WO2019056729A1

WO2019056729A1 - Coverage pre-check method, device, storage medium and terminal

Info

Publication number: WO2019056729A1
Application number: PCT/CN2018/081511
Authority: WO
Inventors: 伏宜兴; 李胜胜
Original assignee: 平安科技（深圳）有限公司
Priority date: 2017-09-25
Filing date: 2018-04-02
Publication date: 2019-03-28
Also published as: CN107844947A

Abstract

The present application is applicable to the technical field of communications, and provides a coverage pre-check method, device, storage medium and terminal, the method comprising: according to an accident date and a customer number, acquiring insurance benefit information corresponding to an applicant when performing self-service claim reporting; querying the insurance benefit information according to reason for application, treatment type and insurance category, and acquiring a medical liability insurance category applicable to the present self-service claim; calculating the remaining claim amount of the medical liability insurance category for each medical liability insurance category; verifying whether the remaining claim amount is a preset value, and if the verification result is positive, outputting a prompt message on a reporting interface that the medical liability insurance category cannot be claimed, and/or, configuring a claim application identifier of the medical liability insurance category on the reporting interface to be hidden or non-usable. The present application reduces the amount of cases received for which a payment is refused, and solves the problem of the existing technology wherein claim efficiency is low because all self-service claim reports are allowed to be submitted according to normal claimable cases.

Description

Method, device, storage medium and terminal for pre-checking

This application is based on the Chinese invention patent application filed on September 25, 2017, with the application number of 201710873190.1, entitled "Method, Device, Storage Medium and Terminal for Pre-Verification Check", and requires priority.

Technical field

The present application belongs to the field of communications technologies, and in particular, to a method, an apparatus, a storage medium, and a terminal for a guaranteed amount of pre-check.

Background technique

For some claims cases, the user can initiate self-service claims through the APP on the mobile terminal, realizing the operation of claiming with the geographic compensation at any time, greatly improving the user's experience. After multiple claims, some of the user's insurance policies may have expired or the insurance amount is insufficient. For these claims, the claim system is refused. However, in the prior art, when the self-service claims are initiated by the APP, the user fails to know the insurance amount information of the policy, and all the self-service claims reports are submitted according to the normal solvable claims, and then the insurance amount verification and the chargeback are completed in the claims accounting section. The notice greatly increased the workload of the background claims operators, which in turn affected the claims efficiency.

Summary of the invention

The embodiment of the present application provides a method, a device, a storage medium, and a terminal for guaranteeing pre-checking, so as to solve the problem that the prior art allows all self-service claims to be submitted in a normal solvable case, resulting in low claim efficiency.

In a first aspect, a method of preserving a pre-check, the method comprising:

When the self-service claim is filed, the benefit information corresponding to the claim applicant is obtained according to the date of the insurance and the customer number;

Obtain the application reason, treatment type and insurance type of the self-service claim, and query the benefit information according to the application reason, treatment type and insurance type, and obtain the medical liability insurance applicable to the self-service claim;

Calculating the remaining claims amount of the medical liability insurance for each type of medical liability insurance;

Verifying whether the remaining insured amount is a preset value, and when the verification result is YES, outputting the medical liability insurance type unrecognizable prompt information on the reporting interface, and/or, the medical liability insurance type on the reporting interface The claim application identifier is set to be hidden or unavailable;

The customer number is the unique identification information of the claim applicant in the claim system, and the database is queried according to the name, document type, document number, gender and date of birth of the claim applicant when the claimant registers the user account. get.

Further, the obtaining the benefit information corresponding to the claim applicant according to the date of the insurance and the customer number includes:

Querying the claim database according to the customer number, and obtaining the policy number of the claim applicant as the insured;

Obtaining the sub-order number corresponding to the claim applicant under the policy number and the insurance information included in the sub-order number;

Querying the order number and the insurance type information according to the date of the insurance, and obtaining the solvable insurance type applicable to the claim applicant.

Further, the inquiring the benefit information according to the application reason, the type of treatment, and the type of insurance, and obtaining the medical liability insurance applicable to the self-service claim include:

Responsible matching of the claimable insurance species according to the reason for the application, the type of treatment, and the type of insurance;

Obtain the types of claims that meet the reasons for the application and the type of treatment as the medical liability insurance for this self-service claim.

Further, the calculating the remaining claim amount of the medical liability insurance includes:

For each medical liability insurance type, obtaining a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

Obtain the amount of claims corresponding to each historical claim record;

Calculating a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.

