively, the claim method may be determined as to whether the claim is to be made using a medical certificate from a medical institution. In this case, the insurance money transfer processing unit 16 acquires the medical bill information (receipt) included in the medical billing information acquired from the medical institution server 3 . The insurance payment processing unit 16 reads the type of disease and the type of patient (inpatient, outpatient, etc.) described in the medical statement information. Based on at least one of the type of disease and the type of patient described in the medical statement information, the insurance claim transfer processing unit 16 uses the medical statement information to make a claim for insurance benefits, or to perform a diagnosis by a medical institution. to determine whether or not to file a claim. For example, the insurance money transfer processing unit 16 may determine that an insurance claim should be made using a medical certificate if the patient has a specific disease. Alternatively, the insurance money transfer processing unit 16 may determine that an insurance claim is to be made using the medical statement information in the case of a specific disease. Alternatively, the insurance money transfer processing unit 16 may determine that an insurance money claim is to be made using both the medical statement information and the medical certificate in the case of a specific disease. Further, based on the type of patient (inpatient, outpatient, etc.), the insurance payment processing unit 16 requests insurance payment using a medical certificate from a medical institution, or makes an insurance claim using medical statement information. It may be determined whether to make a claim or to make a claim using both the medical statement information and the medical certificate.

The insurance money transfer processing unit 16 makes a claim for insurance money using a medical certificate from a medical institution, or uses medical bill information, or uses both medical bill information and a medical bill. Insurance benefit claim information is generated based on the claim method, such as whether or not to claim insurance benefit (step S405). For example, the insurance money transfer processing unit 16 reads the information of a predetermined item described in the medical statement information or the medical certificate, inputs the numerical value of the item and the presence or absence of information into the insurance money calculation formula, and obtains the result. Old insurance claim information may be generated that includes the amount of the insurance paid. Then, the insurance money transfer processing unit 16 transmits the insurance money claim information to the insurance company server 4 . In this process, when the diagnostic fee payment management server 1 determines that a payment request is to be made, a method corresponding to the determination result of the billing method is used to transfer the payment to the insurance company corresponding to the medical expenses paid in advance by the payment transfer processing. is one aspect of the process of generating a bill for payment.

In addition, the above-described processing is performed by the diagnostic fee payment management server 1, based on whether or not the medical billing information includes the medical bill information, to the insurance company for the insurance money corresponding to the medical fee paid by the advance transfer processing. This is one aspect of processing for determining whether or not to make a claim for payment, and generating a claim for payment of the insurance money to the insurance company when medical statement information is included.
In the above-described processing, the diagnostic fee payment management server 1 makes a payment request to the insurance company for the insurance money corresponding to the medical fee paid by the payment transfer processing based on the contents of the medical bill information included in the medical fee billing information. and if it is determined that a claim will be made to the insurance company based on the contents of the medical bill information, the amount of the insurance money corresponding to the medical expenses paid in advance by the advance transfer process. 1 is one aspect of the process of generating a payment request;

In the above-described process, the diagnosis fee payment management server 1 (contractor determination means) may determine whether the contractor is an insurance-applicable policyholder or a non-insurance-applicable policyholder based on the contract status information of the policyholder. good. In this case, the diagnosis fee payment management server 1 generates a payment claim to the insurance company for the insurance money corresponding to the medical expenses paid in advance by the payment transfer process when the policyholder is an insurance coverage policyholder. good too.

With the above processing, the contractor who has made a contract for the medical expense payment management service can enjoy the service of automatically receiving a solatium payment when medical expenses are incurred. Further, according to the above-described processing, it is determined whether or not to perform the payment transfer processing and the claim for insurance benefits based on the contract status information regarding the policyholder's payment transfer processing. It is possible to provide flexible insurance services by reducing the burden of paying at medical institutions and claiming insurance claims, which policyholders find troublesome.

FIG. 11 is a diagram showing a first management server and a second management server that constitute the medical fee payment management system.
FIG. 12 is a sixth diagram showing the processing flow of the medical fee payment management system.
Here, the medical fee payment management server 1 may be composed of a plurality of server devices such as a first management server 5 (debt processing means) and a second management server 6 (debt processing means). The first management server 5 and the second management server 6 may be operated by the first company in charge of the medical fee payment management service and the first company in charge of the medical fee payment management service, respectively. The first management server 5 manages medical statement information included in the medical billing information, and the second management server 6 manages the contractor's information and claims for insurance benefits to the insurance company. good. The first management server 5 may have at least the function of the payment transfer processing unit 14 , and the second management server 6 may have at least the function of the insurance money transfer processing unit 16 .

Then, the first company that manages the first management server 5 concludes a contract for reimbursement of medical expenses (or medical expenses) with the medical institution. The first company that manages the first management server 5 reimburses the medical expenses by the reimbursement process. The reimbursement for medical expenses to the contracting party due to this reimbursement of medical expenses is transferred from the first company to the second company, and the medical expenses reimbursed are transferred from the second company to the first company along with the transfer of receivables. transferred to. Then, the second management server 6 operated by the second company may make an insurance claim to the insurance company server. In addition, the second management server 6 operated by the second company may transmit to the financial institution server 2 a medical fee collection instruction from the contractor's account to the own company's account in conjunction with the transfer of the bond.

