KR101836465B1 - System and method for screening health insurance review and assessment - Google Patents

Abstract

According to an embodiment of the present invention, a health insurance inspection request screening system comprises: an inspection instruction providing unit configured to search for inspection instruction content associated with prescription information of a patient in an inspection instruction database in which the prescription information of the patient is associated with corresponding inspection instruction content and the associated information is stored and to expose the associated inspection instruction content to a medical care institution terminal; a keyword searching unit configured to search for major keywords associated with the inspection instruction content in a keyword management database in which major keywords, pre-extracted based on the inspection instruction content, are associated with the prescription information of the patient and the associated information is stored and to expose the associated major keywords to the medical care institution terminal; a keyword receiving unit configured to receive at least one selected major keyword as an input keyword when the at least one of the major keywords is selected by the medical care institution terminal; and an inspection determining unit configured to execute inspection with respect to the prescription information based on the input keyword to determine whether the prescription information is deductible and non-deductible.

Description

SYSTEM AND METHOD FOR SCREENING HEALTH INSURANCE REVIEW AND ASSESSMENT

Embodiments of the present invention relate to a healthcare screening request management technology, and more particularly, to a screening system and method for a health insurance screening request.

The payment of the medical expenses (medical care benefits, medical benefits, etc.) of the medical institution according to the health insurance system is transmitted by the medical institution to the medical insurance examination and evaluation office for the medical expenses bill and the medical insurance examination and evaluation institution, The National Health Insurance Corporation will pay the medical expenses to the relevant medical institution based on the examination result notified by the National Health Insurance Evaluation and Assessment Service.

The Health Insurance Review and Assessment Service divides the bill and statement submitted by medical institutions such as general professional medical institutions, general hospitals, hospitals, medical clinics, dental clinics, oriental medicine clinics, pharmacies and health institutions to the auditors, Have them judge whether the amount is appropriate.

However, according to the procedure for requesting general health insurance review, prior to submitting the above claim and statement to the Health Insurance Review and Assessment Service in the medical institution, the doctor should know the contents of the examination guidelines in principle and should not prescribe a prescription contrary to the examination guidelines .

However, the content of the above-mentioned examination guidelines may change according to the notification of the health insurance examination & assessment institute, and the contents thereof are difficult to understand instantaneously, so that it is difficult for physicians to judge the screening of the patient's prescription information in real time .

Therefore, there is a need for a technique that allows a doctor to easily and easily screen the contents of the examination guidelines without having to read and understand them.

A related prior art is Korean Patent Registration No. 10-0597289 entitled " Electronic examination method for medical fee, registration date: 2006.06.28 ".

One embodiment of the present invention extracts and displays key keywords that are meaningful in screening from the content of a screening guide so that a doctor can easily and easily select key keywords without having to read and understand the contents of the screening guidelines for health insurance And a screening system and method for requesting screening of health insurance for inputting and screening.

The problems to be solved by the present invention are not limited to the above-mentioned problem (s), and another problem (s) not mentioned can be clearly understood by those skilled in the art from the following description.

The health insurance screening requesting screening system according to an embodiment of the present invention searches the examination guidelines related to the patient's prescription information from the examination guidance database stored in association with the prescription information of the patient and the contents of the examination guidance, Exposure Guidance Guidance Offering; A keyword retrieval unit for retrieving a main keyword associated with the content of the examination instruction from the keyword management database stored in association with the prescription information of the patient based on the contents of the examination instruction, A keyword input unit for receiving at least one of the main keywords as an input keyword when at least one of the main keywords is selected by the medical institution terminal; And a judging judgment unit for checking the prescription information based on the input keyword to judge whether the prescription information is to be paid or not paid.

The health insurance screening requesting screening system according to an embodiment of the present invention further includes a keyword management unit for extracting main keywords from the contents of the examination instructions based on the natural language processing algorithm and storing and managing the main keywords in the keyword management database can do.

The keyword management unit may extract the main keyword from the contents of the examination instructions exposed on the screen of the medical institution every time the examination about the contents of the examination instructions is updated.

