WO2019041913A1 - 保险数据处理方法、装置、计算机设备和存储介质 - Google Patents

保险数据处理方法、装置、计算机设备和存储介质 Download PDF

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Publication number
WO2019041913A1
WO2019041913A1 PCT/CN2018/088570 CN2018088570W WO2019041913A1 WO 2019041913 A1 WO2019041913 A1 WO 2019041913A1 CN 2018088570 W CN2018088570 W CN 2018088570W WO 2019041913 A1 WO2019041913 A1 WO 2019041913A1
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responsibility
responsibility attribute
attribute
attribute value
input
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PCT/CN2018/088570
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English (en)
French (fr)
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王燕
梁效栋
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平安科技（深圳）有限公司
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    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q10/00—Administration; Management
    • G06Q10/06—Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
    • G06Q10/063—Operations research, analysis or management
    • G06Q10/0637—Strategic management or analysis, e.g. setting a goal or target of an organisation; Planning actions based on goals; Analysis or evaluation of effectiveness of goals
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q20/00—Payment architectures, schemes or protocols
    • G06Q20/08—Payment architectures
    • G06Q20/085—Payment architectures involving remote charge determination or related payment systems
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08—Insurance

Definitions

  • the present application relates to an insurance data processing method, apparatus, computer device and storage medium.
  • the traditional medical insurance claims method is a manual settlement claim.
  • professionals who need insurance knowledge, legal knowledge, and medical claims knowledge should review the claims bill, verify the insurance liability, and adjust the insurance amount; however, the inventor realizes that The medical insurance claims method has strong labor intensity, low claims efficiency, long settlement time, and the claim accuracy is easy to accept the experience of the compensation personnel, and the claim accuracy is low.
  • An insurance data processing method comprising:
  • the terminal obtains the input policy number through the claim service system, and obtains corresponding scenario information according to the policy number, where the scenario information includes multiple responsibility attributes and a responsibility attribute value corresponding to each responsibility attribute;
  • the terminal obtains the input responsibility attribute value, obtains the responsibility attribute in the matched scene information according to the input responsibility attribute value, and compares the input responsibility attribute value with the acquired responsibility attribute value corresponding to the acquired responsibility attribute;
  • the terminal reads the compensation rule data corresponding to the pre-stored scene information
  • the terminal processes the claims rule data to obtain a payout value, generates a payout instruction, and sends the payout order to the payment platform.
  • An insurance data processing device includes:
  • the scenario information obtaining module is configured to obtain the input policy number through the claim service system, and obtain corresponding scenario information according to the policy number, where the scenario information includes multiple responsibility attributes and a responsibility attribute value corresponding to each responsibility attribute;
  • the responsibility attribute matching module is configured to obtain the input responsibility attribute value, obtain the responsibility attribute in the matched scene information according to the input responsibility attribute value, and compare the input responsibility attribute value with the acquired responsibility attribute value corresponding to the acquired responsibility attribute;
  • a compensation rule obtaining module configured to read the compensation rule data corresponding to the pre-stored scene information when the input responsibility attribute value is the same as the acquired responsibility attribute value of the responsibility attribute;
  • the payout module is configured to process the payout rule data to obtain a payout value, generate a payout instruction, and send the payout instruction to the payment platform.
  • a computer device comprising a memory and one or more processors having stored therein computer readable instructions, the computer readable instructions being executable by the processor to cause the one or more processors to execute The following steps:
  • the scenario information includes a plurality of responsibility attributes and a responsibility attribute value corresponding to each responsibility attribute;
  • the pre-stored scene information corresponding to the compensation rule data is read;
  • One or more non-transitory computer readable instruction storage media storing computer readable instructions, when executed by one or more processors, cause one or more processors to perform the steps of:
  • the scenario information includes a plurality of responsibility attributes and a responsibility attribute value corresponding to each responsibility attribute;
  • the pre-stored scene information corresponding to the compensation rule data is read;
  • FIG. 1 is a flow diagram of an insurance data processing method in accordance with one or more embodiments.
  • FIG. 2 is a block diagram of an insurance data processing apparatus in accordance with one or more embodiments.
  • FIG. 3 is a block diagram of a responsible attribute matching module in accordance with one or more embodiments.
  • FIG. 4 is a block diagram of an insurance data processing apparatus in accordance with still another embodiment.
  • FIG. 5 is a block diagram of a computer device in accordance with one or more embodiments.
  • an insurance data processing method includes the following steps:
  • Step 102 The terminal obtains the input policy number through the claim service system, and obtains corresponding scenario information according to the policy number.
  • the scenario information includes multiple responsibility attributes and a responsibility attribute value corresponding to each responsibility attribute.
  • the scenario information corresponds to the policy responsibility, and includes multiple responsibility attributes corresponding to the policy liability and a responsibility attribute value corresponding to each responsibility attribute.
  • the liability attributes include attributes of the nature of the accident, type of treatment, type of expense, type of disease, nature of the hospital, use of health care, and the like, and attributes corresponding to the policy's agreed obligations.
  • the liability attribute value is the specific value of each responsibility attribute.
  • the nature of the accident is illness or accident, or illness and accident, etc.
  • the type of treatment includes outpatient or hospitalization, whether the nature of the hospital is a designated hospital, etc. Among them, illness or accident
  • the specific nature is the responsibility attribute value of the liability attribute of the accident nature, and the outpatient and hospitalization are the responsibility attribute values of the treatment type responsibility attribute.
  • the specific attribute value of the responsibility attribute is defined according to the responsibility of the policy.
  • a policy may include multiple policy responsibilities, so a policy number may correspond to multiple scene information.
  • the terminal stores a scenario information table, where the scenario information table stores the policy number and the corresponding scenario information, and the responsibility attribute corresponding to the scenario information and the responsibility attribute value of each attribute, and the terminal obtains the input policy number through the claims service system. Then, the scene information table is searched according to the policy number to obtain all the scene information corresponding to the policy number.
  • Step 104 The terminal acquires the input responsibility attribute value, obtains the responsibility attribute in the matched scene information according to the input responsibility attribute value, and compares the input responsibility attribute value with the acquired responsibility attribute value corresponding to the acquired responsibility attribute.
  • the terminal determines the responsibility attribute corresponding to the responsibility attribute value according to the input responsibility attribute value, and searches the scene information table according to the determined responsibility attribute, and inputs the corresponding responsibility attribute value.
  • the responsibility attribute is matched with the scene information obtained in step 102.
  • the input responsibility attribute value matches the scene information.
  • the terminal acquires a scene matching the input responsibility attribute value.
  • the responsibility attribute in the information compares the entered responsibility attribute value with the responsibility attribute value corresponding to the acquired responsibility attribute.
  • Step 106 When the input responsibility attribute value is the same as the responsibility attribute value of the acquired responsibility attribute, the terminal reads the compensation rule data corresponding to the pre-stored scene information.
  • the input responsibility attribute value is successfully matched with the scene information.
  • the plurality of input attribute attribute values are compared with the responsibility attribute value of the corresponding responsibility attribute in the matched scene information, when the plurality of input responsibility attribute values are If the value of the responsibility attribute of the corresponding responsibility attribute in the same scene information is the same, the multiple attribute attribute values entered are successfully matched with the scene information.
  • the terminal reads the pre-stored payment rule data corresponding to the scene information, and performs step 108. Further, in some embodiments, if the input responsibility attribute value is successfully matched with the plurality of scene information, the terminal separately acquires the compensation rule data corresponding to each scene information.
  • Step 108 The terminal processes the payout rule data to obtain a payout value, generates a payout instruction, and sends the payout instruction to the payment platform.
  • the claims rule data includes data such as a payout ratio, a payout calculation formula, and the like.
  • the terminal processes the input responsibility attribute value related to the billing information according to the payment rule data, calculates a payment value, generates a compensation instruction according to the payment value, and sends the compensation instruction to the payment platform, and the payment platform Complete the claim payment.
