A Blockchain-Based System for Secure and Transparent Healthcare Insurance Claim Authentication

Abstract

The healthcare and insurance industries face significant challenges in data authenticity, fraud prevention, and secure processing. This paper presents a blockchain-based insurance claim authentication system that ensures transparency, security, and efficiency. The system facilitates seamless interactions among hospitals, insurance companies, and patients using Ganache, Truffle, MetaMask, and Django. It leverages cryptographic methods, digital signatures, and smart contracts to validate transactions, thereby enhancing trust and minimizing manual errors.

Introduction

Advancements in blockchain technology have significantly improved data security, transparency, and automation, especially in healthcare and insurance industries where traditional claim systems face inefficiencies, fraud, and lack of transparency. This paper proposes a blockchain-based insurance claim authentication system that uses smart contracts and cryptographic techniques to automate and secure key processes like bill verification and policy validation.

The system, implemented using Ganache, Truffle, MetaMask, and Django, involves three main portals: Hospital, Insurance Company, and Patient. It ensures transaction integrity through digital signatures and cryptographic hashing, preventing data tampering and unauthorized changes. By decentralizing the claim process, it reduces intermediaries, minimizes human errors, speeds up verification, and fosters trust among stakeholders.

The literature review highlights blockchain’s benefits—decentralization, immutability, and tamper resistance—and its applications in combating insurance fraud, securing patient data, and improving interoperability in healthcare. Prior studies demonstrate blockchain’s role in fraud detection through real-time analytics and smart contracts, automating claims processing, and maintaining transparent, immutable records.

The proposed system’s core features include:

• Insurance policy management by companies,

• Bill processing and signing by hospitals,

• Cryptographic authentication of claims using digital signatures and hashes,

• Automated verification and policy coverage checks via Ethereum smart contracts.

Workflow steps involve hospitals submitting signed bills to the blockchain, smart contracts validating claims, and patients accessing verified claim statuses. The system ensures tamper-proof storage of all transactions.

Testing and evaluation show the system correctly approves valid claims and rejects tampered or fraudulent ones, effectively maintaining data integrity and speeding up the claim process. Each portal supports appropriate functions—submission and signing by hospitals, policy management and verification by insurers, and transparent bill viewing by patients—ensuring secure, efficient, and reliable insurance claim authentication.

Conclusion

The blockchain-based insurance claims system transforms traditional claim processing by eliminating manual checks, reducing fraud, and ensuring transparency through an immutable blockchain framework. By leveraging hashing and hospital signature authentication, it enhances data integrity while automating claim verification via smart contracts. This reduces human intervention, accelerates approvals, and improves efficiency for hospitals, insurance companies, and patients. Future enhancements include integrating layer 2 protocols for scalability, machine learning for fraud detection, and interoperability with healthcare systems for seamless data exchange. Real-time claim tracking and insurer communication will further streamline the process, making insurance claims more secure, transparent, and efficient.

References

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Copyright

Copyright © 2025 Shruthi. P, Divya Mallikarjuna, Uthpala V S, Harini Yalipi . This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.