WO2002082349A1 - Method for managing medical insurance and recording medium for the same - Google Patents

Method for managing medical insurance and recording medium for the same Download PDF

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Publication number
WO2002082349A1
WO2002082349A1 PCT/KR2001/001011 KR0101011W WO02082349A1 WO 2002082349 A1 WO2002082349 A1 WO 2002082349A1 KR 0101011 W KR0101011 W KR 0101011W WO 02082349 A1 WO02082349 A1 WO 02082349A1
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WO
WIPO (PCT)
Prior art keywords
approval
web server
fee
insurance
examination
Prior art date
Application number
PCT/KR2001/001011
Other languages
French (fr)
Inventor
Dong-Ho Lee
Original Assignee
Shinboram Co., Ltd.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Shinboram Co., Ltd. filed Critical Shinboram Co., Ltd.
Publication of WO2002082349A1 publication Critical patent/WO2002082349A1/en

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Classifications

    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H15/00—ICT specially adapted for medical reports, e.g. generation or transmission thereof
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q10/00—Administration; Management
    • G06Q10/10—Office automation; Time management
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08—Insurance

Definitions

  • This invention relates to a method for managing medical insurance by using a communication network and a recording medium for reading a program regarding the same with a computer, and in particular to a medical insurance managing method and a recording medium for reading a program regarding the same with a computer which may prevent insufficiency in medical insurance finance caused from false medical insurance payment claims, inefficiency in the medical insurance payment issuance examination process, use of medical insurance by ineligible persons and excessive claims for insurance payments, by using a credit card checking device and a credit card inquiry network through the existing public switched telephone network(PSTN) and managing the information regarding the total amount of the medical service commission fees for each medical institution at the insurance corporation server or by managing information regarding prescription information and commission fee for respective patients for each medical institution through the internet.
  • PSTN public switched telephone network
  • the object of the present invention is to resolve the above problems by providing a method for managing medical insurance and a recording medium for reading a program regarding the same with a computer to prevent insufficiency of medical insurance finance caused from false and excessive medical insurance payment claims, unjust services use by persons who have not paid insurance fees, inefficiency in the medical insurance payment issuance examination, by using the credit card checking device and credit card inquiry network through the existing public switched telephone network(PSTN) and managing the information regarding the total amount of the medical service commission fees for each medical institution at the insurance corporation server or by managing information regarding prescription information and commission fee for respective patients for each medical institution through the internet.
  • PSTN public switched telephone network
  • the medical insurance managing method includes the steps of a web server providing a hospital with client software(S20); and said web server transmitting/receiving examination fee request and approval information(S26), wherein the step of said web server transmitting/receiving examination fee request and approval information(S26) includes the steps of: said web server receiving information including at least one among the medical insurance card number, prescription, examination fee and the examination fee approval request from said hospital(S32); said web server transmitting information including at least one among the medical insurance card number, prescription, examination fee and the examination fee approval request to a insurance approval server(S34); said web server receiving information including at least one among an examination fee approval message and a approval number(S40); and said web server transmitting information including at least one among the examination fee approval message and the approval number to said hospital(S42).
  • the method for managing medical insurance includes the steps of a web server providing a pharmacy with a client software(S20); and said web server transmitting/receiving examination fee request and approval information(S26), wherein the step of said web server transmitting/receiving examination fee request and approval information(S26) includes the steps of: said web server receiving medical insurance card number from said pharmacy (S54); said web server transmitting the prescription of the patient applicable to the said medical insurance card number to said pharmacy(S ⁇ O); said web server receiving information including at least one among a medicine preparation fee and a medicine preparation fee approval request from said pharmacy(S62); said web server transmitting information including at least one among a medical insurance card number, a medicine preparation fee and medicine preparation fee approval request to a insurance approval server(S64); said web server receiving information including at least one among a medicine preparation fee approval message and an approval number from said insurance approval server(S70); and said web server transmitting information including at least one among the medicine preparation fee approval message and the approval number to said pharmacy(S72).
  • the recording medium which performs said aspect of the present invention is a recording medium which manages medical insurance by allowing the medical insurance related information to be transmitted/received to the hospital and insurance approval server through the web server and the internet and a program for executing the following functions is recorded therein such that it may be read by a computer:
  • Functions of said web server receiving information including at least one among the medical insurance card number, prescription, examination fee and examination fee approval request from the hospital; said web server transmitting information including at least one among said medical insurance card number, prescription, examination fee and examination fee approval request to an insurance approval server; said web server receiving information including at least one among an examination fee approval message and approval number from said insurance approval server; and said web server transmitting information including at least one among the examination fee approval message and approval number to said hospital.
  • the recording medium which performs said another aspect of the present invention is a recording medium which manages medical insurance by allowing the medical insurance related information to be transmitted/received to the pharmacy and insurance approval server through the web server and the internet and a program for executing the following functions is recorded therein such that it may be read by a computer: Functions of said web server receiving the medical insurance card number from the pharmacy; said web server transmitting prescription of the patient applicable to said medical insurance card number to said pharmacy; said web server receiving information including at least one among a medicine preparation fee and medicine preparation fee approval request from said pharmacy; said web server transmitting information including at least one among said medical insurance card number, medicine preparation fee and medicine preparation fee approval request to the insurance approval server; said web server receiving information including at least one among medicine preparation fee approval message and approval number from said insurance approval server; and said web server transmitting information including at least one among medicine preparation fee approval message and approval number to said pharmacy.
  • Figure 1 is a first example drawing of the information communication system to which the present invention is applied;
  • Figure 2 is an example drawing of a magnetic strip type medical insurance card to which the present invention is applied;
  • Figure 3 is a flow chart of the medical insurance managing method according to the first embodiment of the present invention.
  • Figure 4 is a second example drawing of the information communication system to which the present invention is applied.
  • Figure 5 is a flow chart of the medical insurance managing method according to the second embodiment of the present invention.
  • Figure 6 is a detailed flow chart of the examination fee request step among the medical service commission fee request and approval step according to the second embodiment of the present invention.
  • FIG. 7a and 7b are detailed flow charts of the medicine preparation fee request step among the medical service commission fee request and approval step according to the second embodiment of the present invention.
  • Figure 8 is an example drawing of a 'Examination Information Summary' window of the patient which is transmitted to the pharmacy.
  • Figure 1 is a first example drawing of the information communication system to which the present invention is applied.
  • the communication system to which the present invention is applied includes a Public Switched Telephone Network(PSTN; 100) which supports the present invention such that the services related to this invention may be conducted online, a inquiry device(200) which reads the insurance certificate number of the medical insurance card of the patient, transmits the said read number to the administrator server and transmits the medical service commission fee to the administrator server, and receives information on whether or not the medical service commission fee(referred to as "fee" hereinafter) approval may be settled from the administrator server, a administrator server(300) which transmits, receives and stores requisite information between said medical institution card inquiry device(200) and the insurance corporation server, and an insurance corporation server(400) which receives fee settlement approval request information from said administrator server(300) and transmits information on the settlement status regarding the request to said administrator server(300) and stores requisite information.
  • PSTN Public Switched Telephone Network
  • a medical institution which is provided with said medical institution inquiry device(200) refers to a hospital, a doctor's office, a pharmacy or any medical service providing institution defined and regulated by relevant laws.
  • said medical institution inquiry device(200) includes a reader which performs the function of reading requisite information from the medical insurance card of the patient according to the present invention, a display which performs the function of displaying settlement approval messages and settlement details of the medical insurance card received from said administrator server(300), a printer which prints the medical insurance card sales receipt according to the settlement details, and a controller which performs the function of transmitting information from said reader and said computer to said administrator server(300) and controlling said reader, display and printer.
