BLOCKCHAIN BASED CROWDSOURCING MEDICAL BILLING FOR MEDICAL INSURANCE CLAIMS PROCESSING

Abstract

A computer implemented method for detecting, validating and auto-adjudicate health insurance claims billing errors, rejections and potential claim denial in real-time using blockchain based platform, wherein, information or responses is provided by the live forum, plurality of medical biller community and healthcare service provider (HSP). The validation of the claim errors, rejections and potential claim denial for early detection, validation and correction of medical billing errors in real-time, further comprises steps of: initial feedback from the live forum comprising groups of unified biller community intelligence (UBCI), medical billers providing online response to medical related queries and questionnaires; and final validation of the claim errors, rejections and potential claim denial by matching value of the blockchain transaction to plurality of medical biller community server and healthcare service provider (HSP) server comprises verified stored records, as the blockchain based platform.

Claims

1. A computer implemented method for detecting, validating and auto-adjudicate health insurance claims billing errors, rejections and potential claim denial in real-time using blockchain based platform database, the method comprising the steps of: a) generating a hash value of a first medical biller with identifier hash for distinguishing among entries, a record hash for respective recording, and the data hash; b) sending the hash value to a second medical biller through a blockchain network in which the blockchain network adds information and/or responses in the data hash to one or more blocks in an existing blockchain; and c) validating the claim errors, rejections and potential claim denial by matching the hash value the first medical biller to a similar or same hash value of the blockchain transaction with a blockchain based platform, wherein, information or responses is provided by the live forum, plurality of medical biller community and healthcare service provider (HSP); validation of the claim errors, rejections and potential claim denial for early detection, validation and correction of medical billing errors in real-time, further comprises steps of: initial feedback from the live forum comprising groups of unified biller community intelligence (UBCI), medical billers providing online response to medical related queries and questionnaires; and final validation of the claim errors, rejections and potential claim denial by matching value of the blockchain transaction to plurality of medical biller community server and healthcare service provider (HSP) server comprises verified stored records, as the blockchain based platform.

2. The method for auto-adjudicate health insurance claims billing errors of claim 1, wherein a decentralized nature of the blockchain system allows any approved medical biller or group of medical billers to join a live exchange community

3. The method for auto-adjudicate health insurance claims billing errors of claim 1, wherein the blockchain based platform provides blockchain transaction details from verified data by groups of medical biller users

4. A computer implemented method for detecting, validating and auto-adjudicate health insurance claims billing errors, rejections and potential claim denial in real-time using blockchain based platform database before re-submission, the method comprising the steps of: a) re-generating a hash value of a first medical biller with identifier hash for distinguishing among entries, a record hash for respective recording, and the data hash; b) sending the hash value to a second medical biller through a blockchain network in which the blockchain network adds information and/or responses in the data hash to one or more blocks in an existing blockchain; and c) validating the claim errors, rejections and potential claim denial by matching the hash value the first medical biller to a similar or same hash value of the blockchain transaction with a blockchain based platform, wherein, information or responses is provided by the live forum, plurality of medical biller community and healthcare service provider (HSP); validation of the claim errors, rejections and potential claim denial for early detection, validation and correction of medical billing errors in real-time, further comprises steps of: initial feedback from the live forum comprising groups of unified biller community intelligence (UBCI), medical billers providing online response to medical related queries and questionnaires; and final validation of the claim errors, rejections and potential claim denial by matching value of the blockchain transaction to plurality of medical biller community server and healthcare service provider (HSP) server comprises verified stored records, as the blockchain based platform.