The keyword search unit may expose the searched keyword in a query format or a graphic format.

The keyword searching unit may classify the searched keyword into categories classified according to a predetermined classification criterion as an inspection subject or an authorized condition.

Wherein the keyword search unit performs keyword filtering based on the association between the selected main keyword and the remaining main keywords when any one of the main keywords classified as the category is selected, (N is a natural number) on the screen of the medical institution.

The screening system for a health insurance screening request according to an embodiment of the present invention is characterized in that, in the case of the prescription information for which the judgment as to whether the subject is to be paid or not paid by the examination judging unit is considered to be ambiguous, And a message notification unit for providing a message alarm function.

The screening method of a health insurance screening request according to an embodiment of the present invention is a method of screening a screening guide related to prescription information of a patient from a screening guide database stored in association with prescription information of a patient and contents of the examination guide, Exposing; Retrieving a main keyword associated with the contents of the examination instruction from the keyword management database stored in association with the prescription information of the patient based on the contents of the examination instruction and exposing the keyword to the medical care institution terminal; Receiving at least one main keyword selected as an input keyword when at least one of the main keywords is selected by the medical institution terminal; And performing a check on the prescription information based on the input keyword to determine whether the prescription information is to be paid or not paid.

The details of other embodiments are included in the detailed description and the accompanying drawings.

According to one embodiment of the present invention, by extracting and showing the main keywords meaningful in screening from the content of the examination guidelines, it is possible to easily and quickly search the main keywords without needing the doctor to read and understand all contents of the examination guidelines on health insurance Making it easy to select, input, and screen.

1 is a block diagram illustrating a screening system for a health insurance screening request according to an embodiment of the present invention.
FIGS. 2 to 12 are views showing examples of a screen layout in which a health insurance screening request screening system according to an embodiment of the present invention is implemented.
FIG. 13 is a flowchart illustrating a health insurance screening request screening method according to an embodiment of the present invention.

BRIEF DESCRIPTION OF THE DRAWINGS The advantages and / or features of the present invention, and how to accomplish them, will become apparent with reference to the embodiments described in detail below with reference to the accompanying drawings. It should be understood, however, that the invention is not limited to the disclosed embodiments, but is capable of many different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete, To fully disclose the scope of the invention to those skilled in the art, and the invention is only defined by the scope of the claims. Like reference numerals refer to like elements throughout the specification.

Hereinafter, embodiments of the present invention will be described in detail with reference to the accompanying drawings.

1 is a block diagram illustrating a screening system for a health insurance screening request according to an embodiment of the present invention.

Referring to FIG. 1, a health insurance screening requesting screening system 100 according to an embodiment of the present invention includes a screening instruction database 105, a screening instruction providing unit 110, a keyword management database 115, a keyword managing unit 120 A keyword searching unit 130, a keyword inputting unit 140, a judging deciding unit 150, a message notifying unit 160, and a control unit 170.

Here, the respective components 105, 110, 115, 120, 130, 140, 150, 160, and 170 may be installed inside a medical terminal. For reference, the above-mentioned medical institution terminal includes all terminals used for screening of health insurance screening at a medical institution such as a comprehensive specialized medical institution, general hospital, hospital, medical clinic, dental clinic, oriental medicine clinic, pharmacy, .

The examination guideline database 105 associates and stores patient prescription information and contents of the examination guideline. That is, the examination guideline database 105 may store prescription information such as surgery / procedure, examination, medicines / injections, etc. in advance by matching the contents of the examination guideline.

To this end, the examination guidance database 105 gives a hash value to the patient's prescription information and the contents of the examination guidance, and uses the hash value as an index to perform surgery / treatment, examination, medicine / Prescription information such as injection can be stored and matched with the contents of the examination guide.

The examination guideline providing unit 110 retrieves examination guideline contents related to the prescription information of the patient from the examination guideline database 105 in which prescription information of the patient and contents of the examination guideline are stored in association with each other.

At this time, the examination guideline providing unit 110 can search the examination guideline database 105 using the hash value given to the patient's prescription information as an index.

