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Kurt Speer

Kurt Speer

VP of Financial Investigation and Provider Review at Highmark Blue Cross Blue Shield; healthcare fraud detection and payment integrity expert.

Jul 16, 2026

4:19
But what are some of the types of things that AI is helping you spot, maybe a little more specific for listeners to understand the types of maybe fraud or abuse or other things that you're able to spot?
4:30
If I think about maybe going all the way from what I consider the left-hand side of claims errors all the way to the far right of true fraud scheme, I think AI is kind of used in each part of that from what I've seen.
4:45
From things like on the far left-hand side, you know, I mentioned ambient listening systems and coding systems using AI where...
4:52
These technologies are allowing providers to now capture member encounters, allow the clinicians to spend more face-to-face time with the patients, spend more time in an exam room versus charting their notes and their medical records.
5:08
So creating a lot of efficiency, I think from that perspective, all the way through from a payment integrity perspective, some of the ways that we've leveraged it over the past couple of years are things like natural language processing, which allows us to upload a medical record that maybe is a thousand pages in length and really highlight and call out some of the key areas that we need to focus on as part of our review.
5:34
So instead of having a clinician or a coder, you know, pulling up a claim and a medical record and kind of holding those things together and trying to go back and forth and figure out, hey, does the record match what's being put on a claim and where do I go in a medical record to find that information? Technology is allowing us to do that.
5:52
So it's allowing us to look at more claims.
8:57
Do you have any advice about guardrails and how to implement them in your organization?

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