Medical Application System Module Design

(1) Application System Module Design
1. Medical insurance center Information System
Medical insurance center information system includes insurance management, collection management, transfer management, medical management, approval management, settlement management, financial management, financial inspection, statistical analysis, communication management, Card Issuing Management, System 13 sub-modules, such as management and medical insurance policy management. The information system of the medical insurance center is used to establish and manage the insurance fund collection, personal medical insurance accounts, and overall planning fund accounts, and issue IC cards and medical insurance certificates containing personal information, it is responsible for settlement with banks and medical institutions, cash reimbursement of the insured, financial management, and other regular services. At the same time, it can promptly and dynamically understand the usage of medical expenses of insured persons, so as to supervise and manage medical treatment behaviors of medical institutions. It can also flexibly adjust the relevant policies of medical insurance according to the actual situation.
2. Medical Institution Information System
Make full use of the software and hardware of the existing computer system of the Designated Hospital, and add functional modules for the insured in the foreground application software, install middleware software on the server side of the hospital system (the server side of several major hospitals is loaded with mqservers corresponding to the operating system used, and mqclient can be loaded by other institutions ), thus, a reliable, secure, and independent data exchange channel can be established between medical care centers and medical institutions. For newly established medical institutions with information management, the Windows operating system is used in principle, the SQL Server is used in the database, TCP/IP is used in the network protocol, and Windows98/95 is used in the client operating system, with delphi4 as the front-end development tool, the medical insurance center is connected to large designated medical institutions through the ddnleased line. Small medical organizations can use single-host operations to maintain contact with the medical insurance center through dialing.
The management system of designated medical institutions (hospitals) mainly includes outpatient management, hospitalization management, pharmacy management, financial management, system management, communication management, statistical analysis, and comprehensive query.
(2) Application system module function Introduction
The system includes two subsystems: the Information System of the medical insurance center and the information system of the designated medical institution.
The main function modules of the information system of the medical insurance center are as follows:

Counter business function module system management function module
1. Insurance function Management Module 1. Statistical analysis function module
2. Collection Management function module 2. Financial management function module
3. Approval Management Function Module 3. fund allocation function module
4. Allocation Management function module 4. inspection and review function module
5. Medical Management Function Module 5. dictionary maintenance function module
6. Payment Management function module 6. System Maintenance function module
7. Reimbursement Management Function Module 7. Policy Management function module
8. integrated query function module 8. IC card function Management Module
9. Communication Management Module

 

 

Main function modules of designated institutions:

Outpatient management module hospitalization Management Module
1. Price planning function module 1. Price planning function module
2. return operation module 2. return operation module
3. On-duty checkout Module 3. On-duty checkout Module
4. Statistical Report Module 4. Statistical Report Module
5. Integrated Query Module 5. Integrated Query Module
6. Communication Management Module
Function modules of the medical insurance center

Insurance Management provides management functions such as entry, payment, and transfer of basic information of units and individuals, and manages changes such as unit merger, separation, bankruptcy, surrender, warranty extension, and laid-off, the system automatically generates reports by daily, daily, monthly, and quarterly reports. At the end of the year and the beginning of the month, the insurance management module will automatically review units and individuals, automatically generate a payment table, and automatically transfer the flow, and provide comprehensive information query functions.

 

Generate a payment notice based on the unit's payment flow, enter the payment record (Transfer Basis) based on the user's payment receipt form, and print the payment receipt form; provide the handling functions of various payment methods, such as cash collection and bank collection; carry forward the account at the end of the year, and provide comprehensive query of relevant information.

The insured personnel must apply to the medical insurance center for medical treatment, transfer to hospital, emergency department, chronic diseases, and other situations outside of the city. The approval record is the basis for providing medical expense reimbursement; the basis for deferred payment approval and deferred transfer; loss Reporting and completing cards must be strictly reviewed. The approval record is the basis for card making. Comprehensive query of relevant information is also provided. The preceding functions have permission requirements.
The insured personnel must apply to the medical insurance center for medical treatment, transfer to hospital, emergency department, chronic diseases, and other situations outside of the city. The approval record is the basis for providing medical expense reimbursement; the basis for deferred payment approval and deferred transfer; loss Reporting and completing cards must be strictly reviewed. The approval record is the basis for card making. Comprehensive query of relevant information is also provided. The preceding functions have permission requirements.

The medical insurance center reviews the outpatient information, prescription details, number of visits, and other basic information uploaded by designated hospitals.

The detailed records of each medical expense can be traced to find the corresponding detailed records of the prescription ticket, and the boundaries can be defined. The system automatically counts the detailed records of the exceeding targets for inspection.

Dictionary maintenance, such as interest dictionary and expense dictionary; user management, permission management, expired data backup, and deletion.

 

Powerful query statistics function. The comprehensive application of multi-condition query allows managers to conveniently query and count the data they care about. The query statistics are displayed in combination with charts to display the results at a glance. Specific sub-functions: Statistical Analysis of insurance and medical care.

 

Adopts the standard double-entry billing method. It is seamlessly connected to the Fund Collection and Payment System of the medical insurance center for data sharing. It has a complete accounting monitoring system and financial statistical analysis and management functions. It is easy to use, easy to operate.

 

Medical insurance payment policy management, medical insurance fund collection policy management, and personnel category management.