KR20060029127A - Financial stabilization system of national health insurance - Google Patents

Abstract

The present invention relates to the national health insurance financial stabilization system, and more specifically, the National Health Insurance Corporation, the work supervision, which pays the costs of subscribers, dependents, nursing institutions, health insurance review and evaluation unit, which constitute the national health insurance benefit system. The Health and Welfare Department, an organization, provides real-time notification of visits to care centers by patients, confirmation of patient visits and time data, confirmation of medical expenses and dispensing expenses by patients, and the payment of care benefits through real-time transmission of bills. Expand the patient's right to participate in expenditures, and make various data such as claims and examination contents into data to prevent the loss of care benefits due to convenience of claim for medical benefit payment, streamlining examination work, and improvement of care payment examination office work. Mistakes, excesses, false and fraudulent claims, etc. in the claim of medical expenses of the institution The National Health Insurance Financial Stabilization System can prevent various factors in advance. The National Health Insurance Financial Stabilization System includes a health insurance card, a health insurance card identification terminal, a care institution client, a care payment expenditure stabilization server, a review and evaluation server, The Health Insurance Corporation server, the Ministry of Health and Welfare, and the patient client consists of stabilizing the national health insurance finance.

 National Health Insurance, Ministry of Health and Welfare, Cards, Computers, Servers, Programs, Subscribers, Dependents, Nursing Care Benefits, Finance, Health Insurance Review and Assessment Service, National Health Insurance Service

Description

Financial stabilization system of national health insurance

1 is a block diagram of a national health insurance financial stabilization system according to a preferred embodiment of the present invention,

2 is a health insurance card constructed in FIG.

3 is personal information data entered in the health insurance card of FIG.

Figure 4 is a block diagram of the data flow between the care institution client and care payment expenses stabilization server established in Figure 1,

5 is an exemplary diagram of medical care payment cost data among the data exchanged in FIG. 4;

Figure 6 is a block diagram of the prescription data and medical care payment bill data flow generated in the pharmacy according to an embodiment of the present invention,

7 is a schematic diagram of a system for providing a medical care payment cost in accordance with a preferred embodiment of the present invention;

8 is a block diagram of a system for issuing a cost after the adjustment according to a preferred embodiment of the present invention.

Explanation of Codes on Major Parts of Drawings

10: memory device (eg chip) 100: health insurance card

200: health insurance card identification terminal 300: medical care institution client

400: stabilization of expenditure of medical care benefits server: 500 server

600: National Health Insurance Service Server 700: patient client

800: Homepage 900: Care benefit statement data

1000: Pharmacy Nursing Clients

1100: Medical Care Cost Review Client

1200: Health and Welfare Department Server

The present invention relates to a national health insurance financial stabilization system, and more specifically, to provide a system of national health insurance benefit payment system to pay the patient, nursing institution, screening and evaluation, medical care benefits for the medical care provider The system consists of the National Health Insurance Corporation, which manages qualifications, the Ministry of Health and Welfare, which oversees the work of these reviewers and the National Health Insurance Corporation.

In other words, the system provides real-time notification of visits to nursing homes by the patient, confirms the date and time data of the patient, confirms the size and cost of medical expenses and the date and time of payment of medical expenses, and supports the preparation and payment of medical bills. To this end, patients' right to participate in the expenditures of care payments made between nursing agencies and reviewers was expanded, and data on various information, such as claims for care payments and the details of care payment costs, were converted into data for convenience and review. The aim is to prevent the loss of medical care benefits by streamlining health care and improving the medical care examination work.

The National Health Insurance System, currently implemented by the Ministry of Health and Welfare, issued the National Health Insurance Corporation a health insurance card equivalent to one household or one person per household, and patients who were sick or injured visited nursing homes. When presenting the above health insurance card and receiving medical care benefits, the nursing institution claims the patient's partial copayment and claims the insurer's copayment to the Evaluation and Assessment Service. The Corporation pays insurance premiums to nursing homes.

According to the statistics of the Korea Health Insurance Review and Assessment Service for the last three years of the health insurance system, the number of cases adjusted by the nursing institution is about 50 million cases a year, and the cost ranges from 250 billion won to 300 billion won a year. The number and cost of the review adjustments are excerpted from the statement by the review agency during the review process. Among these cases, other factors, including false, fraudulent and overclaims, were misjudged due to error in billing. There is a thing.

More specifically, in 2003, the total number of medical care payments was 620 million, and the total cost of medical care was 20.55 trillion won, out of about 570 million cases excluding the adjustment of about 50 million cases. It is not known that there are legitimate benefits without many factors.

