JP2018018352A - A mechanism to eliminate the partial contribution liability to medical institutions of patients with insurance benefits of medical insurance - Google Patents

Abstract

PROBLEM TO BE SOLVED: To eliminate cash payment at an accounting window by using a private insurance.SOLUTION: A medical expense advance payment processing assistance device is provided with: a storage unit that stores subscription insurance company information indicating an insurance company of an insurance to which each member subscribes; a reception unit that receives medical expense advance payment request information; an advance payment processing unit that carries out a medical expense advance payment processing according to the medical expense advance payment request information; an insurance company detection unit that reads the insurance company of the insurance to which each member subscribes, the member being indicated by the medical expense advance payment request information regarding the advance-paid medical expense; a medical certificate creation request information output unit that outputs medical certificate creation request information indicating a medical certificate creation request to the medical institution of the medical expense advance payment request source; and an insurance payment charge information output unit that outputs insurance payment charge information indicating a payment charge of insurance money or a benefit through presentation of the created medical certificate and indicating the insurance company detected by the insurance company detection unit as a payment charge destination insurance company.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a mechanism for resolving a partial contribution liability to a medical institution of a patient with an insurance benefit of medical insurance, and in particular, a medical cost reimbursement processing support device, a service provision support system, a medical cost reimbursement processing support method, and Regarding the program.

  When receiving medical treatment or medical supplies at a medical institution such as receiving treatment at a hospital, the patient does not have to pay for social insurance coverage and pays his / her own contribution. Furthermore, Patent Document 1 discloses a payment system that can be used to postpay the self-pay portion. By postpaying the medical expenses, you do not have to exchange cash at the accounting counter.

Japanese Patent No. 4443946

As a method for reducing the self-payment of medical expenses by the patient, there is a method of using private insurance such as medical insurance or life insurance with a special contract. However, in private insurance, patients are required to pay insurance claims or benefits after receiving medical practice or medical supplies at a medical institution, and are paid at a later date after examination by an insurance company. For this reason, patients could not eliminate cash payments at the counter using private insurance.
If private insurance can be used to eliminate cash payments at the accounting counter, patient convenience will increase.

  The present invention provides a medical expenses reimbursement processing support apparatus, a service provision support system, a medical expenses reimbursement processing support method, and a program capable of eliminating cash payment at an accounting window using private insurance.

  According to the first aspect of the present invention, the medical expenses reimbursement processing support device is a member of the medical expenses reimbursement service using insurance, and the insurance company information indicating the insurance company to which the member is enrolled. A storage unit for storing medical information, a receiving unit for receiving medical cost reimbursement request information indicating a member, a medical fee amount for the member, and a medical institution from which a medical cost reimbursement request is made, and the medical cost reimbursement request An insurance company that reads out the insurance company in which the member indicated by the medical expense replacement payment information that has undergone the advance payment processing from the above-mentioned insurance company information, which performs the advance payment processing according to the information A detection unit; a medical certificate creation request information output unit that outputs a medical certificate creation request information indicating a medical certificate creation request to the medical institution that requests the medical cost replacement payment indicated by the medical cost replacement payment request information; and the medical certificate creation Shows the claim for insurance money or benefits by presenting the medical certificate created according to the request information, and outputs the insurance claim information indicating the insurance company detected by the insurance company detector as the billing insurance company An insurance payment request information output unit.

  Insurance amount information acquisition unit for acquiring information on the amount of insurance money or benefits paid according to the insurance payment request information, and a difference amount for calculating the difference between the amount of the insurance money or benefits and the amount of the medical expenses You may make it further provide a calculation part and the adjustment process part which performs the adjustment process of the said difference.

  According to the second aspect of the present invention, the service provision support system includes a medical institution terminal device and a medical expense reimbursement processing support device, and the medical institution terminal apparatus uses a medical expense reimbursement service using insurance. The medical cost reimbursement processing information is transmitted to the medical cost reimbursement processing device indicating the member's member, the amount of medical expenses for the member, and the medical institution that requested the reimbursement of medical expenses, and the medical cost reimbursement processing support The apparatus includes a storage unit that stores, for each member, insurance company information indicating an insurance company to which the member has subscribed, a receiving unit that receives the medical cost reimbursement request information, and the medical cost reimbursement request A reimbursement processing unit that performs reimbursement of medical expenses according to the information, and a member that the member indicated by the reimbursement request for reimbursement of medical expenses that has been reimbursed, reads out the insurance company that is insured from the enrolled insurance company information. A company detection unit; a medical certificate creation request information output unit that outputs a medical certificate creation request information indicating a medical certificate creation request to the medical institution that requests the medical cost replacement payment indicated by the medical cost replacement payment request information; and the medical certificate The insurance payment request information showing the insurance claim or claim payment request by presenting the medical certificate prepared according to the creation request information, and indicating the insurance company detected by the insurance company detection unit as the payment request insurance company An insurance payment request information output unit for outputting.

  According to the third aspect of the present invention, the medical expenses reimbursement processing support method is a method of supporting insurance company information indicating an insurance insurer to which each member of the medical expenses reimbursement service using insurance belongs. Receiving a medical cost reimbursement request information indicating a member, the amount of medical expenses for the member, and the medical institution that requested the medical cost reimbursement A replacement payment processing step in which the medical cost replacement payment processing support device performs a medical cost replacement payment process according to the medical cost replacement payment request information; and the medical cost replacement payment processing support device has been replaced An insurance company detection step of reading out from the insurer information the insurance company to which the member indicated by the medical cost reimbursement request information belongs, and the medical cost reimbursement processing support device includes the medical A medical certificate creation request information output step for outputting a medical certificate creation request information indicating a medical certificate creation request for a medical institution that is the medical cost reimbursement request source indicated by the medical cost reimbursement request information; An insurance payment indicating a claim for insurance money or benefits by presenting a medical certificate created in accordance with the medical certificate preparation request information, and indicating an insurance company detected by the insurance company detection unit as a payment request insurance company An insurance payment claim information output step for outputting claim information.

  According to the fourth aspect of the present invention, the program stores, for each member of the medical expenses reimbursement service using insurance, a storage unit that stores the insurance company information indicating the insurance company to which the member subscribes. A receiving step of receiving medical expense reimbursement request information indicating a member, the amount of medical expenses for the member, and a medical institution from which the medical cost reimbursement request has been made in a computer that controls the medical expense reimbursement processing support apparatus provided; A reimbursement process step for performing reimbursement of medical expenses in accordance with the reimbursement request information for medical expenses, and an insurance company in which a member indicated by reimbursement information for reimbursed medical expenses has joined the insurance An insurance company detection step to be read from the insurance company information, and a medical certificate preparation request indicating a medical certificate preparation request to the medical institution that requested the medical expense replacement payment indicated by the medical cost replacement payment information. A medical certificate creation request information output step for outputting information, and a claim for payment of insurance money or benefits by presenting a medical certificate created according to the medical certificate creation request information, detected by the insurance company detection unit This is a program for executing an insurance payment request information output step of outputting insurance payment request information indicating the insurance company as the payment request insurance company.

