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groups:healthcare:np16 [2018/08/16 17:42] (current)
Jennifer DeVivo created
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 +Hyperledger Project\\
 +Healthcare Working Group (HCWG) Payer Subgroup Meeting\\
 +August 14, 2018 \\
 +Chat:  https://​​channel/​healthcare-wg (you can use your LFID to login)\\
 +Github: ​ https://​​hyperledger\\
 +Wiki:  https://​\\
 +HCWG Wiki: https://​​groups/​healthcare/​healthcare-wg \\
 +Public lists: ​ https://​\\
 +Meetings: ​ https://​​community/​calendar-public-meetings \\
 +Linux Foundation Antitrust reminder: https://​​antitrust-policy\\
 +Meeting Notes\\
 +Prior Auth Process https://​​g/​healthcare-wg/​attachment/​540/​1/​prior-authorization-process.png
 +PA Process flow https://​​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
groups/healthcare/np16.txt ยท Last modified: 2018/08/16 17:42 by Jennifer DeVivo