Risk assessment method, device and equipment for medical claim settlement and storage medium

A risk assessment and data technology, applied in data processing applications, instruments, finance, etc., can solve the problems of fraudulent claim verification and inaccuracy, and achieve the effect of reducing the risk of claim settlement

Pending Publication Date: 2022-03-25
PING AN TECH (SHENZHEN) CO LTD
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

[0003] In order to solve the technical problems of fraudulent claims or inaccurate claim verification in existing technical health insurance claims

Method used

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  • Risk assessment method, device and equipment for medical claim settlement and storage medium
  • Risk assessment method, device and equipment for medical claim settlement and storage medium
  • Risk assessment method, device and equipment for medical claim settlement and storage medium

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Embodiment Construction

[0020] In order to make the purposes, technical solutions and advantages of the embodiments of the present application clearer, the technical solutions in the embodiments of the present application will be clearly and completely described below in conjunction with the drawings in the embodiments of the present application. Obviously, the described embodiments It is a part of the embodiments of this application, but not all of them. Based on the embodiments in the present application, all other embodiments obtained by persons of ordinary skill in the art without making creative efforts belong to the protection scope of the present application. It should be understood that the specific embodiments described here are only used to explain the present application, and are not intended to limit the present application.

[0021] The risk assessment method for medical claims provided by this application can be applied in such as figure 1 In the application environment, the terminal d...

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Abstract

The invention relates to the field of artificial intelligence, and provides a risk assessment method and device for medical claim settlement, equipment and a storage medium, and the method comprises the steps: obtaining the diagnosis data of a to-be-claimed user and the corresponding treatment list data; judging whether a treatment item in the treatment list data is used for treating a diagnosis disease in the diagnosis data or not; and if it is determined that the treatment items in the treatment list data are not all used for treatment of the diagnosis disease in the diagnosis data, determining that the claim settlement of the user to be subjected to claim settlement is doubted. Through intelligent matching of the diagnosis information and the treatment information, the claim settlement risk is evaluated automatically and accurately, and the claim settlement risk is reduced.

Description

technical field [0001] The present application relates to the technical field of medical insurance claims, in particular to a risk assessment method, device, equipment and storage medium for medical claims. Background technique [0002] At present, in the field of health insurance claim settlement, the compensation amount is generally calculated directly based on the cost of medicines and related adjuvant treatment items. In this way, when the diagnosis information is irrelevant to the medication information and adjuvant treatment items or the actual dosage of the medicine does not match, there will be inaccurate claims settlement and fraudulent claims. If a manual review method is used to verify whether the claims are reasonable, the requirements for the medical professional knowledge of the staff are relatively high, and it is time-consuming and laborious, and the efficiency is relatively low. Contents of the invention [0003] In order to solve the technical problems o...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): G06Q40/08G06Q10/06
CPCG06Q40/08G06Q10/0635G06Q10/0639
Inventor 刘建立
Owner PING AN TECH (SHENZHEN) CO LTD
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