Automated Preauthorization via Blockchain and Machine Learning
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Solution Overview
Problem
Traditional preauthorization processes are time-consuming and lack transparent documentation, relying heavily on manual reviews and lacking automated validation mechanisms.
Innovation Solution
A system utilizing machine learning and blockchain algorithms to automatically validate authorization requests by converting information into structured, encrypted formats, determining approval status, and storing it on a blockchain for secure and transparent access.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If manual review processes are used for preauthorization, then thorough validation can be performed, but the process becomes time-consuming and inefficient
Solution Approach 1:
The patent replaces manual mechanical review processes with automated machine learning algorithms and natural language processing systems. These systems automatically validate authorization requests against requirements, extracting information from unstructured documents and making approval decisions without human intervention, thereby maintaining validation thoroughness while dramatically reducing processing time
Solution Approach 2:
The system enables self-service automation where the machine learning models independently perform validation tasks. The natural language processing algorithms automatically extract relevant information from authorization requests and compare them against stored requirements, allowing the system to validate requests autonomously without requiring manual reviewer involvement for routine cases
2Loss of information
If traditional documentation methods are used for preauthorization, then records can be maintained, but transparency and security are compromised
Solution Approach 1:
The patent introduces blockchain technology as an intermediary layer between the authorization requests and the documentation system. The blockchain serves as a decentralized, immutable ledger that records all authorization transactions with timestamps and cryptographic hashes, providing transparent and secure documentation that maintains information completeness while enhancing security and traceability
Solution Approach 2:
The system transforms documentation from traditional mutable formats to immutable blockchain records. By changing the fundamental parameter of document storage from centralized databases to distributed blockchain ledgers, the system achieves both transparency through decentralized access and security through cryptographic immutability, while maintaining complete information records
3Productivity
If automated processing is implemented, then efficiency improves, but system complexity increases
Solution Approach 1:
The patent employs machine learning models that perform multiple functions: extracting information from unstructured text, validating against requirements, making approval decisions, and generating documentation. This multi-functionality consolidates what would otherwise require separate systems into a single automated platform, improving efficiency while managing complexity through functional integration
Solution Approach 2:
The blockchain serves as a simplifying intermediary that handles complexity management. By offloading security, transparency, and record-keeping functions to the blockchain layer, the automated processing system can focus on validation logic without needing to implement its own complex security and documentation infrastructure, thereby improving efficiency without proportionally increasing overall system complexity
Data Source
AI summary
Systems and methods for automatically approving prior authorization requests for an episode of service are described. An illustrative system may be used by insurance providers, clients, and third parties to request prior authorizations for episodes of service with real-time approvals if a requested service meets authorization criteria. Throughout each step of the authorization process, transactional information is logged and securely sent to all key parties using the blockchain.