KR20200024643A - Method for providing medical service, device and server - Google Patents

Abstract

A method for providing a medical service comprises: a step of receiving at least one among treatment detail information, receipt information, and prescription information for a treatment from a server of the national health insurance service; a step of transmitting at least one among the treatment detail information, the receipt information, and the prescription information for the treatment to a user terminal; and a step of checking whether insurance money for the treatment is fraudulently claimed based on location information of the user terminal. The step of checking whether the insurance money for the treatment is fraudulently claimed includes: a step of collecting the location information of the user terminal; and a step of determining whether the user terminal is located within a preset range from the location of a hospital based on the location information of the user terminal.

Description

METHOD FOR PROVIDING MEDICAL SERVICE, DEVICE AND SERVER}

The present invention relates to a medical service providing method, a terminal and a server.

Under the current health insurance system, health insurance eligibility and identity verification are unclear, resulting in distorted treatment due to the transfer or rental of medical insurance card, or duplicate medical treatment of medical institutions, resulting in unfair or false health insurance. Claims are occurring frequently.

In addition, in the case of the insured, in order to claim a large amount of insurance premiums, only the hospitalization record may be false, and the normal life may be performed. There are many. In such cases, insurance companies or medical insurance companies cannot check the patient's exact medical records, so they have to leave it to the patient or doctor's conscience.

The payment of insurance benefits due to fraudulent use of medical insurance cards and false fraudulent claims is a serious social problem because it is borne by the general public, who are purely health insurance subscribers. In the event of fraudulent use of such health insurance cards and claims of false fraud, various sanctions are regulated by the National Health Insurance Act, etc., but it is not sufficient to eradicate the illegal use of medical insurance cards and false claims.

In addition, the current insurance payment system is difficult to prevent if the medical institutions illegally use the patient's personal information and the health insurance card's identification number, or forgery or unfair claims for insurance benefits by forgery of medical records. At present, however, only the method of disclosing and sanctioning false or unfair claims through the after-sale due diligence and audit by the Korea Evaluation and Assessment Service after paying the insurance premium is used. This ex post evaluation method has a problem that the human resources and financial costs of the auditor increase, and due to human and financial limitations, due diligence and auditing scope for false fraudulent claims are very limited.

Korean Registered Patent Publication No. 10-1856638 (registered May 5, 2018)

The present invention is to solve the above-mentioned problems of the prior art, to receive a request for appointment of the treatment from the user terminal, and to receive a treatment for the reservation request of the treatment from the terminal provided in the hospital. In addition, the present invention is to determine whether the claims for medical treatment is unfairly based on the location information of the user terminal. However, the technical problem to be achieved by the present embodiment is not limited to the technical problems as described above, and other technical problems may exist.

As a technical means for achieving the above-described technical problem, the medical service providing method according to the first aspect of the present invention comprises the steps of receiving at least one of medical history information, storage information and prescription information for the treatment from the server of the Health Insurance Corporation ; Transmitting at least one of medical history information, accommodation information, and prescription information of the medical care to a user terminal; And determining whether an insurance claim for the medical treatment is unfairly based on location information of the user terminal. The step of determining whether the claim for medical care is unfairly charged includes collecting location information of the user terminal and determining whether the user terminal is located within a preset range from a location of a hospital based on the location information of the user terminal. Determining may include.

According to a second aspect of the present invention, a user terminal for providing a medical service includes a medical care information providing unit configured to receive and provide at least one of medical care history information, storage information, and prescription information for medical care from a medical service providing server; And an insurance claim claim for claiming the insurance for the medical care based on the location information of the user terminal. The location information of the user terminal is collected by the medical service providing server, and based on the location information of the user terminal, it is determined whether the user terminal is located within a preset range from the location of the hospital, and the user terminal is a hospital Based on whether or not located within a predetermined range from the location of can be determined whether the claim for the medical care is unfairly charged.

The medical service providing server according to the third aspect of the present invention includes a medical care information providing unit for transmitting at least one of medical care history information, accommodation information, and prescription information for medical care received from a server of the Health Insurance Corporation to a user terminal; And an unfair claim checking unit for checking whether the insurance premium is unfairly billed based on the location information of the user terminal. The invalid claim confirmation unit may collect location information of the user terminal and determine whether the user terminal is located within a preset range from the location of the hospital based on the location information of the user terminal.

The above-described problem solving means are merely exemplary, and should not be construed as limiting the present invention. In addition to the exemplary embodiments described above, there may be additional embodiments described in the drawings and detailed description of the invention.

According to any one of the above-described problem solving means of the present invention, the present invention can receive a request for appointment of the treatment from the user terminal, and can receive the treatment for the appointment request of the treatment from the terminal provided in the hospital.

Through this, the present invention can prevent the theft of the health insurance card and the unauthorized theft of the personal name, the user does not need to visit the hospital directly for the appointment of the hospital, it is possible to prevent infection by minimizing contact between patients. It also reduces the time spent waiting in hospitals for appointments and receptions. In addition, since medical care reception, receipt processing and prescription information are output through a terminal provided in a hospital, labor costs can be reduced by replacing administrative personnel.

