JPH11175615A - Processing method and system for inspecting contents of application for care insurance system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To attain a system for inspecting consistency between reception history data stored in an IC card and provision history data provided at the time of applying for insurance money in a care insurance system applied contents inspection system capable of preventing the generation of an illegal application for a care insulance money in a care insurance system. SOLUTION: At the time of providing service, a helper's terminal 50 inspects (52) whether practical provision time is included in a prescribed proper range or not, and when the time is proper, writes service reception history information in a care-needed person IC card 20 and writes service provision history information in a helper IC card 40. The service reception history information is read out (12) by a reception history processor 10 and transferred to an inspection processor 60 and the service provision history information is read out (32) by a service provision history processor 30 and transferred to the processor 60. The processor 60 checks (52) whether service provision history information data coincide with service reception history information data or not and outputs (63) non-coincidence data.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a system for inspecting the contents of insurance claims for service benefits in a long-term care insurance system.

[0002] When the aging society comes in earnest, the nursing care insurance system is established because the nursing care for the elderly cannot be supported by the conventional home-based care alone. There is a need for a computer system that allows the nursing care insurance system to operate without any problems.

[0003]

2. Description of the Related Art First, an outline of a long-term care insurance system will be described.
The long-term care insurance system is intended to unify the long-term care services provided by local governments as welfare measures and the nursing care services provided as part of the elderly insurance as one care insurance. .

The insurer of the long-term care insurance system is a municipality,
The insured is 45 years old and older (No. 1 insured) and 45
He is a middle-aged person (No. 2 insured person) aged between 65 and 65. The insured pays the premium and, if the elderly are in need of nursing care, apply to the relevant municipality for the qualification of requiring nursing care. The municipalities will examine the application for qualification for requiring caregiver, approve the qualification, and issue a long-term care insurance card, etc., with a maximum number of payment points according to the level of the required nursing care condition .

[0005] The certified care-requiring person presents a long-term care insurance card or the like to various nursing care service providers operated by private companies or the like, and requests payment of nursing care services such as dispatch of helpers. Nursing care service providers provide services based on requests. At the time of service provision, 10% of the cost is collected from the care recipient who is the recipient based on points determined for each type of care, and for the remaining 90%,
Claims are filed with the insurance claim claim inspection organization (National Federation of Health Insurance Organizations) with a statement of claims for long-term care insurance claims.

The Federation of National Health Insurance Organizations examines the contents of the claim and, if appropriate, distributes it to the relevant municipalities (insurers) and claims the insurance. Municipalities, etc. pay the insurance money to nursing care service providers through the National Health Insurance Federation.

In the long-term care insurance system, various forms of documents involving complicated point calculations must be exchanged between municipalities (insurers), care recipients (insured), and service providers. On the other hand, many municipalities, etc., who need to deal with the current scale, have a very large administrative burden.

[0008] In order to reduce the burden of paperwork related to this long-term care insurance, instead of the paper receipt qualification certificate such as a conventional health insurance card, a long-term care insurance card is made into an IC card and distributed to authorized persons requiring long-term care. A system that performs a part of paperwork has been considered.

[0009] When certifying the qualification of receiving, an IC card storing the payment points is distributed. When the care service provider provides the care service, a predetermined point is subtracted from the payment point stored in the IC card. It is intended to make it possible to use the point data of the IC card as it is when requesting a nursing care fee.

[0010]

On the other hand, when an IC card is used, there are the following problems. Under the current long-term care insurance system, applications for requests for long-term care fees are to be submitted in writing. In other words, when managing the upper limit of the payment points by distributing the IC card, the caregiver shows the nursing insurance card to the service provider when receiving the nursing care service. Since hospitals apply for nursing care remuneration in writing, it is not possible to confirm whether the nursing care insurance card submitted at that time has exceeded the maximum number of IC card payment points. In addition, the point information of the IC card is not reflected on the long-term care insurance card, and a certain time difference occurs before the service provider knows the information.

