Z K P 3 M E D I C A L C L A I M M A N A G E M E N T S Y S T E M C O R D A C O N T O K Y O

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1 Z K P 3 M E D I C A L C L A I M M A N A G E M E N T S Y S T E M C O R D A C O N T O K Y O

2 A B O U T e M A L I. I O emali.io was informally formed in March 2016 by two scientists headed by L. Ma, Ph.D. and incorporated in August The company s primary goal is to develop blockchain applications to solve real world challenges: FinTech, InsurTech and LegalTech industries. Currently, the team has 17 members, two-third are blockchain programmers and three Scientists (Ph.D.). Admitted to Hong Kong Science and Technology s Incu-Tech Program in April 2017 Designated a certified trainer on enterprise software firm R3 s Corda distributed ledger technology (DLT) platform. Co-organizer of R3 Corda Hong Kong Meetup Founding Member of Hong Kong Insurtech Association 1

3 e M A L I. I O s C o r d a I n i t i a t i v e emali is also actively engaging local universities and Law Society of Hong Kong to provide training courses and seminars in Blockchain: Technology, Business and Legal. emali is supporting Hang Seng Management College (co-operated by Hang Seng Management College and Hong Kong Blockchain Society) Hong Kong Polytechnic University City University of Hong Kong to set up Corda Training and Testing Laboratory. 2

4 Z K P 3 K E Y T E A M M E M B E R S Dr. Lawrence Ma Chief Scientist Currently CEO of emali.io, President of Hong Kong Blockchain and Committee Member of China s Central University of Finance and Economic s Da Xin Blockchain Research Center Expert Committee. Peter Woo Chief Strategist Peter is currently the Chief Strategist of emali and a vice president of Hong Kong Blockchain Society. He has previously worked for several international firms, including AT&T Asia China as the roles of Director and Managing Director of Doubleclicks Asia Pacific. (BA) Yale, (MS) Stanford and (PhD) Cornell in mathematics Dr. Au Man Ho Allen Chief Cryptographer Dr. Au is a consultant to emali. He is a professor at the Hong Kong Polytechnic University. Dr. Au is a pioneer in blockchain cryptography & a committee member of the ISO/IEC JTC 1/SC 27 working group 2 - Cryptography and security mechanisms. Brendan Ma Chief Product Officer A project manager, front-end developer & a multidisciplinary designer with an eye for pixel perfection. From working with tech startups to advertising agencies, Brendan has continued to see the completion of projects of various sizes with his problem solving & knowledge of the digital industry. 3

5 A C H I E V E M E N T S & H O N O U R S December 2016 First prize in the first AIA Blockchain Global Challenge Professional Category (entries from 19 countries and 30+ teams) and First and Second in the Student Category May 2017 Finalist at 2017 JumpStarter Fintech Semi pitch July 2017 Invited to present at HSBC Startup Night July 2017 Dr. Ma appointed president of Hong Kong Blockchain society. Peter Woo appointed vice president of Hong Kong Blockchain society. September 2017 Invited to showcase Medical Claim Management System at TechCruch Disrupt SF 2017 December 2017 Dr. Ma appointed Committee Member of China s Central University of Finance and Economic s Da Xin Blockchain Research Center Expert Committee November 2017 Finalist at DIT Hong Kong FinTech Awards 2017 (launched by Department for International Trade) Designated a certified trainer on Corda platform Jan 2018 Zurich Insurtech Challenge Finalist March 2018 Invited to present emali s Medical Claim Management System at R3 s CordaCon Tokyo 2018 Founding member of Hong Kong Insurtech Association 4

6 D L T H A S P O T E N T I A L I M P A C T A C R O S S T H E W H O L E V A L U E C H A I N O F I N S U R A N C E Product development and distribution Pricing / underwriting Payment & collections Claims Policy / administration and back offices Risk capital & investment management Potential Potential use cases Use DLT as a reliable registry for on-demand / usage-based insurance or micro-insurances Using DLT as payment infrastructure (especially across multiple countries) Leverage DLT for information about insured goods and events in order to fight fraud On boarding of new customers and verification of policyholder identity using DLT Make data available for re-insurers or other parties in a controlled way Potential use cases with smart contracts Offer P2P insurance via DLT for customers to customer promotion and sales, and automated ops with smart contracts Use DLT for P2P insurance underwriting, include external data, smart contacts and peers (human) to determine tariff Automate payments through smart contracts evaluating conditions for paying out claims Automate claims triggering and handling with smart contracts, and e.g., with sensors (IOT) Use smart contracts to automatically determine payouts e.g. triggering process of catastrophe swaps and bonds Key benefits Reduce cost related to commission and sales and operations Increase trust of customers due to open, distributed system Reduce cost of operations Re-use platform for other types of insurances Include external data for (semi-) automatic pricing Reduce cost and increase speed for payments Reduce average claims cost related to 1. Claims administration 2. Damage from multiple claim fraud and fraud detection Improve identification of claim events Reduced admin cost and speed-up process for onboarding Reduce admin costs Automate and increase reliability auditability and speed for financial instruments transactions based on defined events 4

