AI Solutions for Healthcare
September 2022 AI Alert

September 2022 AI Alert

Double-down on Single Diagnosis Care Management Codes   Care management services are defined as the management and support services provided personally by the physician or by their clinical staff (under the direction of a physician or other qualified healthcare...
August 2022 AI Alert

August 2022 AI Alert

Monkeypox Declared a Public Health Emergency – Coding Guidelines and Health Plan Preparation    On August 4, 2022, the USA declared monkeypox a public health emergency. On July 26, 2022, the American Medical Association (AMA) published the coding details for testing...
July 2022 AI Alert

July 2022 AI Alert

Dental Fraud, Waste and Abuse:A Billion(s) Dollar Problem   According to the National Health Care Anti-Fraud Association of the $250 Billion spent on dental care procedures annually nationwide, an estimated $12.5 Billion (or 5%) is lost to dental fraud, waste, and...
June 2022 AI Alert

June 2022 AI Alert

Educating your Pharmacy Network for Audit Preparedness   Pharmacies have always been a critical access point for healthcare information. A pharmacist is ever available to patients and offers free healthcare advice, thereby increasing access to the medical system at a...
May 2022 AI Alert

May 2022 AI Alert

Telehealth Place of Service Coding Changes The Centers for Medicare and Medicaid Services (CMS) recently made changes to The Place of Service (POS) code set. The POS code set provides setting information necessary to pay claims correctly. The CMS POS Workgroup revised...

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 >