The examination instruction providing unit 110 provides the contents of the examination instruction guide retrieved from the examination instruction database 105 to the medical institution terminal and exposes the contents on the screen of the medical institution terminal.

Here, the content of the examination guidelines may change according to the notification of the health insurance examination & assessment institute, and the contents thereof are difficult to understand. Therefore, it is difficult for physicians to determine the screening of the patient's prescription information in real time there was.

Accordingly, in one embodiment of the present invention, in order to allow a doctor to easily and easily screen the contents of the examination guidelines without having to read and understand the contents of the examination instructions, a technique of extracting and displaying key keywords meaningful in performing screening from the contents of the examination instructions .

Hereinafter, the keyword managing unit 120 and the keyword searching unit 130, which perform a technique of extracting and displaying the main keyword from the content of the examination guidelines, will be described in detail.

The keyword managing unit 120 extracts a main keyword from the content of the examination instruction based on a natural language processing algorithm. That is, the keyword management unit 120 extracts the main keyword from the content of the examination guide based on a natural language processing algorithm such as an ontology and morphological analysis.

The keyword management unit 120 stores and manages the extracted main keyword in the keyword management database 115. [ At this time, the keyword management unit 120 may assign a hash value to the extracted key keyword, and may store and manage the hash value as an index by matching the hash value with the hash value given to the prescription information of the patient and the content of the examination guidance have.

The keyword management unit 120 may extract the main keyword from the content of the examination instruction exposed on the screen of the medical institution terminal every time the examination related to the examination instruction content is updated.

Specifically, the content of the examination guidelines is changed each time notification is given from the Health Insurance Review and Evaluation Service. In other words, the contents of the examination guidelines are changed each time the notification of the NHIC is updated. Therefore, the keyword management unit 120 extracts the main keyword (including the changed keyword) by performing the natural language processing algorithm on the content of the examination guidance every time a notice about the new examination guidance is obtained from the health insurance examination and evaluation institution can do.

In this way, the keyword management database 115 may store the main keyword extracted based on the examination guide contents in association with the prescription information of the patient. Also, as described above, the keyword management database 115 can update the stored contents with the newly extracted main keywords every time a notice is received from the health insurance assessment and assessment institution.

The keyword searching unit 130 searches the keyword management database 115 for a main keyword associated with the content of the examination instruction. At this time, the keyword search unit 130 can search the keyword management database 115 using the hash values given to the content of the examination instructions and the main keywords as an index.

The keyword searching unit 130 provides the corresponding main keyword retrieved from the keyword management database 115 to the medical institution to expose the keyword on the screen of the medical institution.

At this time, the keyword search unit 130 may search for the keyword " | " And can be displayed on a predetermined area of the screen of the medical institution (refer to '220' in FIG. 2). In addition, the keyword search unit 130 may display the main keyword in a state in which the main keyword can be selected and input through a mouse click or the like.

As another example, the keyword search unit 130 may display the searched main keywords on a certain area of the screen of the medical institution terminal in various ways such as a query format or a graphic format (see FIG. 6) .

In another embodiment, the keyword search unit 130 classifies and sorts the searched main keywords into inspection targets according to a predetermined classification criterion (see Figs. 9 and 10) (See Figs. 7, 8, 11 and 12).

In this case, when one of the main keywords classified in the category is selected, the keyword searching unit 130 may perform keyword filtering based on the association between the selected main keyword and the remaining main keywords.

For example, there are seven keywords such as A, B, C, D, E, F, and G as the main keywords classified as categories, and A is related to B, D, and E while the remaining keywords C, F, G Is not highly relevant. In this case, when the user (doctor) selects A, the keyword search unit 130 leaves B, D, and E having high relevance to A as they are in the main keyword exposure region, and selects C, F, For G, keyword filtering can be performed to make it invisible in key keyword exposure areas.

At this time, the keyword searching unit 130 may display all of B, D, and E having high relevance to A in the main keyword exposure region. Alternatively, only the B and D are prioritized and exposed to the main keyword exposure region (Assuming the order of priority is BDE order).

