Intelligent auditing system and auditing algorithm for serious illness medical insurance

Abstract

The invention provides an intelligent auditing system for serious illness medical insurance. The system includes a database module, an intelligent auditing engine and a basic information base management module, wherein the database module is used for obtaining serious illness medical insurance data, the intelligent auditing engine is used for performing auditing processing on the correlation matching degree of attribute items of the serious illness medical insurance data, the basic information base management module stores attribute information of basic data, and the intelligent auditing engine is connected with the database module and the basic information base management module and completes auditing processing of data of the database module and the basic information base management module. Through the technical content provided by the invention, medical insurance data can be audited rapidly, a deduction strategy can be executed automatically on illegal medical insurance data, and auditing personnel only needs to perform manual auditing on part of invoices where problems exist, thereby improving auditing efficiency.

Description

technical field [0001] The invention relates to the technical field of medical insurance review and management, in particular to a review method and system for serious illness medical insurance reimbursement documents. Background technique [0002] In our daily life, we often encounter problems such as long medical insurance review cycles and errors in medical insurance document review. Faced with the accumulation of medical insurance review documents, the workload of reviewers is too heavy, and the traditional manual review mode can no longer cope with the current situation. Such a huge amount of medical insurance data. [0003] At present, although there are some medical insurance review platforms on the market, the functions of these review platforms are too simple to deal with various special problems that arise in the actual review process. For example, these audit platforms usually establish a unified audit rule base, and the rule base contains many preset audit rules...

AI Technical Summary

Problems solved by technology

[0004] In order to overcome the problems of single audit rules and low data processing capacity in the prior art, the purpose of the present invention is to provide an intelligent medical expense rule engine

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