Figure 5 Smart contract for enabling communication between patient and service

Figure 5 smart contract for enabling communication

This preview shows page 11 - 13 out of 23 pages.

receive recommendations from junior doctors. Figure 5. Smart contract for enabling communication between patient and service provider. 5.2.4. Data Flow for Healthcare Reimbursement The main objective is to speed up the process of reimbursement for the health care system. In this, physicians will be able to proceed quickly with care instead of having to put on hold the treatment of their patient while waiting for the payer to respond. The execution of automated smart contracts will monitor the whole process. Reducing- and ultimately eliminating-the error-laden human e ff ort to manually review and respond to requests for prior authorization, and reducing appeals triggered by incorrect interpretation of manually written prior authorization forms. Health Insurance Company posts their policies via blockchain smart contracts containing the policies used to determine authorization. A supplier then submits to the blockchain an application for prior authorization for a specialist appointment, treatment or prescription. The smart contract for a medical policy of the payer determines automatically authorization using the medical information of the patient stored via Ethereum blockchain and the information in the request. Authorization data will then be returned to the provider immediately. Also, the patient-as well as any laboratories, pharmacies, specialists and other stakeholders to whom the patient has delegated access–could verify the insurance authorization in real-time. The whole process can be seen in Figure 6 . The automated process of prior authorization would result in significant cost savings for payers, which currently spends substantial amounts on manually reviewing and responding to requests. Doctors will be able to proceed quickly with treatment instead of having to stop the care of their patient while waiting for the payer’s response. Furthermore, patients will be spared concerned as to whether their insurance will cover the treatment recommended by their doctor. With immediately available prior authorization information, doctors and patients can work together easily with a care plan tailored specifically to the needs of the patient and the appropriate insurance coverage.
Image of page 11
Electronics 2020 , 9 , 94 12 of 23 for prior authorization for a specialist appointment, treatment or prescription. The smart contract for a medical policy of the payer determines automatically authorization using the medical information of the patient stored via Ethereum blockchain and the information in the request. Authorization data will then be returned to the provider immediately. Also, the patient-as well as any laboratories, pharmacies, specialists and other stakeholders to whom the patient has delegated access–could verify the insurance authorization in real-time. The whole process can be seen in Figure 6.
Image of page 12
Image of page 13

You've reached the end of your free preview.

Want to read all 23 pages?

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern

Stuck? We have tutors online 24/7 who can help you get unstuck.
A+ icon
Ask Expert Tutors You can ask You can ask You can ask (will expire )
Answers in as fast as 15 minutes
A+ icon
Ask Expert Tutors