基于规则引擎的医保审核系统研究  

Research of Medical Insurance Audit System Based on Rules Engine

作　　者：冷金昌[1] 彭坤[2] 孙晓玮[1] 

机构地区：[1]解放军总医院第一附属医院,北京海淀区阜成路51号100048 [2]解放军总医院第一附属医院信息科

出　　处：《中国数字医学》2014年第12期4-5,16,共3页China Digital Medicine

基　　金：科技部国家科技支撑计划(编号:2011BAH15B08)~~

摘　　要：针对医院医保审核的业务需求,采用规则引擎技术,开发了一套面向医疗保险患者的医保智能审核信息系统。该软件实现了医院对各类医保的医疗费用进行全面审核及监控管理,减少出错与医保拒付,提升了医院医保的综合管理水平,具有较强的现实意义。For the settle requirement of medical insurance audit in hospital,by applying the technique of rule engine,a set of medical insurance audit system is developed,which successfully makes hospital achieve full audit and monitoring management for various of medical insurance expenses,reduces the risk of missed payments,enhances the comprehensive management level of the hospital medical insurance.It has a strong practical significance.

关 键 词：医疗保险 审核 规则引擎 

分 类 号：R319[医药卫生—基础医学]