In such a case, a claim assignment process is performed between the first management server 5 and the second management server 6 . As an example, the first management server 5 detects the completion of the payment transfer (step S701). When the first management server 5 detects the completion of the payment transfer, the first management server 5 generates credit transfer information (step S702). This credit transfer information may include information such as contractor ID, contractor name, out-of-pocket amount, medical expenses, insurance contract number, and the like. The first management server 5 then outputs a claim transfer contract containing the claim transfer information. For example, this output may be a process of generating document information in which information included in the credit transfer information is described in a predetermined data format, and storing the document information in a predetermined storage unit. Alternatively, the first management server 5 may print the document of the bond transfer agreement.

The first management server 5 transmits the credit transfer information to the second management server 6 (step S703). As a result, the first company transmits the claim transfer information related to the claim transfer contract to the second company. Based on the credit transfer information, the second management server 6 transmits a credit transfer approval screen to the terminal device 61 in the second company connected via the communication network (step S704). This credit transfer approval screen is a web page for the administrator to approve the credit transfer from the first company to the second company. That is, the second management server 6 has a web server function, and based on the communication connection from the terminal device 61, transmits the web page of the credit transfer approval screen to the terminal device.

The administrator presses an approval button on the web page of the credit transfer approval screen displayed on the terminal device 61 . Based on the pressing operation of the approval button, the terminal device 61 transmits to the second management server 6 the approval information about the claim transfer contract corresponding to the predetermined claim transfer information. The second management server 6 receives the approval information (step S705). The second management server 6 transmits the approval information to the first management server 5 (step S706). This approval information includes information such as an identifier that identifies the approved credit transfer contract. The first management server 5 performs a process of recording the claim transfer information corresponding to the approved claim transfer contract in the database as a claim transfer management target (step S707). Based on the approval of the credit transfer contract, the first management server 5 generates a payment instruction for the credit transfer amount (medical expenses) from the account of the second company to the account of the first company (step S708). The first management server 5 transmits the payment instruction for the transfer of the claim to the financial institution server 2 (step S709). The transfer payment instruction includes the transfer amount (medical expenses), the account number of the second company that is the transfer source, the account number of the first company that is the transfer destination, and the like. The financial institution server 2 transfers the transfer amount ( medical expenses) are transferred.

According to the processing by the first management server 5 and the second management server 6 as described above, it is possible to separately manage the management of medical statement information and the processing of claims for insurance benefits.

Each server described above has a computer system inside. A program for causing each server to perform each process described above is stored in a computer-readable recording medium of the server, and the computer of the server reads and executes the program to perform the above process. will be Here, the computer-readable recording medium refers to magnetic disks, magneto-optical disks, CD-ROMs, DVD-ROMs, semiconductor memories, and the like. Alternatively, the computer program may be distributed to a computer via a communication line, and the computer receiving the distribution may execute the program.

Further, the program may be for implementing part of the functions of the processing units described above. Further, it may be a so-called difference file (difference program) that can realize the above-described functions in combination with a program already recorded in the computer system.

100: medical fee payment management system 1: medical fee payment management server (service provider computer system)
2 Financial institution server (financial institution computer system)
3... Medical institution server (medical institution computer system)
4... Insurance company server (insurance company computer system)
11, 21... Control unit 12... Membership fee processing unit 13... Insurance premium management unit 14... Reimbursement processing unit (reimbursement processing means)
15 Medical fee collection processing unit (medical fee collection processing means)
16 ... insurance money transfer processing unit (claim presence/absence determination means, insurance claim processing means, claim method determination means)
17 Service maintenance determination unit 18, 27 Notification unit 22 Reserve processing unit 23 Transfer processing unit 24 Balance confirmation unit 25 Loan processing unit 26 Interest rate management Department

Claims (14)

