CN109615536A - Settlement of insurance claim method, apparatus, equipment and readable storage medium storing program for executing based on OCR technique - Google Patents
Settlement of insurance claim method, apparatus, equipment and readable storage medium storing program for executing based on OCR technique Download PDFInfo
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- CN109615536A CN109615536A CN201811524325.4A CN201811524325A CN109615536A CN 109615536 A CN109615536 A CN 109615536A CN 201811524325 A CN201811524325 A CN 201811524325A CN 109615536 A CN109615536 A CN 109615536A
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Abstract
The present invention provides a kind of settlement of insurance claim method, unit and readable storage medium storing program for executing based on OCR technique, when providing Claims Resolution service for client, the special medicine type that can be related to according to Claims Resolution obtains corresponding audit images of materials, and intelligent recognition is carried out to image based on optical character identification OCR technique, extraction obtains required Claims Review information, provides convenience to provide Claims Review material for warrantee；The Claims Review information can be audited automatically by preset Claims Resolution rule simultaneously, to realize intelligent and automation settlement of insurance claim, improve the efficiency of service of special medicine settlement of insurance claim, also help reduction human cost.
Description
Technical field
The present invention relates to big data technical field more particularly to a kind of settlement of insurance claim method, apparatus based on OCR technique,
Equipment and readable storage medium storing program for executing.
Background technique
With the development of medical technology, special medicine (carries out special treatment for a certain disease, there is high science to contain in the market
Amount, the high drug of technical difficulty) gradually increase, such as training azoles pa Buddhist nun (dimension Quan Te), reed can be for Buddhist nun's piece (victory is scrupulously and respectfully defended)；But in the market
Special medicine price costly.In order to mitigate burden of patients, some insurance institutions propose the medical expenses of special medicine being incorporated into guarantor
In danger reimbursement range, special medicine insurance service is provided.
At present for this special medicine insurance when settling a claim, mainly claims personnel requests Claims Resolution to carry out Claims Review
Deng the efficiency of service of this settlement of insurance claim method is lower, and especially will appear when task amount is larger can not reply client in time
The case where.
Summary of the invention
The settlement of insurance claim method, apparatus that the main purpose of the present invention is to provide a kind of based on OCR technique, equipment and readable
Storage medium, it is intended to which solution manually provides the low technical problem of settlement of insurance claim efficiency of service.
To achieve the above object, the present invention provides a kind of settlement of insurance claim method based on OCR technique, the settlement of insurance claim side
Method includes:
When the special pharmacology for receiving requesting terminal transmission pays for request, is paid for according to the special pharmacology and request corresponding insurance special
Medicine audits material type needed for determining, and returns to corresponding images of materials to the requesting terminal and upload prompt；
The images of materials that the requesting terminal uploads is received, and by optical character identification OCR technique to the material figure
As being identified, corresponding Claims Review information is obtained；
The Claims Review information is audited based on default Claims Resolution rule, to judge whether the special pharmacology pays for request
Rationally；
If spy's pharmacology pays for request rationally, is sent to corresponding financial system and suggest compensating information.
In addition, to achieve the above object, the present invention also provides a kind of settlement of insurance claim device based on OCR technique, the guarantor
Nearly Claims Resolution device includes:
Image uploading module, when for paying for request in the special pharmacology for receiving requesting terminal transmission, according to the special pharmacology
It pays for and audits material type needed for requesting the special medicine of corresponding insurance to determine, and returned in corresponding images of materials to the requesting terminal
Pass prompt；
Picture recognition module, the images of materials uploaded for receiving the requesting terminal, and pass through optical character identification OCR
Technology identifies the images of materials, obtains corresponding Claims Review information；
Claims Resolution judgment module, for being audited based on default Claims Resolution rule to the Claims Review information, to judge
Whether reasonable state special pharmacology compensation request；
Information sending module sends to corresponding financial system if paying for request rationally for the special pharmacology and suggests paying for
Pay information.
In addition, to achieve the above object, the present invention also provides a kind of settlement of insurance claim equipment based on OCR technique, the guarantor
Danger Claims Resolution equipment includes processor, memory and is stored in the insurance that can be executed on the memory and by the processor
Claims Resolution program, wherein realizing the step such as above-mentioned settlement of insurance claim method when the settlement of insurance claim program is executed by the processor
Suddenly.
In addition, to achieve the above object, the present invention also provides a kind of readable storage medium storing program for executing, being deposited on the readable storage medium storing program for executing
Settlement of insurance claim program is contained, wherein realizing such as above-mentioned settlement of insurance claim method when the settlement of insurance claim program is executed by processor
The step of.
For the present invention when providing Claims Resolution service for client, the special medicine type that can be related to according to Claims Resolution obtains corresponding audit material
Expect image, and intelligent recognition is carried out to image based on optical character identification OCR technique, extracts and obtain required Claims Review letter
Breath, provides convenience to provide Claims Review material for warrantee；The Claims Resolution can be examined by preset Claims Resolution rule simultaneously
Nuclear information is audited automatically, to realize intelligent and automation settlement of insurance claim, improves the service of special medicine settlement of insurance claim
Efficiency also helps reduction human cost.
Detailed description of the invention
Fig. 1 is the hardware configuration signal of the settlement of insurance claim equipment based on OCR technique involved in the embodiment of the present invention
Figure；
Fig. 2 is that the present invention is based on the flow diagrams of the settlement of insurance claim method first embodiment of OCR technique；
Fig. 3 is that the present invention is based on the functional block diagrams of the settlement of insurance claim device first embodiment of OCR technique.
The embodiments will be further described with reference to the accompanying drawings for the realization, the function and the advantages of the object of the present invention.
Specific embodiment
It should be appreciated that the specific embodiments described herein are merely illustrative of the present invention, it is not intended to limit the present invention.
The present embodiments relate to the settlement of insurance claim method based on OCR technique be mainly used in the guarantor based on OCR technique
Danger Claims Resolution equipment, the settlement of insurance claim equipment can be personal computer (personal computer, PC), laptop, clothes
The equipment having data processing function such as business device.
Referring to Fig.1, Fig. 1 is the hardware of the settlement of insurance claim equipment based on OCR technique involved in the embodiment of the present invention
Structural schematic diagram.In the embodiment of the present invention, which may include (such as the central processing unit of processor 1001
Central Processing Unit, CPU), communication bus 1002, user interface 1003, network interface 1004, memory
1005.Wherein, communication bus 1002 is for realizing the connection communication between these components；User interface 1003 may include display
Shield (Display), input unit such as keyboard (Keyboard)；Network interface 1004 optionally may include that the wired of standard connects
Mouth, wireless interface (such as Wireless Fidelity WIreless-FIdelity, WI-FI interface)；Memory 1005 can be high speed and deposit at random
Access to memory (random access memory, RAM), is also possible to stable memory (non-volatile memory),
Such as magnetic disk storage, memory 1005 optionally can also be the storage device independently of aforementioned processor 1001.This field
Technical staff is appreciated that hardware configuration shown in Fig. 1 and does not constitute a limitation of the invention, and may include more than illustrating
Or less component, perhaps combine certain components or different component layouts.
