Title:
RISK CONTROL METHOD FOR DETERMINING IRREGULAR MEDICAL INSURANCE BEHAVIOR BY MEANS OF DATA ANALYSIS
Document Type and Number:
WIPO Patent Application WO/2019/169826
Kind Code:
A1
Abstract:
The present application relates to a risk control method for determining irregular medical insurance behavior by means of data analysis. The method comprises: step 1: acquiring current and historical medical treatment behavior data of a person under risk control and personal information and public data related to the person under risk control; step 2: extracting, from the data acquired in step 1, features related to medical treatment behavior of the person under risk control; step 3: classifying, according to the extracted features, each medical treatment behavior of the current and historical medical treatment behavior of the person under risk control into corresponding medical treatment categories, so as to generate a medical treatment category sequence; step 4: using the medical treatment category sequence generated in step 3 as an observation sequence, using a medical treatment purpose as a hidden state, and calculating, according to a Hidden Markov model, a most likely hidden state sequence which comprises a most likely medical treatment purpose; and step 5: if the most likely medical treatment purpose of the person under risk control comprised in the hidden state sequence corresponds to an abnormal purpose, outputting medical data related to the current and historical medical treatment behavior of the person under risk control.
Inventors:
CHENG JIAN (CN)
Application Number:
PCT/CN2018/097746
Publication Date:
September 12, 2019
Filing Date:
July 30, 2018
Export Citation:
Assignee:
PING AN MEDICAL AND HEALTHCARE MAN CO LTD (CN)
International Classes:
G06Q40/08; G16H40/20
Foreign References:
| CN103761748A | 2014-04-30 | |||
| CN102013084A | 2011-04-13 | |||
| CN107464115A | 2017-12-12 | |||
| US20160267224A1 | 2016-09-15 |
Attorney, Agent or Firm:
INTELLECPRO CHINA LIMITED (CN)
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