AI Solutions for Healthcare

When it comes to protecting healthcare dollars, working closely with customers is paramount

By Rena Bielinski, Vice President of Customer Success at Codoxo

Without question, fraud, waste, abuse and errors remain a grim constant in healthcare today. That’s why being a step ahead of fraud schemes is the best way forward. It’s time for all healthcare organizations to be equipped to battle emerging fraud schemes before they’re fully robust and identified.

This is hugely important. A decrease in the time it takes to identify fraud, waste and abuse leads to an increase in savings. This is Codoxo’s purpose. We provide healthcare payers with the right data and insight to dramatically reduce and control needless and avoidable costs.

But we’re much more than the innovative AI technology that helps us do that. Being non-traditional and future-focused, Codoxo is leading a movement to disrupt the status quo in the quest to inspire long-term change. Our customers are joining us, as we help them glimpse what’s possible and build toward it, together.

Creating a culture of collaboration

Across Codoxo, we’re driven to delight our customers and ensure their success. It’s our goal to establish collaborative long-term partnerships with our clients so, together, we can constantly improve, solve and return meaningful cost savings.

We strive to understand every detail and facet of our customers’ organizations and business models. As an Accredited Healthcare Fraud Investigator (AHFI), and having earned my Doctor of Pharmacy degree from the University of Illinois College of Pharmacy in Chicago (UIC), my role is focused on understanding the nuanced details of payer claims data, especially what’s right and what’s not.

With the right teams to manage each customer’s specific implementation, we can better understand what they are looking for and deliver what they need. We are always asking: Are we getting the data we need? Is it accurate? Is it helping you meet current objectives? What are your newest challenges?

Knowledge sharing every step of the way

And as a company, we believe that sharing knowledge and best practices with our customers is vital. For example, our monthly Forensic AI Alerts detail the latest billing schemes, such as the newest alert on important Covid-19 vaccine updates. This is one reason why our clients consider us experts – not just about our own AI platform, but in the healthcare industry as a whole.

(If you have a moment, check out one of my favorite recent alerts – Foot Baths are Afoot – that talks about one of last summer’s newest emerging schemes within healthcare prescription fraud. It’s an older scheme that resurfaced during the pandemic).

We listen then work together to push the boundaries of what’s possible

The COVID-19 pandemic has presented our clients with new and unexpected challenges. Lost employer group memberships, the decline of elective procedures, a shift from in-office to online visits – all of these have had a tremendous impact on costs. And they have thrown the door wide open for new, rampant fraud and abuse opportunities. Some of these changes – like the rise of telehealth – have also accelerated what were slower-moving trends.

Listening closely to our customers talk about the issues they are dealing with helps us make sure that they – and their employees and clients – are getting the insights they need to make healthcare more affordable and effective for everyone.

Together, we see a better way. And that’s what the Codoxo movement is all about.

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

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 >