  According to this invention, payment of cash at an accounting window can be eliminated using private insurance.

It is explanatory drawing which shows the outline of the flow of the process in one Embodiment of this invention. It is a schematic block diagram which shows the function structure of the service provision assistance system which concerns on the embodiment. It is explanatory drawing which shows the example of a data structure of the contract insurance information which the insurance information management system concerning the embodiment memorize | stores. It is a schematic block diagram which shows the function structure of the medical institution terminal device which concerns on the embodiment. It is a schematic block diagram which shows the function structure of the medical expenses replacement payment process assistance apparatus which concerns on the embodiment. It is explanatory drawing which shows the example of a data structure of the member information which the 2nd memory | storage part which concerns on the same embodiment memorize | stores. It is explanatory drawing which shows the example of a data structure of the service utilization information which the 2nd memory | storage part which concerns on the same embodiment memorize | stores. It is explanatory drawing which shows the example of operation | movement of the service provision assistance system at the time of the private insurance contract in the embodiment. It is explanatory drawing which shows the example of operation | movement of the service provision assistance system at the time of medical expenses postpay service use by application of private insurance in the embodiment. It is explanatory drawing which shows the example of operation | movement of the service provision assistance system at the time of the medical expenses reimbursement organization which concerns on the embodiment performing the reimbursement for the medical expenses self-pay with respect to a medical institution. It is explanatory drawing which shows the example of operation | movement of the service provision support system at the time of the medical expenses reimbursement organization which concerns on the embodiment performing an insurance company's proxy claim of insurance money benefits. It is explanatory drawing which shows the example of operation | movement of a service provision support system when the medical expenses reimbursement processing support apparatus which concerns on the embodiment performs adjustment of the excess and deficiency of the amount of insurance money benefit with respect to the reimbursement amount of medical expenses. is there.

Hereinafter, although embodiment of this invention is described, the following embodiment does not limit the invention concerning a claim. In addition, not all the combinations of features described in the embodiments are essential for the solving means of the invention.
FIG. 1 is an explanatory diagram showing an outline of the flow of processing in an embodiment of the present invention.
The present embodiment relates to the payment of the self-payment of the medical expenses when the member of the post-payment medical service provided by the medical expenses reimbursement organization receives the medical service at the medical institution. In the following, the medical expenses self-payment is also simply referred to as medical expenses, unless it is necessary to clearly indicate the distinction between the medical insurance coverage and the self-payment. In the following, members of the post-payment service for medical expenses are also simply referred to as members or postpaid members.

  The medical institution here may be a medical institution that can use private insurance, and is not limited to a specific one. For example, the medical institution here may be a hospital, a clinic, a clinic, a pharmacy, or the like. Moreover, medical treatment here is a general term for work performed by medical institutions. The provision of medical care here may be the provision of medical practices by medical personnel such as doctors or nurses, the provision of articles such as the provision of pharmaceuticals, or a combination thereof. .

The private insurance here is insurance that can be applied to the self-payment of medical expenses provided by a private insurance company, and is called private insurance to distinguish it from social insurance. For example, the private insurance referred to here may be medical insurance or life insurance with a medical provision.
Social insurance here refers to insurance managed and operated by a public institution. Hereinafter, an organization that manages and operates social insurance is referred to as an insurer.
In the following, insurance benefits and claims are collectively referred to as benefits insurance or insurance. Benefits here are money that insurance continues after payment. On the other hand, insurance money is money for which insurance is terminated at the time of payment. In addition, payment of benefits and insurance payments are collectively referred to as insurance payments. Or it may be described as payment of benefits or insurance.

A member who has received medical care at a medical institution does not need to pay at a medical institution's accounting window by using a post-payment service for medical expenses. In particular, the member can leave the medical institution before the medical expenses are calculated and fixed by accounting, and the waiting time in the accounting order can be reduced.
Here, normally, medical expenses related to medical care to which insurance is applied are determined in advance, and negotiation of the amount of medical expenses is not performed. For this reason, it is not necessary for the patient to be present to calculate and confirm the medical expenses. Therefore, a member who uses the post-payment service for medical expenses can leave the medical institution before the medical expenses are calculated and fixed, except when there are special circumstances such as when it is necessary to confirm the medical expenses.

  A prerequisite for receiving provision of a postpaid medical service is to become a member of the service in advance. Those who wish to receive the service apply to the medical expenses reimbursement organization for the use of the service and receive consent, and become members in advance. The contents of the post-payment service for medical expenses are stipulated in, for example, a contract (hereinafter referred to as a postpaid member contract). In particular, a contract is signed in advance between the member and the medical expenses reimbursement institution to request and receive the insurance benefits.

  In the post-payment service for medical expenses with private insurance, the medical expenses reimbursement institution pays the medical institution for the self-payment of the medical expenses and collects the reimbursement from the benefits paid by the member's private insurance. . Further, the medical expenses reimbursement organization settles the difference between the reimbursement amount and the collected amount. As shown in FIG. 1, the medical expenses reimbursement organization may settle the difference through the collection agency. Alternatively, the medical expenses reimbursement organization may pay the difference directly with the member without going through the collection agency such as transferring surplus money to the member's account.

The medical expenses reimbursement organization reimburses the member's own medical expenses in accordance with the request from the medical institution. By reimbursement, the medical expenses paid by the medical institution for its members are transferred to the medical expenses reimbursement organization.
In order to smoothly operate the post-payment service for medical expenses, a contract must be concluded in advance between the medical expenses reimbursement institution and the medical institution to make advance payments and transfer of claims for the medical expenses. Also good. The contract in this case is a comprehensive contract in that the member is not specified.
In advance, an insurance company and a member will attach a special contract to the medical insurance policy to pay insurance benefits directly. The direct payment of insurance benefits here is so-called in-kind benefits in which part or all of the insurance benefits are paid for by providing medical care in place of money.

The medical expenses reimbursement organization, which has paid the reimbursement of the members' own medical expenses to the medical institutions and received the receivables, charges the insurance company for insurance benefits. Then, the medical expenses reimbursement organization receives the insurance benefits on their behalf. The proxy in the proxy request and proxy reception here is to represent the member who is the beneficiary of the insurance benefits.
Furthermore, as described above, the medical expenses reimbursement organization settles the difference between the reimbursement paid for by the member's own medical expenses and the amount collected by proxy receipt of the insurance benefits.

  The number of medical institutions, insurance companies, and members (patients) is not limited to one (or one person) shown in FIG. Further, any one of medical institutions, insurance companies, members, or a combination thereof may be included in the external configuration without being included in the service providing support system 1.

FIG. 2 is a schematic block diagram showing a functional configuration of the service providing support system according to the embodiment of the present invention. As shown in FIG. 2, the service providing support system 1 includes a medical institution terminal device 100, a medical expense reimbursement processing support device 200, an insurance information management system 300, and a collection agency processing system 400.
The service provision support system 1 is a system that supports provision of a post-payment medical service described with reference to FIG.

