CN112508721A - Deposit-free implementation method, device, medium and electronic equipment - Google Patents
Deposit-free implementation method, device, medium and electronic equipment Download PDFInfo
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Abstract
The invention provides a deposit-free implementation method, which comprises the following steps: obtaining deposit-free application data of a user; verifying whether the deposit-free application data meets the condition of deposit-free application by using a rule engine; if the condition of the deposit-free application is met, sending deposit-free service agreement data; receiving electronic signature data signed by the user for the deposit-free service agreement data; according to the electronic signature data, the pre-authorization notice is sent, so that the application period can be shortened by applying for the deposit-free mode, the processing speed is increased, and the risk is controlled. The invention also provides a deposit-free realizing device, a medium and electronic equipment.
Description
Technical Field
The invention relates to the technical field of data processing, in particular to a deposit-free implementation method, device, medium and electronic equipment.
Background
At present, under the traditional insurance mode of the existing medical financial system and medical insurance, for clients, if serious diseases are unfortunate, a huge amount of hospitalization deposit must be paid before admission. For patients whose income is not very high, it may not be affordable. Aiming at the situation, the insurance company applies for the deposit-free online before the current situation, and the information of the applicant is checked manually. In view of this situation, the inventors found that the following problems exist in the related art when the inventive concept of the present invention is implemented: the system has the advantages of long application period, low processing efficiency, incapability of controlling risks, incapability of assisting the increase of service sales, incapability of judging whether the deposit-free amount applied by a patient meets the requirements of various hospitals, increase of expenditure of manpower and material resources of insurance companies and reduction of user experience.
It is to be noted that the information disclosed in the above background section is only for enhancement of understanding of the background of the present invention and therefore may include information that does not constitute prior art known to a person of ordinary skill in the art.
Disclosure of Invention
The embodiment of the invention aims to provide a deposit-free implementation method, device, medium and electronic equipment, so that the application period can be reduced to a certain extent at least, the processing speed is increased, and the risk control is realized.
Additional features and advantages of the invention will be set forth in the detailed description which follows, or may be learned by practice of the invention.
According to a first aspect of the embodiments of the present invention, a deposit free implementation method is provided, including: obtaining deposit-free application data of a user, wherein the deposit-free application data comprises any one or more of the following items: identity information data, policy information data, application amount data and hospital information data; verifying whether the deposit-free application data meets the condition of deposit-free application by using a rule engine; if the condition of the deposit-free application is met, sending deposit-free service agreement data; receiving electronic signature data signed by the user for the deposit-free service agreement data; sending a pre-authorization notice according to the electronic signature data; wherein, the condition for verifying whether the deposit-free application data meets the deposit-free application by using a rule engine comprises the following steps: verifying whether the identity information data is in a preset blacklist or not; verifying whether the policy in the policy information data is a valid policy; and verifying whether the application amount data is smaller than the application amount preset by the hospital.
In some embodiments of the present invention, if the condition of the deposit-exempt application is satisfied, sending deposit-exempt service agreement data includes: and if the identity information data is not in the preset blacklist, the policy in the policy information data is an effective policy, and the application amount data is less than or equal to the application amount preset by the hospital, sending the deposit-free service agreement data to a terminal.
In some embodiments of the invention, when the policy in the policy information data is a valid policy, the method further comprises: verifying whether the insurance policy in the insurance policy information data is the insurance policy applied in the social insurance identity; verifying whether the hospital information data supports settlement in a social security mode; verifying whether the policy in the policy information data triggers the verification of the high-risk service department; checking whether the policy in the policy information data has a historical claim settlement record or not; and checking whether the identity information data has a preset type case, and if so, continuously checking whether the case state of the preset type case is a preset state.
In some embodiments of the present invention, before verifying whether the application amount data is less than the application amount preset by the hospital, the method further comprises: verifying whether the remaining warranty of the policy in the policy information data is greater than or equal to a first threshold value, wherein the first threshold value comprises a threshold value determined according to the total warranty of the policy; and if the remaining amount of the policy is greater than or equal to the first threshold, verifying whether the application amount data is less than the remaining amount of the policy.
In some embodiments of the invention, the method further comprises: verifying whether the identity information data is a user applying for deposit-free for two or more times, and if the identity information data is the user applying for deposit-free for two or more times, continuously verifying whether the accumulated applied amount is greater than or equal to a second threshold value, wherein the second threshold value is different from the first threshold value, and the second threshold value comprises a threshold value determined according to the remaining amount of the policy; and if the accumulated application amount is larger than or equal to the second threshold value, sending a deposit-free early warning.
In some embodiments of the invention, the method further comprises: verifying whether the difference between the remaining amount of the policy and the accumulated application amount is greater than or equal to the first threshold; and if the remaining amount of the policy with the difference between the accumulated application amount is greater than or equal to the first threshold value, checking whether the current application amount is less than the difference between the preset application amount of the hospital and the accumulated application amount, and checking whether the current application amount is less than the remaining amount of the policy with the difference between the accumulated application amount.
In some embodiments of the invention, the method further comprises: and associating the deposit-free application data with the preset type case through an association rule.
In some embodiments of the invention, the method further comprises: acquiring the fee evasion amount of the user; and recording the fee evasion amount of the user in the effective insurance policy of the user, and paying to a hospital based on the fee evasion amount of the user and the application amount data of the user.