  • Said reader is not limited to a magnetic strip reader, and it may also be a radio frequency reader or a IC reader which has an IC chip built-in the card and reads necessary information by directly contacting the IC pin.
  • Said administrator server(300) includes a web server(310) which performs the functions of receiving information regarding fee settlement approval request from said inquiry device(200) and transmitting said information regarding the fee settlement approval request to said insurance corporation server(400), and receiving information regarding settlement approval status from said insurance corporation server(400) and transmitting said information regarding the settlement approval status to said inquiry device(200), and a database server(320) which stores information regarding the medical institution which requested the fee settlement approval, fee amount, medical insurance card number, and fee approval number.
  • said administrator server is also programmed to perform the functions of a Value Added Network(VAN) server.
  • VAN Value Added Network
  • Said insurance corporation server(400) includes an insurance approval server(410) which performs the functions of receiving information regarding the medical insurance card number of the patient, fee settlement approval request information, information regarding the requesting medical institution , fee amount and the like from said web server (310) and determining the settlement approval status and transmitting the information regarding the approval status and the fee settlement information to said web server, and a database server(420) which stores the medical insurance card number of the patient for each medical institution, date of medical service provision, the medical institution which has provided the medical service, the settled fee amount for said service, the insurance fee payment details of the patient applicable to said medical insurance card number and the like.
  • Figure 2 is an example drawing of a magnetic strip type card among medical insurance cards which are read by the said inquiry device.
  • the issuance objects of said medical insurance card are all members of medical insurance, and the use for said medical insurance card is as a substitute of the medical insurance certificate and proof of eligibility, and the information recorded on said medical insurance card is the insurance card number or in the case of corporate medical insurance, it is the information on the applicable institution.
  • said medical insurance card according to the present invention is not limited to the type, use, and recorded information of the card exemplified in figure 2.
  • Figure 3 is a flow chart of the medical insurance managing method according to the first embodiment of the present invention.
  • the medical institution provide the patients with medical service and uses its inquiry device(200) to read the medical insurance card of the patient and inputs the fee amount into said inquiry device (200) (S2).
  • the information read by said reader is the medical insurance certificate number of the patient or in the case said patient is a member of corporate medical insurance, the information is the applicable institution code.
  • the web server(310) receives information from said medical institution card inquiry device(200) according to S2, and said web server(310) transmits said read medical certificate number, fee amount, examination institution, examination date and fee settlement approval request information to the insurance approval server(410), and the database server stores said medical certificate number, fee amount, examination institution, examination date and fee settlement approval request information in the patient database(S4).
  • Said insurance approval server(410) stores said read medical certificate number, fee amount, examination institution, examination date and fee settlement approval request information received according to S4 in the patient database applicable to said medical insurance card number, and said insurance approval server(410) receives the medical insurance fee payment status among said patient database from said web server and uses this information as basic material in determining whether or not the settlement on the medical service commission fee amount of the patient is to be approved(S ⁇ ).
  • Said insurance approval server(410) uses the medical insurance fee payment status information received according to S6, and determines settlement approval status regarding the medical service commission fee amount of said patient (S8).
  • said insurance approval server(410) transmits a disapproval message to the inquiry device(200) through said web server(310), and the printer of said inquiry device(200) prints said disapproval message(SlO).
  • said insurance approval server(410) approves, said insurance approval server(410) settles said medical service commission fee amount and said database server(420) stores said settlement information in the patient database applicable to said medical insurance card number(S12).
  • Said web server(310) receives insurance use approval and approval number from said insurance approval server and transmits this to said inquiry device(200), and said database server(320) stores information regarding insurance use approval and approval number into the database of the patient applicable to said medical insurance card number(S14).
  • Said inquiry device(420) prints the sales receipt including the information regarding approval number, fee amount transmitted from said web server(310), through said printer (S16).
  • said insurance corporation server(400) may manage information regarding the medical insurance fee payment status of the patient applicable to the medical insurance card number, and thereby said insurance corporation server(400) may prevent use of insurance money by ineligible persons.
  • said insurance corporation server(400) may manage the examination information of insurance users for each medical service providing institution, and automatically calculate the total monthly amount of insurance money that said respective medical service providing institutions must pay, and thereby may serve to prevent false/excessive request of medical insurance fees.
  • Figure 4 is a second example drawing of the information communication system to which the present invention is applied.
  • the communication system to which the present invention is applied includes an internet network(500) which supports the services regarding the present invention such that the services may be performed online, a hospital computer(600)(referred to as "hospital” hereinafter) which transmits information regarding medical insurance card number, prescription, examination fee and examination fee approval request to the administrator server and receives information regarding examination fee approval, a pharmacy computer(700)(referred to as "pharmacy” hereinafter) which receives the prescription from the administrator server and transmits information regarding the medicine preparation fee and medicine preparation fee approval request to the administrator server and receives information regarding the medicine preparation fee approval from the administrator server, an administrator server(800) which receives information regarding the medical insurance card number, prescription, examination fee, examination fee approval request from the hospital( ⁇ OO) and stores the same, and stores information regarding examination fee approval status and transmits the same to said hospital(600), and transmits information regarding the examination details of the patient, prescription, medicine preparation fee approval status to said pharmacy(700)
  • Said internet network(500) uses TCP/IP and allows functions of file viewing, transmitting electronic mail and the like.
  • said hospital( ⁇ OO) and said pharmacy(700) includes an OS exceeding at least Windows 95/NT4, CPU over Pentium
  • Said administrator server(800) includes a web server(810) which transmits and receives information regarding medical insurance card number, prescription, examination fee or medicine preparation fee and the approval requests thereof, and information regarding the examination fee and medicine preparation fee approval message and approval number to and from said hospital( ⁇ OO) or pharmacy(700) and the insurance corporation server, and a database server(820) which stores information that is provided by said hospital( ⁇ OO) or pharmacy(700) upon member entry, information regarding the medical insurance card number, prescription contents, examination fee or medicine preparation fee, examination fee or medicine preparation fee approval request or examination fee and medicine preparation fee approval message and approval number, examination fee or medicine preparation fee disapproval message and the like.
  • Said insurance corporation server(900) includes a insurance approval server(910) which transmits and receives information regarding the insurance card number, prescription, examination fee or medicine preparation fee and the approval requests thereof, and information regarding the examination fee or medicine preparation fee approval message and approval number to and from said web server(810), and determines the examination fee or medicine preparation fee approval status, and a database server(920) which stores information regarding the medical insurance card number, prescription contents, examination fee or medicine preparation fee, examination fee or medicine preparation fee approval request or examination fee and medicine preparation fee approval message and approval number, examination fee or medicine preparation fee disapproval message, and the insurance fee payment details of the patient applicable to said medical insurance card number.
  • a database server(920) which stores information regarding the medical insurance card number, prescription contents, examination fee or medicine preparation fee, examination fee or medicine preparation fee approval request or examination fee and medicine preparation fee approval message and approval number, examination fee or medicine preparation fee disapproval message, and the insurance fee payment details of the patient applicable to said medical insurance card number.
  • Figure 5 is an overall flowchart of the method for managing medical insurance according to the second preferred embodiment of the present invention.
  • the hospital( ⁇ OO) or pharmacy(700) installs a client software, as a program provided by the administrator, and logs on to the administrator server where the client software allows the examination fee or medicine preparation fee request and approval according to the present invention to be performed online(S20).
  • Said hospital(600) or pharmacy(700) may install said client software through a medium that may store information such as a floppy disc or a compact disc but it is preferable that the hospital(600) or pharmacy(700) log on to the administrator website and download the software, then install it.
  • the web server(810) determines whether or not said hospital(600) or pharmacy(700) has been registered for membership(S22).
  • said web server(810) prompts said hospital(600) or pharmacy(700) to perform the procedure for membership registration(S24).
