AI Solutions for Healthcare

Re-think healthcare affordability and effectiveness

Fraud detection

Network management

Payment integrity

Clinical insights

Program integrity

Value-based performance

Learn more about Codoxo

Saving millions at world-class insurance companies and healthcare agencies including:

State Medicaid Agency

2+ million recipients

Southeast Plan

3+ million members

Midwest Plan

2.9 million members

Pacific Health Plan

700K+ members

Codoxo’s Forensic AI Platform protects your plan from unforeseen risks and costs

Every year billions of dollars are lost to fraud, waste and abuse in healthcare. With millions of claims coming in it’s hard to distinguish between appropriate care, a simple coding mistake, and intentional fraud. Artificial intelligence (AI) gives you a powerful way to detect new problems and take action to control costs – before they add up to a big hit on your bottom line.

1 billion

Claims processed
by AI

$500M

Identified savings
by Codoxo

%

Reduction in false positives

%

Increase in productivity

"Codoxo's Forensic AI Platform is a game changer.
AI is helping us identify, prevent, and stop potentially fraudulent activities earlier than ever.”
Highmark

– Kurt Spear, Vice President Financial Investigations and Provider Review

Codoxo_ProductStackDiagram_FINAL

AI Solutions for Healthcare

The Codoxo Healthcare Integrity Suite gives you a powerful way to detect new problems and take action to control costs with a full set of applications that help each team quickly research issues and get behavior-based context to inform and accelerate the best next step.

Resources

I

PODCAST

FNO: InsureTech Podcast

Check out our recent podcast with FNO: InsureTech on how healthcare fraud, waste and abuse is tackled with tech.
I

SESSION

Highmark NHCAA Session

Learn how Highmark and Codoxo collaborate on psychotherapy analytics and savings in this recent NHCAA training session.
i

Whitepaper

COVID-19 FWA Schemes Report

30 page special report on emerging COVID-19 related FWA schemes

FORENSIC AI PLATFORM

Our Forensic AI Engine analyzes your data, detects problems, and builds connections across your data to provide actionable insights

Insight Scope

For everyone across the health plan

Clinical Scope

For clinical teams

Network Scope

For network teams

Payment Scope

For payment integrity teams

Provider Scope

For network and payment teams

Fraud Scope

For SIU teams

SERVICES

We provide a full range of professional services, from data migration and ongoing customer success through flexible virtual SIU options.

Fraudscope is now Codoxo. LEARN MORE >