5. The method for auto-adjudicate health insurance claims billing errors of claim 4, wherein, the blockchain system allows any approved medical biller or group of medical billers to join an exchange community live and provides solution

6. The method for auto-adjudicate health insurance claims billing errors of claim 4, wherein, blockchain based platform provides blockchain transaction details from verified data by groups of medical biller users

7. A system for detecting, validating and auto-adjudicate health insurance claims billing errors, rejections and potential claim denial in real-time using blockchain based platform database, the method comprising the steps of: a) hash value blockchain generator for regenerating a hash value for a first medical biller with identifier hash for distinguishing among entries, a record hash for respective recording, and the data hash; b) plurality of health blockchain for communicating the hash value to a second medical biller through a blockchain network in which the blockchain network adds information or responses in the data hash to one or more blocks in an existing blockchain; and c) a blockchain based platform for verifying the medical bills by matching value of the blockchain transaction with the blockchain based platform, wherein, information or responses is provided by the live forum, plurality of medical biller community and healthcare service provider (HSP); validation of the claim errors, rejections and potential claim denial for early detection, validation and correction of medical billing errors in real-time, further comprises steps of: initial feedback from the live forum comprising groups of unified biller community intelligence (UBCI), medical billers providing online response to medical related queries and questionnaires; and final validation of the claim errors, rejections and potential claim denial by matching value of the blockchain transaction to plurality of medical biller community server and healthcare service provider (HSP) server comprises verified stored records, as the blockchain based platform.

Description

BRIEF DESCRIPTION OF THE DRAWING

[0022] The present invention may be understood in more details and more particularly description of the invention briefly summarized above by reference to certain embodiments thereof which are illustrated in the appended drawings, which drawings form a part of this specification. It is to be noted, however, that the appended drawings illustrate preferred embodiments of the invention and are therefore not to be considered limiting of its scope, for the invention may admit to other equally effective equivalent embodiments.

[0023] FIG. 1 is a schematic of blockchain based system and method for detecting, validating and adjudicating the claim errors in accordance with an embodiment of the invention;

[0024] FIG. 2 provides blockchain system environment architecture, in accordance with one embodiment of the present invention;

[0025] FIG. 3 illustrates blocks in a blockchain based platform in accordance with an embodiment of the invention; and

[0026] FIG. 4 provides a process flow illustrating a block chain provided for facilitating, detecting and adjudicating medical billing errors in real-time, in accordance with an embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

[0027] The present invention will now be described more fully hereinafter with reference to the accompanying drawings in which a preferred embodiment of the invention is shown. This invention may, however, be embodied in many different forms and should not be construed as being limited to the embodiment set forth herein. Rather, the embodiment is provided so that this invention will be thorough, and will fully convey the scope of the invention to those skilled in the art.

[0028] In an embodiment of the present invention, the method and system provide a decentralized blockchain based platform that documents the data transfer from one creator to other or various end-users, and/or between end users. The system and method enable use of commercial blockchain otherwise known as a distributed ledger to create live medical related data groups of medical billers such as Unified Billing Community Intelligence and provide as live crowdsourcing data and store this publicly verifiable record of digital transactions in a blockchain based platform. The Blockchain system provides decentralized distributed ledger or a public ledger, and a transaction database. The commercial blockchain system analyses the given medical billing identified query against one or more set of known and identified medical billing elements stored in the blockchain based platform by the medical biller's community. The system allows the data to be stored, modified, maintained, and verified on several independent nodes and establishes security by keys on the database rather than the source and origin of the information. In an event of a member making a transaction, date and time is stamped along with a key using the member's private key such as biometrics, or any form of unique identification.

[0029] In yet another embodiment, the system records every subsequent medical transaction related data and/or query, and a new key is generated into blockchain system which includes the earlier key. The present blockchain system provides each data block in the chain in an encrypted form using public key cryptography which can be unlocked while processing medical claim errors with the use of a private key or password, which could be held by healthcare service providers, UBCI users, and/or seekers. Hence, without access to the key, the data stored in blockchain is inaccessible and it is impossible to hack in a single block of data or changes to the data blocks to be made.