With continued reference to Fig. 1, the memory 1005 in Fig. 1 as a kind of computer readable storage medium may include operation system
System, network communication module and settlement of insurance claim program.In Fig. 1, network communication module can be used for connection request terminal, with request
Terminal carries out data communication；And processor 1001 can call the settlement of insurance claim program stored in memory 1005, and execute sheet
The settlement of insurance claim method based on OCR technique that inventive embodiments provide.
The settlement of insurance claim method based on OCR technique that the embodiment of the invention provides a kind of.
It is that the present invention is based on the flow diagrams of the settlement of insurance claim method first embodiment of OCR technique referring to Fig. 2, Fig. 2.
In the present embodiment, the settlement of insurance claim method the following steps are included:
Step S10 pays for request according to the special pharmacology and corresponds to when the special pharmacology for receiving requesting terminal transmission pays for request
Insurance spy's medicine determine needed for audit material type, and return to corresponding images of materials to the requesting terminal and upload prompt；
Some insurance institutions propose to be incorporated into the medical expenses of special medicine in insurance reimbursement range at present, provide special medicine insurance
Service.For this special medicine insurance when settling a claim, mainly Claims Resolution is requested by claims personnel to carry out Claims Review etc., this
The efficiency of service of kind settlement of insurance claim method is lower, especially will appear the feelings that can not reply client in time when task amount is larger
Condition.In this regard, a kind of settlement of insurance claim method based on OCR technique is proposed in the present embodiment, it, can when providing Claims Resolution service for client
Corresponding audit images of materials is obtained according to the special medicine type that Claims Resolution is related to, and based on optical character identification OCR technique to image
Intelligent recognition is carried out, extraction obtains required Claims Review information, to provide the Claims Review material side of providing for warrantee
Just；The Claims Review information can be audited automatically by preset Claims Resolution rule simultaneously, to realize intelligent and automatic
The settlement of insurance claim of change improves the efficiency of service of special medicine settlement of insurance claim, also helps reduction human cost.
The settlement of insurance claim method based on OCR technique in the present embodiment is real by the settlement of insurance claim equipment based on OCR technique
Existing, which can be described as settlement of insurance claim terminal again, which can be personal computer
(personal computer, PC), server etc..In the present embodiment, there is Claims Resolution event (quilt in the warrantee of special medicine insurance
Guarantor's illness simultaneously has purchased the insurance spy medicine arranged in special medicine insurance) when, warrantee (or insurer or beneficiary) can lead to
It crosses a requesting terminal (requesting terminal can be PC PC, laptop, mobile phone etc.) and carries out Claims Resolution operation, request is eventually
End then operates to settlement of insurance claim terminal according to the Claims Resolution and sends corresponding special pharmacology compensation request.Settlement of insurance claim terminal is receiving this
When special pharmacology pays for request, it will sentence according to the corresponding Claims Review information of the Claims Resolution request, and based on default Claims Resolution rule
Whether spy's pharmacology of breaking pays for request reasonable.It is worth noting that generally requiring the illness note for obtaining warrantee when being settled a claim
Record, medical treatment situation, prescription record etc., and for different insurance spy's medicines, since it is applicable in disease difference, illness Claims Review money
Material may there is also differences, and therefore, settlement of insurance claim terminal can be when obtaining Claims Review information according to the class for insuring special medicine
The Claims Review information of type acquisition corresponding types.And warrantee provides the convenience of information (data) for convenience, warrantee can be with
It is to provide the images of materials of relevant papery audit material, OCR (Optical Character is passed through by settlement of insurance claim terminal
Recognition, optical character identification) technology identifies the images of materials to obtain corresponding Claims Review information.Specifically
, settlement of insurance claim terminal will pay for request according to spy's pharmacology and correspond to when the special pharmacology for receiving requesting terminal transmission pays for request
Insure required for special medicine type determines involved in special medicine insurance and audit material type, then returns and correspond to the requesting terminal
Images of materials upload prompt.Warrantee needs to pass through Claims Resolution when seeing that the images of materials uploads prompt by terminal of settling a claim
Terminal uploads corresponding images of materials, which can be warrantee person and pass through the Claims Resolution of Claims Resolution terminal captured in real-time papery
Audit material obtains, and is also possible to be stored in advance in Claims Resolution terminal or Dropbox etc..
Step S20 receives the images of materials that the requesting terminal uploads, and by optical character identification OCR technique to institute
It states images of materials to be identified, obtains corresponding Claims Review information；
In the present embodiment, settlement of insurance claim terminal when obtaining images of materials, will by OCR technique to the images of materials into
Row identification, and extract and obtain required Claims Review information.Certainly, in order to guarantee subsequent image identification accuracy, for material
Expect that the image attributes such as resolution ratio, picture size, the image file format of image can also be required；It is pre- in settlement of insurance claim terminal
Picture specification standard corresponding to all kinds of audit materials is first set, when receiving the images of materials of requesting terminal upload, by root
Judge whether the images of materials complies with standard according to the picture specification standard；If not meeting, settlement of insurance claim terminal can be to request eventually
End returns to secondary upload prompt, to notify warrantee to upload credit certificate image again；If meeting, the figure of next step will do it
As identification operation.
When being identified to images of materials, it is contemplated that it is (certain with certain rule for auditing the content distribution of material
Different types of material, content distribution rule are also different), it therefore, can be first according to material when being identified to images of materials
The material type of image carries out region division to images of materials, marks off the effective coverage including effective msu message, this is effectively
The image in region can be described as effective image, then carry out subsequent character feature extraction and identification for the effective image again, from
And reduce data calculating and treating capacity, improve recognition efficiency.It certainly, can also be to effective image after obtaining effective image
Other pretreatments are carried out, to facilitate subsequent feature to identify, such as the operation such as image binaryzation, noise reduction.Wherein, binaryzation is
Refer to and convert the bianry image containing only two kinds of black-white colors for effective image (or images of materials), this is because contained by color image
Information content is huge, and calculation amount can also increase with it when carrying out subsequent processing to it, the time of cost also can side length, therefore for improve
The efficiency of processing and identification first can carry out binary conversion treatment to cromogram；Denoising is then by filter or other way solution
The problem of certainly digital picture leads to image quality decrease due to noise jamming.It, can be to effectively figure when obtaining effective image
Character feature extraction is carried out as in.It is the main foundation identified that character feature, which can be said, and easy distinguish can be divided into two classes: one is system
The feature of meter, as in character zone black/white count ratio, when character zone is divided into several regions, this one by one region it is black/
The joint of white point number ratio, just at a numerical value vector in space, when comparing, basic mathematical theory is just enough to deal with；
And another category feature be structure feature, after character image graph thinning, obtain the stroke endpoint of character, the quantity in crosspoint and
Position is as feature.In the character feature for getting effective image, corresponding comparison method can be cooperated, by the character feature with
Alternative features in character repertoire are matched, to find immediate alternative features, and according to this closest to alternative features
Character meaning determines the meaning of each character in the effective image；In determining effective image when each character meaning, each character is contained
Justice, which carries out splicing, can be obtained corresponding Claims Review information.
