Hyperledger Wiki Archive - read only

Hyperledger Project
Healthcare Working Group (HCWG) Payer Subgroup Meeting
August 14, 2018

Resources:
Chat: https://chat.hyperledger.org/channel/healthcare-wg (you can use your LFID to login)
Github: https://github.com/hyperledger
Wiki: https://wiki.hyperledger.org
HCWG Wiki: https://wiki.hyperledger.org/groups/healthcare/healthcare-wg
Public lists: https://lists.hyperledger.org
Meetings: https://wiki.hyperledger.org/community/calendar-public-meetings

Linux Foundation Antitrust reminder: https://www.linuxfoundation.org/antitrust-policy

Meeting Notes

Prior Auth Process https://lists.hyperledger.org/g/healthcare-wg/attachment/540/1/prior-authorization-process.png

PA Process flow https://lists.hyperledger.org/g/healthcare-wg/attachment/540/2/PA%20Process%20Flow.png

VA problem is a problem that needs to be solved. Veterans choice program - split, outsource care to a payor network - too big of a problem, talk about a whitepaper

Pre Authorization as a use case

• Soft Prior Auth
• Hard Prior Auth
• Patient has identity in a digital wallet
  • Does person have auth for specialist consultation?
  • Patient initiates medical encounter
    • Depending on insurance either
      • Goes to primary physician
      • Goes to specialist
    • Provider uses trust certificate to identify your payor
    • Some kind of ID card, digital certificate, chip reader
  • Exam, Dr wants to send you to a specialist for further tests
  • Nurse uses your certificate to send to the payor to see if they need Prior Auth
    • If no - order test
    • If yes - place order form for prior auth
      • Auth process
        • Internal channel processes
          • Collaboration between physician, medical records, contractors,
          • External info required
    • Query against EHR in a zero knowledge proof
    • Publish criteria for approval, submit all info up front for prior auth, immediate auth unless marginal result
  • Build out private channel in Payor network
    • Business
    • Medical
    • Forms submitted
      • Goes onto ledger
      • Approve, reject, qualify request
  • Data model that needs to go to the ledger, needs a consensus mechanism, endorsed, put a block on the ledger
    • Valid patient
    • Valid provider
    • Payor notified Prior auth request made
      • Get transaction from the ledger and process it