[0030] In an embodiment of the present invention a computer implemented method for detecting, validating and adjudicating the claim errors, rejections and potential claim denial in real-time using blockchain based platform database before re-submission, the method comprising the steps of: a) re-generating a hash value of a first medical biller with identifier hash for distinguishing among entries, a record hash for respective recording, and the data hash; b) sending the hash value to a second medical biller through a blockchain network in which the blockchain network adds information and/or responses in the data hash to one or more blocks in an existing blockchain; and c) validating the claim errors, rejections and potential claim denial by matching the hash value the first medical biller to a similar or same hash value of the blockchain transaction with a blockchain based platform, wherein, information or responses is provided by the live forum, plurality of medical biller community and healthcare service provider (HSP); validation of the claim errors, rejections and potential claim denial for early detection, validation and correction of medical billing errors in real-time, further comprises steps of: initial feedback from the live forum comprising groups of unified biller community intelligence (UBCI), medical billers providing online response to medical related queries and questionnaires; and final validation of the claim errors, rejections and potential claim denial by matching value of the blockchain transaction to plurality of medical biller community server and healthcare service provider (HSP) server comprises verified stored records, as the blockchain based platform.

[0031] In yet another embodiment the system for detecting, validating and adjudicating the claim errors, rejections and potential claim denial in real-time using blockchain based platform database, the method comprising the steps of: a) a hash value blockchain generator for regenerating a hash value for a first medical biller with identifier hash for distinguishing among entries, a record hash for respective recording, and the data hash; b) a plurality of health blockchain for communicating the hash value to a second medical biller through a blockchain network in which the blockchain network adds information or responses in the data hash to one or more blocks in an existing blockchain; and c) a blockchain based platform for verifying the medical bills by matching value of the blockchain transaction with the blockchain based platform, wherein, information or responses is provided by the live forum, plurality of medical biller community and healthcare service provider (HSP); validation of the claim errors, rejections and potential claim denial for early detection, validation and correction of medical billing errors in real-time, further comprises steps of: initial feedback from the live forum comprising groups of unified biller community intelligence (UBCI), medical billers providing online response to medical related queries and questionnaires; and final validation of the claim errors, rejections and potential claim denial by matching value of the blockchain transaction to plurality of medical biller community server and healthcare service provider (HSP) server comprises verified stored records, as the blockchain based platform.

[0032] In FIG. 1 a blockchain based system in accordance with an embodiment of the invention is illustrated. The system (100) includes a blockchain based platform (110) that communicates with one or more nodes via a network (120). Additionally, the system (100) includes a variety of digital devices that may run on hardware such as personal computers (130), mobile phones (140), personal computing devices (160), some of which may communicate on the network 120 via a wireless access point (150). The blockchain based system (100) comprising a blockchain based platform (110) configured to create an initial genesis block in a ledger file. This new ledger file may be transmitted over the network (120) to other nodes including digital devices (130), (140), (160), and other blockchain management devices (110). In many embodiments, blockchain based system (100) is decentralized in which entire copies of a particular ledger file are stored on multiple nodes. In other embodiments, some copies may be a pruned copy of the ledger file. Participating nodes may utilize a copy of the ledger and make the transaction history available for download to others per default via network (120) such as by utilizing peer-to-peer protocols.

[0033] In an embodiment of the present invention, the invention provides blockchain system environment architecture 200, in accordance with an embodiment of the present invention. The invention uses a decentralized blockchain based platform configuration or architecture that enables a reduction in overhead costs, particularly for development and maintenance of medical claim billing systems. The successful deployment of blockchain for error-free medical claim records allows data transition in real-time between related parties in an efficient, consensus-based, seamless manner to ensure every claim are paid upon the first claim submission to payers. The decentralized nature of the blockchain system allows approved medical biller or group of medical billers to join an exchange community live and provides solution without the need to build data exchange pipes/servers between certain entities. Furthermore, the present blockchain system provides medical billing management workflow to enable the medical claim to be complete, accurate, and timely to ensure every claim are paid upon the first claim submission to payers.