Step S30 audits the Claims Review information based on default Claims Resolution rule, to judge that the special pharmacology is paid for
Whether request reasonable；
In the present embodiment, when obtaining Claims Review information, settlement of insurance claim terminal can be based on default Claims Resolution rule to this
Claims Review information is audited, judges whether spy's pharmacology pays for request reasonable；And when being audited to Claims Review information,
It then can be from the progress of multiple dimensions.
Optionally, when auditing to Claims Review information, it can be whether audit medication suits the medicine to the illness.Specifically, insurance
Claims Resolution terminal can obtain medical diagnosis on disease record from Claims Review acquisition of information, include warrantee just in medical diagnosis on disease record
Examine disease of diagnosing a disease really given by Shi doctor；Then settlement of insurance claim terminal will acquire the applicable disease information for insuring special medicine, and judge disease
Whether disease of diagnosing a disease really in sick idagnostic logout belongs to the applicable disease for insuring special medicine；For example, for insuring special medicine injection toltrazuril
Monoclonal antibody, being mainly used for the metastatic breast cancer that treatment HER2 is over-expressed, (HER2 overexpression is defined as using the inspection having verified that
IHC3+ the or IHC2+/FISH+ result that survey method obtains), settlement of insurance claim terminal needs to be remembered according to medical diagnosis on disease in audit
Record judges whether that warrantee makes a definite diagnosis whether illness belongs to above-mentioned applicable disease；If this, which makes a definite diagnosis illness, belongs to the applicable disease for insuring special medicine,
Then it is believed that it is reasonable that spy's pharmacology, which pays for request,；And if this is made a definite diagnosis illness and is not belonging to insure the applicable disease of special medicine, may be
There is the behavior of false reimbursement, fraud insurance fraud in warrantee, at this time it is believed that it is unreasonable that spy's pharmacology, which pays for request,.
Optionally, when being audited to Claims Review information, judging whether Claims Resolution request is reasonable, it can also be audit quilt
Whether the medicinal dose of spy of guarantor is normal.Specifically, settlement of insurance claim terminal can obtain special medicine purchase from Claims Review acquisition of information
Record can determine that the actual purchase amount of warrantee's medicine special for insurance according to spy's medicine purchaser record；Meanwhile settlement of insurance claim is whole
End can also obtain the specification information for insuring special medicine, and theoretical the using of the special medicine of insurance is calculated according to the specification information
Amount, for example, including course for the treatment of dosage (box /), course for the treatment of duration (moon) in specification information, according to the course for the treatment of dosage and course for the treatment of duration
The theoretical usage amount of predetermined period (such as 1 year) can be calculated, special medicine injection Herceptin (Trastuzumab, Yi Zhongyong are such as insured
In the injection of the metastatic breast cancer for the treatment of HER2 overexpression) specification information in, it is each course for the treatment of dosage 1, each
It the course for the treatment of 1 month, was calculated by 12 months within 1 year, then injection Herceptin 1 year theoretical usage amount is
12/ course for the treatment of duration=12 (branch) theoretical usage amount=course for the treatment of dosage *.
Then, settlement of insurance claim terminal can compare theoretical usage amount and actual purchase amount, be sentenced according to theoretical usage amount
Whether disconnected actual purchase amount is abnormal, if actual purchase amount is not more than theoretical usage amount, (or actual purchase amount is used no more than theoretical
The presupposition multiple of amount), then it is believed that the actual purchase amount is normal, it is thus regarded that spy's pharmacology pays for request rationally；And if practical purchase
The amount of buying is greater than theoretical usage amount (or actual purchase amount is greater than presupposition multiple of theoretical usage amount), then it is believed that the actual purchase amount
Abnormal, which may be that warrantee causes in the presence of the behavior of false purchase medicine, and settlement of insurance claim terminal is believed that spy's pharmacology at this time
It is unreasonable to pay for request.
Worth explanation yes, is illustrated for above two audit, be may be used in combination in specific implementation, such as first judgement is used
Whether medicine suits the medicine to the illness, and judges whether purchase dose is normal again when medication is suited the medicine to the illness；When medication is suited the medicine to the illness and purchase dose is normal, just think special
It is reasonable that pharmacology pays for request.Certainly, (whether can also be deposited from the reasonability that other aspects pay for request to special pharmacology in specific implementation
In insurance fraud) it is audited.
Step S40 sends to corresponding financial system if spy's pharmacology pays for request rationally and suggests compensating information.
In the present embodiment, settlement of insurance claim terminal is after auditing Claims Review information, if no abnormal information is (such as
Fraud, insurance fraud etc.), it is believed that spy's pharmacology pays for request rationally, then settlement of insurance claim terminal will send to associated financial system and suggest
Information is compensated, is carried out at corresponding compensation so that financial system (or relevant financial personnel) compensates information according to the suggestion
Reason.Certainly, it is operated for convenience of subsequent compensation, settlement of insurance claim terminal, can also be from Claims Resolution when judging that special pharmacology compensation request is reasonable
Special medicine disbursement is obtained in msu message, is then calculated according to the corresponding payout schedule of special medicine support cost and special medicine insurance
Obtain compensation expense；When obtaining compensation expense, corresponding suggestion can be generated according to the compensation expense and compensate information, and should
It is recommended that compensating information is sent to financial system, compensated so as to obtain financial system according to the compensation expense.In addition, the suggestion
Compensating in information can also include other contents, and the msu message of request, associated policy information etc. are paid for for example including special pharmacology.
And in specific implementation, if settlement of insurance claim terminal, after auditing to Claims Review information, if noting abnormalities, (such as medicine is not right
Disease, purchase dose exception etc.), it is believed that spy's pharmacology pays for the processing letter that request is unreasonable, then can settle a claim to requesting terminal return refusal
Breath, or be to send to suggest review information to relevant review terminal, so that related reviewing officer asks spy's pharmacology compensation
It asks and is checked.
