Ping An Healthcare Technology Wins Bid for Fujian Provincial Medical Insurance Information Platform Project, Expanding Its Footprint to 25 Provinces

Recently, Ping An Medical Insurance Technology announced another victory in its medical information platform construction project, successfully winning the bid for the "Fujian Provincial Healthcare Security Administration's Procurement Project for Big Data Analysis and Regulatory Application Software Services." The scope of work includes five subsystems: the Intelligent Regulatory Knowledge Base Subsystem, Internal Control Management Subsystem, Medical Expense Audit and Verification Business Subsystem, Operational Monitoring Subsystem, and Healthcare Security Decision-Making Subsystem.

As a key national pilot province for healthcare reform, Fujian has selected Ping An Health Insurance Technology to support the Fujian Provincial Healthcare Security Administration and local healthcare security departments across the province. This partnership aims to fully achieve information sharing, application synergy, and open collaboration across horizontal and vertical dimensions, internally and externally, and between government and market entities. The initiative will enhance the efficiency of fund supervision, strengthen the risk resistance of healthcare security funds, and ensure their sustainable coverage capacity.

It is reported that the winning bid for this project has set a new record for Ping An Health Insurance Technology’s provincial platform projects, marking the comprehensive coverage of Fujian’s data middle-office stronghold by its three core products: intelligent supervision, macro-level decision-making, and operational monitoring. This achievement lays a solid foundation for future business models and scenario exploration. A project leader at Ping An Health Insurance Technology stated that the company is leveraging its advanced and comprehensive knowledge system to build an all-encompassing intelligent healthcare security supervision platform for Fujian Province, thereby safeguarding the security of healthcare security funds at the source while promoting the improvement of healthcare security data. By employing technologies such as big data to enable intelligent decision-making in healthcare security, the company replaces manual experience with data analytics to accurately predict risks. Furthermore, through graphical data visualization, it provides the Healthcare Security Administration with a cockpit-style dashboard service, offering clear visibility into various data indicators and contributing to the intelligence and modernization of Fujian Province’s healthcare security system.

Since 2019, the National Healthcare Security Administration and local healthcare security bureaus across China have collaborated with third-party service platforms to accelerate the development of healthcare security information systems. Ping An Healthcare Security Technology has made significant progress in the construction of provincial-level platforms, with its achievements in macro-level decision-making, operational monitoring, intelligent supervision, and comprehensive payment systems receiving widespread recognition.

Currently, the main construction of the National Healthcare Security Administration Information Platform has been basically completed, and the unified national healthcare security information platform has gone live in many regions across China. It is reported that as of October 2021, Ping An Health Insurance Technology successfully won bids for 25 provincial-level platform system construction projects in the standardization of healthcare security informatization nationwide, and facilitated the successful launch (including trial operations) of 20 provincial-level platform projects in Shandong, Yunnan, Qinghai, Hainan, Guangdong, Guizhou, Xinjiang, Tibet, Anhui, Heilongjiang, Shaanxi, and other provinces.

It is reported that in 2019, Ping An Health Insurance Technology won the bid for the procurement project to construct the Macro-Decision Big Data Application Subsystem and the Operation Monitoring Subsystem of the National Healthcare Security Administration’s healthcare security information platform. Currently, both projects have been successfully launched and are operating stably, with their technology and services receiving consistent acclaim. As a data technology company focused on China’s broader healthcare industry, Ping An Health Insurance Technology has cultivated deep expertise in the sector for many years, boasting a large team of experts in health insurance operations, clinical practices, actuarial science, and algorithmic technologies. Leveraging its “strong business acumen + advanced technology” capabilities, the company has developed an “AI Big Data Risk Control System” driven by a dual-engine approach. This system provides macro-decision support and operational monitoring capabilities to the National Healthcare Security Administration, facilitating the digital transformation of health insurance management.

A representative from Ping An Health Insurance Technology introduced that the system starts with data. At the algorithm design level, it employs various self-developed anomaly detection algorithms and AI integration solutions to effectively uncover potential insurance fraud and abuse. In terms of data governance, it utilizes automated code mapping and automated table alignment technologies, reducing the cost of manual code mapping. At the knowledge base level, it has built a proprietary 360-degree profiling system along with scenario libraries, standard metric libraries, statistical rule libraries, policy rule libraries, empirical rule libraries, and specialized governance libraries, supporting multi-dimensional anomaly identification. Architecturally, it innovatively applies a model-sharing architecture to achieve a balance between rapid small-batch and large-batch data analysis, thereby meeting multiple requirements for stability, speed, and resource efficiency. It is reported that the system is capable of detecting nearly 50 typical health insurance fraud scenarios. Leveraging robust data accumulation and intelligent technologies, it provides users with precise and efficient cost-control services.

As a key component of Ping An’s integrated healthcare ecosystem, Ping An HealthCare Technology leverages the technological expertise accumulated by Ping An Group to deepen its presence in the medical insurance payment sector. Through continuous technological innovation, it provides provincial and municipal medical insurance bureaus with comprehensive solutions for the collection, storage, processing, analysis, and service of big data related to medical insurance risk control. These efforts help standardize the use of medical insurance funds, improve their utilization efficiency, combat fraud and deceptive claims, and support the ongoing reform of the medical insurance system. In response to recent market rumors that “Ping An Group may sell Ping An HealthCare Technology,” a company representative stated that Ping An’s healthcare technology initiatives have always been closely aligned with the development of its core financial and insurance businesses, working together to create “finance with warmth.” Ping An HealthCare Technology will continue to reform and upgrade its business strategies, organizational structure, and other aspects in response to customer needs and changes in the market environment, thereby steadily enhancing the company’s core competitiveness.