The medical institution terminal device 100 is provided in the medical institution and supports the execution of processing related to the request for the self-payment of the medical expenses of the member performed by the medical institution to the medical expenses reimbursement payment institution. That is, the medical institution terminal device 100 supports the execution of various processes performed by the medical institution in connection with the post-payment service for medical expenses. The medical institution terminal device 100 is configured using a computer such as a personal computer (PC).
The medical expense reimbursement processing support device 200 is provided in the medical expenses reimbursement organization and supports the execution of various processes related to the medical expenses reimbursement by the medical expenses reimbursement organization. That is, the medical expenses reimbursement processing support apparatus 200 supports the execution of various processes performed by the medical expenses reimbursement organization in relation to the medical expenses postpay service. The medical expense reimbursement processing support device 200 is configured using a computer such as a server device, for example.

The insurance information management system 300 is provided in an insurance company and stores and manages information related to insurance contracted by the insurance company. The insurance information management system 300 is configured using a computer such as a server device. Hereinafter, information stored and managed by the insurance information management system 300 is referred to as contract insurance information.
In particular, the insurance information management system 300 stores the contract insurance information regarding the contracted insurance at the time of an insurance contract with a post-payment special contract for medical expenses, and provides the information to the medical expenses advanced payment processing support apparatus 200.
In addition, the insurance information management system 300, in response to a credit confirmation inquiry from the medical expenses reimbursement processing support device 200, determines whether or not the insurance benefits can be paid, such as whether there is an insurance contract corresponding to the inquiry and the payment status of the insurance premium. Answer information related to.
In addition, the insurance information management system 300 replies the benefit amount determined in the examination in response to the insurance claim benefit surrogate request from the medical expenses reimbursement processing support device 200.

  FIG. 3 is an explanatory diagram illustrating an example of a data configuration of contract insurance information stored in the insurance information management system 300. In the example shown in FIG. 3, the contract insurance information is configured as tabular data (table format), and one row corresponds to one insurance contract. In the example of FIG. 3, each line of the contract insurance information includes an “insurance contract number” column, an “insurance contract basic information” column, and an “information regarding benefit direct payment special contract” column. The “Insurance policy basic information” field includes a “Name” field, a “Birth date” field, a “Contact” field, a plurality of “Insurance contract condition” fields (“Insurance contract condition 1” field, “Insurance contract” field). Condition 2 ”column,...). The “information regarding benefit direct payment special provision” column includes a “postpaid member number” column, a “proxy request source” column, and a “proxy receipt account” column.

The “insurance policy number” column stores an insurance policy number. The insurance contract number here is an identification number for identifying the insurance contract.
The “basic information” column stores basic information related to the insurance contract identified by the insurance contract number.
The “name”, “birth date”, and “contact” fields are the name, date of birth, and contact information (for example, e-mail address) of the insured person of the insurance contract identified by the insurance contract number. (Or telephone number).
Each of the plurality of “insurance policy conditions” columns stores the conditions attached to the insurance contract identified by the insurance contract number.

The “information regarding benefit direct payment special provision” column stores information regarding the special benefit when the benefit direct payment special contract is attached to the insurance contract identified by the insurance contract number.
The “postpaid member number” column stores the member number assigned to the insured person of the insurance contract identified by the insurance contract number by the medical expenses postpaid service of the medical expenses reimbursement organization.
The “proxy request source” column stores information for identifying a medical expenses reimbursement organization that makes a claim for the insurance benefit based on the insurance contract identified by the insurance contract number. The “proxy billing source” field may store the name of the medical expenses reimbursement organization, or may store an identification number for identifying the medical expenses reimbursement organization.
The “proxy receipt account” column stores the account information of the transfer destination of the insurance benefit when the proxy claim for the insurance benefit based on the insurance contract identified by the insurance contract number is received.

  The collection agency processing system 400 is provided in a collection agency, and executes a collection agency process of a bond in response to a collection request from a medical expense replacement payment agency. The collection proxy processing system 400 is configured using a computer such as a server device, for example. As the collection proxy processing system 400, for example, an existing system such as a credit card company system or a payment collection service company system, or a combination thereof can be used.

  For example, when the member pays a debt (payment of medical expenses) by account transfer, the collection agent processing system 400 notifies the member of the amount of the debt requested to be collected from the medical expenses reimbursement organization. When the member pays the debt by the specified amount of account transfer, the collection agent processing system 400 remits the paid money to the requesting medical expenses reimbursement organization. The collection agency processing system 400 may remit money of the amount minus the fee, or may receive a fee separately from the medical expenses reimbursement organization.

  In addition, when the member pays the debt by credit card payment, the collection agency processing system 400 notifies the member of the claim with the bill for the credit card usage fee and receives the payment of the credit usage fee. Collect. Further, the collection agent processing system 400 remits the amount requested to be collected from the medical expenses reimbursement organization to the medical expenses reimbursement organization. As in the case of fund transfer, the collection agent processing system 400 may remit money of the amount after subtracting the fee, or may receive a separate fee from the medical expenses reimbursement organization.

  In addition, when a member pays a debt by means of a lump sum of communication traffic, the collection agent processing system 400 notifies the member of the receivable with a communication fee invoice and collects the receivable by receiving payment of the communication fee. Do. Further, the collection agent processing system 400 remits the amount requested to be collected from the medical expenses reimbursement organization to the medical expenses reimbursement organization. As in the case of fund transfer, the collection agent processing system 400 may remit money of the amount after subtracting the fee, or may receive a separate fee from the medical expenses reimbursement organization.

FIG. 4 is a schematic block diagram illustrating a functional configuration of the medical institution terminal device 100. As illustrated in FIG. 4, the medical institution terminal device 100 includes a first communication unit 110, a first display unit 120, a first operation input unit 130, a first storage unit 180, and a first control unit 190. Prepare. The first control unit 190 includes a credit inquiry processing unit 191 and a medical billing processing unit 192.
The first communication unit 110 includes a communication circuit and communicates with other devices. In particular, the first communication unit 110 transmits credit inquiry information to the medical expense reimbursement processing support device 200 according to the control of the credit inquiry processing unit 191, and receives an answer to the credit inquiry information. The credit inquiry information referred to here is information (information indicating the inquiry) for inquiring whether or not post-payment of medical expenses can be applied when a patient offers post-payment of medical expenses.
In addition, the first communication unit 110 transmits medical cost reimbursement request information to the medical cost reimbursement processing support device 200 according to the control of the medical cost request processing unit 192. The medical expenses reimbursement request information here is information for requesting reimbursement of medical expenses (information indicating a request for reimbursement of medical expenses). In particular, the first communication unit 110 includes a medical fee that includes information for identifying a patient who has applied for postpayment of a medical fee, an amount of the medical fee for the member, and information for identifying a medical institution that requests a medical cost reimbursement. The advance payment request information is transmitted to the medical expense advance payment processing support apparatus 200.

