AI Solutions for Healthcare

It’s our superpower to help our customers embrace change and reap the cost-saving benefits of innovative AI.

by Saurav Subedi, Director of Data Science

Codoxo is disrupting the status quo of healthcare cost containment. We empower our customers in their journey towards centralized cost containment programs by breaking down silos and improving transparency and alignment across different departments within their organizations. We build on an AI technology foundation, developed, and maintained through years of academic research and industry experience. We bring innovation to their core strategic payment integrity functions and help them realize a significant return on investment within short periods.

Across the company, we are driven to delight our customers and ensure their success. Our goal is to create long-term collaborative partnerships to improve, solve, and return meaningful savings constantly. We have built strong partnerships with healthcare payers, agencies, and PBM/PBAs over the past five years and are helping them envision and accelerate their evolution towards the future of healthcare cost containment. Codoxo has helped healthcare payers save more than $500 million through continuous innovation and agility in just a few short years.

Our solution applies the most effective AI, highly accurate and explainable, to look beyond traditional coding edits and target a widespread, highly dynamic world of Fraud, Waste, Abuse, and Errors. Our self-learning AI proactively identifies problems in their nascency and addresses them at various stages of claims processing and payment workflow before they become chronic, entrenched issues. In recent years, our customers have benefited the most from our solution by focusing their efforts at the post-adjudication, pre-payment stages, including longer-term provider education tools. Continuous monitoring for provider education and timely interventions is critical to maximizing savings and minimizing provider abrasion. We have received highly positive feedback from our clientele, particularly regarding our innovation, agility, and accuracy.

Not only is our customer feedback humbling and rewarding, but it also signals that a solution like Codoxo’s hasn’t existed in the market.

Jumpstarting greater transparency and savings

Most health insurers face a severe lack of visibility across teams, with siloed claims processing workstreams being a fact of life. Such deeply entrenched organizational constraints remain major barriers to stopping significant unnecessary costs in the industry.

Fortunately, a spark of progress is underway. Some innovative-minded healthcare payers are starting to realize the value of cross-team insight and collaboration. These innovators are establishing Payment Integrity Offices (PIOs) to ensure transparency and cohesion across claims processing activities and departments. These steps often correlate with moving claims data review upstream within pre-payment.

To eliminate this barrier, our platform doesn’t allow data to live in silos. It combines the many facets of claims data into a holistic view, identifying suspicious cases quickly and early in the process – avoiding or stopping financial losses before they create a big hit to the bottom line.

In a recent comparison study for a healthcare payer customer, we applied our Forensic AI Platform to analyze claims data that previously had been processed with multiple existing internal tools and manual efforts. Together we discovered that Codoxo’s platform, by itself, pinpointed suspicious claims during the pre-pay phase amounting to 97% of the dollar value lost downstream. In one upfront sweep, a single tool identified nearly all cases requiring post-pay recovery efforts. Furthermore, pre-pay intervention means more upfront savings and less provider abrasion and financial loss. This remarkable speed to insight motivates us to continuously push the boundaries of what’s possible with AI. Because as pre-pay intervention steps up, downstream recovery, provider abrasion, and financial losses are mitigated.

Turbocharging change in healthcare

About two-thirds of all recoveries still occur during post-pay phases. It’s time to turbocharge change, starting with placing more checks and balances early in the process.

Sophisticated AI payment integrity tools such as Codoxo’s Payment Scope, Provider Scope, and Audit Scope are doing just this by unifying teams with holistic and actionable views of claims data. They are also flagging claims upfront with speed and precision and guiding provider billing behaviors to remediate errors.

These groundbreaking payment integrity innovations bring us much closer to achieving what we all intrinsically desire – more affordable and effective healthcare.

Let us show you the way, and together we’ll make an impact. Join our movement.

View our recent video to learn more about Codoxo’s mission and our movement.

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 >