Transaction & settlement for healthcare.

Claims, premiums, and provider disbursement at scale. Institutional-grade reliability across payer, provider, and regulated health-tech.

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Overview

Transaction & settlement infrastructure for healthcare, built to the standard institutions in this sector are required to operate.

XVICA designs, builds, and operates this layer for healthcare clients in the UK, US, Canada, and Australia. The work is specified against the regulatory regime, the operational profile, and the examination expectations of this sector before any code is written.

01Why it matters

What healthcare cannot get wrong here.

A mis-adjudicated claim affects a patient, not just a line on a statement.
Payer-provider reconciliation cycles absorb clinical time that should be clinical work.
Data carried alongside payments is regulated health data, not commercial data.
Fraud typologies in healthcare payment are specific and evolving.

02Regulatory posture

Named regimes, mapped controls

Regulatory requirements are translated into explicit control requirements, then mapped to tests and evidence collection. Nothing is implied.

UK healthcare

NHS Data Security and Protection Toolkit, DCB0129 and DCB0160 clinical risk management, and NHS standard contract financial controls.

US healthcare

HIPAA privacy and security, HITECH, and the Affordable Care Act payment integrity requirements where applicable.

Data protection

UK GDPR and EU GDPR, with Article 9 special-category handling for clinical data and Article 30 records of processing maintained in-system.

03Reference architecture

Design decisions distinctive to this intersection

Components and design choices that recur across our work for this sector. Each deployment is specified individually.

Claim-aware ledger

The ledger understands claims, lines, and episodes — not just postings. Adjudication outcomes are inseparable from their financial effect.

Clinical-safety observability

Hazard log integrated with the monitoring stack. Anomalies that might affect a patient escalate differently from anomalies that only affect a statement.

PII/PHI segregation

Financial flows tokenise health data at the ledger boundary. Access to identifying data is brokered and audited.

Payer-provider reconciliation

Automated against remittance advices (835/820 equivalents) with exception workflow tied to case management.

Fraud patterns specific to health

Detection tuned to unbundling, upcoding, duplicate-claim, and phantom-provider typologies rather than generic payment fraud.

04XVICA's approach

How we work in healthcare.

Healthcare transaction work sits at the intersection of two regulated disciplines: regulated financial operations and regulated patient data. Neither tolerates the shortcuts the other might forgive. Our engagements start by separating those concerns in the architecture rather than in documentation: the financial ledger does not hold identifying clinical data, and the clinical record is not the source of truth for money. What crosses between them crosses through tokenisation and audited access. The practical consequence is that a finance team can reconcile without touching patient-identifiable information, a clinical-safety officer can investigate a hazard without access to the ledger, and an information-governance review does not need to re-audit both systems to approve one change.

05Engagement