[0034] In another embodiment of the present invention, the blockchain system operates as a standalone system or in conjunction by connecting to other medical billing platforms at various stages, or as a separate framework. The blockchain system comprises live crowdsourcing data by medical billers is implemented and executed on a device. The device can be a handheld device and/or web-enabled device and/or desktop enabled personal computer that comprises a processor, an addressable memory, and other conventional features such as a display, local memory, input/output ports, and a network interface. The blockchain system enabled device executes a web browser for interpreting HTML or other display instructions in a web page.

[0035] As shown in FIG. 2, the decentralized blockchain based platform stores live crowdsourcing data from large-scale medical billing users' communities and other users, exchanging live discrete information into commercial digital distributed ledger and facilitate validation and verification the given medical billing identified query against one or more set of known and identified medical billing elements store in the blockchain based platform by the medical biller's community. Such a decentralized block chain configuration ensures storing live medical related queries and questionnaire by groups of medical biller users i.e. Unified Billing Community Intelligence and verified by authority/validators that not only for keeping medical records secure but pulling together fragmented medical records stored by multiple Unified Billing Community Intelligence providers.

[0036] Accordingly, a block chain configuration may be used to maintain an accurate ledger of resources from the medical billers community (UBCI) comprises experts, skilled, novice and experienced medical billers, medical coders, claims auditors, practice consultants, denial management experts, account receivables and medical practitioners, billing managers, practice administrators and other related medical billing professionals together referred herein as medical billers or medical billing users, who are sharing expertise, complex billing know-how, payer nuances and other information to help each other in real-time using shared expertise of similar claims, payers, specialties of a billable codes (CPT/HCPCS) and other related combinations into different questionnaire and their answers on the live forum and storing into digital distributed ledger.

[0037] The fundamental structure of a decentralized blockchain ledger includes blocks which are linked together to form a blockchain. The present blockchain based platform system, for every medical claim submission, would not have to take much time to gather records from multiple providers and medical billing elements data from UBCI, and to send these medical billing data to their insurance payers in real-time. The blockchain system also allows simply to be added such as the new specialist, new insurance payers, or new rules and regulation to the database. From there, users can access the same information as everyone else already participating.

[0038] In additional embodiments, assets in a blockchain are represented by a hash (sometimes referred to as a cryptographic hash). The use of a database listing meta data of creations with their respective hashes can aide in the search for creations in the block chain. In certain embodiments, this database is stored within the blockchain itself. In certain other embodiments, the database is stored externally from the blockchain and referenced by methods including, but not limited to, links to other blocks in different block chains, hard drive sector locations, and/or URL addresses.

[0039] FIG. 3 illustrates blocks in a blockchain based platform in accordance with an embodiment of the invention. In an embodiment of the present invention, the ledger block chain segment (300) contains a first block N (310) for a first medical biller and a subsequent block N+1 320 for a second medical biller and so on. In a number of embodiments, each block contains a hash value in the chain. When a hash value is generated at a first medical biller at block N hash (330) its subsequent answer as identification hash (340), a record hash (350) and a data hash (360). The hash value generated from the first medical biller will be recorded and a portion of the hash value is sent for identification to a second medical biller. Then, the blockchain based platform provides input information from verified data by groups of medical biller users i.e. Unified Billing Community Intelligence and healthcare service provider (hsp) server, and detects, validates and corrects claim errors rejections and potential denial issues in real-time.

[0040] As shown in FIG. 4 a process (400) for facilitating, detecting, and detecting, validating and auto-adjudicate health insurance claims billing errors, rejections and potential claim denial in real-time, which comprises regenerating a hash value at a first medical biller based on medical query and their answer as identification hash, a record hash and a data hash. Then the hash value of first medical biller is sent for record identification to a second medical biller, from the first medical biller device. Then the record identification and the portion of the hash value generated form second medical biller device is be sent to the core server for retrieval of de-identified data. Then blockchain based platforms verify the hash value using the transaction identification, from the second client device. The blockchain based platform provides input information from verified data by groups of medical biller users i.e. Unified Billing Community Intelligence, medical biller community server, and healthcare service provider (hsp) server, and detects, validates and corrects claim errors, rejections, and potential denial issues in real-time.