At the end of 2003, there were a total of 67,960 nursing institutions. The Health Insurance Review and Assessment Service provided EDI (electronic document request) and AFK (billing error) for the convenience of offline review. Although a green institution system has been introduced and implemented, even a credible claim system does not eliminate financial loss factors such as false and unfair claims.

The Ministry of Health and Welfare conducts 680 surveys in 350 places a year to prevent false and fraudulent claims by nursing agencies, but less than 1% of the total claiming agencies are surveyed. It is extremely low and it takes about six months from the time of investigation to administrative disposition, and the period for claiming medical expenses paid by nursing agencies is limited to one year and six months.

As such, normal expenditure and abnormal expenditures are mixed in the expenditure of nursing care benefits, but no one knows exactly the size of the abnormal expenditure, that is, the amount of the loss of care benefits. The cost is 20.55 trillion won + medical expenses 2.22 trillion won = 22.77 trillion won, and multiplying the false and fraudulent claims by 10% to 20% will result in an abnormal charge amount of 2.27 trillion to 4.45 trillion won. Occurs.

According to the statistics of national health care benefits, the national health care benefit costs for the past three years were 20,533 billion won in 2003, 19.06 trillion won in 2002, and 17,8198 billion won in 2001. The amount adjusted by the Korea Health Insurance Review and Assessment Service was 2652 billion won in 2003, 2968 billion won in 2002, and 2465 billion won in 2001, and the Ministry of Health and Welfare surveyed nursing homes in the field and found false claims for fraud in 2004. 100 billion won, 535 institutions in 12.5 billion won, 503 institutions 6.9 billion won in 2002, 640 institutions 11 billion won in 2001, which is less than 1% a year.

In addition to the above-mentioned financial problems, the current health insurance system has a number of problems. First of all, the health insurance card is made of paper, which quickly becomes dirty, damaged and damaged by the nursing institution. There is a problem that there may be a misunderstanding and the health insurance card is checked by the nursing institution in the process of the patient visiting the nursing institution and presenting the health insurance card. There is a problem in that the patient repeatedly visits the nursing home or not and does not know immediately or later, and uses the list of patients who have not visited the nursing home periodically and uses the list elsewhere.

Another problem relates to receipts that patients receive after receiving care from a nursing institution.In spite of the monetary transaction of insurance elements such as patients, the Health Insurance Review and Assessment Service, the National Health Insurance Service, and nursing institutions, the proof of transaction is merely a receipt between the patient and the nursing institution. It is treated as a simple receipt, and the patient's actual care payment cost is not known at all while the care institution claims the medical insurance fee to the Health Insurance Review & Assessment Service and fails to exercise the right to participate in the claim. (Medical expenses, dispensing expenses) Unlike the billing and the increase in the period of care benefits arbitrarily occurs, there was a problem that the patient or the Health Insurance Review and Assessment Service has no way of knowing.

Another problem is related to the Health Insurance Review and Assessment Service, which allows the Health Insurance Review and Assessment Service to connect offline to the nursing institution and charge the benefit payment once a month for outpatients and once a week for hospitalization. As the case is requested on a case-by-case basis, claims review and in-depth analysis have limitations depending on the contents submitted, and there is virtually no event control mechanism for loss of care benefits, except for foreign injury patients. There was a problem that it was difficult to provide an intentional delayed billing opportunity to provide an opportunity to change the contents of a claim by intervention, and to avoid exposing the facts of the changed contents to the inquiry of the examinee.

Another problem is related to billing for care benefits of care institutions. Many care institutions use the billing agency for medical care due to lack of self-billability and various other reasons for billing care benefits offline. Even if there was a problem of performing the dual task of rewriting the data to be submitted to the Health Insurance Review and Assessment Service offline.

In addition, there was a problem of increasing insurance financial expenditure by generating agency fees affecting the income of the requesting nursing institution and generating abnormal agency fees to increase its own profits.

In light of these problems, the present inventors examined whether there are publicly available prior arts, and according to the present invention, fortunately, in order to solve the problem of unfairly and falsely requesting the computer management and review and evaluation agency for the important medical history and specificity of the patient offline. Korean Patent Publication No. 10-2002-0088699 has been applied for a technology to introduce a health insurance certification system using an insurance card, and also to solve the problem of false and unfair claims of insurance benefits in medical service institutions. It can be confirmed that Korean Patent Publication No. 10-2001-0067916 has been applied for a technology for introducing a computer-readable recording medium recording a method for managing health insurance related to national health insurance and a program related thereto. However, the disclosed techniques will not be able to overcome the problem to be solved by the present invention.

