Encrypted Provider Identifier Correlation in Medical Claims
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
The healthcare industry faces challenges in managing and reporting medical claims due to the large volume of submissions, with existing methods often providing inaccurate summaries of physician activities and violating patient and provider privacy through the use of identifiable information.
Innovation Solution
A system and method for collecting and providing information from medical claim transactions by encrypting provider identifiers, allowing for the correlation of claim transactions with provider information without revealing specific identities, using a central location with a database and encryption processes to match and associate encrypted data, ensuring compliance with privacy laws like HIPAA.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If provider identifiers are used to correlate claim transactions with provider information, then accurate reporting of provider activities is achieved, but patient and provider privacy is violated
Solution Approach 1:
The patent extracts the provider identifier from the claim transaction data and processes it separately through encryption. The encrypted identifier is then used for correlation, separating the identifying function from the privacy-sensitive original data, thus achieving accurate reporting without exposing actual provider identities.
Solution Approach 2:
The patent introduces an encrypted provider identifier as an intermediary element between the original claim transaction data and the provider information database. This intermediary allows correlation and accurate reporting while preventing direct access to actual provider identities, thus mediating between accuracy requirements and privacy protection.
2Object-affected harmful factors
If encrypted provider identifiers are used to maintain privacy, then patient and provider anonymity is preserved, but the ability to correlate claim transactions with provider information is compromised
Solution Approach 1:
The patent creates an encrypted copy of the provider identifier that preserves the correlation capability while protecting the original information. The encrypted identifier serves as a functional copy that can be used for matching and reporting without revealing the actual provider identity, thus maintaining correlation ability under privacy constraints.
3Ease of operation
If manual conversion tables are used to convert between identification codes and provider names, then provider identity information is accessible, but processing efficiency and productivity are reduced
Solution Approach 1:
The patent performs the encryption of provider identifiers in advance, during the initial data processing stage. This preliminary encryption action eliminates the need for manual conversion tables later in the process, as the encrypted identifiers can be directly used for correlation without requiring manual lookup or conversion, thus improving processing efficiency while maintaining information accessibility.
Data Source
AI summary
The present invention relates to a method and a system for collecting and providing reports of activities of medical service providers, while encrypting confidential information. Specifically, the present invention provides systems and methods for collecting and providing information from medical claim transactions without information for specifically identifying the particular medical service provider. The present invention also allows for correlation of medical claim transactions with providers' information without using information that can be used to specifically identify the particular medical service provider (provider identifier).