• Journal of dental hygiene science
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• v.11 no.1
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• pp.31-35
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• 2011

The purpose of this study was to examine the state of the claim of dental clinics for payment from the national health insurance corporation in a bid to provide some information on the efficient management of payment claim by dental institutions. The findings of the study were as follows: As for the form of payment claim, 45.4 percent claimed payment by themselves, and 54.6 percent asked an agent to do that on behalf of them. Concerning the type of occupation of the applicants, dental hygienists demanded payment in the biggest number of the dental clinics(78.2%). The most common number of cases that the dental clinics demanded payment was between 201 and 400(40.3%). The dental clinics asked an agent to claim payment when the number of payment claim cases was smaller, and they claimed payment by themselves when the number of payment claim cases was larger. Regarding the reason why the dental institutions asked an agent for payment claim, the biggest group(28.0%) cited complicated claim procedure as the reason, and the second largest group(22.6%) answered that they weren't used to doing that. The third greatest group(20.8%) pointed out a shortage of personnels that would be responsible for that as the reason.

• Journal of the Korean association of regional geographers
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• v.15 no.2
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• pp.292-306
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• 2009

This study has the purpose of reviewing the period when four types of alternative versions of ${\ll}$Cheonggudo(靑邱圖)${\gg}$ were produced. The study results can be summarized as follows: First, "Cheonggudobeomrye(靑邱圖凡例)" was drawn up after 1834 when the "Cheonggudoje(靑邱圖題)" was drawn up. Second, it was highly possible that was drawn beginning from 1846 when Chongyungcheong(摠戎廳) was changed into Chongwiyeong(總衛營) to 1849 when Chongwiyeong was changed into Cheongyungcheong again. Third, it was highly possible that "Cheonggudobeomre" in which it was recorded that was inserted was also drawn up after 1864. Fourth, the order of drawing up the records were as follows: ${\ll}$Cheonggudo${\gg}$ without "Cheonggudobeomrye" and ${\rightarrow}$ ${\ll}$Cheonggudo${\gg}$ that has the but without "Cheonggudobeomrye" ${\rightarrow}$ ${\ll}$Cheonggudo${\gg}$ that has "Cheonggudobeomrye" and which was represented by a shape like a peak ${\rightarrow}$ ${\ll}$Cheonggudo${\gg}$ that has "Cheonggudobeomrye" and was represented by a shape of mountain range.

• Proceedings of the Korea Society for Industrial Systems Conference
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• 1999.12a
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• pp.411-419
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• 1999

