CN107767123A - A kind of declaration form responsibility detailed checking method and device - Google Patents
A kind of declaration form responsibility detailed checking method and device Download PDFInfo
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- CN107767123A CN107767123A CN201711113080.1A CN201711113080A CN107767123A CN 107767123 A CN107767123 A CN 107767123A CN 201711113080 A CN201711113080 A CN 201711113080A CN 107767123 A CN107767123 A CN 107767123A
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Abstract
This application discloses a kind of declaration form responsibility detailed checking method and device, wherein methods described includes：Obtain the billing data and declaration form data of settlement of insurance claim case to be checked；By the detailed verification rule of the responsibility edited in advance, the bill expense and diagnosis and treatment type in billing data are matched with the responsibility managing detailed catalogue in declaration form data；According to matching result, the optimal responsibility managing detailed catalogue corresponding with billing data is determined from declaration form data.By such scheme, can automatically according to settlement of insurance claim case to be checked billing data from multiple responsibility managing detailed catalogues in corresponding declaration form data, Automatic sieve selects optimal responsibility managing detailed catalogue.The process of automatic screening is entirely to automate what is carried out, is participated in without artificial, and screening process speed is fast, the degree of accuracy is high, and then saves substantial amounts of human resources, while effectively reduces error rate, improves the timeliness and accuracy of the detailed audit process of declaration form responsibility.
Description
Technical field
The application belongs to settlement of insurance claim technical field, more particularly to a kind of declaration form responsibility detailed checking method and dress
Put.
Background technology
Improved with the living standard of present people, increasing people can cause part fund input insurance company
Insurance company needs Claims Resolution case to be processed more and more, and user needs to ask for reparation to insurance company after Claims Resolution case generation,
Insurance company will carry out Claims Resolution operation according to the related declaration form data of Claims Resolution case.
At present, when settlement of insurance claim is applied for, the special staff of insurance company is manually adjusting on interface user
The declaration form of user's Claims Resolution case can be selected first, then by the Claims Resolution bill expense of the user of input system and phase on declaration form
The responsibility detail answered matches one by one, and it is detailed to find the optimal responsibility corresponding with Claims Resolution bill expense.
But the mode of this artificial screening responsibility detail needs to take substantial amounts of human resources, when the Claims Resolution account of user
When list or more bill expense item quantity, it is less efficient to will result in the detailed verification of declaration form responsibility, and error rate is higher, enters
And it have impact on the timeliness and accuracy of settlement of insurance claim.
The content of the invention
In view of this, this application provides a kind of declaration form responsibility detailed checking method and device, main purpose to be to solve
The problem of human resources that certainly the detailed mode of artificial screening responsibility takes are more, verification is less efficient, and error rate is higher.
First aspect according to the application, there is provided a kind of detailed checking method of declaration form responsibility, methods described include：
Obtain the billing data and declaration form data of settlement of insurance claim case to be checked；
By the detailed verification rule of the responsibility edited in advance, by the bill expense and diagnosis and treatment type in the billing data,
Matched with the responsibility managing detailed catalogue in the declaration form data；
According to matching result, the detailed letter of the optimal responsibility corresponding with the billing data is determined from the declaration form data
Breath.
Second aspect according to the application, there is provided a kind of detailed checking device of declaration form responsibility, described device include：
Acquiring unit, for obtaining the billing data and declaration form data of settlement of insurance claim case to be checked；
Matching unit, for the detailed verification rule of responsibility by editing in advance, the bill in the billing data is taken
With with diagnosis and treatment type, matched with the responsibility managing detailed catalogue in the declaration form data；
Determining unit, for according to matching result, being determined from the declaration form data corresponding with the billing data
Optimal responsibility managing detailed catalogue.
The third aspect according to the application, there is provided a kind of storage device, be stored thereon with computer program, described program quilt
The checking method of the declaration form responsibility detail described in first aspect is realized during computing device.
Fourth aspect according to the application, there is provided a kind of entity apparatus of the detailed verification of declaration form responsibility, described device include
Storage device and processor,
The storage device, for storing computer program；
The processor, for performing the computer program to realize the detailed core of declaration form responsibility described in first aspect
To method.
By above-mentioned technical proposal, the checking method and device of a kind of declaration form responsibility detail that the application provides can be certainly
The dynamic billing data and declaration form data for obtaining settlement of insurance claim case to be checked；It is regular by the detailed verification of the responsibility edited in advance,
By the bill expense and diagnosis and treatment type in billing data, matched with the responsibility managing detailed catalogue in declaration form data；According to matching
As a result, the optimal responsibility managing detailed catalogue corresponding with the billing data is determined from declaration form data.The process entirely screened is complete
Portion is that automation is carried out, and is participated in without artificial, and screening process speed is fast, the degree of accuracy is high, and then saves substantial amounts of manpower
Resource, while error rate is effectively reduced, improve the timeliness and accuracy of the detailed audit process of declaration form responsibility.
Described above is only the general introduction of technical scheme, in order to better understand the technological means of the application,
And can be practiced according to the content of specification, and in order to allow above and other objects, features and advantages of the application can
Become apparent, below especially exemplified by the embodiment of the application.
Brief description of the drawings
The accompanying drawing of a part for constitution instruction describes embodiments herein, and is used to explain together with description
The principle of the application.