In a second aspect, a device for insured pre-verification, the device comprising:

The obtaining module is configured to obtain the benefit information corresponding to the claim applicant according to the date of the insurance and the customer number when performing the self-service claim declaration;

The query module is configured to obtain the application reason, the type of treatment and the type of insurance of the self-service claim, and query the benefit information according to the application reason, the type of treatment and the type of insurance, and obtain the medical liability insurance applicable to the self-service claim;

a calculation module, configured to calculate a remaining claim amount of the medical liability insurance for each medical liability insurance type;

a verification module, configured to verify whether the remaining claims amount is a preset value, and when the verification result is yes, outputting the medical liability insurance type unrecognizable prompt information on the reporting interface, and/or, the reporting interface The claims application identifier of the medical liability insurance is hidden or unavailable;

Further, the obtaining module includes:

a first obtaining unit, configured to query a claim database according to the customer number, and obtain the policy number of the claim applicant as the insured;

a second obtaining unit, configured to obtain a sub-order number corresponding to the claim applicant under the policy number and the insurance information included in the sub-order number;

And a third obtaining unit, configured to query the information of the order number and the insurance type according to the date of the insurance, and obtain a claimable insurance type applicable to the claim applicant.

Further, the query module includes:

a matching unit, configured to perform responsibility matching on the chargeable insurance according to the application reason, the type of treatment, and the type of insurance;

The insurance acquisition unit is configured to obtain a medical insurance product that meets the reason for the application and the type of treatment as the medical liability insurance for the self-service claim.

Further, the calculation module includes:

a claim record obtaining unit, configured to obtain, for each medical liability insurance type, a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

The claim amount obtaining unit is configured to obtain the amount of the claim corresponding to each historical claim record;

The calculating unit is configured to calculate a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.

A third aspect, one or more non-volatile readable storage media storing computer readable instructions, when executed by one or more processors, causing said one or more processors to execute The following steps:

In a fourth aspect, the embodiment of the present application further provides a terminal, including a memory, a processor, and computer readable instructions stored on the memory and executable on the processor, when the processor executes the computer readable instruction Implement the following steps:

Verifying whether the remaining claims amount is a preset value, and when the verification result is YES, outputting the medical liability insurance type unrecognizable prompt information on the reporting interface, and/or, the medical liability insurance type on the reporting interface The claim application identifier is set to be hidden or unavailable;

Details of one or more embodiments of the present application are set forth in the accompanying drawings and description below. Other features and advantages of the present invention will be apparent from the description, drawings and claims.

DRAWINGS

In order to more clearly illustrate the embodiments of the present application or the technical solutions in the prior art, the drawings to be used in the embodiments or the prior art description will be briefly described below. Obviously, the drawings in the following description are only It is a certain embodiment of the present application, and other drawings can be obtained according to the drawings without any creative work for those skilled in the art.

1 is a first implementation flowchart of a method for guarantee pre-checking provided by an embodiment of the present application;

2 is a second implementation flowchart of a method for guarantee pre-checking provided by an embodiment of the present application;

3 is a third implementation flowchart of a method for guarantee pre-checking provided by an embodiment of the present application;

4 is a fourth implementation flowchart of a method for guarantee pre-checking provided by an embodiment of the present application;

FIG. 5 is a structural diagram of a device for performing a pre-check according to an embodiment of the present application; FIG.

FIG. 6 is a schematic diagram of a terminal provided by an embodiment of the present application.

Detailed ways

In order to make the objects, technical solutions, and advantages of the present application more comprehensible, the present application will be further described in detail below with reference to the accompanying drawings and embodiments. It is understood that the specific embodiments described herein are merely illustrative of the application and are not intended to be limiting.

Although through the APP, users can file self-service claims anytime and anywhere, which greatly facilitates the user and enhances the user experience. However, if the policy for the user to initiate the self-service claim has expired or the insurance amount is insufficient, the claim system is refused to pay. The existing self-service claims technology allows all self-service claims to be submitted in normal solvable cases, and then enters the claims accounting process before the self-service claims are insured. It can be seen that the cases in which these claims systems refuse to pay greatly increase the workload of claimants. In view of this, the embodiment of the present application implements the insured verification from the claims accounting link to the reporting link, and realizes the function of the pre-inspection of the insured amount, and can reduce the receiving amount of the refusal case in the reporting stage of the self-service claims.

FIG. 1 shows a first implementation flow of a method for guarantee pre-checking provided by an embodiment of the present application. Referring to FIG. 1, the method for the pre-validation check includes:

In step S101, when the self-service claim is issued, the benefit information corresponding to the claim applicant is obtained according to the date of the insurance and the customer number.

Here, the customer number is the unique identification information of the claim applicant in the claim system, and is calculated according to the name, document type, document number, gender and date of birth of the claim applicant when the claim applicant is registered.