The first display unit 120 includes a display screen such as a liquid crystal panel or an LED (Light Emitting Diode) panel, and displays various images. In particular, the first display unit 120 displays an input screen for a credit inquiry and a response to the credit inquiry in the case where the patient has applied for postpaid medical expenses. The first display unit 120 displays an input screen for requesting replacement payment of medical expenses.
The first operation input unit 130 includes input devices such as a keyboard and a mouse and receives user operations. In particular, the first operation input unit 130 performs a credit inquiry such as an input operation of information for identifying a patient who has applied for postpaid medical expenses while the first display unit 120 is displaying an input screen for a credit inquiry. To receive user operations. In addition, the first operation input unit 130 is a medical operation such as an input operation in the form of postpayment of medical expenses used by the patient in a state where the first display unit 120 displays an input screen for requesting replacement of medical expenses. A user operation for requesting reimbursement of expenses is received.

The 1st memory | storage part 180 is comprised using the memory | storage device with which the medical institution terminal device 100 is provided, and memorize | stores various information.
The first control unit 190 controls each unit of the medical institution terminal device 100 to execute various processes. The first control unit 190 is realized, for example, when a CPU (Central Processing Unit) provided in the medical institution terminal device 100 reads out and executes a program from the first storage unit 180.
The credit inquiry processing unit 191 performs credit inquiry processing when the patient offers to postpay medical expenses. Specifically, the credit inquiry processing unit 191 displays an input screen for credit inquiry on the first display unit 120 in accordance with a user operation instructing the start of credit inquiry processing. Then, the credit inquiry processing unit 191 generates credit inquiry information according to the user operation received by the first operation input unit 130 and causes the first communication unit 110 to transmit the credit inquiry information. When the first communication unit 110 receives an answer to the credit inquiry information, the credit inquiry processing unit 191 causes the first display unit 120 to display the obtained answer.

The medical cost claim processing unit 192 performs a medical cost replacement payment request to the medical cost replacement payment support apparatus 200. Specifically, when the first operation input unit 130 receives a user operation for specifying a patient and instructing the start of processing for a medical expense reimbursement request, the medical cost request processing unit 192 performs a credit inquiry about the specified patient. It is determined whether or not an answer indicating that postpayment is possible is obtained. When it is determined that an answer indicating that postpayment is possible is obtained, the medical expense request processing unit 192 causes the first display unit 120 to display an input screen for requesting replacement payment of medical expenses. Then, the medical cost billing processing unit 192 generates medical cost reimbursement billing information according to the user operation received by the first operation input unit 130 and causes the first communication unit 110 to transmit it. The medical cost claim processing unit 192 sets, for example, the patient's self-pay portion of the medical cost calculated by accounting for the patient who is the subject of the post-payment of the medical cost as the replacement payment request amount.
On the other hand, if it is determined that a reply indicating that postpayment is possible is not obtained in the credit inquiry regarding the patient specified by the user operation, the medical expense request processing unit 192 ends the medical expense reimbursement request process. Thereby, the medical institution terminal device 100 can suppress the medical cost reimbursement claim for the patient who is determined to be unable to pay the medical cost later.

FIG. 5 is a schematic block diagram showing a functional configuration of the medical expense reimbursement processing support apparatus 200. As illustrated in FIG. 5, the medical expense reimbursement process support device 200 includes a second communication unit 210, a second display unit 220, a second operation input unit 230, a second storage unit 280, and a second control unit. 290. The second control unit 290 includes a credit processing unit 291, an advance payment processing unit 292, an insurance company detection unit 293, a medical certificate format acquisition unit 294, a medical certificate creation request processing unit 295, and an insurance payment request processing unit 296. And a difference calculation unit 297 and a settlement processing unit 298.
The second communication unit 210 includes a communication circuit and communicates with other devices. In particular, the second communication unit 210 transmits and receives various types of information related to the determination of whether or not medical expenses can be paid later. Specifically, the second communication unit 210 receives credit inquiry information from the first communication unit 110 of the medical institution terminal device 100, transmits a contract insurance information confirmation request to the insurance information management system 300, an insurance information management system The contract insurance information confirmation result is received from 300, and a response to the credit inquiry to the first communication unit 110 is transmitted.
Moreover, the 2nd communication part 210 corresponds to the example of a receiving part, and receives the medical expenses replacement payment request information which the 1st communication part 110 transmitted.
The second communication unit 210 corresponds to an example of an insurance amount information acquisition unit, and receives from the insurance information management system 300 the amount information of the insurance benefit paid by the insurance company according to the insurance payment request.

The second display unit 220 includes a display screen such as a liquid crystal panel or an LED panel, and displays various images.
The second operation input unit 230 includes input devices such as a keyboard and a mouse and receives user operations.
The 2nd memory | storage part 280 is comprised using the memory | storage device with which the medical expenses advance payment process assistance apparatus 200 is provided, and memorize | stores various information. In particular, the second storage unit 280 stores member information and service usage information. The member information here is information on a member of a post-payment service for medical expenses. The service use information is information on a specific case of using the post-payment medical service.

  FIG. 6 is an explanatory diagram illustrating an example of a data configuration of member information stored in the second storage unit 280. In the example shown in FIG. 6, the member information is configured as tabular data, and one row corresponds to one member. In the example of FIG. 6, each row of member information includes a “post-paid member number” column, a “member basic information” column, and a “information relating to private insurance coverage special provision” column. The “member basic information” column includes a “name” column, an “address” column, and a “contact” column. The “information on private insurance application special provision” column includes a “special agreement flag” column, an “insurance company” column, an “insurance company contact” column, and a “contract number” column.

The “postpaid member number” column stores the member number assigned by the postpaid medical expenses service.
The “member basic information” column stores basic information about the member identified by the member number.
The “name” field, the “address” field, and the “contact address” field each store the name, address, and contact information (for example, an e-mail address or telephone number) of the member identified by the member number.

In the “Information on special provisions for private insurance” column, whether or not the member identified by the membership number is set to use the medical expenses postpaid service to which private insurance is applied is set. If so, store information about the applicable insurance.
The “special contract flag” column stores a special contract flag indicating whether or not the member identified by the member number uses the postpaid service for medical expenses to which private insurance is applied. For example, the value “1” in the “special contract flag” column indicates a setting for using a post-payment service for medical expenses to which private insurance is applied. On the other hand, the value “0” in the “special contract flag” column indicates a setting that does not use the post-payment service for medical expenses to which private insurance is applied.

The “insurance company” column, “insurance company contact” column, and “contract number” column are the insurance companies and insurances that apply when the medical expenses postpay service is applied. Stores company contact information (for example, telephone number) and contract number of the insurance.
The member information shown in FIG. 6 corresponds to an example of participating insurance company information.

  FIG. 7 is an explanatory diagram illustrating an example of a data configuration of service usage information stored in the second storage unit 280. In the example illustrated in FIG. 7, the service usage information is configured as tabular data, and one row corresponds to one case of medical cost postpaid service usage. In the example of FIG. 7, each row of member information includes a “postpaid member number” column, a “use date” column, a “used medical institution” column, a “use amount” column, and a “private insurance application special flag” column. And a “benefit amount” column and a “payment amount” column.