7 D L T P L A Y E R S O F I N S U R A N C E S E C T O R START-UPS INSURERS OTHERS 5

8 C U R R E N T S T A T E & P A I N P O I N T S Current Hospital / Clinic Admission PAIN POINTS A lot of paperwork Requires TPA Current Hospital / Clinic Discharge / Payment Long manual claim process Over claim Current Claims Process for Reimbursement Double claim & fraud Needs patients to settle payment Proof of identity issue Health care records (ehr) not portable Areas of Inefficiency 7

9 W H Y D I S T R I B U T E D L E D G E R T E C H N O L O G Y ( D L T )? Today, each organization maintains its own ledger, which records that firm s view of its agreements and positions with respect to its customer set and its counterparts. Clinic / Hospital Insurance Company Clinic / Hospital Insurance Company This duplication leads to inconsistencies, driving the need for costly Action Action Action Action matching, reconciliation and fixing of errors. As a result, firms must continuously engage in the process of reconciliation. This is a manual, error-prone and time-consuming endeavour. Perception Perception Shared Perception = Truth Distributed ledgers are systems that enable parties who don t fully trust each other to form and maintain consensus about the existence, status Processing Processing Shared Processing Logic and evolution of a set of shared facts. Internet Shared Communication Introducing emali s ZKP3 Medical Claim Management System built using DLT NOW AFTER SHARED LEDGER 8

10 F U T U R E S T A T E & B E N E F I T S PATIENT CLINIC INSURANCE COMPANY POLICY ORACLE 1. Patient opens mobile app, submits medical & insurance info to clinic. 2. Patient receives treatment, clinic prepares claim template with billing information. 3. Patient and insured employee (for group policy) digitally signs claim & billing information. 4. Clinic submit claim to insurance company via CorDapp on ZKP3 System. 5. Receives claim, request policy information from policy oracle. 6. Use CorDapp on ZKP3 System to check if claim is valid 8a. Patient can claim with another insurance policy, process restarts & new claim is created 8. If claim amount exceeds billing 8b. Patient bares the exceeded amount 7. If claim is valid, automatically approved & status is updated for the patient & clinic / hospital. accept reject 9. If claim is invalid, patient can raise dispute to the regulator. BENEFITS TO INSURANCE COMPANY Automate Claim Process Reduces Paperwork & Due Diligence Reduces Manpower Reduces Fraudulent Risks 9

11 Patient uses identity management app (VEDA) to provide the clinic with his/her personal info & insurance policy. P A T I E N T O N B O A R D I N G A T T H E C L I N I C Ω All of the patient s information will be fully attested by the corresponding issuers. Patient simply scans QR code & authorizes the clinic to review his/her credentials. Patient & insurance info automatically passed to clinic web app after approval. 9

12 C L I N I C C L A I M P R O C E S S I N G Clinic uses web app (clinic sys) to prepare the claim form by entering patient info, diagnosis & billing information. Once submitted, patient will be notified to sign & approve the claim application. 10

13 P A T I E N T D I G I T I A L L Y S I G N S C L A I M Ω Patient can now review their claim info (diagnosis, billing & clinic remarks). If patient agrees with the claim application, he/she can digitally sign. Claim application is then passed seamlessly to clinic node then insurance company for approval. 11

14 S T A T U S U P D A T E F O R A L L P A R T I E S 12

15 I N S U R A N C E C O M P A N Y D I S P U T E H A N D L I N G In the case of dispute, insurance companies after review can change status of the claim if necessary. This change will be written back on the ledger. 114

16 C L A I M I S P L A C E S O N T H E D L T Claim status is placed on the distributed ledger and cannot be removed or tampered with 14

17 Z K P 3 M E D I C A L C L A I M S Y S T E M O V E R V I E W Client (employer + patient) VEDA Proof of Identity & Insurance Policy by patient to clinic Clinic Node 1 ZKP3 DLT NETWORK Regulator Node Insurance Node2 Claim Processing Module 1. Claim Approval using smart contact 2. Handles Disputes CLIENT SIDE INSURANCE SIDE Claim Processing Module 1. Verify patient s identity and eligibility to claim 2. Access patient info 3. Submit claim information via smart contract Distributed Notary Service Notary Node Network Map Node Certificate Authority Policy Oracle 3 Pass policy info to smart contract to validate claim 1 Multiple clinics may exist 2 Multiple insurance companies may exist 3 Each insurance company has its own policy oracle Door Man 15