In other words, the keyword searching unit 130 may expose only the remaining N major keywords (N is a natural number) having a relatively high relevance to the selected main keyword on the screen of the medical institution through the keyword filtering.

Accordingly, the user can more easily select and input the main keyword, and further improve the accuracy in selecting and inputting the main keyword, thereby improving the quality of the work related to the health insurance examination request.

When at least one of the main keywords is selected by the medical institution terminal, the keyword input unit 140 receives the selected at least one main keyword as an input keyword.

In detail, the user can select the main keyword (s) most relevant to the prescription information of the patient through mouse click or the like by reporting the main keyword displayed on the screen of the medical institution. Accordingly, the keyword input unit 140 can receive the selected main keyword (s) as a (meaningful) input keyword having high relevance to the prescription information of the patient.

The examination judging unit 150 checks the prescription information based on the input keyword, and judges whether the prescription information is to be paid or not, based on the result of the check.

For this, the examination judging unit 150 may further include a mapping table for recording data on whether or not to be paid (or not paid) according to the input keyword for each of the prescribed information.

Accordingly, the examination judging unit 150 can check the prescription information by referring to the mapping table, and judge whether the prescription information is the payee object or the non-payee object based on the result of the check have.

In the case of the prescription information for which the subject of the salary or the non-payment is not judged by the examination judging unit 150, the message informing unit 160 regards the judgment of whether the prescription information is to be paid or not paid to be ambiguous, Can be provided.

For example, in the case of the prescription information that is not judged by the judging unit 150 that the object of salary or non-salutation is not determined, the message notification unit 160 may notify the user of the message " As an alarm. Alternatively, the message notification unit 160 may insert a mark such as a red triangle mark beside the corresponding prescription information in the case of the prescription information that is not judged by the examination judging unit 150 to be paid or not paid And may provide an alarm function in various ways.

The control unit 170 may include a screening system 100 for requesting screening of health insurance according to an embodiment of the present invention such as the screening instruction providing unit 110, the keyword managing unit 120, the keyword searching unit 130, The keyword input unit 140, the examination determination unit 150, the message notification unit 160, and the like.

FIGS. 2 to 12 are views showing examples of a screen layout in which a health insurance screening request screening system according to an embodiment of the present invention is implemented.

As shown in FIG. 2, a screen displaying the screening system of the health insurance screening request according to an embodiment of the present invention is displayed on the terminal for the medical institution. At this time, And the main keywords extracted from the contents of the examination guidelines are exposed and displayed in the main keyword exposure area 220. As shown in FIG. When the user selects (clicks) one or more main keywords in the main keyword exposure area 220, the subject of the payment or non-payment of the prescription information is exposed and displayed in the exposure area 230 as a result of the check. On the other hand, if the necessary corporal punishment tab located next to the above affirmation tab is clicked, a screen as shown in FIG. 3 is displayed.

2 and 3, the main keyword is exposed to the main keyword exposure region 220. However, in the embodiment of FIG. 4, the main keyword is underlined or different in the review guidance exposure region 410, The colors (red, blue, etc.) can be displayed separately from other screening instructions. On the other hand, if the required corporal puncture tab located on the side of the affirmative affirmation tab of FIG. 4 is clicked, a screen as shown in FIG. 5 is displayed. When a network graph tab located next to the required corporal puncture tab of FIG. 4 is clicked, I.e., the main keywords may be displayed in a graphical format.

In another embodiment, as shown in FIG. 7, the content of the examination instruction is exposed in the examination instruction exposure area 710, and the main keywords extracted from the contents of the examination instruction are exposed in the main keyword exposure area 720 At this time, the main keyword exposure area 720 may be classified and classified according to a recognition condition such as viewpoint, classification, career, corporal affair, and state according to a predetermined classification criterion.

