医疗保险医疗服务监控,需要信息技术与专业管理有机结合。近年,不少地区在推进信息化的进程中,致力于医疗服务监管系统的建设,从摆脱手工操作起步,逐步提高自动化程度。比如,江苏省无锡市通过对医保监控平台各项功能的一系列改造,使其具有分四个维度对违规现象进行全面监控,利用医保管理知识库、临床诊疗知识库和药品知识库对医疗服务行为进行全方位监控,以及针对基金运行情况进行预警预报三大功能。吉林省的监控系统则具有疑点自动提示、人工甄别审核、违规自动提示警示、违规自动拦截阻挡、违规自动审核拒付多重监控审核功能,对 Medical insurance medical service monitoring, the need for information technology and professional management of organic combination. In recent years, in many areas, in the process of promoting informationization, they are committed to building a health care regulatory system, starting with getting rid of manual operations and gradually increasing the degree of automation. For example, Wuxi City, Jiangsu Province through a series of transformation of the functions of the health insurance monitoring platform, it has four dimensions to conduct a comprehensive monitoring of non-compliance, the use of health care management knowledge base, clinical diagnosis and treatment of knowledge base and medical knowledge base for medical services Conduct a comprehensive monitoring of the behavior, as well as three major functions of early warning and forecasting for the operation of the Fund. The monitoring system in Jilin Province has the doubts automatic reminder, manual screening audit, automatic warning of violations, illegal block automatically blocked, illegal automatic review of non-compliance with multiple monitoring and checking functions, right