Case Study: Highmark Blue Cross Blue Shield identifies millions in new active cases with Codoxo AI Solutions

Highmark Identifies Millions in New Active Cases With AI-Powered Provider Analysis from Codoxo

Highmark Blue Cross Blue Shield, one of the largest health plans in the U.S., needed a more advanced way to detect new and evolving fraud, waste, and abuse patterns in post-pay provider claims. Its Financial Investigation and Provider Review team relied on traditional rules-based systems, but wanted better visibility into emerging billing issues that could create significant financial risk.

To address this, Highmark implemented the Codoxo Forensic AI Platform to analyze all post-pay provider claims and support weekly issue prioritization by a dedicated ideation team. Codoxo’s AI has already identified millions of dollars in cases that Highmark is actively investigating, and the health plan plans to extend the solution into the pre-pay stage to accelerate reviews and catch potential FWA earlier.

Highmark Blue Cross Blue Shield

Kurt Spear

Vice President of Financial Investigation and Provider Review