Abstract
The current model of healthcare insurance claim adjudication faces significant challenges, in particular fraudulent claims which significantly strain the economy. This paper introduces a novel approach that integrates Data Aggregation, Artificial Intelligence (AI), and Blockchain technologies to enhance the efficiency of healthcare claim adjudication. We present in this study an initial framework that integrates an AI-enhanced smart contract at the data aggregation level. A new concept that enhances the existing smart contract models commonly discussed in blockchain-related insurance literature. Our primary goal is to improve fraud detection and maximize the use of extensive data generated within the insurance ecosystem for prediction, learning, and strategic planning. The concept of an AI-data aggregation-level smart contract, introduced here, holds promise for broad application across various blockchain platforms, not limited to our discussion on healthcare claims insurance adjudication.
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