  • the web server(810) Upon membership registration as said S24, the web server(810) receives information on company registration number, address, phone number, field of business, name of owner, address of the owner, ID and password from said hospital(600) or pharmacy(700) and stores said information in the database server(820).
  • the information stored in said database server is not limited to the above.
  • said hospital( ⁇ OO) or pharmacy(700) transmits the service content that has been provided to said patient to said web server(810) and while doing so, when said hospitaK ⁇ OO) or pharmacy(700) requests medical service commission fee such as the examination fee or medicine preparation fee, said database server(820) stores said information regarding said medical service, and said web server(810) transmits the information received from said hospital( ⁇ OO) or pharmacy(700) to the insurance approval server(910).
  • the database server(920) stores necessary information among information regarding said medical service, then said insurance approval server(910) uses the already stored information regarding the insurance fee payment status of said patent to determine the status of the patient and in case the patient in not an ineligible person, the fee request for said medical service provided to said patient is approved. (S26).
  • said insurance approval server(910) transmits the information regarding insurance use approval to said web server(810), and said database server(820) stores said information regarding said insurance use approval, then said web server(810) transmits the information regarding said insurance use approval to said hospital( ⁇ OO) or pharmacy(700).
  • said hospital( ⁇ OO) or pharmacy(700) receives the above information and prints the sales receipt for said medical service fee through the printer(S28).
  • said web server(810) transfers the procedure to said S26.
  • FIG. 6 is a detailed flow chart of the examination fee request step among the medical service fee request and approval step according to the second preferred embodiment of the present invention.
  • the hos ⁇ ital(600) logs on to the administrator server and uses at least one among the ID or password to perform the login procedure(S30).
  • the web server(810) receives information regarding the medical insurance card number, prescription, examination fee and examination fee approval request of the patient from said hospital( ⁇ OO), and the database server(820) stores information regarding said medical insurance card number, prescription, examination fee and examination fee approval request of said patient which said web server(810) has received in the patient database applicable to said insurance card number(S32).
  • the prescription said web server(810) receives according to said S32 includes at least the name of patient, resident registration number, name of the medical institution, phone number, the illness classification code, name of the physician, type of license, number, name of the prescribed medicine, dosage, direction for use, total quantity, date of prescription, term of use, and other particulars to be considered when prescribing medicine
  • Said web server(810) transmits the information regarding the medical insurance card number, prescription, examination fee and examination fee approval request received through S32 to the insurance approval server(910)(S34).
  • Said insurance approval server(910) stores the information regarding the medical insurance card number, prescription, examination fee and examination fee approval request received from the web server(810) according to S34 in the patient database applicable to said insurance card number(S36).
  • Said insurance approval server(910) receives the medical insurance fee payment status of said patient among the patient database applicable to the insurance card number and determines whether the medical insurance fee payment status of said patient corresponds to a pre-established standard that the administrator has set and determines whether to approve of the examination fee request made by said hospital(600)(S38).
  • said database server(920) stores said examination fee approval message and approval number in the patient database applicable to said medical insurance card
  • said web server(810) receives information regarding said examination fee approval message and approval number from said insurance approval server(910)
  • said database server(820) stores information regarding said examination fee approval message and approval number in the patient database applicable said medical insurance card number(S40).
  • Said web server (810) transmits said examination fee approval message and approval number to said hospital( ⁇ OO) and said hospital( ⁇ OO) receives and stores said examination fee approval message and approval number(S42)
  • Said hospital( ⁇ OO) prints a sales receipt including the examination fee approval message and approval number received according to said S42 in the name of the patient applicable to said medical insurance card number(S44).
  • said database server stores a disapproval message in the patient database applicable to said medical insurance card number, and said web server(810) receives an examination fee disapproval message from said insurance approval server(910), and said database server(820) stores the examination fee disapproval message in the patient database applicable to said medical insurance card number(S46).
  • Said web server(810) transmits said examination fee disapproval message to the hospital(600), and said hospital( ⁇ OO) receives and stores said examination fee disapproval message(S48).
  • Said hospital( ⁇ OO) prints a sales receipt including the examination fee disapproval message received according to said S48 in the name of the patient applicable to said medical insurance card number(S50).
  • Figure 7a and 7b are detailed flow charts of the medicine preparation fee request step among the medical service commission fee request and approval step according to the second embodiment of the present invention.
  • the pharmacy(700) logs on to the administrator website and uses at least one among the ID or password to perform the login procedure(S52).
  • the web server(810) receives the medical insurance card number from said pharmacy(700)(S54).
  • Said web server(810) transmits a examination information summary of the patient applicable to said medical insurance card number to said pharmacy(700)(S56).
  • the examination information summary according to said S54 is information giving a summarized account of examination date of said patient, institution, physician, examination fee and other information within a period pre-established by the administrator, wherein figure 8 is a example 'examination information summary' of the patient which is transmitted to said pharmacy(700).
  • Said web server(810) transmits the prescription of the patient applicable to said medical insurance which is stored in the database server(820) in said step S32 to said pharmacy(700)(S60).
  • the prescription transmitted to said pharmacy(700) according to said S60 includes at least the name of patient, resident registration number, name of the medical institution, phone number, the illness classification code, name of the physician, type of license, number, name of the prescribed medicine, dosage, direction for use, total quantity, date of prescription, term of use, and other particulars to be considered when prescribing medicine.
  • Said web server( ⁇ l ⁇ ) receives information regarding the medicine preparation fee and medicine preparation fee approval request from the pharmacy(700), and the database server(820) stores information regarding the medicine preparation fee and medicine preparation fee approval request in the patient database applicable to the medical insurance card number according to said S54(S62).
  • Said web server( ⁇ l ⁇ ) transmits information regarding said medical insurance card number, medicine preparation fee and medicine preparation fee approval request to the insurance approval server(910)(S64).
  • Said insurance approval server(910) receives information regarding said medical insurance card number, medicine preparation fee and medicine preparation fee approval request from said web server( ⁇ l ⁇ ), and the data server(920) stores information regarding the medicine preparation fee and medicine preparation fee approval request transmitted from the insurance approval server(910) in the patient database applicable to said medical insurance card number(S66).
  • Said insurance approval server(910) receives the medical insurance fee payment status of said patient among the patient database applicable to the insurance card number and determines whether the medical insurance fee payment status of said patient corresponds to a pre-established standard that the administrator has set and determines whether to approve of the medicine preparation fee request made by said pharmacy(700)(S6 ⁇ ).
  • said database server(920) stores said medicine preparation fee approval message and approval number in the patient database applicable to said medical insurance card
  • said web server( ⁇ l ⁇ ) receives information regarding said medicine preparation fee approval message and approval number from said insurance approval server(910)
  • said database server( ⁇ 20) stores information regarding said medicine preparation fee approval message and approval number in the patient database applicable said medical insurance card number(S70).
  • Said web server ( ⁇ lO) transmits said medicine preparation fee approval message and approval number to said pharmacy(700) and said pharmacy(700) receives and stores said medicine preparation fee approval message and approval number(S72)
  • Said pharmacy(700) prints a sales receipt including the examination fee approval message and approval number received according to said S72 in the name of the patient applicable to said medical insurance card number(S74).
  • said database server stores a disapproval message in the patient database applicable to said medical insurance card number
  • said web server( ⁇ l ⁇ ) receives a medicine preparation fee disapproval message from said insurance approval server(910)
  • said database server( ⁇ 20) stores the medicine preparation fee disapproval message in the patient database applicable to said medical insurance card number(S76).
  • Said web server( ⁇ l ⁇ ) transmits said medicine preparation fee disapproval message to the pharmacy(700), and said pharmacy(700) receives and stores said medicine preparation fee disapproval message(S7 ⁇ ).
  • Said pharmacy(600) prints a sales receipt including the medicine preparation fee disapproval message received according to said S7 ⁇ in the name of the patient applicable to said medical insurance card number(S ⁇ O).
  • said insurance corporation server may manage information regarding the medical insurance fee payment status of patients applicable to the insurance card numbers and thereby said insurance corporation may prevent use of insurance money by ineligible persons.
  • said insurance corporation server may manage detailed information of the medical services provided at hospitals or pharmacies and therefore may serve as a function of preventing false/excessive requests of medical insurance money.