The “postpaid member number” column stores the member number assigned by the postpaid medical expenses service.
The “use date” column stores the date on which the post-payment service for medical expenses was used.
The “used medical institution” column stores information (for example, the name of a medical institution) that identifies a medical institution for which a post-payment medical service is used.

The “use amount” column stores an amount that is postpaid in the postpaid medical cost service. This amount is the amount reimbursed by the medical expenses reimbursement organization.
The “private insurance application special flag” column stores a private insurance application special flag indicating whether or not private insurance is applied. For example, a value “1” in the “private insurance applicable special contract flag” column indicates that private insurance is applied. On the other hand, the value “0” in the “private insurance applicable special contract flag” column indicates that private insurance is not applied. When private insurance is not applied, the medical expenses reimbursement organization receives payment for medical expenses reimbursement (post-payment for self-payment of medical expenses) from the member directly or through a collection agency.

The “benefit amount” column stores the amount of benefit provided by the insurance benefit when private insurance is applied.
The “settlement amount” column stores the settlement amount when private insurance is applied. Specifically, the “payment amount” column stores a difference obtained by subtracting the amount in the “utilization amount” column from the amount in the “benefit amount” column. If this difference is positive (+), it indicates a refund to the member. On the other hand, if this difference is negative (-), it indicates a charge to the member.

The 2nd control part 290 controls each part of the medical expenses advance payment process assistance apparatus 200, and performs various processes. The second control unit 290 is realized, for example, when the CPU included in the medical expense reimbursement processing support apparatus 200 reads out and executes a program from the second storage unit 280.
The credit processing unit 291 performs processing corresponding to credit inquiry information from the medical institution terminal device 100. Specifically, when the second communication unit 210 receives credit inquiry information, the credit processing unit 291 specifies a member from the credit inquiry information. Further, the credit processing unit 291 specifies whether or not the post-payment service for medical expenses to be used is the postpayment service for medical expenses to which private insurance is applied, from the credit inquiry information.

  In the case of using the post-payment service for medical expenses to which private insurance is applied, the credit processing unit 291 reads the insurance company, contact information, and contract number of the insurance used by the member indicated by the credit inquiry information from the member information. Then, the credit processing unit 291 inquires of the insurance information management system 300 about the state of this insurance. Alternatively, the credit processing unit 291 displays the insurance company, the contact information, and the contract number of the insurance on the second display unit 220 so as to prompt the person in charge of the medical expenses reimbursement organization to make an inquiry to the insurance company. Also good.

  When the second communication unit 210 receives a response from the insurance information management system 300 in response to the insurance status inquiry, the credit processing unit 291 receives a credit from the medical institution terminal device 100 in response to the response from the insurance information management system 300. Answer the inquiry. Specifically, when the insurance is valid and the insurance benefits can be paid, the credit processing unit 291 replies that credit is possible. A reply of creditable indicates that a postpaid medical cost service is available. On the other hand, the credit processing unit 291 replies that credit is not possible when the insurance benefit has not been paid, such as when the insurance has already been canceled or the payment of insurance premiums has been delayed. An answer that credit is not possible indicates that the post-payment service for medical expenses cannot be used.

The advance payment processing unit 292 performs a medical cost advance payment process according to the medical cost advance payment request information received from the medical institution terminal device 100 by the second communication unit 210. Specifically, the advance payment processing unit 292 generates a signal for instructing internet banking to transfer the advance payment to the account of the medical institution, and transmits the signal via the second communication unit 210.
Alternatively, the reimbursement processing unit 292 may generate a message that prompts the person in charge of the medical expenses reimbursement organization to transfer reimbursement money to the account of the medical institution, and causes the second display unit 220 to display the message. Good.

The insurance company detection unit 293 reads, from the member information, the insurance company in which the member indicated by the medical expense reimbursement request information that has undergone the reimbursement process has joined.
The medical certificate format acquisition unit 294 performs processing for acquiring a medical certificate format corresponding to the insurance company detected by the insurance company detection unit 293. Here, it is common that the format of a document such as a medical certificate is prescribed for each insurance company, and the medical certificate format acquisition unit 294 receives a medical certificate in a format prescribed by the insurance company that is the claimee of the insurance benefit. Process to get.

For example, the medical certificate format acquisition unit 294 may generate an e-mail requesting the format of the medical certificate and transmit it to the insurance information management system 300 via the second communication unit 210. Alternatively, if the medical certificate is published as electronic data on the insurance company's web page, the medical certificate format acquisition unit 294 may access the insurance company's web page to acquire the electronic data of the medical certificate. Good. When the medical certificate format acquisition unit 294 acquires the format of the medical certificate each time a medical certificate is required, the medical expense reimbursement processing support device 200 can quickly respond to the revision of the format of the medical certificate.
Alternatively, the medical certificate format acquisition unit 294 may generate a message that prompts the person in charge of the medical expenses reimbursement organization to request a medical certificate format and display the message on the second display unit 220. The format of the medical certificate referred to here may be electronic data in the format of a medical certificate, or may be a medical certificate entry form.

The medical certificate creation request processing unit 295 outputs medical certificate creation request information indicating a medical certificate creation request to the medical institution that requested the medical cost replacement payment indicated by the medical cost replacement payment request information.
For example, when the medical certificate format is obtained as electronic data, the medical certificate creation request processing unit 295 generates an e-mail requesting the creation of the medical certificate, affixes the medical certificate format, and passes through the second communication unit 210. You may make it transmit to the medical institution of the medical expenses advance payment request. In this case, the combination of the medical certificate creation request processing unit 295 and the second communication unit 210 corresponds to an example of the medical certificate creation request information output unit, and the e-mail transmitted by the second communication unit 210 is the medical certificate creation request information. It corresponds to an example.

  Alternatively, the medical certificate creation request processing unit 295 may generate a message that prompts the person in charge of the medical expenses reimbursement organization to create a medical certificate and display the message on the second display unit 220. In this case, the combination of the medical certificate creation request processing unit 295 and the second display unit 220 corresponds to an example of the medical certificate creation request information output unit, and the message displayed by the second display unit 220 is an example of the medical certificate creation request information. It corresponds to.

The insurance payment request processing unit 296 outputs insurance payment request information. The insurance payment request information generated by the insurance payment request processing unit 296 indicates a claim for payment of insurance benefits by presenting a medical certificate created according to the medical certificate preparation request information, and is detected by the insurance company detection unit The insured company is shown as the invoiced insurer.
For example, when the medical certificate is obtained by electronic data, the insurance payment request processing unit 296 generates an e-mail requesting payment of the insurance benefit, attaches the medical certificate, and insures through the second communication unit 210. You may make it transmit to a company. In this case, a combination of the insurance payment request processing unit 296 and the second communication unit 210 corresponds to an example of an insurance payment request information output unit, and an email transmitted by the second communication unit 210 corresponds to an example of insurance payment request information. To do.

  Alternatively, the insurance payment request processing unit 296 generates a message that prompts the person in charge of the medical expenses reimbursement organization to send a medical certificate to the insurance company to request payment of the insurance benefits, and generates a message on the second display unit 220. You may make it display. In this case, a combination of the insurance payment request processing unit 296 and the second display unit 220 corresponds to an example of the insurance payment request information output unit, and a message displayed by the second display unit 220 corresponds to an example of the insurance payment request information. .