In addition, the present invention can reduce the waiting time when the user visits the hospital and pharmacy by providing congestion information for the hospital and pharmacy to the user terminal. In addition, since the congestion of hospitals and pharmacies can be reduced, it is possible to maintain a pleasant hospital and pharmacy environment.

In addition, since the present invention checks whether claims for medical treatment are unfairly based on the location information of the user terminal, it is possible to grasp the real-time medical treatment status of the user, thereby preventing false claims of insurance.

In addition, the present invention can provide an insurance claim service through a medical service application installed in the user terminal, thereby increasing the convenience of the user by reducing the hassle of submitting the document to the insurance company separately.

In addition, the present invention can check whether the user's insurance claims unfairly false through the location check of the user terminal, and through this, it is possible to check the legitimacy of whether the user received medical treatment in the hospital, so Transparent operation can secure the budget for the people in the blind spot of care. In addition, the present invention can reduce labor costs for due diligence and audit for fraudulent false claims of insurance claims.

In addition, the present invention can prevent claim claims based on the location information of the user terminal, and can prevent false claims for hospitals that are not registered in the location information of the user terminal.

In addition, the present invention can grasp the disease pattern data of a plurality of users based on the request for appointment of the treatment received from the plurality of user terminals, and can be customized national medical at the national level that can analyze and manage the influence and situation of major diseases Can provide services.

1 is a block diagram of a medical service providing system according to an embodiment of the present invention.
2 is a block diagram of a medical service providing server shown in FIG. 1 according to an embodiment of the present invention.
3A to 3D are diagrams for describing a method of providing a medical service to a user terminal according to an embodiment of the present invention.
4 is a flowchart illustrating a medical service providing method in a medical service providing server according to an exemplary embodiment of the present invention.
5 is a block diagram of the user terminal illustrated in FIG. 1 according to an embodiment of the present invention.
6 is a flowchart illustrating a medical service providing method in a user terminal according to an embodiment of the present invention.

DETAILED DESCRIPTION Hereinafter, exemplary embodiments of the present invention will be described in detail with reference to the accompanying drawings so that those skilled in the art may easily implement the present invention. As those skilled in the art would realize, the described embodiments may be modified in various different ways, all without departing from the spirit or scope of the present invention. In the drawings, parts irrelevant to the description are omitted in order to clearly describe the present invention, and like reference numerals designate like parts throughout the specification.

Throughout the specification, when a part is "connected" to another part, it includes not only "directly connected" but also "electrically connected" with another element in between. . In addition, when a part is said to "include" a certain component, this means that it may further include other components, except to exclude other components unless otherwise stated.

In the present specification, the term 'unit' includes a unit realized by hardware, a unit realized by software, and a unit realized by both. In addition, one unit may be realized using two or more pieces of hardware, and two or more units may be realized by one piece of hardware.

Some of the operations or functions described as being performed by the terminal or the device in the present specification may instead be performed in a server connected to the terminal or the device. Similarly, some of the operations or functions described as being performed by the server may be performed by a terminal or a device connected to the server.

Hereinafter, with reference to the accompanying configuration diagram or processing flow chart, it will be described in detail for the practice of the present invention.

1 is a block diagram of a medical service providing system according to an embodiment of the present invention.

Referring to FIG. 1, the medical service providing system may include a medical service providing server 100, a user terminal 110, and a terminal 120 provided in a hospital 10. However, since the medical service providing system of FIG. 1 is only one embodiment of the present invention, the present invention is not limitedly interpreted through FIG. 1 and may be configured differently from FIG. 1 according to various embodiments of the present invention. .

In general, each component of the medical care providing system of FIG. 1 is connected through a network (not shown). A network refers to a connection structure capable of exchanging information between nodes such as terminals and servers, and includes a local area network (LAN), a wide area network (WAN), and the Internet (WWW: World). Wide Web), wired / wireless data communication network, telephone network, wired / wireless television communication network, and the like. Examples of wireless data networks include 3G, 4G, 5G, 3rd Generation Partnership Project (3GPP), Long Term Evolution (LTE), World Interoperability for Microwave Access (WIMAX), Wi-Fi, Bluetooth communication, Infrared communication, Ultrasound Communication, visible light communication (VLC), liFi (LiFi) and the like, but are not limited thereto.

The user terminal 110 may be a terminal on which a medical service application is provided that provides a function of appointment of a medical treatment and claims.

The user terminal 110 may transmit a request for reservation of medical care including the hospital information and the patient information input from the user through the medical service application to the medical service providing server 100.

The medical service providing server 100 may schedule a user's medical treatment to a hospital server (not shown) based on a medical treatment reservation request including the hospital information and the patient's information received from the user terminal 110.

The medical service providing server 100 may receive a medical treatment in response to a reservation request for medical treatment of the user terminal 110 from the terminal 120 provided in the hospital 10. Here, the terminal 120 provided in the hospital 10 is a terminal that provides a service for receiving on-site medical care, storage payment, and a prescription. For example, the terminal 120 may include a kiosk.

The medical service providing server 100 may receive medical care history information, storage information, and prescription information about medical care transmitted from a hospital server (not shown) of the hospital 10 when the storage processing of the patient's care is completed in the hospital 10. Received through the server 130 of the Health Insurance Corporation, and may transmit at least one of the medical history information, storage information and prescription information for the received medical care to the user terminal (110). Here, the server 130 of the Health Insurance Corporation may be a server operated by the National Health Insurance Corporation.

