AI Solutions for Healthcare

Medicaid Agencies

Improve program integrity with AI analysis of your Medicaid encounters and claims

Whether your state has privatized Medicaid, or you run your Medicaid program centrally, ensuring members get the care they need while controlling costs is hard. You need to determine eligibility, establish first and second payer designations, and ensure that all claims and encounters you receive are legitimate.

Most providers are trying to provide the best possible care for every patient, but there are always a few who make accidental mistakes, and others looking for new ways to defraud your Medicaid program.  When you get thousands of claims a month, it is really hard to identify every problem and surprise costs can add up quickly.

That’s why we built the Codoxo Healthcare Integrity Suite – to help Medicaid agencies quickly identify problems and take action to control costs. The Codoxo Forensic AI Platform analyzes both your encounters and full claims and gives your teams behavior-based context and insights that simply aren’t possible with existing rules-based solutions.

Medicaid Plans

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 Medicaid agency leaders identify problems and take action to control costs. Using our AI encounters analysis and program integrity solutions Medicaid agencies achieve significant cost savings and run higher integrity programs.

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 Medicaid agancies.

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 >