AI Solutions for Healthcare

Union-sponsored Health Plans

Reduce health care costs for your union members with new AI-powered solutions

Ten million Americans get their healthcare through their unions. The Taft Hartley Act has done an amazing job of helping everyone from teamsters and teachers, to nurses and people working in the entertainment industry access healthcare at affordable prices through their unions. You give your members the opportunity to buy healthcare insurance at competitive prices and you need to do everything possible to protect against surprise costs to keep your healthcare costs as low as possible.

But it is especially tough for union-sponsored health plans because your members are widely distributed, and you get claims from providers and facilities all over the country. Spreadsheets, data warehouse reports, and rules-based engines simply can’t identify all the accidental mistakes, and intentional efforts to defraud your plan, that can add up quickly and hurt your ability to keep health costs low.

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

Taft Hartley Plans

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 helps union-sponsored plan leaders identify new problems and act quickly to control healthcare costs. Using our Forensic AI coding analysis platform Taft Hartley plans 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_ProductStackDiagram_FINAL

AI Solutions for Healthcare

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.

"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

Ready to get started?

Request a demo or talk to our technical sales team to answer your questions.

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 >