In the embodiment of the present application, the self-service claims report refers to initiating a claim declaration on the designated APP. Therefore, the embodiment of the present application requires the user who applies for the self-service claim to log in to the designated APP in advance, and inputs five basic information to complete the operation of registering the user account. The five basic information includes name, document type, document number, gender, and date of birth. The background server obtains the customer number corresponding to the user according to the five basic information query databases, and the customer number is assigned to the user when the user first purchases the policy, and is subsequently used to associate the policy information related to the user. When the self-service claim is filed, the date and the customer number entered by the user are obtained through the specified APP, and then the benefit information corresponding to the claim applicant can be obtained according to the date and the customer number. The benefit information is a claimable insurance type included in the effective policy purchased by the claim applicant. The time of the out-of-risk refers to the time when the compensation or payment condition specified or agreed upon on the insurance contract occurs after the occurrence of the insured event. Illustratively, for medical insurance, the time of the insurance includes, but is not limited to, the billing date and the date of the medical insurance; for vehicle insurance, the time of the accident includes, but is not limited to, the date of the traffic accident. The embodiment of the present application is useful for reducing the difficulty of managing the policy of different claim applicants by using the customer number to uniquely locate the benefit information of the claim applicant. This is because when using the ID number, it needs to correspond to the type of the certificate. Different types of documents include, but are not limited to, ID card, driver's license number, passport, military ID, foreigner's residence permit, etc. It is difficult to manage different claim applicants. The embodiment of the present application effectively circumvents the complicated logic brought by the use of the document number.

In step S102, the application reason, the type of treatment, and the type of insurance of the self-service claim are obtained, and the benefit information is inquired according to the application reason, the type of treatment, and the type of insurance, and the medical liability insurance applicable to the self-service claim is obtained.

Here, the insurance type refers to the insurance category that the claim applicant claims to claim, including but not limited to insurance, health insurance, accident insurance, pension insurance, child insurance, female insurance, dividend insurance, comprehensive insurance, motor vehicle insurance, Family property insurance. The embodiments of the present application are directed to medical insurance. Accordingly, the reasons for the application include, but are not limited to, accidental visits, outpatient visits, and hospital visits, and the types of treatments include, but are not limited to, medications and medication lists, surgical treatments, and surgical details. At the stage of claiming the applicant through the APP, the APP obtains the reason for the self-service claim, the type of treatment, and the type of insurance, and then obtains the applicable self-service claims based on the application reason, the type of treatment, and the type of insurance. Medical liability insurance.

In step S103, for each medical liability insurance, the remaining claims amount of the medical liability insurance is calculated.

Here, when insured, each type of medical liability insurance has agreed on the corresponding insured limit, and multiple claims can be made within the limit of the insured amount when claiming. The remaining claim amount is the remaining amount of the medical liability insurance after n claims; if it is the first claim, the remaining claim amount is the limit of the insured amount; if the nth claim is, the remaining claim amount is the insured limit The difference from the previous n-1 historical claims amount.

In step S104, it is verified whether the remaining claim amount is a preset value, and when the verification result is YES, the prompt information of the medical liability insurance type unresolvable is output on the reporting interface, and/or, the reporting interface is The claims application ID of the medical liability insurance is set to be hidden or unavailable.

Here, the preset value is a criterion for determining whether the current claim applicant has the claim right, and is preferably 0. After obtaining the remaining claims amount of the medical liability insurance, the remaining claims amount is compared with the preset value. If the remaining claim amount is a preset value, it indicates that the current claims applicant's claim amount has been used up, and does not have the right to initiate the claim, the prompt information of the medical liability insurance type unresolvable is output on the APP's reporting interface, and / The claim application identification of the medical liability insurance on the reporting interface is hidden or unavailable, so that the claim applicant cannot initiate self-service claims to reduce the amount of acceptance of the chargeback case.

Where the claim application identification is set to be hidden, the method can be used:

$("#crop").hide(); or document.getElementById(‘crop’).style.display="none";

If the claim application ID is not available, the logo is grayed out and the method can be used:

document.getElementById("crop").setAttribute("disabled",true);

If the remaining claim amount is not the preset value, it indicates that the current claim applicant still has a claim amount, and the claim applicant has the right to initiate the claim, and the claims application identifier of the medical liability insurance type is displayed on the reporting interface by:

$("#crop").show(); or

document.getElementById(‘crop’).style.display="inline-block";

At the same time, the claim application identification of the medical liability insurance type is made available on the reporting interface by:

document.getElementById("crop").removeAttribute("disabled");

In summary, the embodiment of the present application implements the insured verification from the claims accounting link to the reporting link: when the self-service claims are filed, the medical liability applicable to the self-service claims is obtained by querying the benefit information. For each type of medical liability insurance, calculate the remaining claims amount of the medical liability insurance type; verify whether the remaining claims amount is a preset value, and output the medical liability insurance type unresolvable on the reporting interface according to the verification result The prompt information, and/or, the claim application identifier of the medical liability insurance type on the reporting interface is hidden or unavailable; thereby realizing the function of the pre-inspection of the insured amount, and reducing the chargeback in the reporting stage of the self-service claims The receiving amount of the case, that is, the claim case in which the remaining claim amount is the preset value, solves the problem that the prior art allows all self-service claims to be submitted in the normal solvable case, resulting in low claim efficiency, which is beneficial to improve the claim efficiency.