  • the terminal when the input responsibility attribute value is successfully matched with the plurality of scene information, and the terminal acquires the compensation rule data corresponding to the plurality of scene information, the terminal respectively processes the compensation rule data corresponding to each acquired scene information to obtain multiple Pay the value, and select the largest payout value among the multiple payout values to generate the payout order and send it to the payment platform.
  • the insurance data processing method obtains the input policy number through the claim service system, determines the scenario information corresponding to the policy number, and obtains the responsibility attribute in the matched scene information according to the obtained input responsibility attribute value, and inputs the responsible attribute value.
  • the liability attribute value corresponding to the acquired responsibility attribute is compared; when the input responsibility attribute value is the same as the acquired responsibility attribute attribute value, the pre-stored scene information corresponding to the compensation rule data is read, and the compensation rule data is processed. Get the payout value, generate a payout order, and send the payout order to the payment platform.
  • the above insurance data processing method obtains the claims rule data by matching the input responsibility attribute value with the pre-stored scene information, thereby realizing the automatic settlement and settlement of the medical insurance policy, thereby greatly improving the claim settlement efficiency, effectively saving the claim settlement time, and effectively avoiding the problem.
  • the influence of human factors on the accuracy of claims has greatly improved the accuracy of claims.
  • step 104 the step of comparing the input responsibility attribute value with the acquired responsibility attribute value corresponding to the acquired responsibility attribute includes: searching for an attribute level of the responsibility attribute corresponding to the input responsibility attribute value; The value of the input responsibility attribute is compared with the responsibility attribute value of the corresponding responsibility attribute in the scene information one by one until the input responsibility attribute value is different from the responsibility attribute value of the corresponding responsibility attribute in the scene information.
  • the terminal pre-stores an attribute level classification table, where the attribute level classification table stores a correspondence relationship between the responsibility attribute and the corresponding attribute level, and the attribute level of the specific responsibility attribute may be divided according to the importance degree of the attribute, or may also be set according to the matching frequency, Other division principles may be set according to actual needs, and the embodiment is not specifically limited.
  • the responsibility attribute is divided into two attribute levels, and the attribute level of the core responsibility attribute such as the nature of the accident, the type of treatment to be refined, and the expense item are defined. It is the first level; the attribute level of the responsibility attribute such as the operation level, occupation type, and work injury use is the second level.
  • the terminal After obtaining the input responsibility attribute value, the terminal searches the attribute level classification table according to the responsibility attribute corresponding to the input responsibility attribute value, obtains the attribute level of the responsibility attribute corresponding to each responsibility attribute value, and then inputs the information according to the level of the attribute level one by one.
  • the responsibility attribute value is compared with the responsibility attribute value of the corresponding responsibility attribute in the scene information until the input responsibility attribute value is different from the responsibility attribute value of the corresponding responsibility attribute in the scene information. If the value of the responsibility attribute is the same as the value of the responsibility attribute of the corresponding responsibility attribute in the scene information, the scene information is successfully matched, and the terminal reads the compensation rule data corresponding to the pre-stored scene information and performs step 108 to perform the claim compensation operation. If the value of the responsible attribute is not the same as the value of the responsibility attribute of the corresponding responsibility attribute in the scene information, the scene information is matched, the scene information is matched, and the claim fails.
  • the input responsibility attribute value is hierarchically matched according to the responsibility level of the responsibility attribute corresponding to the responsibility attribute value, and if the first level responsibility attribute is matched successfully, the second level of the responsibility attribute value is continued to be matched, otherwise, if If the first level of responsibility attribute value matching is unsuccessful, the next level of responsibility attribute value is no longer compared, and the scene information matching ends, so that the input responsibility attribute does not need to be entered when the input responsibility attribute value does not match the scene information. All the values are compared with the responsibility attribute values of the corresponding responsibility attributes in the scene information to obtain matching results, which helps to further improve the matching efficiency.
  • the hierarchical level of the responsibility attribute may be arbitrarily set according to the actual application, for example, more than two attribute levels may be used. This embodiment does not specifically limit the two attribute levels.
  • the above-mentioned responsibility attribute value is compared with the responsibility attribute value of the corresponding responsibility attribute in the scene information according to the level of the attribute level, until the responsibility attribute value of the input and the corresponding responsibility attribute in the scene information are responsible.
  • the method further includes: when the input responsibility attribute value is different from the responsibility attribute value of the corresponding responsibility attribute in the scene information, displaying the chargeback information or the manual review reminder information through a popup box.
  • the attribute attributes of different responsibility attributes are different.
  • the processing manner adopted is also different.
  • the content defines the processing method when the responsibility attribute does not match.
  • the specific processing method includes prompting manual review or direct chargeback. For example, if the above-mentioned accidental medical liability is still taken as an example, if the liability attribute values of the core responsibility attributes such as the nature of the accident, the type of treatment to be refined, and the expense item are not the same, the direct refusal is paid; and the attribute of the surgical grade requires manual evaluation of the specific level.
  • Responsibility attributes such as category and work injury use need to manually select specific values.
  • the attribute level classification table also stores the content of the reminder information when the responsibility attribute value is different.
  • the terminal searches the attribute level classification table to obtain The reminder information corresponding to the responsibility attribute and the reminder information is displayed through a pop-up box, and the specific reminder information includes the chargeback information or the manual review reminder information.
  • the terminal determines the responsibility attribute according to the obtained entry information (such as treatment hospital, treatment type, clinical diagnosis, bill type), obtains the input responsibility attribute value, generates a liability attribute table of the claim case, and records The responsibility attribute and responsibility attribute value of the case, and then the first level of responsibility attribute matching, taking the accidental medical responsibility as an example, the liability attribute value of the three core responsibility attributes to be entered (accident nature, refinement treatment type, expense item) Compare with the responsibility attribute value corresponding to the responsibility attribute in the scene information matching the accidental medical responsibility. If the responsibility attribute values of the three responsible attributes entered are consistent with the responsibility attribute values corresponding to the responsibility attribute in the scene information, the first The core responsibility attribute of the level is matched, and the second level of responsibility attribute matching is performed.
  • the obtained entry information such as treatment hospital, treatment type, clinical diagnosis, bill type
  • the direct charge is rejected. If one of the responsibility attribute values is inconsistent, the direct charge is rejected. If the responsibility attribute of the first level is successfully matched, the responsibility attribute value of the input second level is further compared with the responsibility attribute value of the corresponding responsibility attribute in the matching scene information according to the scene information on the first level matching. The value of the responsibility attribute of the second level is the same as the value of the responsibility attribute of the corresponding responsibility attribute in the scene information. If the scene information is matched successfully, the claim case matches the scene information, and the settlement can be automatically performed according to the scene information. The terminal acquires a payment rule corresponding to the scenario information, and calculates a payment value according to the payment rule.
  • the terminal searches for the attribute level classification table to obtain the reminder information corresponding to the responsibility attribute value, and outputs the display through the pop-up box.
  • Reminder information such as prompting to manually select specific attribute values to re-perform scene matching reminding information or manual review and evaluation reminding information, and automatic refusal reminding and refusal reason analysis information.
  • the policy responsibility matching may also be performed before the first level responsibility attribute is matched, for example, the terminal according to the obtained input information (such as treatment hospital, treatment type, clinical diagnosis)
  • the billing type determines the claim liability (accident medical liability), matches the determined claims liability with the scenario information obtained in step 102 according to the policy number, and compares the policy liability corresponding to the scenario information with the claim liability, if the two are the same If the claim responsibility is successfully matched, the first level of responsibility attribute matching is further performed. If the two are not the same, the direct rejection or prompt manual review is performed, and the scene information matching ends.
  • the step of comparing the input responsibility attribute value with the responsibility attribute value corresponding to the acquired responsibility attribute according to the responsibility attribute in the matching scene information obtained from the input responsibility attribute value includes: obtaining and inputting The attribute category of the responsibility attribute corresponding to the responsibility attribute value; when the attribute category is the billing category, the pre-stored corresponding responsibility attribute check table is searched according to the input responsibility attribute value, and the responsibility attribute value corresponding to the acquired responsibility attribute is generated.