In this case, if the service provider directly uses the IC card when providing the service of the care-requiring person, it is possible to judge whether or not the upper limit of the payment point is exceeded when providing the care service.

However, if only the IC card is handed out to the person requiring care, for example, in the case of providing a service such as lending of nursing care equipment such as a wheelchair, a third party such as a family member may replace the person requiring care. In some cases, services may be provided, and in other cases, it may be difficult to confirm whether a care service recipient is a qualified individual.

[0013] Further, there is a possibility that the service providing organization may deduct points from the IC card that are more than a predetermined number of points of the service actually performed and make an unauthorized request.

Therefore, it is necessary that the point of the service actually provided is reflected in the data at the time of claiming the insurance claim. For that purpose, it is necessary to check the data at the time of claiming the insurance claim.

The present invention realizes a system for checking the consistency between data stored in an IC card and data submitted at the time of a care insurance claim in order to prevent an unauthorized claim of a care insurance claim in the care insurance system. The purpose is to do.

[0016]

FIG. 1 is a block diagram showing a configuration example of the present invention. The receiving qualification institution (municipalities, etc.) 1 is an insurer, certifies the receiving qualification of long-term care insurance by applying for a care-requiring person, issues a care-requiring person IC card 20, and checks the service receiving status. , Is an organization that notifies the request examination organization 6 of the receipt status.

The service providing institution 3 is an institution that provides various nursing care services at the request of the care-requiring person and requests insurance based on predetermined points. Claims examination body 6
Examines the contents of the claim based on the service receipt history information from the qualifying institution 1 when the care provider claims the care insurance from the service providing institution 3. An agency that mediates payments.

The qualification / receipt history processing device 10 is installed in the qualification certification organization 1 and has basic information / benefit information setting means 11, service reception history information reading means 12, and service reception history information output means 13.

The basic information / benefit information setting means 11 sets basic information such as the insured person's number, address, name, date of birth, etc., and payment information such as the degree of need for nursing care and the upper limit point of the payment on the care-requirer IC card 20. -A means of updating.

Service reception history information reading means 12
Is means for reading service reception history information stored in the care-requiring person IC card 20. The service reception history information includes the details of the service received by the care recipient, the name of the company, the date, the start time, the end time, and the points of the service.

The service reception history information output means 13 is a means for compiling the service reception history information read every predetermined period and outputting it to a storage medium or a communication medium for sending to the billing examination organization 6.

The helper terminal 50 is constituted by a portable computer or the like of a care service provider, and is installed or carried in at a site where services are actually provided. The helper terminal 50 has an IC card information reading / writing means 51, a payment check processing means 52, and a point transfer processing means 53.

IC card information reading / writing means 5
1 is the care recipient I inserted when the service is implemented
It is means for reading information stored in the C card 20 and the helper IC card 40 or writing information.

The payment check processing means 52 is a means for judging whether or not the actual time at which the service was performed is within an appropriate range, based on the basic time determined for each service content.

The point transfer processing means 53 subtracts points determined for each service content from the care-requiring person's IC card 20 when the care service is provided, and provides the helper IC.
This is a means for adding to the points stored in the card 40.

The service payment history processing device 30 comprises:
It is installed in the service providing organization 3 and has information setting means 31, service payment history information reading means 32, and service payment history information output means 33.

The information setting means 31 is means for setting various information such as a service information table stored in the helper IC card 40. The service payment history information reading means 32 is a means for reading the service payment history information stored in the helper IC card 40. The service payment history information includes, for example, the insured number, name, service content,
Date, start time, end time, points, etc. of the service.

The service payment history information output means 33 is a means for collecting and outputting the service payment history information read by the service payment history information reading means 32 so as to send the service payment history information to the claim examination organization 6 when claiming the insurance money.

The examination processing device 60 is installed in the billing examination organization 6 and has service history information reading means 61, check processing means 62, and error output means 63. The service history information reading means 61 is a means for reading the service reception history information output from the qualification / reception history processing device 10 and the service payment history information output from the service payment history processing device 30.