The medical service providing server 100 may provide the user terminal 110 with information of a pharmacy for dispensing a drug corresponding to prescription information for medical treatment. In detail, the medical service providing server 100 may provide information of a plurality of pharmacies to the user terminal 110 based on the location information of the user terminal 110, and select one of the plurality of pharmacies from the user terminal 110. Upon receipt, information about the selected pharmacy and the prescription information of the user may be transmitted to the pharmacy management server 150. At this time, the prescription information of the user is transmitted from the pharmacy management server 150 to the pharmacy selected by the user terminal 110.

The user terminal 110 may request the medical service providing server 100 to request a medical insurance claim through the medical service application.

When the medical service providing server 100 receives the insurance claim request for medical treatment from the user terminal 110, the medical service providing server 100 may determine whether the medical insurance premium is unfairly charged based on the location information of the user terminal 110.

When the medical service providing server 100 receives the insurance claim request for medical treatment from the user terminal 110, the medical service providing server 100 transmits the accommodation information about the medical treatment of the user and the location information of the user terminal 110 to the server 140 of the insurance company. Can be. Here, the server 140 of the insurance company may be a server of a private insurance company (eg, life insurance company, non-life insurance company, etc.) operating the insurance product subscribed to by the user. The server 140 of the insurance company may determine whether to approve the claim based on whether the user terminal 110 is located within a predetermined range from the location of the hospital 10 at the date when the user schedules the medical treatment.

When the medical service providing server 100 receives the processing result information on the insurance claim request from the server 140 of the insurance company, the medical service providing server 100 may transfer the processing result information on the insurance claim request to the user terminal 110.

Hereinafter, the operation of each component of the medical service providing system of FIG. 1 will be described in more detail.

2 is a block diagram of the medical service providing server 100 shown in FIG. 1 according to an embodiment of the present invention.

Referring to FIG. 2, the medical service providing server 100 may include a user authentication performing unit 200, a medical treatment appointment processing unit 210, a medical treatment receiving unit 220, a medical information receiving unit 230, a medical information providing unit 240, It may include an unfair claim confirmation unit 250, insurance claim processing unit 260, pharmacy dispensing 270 and the medication notification unit 280. Here, the unfair billing confirmation unit 250 may include a location information collection unit 252 and the location determination unit 254. However, the medical service providing server 100 shown in FIG. 2 is just one implementation example of the present invention, and various modifications are possible based on the components shown in FIG. 2.

Hereinafter, a description will be given with reference to FIGS. 3A to 3D together with FIG. 2.

The user authentication performing unit 200 may receive user information from the user terminal 110 when the user terminal 110 that installs the medical service application requests membership to use the medical service application. Here, the user information may include, for example, the date of birth of the user, gender and name.

The user authentication performing unit 200 may perform authentication of the user on the user terminal 110 based on the user information received from the user terminal 110.

For example, the user authentication performing unit 200 may transmit the user information received from the user terminal 110 to the server 130 of the health insurance corporation to request whether the user is eligible for health insurance. Here, the server 130 of the Health Insurance Corporation may be a server operated by the National Health Insurance Corporation.

The user authentication performing unit 200 may perform authentication of the user based on a result of the health insurance qualification status of the user received from the server 130 of the health insurance corporation. For example, the user authentication performing unit 200 receives the user's health insurance card information (for example, the health insurance card number) from the server 130 of the health insurance corporation when the user is subscribed to the health insurance, and receives the received health User authentication can be performed according to insurance card information.

The user authentication performing unit 200 may perform authentication of a user through an opening communication company of the user terminal 110. For example, the user authentication performing unit 200 may perform the real name authentication of the user through the opening communication company of the user terminal 110.

In addition, the user authentication performing unit 200 may determine whether the real name authentication information is consistent with the health insurance card information received from the server 130 of the Health Insurance Corporation.

In this manner, the user authentication performing unit 200 performs real name authentication of the user terminal 110, so that it is possible to confirm whether the insurance claim is unfairly based on the location information of the user terminal 110.

The medical treatment appointment processing unit 210 may provide the user terminal 110 with information about the plurality of hospitals based on the search request of the hospital received from the user terminal 110. Here, the information on the plurality of hospitals may include a hospital name, location information and contact information of the hospital.

For example, the medical treatment appointment processing unit 210 may provide information about a plurality of hospitals existing at a predetermined distance from the location of the user terminal 110 based on the medical treatment input by the user terminal 110. Can be provided to As another example, the medical treatment appointment processing unit 210 may provide specific hospital information input or selected by the user terminal 110 to the user terminal 110 or may exist at a predetermined distance from a location input by the user terminal 110. Information about a plurality of hospitals for treating a subject may be provided to the user terminal 110. As another example, the medical treatment appointment processing unit 210 may inform the user terminal 110 of the status information of the medical hospital to treat the holidays.

For example, the medical treatment appointment processing unit 210 may provide the user terminal 110 with a hospital search result in which locations of a plurality of hospitals searched for a search request of a hospital received from the user terminal 110 are displayed on a map. .