18 Z K P 3 M E D I C A L C L A I M M A N A G E M E N T S Y S T E M COMPONENTS FEATURES Claim Approval/Rejection for patients in real time Easily adopted to handle other types of claim (travel, automobile etc) Claim Processing Module Privacy Protection- Participants within the network only see the information that is relevant to them. ZKP3 system will further enhance privacy by using zero knowledge proof Solves the Multiple Claim problem without sharing any details of patient (each insurance company will only know about its own policies used by a patient to claim at a particular clinic or hospital visit but it has no information about other insurance companies policies used by the patient to claim for the same visit) using zero knowledge proof VEDA Mechanism to handle claim dispute including revealing necessary information to regulator using the shared ledger ZKP3 Notary Network that guarantees the uniqueness of ledger updates (prevents double spending) is comprised of legal practitioners and authorised entities from different jurisdiction Notary Network Handle both group and individual policy Agnostic to underlying distributed ledger platform 17

19 M U L T I P L E C L A I M S It is not illegal for an individual to have multiple health insurance policies. If a person has more than one individual health policies or a group policy, he/she must ensure that all the insurers are aware of the other existing policies. This is to prevent an individual from making multiple claims and ending up making a profit. Multiple Claims can be resolved using a centralized solution each insurance company sends its claims to a trusted third party to check for multiple claims. Who would run this database? Who would own it? What would stop those jurisdictions abusing the mountain of sensitive information it would have? What if it were hacked? How would you manage access control? 17

20 D L T A P P R O A C H T O S O L V E M U L T I P L E C L A I M S P R O B L E M One key characteristic of distributed ledgers is that they offer a single view of shared facts. Client Privacy Issue An insurer would not want to leak any information of its client to other insurers. emali s solution to solve the client privacy issue: Say a client is making multiple claims. The first Insurer that receives the claim signs it with a special kind of signature and submit to a DLT. The special signature has the following: Whoever verifies the signature only knows that it has been signed by one of the members of a group but will not know which one. If required, the party who has made this special signature can prove that it is the one that has signed the claim. The second insurer who receives the claim will check from the DLT that the client has made a claim before. Moreover, the protocol can be designed in a way that checks whether the amount of claim so far exceeds the amount of the bill. The process continues with claims on the remaining policies. 18

21 D I S T R I B U T E D L E D G E R We are using R3 Corda Distributed Ledger which has the following properties: Distributed Ledger Technology (DLT) Designed to easily integrate with existing systems (SQL databases and message queues) Participants within the network only see the data that is relevant to them Built in Security and Scalability Designed to be fully integrated with legally enforceable agreements No single central store of data 19

22 D I G I T A L I D E N T I T Y M A N A G E M E N T S Y S T E M - V E D A VEDA stands for verification via Dependable Authorities, it is an extensive collection of personal identity information with varying degrees of confidence regarding legitimacy. VEDA provides the following services / features: One Time On-Boarding Only required to collect patient s information (personal & insurance policy) once. Self-Sovereign Owner of the personal identity information is able to control his/her identity attributes. Legitimacy of Client s Info Attestations of identity attributes of client (employer/patient) are digitally signed by authorities (e.g. policy info by insurers) Verification of Identity Attributes Clinics/Hospital can verify patient s attributes that have been attested by insurer.(e.g. checking whether patient is covered by a policy) Revocation of Attestations Revocation of attestation (e.g. client terminates policy or client leaves a company (group policy) can be effected on a real time basis Zero Knowledge Proof For privacy enhancement, patient may provide proof of identity attributes instead of the attributes for clinic/hospital to verify 20

23 A T T E S T A T I O N D A T A F L O W 2. Encrypted credentials 3. Pass encrypted creds 4. Pass encrypted creds 5. Decrypt creds & sign if accept APP 1. Pass credentials Crypto Library 9. Status update VEDA Server 7. Pass signed creds APP 6. Output signed Creds Crypto Library Holder s Terminal 8. Place signed creds Validator s Terminal DLT / BLOCKCHAIN

24 I N S P E C T I O N D A T A F L O W DLT / BLOCKCHAIN 6. Check that proof matches 7. Provide result 1. Create statement Crypto Library APP 10. Status update VEDA Server 9. Status update 5. Check statement proof 2. Generate statement Proof 3. Pass statement proof 4. Pass statement proof APP 8. Accepts or rejects result Crypto Library Holder s Terminal Inspector s Terminal