Further, based on the first implementation flow of the method for guarantee pre-checking provided in FIG. 1 , a second implementation flow of the method for guarantee pre-checking provided by the embodiment of the present application is proposed.

As shown in FIG. 2, it is a schematic diagram of a second implementation process of the method for guarantee pre-checking provided by the embodiment of the present application. In the embodiment of the present application, the step S101 further includes:

In step S1011, the claim database is queried according to the customer number, and the policy number of the claim applicant as the insured is obtained.

In the embodiment of the present application, the claim database maintains a correspondence between the customer number of the claim applicant and the policy number of the claim applicant as the insured. A customer number may correspond to one or more policy numbers. After obtaining the customer number, the SQL execution object is generated by reading the preset SQL query statement, querying the claim database, traversing all the corresponding relationships, and obtaining the policy number corresponding to the customer number.

In step S1012, the order number corresponding to the claim applicant under the policy number and the insurance information included in the order number are obtained.

Here, for group insurance, the insurance policy purchased by the enterprise corresponds to a policy number, and the policy number is used to distinguish the policyholder, that is, the enterprise. Each employee in the enterprise corresponds to a single order number, which is used to distinguish different insured employees. Different insured employees are not exactly the same type of insurance. The embodiment of the present application further queries the sub-number corresponding to the claim applicant under the policy number based on the customer number, and obtains the insurance information included in the sub-order number.

For the individual insurance, the policy number and the order number are the same, and the associated policy number is obtained according to the customer number to obtain the order number, thereby obtaining the insurance information included.

In step S1013, the piece number and the insurance type information are queried according to the date of the insurance, and the claimable insurance type applicable to the claim applicant is obtained.

Since all the order numbers and their insurance information corresponding to the claimant in the historical time are recorded in the claim database, the part number of the order number queried in step S1012 may have expired. Therefore, after obtaining the sub-order number and its insurance information, it is further required to be further screened based on the date of the insurance, and the sub-order number including the expiration date of the insurance period is obtained, and the insurance information corresponding to the sub-order number is applicable as described above. Claiming the claimable insurance for the applicant to remove the expired insurance policy, screen out the valid claims insurance, and obtain the benefit information.

Further, based on the second implementation flow of the method for guarantee pre-checking provided in FIG. 2, a third implementation flow of the method for guarantee pre-checking provided by the embodiment of the present application is proposed.

As shown in FIG. 3, it is a schematic diagram of a third implementation process of the method for guarantee pre-checking provided by the embodiment of the present application. In the embodiment of the present application, the step S102 further includes:

In step S1021, the liability insurance is matched according to the application reason, the type of treatment, and the type of insurance.

Here, the benefit information obtained by the step S101, such as the claims insurance type, is stored in the designated form. The responsibility matching is based on the application reason, the type of treatment and the type of insurance as a query condition, and the specified form is subjected to a fuzzy query using an SQL statement, and the claimable insurance type that satisfies the query condition is matched from the chargeable insurance type. In practical applications, LIKE is used to find the tuple that matches the specified column name with the matching string constant. Therefore, the LIKE operator and the wildcard can be used to implement the fuzzy query; if the result is to be inverted, it can be used before the LIKE operation. The NOT operator.

In step S1022, the claimable insurance type that meets the application reason and the type of treatment is acquired as the medical liability insurance for the self-service claim.

Illustratively, it is assumed that the benefit information obtained in step S101, such as the claims insurance type, is stored in the table Stock; the application reason is the outpatient service, the treatment type is drug treatment and medication list, and the insurance type is medical insurance, and the inquiry meets the application reason. For the encoding of the types of treatments, the format of the LIKE operator is as follows:

SELECT mat_num

FROM stock

WHERE mat_num LIKE 'outpatient, drug treatment and medication list, medical insurance'

By using the LIKE operator, in the actual application, even if the claim applicant cannot give the exact value of any one or more of the application reason, treatment type or insurance type, the fuzzy query can be completed from the specified form, effectively improving the responsibility. The scope of the match and the user's experience.

Further, based on the first implementation flow of the method for guarantee pre-checking provided in FIG. 1 , a fourth implementation flow of the method for guarantee pre-checking provided by the embodiment of the present application is proposed.

As shown in FIG. 4 , it is a schematic diagram of a fourth implementation process of the method for guarantee pre-checking provided by the embodiment of the present application. In the embodiment of the present application, the step S103 further includes:

In step S1031, for each medical liability insurance, the insurance coverage corresponding to the claim applicant and the historical claim record of the claim applicant are obtained.

Here, the claim database maintains a record table for recording the claim settlement history of the claimant, and updating the record table each time a claim is made. When querying the claim settlement history of the claimant, it is obtained by querying all the columns and rows. Illustratively, assuming that recores is the table name of the historical claim record table, and the claim applicant's customer number is 001, the SELECT statement corresponding to the historical claim record of the search customer number 001 may be:

SELECT^FROM recores

WHERE nat_num=001

In step S1032, the amount of the claims corresponding to each historical claim record is obtained.