Abstract

A method of managing medical insurance and a recording medium for the same are disclosed in the present invention comprising the steps of a web server providing a hospital with client software (S20) and said web server transmitting and receiving examination fee request and approval information (S26), wherein the step of said web server transmitting and receiving examination fee request and approval information (S26) includes the steps of said web server receiving information including at least one among the medical insurance card number, prescription, examination fee and examination fee approval request from said hospital (S32), said web server transmitting information including at least one among the medical insurance card number, prescription, examination fee and examination fee approval request to an insurance approval server (S34), said web server receiving information including at least one among the examination fee approval message and approval number from said insurance approval server (S40) and said web server transmitting information including at least one among the examination fee approval message and approval number to said hospital (S42).

Description

Method for managing medical insurance and recording medium for the same
FIELD OF INVENTION This invention relates to a method for managing medical insurance by using a communication network and a recording medium for reading a program regarding the same with a computer, and in particular to a medical insurance managing method and a recording medium for reading a program regarding the same with a computer which may prevent insufficiency in medical insurance finance caused from false medical insurance payment claims, inefficiency in the medical insurance payment issuance examination process, use of medical insurance by ineligible persons and excessive claims for insurance payments, by using a credit card checking device and a credit card inquiry network through the existing public switched telephone network(PSTN) and managing the information regarding the total amount of the medical service commission fees for each medical institution at the insurance corporation server or by managing information regarding prescription information and commission fee for respective patients for each medical institution through the internet.
BACKGROUND OF INVENTION Conventionally, for medical insurance payments to be paid for services provided to patients at a medical institution, in particularly a hospital or a pharmacy, the name of the patient, examination date, medical institution code are recorded on the insurance payment register and this is declared every month to the National Health Insurance Corporation, and a routine formality of document examination is taken place at the National Health Insurance Corporation, and the requested amount is paid to the medical institution which has provided the services.
Therefore, some medical institutions misuse this system and frequently claim false excessive amounts as insurance payments and thereby cause a problem of weakness in the financial state of the medical insurance budget.
In addition, at the current state where the medical insurance fee payment confirmation system has been abrogated, the persons with long-term debts of insurance fee nonpayment add to the problem of weakness in medical insurance finance by unjustly using medical services. The object of the present invention is to resolve the above problems by providing a method for managing medical insurance and a recording medium for reading a program regarding the same with a computer to prevent insufficiency of medical insurance finance caused from false and excessive medical insurance payment claims, unjust services use by persons who have not paid insurance fees, inefficiency in the medical insurance payment issuance examination, by using the credit card checking device and credit card inquiry network through the existing public switched telephone network(PSTN) and managing the information regarding the total amount of the medical service commission fees for each medical institution at the insurance corporation server or by managing information regarding prescription information and commission fee for respective patients for each medical institution through the internet.
SUMMARY OF INVENTION
The medical insurance managing method according to one aspect of the present invention includes the steps of a web server providing a hospital with client software(S20); and said web server transmitting/receiving examination fee request and approval information(S26), wherein the step of said web server transmitting/receiving examination fee request and approval information(S26) includes the steps of: said web server receiving information including at least one among the medical insurance card number, prescription, examination fee and the examination fee approval request from said hospital(S32); said web server transmitting information including at least one among the medical insurance card number, prescription, examination fee and the examination fee approval request to a insurance approval server(S34); said web server receiving information including at least one among an examination fee approval message and a approval number(S40); and said web server transmitting information including at least one among the examination fee approval message and the approval number to said hospital(S42).
The method for managing medical insurance according to another aspect of the present invention includes the steps of a web server providing a pharmacy with a client software(S20); and said web server transmitting/receiving examination fee request and approval information(S26), wherein the step of said web server transmitting/receiving examination fee request and approval information(S26) includes the steps of: said web server receiving medical insurance card number from said pharmacy (S54); said web server transmitting the prescription of the patient applicable to the said medical insurance card number to said pharmacy(SΘO); said web server receiving information including at least one among a medicine preparation fee and a medicine preparation fee approval request from said pharmacy(S62); said web server transmitting information including at least one among a medical insurance card number, a medicine preparation fee and medicine preparation fee approval request to a insurance approval server(S64); said web server receiving information including at least one among a medicine preparation fee approval message and an approval number from said insurance approval server(S70); and said web server transmitting information including at least one among the medicine preparation fee approval message and the approval number to said pharmacy(S72). In addition, the recording medium which performs said aspect of the present invention is a recording medium which manages medical insurance by allowing the medical insurance related information to be transmitted/received to the hospital and insurance approval server through the web server and the internet and a program for executing the following functions is recorded therein such that it may be read by a computer:
Functions of said web server receiving information including at least one among the medical insurance card number, prescription, examination fee and examination fee approval request from the hospital; said web server transmitting information including at least one among said medical insurance card number, prescription, examination fee and examination fee approval request to an insurance approval server; said web server receiving information including at least one among an examination fee approval message and approval number from said insurance approval server; and said web server transmitting information including at least one among the examination fee approval message and approval number to said hospital.
In addition, the recording medium which performs said another aspect of the present invention is a recording medium which manages medical insurance by allowing the medical insurance related information to be transmitted/received to the pharmacy and insurance approval server through the web server and the internet and a program for executing the following functions is recorded therein such that it may be read by a computer: Functions of said web server receiving the medical insurance card number from the pharmacy; said web server transmitting prescription of the patient applicable to said medical insurance card number to said pharmacy; said web server receiving information including at least one among a medicine preparation fee and medicine preparation fee approval request from said pharmacy; said web server transmitting information including at least one among said medical insurance card number, medicine preparation fee and medicine preparation fee approval request to the insurance approval server; said web server receiving information including at least one among medicine preparation fee approval message and approval number from said insurance approval server; and said web server transmitting information including at least one among medicine preparation fee approval message and approval number to said pharmacy.
The present invention is described in detail hereinafter with reference to the attached drawings.
BRIEF DESCRIPTION OF DRAWINGS
Figure 1 is a first example drawing of the information communication system to which the present invention is applied; Figure 2 is an example drawing of a magnetic strip type medical insurance card to which the present invention is applied;
Figure 3 is a flow chart of the medical insurance managing method according to the first embodiment of the present invention;
