Integrating AI to Help Improve Your Blue Cross Experience

Navigating the healthcare system can be challenging. Often times, it involves complex questions, stressful experiences, or life-changing decisions. At Blue Cross and Blue Shield of Minnesota, we strive to show up for members as a trusted resource in each of these moments. 

We believe responsible and transparent integration of Artificial Intelligence (AI) tools can give our teams even more time and insights to focus on what matters most - like listening, problem‑solving, and ensuring everyone gets the care they need. 

"Whether we're helping to coordinate care across multiple appointments or reviewing authorization requests from doctors and hospitals, I always say our teams are meeting members in some their most vulnerable moments," said Emily Griese, Vice President of Clinical Operations. "That might be when someone has just returned home from the hospital, received a bill, and a case manager is reaching out to support them. In those moments, having a human connection really matters. The question is: how do we use AI to remove barriers, so our teams can connect with members in more meaningful ways?"

From productive call center interactions to quicker prior authorization approvals, we’re using AI across many areas of our organization to improve the healthcare experience for our members.

Proactive care through predictive insight

Health outcomes can improve when we can see risks as soon as possible and act quickly. That's why we are leveraging AI to create more robust predictive capabilities. Early identification of possible health risks allows us to step in with timely updates and guidance for the member. This can take the form of connecting them to the right resources, care programs, and preventive services, all at the right time. 

Getting to a faster “yes”

Prior authorization plays an important role in healthcare by ensuring patients receive the most effective, evidence‑based care at the right time and place. By confirming that treatments are covered and appropriate, it helps lower out‑of‑pocket costs for members and keeps premiums more affordable for everyone. 

By using past claims history to spot patterns and automate parts of the prior authorization process, new AI tools enable approvals to happen faster, helping members get the care they need sooner. 

Importantly, if the data doesn't indicate clearly that a request should be approved, a licensed clinician reviews the case and decides the appropriate action. At Blue Cross, we do not use AI for prior authorization denials.

Today, 65% of qualified prior authorization requests are approved in near real time, helping members and providers move forward with less delay. 

Conversations that put the focus on care

While many of our AI tools support members directly, we’re also implementing AI behind the scenes to help our teams better support our members.

For example, we are transforming our call center capabilities with live call transcriptions and automatic summaries. This means our service representatives spend less time taking notes and more time focused on solving problems in real time for the caller. 

New AI tools also help our member service teams by providing a clear summary of the member’s healthcare situation based on claims data, helping to provide explanations that are easy to follow during moments that may already feel overwhelming.

Susie Cebulla, Vice President of Operations Member Services, sees these AI tools as a foundation for what comes next.

"When you think about transcription, for instance, we see a future where real-time knowledge articles surface during the conversation, helping our associates answer questions more easily," Cebulla said. "And with real-time claims information, we can now demonstrate and share that information with members in different ways. 

Another example is a new AI solution that summarizes the members’ previous three to five calls, allowing our care managers to quickly understand the situation and get to the core issue, saving six minutes per call on average.

Together, these tools ensure our teams have the right information at the right time, so members always receive a personalized and care-focused experience. 

AI for a healthy future

Blue Cross believes AI should make healthcare feel more human. By supporting our members and employees with better tools, we are creating space for personalized care and an improved healthcare experience for members. 

Learn more about the other tools we use to support members, including solutions like Blue Care Advisor.