According to a second aspect of the embodiments of the present invention, there is provided a deposit-free implementation apparatus, including: the system comprises a first acquisition module, a second acquisition module and a third acquisition module, wherein the first acquisition module is used for acquiring deposit-free application data of a user, and the deposit-free application data comprises any one or more of the following items: identity information data, policy information data, application amount data and hospital information data; the first verification module is used for verifying whether the deposit-free application data meets the condition of deposit-free application or not by using a rule engine; the first sending module is used for sending the deposit-free service agreement data if the deposit-free application condition is met; the receiving module is used for receiving electronic signature data signed by the user aiming at the deposit-free service agreement data; the second sending module is used for sending a pre-authorization notice according to the electronic signature data; wherein the first verification module is configured to: verifying whether the identity information data is in a preset blacklist or not; verifying whether the policy in the policy information data is a valid policy; and verifying whether the application amount data is smaller than the application amount preset by the hospital.
In some embodiments of the invention, the first transmitting module is configured to: and if the identity information data is not in the preset blacklist, the policy in the policy information data is an effective policy, and the application amount data is less than or equal to the application amount preset by the hospital, sending the deposit-free service agreement data to a terminal.
In some embodiments of the invention, when the policy in the policy information data is a valid policy, the apparatus further comprises a second verification module configured to: verifying whether the insurance policy in the insurance policy information data is the insurance policy applied in the social insurance identity; verifying whether the hospital information data supports settlement in a social security mode; verifying whether the policy in the policy information data triggers the verification of the high-risk service department; checking whether the policy in the policy information data has a historical claim settlement record or not; and checking whether the identity information data has a preset type case, and if so, continuously checking whether the case state of the preset type case is a preset state.
In some embodiments of the invention, before verifying whether the application amount data is less than the preset application amount of the hospital, the apparatus further comprises a third verification module configured to: verifying whether the remaining warranty of the policy in the policy information data is greater than or equal to a first threshold value, wherein the first threshold value comprises a threshold value determined according to the total warranty of the policy; and if the remaining amount of the policy is greater than or equal to the first threshold, verifying whether the application amount data is less than the remaining amount of the policy.
In some embodiments of the present invention, the apparatus further includes a fourth verification module, configured to verify whether the identity information data is a user applying for deposit twice or more, and if the identity information data is a user applying for deposit twice or more, continue to verify whether an accumulated amount of application is greater than or equal to a second threshold, where the second threshold is different from the first threshold, and the second threshold includes a threshold determined according to a remaining amount of the policy; and the third sending module is used for sending the deposit-free early warning if the accumulated application amount is more than or equal to the second threshold value.
In some embodiments of the invention, the apparatus further comprises a fifth verification module configured to: verifying whether the difference between the remaining amount of the policy and the accumulated application amount is greater than or equal to the first threshold; and if the remaining amount of the policy with the difference between the accumulated application amount is greater than or equal to the first threshold value, checking whether the current application amount is less than the difference between the preset application amount of the hospital and the accumulated application amount, and checking whether the current application amount is less than the remaining amount of the policy with the difference between the accumulated application amount.
In some embodiments of the present invention, the apparatus further includes an association module, configured to associate the deposit exemption application data with the preset type case through an association rule.
In some embodiments of the invention, the apparatus further comprises: the second acquisition module is used for acquiring the fee evasion amount of the user; and the record payment module is used for recording the fee evasion amount of the user in the effective insurance policy of the user and paying to the hospital based on the fee evasion amount of the user and the application amount data of the user.
The technical scheme provided by the embodiment of the invention has the following beneficial effects:
in the technical scheme provided by some embodiments of the invention, a rule engine is used for verifying whether deposit-free application data meets the condition of deposit-free application or not is obtained, if the deposit-free application condition is met, deposit-free service agreement data is sent, electronic signature data signed by a user aiming at the deposit-free service agreement data is received, and a pre-authorization notice sheet is sent according to the electronic signature data, so that online deposit-free application is realized.
It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed.
Drawings
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments consistent with the invention and together with the description, serve to explain the principles of the invention. It is obvious that the drawings in the following description are only some embodiments of the invention, and that for a person skilled in the art, other drawings can be derived from them without inventive effort. In the drawings:
FIG. 1 is a diagram illustrating an exemplary system architecture to which an deposit free implementation method or deposit free implementation apparatus of embodiments of the invention may be applied;
FIG. 2 schematically illustrates a flow diagram of a deposit-free implementation method according to an embodiment of the invention;
FIG. 3 schematically illustrates a flow diagram of a deposit-free implementation method according to another embodiment of the invention;
FIG. 4 schematically illustrates a flow diagram of a deposit-free implementation method according to another embodiment of the invention;
FIG. 5 schematically illustrates a block diagram of a deposit-free fulfillment apparatus, in accordance with an embodiment of the present invention;
FIG. 6 schematically illustrates a block diagram of a deposit-free implementation according to another embodiment of the present invention;
FIG. 7 schematically illustrates a block diagram of a deposit-free fulfillment apparatus, in accordance with another embodiment of the present invention;
FIG. 8 schematically illustrates a block diagram of a deposit-free fulfillment apparatus, in accordance with another embodiment of the present invention;
FIG. 9 schematically illustrates a block diagram of a deposit-free fulfillment apparatus, in accordance with another embodiment of the present invention;
FIG. 10 illustrates a schematic structural diagram of a computer system suitable for use with the electronic device to implement an embodiment of the invention.
Detailed Description
Example embodiments will now be described more fully with reference to the accompanying drawings. Example embodiments may, however, be embodied in many different forms and should not be construed as limited to the examples set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the concept of example embodiments to those skilled in the art.
Furthermore, the described features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. In the following description, numerous specific details are provided to provide a thorough understanding of embodiments of the invention. One skilled in the relevant art will recognize, however, that the invention may be practiced without one or more of the specific details, or with other methods, components, devices, steps, and so forth. In other instances, well-known methods, devices, implementations or operations have not been shown or described in detail to avoid obscuring aspects of the invention.