Figure 4 is a second example drawing of the information communication system to which the present invention is applied;
Figure 5 is a flow chart of the medical insurance managing method according to the second embodiment of the present invention;
Figure 6 is a detailed flow chart of the examination fee request step among the medical service commission fee request and approval step according to the second embodiment of the present invention;
Figure 7a and 7b are detailed flow charts of the medicine preparation fee request step among the medical service commission fee request and approval step according to the second embodiment of the present invention; and
Figure 8 is an example drawing of a 'Examination Information Summary' window of the patient which is transmitted to the pharmacy.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Figure 1 is a first example drawing of the information communication system to which the present invention is applied.
As depicted in figure 1, the communication system to which the present invention is applied, includes a Public Switched Telephone Network(PSTN; 100) which supports the present invention such that the services related to this invention may be conducted online, a inquiry device(200) which reads the insurance certificate number of the medical insurance card of the patient, transmits the said read number to the administrator server and transmits the medical service commission fee to the administrator server, and receives information on whether or not the medical service commission fee(referred to as "fee" hereinafter) approval may be settled from the administrator server, a administrator server(300) which transmits, receives and stores requisite information between said medical institution card inquiry device(200) and the insurance corporation server, and an insurance corporation server(400) which receives fee settlement approval request information from said administrator server(300) and transmits information on the settlement status regarding the request to said administrator server(300) and stores requisite information.
A medical institution which is provided with said medical institution inquiry device(200) refers to a hospital, a doctor's office, a pharmacy or any medical service providing institution defined and regulated by relevant laws.
In addition, said medical institution inquiry device(200)(referred to as "inquiry device" hereinafter) includes a reader which performs the function of reading requisite information from the medical insurance card of the patient according to the present invention, a display which performs the function of displaying settlement approval messages and settlement details of the medical insurance card received from said administrator server(300), a printer which prints the medical insurance card sales receipt according to the settlement details, and a controller which performs the function of transmitting information from said reader and said computer to said administrator server(300) and controlling said reader, display and printer. Said reader is not limited to a magnetic strip reader, and it may also be a radio frequency reader or a IC reader which has an IC chip built-in the card and reads necessary information by directly contacting the IC pin.
Said administrator server(300) includes a web server(310) which performs the functions of receiving information regarding fee settlement approval request from said inquiry device(200) and transmitting said information regarding the fee settlement approval request to said insurance corporation server(400), and receiving information regarding settlement approval status from said insurance corporation server(400) and transmitting said information regarding the settlement approval status to said inquiry device(200), and a database server(320) which stores information regarding the medical institution which requested the fee settlement approval, fee amount, medical insurance card number, and fee approval number. In addition, besides the above mentioned functions, said administrator server is also programmed to perform the functions of a Value Added Network(VAN) server.
Said insurance corporation server(400) includes an insurance approval server(410) which performs the functions of receiving information regarding the medical insurance card number of the patient, fee settlement approval request information, information regarding the requesting medical institution , fee amount and the like from said web server (310) and determining the settlement approval status and transmitting the information regarding the approval status and the fee settlement information to said web server, and a database server(420) which stores the medical insurance card number of the patient for each medical institution, date of medical service provision, the medical institution which has provided the medical service, the settled fee amount for said service, the insurance fee payment details of the patient applicable to said medical insurance card number and the like.
Figure 2 is an example drawing of a magnetic strip type card among medical insurance cards which are read by the said inquiry device.
The issuance objects of said medical insurance card are all members of medical insurance, and the use for said medical insurance card is as a substitute of the medical insurance certificate and proof of eligibility, and the information recorded on said medical insurance card is the insurance card number or in the case of corporate medical insurance, it is the information on the applicable institution. However, said medical insurance card according to the present invention is not limited to the type, use, and recorded information of the card exemplified in figure 2.
Figure 3 is a flow chart of the medical insurance managing method according to the first embodiment of the present invention. The medical institution provide the patients with medical service and uses its inquiry device(200) to read the medical insurance card of the patient and inputs the fee amount into said inquiry device (200) (S2).
The information read by said reader is the medical insurance certificate number of the patient or in the case said patient is a member of corporate medical insurance, the information is the applicable institution code.
The web server(310) receives information from said medical institution card inquiry device(200) according to S2, and said web server(310) transmits said read medical certificate number, fee amount, examination institution, examination date and fee settlement approval request information to the insurance approval server(410), and the database server stores said medical certificate number, fee amount, examination institution, examination date and fee settlement approval request information in the patient database(S4).
Said insurance approval server(410) stores said read medical certificate number, fee amount, examination institution, examination date and fee settlement approval request information received according to S4 in the patient database applicable to said medical insurance card number, and said insurance approval server(410) receives the medical insurance fee payment status among said patient database from said web server and uses this information as basic material in determining whether or not the settlement on the medical service commission fee amount of the patient is to be approved(SΘ). Said insurance approval server(410) uses the medical insurance fee payment status information received according to S6, and determines settlement approval status regarding the medical service commission fee amount of said patient (S8).
As a result of S8, in case said insurance approval server(410) disapproves, said insurance approval server( 10) transmits a disapproval message to the inquiry device(200) through said web server(310), and the printer of said inquiry device(200) prints said disapproval message(SlO). As a result of S8, in case said insurance approval server(410) approves, said insurance approval server(410) settles said medical service commission fee amount and said database server(420) stores said settlement information in the patient database applicable to said medical insurance card number(S12).
Said web server(310) receives insurance use approval and approval number from said insurance approval server and transmits this to said inquiry device(200), and said database server(320) stores information regarding insurance use approval and approval number into the database of the patient applicable to said medical insurance card number(S14).
Said inquiry device(420) prints the sales receipt including the information regarding approval number, fee amount transmitted from said web server(310), through said printer (S16).
By performing the above, said insurance corporation server(400) may manage information regarding the medical insurance fee payment status of the patient applicable to the medical insurance card number, and thereby said insurance corporation server(400) may prevent use of insurance money by ineligible persons.
In addition, said insurance corporation server(400) may manage the examination information of insurance users for each medical service providing institution, and automatically calculate the total monthly amount of insurance money that said respective medical service providing institutions must pay, and thereby may serve to prevent false/excessive request of medical insurance fees.
