Healthcare: adjudicated means paid

A provider's cash waits between the claim decision and the money: adjudication, then a payment run, then clearing, then matching a remittance advice to a deposit, which can take days to weeks. On a PulseVM network shared by payer and provider, adjudication and payment are one transaction, final in about a second, and both sides read the same record.

Adjudicate, then pay versus adjudicate equals pay

Step	Typical today	On a shared PulseVM ledger
Claim submitted	Clearinghouse forwards the claim to the payer	Provider records a claim reference and file fingerprint under stmary.hosp@billing
Adjudicated	Payer decides; result sits in the payer's system	Payer's engine calls claims.adj::adjudicate under bluepl@adjud
Paid	Next scheduled payment run, then bank clearing: days to weeks from decision	Same transaction as the decision: allowed amount moves to stmary.hosp, final in about a second
Reconciled	Provider matches a remittance advice to a bank deposit, chases mismatches	Nothing to match: decision, amount and payment are one record
Audited	Sampled from each party's systems, weeks later	Read the ledger directly, any time

How it works on PulseVM

Account	Role	Permission that matters
bluepl	Health plan (payer)	owner and active held by finance officers, 2 of 3; active funds the payer's settlement balance
claims.adj	Settlement contract	Holds each payer's funded balance; checks the claim and pays the allowed amount inline with its pulse.code grant
bluepl adjud permission	Adjudication engine's key	Linked to claims.adj::adjudicate only; per-claim cap and daily budget in the contract
bluepl review permission	Clinical and finance reviewers	2 of 3 reviewers, linked to claims.adj::override for claims above the cap
stmary.hosp	Provider	billing permission linked to claims.adj::submit; can post claims, cannot move money
exam.audit	Auditor	No keys on anyone's account; read access to the network's history

The payer stakes the network resources for its providers, so a clinic joins without buying a token.

Who can see what

A PulseVM network is private to its members; visibility is decided by who is admitted and by what you put on chain (privacy).

	Claim reference, fingerprint, amount, status, signer	Clinical record, patient identity
Payer	Reads the full ledger	In its own systems, as today
Provider	Reads the full ledger of its network	In its own systems, as today
Auditor	Read access granted by the members	Requested through existing channels

To keep one provider's volumes away from another, run a network per relationship or encrypt payloads at the application layer. Health data itself stays off chain in every design.

Delegated authority: the adjudication engine

Auto-adjudication is where most volume is decided, so the engine's key is the one to fence in. It sits on the adjud permission, linked to one action. The contract enforces a per-claim cap and a daily budget; above the cap, the claim waits for the review permission's two signatures. The engine cannot transfer funds, add a payee or change a permission. It is the same pattern live on XPR Network for trading bots; see the delegated authority case study.

Frequently asked questions

Does patient health information go on the ledger?

It should not. The design keeps clinical records and patient identifiers in the systems that already hold them. The ledger carries a claim reference, a fingerprint of the claim file, the allowed amount, the status and who signed each step. That is enough to settle and audit the payment without putting health data on any chain.

How does adjudicate equal pay?

The adjudication action and the payment are one transaction. When the payer's adjudication engine approves a claim, the settlement contract pays the allowed amount from the payer's funded settlement balance to the provider's account in the same step, final in about a second. There is no separate payment run and no remittance file to match to a deposit.

Can an automated adjudication engine pay claims without a person?

Within limits you set. The engine's key sits on a permission linked to the adjudicate action only, and the contract enforces a per-claim cap and a daily budget. Claims above the cap route to a human review permission that needs two reviewers. The engine's key cannot transfer funds or change any permission.

Can we use this with real claims today?

Not yet. PulseVM is at the test-network stage, and pilots with synthetic or de-identified claims are run with Metallicus. The account and permission model underneath runs in production on XPR Network.

Next step

Start with one payer, a few providers and a de-identified claim set, and measure decision-to-cash on a test network. Talk to Metallicus →