The block diagrams shown in the figures are functional entities only and do not necessarily correspond to physically separate entities. I.e. these functional entities may be implemented in the form of software, or in one or more hardware modules or integrated circuits, or in different networks and/or processor means and/or microcontroller means.
The flow charts shown in the drawings are merely illustrative and do not necessarily include all of the contents and operations/steps, nor do they necessarily have to be performed in the order described. For example, some operations/steps may be decomposed, and some operations/steps may be combined or partially combined, so that the actual execution sequence may be changed according to the actual situation.
Fig. 1 is a schematic diagram illustrating an exemplary system architecture to which the deposit free implementation method or deposit free implementation apparatus according to the embodiment of the present invention may be applied.
As shown in fig. 1, the system architecture 100 may include one or more of terminal devices 101, 102, 103, a network 104, and a server 105. The network 104 serves as a medium for providing communication links between the terminal devices 101, 102, 103 and the server 105. Network 104 may include various connection types, such as wired, wireless communication links, or fiber optic cables, to name a few.
It should be understood that the number of terminal devices, networks, and servers in fig. 1 is merely illustrative. There may be any number of terminal devices, networks, and servers, as desired for implementation. For example, server 105 may be a server cluster comprised of multiple servers, or the like.
The user may use the terminal devices 101, 102, 103 to interact with the server 105 via the network 104 to receive or send messages or the like. The terminal devices 101, 102, 103 may be various electronic devices having a display screen, including but not limited to smart phones, tablet computers, portable computers, desktop computers, and the like.
The server 105 may be a server that provides various services. For example, the server 105 can obtain the deposit-free application data of the user from the terminal device 103 (or the terminal device 101 or 102), check by using a rule engine whether the deposit-free application data meets the condition of the deposit-free application, send the deposit-free service agreement data if the condition of the deposit-free application is met, receive the electronic signature data signed by the deposit-free service agreement data, send the pre-authorization notice according to the electronic signature data, realize the online application of the deposit-free, apply for the deposit-free in such a way to reduce the application period, improve the processing speed, realize the control risk and increase the sales volume of the assisted business, and reduce the expenditure of manpower and material resources of the insurance company, thereby improving the user experience.
In some embodiments, the deposit-free implementation method provided by the embodiments of the present invention is generally executed by the server 105, and accordingly, the deposit-free implementation apparatus is generally disposed in the server 105. In other embodiments, some terminals may have similar functionality as the server to perform the method. Therefore, the deposit-free implementation method provided by the embodiment of the invention is not limited to be executed at the server side.
Fig. 2 schematically shows a flowchart of a deposit-free implementation method according to an embodiment of the invention.
As shown in fig. 2, the deposit-free implementation method may include steps S210 to S250.
In step S210, the deposit free application data of the user is acquired.
In step S220, the rule engine is used to check whether the deposit-free application data satisfies the condition of deposit-free application.
In step S230, if the condition of the deposit free application is satisfied, the deposit free service agreement data is transmitted.
In step S240, electronic signature data signed by the user for the deposit-exempt service agreement data is received.
In step S250, a pre-authorization notice is sent according to the electronic signature data.
The method can acquire the condition that whether the deposit-free application data meet the deposit-free application by using a rule engine, if the deposit-free application condition is met, the deposit-free service agreement data is sent, the electronic signature data signed by the deposit-free service agreement data by a user is received, and a pre-authorization notice is sent according to the electronic signature data, so that online deposit-free application is realized, the application period can be shortened by applying for deposit-free, the processing speed is increased, the risk control is realized, the increase of the sales volume of the power-assisted business is facilitated, the expenditure of manpower and material resources of an insurance company is reduced, and the user experience is improved.
In an embodiment of the invention, the user can enter the user interaction interface for applying for the deposit free through social software, or the user can also enter the user interaction interface for applying for the deposit free through scanning a two-dimensional code provided by a hospital. The user may enter the deposit free application data in the user interaction interface.
In one embodiment of the invention, the deposit free application data includes any one or more of: identity information data, policy information data, application amount data and hospital information data.
In an embodiment of the present invention, the user identification data may refer to a name of the user, an identification number of the user, a social security card number of the user, a passport number of the user, and the like, but is not limited thereto. The policy information data may refer to, but is not limited to, the policy number, the policy expiration date, the type of risk of the policy, the historical claims record of the policy, whether the applicant applies the policy in social security status, the total amount of the policy, the remaining amount of the policy, and the like. The application amount data may refer to the amount of deposit free that the user wants to apply for. The hospital may refer to the name of the hospital, the department in which the patient is visiting, the admission information of the patient, the admission registration information of the patient, whether the hospital pays the social security settlement, and the application amount preset by the hospital.
In one embodiment of the invention, the condition for verifying whether the deposit-exempt application data meets the deposit-exempt application by using the rule engine comprises the following steps: verifying whether the identity information data is in a preset blacklist or not; verifying whether the policy in the policy information data is a valid policy; and verifying whether the application amount data is smaller than the preset application amount of the hospital or not, and realizing that whether the deposit-free amount applied by the patient meets the requirements of each hospital or not is automatically judged on line. And if the identity information data is not in the preset blacklist, the policy in the policy information data is an effective policy, and the application amount data is less than or equal to the application amount preset by the hospital, sending the deposit-free service agreement data to a terminal. In the embodiment, the self-checking result can be fed back in real time by using the rule engine; if the self-check passes, informing the client of the obtained deposit-free amount in real time, and if the self-check does not pass, informing the client of the reason of not passing in real time; if the self-check needs to be performed by a person, the deposit-free application enters a back-end auditing operation system, and the auditing is performed by a manual auditor.