After the historical claim record of the claim applicant is queried, the claim amount of each historical claim record is obtained. Exemplarily, suppose the claimant A's insurance limit is 1000 yuan, there are three historical claims records, and the first claim amount is 200 yuan, and the second claim amount is 150 yuan, the third claim is obtained through step S1032. The amount is 300 yuan.

In step S1033, a difference between the insured limit and the claim amount is calculated to obtain a remaining claim amount of the medical liability insurance.

Here, the remaining claim amount should be the difference obtained by subtracting the amount of the claims corresponding to each historical claim record in turn. As mentioned above, the claimant A's residual claim amount is 1000-200-150-300=350 yuan.

Through the above steps S1031 to S1033, the pre-calculation of the remaining claim amount of the medical liability insurance is realized, and the remaining claim amount will be verified in step S104 to realize the function of the pre-validation check. The embodiment of the present application calculates the residual claim amount based on the selected medical liability insurance, combined with the factual basis of the historical claim record, effectively reduces the calculation amount, and improves the efficiency and accuracy of the pre-calculation.

It should be understood that, in the foregoing embodiments, the size of the serial number of each step does not mean the order of execution order, and the order of execution of each step should be determined by its function and internal logic, and should not constitute any implementation process of the embodiment of the present application. limited.

It should be noted that those skilled in the art can understand that all or part of the steps of implementing the above embodiments may be completed by hardware, or may be instructed by computer readable instructions, and the computer readable instructions may be stored. In a non-volatile readable storage medium, the storage medium may be a read only memory, a magnetic disk or an optical disk, or the like.

FIG. 5 is a structural diagram showing the structure of the pre-checking device provided by the embodiment of the present application. For the convenience of description, only parts related to the embodiment of the present application are shown.

In the embodiment of the present application, the device for guaranteeing the pre-verification is used to implement the method of the pre-inspection verification described in the foregoing embodiments of FIG. 1 to FIG. 4, and may be a software unit built in the terminal, A hardware unit or a combination of hardware and software.

Referring to FIG. 5, the device for guaranteeing the pre-check includes:

The obtaining module 51 is configured to obtain the benefit information corresponding to the claim applicant according to the date of the insurance and the customer number when performing the self-service claim declaration;

The query module 52 is configured to obtain the application reason, the type of treatment, and the type of insurance of the self-service claim, and query the benefit information according to the application reason, the type of treatment, and the type of insurance, and obtain the medical liability insurance applicable to the self-service claim. ;

The calculating module 53 is configured to calculate a remaining claim amount of the medical liability insurance type for each medical liability insurance type;

The verification module 54 is configured to verify whether the remaining claims amount is a preset value, and when the verification result is yes, output the prompt information of the medical liability insurance type unresolvable on the reporting interface, and/or, declare The claim application identification of the medical liability insurance on the interface is hidden or unavailable.

When the claim applicant enters the APP interface to perform the self-service claim filing, the embodiment of the present application first obtains the benefit information corresponding to the claim applicant according to the risk date and the customer number by the obtaining module 51. The benefit information is a claimable insurance type included in the effective policy purchased by the claim applicant. The time of the out-of-risk refers to the time when the compensation or payment condition specified or agreed upon on the insurance contract occurs after the occurrence of the insured event. Illustratively, for medical insurance, the time of the insurance includes, but is not limited to, the billing date and the date of the medical insurance; for vehicle insurance, the time of the accident includes, but is not limited to, the date of the traffic accident. Optionally, the obtaining module 51 further includes:

The first obtaining unit 511 is configured to query the claim database according to the customer number, and obtain the policy number of the claim applicant as the insured;

The second obtaining unit 512 is configured to obtain the order number corresponding to the claim applicant under the policy number and the insurance information included in the order number;

The third obtaining unit 513 is configured to query the order number and the insurance type information according to the risk date, and obtain a claimable insurance type applicable to the claim applicant.

In the embodiment of the present application, the claim database maintains the correspondence between the customer number of the claim applicant and the policy number of the claim applicant as the insured. A customer number may correspond to one or more policy numbers. After obtaining the customer ID, the first acquiring unit 511 first reads the preset SQL query statement, generates an SQL execution object, queries the claims database, traverses all the corresponding relationships, and obtains a correspondence corresponding to the customer number. Policy number. Then, the second obtaining unit 512 further queries the order number corresponding to the claim applicant under the policy number based on the customer number, and obtains the insurance information included in the order number. Since all the order numbers and their insurance information corresponding to the claim applicants on the historical time are recorded in the claim database, the possible part of the order number queried by the second obtaining unit 512 has expired. Therefore, after obtaining the sub-number and its insurance information, the third obtaining unit 513 further needs to be further filtered based on the date of the insurance, and obtain the sub-order number whose insurance period includes the expiration date, where the sub-number corresponds to The insurance information is used as the claimable insurance for the claim applicant to remove the expired insurance policy and filter out the valid claims insurance.