Referring to the drawings, according to following detailed description, the application can be more clearly understood, wherein：
Fig. 1 is the flow chart of one embodiment of the detailed checking method of the declaration form responsibility of the application；
Fig. 2 is the flow chart of another embodiment of the detailed checking method of the declaration form responsibility of the application；
Fig. 3 is the structural representation of one embodiment of the detailed checking device of the declaration form responsibility of the application；
Fig. 4 is the structural representation of another embodiment of the detailed checking device of the declaration form responsibility of the application；
Fig. 5 is the structural representation of the embodiment of the detailed verification entity apparatus of the declaration form responsibility of the application.
Embodiment
The exemplary embodiment of the disclosure is more fully described below with reference to accompanying drawings.Although the disclosure is shown in accompanying drawing
Exemplary embodiment, it being understood, however, that may be realized in various forms the disclosure without should be by embodiments set forth here
Limited.On the contrary, these embodiments are provided to facilitate a more thoroughly understanding of the present invention, and can be by the scope of the present disclosure
Completely it is communicated to those skilled in the art.
The embodiment of the present application provides a kind of detailed checking method of declaration form responsibility, can be managed automatically according to verification insurance is treated
The billing data of case is paid for from multiple responsibility managing detailed catalogues in corresponding declaration form data, filters out the detailed letter of optimal responsibility
Breath, whole process while saving human resources, reduce error rate, improve declaration form responsibility detail without manually participating in
Audit process timeliness and accuracy.
As shown in figure 1, the step of checking method of the declaration form responsibility detail of the present embodiment, includes：
Step 101, the billing data and declaration form data of settlement of insurance claim case to be checked are obtained.
Wherein, billing data includes：Medical institutions and personal information, Claims Resolution case status information, the world of user's Claims Resolution
Classification of diseases information, treatment type information, accident pattern information etc.；Declaration form data include：Declaration form insurance kind information, policy type letter
Breath, declaration form insured amount information, declaration form responsibility managing detailed catalogue etc.；Declaration form responsibility managing detailed catalogue includes：The detailed mark of responsibility, compensate
Ratio, compensate scope, compensate limit, compensation condition etc..
Executive agent for the present embodiment can be the device for realizing declaration form responsibility detail automatic checking, be automatically found with
The optimal responsibility managing detailed catalogue of billing data matching, and then can help to accelerate settlement of insurance claim processing, in the device course of work
In, before the declaration form data of settlement of insurance claim case to be checked are obtained, if settlement of insurance claim case to be checked corresponds to multiple declaration forms
Data, it is necessary to carry out screening verification from this multiple declaration form data.
Specifically, automatic auditing standards will not be met in multiple declaration form data (for example, declaration form classification is not belonging to automatically first
The classification of examination ＆ verification, or declaration form data have failed, or the condition etc. for needing to carry out manual examination and verification in declaration form data be present) declaration form
Data are rejected.Then the declaration form data of automatic auditing standards will be met, carry out the setting of priority, and according to priority by height
To low smooth arrangement.The declaration form data of highest priority are finally therefrom chosen as final declaration form data.
Wherein, the priority set-up mode of declaration form data includes：
Priority arrangement is carried out according to the descending order of the declaration form amount of money, or according to day of due date by the early order to evening
Carry out priority arrangement.Can also the collective reference declaration form amount of money and day of due date priority arrangement is carried out to non-failed declaration form data.
Configure corresponding weighted value for the declaration form amount of money and day of due date, processing be weighted to the weighted value of the two, then according to weighting at
Numerical value after reason carries out priority arrangement to declaration form data.
Or priority arrangement can also be carried out to declaration form data in the following manner：
The declaration form amount of money and high-end protection amount are contrasted first, the declaration form amount of money is then more than or equal to high-end insured amount declaration form
Data are defined as high-end declaration form.If the high-end declaration form quantity obtained is one, using the high-end declaration form as highest priority
Declaration form data, if the high-end declaration form quantity obtained is multiple, priority arrangement is carried out by the early order to evening according to day of due date
(i.e. the more early priority of day of due date is higher), because the declaration form data that day of due date is more early, illustrates that it will fail, more should preferentially locate
Reason.
If the declaration form amount of money be present is less than high-end insured amount declaration form data, the declaration form amount of money and low side protection amount are contrasted,
The declaration form amount of money is less than or equal to the insured amount declaration form data of low side and is defined as low side declaration form.If the low side declaration form quantity obtained is one
It is individual, then using the low side declaration form declaration form data minimum as priority, if the low side declaration form quantity obtained is multiple, according to full
Day phase carries out priority arrangement (i.e. the more early priority of day of due date is higher) by the early order to evening.
The declaration form data being in for the declaration form amount of money between high-end insured amount and low side protection amount, then get over according to declaration form amount of money numerical value
The big principle that priority is higher or the more early priority of day of due date is higher, for the middle corresponding priority of declaration form data configuration.
Then according to the priority order from high to low of above-mentioned setting to all declaration form numbers for meeting automatic auditing standards
According to being arranged, and the declaration form data of highest priority are therefrom chosen as final declaration form data.