The present invention is to solve the above problems,

An object of the present invention is to provide a health insurance card information issued to the patient, medical care benefits information and medical care expense statement information generated after the medical care benefits in the nursing institution to DB and stabilize the health of the health insurance by using the DB It is to provide a health insurance financial stabilization system.

The other purpose is to check the visit time of the patient, and to claim errors in initial and emergency expenses, medical expenses and preparation expenses at night and holidays, and claims using non-visit patients, and national health insurance to prevent claims of ghost patients. It is to provide a financial stabilization system.

Another purpose is to allow the health insurance reviewer and the patient to immediately check the contents after the payment of the medical benefits at the nursing institution in real time to prevent simple errors, intentional overcharge, and false claims. It is to provide a health insurance financial stabilization system.

The above object of the present invention is a health insurance card with a memory device for inputting information of subscribers and dependents issued by the Health Insurance Corporation server; A health insurance card identification terminal for reading information of a patient entered in the health insurance card; The information read from the health insurance card identification terminal is input to the program built so that the medical history and medical care benefit statement appears, the patient's medical history and medical care billing details are input, and then the medical data and medical care billing statement data are entered. Producing care institution clients; The pharmacy client determines the presence or absence of a prescription according to the patient's medical history, and in the case of prescription use, the prescription information is input, the patient's prescription and the bill for medical expenses are input, and the pharmacy client generates the prescription data and the bill for medical expenses. ; A care payment expense stabilization server that collects and generates medical care data, prescriptions, medical data generated by the medical care institution client, and medical care benefit expense statement data generated by the pharmacy client; The DB for each medical care institution established by the care payment expenditure stabilization server is reconstructed by the type, size and region of the care institution, and the pharmacy DB is reconstructed by the type, size and region to reconstruct the DB from the screening coordination client. An auditor evaluation server for storing the audited care payment result DB; A health insurance corporation server for transmitting payment details to a medical care institution client and a pharmacy client according to the medical care payment result; Health and Welfare Department server for supervising the medical care benefits of the server and the Health Insurance Corporation server; It can be achieved by the patient client receiving the medical data, prescription and medical care payment cost data generated by the medical care institution client.

In addition, the data visited by the patient to the medical treatment institution and pharmacy nursing institution, and the data embedded in the health insurance card are identified at the health insurance card identification terminal and transmitted to the medical expenses payment expenditure stabilization server to recognize the patient's visit, The expenditure stabilization server is characterized in that the date and time data visited by the patient, the initial or re-determination decision, the number of medical treatments related to the patient, the number of preparations and surcharges are transmitted.

The signal identifying the health insurance card in the health insurance card identification terminal is transmitted to the patient client and the care payment expense stabilization server at the same time by the treatment institution client in combination with the medical care data and the medical care payment cost statement data, and the preparation data and The benefit payment statement data is transmitted from the pharmacy nursing institution client to the patient client at the same time and to the payment benefit stabilization server.

In addition, the medical care data, the dispensing data and medical care payment statement data is registered on the home page, characterized in that the patient client is viewed, the medical care payment expenditure stabilization server is a herbal DB, dentistry DB (medical DB, dental DB, midwives DB , Health institution DB) and pharmacy DB, and are constructed by care institutions, and the server of the assessment agency is re-established by care institutions by type, size, and region. It is done.

The health insurance corporation server establishes a nursing benefit cost to be paid to a nursing institution according to a notice of an evaluation evaluation server, and is registered on a homepage and viewed by a nursing institution client. It is characterized by being built by receiving the data of the Insurance Corporation server and supervising nursing care benefits,

The prescription DB, which is transmitted from the medical, dental, midwives, and health care institutions for each medical institution and is built on the bill for the payment of medical expenses, is notified to the pharmacy care institution by a signal identifying the health insurance card in the health insurance card identification terminal. It is done.

In addition, the information of subscribers and dependents stored in the health insurance corporation server is further configured to be used as a comparison data because the scanned data of the resident registration card is further included.

DB mentioned above is an abbreviation for Date Base.

The present invention is a member of the national health insurance benefit system, dependents (hereinafter referred to as patients), nursing institutions, health insurance review and evaluation unit (hereinafter referred to as review and evaluation agency) and the National Health Insurance Corporation, The Health and Welfare Department, a work supervisory institution, is configured as a system to provide real-time notification of visits to care centers by patients, confirmation of patient visits and time data, confirmation of medical expenses and dispensing costs by patients, and real-time transmission of medical bills. Increase the patient's right to participate in payroll expenses, and make various data such as claims and review contents to prevent the loss of care benefits by improving the convenience of claiming medical care costs, streamlining the screening work, and improving the work of care payment examination office work. Also, there are many factors in the claim of the medical expenses of a nursing institution, such as error, excess, false and fraudulent claims. It intended to prevent the.

