KR20020028296A - Managing system for network-based request of medical treatment and examination of outside order - Google Patents

Abstract

PURPOSE: A medical fee request and outside assessment operation system is provided to construct a database for calculating therapeutic fee and medicine fee at a server of an insurance company, to enable a plurality of hospitals to request a medical fee to the server, and to make an outside company assess the request over a network. CONSTITUTION: The method comprises steps of an assessment server operator constructing an automatic operation program for automatically managing the request of the medical fee, the assessment of the medical fee and the check of the assessment, offering the operation program to the hospitals and the outside assessor, and issuing authentication data for enabling the hospitals and the assessors to access the assessment server over the network(S100), the assessment server receiving the request of the medical fee, checking the hospital data, the patient name and the kind of the therapy, and arranging the request and the assessment on the request to a person in charge of compensation and the assessor, respectively(S200), the assessment server assessing the request based on specifications written in a form, sending the first assessment result and the request of the medical fee to the arranged outside assessor, the assessor assessing the request of the medical fee, and the assessment server transmitting the assessment result to the hospitals(S300), and the assessment receiving an agreement from the hospitals, and determining an insurance money for treating the patient and an assessment fee(S400).

Description

Managing system for network-based request of medical treatment and examination of outside order}

The present invention relates to a treatment billing and outsourcing operation management system.

More specifically, the insurance company establishes and manages a database of fees, drug prices, and contract prices related to billing and review of treatment costs, and performs outsourcing work for billing and reviewing treatment costs of various medical institutions. The present invention relates to a network-based treatment fee billing and outsourcing operation system that can be automatically processed using a network such as the Internet.

In general, insurance means guarantees for damages, and many people earn a certain amount (premium) in advance in case of accidental accidents that cause people or goods to lose money. It is a system to cover the damages to those who have been in an accident.

Such an insurance system enables various people to secure stable economic activities by maintaining stable family life and business management, as well as smooth capital supply by collecting small premiums and forming large capital. It is possible to promote savings and increase the value of collateral for financial purposes, and to prevent accidents such as fires and traffic accidents caused by injustice.

Due to the various reasons mentioned above, today's insurance may become a part of life, medical insurance to reduce the medical expenses incurred by the use of hospitals or clinics, or travel insurance for short-term travel or business trip risks. The number of insurance products is increasing day by day, such as insurance products for fires, insurance products for physical accidents such as traffic accidents, and health insurance products related to various diseases.

Insurance companies dealing with such various insurance products are rapidly increasing their claims for medical treatment, especially due to traffic accidents. We are striving to handle the cost of treatment fee and payment of treatment fee more efficiently.

1 is a view for explaining an example of the general treatment fee claim and outsourcing work as described above.

As shown, the medical institution (1) that treats a patient writes out the medical expenses incurred in the treatment process on an invoice form (e.g., a claim for payment of auto insurance premiums) and then writes to the compensation manager (2) of each compensation center. As individual receptionist.

Then, the compensation officer (2) of the compensation center asks the outsourcing fee reviewers (3) belonging to each compensation center to review the bill of care received from the medical institution (1), and the outsourcing fee reviewers (3) After the completion of the examination of the treatment fee according to the details of the bill for the treatment fee requested in (1), the result of the examination shall be written on a notified form (for example, a bill for payment review) and submitted to the compensation officer (2).

The compensation officer (2), who has received the examination results from the outsourcing fee reviewer (3), delivers the payment request review with the examination result to the medical institution (1), and receives the payment request review consent form from the medical institution (1) within 7 days. After that, the result of the payment request review agreement received from the medical institution 1 is input to the host computer 4.

As a result, the host computer 4 finally determines the treatment fee decision insurance fee and the examination fee insurance fee based on the result of the payment request review agreement. The fee shall be paid to the auditor.

On the other hand, Figure 2 is a view for explaining another example of the general treatment cost claim and outsourcing work.

As shown in the figure, the medical institution server 20 transfers the treatment fee bill (EDI document) generated in the course of treatment through the network communication network 10 (eg, the Korea Telecom EDI (Electronic Data Interchange) relay network to the examination server 30. Send it.

Then, the examination server 30 sends the receipt (or return certificate) of the treatment fee bill to the medical institution server 20, and transmits the treatment fee bill received from the medical institution server 20 to the host computer 40.

