CASE STUDY
Midwestern Blues Health Plan
Leading healthcare payer educates providers and avoids pre-claim costs
with AI-based provider portal
A leading midwestern Blues healthcare payer sought to improve their payment integrity processes and reduce coding errors while minimizing provider abrasion. Having utilized Fraud Scope – Codoxo’s AI-driven fraud, waste, and abuse platform – since 2018, the healthcare payer saw an opportunity to address the rising costs associated with coding inaccuracies at the provider level by extending their relationship with Codoxo. Their goal was to engage providers pre-claim using AI to identify potential billing concerns early, preventing errors before claim submission and enhancing compliance.
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