Hereinafter, the configuration of the present invention will be described in detail with reference to the accompanying drawings for a preferred embodiment.

1 is a block diagram of a medical care institution system of the health insurance financial stabilization system according to a preferred embodiment of the present invention, it is determined whether the medical care institution client 300 only need care or go to a pharmacy with a prescription It is supposed to.

Therefore, if there is no prescription in the prescription of the rumurutin 700, the following medical treatment institution system is configured and operates.

That is, the medical care institution system includes a health insurance card 100 held by a patient in order to receive health insurance services, a health insurance card identification terminal 200 for reading the health insurance card 100, and the health insurance card. Nursing care payment expenses stabilization server for collecting and analyzing the medical care institution client 300, the medical care institution client 300 is input to be used in the nursing institution and the information read from the identification terminal ( 400), the evaluation evaluation server 500 that examines and adjusts the medical care benefit cost statement data analyzed by the medical care allowance expense expenditure stabilization server 400, and the result value of the medical care benefit cost statement data that examines and adjusts the medical care benefit cost. National Health Insurance Corporation server (600) that receives and executes the health service, and the server for the evaluation and evaluation server and the management of the qualification and the payment of medical expenses. To receive a reimbursement from the Department of Health and Human Services information transmission server 1200, a client care nursing homes (300), which oversees the work of the Agency risk patients Server is configured as a client (700).

And when it is recognized that a prescription is necessary in the nursing institution client 300 during the operation of the medical care institution system (if taking medicine in the pharmacy, etc.) will be issued a prescription.

In other words, when a prescription is issued in the presence or absence of a prescription judgment routine 900, the pharmacy nursing institution system to perform a health insurance card 100, and the health insurance card carried by the patient in order to receive health insurance services A health insurance card identification terminal 200 for reading 100;

Medicaid payment agency to collect and analyze the information provided by the pharmacy nursing institution client 300 and the pharmacy nursing care information transmitted from a plurality of pharmacy nursing institution client 300 is inputted to use the information read from the health insurance card identification terminal Expenditure stabilization server 400, the examination and evaluation server 500 to examine and adjust the medical care payment cost statement data analyzed by the medical care payment cost expenditure stabilization server 400, and the medical care payment cost statement that examines and adjusted the medical care benefit costs Health oversight of the work of the National Health Insurance Corporation server 600, which receives and executes the result of the data, and the National Health Insurance Corporation server that handles the billing and examination of medical care benefits and the Health Insurance Corporation server that handles qualification management and payment Welfare department server 1200, the medical care institution consists of a patient client 700 for receiving care payment information transmitted from the client 300.

As shown in FIG. 2, the health insurance card 100 is a means for providing health insurance services to all citizens by issuing from the National Health Insurance Service server 600. The health insurance card 100 is stored therein. The device 10 is built-in and stores very brief information such as the names of subscribers and dependents, the health insurance card number in the storage device 10 and provides them to the public.

At this time, the specific information of subscribers and dependents not stored in the storage device 10 is classified and stored on the basis of the application target (person) in order to service the health insurance for each individual in the health insurance corporation server 600 inside the system. do. That is, according to the National Health Insurance Act, the subscribers and dependents covered by the health insurance are classified into national health insurance subscribers and national health insurance dependents, and the subscribers are classified as workplace subscribers and local subscribers, and the dependents are spouses and immediate survivors. And their immediate family members and their spouses, brothers and sisters.

The health insurance subjects classified as described above are constructed with a current health insurance card number system or a health insurance card number in the form of a serial number shown in FIG. 3, which is data and stored to confirm who is eligible for health insurance service. do. Among the serial numbers shown in FIG. 3, A is designated by 1 for a National Health Insurance subscriber classified by the National Health Insurance Act, and 2 by a National Health Insurance dependent. In the medical benefit service in charge of the Evaluation and Evaluation Office, the first class of medical benefits beneficiaries shall be designated as 3 and the second class of medical benefits beneficiaries shall be designated as 4, and either of them shall be selected.

As shown in B, it distinguishes between the subscriber and the local member, the member of the workplace is designated as 1, the member of the region is designated as 2, any one of them is selected, and the figure C represents the member who pays the health insurance premium. Designates 1 and 1 for spouse, 2 for spouse, 3 for direct lineal (including spouse's line), 4 for 4 line and 5 for spouse and sister. One of them. That is, the combined number shown in FIG. 3 implies that they are national health insurance subscribers, work subscribers, identity inquiry health insurance card numbers, and the like.

