The Research And Desigh Of Direct-billing Claim System For Commercial Health Insurance

The claim of commercial health insurance is a process of acceptance,on-site survey,examination and payment.For the traditional mode of insurance claim,the insured person need to go to the insurance company to submit the medical treatment materials for the claim.Insurance companies usually need three to five working days to review the case and finally give the claim conclusion.The process is tedious and time-consuming,which restricts the expansion of the insurance company's business.The direct-billing claim mode refers to that the insured person agrees the hospital to transmit his medical data to the insurance company in real time,when he is under medical treatment in the hospital.The insurance company's claim-billing system will process the data,and return the claim result to the hospital.And the medical expenses will be paid by the hospital firstly.The insurance company and the hospital will have a regular settlement.Combined with the research and development experience of relevant systems at home and abroad,the thesis studies and designs the direct-billing claim system of commercial health insurance.The direct-billing claim system consists of two major systems,data docking system and business processing system.The data docking system is responsible for the data transmission between the insurance company and the hospital.The business process system is a system for processing the business logic of the insurance claim.Combined with the business process,the thesis designs the data exchange interfaces and the data docking process between the insurance company and the hospital,and designs the system realization of the insurance claim automation process.The direct-billing claim system is compatible with various data message templates,and realizes the rapid access of the medical institutions.At the same time,it realizes the automation of the claims settlement process,which not only helps the insurance company save a lot of manpower cost,but also improves the customer satisfaction and reduces the claim disputes.