Optionally, the query module 52 further includes:

The matching unit 521 is configured to perform responsible matching on the chargeable insurance according to the application reason, the type of treatment, and the type of insurance;

The insurance acquiring unit 522 is configured to obtain a medical liability insurance type that meets the application reason and the type of treatment as the medical liability insurance of the self-service compensation.

Here, the benefit information obtained by the acquisition module 51, such as the claims insurance type, is stored in the specified form. The responsibility matching is based on the application reason, the type of treatment and the type of insurance as a query condition, and the specified form is subjected to a fuzzy query using an SQL statement, and the claimable insurance type that satisfies the query condition is matched from the chargeable insurance type. In practical applications, LIKE is used to find a tuple whose specified column name matches the matching string constant; therefore, the matching unit 521 can use the LIKE operator and the wildcard to implement the fuzzy query; if the result is negated, Use the NOT operator before the LIKE operation. Exemplarily, it is assumed that the benefit information obtained by the obtaining module 51, such as the claims insurance type, is stored in the table Stock; the application reason is the outpatient service, the treatment type is the drug treatment and medication list, and the insurance type is medical insurance, and the inquiry conforms to the application. For the reason, the type of treatment of the types of claims insurance, the format of the LIKE operator is as follows:

SELECT mat_num

FROM stock

By using the LIKE operator, in the actual application, even if the claim applicant cannot give the exact value of any one or more of the application reason, treatment type or insurance type, the fuzzy query can be completed from the specified form, and the responsibility matching is improved. Scope of application and user experience.

Optionally, the calculating module 53 further includes:

The claim record obtaining unit 531 is configured to obtain, for each medical liability insurance, a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

The claim amount obtaining unit 532 is configured to obtain a claim amount corresponding to each historical claim record;

The calculating unit 533 is configured to calculate a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.

Here, when insured, each type of medical liability insurance has agreed on the corresponding insured limit, and multiple claims can be made within the limit of the insured amount when claiming. The remaining claim amount is the remaining amount of the medical liability insurance after n claims; if it is the first claim, the remaining claim amount is the limit of the insured amount; if the nth claim is, the remaining claim amount is the insured limit The difference from the previous n-1 historical claims amount. The preset value is a criterion for determining whether the current claim applicant has the claim right, and is preferably 0. After obtaining the remaining claims amount of the medical liability insurance, the remaining claims amount is compared with the preset value by the verification module 54. If the remaining claim amount is a preset value, it indicates that the current claims applicant's claim amount has been used up, and does not have the right to initiate the claim, the prompt information of the medical liability insurance type unresolvable is output on the APP's reporting interface, and / The claim application identification of the medical liability insurance on the reporting interface is hidden or unavailable, so that the claim applicant cannot initiate self-service claims to reduce the amount of acceptance of the chargeback case.

It should be noted that the terminal in the embodiment of the present application may be used to implement all the technical solutions in the foregoing method embodiments. It will be clearly understood by those skilled in the art that, for convenience and brevity of description, only the division of each functional unit and module described above is exemplified. In practical applications, the above functions may be assigned to different functional units according to needs. The module is completed by dividing the internal structure of the device into different functional units or modules to perform all or part of the functions described above.

In the above embodiments, the descriptions of the various embodiments are different, and the parts that are not detailed or described in the specific embodiments may be referred to the related descriptions of other embodiments.

FIG. 6 is a schematic diagram of a terminal according to an embodiment of the present application. As shown in FIG. 6, the terminal 6 of this embodiment includes a processor 60, a memory 61, and computer readable instructions 62 stored in the memory 61 and executable on the processor 60. The steps in the method embodiment of implementing the above-described guaranteed pre-checking when the processor 60 executes the computer readable instructions 62, such as steps S101 to S104 shown in FIG. 1 and steps S1011 to S1013 shown in FIG. Steps S1021 to S1022 shown in FIG. 3 and steps S1031 to S1033 shown in FIG. Alternatively, the functions of the modules/units in the apparatus embodiment for implementing the above-described guaranteed pre-checking when the processor 60 executes the computer readable instructions 62, such as the functions of the modules 51 to 54 shown in FIG.

It will be understood that one or more non-volatile readable storage media storing computer readable instructions may comprise: any entity or device capable of carrying the computer readable instruction code, a recording medium, a USB flash drive, a mobile hard drive, Disk, optical disk, computer memory, Read-Only Memory (ROM), Random Access Memory (RAM), electrical carrier signals, telecommunications signals, and software distribution media.