Thereafter, the host computer 40 searches for the damage information (accident number) described through the treatment fee invoice received from the examination server 30, and allocates the medical institution to the specific compensation manager 50.

After assigning the medical institution to the specific compensation manager 50, the host computer 40 resends the treatment fee bill to the examination server 30 so that the internal medical expenses reviewer 60 performs the examination according to the treatment fee bill. At this time, before the internal medicine treatment fee examiner 60 performs the examination, the examination server 30 primarily performs the treatment fee bill examination according to a program set therein.

When the examination is finally completed by the internal medical expenses reviewer 60, each compensation officer 50 checks the examination result and sends a payment request review containing the examination result to the medical institution server 20 through the network communication network 10. The payment request review agreement is received from the medical institution server 20 and the payment request review agreement is input to the host computer 40.

Accordingly, the host computer 40 confirms the final payment amount based on the result of the payment request review agreement, and the examination server 30 transmits the payment history notification letter containing the examination result of the host computer 40 to the corresponding medical institution. It is sent to the server 20, and pays the insurance money determined according to the examination result to the medical institution server 20.

However, in the conventional system for performing medical billing and outsourcing work as described above, each medical institution receives a premium claim after receiving the result of the work provided by the insurance company through the network whenever the medical bill or the drug price changes. In addition to updating the software to be performed, even if the payment process is changed due to the revision of the law, it is difficult to develop and maintain the program because the premium billing software must be developed and updated to each medical institution through an external program developer. Many.

In addition, the insurance company must have a professional manpower to examine the medical expenses requested by each medical institution, and during the examination of the medical expenses, provide the data to be reviewed by the relevant professional personnel manually, and then be notified of the evaluation results of each professional staff to examine the medical expenses. And because of the payment service must be carried out the problem that the treatment fee examination and treatment fee payment task did not proceed quickly.

In addition, in the case of hiring a professional manpower to perform the treatment cost examination by itself, it is not efficient because a separate equipment and office space should be provided. There was a problem that it was difficult to manage the professional manpower because it had to outsource the manpower and conduct outsourcing examination.

The purpose of the present invention is to solve the above-mentioned problems, and to manage and operate the database of the number of charges and examinations related to the treatment fee, the price, the contract price, etc. at the insurer, and at the same time, the cost of treatment of various medical institutions by hand It is to provide a network-based treatment fee billing and outsourcing operation system that allows the outsourcing work that performs billing and treatment fee examinations to be automatically processed using a network such as the Internet.

1 and 2 are views for explaining an example of the general treatment fee claim and outsourcing work,

3 is a block diagram schematically showing the configuration of a network-based treatment fee request and outsourcing examination operating system according to the present invention;

Figure 4 is a flow chart illustrating in detail the operation of the network-based treatment fee billing and outsourcing audit operation method according to the present invention,

5 to 8 are flowcharts showing in detail the operation of each subroutine of FIG.

Explanation of symbols on the main parts of the drawings

100: network communication network 200: medical institution server

300: triage server 400: host computer

500: Compensation Officer Computer 600: Treatment Fee Examiner Computer

The network-based treatment fee billing and outsourcing examination operating system according to the present invention for achieving the above object comprises: a network communication network for connecting data unspecified a number of communication lines and mutual data communication; Establish a communication connection with the outside to provide the treatment fee and outsourcing service through the network communication network, and use the treatment fee billing program to prepare and send the treatment bill including the victim information and treatment information to the outside. A plurality of medical institution servers provided with the payment request review report according to the result of the examination, the payment request review agreement provided from the outside, and the payment request review agreement indicating whether to agree with the external payment request, and receiving the treatment fee from the outside; An operator program is in place to manage treatment billing, screening work of outsourcing fee reviewers, and review results of compensation officers, and when a bill is input from a plurality of medical institution servers through a network network, victim information described in the bill And treatment information is transmitted to the outside, and when the information on the assignment of the compensation officer and the outsourcing fee reviewer is provided from the outside, the expert program in the operator program automatically performs the first treatment fee review based on the treatment information on the treatment fee bill. Upon completion of the screening, the results of the first screening fee and bills to be reviewed are sent to the outsourcing fee screening computer through the network network.When the outsourcing fee reviewer completes the screening through the screening program, the compensation officer checks the screening results. After confirming the result of the audit by comparing with the first audit result through RAM, and sending the final audit result to the outside, a payment request review report according to the audit result is prepared and sent to the medical institution server, and the payment request review from the medical institution server A review server for finally determining a treatment non-determination insurance benefit based on the consent form, and transmitting the predetermined fee data according to the final treatment-determination insurance money and the examination results performed by a plurality of outsourcing treatment fee reviewers to the outside; After receiving the medical institution information, the victim information, and the treatment information written in the treatment fee bill from the review server, assigning the specific compensation manager and the outsourcing fee reviewer among the plurality of compensation managers and outsourcing cost reviewers registered in the database and assigning the result of the assignment It transmits to the screening server, receives and stores the final screening result by the outsourcing fee reviewer from the screening server, pays the treatment fee insurance premium finally determined based on the payment request agreement agreement of the specific medical institution server from the screening server, and the screening server Characterized in that it comprises a host computer that pays a predetermined fee according to the audit results determined by the outsourced treatment fee reviewer.

