Generative AI for Payment Integrity:
Harnessing AI Innovation to Future-Proof
Healthcare Payments

This whitepaper explores the groundbreaking impact of generative AI on the healthcare industry, particularly in the realm of payment integrity. With the release of OpenAI’s latest version of ChatGPT and the widespread adoption of large language models and transformer models, generative AI is poised to revolutionize healthcare by automating complex and time-consuming tasks, improving resource efficiencies, increasing accuracy, and lowering costs. This technology offers tremendous promise in the face of rising healthcare expenditures, slow technology adoption, worker burnout and shortages, and losses due to fraud, waste, and abuse. In this whitepaper we offer practical tips and best practices for leveraging generative AI to boost payment strategies and drive transformative change in the healthcare industry.

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FORENSIC AI PLATFORM

Our Forensic AI Engine analyzes your data, detects problems, and builds connections across your data to provide actionable insights

Insight Scope

For everyone across the health plan

Clinical Scope

For clinical teams

Audit Scope

For everyone across the health plan and PBM

Network Scope

For network teams

Payment Scope

For payment integrity teams

Provider Scope

For network and payment teams

Fraud Scope

For SIU teams

SERVICES

We provide a full range of professional services, from data migration and ongoing customer success through flexible virtual SIU options.