KR20230038851A - Proxy requesting system for providing medical expenses - Google Patents

Abstract

The present invention relates to a medical expenses payment claim agency system. The medical expenses payment claim agency system can simplify a work for claiming medical expenses by automatically performing the medical expense agency claim, and the medical expense payment claim agency system can not only lower a work skill level, but also shorten a time required to claim medical expenses. The medical expenses payment claim agency system includes a digital power of attorney generator, a medical expense calculation unit, and a medical expenses payment claim agency.

Description

Medical expenses payment claim agency system {Proxy requesting system for providing medical expenses}

TECHNICAL FIELD The present invention relates to a medical care payment technology, and more particularly, to a medical care payment claim agency system.

According to Article 12 of the Medical Benefits Act, “a beneficiary receives medical benefits for disease, injury, childbirth, etc. from an institution prescribed by the Ordinance of the Ministry of Health and Welfare as an institution that performs the same function as a medical benefit institution for urgent or other unavoidable reasons prescribed by Ordinance of the Ministry of Health and Welfare. When a child is born at a place other than a benefit institution, the amount equivalent to the medical benefit shall be paid to the beneficiary as medical expenses, as prescribed by the Ordinance of the Ministry of Health and Welfare.'

Patients (recipients) or their agents can claim medical expenses through the medical expenses claiming institution. Until now, the medical expenses claiming institution was the pharmacy, but recently, medical device sales businesses are expected to be added. Although patients (recipients) may directly visit such medical expenses claiming institutions and claim medical expenses, in most cases, agents such as family members visit pharmacies and claim medical expenses instead of patients receiving medical care.

In case of claiming medical expenses by proxy, submit the prescription, the patient's ID card and the representative's ID card, write the patient information on the medical expense payment claim power of attorney, and sign and submit with the agent's consent. Request medical expenses by faxing a copy of the patient's ID, a copy of the agent's ID, a power of attorney, and a tax invoice by fax to

Then, the person in charge of the branch of the National Health Insurance Corporation approves the medical expense claim, and when the medical expense claim is approved, the medical expense claiming institution accesses the medical institution information field of the National Health Insurance Corporation and writes prescription details and sales details. and upload scans of prescriptions, tax invoices, and receipts.

In this way, since the claim for medical care expenses has been made manually so far, even one claim for medical expenses had to go through a complicated procedure, which not only required high work proficiency for medical expenses, but also took a considerable amount of time to claim. Therefore, the present inventors have researched a technique capable of automatically performing such billing for care expenses by proxy.

Republic of Korea Patent No. 10-1579041 (Announcement date: 2015.12.21)

The present invention provides a nursing care payment claim agency system that can simplify the work for claiming medical care expenses by automatically performing the claiming for medical care expenses, reduce work skills, and reduce the time required for claiming medical expenses. for that purpose

According to one aspect of the present invention for achieving the above object, the medical care payment claim agency system includes a digital power of attorney generating unit for generating a digital power of attorney including a signature image of a medical care payment claim agent; a medical care cost calculation unit that calculates a medical care cost for consumable materials included in prescription information of a patient subject to a claim for medical care cost payment; Medical expenses payment request information including the patient's ID image, the medical expenses payment claim agent's identity card image, the digital power of attorney generated by the digital power of attorney generation unit, and the medical expenses calculated by the medical expenses calculation unit are stored in NHI. A medical care expense payment claim agent unit is transmitted to the medical care expense management server of the Insurance Management Corporation to act as an agent for the medical care expense payment claim.

According to an additional aspect of the present invention, when the nursing care payment claim agency system approves the medical care cost payment from the medical care cost management server of the National Health Insurance Corporation, the purchase of consumable materials included in the prescription information of the patient subject to the medical care payment claim a payment processing unit that processes payment for the person who subtracted medical expenses from the price; A sales details register for storing and registering payment details processed by the payment processing unit and prescription information of a patient subject to payment of medical expenses in the medical expenses management server of the National Health Insurance Corporation is further included.