  • the accountability attribute value of the comparison compares the generated responsibility attribute value for comparing the responsibility attribute value corresponding to the acquired responsibility attribute with the responsibility attribute value corresponding to the acquired responsibility attribute.
  • the responsibility attribute category of the responsibility attribute is divided according to the entry manner of the responsibility attribute, and the responsibility attribute category includes three categories: the pre-personal responsibility attribute, the billing type responsibility attribute, and the adjustment page manual intervention responsibility attribute, wherein
  • the pre-manual liability attribute is related to the claim material, and has nothing to do with the bill.
  • the adjustment page manual intervention responsibility attribute is entered on the manual audit adjustment page.
  • the scene information is re-matched, including occupation category, disease type, medical accident level, disability ratio standard, work injury.
  • Responsibility attributes such as usage, maternity insurance use, etc.
  • the liability attribute of the billing type is related to the content of the bill.
  • the terminal checks the attribute value of the claim liability and generates a responsibility attribute value for comparing the responsibility attribute value corresponding to the acquired responsibility attribute to match the scene information, for example, for the fixed point.
  • the input personnel can not confirm whether the hospital on the bill is a designated hospital, the entry personnel enter the name of the hospital according to the bill, and after obtaining the name of the hospital, the terminal looks up the responsibility attribute checklist to perform the fixed hospital check, if the responsibility is If the name of the hospital entered is found in the attribute checklist, the generated attribute value of the designated hospital is generated. Otherwise, the attribute value of the hospital that is not the fixed point hospital is generated.
  • the liability attributes of the bill type include the type of the accident, the type of the treatment to be refined, the cost item, the place of the accident, the type of the fee, the limitation of the number of visits, the time of the accident, the designated hospital, the use of the medical insurance, and the type of surgery.
  • the insurance data processing method further includes: the terminal obtaining the policy effective order, the policy effective order carrying the policy number; confirming the policy type insurance code according to the policy number, and obtaining the pre-stored policy liability data according to the policy type code;
  • the data obtains the responsibility attribute corresponding to the policy liability and the responsibility attribute value corresponding to each responsibility attribute from the responsibility attribute database, and generates scene information corresponding to the policy responsibility according to the obtained responsibility attribute and the responsibility attribute value corresponding to each responsibility attribute;
  • the claim rule data corresponding to the scenario information is read, and the corresponding relationship between the scenario information and the corresponding payout rule data is established and stored.
  • the scenario information is defined according to the policy liability
  • the terminal pre-stores the responsibility attribute database, and the responsibility attribute database stores a plurality of liability attributes related to the medical insurance claims and corresponding responsibility attribute values.
  • the terminal obtains the policy effective order through the policy service system, or obtains the policy effective order through the auxiliary entry, and the policy effective order carries the policy number; after the terminal obtains the policy effective order, the terminal confirms the insurance according to the insurance policy number.
  • the code confirms the policy liability and obtains the pre-stored policy liability data.
  • the terminal selects the responsibility attribute corresponding to the policy liability and the responsibility attribute value corresponding to each responsibility attribute from the liability attribute database according to the policy liability data, and generates a scenario corresponding to the policy responsibility.
  • the terminal reads the payment rule data corresponding to the scene information, establishes and stores the corresponding relationship between the scene information and the corresponding compensation rule data, and completes the configuration of the scene information.
  • steps in the flowchart of FIG. 1 are sequentially displayed as indicated by the arrows, these steps are not necessarily performed in the order indicated by the arrows. Except as explicitly stated herein, the execution of these steps is not strictly limited, and the steps may be performed in other orders. Moreover, at least some of the steps in FIG. 1 may include a plurality of sub-steps or stages, which are not necessarily performed at the same time, but may be executed at different times, and the execution of these sub-steps or stages The order is also not necessarily sequential, but may be performed alternately or alternately with other steps or at least a portion of the sub-steps or stages of the other steps.
  • an insurance data processing apparatus 200 includes:
  • the scenario information obtaining module 202 is configured to obtain an input policy number by using the claim service system, and obtain corresponding scenario information according to the policy number, where the scenario information includes multiple responsibility attributes and a responsibility attribute value corresponding to each responsibility attribute;
  • the responsibility attribute matching module 204 is configured to obtain the input responsibility attribute value, obtain the responsibility attribute in the matched scene information according to the input responsibility attribute value, and compare the input responsibility attribute value with the acquired responsibility attribute value corresponding to the acquired responsibility attribute;
  • the claim rule obtaining module 206 is configured to read the compensation rule data corresponding to the pre-stored scene information when the input responsibility attribute value is the same as the acquired responsibility attribute value of the responsibility attribute;
  • the payout module 208 is configured to process the payout rule data to obtain a payout value, generate a payout instruction, and send the payout instruction to the payment platform.
  • the responsibility attribute matching module 204 includes:
  • the attribute level finding submodule 2042 is configured to search for an attribute level of the responsibility attribute corresponding to the input responsibility attribute value
  • the responsibility attribute matching sub-module 2044 is configured to compare the input responsibility attribute value with the responsibility attribute value of the corresponding responsibility attribute in the scene information one by one according to the level of the attribute level until the input responsibility attribute value and the corresponding responsibility attribute in the scene information The responsibility attribute values are not the same.
  • the responsibility attribute matching module 204 further includes:
  • the information reminding sub-module 2046 is configured to display the chargeback information or the manual review reminder information through a pop-up box when the claim responsibility attribute with the highest attribute level priority is different from the scene responsibility attribute value of the corresponding responsibility attribute in the claim scenario.
  • the responsibility attribute matching module 204 further includes:
  • the attribute category obtaining submodule 2047 is configured to obtain an attribute category of the responsibility attribute corresponding to the input responsibility attribute value
  • the responsibility attribute verification sub-module 2048 is configured to: when the attribute category is a billing class, search for a pre-stored corresponding responsibility attribute check table according to the input responsibility attribute value, and generate a responsibility attribute value corresponding to the acquired responsibility attribute for comparison.
  • the responsibility attribute value is sent to the responsibility attribute matching sub-module 2044;
  • the responsibility attribute matching sub-module 2044 compares the received responsibility attribute value for comparing the responsibility attribute value corresponding to the acquired responsibility attribute with the responsibility attribute value corresponding to the acquired responsibility attribute.
  • the above-described insurance data processing apparatus 200 further includes:
  • the policy liability data obtaining module 210 is configured to obtain a policy effective order, the policy effective order carries the policy number, confirms the policy insurance code according to the policy number, and obtains the pre-stored policy liability data according to the policy insurance code;
  • the scenario information generating module 212 is configured to obtain, from the liability attribute database, the responsibility attribute corresponding to the policy liability and the responsibility attribute value corresponding to each responsibility attribute according to the policy liability data, according to the acquired responsibility attribute and the responsibility corresponding to each responsibility attribute.
  • the attribute value generates scene information corresponding to the policy responsibility;
  • the claim rule storage module 214 is configured to read the claim rule data corresponding to the scene information, and establish and store the corresponding relationship between the scene information and the corresponding claim rule data.
  • Each of the above-described insurance data processing devices may be implemented in whole or in part by software, hardware, and combinations thereof.
  • Each of the above modules may be embedded in or independent of the processor in the computer device, or may be stored in a memory in the computer device in a software form, so that the processor invokes the operations corresponding to the above modules.
  • a computer device which may be a server, and its internal structure diagram may be as shown in FIG.
  • the computer device includes a processor, memory, network interface, and database connected by a system bus.
  • the processor of the computer device is used to provide computing and control capabilities.
  • the memory of the computer device includes a non-volatile storage medium, an internal memory.
  • the non-volatile storage medium stores an operating system, computer readable instructions, and a database.
  • the internal memory provides an environment for operation of an operating system and computer readable instructions in a non-volatile storage medium.
  • the database of the computer device is used to store insurance data processing data.
  • the network interface of the computer device is used to communicate with an external terminal via a network connection.
  • the computer readable instructions are executed by the processor to implement an insurance data processing method.