In this way, a serial number for distinguishing between a subscriber and a dependent is stored in the storage device 10, and personal identification information such as a resident registration number, a name, an address, and a business symbol of the health insurance card holder is provided by the Health Insurance Corporation server 600. In the care institution client 300 or pharmacy client 1000 is provided.

The above-described serial number is only an example and may be changed by various formula structures.

The memory device 10 checks the health insurance card identification terminal 200 installed in a medical, dental, midwife, health institution, oriental medicine, pharmacy, etc. information of the memory device 10 is the health insurance card identification terminal 200 It is input to and is transmitted to the medical care institution client 300 and the pharmacy care institution client 1000.

The health insurance card 100 is provided to each of the citizens one by one so that patients can easily visit the nursing homes and use the insurance card as a premium payer for the flow of medical care benefits in the system. It is also preferable. If you pay to each of the citizens, it will take a lot of production costs, and if you make and pay for each household unit, there is an unfavorable point, such as exposing secrets to be kept even between families or inconvenience in use.

When a patient who visits a nursing institution fails to submit the health insurance card 100 issued by the National Health Insurance Corporation, the public identification card may be temporarily submitted and converted into an electronic signal for use.

For example, in case of using the ID card as a public ID card, the scanned data of the ID card is further included as the information of the patient stored in the health insurance corporation server. When the ID card is scanned and inputted, the data is compared and matched. Judging whether or not to determine whether or not.

In terms of medical care institutions, health insurance card identification is controlled for general medical care, hospitals, dental hospitals, oriental hospitals, nursing hospitals, clinics, dental clinics, oriental medical clinics, midwives, and health institutions. Medical care institution client 300 is attached to the terminal 200 is attached and the health insurance card identification terminal 200, if the health insurance card (100) is checked while the patient visits the medical care institution while verifying medical care benefits When a visit plays an important role in the initial calculation of expenses, the day of the week is entered and the date and time data are transmitted to the nursing benefit payment expenditure stabilization server 400 to be confirmed. In the reconciliation of the salary cost audit adjustment client (1100), in the case of reconciliation of the initial / re-expense, the night / holiday early / re-examination or medical expenses, the night / holiday preparation fee It becomes data.

The medical care institution client 300 has a program for computerized treatment of the patient's medical care benefits and medical care payment costs is installed and the medical care payment history data generated after the patient receives medical care benefits from the medical care institution, and medical care Payroll expense statement data 900 is generated.

At this time, the number of medical treatment and the drug price criteria necessary for the generation of medical care benefit history data, medical care benefit cost statement data (900), the Health Insurance Review and Assessment Service server (500) and the medical care payment cost stabilization server (400) from the Ministry of Health and Welfare (1200) It is supplied through.

The medical care benefit history data and medical care benefit statement data (900) is completed in the medical care institution client 300 and the patient pays the deductible in a convenient way, the health insurance card (100) health insurance card identification terminal ( In step 200), the signal is combined with the medical care benefit history data and the medical care payment cost statement data 900, and a database (DB) is provided to the medical care payment expenditure stabilization server 400 by the flow as shown in FIG. Is built.

In other words, the medical care institution client 300, the medical care payment history data of the data generated after the patient receives medical care at the medical care institution appears in a text form or listed form written in the form and check the patient's health insurance card email As soon as it is transmitted to the patient client 700 or the medical account book, the medical care payment expense statement data 900 shown in FIG. 5 is transmitted to the medical care payment cost stabilization server 400 to be databaseized and made into a database. .

At this time, the database (DB) is largely classified into a herbal database (DB), a dentistry (medical, dental, midwives, health institutions) database (DB) and the herbal database (DB) is treated in a oriental medical care institution Medical bills and billing data together with the medical treatment and prescription details to build a medical care database (DB) separately on the medical care costs expenditure stabilization server 400, and the medical database (DB) As it is divided into the prescription and the prescription, medical treatment billing data is classified into a database.

When the database (DB) constructed as described above is registered on the homepage 800 operated by the care payment expenditure stabilization server 400, the patient client 700 receives the medical history received by the medical care institution client 300 by e-mail. If there is a difference after comparing whether the medical history registered on the homepage 800 and the same, the patient can prevent the false and fraudulent claims by describing the difference.