According to an additional aspect of the present invention, the medical care payment claim agency system further includes a code recognition unit for recognizing an identification code attached to consumable materials to be sold to a patient subject to a medical care payment claim.

According to an additional aspect of the present invention, when the payment processing unit matches the consumable material corresponding to the identification code attached to the consumable material recognized by the code recognition unit and the consumable material included in the prescription information of the patient subject to payment of medical expenses. It can be implemented to process payment.

According to an additional aspect of the present invention, the medical care payment claim agency system further includes a consent signature input unit for receiving consent and a signature for a medical care payment claim agency delegation from a medical care payment claim agency agent.

According to an additional aspect of the present invention, the medical care payment claim agency system further includes a scanner for scanning a prescription of a patient subject to a claim for medical care payment, an ID of the patient subject to a claim for medical care payment, and an ID of an agent for claiming medical care payment.

According to an additional aspect of the present invention, the medical care payment claim agency system includes a prescription information extraction unit for extracting prescription information of a patient subject to a claim for medical care payment from the prescription of the patient subject to a claim for medical care payment, which is scanned by a scanner; The image storage unit may further include an ID image storage unit that stores the ID of the patient subject to claim for medical care expenses and the ID of the agent for payment of medical care expenses scanned by the scanner as image files.

The present invention has the effect of simplifying the work for claiming medical care expenses, lowering the work skill level, and shortening the time required for claiming medical care expenses by automatically performing the medical care expenses agency claim.

1 is a block diagram showing the configuration of an embodiment of a nursing care payment claim agency system according to the present invention.
2 is a flowchart illustrating an example of an operation of acting as an agent for a claim for medical care payment of the medical care payment claim system according to the present invention.

Hereinafter, the present invention will be described in detail so that those skilled in the art can easily understand and reproduce the present invention through preferred embodiments described with reference to the accompanying drawings. Although specific embodiments are illustrated in the drawings and related details are described, they are not intended to limit the various embodiments of the present invention to any particular form.

In describing the present invention, if it is determined that a detailed description of a related known function or configuration may unnecessarily obscure the gist of the embodiments of the present invention, the detailed description will be omitted.

It is understood that when an element is referred to as being "connected" or "connected" to another element, it may be directly connected or connected to the other element, but other elements may exist in the middle. It should be.

On the other hand, when a component is referred to as “directly connected” or “directly connected” to another component, it should be understood that no other component exists in the middle.

1 is a block diagram showing the configuration of an embodiment of a nursing care payment claim agency system according to the present invention. The nursing care payment claim agency system according to the present invention may be implemented in the form of software loaded on a CAT or POS terminal of a nursing care claiming institution, such as a pharmacy or a medical equipment store, or software loaded on a kiosk terminal linked thereto, It is not limited to this.

As shown in FIG. 1, the medical care expense payment claim agency system 100 according to this embodiment includes a digital power of attorney generator 110, a medical care expense calculator 120, and a medical care expense payment claim agency 130. .

The digital power of attorney generating unit 110 creates a digital power of attorney including a signature image of an agent for claiming medical care expenses. For example, the digital power of attorney generator 110 reads a pre-stored standardized digital power of attorney image from a memory (not shown in the drawing) and overlays the signature image of the agent for payment of medical expenses on the signature image area on the standardized digital power of attorney image to create a digital power of attorney. can be implemented to create

At this time, the standardized digital power of attorney image may include the content that the medical care payment claim agent acts as an agent for the medical care payment claim, and additionally, medical care cost billing institution information such as the name of a pharmacy and medical device dealer, and the name of a patient subject to a medical care payment claim. Patient information to be billed for may also be included.

The medical care cost calculator 120 calculates the medical care cost for consumable materials included in the prescription information of the patient to whom the medical care cost payment is claimed. Here, the consumable materials refer to various consumable materials consumed for the treatment of patients subject to payment of medical expenses, such as blood glucose measurement test strips and insulin syringes consumed for blood glucose measurement or insulin injection of diabetic patients. On the other hand, medical expenses for consumable materials may be a specific amount or ratio prescribed through the Medical Benefit Act, its enforcement decree or enforcement regulations, and the like.

