AI Solutions for Healthcare

Federal Agency Healthcare Insurers

Improve transparency and control healthcare costs for your federal agency with innovative AI products

Whether you work for the Department of Defense, National Institutes of Health, or the State Department, or any of the hundreds of other federal agencies protecting the health and safety of your country, you need better tools and more transparency to successfully control your healthcare costs. Whether your agency covers millions of people, or you provide operational or policy oversight to state and or commercial entities, you need to ensure healthcare dollars go to healthcare. Most providers operate with integrity, but those few that make accidental mistakes on their claims, or commit fraud, can drive up your healthcare costs exponentially.

It is really hard to identify the problematic claims when patient care protocols are constantly evolving, and data is spread across so many systems. Spreadsheets, data warehouse reports, and rules-based systems alone aren’t enough anymore. These approaches don’t give your teams behavior-based insights or a way to identify new and emerging problems before they become big problems.

That’s why we built the Codoxo Healthcare Integrity Suite. Codoxo gives commercial, state and federal agencies an easier way to de-risk your health plan operations and improve program integrity with new innovative AI products.

Federal Agencies

We invest heavily in our people and our technology to help us push the boundaries of what’s possible.
We have helped achieve savings at world-class payers and healthcare agencies including:

Highmark

6+ million members

State Medicaid Agency

1.5+ million recipients

Southeast Health Plan

3.5+ million members

Pacific Health Plan

700k+ members

Mid-State Health Plan

3.5+ million members

Midwest Plan

2.5+ million members

We invest heavily in our people and our technology to help us push the boundaries of what’s possible.

We have helped achieve savings at world-class payers and healthcare agencies including:

Highmark

6+ million members

State Medicaid Agency

1.5+ million recipients

Southeast Health Plan

3.5+ million members

Pacific Health Plan

700k+ members

Mid-State Health Plan

3.5+ million members

Midwest Plan

2.5+ million members

Codoxo helps federal agency leaders identify new problems and act quickly to control healthcare costs. Using our Forensic AI claims analysis federal agencies can gain significant efficiency, transparency, and cost savings across your program.

Forensic AI Engine analyzes your existing claims data, identifies practices that intentionally or unintentionally waste money, and builds connections across your data to provide actionable insights.

AI analyzes all claim types and Codoxo can easily ingest all professional, facility, pharmaceutical, behavioral, dental, and workers comp claims.

Patented-AI analyzes all codes to identify issues and opportunities that may arise from complex claims and codes in addition to the standard ones which helps discover a wider range of existing and emerging problems.

Automatically and accurately detect existing and emerging fraud schemes with an AI-assisted solution for federal agencies.

Easy-to-use reports and queries democratize access to claim, provider, facility and member insights and gives everyone across your teams’ behavior-based context.

Gives network teams insights to engage with each group, plan and network and work with them to bring down costs.

Brings down costs pre-claim with unique provider and facility insights that can be shared with providers to show where their coding practices differ significantly from their peers.

Identify claim accuracy issues before claims are paid with patented-AI products for payment integrity.

Accelerate prior authorizations with AI-assisted reviews and integrity checks.

codoxo product diagram

AI Solutions for Healthcare

codoxo product diagram

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

– Kurt Spear, Vice President Financial Investigations and Provider Review
HIGHMARK

Ready for a better solution?

Request a demo to learn what we can do for you.

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 >