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Provider verification is an expensive prospect. Data also may be stored in multiple formats and locations, increasing the odds of PSV inconsistencies. Incorrect addresses or misspelled provider names may be entered. Adding another layer of inaccuracy is simple human error. Too many times, stale data causes payers to reject legitimate claims, angering the membership and damaging the payers’ reputations.
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What if that data update doesn’t reach all the different insurance companies his patients use?” “Say, for example, a doctor changes his office, opens a new branch, or joins another practice group. “Provider information usually gets stale,” Mandal explains. While PSV is essential, it is also fraught with difficulties that inspired Mandal to devise the NPI Coin solution. PSV also helps payers identify fraud, waste, and abuse. “Every payer organization needs to deploy PSV to validate that patients are visiting the right providers,” Mandal explains. Claims are settled and reconciled through an expensive, highly regulated process called primary source verification (PSV). healthcare, payers must manage contracts with providers and keep all provider information accurate and up to date. Mandal’s idea: Why not use blockchain networks and tokens to remove this friction? Part 1: Envisioning a blockchain solution for provider verification These changes can cause challenges that ripple through the healthcare ecosystem. Provider data changes frequently because doctors add certifications, switch employers, change their legal names, and so on. Providers are the clinicians, hospitals, and healthcare companies that diagnose and treat injuries and illnesses and transact business with health insurance companies (also called payers), and patients (also called the membership of payer companies).Ĭonfirming the accuracy of provider data is a consistent source of friction.
Instead, he focused on a slice of the challenge: provider data verification. healthcare sector, where spending of $4.1 trillion accounts for nearly one-fifth of U.S. Mandal needed a realistic proposal, as he could not take on verifying all medical data in the vast U.S. Mandal proposed using blockchain to confirm the accuracy of a specific subset of healthcare data. He drew on this background in recent MIT blockchain course that asked students to map out real-world use cases for blockchain technologies.
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Mandal also is an MIT-certified blockchain professional with many years of experience implementing healthcare technologies. IT system integrator that is helping clients develop blockchain solutions. NPI Coin was proposed by Alok Mandal, vice president of technology with a leading U.S. How automation helps: The processes and algorithms that simplify the inherent complexities of blockchain networks.īackground: Identifying a blockchain opportunity in healthcare.The roadblocks to implementation: The human and technical obstacles we must overcome to launch NPI Coin.How NPI Coin helps: The potential of a token-based blockchain network to address these pain points.Why we need it: The pain points that plague our current provider verification system.This proposal explores the potential of an NPI Coin ecosystem in four parts: With network effects, more entrants joining the NPI Coin ecosystem would drive more value over time. NPI Coin would be a medium of exchange that gives network users a strong incentive to participate. We propose an NPI Coin that applies this principle to provider verification. The most recognized example is Bitcoin, which awards coins to blockchain participants called miners who deploy computing resources to fulfill the network’s goals. In blockchain networks, tokens reward people for activities that encourage useful outcomes. Each clinician also has an NPI, making it a useful standard for vetting provider data across the healthcare ecosystem. Like a Social Security number for the healthcare industry, an NPI is a unique identifier for medical providers, insurers, and medical clearinghouses. Why call it NPI Coin? NPI means National Provider Identifier. How would this work? Through the implementation of a blockchain network using a token called NPI Coin to reward network participants. But innovations in cryptography and blockchain networking are clearing the path to more accurate and less costly provider verification. Unfortunately, provider verification tends to be complex, expensive, and error-prone. Patients need health insurance companies to match their medical needs with an approved provider to ensure that claims are paid. This is especially true in the domain of provider verification. The healthcare industry depends on elaborate, costly processes to keep healthcare data timely and accurate.
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