Here, if the user clicks one or more of the recognition conditions, the main keywords having low relevance to the main keyword are filtered and disappear from the main keyword exposure region 720, Only the key keyword exposure area 720 remains. For example, if 'multiple pregnancy' is selected in FIG. 7, as shown in FIG. 8, in the main keyword exposure area 720, 'pregnancy only 22 weeks to less than 34 weeks' Only the main keywords such as 'pregnant woman' and 'having pain' are exposed, and the remaining main keywords are disappeared.

As a result of inspection, in the exposed area 730, a main keyword such as 'multiple pregnancy' as shown in FIG. 8 can be displayed as a condition selected. In addition, as a result of the checking in FIG. 8, the inspection result (recognized or unrecognized) according to the selected condition may be displayed in the exposed area 730. For reference, in the above-mentioned check result, recognition refers to the salary object, and non-recognition refers to the non-salaried object.

In another embodiment, as shown in FIG. 9, the contents of the examination guidelines are exposed in the examination guidance exposure area 910, and the main keywords extracted from the contents of the examination guidance are exposed to the main keyword exposure area 920 At this time, the main keyword exposure area 920 may be classified and classified according to a predetermined classification criterion into view items such as a viewpoint, a state, a classification, a career, a disease, a purpose, and the like.

If the user clicks on one or more of the inspection objects, the main keywords having low relevance to the corresponding main keyword are filtered and disappear from the main keyword exposure area 920, Only the main keyword exposure area 920 remains. For example, if 'multiple pregnancy' is selected in FIG. 9, as shown in FIG. 10, in the main keyword exposure area 920, 'pregnancy only 22 weeks to less than 34 weeks' Only major keywords such as 'having pain' and 'expectant mothers' are exposed, and the other major keywords are disappeared.

As a result of inspection, the main keywords such as 'multiple pregnancy' can be displayed as the selected condition in the exposure area 930 as shown in FIG. In addition, the inspection result (recognized or unrecognized) according to the selected inspection object may be displayed in the exposure area 930 as an inspection result of FIG. For reference, in the above-mentioned check result, recognition refers to the salary object, and non-recognition refers to the non-salaried object.

11, the contents of the examination guidelines are exposed in the examination guidance exposure area 1110, and the main keywords extracted from the contents of the examination guidance are exposed to the main keyword exposure area 1120 At this time, the main keywords may be classified in the main keyword exposure area 1120 according to the classification criteria of the major / middle / small categories and exposed.

For example, the conditions for recognition of the large category include "Pregnancy only 22 weeks to 34 weeks old pregnant women" and "Pregnancy only 34 weeks pregnant women" The criteria for admission in the middle category are 'early delivery', 'uterine anomaly', 'uterine myoma', 'multiple pregnancy', '30% or more defect in cervix', ' Neck ligation. 'The conditions for recognition of the small category of' early labor 'may include' early delivery 'and' uterine anomaly '.

Here, if the user clicks on one or more of the authorization conditions, the corresponding main keyword is displayed in red in the screening instruction exposure area 1110, as shown in FIG. 12, have. In addition, the main keyword exposure area 1120 may display an inspection result (recognized or unrecognized) according to the selected condition (recognition condition). For reference, in the above-mentioned check result, recognition refers to the salary object, and non-recognition refers to the non-salaried object.

FIG. 13 is a flowchart illustrating a health insurance screening request screening method according to an embodiment of the present invention. Here, the health insurance screening request screening method may be performed by the health insurance screening request screening system 100 of FIG.

Referring to FIGS. 1 and 13, in step 1310, the health insurance screening request screening system 100 receives from the examination guide database 105 stored in association with prescription information of the patient and the content of the examination guide, The contents of the examination guidelines related to the information are searched and exposed to the terminal of the medical care institution.

Next, in step 1320, the health insurance screening request screening system 100 receives from the keyword management database 115 the main keyword extracted based on the content of the examination guide, in association with the prescription information of the patient, The main keyword associated with the content of the examination guidelines is searched and exposed to the medical institution terminal.

Next, if the main keyword is selected by the medical institution terminal in step 1330, the health insurance screening request screening system 100 receives the selected at least one main keyword as an input keyword in step 1340 .