25 Z E R O K N O W L E D G E P R O O F Zero Knowledge proofs are generating excitement lately due to their potential for increasing privacy and security for DLT participants. It shows great promise as a way of enforcing honest behavior and ensuring that a transaction is valid (without revealing the actual purpose of the transaction or other sensitive details. Zero-knowledge proof capability is not, however, without its challenges Performance and the level of compute power required to support trust setup are still issues In October 2016, Zcash was launched using a zero knowledge proof protocol called zk-snark In October 2017, JPMorgan s Quorum introduced the first integration of a zero-knowledge security layer (ZSL) into its enterprise blockchain. In Nov 2017, ING unveiled its own zero-knowledge range proof, asserting that it is 10X more efficient than other options on the Ethereum network. 23

26 Z E R O K N O W L E D G E P R O O F Claim Prof. Bob Dr. Alice (proof) Accept / Reject Claim true Prof. Bob accepts but learns nothing Goldwasser-Micali Claim false Prof. Bob rejects (with high probability) -Rackoff

27 T H E U N I V E R S A L I T Y O F Z E R O K N O W L E D G E Theorem: Everything you can prove at all, you can prove in Zero Knowledge Goldreich-Micali -Wigderson

28 C R E D E N T I A L S MI6: British Intelligence James Service MI6 says Name James Address Birthdate Birthplace Citizenship MI6 says Name James Address Birthdate Birthplace Citizenship Reveals a lot of information about James 26

29 A N E W M O D E L : A N N O Y M O U S C R E D E N T I A L MI6: British Intelligence James Service Cred from MI6 Name James Address Birthdate Birthplace Citizenship I have a cred from MI6 saying BRITISH resident Age >21 Reveals only what James chooses to reveal Need not reveal his name (Need Accountability) 27

30 H O W I T W O R K S : A N N O Y M O U S C R E D E N T I A L MI6: British Intelligence James Service Cred from MI6 Name James Address Birthdate Birthplace Citizenship Zero Knowledge Proof I have signature from MI6 BRITISH #>21 Proof does not reveal Rest of message Signature 28

31 N O T A R Y S E R V I C E N E T W O R K ( N S N ) NSN is a permissioned notary network comprising of legal practitioners and authorised entities for notarising transactions in distributed ledger platforms, such as Corda. NSN provides the following services / features: Attesting Patient Credentials Verifying Transactions Prevents Double Spending 29

32 I M P A C T F O R S T A K E H O L D E R S CLIENT / PATIENTS AFFILIATED CLINICS INSURANCE COMPANIES Provisioning Insurance Policyholder provides require information for activation Identity & Personal Information is cryptographically protected and securely managed; Identity is uniquely paired with the phone and protected by public & private keys These information will be used but not stored Only required information will be passed based on relevancy Client information will be provided by Patients themselves Information are Authenticated Privacy is protected since information accessibility is authorized by patients only (Self Sovereign Identity) No more paper, Forms to fill and Documents to File; Records are hashed & protected yet transparent & Auditable Automate claim process Reduces paperwork & due diligence Reduces manpower Reduces Fraudulent risks Improve Data Access and Visibility Lower overall cost due to faster transactions and processes automated by smart contracts VEDA CLAIM PROCESSING MODULE CLAIM PROCESSING MODULE NOTARY NETWORK 31

33 P R O D U C T S : e M A L I Z K P 3 S Y S T E M S Clinics / Hospital ez-claim Policy Identity Management Fraud Detection Loyalty & Engagement Claim Settlement Report & Analytics Client Identity Management 31

34 M I L E S T O N E S Q3 Q4 emali is established Winner of AIA Global Blockchain Challenge with a proposal on Real Time Clinical Claim using Blockchain Q1 Q2 Prototyping of ZKP3 System using R3 s Corda DLT started Admitted to Hong Kong Science and Technology Park s Incu-Tech Program Q1 Q2 Beta Version of ZKP3 System (including VEDA) will be completed Launching of ZKP3 System Version 1 Q3 Prototype of ZKP3 System (ex VEDA component) completed Q3 Launching of ZKP3 System Version 2 (with zero knowledge proof) Q4 Prototyping of VEDA started Become an official partner of R3 Initiate a project with The Polytechnic University of Hong Kong on solving insurance multiple claim problem 32

35 S U M M A R Y emali s ZKP3 Medical Claim Management System is an end to end solution that addresses current pain issues in on-boarding admission, discharge/payment and claim process for reimbursement. ZKP3 System is built using distributed ledger technology which allows clinics/hospitals and insurance company to form and maintain consensus about the existence, status and evolution of a set of shared facts. Multiple Claim Problem is solved without sharing any details of patient/insuree. Patient/Insuree s privacy is fully protected by emali s proprietary ZKP3 s zero knowledge proof protocol. VEDA s Self-Sovereign Identity also streamlines on-boarding process. ZKP3 s VEDA uses cryptography to verify patient/insuree s identity and eligibility to claim. Codes (cryptographic protocol) and architecture of ZKP3 System are audited by independent industry experts. 33

36 T H A N K Y O U e. info@emali.io w EMALI.IO Limited. All rights reserved.