In the present embodiment, settlement of insurance claim terminal is when the special pharmacology for receiving requesting terminal transmission pays for request, according to described
Special pharmacology, which is paid for, requests to audit material type needed for the special medicine of corresponding insurance is determining, and returns to corresponding material to the requesting terminal
Image uploads prompt；The images of materials that the requesting terminal uploads is received, and by optical character identification OCR technique to the material
Material image is identified, corresponding Claims Review information is obtained；The Claims Review information is carried out based on default Claims Resolution rule
Audit, to judge that it is whether reasonable that the special pharmacology pays for request；If spy's pharmacology pays for request rationally, to corresponding financial system
It sends and suggests compensating information.By the above-mentioned means, the present embodiment when providing Claims Resolution service for client, can be related to according to Claims Resolution
Special medicine type obtains corresponding audit images of materials, and carries out intelligent recognition to image based on optical character identification OCR technique, mentions
Required Claims Review information is obtained, is provided convenience to provide Claims Review material for warrantee；It simultaneously can be by pre-
If Claims Resolution rule the Claims Review information is audited automatically, to realize intelligent and automation settlement of insurance claim, mention
The high efficiency of service of special medicine settlement of insurance claim, also helps reduction human cost.
Based on above-mentioned embodiment illustrated in fig. 2, propose that the present invention is based on the implementations of the second of the settlement of insurance claim method of OCR technique
Example.
In the present embodiment, before step S10 further include:
When receiving the special medicine taking out insurances request for terminal transmission of insuring, determined according to the special medicine taking out insurances request
The special medicine of corresponding insurance, and obtain the annual cost per capita for insuring special medicine and applicable disease disease incidence and the special medicine insurance
Payout schedule；
The pricing function of special medicine insurance can also be integrated in the present embodiment, in settlement of insurance claim terminal, with big data analysis
Mode realize and charge on the intelligent pricing and line of the insurance of special medicine, to further increase the efficiency of insurance service, and reduce people
The work amount of labour.Specifically, can insure when the personnel that insure (can not be the same person with warrantee) need to buy special medicine insurance
Corresponding operating is carried out in terminal (terminal of insuring can be PC PC, laptop, mobile phone etc.), terminal of insuring then root
Corresponding special medicine taking out insurances request is sent to settlement of insurance claim terminal according to the operation for the personnel of insuring.Settlement of insurance claim terminal is receiving
When spy's medicine taking out insurances are requested, first has to insure spy's medicine and fix a price.At this point, settlement of insurance claim terminal will determine first
The corresponding insurance spy's medicine of spy's medicine taking out insurances request, i.e., the insurance service which class spy's medicine determining insurer needs to buy (will
Which class spy's medicine is included in insurance reimbursement range).Determination for insurance spy's medicine can be settlement of insurance claim terminal and receive the spy
When medicine taking out insurances are requested, special medicine inquiry message is returned to terminal of insuring, includes optional special pharmacopoeia in spy's medicine inquiry message
Class, so that the insurance spy pharmacopoeia class that the personnel that insure are manually entered selection according to the inquiry message in terminal of insuring is (or logical
Cross the mode of selection menu option) and it is sent to settlement of insurance claim terminal；It can certainly be that insurer throws in terminal of insuring
Relevant insurance special pharmacopoeia category information is directly entered when protecting operation, and insurance spy's pharmacopoeia class of selection is added to spy by insuring terminal
It is sent to settlement of insurance claim terminal together in the request of medicine taking out insurances.
Settlement of insurance claim terminal will obtain the expense situation and insurance of insurance spy's medicine in the insurance spy's medicine for determining selection
The applicable disease disease incidence of special medicine；The expense situation for wherein insuring special medicine is to buy the disbursement of spy's medicine, for the expense feelings
Condition, it is contemplated that the factors such as special medication journey, application method are characterized (i.e. insurance spy's medicine with annual cost per capita in this implementation column
Applicable disease patient normal use the case where insuring special medicine next year required for spy's medicine buying expenses).For insuring special medicine
Annual cost and applicable disease disease incidence per capita, can be and be calculated by special medicine specification information, which includes
Application method (instructions of taking), specification unit price and applicable disease disease incidence；For convenience of description, it is calculated by specification information
Annual cost per capita can be described as " specification per capita annual cost ".Specifically, settlement of insurance claim terminal will obtain the special medicine of insurance first
Specification information, include specification unit price, course for the treatment of dosage (box /), course for the treatment of duration (moon) etc. in the specification information, such as
For special medicine injection Herceptin (Trastuzumab, it is a kind of for treat HER2 overexpression metastatic breast cancer injection
Agent), every price is 24900 yuan, 1 box of each course for the treatment of dosage, each course for the treatment of 1 month；It was calculated by 12 months within 1 year, then injection
The specification of Herceptin annual cost per capita are as follows:
Specification annual cost=specification unit price * (12/ course for the treatment of duration of course for the treatment of dosage *)=298800 yuan per capita.
The annual cost per capita of medicine special for insurance and applicable disease disease incidence, can also be the history medicine according to insurance spy's medicine
Object expense and history disease incidence (historical data) determine；For convenience of description, the annual cost per capita determined according to history consumption cost
It can be described as " history per capita annual cost ".Specifically, settlement of insurance claim terminal will obtain the history consumption cost information with reference to city
With history disease incidence；The history consumption cost and history disease incidence can be settlement of insurance claim terminal and with reference to the hospitals in city
System (or medical system, drug system etc.) is connected and is acquired；It and include with reference in city for history consumption cost information
Special medicine is insured in the history annual total costs and medication number of a certain annual (or nearest 1 year)；According to the history annual total costs
It can be calculated with medication number with reference to insuring the history of special medicine annual cost per capita in city, namely:
History annual cost=history annual total costs/number of users per capita.
Certainly, the history that obtains above by historical data annual cost and is obtained by specification information per capita
Specification annual cost per capita belongs to experience and/or predicts the obtained data of scope, therefore can be collectively referred to as prediction per capita
Annual cost；In order to enable subsequent calculated result can tally with the actual situation, it may be incorporated into preset expense loading risks and assumptions
(expense loading risks and assumptions are greater than or equal to zero), the time trend factor (the time trend factor is greater than or equal to zero), with characterization
Next insurance period possible risk situation (such as characterization currency inflation, drug price variation), thus per capita to prediction
Annual cost is adjusted (or amendment), to obtain annual cost per capita；Specifically, can annual cost (be gone through per capita according to above-mentioned prediction
History annual cost or specification annual cost per capita per capita) and expense loading risks and assumptions, the time trend factor, it calculates and insures special medicine
Annual cost per capita, it may be assumed that
Annual cost=prediction annual cost * (1+ expense loading risks and assumptions) * (the 1+ time trend factor) per capita per capita.