  • FIG. 5 is only a block diagram of a part of the structure related to the solution of the present application, and does not constitute a limitation of the computer device to which the solution of the present application is applied.
  • the specific computer device may It includes more or fewer components than those shown in the figures, or some components are combined, or have different component arrangements.
  • a computer device comprising a memory and one or more processors having stored therein computer readable instructions, the computer readable instructions being executed by the processor such that the one or more processors perform the following steps:
  • the scenario information includes a plurality of responsibility attributes and a responsibility attribute value corresponding to each responsibility attribute;
  • the pre-stored scene information corresponding to the compensation rule data is read;
  • the processor implements the computer readable instructions to compare the entered responsibility attribute value with the responsible attribute value corresponding to the acquired responsibility attribute, including:
  • the input responsibility attribute value is compared with the corresponding responsibility attribute attribute value in the scene information according to the level of the attribute level until the input responsibility attribute value is different from the responsibility attribute value of the corresponding responsibility attribute in the scene information.
  • the input responsibility attribute value is compared one by one according to the attribute level to the responsibility attribute value of the corresponding responsibility attribute in the scene information until the input responsibility attribute value is After the responsibility attribute values of the corresponding responsibility attributes in the scene information are different, they also include:
  • the chargeback information or the manual review reminder information is displayed through a popup box.
  • the processor executes the computer readable instructions, the responsibility attribute in the scene information matching the input responsibility attribute value is obtained, and the input responsibility attribute value and the acquired responsibility attribute value are performed. Comparison, including:
  • the pre-stored corresponding responsibility attribute check table is searched according to the input responsibility attribute value, and the responsibility attribute value for comparing the responsibility attribute value corresponding to the acquired responsibility attribute is generated, and the generated attribute is used for The responsibility attribute value that is compared with the responsibility attribute value corresponding to the acquired responsibility attribute is compared with the responsibility attribute value corresponding to the acquired responsibility attribute.
  • the processor further implements the following steps when executing the computer readable instructions:
  • the terminal obtains the policy effective order, and the policy effective order carries the policy number
  • the claim rule data corresponding to the scenario information is read, and the corresponding relationship between the scenario information and the corresponding payout rule data is established and stored.
  • One or more non-transitory computer readable instruction storage media storing computer readable instructions, when executed by one or more processors, cause one or more processors to perform the steps of:
  • the scenario information includes a plurality of responsibility attributes and a responsibility attribute value corresponding to each responsibility attribute;
  • the pre-stored scene information corresponding to the compensation rule data is read;
  • the program is implemented by the processor to compare the entered responsibility attribute value with the responsible attribute value corresponding to the acquired responsibility attribute, including:
  • the input responsibility attribute value is compared with the corresponding responsibility attribute attribute value in the scene information according to the level of the attribute level until the input responsibility attribute value is different from the responsibility attribute value of the corresponding responsibility attribute in the scene information.
  • the program is executed by the processor to compare the input responsibility attribute value with the responsibility attribute value of the corresponding responsibility attribute in the scene information according to the level of the attribute, until the input responsibility attribute value and the scene are input. After the responsibility attribute values of the corresponding responsibility attributes in the information are different, it also includes:
  • the chargeback information or the manual review reminder information is displayed through a popup box.
  • the program is executed by the processor to compare the responsibility attribute value in the scene information matching the input responsibility attribute value with the responsibility attribute value corresponding to the acquired responsibility attribute.
  • the pre-stored corresponding responsibility attribute check table is searched according to the input responsibility attribute value, and the responsibility attribute value for comparing the responsibility attribute value corresponding to the acquired responsibility attribute is generated, and the generated attribute is used for The responsibility attribute value that is compared with the responsibility attribute value corresponding to the acquired responsibility attribute is compared with the responsibility attribute value corresponding to the acquired responsibility attribute.
  • the program is implemented by the processor to implement the following steps:
  • the terminal obtains the policy effective order, and the policy effective order carries the policy number
  • the claim rule data corresponding to the scenario information is read, and the corresponding relationship between the scenario information and the corresponding payout rule data is established and stored.
  • Non-volatile memory can include read only memory (ROM), programmable ROM (PROM), electrically programmable ROM (EPROM), electrically erasable programmable ROM (EEPROM), or flash memory.
  • Volatile memory can include random access memory (RAM) or external cache memory.
  • RAM is available in a variety of formats, such as static RAM (SRAM), dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDRSDRAM), enhanced SDRAM (ESDRAM), synchronization chain.
  • SRAM static RAM
  • DRAM dynamic RAM
  • SDRAM synchronous DRAM
  • DDRSDRAM double data rate SDRAM
  • ESDRAM enhanced SDRAM
  • Synchlink DRAM SLDRAM
  • Memory Bus Radbus
  • RDRAM Direct RAM
  • DRAM Direct Memory Bus Dynamic RAM
  • RDRAM Memory Bus Dynamic RAM

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Abstract

一种保险数据处理方法，包括：终端获取输入的保单号，根据保单号获取对应的场景信息，场景信息包括多个责任属性及每个责任属性对应的责任属性值；终端获取输入的责任属性值，根据输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较；当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的场景信息对应的赔付规则数据；对赔付规则数据进行处理得到赔付数值，生成赔付指令，将赔付指令发送至支付平台。

Description

保险数据处理方法、装置、计算机设备和存储介质
相关申请的交叉引用
本申请要求于2017年8月30日提交中国专利局，申请号为201710765659X，申请名称为“保险数据处理方法及装置”的中国专利申请的优先权，其全部内容通过引用结合在本申请中。
技术领域
本申请涉及一种保险数据处理方法、装置、计算机设备和存储介质。
背景技术
传统医疗保险理赔方式为人工结算理赔，医疗保险理赔时，需要有保险知识、法律知识、医疗理赔知识的专业人士审核理赔账单、核定保险责任，理算保险金额；然而，发明人意识到，该种医疗保险理赔方式对理赔人员人工劳动强度大、理赔效率低、理赔时效长，且理赔精度容易受理赔人员的经验影响，理赔准确性低。
发明内容
根据本申请公开的各种实施例，提供一种保险数据处理方法、装置、计算机设备和存储介质。
一种保险数据处理方法，包括：
终端通过理赔业务系统获取输入的保单号，根据保单号获取对应的场景信息，场景信息包括多个责任属性及每个责任属性对应的责任属性值；
终端获取输入的责任属性值，根据输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
当输入的责任属性值与获取到的责任属性的责任属性值相同时，终端读取预存的场景信息对应的赔付规则数据；及
终端对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
一种保险数据处理装置，包括：
场景信息获取模块，用于通过理赔业务系统获取输入的保单号，根据保单号获取对应的场景信息，场景信息包括多个责任属性及每个责任属性对应的责任属性值；
责任属性匹配模块，用于获取输入的责任属性值，根据输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
赔付规则获取模块，用于当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的场景信息对应的赔付规则数据；及
赔付模块，用于对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
一种计算机设备，包括存储器和一个或多个处理器，所述存储器中储存有计算机可读指令，所述计算机可读指令被所述处理器执行时，使得所述一个或多个处理器执行以下步骤：
通过理赔业务系统获取输入的保单号，根据保单号获取对应的场景信息，场景信息包括多个责任属性及每个责任属性对应的责任属性值；
获取输入的责任属性值，根据输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的场景信息对应的赔付规则数据；及
对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
一个或多个存储有计算机可读指令的非易失性计算机可读指令存储介质，计算机可读指令被一个或多个处理器执行时，使得一个或多个处理器执行以下步骤：
通过理赔业务系统获取输入的保单号，根据保单号获取对应的场景信息，场景信息包括多个责任属性及每个责任属性对应的责任属性值；
获取输入的责任属性值，根据输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的场景信息对应的赔付规则数据；及
对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
本申请的一个或多个实施例的细节在下面的附图和描述中提出。本申请的其它特征和优点将从说明书、附图以及权利要求书变得明显。
附图说明
为了更清楚地说明本申请实施例中的技术方案，下面将对实施例中所需要使用的附图作简单地介绍，显而易见地，下面描述中的附图仅仅是本申请的一些实施例，对于本领域普通技术人员来讲，在不付出创造性劳动的前提下，还可以根据这些附图获得其它的附图。
图1为根据一个或多个实施例中保险数据处理方法的流程示意图。
图2为根据一个或多个实施例中保险数据处理装置的框图。
图3为根据一个或多个实施例中责任属性匹配模块的框图。
图4为根据又一个或多个实施例中保险数据处理装置的框图。
图5为根据一个或多个实施例中计算机设备的框图。
具体实施方式
为了使本申请的技术方案及优点更加清楚明白，以下结合附图及实施例，对本申请进行进一步详细说明。应当理解，此处所描述的具体实施例仅仅用以解释本申请，并不用于限定本申请。
如图1所示，一种保险数据处理方法，包括以下步骤：
步骤102：终端通过理赔业务系统获取输入的保单号，根据保单号获取对应的场景信息，场景信息包括多个责任属性及每个责任属性对应的责任属性值。
具体地，场景信息与保单责任对应，包括与保单责任对应的多个责任属性及每个责任属性对应的责任属性值。在一些实施例中，责任属性包括事故性质、治疗类型、费用类型、疾病类型、医院性质、医保使用情况等多个与保单约定责任对应的属性。责任属性值为每个责任属性的具体取值，如，事故性质为疾病或意外，或疾病和意外等，治疗类型包括门诊或住院，医院性质是否为定点医院等，其中，疾病或意外等事故具体性质即为事故性质责任属性的责任属性值，门诊、住院等则为治疗类型责任属性的责任属性值，具体么个责任属性的责任属性值根据保单约定的责任定义。
一般的，一个保单可能包括多个保单责任，因此，一个保单号可能对应多个场景信息。在一些实施例中，终端存储场景信息表，场景信息表存储保单号和对应的场景信息，及场景信息对应的责任属性和每个属性的责任属性值，终端通过理赔业务系统获取输入的保单号后根据保单号查找场景信息表获取与保单号对应的所有场景信息。
