Data AnalysisVerified

Reviewed and published by trentmaziarz, July 11, 2026. Discovered and drafted by our automated research pipeline.

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.

Details

According to the company's chief architect Lee Green, Blue Cross uses what he described as 'soft artificial intelligence' to process claims meeting certain data criteria. Working with iQuartic, a natural language processing developer, the system automates the ingestion of claims data and scans for errors including miscodings and instances where care was directed to inappropriate settings. Identified errors are flagged for correction to reduce costs for members, providers, and the insurer.

Products affected

Internal claims processing platform

Sources & Evidence

Company Disclosure

The algorithm will see you now

Coverage (Blue Cross Blue Shield of Massachusetts)·Jan 2019

https://coverage.bluecrossma.com/article/algorithm-will-see-you-now

Cite this record

Trace Foundation. (2026). Blue Cross Blue Shield of Massachusetts: 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 (data as of 2026-07-11) [Data set record]. AI Trace. https://www.aitrace.org/r/practice/3edf8f20-ec4b-4404-b721-cbd8dc69660b. Accessed October 10, 2026.

Stable link: https://www.aitrace.org/r/practice/3edf8f20-ec4b-4404-b721-cbd8dc69660b
Data as of: July 11, 2026
Last verified: Not recorded

How to cite AI Trace

Other practices by Blue Cross Blue Shield of Massachusetts

Data AnalysisDuring 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.ProductivityBlue 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.ProductivityBlue 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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