The benefit payment statement data 900 is programmed in the computer to output the details shown in Figure 5 installed on the medical care institution client 300, the portion A portion of the benefit payment statement data 900 shown is a health insurance card According to the identification of (100), the data on the patient provided by the Health Insurance Corporation server 500 is automatically supplied through the nursing benefit stabilization server 400, and the illustrated part B is for entering the medical care reimbursement from the nursing institution. Part C, which is a part, shows a bill for billing of care benefits and is sent to the patient client 700 by e-mail when the patient who pays the fee is identified again by the health insurance card 100, and the bill for health care expenditure stabilization server 400 is shown. Will be sent to.

On the side of the pharmacy nursing care, as shown in FIG. 6, the prescription data and the medical care payment expense statement data generated after the patient receives the medical care at the medical care institution client 300 are transmitted to the medical care cost expenditure stabilization server 400. It is a database.

Since the pharmacy nursing institution client (1000) visited by the patient among a number of pharmacy nursing institution clients (1000) distributed throughout the country first read the health insurance card 100 presented by the patient in the health insurance card identification terminal (200) After requesting prescription data using the information read by the pharmacy nursing institution client 1000, the medical expenses payment expenditure stabilization server 400 is a prescription transmitted from the medical treatment institution client 300 visited the patient received the medical care benefits The data is found and transmitted to the pharmacy care institution client 1000.

The pharmacy nursing institution has a pharmacy nursing institution client (1000) equipped with a health insurance card identification terminal (200) for controlling the patient's prescription information, nursing benefit information, billing information for the benefit payment is built and the health insurance card identification terminal ( If the health insurance card (100) is checked, the visitor plays an important role in the initial calculation of the cost of care while proving that the patient has visited a pharmacy care institution, the day of the week is entered, and the date and time data are provided. It is transmitted to the cost expenditure stabilization server 400 and is confirmed, and the future medical care payment cost assessment adjustment client 1100 is the data for judging the error claim for the night / holiday dispensing fee during the adjustment.

The pharmacy nursing institution client 1000 has a program that is computerized processing of dispensing details and medical care payment costs and the medical care payment data generated after the patient receives medical care benefits at the pharmacy nursing home, and the medical bill of medical expenses Data 900 is generated.

At this time, the number of medical supplies required for the generation of medical care benefit history data and medical care benefit statement data (900), the drug price standard is the Health Insurance Review and Assessment Service server (500) and the medical care payment cost stabilization server (400) from the Ministry of Health and Welfare (1200) It is supplied through.

The medical care benefit history data and medical care benefit statement data (900) is completed in the pharmacy care institution client (1000) and the patient pays the deductible in a convenient way after the health insurance card (100) health insurance card identification terminal If it is checked (200), this signal is combined with the medical care benefit history data and medical care benefit bill data 900, the database (DB) to the medical care benefit expenditure stabilization server 400 by the flow as shown in FIG. Is built.

In other words, the pharmacy nursing institution client (1000) is a text form of the medical care payment history data after the patient receives medical care at the pharmacy nursing institution, or a document written in the listed form appears and check with the patient's health insurance card email As soon as it is transmitted to the patient client 700 or the medical account book, the medical care payment expense statement data 900 shown in FIG. 5 is transmitted to the medical care payment cost stabilization server 400 to be databaseized and made into a database. .

At this time, the database DB is classified into a pharmacy database (DB) and a detailed pharmacy database (DB).

When the database (DB) constructed as described above is registered on the homepage 800 operated by the care payment expenditure stabilization server 400, the patient client 700 receives the medical history received by the pharmacy care institution client 300 by e-mail. If there is a difference after comparing whether the medical history registered on the homepage 800 and the same, the patient can prevent the false and fraudulent claims by describing the difference.

The benefit payment statement data 900 is programmed in a computer to output the details shown in Figure 5 is installed in the pharmacy nursing home client 1000, and part A is shown health care card for the benefit payment statement data (900) According to the identification of (100), the data on the patient provided by the Health Insurance Corporation server 500 is automatically supplied through the nursing benefit stabilization server 400, and the illustrated part B is used to input the nursing benefit history from the nursing institution. Part C, which is a part, shows a bill for billing of care benefits and is sent to the patient client 700 by e-mail when the patient who pays the fee is identified again by the health insurance card 100, and the bill for health care expenditure stabilization server 400 is shown. Will be sent to.

Then, when the database (DB) is transmitted to the assessment evaluation server 500 as shown in FIG. 7, the assessment evaluation server 500 cares again the database (DB) built on the care payment expenses stabilization server 400 Distinguished by size of institution (ie, general hospital, hospital, clinic, pharmacy, etc.), and then divided by region to build a database.

