Prior authorization through blockchain

Principle Health Systems and Coral Health have collaborated to use blockchain to improve workflow of providers by improving the process of prior authorization. Prior authorization costs between US $23-US $31 billion annually to the US healthcare system. The platform uses smart contracts to automate prior authorizations by referencing the data of applicable patient stored in the system and deciding the eligibility of patient in real-time.

Company

Principle Health Systems

Coral Health

Status

Complete

Tags
  • Healthcare services
  • Health tech
  • Identity
  • Data Security
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Problem statement

Payers and providers spend considerable amount of time working through the prior authorization process also, patients end up waiting for what could potentially be a life-saving procedure.

Approach

Blockchain-backed platform which can speed up care delivery, automate multiparty administrative processes, and improve health outcomes by enabling real-time access to authenticated healthcare information.

Technical details

It is a three-step process:

  1. Helping patients to conveniently and securely access to their data.
  2. Removing the data entry work that Principle Health is doing by extracting the applicable prior authorization form from the website of payer and pre-filling the forms using the information of patients from Principle Health’s EHR.
  3. Working with payers to remove the need to fax information back and forth by programming smart contracts that contain all of the payer’s health plan information required to assess a request and approve/deny prior authorization. These smart contracts can automatically access the applicable patient medical information and compare that information to the payer’s health plan, make a determination, and provide the results back to Principle Health.

The Coral Health system has been conceived and developed on the Ethereum blockchain. It consists of two elements: a Coral Health token (standard ERC20 token) and the Coral Health Ledger Smart Contract. The Coral Health Ledger Smart Contract is a contract that keeps a complete list of medical data files and access control list.

Coral Health is set to modernize healthcare infrastructure by leveraging blockchain’s decentralized ledger. The ledger, which is updated in real-time, will connect hospitals, departments and other parties in the healthcare field, creating a single, unified network for hospital records. The flagship mobile app, Coral Health Records, was available through Google Play and Apple App stores in October, 2018. They plan to begin sales rollout of Coral Health to payers throughout the US in Q1, 2020.

Get Smart On Blockchain, U.S. Chamber of Commerce, 2018

Presented

Blockchain impact, 2018

Presented

Business of Health, 2018

Presented

Distributed Health, Nashville 2018

Presented