In addition, the network-based treatment fee billing and outsourcing audit operation method according to the present invention, (1) after establishing the operator program for managing the treatment billing, screen screening business, audit results verification task in the examination server a plurality of medical institution server and Providing each of the programs for requesting the treatment fee and the examination work to the outsourcing fee reviewer computer, and issuing authentication data for access to the examination institution to the medical institution and the outsourcing fee reviewer; (2) When the treatment fee bill is input from the specific institution server to the review server, the host computer checks the medical institution information, the victim information, and the treatment information on the treatment fee bill, and the specific compensation manager and the outsourcing fee for the treatment fee request and examination work. Assigning reviewers; (3) After the examination server automatically performs the first treatment fee examination based on the details of the medical bills input from the medical institution server, the first treatment fee examination data and the contents of the medical bills are provided to the outsourcing fee reviewer, and the outsourcing fee reviewer Preparing a payment request review report based on the examination result and providing it to the medical institution server; (4) When the payment request review agreement is input from the medical institution server, the examination server determines the treatment cost insurance fee, pays the treatment cost insurance fee to the medical institution through the host computer, and a predetermined fee according to the review results of a plurality of outsourcing fee reviewers. Determining the characterized in that it comprises the process of paying the fee to the outsourced treatment fee reviewer through the host computer.

Hereinafter, with reference to the accompanying drawings will be described in detail the network-based treatment fee billing and outsourcing operation management system of the present invention.

3 is a block diagram schematically showing the configuration of a network-based treatment fee billing and outsourcing examination operating system according to the present invention.

As shown, the network communication network 100 is a communication network such as a wired / wireless internet, and connects a communication line between a plurality of medical institution server 200, a review server 300, and a plurality of treatment fee examiner computers 600 to be described later. Thus, data communication related to the billing and examination work of treatment fee is made to each other.

The plurality of medical institution server 200 has a program and communication program associated with the treatment billing to establish a communication connection with the examination server 300 that provides the treatment fee billing and outsourcing service through the network communication network 100, By using the treatment fee billing program provided by the examination server 300, a treatment fee invoice including the victim information and treatment information is prepared and transmitted to the examination server 300, according to the result of the examination of the treatment fee bill from the examination server 300 The payment request review is provided, and after receiving the payment request review agreement indicating whether or not to agree to check the payment request review provided by the review server 300 receives the treatment fee from the host computer (400).

Examination server 300 is an operator program for managing the billing of treatment costs, screening work of the outsourcing treatment fee reviewer, review results of the compensation person in charge, and establishes an operator program, from the plurality of medical institution server 200 through the network communication network (100) When the treatment fee bill is input, the victim information and treatment information described in the treatment fee bill are transmitted to the host computer 400 to be described later. When the compensation person and outsourcing fee reviewer assignment information are provided from the host computer 400, the expert program in the operator program is executed. Based on the treatment information described in the treatment fee bill, the first treatment fee examination is automatically performed to check whether the claim is over-medical and error claims, and when the first treatment fee review through the expert program is completed, outsourcing through the network communication network (100) Treatment fee examiner computer 600 and the first treatment fee screening result Send billing information for review.

When the outsourcing fee reviewer completes the screening using the screen screening program, the screening server 300 compares the screening result with the first screening result through the screening result verification program, and finally checks the host computer ( At the same time, the final examination result is transmitted to the medical institution server 200 and the payment request review agreement is input from the medical institution server 200. The insurance premium is finally determined, and predetermined fee data according to the final treatment fee insurance premium and the examination results performed by the plurality of outsourced treatment fee reviewers are transmitted to the host computer 400.