Finally, by the declaration form data extract preservation in temporary storage with the settlement of insurance claim case phase to be checked
In corresponding file.And the declaration form number for obtaining the billing data of the settlement of insurance claim case to be checked got and such scheme
According to carrying out correspondingly, while the billing data also preserved corresponding with the settlement of insurance claim case to be checked into temporary storage
File in.During for subsequently needing reconciliation forms data or declaration form data to be handled, directly transferred from temporary storage.
Step 102, by the detailed verification rule of the responsibility edited in advance, by the bill expense and diagnosis and treatment class in billing data
Type, matched with the responsibility managing detailed catalogue in declaration form data.
Wherein, bill expense can take including medicine, bed expense, treatment cost, nurse fees, Operation Fee, Anesthetic Fee etc.；Responsibility
Managing detailed catalogue can include：The detailed mark of responsibility, ratio is compensated, scope is compensated, compensates limit, compensation condition etc.；Diagnosis and treatment type
It can include：Diagnosis and treatment type includes：Acupuncture and moxibustion treatment, physical treatment, champignon therapy, magnetic therapy therapy etc.；The detailed verification rule of responsibility
It can be edited in advance according to the actual conditions of settlement of insurance claim business, such as the verification rule can be different bill expenses, examine
Type is treated, from the mapping relations between different responsibility managing detailed catalogues, it is suitable in declaration form data to be found according to the mapping relations
Responsibility managing detailed catalogue.
In the present embodiment, extract in the bill expense and diagnosis and treatment type in billing data, and extraction declaration form data
Multiple responsibility managing detailed catalogues.According to the detailed verification rule of responsibility, multiple responsibility managing detailed catalogues are screened, filters out and extracts
Bill expense and the corresponding responsibility managing detailed catalogue of diagnosis and treatment type.
For example, certain user has bought medical insurance, after certain user is sick, pay demand note (the i.e. bill expense that hospital opens is held
With) and condition-inference book (diagnosis and treatment type), when asking for reparation to insurance company, medical treatment that insurance company will buy according to user
Insurance, reparation foundation of the most suitable declaration form data as the user is chosen, due to enumerating a lot of duties in declaration form data
Appoint managing detailed catalogue, these responsibility managing detailed catalogues are entirely not necessarily the content related to the sick situation that user is current.Therefore
According to pay demand note and condition-inference book, selected and the most suitable responsibility managing detailed catalogue of user's state of an illness from these responsibility managing detailed catalogues.
The maximum condition compensated the amount of money, compensate hospital is have recorded in the responsibility managing detailed catalogue (for example, must be more than diformazan rank
Hospital), state of an illness condition, compensate the species (for example, cost of hospitalization, medical fee) of expense, compensation ratio corresponding to various expenses etc..
Step 103, according to matching result, the detailed letter of the optimal responsibility corresponding with billing data is determined from declaration form data
Breath.
In the above-mentioned technical solutions, the duty corresponding with bill expense and diagnosis and treatment type above-mentioned steps 102 matched
Appoint managing detailed catalogue as optimal responsibility managing detailed catalogue.Then verification is treated according to the Claims Resolution condition in optimal responsibility managing detailed catalogue to protect
The billing data of danger Claims Resolution case is adjusted, and is adjusted out settling fee corresponding to each bill expense and is added up, is obtained
Final Claims Resolution total value.So that insurance company compensates according to the Claims Resolution total value to the client of settlement of insurance claim case.
Pass through above-mentioned technical proposal, can automatically according to settlement of insurance claim case to be checked billing data from corresponding declaration form
In multiple responsibility managing detailed catalogues in data, Automatic sieve selects optimal responsibility managing detailed catalogue.The process of automatic screening is entirely certainly
What dynamicization was carried out, participated in without artificial, and screening process speed is fast, the degree of accuracy is high, and then substantial amounts of human resources are saved, together
Shi Youxiao reduces error rate, improves the timeliness and accuracy of the detailed audit process of declaration form responsibility.
In a particular embodiment, step 102 specifically includes：
Step 1021, from the first default responsibility detail list, obtain and the bill expense in billing data, diagnosis and treatment type pair
The responsibility managing detailed catalogue answered, and expense priority corresponding with responsibility managing detailed catalogue.
Wherein, preserved in the first default responsibility detail list different bill expenses, diagnosis and treatment type, responsibility managing detailed catalogue and
Mapping relations between expense priority；Expense priority can indicate which expense is preferentially compensated.
Step 1022, from the second default responsibility detail list, obtain corresponding with the declaration form insurance kind information in declaration form data
Responsibility managing detailed catalogue.
Wherein, the detailed letter of responsibility corresponding to different declaration form insurance kind information difference is preserved in the second default responsibility detail list
Breath.
Step 1023, by the duty corresponding with declaration form insurance kind information of responsibility managing detailed catalogue corresponding to bill expense, diagnosis and treatment type
Managing detailed catalogue is appointed to be matched.