Next, in step 1350, the health insurance screening request screening system 100 checks the prescription information based on the input keyword to determine whether the prescription information is to be paid or not paid.

Embodiments of the present invention include computer readable media including program instructions for performing various computer implemented operations. The computer-readable medium may include program instructions, local data files, local data structures, etc., alone or in combination. Such media may be those specially designed and constructed for the present invention or may be those known to those skilled in the computer software. Examples of computer-readable media include magnetic media such as hard disks, floppy disks and magnetic tape, optical recording media such as CD-ROMs and DVDs, magneto-optical media such as floppy disks, and ROMs, And hardware devices specifically configured to store and execute the same program instructions. Examples of program instructions include machine language code such as those produced by a compiler, as well as high-level language code that can be executed by a computer using an interpreter or the like.

While the present invention has been described in connection with what is presently considered to be practical exemplary embodiments, it is to be understood that the invention is not limited to the disclosed embodiments. Therefore, the scope of the present invention should not be limited to the described embodiments, but should be determined by the scope of the appended claims and equivalents thereof.

While the present invention has been particularly shown and described with reference to exemplary embodiments thereof, it is to be understood that the invention is not limited to the disclosed exemplary embodiments, but, on the contrary, Modification is possible. Accordingly, the spirit of the present invention should be understood only in accordance with the following claims, and all equivalents or equivalent variations thereof are included in the scope of the present invention.

105: Examination Guideline DB
110: Examination Guidelines
115: Keyword management DB
120: Keyword management section
130:
140: Keyword input section
150:
160: Message notification section
170:

Claims (8)

Examining guide instruction for searching contents of the examination instructions related to the patient's prescription information from the examination guide database stored in association with the prescription information of the patient and contents of the examination guide,
A keyword retrieval unit for retrieving a main keyword associated with the content of the examination instruction from the keyword management database stored in association with the prescription information of the patient based on the contents of the examination instruction,
A keyword input unit for receiving at least one of the main keywords as an input keyword when at least one of the main keywords is selected by the medical institution terminal; And
A judging judging section for judging whether the prescription information is to be paid or not paid by executing the check on the prescription information based on the input keyword,
And a health screening request screening system.
The method according to claim 1,
Extracting a main keyword from the contents of the examination guidance based on a natural language processing algorithm, and storing and managing the main keyword in the keyword management database,
Further comprising a screening system for requesting examination of health insurance.
3. The method of claim 2,
The keyword management unit
Wherein the main keyword is extracted from the contents of the examination instructions exposed on the screen of the medical institution terminal every time the examination about the contents of the examination instruction is updated.
The method according to claim 1,
The keyword search unit
Wherein the searched main keyword is exposed in a query format or a graphical format.
The method according to claim 1,
The keyword search unit
Wherein the searched main keyword is categorized in accordance with a predetermined classification standard and categorized as an inspection subject or an authorization condition and then exposed.
6. The method of claim 5,
The keyword search unit
Performing keyword filtering based on the association between the selected main keyword and the remaining main keywords when any one of the main keywords classified as the category is selected and selecting one of the N keywords having relatively high relevance to the selected main keyword And the remaining main keywords (N is a natural number) are exposed on the screen of the medical institution terminal.
The method according to claim 1,
A message notification unit for providing a message alarm function by considering that the determination of whether the prescription information is to be paid or not paid is ambiguous in the case of the prescription information for which the judgment of whether or not the object of salary or non-
Further comprising a screening system for requesting examination of health insurance.
Retrieving the contents of the examination instructions related to the patient's prescription information from the examination guidance database stored in association with the contents of the patient's prescription information and the examination guidelines, and exposing the contents to the medical care institution terminal;
Retrieving a main keyword associated with the contents of the examination instruction from the keyword management database stored in association with the prescription information of the patient based on the contents of the examination instruction and exposing the keyword to the medical care institution terminal;
Receiving at least one main keyword selected as an input keyword when at least one of the main keywords is selected by the medical institution terminal; And
Performing a check on the prescription information based on the input keyword and determining whether the prescription information is to be paid or not paid
And a health insurance screening request screening method.

Images