The difference calculation unit 297 calculates the difference between the amount of insurance benefits and the amount of medical expenses. Specifically, the difference calculation unit 297 calculates the amount in the “settlement amount” column of the service usage information illustrated in FIG. 7 and stores it in the “production amount” column.
The settlement processing unit 298 performs settlement processing for the difference calculated by the difference calculation unit 297. For example, the settlement processing unit 298 generates an e-mail requesting settlement of the difference calculated by the difference calculation unit 297 and transmits it to the collection agent processing system 400 via the second communication unit 210.

Next, the operation of the service providing support system 1 will be described with reference to FIGS.
FIG. 8 is an explanatory diagram showing an example of the operation of the service providing support system 1 at the time of private insurance contract.
At the time of contracting with private medical insurance, a person who wishes to receive a post-payment service for medical expenses by applying private insurance contracts an insurance with a special contract for direct payment of benefits (sequence S101). The special contract here is
(1) The contractor must also register as a member of “Medical Expense Postpaid Service”,
(2) When the contractor pays the medical expenses to the medical expenses reimbursement organization after using the “Medical Expenses Postpaid Service”, and pays the medical insurance benefits, and
(3) The medical expenses reimbursement organization shall give prior approval to the insurance company for the implementation of claims for insurance claims as the agent of the contractor.

Next, the insurance company registers contract insurance information in the insurance information management system (sequence S102). At that time, the following information is also registered in the insurance information management system.
(1) Applying for a benefit direct payment special contract (2) Applying for a postpaid medical expenses service (3) Information identifying the medical expenses reimbursement agency that is the insurance claim agent in the above special contract

The medical expenses reimbursement institution receives information from the insurance company and performs postpaid member registration (sequence S103). At that time, the medical expenses reimbursement organization registers information (specifically, the name of the insurance company, the contents of the insurance contract, etc.) relating to the medical insurance (special contract for direct payment of benefits) in the member information.
After the sequence S103, the process of FIG.

FIG. 9 is an explanatory diagram showing an example of the operation of the service providing support system 1 when using a post-payment medical service by applying private insurance.
In the process of FIG. 9, the member makes an application for use of a postpaid medical cost service by applying private insurance at a medical institution (sequence S111).
The medical institution terminal device 100 accesses the medical expense reimbursement processing support device 200 according to the operation of the person in charge of the medical institution, and makes a credit inquiry (sequence S112).

The medical expense reimbursement processing support device 200 accesses the insurance information management system 300 in response to the credit inquiry from the medical institution terminal device 100 and requests confirmation of the member's insurance information (sequence S113). For example, the medical expense reimbursement processing support apparatus 200 requests confirmation of whether or not the medical insurance contract is continued.
The insurance information management system 300 confirms the insurance information in response to the request from the medical expenses reimbursement processing support device 200, and replies to the medical expenses reimbursement processing support device 200 (sequence S114). In the example of FIG. 9, the insurance contract is continued, and the medical expense reimbursement processing support apparatus 200 determines that credit is possible and returns a determination result to the medical institution terminal apparatus 100.

The medical institution terminal device 100 that has received the answer that credit is possible performs use registration of the post-payment medical service (sequence S115). In addition, the medical institution terminal device 100 notifies the medical expense reimbursement processing support device 200 that registration has been performed, and the medical cost reimbursement processing support device 200 that has received the notification registers service usage information (sequence S116). ). Here, the medical expense reimbursement processing support apparatus 200 registers the service usage information with the usage amount column blank.
When the medical expenses are calculated and confirmed by accounting after the medical provision to the members, the medical institution terminal device 100 registers the post-payment amount for the medical expenses self-pay (sequence S121). In addition, the medical institution terminal device 100 notifies the medical expense reimbursement processing support device 200 of the amount of self-pay for the medical expenses, and the medical cost reimbursement processing support device 200 uses the notified amount of service usage information as a usage fee. Register in the column (sequence S122).
The notification of the amount of self-pay for the medical expenses from the medical institution terminal device 100 to the medical expenses reimbursement processing support apparatus 200 corresponds to an example of the medical expenses reimbursement request, and the notified amount corresponds to the example of the reimbursement amount To do. As will be described later, the medical expense reimbursement processing support apparatus 200 totals the amount of medical expenses for each medical institution, for example, in a monthly closing, and transfers the total amount to the account of the medical institution.
Members do not need to be present for accounting. Therefore, it is possible to leave the medical institution without waiting for the accounting order, and the waiting time can be reduced.
After the sequence S122, the process of FIG. 9 ends.

FIG. 10 is an explanatory diagram showing an example of the operation of the service providing support system 1 when the medical expense reimbursement organization makes a reimbursement for the medical institution to pay its own medical expenses.
The medical expense reimbursement processing support apparatus 200 performs processing by, for example, monthly closing according to the operation of the staff of the medical expenses reimbursement organization, calculates the use amount of the postpaid medical expenses service for each medical institution, and demarcates the amount of reimbursement payment (Sequence S131).

  Further, the medical expenses reimbursement processing support device 200 performs processing for sending a document such as a medical certificate necessary for proxy claim for insurance benefits to a medical institution to request description and return (sequence S132). For example, as described above, the insurance company detection unit 293 reads the insurance company from the member information. And the medical certificate format acquisition part 294 acquires the medical certificate format according to the insurance company which the insurance company detection part 293 read. For example, when the medical certificate format is provided in paper, the medical certificate creation request processing unit 295 generates a message that prompts the person in charge of the medical expenses reimbursement organization to create a medical certificate and generates the second display unit 220. To display. According to this message, the person in charge of the medical expenses reimbursement organization mails the medical certificate format to the medical institution and requests entry and return of necessary items.

The medical institution fills in the necessary items in the document requested by the medical expenses reimbursement institution and returns it (sequence S133).
When the document requested from the medical institution is returned and received by the medical expenses reimbursement organization (sequence S134), the medical expenses reimbursement processing support apparatus 200 performs a medical expenses reimbursement process (sequence S135). For example, as described above, the advance payment processing unit 292 performs internet banking to transfer the advance payment to the account of the medical institution in accordance with the medical expense advance payment request information from the medical institution terminal device 100. Alternatively, the reimbursement processing unit 292 may generate a message that prompts the person in charge of the medical expenses reimbursement organization to transfer reimbursement money to the account of the medical institution, and causes the second display unit 220 to display the message. Good.

FIG. 10 shows an example in which the medical expense reimbursement organization collects the settlement fee from the medical institution, and the advance payment processing unit 292 calculates an amount obtained by subtracting the settlement fee from the total amount of post-paid medical expenses for the month. I'm paying. The settlement fee here is a fee charged by the medical expenses reimbursement organization as a price for collecting the medical expenses to the medical institutions. However, as described above, the method by which the medical expense reimbursement organization collects the fee is not limited to the method of collecting the fee from the medical institution.
By the advance payment in the sequence S135, the medical expense advance payment institution purchases the receivable for the medical cost self-payment that the medical institution had for the patient. In other words, the medical expenses reimbursement organization receives a credit transfer from the medical institution.
After the sequence S135, the process of FIG.

