AI Solutions for Healthcare

Employer-sponsored Healthcare Plans

Reduce employee healthcare costs to improve company profitability

Self-insuring your employee’s healthcare can save large companies money, but also exposes your business to a lot of risk. An insurance company or third-party administrator may handle the administrative side for you, but your company is solely responsible for every healthcare dollar.

Even though you have a known pool of employees, predicting and controlling costs is still really hard for self-insured group health plans. While most providers and facilities are trying to do the right thing, there are always a few that make expensive coding mistakes. And your self-insured approach doesn’t protect you from those bad actors looking for new ways to defraud the healthcare system.

That’s why we built the Codoxo Healthcare Integrity Suite – to help companies similar to yours who self-insure their employees reduce healthcare costs and improve their profitability. The Codoxo Forensic AI Platform analyzes all employee healthcare claims and identifies problematic behaviors by providers, facilities, pharmacies, and dentists that can drive up costs unexpectedly. Our AI solutions for employee healthcare give you actionable insights so your healthcare teams or administrators can act quickly to control costs.

Approaches

Saving millions at world-class insurance companies and healthcare agencies including:

State Medicaid Agency

2+ million recipients

Southeast Plan

3+ million members

Midwest Plan

2.9 million members

Pacific Health Plan

700K+ members

Codoxo helps employer-sponsored health plan leaders identify problems and take action to control costs. Using our AI employee healthcare analysis solutions employer-sponsored plans achieve significant cost savings and run higher integrity healthcare programs for their employees.

Forensic AI Engine analyzes your existing claims data, identifies practices that intentionally or unintentionally waste money, and builds connections across your data to provide actionable insights.

AI analyzes all claim types and Codoxo can easily ingest all professional, facility, pharmaceutical, behavioral, dental, and workers comp claims.

Patented-AI analyzes all codes 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.

Automatically and accurately detect existing and emerging fraud schemes with an AI-assisted solution for employer-sponsored healthcare plans.

Easy-to-use reports and queries democratize access to claim, provider, facility and member insights and gives everyone across your teams’ behavior-based context.

Gives network teams insights to engage with each group, plan and network and work with them to bring down costs.

Brings down costs pre-claim with unique provider and facility insights that can be shared with providers to show where their coding practices differ significantly from their peers.

Identify claim accuracy issues before claims are paid with patented-AI products for payment integrity.

Accelerate prior authorizations with AI-assisted reviews and integrity checks.

Codoxo_ProductStackDiagram_FINAL

AI Solutions for Healthcare

The Codoxo Healthcare Integrity Suite gives you a powerful way to identify problems and take action to control costs with a full set of applications that help each team quickly research issues and get behavioral context to inform and accelerate the best next step.

"Codoxo's Forensic AI Platform is a game changer.
AI is helping us identify, prevent, and stop potentially fraudulent activities earlier than ever.”
Highmark

– Kurt Spear, Vice President Financial Investigations and Provider Review

Ready to get started?

Request a demo or talk to our technical sales team to answer your questions.

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 >