The check processing means 62 is a means for checking the service reception history information and the service payment history information read from the service history information reading means 61 to check whether the data match.

The error output means 63 is means for outputting, as an error, unmatched data as a result of the matching processing by the check processing means 62. Although the helper terminal 50 uses the helper IC card 40 as a storage medium for storing the service payment history information, the helper terminal 50 is not necessarily an IC card.
Alternatively, a hard disk or floppy disk or the like built in can be used. However, the use of an IC card rather than a storage medium such as a hard disk is very convenient for the individual helper to carry and manage, and when the service payment history processing device 30 reads the service payment history information. Is also convenient.

[0032]

DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of the present invention will be described below. FIG. 2 is a diagram showing an outline of the processing operation of the present system.

(A) The care recipient 2 who is the insured applies to the receiving qualification institution 1 for an application for a qualification for requiring care. (b) The eligibility qualification organization 1 certifies the qualification of benefits based on the application of the care recipient 2, and provides the care recipient IC for each care recipient.
Distribute the card 20. At the same time, the receiving qualification institution 1 notifies the request examination institution 6 of the care recipient 2 and the upper limit of the paid points.

Basic information,
Payment information and service reception history information are stored. FIG. 3 is a diagram showing an example of the data structure of the care-requiring person IC card 20 to be distributed. Basic information includes insured number,
Information on the insured person, such as address, name, date of birth, etc., is provided as benefit information, the degree of nursing care required indicating the degree of need for nursing care, the upper limit of points to be paid according to the degree of care required, The current point is stored.

The service reception history information includes, when the service is actually provided, the content of the service received, the name of the provider of the service, the date and time of the service provision, the start time and the end time, the service provision Are recorded.

(C) The care recipient 2 is the service provider 3
Then, as a service payment, ask for bathing assistance, for example. (d) Helper 4 dispatched from service provider 3
The bathing assistance service is provided to the care recipient 2 by carrying the helper IC card 40.

(E) In providing the service, the care-requirer IC card 20 and the helper IC card 40 are inserted into the helper terminal 50 to receive the service contents such as the provided service contents, the provided start time and provided end time. Then, the payment history information is written, and the number of points corresponding to the provided service is transferred from the care-requirer IC card 20 to the helper IC card 40.

At the same time, in the service information table, a standard time (basic time) required for provision for each service content is determined, and the time required for actual service provision is appropriate in view of the actual service content. Check whether it is in the service information table.

FIG. 4 is a diagram showing an example of the data structure of the service information table. The service information table is stored in either the helper terminal 50 or the helper IC card 40, and for each type of service content, a basic time indicating a standard time required for providing the service and an error of the basic time. An error indicating the time allowed and a reference point indicating the number of points corresponding to the provided service are defined.

For example, in the case of bathing assistance, the time required for service provision is one hour (1:00), and the error is 30 minutes. It is determined that five points, which are reference points for bathing assistance, are transferred from the care-requirer IC card 20 to the helper IC card 40.

Each time the care recipient 2 receives a service,
The processing of (c) to (e) is repeated. Service reception history information is stored in the care-requiring person IC card 20 each time.
Further, the helper IC card 40 stores service payment history information related to the service provided by the helper.

FIG. 5 is a diagram showing an example of service payment history information. As service payment history information, the number of the insured who provided the service, the name of the insured,
The date, start time, and end time are stored, and if the service is provided properly, a predetermined reference point is stored.

The service contents, date, start time, end time and points of the service reception history information stored in the care-requirer IC card 20 are stored in the service payment history stored in the helper IC card 40. They are the same as the information service contents, date, start time, end time, and points.

(F) The care-requiring person 2 notifies the receiving situation at predetermined intervals, and submits the care-requiring person IC card 20 to the receiving qualification institution 1. This allows the care recipient IC card 20
Of service reception history information.

