医院医保结算系统流程优化与实现方案

打开文本图片集

中图分类号：TP311.5 文献标识码：A 文章编号：2096-4706（2025）24-0159-05

Abstract： With therapid development ofmedical informatization，medical insurance setlement，as a core link in medical services，its eficiencyandconvenience directlyafect the patientexperienceandtheutilzationof medicalresources.Based ontheanalysisoftheexistingoutpatientandinpatientsettlement processes，the processand systemconnectionstructureare optimizedandinnovatedinthispaper.ByadoptingtheJavadevelopmentenvironmentandSpringBootframework technology，a smartmedicalinsurancecomprehensiveserviceplatformschemebasedoncloudcomputing，BigDataandAifcial Intellgence is designedandimplemented.Thisseme integrates functionssuchaspatientappointmentegistrationnpatientgistration discharge settlement and medical insurance reimbursement intoone，achieving seamlesscommection between the hospital's internalinformation systemandthe medical insurancesystem whileensuringreal-timedata synchronizationandupdate.Atthe same time，encryption technology is adopted to ensure the security of data transmission.

Keywords： medical insurance settement; one-stop settlement; national medical insurance interface; admission and discharge; settlement process optimization; upload of expense details; reversal transaction

0 引言

医保结算是连接医疗机构、参保人与医保机构的核心环节。（剩余5124字）