Enhancing Privacy and Security in Healthcare Insurance Claims: A Blockchain-Based Decentralized Framework for HIPAA Compliance

Healthcare insurance claim processing traditionally relies on centralized clearinghouses, creating potential privacy risks through the inadvertent or malicious exposure of sensitive patient information. To address these vulnerabilities, this paper proposes a decentralized solution leveraging blockchain technology to replace the role of clearinghouses in the healthcare insurance claim process. Our approach enhances patient privacy by implementing a HIPAA-compliant system designed to secure data exchange and automate the claim process through distributed, immutable ledgers. We developed specialized data structures to store patient information, medical service records, insurance payments, and agreements, all maintained within the blockchain ledger for transparency and security. Smart contracts are defined to assure privacy and streamline claim processing, automating key steps while ensuring compliance with regulatory requirements. The framework was implemented using Hyperledger Fabric and evaluated for performance and response time, demonstrating a marked improvement in data integrity, security, and operational efficiency over conventional systems. This blockchain-based approach offers a scalable, secure, and privacy-centric solution, advancing the healthcare sector’s capacity for safe and efficient insurance claims handling.