(G) The receiving qualification institution 1 uses the qualification and receiving history processing device 10 to read the service receiving history information of the IC card 20 for the care-requiring person. (h) The receiving qualification institution 1 notifies the service inspecting organization 6 of the read service receiving history information.

(I) The service provider 3 is a helper IC
The service payment history processing device 30 reads the contents of the card 40 and attaches the contents of the service payment history information at predetermined intervals to make a claim for insurance money.

(J) The request examination organization 6 compares the service reception history information notified from the eligibility qualification organization 1 with the service payment history information submitted from the service provider 3 to determine whether or not the data match. Investigate and check for improper or improper claims.

(K) If there is data that does not match as a result of matching the data, the information is output as an error list. FIG. 6 is a diagram illustrating an output example of an error list.

The examination processing device 60 outputs an error list, for example, for each date when the service was provided, for the data whose contents do not match, or the data whose data exists only in one of them. The case shown in FIG. 6 shows a case where the service contents and the service time (start time) of the service reception history information and the service payment history information do not match, and the case shown in FIG. 6 shows the service reception history information or the service payment. An example is shown in which data exists in only one of the history information.

(L) As a result of matching the data, if there is no inconsistent data, pay the service provider 3 an insurance money. In the description using FIG. 2, a case is described in which a portable computer such as a notebook computer is used as the helper terminal 50, and the helper IC card 40 is carried for each helper. However, it is also possible to integrate the helper terminal 50 and the helper IC card 40 and use a portable small terminal that has a storage medium and can record data of an unspecified number of care recipients 2.

Further, data transfer between the helper terminal 50 and the service payment history processing device 30, the service payment history processing device 30, the examination processing device 60, and the qualification / reception history performed through the helper IC card 40 are performed. The transfer of data between the processing device 10 and the examination processing device 60 can also be performed online or the like.

FIGS. 7 and 8 show examples of the processing screen. The processing flow will be described in more detail with reference to FIGS. It is assumed that the helper IC card 40 is inserted in the helper terminal 50 in advance.

When the provision of the service is started, FIG.
As shown in (A), a window prompting insertion of the care-requirer IC card is first displayed on the screen of the helper terminal 50. The care-requirer IC card 20 is inserted, and the OK button is selected.

The IC card information reading / writing means 51 of the helper terminal 50 allows the care recipient IC card 2
From 0, necessary information such as the insured person's name, address, upper limit point of payment points, and current points is read and displayed on the screen as shown in FIG. 7B. Subsequently, the current time (for example, “15:00”) is stored in the care-requirer IC card 20.
Is written as the start time and displayed on the screen.

Next, a window for selecting service contents is displayed. As shown in FIG. 7C, a service to be provided is selected from a list of services such as bathing assistance and meal assistance. When “bathing assistance” is selected, FIG. 8 (A)
As shown in FIG. 5, the helper terminal 50 displays "service assistance" in the service content field, "1:00" in the basic time field, and "5" in the service point field based on the service information table. Point "is displayed.

After the above input is completed, the helper 4 actually provides the service while the care-requiring person IC card 20 is inserted. If the end button on the screen is selected when the provision of the service is finished, the helper terminal 50
The current time (for example, “1
6:15 ”) is written as the end time and displayed on the screen.

Next, the service provision status is checked. Specifically, the time required for providing the service is calculated from the start time and the end time by the payment check processing means 52, and the calculated time is compared with the service information table to determine whether the execution time is appropriate. I do.

For example, if the basic time is 1 hour and the error is 30 minutes, if the time required for service provision is in the range of 30 minutes to 1 hour 30 minutes, it is determined that the time is appropriate.
Therefore, if the actual time required to provide a service exceeds two hours, a warning message is displayed indicating that other services are not being provided, since the appropriate time has been exceeded. Prompts the user to select another service. Start time 15:00, end time 16: 1
If it is 5, the time required for providing the service is one hour and fifteen minutes, and it is determined that the time is within the appropriate time range, so no warning message is issued.

