AI Solutions for Healthcare

Building a culture of collaboration is critical for innovation. Codoxo’s first-ever Customer Conference ran October 11-13 and accomplished just that by bringing together artificial intelligence (AI), Payment Integrity and Special Investigative Unit (SIU) pioneers from Codoxo and our healthcare customers.

The three-day conference bolstered our efforts to create collaborative, long-term partnerships with our clients and their PI and FWA teams. With the pace of AI advancements in the healthcare payer industry, it’s critically important for teams, customers, and partners to exchange learnings to improve their own bottom lines and help decrease U.S. healthcare costs overall.

Empowering customer knowledge of Codoxo’s Unified Cost Containment Platform was key in holding a successful event. Our platform comprises a suite of products enabling users across the entire payment spectrum to collaborate with new levels of visibility and transparency, all using the same platform and claims data.

We’re thrilled at the outstanding turnout among our customers – healthcare payers, agencies, and plans in the medical, pharmacy, and dental fields. They enjoyed live demonstrations of Codoxo products such as Fraud Scope, Provider Scope, and Audit Scope. Attendees also gleaned insights from best practices and use cases from Codoxo subject matter experts and industry peers. Perhaps most importantly, our customers had many opportunities to openly share their challenges, ask questions, and provide valuable feedback.

What customers said about Codoxo products

Who better to share real-world stories about our products in action than our customers? Each day of the conference offered a new chance for clients to hear how their peers are best utilizing Codoxo’s innovative AI to reduce fraud, waste, and abuse (FWA) and ensure payment integrity in order to help create a better future for healthcare.

On Day 1, seven SIU and PI customers gathered together for a roundtable discussion focused on sharing effective approaches to lead development. Panelists walked attendees through a recent lead that was identified by the Fraud Scope platform, the actions taken, and the outcome or current state of the lead. Lead examples included topics across telehealth, physical therapy, speech therapy, and COVID testing.

On Day 2, a healthcare payer customer shared their journey to adopting AI-driven provider education and compliance, and its ability to help them gain greater insight into provider coding and billing patterns and behaviors.

On Day 3, attendees heard from a pharmacy benefits administrator (PBA) client who adopted Codoxo’s Audit Scope platform to help them move from reactive payment integrity to proactive approach. They shared how the platform helped them identify fraud such as pre-menopausal medications being prescribed to men and younger or older women. “Everyone struggles with one place to capture their audit activity – it can be a very manual process,” said the customer. “Audit Scope really meets a need for those in the market doing audits.”

Shining the spotlight on Fraud Scope

Multiple sessions during the virtual conference focused on Codoxo’s cornerstone product, Fraud Scope, which automatically detects new and emerging fraud schemes, streamlines the collection of evidence chains, and gives SIU teams integrated case workflow for the FWA investigations that they choose to pursue.

Whether customers were looking for a high-level overview of how the product works or wanted to dig deeper with use cases, our Codoxo team hosted daily sessions, complete with demos, best practices, and examples to share for newbies and long-time users alike.

When surveyed following the live event, customers voted on their favorite session attended. An overwhelming response indicated the Fraud Scope Best Practices and Use Cases session presented by Codoxo’s Derik Ciccarelli was the leading vote, followed by the Customer Round Table: Approaches to Lead Development in a close second.

Attendees were polled during the conference and shared that Fraud Scope can help SIUs overcome some of their top challenges. In fact, the poll exposed the following top challenges across the Codoxo customer community, including:

    • 50% – Managing FWA risk without contributing to provider abrasion
    • 30% – Staying ahead of emerging FWA risk
    • 8% – SIU productivity
    • 8% – Keeping up with reporting needs
    • 5% – Effectively sharing FWA leads between SIU and PI teams

Products like Fraud Scope help clients achieve rapid successes. For SIUs, this success is measured by:

    • Productivity: Review maximum number of FWA leads per month/quarter;
    • Savings & recovery: Identify/build cases for target dollar amount recovery; and/or
    • Risk management: Effectively identify/monitor for emerging schemes.

Innovation updates from Codoxo leaders

During the Codoxo Roadmap Update session, Rajesh Razdan, Codoxo’s VP of Products, shared an overview of improvements made across detection, data, and reporting, as well as a user experience (UX) overhaul with Audit Scope and new coding themes for educational purposes for Provider Scope.

“We pride ourselves on being customer focused and pushing the limits of innovation, while at the same time staying responsive to our customer needs,” Razdan said. “We also have subject matter experts who have more than 100 years of combined industry experience that helps us in achieving the balance between innovation and customer responsiveness.”

This responsiveness will come in handy as we align ourselves with the priorities of our customers. When polled during the Roadmap session, customers shared that they will prioritize:

    • increased focus on Pre-Pay FWA monitoring and intervention: 30%;
    • increased reliance on AI for identifying FWA leads : 32%;
    • and increase in collaboration between SIU, PI, Network relations teams for holistic payment integrity management: 38%.

Razden agreed that these poll results were in alignment with the feedback that we regularly receive during customer discussion calls.

Codoxo’s Director of Data Science, Saurav Subedi, Ph.D., shared an update on data science projects aimed at delivering accurate and timely detection of outlier behavior and trends. “Schemes are always changing – we can detect those and prioritize them for you,” Dr. Subedi said, noting that reducing the amount of time it takes to detect and track schemes is a priority.

During the Data Science Roadmap session, Dr. Subedi asked which of the following processes takes the most amount of customers’ time. Here’s what they shared:

    • 45% indicated Investigation/Analysis/Validation
    • 32% indicated Lead Identification
    • 14% indicated Reporting
    • 9% indicated Case/Audit Management

Connecting and celebrating rockstar customers

Not only did customers connect and interact with Codoxo subject matter experts across Development, Engineering, Product, Data Science, and Executive teams during a speed networking session, but they also participated in friendly competition and networking during a live trivia event with chances to win prizes.

During the conference, we also introduced our Codoxo Rockstar Award. This honor will be awarded annually to the top three users of the Codoxo platform from January 1-December 1, 2022. The goal of the award is to recognize and celebrate Codoxo customers who are working every day to help make healthcare more affordable and effective for everyone.

We’re just getting started

“We’re overjoyed with the positive client feedback about our first annual Customer Conference.” stated Rena Bielinski, VP of Customer Success with Codoxo. “Clients are saying it was well organized, they made valuable networking connections, and actionable take-aways already are enhancing the work they do on a daily basis. This is exactly what we set out to deliver to our customer community.”

Codoxo plans to host the customer conference annually, with the possibility of increased learning and use case sharing throughout the coming year.

Wrapping up the conference, Dr. Musheer Ahmed, CEO and founder of Codoxo, acknowledged just how much the company’s AI tools have evolved, even in just the past few years.

“Hopefully our customers have a sense of the work that’s going on. Those who’ve been using the product have seen dramatic changes happen over time,” Dr. Ahmed said. “We’re deeply committed to continuing to enhance and improve our products, with customer feedback guiding the way.”