In this case, when the above-described examination server 300 receives data indicating that the treatment fee bill is inappropriate from the host computer 400 confirming the treatment fee bill input from the specific medical institution server 200, the medical institution server is created after the reason for return is made. Return the bill for medical expenses input at 200.

When the first treatment fee examination is automatically performed based on the treatment information described in the treatment fee bill inputted from the plurality of medical institution servers 200 through the expert program in the operator program established in the examination server 300, The information on the multiple medical institutions, the victim information, the number, the medicine price, the contract price, the material price, the sickness, the outsourcing fee reviewer information, the examination settlement information, and the examination criteria information are used to check whether the claims are over-medicated and the error of the claims.

In addition, when the examination server 300 requests the treatment fee examination to the outsourcing fee reviewer, the outsourcing fee reviewer logs in to the review server 300 through the network communication network 100, and then, in the review server 300. The screening program will provide a screening program.

And, if there is a disagreement in the evaluation result, the compensation officer who checks the result of the examination performed by the outsourcing fee reviewers through the compensation manager computer 500, writes an opinion according to the request for re-examination and asks the outsourcing fee reviewer to review again. In addition, if a full agreement is not entered from the specific medical institution server 200 confirming the payment request review report based on the result of the review, and a partial agreement or a full agreement is entered, the compensation officer will contact the outsourcing fee examiner. Reconsideration is requested, and if adjustment is not possible, part of the actual amount of the medical bill is paid and the final decision is made by the Dispute Hearing.

The host computer 400 receives and confirms the medical institution information, the victim information, and the treatment information described in the treatment fee bill from the examination server 300, and at the same time, a specific compensation manager among the plurality of compensation officers and outsourced treatment fee examiners registered in the database. After assigning the outsourcing treatment fee examiner, the allocation result is transmitted to the examination server 300, and the final examination result by the outsourcing treatment fee examiner is received from the examination server 300, and stored, and the specific medical institution server 200 is selected from the examination server 300. The treatment fee insurance premium finally decided based on the payment request review agreement of the company is paid to the relevant medical institution through a CMS (Cash Management System), etc., and a predetermined fee according to the examination results determined by the examination server 300 is paid to the outsourcing fee examiner. .

In this case, the host computer 400 described above accumulates fee information according to the examination results performed by a plurality of outsourcing treatment fee examiners who examine a treatment fee request in response to a request from the examination server 300, and builds a database for the outsourcing treatment fee. According to the reviewer's inquiry, fee information based on the review results is provided to the outsourcing fee reviewer.

Next, an embodiment of a network-based treatment fee billing and outsourcing operation operating method according to the present invention configured as described above will be described in detail with reference to FIGS. 4 to 8.

4 to 8 are flowcharts showing in detail the operation of the network-based treatment fee billing and outsourcing examination operating method according to the present invention.

First, the administrator of the examination server 300 establishes an operator program to automatically manage the treatment fee billing, screening work, and audit result checking work on a network basis, and then the plurality of medical institution server 200 and the outsourcing fee checker computer. Provides and installs a program for the treatment fee claim and the examination work, respectively (600), and issues authentication data that can be connected to the examination server 300 through the network communication network 100 such as the Internet to the medical institution and outsourcing fee reviewers. (S100).

In detail, the examination server 300 operator develops an operator program that manages treatment fee billing work, screening work, and audit result checking work automatically through the network communication network 100 to request treatment fee and outsourcing. Start the examination operation service (S110), and installs and provides a program related to the treatment fee claim and the examination of the established operator program to the plurality of medical institution server 200 and the outsourcing treatment fee examiner computer (600) (S120). At this time, the examination server 300 that has built the operator program is building a plurality of medical institution information, victim information, number, drug price, contract price, material charges, corporal, outsourcing fee reviewer information, examination settlement information, examination criteria information, etc. .

In addition, the examination server 300 in which the operator program is constructed may include a medical institution code (outsourcing treatment fee examiner code), an authentication key, and an ID that can be connected to the examination server 300 through a network communication network 100 to a plurality of medical institutions and outsourcing treatment fee examiners. Issuing authentication data, such as password (S130), and stores the authentication data issued to a plurality of medical institutions and outsourced treatment fee reviewer in a database (S140).

