AI Usage at a Glance
Jan 1, 2019
Data AnalysisPractice documented: Blue Cross Blue Shield of Massachusetts uses an AI system, built in partnership with technology company iQuartic, that automatically ingests and scans millions of claims data points to identify billing gaps, miscoded procedures, and misdirected care. This system operates as an internal tool within the company's claims processing workflow.
Practice DocumentedView practice →Oct 12, 2022
ProductivityPractice documented: Blue Cross Blue Shield of Massachusetts tested an AI system called FastPass that automatically processed prior authorization requests for medical procedures, reducing approval times from an average of nine days to less than one day. The pilot ran at New England Baptist Hospital in 2022 in partnership with AI company Olive.
Practice DocumentedView practice →Jan 9, 2023
Data AnalysisPractice documented: During the COVID-19 pandemic, Blue Cross Blue Shield of Massachusetts used an AI algorithm to identify which of its members were at the highest risk of developing serious health conditions if infected with COVID-19, then routed those members to a team of nurse case managers for direct outreach and support.
Practice DocumentedView practice →Jan 9, 2023
Data AnalysisPractice documented: Blue Cross Blue Shield of Massachusetts uses an AI algorithm that scans claims data and flags suspicious billing activity before a claim is paid, enabling the company's fraud investigation team to review potential cases proactively. This system replaced a prior process that only recovered money after fraudulent claims were already paid.
Practice DocumentedView practice →Jan 31, 2023
Data AnalysisNew evidence: How BCBS Massachusetts is using AI to fight fraud
Evidence AddedView practice →Jun 27, 2024
Data AnalysisPractice documented: Blue Cross Blue Shield of Massachusetts uses an internal process of conducting 'equity audits' on all its AI-driven programs to check whether those models produce fair outcomes across its nearly 3 million members regardless of race or ethnicity. This practice is described by the company as an ongoing governance activity.
Practice DocumentedView practice →Jun 12, 2025
ProductivityPractice documented: Blue Cross Blue Shield of Massachusetts uses an intelligent automation program to automate internal business workflows, with the stated goal of freeing up employees' time for more complex work. The company maintains a dedicated Intelligent Automation team and has posted roles for engineers with robotic process automation expertise.
Practice DocumentedView practice →During the COVID-19 pandemic, Blue Cross Blue Shield of Massachusetts used an AI algorithm to identify which of its members were at the highest risk of developing serious health conditions if infected with COVID-19, then routed those members to a team of nurse case managers for direct outreach and support.
The company's data and analytics team built a predictive model that analyzed member health data to score COVID-19 risk levels. Members identified as high-risk were then contacted by Blue Cross nurse case managers who provided education and support resources. The company's chief data and analytics officer noted the model was a continuation of its broader use of AI to assist members and said the team planned to continue fine-tuning it.
Blue Cross Blue Shield of Massachusetts tested an AI system called FastPass that automatically processed prior authorization requests for medical procedures, reducing approval times from an average of nine days to less than one day. The pilot ran at New England Baptist Hospital in 2022 in partnership with AI company Olive.
FastPass used AI to cross-check a provider's prior authorization requirements in real time and, when authorization was required, matched the patient's electronic medical record clinical history against Blue Cross's medical necessity criteria to automatically generate a recommendation. For more complex cases requiring human review, the system automatically packaged and surfaced all relevant clinical documentation for the clinical review team. The pilot covered hip and knee procedures for 32 orthopedic providers over four months, and 88% of prior authorization submissions were processed automatically in real time.
Blue Cross Blue Shield of Massachusetts uses an intelligent automation program to automate internal business workflows, with the stated goal of freeing up employees' time for more complex work. The company maintains a dedicated Intelligent Automation team and has posted roles for engineers with robotic process automation expertise.
The company's careers site and a YouTube video produced by Blue Cross describe an intelligent automation program that applies automation tools — including robotic process automation (RPA) — to internal business processes. The company has an Intelligent Automation team responsible for developing, testing, and maintaining automated workflow solutions. Specific workflows automated by this program are not named in available public sources.
During the COVID-19 pandemic, Blue Cross Blue Shield of Massachusetts used an AI algorithm to identify which of its members were at the highest risk of developing serious health conditions if infected with COVID-19, then routed those members to a team of nurse case managers for direct outreach and support.
Blue Cross Blue Shield of Massachusetts uses an internal process of conducting 'equity audits' on all its AI-driven programs to check whether those models produce fair outcomes across its nearly 3 million members regardless of race or ethnicity. This practice is described by the company as an ongoing governance activity.
Blue Cross Blue Shield of Massachusetts uses an AI system, built in partnership with technology company iQuartic, that automatically ingests and scans millions of claims data points to identify billing gaps, miscoded procedures, and misdirected care. This system operates as an internal tool within the company's claims processing workflow.
Blue Cross Blue Shield of Massachusetts uses an AI algorithm that scans claims data and flags suspicious billing activity before a claim is paid, enabling the company's fraud investigation team to review potential cases proactively. This system replaced a prior process that only recovered money after fraudulent claims were already paid.
Blue Cross Blue Shield of Massachusetts tested an AI system called FastPass that automatically processed prior authorization requests for medical procedures, reducing approval times from an average of nine days to less than one day. The pilot ran at New England Baptist Hospital in 2022 in partnership with AI company Olive.
Blue Cross Blue Shield of Massachusetts uses an intelligent automation program to automate internal business workflows, with the stated goal of freeing up employees' time for more complex work. The company maintains a dedicated Intelligent Automation team and has posted roles for engineers with robotic process automation expertise.
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