Blockchain-Based Processing of Health Insurance Claims for Prescription Drugs

The current legacy system used in processing health insurance claims causes a huge amount of financial loss every year due to fraud claims. It is also highly prone to privacy and security threats due to the use of traditional methods. Health insurance claims for prescription drugs are one such claim that is highly prone to being tampered with. Also, there is a lack of linkage in the prescription data between the medical care provider and the pharmacy, which also leads to miscommunication and the use of false prescriptions. In this paper, we propose processing health insurance claims for drug prescriptions using blockchain technology that manages the processing of prescription drugs in a private, secure, trustworthy, and decentralized manner. The proposed system utilizes a private Ethereum blockchain. The system includes two smart contracts: registration and approval smart contracts, which provide traceability and trustworthiness to the system. The system was integrated with off-chain storage (IPFS) and a fronted decentralized applications (DApps), which improves the accessibility of centralized patient information by authorized parties. To maintain the privacy of the data, a gateway is used to filter the data that can be viewed by the participants. We present the system architecture, sequence diagrams, entity-relationship diagram, and algorithms to demonstrate the working principles of the proposed process for processing health insurance claims for prescription drugs using blockchain. The performance of the proposed solution is evaluated by conducting security analysis and comparing it to the existing solutions. Our smart contract code is publicly available on GitHub.