Innovation Project Summary Glimpse

Blockchain & Group Benefit Coordination

Many processes within the insurance industry are complicated and manual. Blockchain technology offers the opportunity to streamline these multi-party processes.

4
Weeks
4
Memebers

Toronto
2017
OCT - NOV
1
MVP
logo-cycle

Problem

How might we eliminate the complexity of the coordination of benefits paramedical claims process?

Streamlining manual and complex multi-party processes

WHY?

The Current COB Experience Pain Points

Customer
  • Not same experience across service providers
  • Pay up front and hope to be reimbursed
  • Claim submission required for each insurer
  • Confused about who to submit to first
Service Providers
  • Claim submission is complicated on paper
  • One online tool available
  • Need information on claim status
  • Customers asked to submit COB on their behalf
  • Want to provide claim submission as a service
Insurers
  • High costs related to low placement
  • Negative brand perception
  • Needs to validate EOB information
  • Customer mistakes cause unnecessary re-work
  • Second submission is often required  
  • High effort to evaluate and validate who the first insurer is
ADJUDICATORS
  • Negative brand perception
  • Needs to validate EOB information
  • Customer mistakes cause unnecessary re-work
  • Second submission is often required
  • High effort to evaluate and validate claims
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Discovery

What should this process look like in today's digital age?

How can policy holders have a more seamless process similar to dental claims?

Can policy holders submit data once and have the process automated between insurers?

blockchain2

SOLUTION

To encapsulate these innovations, the team created a new digital platform called "Road Runner" focused on accelerating the APS process.

The solution, named Clowder by the project team, is focused on eliminating the need for plan members (who have multiple health coverages) to re-submit their paramedical claim to the second & subsequent insurers by using Blockchain hyperledger fabric technology. In addition, Clowder is a proof of concept for how we can leverage Blockchain technology within the insurance industry.

This MVP enables a customer to submit a single claim, and have it adjudicated by two insurance providers.

blockchain2_1

In theory, any number of insurance providers and customers may be added to the solution. This would allow, for example, a single claim to be adjudicated by more than two insurers.

blockchain2_2
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ESTIMATED IMPACT

Brings improved data quality through new digital tools

Shares an immutable record of the claim across multiple insurers

Simplifies claim process and identification of primary payer for policy holder

GOB5

COB Cost

reduction

resulting from resubmissions and calls associated with error in customer COB claim process

GOB6

Fraud

reduction

due to reliable, standardized EOB documentation through blockchain implementation

GOB7

Claim Submission

simplifed, transparent, faster

ensures information consistency through collaboration

RESULTS

In this four-week sprint, the team aimed to design the minimum viable product (or MVP) to test with real customers.

5
Empathy Maps
34
User Interviews
66
Surveys
30
Wireframes
16
MVP Screens
3
Prototype Iterations
1
Innovation Report
2
Project Presentations
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