Codoxo’s new ClaimPilot turbocharges payment integrity in healthcare by significantly improving efficiencies and drastically reducing costs – and much more.
Generative AI is poised to deliver fresh oxygen to a U.S. healthcare system battling rising costs and demands for better patient and workforce experiences, among other systemic challenges. With game-changing healthcare outcomes already being realized from this ultra-advanced type of artificial intelligence, healthcare executives have little choice than to pay attention to what generative AI can really do.
Codoxo is excited to share the industry’s newest use case of generative AI: automating processes, improving resource efficiencies, and lowering costs in dramatic new ways that are redefining the future of healthcare cost containment.
Fueling Zero-Touch Payment Integrity With ClaimPilot
In late July, Codoxo launched ClaimPilot – the first and only generative AI platform fueling a future of near “zero-touch” payment integrity. The ClaimPilot platform empowers Payment Integrity and SIU teams to focus on what matters most – maximized savings and ROI through faster, more efficient and accurate validation of claims payments.
As the newest enhancement to Codoxo’s award-winning Unified Cost Containment Platform, ClaimPilot safely and securely integrates across Codoxo’s spectrum of payment integrity and fraud, waste, and abuse (FWA) solutions to deliver extreme automation and exponential resource efficiencies with greater accuracy.
These powerful capabilities enable healthcare payment integrity teams to reduce administrative burdens and focus on their highest priorities while generating substantial cost savings to healthcare organizations, estimated at an average $66 per member per year (PMPY) through their entire cost containment journey.
Tackling the Untouchable With Clinical ClaimPilot
Clinical ClaimPilot is Codoxo’s first applied generative AI product, focusing on addressing healthcare payers’ most dire need: automating in-patient and facility claim audits. Representing up to 45% of costs in healthcare, this vast segment of audits has remained relatively untouched – until now. These highly complex and interrelated claims – which comprise extended hospital stays, multiple care teams, and batteries of tests – require human review and validation. As a result, in-patient and facility claim audits are done selectively (limited to high dollar thresholds); manually (requiring cumbersome clinician review); and slowly (often taking 1-3 weeks to review a single audit).
The benefits of Clinical ClaimPilot are far reaching. The most immediate impact: Clinical ClaimPilot exponentially speeds audit turnaround times. Today, a single in-patient or facility claim audit takes an average of 15 days for clinician review, from start to finish. ClaimPilot makes it possible to accomplish this same review within 24 hours or less. Healthcare organizations also will increase their number of audits completed per day from just two or three to more than 20.
Additionally, most payment integrity teams set a dollar threshold on in-patient and facility claims reviews, restricting reviews to high-dollar ranges due to limited resources. With Clinical ClaimPilot, healthcare organizations can review, audit, and/or investigate any and all claims regardless of dollar value, exponentially expanding savings opportunities.
Perhaps most importantly, Clinical ClaimPilot empowers clinicians to leave the administrative work to ClaimPilot and focus on higher value work. Rather than weeding through granular and lengthy medical records, contracts and hospital bills – often hundreds of pages long –– clinicians can focus more strategically: on real clinical expertise and patient care. Claim audit review automation empowers healthcare organizations to do more with the resources they already have while supporting the overall satisfaction of their people.
ClaimPilot and Clinical ClaimPilot drive entirely new levels of automation, security and accuracy to payment integrity programs for greater savings and ROI.
Our AI Vision and Promise
Generative AI is a natural progression for Codoxo. At our core, we’re an AI innovation company driven to build the most effective AI with purpose, integrity, and academic rigor in every step of our process.
We’re also a healthcare company. As specialists in healthcare payment integrity and fraud, waste and abuse, we’re ambitious in our pursuit to solve the industry’s toughest cost containment problems.
Above all, Codoxo is an integral stakeholder in the transformation of the American healthcare system. With each new customer implementation, we’re improving the affordability and effectiveness of our nation’s healthcare system. Our vision is to leverage rapidly progressing AI capabilities to dramatically reduce the cost of U.S. healthcare with more accurate payments and less fraud, waste, and abuse.
Not only do we promise to lead the industry with responsible AI innovation, but we pledge to help you navigate the AI landscape as a trusted partner.
Let’s work together to positively impact the future of healthcare. To learn more or speak to a Codoxo team member, email info@codoxo.com.
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
Audit Scope
For everyone across the health plan and PBM
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.