EBPP는 소비자, 사업자간에 고지서 발송, 접수 및 지불을 네트워크를 통하여 전자적으로 처리하는데 필요한 환경을 의미하며, 인터넷을 기반으로 하여 전자우편 혹은 웹 페이지를 통하여 고지서를 처리한다 EBPP 시스템은 크게 소비자, 사업자 그리고 은행간의 거래로 이루어 지지만 컴퓨터 및 인터넷의 보급의 한계 등의 문제로 현재로서 모든 고지서를 전자적으로 처리하는 것은 무리가 따른다. 그럼에도 불구하고 EBPP 시스템은 1) 경쟁력 확보를 위해 기업/금융 기관들이 인터넷을 통한 고품질 서비스 개발에 주력하는 추세이고, 2) 고객과의 보다 긴밀한 관계 유지를 위한 수단 제공하며, 3) 인터넷 등 온라인 통신 인구가 급격한 증가(2701년에 전체 인구의 약 50%가 활용할 것으로 전망)하고 있으며,4) 소비자를게 보다 편리한 지불방법 제시해주며, 5) 또 다른 마케팅 매체로 활용 가능하므로 앞으로의 전망이 매우 밝다. EBPP시스템은 크게 금융기관, 기업, 소비자 부분으로 구성되며, 소비자와 접촉 방법으로는 대표적으로 Web과 전자우편을 생각할 수 있으며, EBPP 시스템을 구축하기 위해서는 기본적으로 상접 혹은 기업에서 청구에 필요한 정보를 등록시키는 통합 청구서버(Bill consolidation server), 소비자에게 청구 가능한 정보를 갖고있는 청구 제시서버 (Bill presentment server), 소비자의 지불요청에 따라 은행으로부터 지불을 요구하는 지불서버(Payment gateway) 등이 필요하며, 이들 각각의 서버들의 구성 요소들은 제공하는 서비스에 따라 달라질 수 있다. 통합 청구서버에서 청구 제시서버로 전송되는 청구 건은 통상적으로 실시간 처리되는 것이 아니라 통합 청구서버에 존재하는 Spool DB에 저장되어 그 양이 일정한도를 넘어서면 자동 전송되도록 하여, 망의 할용도를 높이는 역할을 수행한다. 청구 제시서버의 DB에 등록된 청구 건은 인터넷을 통해 소비자에게 청구되며, 소비자에게 전송 되는 청구서는 사용자DB를 참조하여 사용자가 미리 정의한 원하는 형태로 변환되어 전달되며, 필요시 암호화 과정을 거치는 것이 가능해야 한다. 전송된 청구서는 전자우편의 경우, 암호해독이 가능한 전용 브라우저를 통해 열람 되며, 이는 다시 전용 브라우저를 통해 지불인증이 승인되어 청구 제시서버에게 전송된다. EBPP 시스템의 제어 흐름은 크게 기업이 청구 정보를 소비자에게 제시하는 흐름과 소비자의 지불 승인으로 인해 기업이 은행에 지불을 요구하는 흐름으로 구분할 수 있다. 본 논문에서는 통합 청구서버 및 정구 제시서버의 역할 및 구성 요소들에 대해 서술하고, EBPP 시스템과 연동하여야 하는 메일 서버와의 상호 작용에 대해 서술할 것이다. 본 시스템을 아직 구현이 되지 않은 관계로 시스템의 성능 등의 수치적 결과를 제시할 수 없는 상태다.

• 발명특허
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• v.36 no.9
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• pp.20-25
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• 2011

무권리자의 특허출원에 대해서는 특허법상 특허심판원에 특허심판 청구를 하여 특허권을 등록무효시키는 것이 종래의 방법이나, 특허심판원을 거치지 않고 일반 법원에 직접 청구하는 것이 가능한지, 가능하다면 말소청구와 이전등록청구 중 어느 방법에 의하여야 하는지에 관해 알아보자.

• Journal of Korea Fair Competition Federation
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• no.131
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• pp.2-31
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• 2007

경쟁당국의 집행을 보완하고 피해자 구제를 위하여 금지청구권의 도입과 그 입법시 남소 방지를 위하여 금지청구권의 행사요건을 강화하되, 금지청구의 대상에 대하여는 제한하지 않을 것 등을 제시하고자 한다.

• Health Policy and Management
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• v.34 no.2
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• pp.163-177
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• 2024

Background: This study aims to examine changes in fraudulent claim counts and total reimbursements before and after enhancements in counterfeit claim controls and monitoring of provider claim patterns under the "Proactive self-audit pilot program of fraudulent claims." Methods: This study used the claims data and hospital information (July 2021-February 2022) of the Health Insurance Review and Assessment Service. The data was collected from 1,129 hospitals assigned to the pilot program, selected from the providers who filed a claim for reimbursement for intravenous injections. Paired and independent t-tests, along with regression analysis, were utilized to analyze changing patterns and factors influencing claim behaviors. Results: This program led to a reduction in the number of fraudulent claims and the total amount of reimbursements across all levels of hospitals in the experimental groups (except for physicians below 40 years old). In the control group, general hospitals and hospitals demonstrated some significant decreases based on the duration since opening, while clinics showed significant reductions in specified subjects. Additionally, a notable increase was observed among male physicians over the age of 50 years. Overall, claims and reimbursements significantly declined after the intervention. Furthermore, a positive correlation was found between hospital opening duration and claim numbers, suggesting longer-established hospitals were more likely to file claims. Conclusion: The results indicate that the pilot program successfully encouraged providers to autonomously minimize fraudulent claims. Therefore, it is advised to extend further support, including promotional activities, training, seminars, and continuous monitoring, to nonparticipating hospitals to facilitate independent improvements in their claim practices.