The medical care expense payment request agency 130 includes the patient's ID image, the medical care expense payment agent's ID image, the digital power of attorney generated by the digital power of attorney generator 110, and the medical care expense calculator 120 Request information for medical expenses including the medical expenses calculated by is transmitted to the medical expenses management server 200 of the National Health Insurance Corporation, and the medical expenses payment request is acted as an agent.

Upon receiving the medical expenses payment request information transmitted from the medical expenses payment claim agency system 100, the medical expenses management server 200 of the National Health Insurance Corporation approves the medical expenses payment for the patient subject to the medical expenses payment claim, and displays the medical expenses payment approval result as the medical expenses It is transmitted to the payment claim agency system 100.

With this implementation, the present invention can simplify the work for claiming medical care expenses by automatically performing the claim for medical care expenses, reduce work skills, and shorten the time required for claiming medical expenses.

Meanwhile, according to an additional aspect of the present invention, the nursing care payment claim agency system 100 according to the present invention may further include a payment processing unit 140 and a sales details registering unit 150.

The payment processing unit 140 subtracts the medical expenses from the purchase price for consumable materials included in the prescription information of the patient subject to the medical expenses payment claim when approval for medical expenses is paid from the medical expenses management server 200 of the National Health Insurance Corporation. Process the payment amount.

At this time, the payment processing unit 140 may be implemented to issue an electronic tax invoice when the payment processing for the payment amount is made. For example, the payment processing unit 140 may be implemented to issue an electronic tax invoice to a smart phone possessed by an agent for claiming medical care expenses, but is not limited thereto.

The sales details registration unit 150 stores and registers payment details processed by the payment processing unit 140 and prescription information of a patient subject to payment of medical expenses in the medical expenses management server 200 of the National Health Insurance Corporation.

At this time, the sales details register 150 stores the patient's identification card image, the medical expenses payment agent's identity card image, the digital power of attorney, and the electronic tax invoice in the medical expenses management server 200 of the National Health Insurance Corporation. It may be implemented to further store and register.

With this implementation, the present invention can simplify the work for claiming medical care expenses by automatically performing the claim for medical care expenses, reduce work skills, and shorten the time required for claiming medical expenses.

Meanwhile, according to an additional aspect of the present invention, the nursing care payment claim agency system 100 according to the present invention may further include a code recognition unit 160. The code recognition unit 160 recognizes an identification code attached to consumable materials to be sold to a patient subject to payment of medical expenses. In this case, the identification code attached to the consumable material may be a barcode or QR code in which consumable material information is recorded, and the code recognition unit 160 may be a barcode or QR code reader.

When the identification code attached to the consumable material is recognized by the code recognition unit 160, the payment processing unit 140 receives the consumable material corresponding to the identification code attached to the consumable material recognized by the code recognition unit 160, and the medical expenses. When the consumable materials included in the prescription information of the patient subject to payment request match, it may be implemented to process the payment.

By implementing in this way, the present invention can automatically verify that the consumable materials included in the prescription information of the patient subject to payment of medical expenses are properly paid and purchased. can prevent

Meanwhile, according to an additional aspect of the present invention, the nursing care payment claim agency system 100 according to the present invention may further include a consent signature input unit 170. The consent signature input unit 170 receives consent and a signature for delegation of a medical expenses payment claim from an agent for a medical expenses payment claim.

For example, when the consent signature input unit 170 outputs a software confirmation button agreeing to delegation of a medical care payment claim agency on a touch screen (not shown in the drawing), and the medical care payment claim agency agent touches a software confirmation button output on the touch screen screen, It can be implemented so that an agent delegation agreement for medical care payment claim is made.

On the other hand, the consent signature input unit 170 outputs a user interface for requesting signature input on a touch screen (not shown), and the agent for medical care payment claim touches the signature input field on the user interface output through the touch screen screen. It can be implemented so that signature input is made by dragging. By implementing the present invention in this way, the medical care payment request agency is made only when the consent and signature of the agent for the medical care payment claim is made.