步骤104：终端获取输入的责任属性值，根据输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较。
具体地，终端通过理赔业务系统获取输入的责任属性值后，根据输入的责任属性值确定该责任属性值对应的责任属性，根据确定的责任属性查找场景信息表，将输入的责任属性值对应的责任属性与步骤102中获取到的场景信息进行匹配，当场景信息中包括相同的责任属性时，输入的责任属性值与场景信息相匹配，此时，终端获取与输入的责任属性值匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较。
步骤106：当输入的责任属性值与获取到的责任属性的责任属性值相同时，终端读取预存的场景信息对应的赔付规则数据。
具体地，当输入的责任属性值与获取到的责任属性的责任属性值相同时，输入的责任属性值与场景信息匹配成功。在一些实施例中，如果输入的责任属性值为多个，则将输入的多个责任属性值均与匹配的场景信息中对应责任属性的责任属性值进行比较，当多个输入的责任属性值均与同一场景信息中的对应责任属性的责任属性值相同时，则输入的多个 责任属性值与场景信息匹配成功。当输入的责任属性值与场景信息匹配成功时，终端读取预存的与该场景信息对应的赔付规则数据，执行步骤108。进一步地，在一些实施例中，如果输入的责任属性值与多个场景信息匹配成功，则终端分别获取每个场景信息对应的赔付规则数据。
步骤108：终端对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
具体地，赔付规则数据包括赔付比例、赔付计算公式等数据。终端获取到赔付规则数据后，根据赔付规则数据对输入的与账单信息相关的责任属性值进行处理，计算得到赔付数值，根据赔付数值生成赔付指令，并将赔付指令发送至支付平台，由支付平台完成理赔支付。进一步地，当输入的责任属性值与多个场景信息匹配成功，终端获取多个场景信息对应的赔付规则数据时，终端分别根据获取到的每个场景信息对应的赔付规则数据进行处理得到多个赔付数值，并选取多个赔付数值中最大的赔付数值生成赔付指令发送至支付平台。
上述保险数据处理方法，通过理赔业务系统获取输入的保单号，确定保单号对应的场景信息；再根据获取到的输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较；当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的场景信息对应的赔付规则数据，对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。上述保险数据处理方法通过将输入的责任属性值与预存的场景信息匹配获取赔付规则数据进行理赔结算，实现了医疗保险保单自动理赔结算，大大提高了理赔效率，有效节约理赔时效，且有效避免了人为因素对理赔准确性的影响，大大提高了理赔精度。
在一些实施例中，步骤104中，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较的步骤包括：查找输入的责任属性值对应的责任属性的属性级别；按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同。
具体地，终端预先存储属性级别分类表，属性级别分类表存储责任属性与对应的属性级别的对应关系，具体责任属性的属性级别可根据属性重要程度进行划分，或者也可以根据匹配频率设置，还可根据实际需要设定其它划分原则，本实施例并不做具体限定。如，在一些实施例中，以意外医疗责任为例，按照属性重要程度进行划分，将责任属性分为两个属性级别，定义事故性质、细化治疗类型、费用项目等核心责任属性的属性级别为第一级；手术等级、职业类别、工伤使用情况等责任属性的属性级别为第二级。终端获取到输入的责任属性值后，根据输入的责任属性值对应的责任属性查找属性级别分类表，获取每个责任属性值对应的责任属性的属性级别，之后按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同。如果输入的责任属性值与场景信息中对应的 责任属性的责任属性值均相同，则场景信息匹配成功，终端读取预存的场景信息对应的赔付规则数据并执行步骤108，进行理赔赔付操作。如果输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同，则结束场景信息匹配，场景信息匹配失败，本次理赔失败。
本实施例中，根据责任属性值对应的责任属性的责任级别对输入的责任属性值进行分级匹配，如果第一级别的责任属性则匹配成功，继续匹配第二级别的责任属性值，否则，如果第一级别的责任属性值匹配不成功，则不再继续比较下一级别的责任属性值，场景信息匹配结束，从而使得在输入的责任属性值与场景信息不匹配时，无需将输入的责任属性值全部与场景信息中对应的责任属性的责任属性值全部进行比较再得出匹配结果，有助于进一步提高匹配效率。
以上以责任属性分为两个属性级别进行说明，但是，需要说明的是，在具体应用中可根据实际应用情况任意设置责任属性的分级级数，例如，可以多于两个属性级别也可以少于两个属性级别，本实施例并不做具体限定。
在一些实施例中，上述按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同的步骤之后，还包括：当输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同时，通过弹出框显示拒付信息或人工审核提醒信息。
具体地，不同责任属性的属性性质不同，当输入的责任属性值与场景信息中的对应的责任属性的责任属性值不相同时，采用的处理方式也不同，本实施例中，预先根据责任属性的内容定义责任属性不匹配时的处理方式，具体处理方式包括提示人工审核或直接拒付。如，仍以上述意外医疗责任为例，事故性质、细化治疗类型、费用项目等核心责任属性的责任属性值不相同时，直接拒付；而手术等级责任属性则需要人工评估具体等级，职业类别、工伤使用情况等责任属性需要人工选择具体值，该类非直接拒付的责任属性的责任属性值不相同时，输出人工审核提醒信息。属性级别分类表中还存储有责任属性值不相同时对应的提醒信息内容，当输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同时，终端查找属性级别分类表，获取责任属性对应的提醒信息并通过弹出框显示提醒信息，具体提醒信息包括拒付信息或人工审核提醒信息。
具体地，上述实施例中，终端根据获取到的录入信息(如治疗医院、治疗类型、临床诊断、帐单类型)确定责任属性，获取输入的责任属性值，生成理赔案件的责任属性表，记录该案件的责任属性和责任属性值，之后进行第一级别责任属性匹配，以意外医疗责任为例，将输入的三个核心责任属性的责任属性值(事故性质、细化治疗类型、费用项目)与和意外医疗责任相匹配的场景信息中的责任属性对应的责任属性值进行比较，若输入的三个责任属性的责任属性值均与场景信息中责任属性对应的责任属性值一致，则第一级别的核心责任属性匹配通过，进行第二级别的责任属性匹配，若其中有一个责任属性值不一致，则直接拒付。如果第一级别的责任属性匹配成功，则根据第一级别匹配上的场景信息， 进一步将输入的第二级别的责任属性值与匹配上的场景信息中对应责任属性的责任属性值进行比较，如果所有输入的第二级别的责任属性值均与场景信息中对应责任属性的责任属性值相同，则场景信息匹配成功，理赔案件匹配上该场景信息，可以根据此场景信息进行自动结算，此时，终端获取该场景信息对应的赔付规则，根据赔付规则计算赔付数值。输入的第二级别的责任属性值与场景信息中对应责任属性的责任属性值不相同，则匹配失败，终端查找属性级别分类表获取该责任属性值对应的提醒信息，并通过弹出框输出显示获取到的提醒信息，如提示人工选择具体的属性值重新进行场景匹配提醒信息或人工审核评估提醒信息，及自动拒付提醒及拒付原因分析信息等。
进一步的，在一些实施例中，为了进一步提高匹配效率，还可以在第一级别责任属性匹配前先进行保单责任匹配，如，终端根据获取到的录入信息(如治疗医院、治疗类型、临床诊断、帐单类型)确定理赔责任(意外医疗责任)，将确定的理赔责任与步骤102中根据保单号获取的场景信息进行匹配，比较场景信息对应的保单责任是否与理赔责任相同，如果二者相同，则理赔责任匹配成功，进一步进行第一级别责任属性匹配，如果二者不相同，则直接拒付或提示人工审核，场景信息匹配结束。
在一些实施例中，根据与输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较的步骤，包括：获取与输入的责任属性值对应的责任属性的属性类别；当属性类别为账单类时，根据输入的责任属性值查找预存的对应的责任属性校验表，生成用于与获取的责任属性对应的责任属性值进行比较的责任属性值，将生成的用于与获取的责任属性对应的责任属性值进行比较的责任属性值与获取的责任属性对应的责任属性值进行比较。
具体地，本实施例中，根据责任属性的录入方式划分责任属性的责任属性类别，责任属性类别包括前置人工责任属性、帐单类责任属性和理算页面人工干预责任属性三个类别，其中，前置人工责任属性与理赔材料有关，与账单无关，辅助录入时可在理赔业务系统录入页面直接选择确认，包括交通责任、是否出差、是否职业病、是否工作意外及出险时身份等责任属性。理算页面人工干预责任属性在人工审核理算页面进行录入，人工审核时根据理赔资料录入相应属性值后再重新进行场景信息匹配，包括职业类别、疾病类型、医疗事故等级、残疾比例标准、工伤使用情况、生育保险使用情况等责任属性。账单类责任属性和账单内容有关，辅助录入后终端对理赔责任属性值进行校验后生成用于与获取的责任属性对应的责任属性值进行比较的责任属性值进行场景信息匹配，如，对于定点医院属性，辅助录入时录入人员无法确认账单上的就诊医院是否为定点医院，录入人员根据账单录入医院名称，获取到医院名称后，终端查找责任属性校验表进行定点医院校验，如果在责任属性校验表中查找到录入的医院名称，则生成是定点医院的责任属性值，否则，生成不是定点医院的责任属性值。本实施例中，账单类责任属性包括事故类型、细化治疗类型、费用项目、出险地、费用类型、就诊次数限制、事故时间、定点医院、医保使用情况、手术类型等属性。
在一些实施例中，上述保险数据处理方法还包括：终端获取保单生效指令，保单生效指令携带保单号；根据保单号确认保单险种代码，并根据保单险种代码获取预存的保单责任数据；根据保单责任数据从责任属性数据库中获取与保单责任对应的责任属性及每个责任属性对应的责任属性值，根据获取到的责任属性及每个责任属性对应的责任属性值生成与保单责任对应的场景信息；读取与场景信息对应的赔付规则数据，建立并存储场景信息与对应的赔付规则数据的对应关系。
具体地，场景信息根据保单责任定义，终端预先存储责任属性数据库，责任属性数据库中存储医疗保险理赔相关的多个责任属性及对应的责任属性值。本实施例中，当保单生效后，终端通过保单服务系统获取保单生效指令，或通过辅助录入获取保单生效指令，保单生效指令携带保单号；终端获取到保单生效指令后，根据保险单号确认险种代码确认保单责任，获取预存的保单责任数据；之后，终端根据保单责任数据从责任属性库中选取与保单责任对应的责任属性及每个责任属性对应的责任属性值，生成与保单责任对应的场景信息；最后，终端读取与场景信息对应的赔付规则数据，建立并存储场景信息与对应的赔付规则数据的对应关系，完成场景信息配置。