For example, expense loading risks and assumptions take 0.15, and the time trend factor takes when annual cost is 298800 yuan per capita for prediction
When 0, the annual cost per capita for insuring special medicine is
Annual cost=298800* (1+15%) * (1+0)=343620 (member) per capita.
In the present embodiment, settlement of insurance claim terminal is when obtaining the annual cost per capita for insuring special medicine and applicable disease disease incidence, also
It will acquire the payout schedule of special medicine insurance, which is the compensation standard and explanation of insurance institution when compensation event occurs
(or plan, amount of money etc.).For example, the payout schedule includes compensation ratio table, shown in table 1 specific as follows
Table 1 compensates ratio table
| Amount paid (ten thousand) | Compensation ratio |
| No more than 10,000 | 95% |
| More than 10,000 to 30,000 part | 95% |
| More than 30,000 to 50,000 part | 95% |
| Part more than 50,000 | 95% |
When determining event expenditure of warrantee's (insure personnel not necessarily warrantee) when compensation event occurs, (purchase is protected
Danger spy's medicine expenditure) when, settlement of insurance claim terminal can be calculated according to the expenditure and above-mentioned compensation ratio meter and compensate the amount of money.Certainly, exist
In specific implementation, payout schedule can be to be indicated in other ways.And the payout schedule can be and be passed through by the personnel of insuring
Terminal of insuring is entered and sent immediately when triggering special medicine taking out insurances request to settlement of insurance claim terminal, is also possible to be stored in advance in
In settlement of insurance claim terminal.It is worth noting that if including a variety of different insurance spy's medicines in the insurance of special medicine, can also be pair
A kind of payout schedule is separately provided in different insurance spy's medicines.
According to the annual cost per capita, described it is applicable in disease disease incidence and the payout schedule obtains year of the special medicine insurance
Risk premium, and obtain according to the year risk premium and default Management plan the Nian Maobao per capita of the special medicine insurance plan
Take；
In the present embodiment, settlement of insurance claim terminal is obtaining insuring the annual cost per capita of special medicine, is being applicable in disease disease incidence and compensation
When scheme, can first according to this per capita annual cost and payout schedule obtain insure special medicine compensate (i.e. warrantee in estimated year per capita
Pay the number to need to compensate when annual cost per capita year)；For example, may include as shown in Table 1 above for payout schedule
Compensation ratio table, and the annual cost per capita for insuring special medicine injection Herceptin is 343620 yuan, then injection toltrazuril
Monoclonal antibody expects that year compensation is per capita
It is expected that year compensation=(10000-0) * 0.95+ (30000-10000) * 0.95+ (50000-30000) * 0.95+ per capita
(343620-50000) * 0.95=326439 (member).
It is obtaining insuring when compensating in estimated year per capita of special medicine, can compensate in year per capita on the estimation and applicable disease disease incidence meter
It calculates and obtains the year risk premium of special medicine insurance, it may be assumed that
Special medicine risk premium=estimated * that compensates per capita is applicable in disease disease incidence.
In the present embodiment, special medicine insurance has been arrived when year risk premium is calculated in terms of warrantee's compensation
Data are paid, and for the price of special medicine insurance, it is also necessary to consider the factors such as operation expenditure and the profit of insurance institution.Specifically
, settlement of insurance claim terminal also needs to obtain default Management plan, obtains special medicine according to default Management plan and year risk premium and protects
The year gross premium per capita nearly planned；The default Management plan can be the number being set in advance in financial system or operation system
It is obtained from the financial system or operation system according to, settlement of insurance claim terminal fixing a price；Can certainly be stored in advance in
In settlement of insurance claim terminal.Wherein, default Management plan may include default operation cost per capita, default expenses of taxation ratio and pre-
If profit margin；When operation cost provides insurance service for each warrantee per capita operation cost (including system cost, manpower at
This etc.)；Default expenses of taxation ratio is the ratio of paying taxes of premium；Default profit margin then characterizes the estimated profit situation of insurance institution.?
When obtaining a year risk premium, default operation cost per capita, default expenses of taxation ratio and default profit margin, settlement of insurance claim terminal can be by it
It brings into default gross premium formula, the year gross premium per capita of special medicine insurance is calculated, presets gross premium formula are as follows:
Wherein, F is the year gross premium per capita；
R is the year risk premium, 0 < R；
C is the default operation cost per capita, 0 < C；
T is the default expenses of taxation ratio, 0 < T < 1；
Pr is the default profit margin, 0 < pr < 1.
In this implementation column, settlement of insurance claim terminal completes spy when the gross premium of year per capita of special medicine insurance is calculated
The price-setting process of medicine insurance.
Corresponding special medicine insurance policy and payment link are generated according to the gross premium of year per capita, and by the payment link
It is back to the terminal of insuring, to complete the payment of the special medicine insurance policy；
In the present embodiment, settlement of insurance claim terminal, can be according to this per capita when obtaining the gross premium of year per capita of special medicine insurance
The corresponding special medicine insurance policy of year gross premium generation.Certainly, during generating special medicine insurance policy, it is also necessary to warrantee's
Essential information, such as name, address, contact method can be the personnel of insuring and carrying out operation of insuring for these essential informations
Shi Yiqi is provided.Settlement of insurance claim terminal will additionally generate corresponding payment link, and should while generating special medicine insurance policy
Payment link is back to terminal of insuring.Terminal of insuring can show that special medicine insurance policy has been given birth to when receiving the payment link
At prompt, and show the payment link for insuring personnel's pay-per-click.Personnel insure in click opening branch in terminal of insuring
After paying link, payment interface can be entered, (insure the product information for showing this special medicine insurance policy special in the payment interface
Medicine), the gross premium information of year per capita of required payment, and show different types of means of payment option it is selective (such as bank card,
Third-party payment platform etc.), the personnel of insuring can be chosen according to their own situation suitable mode, input account into related payment interface
Family information is to pay.Wherein, if the personnel that insure are paid by way of bank card, personnel are insured when paying successfully,
Bank Fang Huixiang settlement of insurance claim terminal sends relevant notice of transferring accounts；Settlement of insurance claim terminal receive this transfer accounts notify when, i.e.,
Think that declaration form completes payment, then can send corresponding payment successful information to terminal of insuring；And the payment of Third-party payment platform
Detection is similar with the detection of bank card, and details are not described herein again.