The above-mentioned embodiments are only used to explain the technical solutions of the present application, and are not limited thereto; although the present application has been described in detail with reference to the foregoing embodiments, those skilled in the art should understand that they can still implement the foregoing embodiments. The technical solutions described in the examples are modified or equivalently replaced with some of the technical features; and the modifications or substitutions do not deviate from the spirit and scope of the technical solutions of the embodiments of the present application, and should be included in Within the scope of protection of this application.

Claims

A method for guarantee pre-checking, characterized in that the method comprises:

When the self-service claim is filed, the benefit information corresponding to the claim applicant is obtained according to the date of the insurance and the customer number;

Obtain the application reason, treatment type and insurance type of the self-service claim, and query the benefit information according to the application reason, treatment type and insurance type, and obtain the medical liability insurance applicable to the self-service claim;

Calculating the remaining claims amount of the medical liability insurance for each type of medical liability insurance;

Verifying whether the remaining insured amount is a preset value, and when the verification result is YES, outputting the medical liability insurance type unrecognizable prompt information on the reporting interface, and/or, the medical liability insurance type on the reporting interface The claim application identifier is set to be hidden or unavailable;

The customer number is the unique identification information of the claim applicant in the claim system, and the database is queried according to the name, document type, document number, gender and date of birth of the claim applicant when the claimant registers the user account. get.
The method of claim 1 according to claim 1, wherein the obtaining the benefit information corresponding to the claim applicant according to the date of the insurance and the customer number comprises:

Querying the claim database according to the customer number, and obtaining the policy number of the claim applicant as the insured;

Obtaining the sub-order number corresponding to the claim applicant under the policy number and the insurance information included in the sub-order number;

Querying the order number and the insurance type information according to the date of the insurance, and obtaining the solvable insurance type applicable to the claim applicant.
The method of claim 2 according to claim 2, wherein the querying the benefit information according to the application reason, the type of treatment, and the type of insurance, and obtaining the medical responsibility applicable to the self-service claim Insurance includes:

Responsible matching of the claimable insurance species according to the reason for the application, the type of treatment, and the type of insurance;

Obtain the types of claims that meet the reasons for the application and the type of treatment as the medical liability insurance for this self-service claim.
The method of claim 1 according to claim 1, wherein said calculating a residual claim amount of said medical liability insurance comprises:

For each medical liability insurance type, obtaining a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

Obtain the amount of claims corresponding to each historical claim record;

Calculating a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.
A method of claim pre-verification according to claim 2 or claim 3, wherein said calculating the remaining claims limit of said medical liability insurance comprises:

For each medical liability insurance type, obtaining a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

Obtain the amount of claims corresponding to each historical claim record;

Calculating a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.
A device for preserving a pre-check, characterized in that the device comprises:

The obtaining module is configured to obtain the benefit information corresponding to the claim applicant according to the date of the insurance and the customer number when performing the self-service claim declaration;

The query module is configured to obtain the application reason, the type of treatment and the type of insurance of the self-service claim, and query the benefit information according to the application reason, the type of treatment and the type of insurance, and obtain the medical liability insurance applicable to the self-service claim;

a calculation module, configured to calculate a remaining claim amount of the medical liability insurance for each medical liability insurance type;

a verification module, configured to verify whether the remaining claims amount is a preset value, and when the verification result is yes, outputting the medical liability insurance type unrecognizable prompt information on the reporting interface, and/or, the reporting interface The claims application identifier of the medical liability insurance is hidden or unavailable;

The customer number is the unique identification information of the claim applicant in the claim system, and the database is queried according to the name, document type, document number, gender and date of birth of the claim applicant when the claimant registers the user account. get.
The device of claim 6, wherein the obtaining module comprises:

a first obtaining unit, configured to query a claim database according to the customer number, and obtain the policy number of the claim applicant as the insured;

a second obtaining unit, configured to obtain a sub-order number corresponding to the claim applicant under the policy number and the insurance information included in the sub-order number;

And a third obtaining unit, configured to query the information of the order number and the insurance type according to the date of the insurance, and obtain a claimable insurance type applicable to the claim applicant.
The device of claim 7 of claim 7, wherein the query module comprises:

a matching unit, configured to perform responsibility matching on the chargeable insurance according to the application reason, the type of treatment, and the type of insurance;

The insurance acquisition unit is configured to obtain a medical insurance product that meets the reason for the application and the type of treatment as the medical liability insurance for the self-service claim.
The apparatus of claim 6, wherein the calculation module comprises:

a claim record obtaining unit, configured to obtain, for each medical liability insurance type, a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

The claim amount obtaining unit is configured to obtain the amount of the claim corresponding to each historical claim record;

The calculating unit is configured to calculate a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.
The device of claim 7 or claim 8, wherein the calculation module comprises:

a claim record obtaining unit, configured to obtain, for each medical liability insurance type, a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

The claim amount obtaining unit is configured to obtain the amount of the claim corresponding to each historical claim record;