In the above-mentioned technical solutions, all bill expenses in billing data are extracted, and each bill expense corresponds to
Diagnosis and treatment type, and searched according to diagnosis and treatment type and/or bill expense from the first default responsibility detail list, and extract with
Diagnosis and treatment type and/or the corresponding responsibility managing detailed catalogue of bill expense (a kind of responsibility is detailed) and expense priority.Then, then obtain
Declaration form insurance kind information in forms data of going bail for, from the second default responsibility detail list, search corresponding with the declaration form insurance kind information
Responsibility managing detailed catalogue (two class responsibilities are detailed).A kind of responsibility it is detailed with two class responsibilities are detailed is matched one by one, extract match into
Expense priority corresponding to the responsibility managing detailed catalogue of work(and acquisition, by the responsibility managing detailed catalogue and its corresponding expense priority
It is stored in temporary storage.
In a particular embodiment, step 103 specifically includes：
Step 1031, it is determined that expense priority corresponding to each responsibility managing detailed catalogue matched；
Step 1032, by the responsibility managing detailed catalogue matched of expense highest priority, it is defined as and bill expense, diagnosis and treatment
The corresponding optimal responsibility managing detailed catalogue of type.
In the above-mentioned technical solutions, each responsibility managing detailed catalogue and its correspondence that the match is successful are transferred from temporary storage
Expense priority, then each responsibility managing detailed catalogue is arranged according to the order of expense priority from high to low.From
A middle responsibility managing detailed catalogue for choosing highest priority is optimal responsibility managing detailed catalogue, according in optimal responsibility managing detailed catalogue
The billing data that Claims Resolution condition treats verification settlement of insurance claim case is adjusted, and is obtained and is compensated the amount of money, and compensates to user.
In a particular embodiment, if the responsibility managing detailed catalogue matched of multiple expense highest priorities, step be present
1032 specifically include：
Step 1032a, randomly choose a duty in the responsibility managing detailed catalogue matched of multiple expense highest priorities
Appoint managing detailed catalogue, as the optimal responsibility managing detailed catalogue corresponding with bill expense, diagnosis and treatment type.
Or
Step 1032b, with reference to bill expense, diagnosis and treatment type, select the responsibility matched of multiple expense highest priorities
A maximum responsibility managing detailed catalogue of the amount of money is compensated in managing detailed catalogue, as corresponding with bill expense, diagnosis and treatment type optimal
Responsibility managing detailed catalogue.
For example, the optimal responsibility managing detailed catalogue of random screening in qualified responsibility managing detailed catalogue can be matched from multiple.Also may be used
With according to the Claims Resolution ratio described in each responsibility managing detailed catalogue, Claims Resolution limit, the information such as Claims Resolution condition, and treat verification insurance
Bill expense and diagnosis and treatment type in the billing data for case of settling a claim, calculate the compensation gold corresponding with each responsibility managing detailed catalogue
Volume.And each responsibility managing detailed catalogue is arranged according to the descending order of the amount of money is compensated, and therefrom choose and compensate the amount of money
A maximum responsibility managing detailed catalogue is as optimal responsibility managing detailed catalogue.
In a particular embodiment, before step 102, method also includes：
Step 102 ', count different bill expense, diagnosis and treatment type respectively corresponding to responsibility managing detailed catalogue, and according to reception
The priority configuration-direct arrived, the corresponding expense priority of responsibility managing detailed catalogue that configuration statistics obtains；And the different declaration forms of statistics
The responsibility managing detailed catalogue that the declaration form of insurance kind information is included.
Step 102 ", by responsibility managing detailed catalogue corresponding to different bill expenses, diagnosis and treatment type difference, and the detailed letter of responsibility
Corresponding expense priority is ceased to be stored in the first default responsibility detail list；And the duty for including different declaration form insurance kind information respectively
Managing detailed catalogue is appointed to be stored in the second default responsibility detail list.
Step 102 " ', according to the first default responsibility detail list and the second default responsibility detail list after preservation data, editor
The detailed verification rule of responsibility.
In the above-mentioned technical solutions, responsibility is preset previously according to the every terms of information editor first of the various insurance types of statistics
Detail list, and the second default responsibility detail list.And then ensure detailed in the first default responsibility detail list and the second default responsibility
In all corresponding every terms of information of settlement of insurance claim case are all contained in table.
The detailed verification rule of corresponding responsibility includes：The first bill in the billing data of settlement of insurance claim case to be checked
Expense and diagnosis and treatment type, searched from the first default responsibility detail list, then according to settlement of insurance claim case declaration form data to be checked
Searched from the second default responsibility detail list.Or first preset duty from second according to settlement of insurance claim case declaration form data to be checked
Appoint and searched in detail list, then the bill expense and diagnosis and treatment type in the billing data of settlement of insurance claim case to be checked, from
Searched in first default responsibility detail list.Or the two is searched simultaneously.Finally, by the two class responsibility managing detailed catalogues progress of lookup
Match somebody with somebody.