In the present embodiment, settlement of insurance claim terminal can also complete Insurance Pricing, Premium by the way of big data
Process is furthermore achieved the intelligence and automation of special medicine insurance service, improves efficiency of service, reduce human cost；
Meanwhile when carrying out Insurance Pricing, multiple influence factor meters such as special medicine cost of use, disease incidence, operation cost are combined
The gross premium for calculating special medicine insurance plan fixes a price to special medicine insurance plan in a manner of big data analysis processing, thus more
Special medicine insurance plan Influence Factors of Price is comprehensively considered, price result is enabled more to meet the true operation of insurance institution
The market demand of situation and special medicine, improves the reasonability and accuracy of price.
In addition, the embodiment of the present invention also provides a kind of settlement of insurance claim device based on OCR technique.
It is that the present invention is based on the signals of the functional module of the settlement of insurance claim device first embodiment of OCR technique referring to Fig. 3, Fig. 3
Figure.
In the present embodiment, the settlement of insurance claim device includes:
Image uploading module 10, when for paying for request in the special pharmacology for receiving requesting terminal transmission, according to the special medicine
Material type is audited in Claims Resolution needed for requesting the special medicine of corresponding insurance to determine, and returns to corresponding images of materials to the requesting terminal
Upload prompt；
Picture recognition module 20, the images of materials uploaded for receiving the requesting terminal, and pass through optical character identification
OCR technique identifies the images of materials, obtains corresponding Claims Review information；
Claims Resolution judgment module 30, for being audited based on default Claims Resolution rule to the Claims Review information, to judge
Whether spy's pharmacology pays for request reasonable；
Information sending module 40 sends to corresponding financial system and suggests if paying for request rationally for the special pharmacology
Compensate information.
Wherein, each virtual functions module of the above-mentioned settlement of insurance claim device based on OCR technique, which is stored in shown in Fig. 1, is based on
It is functional for realizing the institute of settlement of insurance claim program in the memory 1005 of the settlement of insurance claim equipment of OCR technique；Each module is located
It manages when device 1001 executes, it can be achieved that the intelligence of special medicine settlement of insurance claim and the function of automation.
Further, the Claims Resolution judgment module 20, comprising:
First determination unit, for obtaining medical diagnosis on disease record from the Claims Review information, and according to the disease
Idagnostic logout, which determines that the special pharmacology is paid for, requests corresponding warrantee to diagnose a disease really disease；
First judging unit, for judging the applicable disease made a definite diagnosis illness and whether belong to the special medicine of the insurance, with judgement
Whether spy's pharmacology pays for request reasonable.
Further, the Claims Resolution judgment module 20, comprising:
Second determination unit, for obtaining special medicine purchaser record from the Claims Review information, and according to the special medicine
Purchaser record determines the actual purchase amount for insuring special medicine；
Usage amount computing unit, for obtaining the specification information for insuring special medicine, and according to the specification information
Calculate the theoretical usage amount for insuring special medicine；
Second judgment unit, for judging whether the actual purchase amount is abnormal according to the theoretical usage amount, with judgement
Whether spy's pharmacology pays for request reasonable.
Further, described image identification module 20, comprising:
Area division unit carries out region to the images of materials for the material type according to the images of materials and draws
Point, obtain effective image；
Feature extraction unit obtains character feature for carrying out feature extraction to the effective image, and by the character
Feature is compared with the default alternative features, to obtain corresponding Claims Review information according to comparison result.
Further, the settlement of insurance claim device further include:
Special medicine determining module, when for being requested in the special medicine taking out insurances for receiving terminal transmission of insuring, according to the spy
The request of medicine taking out insurances determines the special medicine of corresponding insurance, and obtains the annual cost per capita for insuring special medicine and the morbidity of applicable disease
Rate and the payout schedule of the special medicine insurance；
Gross premium obtains module, for according to annual cost, the applicable disease disease incidence and the payout schedule per capita
The year risk premium of the special medicine insurance is obtained, and the special medicine is obtained according to the year risk premium and default Management plan and is protected
The year gross premium per capita of danger；
Declaration form generation module, for generating corresponding special medicine insurance policy and payment chain according to the year gross premium per capita
It connects, and the payment link is back to the terminal of insuring, to complete the payment of the special medicine insurance policy.
Further, the default Management plan includes default operation cost per capita, default expenses of taxation ratio and default profit
Rate,
The gross premium obtains module, is specifically used for according to the year risk premium, the default operation cost, institute per capita
State the year per capita that the special medicine insurance plan is calculated in default expenses of taxation ratio, the default profit margin and default gross premium formula
Gross premium, wherein the default gross premium formula are as follows:
Wherein, F is the year gross premium per capita；
R is the year risk premium, 0 < R；
C is the default operation cost per capita, 0 < C；
T is the default expenses of taxation ratio, 0 < T < 1；
Pr is the default profit margin, 0 < pr < 1.
Further, the information sending module 40 includes:
Computing unit is compensated, it is special according to the Claims Review acquisition of information if paying for request rationally for the special pharmacology
Medicine disbursement, and compensation expense is calculated according to the special medicine disbursement and the payout schedule；
Information transmitting unit, for generating corresponding suggestions compensation information according to the compensation expense, and by the suggestion
It compensates information and is sent to corresponding financial system.
Wherein, the function of modules is realized with above-mentioned based on OCR skill in the above-mentioned settlement of insurance claim device based on OCR technique
Each step is corresponding in the settlement of insurance claim embodiment of the method for art, and function and realization process no longer repeat one by one here.
In addition, the embodiment of the present invention also provides a kind of readable storage medium storing program for executing.
Settlement of insurance claim program is stored on readable storage medium storing program for executing of the present invention, wherein the settlement of insurance claim program is held by processor
When row, realize such as the step of the above-mentioned settlement of insurance claim method based on OCR technique.
Wherein, settlement of insurance claim program, which is performed realized method, can refer to that the present invention is based on the insurance of OCR technique reasons
Each embodiment of compensation method, details are not described herein again.
It should be noted that, in this document, the terms "include", "comprise" or its any other variant are intended to non-row
His property includes, so that the process, method, article or the system that include a series of elements not only include those elements, and
And further include other elements that are not explicitly listed, or further include for this process, method, article or system institute it is intrinsic
Element.In the absence of more restrictions, the element limited by sentence "including a ...", it is not excluded that including being somebody's turn to do
There is also other identical elements in the process, method of element, article or system.
The serial number of the above embodiments of the invention is only for description, does not represent the advantages or disadvantages of the embodiments.
