How Highmark used AI, partnerships to save $245M in 2021

Highmark announced that its Financial Investigations and Provider Review department saved the payer more than $245 million by identifying and addressing potential fraud, waste and abuse in 2021. 

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The department uses artificial intelligence and partnerships with providers and regulators to flag factors that could result in avoidable losses. 

About $152 million in savings came from employer-sponsored insurance, $49 million from the Blue Card program, and the rest from Medicare Advantage, ACA and federal employee programs. 

$184 million came from billing or coding errors, fraud, waste or abuse, according to the payer. 

The department has saved the payer about $1 billion since being established in 2017.

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