应该理解的是，虽然图1的流程图中的各个步骤按照箭头的指示依次显示，但是这些步骤并不是必然按照箭头指示的顺序依次执行。除非本文中有明确的说明，这些步骤的执行并没有严格的顺序限制，这些步骤可以以其它的顺序执行。而且，图1中的至少一部分步骤可以包括多个子步骤或者多个阶段，这些子步骤或者阶段并不必然是在同一时刻执行完成，而是可以在不同的时刻执行，这些子步骤或者阶段的执行顺序也不必然是依次进行，而是可以与其它步骤或者其它步骤的子步骤或者阶段的至少一部分轮流或者交替地执行。
请参阅图2，一种保险数据处理装置200，包括：
场景信息获取模块202，用于通过理赔业务系统获取输入的保单号，根据保单号获取对应的场景信息，场景信息包括多个责任属性及每个责任属性对应的责任属性值；
责任属性匹配模块204，用于获取输入的责任属性值，根据输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
赔付规则获取模块206，用于当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的场景信息对应的赔付规则数据；
赔付模块208，用于对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
如图3所示，在一些实施例中，责任属性匹配模块204包括：
属性级别查找子模块2042，用于查找输入的责任属性值对应的责任属性的属性级别；
责任属性匹配子模块2044，用于按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同。
在一些实施例中，责任属性匹配模块204还包括：
信息提醒子模块2046，用于当属性级别优先级高的理赔责任属性与理赔场景中对应责任属性的场景责任属性值不同时，通过弹出框显示拒付信息或人工审核提醒信息。
在一些实施例中，责任属性匹配模块204还包括：
属性类别获取子模块2047，用于获取与输入的责任属性值对应的责任属性的属性类别；
责任属性校验子模块2048，用于当属性类别为账单类时，根据输入的责任属性值查找预存的对应的责任属性校验表，生成用于与获取的责任属性对应的责任属性值进行比较的责任属性值发送至责任属性匹配子模块2044；
责任属性匹配子模块2044将接收到的用于与获取的责任属性对应的责任属性值进行比较的责任属性值与获取的责任属性对应的责任属性值进行比较。
如图4所示，在一些实施例中，上述保险数据处理装置200还包括：
保单责任数据获取模块210，用于获取保单生效指令，保单生效指令携带保单号，根据保单号确认保单险种代码，并根据保单险种代码获取预存的保单责任数据；
场景信息生成模块212，用于根据保单责任数据从责任属性数据库中获取与保单责任对应的责任属性及每个责任属性对应的责任属性值，根据获取到的责任属性及每个责任属性对应的责任属性值生成与保单责任对应的场景信息；
赔付规则存储模块214，用于读取与场景信息对应的赔付规则数据，建立并存储场景信息与对应的赔付规则数据的对应关系。
关于保险数据处理装置的具体限定可以参见上文中对于保险数据处理方法的限定，在此不再赘述。上述保险数据处理装置中的各个模块可全部或部分通过软件、硬件及其组合来实现。上述各模块可以硬件形式内嵌于或独立于计算机设备中的处理器中，也可以以软件形式存储于计算机设备中的存储器中，以便于处理器调用执行以上各个模块对应的操作。
在一个实施例中，提供了一种计算机设备，该计算机设备可以是服务器，其内部结构图可以如图5所示。该计算机设备包括通过系统总线连接的处理器、存储器、网络接口和数据库。其中，该计算机设备的处理器用于提供计算和控制能力。该计算机设备的存储器包括非易失性存储介质、内存储器。该非易失性存储介质存储有操作系统、计算机可读指令和数据库。该内存储器为非易失性存储介质中的操作系统和计算机可读指令的运行提供环境。该计算机设备的数据库用于存储保险数据处理数据。该计算机设备的网络接口用于与外部的终端通过网络连接通信。该计算机可读指令被处理器执行时以实现一种保险数据处理方法。
本领域技术人员可以理解，图5中示出的结构，仅仅是与本申请方案相关的部分结构的框图，并不构成对本申请方案所应用于其上的计算机设备的限定，具体的计算机设备可以包括比图中所示更多或更少的部件，或者组合某些部件，或者具有不同的部件布置。
一种计算机设备，包括存储器和一个或多个处理器，存储器中储存有计算机可读指令，计算机可读指令被处理器执行时，使得一个或多个处理器执行以下步骤：
通过理赔业务系统获取输入的保单号，根据保单号获取对应的场景信息，场景信息包括多个责任属性及每个责任属性对应的责任属性值；
获取输入的责任属性值，根据输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的场景信息对应的赔付规则数据；及
对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
在一些实施例中，处理器执行计算机可读指令时实现的将输入的责任属性值与获取的责任属性对应的责任属性值进行比较，包括：
查找输入的责任属性值对应的责任属性的属性级别；及
按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同。
在一些实施例中，处理器执行计算机可读指令时实现的按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同之后，还包括：
当输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同时，通过弹出框显示拒付信息或人工审核提醒信息。
在一些实施例中，处理器执行计算机可读指令时实现的根据与输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较，包括：
获取与输入的责任属性值对应的责任属性的属性类别；及
当属性类别为账单类时，根据输入的责任属性值查找预存的对应的责任属性校验表，生成用于与获取的责任属性对应的责任属性值进行比较的责任属性值，将生成的用于与获取的责任属性对应的责任属性值进行比较的责任属性值与获取的责任属性对应的责任属性值进行比较。
在一些实施例中，处理器执行计算机可读指令时还实现以下步骤：
终端获取保单生效指令，保单生效指令携带保单号；
根据保单号确认保单险种代码，并根据保单险种代码获取预存的保单责任数据；
根据保单责任数据从责任属性数据库中获取与保单责任对应的责任属性及每个责任属性对应的责任属性值，根据获取到的责任属性及每个责任属性对应的责任属性值生成与保单责任对应的场景信息；及
读取与场景信息对应的赔付规则数据，建立并存储场景信息与对应的赔付规则数据的对应关系。
一个或多个存储有计算机可读指令的非易失性计算机可读指令存储介质，计算机可读指令被一个或多个处理器执行时，使得一个或多个处理器执行以下步骤：
通过理赔业务系统获取输入的保单号，根据保单号获取对应的场景信息，场景信息包括多个责任属性及每个责任属性对应的责任属性值；
获取输入的责任属性值，根据输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的场景信息对应的赔付规则数据；及
对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
在一些实施例中，该程序被处理器执行时实现的将输入的责任属性值与获取的责任属性对应的责任属性值进行比较，包括：
查找输入的责任属性值对应的责任属性的属性级别；及
按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同。
在一些实施例中，该程序被处理器执行时实现的按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同之后，还包括：
当输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同时，通过弹出框显示拒付信息或人工审核提醒信息。
在一些实施例中，该程序被处理器执行时实现的根据与输入的责任属性值获取匹配的场景信息中的责任属性，将输入的责任属性值与获取的责任属性对应的责任属性值进行比较，包括：
获取与输入的责任属性值对应的责任属性的属性类别；及
当属性类别为账单类时，根据输入的责任属性值查找预存的对应的责任属性校验表，生成用于与获取的责任属性对应的责任属性值进行比较的责任属性值，将生成的用于与获取的责任属性对应的责任属性值进行比较的责任属性值与获取的责任属性对应的责任属性值进行比较。
在一些实施例中，该程序被处理器执行时实现以下步骤：
终端获取保单生效指令，保单生效指令携带保单号；
根据保单号确认保单险种代码，并根据保单险种代码获取预存的保单责任数据；
根据保单责任数据从责任属性数据库中获取与保单责任对应的责任属性及每个责任 属性对应的责任属性值，根据获取到的责任属性及每个责任属性对应的责任属性值生成与保单责任对应的场景信息；及
读取与场景信息对应的赔付规则数据，建立并存储场景信息与对应的赔付规则数据的对应关系。
本领域普通技术人员可以理解实现上述实施例方法中的全部或部分流程，是可以通过计算机可读指令来指令相关的硬件来完成，所述的计算机可读指令可存储于一非易失性计算机可读取存储介质中，该计算机可读指令在执行时，可包括如上述各方法的实施例的流程。其中，本申请所提供的各实施例中所使用的对存储器、存储、数据库或其它介质的任何引用，均可包括非易失性和/或易失性存储器。非易失性存储器可包括只读存储器(ROM)、可编程ROM(PROM)、电可编程ROM(EPROM)、电可擦除可编程ROM(EEPROM)或闪存。易失性存储器可包括随机存取存储器(RAM)或者外部高速缓冲存储器。作为说明而非局限，RAM以多种形式可得，诸如静态RAM(SRAM)、动态RAM(DRAM)、同步DRAM(SDRAM)、双数据率SDRAM(DDRSDRAM)、增强型SDRAM(ESDRAM)、同步链路(Synchlink)DRAM(SLDRAM)、存储器总线(Rambus)直接RAM(RDRAM)、直接存储器总线动态RAM(DRDRAM)、以及存储器总线动态RAM(RDRAM)等。
以上实施例的各技术特征可以进行任意的组合，为使描述简洁，未对上述实施例中的各个技术特征所有可能的组合都进行描述，然而，只要这些技术特征的组合不存在矛盾，都应当认为是本说明书记载的范围。
以上所述实施例仅表达了本申请的几种实施方式，其描述较为具体和详细，但并不能因此而理解为对发明专利范围的限制。应当指出的是，对于本领域的普通技术人员来说，在不脱离本申请构思的前提下，还可以做出若干变形和改进，这些都属于本申请的保护范围。因此，本申请专利的保护范围应以所附权利要求为准。

Claims (20)

  1. 一种保险数据处理方法，包括：
    终端通过理赔业务系统获取输入的保单号，根据所述保单号获取对应的场景信息，所述场景信息包括多个责任属性及每个责任属性对应的责任属性值；
    终端获取输入的责任属性值，根据所述输入的责任属性值获取匹配的场景信息中的责任属性，将所述输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