In one embodiment of the invention, electronic signature data signed by a user for deposit free service agreement data is received. For example, after the verification passes, the deposit-free service agreement data is sent to the terminal, the user can browse the deposit-free service agreement data at the terminal, that is, whether the user agrees to sign the deposit-free service agreement, does not agree to sign the deposit-free service agreement, fails to apply for the deposit, agrees to sign the deposit, succeeds in applying for the deposit, at the moment, the system sends a pre-authorization notice sheet to the terminal to inform that the user applies for the deposit corresponding to the hospital, and can perform deposit-free treatment on the user if the hospital agrees. In this case, when the user is discharged, only the expense amount, the social insurance amount and the merchant insurance reimbursement amount need to be submitted, so that the economic burden of the client is greatly reduced, and the cultural care is embodied.
In one embodiment of the present invention, when the policy in the policy information data is a valid policy, the method further comprises: verifying whether the insurance policy in the insurance policy information data is the insurance policy applied in the social insurance identity; verifying whether hospital information data support settlement in a social insurance mode; verifying whether the policy in the policy information data triggers the verification of the high-risk service department; checking whether the policy in the policy information data has a historical claim settlement record; and checking whether the identity information data has a preset type case, and if so, continuously checking whether the case state of the preset type case is a preset state. In this embodiment, if the policy in the policy information data is not the policy applied for social security identity, it is continuously checked whether the policy in the policy information data triggers the verification of the high-risk service unit, and if the policy in the policy information data has triggered the verification of the high-risk service unit, the verification fails, i.e., the deposit-free application fails. If the hospital in the hospital information data does not support settlement in a social security mode, the verification fails, namely the deposit-free application fails. And if the policy in the policy information data does not have the historical claim settlement records, manually checking.
In an embodiment of the present invention, the preset status is no liability of reimbursement for visit, regular reimbursement, settlement to be settled in hospital, reimbursement to core system, and settlement already settled in hospital. In this embodiment, if the case status of the preset type case is any one of the preset statuses, the verification fails, i.e. the deposit free application fails.
Based on the foregoing embodiment, if the policy in the policy information data is the policy applied by the social security identity, the hospital information data supports settlement in the social security manner, the policy in the policy information data does not trigger verification of the high risk service department, the policy in the policy information data has historical claim records, and the identity information data has a preset type case, and the case status of the preset type case is different from the preset status, in this case, the applied amount data is verified.
In an embodiment of the present invention, before verifying whether the application amount data is less than the preset application amount of the hospital, the method further includes: it is verified whether the remaining amount of the policy in the policy information data is equal to or greater than a first threshold value, the first threshold value including a threshold value determined according to the total amount of the policy. For example, the first threshold may be twenty percent of the total warranty of the policy. And if the remaining amount of the policy is greater than or equal to the first threshold, verifying whether the application amount data is less than the remaining amount of the policy. In this embodiment, if the application amount data is less than the remaining amount of the policy, the amount of the deposit exempt in the application amount data is taken as the amount of the last deposit exempt.
In one embodiment of the invention, the method further comprises: will through the association rule exempt from deposit application data with predetermine the type case and carry out the association, be convenient for like this the check personnel when handling predetermined type case, can clearly know which are exempt from deposit cases, to exempting from deposit cases, promote the processing ageing. For example, the hospitalization hospital, the client name, the certificate type, the certificate number and the hospitalization date in the deposit exemption application data are associated with the hospitalization hospital, the client name, the certificate type, the certificate number and the hospitalization date of the preset type case, if the hospitalization hospital, the client name, the certificate type, the certificate number and the hospitalization date in the deposit exemption application data are the same as any two or more than two of the hospitalization hospital, the client name, the certificate type, the certificate number and the hospitalization date of the preset type case, the association is successful, and then the deposit exemption applications applied by the current time and subsequent users can be recorded under the case number of the health insurance case.
In one embodiment of the present invention, the predetermined type of case may be an insurance case related to a deposit-free application in an insurance company. For example, the preset type case may be a health care pass through case in an insurance company.
Fig. 3 schematically shows a flow diagram of a deposit-free implementation method according to another embodiment of the invention.
As shown in fig. 3, the method further includes steps S310 and S320.
In step S310, it is checked whether the identity information data is a user applying for deposit free twice or more, and if the identity information data is a user applying for deposit free twice or more, it is checked whether the accumulated applied amount is greater than or equal to a second threshold value, which is different from the first threshold value, and the second threshold value includes a threshold value determined according to the remaining amount of the policy.
In step S320, if the accumulated application amount is greater than or equal to the second threshold, a deposit free warning is sent.
The method can support multiple online applications for deposit-free money, and if the accumulated application amount of two or more times is larger than or equal to a second threshold value, a deposit-free money early warning is sent to prompt that the accumulated application amount of the user is close to the remaining amount of the policy, and the user is interested in normal settlement during discharge.
In one embodiment of the invention, the second threshold may be sixty percent of the remaining amount of the policy. For example, when the accumulated deposit-free amount of a hospital stay is more than or equal to 60% of the remaining amount of the policy, a notice is pushed to the visit staff of the hospital, and the deposit-free early warning of the health care entrance, the name of the hospital, the name of the client, the information of the identity card and the accumulated deposit-free amount are sent. The customer accumulates the amount of the deposit free to be close to the remaining amount of the policy, and pays attention to the normal settlement when the customer is discharged.
