Blockchain-Based Solutions for Health Insurance Claims and Credentials Verification

Abstract

The healthcare industry is a complicated system that crosses numerous organizational and geographical boundaries. It serves as an important pillar for many essential services that are required in daily life. 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 be 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. Furthermore, healthcare credentialing is crucial for verifying healthcare professionals' qualifications and experience. Despite the importance of these two aspects, the current healthcare system lacks a transparent, secure, and reliable system that addresses the existing problems and impurities that endanger patient safety. In this thesis, we propose processing health insurance claims for drug prescriptions using blockchain technology in a secure, trustworthy, private, and decentralized manner. In addition, we propose a blockchain-based approach that can be used to share, secure, and verify healthcare professionals' credentials in a transparent and trusted manner. The proposed solutions leverage key benefits of blockchain technology, such as decentralization, immutability, and security, to create a transparent and efficient system to manage the processing of prescription drug claims and verify and store the credentials of healthcare professionals.

For all the proposed solutions, we present the system architecture, sequence diagrams, entity-relationship diagrams, and algorithms to demonstrate the working principles of our approaches. The performance of the proposed solutions is evaluated by conducting a security analysis and comparing it to the existing solutions. Our smart contract codes are publicly available on GitHub.

Date of Award	Apr 2023
Original language	American English
Supervisor	Raja Jayaraman (Supervisor)