Meanwhile, according to an additional aspect of the present invention, the nursing care payment claim agency system 100 according to the present invention may further include a scanner 180. The scanner 180 scans the prescription of the patient subject to payment of medical care expenses, the ID of the patient subject to payment of medical expenses, and the ID of the agent for payment of medical care expenses.

For example, the scanner 180 may be a camera that takes pictures of a prescription of a patient subject to payment of medical care expenses, an identification card of the patient subject to payment of medical expenses, and an identification card of an agent for claiming medical care expenses. By implementing in this way, the present invention can acquire a prescription image of a patient subject to payment of medical expenses, an image of an ID of a patient subject to a claim for medical expenses, and an image of an identification card of an agent for payment of medical expenses.

Meanwhile, according to an additional aspect of the present invention, the nursing care payment claim agency system 100 according to the present invention may further include a prescription information extractor 190 and an identification card image storage unit 192.

The prescription information extraction unit 190 extracts prescription information of a patient subject to payment of medical expenses from the prescription of the patient subject to payment of medical expenses, which is scanned by the scanner 180 . For example, the prescription information extractor 190 may be implemented to recognize the prescription text of a patient subject to payment of medical expenses using OCR technology from a prescription image of the patient subject to payment of medical expenses.

The ID image storage unit 192 stores the ID of the patient subject to payment of medical care expenses and the ID of the agent for payment of medical care expenses scanned by the scanner 180 as image files in the DB.

The prescription information of the patient subject to medical expenses payment extracted by the prescription information extractor 190 can be used when the payment processing unit 140 pays for consumable materials, and the patient subject to medical expenses payment is stored by the ID image storage unit 192. The ID image of and the ID image of the agent for claiming medical care expenses can be used when the medical expenses payment claim agency 130 requests medical expenses payment to the medical expenses management server 200 of the National Health Insurance Corporation.

Referring to FIG. 2 is a flowchart illustrating an example of an operation of acting as an agent for a claim for medical care payment of the medical care payment claim system according to the present invention.

When the medical expense payment claim agent visits the medical expense claiming agency and submits the patient's prescription, the medical expense payment claimant's identification card, and the medical expense payment agent's identity card, in step 310, the medical expense payment claim agency system The prescription of the patient to be claimed for payment, the ID of the patient to be claimed for medical care expenses, and the ID of the agent for billing for medical care expenses are scanned.

Then, in step 320, the medical care payment claim agency system extracts the prescription information of the patient eligible for medical care payment claim from the prescription of the patient subject to medical care payment claim scanned in step 310, and the patient's identification card and treatment cost payment claim agent agent. 's ID is saved as an image file.

Then, in step 330, the medical expenses payment claim agency system requests the medical expenses payment claim agency agent to input consent and signature for delegation of medical expenses payment claim, and inputs consent and signature for delegation of medical expenses payment claim agency from the medical expenses payment claim agency agent. receive

Then, in step 340, the medical care payment claim agency system generates a digital power of attorney including the signature image of the medical care payment claim agent input in step 330.

Then, in step 350, the medical care payment claim agency system calculates the medical care cost for consumable materials included in the prescription information of the patient to be claimed for medical care payment extracted in step 320.

Next, in step 360, the medical care payment claim agency system stores the patient's ID image stored in step 320, the ID image of the medical care cost payment agent agent, the digital power of attorney generated in step 340, and in step 350 Request information for medical expenses including the medical expenses calculated by the method is transmitted to the medical expenses management server of the National Health Insurance Corporation, and the medical expenses payment request is acted as an agent.

When the medical expense management server of the National Health Insurance Service, which has received the medical expense payment request information, approves the medical expenses payment for the patient subject to the medical expenses payment claim, in step 370, the medical expenses payment claim agency system sells consumables to the patient subject to the medical expenses payment claim. Recognize the identification code attached to the material.