In one embodiment of the invention, the method further comprises: verifying whether the difference between the remaining amount of the policy and the accumulated applied amount is greater than or equal to a first threshold; and if the difference between the remaining amount of the policy and the accumulated application amount is greater than or equal to the first threshold, checking whether the current application amount is smaller than the difference between the preset application amount of the hospital and the accumulated application amount, and checking whether the current application amount is smaller than the difference between the remaining amount of the policy and the accumulated application amount. In this embodiment, if the difference between the remaining amount of the policy and the accumulated amount of the application is greater than or equal to the first threshold, the data of the amount of the application is verified according to the following rule: and checking whether the current application amount is smaller than the difference between the preset application amount and the accumulated application amount of the hospital and whether the current application amount is smaller than the difference between the remaining insurance amount and the accumulated application amount of the policy. And when the application amount is smaller than the difference between the application amount preset by the hospital and the accumulated application amount and the application amount is smaller than the difference between the remaining insurance amount of the policy and the accumulated application amount, taking the application amount as the final deposit-free amount.
Fig. 4 schematically shows a flow diagram of a deposit-free implementation method according to another embodiment of the invention.
As shown in fig. 4, the method further includes step S410 and step S420.
In step S410, the fee evasion amount of the user is acquired.
In step S420, the fee evasion amount of the user is recorded in the valid policy of the user, and payment is made to the hospital based on the fee evasion amount of the user and the application amount data of the user.
The method can record the fee evasion amount of the user in the effective insurance policy of the user, and pay to the hospital based on the fee evasion amount of the user and the application amount data of the user, thereby effectively avoiding the fee evasion of the user.
In one embodiment of the invention, when the hospital finds that the user escapes (leaves without going through the discharge procedure), the arrearage process can be initiated through a [ client arrearage ] function key in a 'deposit free inquiry' menu in the user interaction interface of the hospital terminal. After the hospital terminal confirms that the arrearage process is initiated, the visiting rechecking personnel of the insurance company can check the deposit-free case in a client arrearage confirmation menu, and a [ arrearage confirmation ] button is clicked to make a conclusion on whether the deposit-free case client arrearages or not: if 'no confirmation' is selected, the deposit-free case disappears from the arrearage confirmation pool, the normal circulation of the deposit-free process is not affected, the medical care personnel can check the result of the arrearage confirmation through a button of 'arrearage confirmation details' in a 'hospitalization deposit-free inquiry' menu on a user interaction interface of the hospital terminal, and the arrearage process is ended; if 'confirmation' is selected, the result can be checked in the defaulting confirmation details, and after checking, the operator of the hospital terminal can directly initiate settlement and transaction. The settlement is confirmed by an operator of the hospital terminal instead of the user, and the case is automatically settled after the confirmation is finished. At the moment, the system needs to judge whether to escape, and if not, the deposit-free case enters the existing payment process. If yes, the deposit-free case enters the arrearage payment process. In the arrearage payment process, a new transaction is generated for paying the amount of fee evasion of the client to the hospital, and an account receivable with the same amount of money is hung under the policy corresponding to the free deposit risk type accorded by the client. Meanwhile, the normal payment amount of the deposit-free dangerous seed is not changed, and the deposit-free dangerous seed is paid to the hospital and is not paid to the client any more.
Specifically, when the fee evasion case ends, the LIC interface is called to end, a payment number for normal payment is generated, and if the case ends successfully, an arrearage payment list is entered (the payment of all related cases of the case enters the list). The account of the fee evasion needs to be hung under the risk meeting the deposit-free condition in the risk related to the case, and if a plurality of deposit-free risks exist, the account is hung under the risk with the highest paying amount (if the same, the account is hung under one of the deposit-free risks). After entering the arrears payment list, for the payment record needing to be posted, a [ generate fee evasion ] button is displayed on the right side, and the fee evasion interface capable of calling the CSC is clicked to establish fee evasion payment. The failure can be initiated repeatedly, the ash is not available after the successful button is pressed, the generated fee evasion payment enters an arrearage confirmation list, and at the moment, the left checking frames of all records of the case are changed into a checking state, so that the payment confirmation can be carried out.
Fig. 5 schematically shows a block diagram of a deposit-free implementation apparatus according to an embodiment of the invention.
As shown in fig. 5, the deposit exemption implementation apparatus 500 includes a first obtaining module 501, a first verification module 502, a first sending module 503, a receiving module 504, and a second sending module 505.
Specifically, the first obtaining module 501 is configured to obtain deposit free application data of a user;
the first verification module 502 is used for verifying whether the deposit-free application data meets the condition of deposit-free application by using a rule engine;
a first sending module 503, if the condition of deposit free application is satisfied, sending deposit free service agreement data;
a receiving module 504, configured to receive electronic signature data signed by the user for the deposit-free service agreement data;
and a second sending module 505, configured to send a pre-authorization notice according to the electronic signature data.
This exempt from deposit realization device 500 can acquire and utilize the rule engine to verify and exempt from the condition that the deposit application data satisfied the deposit application, if satisfy the condition of exempting from the deposit application, send and exempt from deposit service agreement data, the receiving user is directed against the electronic signature data of exempting from deposit service agreement data signing to according to this electronic signature data transmission preauthorization notice sheet, realized that the online application exempts from the deposit, the deposit can be reduced application cycle with this mode application exempt from the deposit, promotes the processing speed, realizes that control risk and helping hand business sales volume increase, has still reduced insurance company's manpower and materials's expenditure, thereby improves user experience.
According to an embodiment of the present invention, the deposit-exempting implementation apparatus 500 may be used to implement the deposit-exempting implementation method described in the embodiment of fig. 2.
