Milliman asked Mastercard® Healthcare Solutions to build an AI model that would improve its fraud detection capabilities and improve operational efficiencies, with the potential to save millions of dollars in fraudulent or inappropriate claims to Milliman’s clients. This case study:
Walks through a six-step AI model development process
Identifies 2,700 high-risk providers
Identifies more than $230 million of recoverable claims paid, three times the results of its legacy fraud detection solution for the same data
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Milliman payment integrity and AI Express
Milliman’s Payment Integrity Tool and Mastercard’s AI Express Tool identified $239 million in healthcare fraud, waste and abuse.