Figure 4 is a second example drawing of the information communication system to which the present invention is applied. As depicted, the communication system to which the present invention is applied includes an internet network(500) which supports the services regarding the present invention such that the services may be performed online, a hospital computer(600)(referred to as "hospital" hereinafter) which transmits information regarding medical insurance card number, prescription, examination fee and examination fee approval request to the administrator server and receives information regarding examination fee approval, a pharmacy computer(700)(referred to as "pharmacy" hereinafter) which receives the prescription from the administrator server and transmits information regarding the medicine preparation fee and medicine preparation fee approval request to the administrator server and receives information regarding the medicine preparation fee approval from the administrator server, an administrator server(800) which receives information regarding the medical insurance card number, prescription, examination fee, examination fee approval request from the hospital(ΘOO) and stores the same, and stores information regarding examination fee approval status and transmits the same to said hospital(600), and transmits information regarding the examination details of the patient, prescription, medicine preparation fee approval status to said pharmacy(700) and stores information regarding medicine preparation fee, medicine preparation fee request and transmits information regarding the prescription, examination fee, medicine preparation fee request to the insurance corporation server, and a insurance corporation server(800) which receives information regarding the prescription, examination fee, medicine preparation fee and said examination fee or medicine preparation fee request approval request from the administrator server(800) and stores the same, and determines said examination fee or the approval regarding the medicine preparation fee request and transmits information regarding the same to said administrator server(800).
Said internet network(500) uses TCP/IP and allows functions of file viewing, transmitting electronic mail and the like.
It is preferable that said hospital(βOO) and said pharmacy(700) includes an OS exceeding at least Windows 95/NT4, CPU over Pentium
100 MHz, memory over 16Mb, hard disk capacity over 20Mb, and that they provided with an inquiry device including a reader and printer among said medical institution card inquiry device(200) of the first embodiment.
Details regarding the specifications of said reader are identical to those of the reader of said first preferred embodiment, and the details regarding the specifications of the medical insurance card is also identical to those of the medical insurance card of the first preferred embodiment.
Said administrator server(800) includes a web server(810) which transmits and receives information regarding medical insurance card number, prescription, examination fee or medicine preparation fee and the approval requests thereof, and information regarding the examination fee and medicine preparation fee approval message and approval number to and from said hospital(βOO) or pharmacy(700) and the insurance corporation server, and a database server(820) which stores information that is provided by said hospital(ΘOO) or pharmacy(700) upon member entry, information regarding the medical insurance card number, prescription contents, examination fee or medicine preparation fee, examination fee or medicine preparation fee approval request or examination fee and medicine preparation fee approval message and approval number, examination fee or medicine preparation fee disapproval message and the like.
In addition, besides the above mentioned functions, said administrator server is program to perform functions of a VAN company. Said insurance corporation server(900) includes a insurance approval server(910) which transmits and receives information regarding the insurance card number, prescription, examination fee or medicine preparation fee and the approval requests thereof, and information regarding the examination fee or medicine preparation fee approval message and approval number to and from said web server(810), and determines the examination fee or medicine preparation fee approval status, and a database server(920) which stores information regarding the medical insurance card number, prescription contents, examination fee or medicine preparation fee, examination fee or medicine preparation fee approval request or examination fee and medicine preparation fee approval message and approval number, examination fee or medicine preparation fee disapproval message, and the insurance fee payment details of the patient applicable to said medical insurance card number.
Figure 5 is an overall flowchart of the method for managing medical insurance according to the second preferred embodiment of the present invention.
The hospital(ΘOO) or pharmacy(700) installs a client software, as a program provided by the administrator, and logs on to the administrator server where the client software allows the examination fee or medicine preparation fee request and approval according to the present invention to be performed online(S20).
Said hospital(600) or pharmacy(700) may install said client software through a medium that may store information such as a floppy disc or a compact disc but it is preferable that the hospital(600) or pharmacy(700) log on to the administrator website and download the software, then install it.
When said hospital(ΘOO) or pharmacy(700) installs the client software as according to said S20 and logs on to the administrator server(800), the web server(810) determines whether or not said hospital(600) or pharmacy(700) has been registered for membership(S22).
As a result of S22, in case said hospitaKβOO) or pharmacy(700) has not been registered for membership, said web server(810) prompts said hospital(600) or pharmacy(700) to perform the procedure for membership registration(S24).
Upon membership registration as said S24, the web server(810) receives information on company registration number, address, phone number, field of business, name of owner, address of the owner, ID and password from said hospital(600) or pharmacy(700) and stores said information in the database server(820).
However, in the present invention, the information stored in said database server is not limited to the above.
After the hospital or pharmacy provides medical services such as examination, consultation or medicine preparation to the patient, said hospital(βOO) or pharmacy(700) transmits the service content that has been provided to said patient to said web server(810) and while doing so, when said hospitaKβOO) or pharmacy(700) requests medical service commission fee such as the examination fee or medicine preparation fee, said database server(820) stores said information regarding said medical service, and said web server(810) transmits the information received from said hospital(βOO) or pharmacy(700) to the insurance approval server(910). The database server(920) stores necessary information among information regarding said medical service, then said insurance approval server(910) uses the already stored information regarding the insurance fee payment status of said patent to determine the status of the patient and in case the patient in not an ineligible person, the fee request for said medical service provided to said patient is approved. (S26).
In the case of said insurance approval server(910) approving of the medical service commission fee according to said S26, said insurance approval server(910) transmits the information regarding insurance use approval to said web server(810), and said database server(820) stores said information regarding said insurance use approval, then said web server(810) transmits the information regarding said insurance use approval to said hospital(βOO) or pharmacy(700).
Accordingly, said hospital(βOO) or pharmacy(700) receives the above information and prints the sales receipt for said medical service fee through the printer(S28).
As a result of said S22, in case said hospital(βOO) or pharmacy(700) has been registered for membership, said web server(810) transfers the procedure to said S26.
At the hospital or pharmacy, said hospital(βOO) or pharmacy(700) requests commission fees from the insurance corporation every month based on the fee request information stored at said hospital(βOO) or pharmacy(700), and through comparison, said insurance corporation pays only the commission fees applicable to the information which matches the information regarding the approval date, fee amount, number of cases and other detailed information of said commission fees which are stored in said database server. Figure 6 is a detailed flow chart of the examination fee request step among the medical service fee request and approval step according to the second preferred embodiment of the present invention.
The hosρital(600) logs on to the administrator server and uses at least one among the ID or password to perform the login procedure(S30). The web server(810) receives information regarding the medical insurance card number, prescription, examination fee and examination fee approval request of the patient from said hospital(βOO), and the database server(820) stores information regarding said medical insurance card number, prescription, examination fee and examination fee approval request of said patient which said web server(810) has received in the patient database applicable to said insurance card number(S32).