FIG. 11 is an explanatory diagram showing an example of the operation of the service providing support system 1 when the medical expenses reimbursement organization makes a claim for insurance benefits to an insurance company.
The insurance payment request processing unit 296 of the medical expense reimbursement processing support device 200 performs a process for substituting insurance benefits to the insurance company (sequence S141). For example, as described above, the insurance payment request processing unit 296 generates an e-mail requesting payment of the insurance benefit, attaches a medical certificate, and transmits it to the insurance company via the second communication unit 210. Alternatively, the insurance payment request processing unit 296 generates a message that prompts the person in charge of the medical expenses reimbursement organization to send a medical certificate to the insurance company to request payment of the insurance benefits, and generates a message on the second display unit 220. You may make it display.

The insurance company that has received the proxy claim for the insurance benefit conducts an examination for the insurance benefit based on the received documents such as the medical certificate, and determines the benefit amount of the insurance benefit (sequence S142). . Then, the insurance information management system 300 notifies the determined medical benefit payment amount to the medical expenses advance payment processing support apparatus 200.
The medical expenses reimbursement organization confirms the amount of the insurance benefit determined by the insurance company (sequence S143). In particular, the second communication unit 210 receives a notification of the amount of insurance benefit from the insurance information management system 300.
After sequence S143, the process in FIG. 11 is terminated.

FIG. 12 is an explanatory diagram showing an example of the operation of the service providing support system 1 when the medical expenses reimbursement processing support apparatus 200 performs adjustment of excess or deficiency of the amount of the insurance benefit for the reimbursement amount of the medical expenses. It is.
The insurance company that has determined the amount of the insurance benefit in sequence S143 in FIG. 11 sends the sum of the insurance benefit plus the incidental expenses to the medical expenses reimbursement organization (sequence S151), and the medical expenses reimbursement organization Is received (sequence S152). The insurance incidental fee here is a fee paid by the insurance company as compensation for the administrative procedure for direct payment of benefits to the medical expenses reimbursement organization. However, the method of collecting the fee by the medical expenses reimbursement organization is not limited to the method of collecting from the insurance company. The insurance company may remit only the insurance benefit in sequence S151.

  In the medical expenses reimbursement organization that has received the insurance benefits and the insurance incidental expenses, the difference calculation unit 297 of the medical expenses reimbursement processing support apparatus 200 calculates and reimburses the reimbursement amount of the medical expenses from the amount of the received insurance benefits. A difference obtained by subtracting the fee is calculated (sequence S153). The settlement fee here is a fee that a member of the post-payment medical service pays when using the service. However, the method of collecting the fee by the medical expenses reimbursement organization is not limited to the method of collecting the fee from the member. The difference calculation unit 297 may calculate a difference obtained by subtracting the advance payment amount of the medical expenses from the amount of the insurance benefit.

Next, in the medical expense reimbursement processing support apparatus 200, the settlement processing unit 298 determines whether the difference calculated by the difference calculation unit 297 in sequence S153 is excessive or insufficient (sequence S154). When the difference calculated by the difference calculation unit 297 is positive (+), the settlement processing unit 298 determines that a surplus has occurred, transfers the difference to the member (sequence S155), and the member receives it (sequence S156). .
On the other hand, if the difference calculated by the difference calculation unit 297 is negative (−), the settlement processing unit 298 determines that there is a shortage and charges the member for the difference (sequence S157). Or you may make it process that the medical expenses advance payment process assistance apparatus 200 lent the difference amount to the member.

The member who has received the request for the difference sends the requested difference to the medical expenses reimbursement organization (sequence S158), and the medical expenses reimbursement organization receives (sequence S159). The member remits the difference to the medical expenses reimbursement organization through, for example, a collection agency. If interest or interest is incurred on the difference, such as when the difference is loaned, the member repays the difference plus interest or interest.
After sequence S159, the process of FIG.

  As mentioned above, the 2nd memory | storage part 280 memorize | stores the joining insurance company information which shows the insurance company of the insurance which the said member has subscribed for every member of the medical expenses advance payment service using insurance. Further, the second communication unit 210 receives medical cost reimbursement request information indicating the member, the amount of medical expenses for the member, and the medical institution that requested the medical cost reimbursement. The advance payment processing unit 292 performs a medical expense advance payment process according to the medical expense advance payment request information. The insurance company detection unit 293 reads, from the insurance company information, the insurance company in which the member indicated by the medical expense replacement payment request information that has been processed for replacement payments belongs. The medical certificate creation request information output unit that combines the medical certificate creation request processing unit 295 and the second communication unit 210 indicates a medical certificate creation request to the medical institution that requested the medical cost replacement payment indicated by the medical cost replacement payment request information. Outputs medical certificate creation request information. The insurance payment request information output unit that combines the insurance payment request processing unit 296 and the second communication unit 210 outputs insurance payment request information. This insurance payment request information indicates a claim for insurance money or benefits by presenting a medical certificate prepared in accordance with the medical certificate preparation request information, and the insurance company detected by the insurance company detection unit indicates the invoice destination. Show as insurance company.

  Thereby, the medical expenses reimbursement processing support apparatus 200 supports the reimbursement of the medical expenses paid by the member by the medical expenses reimbursement organization and the proxy claim for the insurance benefits. The medical expenses reimbursement organization makes the reimbursement for the member's own medical expenses based on the private insurance, thereby eliminating the cash payment at the accounting window using the private insurance. In particular, patients (members) do not have to pay cash at an accounting window, thereby eliminating the trouble of delivering cash. Furthermore, the patient does not have to wait for the accounting turn, and the waiting time can be reduced. In addition, since the medical expenses reimbursement organization requests insurance benefits, the patient does not need to make a claim to the insurance company. In this respect, the load on the patient can be reduced.

In addition, for insurance companies, it is possible to reduce the loss of insurance benefits due to patients not making insurance claims.
In addition, for medical expenses reimbursement institutions, medical expenses postpay service can be performed as a commercial business. For example, a medical expenses reimbursement organization can earn revenue from a medical institution in the form of a settlement fee that the medical institution pays to the medical expenses reimbursement organization as a consideration for collecting the medical expenses. In addition, the medical expenses reimbursement institution may earn revenue from the insurance company in the form of insurance incidental income, which is a fee paid by the insurance company as a compensation for the direct payment of benefits to the medical expenses reimbursement institution. it can. In addition, the medical expenses reimbursement institution pays the patient's revenue in the form of a reimbursement fee that the patient pays to the medical expenses reimbursement institution for the postpaid service for the self-payment of the medical expenses and the proxy claim for the insurance benefits. Can be obtained. In addition, when the medical expenses reimbursement organization lends the difference to the patient, the medical expenses reimbursement organization can obtain revenue from the patient in the form of a loan interest as a consideration for the lending.