In some embodiments of the present invention, the first verification module 502 is configured to: verifying whether the identity information data is in a preset blacklist or not; verifying whether the policy in the policy information data is a valid policy; and verifying whether the application amount data is smaller than the application amount preset by the hospital.
In some embodiments of the present invention, the first sending module 503 is configured to: and if the identity information data is not in the preset blacklist, the policy in the policy information data is an effective policy, and the application amount data is less than or equal to the application amount preset by the hospital, sending the deposit-free service agreement data to a terminal.
Fig. 6 schematically shows a block diagram of a deposit-free implementing apparatus according to another embodiment of the present invention.
As shown in fig. 6, the deposit-free implementation apparatus 500 further includes a second verification module 506 and a third verification module 507.
In particular, the second verification module 506 is configured to: verifying whether the insurance policy in the insurance policy information data is the insurance policy applied in the social insurance identity; verifying whether the hospital information data supports settlement in a social security mode; verifying whether the policy in the policy information data triggers the verification of the high-risk service department; checking whether the policy in the policy information data has a historical claim settlement record or not; and checking whether the identity information data has a preset type case, and if so, continuously checking whether the case state of the preset type case is a preset state.
The third verification module 507 is configured to: verifying whether the remaining warranty of the policy in the policy information data is greater than or equal to a first threshold value, wherein the first threshold value comprises a threshold value determined according to the total warranty of the policy; and if the remaining amount of the policy is greater than or equal to the first threshold, verifying whether the application amount data is less than the remaining amount of the policy.
Fig. 7 schematically shows a block diagram of a deposit-free implementing apparatus according to another embodiment of the present invention.
As shown in fig. 7, the deposit exemption implementation apparatus 500 further includes a fourth verification module 508 and a third sending module 509.
Specifically, the fourth verification module 508 is configured to verify whether the identity information data is a user applying for deposit free twice or more, if so, continuously verify whether the accumulated application amount is greater than or equal to a second threshold, the second threshold is different from the first threshold, and the second threshold includes a threshold determined according to the remaining amount of the policy.
And a third sending module 509, configured to send a deposit-free warning if the accumulated application amount is greater than or equal to the second threshold.
The deposit-free realizing device 500 can support multiple online applications for deposit-free, and if the accumulated application amount of two or more times is larger than or equal to the second threshold value, sends deposit-free early warning to prompt that the accumulated application amount of the user is close to the remaining amount of the policy, and pays attention to normal settlement during discharge.
According to an embodiment of the present invention, the deposit-exempting implementation apparatus 500 may be used to implement the deposit-exempting implementation method described in the embodiment of fig. 3.
Fig. 8 schematically shows a block diagram of a deposit-free implementing apparatus according to another embodiment of the present invention.
As shown in fig. 8, the deposit-exempt implementation apparatus 500 further includes a fifth verification module 510 and an association module 511.
Specifically, the fifth verification module 510 is configured to: verifying whether the difference between the remaining amount of the policy and the accumulated application amount is greater than or equal to the first threshold; and if the remaining amount of the policy with the difference between the accumulated application amount is greater than or equal to the first threshold value, checking whether the current application amount is less than the difference between the preset application amount of the hospital and the accumulated application amount, and checking whether the current application amount is less than the remaining amount of the policy with the difference between the accumulated application amount.
The association module 511 is configured to associate the deposit-free application data with the preset type case through an association rule.
Fig. 9 schematically shows a block diagram of a deposit-free implementing apparatus according to another embodiment of the present invention.
As shown in fig. 9, the deposit-exempt implementation apparatus 500 further includes a second obtaining module 512 and a record payment module 513.
Specifically, the second obtaining module 512 is configured to obtain the fee evasion amount of the user.
And a record payment module 513, configured to record the fee evasion amount of the user in the valid policy of the user, and pay to a hospital based on the fee evasion amount of the user and the application amount data of the user.
This deposit-free realizes device 500 can be with the record of the amount of fee evasion of user in user's effective insurance policy to pay to the hospital based on the amount of fee evasion of user and the application amount data of user, effectively avoid the customer to evade the fee.
According to the embodiment of the present invention, the deposit-exempting implementation apparatus 500 may be used to implement the deposit-exempting implementation method described in the embodiment of fig. 4.
For details that are not disclosed in the embodiment of the device of the present invention, please refer to the above-mentioned embodiment of the deposit-free implementation method of the present invention for the details that are not disclosed in the embodiment of the device of the present invention, because each module of the deposit-free implementation device 500 of the present invention can be used to implement the steps of the above-mentioned embodiment of the deposit-free implementation method of fig. 2 to 4.
It is understood that the first obtaining module 501, the first verifying module 502, the first sending module 503, the receiving module 504, the second sending module 505, the second verifying module 506, the third verifying module 507, the fourth verifying module 508, the third sending module 509, the fifth verifying module 510, the associating module 511, the second obtaining module 512, and the record payment module 513 may be combined into one module to be implemented, or any one of them may be split into a plurality of modules. Alternatively, at least part of the functionality of one or more of these modules may be combined with at least part of the functionality of the other modules and implemented in one module. According to an embodiment of the present invention, at least one of the first obtaining module 501, the first verifying module 502, the first sending module 503, the receiving module 504, the second sending module 505, the second verifying module 506, the third verifying module 507, the fourth verifying module 508, the third sending module 509, the fifth verifying module 510, the associating module 511, the second obtaining module 512, and the record paying module 513 may be at least partially implemented as a hardware circuit, such as a Field Programmable Gate Array (FPGA), a Programmable Logic Array (PLA), a system on a chip, a system on a substrate, a system on a package, an Application Specific Integrated Circuit (ASIC), or may be implemented in hardware or firmware in any other reasonable manner of integrating or packaging a circuit, or in a suitable combination of three implementations of software, hardware, and firmware. Alternatively, at least one of the first obtaining module 501, the first verifying module 502, the first sending module 503, the receiving module 504, the second sending module 505, the second verifying module 506, the third verifying module 507, the fourth verifying module 508, the third sending module 509, the fifth verifying module 510, the associating module 511, the second obtaining module 512, and the record payment module 513 may be at least partially implemented as a computer program module that, when executed by a computer, may perform the functions of the respective modules.
