DokChain Use Case

Autonomous Auto-Adjudication

Medical claims processing is notoriously complicated, and represents a significant percentage of the business overhead for providers. Traditional intermediaries like clearinghouses and third party administrators tend to just increase the complexity and reduce the transparency of conducting business, and current auto-adjudication software still falls short.

PokitDok and our DokChain Alliance members have agreed that an artificially intelligent, smart contract mediated claims adjudication protocol is a highly desirable use case to pursue. Such a system will allow for near real-time adjudication and remittance of submitted claims. In turn, this will save time and money for payers and providers, and reduce the uncertainty and latency of out-of-pocket expenses for consumers. And because the system will run within the DokChain distributed network, updated rules and optimal payment schemes can be learned in real-time over a broad range of plans and health systems.

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The DokChain network protocol allows us to prove:

1. identities of the parties involved in each transaction. DokChain’s Identity by Consensus allows us to generate and manage an identity while maintaining privacy and anonymity, and providing a very high level of identity validation confidence.
2. The time at which a transaction takes place. Identity by Consensus also provides auditable transparency of all interactions.
3. The exact payment conditions at the time of the service. The conditions for payment are defined in the terms of the smart contract. Since the actual smart contract is “registered” on the blockchain, the knowledge of these conditions can be looked up at any time.
4. That the conditions were satisfied by all parties.

For more details on DokChain Autonomous Auto-Adjudication, download our whitepaper.