Audit Scope
Automates and streamlines end-to-end audit detection and workflow while ensuring compliance.
Codoxo’s Audit Scope platform is used by PBMs and healthcare payers to automate and streamline end-to-end audit detection and workflow while ensuring compliance.
Audit Scope provides seamless integration of detection, selection, audit creation, tracking and reporting of audits across all pre-pay and post-pay functions. When paired with Codoxo’s advanced AI detection technology such as that used in Codoxo’s Fraud Scope solution, healthcare organizations are able to create efficiencies and break down data silos to create a single view across all claims, audits, and departments.
Our Audit Scope solution is used across all functions of a PBM, state agency or Health Plan’s cost containment operations, including Compliance, Legal, Network, Clinical and Fraud, Waste, and Abuse teams. Audit Scope provides users and leaders with:
Rapid and accurate detection
Deep insights into reasons for detection,
Easy and intuitive review and selection workflow,
Client/internal contract and government compliance
Flexibility
Seamless transition from pre-pay to post-pay
End-to-end case management module for managing all aspects of an audit case,
Integrated communication capabilities including HIPPA compliant
AI analyzes
all claim types
Codoxo can ingest and analyze all professional, facility, pharmaceutical, behavioral, dental, and workers comp claims.
AI analyzes
all CODES
Our patented AI technology has the ability 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.
Audit Scope is built on our Forensic AI Platform and a part of the Codoxo Unified Cost Containment Platform
Our AI engine analyzes your claims data, detects practices that intentionally or unintentionally waste money, and builds connections across your data to provide actionable insights.
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
Ready for a better solution?
Request a demo to learn what we can do for you.
