Problems with Medical Claims that Artificial Intelligence (AI) and Blockchain Can Fix

Abstract

In medical insurance, there are both valid and legitimate claims that should be covered by the insurer and fraudulent or inappropriate claims that should not be paid. Problems arise in scenarios when valid claims are not paid and when fraudulent or inappropriate claims are paid.  Hospitals and insurers play critical roles in these cases. Artificial Intelligence (AI) and blockchain technologies can play significant roles in addressing the problems associated with medical insurance claims. Some of the ways in which these technologies can help are using AI algorithms to analyze data stored on the blockchain for fraud detection, and leveraging blockchain's transparency to improve the accuracy of AI models by providing access to a larger dataset. The author addresses approaches for each senario.