The calculating unit is configured to calculate a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.
One or more non-transitory readable storage mediums storing computer readable instructions, wherein when the computer readable instructions are executed by one or more processors, cause the one or more processors to execute The following steps:

When the self-service claim is filed, the benefit information corresponding to the claim applicant is obtained according to the date of the insurance and the customer number;

Obtain the application reason, treatment type and insurance type of the self-service claim, and query the benefit information according to the application reason, treatment type and insurance type, and obtain the medical liability insurance applicable to the self-service claim;

Calculating the remaining claims amount of the medical liability insurance for each type of medical liability insurance;

Verifying whether the remaining insured amount is a preset value, and when the verification result is YES, outputting the medical liability insurance type unrecognizable prompt information on the reporting interface, and/or, the medical liability insurance type on the reporting interface The claim application identifier is set to be hidden or unavailable;

The customer number is the unique identification information of the claim applicant in the claim system, and the database is queried according to the name, document type, document number, gender and date of birth of the claim applicant when the claimant registers the user account. get.
The non-volatile readable storage medium according to claim 11, wherein the obtaining the benefit information corresponding to the claim applicant according to the date of the insurance and the customer number comprises:

Querying the claim database according to the customer number, and obtaining the policy number of the claim applicant as the insured;

Obtaining the sub-order number corresponding to the claim applicant under the policy number and the insurance information included in the sub-order number;

Querying the order number and the insurance type information according to the date of the insurance, and obtaining the solvable insurance type applicable to the claim applicant.
The non-volatile readable storage medium according to claim 12, wherein said inquiring said benefit information according to said application reason, type of treatment, and type of insurance, obtaining medical responsibility applicable to the self-service claim Insurance includes:

Responsible matching of the claimable insurance species according to the reason for the application, the type of treatment, and the type of insurance;

Obtain the types of claims that meet the reasons for the application and the type of treatment as the medical liability insurance for this self-service claim.
The non-volatile readable storage medium according to claim 11, wherein said calculating a remaining claim amount of said medical liability insurance comprises:

For each medical liability insurance type, obtaining a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

Obtain the amount of claims corresponding to each historical claim record;

Calculating a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.
The non-volatile readable storage medium according to claim 12 or 13, wherein said calculating the remaining claims limit of said medical liability insurance comprises:

For each medical liability insurance type, obtaining a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

Obtain the amount of claims corresponding to each historical claim record;

Calculating a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.
A terminal comprising a memory, a processor, and computer readable instructions stored on the memory and operable on the processor, wherein the processor, when executing the computer readable instructions, implements the following steps:

When the self-service claim is filed, the benefit information corresponding to the claim applicant is obtained according to the date of the insurance and the customer number;

Obtain the application reason, treatment type and insurance type of the self-service claim, and query the benefit information according to the application reason, treatment type and insurance type, and obtain the medical liability insurance applicable to the self-service claim;

Calculating the remaining claims amount of the medical liability insurance for each type of medical liability insurance;

Verifying whether the remaining claims amount is a preset value, and when the verification result is YES, outputting the medical liability insurance type unrecognizable prompt information on the reporting interface, and/or, the medical liability insurance type on the reporting interface The claim application identifier is set to be hidden or unavailable;

The customer number is the unique identification information of the claim applicant in the claim system, and the database is queried according to the name, document type, document number, gender and date of birth of the claim applicant when the claimant registers the user account. get.
The terminal according to claim 16, wherein the obtaining the benefit information corresponding to the claim applicant according to the date of the insurance and the customer number comprises:

Querying the claim database according to the customer number, and obtaining the policy number of the claim applicant as the insured;

Obtaining the sub-order number corresponding to the claim applicant under the policy number and the insurance information included in the sub-order number;

Querying the order number and the insurance type information according to the date of the insurance, and obtaining the solvable insurance type applicable to the claim applicant.
The terminal according to claim 17, wherein the querying the benefit information according to the application reason, the type of treatment, and the type of insurance, and obtaining the medical liability insurance applicable to the self-service claim includes:

Responsible matching of the claimable insurance species according to the reason for the application, the type of treatment, and the type of insurance;

Obtain the types of claims that meet the reasons for the application and the type of treatment as the medical liability insurance for this self-service claim.
The terminal according to claim 16, wherein said calculating a remaining claim amount of said medical liability insurance comprises:

For each medical liability insurance type, obtaining a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

Obtain the amount of claims corresponding to each historical claim record;

Calculating a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.
The terminal according to claim 17 or 18, wherein said calculating the remaining claim amount of said medical liability insurance comprises:

For each medical liability insurance type, obtaining a coverage limit corresponding to the claim applicant and a historical claim record of the claim applicant;

Obtain the amount of claims corresponding to each historical claim record;

Calculating a difference between the insured limit and the claim amount to obtain a remaining claim amount of the medical liability insurance.