医保智能审核系统的技术创新研究  

Research on Technical Innovation for the Intelligent Audit System of Medical Insurance

作　　者：彭坤[1] 冷金昌[1] 孙晓玮[1] 

机构地区：[1]解放军总医院第一附属医院,北京100048

出　　处：《现代仪器与医疗》2015年第1期27-29,共3页Modern Instruments & Medical Treatment

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。实现了医院医保审核业务逻辑规则的灵活可配置。同时根据医保审核工作的特点,对规则引擎进行了改进,将改进后的规则引擎应用于系统中,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,提升了医院医保的综合管理水平。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, the business logic rules could be confi gured fl exibly. Meanwhile some methods are proposed to enhance the performance of rule engine according to the characteristics of medical insurance audit work. The improved system successfully makes hospital achieve full audit and monitoring management for various of medical insurance expenses, enhances the comprehensive management level of the hospital medical insurance.

关 键 词：医疗保险 审核 规则引擎 RETE算法 

分 类 号：R197[医药卫生—卫生事业管理]