AI Solutions for Healthcare

PRODUCT OVERVIEW

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 exiting 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.

Codoxo_ProductStackDiagram_FINAL

Behavior-based Analysis

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.

Detection Engine

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

Prescriptive Insights

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

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.

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. 

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. 

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. 

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. 

1 billion

Claims processed
by AI

$500M

Identified savings
by Codoxo

%

Reduction in false positives

%

Increase in productivity

"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

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

State Medicaid Agency

2+ million recipients

Southeast Blue Plan

3+ million members

Midwest Blue Plan

2.9 million members

Pacific Health Plan

700K+ members

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 >