Give your teams an AI boost
Codoxo uses AI to help healthcare companies and agencies detect and respond quickly to problems and opportunities to control costs. Our powerful AI can uncover existing problems and detect emerging problems before they add up to a big hit on your bottom line.
Forensic AI Engine
Our AI engine analyzes your claims data, detects practices that intentionally or unintentionally waste money, and builds connections across your data to provide actionable insights. Codoxo can analyze all types of professional, facility, pharmacy, behavioral, dental and workers comp claims.
Analyzes professional, facility, pharmacy, behavioral, dental, and workers comp claims and identifies behavior patterns at every level – from individual claims and providers up through groups, networks and plans.
Our patented algorithm uses a combination of rules and artificial intelligence to identify new problems and outlier behavior earlier than traditional techniques.
AI measures and gathers your data to generate actionable insights that help teams prioritize, influence behavior, and act quickly when there is a problem.
Codoxo Healthcare Integrity Suite
We’ve built a full set of applications that help every team leverage AI-generated insights about your claims and take steps to control costs
Gives you comparative data for each healthcare group, plan, hospital, pharmacy, dental practice and provider in your network so your network team can go into every contract negotiation with the data you need to bring down long-term costs.
Compares each provider’s claims and coding practices to their peers, identifies outlier behavior, and proactively engages providers to improve claim integrity and bring down pre-claim costs.
Accelerates pre-authorization approvals for providers with strong integrity scores and flags requests that need a closer look based on recent provider behavior or emerging FWA schemes.
Proactively flags problematic claims and gives analysts an easy way to follow up on claims with pre-pay intelligence, easy-to-use claim workflow, and provider outreach automation.
Automatically detects new and emerging fraud schemes, streamlines collection of evidence chains, and gives SIU teams integrated case workflow for the investigations you choose to pursue.
Reduction in false positives
Increase in productivity
"Codoxo's Forensic AI Platform is a game changer.
– Kurt Spear, Vice President Financial Investigations and Provider Review
Saving millions at world-class insurance companies and healthcare agencies, including:
State Medicaid Agency
2+ million recipients
3+ million members
2.9 million members
Pacific Health Plan