Provider Contract & Medical Policy Compliance
Ensure Adherence to Provider Reimbursement Policies and Contracts for Unparalleled Payment Accuracy and Stronger Provider Relationships.
Generative AI-driven solution streamlines and automates provider compliance monitoring and contract validation, ensuring accurate provider reimbursement while improving provider relationships.
Proactive Provider Billing Compliance Monitoring Prevents Payment Issues
Healthcare payers face a significant challenge: ensuring their provider networks stay current with evolving medical policies while maintaining compliance with contract terms.
Harnessing the power of generative AI, our market-leading contract and medical policy provider compliance solution automatically analyzes and interprets complex contract terms and reimbursement policies and transforms error-prone manual reviews into precise, consistent evaluations of claims against medical policies and contract terms.
By automatically validating complex requirements during post-submission review, we identify billing and payment errors, to enhance payment accuracy and proper reimbursement.
Reduce Compliance Errors by 99% – AI Makes It Possible.
Gen AI Brings Dramatic Efficiency & Accuracy To Provider Contract & Medical Policy Compliance
- Automated Compliance Monitoring: Real-time tracking of provider compliance metrics with proactive issue detection
- Provider Reimbursement Validation: Streamline payment processes by validating claims against current policies
- Medical Coding Accuracy Tools: Support accurate coding through automated validation and provider feedback
- Policy Change Detection: Continuously monitor and identify updates that affect provider billing requirements
Prevent Payment Issues with Proactive Provider Compliance
Validate Provider Compliance Automatically
Automate policy validation with generative AI that understands complex reimbursement terminology
Enhance Medical Coding Accuracy
Using AI-generated rules that surface payment errors
Scale Provider Compliance Monitoring
Across your entire network without increasing administrative burden
Reduce Provider
Abrasion
Through consistent policy application and transparent payment decisions
Improve Network Performance
With intelligent validation against current policy requirements
Explore Codoxo’s Full Solutions Offerings
Faster Compliance, Fewer Disputes, Better Healthcare Payments
application of provider contracts as compared to claim submissions to identify improperly billed/paid claims (from 90-180 days to 1-2 weeks)
Smarter Healthcare Cost Containment Starts With Codoxo
Codoxo’s Provider Contract and Medical Policy Compliance solutions are delivered through our Unified Cost Containment Platform, empowering healthcare organizations to take a seismic shift left by ensuring faster, more accurate claim payments, reduced fraud, waste, and abuse, and enhanced operational efficiency. By transforming the landscape of healthcare cost containment and payment integrity with industry-leading AI, Codoxo is at the forefront of making healthcare more affordable and effective.
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