Core Insights - The "Cai Shi Qi AI Medical Insurance Intelligent Control System" was officially launched on November 8, developed by the Shenzhen Institute of Computing Science in collaboration with the Shenzhen Health Research Data Management Center [1] Group 1: Challenges in Medical Insurance - China's medical insurance fund faces regulatory pressure with annual expenditures exceeding 2.9 trillion yuan, leading to three core challenges: complex medical scenarios, rapid iteration of diagnostic technologies, and explosive growth of medical data [3] - Traditional manual rules are insufficient to cover the diverse medical scenarios, and the rules are lagging behind clinical practices due to the fast-paced evolution of diagnostic technologies [3] Group 2: AI Medical Insurance Intelligent Control System - The AI Medical Insurance Intelligent Control System utilizes a "dual-engine" architecture driven by rules and machine learning, integrating over 15,000 rules and training on 18,000 medical insurance review data sets, along with over a million outpatient, inpatient data, and payment records [3] - The system enhances hospitals' self-checking and correction capabilities for medical insurance reimbursements, providing complete supporting data for compliant reimbursements [3] Group 3: System Features and Performance - The system covers the entire process of intelligent control, including pre-warning, in-process monitoring, and post-review, with four core scenarios: intelligent diagnostic reminders, pre-discharge intelligent review, T+1 settlement control, and daily review intelligent appeals [5] - In a pilot application at Nanshan District People's Hospital, the system achieved significant results, including timely daily updates, an accuracy rate exceeding 87%, and a 90-fold efficiency improvement, reducing review time from 15 minutes to 10 seconds [6] - The system also helped the hospital reduce expenses in the medical insurance reimbursement settlement process by 75% [6]