Referring now to FIG. 10, shown is a block diagram of a computer system 1000 suitable for use with the electronic device implementing an embodiment of the present invention. The computer system 1000 of the electronic device shown in fig. 10 is only an example, and should not bring any limitation to the function and the scope of use of the embodiments of the present invention.
As shown in fig. 10, the computer system 1000 includes a Central Processing Unit (CPU)1001 that can perform various appropriate actions and processes according to a program stored in a Read Only Memory (ROM)1002 or a program loaded from a storage section 1008 into a Random Access Memory (RAM) 1003. In the RAM 1003, various programs and data necessary for system operation are also stored. The CPU 1001, ROM 1002, and RAM 1003 are connected to each other via a bus 1004. An input/output (I/O) interface 1005 is also connected to bus 1004.
The following components are connected to the I/O interface 1005: an input section 1006 including a keyboard, a mouse, and the like; an output section 1007 including a display such as a Cathode Ray Tube (CRT), a Liquid Crystal Display (LCD), and the like, and a speaker; a storage portion 1008 including a hard disk and the like; and a communication section 1009 including a network interface card such as a LAN card, a modem, or the like. The communication section 1009 performs communication processing via a network such as the internet. The driver 1010 is also connected to the I/O interface 1005 as necessary. A removable medium 1011 such as a magnetic disk, an optical disk, a magneto-optical disk, a semiconductor memory, or the like is mounted on the drive 1010 as necessary, so that a computer program read out therefrom is mounted into the storage section 1008 as necessary.
In particular, according to an embodiment of the present invention, the processes described above with reference to the flowcharts may be implemented as computer software programs. For example, embodiments of the invention include a computer program product comprising a computer program embodied on a computer-readable medium, the computer program comprising program code for performing the method illustrated in the flow chart. In such an embodiment, the computer program may be downloaded and installed from a network through the communication part 1009 and/or installed from the removable medium 1011. The computer program executes the above-described functions defined in the system of the present application when executed by the Central Processing Unit (CPU) 1001.
It should be noted that the computer readable medium shown in the present invention can be a computer readable signal medium or a computer readable storage medium or any combination of the two. A computer readable storage medium may be, for example, but not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, or device, or any combination of the foregoing. More specific examples of the computer readable storage medium may include, but are not limited to: an electrical connection having one or more wires, a portable computer diskette, a hard disk, a Random Access Memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or flash memory), an optical fiber, a portable compact disc read-only memory (CD-ROM), an optical storage device, a magnetic storage device, or any suitable combination of the foregoing. In the present invention, a computer readable storage medium may be any tangible medium that can contain, or store a program for use by or in connection with an instruction execution system, apparatus, or device. In the present invention, however, a computer readable signal medium may include a propagated data signal with computer readable program code embodied therein, for example, in baseband or as part of a carrier wave. Such a propagated data signal may take many forms, including, but not limited to, electro-magnetic, optical, or any suitable combination thereof. A computer readable signal medium may also be any computer readable medium that is not a computer readable storage medium and that can communicate, propagate, or transport a program for use by or in connection with an instruction execution system, apparatus, or device. Program code embodied on a computer readable medium may be transmitted using any appropriate medium, including but not limited to: wireless, wire, fiber optic cable, RF, etc., or any suitable combination of the foregoing.
The flowchart and block diagrams in the figures illustrate the architecture, functionality, and operation of possible implementations of systems, methods and computer program products according to various embodiments of the present invention. In this regard, each block in the flowchart or block diagrams may represent a module, segment, or portion of code, which comprises one or more executable instructions for implementing the specified logical function(s). It should also be noted that, in some alternative implementations, the functions noted in the block may occur out of the order noted in the figures. For example, two blocks shown in succession may, in fact, be executed substantially concurrently, or the blocks may sometimes be executed in the reverse order, depending upon the functionality involved. It will also be noted that each block of the block diagrams or flowchart illustration, and combinations of blocks in the block diagrams or flowchart illustration, can be implemented by special purpose hardware-based systems which perform the specified functions or acts, or combinations of special purpose hardware and computer instructions.
The units described in the embodiments of the present invention may be implemented by software, or may be implemented by hardware, and the described units may also be disposed in a processor. Wherein the names of the elements do not in some way constitute a limitation on the elements themselves.
As another aspect, the present application also provides a computer-readable medium, which may be contained in the electronic device described in the above embodiments; or may exist separately without being assembled into the electronic device. The computer readable medium carries one or more programs which, when executed by the electronic device, cause the electronic device to implement the deposit free implementation method as described in the above embodiments.
For example, the electronic device may implement the following as shown in fig. 2: in step S210, the deposit free application data of the user is acquired. In step S220, the rule engine is used to check whether the deposit-free application data satisfies the condition of deposit-free application. In step S230, if the condition of the deposit free application is satisfied, the deposit free service agreement data is transmitted. In step S240, electronic signature data signed by the user for the deposit-exempt service agreement data is received. In step S250, a pre-authorization notice is sent according to the electronic signature data.