For example, different bill expenses, diagnosis and treatment type, responsibility managing detailed catalogue and expense priority are preserved in table a
Between mapping relations, preserve in table b different declaration form insurance kind information respectively corresponding to responsibility managing detailed catalogue；Managed to insurance
When paying for the progress responsibility detail verification of case 1, all expenses and diagnostic-type in its billing data are analyzed, according to above-mentioned table a, are looked into
Ask responsibility managing detailed catalogue corresponding with expense, diagnosis and treatment type in the billing data and expense corresponding with the responsibility managing detailed catalogue
Priority；And the declaration form insurance kind information insured is obtained from its declaration form data, and inquiry and the declaration form insurance kind information from table b
Corresponding responsibility managing detailed catalogue；The responsibility managing detailed catalogue for inquiring about to obtain from table a is detailed with inquiring each responsibility from table b
Information is matched；Obtain the responsibility managing detailed catalogue of matching, and according to corresponding expense priority, it is determined that with the billing data
Optimal responsibility under declaration form corresponding to expense, diagnosis and treatment type defines is detailed, and matching result is saved in record sheet；Such as bill
Expense is acupuncture and moxibustion therapy expense, and diagnosis and treatment type is acupuncture and moxibustion therapy, and by inquiring about relation mapping table a, b, inquiry obtains corresponding responsibility
Detail is identified as 3330AAAN, 3330AAAA, and 3330AAAN corresponds to the detailed expense priority of responsibility and is higher than 3330AAAA pairs
The detailed expense priority of responsibility is answered, then the optimal responsibility for determining the bill expense in the case where declaration form defines is inquired about according to 3330AAAN
It is detailed.
In a particular embodiment, step 102 " ' specifically include：
Edlin exploitation and encapsulation process are entered to the detailed verification rule of responsibility, obtained corresponding with the detailed verification rule of responsibility
Application programming interface API.Developed and encapsulation process, entered using regulation engine DROOLS verification rules detailed to responsibility
And obtain corresponding api interface.
Step 102 specifically includes：
By transferring api interface, realize using the detailed verification rule of responsibility, by the bill expense in billing data and diagnosis and treatment
Type, matched with the responsibility managing detailed catalogue in declaration form data.
In the above-mentioned technical solutions, api interface corresponding with the detailed verification rule of responsibility is transferred, starts DROOLS, utilizes
DROOLS obtains power function corresponding to the detailed verification rule of responsibility, according to the execution step of the power function by billing data
Bill expense and diagnosis and treatment type, matched with the responsibility managing detailed catalogue in declaration form data.
As shown in Fig. 2 in a particular embodiment, method also includes：
Step 10a, the detailed verification rule of responsibility is periodically or non-periodically updated.
Step 102 specifically includes：
By the detailed verification rule of responsibility after renewal, by the bill expense and diagnosis and treatment type in billing data, with declaration form
Responsibility managing detailed catalogue in data is matched.
In the above-mentioned technical solutions, periodically or non-periodically the detailed verification rule of responsibility can be updated.The renewal can
To be the detailed verification rule of the new responsibility of addition or delete the detailed verification rule of responsibility or the detailed verification rule of modification responsibility.
, can be according to the interval time of setting, periodically to specific website or server if this is updated to regularly update
Whether search has a responsibility for the more new content of detailed verification rule, if so, then being downloaded from website or server needs what is updated
The detailed verification rule of responsibility, and the detailed verification rule of local responsibility is updated.If after no, continuing waiting for interval time
Scanned for again to specific website or server and repeat such scheme.
Can also be that insurance company's system is updated according to rule of checking detailed to responsibility is actually needed irregularly.This is more
It can be newly to be updated manually by staff, button is either updated corresponding to triggering from the specific website of trend or service
Device searches for the more new content of the detailed verification rule of corresponding responsibility, is automatically updated.
As the specific implementation of Fig. 1 methods, the embodiment of the present application provides a kind of detailed checking device of declaration form responsibility, such as
Shown in Fig. 3, the device of the present embodiment includes：Acquiring unit 21, matching unit 22 and determining unit 23.
Acquiring unit 21, for obtaining the billing data and declaration form data of settlement of insurance claim case to be checked；
Matching unit 22, for the detailed verification rule of responsibility by editing in advance, by the bill expense in billing data
With diagnosis and treatment type, matched with the responsibility managing detailed catalogue in declaration form data；
Determining unit 23, for according to matching result, the optimal duty corresponding with billing data to be determined from declaration form data
Appoint managing detailed catalogue.
In a particular embodiment, matching unit 22 specifically includes：
Acquisition module, for from the first default responsibility detail list, obtaining and the bill expense in billing data, diagnosis and treatment class
Responsibility managing detailed catalogue corresponding to type, and expense priority corresponding with responsibility managing detailed catalogue, protect in the first default responsibility detail list
There are the mapping relations between different bill expenses, diagnosis and treatment type, responsibility managing detailed catalogue and expense priority；
Acquisition module, it is additionally operable to from the second default responsibility detail list, obtains and the declaration form insurance kind information in declaration form data
Corresponding responsibility managing detailed catalogue, preserve in the second default responsibility detail list different declaration form insurance kind information respectively corresponding to responsibility
Managing detailed catalogue；
Matching module, for responsibility managing detailed catalogue corresponding to bill expense, diagnosis and treatment type is corresponding with declaration form insurance kind information
Responsibility managing detailed catalogue matched.
In a particular embodiment, determining unit 23 specifically includes：
Expense Priority Determination module, expense priority corresponding to each responsibility managing detailed catalogue matched for determination；
Optimal responsibility detail determining module, for by the responsibility managing detailed catalogue matched of expense highest priority, it is determined that
For the optimal responsibility managing detailed catalogue corresponding with bill expense, diagnosis and treatment type.
