Data Mining Services
Your Key to Uncovering Hidden Payment Integrity Opportunities
Codoxo’s Data Mining Services help uncover additional overpayments for recovery with precision and efficiency. Leveraging advanced AI tools, our payment integrity experts identify anomalies and outliers often overlooked by other solutions.
Health plans and state Medicaid agencies typically operate mature payment integrity (PI) processes, made up of an ecosystem of internal teams and vendors. However, over time, these traditional approaches develop blind spots leading to money being left on the table.
Codoxo’s AI-driven Data Mining Services enables payers and state agencies to remove these blind spots and uncover previously missed improper payment / overpayment opportunities which could yield millions of dollars in savings.
Combined with our ability to perform root cause analysis (so you’re not chasing the same dollars every month), your organization can act on PI opportunities that otherwise would have been missed and take proper corrective action to improve provider coding and billing practices.
Codoxo recently partnered with a leading national health plan who had built a mature payment integrity program supported by experienced internal teams, established workflows, and multiple vendor partners. While those efforts consistently identified and recovered overpayments, leadership recognized that even sophisticated programs can develop blind spots over time.
The organization sought an objective assessment of its historical claims data to answer a critical question: Were additional savings opportunities going undetected?
Codoxo analyzed multiple years of datasets across categories, representing 37M claims, 108M
claim lines, and $20B+ in paid claims.
Results:
Identified
$60M+ in payment integrity exposure
Validated
$30M+ in opportunities for additional review and potential recovery
Identified
multiple previously unidentified payment integrity concepts
Identified
opportunities to strengthen eligibility and
reimbursement policies root cause analysis
and actionable recommendations to help
prevent future overpayments
The longer you wait to act, the more you have to lose.
Schedule your AI Data Mining demo today.