In this case, as shown in FIG. 3A, the medical treatment appointment processing unit 210 displays color information (or information on the number of waiting persons of the hospital) on a map of congestion information (that is, medical treatment reservation and waiting status information of a plurality of hospitals) searched for. It can be provided to the user terminal 110 by displaying.

That is, the color of each hospital (or the number of people waiting for the hospital) may be displayed differently on the map according to the congestion degree of the hospital.

For example, in a hospital where the number of patients waiting to be treated in a plurality of searched hospitals exceeds a predetermined first threshold value, it may be displayed on a map with a red color (or number of waiting people) indicating congestion.

In addition, in a hospital where the number of patients waiting to be present exists between the first and second thresholds, the map may be displayed in a blue color (or the number of waiting persons) indicating congestion.

In addition, when the number of patients waiting to be treated is less than the second predetermined threshold, it may be displayed on the map in black color (or the number of waiting persons) indicating that the degree of congestion in the hospital is good.

In this way, by displaying the congestion degree of each hospital, the user can check the congestion degree of the hospital and visit the hospital at the scheduled time of treatment. It is also possible to prevent a patient from concentrating on a particular hospital by allowing patients to book a hospital with low congestion.

The medical treatment appointment processing unit 210 may receive a medical treatment reservation request including information of a hospital and information of a patient from the user terminal 110. Here, the hospital information may include identification information on the hospital selected by the user, and the patient information may include the patient name, the age of the patient, the date of birth, and the health insurance card information of the patient.

For example, referring to FIGS. 3A to 3B, a user selects a specific hospital 300 among a plurality of hospitals output on a map through a medical service application, and inputs information of a patient to be treated at a specific hospital 300. By doing so, it is possible to request a medical appointment to a specific hospital 300.

In this case, the treatment appointment button 302 may be displayed in a first color corresponding to an inactive state before receiving an appointment, and then change to a second color corresponding to an activation state when an appointment is received. .

Thereafter, the treatment appointment processing unit 210 may check whether the user and the patient of the user terminal 110 who requested the appointment of the treatment match. For example, the medical treatment appointment processing unit 210 may confirm whether the information of the real name authenticated user matches the patient when authenticating the user.

Thereafter, when the user and the patient of the user terminal 110 coincide with the patient appointment processor 210, the patient appointment processor 210 may schedule the patient's care to a server (not shown) of a specific hospital selected by the user. At this time, when the patient's medical treatment is reserved at the server (not shown) of the specific hospital, the medical treatment appointment processing unit 210 receives the patient's medical appointment number generated from the server (not shown) of the specific hospital and receives the received patient. The medical appointment number may be transmitted to the user terminal 110.

The treatment reception unit 220 may receive a treatment for a reservation request of the treatment from the terminal 120 provided in the hospital 10. Here, the terminal 120 provided in the hospital 10 is a terminal that provides a service for receiving on-site medical care, storage payment, and a prescription. For example, the terminal 120 may include a kiosk.

For example, the user terminal 110 located in the hospital 10 transmits the medical treatment reservation number of the patient to the terminal 120 provided in the hospital 10 through Bluetooth communication, or the terminal 120 provided in the hospital 10. When the user directly inputs the patient's medical appointment number through the medical care reception application of), the medical reception unit 220 may receive medical care based on the patient's medical appointment number from the terminal 120 provided in the hospital 10. Can be. For example, when the number of waiters using the terminal 120 provided in the hospital 10 is large, the user may revisit at the scheduled time of treatment through the hospital revisit notification setting.

The treatment information receiving unit 230 may receive treatment history information, storage information, and prescription information about treatment from the server 130 of the health insurance corporation. Specifically, after the storage processing for the patient's care in the hospital 10, the hospital server (not shown) of the hospital 10 is the medical history information on the patient's care, the server 130 of the Health Insurance Corporation, storage information And transmits the prescription information, the medical care information receiving unit 230 may receive medical care history information, storage information and prescription information for the treatment of the patient from the server 130 of the Health Insurance Corporation.

The treatment information providing unit 240 may transmit at least one of treatment history information, storage information, and prescription information about the treatment of the patient received from the server 130 of the health insurance corporation to the user terminal 110.

For example, referring to FIG. 3B, the user terminal 110 may be provided with information that the patient has received medical care at the hospital 10 through a medical service application. For example, the user terminal 110 may select and confirm at least one of the medical history information 304, the accommodation information 305, and the prescription information 306 for the treatment of the patient through the medical service application.

For example, when the user selects the prescription information 306 in the medical service application, the medical care information providing unit 240 may provide the user terminal 110 with information about the medicine and the manufacturing quantity information for treating the patient. .

The pharmacy dispatcher 270 may allocate a pharmacy to the user terminal 110 to prepare a drug corresponding to prescription information of the patient's care.

For example, referring to FIGS. 3B-3C, when the user selects the prescription information 306 in the medical service application, the pharmacy doubling unit 270 may prepare a plurality of pharmacies to dispense the medicine corresponding to the prescription information 306. Pharmacy search results displayed on the map may be provided to the user terminal 110.

In this case, the pharmacy locator 270 displays the information of the plurality of pharmacies existing within a preset range from the location of the user terminal 110 on the map based on the location information of the user terminal 110, thereby displaying the user terminal 110. ) Can be sent. Here, the information of the plurality of pharmacies may include, for example, locations of each of the plurality of pharmacies and the amount of preparation received for each of the plurality of pharmacies.

