Abstract: In an embodiment, systems and methods for reviewing payments using artificial intelligence are provided. Training data is collected that includes payments made by insurance payors for claims received from medical providers. The payments may have been verified as correct and include metadata about the associated claim such as the medical service and whether the claim was in or out of network. The training data is used to train a model that predicts a payment amount for a claim from a medical provider for an insurance payor. When a payment is received, the model is used to predict the payment amount for the payment. The predicted amount is compared with the actual payment amount and is used to determine if the payment is anomalous. If the payment is anomalous, it is provided to an auditor who checks the payment for compliance with a contract between the payor and the provider.

Abstract: A method includes receiving information associated with a stimulus, the information associated with the stimulus comprising first information associated with a medical claim for services provided to a patient and second information associated with a provider that provided the services to the patient; and predicting, using an artificial intelligence engine, when an event will occur in response to the stimulus.