Connect with us

Finance

Mastercard AI Modeling Capability Enhances Milliman Payment Integrity Solution

Feedzai

Mastercard® announced it recently completed a successful proof of concept coupling Mastercard’s artificial intelligence modeling technology with the Milliman Payment Integrity solution (MPI) to enhance detection of suspected healthcare fraud, waste, and abuse (FWA). Recognizing the value of this combined solution for their clients, Mastercard and Milliman have entered into a formal reseller agreement.

The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to healthcare fraud are in the tens of billions of dollars each year – with some government and law enforcement agencies placing the loss as high as 10% of U.S. annual health outlays, or more than $300 billion a year.

Milliman Payment Integrity is a multifactor, rules-based solution that audits health insurance claims to identify potentially inappropriate billing or providers engaging in FWA. Working with Milliman, Mastercard’s team of data scientists used its six-step AI model development process, AI Express, to develop three AI models that would leverage outputs from the Milliman Payment Integrity solution: a model to score provider-level risks, a model to evaluate claim-level risks and a combined model to evaluate the intersection of claims and providers.

The results were significant. Upwards of 80% of the claims identified by MPI from providers flagged by the AI model raised FWA concerns. When applied to a single mid-sized health insurance payer, the proof of concept identified more than $239 million in potential savings from 2,700 providers flagged for potential fraudulent claims.

“Mastercard’s solutions designed to make payment systems operate more efficiently also provide the same benefits to the healthcare industry,” said Raja Rajamannar, Chief Marketing and Communications Officer and President of Healthcare at Mastercard. “Milliman’s objectives were to enhance its existing rules-based payment integrity solution with non-discreet testing capabilities. Leveraging our proprietary technology to build a custom AI model helped them to do just that – provide enhanced fraud detection and operational efficiencies to improve their customers’ experience.”

“The Milliman Payment Integrity team is excited about the enhanced fraud, waste, and abuse detection capabilities we can now offer our clients through the Mastercard FWA AI model,” said David Cusick, a Milliman principal.  “Our proof-of-concept with Mastercard shows there is a very compelling value proposition when coupling our existing technology solution with Mastercard’s advanced AI and machine learning capabilities.”

Source: Mastercard

Continue Reading
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

Text Translator

Awards Ceremony

Click on the Image to view the Magazine


Global Brands Magazine is a leading brands magazine providing opinions and news related to various brands across the world. The company is head quartered in the United Kingdom. A fully autonomous branding magazine, Global Brands Magazine represents an astute source of information from across industries. The magazine provides the reader with up- to date news, reviews, opinions and polls on leading brands across the globe.


Copyright - Global Brands Publications Limited © 2024. Global Brands Publications is not responsible for the content of external sites.

Translate »