Through the above description of the embodiments, those skilled in the art can be understood that above-described embodiment side
Method can be realized by means of software and necessary general hardware platform, naturally it is also possible to by hardware, but in many cases
The former is more preferably embodiment.Based on this understanding, technical solution of the present invention substantially in other words does the prior art
The part contributed out can be embodied in the form of software products, which is stored in one as described above
In storage medium (such as ROM/RAM, magnetic disk, CD), including some instructions are used so that terminal device (it can be mobile phone,
Computer, server, air conditioner or network equipment etc.) execute method described in each embodiment of the present invention.
The above is only a preferred embodiment of the present invention, is not intended to limit the scope of the invention, all to utilize this hair
Equivalent structure or equivalent flow shift made by bright specification and accompanying drawing content is applied directly or indirectly in other relevant skills
Art field, is included within the scope of the present invention.
Claims (10)
1. a kind of settlement of insurance claim method based on OCR technique, which is characterized in that the settlement of insurance claim method is applied to settlement of insurance claim
Terminal, the settlement of insurance claim method include:
When the special pharmacology for receiving requesting terminal transmission pays for request, is paid for according to the special pharmacology and request the special medicine of corresponding insurance true
Material type is audited needed for fixed, and is returned to corresponding images of materials to the requesting terminal and uploaded prompt；
Receive the images of materials that the requesting terminal uploads, and by optical character identification OCR technique to the images of materials into
Row identification, obtains corresponding Claims Review information；
The Claims Review information is audited based on default Claims Resolution rule, to judge that the special pharmacology pays for whether request closes
Reason；
If spy's pharmacology pays for request rationally, is sent to corresponding financial system and suggest compensating information.
2. settlement of insurance claim method as described in claim 1, which is characterized in that described regular to the Claims Resolution based on default Claims Resolution
Msu message is audited, to judge that the special pharmacology pays for request whether reasonable step includes:
Medical diagnosis on disease record is obtained from the Claims Review information, and the special pharmacology is determined according to medical diagnosis on disease record
It pays for and corresponding warrantee is requested to diagnose a disease really disease；
Make a definite diagnosis whether illness belongs to the applicable disease for insuring special medicine described in judgement, to judge that the special pharmacology pays for whether request closes
Reason.
3. settlement of insurance claim method as described in claim 1, which is characterized in that described regular to the Claims Resolution based on default Claims Resolution
Audit material is audited, to judge that the special pharmacology pays for request whether reasonable step includes:
Special medicine purchaser record is obtained from the Claims Review information, and determines that the insurance is special according to the special medicine purchaser record
The actual purchase amount of medicine；
The specification information for insuring special medicine is obtained, and calculate the theory for insuring special medicine according to the specification information to make
Dosage；
Judge whether the actual purchase amount is abnormal according to the theoretical usage amount, to judge that the special pharmacology pays for whether request closes
Reason.
4. settlement of insurance claim method as described in claim 1, which is characterized in that described to pass through optical character identification OCR technique pair
The step of images of materials is identified, obtains corresponding Claims Review information include:
Region division is carried out to the images of materials according to the material type of the images of materials, obtains effective image；
Feature extraction is carried out to the effective image, obtains character feature, and the character feature is preset into alternative spy with described
Sign is compared, to obtain corresponding Claims Review information according to comparison result.
5. settlement of insurance claim method as described in claim 1, which is characterized in that described in the special medicine for receiving requesting terminal transmission
When Claims Resolution request, is paid for according to the special pharmacology and audit material type needed for requesting the special medicine of corresponding insurance to determine, and asked to described
Before asking terminal to return to the step of corresponding images of materials uploads prompt, further includes:
When receiving the special medicine taking out insurances request for terminal transmission of insuring, is determined and corresponded to according to the special medicine taking out insurances request
Insurance spy's medicine, and obtain the annual cost per capita for insuring special medicine and be applicable in the compensation of disease disease incidence and the special medicine insurance
The scheme of paying；
According to the annual cost per capita, described it is applicable in disease disease incidence and the payout schedule obtains the year risk of the special medicine insurance
Premium, and the year gross premium per capita that the special medicine insures is obtained according to the year risk premium and default Management plan；
Corresponding special medicine insurance policy and payment link are generated according to the gross premium of year per capita, and the payment link is returned
To the terminal of insuring, to complete the payment of the special medicine insurance policy.
6. settlement of insurance claim method as claimed in claim 5, which is characterized in that the default Management plan includes presetting to transport per capita
Cost, default expenses of taxation ratio and default profit margin are sought,
The gross premium of year per capita that the special medicine insurance plan is obtained according to the year risk premium and default Management plan
Step includes:
According to the year risk premium, the default operation cost per capita, the default expenses of taxation ratio, the default profit margin and
The year gross premium per capita of the special medicine insurance is calculated in default gross premium formula, wherein the default gross premium formula are as follows:
Wherein, F is the year gross premium per capita；
R is the year risk premium, 0 < R；
C is the default operation cost per capita, 0 < C；
T is the default expenses of taxation ratio, 0 < T < 1；
Pr is the default profit margin, 0 < pr < 1.
7. settlement of insurance claim method as claimed in claim 5, which is characterized in that if spy's pharmacology pays for request rationally,
It is sent to corresponding financial system and suggests that the step of compensating information includes:
If spy's pharmacology pays for request rationally, according to the Claims Review acquisition of information spy medicine disbursement, and according to described
Special medicine disbursement and the payout schedule calculate compensation expense；
Corresponding suggestion is generated according to the compensation expense and compensates information, and suggestion compensation information is sent to corresponding wealth
Business system.
8. a kind of settlement of insurance claim device based on OCR technique, which is characterized in that the settlement of insurance claim device includes:
Image uploading module when for paying for request in the special pharmacology for receiving requesting terminal transmission, is asked according to the special pharmacology compensation
Material type is audited needed for asking the special medicine of corresponding insurance to determine, and is returned to corresponding images of materials upload to the requesting terminal and mentioned
Show；
Picture recognition module, the images of materials uploaded for receiving the requesting terminal, and pass through optical character identification OCR technique
The images of materials is identified, corresponding Claims Review information is obtained；
Claims Resolution judgment module, for being audited based on default Claims Resolution rule to the Claims Review information, to judge the spy
Whether pharmacology pays for request reasonable；
Information sending module sends to corresponding financial system if paying for request rationally for the special pharmacology and suggests compensating letter
Breath.
9. a kind of settlement of insurance claim equipment based on OCR technique, which is characterized in that the settlement of insurance claim equipment includes processor, deposits
Reservoir and it is stored in the settlement of insurance claim program that can be executed on the memory and by the processor, wherein the insurance is managed
Program is paid for when being executed by the processor, the step of settlement of insurance claim method of the realization as described in any one of claims 1 to 7.