As described above, the database (DB) established in the server for evaluating and evaluating the server (DB) is a database (DB) corresponding to the area in charge, the nursing institution in charge, etc. in a plurality of nursing benefit cost examination and adjustment clients 1100 connected to the audit and evaluator server 500. ). The extracted database (DB) is displayed on the medical expenses payment screening coordination client (1100), the total amount billed by the nursing institution appears, and the reviewer assesses the national health insurance benefit standards, the comparison of claims trends between the medical institutions, the patient's medical trends If the amount of money and the amount of money that are not determined are input to the examination adjustment client 1100, the input information is transmitted to the medical treatment institution client 300 and the pharmacy nursing institution client 1000 via the evaluation evaluation server 500.

If the medical care institution client 300 and the pharmacy nursing institution client 1000 object to the amount that was not paid, and the attached data on the objection are transmitted to the medical benefit payment examination and adjustment client 1100, the medical care benefits The cost review adjustment client 1100 opens the attached data on the objection and reassesss it according to the National Health Insurance benefit standard based on the opened data, and divides it into an amount to be repaid and an amount not to be paid. The remaining amount is sent to the medical care institution client 300 and the pharmacy care institution client 1000 and thereafter, there is no re-examination, and the final adjustment in the screening and adjustment client is performed on the homepage 800-1. Make it available to nursing homes.

At this time, the database (DB) reconstructed in the assessment evaluation server (500) is the data to be received from the medical care institution client (300) and the pharmacy nursing institution client (1000) care benefits data executed by the Health Insurance Corporation server (600) In addition to the reconstruction to the base (DB), the database (DB) has been rebuilt so that the reimbursement can be easily adjusted in the medical care benefit cost adjustment client 1100.

On the other hand, the result of the medical care payment cost statement data screened by a plurality of medical care payment cost audit adjustment client 1100 is transmitted to and stored in the assessment evaluation server 500. As shown in FIG. 8, the stored result value is transmitted from the KISA server 500 to the National Health Insurance Corporation server 600, and the result value is converted into the payment intention and the payment amount from the National Health Insurance Corporation server 600. The medical treatment institution client 300 and the pharmacy nursing institution client 1000 and the same contents are registered on the homepage 800-2 to be viewed on the medical treatment institution client 300 and the pharmacy nursing institution client 1000. It is built to be.

In addition, the National Health Insurance Corporation server (600) allows the patient client (700) to send payment facts of the medical expenses paid by the patient.

On the other hand, the Ministry of Health and Welfare server 1200 receives the billing and examination results of the nursing institution of the examiner and evaluator's server 500, and receives the payment of the expenses to the nursing institution of the National Health Insurance Corporation server 600, the National Assessment Service, National Health Insurance It is to supervise industrial complexes and nursing homes, and provides the standard of care, the number and the price of medicines for these institutions.

The present invention described above is merely illustrative of the technical idea, and those skilled in the art to which the present invention pertains can be modified by various applications and simple change programs without departing from the essential characteristics of the present invention. This will be possible. Therefore, the embodiments disclosed in the present invention are not intended to limit the technical spirit of the present invention, but are to be described and should be construed by the following claims as applicable to medical benefits, industrial accident insurance, liability insurance, and life insurance in addition to these embodiments. All technical ideas within the equivalent scope are included in the scope of the present invention.

As described above, the present invention allows the subscriber or dependent to use the health insurance card in the nursing institution, providing convenience to each unit constituting the system, reducing various costs, and improving the health of visits and information of the patients who visited the nursing institution. By providing the insurance review agency with real-time notification, it is impossible for the nursing institution to make a claim using non-visiting patients, and also reduces the number of phantom male and female patients, prevents the loss of the patient's qualification and suspension, and the use of the benefit limiter. It is easy to pre- or follow-up management of liability insurance patient, fire patient, assault patient, self-injury patient, etc. It is effective in preventing and when the medical expenses are incurred, the duration of medical treatment, contents, and medical expenses are As it can be confirmed and confirmed, it has the effect of blocking period change request, cost change request, contents change and alteration request, and if the patient pays the medical care payment cost at the nursing institution, the contents are immediately checked in real time by the Health Insurance Review and Assessment Service. It is a very excellent invention in the e-commerce industry by having the effect of blocking the simple error claim, intentional error claim, simple excess claim, intentional excess claim, false fraudulent claims.