If it is determined that the service actually provided is within a proper time, the point transfer processing means 53
, The number of points of the service content selected earlier is
The current point of the care-requiring person IC card 20 is subtracted from the current point, and at the same time, the number of points of the service payment history information is written. In addition, as shown in FIG. 8B, a confirmation window showing the current point and the remaining points is displayed on the screen.

IC card information reading / writing means 5
According to 1, the data of the service reception history information (the contents of the provided service, the name of the provided provider, the provided date, the start time, the end time, and the used point) are written in the care-requiring person IC card 20.

Further, in the storage area of the helper terminal 50,
The data (insured person number, insured person name, selected service contents, provision date, start time, end time) read from the care-requiring person IC card 20 is written.

Here, the same data (service contents, date) is stored in the service reception history information stored in the care recipient card 20 and the service payment history information stored in the helper IC card 40 of the helper terminal 50. , Start time, end time, and points) are stored.

When the care-requiring person 2 notifies the reception status every predetermined period, the qualification / reception history processing device 10 of the receiving qualification institution 1 reads the service reception history information of the care-requiring person IC card 20. The upper limit of the payment of the care-requirer IC card 20 and the current point are updated.

The qualification / receipt history processing device 10 outputs the service receipt history information for each predetermined period and notifies the billing examination organization 6. On the other hand, the service payment history processing device 30 of the service providing organization 3 includes a helper IC card 40.
The service payment history information is read from the server, and the service payment history information read every predetermined period is output and submitted to the claim examination organization 6 together with the insurance payment request document.

The examination processing device 60 of the billing examination organization 6 uses the service history information reading means 61 to read the service reception history information from the receiving qualification institution 1 and the service payment history information from the service providing organization 3.

The check processing means 62 compares these two data based on the date and the insured person name, and checks whether there is any data that is not the same. For example,
By checking the start time and the end time, it is possible to detect whether or not the service providing organization 3 has provided an illegal service.

The error output means 63 outputs the data detected by the check processing means 62 as an error list. The billing examination body 6 provides guidance to the service providing organization 3 if there is any improper request regarding the data output as an error, and pays as invoiced if no error is output.

FIG. 9 is a processing flowchart of the helper terminal at the time of providing a service. The helper terminal 50 is
When the care-requiring person IC card 20 is inserted, the basic information and the payment information are read (S1), and the current time is written in the care-requiring person IC card 20 as the start time (S2). Next, a service content selection window is displayed (S3), and the process waits until the service content is selected (S4). When the service content is selected, the service content and its basic time and error are acquired (S5).

When the service is provided and terminated, it is checked whether or not an end instruction has been input (S6). If the end instruction has been input, the service providing time is checked and the payment point is transferred (S7).

The data (service contents, name of company, date, start time, end time, points, etc.) is written in the care-requirer IC card 20 (S8), and the data is stored in the memory of the helper terminal 50 or the helper IC card 40. (Insured number, name, service content, date, start time, end time, points, etc.) are written (S9).

FIG. 10 is a processing flowchart of the service providing status check processing and the transfer processing of the payment point in S7 in the processing flow chart shown in FIG.
The helper terminal 50 obtains the time T between the end time and the start time (S11), and checks whether or not the time T is within an appropriate range of the selected service (S12). Time T
If is within the proper range, the process proceeds to S14, and if not, a warning process for an additional service is performed (S13). S14
Then, look at the current point of the care recipient IC card 20,
If the upper limit point is insufficient, a warning processing of the upper limit is performed (S15).

Subsequently, the points corresponding to the services provided from the care-requiring person IC card 20 are subtracted (S16),
The data of the service payment history information (service contents, trader name, date, end time, points, etc.) is written into the care-requiring person IC card 20 (S17). Further, the data of the service reception history information (insured person number, name, service content, date, start time, end time, points, etc.) is written in the memory of the helper terminal (S18), and the process ends.

