Bundled Payment Episode Administration Using Smart Contracts And Distributed Ledger
Payment administration systems and methods. A system includes first and second provider entities, a risk bearing entity, a distributed ledger and a payment manager application. The first provider entity provides at least a first step of the bundled treatment episode. The second provider entity provides at least a second step of the bundled treatment episode. The risk bearing entity approves the bundled treatment episode. The first and second provider entities and the risk bearing entity enter into one or more smart contracts related to payments for the bundled treatment episode. The distributed ledger enforces the one or more smart contracts. The payment manager application uses the distributed ledger technology. Each of the first and second provider entities send claims to the payment manager application. The payment manager application tags the claims as being part of the bundled treatment episode and approves the claims in accordance with the smart contracts.
Claim CLM-00001. 1. A payment administration system for administering payments related to a bundled treatment episode involving multiple providers, the system comprising:
a first provider entity for providing at least a first step of the bundled treatment episode; a second provider entity for providing at least a second step of the bundled treatment episode; a risk bearing entity for approving the bundled treatment episode, wherein the first and second provider entities and the risk bearing entity enter into one or more smart contracts related to payments for the bundled treatment episode; a distributed ledger for enforcing the one or more smart contracts; and a payment manager application using the distributed ledger technology, wherein each of the first and second provider entities send claims to the payment manager application, and the payment manager application tags the claims as being part of the bundled treatment episode and approves the claims in accordance with the smart contracts.
Claim CLM-00010. 10. A payment administration method for administering payments related to a bundled treatment episode involving multiple providers, the method comprising:
initiating a bundled treatment episode; approving the bundled treatment episode; establishing one or more smart contracts related to payments for the bundled treatment episode; providing at least a first step of the bundled treatment episode; providing at least a second step of the bundled treatment episode; sending claims related to the first and second steps; tagging the claims as being part of the bundled treatment episode; approving the claims in accordance with the smart contracts.