In addition, the pharmacy locator 270 may provide the user terminal 110 with congestion information about a plurality of pharmacies existing within a preset range from the location information of the user terminal 110.

For example, as illustrated in FIG. 3C, the pharmacy dispatcher 270 converts congestion information (that is, information on the amount of pharmacy received at the pharmacy) into color information (or information on the number of people waiting) on a map. The display may be provided to the user terminal 110. That is, the color (or information on the number of people waiting) of each pharmacy may be displayed differently on the map according to the congestion degree of the pharmacy.

For example, in the case of a pharmacy in which the amount of the pharmacy's preparation received exceeds a predetermined first threshold value, the pharmacy may be displayed on a map with a red color (or number of waiting persons) indicating congestion.

In addition, in the case of a pharmacy in which the amount of preparation of the pharmacy is present between a predetermined first threshold value and a second threshold value, it may be displayed on a map in blue color (or number of waiting persons) indicating congestion.

In addition, when the dosage amount of the pharmacy is less than the second preset threshold, it may be displayed on the map in black color (or the number of waiting persons) indicating that the degree of congestion in the pharmacy is good.

By displaying the congestion level of each pharmacy on the map in this way, the user can select a low-congestion pharmacy and request drug preparation in advance without having to wait in the pharmacy.

The pharmacy dispatcher 270 selects one pharmacy from the user terminal 110 among the plurality of pharmacies provided to the user terminal 110, and receives the visit time information to the pharmacy set by the user from the user terminal 110. can do.

The pharmacy locator 270 may provide the user terminal 110 with estimated time information until drug preparation is completed in the corresponding pharmacy based on the degree of congestion of the pharmacy selected by the user terminal 110.

The pharmacy dispatcher 270 may transmit the visit time information of the user to the pharmacy selected by the user terminal 110 and the prescription information of the user's medical treatment to the pharmacy management server 150. In this way, since the visit time information and prescription information of the user are transmitted to the pharmacy management server 150 by the medical service providing server 100, the user can directly carry the prescription and go to the corresponding pharmacy, and the user sets Since the drug is pre-filled at the pharmacy before one visit time, the user can visit the pharmacy and receive the medicine at the visit time set by the user, without having to wait for the drug preparation at the pharmacy.

The medication notification unit 280 may provide the medication information to the user terminal 110 based on the prescription information about the user's medical treatment.

For example, the medication notification unit 280 receives medication information including medication time information from the pharmacy management server 150 when the user has received the medicine at the pharmacy, and based on the received medication information, the user terminal ( 110 may provide a medication notification message (eg, a medication notification message every time a medicine is taken).

As another example, referring to FIG. 3D, when the user sets a separate notification of the medication time based on the prescription information for the treatment through the medical service application, the medication notification unit 280 may notify the medication time of the medication set by the user. Based on the medication time can be provided to the user terminal 110 for each medication time.

In another embodiment, the medication notification unit 280 re-visits the hospital based on the date information set by the user when the user sets a scheduled date for the user to return to the hospital or perform a medical checkup through a medical service application. Alternatively, the medical examination notification message may be provided to the user terminal 110.

The insurance claim processor 260 may receive a claim for medical treatment from the user terminal 110. For example, referring to FIG. 3B, when a user receives a claim 310 for medical treatment through a medical service application, the claim processing unit 260 requests a claim for medical treatment from the user terminal 110. You can get it.

The unfair claim check unit 250 may check whether the claim for medical care is unfairly claimed when a claim for medical care is received from a user.

For example, when the user terminal 110 receives the insurance claim 310 for the medical treatment through the medical service application, the unfair claim check unit 250 based on the location information of the user terminal 110 for the medical treatment You can find out if your claim is unfair.

For example, the location information collection unit 252 may collect the location information of the user terminal 110 in real time after the user receives the treatment through the terminal 120 provided in the hospital 10. Alternatively, the location government collection unit 252 may receive the location information of the user terminal 110 after receiving at least one of medical history information, accommodation information, and prescription information for medical treatment from a server of the health insurance corporation.

The location determiner 254 may determine whether the user terminal 110 is located within a preset range from the location of the hospital 10 at the time when the user schedules medical treatment based on the location information of the user terminal 110. have.

At this time, when the user terminal 110 is located in a predetermined range from the location of the hospital 10, the authenticity of the user's care can be confirmed.

If the user terminal 110 is not located within a preset range from the location of the hospital 10 at the time when the user schedules medical treatment after the user receives the insurance claim, the invalid claim confirmation unit 250 of the Health Insurance Corporation The server 130 may transmit suspicious information regarding an insurance claim fraud including the location information of the user terminal 110. At this time, the server 130 of the Health Insurance Corporation may determine the claim unfair claims of the user of the user terminal 110 based on the suspicious information about the claim unfair claims.

When the claim request processing unit 260 receives a claim for medical treatment (eg, a loss insurance claim) from the user terminal 110, the user pays the storage information (medical cost) of the care paid to the hospital 10 and the pharmacy. Storing information (medical prescription fee) of the drug preparation and the location information of the user terminal 110 can be transmitted to the server 140 of the insurance company. Here, the server 140 of the insurance company may be a server operated by a private insurance company (eg, life insurance company, non-life insurance company, etc.) operating the insurance product subscribed to by the user.

