In the last few years, Blockchain has garnered an increasing interest in the healthcare sector. Patients and Members have a lack of clarity on the types of services rendered to them, or who the rendering provider is and what are their liabilities.
Sometimes service providers belong to different hospitals, clinics and other healthcare units and the claims related to some of these services are made at different times and not all at once. Because of this, the Explanation of Benefits (EOB) that members receive may not reflect all the services related to the surgery in that month. Secondly, members may receive notifications to pay coinsurance and other charges of personal liability from some of the rendering providers about which members have no clarity. The EOB does not reflect that clarity and there is no direct guideline from Payers' customer service department. As a result, customer service representatives are unable to help patients with their queries, patients remain dissatisfied and lose interest, the turnaround time in claim settlement goes up, and the chances of bad debts increase.
In connected health, Patients, Providers, Payers and other entities must come together on a common Blockchain platform to experience value-based healthcare. Payers and providers need to solve different challenges they face with traditional patient information sharing. At the same time, patients need to see a clear Explanation of Benefit statement and experience smooth claims management.
In this solution, medical professionals offering a service can access the application and view, create, and manage the services in a controlled way with full audit capabilities. Blockchain ensures that all entities can manage and maintain their respective updates into immutable blocks in a consistent manner.
Provides a clear and an integrated view of the services rendered to patients
Records maintain sanctity offering single source of truth of all the rendered services
Members receive fruitful help from their payer's customer service representatives on any mismatches in their EOB
Hyperledger Fabric v2.2.x, ReactJs, NodeJs, Active MQ, Apache Spark, Mongodb