STTR Phase I: CLEAR: Reducing Claims Denials in Healthcare Through Blockchain and Machine Learning

该小型企业创新研究（SBIR）项目的更广泛影响/商业潜力是围绕医疗保健系统中的利益相关者所使用的业务逻辑创建透明度，以做出交易决策，并围绕作为正在进行的工作的一部分的医疗保健交易的当前状态创建一致性。对于大多数与医疗保健系统互动的人来说，它或多或少像一个“黑匣子”，有时会做出违背逻辑和常识的决定。我们的目标是使用区块链和机器学习技术将这个“黑盒子”转化为“玻璃盒子”。“该项目的商业影响可能是通过消除冗余工作、返工和错误，为医疗保健提供者减少高达25%的索赔处理成本。STTR第一阶段项目提出了两项创新：1）通过区块链管理索赔交易和原因代码，以便提供商和付款人可以自信地了解索赔的准确状态，以及2）复杂的统计和深度学习算法，用于预测索赔拒绝的可能性，并对相关注释和上诉进行自然语言处理。我们的产品是一种数学驱动的软件服务，利用多种技术进行创新：区块链分布式账本，智能合约和代币，以及预测，推荐，预测，非线性优化和自然语言处理引擎，保护数据管理系统。该奖项反映了NSF的法定使命，并通过使用基金会的智力价值进行评估，被认为值得支持和更广泛的影响审查标准。

The broader impact/commercial potential of this Small Business Innovation Research (SBIR) project is to create transparency around the business logic used by stakeholders in the healthcare system to make transactional decisions as well as create alignment around the current status of healthcare transactions that are part of the work in process. To most people who interact with the healthcare system, it functions more or less as a "black box" with decisions that sometimes defy logic and common sense. Our goal is to use Blockchain and Machine Learning technology to convert this "black box" into a "glass box." The commercial impact of this project could be an up to 25% reduction in claims processing costs for healthcare providers by the elimination of redundant work, re-work and errors. This STTR Phase 1 project proposes two innovations: 1) claims transaction and reason codes managed through a Blockchain so that Providers and Payers can confidently know the accurate status of a claim, and 2) sophisticated statistical and deep learning algorithms for predicting the likelihood of a claim denial with natural language processing of associated notes and appeals. Our product is a mathematically driven software service that utilizes and innovates with multiple technologies: Blockchain distributed ledgers, smart contracts and tokens, and prediction, recommendation, forecasting, non-linear optimization and natural language processing engines within a privacy-preserving data management system.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.