10. a kind of readable storage medium storing program for executing, which is characterized in that settlement of insurance claim program is stored on the readable storage medium storing program for executing, wherein
When the settlement of insurance claim program is executed by processor, realizing the settlement of insurance claim method as described in any one of claims 1 to 7
Step.
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|---|---|---|---|---|
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| CN114373183A (en) * | 2022-01-13 | 2022-04-19 | 北京圆心惠保科技有限公司 | Prescription auditing system |
| CN115018551A (en) * | 2022-06-29 | 2022-09-06 | 北京飞天经纬科技股份有限公司 | CRM data management method and device for advertisement service and storage medium |
| CN115147082A (en) * | 2022-07-13 | 2022-10-04 | 上海镁信健康科技有限公司 | An intelligent insurance claim settlement system based on special drugs |
| CN116385183A (en) * | 2023-04-06 | 2023-07-04 | 北京中科万国互联网技术有限公司 | Full-flow management method and device on insurance business line |
Citations (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104182824A (en) * | 2014-08-08 | 2014-12-03 | 平安养老保险股份有限公司 | Rule checking system and rule checking method for recognizing medical insurance reimbursement violations |
| CN107689006A (en) * | 2017-03-13 | 2018-02-13 | 平安科技（深圳）有限公司 | Claims Resolution bill recognition methods and device |
| CN107871285A (en) * | 2017-12-06 | 2018-04-03 | 和金在线（北京）科技有限公司 | A kind of health insurance pays for the method for detecting and system of fraud and abuse |
| CN108053329A (en) * | 2018-01-19 | 2018-05-18 | 泰康保险集团股份有限公司 | Information processing method, device, medium and electronic equipment for insurance claims |
| CN108090511A (en) * | 2017-12-15 | 2018-05-29 | 泰康保险集团股份有限公司 | Image classification method, device, electronic equipment and readable storage medium storing program for executing |
| CN108305175A (en) * | 2017-12-30 | 2018-07-20 | 上海栈略数据技术有限公司 | Settlement of insurance claim air control assisted verification system based on intellectual medical knowledge mapping |
| CN108346106A (en) * | 2018-02-23 | 2018-07-31 | 平安科技（深圳）有限公司 | Bill entry method, system, optical character recognition server and storage medium |
-
2018
- 2018-12-13 CN CN201811524325.4A patent/CN109615536A/en active Pending
Patent Citations (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104182824A (en) * | 2014-08-08 | 2014-12-03 | 平安养老保险股份有限公司 | Rule checking system and rule checking method for recognizing medical insurance reimbursement violations |
| CN107689006A (en) * | 2017-03-13 | 2018-02-13 | 平安科技（深圳）有限公司 | Claims Resolution bill recognition methods and device |
| CN107871285A (en) * | 2017-12-06 | 2018-04-03 | 和金在线（北京）科技有限公司 | A kind of health insurance pays for the method for detecting and system of fraud and abuse |
| CN108090511A (en) * | 2017-12-15 | 2018-05-29 | 泰康保险集团股份有限公司 | Image classification method, device, electronic equipment and readable storage medium storing program for executing |
| CN108305175A (en) * | 2017-12-30 | 2018-07-20 | 上海栈略数据技术有限公司 | Settlement of insurance claim air control assisted verification system based on intellectual medical knowledge mapping |
| CN108053329A (en) * | 2018-01-19 | 2018-05-18 | 泰康保险集团股份有限公司 | Information processing method, device, medium and electronic equipment for insurance claims |
| CN108346106A (en) * | 2018-02-23 | 2018-07-31 | 平安科技（深圳）有限公司 | Bill entry method, system, optical character recognition server and storage medium |
Cited By (25)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN110706116A (en) * | 2019-08-15 | 2020-01-17 | 平安健康保险股份有限公司 | Data processing method, device, equipment and storage medium based on LBS technology |
| CN110706116B (en) * | 2019-08-15 | 2024-11-26 | 平安健康保险股份有限公司 | Data processing method, device, equipment and storage medium based on LBS technology |
| CN110689322A (en) * | 2019-09-27 | 2020-01-14 | 成都知识视觉科技有限公司 | Artificial intelligence auxiliary claims checking system suitable for insurance claims settlement process |
| CN110729040A (en) * | 2019-10-23 | 2020-01-24 | 泰康保险集团股份有限公司 | Prescription auditing method and device, storage medium and electronic equipment |
| CN111105304A (en) * | 2019-11-19 | 2020-05-05 | 泰康保险集团股份有限公司 | Data processing method and device, storage medium and electronic terminal |
| CN110956140B (en) * | 2019-12-02 | 2022-09-02 | 蚂蚁胜信(上海)信息技术有限公司 | Image information extraction method, device, equipment and storage medium |
| CN110956140A (en) * | 2019-12-02 | 2020-04-03 | 支付宝(杭州)信息技术有限公司 | Image information extraction method and device |
| CN111383124A (en) * | 2020-05-29 | 2020-07-07 | 支付宝(杭州)信息技术有限公司 | User material verification method and device |
| CN111383124B (en) * | 2020-05-29 | 2024-06-14 | 蚂蚁胜信(上海)信息技术有限公司 | User material verification method and device |
| CN111402072A (en) * | 2020-06-05 | 2020-07-10 | 支付宝(杭州)信息技术有限公司 | Information processing method and device |
| CN111461681A (en) * | 2020-06-19 | 2020-07-28 | 支付宝(杭州)信息技术有限公司 | Auditing method and device |
| CN112950170A (en) * | 2020-06-19 | 2021-06-11 | 支付宝(杭州)信息技术有限公司 | Auditing method and device |
| CN112634063A (en) * | 2020-12-02 | 2021-04-09 | 北京健康之家科技有限公司 | Insurance claim settlement auditing method and device and electronic equipment |
| CN112528887A (en) * | 2020-12-16 | 2021-03-19 | 支付宝(杭州)信息技术有限公司 | Auditing method and device |
| CN112528887B (en) * | 2020-12-16 | 2022-10-28 | 蚂蚁胜信(上海)信息技术有限公司 | Auditing method and device |
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Effective date of registration: 20220527 Address after: 518000 China Aviation Center 2901, No. 1018, Huafu Road, Huahang community, Huaqiang North Street, Futian District, Shenzhen, Guangdong Province Applicant after: Shenzhen Ping An medical and Health Technology Service Co.,Ltd. Address before: Room 12G, Block H, 666 Beijing East Road, Huangpu District, Shanghai 200000 Applicant before: PING AN MEDICAL AND HEALTHCARE MANAGEMENT Co.,Ltd. |
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Application publication date: 20190412 |