In a particular embodiment, it is optimal if the responsibility managing detailed catalogue matched of multiple expense highest priorities be present
Responsibility detail determining module, is specifically included：
Selecting module, one in the responsibility managing detailed catalogue matched for randomly choosing multiple expense highest priorities
Responsibility managing detailed catalogue, as the optimal responsibility managing detailed catalogue corresponding with bill expense, diagnosis and treatment type；Or
Selecting module, it is additionally operable to reference to bill expense, diagnosis and treatment type, selects matching for multiple expense highest priorities
A maximum responsibility managing detailed catalogue of the amount of money is compensated in responsibility managing detailed catalogue, as corresponding with bill expense, diagnosis and treatment type
Optimal responsibility managing detailed catalogue.
In a particular embodiment, device also includes：
Statistic unit, for count different bill expense, diagnosis and treatment type respectively corresponding to responsibility managing detailed catalogue, and according to
The priority configuration-direct received, the corresponding expense priority of responsibility managing detailed catalogue that configuration statistics obtains；And
Statistic unit, it is additionally operable to count the responsibility managing detailed catalogue that the declaration form of different declaration form insurance kind information is included；
Storage unit, for responsibility managing detailed catalogue corresponding to different bill expenses, diagnosis and treatment type difference, and responsibility is bright
The thin corresponding expense priority of information is stored in the first default responsibility detail list；And
Storage unit, it is additionally operable to the responsibility managing detailed catalogue that different declaration form insurance kind information include respectively being stored in second and presets
In responsibility detail list；
Edit cell, for presetting responsibility detail list according to the first default responsibility detail list and second after preservation data,
The detailed verification rule of editor's responsibility.
In a particular embodiment, edit cell, it is additionally operable to enter at edlin exploitation and encapsulation the detailed verification rule of responsibility
Reason, obtain application programming interface API corresponding with the detailed verification rule of responsibility；
Matching unit 22, is specifically included：
By transferring api interface, realize using the detailed verification rule of responsibility, by the bill expense in billing data and diagnosis and treatment
Type, matched with the responsibility managing detailed catalogue in declaration form data.
In a particular embodiment, as shown in figure 4, device also includes：
Updating block 2a, for periodically or non-periodically being updated to the detailed verification rule of responsibility；
Matching unit 22, it is additionally operable to by the detailed verification rule of responsibility after renewal, by the bill expense in billing data
With diagnosis and treatment type, matched with the responsibility managing detailed catalogue in declaration form data.
Based on method shown in above-mentioned Fig. 1,2, accordingly, the embodiment of the present application additionally provides a kind of storage device, deposits thereon
Computer program is contained, Fig. 1 is realized when program is executed by processor, the step in embodiment corresponding to method shown in 2.
Based on method shown in above-mentioned Fig. 1,2 and Fig. 3, the embodiment of 4 shown devices, the embodiment of the present application additionally provides one kind
The entity apparatus of the detailed verification of declaration form responsibility, as shown in figure 5, including storage device 32 and processor 31, wherein storage device 32
It is arranged at processor 31 in bus 33.
Storage device 32, for storing computer program；
Processor 31, for performing computer program to realize Fig. 1, the step in embodiment corresponding to method shown in 2.
, can be automatically according to the billing data slave phase of settlement of insurance claim case to be checked by the above-mentioned technical proposal of the application
In multiple responsibility managing detailed catalogues in the declaration form data answered, Automatic sieve selects optimal responsibility managing detailed catalogue.The process of automatic screening
Entirely automation is carried out, and is participated in without artificial, and screening process speed is fast, the degree of accuracy is high.Substantial amounts of people can be saved
Power resource, while error rate is effectively reduced, improve the timeliness and accuracy of the detailed audit process of declaration form responsibility.
Through the above description of the embodiments, those skilled in the art can be understood that the application can lead to
Hardware realization is crossed, the mode of necessary general hardware platform can also be added by software to realize.Based on such understanding, this Shen
Technical scheme please can be embodied in the form of software product, and the software product can be stored in a non-volatile memories
In medium (can be CD-ROM, USB flash disk, mobile hard disk etc.), including some instructions are causing a computer equipment (can be
Personal computer, server, or network equipment etc.) perform each implement scene of the application described in method.
It will be appreciated by those skilled in the art that accompanying drawing is a schematic diagram for being preferable to carry out scene, module in accompanying drawing or
Flow is not necessarily implemented necessary to the application.
It will be appreciated by those skilled in the art that the module in device in implement scene can be described according to implement scene into
Row is distributed in the device of implement scene, can also carry out one or more dresses that respective change is disposed other than this implement scene
In putting.The module of above-mentioned implement scene can be merged into a module, can also be further split into multiple submodule.
Above-mentioned the application sequence number is for illustration only, does not represent the quality of implement scene.
Disclosed above is only several specific implementation scenes of the application, and still, the application is not limited to this, Ren Heben
What the technical staff in field can think change should all fall into the protection domain of the application.
Claims (10)
1. the detailed checking method of a kind of declaration form responsibility, it is characterised in that methods described includes：
Obtain the billing data and declaration form data of settlement of insurance claim case to be checked；
By the detailed verification rule of the responsibility edited in advance, by the bill expense and diagnosis and treatment type in the billing data, with institute
The responsibility managing detailed catalogue stated in declaration form data is matched；
According to matching result, the optimal responsibility managing detailed catalogue corresponding with the billing data is determined from the declaration form data.
