大数据与医保智能审核深度融合的探索——基于成都市的实践

Exploring the Deep Fusion of Big Data and Medical Insurance Intelligent Auditing——Based on the practice of Chengdu

成都市医保局通过深入挖掘、高效使用医保大数据,促进智能审核升级迭代,构建起包括两套规则、三个系统和五个工作机制在内的全方位、多角度智能审核体系。目前,成都市所有联网结算医疗费用全部实现智能审核,同时对智能审核的规则配置、系统建设、审核流程进行标准化管理,审核体系初步实现高效率和标准化。

Chengdu Medical Insurance Bureau promotes the upgrade iteration of intelligent auditing by digging in depth and using the big data of medical insurance effi ciently, and constructs an all-round and multiangle intelligent auditing system including two rules, three systems and fi ve working mechanisms.At present, all networked settlement medical expenses in Chengdu have been intelligently audited. At the same time, the rules, system construction and auditing process of intelligent auditing have been standardized, and the auditing system has initially achieved high effi ciency and standardization.