Toward Privacy-Assured Health Insurance Claims

According to HIPAA (Health Insurance Portability and Accountability Act), the medical insurance claim process is carried out by healthcare providers, insurance companies, and clearinghouses. The clearinghouse coordinates the medical insurance claims between providers and insurance companies. As centralized communication hubs, clearinghouses may maliciously or unintentionally leak patient information. In this work, we propose a distributed solution to replace the role of clearinghouses during health insurance claim process and mitigate the risk of data leakage among parties in Healthcare sector. Our solution enhances the patients' privacy protection through developing a HIPAA compliance system for the medical insurance claim process in a decentralized manner using blockchain technology. Blockchain ensures transaction integrity and anonymity of cryptocurrencies by using distributed immutable ledgers. We first design data structures for patient information, medical service record, insurance payment, and insurance agreements within the ledger. We then focus on defining smart contracts for privacy assurance, as well as automating the insurance claim process. We implement and evaluate the proposed framework with Hyperledger Fabric, showing promising performance and response time.