Blockchain Smart Contract Benefits Validation
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Solution Overview
Problem
Current systems face challenges in providing real-time benefits coverage validation, leading to delays and denials of services due to outdated information, as insurance companies and benefits vendors do not receive timely updates on individuals' coverage status.
Innovation Solution
The Distributed Benefits Coverage Validation Apparatuses, Processes, and Systems utilize smart contracts on a blockchain to synchronize benefits status in real-time, allowing individuals to verify active coverage at the point of service through the MyCoverage App, shifting the proof of coverage from insurance companies to benefits recordkeepers with more timely data.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Speed
If traditional benefits validation systems are used, then data security and access control are maintained through centralized management, but real-time coverage validation is delayed due to outdated information in vendor systems
Solution Approach 1:
The patent introduces a blockchain-based smart contract as an intermediary between the benefits recordkeeper and vendor systems. The smart contract stores coverage status data on-chain, allowing vendors to query and validate coverage in real-time without directly accessing the recordkeeper's internal systems. This resolves the contradiction by enabling fast validation through the blockchain intermediary while maintaining the security and data integrity of the original centralized system.
Solution Approach 2:
The system pre-loads coverage status data onto the blockchain via smart contracts before vendors need to validate it. The benefits recordkeeper continuously updates the smart contract with current coverage status, so when a vendor queries the system, the information is already available and current. This eliminates the delay caused by traditional batch updates and enables real-time validation.
2Reliability
If coverage status is stored in centralized vendor systems, then data access is controlled, but updates are delayed causing service denials
Solution Approach 1:
The smart contract continuously maintains up-to-date coverage status by receiving real-time updates from the benefits recordkeeper. Instead of periodic batch updates, the system implements continuous synchronization where any change in coverage status is immediately reflected on the blockchain. This ensures vendors always access current information without delays, resolving the contradiction between reliability and update timing.
Solution Approach 2:
The system creates a copy of the coverage status data in the smart contract on the blockchain, which vendors can query without accessing the recordkeeper's primary database. This copy is kept synchronized with the original data through continuous updates, allowing vendors to validate coverage accurately while the recordkeeper maintains control over the source data. The copy enables fast access without compromising the integrity or security of the original system.
3Ease of operation
If individuals must provide proof of coverage at point of service, then coverage verification is ensured, but service access is delayed due to validation processing time
Solution Approach 1:
The patent replaces the traditional mechanical validation process (manual verification, batch processing, phone calls) with an automated blockchain-based system. Vendors query the smart contract directly via API, receiving instant validation results. This substitution of automated digital verification for manual processes dramatically reduces validation time while maintaining verification accuracy, resolving the contradiction between ease of operation and processing speed.
Solution Approach 2:
The smart contract enables self-service validation where the vendor system automatically queries and validates coverage status without human intervention. The blockchain network itself performs the verification, returning results instantly. This eliminates the need for manual validation steps and reduces processing time to seconds, making the process both easier and faster.
Data Source
AI summary
The Distributed Benefits Coverage Validation Apparatuses, Processes and Systems (“DBCV”) transforms provider info, add provider transaction request, employee subscriber ID card data datastructure/inputs via DBCV components into add provider transaction response, benefit coverage validation notification outputs. A benefit coverage validation request datastructure structured to specify subscriber ID card data associated with a beneficiary is obtained. A blockchain address of a smart contract associated with the beneficiary is determined via the subscriber ID card data. Encrypted benefit coverage data associated with the beneficiary is obtained by sending a blockchain transaction to the blockchain address of the smart contract. An encryption key corresponding to the encrypted benefit coverage data is obtained from a key management server. The encrypted benefit coverage data associated with the beneficiary is decrypted with the encryption key. The decrypted benefit coverage data is evaluated to determine a benefit status corresponding to a benefit provided by a provider.