After developing and building the operator program in the screening server 300 through the above-described process (S100), and after installing the program related to the treatment billing and examination work on each medical institution server 200 and outsourcing treatment fee examiner computer 600 When the treatment fee bill is input from the specific medical institution server 200 through the network communication network 100, the host computer 400 checks the medical institution information, the victim information, and the treatment information described in the treatment fee bill, and requests the treatment fee and the examination work. Assign a specific compensation officer and outsourcing fee examiner to perform (S200).

In detail, the examination server 300 inputs authentication data such as a medical institution code, an ID, a password, etc. from a specific medical institution server 200 connected through the network communication network 100 and then proceeds with the communication connection (S210). In order to charge medical expenses for traffic accidents, the victim information (accident number, accident resident registration number, etc.) and treatment information (diagnosis name, treatment period, treatment contents, number, medicine price, etc.) are used by using the program related to the medical billing service. After filling out the treatment fee bill, it is determined whether it is input to the examination server 300 through the network communication network 100 (S220).

When the treatment fee bill is input from the specific medical institution server 200, the examination server 300 assigns a receipt number of the treatment fee bill input from the specific medical institution server 200, and then transmits the treatment fee bill information to the host computer 400 ( In operation S230, the host computer 400 checks the corresponding treatment fee information and determines whether all necessary data has been described (S240).

As a result of the determination of the host computer 400, when there is no abnormality in the data of the treatment fee bill inputted from the medical institution server 200, the examination server 300 issues a treatment fee bill receipt and transmits it to the medical institution server 200 ( S250), if there is an abnormality in the data of the treatment fee bill input from the medical institution server 200, the examination server 300 is the reason for the return (for example, accident number missing, duplicate claim, error of the medical institution information and missing, etc.) ) And returns the treatment fee bill to the medical institution server 200 (S260).

At this time, the host computer 400 is the medical institution information (bank account, business registration number, medical institution code, hospital compensation officer, etc.), the victim information (accident number, victim's name, social security number) through the medical bills input from the medical institution server 200 When confirming the payment of the same period, etc.), a specific compensation officer who will be in charge of the medical institution and an outsourced treatment fee examiner who will perform the treatment fee bill examination will be assigned and sent to the examination server 300.

Subsequently, the examination server 300 receives an assignment result of a specific compensation officer and an outsourced treatment fee examiner who performs the treatment fee request and examination work from the host computer 400 (S270), and the assignment provided by the host computer 400. According to the result, a specific compensation officer is assigned to the medical institution, and a specific outsourcing fee reviewer is assigned to the medical bill request examination of the medical institution (S280).

After the treatment fee bill is input through the above-described process (S200) and a specific compensation officer and an outsourced treatment fee reviewer are assigned, the examination server 300 is based on the details of the treatment fee bill input from the medical institution server 200, and the over-care of the claim. After the first treatment fee examination is performed automatically to check for errors, the primary treatment fee examination data and the contents of the invoice are provided to the outsourcing fee reviewer, and a payment request review is prepared according to the examination result performed by the outsourcing fee reviewer. It provides to the medical institution server 200 (S300).

To describe this in detail, the examination server 300 is the first to check whether the over-care and error of the claim based on the treatment information described in the treatment fee bill input from the specific medical institution server 200 through the expert program in the operator program The treatment fee examination is automatically performed (S310). That is, the medical bills input from the specific medical institution server 200 by using a plurality of medical institution information, victim information, number, drug price, contract price, material charge, corporal health, outsourcing treatment fee reviewer information, examination settlement information, and examination standard information constructed as a database. The first step is to find out whether the treatment information described in the above is correct.

Subsequently, the examination server 300 accesses the first treatment fee examination result data and the contents of the treatment fee bill inputted from the medical institution server 200 to check whether the claim is over-medical and error claims. The outsourcing fee is provided to the examiner to request the examination of the bill of treatment (S320).

According to the request for the treatment fee bill of the examination server 300, the specific outsourcing treatment fee examiner performs the treatment fee examination based on the primary treatment fee examination result data provided by the examination server 300 and the contents of the treatment fee bill input from the medical institution server 200, and the examination. The result is input to the examination server 300 (S330). At this time, the specific outsourced treatment fee reviewer performs a screening through the screen screening program provided by the screening server 300 after logging in to the screening server 300.

