BlockchainTechnologies:AwhitepaperdiscussinghowtheclaimsprocesscanbeimprovedKyleCulver1AbstractThehealthcareindustrysuffersfromaninabilitytoclearlycommunicatecostsinatimelyandeasy-to-understandformat.Thisproblemisasymptomofinteroperabilityissuesandcomplexagreementsbetweenproviders,patients,healthplans/payersandgovernmentregulators.Theseagreementsareencodedinlegallanguagewiththeintentofbeingdefensibleincourt.However,thefocusonlegalenforceability,insteadofunderstandability,createsproblemsresultinginhundredsofbillionsofdollarsspentannuallytoadministeraninefficient,outdatedandcomplexprocessforadjudicatingandpayinghealthplanclaims.Theprocessresultsinerrorsandoftenleavesthepatientunclearonhowmuchtheyneedtopay.Iftheseagreementswereinsteadtranslatedintocomputercode(smartcontracts)leveragingBlockchaintechnologies,theclaimprocesswouldnotonlybeinteroperable,butalsodrivestandardization,researchandinnovation.Transparencyandtrustcanbeinjectedintotheprocesswhenboththelogicandthedatadrivingthesedecisionsisstoredpermanentlyandmadeavailabletoallstakeholdersthroughapeer-to-peerdistributeddatabaselikeblockchain.Theresultwillbeaparadigmshifttowardinteroperabilityandtransparency,enhancingthespeedandaccuracyofcostreportingtopatients.Thispaperdiscusseshowsmartcontracts,blockchainandothertechnologiescanbecombinedintoaplatformthatenablesdrasticimprovementstothehealthcareexperienceforallstakeholders.DISCLAIMER:Theopinionsandviewsexpressedinthisreportarethoseoftheauthor.TheydonotnecessarilyreflecttheviewsofHumana,oranyotheraffiliatedorganization.BackgroundTheClaimsProcessThekeyfinancialmechanismforthehealthcaresystemisthehealthplanclaim.Theclaimprocessstartswiththepatient,whoisrequiredbylawtopossessmedicalcoveragebackedbyahealthplan.Whenapatientneedsservicesfromaprovider(physician,hospital,pharmacyornursinghome),thatproviderutilizesthehealthplanasanintermediarytodetermineservicefees,includingmembercostshareandhealthplancostshare.Inordertodeterminethesecostshares,thehealthplanmustfirstvalida...