In this example, when a service end instruction is issued, it is checked whether or not the time is within the basic time range. However, during the service, a check is made in real time to change the basic time range. An alarm such as sounding a buzzer may be issued in the case of passing.

FIG. 11 is a flowchart of the request examination process. The examination processing device 60 acquires service reception history information (S21) and acquires service payment history information (S22). Based on the payment date and the insured person number, the two information data are matched (S23), and the service content / start time and end time are checked (S2).
4) It is checked whether there is any data that is not the same (S25). If there is non-identical data, an error list is output (S26).

In the above-described embodiment, the service payment contents are checked in two situations, that is, when the service is provided and when the insurance claim is examined. After the end of service provision, the end time is obtained, and the time at which the service was provided for execution is compared with the standard execution time defined for each service. Check to see if there are any other points to subtract, and if too short, check whether the service was actually performed.

Further, at the time of claiming the insurance claim in writing, the service payment history information is submitted, and the service payment history information is compared with the service reception history information obtained through another route, and there is no difference in the contents. Find out if.

As a result, it is possible to prevent the service providing organization from making an improper or unjustified request such as a padding request.

[0078]

As described above, according to the present invention,
When managing service points using a care-requiring person IC card in the nursing care insurance system, it is possible to automatically check for fraudulent and unreasonable insurance claims, thereby enabling smooth operation of the nursing care insurance system.

[Brief description of the drawings]

FIG. 1 is a block diagram illustrating a configuration example of the present invention.

FIG. 2 is a diagram showing an outline of a processing operation of the present invention.

FIG. 3 is a diagram showing an example of a data structure of a care-requiring person IC card.

FIG. 4 is a diagram illustrating an example of a data configuration of a service information table.

FIG. 5 is a diagram showing an example of service payment history information.

FIG. 6 is a diagram showing an output example of a service error list.

FIG. 7 is a diagram showing an example (1) of a processing screen.

FIG. 8 is a diagram showing an example (2) of a processing screen.

FIG. 9 is a processing flowchart when a service is provided.

FIG. 10 is a process flowchart of a service providing status check process and a transfer process of a payment point.

FIG. 11 is a processing flowchart of a claim examination process.

[Explanation of symbols]

 DESCRIPTION OF REFERENCE NUMERALS 1 Receipt qualification institution (municipalities, etc.) 10 Qualification / receipt history processing device 11 Basic information / benefit information setting means 12 Service receipt history information reading means 13 Service receipt history information output means 2 Care-requirer 20 Care-requirer IC Card 3 Service provider 30 Service payment history processing device 31 Information setting means 32 Service payment history information reading means 33 Service payment history information output means 4 Helper 40 Helper IC card 50 Helper terminal 51 IC card information reading / writing means 52 Payment check Processing means 53 Point transfer processing means 6 Claim examination organization 60 Examination processing device 61 Service history information reading means 62 Check processing means 63 Error output means

Claims (6)

