Audit Case Management & Workflow
A New Era of Automated Healthcare Audits Is Here.
Enhance accuracy and streamline healthcare audits with Codoxo’s advanced audit and case management solution. Designed to accelerate medical claims audits and optimize healthcare case management workflows, Codoxo leverages cutting-edge AI technology to deliver robust automation.
Powerful AI for Smarter, Streamlined Healthcare Audits
Our comprehensive solution streamlines medical claims audits while strengthening healthcare compliance initiatives through automated workflows and advanced analytics. By combining generative AI with robust healthcare case management capabilities, our solution empowers healthcare payers to identify high-risk claims, streamline reviews, manage cases, and maximize financial recovery.
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Expedite Audits with Greater Accuracy
Codoxo’s generative AI-powered solution streamlines healthcare compliance and medical claims audits through an intuitive workflow.
- Accurate and rapid detection & risk assessment – the solution continuously analyzes claims data using advanced AI algorithms, automatically identifying high-risk patterns and potential compliance issues. This proactive approach to healthcare audit selection ensures teams focus on claims with the highest probability of recovery.
- Automated case management & workflow – once high-risk claims are identified, the system automatically initiates healthcare case management workflows. It organizes medical claims audits into structured cases, assigns appropriate resources, and manages the end-to-end audit lifecycle – from initial review to final resolution.
- Enhanced review & analysis leveraging generative AI technology – the solution accelerates medical record reviews by:
- Automatically extracting relevant information from medical records
- Cross-referencing against healthcare compliance policies
- Generating detailed audit summaries
- Highlighting potential discrepancies for auditor review
- Streamlined communication & recovery – the system facilitates efficient provider communication through:
- Automated medical record requests
- Built-in provider portal for document submission
- Standardized templates for audit findings
- Integrated appeals management
- Automated recovery tracking and reporting
Throughout each stage, the solution maintains comprehensive audit trails and documentation to support healthcare compliance requirements while providing real-time visibility into audit status and outcomes.
Achieve Audit & Case Management Excellence
Handle an increasing number of cases
Efficiently and accurately
Quickly & accurately flag claims
For audit selections for further review
Expedite healthcare audit reviews
With generative AI-assisted workflows for faster determination
Analyze broad claim sets with unparalleled accuracy
For the most comprehensive view of outlier claims and improper payments
Share powerful reporting & insights
With payment integrity teams, FWA investigators, and government agencies to fuel greater healthcare compliance
Explore Codoxo’s Full Solutions Offerings
Transformative Results with Codoxo
Identified over $6M
Smarter Healthcare Cost Containment Starts With Codoxo
Codoxo’s Audit and Case Management Solutions are delivered through our Unified Cost Containment Platform, empowering healthcare organizations to take a seismic shift left by ensuring faster, more accurate claim payments, reduced fraud, waste, and abuse, and enhanced operational efficiency. By transforming the landscape of healthcare cost containment and payment integrity with industry-leading AI, Codoxo is at the forefront of making healthcare more affordable and effective.
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