AI Solutions for Healthcare
May 2023 AI Alert

May 2023 AI Alert

Psychiatrists Performing Psychotherapy Evaluation & Management (E&M) Services  Recently, several of our business partners expressed concerns with increased utilization by psychiatrists performing psychotherapy services and billing a high-level of...
April 2023 AI Alert

April 2023 AI Alert

Telephone E&M Services: When to “Make the Call” for Records Requests Telephone E&M services, specifically CPT (Current Procedural Terminology) 99441-99443, were infrequently utilized prior to the pandemic.  After a thorough analysis, Codoxo...
March 2023 AI Alert

March 2023 AI Alert

Take a deep breath when reviewing asthma treatments When reviewing asthma treatments, Codoxo noted high utilization of chemotherapy injections by Allergy & Immunology specialists in association with medications to treat eosinophilic asthma and severe asthma. The...
February 2023 AI Alert

February 2023 AI Alert

Gains and Losses with Weight Loss Prescription Drugs   Three weight-loss drugs are approved by the FDA (Food and Drug Administration) for persons with type 2 diabetes and obesity, and the names of the generic drug are tirzepatide, liraglutide, and semaglutide....
January 2023 AI Alert

January 2023 AI Alert

Coding and Billing for Audio-Only Delivered Services using Modifier 93   The healthcare industry has experienced significant growth and adoption of telehealth services over the past several years, and with it, a new trend of delivering audio-only services to...
December 2022 AI Alert

December 2022 AI Alert

Identifying outlier utilization of Synagis during the RSV season   Respiratory syncytial virus [RSV] is a common infection that usually produces mild, cold-like symptoms. Patients diagnosed with RSV and who have pre-existing respiratory issues or...

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

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