It is preferable that the prescription said web server(810) receives according to said S32, includes at least the name of patient, resident registration number, name of the medical institution, phone number, the illness classification code, name of the physician, type of license, number, name of the prescribed medicine, dosage, direction for use, total quantity, date of prescription, term of use, and other particulars to be considered when prescribing medicine Said web server(810) transmits the information regarding the medical insurance card number, prescription, examination fee and examination fee approval request received through S32 to the insurance approval server(910)(S34).
Said insurance approval server(910) stores the information regarding the medical insurance card number, prescription, examination fee and examination fee approval request received from the web server(810) according to S34 in the patient database applicable to said insurance card number(S36).
Said insurance approval server(910) receives the medical insurance fee payment status of said patient among the patient database applicable to the insurance card number and determines whether the medical insurance fee payment status of said patient corresponds to a pre-established standard that the administrator has set and determines whether to approve of the examination fee request made by said hospital(600)(S38).
As a result of S38, in case said insurance approval server(910) approves of the examination fee, said database server(920) stores said examination fee approval message and approval number in the patient database applicable to said medical insurance card, and said web server(810) receives information regarding said examination fee approval message and approval number from said insurance approval server(910), and said database server(820) stores information regarding said examination fee approval message and approval number in the patient database applicable said medical insurance card number(S40).
Said web server (810) transmits said examination fee approval message and approval number to said hospital(βOO) and said hospital(βOO) receives and stores said examination fee approval message and approval number(S42) Said hospital(βOO) prints a sales receipt including the examination fee approval message and approval number received according to said S42 in the name of the patient applicable to said medical insurance card number(S44).
As a result of said S38, in case the examination fee may not be approved, said database server stores a disapproval message in the patient database applicable to said medical insurance card number, and said web server(810) receives an examination fee disapproval message from said insurance approval server(910), and said database server(820) stores the examination fee disapproval message in the patient database applicable to said medical insurance card number(S46).
Said web server(810) transmits said examination fee disapproval message to the hospital(600), and said hospital(βOO) receives and stores said examination fee disapproval message(S48).
Said hospital(βOO) prints a sales receipt including the examination fee disapproval message received according to said S48 in the name of the patient applicable to said medical insurance card number(S50).
Figure 7a and 7b are detailed flow charts of the medicine preparation fee request step among the medical service commission fee request and approval step according to the second embodiment of the present invention.
The pharmacy(700) logs on to the administrator website and uses at least one among the ID or password to perform the login procedure(S52). The web server(810) receives the medical insurance card number from said pharmacy(700)(S54).
Said web server(810) transmits a examination information summary of the patient applicable to said medical insurance card number to said pharmacy(700)(S56). The examination information summary according to said S54 is information giving a summarized account of examination date of said patient, institution, physician, examination fee and other information within a period pre-established by the administrator, wherein figure 8 is a example 'examination information summary' of the patient which is transmitted to said pharmacy(700).
To receive the prescription which includes information on the medicine to be prepared from the 'examination information summary' transmitted according to said S54 at said pharmacy(700), a selection is made among the examination date, institution, physician, examination details from said examination information summary, and said web server(810) receives said selected information(S58).
Said web server(810) transmits the prescription of the patient applicable to said medical insurance which is stored in the database server(820) in said step S32 to said pharmacy(700)(S60). It is preferable that the prescription transmitted to said pharmacy(700) according to said S60 , includes at least the name of patient, resident registration number, name of the medical institution, phone number, the illness classification code, name of the physician, type of license, number, name of the prescribed medicine, dosage, direction for use, total quantity, date of prescription, term of use, and other particulars to be considered when prescribing medicine.
Said web server(δlθ) receives information regarding the medicine preparation fee and medicine preparation fee approval request from the pharmacy(700), and the database server(820) stores information regarding the medicine preparation fee and medicine preparation fee approval request in the patient database applicable to the medical insurance card number according to said S54(S62).
Said web server(δlθ) transmits information regarding said medical insurance card number, medicine preparation fee and medicine preparation fee approval request to the insurance approval server(910)(S64).
Said insurance approval server(910) receives information regarding said medical insurance card number, medicine preparation fee and medicine preparation fee approval request from said web server(δlθ), and the data server(920) stores information regarding the medicine preparation fee and medicine preparation fee approval request transmitted from the insurance approval server(910) in the patient database applicable to said medical insurance card number(S66). Said insurance approval server(910) receives the medical insurance fee payment status of said patient among the patient database applicable to the insurance card number and determines whether the medical insurance fee payment status of said patient corresponds to a pre-established standard that the administrator has set and determines whether to approve of the medicine preparation fee request made by said pharmacy(700)(S6δ).
As a result of S6δ, in case said insurance approval server(910) approves of the medicine preparation fee, said database server(920) stores said medicine preparation fee approval message and approval number in the patient database applicable to said medical insurance card, and said web server(δlθ) receives information regarding said medicine preparation fee approval message and approval number from said insurance approval server(910), and said database server(δ20) stores information regarding said medicine preparation fee approval message and approval number in the patient database applicable said medical insurance card number(S70).
Said web server (δlO) transmits said medicine preparation fee approval message and approval number to said pharmacy(700) and said pharmacy(700) receives and stores said medicine preparation fee approval message and approval number(S72)
Said pharmacy(700) prints a sales receipt including the examination fee approval message and approval number received according to said S72 in the name of the patient applicable to said medical insurance card number(S74).
As a result of said S6δ, in case the medicine preparation fee may not be approved, said database server stores a disapproval message in the patient database applicable to said medical insurance card number, and said web server(δlθ) receives a medicine preparation fee disapproval message from said insurance approval server(910), and said database server(δ20) stores the medicine preparation fee disapproval message in the patient database applicable to said medical insurance card number(S76).
Said web server(δlθ) transmits said medicine preparation fee disapproval message to the pharmacy(700), and said pharmacy(700) receives and stores said medicine preparation fee disapproval message(S7δ).
Said pharmacy(600) prints a sales receipt including the medicine preparation fee disapproval message received according to said S7δ in the name of the patient applicable to said medical insurance card number(SδO).
By implementing the above, said insurance corporation server may manage information regarding the medical insurance fee payment status of patients applicable to the insurance card numbers and thereby said insurance corporation may prevent use of insurance money by ineligible persons.
In addition, said insurance corporation server may manage detailed information of the medical services provided at hospitals or pharmacies and therefore may serve as a function of preventing false/excessive requests of medical insurance money.
It is to be understood, that even though characteristics of the present invention have been set forth in the foregoing description, various changes and alterations may be made by those having ordinary skills in the field of the present invention without departing from the scope of the technical principles and spirit of the present invention, and therefore the scope of the invention is not limited to the foregoing preferred embodiments and attached drawings thereof.