• Journal of Digital Convergence
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• v.14 no.4
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• pp.231-237
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• 2016

The private health insurance covers areas that are not covered by the national health insurance to reinforce insurance guarantee. Realistically, however, many people renunciate small sum insurance claims because the inconvenient claim procedures require a certificate from the hospital for resubmission to the insurance company, which is very time consuming. Therefore, One-stop insurance payout claiming system that is capable of one stop processing of the issuance of e-page safer technology-based certification to claiming of insurance payout by utilizing authorized electronic address (#-mail) through the utilization of private information concealment technology and identification certification technology for the convenience of the subscribers and the simplification of operation was developed.

• Korean Journal of Construction Engineering and Management
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• v.12 no.3
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• pp.121-130
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• 2011

Real option values of early termination payment for selected BTO PPI projects are studied using binomial models. Two cases of early termination payments are considered; an option with the condition of private participants' default, and an option without the condition. Values vary depending upon parameter values such as revenues, costs, discount rates, debt ratio, and volatility of revenues. For selected projects, the option values without the default condition are estimated as 1%~7% of total project costs, whereas the option values with the default condition are estimated as 0%~1.89% of total project cost. When actual revenues differ from the forecasted revenues, apparently the option values deviate from the values based upon the forecasted revenues. When actual revenues fall short of the forecasted revenues, the option values increase by a large amount whereas the option values decrease by a small amount in the opposite case. This implies that the option values can be quite bigger than the values based upon the forecasted revenue especially when the revenue forecast uncertainty is large. This study is expected to play an important role in improving the early termination payment option policy of the government in PPI projects in Korea.

• Journal of Digital Convergence
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• v.11 no.9
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• pp.289-299
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• 2013

The aim of this study was to enhance the NHI claims data-based tuberculosis classification rule of KCDC(Korea centers for disease control & prevention) for an effective TB surveillance system. 8,118 cases, 10% samples of 81,199 TB cases from NHI claims data during 2009, were subject to the Medical Record Survey about whether they are real TB patients. The final study population was 7,132 cases whose medical records were surveyed. The decision tree model was evaluated as the most superior TB patients detection model. This model required the main independent variables of age, the number of anti-tuberculosis drugs, types of medical institution, tuberculosis tests, prescription days, types of TB. This model had sensitivity of 90.6%, PPV of 96.1%, and correct classification rate of 93.8%, which was better than KCDC's TB detection model with two or more NHI claims for TB and TB drugs(sensitivity of 82.6%, PPV of 95%, and correct classification rate of 80%).

• Proceedings of the KAIS Fall Conference
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• 2011.12a
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• pp.248-250
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• 2011

2009년 1월 1일부터 3월 31일까지 신규 개원한 295개 의원급 의료기관을 대상으로 의료기관 행정인력이 있을 때와 없을 때에 따른 진료비 청구에 미치는 요인을 파악한 결과, 지역별로는 경인대권이 54.9% 가장 높은 분포를 보였으며, 진료과목별로는 일반의 29.8%로 높았으며, 행정인력이 많은 진료과도 일반의로 35.5%로 높게 나타났다. 행정인력이 있는 경우 단순청구오류건의 수정 및 이의신청횟수, 보완청구, 누락청구의 횟수도 높은 것으로 확인되며, 행정인력이 있는 경우 삭감된 부분에 대한 회수율일이 행정인력이 없는 경우보다 높은 것으로 확인되었다.이 상의 결과로 볼 때 행정인력은 병원행정 업무를 지속적인 교육과 의료인과의 소통을 통해 합리적인 청구방법 모색이 필요하다. 또한 병원행정인은 환자와 의료인과의 가교 역할을 담당하고 의료기관과 정부 등 관련기관과의 매개자로써 적절한 역할을 통해 의원급 의료기관의 경영의 도움이 될 것으로 사료된다.