福田商保核保理赔2号

当居民购买健康险后发起理赔时，为商保机构提供居民在卫健机构就诊记录查询服务，帮助商保机构解决数据来源合规问题。在理赔调查阶段，为商保机构提供居民就诊详细数据查询服务，患者线上发起理赔申请，进行个人信息授权，商保机构从数据交易平台获取患者理赔所需的就诊详细数据，进行数据治理后加密传输给商保机构，为患者提供便捷医疗费用理赔服务，解决商保理赔"手续繁、垫资长、报销慢"的痛点问题。

When residents file health insurance claims after purchasing commercial health insurance, this service provides commercial insurance institutions with access to residents' medical visit records from healthcare institutions, helping the institutions resolve compliance issues regarding data sources. During the claims investigation phase, the service also offers detailed medical visit data query services for commercial insurance institutions. The specific workflow is: residents initiate claim applications online and grant authorization for their personal information; commercial insurance institutions obtain the detailed visit data required for claims from the data trading platform; after conducting data governance, the data is encrypted and transmitted to commercial insurance institutions. This service delivers convenient medical expense claim services for residents, addressing the well-known pain points of "cumbersome procedures, long advance payment periods, and slow reimbursement" in commercial insurance claims.

搜集汇总

背景与挑战

背景概述

该数据集为商业保险机构提供居民合规就诊记录查询服务，支持加密传输治理后的诊疗数据，简化健康险理赔流程，解决传统理赔手续繁琐、周期长的问题。