[Claims] 1. A care insurance system claim content inspection processing method for examining the details of a care insurance claim in a care insurance system, wherein a care recipient IC card distributed to a care recipient in advance when providing a care service is provided. The process of writing the service receipt history information and the service benefit history information on the storage medium for the care service provider, and the care service provider read from the storage medium for the care service provider at the time of reviewing the claim for care insurance. A process of comparing the service payment history information with the service reception history information read and compiled by the receiving qualification institution from the care-requiring person IC card in the examination processing device of the claim examination organization, and inspecting the necessity of the care insurance claim. Claims inspection processing method for a long-term care insurance system. 2. A qualification / receipt history processing device installed in a receiving qualification institution, a service payment history processing device installed in a service providing institution, an examination processing device installed in a claim examination institution, and Claims inspection processing method for a long-term care insurance system in a system for inspecting claims of a long-term care insurance claim in a long-term care insurance system, comprising a terminal for a long-term care service provider installed or carried in where a long-term care service is provided, The qualification and receipt history processing device
The basic information for identifying the care-requiring person and the point information for receiving the service are written on the care-requiring person IC card distributed to the care-requiring person. The care recipient IC
Check the point information stored in the card, update the point information stored in the care-requiring person IC card according to the service content, write the service reception history information, and store the service payment history information in the storage medium for the care service provider. Writing, the service payment history processing device,
The service payment history information read from the storage medium for the caregiver is compiled for each predetermined period, and the qualification / reception history processing device stores the service reception history information read from the care-requirer IC card for each predetermined period. The examination processing device collates the service payment history information compiled by the service payment history processing device with the service receipt history information compiled by the qualification / receipt history processing device to provide a care insurance claim. Claims inspection processing method for a long-term care insurance system, which inspects whether or not a request is valid. Claim 3 A claim inspection system for a long-term care insurance system for examining claims for a long-term care insurance claim in a long-term care insurance system. Qualification / receipt to write basic information to identify the care recipient and point information to receive the service on the IC card, and to collect service receipt history information read from the care recipient IC card for each predetermined period It is installed or carried in at the place where the nursing care service is actually provided with the history processing device, and at the time of providing the nursing care service, the point information stored in the IC card for the care-requiring person is checked. The point information stored in the card is updated, the service reception history information is written, and the storage medium for the care service provider is updated. A terminal for a care service provider that writes service payment history information on a body, a service payment history processing device that is installed in a service providing organization and collects service payment history information read from the storage medium for a care service provider at predetermined intervals, It is installed in the claim examination organization and checks the service payment history information compiled by the service payment history processing device with the service receipt history information compiled by the qualification / receipt history processing device to determine whether to make a claim for a care insurance claim. A claim inspection system for a long-term care insurance system, comprising: 4. A claim for a care insurance system according to claim 3, wherein the storage medium for the care service provider is an IC card assigned to each care service provider. Content inspection system. 5. A system for inspecting the contents of a care insurance claim in a long-term care insurance system, comprising a qualification / receipt history processing device installed at a qualification institution for receiving care, and nursing care distributed to each care recipient. IC card, service payment history processing device installed in service providing organization, examination processing device installed in claim examination organization, and nursing care service provider installed or brought in where nursing care service is actually provided Terminal, and the qualification / reception history processing device sets the upper limit payment point and the current point of points for receiving basic information and service for specifying the care recipient in the IC card for the care recipient. A processing means for updating; a processing means for reading information stored in the care-requiring person IC card; Processing means for outputting information relating to service reception history, wherein the care-requiring person IC card includes at least basic information set by the qualification / reception history processing device, a payment upper limit point, a current point, and the care service provider. A storage area for storing information on the service reception history of the care-requiring person written by the care terminal, wherein the care service provider terminal has at least a required time, a required point, and a service payment history which are at least a reference for each provided service. Means for reading / writing from / to a storage medium for storing service information set by the processing device and information on a service payment history provided to the care-requiring person; and providing a service based on the service information stored in the storage medium. Processing means for determining whether the actual time obtained is within an appropriate range; Processing means for subtracting the point corresponding to the service from the current point of the care-requiring person's IC card based on the service information stored in the storage medium, wherein the service payment history processing device reads and writes the terminal for the care service provider. Processing means for setting service information defined for each service in a storage medium to be read, processing means for reading information on service payment history from a storage medium read and written by the care service provider terminal, and information on the read service payment history. Processing means for outputting the service receiving history information output from the qualification and receiving history processing apparatus and the service payment history information output from the service payment history processing apparatus. ,
The processing means for checking the read service reception history information and the service payment history information and checking whether or not the data is matched.
Claims inspection system for a long-term care insurance system, characterized by having processing means for outputting unmatched data as an error. 6. The claim inspection system for a long-term care insurance system according to claim 5, wherein the information on the service receipt history includes at least the service contents received,
The information on the service payment history includes at least the number of the insured person who provided the service, the service contents, the start time, the end time, and the information on the service provider history, the start time, the end time, and the subtracted points. Claims inspection system for the long-term care insurance system, which includes point information.