When the treatment fee bill examination by the specific outsourcing fee reviewer is finished, the compensation officer checks the examination result performed by the outsourcing fee reviewer through the compensation representative computer 500 connected to the examination server 300 (S340), the outsourcing fee reviewer After providing the result of the examination to the host computer 400 and at the same time preparing a payment request review report according to the examination result (S350), the payment request review report according to the examination result by the treatment fee bill through a specific medical institution server through the network communication network (100) Provided at 200 (S360).

In this case, if there is any disagreement on the result of the examination performed by the outsourcing fee reviewer, the compensation officer sends a message to the outsourcing fee reviewer and requests a review of the bill.

Finally, after providing the payment request review written according to the examination result performed by the outsourcing fee reviewer to the medical institution server 200 through the above-described process (S300), the examination server 300 from the medical institution server 200 When the payment request review agreement is input, the treatment fee determination insurance money is determined and the insurance money is paid to the medical institution through the host computer 400, and a predetermined fee is determined according to the examination results of the plurality of outsourcing cost reviewers. Through 400) to pay the fee to the outsourcing reviewer (S400).

In detail, the examination server 300 determines whether a payment request review agreement is input from the medical institution server 200 confirming the payment request review report according to the examination result of the outsourcing treatment fee reviewer (S410), and the corresponding medical institution server ( If the payment request review agreement is inputted from (200), it is determined whether or not the full agreement or partial agreement or the total floating in the review result of the payment request review (S420).

That is, the medical institution server 200 confirms the payment request review report according to the result of the examination of the treatment bill, and if they are satisfied with the calculation of the insurance claims they have made, enters the consent server for the full consent to the examination server 300, and agrees to this. If not, the reason for partial agreement or full agreement is provided and provided to the audit server 300.

As a result of the above-described determination (S420), when the medical institution server 200 inputs the full agreement payment request review agreement, the examination server 300 finally determines the treatment fee insurance premium according to the examination result of the outsourcing treatment fee reviewer. (S430).

However, when the determination result of the above-described step (S420), when entering a partial agreement or payment request review agreement of the total floating, the review server 300 re-examines the outsourcing treatment fee reviewer based on the content requested by the medical institution server 200 After the request, and after obtaining the consent of the medical institution server 200 confirming the re-examination results, finally determines the treatment fee insurance premiums according to the examination results (S440).

As described above, when the treatment fee decision insurance money is finally determined according to the payment request review agreement input from the medical institution server 200, the examination server 300 provides the treatment fee insurance money data finally determined to the host computer 400 to determine the treatment cost. The insurance money is controlled to be paid to a specific medical institution (S450).

In addition, the audit server 300 determines a predetermined fee to be paid according to the audit results performed by the plurality of outsourced treatment fee reviewers each time a predetermined period (for example, a month) arrives (S460). As in S450, the predetermined fee data according to the finally determined audit result is provided to the host computer 400, so that the fee according to the audit result is paid to a specific outsourced treatment fee examiner (S460).

As described above, according to the network-based treatment fee billing and outsourcing operation management system of the present invention, the billing and examination work performed automatically between the medical institutions (including pharmacies and assistant technologists), insurance companies and outsourcing fee reviewers through the Internet By doing so, it is possible to eliminate the uneconomic act of simultaneously performing the same work result in multiple billing institutions whenever the number of medical treatments is changed. Since the pre-checking step can be omitted, it is possible to shorten the manual medical billing and review process, and to reduce unnecessary manpower and time waste as in the prior art, thereby increasing economic utility value.

In addition, since the specialists who examine the treatment costs can carry out the work process through the Internet, the insurance company can utilize the excellent workforce in a wide range of areas, and effectively utilize the necessary workforce without investing additional business expenses due to recruitment. There is an advantage to dramatically improve the compensation work.

Herein, while the present invention has been described with reference to the preferred embodiments, those skilled in the art will variously modify the present invention without departing from the spirit and scope of the invention as set forth in the claims below. And can be changed.

