Problem statement

At present, payers use multiple systems to automate healthcare transaction/claims processing. Therefore, there is a need to simplify and standardize transaction processing in healthcare and progress the industry to real-time adjudication.

Approach

Smart contracts are simple, more efficient, and lower-cost solution as they allow self-executing rules that payers implant on a blockchain and are triggered automatically based on events that occur in a transaction.

Technical details

The partnership combines the scale of Change and TIBCO’s smart contract development project, Project Dovetail, to build open-source healthcare transaction-related smart contracts for payers on Change’s Intelligent Healthcare Network (IHN). The IHN, which is running in production, provides claims management transparency and provides an appropriate platform for a scalable blockchain application.

By using the distributed ledger technology, hospitals, physician practices and payers can longitudinally track the real-time status of claims submission and remittance using its Intelligent Healthcare Network.

The platform will aim to enable health plans and their financial partners to easily develop and deploy smart contract-based processes that automate events across the healthcare transaction processing lifecycle.