北京医保离线实时结算的实现及应用

The Implementation of Real-time Medical Insurance Settlement Designed for Offline Scenarios

北京市在2011年起已全面上线医保门诊住院实时结算业务.为了实现在某些无法直接连接医保网络的特殊业务场景下使用医保系统完成实时结算,采用数据库整体搬移、每日结算数据抽取的方式分阶段地完成了这一目标.实践证明,通过业务流程调整、定期更新红名单和相应的技术实现工作,能够完成特殊业务场景下的医保离线结算业务.

Since 2011, the medical insurance real-time settlement service for outpatient in Beijing has been fully online. In order to achieve real-time settlement in some special scenarios which cannot be directly connected to the medical insurance network, in this paper, database migration and transaction data extraction methods were given to achieve this goal. Practice has proved that the offline medical insurance settlement can be completed fully effectively.