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.
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.