Highmark Maximizes Medicare Revenues With SAS

Overview

With the ever-increasing cost of healthcare in the United States, providers and insurers can't afford to under-report potential risks associated with their Medicare/Medicaid patients. Otherwise, they risk losing money when they provide necessary services that might not be related to the initial diagnoses reported to the Centers for Medicare & Medicaid Services (CMS). That's why Highmark relies on SAS Enterprise Miner to build decision trees that map all of the possible outcomes a patient faces based on measures such as symptoms, health history and demographics. Called the Security Blue Reimbursement Model, the application looks for patients who are potentially under-diagnosed for up to 13 conditions and prioritizes them based on risk.