AI Solutions for Healthcare

Audit Scope

Automates and streamlines end-to-end audit detection and workflow while ensuring compliance.

Codoxo Network Scope
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, health plans, state agencies and Pharmacy Benefits Management (PBMs) 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

of potential claims and/or providers for audits when paired with Codoxo’s Fraud Scope, AI-based fraud detection solution and rules-based algorithms

Deep insights into reasons for detection,

including peer-to-peer comparisons, provider performance, and claim level details

Easy and intuitive review and selection workflow,

allowing auditors to drill into each provider or claim and quickly identify and collect supporting claims to add to audit queues

Client/internal contract and government compliance

across state, federal and client-defined requirements

Flexibility

for audit team to create AI-detected, rules-based or manual audits

Seamless transition from pre-pay to post-pay

End-to-end case management module for managing all aspects of an audit case,

including notes, supporting documentation, provider communications, financials, recoveries and reporting

Integrated communication capabilities including HIPPA compliant

email, fax and postal mail

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 Healthcare Integrity Suite

Codoxo_ProductStackDiagram_NetworkScope

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.

Codoxo_ProductStackDiagram_NetworkScope

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.

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

Audit Scope

For everyone across the health plan and PBM

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 >