It should be noted that although in the above detailed description several modules or units of the device for action execution are mentioned, such a division is not mandatory. Indeed, the features and functionality of two or more modules or units described above may be embodied in one module or unit, according to embodiments of the invention. Conversely, the features and functions of one module or unit described above may be further divided into embodiments by a plurality of modules or units.
Through the above description of the embodiments, those skilled in the art will readily understand that the exemplary embodiments described herein may be implemented by software, or by software in combination with necessary hardware. Therefore, the technical solution according to the embodiment of the present invention can be embodied in the form of a software product, which can be stored in a non-volatile storage medium (which can be a CD-ROM, a usb disk, a removable hard disk, etc.) or on a network, and includes several instructions to enable a computing device (which can be a personal computer, a server, a touch terminal, or a network device, etc.) to execute the method according to the embodiment of the present invention.
Other embodiments of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. This application is intended to cover any variations, uses, or adaptations of the invention following, in general, the principles of the invention and including such departures from the present disclosure as come within known or customary practice within the art to which the invention pertains. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.
It will be understood that the invention is not limited to the precise arrangements described above and shown in the drawings and that various modifications and changes may be made without departing from the scope thereof. The scope of the invention is limited only by the appended claims.
Claims (10)
1. A deposit-free implementation method is characterized by comprising the following steps:
obtaining deposit-free application data of a user, wherein the deposit-free application data comprises any one or more of the following items: identity information data, policy information data, application amount data and hospital information data;
verifying whether the deposit-free application data meets the condition of deposit-free application by using a rule engine;
if the condition of the deposit-free application is met, sending deposit-free service agreement data;
receiving electronic signature data signed by the user for the deposit-free service agreement data;
sending a pre-authorization notice according to the electronic signature data;
wherein, utilizing the rules engine to verify whether the deposit-free application data satisfies the conditions of the deposit-free application include:
verifying whether the identity information data is in a preset blacklist or not;
verifying whether the policy in the policy information data is a valid policy; and
and verifying whether the application amount data is smaller than the application amount preset by the hospital.
2. The method of claim 1, wherein sending deposit-exempt service agreement data if the conditions of the deposit-exempt application are met comprises:
and if the identity information data is not in the preset blacklist, the policy in the policy information data is an effective policy, and the application amount data is less than or equal to the application amount preset by the hospital, sending the deposit-free service agreement data to a terminal.
3. The method of claim 1, wherein when the policy in the policy information data is a valid policy, the method further comprises:
verifying whether the insurance policy in the insurance policy information data is the insurance policy applied in the social insurance identity;
verifying whether the hospital information data supports settlement in a social security mode;
verifying whether the policy in the policy information data triggers the verification of the high-risk service department;
checking whether the policy in the policy information data has a historical claim settlement record or not; and
and checking whether the identity information data has a preset type case, and if so, continuously checking whether the case state of the preset type case is a preset state.
4. The method according to claim 1, wherein before verifying whether the application amount data is less than the application amount preset by the hospital, the method further comprises:
verifying whether the remaining warranty of the policy in the policy information data is greater than or equal to a first threshold value, wherein the first threshold value comprises a threshold value determined according to the total warranty of the policy; and
if the remaining amount of the policy is greater than or equal to the first threshold, verifying whether the application amount data is less than the remaining amount of the policy.
5. The method of claim 4, further comprising:
verifying whether the identity information data is a user applying for deposit-free for two or more times, and if the identity information data is the user applying for deposit-free for two or more times, continuously verifying whether the accumulated applied amount is greater than or equal to a second threshold value, wherein the second threshold value is different from the first threshold value, and the second threshold value comprises a threshold value determined according to the remaining amount of the policy;
and if the accumulated application amount is larger than or equal to the second threshold value, sending a deposit-free early warning.
6. The method of claim 5, further comprising:
verifying whether the difference between the remaining amount of the policy and the accumulated application amount is greater than or equal to the first threshold; and
if the remaining amount of the policy with the difference between the accumulated application amount is greater than or equal to the first threshold value, whether the current application amount is smaller than the difference between the preset application amount of the hospital and the accumulated application amount is checked, and whether the current application amount is smaller than the difference between the remaining amount of the policy and the accumulated application amount is checked.
7. The method of claim 3, further comprising:
and associating the deposit-free application data with the preset type case through an association rule.
8. A deposit-free implementation device is characterized by comprising:
the system comprises a first acquisition module, a second acquisition module and a third acquisition module, wherein the first acquisition module is used for acquiring deposit-free application data of a user, and the deposit-free application data comprises any one or more of the following items: identity information data, policy information data, application amount data and hospital information data;
the first verification module is used for verifying whether the deposit-free application data meets the condition of deposit-free application or not by using a rule engine;
the first sending module is used for sending the deposit-free service agreement data if the deposit-free application condition is met;
the receiving module is used for receiving electronic signature data signed by the user aiming at the deposit-free service agreement data;
the second sending module is used for sending a pre-authorization notice according to the electronic signature data;
the first verification module is configured to: verifying whether the identity information data is in a preset blacklist or not; verifying whether the policy in the policy information data is a valid policy; and verifying whether the application amount data is smaller than the application amount preset by the hospital.
9. An electronic device, comprising:
one or more processors; and
storage means for storing one or more programs which, when executed by the one or more processors, cause the one or more processors to carry out a method according to any one of claims 1 to 7.
10. A computer-readable medium, on which a computer program is stored, which program, when being executed by a processor, is adapted to carry out the method according to any one of claims 1 to 7.
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