Here, the server 140 of the insurance company requests the claim of the user terminal 110 based on whether the user terminal 110 is located within a preset range from the location of the hospital 10 at the time when the user schedules medical treatment. You may decide to approve a claim against you, or you may decide to disapprove a claim against a claim fraudulent claim.

The insurance claim processor 260 may receive processing result information on the insurance claim request from the server 140 of the insurance company.

For example, if the user terminal 110 is located within a preset range from the location of the hospital 10 at the time when the user scheduled the medical treatment, the insurance claim processing unit 260 claims claims from the server 140 of the insurance company. The result of the approval of the claim for the request can be received.

Alternatively, if the user terminal 110 is not located within a preset range from the location of the hospital 10 at the time when the user schedules medical care, the insurance claim processor 260 requests a claim from the server 140 of the insurance company. Receive a disapproval result of a claim for.

The insurance claim processor 260 may transmit the processing result information on the insurance claim request to the user terminal 110.

On the other hand, those skilled in the art, user authentication performing unit 200, medical treatment appointment processing unit 210, medical treatment receiving unit 220, medical care information receiving unit 230, medical care information providing unit 240, unfair claim confirmation unit 250, location Each of the information collecting unit 252, the position determining unit 254, the insurance claim processing unit 260, the pharmacy dispensing unit 270, and the medication notification unit 280 may be separately implemented, or one or more of these may be integrated and implemented. I will fully understand that you can.

4 is a flowchart illustrating a medical service providing method in a medical service providing server according to an exemplary embodiment of the present invention.

Referring to FIG. 4, in operation S401, the medical service providing server 100 may receive a request for appointment of medical care including information of a hospital and information of a patient from the user terminal 110.

In operation S403, the medical service providing server 100 may receive medical care for a reservation request of medical care from the terminal 120 provided in the hospital 10.

In operation S405, the medical service providing server 100 may receive medical care history information, accommodation information, and prescription information about medical care from the server 130 of the health insurance corporation.

In operation S407, the medical service providing server 100 may transmit at least one of medical history information, accommodation information, and prescription information about medical care to the user terminal 110.

In operation S409, the medical service providing server 100 may determine whether the medical insurance claim is unfairly charged based on the location information of the user terminal 110.

In the above description, steps S401 to S409 may be further divided into additional steps or combined into fewer steps, according to an embodiment of the present invention. In addition, some steps may be omitted as necessary, and the order between the steps may be changed.

5 is a block diagram of the user terminal 110 shown in FIG. 1 according to an embodiment of the present invention.

Referring to FIG. 5, the user terminal 110 may include an authentication performing unit 500, a medical treatment reservation unit 510, a medical care information providing unit 520, a insurance claim unit 530, a pharmacy reservation unit 540, and a notification setting. It may include a part 550. However, the user terminal 110 shown in FIG. 5 is just one implementation example of the present invention, and various modifications are possible based on the components shown in FIG. 5.

The authentication performing unit 500 may perform authentication of the user based on user information inputted from the user (for example, the date of birth of the user, gender, name, etc.) when the user has registered as a member for use of the medical service application. Can be.

For example, the authentication performing unit 500 may transmit the user's information input from the user to the medical service providing server 100. In this case, the medical service providing server 100 may request the health insurance status of the user from the server 130 of the health insurance corporation.

The authentication performing unit 500 may perform authentication of a user through an opening communication company of the user terminal 110. For example, the authentication performing unit 500 may perform real name authentication of a user through an opening communication company of the user terminal 110.

In addition, the authentication performing unit 500 may determine whether the real name authentication information matches the health insurance card information from the server 130 of the health insurance corporation.

The medical treatment reservation unit 510 may search for a hospital and provide the same to a user according to a search request for a search condition of a hospital input from the user. For example, the medical treatment reservation unit 510 transmits a search request including a search condition of a hospital to the medical service providing server 100, and provides information about a plurality of hospitals received from the medical service providing server 100. Can be provided to Here, the plurality of hospital names, location information and contact information of the hospital may be included.

For example, the medical treatment reservation unit 510 may provide information on a plurality of hospitals existing at a predetermined distance from the location of the user terminal 110 based on the medical treatment input by the user.

For example, the medical treatment reservation unit 510 may display and provide locations of a plurality of hospitals searched on a map. At this time, congestion information (ie, hospital reservation and waiting status information of a plurality of hospitals) for a plurality of hospitals may be displayed on a map. The user may determine the visit of the hospital based on the degree of congestion of the hospital displayed on the map.

The medical treatment reservation unit 510 may schedule a medical treatment by transmitting a medical treatment reservation request including medical information and patient information to the medical service providing server 100 through a medical service application. For example, the hospital information includes identification information about the hospital selected by the user among the plurality of hospitals provided to the user, and the patient's information may include, for example, the name of the patient to be treated, the age of the patient, the date of birth and the patient. Health insurance card information can be included.

Thereafter, the medical treatment reservation unit 510 may check whether the user and the patient match. For example, the medical treatment reservation unit 510 may confirm whether the information of the real name authenticated user matches the patient when authenticating the user.