    当输入的责任属性值与获取到的责任属性的责任属性值相同时，终端读取预存的所述场景信息对应的赔付规则数据；及
    所述终端对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
  2. 根据权利要求1所述的方法，其特征在于，所述将所述输入的责任属性值与获取的责任属性对应的责任属性值进行比较，包括：
    查找所述输入的责任属性值对应的责任属性的属性级别；及
    按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同。
  3. 根据权利要求2所述的方法，其特征在于，所述按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同之后，还包括：
    当输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同时，通过弹出框显示拒付信息或人工审核提醒信息。
  4. 根据权利要求1所述的方法，其特征在于，所述根据与所述输入的责任属性值获取匹配的场景信息中的责任属性，将所述输入的责任属性值与获取的责任属性对应的责任属性值进行比较，包括：
    获取与所述输入的责任属性值对应的责任属性的属性类别；及
    当所述属性类别为账单类时，根据所述输入的责任属性值查找预存的对应的责任属性校验表，生成用于与获取的责任属性对应的责任属性值进行比较的责任属性值，将生成的用于与获取的责任属性对应的责任属性值进行比较的责任属性值与获取的责任属性对应的责任属性值进行比较。
  5. 根据权利要求1所述的方法，其特征在于，还包括：
    终端获取保单生效指令，所述保单生效指令携带保单号；
    根据所述保单号确认保单险种代码，并根据所述保单险种代码获取预存的保单责任数据；
    根据所述保单责任数据从责任属性数据库中获取与所述保单责任对应的责任属性及每个责任属性对应的责任属性值，根据获取到的责任属性及每个责任属性对应的责任属性 值生成与所述保单责任对应的场景信息；及
    读取与所述场景信息对应的赔付规则数据，建立并存储所述场景信息与对应的赔付规则数据的对应关系。
  6. 一种保险数据处理装置，包括：
    场景信息获取模块，用于通过理赔业务系统获取输入的保单号，根据所述保单号获取对应的场景信息，所述场景信息包括多个责任属性及每个责任属性对应的责任属性值；
    责任属性匹配模块，用于获取输入的责任属性值，根据所述输入的责任属性值获取匹配的场景信息中的责任属性，将所述输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
    赔付规则获取模块，用于当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的所述场景信息对应的赔付规则数据；及
    赔付模块，用于对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
  7. 根据权利要求6所述的装置，其特征在于，所述责任属性匹配模块包括：
    属性级别查找子模块，用于查找所述输入的责任属性值对应的责任属性的属性级别；及
    责任属性匹配子模块，用于按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同。
  8. 根据权利要求7所述的装置，其特征在于，所述责任属性匹配模块还包括：
    信息提醒子模块，用于当所述属性级别优先级高的理赔责任属性与所述理赔场景中对应责任属性的场景责任属性值不同时，通过弹出框显示拒付信息或人工审核提醒信息。
  9. 根据权利要求6所述的装置，其特征在于，所述责任属性匹配模块还包括：
    属性类别获取子模块，用于获取与输入的责任属性值对应的责任属性的属性类别；
    责任属性校验子模块，用于当属性类别为账单类时，根据输入的责任属性值查找预存的对应的责任属性校验表，生成用于与获取的责任属性对应的责任属性值进行比较的责任属性值发送至责任属性匹配子模块；及
    责任属性匹配子模块将接收到的用于与获取的责任属性对应的责任属性值进行比较的责任属性值与获取的责任属性对应的责任属性值进行比较。
  10. 根据权利要求6所述的装置，其特征在于，所述装置还包括：
    保单责任数据获取模块，用于获取保单生效指令，保单生效指令携带保单号，根据保单号确认保单险种代码，并根据保单险种代码获取预存的保单责任数据；
    场景信息生成模块，用于根据保单责任数据从责任属性数据库中获取与保单责任对应的责任属性及每个责任属性对应的责任属性值，根据获取到的责任属性及每个责任属性对应的责任属性值生成与保单责任对应的场景信息；及
    赔付规则存储模块，用于读取与场景信息对应的赔付规则数据，建立并存储场景信息与对应的赔付规则数据的对应关系。
  11. 一种计算机设备，包括存储器及一个或多个处理器，所述存储器中储存有计算机可读指令，所述计算机可读指令被所述一个或多个处理器执行时，使得所述一个或多个处理器执行以下步骤：
    通过理赔业务系统获取输入的保单号，根据所述保单号获取对应的场景信息，所述场景信息包括多个责任属性及每个责任属性对应的责任属性值；
    获取输入的责任属性值，根据所述输入的责任属性值获取匹配的场景信息中的责任属性，将所述输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
    当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的所述场景信息对应的赔付规则数据；及
    对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
  12. 根据权利要求11所述的计算机设备，其特征在于，所述处理器执行所述计算机可读指令时执行的所述将所述输入的责任属性值与获取的责任属性对应的责任属性值进行比较，包括：
    查找所述输入的责任属性值对应的责任属性的属性级别；及
    按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同。
  13. 根据权利要求12所述的计算机设备，其特征在于，所述处理器执行所述计算机可读指令时执行的所述按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同之后，还包括：
    当输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同时，通过弹出框显示拒付信息或人工审核提醒信息。
  14. 根据权利要求11所述的计算机设备，其特征在于，所述处理器执行所述计算机可读指令时执行的所述根据与所述输入的责任属性值获取匹配的场景信息中的责任属性，将所述输入的责任属性值与获取的责任属性对应的责任属性值进行比较，包括：
    获取与所述输入的责任属性值对应的责任属性的属性类别；及
    当所述属性类别为账单类时，根据所述输入的责任属性值查找预存的对应的责任属性校验表，生成用于与获取的责任属性对应的责任属性值进行比较的责任属性值，将生成的用于与获取的责任属性对应的责任属性值进行比较的责任属性值与获取的责任属性对应的责任属性值进行比较。
  15. 根据权利要求11所述的计算机设备，其特征在于，所述处理器执行所述计算机 可读指令时还执行以下步骤：
    终端获取保单生效指令，所述保单生效指令携带保单号；
    根据所述保单号确认保单险种代码，并根据所述保单险种代码获取预存的保单责任数据；
    根据所述保单责任数据从责任属性数据库中获取与所述保单责任对应的责任属性及每个责任属性对应的责任属性值，根据获取到的责任属性及每个责任属性对应的责任属性值生成与所述保单责任对应的场景信息；及
    读取与所述场景信息对应的赔付规则数据，建立并存储所述场景信息与对应的赔付规则数据的对应关系。
  16. 一个或多个存储有计算机可读指令的非易失性计算机可读指令存储介质，所述计算机可读指令被一个或多个处理器执行时，使得所述一个或多个处理器执行以下步骤：
    通过理赔业务系统获取输入的保单号，根据所述保单号获取对应的场景信息，所述场景信息包括多个责任属性及每个责任属性对应的责任属性值；
    获取输入的责任属性值，根据所述输入的责任属性值获取匹配的场景信息中的责任属性，将所述输入的责任属性值与获取的责任属性对应的责任属性值进行比较；
    当输入的责任属性值与获取到的责任属性的责任属性值相同时，读取预存的所述场景信息对应的赔付规则数据；及
    对赔付规则数据进行处理得到赔付数值，生成赔付指令，并将赔付指令发送至支付平台。
  17. 根据权利要求16所述的存储介质，其特征在于，所述计算机可读指令被所述处理器执行时执行所述将所述输入的责任属性值与获取的责任属性对应的责任属性值进行比较的步骤，包括：
    查找所述输入的责任属性值对应的责任属性的属性级别；及
    按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同。
  18. 根据权利要求17所述的存储介质，其特征在于，所述计算机可读指令被所述处理器执行时执行所述按照属性级别的高低逐个将输入的责任属性值与场景信息中对应的责任属性的责任属性值进行比较，直到输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同的步骤之后，所述方法还包括：
    当输入的责任属性值与场景信息中对应的责任属性的责任属性值不相同时，通过弹出框显示拒付信息或人工审核提醒信息。
  19. 根据权利要求16所述的存储介质，其特征在于，所述计算机可读指令被所述处理器执行时执行所述根据与所述输入的责任属性值获取匹配的场景信息中的责任属性，将所述输入的责任属性值与获取的责任属性对应的责任属性值进行比较的步骤，包括：
    获取与所述输入的责任属性值对应的责任属性的属性类别；及
    当所述属性类别为账单类时，根据所述输入的责任属性值查找预存的对应的责任属性校验表，生成用于与获取的责任属性对应的责任属性值进行比较的责任属性值，将生成的用于与获取的责任属性对应的责任属性值进行比较的责任属性值与获取的责任属性对应的责任属性值进行比较。
  20. 根据权利要求16所述的存储介质，其特征在于，所述计算机可读指令被所述处理器执行时还执行以下步骤：
    终端获取保单生效指令，所述保单生效指令携带保单号；
    根据所述保单号确认保单险种代码，并根据所述保单险种代码获取预存的保单责任数据；
    根据所述保单责任数据从责任属性数据库中获取与所述保单责任对应的责任属性及每个责任属性对应的责任属性值，根据获取到的责任属性及每个责任属性对应的责任属性值生成与所述保单责任对应的场景信息；及
    读取与所述场景信息对应的赔付规则数据，建立并存储所述场景信息与对应的赔付规则数据的对应关系。
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