reimbursement processing means for performing reimbursement processing of the contractor's medical expenses to the account of the medical institution based on receipt of medical billing information from the medical institution system;
Medical fee collection processing means for collecting the medical fee from a dedicated account of a financial institution that manages the contractor's funds after processing the transfer of the medical fee to the medical institution account;
claim presence/absence determination means for determining whether or not to make a claim to an insurance company for insurance claims corresponding to the medical expenses paid in advance by the reimbursement processing, based on the contract status information related to the reimbursement processing of the contractor; ,
medical expense payment management system. insurance claims processing means for generating a claim for payment of insurance claims corresponding to the medical expenses paid by the reimbursement transfer process to the insurance company when it is determined that the claim for payment will be made;
The medical fee payment management system according to claim 1, comprising: billing method determining means for determining, when it is determined that the billing is to be made, whether to make the billing using the medical statement information or to make the billing using a medical certificate from a medical institution;
The medical fee payment management system according to claim 2, comprising: When it is determined that the claim for payment is to be made, the insurance claim processing means transfers to the insurance company the insurance money corresponding to the medical expenses paid in advance by the reimbursement transfer process by a method according to the determination result of the claim method. a claim processing means for generating a claim;
The medical expense payment management system according to claim 3, comprising: The claim presence/absence determination means requests the insurance company to pay the insurance money corresponding to the medical expenses paid in advance by the reimbursement transfer process based on whether or not the medical bill information includes the medical bill information. determine whether or not to
5. The insurance claim processing means according to claim 4, wherein when the medical statement information is included, the insurance claim processing means generates a payment claim to the insurance company for the insurance money corresponding to the medical expenses paid in advance by the reimbursement transfer process. Medical expense payment management system. Whether the billing presence/absence determination means makes a claim to the insurance company for payment of the insurance money corresponding to the medical expenses paid in advance by the payment transfer process based on the contents of the medical bill information included in the medical billing information. determine whether or not
When the insurance claim processing means determines to make a claim to the insurance company for the insurance money corresponding to the medical expenses paid in advance by the out-of-pocket transfer process based on the contents of the medical bill information, 5. The medical expense payment management system according to claim 4, wherein an insurance payment claim corresponding to the medical expense paid in advance by transfer processing is generated. policyholder determination means for determining whether the policyholder is an insurance-applicable policyholder or a non-insurance-applied policyholder based on the contract status information of the policyholder;
5. From claim 4, wherein the insurance claim processing means generates a payment claim to the insurance company for the insurance money corresponding to the medical expenses paid in advance by the reimbursement transfer process when the policyholder is an insurance-applicable policyholder. The medical expense payment management system according to any one of claims 6. 8. The out-of-pocket payment processing means determines whether or not to perform the out-of-pocket transfer processing of the medical expenses of the contractor to the account of the medical institution based on the receipt of the medical fee billing information. The medical expense payment management system described in the paragraph. credit processing means for generating information regarding the credit transfer of the medical fees based on the results of the remittance processing of the contractor's medical fees to the medical institution account;
The medical fee payment management system according to any one of claims 1 to 8, comprising: a reimbursement processing unit that performs reimbursement processing of the contractor's medical expenses to the account of the medical institution based on receipt of medical billing information from the medical institution system;
a medical fee collection processing unit that collects the medical fee from a dedicated account of a financial institution that manages the contractor's funds after processing the transfer of the medical fee to the medical institution account;
Judging whether or not to make a claim for payment to an insurance company for the insurance money corresponding to the medical expenses paid in advance by the above-mentioned reimbursement transfer processing based on whether or not the medical billing information includes the medical bill information. a determination unit;
an insurance claims processing unit that generates a claim for payment of insurance claims corresponding to the medical expenses paid by the reimbursement process to the insurance company when medical statement information is included;
medical expense payment management system. a reimbursement processing unit that performs reimbursement processing of the contractor's medical expenses to the account of the medical institution based on receipt of medical billing information from the medical institution system;
a medical fee collection processing unit that collects the medical fee from a dedicated account of a financial institution that manages the contractor's funds after processing the transfer of the medical fee to the medical institution account;
a claim presence/absence determination unit that determines whether or not to make a claim for payment of insurance money corresponding to the medical expenses paid in advance by the reimbursement process based on the content of the medical bill information included in the medical billing information;
When it is determined to make a claim to the insurance company for the insurance money corresponding to the medical expenses paid in advance by the above-mentioned payment transfer processing based on the content of the medical bill information, the medical expenses paid in advance by the above-mentioned payment transfer processing are handled. a claims processor that generates a claim for payment of insurance claims to the insurance company;
medical expense payment management system. a reimbursement processing unit that performs reimbursement processing of the contractor's medical expenses to the account of the medical institution based on receipt of medical billing information from the medical institution system;
a policyholder determination unit that determines whether the policyholder is an insurance-applied policyholder or a non-insurance-applied policyholder based on the contract status information of the policyholder;
a medical fee collection processing unit that collects the medical fee from a dedicated account of a financial institution that manages the contractor's funds after processing the transfer of the medical fee to the medical institution account;
an insurance claim processing unit that generates a claim for payment to an insurance company of insurance money corresponding to the medical expenses paid in advance by the reimbursement transfer process when the policyholder is the insurance covered policyholder;
medical expense payment management system. Based on the receipt of medical fee billing information from the medical institution system, the contractor's medical fee will be transferred to the medical institution account,
After processing the transfer of the medical fee to the medical institution account, the medical fee is collected from the dedicated account of the financial institution that manages the funds of the contractor,
Determining whether or not to make a claim to an insurance company for payment of insurance claims corresponding to medical expenses paid in advance by the payment transfer process, based on contract status information relating to the payment transfer process of the contractor. Medical fee payment management method . The computer of the medical fee payment management system,
payment transfer processing means for performing payment transfer processing for the contractor's medical expenses to the medical institution account based on the receipt of medical fee billing information from the medical institution system;
Medical fee collection processing means for collecting the medical fee from a dedicated account of a financial institution that manages the contractor's funds after processing the transfer of the medical fee to the medical institution account;
claim presence/absence determination means for determining whether or not to make a claim to an insurance company for insurance claims corresponding to medical expenses paid in advance by the reimbursement transfer process, based on the contract status information related to the reimbursement transfer process of the contractor;
A program that acts as a

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