The treatment information providing unit 520 may receive at least one of treatment history information, storage information, and prescription information about treatment from the medical service providing server 100, and may provide the received information.

For example, when the storing process for the patient's medical treatment is completed in the hospital 10, the medical care information providing unit 520 may provide at least one of medical history information, storage information, and prescription information for medical treatment through a medical service application. have.

Referring to FIG. 3B, a user may select and confirm at least one of medical care history information 304, accommodation information 305, and prescription information 306 about a patient's care through a medical service application.

For example, when the user selects the prescription information 306 in the medical service application, the user may check the information about the medicine and the manufacturing quantity information for treating the patient.

The pharmacy reservation unit 540 may provide information of a plurality of pharmacies based on the location information of the user terminal 110 through the medical service application. Here, the information of the plurality of pharmacies may include, for example, locations of each of the plurality of pharmacies and the amount of preparation received for each of the plurality of pharmacies.

For example, referring to FIGS. 3B to 3C, the pharmacy reservation unit 540 may display and provide a location of a plurality of pharmacies for preparing a drug corresponding to the prescription information 306 on a map. At this time, the pharmacy reservation unit 540 receives from the medical service providing server 100 information on a plurality of pharmacies existing within a preset range from the location of the user terminal 110 based on the location information of the user terminal 110. Can be displayed on the map.

In addition, the pharmacy reservation unit 540 may provide the medical service providing server 100 with congestion information (that is, information on the amount of preparation of the pharmacy) for a plurality of pharmacies existing within a preset range from the location information of the user terminal 110. Can be displayed on the map. At this time, the color (or information on the number of people waiting) of each pharmacy may be displayed differently on the map according to the congestion degree of the pharmacy.

The pharmacy reservation unit 540 may select one pharmacy from the user among the plurality of pharmacies, and may schedule the preparation of the medicine corresponding to the prescription information to the selected pharmacy.

For example, the pharmacy reservation unit 540 may receive the estimated time information until the completion of the drug in the corresponding pharmacy according to the congestion degree of the selected pharmacy from the medical service providing server 100 to provide to the user. .

For example, if the user sets the visit time information of the pharmacy selected by the user, the visit time information of the user and the prescription information of the user's care are transmitted to the pharmacy management server 150 through the medical service providing server 100. Can take the prescription and go to the pharmacy directly, and the pharmacy pre-fills the drug before the visit time you set, so you don't have to wait for the pharmacy to fill the pharmacy You can go to the pharmacy to pick up your medicine at the visit.

The notification setting unit 550 may receive the medication information based on the prescription information for the medical treatment of the user from the medical service providing server 100.

For example, the notification setting unit 550 may be provided with a medication notification message (eg, a notification of taking a medicine every time a medicine is taken) from the medical service providing server 100 based on the medication information according to the prescription information.

As another example, referring to FIG. 3D, when the user sets a notification of the medication time separately based on the prescription information about the treatment through the medical service application, the notification setting unit 550 may notify the medication information of the medication time set by the user. The medication notification message may be provided to the user every medication time based on the control. In another embodiment, the notification setting unit 550 may return to the hospital or the hospital based on the date information set by the user when the user sets a reservation date for the user to return to the hospital or perform a medical examination through the medical service application. The medical examination notification message may be provided to the user.

The insurance claim unit 530 may claim a medical insurance payment based on the location information of the user terminal 110. At this time, the medical service providing server 100 may determine whether an insurance claim for medical treatment is unfairly based on the location information of the user terminal 110. For example, if the user terminal 110 is not located within a preset range from the location of the hospital 10 at the time when the user schedules medical care after the user receives the claim, the approval for the claim will be denied. Can be. Alternatively, when the user terminal 110 is located within a predetermined range from the location of the hospital 10 at the time when the user schedules medical treatment, the approval of the insurance claim may be granted.

The insurance claim unit 530 may receive processing result information on the claims from the medical service providing server 100 and provide the processing result information on the claims to the user through the medical service application.

On the other hand, those skilled in the art, authentication performing unit 500, medical care reservation unit 510, medical care information providing unit 520, insurance claim unit 530, pharmacy reservation unit 540 and notification setting unit 550 are each separated It will be fully understood that one or more of these may be implemented in combination.

6 is a flowchart illustrating a medical service providing method in a user terminal 110 according to an embodiment of the present invention.

Referring to FIG. 6, in operation S601, the user terminal 110 may transmit a medical service reservation request including medical information and patient information to the medical service providing server 100 to schedule medical care.

In operation S603, the user terminal 110 may receive and provide at least one of medical care history information, accommodation information, and prescription information from the medical service providing server 100.

In operation S605, the user terminal 110 may claim insurance for medical treatment based on the location information of the user terminal 110.

In the above description, steps S601 to S605 may be further divided into additional steps or combined into fewer steps, according to an embodiment of the present invention. In addition, some steps may be omitted as necessary, and the order between the steps may be changed.

An embodiment of the present invention may also be implemented in the form of a recording medium including instructions executable by a computer, such as a program module executed by the computer. Computer readable media can be any available media that can be accessed by a computer and includes both volatile and nonvolatile media, removable and non-removable media. In addition, computer readable media may include all computer storage media. Computer storage media includes both volatile and nonvolatile, removable and non-removable media implemented in any method or technology for storage of information such as computer readable instructions, data structures, program modules or other data.