Claims

Claims
1. A method of managing medical insurance using the internet network comprising the steps of: a web server providing a hospital with client software(S20); and Said web server transmitting and receiving examination fee request and approval information(S2β), wherein, the step of said web server transmitting and receiving examination fee request and approval information(S26) includes the steps of:
- said web server receiving information including at least one among the medical insurance card number, prescription, examination fee and examination fee approval request from said hospital(S32);
- said web server transmitting information including at least one among the medical insurance card number, prescription, examination fee and examination fee approval request to an insurance approval server(S34);
- said web server receiving information including at least one among the examination fee approval message and approval number from said insurance approval server (S40); and
- said web server transmitting information including at least one among the examination fee approval message and approval number to said hospital(S42).
2. The method of managing medical insurance of claims 1 further comprising the steps of: said web server receiving an examination fee disapproval message information from said insurance approval server(S46); and said web server transmitting said examination fee disapproval message information to said hospital(S4δ), before the step of said web server receiving information including at least one among the examination fee approval message and approval number from said insurance approval server(S40).
3. A method of managing medical insurance using the internet network comprising the steps of:
A web server providing a pharmacy with client software(S20); and Said web server transmitting and receiving examination fee request and approval information(S26), wherein, the step of said web server transmitting and receiving examination fee request and approval information(S26) includes the steps of:
- said web server receiving the medical insurance card number from said pharmacy(S54);
- said web server transmitting a prescription for the patient applicable to said medical insurance card number to said pharmacy(S60);
- said web server receiving information including at least one among the medicine preparation fee and medicine preparation fee approval request from said pharmacy(S62);
- said web server transmitting information including at least one among the medical insurance card number, medicine preparation fee and medicine preparation fee approval request to an insurance approval server(S64); - said web server receiving information including at least one among the medicine preparation fee approval message and approval number from said insurance approval server(S70); and
- said web server transmitting information including at least one among the medicine preparation fee approval message and approval number to said pharmacy(S72).
4. The method of managing medical insurance of claim 3 further including the steps of: said web server transmitting an examination information summary of the patient applicable to said medical insurance card number to said pharmacy(S56); said web server receiving selected information regarding specific information among the examination information summary of the patient applicable to said medical insurance card number from said pharmacy(S58), before the step of said web server transmitting a prescription for the patient applicable to said medical insurance card number to said pharmacy(SΘO).
5. The method of managing medical insurance of claim 4, wherein said examination information summary of said step S56 is at least one among the examination date, examination institution and examination details.
6. The method of managing medical insurance of claim 3 further including the steps of:, said web server receiving an medicine preparation fee disapproval message information from said insurance approval server(S76); and said web server transmitting said medicine preparation fee disapproval message information to said pharmacy, before the step of said web server receiving information including at least one among the examination fee approval message and approval number from said insurance approval server(S70). 7. A recording medium which manages medical insurance by allowing medical insurance related information to be transmitted and received to and from hospitals and an insurance approval server through a web server and internet network, wherein a program is recorded therein such that the program may be recognized by a computer to execute the following functions of: said web server receiving said web server receiving information including at least one among the medical insurance card number, prescription, examination fee and examination fee approval request from a hospital; said web server transmitting information including at least one among the medical insurance card number, prescription, examination fee and examination fee approval request to an insurance approval server; said web server receiving information including at least one among the examination fee approval message and approval number from said insurance approval server; and said web server transmitting information including at least one among the examination fee approval message and approval number to said hospital. δ. The recording medium of claim 7 in which a program is recorded therein such that the program may be recognized by a computer to further execute the following functions of: said web server receiving an examination fee disapproval message information from said insurance approval server; and said web server transmitting said examination fee disapproval message information to said hospital, before the function of said web server receiving information including at least one among the examination fee approval message and approval number from said insurance approval server. 9. A recording medium which manages medical insurance by allowing medical insurance related information to be transmitted and received to and from pharmacies and an insurance approval server through a web server and internet network, wherein a program is recorded therein such that the program may be recognized by a computer to execute the following functions of: said web server receiving the medical insurance card number from said pharmacy; said web server transmitting a prescription for the patient applicable to said medical insurance card number to said pharmacy said web server receiving information including at least one among the medicine preparation fee and medicine preparation fee approval request from said pharmacy; said web server transmitting information including at least one among the medical insurance card number, medicine preparation fee and medicine preparation fee approval request to an insurance approval server; said web server receiving information including at least one among the medicine preparation fee approval message and approval number from said insurance approval server; and said web server transmitting information including at least one among the medicine preparation fee approval message and approval number to said pharmacy.
10. The recording medium of claim 9 in which a program is recorded therein such that the program may be recognized by a computer to further execute the following functions of: said web server receiving an medicine preparation fee disapproval message information from said insurance approval server; and said web server transmitting said medicine preparation fee disapproval message information to said pharmacy, before the function of said web server receiving information including at least one among the examination fee approval message and approval number from said insurance approval server.
PCT/KR2001/001011 2001-04-06 2001-06-13 Method for managing medical insurance and recording medium for the same WO2002082349A1 (en)

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JPH06187383A (en) * 1992-12-21 1994-07-08 Hitachi Ltd Outside prescription issue system
JPH06231151A (en) * 1993-01-29 1994-08-19 Sanyo Electric Co Ltd System for managing separation of dispensary from medical practice
US5832488A (en) * 1995-03-29 1998-11-03 Stuart S. Bowie Computer system and method for storing medical histories using a smartcard to store data
US5845255A (en) * 1994-10-28 1998-12-01 Advanced Health Med-E-Systems Corporation Prescription management system

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH06187383A (en) * 1992-12-21 1994-07-08 Hitachi Ltd Outside prescription issue system
JPH06231151A (en) * 1993-01-29 1994-08-19 Sanyo Electric Co Ltd System for managing separation of dispensary from medical practice
US5845255A (en) * 1994-10-28 1998-12-01 Advanced Health Med-E-Systems Corporation Prescription management system
US5832488A (en) * 1995-03-29 1998-11-03 Stuart S. Bowie Computer system and method for storing medical histories using a smartcard to store data

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