Claims (12)

A network communication network which connects a plurality of unspecified communication lines to perform data communication with each other; Perform a communication connection with the outside for providing the treatment fee request and outsourcing service through the network communication network, and using the treatment fee billing program, prepare and send the treatment fee invoice including the victim information and the treatment information to the outside, and the corresponding treatment fee from the outside A plurality of medical institution servers provided with a payment request review report according to the result of the examination of the bill, the payment request review agreement provided from the outside, and the payment request review agreement indicating whether the payment is agreed to the outside and receiving treatment fee from the outside; There is an operator program that manages billing services, screening work of outsourcing fee reviewers, and review results of compensation officers.If bills are entered from a plurality of medical institution servers through the network, the victim is listed in the bill. When the information and treatment information is transmitted to the outside, and the information about the assignment of the compensation officer and the outsourcing treatment fee reviewer is input from the outside, the first treatment fee examination is automatically performed based on the treatment information on the treatment bill through the expert program in the operator program. After the completion of the examination of the primary treatment fee, the results of the primary treatment fee and the invoice for the examination are sent to the outsourcing fee evaluator computer through the network network. Through the verification program, the result of the screening is compared with the first screening result, and the final screening result is sent to the outside. At the same time, a payment request review report according to the screening result is sent to the medical institution server, and the payment is made from the medical institution server. A review server for finally determining a treatment non-determination insurance benefit based on the consent form when the request for review of the request is input, and externally transmitting predetermined fee data according to the final treatment-determination insurance money and the examination results performed by a plurality of outsourcing treatment fee reviewers; And After receiving and confirming the medical institution information, the victim information, and the treatment information described in the treatment fee bill from the examination server, assigning a specific compensation officer and the outsourced treatment fee examiner among the plurality of compensation officers and outsourced treatment fee reviewers registered in the database, and then assigning results Transmits to the screening server, receives and stores the final screening result by the outsourcing fee reviewer from the screening server, and pays the treatment fee insurance premium finally determined based on the payment request review agreement of a specific medical institution server in the screening server. And a host computer that pays a predetermined fee according to the audit results determined by the audit server to the outsourced medical expenses reviewer. The method of claim 1, wherein when the first treatment fee examination is automatically performed based on the treatment information described in the treatment fee invoice through an expert program in the operator program established in the examination server, It checks whether the claim is over-medical or error by using the information of multiple medical institutions, victim information, number, medicine price, contract price, material price, hospital, outsourcing fee reviewer information, screening settlement information, and screening standard information. Network-based billing and outsourcing operation system. The method of claim 1, wherein the examination server, When requesting outsourcing fee reviewer to the outsourcing fee reviewer, the outsourcing fee reviewer can log in to the screening server through the network and then perform the screening through the screen screening program provided by the screening server. Network-based treatment billing and outsourcing operation system. The method of claim 1, wherein the examination server, When data is input from the host computer that checks the medical bills input from the medical institution server, the medical bills are inappropriate. After filling the reason for return, the network-based treatment fee billing and outsourcing operation system, characterized in that for returning the bill of treatment input from the medical institution server. The method of claim 1, wherein the compensation officer who confirms the results of the examination performed by the outsourcing fee reviewers, If there is a disagreement in the result of the review, the network-based treatment fee billing and outsourcing operation system, characterized in that by writing an opinion based on the request for re-examination requesting the re-examination to the outsourcing fee reviewers. The method of claim 1, wherein the examination server, If a partial agreement or full agreement is not entered from the medical institution server confirming the payment request review form according to the result of the review, and a partial agreement or full agreement is entered, the outsourcing fee reviewer is requested to reexamine. The network-based billing and outsourcing operation system, characterized in that, if the adjustment is impossible, the final decision is made by the dispute reviewer after paying a part of the actual bill of the bill. The method of claim 1, wherein the host computer, In accordance with the request of the review server, the fee information according to the audit results performed by a plurality of outsourcing fee reviewers reviewing the request for treatment fee is accumulated and built into a database, Network-based treatment fee billing and outsourcing operation system, characterized in that the fee information according to the evaluation results are provided to the outsourcing fee reviewer according to the inquiry of the outsourcing fee reviewer. (1) After setting up an operator program that manages the treatment fee claim, screening work, and audit result verification task in the audit server, provide a program for treatment billing and examination work to multiple medical institution servers and outsourcing cost auditor computers, respectively. Issuing authentication data for access to the examination server to the medical institution and the outsourcing fee reviewer; (2) When the treatment fee bill is input from the specific institution server to the review server, the host computer checks the medical institution information, the victim information, and the treatment information on