And, in step 380, if the consumable material corresponding to the identification code attached to the consumable material recognized by the medical care payment claim agency system matches the consumable material included in the prescription information of the patient to be claimed for medical care payment, the patient to be claimed for medical care payment Payment is processed for the person who subtracted medical expenses from the purchase price for consumable materials included in the prescription information.

Next, in step 390, the medical care payment claim agency system stores and registers payment details processed in step 380 and prescription information of a patient subject to medical care payment claim in the medical care cost management server of the National Health Insurance Corporation.

With this implementation, the present invention can simplify the work for claiming medical care expenses by automatically performing the claim for medical care expenses, reduce work skills, and shorten the time required for claiming medical expenses.

Various embodiments disclosed in this specification and drawings are only presented as specific examples to aid understanding, and are not intended to limit the scope of various embodiments of the present invention.

Therefore, the scope of various embodiments of the present invention includes all changes or modified forms derived based on the technical spirit of various embodiments of the present invention other than the embodiments described herein are included in the scope of various embodiments of the present invention. should be interpreted as being

INDUSTRIAL APPLICABILITY The present invention can be used industrially in the technical field related to medical care payment and its application technology.

100: Medical expenses payment claim agency system
110: digital power of attorney generation unit
120: medical expenses calculation unit
130: Medical expenses payment claim agency
140: payment processing unit
150: sales history register
160: code recognition unit
170: consent signature input unit
180: scanner
190: prescription information extraction unit
192: ID image storage unit
200: nursing care management server

Claims (7)

a digital power of attorney generating unit that generates a digital power of attorney including a signature image of an agent for payment of medical expenses;
a medical care cost calculation unit that calculates a medical care cost for consumable materials included in prescription information of a patient subject to a claim for medical care cost payment;
Medical expenses payment request information including the patient's ID image, the medical expenses payment claim agent's identity card image, the digital power of attorney generated by the digital power of attorney generation unit, and the medical expenses calculated by the medical expenses calculation unit are stored in NHI. A nursing care payment claim agency that transmits the medical care cost management server of the insurance management corporation and acts as an agent for the medical care payment claim;
Including nursing care payment claim agency system. According to claim 1,
The nursing care payment claim agency system:
When the medical expenses management server of the National Health Insurance Corporation approves the payment of medical expenses, the payment processing unit that processes the amount of payment by subtracting the medical expenses from the purchase price for consumable materials included in the prescription information of the patient subject to the medical expenses payment claim ;
a sales details register for storing and registering payment details processed by the payment processing unit and prescription information of a patient subject to payment of medical expenses in the medical expenses management server of the National Health Insurance Corporation;
More inclusive nursing care payment claim agency system. According to claim 2,
The nursing care payment claim agency system:
a code recognition unit for recognizing an identification code attached to consumable materials to be sold to a patient subject to payment of medical expenses;
More inclusive nursing care payment claim agency system. According to claim 3,
Payment processor:
A medical care expense payment claim agency system that processes payment when the consumable material corresponding to the identification code attached to the consumable material recognized by the code recognition unit matches the consumable material included in the prescription information of the patient subject to the medical expense payment claim. According to any one of claims 1 to 4,
The nursing care payment claim agency system:
A consent signature input unit for receiving consent and signature for delegation of a claim for medical care payment from an agent for a claim for medical care payment;
More inclusive nursing care payment claim agency system. According to claim 5,
The nursing care payment claim agency system:
A scanner that scans the patient's prescription, the patient's ID card and the ID card of the agent for claiming medical care payment;
More inclusive nursing care payment claim agency system. According to claim 6,
The nursing care payment claim agency system:
a prescription information extraction unit extracting prescription information of a patient subject to payment of medical expenses from the prescription of the patient subject to payment of medical expenses, which is scanned by the scanner;
an ID image storage unit for storing the ID of the patient to be claimed for medical care payment and the ID of the agent for claiming medical care payment scanned by the scanner as image files;
More inclusive nursing care payment claim agency system.

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