AI Solutions for Healthcare

Managed Care Plans

Improve healthcare and control costs with AI-assisted payer solutions

Whether you lead a large private health plan that covers tens of millions of members across states, a public plan serving Medicare Advantage and Medicaid options, or a smaller plan serving members of your community – controlling costs is critical for survival.

But accidental coding errors, constantly evolving medical guidelines, and evolving fraud schemes make it hard to control costs – especially when you’re dealing with a large volume of claims every month. Existing rules-based engines, spreadsheets, and data warehouse reports are not enough anymore. These approaches can only identify things your teams already know about, and they don’t give your teams any behavior-based context or insights.

That is why we built the Codoxo Healthcare Integrity Suite – to help payers identify and respond quickly to emerging risks and opportunities to control healthcare costs with AI-assisted solutions.

Featured Businesses

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 managed care plan leaders identify new problems and take action to control costs. Using our AI payer solutions managed care insurers achieve significant cost savings and run programs with greater integrity.

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 commercial health insurers.

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 >