[0041] Although the subject matter presented herein has been described in language specific to computer structural features, methodological acts, and computer readable media, it is to be understood that the present disclosure is not necessarily limited to the specific features, acts, or media described herein. Rather, the specific features, acts and mediums are disclosed as example forms.

[0042] Although the methods as described with reference to the flow diagram illustrated in FIGS. 1-4, many other operations for performing the acts associated with the methods may be used. For example, the order of the operations may be changed, some of the operations described may be optional, and additional operations may be included, in accordance with example embodiments of the disclosure. For example, information and/or responses from live forum of medical billers within the blockchain system could be configured to other blockchain-based systems thus endowed the network with limitless applications use case potential.

[0043] The subject matter described above is provided by way of illustration only and should not be construed as limiting. Various modifications and changes can be made to the subject matter described herein without following the example configurations and applications illustrated and described, and without departing from the true spirit and scope of the present invention.

[0044] The disclosure is described above with reference to block and flow diagrams of systems, methods, apparatuses, and/or computer program products according to example embodiments of the disclosure. It will be understood that one or more blocks of the block diagrams and flow diagrams, and combinations of blocks in the block diagrams and flow diagrams, respectively, can be implemented by computer-executable program instructions. Likewise, some blocks of the block diagrams and flow diagrams may not necessarily need to be performed in the order presented or may not necessarily need to be performed at all, according to some embodiments of the disclosure.

[0045] These computer-executable program instructions may be loaded onto a general-purpose computer, a special-purpose computer, a processor, or other programmable data processing apparatus to produce a particular machine, such that the instructions that execute on the computer, processor, or other programmable data processing apparatus create means for implementing one or more functions specified in the flowchart block or blocks. These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means that implement one or more functions specified in the flow diagram block or blocks. As an example, embodiments of the disclosure may provide for a computer program product, comprising a computer usable medium having a computer readable program code or program instructions embodied therein, said computer readable program code adapted to be executed to implement one or more functions specified in the flow diagram block or blocks. The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational elements or steps to be performed on the computer or other programmable apparatus to produce a computer-implemented process such that the instructions that execute on the computer or other programmable apparatus provide elements or steps for implementing the functions specified in the flow diagram block or

[0046] Accordingly, blocks of the block diagrams and flow diagrams support combinations of mechanisms for performing the specified functions, combinations of elements or steps for performing the specified functions and program instruction means for performing the specified functions. It will also be understood that each block of the block diagrams and flow diagrams, and combinations of blocks in the block diagrams and flow diagrams, can be implemented by special-purpose, hardware-based computer systems that perform the specified functions, elements or steps, or combinations of special purpose hardware and computer instructions.

[0047] It will be appreciated that each of the memories and data storage devices described herein can store responses data and information for subsequent retrieval. The memories and databases can be in communication with each other and/or other databases, such as a centralized database, or other types of data storage devices. When needed, data or information stored in a memory or database may be transmitted to a centralized database capable of receiving data, information, or data records from more than one database or other data storage devices. In other embodiments, the databases shown can be integrated or distributed into any number of databases or other data storage devices.

[0048] Many modifications and other embodiments of the present invention disclosure set forth herein will be apparent having the benefit of the teachings presented in the foregoing descriptions and the associated drawings. Therefore, it is to be understood that the disclosure is not to be limited to the specific embodiments disclosed and that modifications and other embodiments are intended to be included within the scope of the appended claims. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for purposes of limitation.

[0049] While certain exemplary embodiments have been described and shown in the accompanying drawings, it is to be understood that such embodiments are merely illustrative of, and not restrictive on, the broad invention, and that this invention not be limited to the specific constructions and arrangements shown and described, since various other changes, combinations, omissions, modifications and substitutions, in addition to those set forth in the above paragraphs, are possible. Those skilled in the art will appreciate that various adaptations and modifications of the just described embodiments can be configured without departing from the scope and spirit of the invention. Therefore, it is to be understood that, within the scope of the appended claims, the invention may be practiced other than as specifically described herein.