Transforming Healthcare Claims Processing with Blockchain: A Secure and Transparent Approach

Abstract

The healthcare claims processing system is burdened by problems such as inefficiency, fraud, and lack of transparency. This paper proposes a blockchain-based solution to improve claims management by increasing security, traceability, and automation. We propose a framework using smart contracts to validate claims that can be more efficient by allowing processing times to be reduced by more than 70 percent and limit human involvement. The immutability of ledger technology allows the records to not be tampered with, which could ameliorate fraud, which costs the healthcare system around $68 billion annually. The decentralized structure will let us record in real-time the status of claims at providers, payers, and patients, which will support transparency, communication, and trust. Early results show a 40 percent reduction in claim denials in comparison to traditional systems and resolving disputes 90 percent faster than in traditional systems. By utilizing a permissioned blockchain, with existing EHR systems, we provide a compliant solution for processing claims in accordance with HIPAA and GDPR while increasing interoperability. The merger of blockchain with administrative, and compliance deadlines with existing EHR systems is advantageous for operational overhead but more for patient satisfaction reasons. Providing a faster reimbursement cycle for patients greatly increases the timeliness of patient record access.