The foregoing description of the present invention is intended for illustration, and it will be understood by those skilled in the art that the present invention may be easily modified in other specific forms without changing the technical spirit or essential features of the present invention. will be. Therefore, it should be understood that the embodiments described above are exemplary in all respects and not restrictive. For example, each component described as a single type may be implemented in a distributed manner, and similarly, components described as distributed may be implemented in a combined form.

The scope of the present invention is shown by the following claims rather than the detailed description, and all changes or modifications derived from the meaning and scope of the claims and their equivalents should be construed as being included in the scope of the present invention. .

100: medical service providing server
110: user terminal
120: terminal provided in the hospital
130: Health Insurance Corporation server
140: server of the insurance company
150: pharmacy management server

Claims (17)

In the medical service providing method,
Receiving at least one of medical history information, storage information and prescription information for the treatment from the server of the Health Insurance Corporation;
Transmitting at least one of medical history information, accommodation information, and prescription information of the medical care to a user terminal; And
Determining whether an insurance claim for the medical treatment is unfairly based on location information of the user terminal;
Including,
The step of confirming whether the insurance claim for the medical care is unfairly
Collecting location information of the user terminal; And
Determining whether the user terminal is located within a preset range from a location of a hospital based on the location information of the user terminal;
That includes, medical service providing method.
The method of claim 1,
Receiving a request for reservation of medical care including information of the hospital and information of a patient from the user terminal;
That further comprises, medical service providing method.
The method of claim 1,
The step of confirming whether the insurance claim for the medical care is unfairly
If the user terminal is not located within a predetermined range from the location of the hospital, to provide health care service suspicious information about claims fraudulent claims including the location information of the user terminal to the server of the health insurance corporation Way.
The method of claim 1,
Receiving an insurance claim request from the user terminal;
Transmitting the accommodation information and location information of the user terminal to a server of an insurance company;
Receiving processing result information on the insurance claim request from a server of the insurance company; And
Transmitting the processing result information on the claim request to the user terminal;
That includes, medical service providing method.
The method of claim 1,
Allocating a pharmacy for dispensing a drug corresponding to the prescription information to the user terminal
That further comprises, medical service providing method.
The method of claim 5, wherein
Allocating a pharmacy for dispensing a drug corresponding to the prescription information to the user terminal
Transmitting information of a plurality of pharmacies to the user terminal based on the location information of the user terminal;
Receiving information for selecting one of the plurality of pharmacies from the user terminal; And
Transmitting the information on the selected pharmacy and the prescription information to a pharmacy management server
That includes, medical service providing method.
The method of claim 6,
And the information on the plurality of pharmacies includes a location of each of the plurality of pharmacies, and an amount of preparation received for each of the plurality of pharmacies.
The method of claim 6,
The information for selecting one of the plurality of pharmacies includes the visit time information of the selected pharmacy.
The method of claim 1,
Prior to the step of receiving a request for appointment of a treatment including information of a hospital and information of a patient from a user terminal
Performing authentication of a user on the user terminal
That further comprises, medical service providing method.
The method of claim 9,
Receiving a request for appointment of a treatment including information of a hospital and information of a patient from the user terminal is
Confirming whether the user matches the patient; And
Providing congestion information for a plurality of hospitals to the user terminal
That includes, medical service providing method.
The method of claim 1,
Providing medication information to the user terminal based on the prescription information
That further comprises, medical service providing method.
In the user terminal for providing a medical service,
A medical care information providing unit configured to receive and provide at least one of medical history information, storage information, and prescription information about medical care from a medical service providing server; And
Insurance claim unit for claiming the insurance for the care based on the location information of the user terminal
Including,
The location information of the user terminal is collected by the medical service providing server, and based on the location information of the user terminal, it is determined whether the user terminal is located within a preset range from the location of a hospital, and the user terminal is a hospital It is confirmed whether the claims for the medical care against the unfair claims based on whether or not located within a predetermined range from the location of the user terminal.
The method of claim 12,
The medical care reservation unit which reserves the medical care by transmitting a medical care reservation request including the information of the hospital and the patient information to the medical service providing server.
To further include, the user terminal.
The method of claim 12,
A pharmacy reservation unit that provides information on a plurality of pharmacies based on the location information of the user terminal, selects one of the plurality of pharmacies, and reserves a medicine corresponding to the prescription information to the selected pharmacy.
To further include, the user terminal.
The method of claim 14,
The information of the plurality of pharmacies, including the location of each of the plurality of pharmacies, the amount of preparation for each of the plurality of pharmacies, user terminal.
The method of claim 13,
Authentication performing unit for authenticating the user to the user terminal
More,
The medical care reservation unit is to confirm whether the user and the patient match, user terminal.
In the medical service providing server,
A medical care information provider for transmitting at least one of medical care history information, storage information, and prescription information about medical care received from a server of the Health Insurance Corporation to a user terminal; And
An unfair claim checking unit for checking whether the claim for the medical care is unfairly based on the location information of the user terminal
Including,
The invalid claim confirmation unit,
Collecting location information of the user terminal and determining whether the user terminal is located within a predetermined range from a location of a hospital based on the location information of the user terminal.

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