A New Payment Integrity Category at Point Zero: A Better Way to Contain Healthcare Costs While Improving Provider Experience

The U.S. healthcare system is at a breaking point.

Healthcare payers are managing overwhelming claims volumes, with fraud schemes and improper payments costing the industry billions in wasted dollars each year. According to industry data, the administrative burden associated with denied claims, reconsiderations, appeals, and resubmissions comes at an extreme cost – large healthcare payers incur an average of $250 per denied claim. With up to 13% of claims denied annually, the resulting financial toll ranges from $2.6 billion to $13 billion per year for a typical large payer. 

These inefficiencies negatively impact patients, payers, and providers alike—with higher premiums, claim denials, and strained payer-provider relationships. 

America’s healthcare system doesn’t just need a small tweak. It needs a fundamental reset.

At Codoxo, we knew there was a better way.

What if healthcare payers and providers worked in lockstep — before a claim was ever created?

Introducing Point Zero Payment Integrity: a point in time before claims are created, before unnecessary costs are incurred, before providers experience payment delays. 

Point Zero: Where Payment Integrity Begins Before Claims are Created

Point Zero Payment Integrity is a transformative model to shift payment integrity programs further left. Further than ever gone before. It’s the moment before a healthcare claim is even created.

Rather than reacting to errors after a claim is created and seeking payment recoveries, or flagging issues during prepayment review, Point Zero Payment Integrity shifts the focus further upstream to pre-claim provider education, working with providers to submit claims accurately the first time and avoid downstream abrasive payment accuracy activities.

Codoxo is bringing this vision to life at scale, introducing a new category of “pre-claim” payment integrity. 

The Power of Partnership: Reducing Friction, Restoring Trust

Imagine if providers and payers worked as partners in sustaining health and capping healthcare costs. At the heart of Point Zero Payment Integrity is a bold premise: payers and providers can collaborate.

When your payment integrity practices intervene before claim creation, the results are significant:

  • Fewer denied claims
  • Faster, more accurate payments
  • Reduced administrative burdens
  • Better provider experience
Point Zero Pre-Claim Provider Education Solutions

The Point Zero Payment Integrity approach focuses on critical unmet needs within payment integrity. It leverages advanced AI solutions to inform payers and educate providers with real-time benchmarking data for the most accurate claim creation possible:

  • Concept Ideation & Policy Development – A no-code generative AI interface helps teams rapidly identify payment gaps, ideate payment integrity concepts, and create reimbursement policies to contain costs.
  • Pre-Claim Policy Education – Targeted, personalized communication and education surrounding upcoming policy changes, helping providers sift through the noise of policy updates to focus on those that will impact them the most, while giving providers time to adjust coding practices before policies go live.
  • Pre-Claim Provider Coding Accuracy Education – AI-driven identification and detection of inaccurate coding that feeds automated provider education programs through preferred channels, enabling both providers and payers to avoid costly and abrasive downstream payment integrity activities.

We’re seeing this at work already. Health plans leveraging Codoxo’s Point Zero solutions have achieved:

  • $60+ PMPY across the payment spectrum
  • $12-16 PMPY in member savings 
  • 90% gains in workflow automation and productivity
  • Up to 40% reduction in overpayments
  • 20–30x increase in efficiency for SIU and PI teams​
  • 80%+ improved efficiency in claim review process
  • 10x more efficient emerging threats identification
This Isn’t Just Innovation. It’s Liberation from a Broken Model.

Codoxo isn’t improving the old model—we’ve built an entirely new approach to payment integrity. One that prioritizes prevention over correction, education over enforcement, and partnership over policing.

The choice now lies with the industry: continue down a path of fractured relationships and unsustainable costs—or join the movement toward a better way.

We invite you, leaders in payment integrity and cost containment, to be part of this shift.  The choice is yours.

Learn more about Point Zero Payment Integrity.