Claims (10)

A health insurance card 100 having a memory device (eg, a chip) 10 for inputting subscriber and dependent information issued by the health insurance corporation server 600; A health insurance card identification terminal 200 for reading information of a patient inputted to the health insurance card 100; The information read out from the health insurance card identification terminal 200 is input to the program constructed so that the medical history and the medical care benefit statement appear, and the medical data and the medical care payment cost are input after the patient's medical history and the medical bill for medical expenses are input. Medical care institution client 300 for generating statement data; Pharmacy client to determine the presence or absence of a prescription according to the patient's medical history, the prescription information is input in the case of prescription use, input the patient's dispensing history and the bill for medical expenses, and generates the preparation data and medical expenses bill data ( 1000); Nursing benefit payment expenditure stabilization server to collect the medical data, prescription and medical data generated by the medical care institution client 300 and the pharmacy client (1000) and the bill of medical expenses payment specification data to form a database (DB) ( 400); The medical care institution-specific database (DB) established in the medical care payment expenditure stabilization server 400 is reconstructed by the type, size and region of the care institution, and the pharmacy database (DB) by the type, size and region An evaluation and evaluation server (500) for storing and reconstructing the database (DB) into a medical care payment result result database (DB), which is audited by the examination and adjustment client 1100; A health insurance corporation server 600 for transmitting the payment details to the medical care institution client 300 and the pharmacy client 1000 according to the medical care payment result; Health and Welfare Department server (1200) for supervising the nursing care benefits of the assessment agency server 500 and the Health Insurance Corporation server 600; To the client client 700 that receives the medical data, prescription and medical care payment cost data generated by the medical care institution client 300 and the preparation data and medical care payment bill data generated by the pharmacy care institution client 1000 is transmitted. Ministry of Health and Welfare National Health Insurance financial stabilization system, characterized in that made. According to claim 1, the patient visited the medical care institution and pharmacy care institution data and the data embedded in the health insurance card 100 is identified in the health insurance card identification terminal 200 to stabilize the medical care payment expenditure stabilization server 400 The patient's visit is recognized and the patient's visit is paid, and from the stabilization benefit payment server 400, the date and time data visited by the patient, the initial or re-decision, and the number of medical treatments related thereto, the number of preparations and the surcharge is received. Ministry of Health and Welfare Health Insurance Financial Stabilization System. The method of claim 1, wherein the signal identifying the health insurance card 100 in the health insurance card identification terminal 200 is combined with the medical care data and the medical benefit payment statement data, and simultaneously the patient client ( 700, and the medical care payment expenses expenditure stabilization server 400, the dispensing data and medical care payment cost statement data is simultaneously in the pharmacy nursing institution client 1000 and the patient client 700, medical care payment expenditure stabilization server (400) Ministry of Health and Welfare National Health Insurance financial stabilization system, characterized in that the transmission. The system of claim 1, wherein the medical care data, the preparation data, and the medical care benefit statement data are registered on the homepage and viewed on the patient client. According to claim 1, Nursing care cost expenditure stabilization server 400 is a herbal database (DB), a dentistry database (DB) (medical database (DB), dental database (DB), midwives database (DB) Health Insurance Financial Stabilization System of the Ministry of Health and Welfare, which is classified into health care database (DB), and pharmacy database (DB). According to claim 1, the assessment agency server 500, the database for each care institution (DB) built on the care payment expenses stabilization server 400 is reconstructed for each type, size and region of care institutions and at the same time the examination of care benefits costs The Ministry of Health and Welfare National Health Insurance financial stabilization system, characterized in that the results are registered on the homepage (800-1) and read by the patient client (700), medical care institution client 300, pharmacy care institution client (1000). According to claim 1, Health Insurance Corporation server 600 establishes the medical care benefits cost to be paid to the nursing institution by the notification of the assessment agency server 500 and registered on the homepage (800-2) nursing institution client 300 , Health and Welfare Department health insurance financial stabilization system, characterized in that viewed from the pharmacy care institution client (1000). The health welfare financial stabilization system of the Ministry of Health and Welfare according to claim 1, wherein the Health and Welfare Department server 1200 is constructed by receiving data from the Evaluation and Assessment Service server 500 and the Health Insurance Corporation server 600, and supervises nursing care benefits. . According to claim 1, Prescription database (DB) which is transmitted from the medical, dental, midwives, health care institutions for each health institution and built on the stabilization payment expenditure stabilization server 400 is a health insurance card in the health insurance card identification terminal (200) Health and Welfare health insurance financial stabilization system, characterized in that the pharmacy nursing home to be notified by the signal identifying (100). The system of claim 1, wherein the information of the patient stored in the health insurance corporation server further includes scanned data of the resident registration card.

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