Case Study: BlueCross BlueShield reduces medical and dental fraud with Codoxo Fraud Scope

BlueCross BlueShield health plan reduces medical and dental fraud, waste, and abuse

BlueCross BlueShield, a leading midwestern Blues healthcare payer, was losing significant money to medical and dental fraud, waste, and abuse, including mistakenly paid dental services billed under medical benefits. To better detect outlier billing behavior and protect its budget, the payer worked with Codoxo and its Fraud Scope platform, along with its analytics, medical, and dental teams.

Codoxo implemented Fraud Scope to analyze claims data, bridge medical and dental billing information, and identify erroneous and unbundled dental claims billed to medical insurance using AI. Within just a few weeks, BlueCross BlueShield was able to discover incorrect dental billing to the medical plan, establish best practices to prevent it in the future, and use the platform to uncover unbundling at both the service and provider levels, helping reduce dental FWA.

BlueCross BlueShield