AI Solutions for Healthcare

Disrupt the status quo of
unsustainable healthcare costs.

The most effective AI cost containment solution.

Protect your limited healthcare dollars with the most powerful, effective AI in the industry. Our forensic platform helps healthcare companies and agencies quickly and accurately identify existing and emerging problems and ensure payment integrity in ways our competitors cannot.

Codoxo’s powerful forensic platform can uncover fraud, waste and abuse issues to help you respond quickly before they add up to a big hit on your bottom line. That’s seeing tomorrow, today.

Deep Academic
Roots

The most
Effective AI

Constant
Innovation

Proven
Performance

Speed to
Implementation,
Detection & Insights

The Codoxo Difference

Codoxo’s powerful forensic platform can uncover fraud, waste and abuse issues to help you respond quickly before they add up to a big hit on your bottom line. That’s seeing tomorrow, today.

Deep Academic
Roots

The most
Effective AI

Constant
Innovation

Proven
Performance

Speed to
Implementation,
Detection & Insights

The Codoxo Difference

Smarter. Faster. Better.

Developed from the ground up for healthcare cost containment, Codoxo’s forensic AI platform can predict and identify fraud, waste and abuse schemes and ensure payment integrity before your bottom line takes a hit.

The platform is designed to be up and running in weeks, not months, and will delight users with an intuitive, easy-to-use interface. Better yet, cost containment efforts across your payment spectrum can be unified with a single platform.

– J.R. Trevino, Manager, Special Investigations Unit
DRISCOLL HEALTH PLAN

– J.R. Trevino, Manager,
Special Investigations Unit
DRISCOLL HEALTH PLAN

All-in-One Forensic AI Platform

codoxo product diagram

Holistic. Transparent. Collaborative. Codoxo delivers a complete suite of solutions delivered on one AI platform, enabling users across the entire payment spectrum to collaborate and gain visibility and transparency, all on the same claims data.

Users across cost containment departments will have a unified view that eliminates gaps, creates efficiencies, builds connections across your data, and provides more transparent, actionable analytics.

Behavior-Based Analysis

Analyze professional, facility, pharmacy, behavioral, dental, and workers comp claims and identify behavior patterns at every level – from individual claims and providers up through groups, networks and plans.

Detection Engine

Our patented algorithm uses a combination of rules and artificial intelligence to identify new problems and outlier behavior earlier and more accurately than traditional techniques.

Prescriptive Insights

Our proprietary AI measures and gathers your data to generate actionable insights that help teams prioritize, influence behavior, and act quickly when there is a problem.

All-in-One Forensic AI Platform

codoxo product diagram

Holistic. Transparent. Collaborative. Codoxo delivers a complete suite of solutions delivered on one AI platform, enabling users across the entire payment spectrum to collaborate and gain visibility and transparency, all on the same claims data.

Users across cost containment departments will have a unified view that eliminates gaps, creates efficiencies, builds connections across your data, and provides more transparent, actionable analytics.

Behavior-Based Analysis

Analyze professional, facility, pharmacy, behavioral, dental, and workers comp claims and identify behavior patterns at every level – from individual claims and providers up through groups, networks and plans.

Detection Engine

Our patented algorithm uses a combination of rules and artificial intelligence to identify new problems and outlier behavior earlier and more accurately than traditional techniques.

Prescriptive Insights

Our proprietary AI measures and gathers your data to generate actionable insights that help teams prioritize, influence behavior, and act quickly when there is a problem.

1 billion

CLAIMS

PROCESSED

$500M

IDENTIFIED

SAVINGS

%

REDUCTION IN

FALSE POSITIVES

%

INCREASE IN

PRODUCTIVITY

Codoxo Healthcare Integrity Suite

We deliver a full set of applications that help every team leverage AI-generated
insights about your claims and take steps to control costs.

Fraud scope

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.

Payment scope

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. 

Provider scope

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.

Insight scope

Gives everyone across the health plan an easy way to research issues with self-service reporting and querying of claim, provider, facility and member behavior.

Network scope

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.

Clinical scope

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.

Codoxo Healthcare Integrity Suite

We deliver a full set of applications that help every team leverage AI-generated insights about your claims and take steps to control costs.

Fraud scope

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.

Payment scope

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. 

Provider scope

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.

Insight scope

Gives everyone across the health plan an easy way to research issues with self-service reporting and querying of claim, provider, facility and member behavior.

Network scope

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.

Clinical scope

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.

We invest heavily in our people and our technology to help us push the boundaries of what’s possible.
We have helped achieve savings at world-class payers and healthcare agencies including:

Highmark

6+ million members

State Medicaid Agency

1.5+ million recipients

Southeast Health Plan

3.5+ million members

Pacific Health Plan

700k+ members

Mid-State Health Plan

3.5+ million members

Midwest Plan

2.5+ million members

We invest heavily in our people and our technology to help us push the boundaries of what’s possible.

We have helped achieve savings at world-class payers and healthcare agencies including:

Highmark

6+ million members

State Medicaid Agency

1.5+ million recipients

Southeast Health Plan

3.5+ million members

Pacific Health Plan

700k+ members

Mid-State Health Plan

3.5+ million members

Midwest Plan

2.5+ million members

- J.R. Trevino, Manager, Special Investigations Unit
DRISCOLL HEALTH PLAN

– J.R. Trevino, Manager,
Special Investigations Unit
DRISCOLL HEALTH PLAN

Resources

Using AI to Power Successful Unified Cost Containment Programs

5 best practices to using AI solutions for a holistic approach, contributing to better healthcare.

Healthcare
Integrity Suite

Download and share an overview of everything the Healthcare Integrity Suite can do for your organization.

Aite Matrix Payment Integrity
in Healthcare Report

Codoxo Recognized as Leading Contender in Payment Integrity in Healthcare Aite Matrix

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 >