2. according to the method for claim 1, it is characterised in that it is described regular by the detailed verification of pre-defined responsibility,
By the bill expense and diagnosis and treatment type in the billing data, matched with the responsibility managing detailed catalogue in the declaration form data,
Specifically include：
From the first default responsibility detail list, responsibility corresponding with the bill expense in the billing data, diagnosis and treatment type is obtained
Managing detailed catalogue, and expense priority corresponding with the responsibility managing detailed catalogue, preserve in the described first default responsibility detail list
Mapping relations between different bill expense, diagnosis and treatment type, responsibility managing detailed catalogue and expense priority；
From the second default responsibility detail list, the detailed letter of responsibility corresponding with the declaration form insurance kind information in the declaration form data is obtained
Cease, responsibility managing detailed catalogue corresponding to different declaration form insurance kind information difference is preserved in the described second default responsibility detail list；
The responsibility corresponding with the declaration form insurance kind information of responsibility managing detailed catalogue corresponding to the bill expense, diagnosis and treatment type is detailed
Information is matched.
3. according to the method for claim 2, it is characterised in that it is described according to matching result, it is true from the declaration form data
The fixed optimal responsibility managing detailed catalogue corresponding with the billing data, is specifically included：
It is determined that expense priority corresponding to each responsibility managing detailed catalogue matched；
By the responsibility managing detailed catalogue matched of the expense highest priority, it is defined as and the bill expense, diagnosis and treatment type
Corresponding optimal responsibility managing detailed catalogue.
4. according to the method for claim 3, it is characterised in that if matching for multiple expense highest priorities be present
Responsibility managing detailed catalogue, then by the responsibility managing detailed catalogue matched of the expense highest priority, be defined as and the bill
The corresponding optimal responsibility managing detailed catalogue of expense, diagnosis and treatment type, is specifically included：
Randomly choose a responsibility detail in the responsibility managing detailed catalogue matched of the multiple expense highest priority
Information, as the optimal responsibility managing detailed catalogue corresponding with the bill expense, diagnosis and treatment type；Or
With reference to the bill expense, diagnosis and treatment type, select the responsibility matched of the multiple expense highest priority bright
A maximum responsibility managing detailed catalogue of the amount of money is compensated in thin information, as corresponding most with the bill expense, diagnosis and treatment type
Excellent responsibility managing detailed catalogue.
5. according to the method for claim 2, it is characterised in that, will in the detailed verification rule of responsibility by editing in advance
Bill expense and diagnosis and treatment type in the billing data, carry out matching it with the responsibility managing detailed catalogue in the declaration form data
Before, methods described also includes：
Count different bill expense, diagnosis and treatment type respectively corresponding to responsibility managing detailed catalogue, and matched somebody with somebody according to the priority received
Put instruction, the corresponding expense priority of the responsibility managing detailed catalogue that configuration statistics obtains；And
Count the responsibility managing detailed catalogue that the declaration form of different declaration form insurance kind information is included；
By responsibility managing detailed catalogue corresponding to the different bill expenses, diagnosis and treatment type difference, and the responsibility managing detailed catalogue phase
The expense priority answered is stored in the first default responsibility detail list；And
The responsibility managing detailed catalogue that the different declaration form insurance kind information include respectively is stored in the second default responsibility detail list；
According to the described first default responsibility detail list after preservation data and the second default responsibility detail list, the duty is edited
Appoint detailed verification rule.
6. according to the method for claim 5, it is characterised in that the detailed verification rule of the editor's responsibility, specifically include：
Edlin exploitation and encapsulation process are entered to the detailed verification rule of the responsibility, it is right with the detailed verification rule of the responsibility to obtain
The application programming interface API answered；
It is described by the detailed verification rule of the responsibility edited in advance, by the bill expense and diagnosis and treatment type in the billing data,
Matched, specifically included with the responsibility managing detailed catalogue in the declaration form data：
By transferring the api interface, realize using the detailed verification rule of responsibility, by the bill expense in the billing data and
Diagnosis and treatment type, matched with the responsibility managing detailed catalogue in the declaration form data.
7. according to the method described in any one of claim 1 to 6, it is characterised in that methods described also includes：
The detailed verification rule of the responsibility is periodically or non-periodically updated；
It is described by the detailed verification rule of the responsibility edited in advance, by the bill expense and diagnosis and treatment type in the billing data,
Matched, specifically included with the responsibility managing detailed catalogue in the declaration form data：
It is and described by the bill expense and diagnosis and treatment type in the billing data by the detailed verification rule of responsibility after renewal
Responsibility managing detailed catalogue in declaration form data is matched.
8. the detailed checking device of a kind of declaration form responsibility, it is characterised in that described device includes：
Acquiring unit, for obtaining the billing data and declaration form data of settlement of insurance claim case to be checked；
Matching unit, for the detailed verification rule of the responsibility by editing in advance, by the bill expense in the billing data and
Diagnosis and treatment type, matched with the responsibility managing detailed catalogue in the declaration form data；
Determining unit, it is corresponding with the billing data optimal for according to matching result, being determined from the declaration form data
Responsibility managing detailed catalogue.