the treatment fee bill, and the specific compensation manager and the outsourcing fee for the treatment fee request and examination work. Assigning reviewers; (3) After the examination server automatically performs the first treatment fee examination based on the details of the medical bills input from the medical institution server, the first treatment fee examination data and the contents of the medical bills are provided to the outsourcing fee reviewer, and the outsourcing fee reviewer Preparing and providing a payment request review report according to the examination result to the corresponding medical institution server; And (4) When the payment request review agreement is input from the medical institution server, the examination server determines the treatment cost insurance fee, pays the treatment cost insurance fee to the medical institution through the host computer, and a predetermined fee according to the review results of a plurality of outsourcing fee reviewers. Network based treatment fee billing and outsourcing operation method comprising the step of determining and paying a fee to the outsourcing fee reviewer through the host computer. The method of claim 8, wherein the process (1), (1-1) developing an operator program for managing treatment fee billing, screening work, and examination result checking work automatically through a network in the audit server to start billing and outsourcing operation; (1-2) providing and installing a program related to the treatment fee request and the review among the constructed operator programs to a plurality of medical institution servers and outsourced treatment cost examiner computers; (1-3) issuing authentication data for accessing the examination server through a network communication network to a plurality of medical institutions and outsourcing fee reviewers; And (1-4) A network-based treatment fee billing and outsourcing operation method comprising the step of storing the authentication data issued to the plurality of medical institutions and outsourcing fee reviewers in a database. The method of claim 8, wherein the process (2), (2-1) inputting authentication data from a specific medical institution server connected through a network communication network to perform a communication connection to an examination server; (2-2) determining whether a medical expenses bill including medical institution information, victim information, and treatment information is input from a specific medical institution server; (2-3) transmitting the treatment fee bill inputted from the specific medical institution server to the host computer; (2-4) determining whether all necessary data has been described as a result of the treatment fee check of the host computer; (2-5) if there is no abnormality in the result of checking the treatment bill of the host computer, the examination server issues a receipt of the treatment bill and transmits it to the medical institution server; (2-6) if there is an abnormality in the result of checking the treatment fee bill of the host computer, returning the treatment fee bill to the medical institution server after describing the reason for the return from the examination server; (2-7) receiving an assignment result of a specific compensation officer and an outsourcing fee reviewer who performs the billing and examination work from the host computer; And (2-8) A network-based treatment fee comprising assigning a specific compensation officer to the medical institution according to the result of the host computer assignment, and assigning a specific outsourcing fee reviewer to the examination of the treatment fee requested by the medical institution. How to Operate Billing and Outsourcing. The method of claim 8, wherein the process (3), (3-1) automatically conducting a first treatment fee examination to confirm whether the claim is over-medicated and a mistake based on the treatment information described in the treatment fee invoice through the expert program in the operator program; (3-2) providing the first outpatient treatment fee review result data performed by the examination server and the contents of the treatment fee invoice inputted from the medical institution server to a specific outsourcing fee examiner connected to the examination server; (3-3) a specific outsourcing treatment fee reviewer performs the treatment fee examination based on the primary treatment fee examination result data provided by the examination server and the contents of the treatment fee bill input from the medical institution server, and inputs the examination result to the examination server; (3-4) the compensation officer confirms the evaluation result performed by the outsourcing fee reviewer through the compensation officer computer connected to the examination server; (3-5) the compensating person in charge provides the host computer with the result of the examination performed by the outsourcing fee reviewer and prepares a payment request review report according to the result of the examination; And (3-6) A network-based treatment fee request and outsourcing operation method comprising the step of providing the payment request review written by the compensation officer in the review server to the medical institution server. The method of claim 8, wherein the process (4), (4-1) determining whether a payment request review agreement is input from the corresponding medical institution server which has checked the payment request review report provided by the review server; (4-2) if a payment request review agreement is input from the medical institution server, determining whether to agree with the review result of the payment request review form in full; (4-3) in the case of full agreement, finally determining the treatment non-determination insurance premium according to the examination result in the examination server; (4-4) As a result of the determination of step (4-2), in case of partial agreement, the examination server requests re-examination to the outsourcing fee reviewer, obtains the consent of the medical institution server confirming the re-examination result, and then determines the treatment fee according to the evaluation result. Finally determining the insurance claim; (4-5) controlling the treatment server to pay the treatment decision insurance premium to a specific medical institution by providing the treatment decision insurance premium data finally determined by the examination server to the host computer; (4-6) determining a predetermined fee to be paid according to the audit results performed by the plurality of outsourcing fee reviewers at the audit server; And (4-7) The network-based treatment fee billing and outsourcing, comprising the step of providing the host computer with the predetermined fee data according to the audit results determined by the audit server to control the fee to be paid to a specific outsourced treatment fee reviewer. How the audit works.