Recently, Ping An Medical Insurance Technology Medical Information Platform construction project has another good news. The company successfully won the bid for the “Fujian Medical Security Bureau Medical Security Big Data Analysis and Supervision Application Software Service Procurement Project”. The construction content includes “Intelligent Supervision Knowledge Base Subsystem, Internal There are five subsystems: control management subsystem, medical expense audit business subsystem, operation monitoring subsystem, and medical security decision-making subsystem.
Fujian Province is a national key medical reform pilot province. After winning the bid, Ping An Medical Insurance Technology will help the Fujian Provincial Medical Security Bureau and medical insurance departments across the province to fully realize horizontal and vertical, internal and external, government and market information sharing and application Collaboration and open collaboration will improve the efficiency of fund supervision, and improve the anti-risk capability and continuous protection capability of the medical insurance fund.
It is reported that the winning bid of the project refreshed the record of the winning bid amount of the Ping An Medical Insurance Technology Provincial Platform Project, marking that the three core products of intelligent supervision, macro decision-making, and operation monitoring comprehensively cover the data middle and highlands of Fujian, which is a follow-up business model and scenario. Digging to lay a solid foundation. The person in charge of related projects of Ping An Medical Insurance Technology stated that the company has established a comprehensive medical insurance intelligent supervision platform for Fujian Province through an advanced and complete knowledge system to ensure the safety of medical insurance funds from the source, and at the same time promote the improvement of medical insurance data; through big data and other technologies Establishing medical insurance intelligent decision-making, using data analysis to replace manual experience, accurately predicting risks; providing cockpit-style display services for the medical insurance bureau through graphical data display, all data indicators are clear at a glance, contributing to the intelligent and modernization of Fujian medical insurance.
Since 2019, the national and local medical insurance bureaus have combined with third-party service platforms to accelerate the construction of medical insurance informatization. Ping An Medical Insurance Technology has made significant progress in the construction of the provincial platform, and the construction results of macro decision-making, operation monitoring, intelligent supervision and comprehensive payment have been recognized by many parties.
At present, the construction of the main body of the national medical security information platform has been basically completed, and the national unified medical security information platform has been used in many places across the country. It is understood that as of October 2021, Ping An Medical Insurance Technology has successfully won the bid for 25 provincial-level platform system construction projects in the national medical insurance informatization standardization construction, and assisted Shandong, Yunnan, Qinghai, Hainan, Guangdong, Guizhou, Xinjiang, Tibet, 20 provincial-level platform projects including Anhui, Heilongjiang and Shaanxi were successfully launched (including trial operation).
It is understood that in 2019, Ping An Medical Insurance Technology won the bid for the construction project procurement project of the macro decision-making big data application subsystem and the operation monitoring subsystem of the National Medical Security Administration’s medical security information platform. At present, these two projects have been successfully launched and are in stable operation, and their technology and services have been well received. As a data technology company focusing on the large domestic medical and health industry, Ping An Medical Insurance Technology has a large number of medical insurance business experts, clinical business experts, actuarial experts, and algorithm technology experts, and has been intensively working in this industry for many years. Relying on its own “strong business + high technology“, Ping An Medical Insurance Technology has created an “AI big data risk control system” with a two-wheel drive engine to provide macro decision-making and operational monitoring support for the medical insurance bureau, and promote the digital transformation of medical insurance business management.
According to the relevant person in charge of Ping An Medical Insurance Technology, the system starts with data. At the algorithm design level, it adopts a variety of self-developed anomaly recognition algorithms and AI algorithm integration schemes, which can effectively mine potential fraudulent insurance activities; at the data governance level, automation is adopted. Code matching and automatic table alignment technology reduces the cost of manual code matching; at the knowledge base level, a unique 360° portrait system and scene library, standard index library, statistical rule library, policy rule library, experience rule library and special items have been built Governance database, etc., support multi-dimensional anomaly recognition; in terms of architecture, innovative application model sharing architecture achieves a balance between rapid small-batch and large-batch data analysis, so as to meet multiple demands such as stability, speed, and resource saving. It is reported that the system has the ability to capture nearly 50 typical medical insurance fraud scenarios. Based on powerful data accumulation and intelligent technology, it can provide users with accurate and efficient fee control services.
As an important part of Ping An’s health ecosystem, Ping An Medical Technology relies on Ping An’s accumulated scientific and technological strength, deeply cultivates the field of medical insurance payment, and continues to make technological innovations to provide provincial and municipal medical insurance bureaus with big data collection and risk control of medical insurance. The overall solution of storage, processing, analysis and service, standardize the use of medical insurance funds, improve the efficiency of use of medical insurance funds, combat fraud and insurance fraud, and help the continuous advancement of medical insurance reform. In response to recent market rumors that “Ping An Group may sell Ping An Medical Insurance Technology“, the relevant person in charge of the department said that Ping An Group’s medical technology has been closely focusing on the development of the main business of finance and insurance, and working together to create a warm finance. Ping An Medical Technology will continue to reform and upgrade its business strategy and organizational structure in accordance with customer needs and changes in the market environment to continuously improve the company’s core competitiveness.
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