9. a kind of storage device, is stored thereon with computer program, it is characterised in that is realized when described program is executed by processor
The checking method of declaration form responsibility detail described in any one of claim 1 to 7.
A kind of 10. detailed checking device of declaration form responsibility, it is characterised in that described device includes storage device and processor,
The storage device, for storing computer program；
The processor, for performing the computer program to realize that the declaration form responsibility described in any one of claim 1 to 7 is bright
Thin checking method.
Priority Applications (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201711113080.1A CN107767123A (en) | 2017-11-10 | 2017-11-10 | A kind of declaration form responsibility detailed checking method and device |
| PCT/CN2018/074620 WO2019090984A1 (en) | 2017-11-10 | 2018-01-30 | Policy liability detail checking method and device |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201711113080.1A CN107767123A (en) | 2017-11-10 | 2017-11-10 | A kind of declaration form responsibility detailed checking method and device |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN107767123A true CN107767123A (en) | 2018-03-06 |
Family
ID=61273485
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201711113080.1A Pending CN107767123A (en) | 2017-11-10 | 2017-11-10 | A kind of declaration form responsibility detailed checking method and device |
Country Status (2)
| Country | Link |
|---|---|
| CN (1) | CN107767123A (en) |
| WO (1) | WO2019090984A1 (en) |
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| CN108985946A (en) * | 2018-06-14 | 2018-12-11 | 中国平安人寿保险股份有限公司 | A kind of processing method and server of declaration form |
| CN109658258A (en) * | 2018-11-07 | 2019-04-19 | 中国平安财产保险股份有限公司 | Amount for which loss settled based on big data adjusts method, apparatus, computer equipment automatically |
| CN109785165A (en) * | 2018-12-14 | 2019-05-21 | 中国平安财产保险股份有限公司 | Declaration form reparation method, apparatus and computer equipment based on data processing |
| CN109785158A (en) * | 2018-12-13 | 2019-05-21 | 平安医疗健康管理股份有限公司 | A kind of health insurance core duty data processing method, server and computer-readable medium |
| CN111079424A (en) * | 2019-11-15 | 2020-04-28 | 泰康保险集团股份有限公司 | Information auditing method and device |
| CN111242788A (en) * | 2019-12-31 | 2020-06-05 | 北京健康之家科技有限公司 | Service data processing method and device, storage medium and computer equipment |
| CN111784523A (en) * | 2020-06-28 | 2020-10-16 | 平安医疗健康管理股份有限公司 | Crowdsourcing distribution method and device based on policy case |
| CN112270223A (en) * | 2020-10-14 | 2021-01-26 | 招商银行股份有限公司 | Policy viewing method, policy viewing device and computer-readable storage medium |
| CN113283996A (en) * | 2021-05-27 | 2021-08-20 | 北京健康之家科技有限公司 | Policy screening method and storage medium |
| CN113537774A (en) * | 2021-07-16 | 2021-10-22 | 精英数智科技股份有限公司 | Method and system for detecting whether coal mine enterprise policy is valid |
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| CN108985946B (en) * | 2018-06-14 | 2024-03-15 | 中国平安人寿保险股份有限公司 | Processing method of policy and server |
| CN108985946A (en) * | 2018-06-14 | 2018-12-11 | 中国平安人寿保险股份有限公司 | A kind of processing method and server of declaration form |
| CN109658258A (en) * | 2018-11-07 | 2019-04-19 | 中国平安财产保险股份有限公司 | Amount for which loss settled based on big data adjusts method, apparatus, computer equipment automatically |
| CN109785158A (en) * | 2018-12-13 | 2019-05-21 | 平安医疗健康管理股份有限公司 | A kind of health insurance core duty data processing method, server and computer-readable medium |
| CN109785165A (en) * | 2018-12-14 | 2019-05-21 | 中国平安财产保险股份有限公司 | Declaration form reparation method, apparatus and computer equipment based on data processing |
| CN111079424A (en) * | 2019-11-15 | 2020-04-28 | 泰康保险集团股份有限公司 | Information auditing method and device |
| CN111242788A (en) * | 2019-12-31 | 2020-06-05 | 北京健康之家科技有限公司 | Service data processing method and device, storage medium and computer equipment |
| CN111784523A (en) * | 2020-06-28 | 2020-10-16 | 平安医疗健康管理股份有限公司 | Crowdsourcing distribution method and device based on policy case |
| CN112270223A (en) * | 2020-10-14 | 2021-01-26 | 招商银行股份有限公司 | Policy viewing method, policy viewing device and computer-readable storage medium |
| CN112270223B (en) * | 2020-10-14 | 2024-05-31 | 招商银行股份有限公司 | Policy inspection method, policy inspection device and computer readable storage medium |
| CN113283996A (en) * | 2021-05-27 | 2021-08-20 | 北京健康之家科技有限公司 | Policy screening method and storage medium |
| CN113537774A (en) * | 2021-07-16 | 2021-10-22 | 精英数智科技股份有限公司 | Method and system for detecting whether coal mine enterprise policy is valid |
| CN113537774B (en) * | 2021-07-16 | 2023-04-07 | 精英数智科技股份有限公司 | Method and system for detecting whether policy of coal mine enterprise is effective or not |
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|---|---|
| WO2019090984A1 (en) | 2019-05-16 |
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Application publication date: 20180306 |