In addition, the second communication unit 210 acquires information on the amount of insurance money or benefit paid according to the insurance payment request information. The difference calculation unit 297 calculates the difference between the amount of insurance money or benefit and the amount of medical expenses. Then, the settlement processing unit 298 performs settlement processing for the difference.
Thereby, the medical expenses reimbursement processing support apparatus 200 can support the settlement of the difference between the amount of the insurance money or the benefit and the amount of the medical expenses, and the person in charge of the medical expenses reimbursement organization performs the settlement. Can be reduced.

Note that a program for realizing all or part of the functions of the medical institution terminal device 100 and the medical expense reimbursement processing support device 200 is recorded on a computer-readable recording medium, and the program recorded on the recording medium is recorded. The processing of each unit may be performed by being read and executed by a computer system. Here, the “computer system” includes an OS and hardware such as peripheral devices.
Further, the “computer system” includes a homepage providing environment (or display environment) if a WWW system is used.
The “computer-readable recording medium” refers to a portable medium such as a flexible disk, a magneto-optical disk, and a compact disk, and a storage device such as a hard disk built in the computer system. Furthermore, the “computer-readable recording medium” dynamically holds a program for a short time like a communication line when transmitting a program via a network such as the Internet or a communication line such as a telephone line. In this case, a volatile memory in a computer system serving as a server or a client in that case, and a program that holds a program for a certain period of time are also included. The program may be a program for realizing a part of the functions described above, and may be a program capable of realizing the functions described above in combination with a program already recorded in a computer system.

  The embodiment of the present invention has been described in detail with reference to the drawings. However, the specific configuration is not limited to this embodiment, and includes design changes and the like within a scope not departing from the gist of the present invention.

DESCRIPTION OF SYMBOLS 1 Service provision support system 100 Medical institution terminal device 110 1st communication part 120 1st display part 130 1st operation input part 180 1st memory | storage part 190 1st control part 191 Credit inquiry process part 192 Medical expense claim process part 200 Medical expense Replacement payment processing support device 210 Second communication unit 220 Second display unit 230 Second operation input unit 280 Second storage unit 290 Second control unit 291 Credit processing unit 292 Replacement payment processing unit 293 Insurance company detection unit 294 Acquisition of medical certificate format 295 Medical certificate creation request processing unit 296 Insurance payment request processing unit 297 Difference calculation unit 298 Settlement processing unit 300 Insurance information management system 400 Collection agency processing system

Claims (5)

A storage unit for storing information on a participating insurance company indicating an insurance company of the insurance that the member has subscribed for each member of the medical expenses reimbursement service using insurance;
A receiving unit that receives medical expenses reimbursement request information indicating a member, the amount of medical expenses for the member, and a medical institution that requested the reimbursement of medical expenses;
A reimbursement processor that performs reimbursement of medical expenses according to the medical reimbursement request information;
An insurance company detection unit that reads an insurance company in which the member indicated by the medical expense reimbursement request information that has undergone the advance payment process has joined the insurance from the insurance company information;
A medical certificate creation request information output unit that outputs medical certificate creation request information indicating a medical certificate creation request to the medical institution that is the medical cost reimbursement request source indicated by the medical cost reimbursement request information;
An insurance payment indicating a claim for insurance money or benefits by presenting a medical certificate created in accordance with the medical certificate preparation request information, and indicating an insurance company detected by the insurance company detection unit as a payment request insurance company An insurance payment claim information output unit for outputting claim information;
A medical expense reimbursement processing support device. An insurance amount information acquisition unit for acquiring information on the amount of insurance money or benefit paid according to the insurance payment request information;
A difference calculating unit for calculating a difference between the amount of the insurance money or benefit and the amount of the medical expenses;
A settlement processing unit for performing the settlement of the difference;
The medical expense reimbursement processing support device according to claim 1, further comprising: A medical institution terminal device and a medical expense reimbursement processing support device;
The medical institution terminal device stores medical cost reimbursement billing information indicating a member of a medical cost reimbursement service using insurance, a medical cost amount for the member, and a medical institution from which a medical cost reimbursement request is made. Send to the advance payment processing device,
The medical cost reimbursement processing support device is
A storage unit that stores information on the insurance company that indicates the insurance company that the member has joined for each member;
A receiving unit for receiving the medical expenses reimbursement request information;
A reimbursement processor that performs reimbursement of medical expenses according to the medical reimbursement request information;
An insurance company detection unit that reads an insurance company in which the member indicated by the medical expense reimbursement request information that has undergone the advance payment process has joined the insurance from the insurance company information;
A medical certificate creation request information output unit that outputs medical certificate creation request information indicating a medical certificate creation request to the medical institution that is the medical cost reimbursement request source indicated by the medical cost reimbursement request information;
An insurance payment indicating a claim for insurance money or benefits by presenting a medical certificate created in accordance with the medical certificate preparation request information, and indicating an insurance company detected by the insurance company detection unit as a payment request insurance company An insurance payment claim information output unit for outputting claim information;
A service providing support system comprising: A medical expenses reimbursement processing support device comprising a storage unit for storing insured insurance company information indicating an insurance company to which the member has subscribed for each member of the medical expenses reimbursement service using insurance, A receiving step for receiving medical expenses reimbursement request information indicating the amount of medical expenses for the member and the medical institution requesting reimbursement for medical expenses;
The medical expense reimbursement processing support device performs a medical expenses reimbursement process according to the medical cost reimbursement request information,
An insurance company detection step in which the medical cost reimbursement processing support device reads from the participating insurance company information an insurance company in which the member indicated by the reimbursement-processed medical cost reimbursement request information is included,
The medical cost reimbursement processing support device outputs a medical certificate creation request information output step for outputting medical certificate creation request information indicating a medical certificate creation request to the medical institution that requests the medical cost reimbursement indicated by the medical cost reimbursement request information. When,
An insurance company detected by the insurance company detection step, wherein the medical expense reimbursement processing support device shows a claim for insurance money or benefit payment by presenting a medical certificate prepared according to the medical certificate preparation request information An insurance payment claim information output step for outputting insurance payment claim information indicating as a billing insurance company;
Medical expenses reimbursement processing support method including. For a computer that controls a medical expenses reimbursement processing support device that includes a storage unit that stores insured insurance company information indicating an insurance company that the member has subscribed for each member of the medical expenses reimbursement service using insurance,
Receiving a medical cost reimbursement request information indicating the member, the amount of medical expenses for the member, and the medical institution from which the medical expenses were reimbursed;
A reimbursement process step for performing reimbursement of medical expenses according to the medical reimbursement request information;
An insurance company detection step of reading out from the insurance company information the insurance company in which the member indicated by the medical expenses replacement payment request information that has been processed for advance payment;
A medical certificate creation request information output step for outputting a medical certificate creation request information indicating a medical certificate creation request to a medical institution that is a medical cost reimbursement request source indicated by the medical cost reimbursement request information;
Insurance payment showing a claim for insurance money or benefits by presenting a medical certificate prepared according to the medical certificate preparation request information, and indicating the insurance company detected in the insurance company detection step as a payment invoice insurance company Insurance payment claim information output step for outputting claim information;
A program for running

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