Becker's Healthcare January 31, 2023
Blue Cross Blue Shield of Massachusetts is using artificial intelligence to detect more fraudulent claims, an issue that costs the healthcare system billions of dollars every year and raises costs on health plan members.
The payers’ news service wrote Jan. 9 that the company has developed an algorithm that looks through its claims data and flags any suspicious activity before the claim is paid. While BCBS had a fraud detection program previously, it only reclaimed money after the claim was paid.
Potential fraud cases are detected by the algorithm and then uploaded to a dashboard for review. If there is an issue, the claim is frozen until a BCBS team can investigate. If the review is completed with no...
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