More on Claims Processing

Change, TIBCO use blockchain to build smart contract system for payers

Using embedded codes in blockchain technology, claims process themselves.

Susan Morse, Senior Editor

Change Healthcare and TIBCO Software are collaborating on a smart contract system for payers to automate the claims transaction process using blockchain, the companies announced Monday.

Smart contracts enable entities that need to see the information to do so through a shared ledger on the blockchain.

Through this platform, health plans can automate healthcare technology so that, in essence, claims process themselves. Self-executing business rules that payers embed on a blockchain trigger automatically based on events in a transaction.

The collaboration involves Change's Intelligent Healthcare Network and TIBCO's smart contract developer project called Project Dovetail. 

Project Dovetail provides a development framework to allow payers and financial institutions to build the smart contracts.

The smart contract goes on the Intelligent Healthcare Network to increase the efficiency of claims adjudication and payment processes, Change said.

Project Dovetail is slated to become publicly available in the near future.


Smart contracts offer a more efficient and lower-cost solution to what is currently being done because of the automation, Change said. When the transaction lifecycle is complete, the ledger is updated.
It is also aimed at improving providers' revenue cycle performance through faster resolution and remittance.


Current processes to automate have gaps and require manual intervention or additional coding, Change said.


"By bringing smart contracts to claims processing, payers can share a standardized approach that lets them easily write, visualize, test, audit, and implement smart contracts for automating healthcare transaction processes," said Aaron Symanski, chief technology officer, Change Healthcare.


The Change Healthcare Intelligent Healthcare Network reaches approximately 2,100 government and commercial payer connections, 5,500 hospitals, 900,000 physicians, and 33,000 pharmacies. In the fiscal year ended March 31, it facilitated nearly 14 billion healthcare transactions and $2 trillion in annual healthcare expenditures.

Twitter: @SusanJMorse
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