基于ILOG以及临床路径的医疗行业智能审核技术在保险行业的应用

Application of intelligent auditing technology in insurance industry based on ILOG and clinical pathway in medical industry

目前,安徽省一直在进行由商业保险公司经办基本医保和大病医保的试点。基于ILOG规则引擎以及临床路径的智能审核系统可以很好地实现保险公司对医疗机构的行为监管和费用控制,对于保险公司具有重要意义。

At present,Anhui province has been conducting commercial insurance companies to carry out basic medical insurance and serious medical insurance pilot. The intelligent auditing system based on ILOG rules engine and clinical path can realize the behavior regulation and cost control of insurance companies to medical institutions,which is of great significance to insurance companies.