Democratize access to claim, provider, facility and member insights and behavior-based context with easy-to-use reports and queries
Insight Scope gives everyone across your healthcare company or agency an easy way to research issues with self-service reporting and querying of claim, provider, facility and member behavior. Easy-to-use queries and reports make it easy for anyone to take the initiative, follow the data, and act quickly to address problems.
Our healthcare insurance AI software is popular with Clinical Care, Medical Management, Claims Operations and Health Strategy teams because of everything it lets you do:
to search for any claim, claim line, provider, facility, pharmacy, behavioral, dental or workers comp record. Results can also be aggregated by rendering or billing entity.
to access relevant data, filter, sort, visualize and analyze claims, provider, facility, and member behavior over time – without any help from IT.
Unique behavior insights
into problematic insurance claims and provider activity.
makes it easy to see where claims and providers are in relation to each other with a familiar ‘map view’.
based on user preference and filtering criteria to map connections between providers or entities.
views that allow users to identify codes that have frequency and cost for various providers and entities.
AI-based claims risk score
flags suspicious activity accurately and with low false positives. Detailed explanations of each claims risk score are available with the Fraud Scope or Payment Scope application.
Provider integrity score
flags providers associated with suspicious claims activity or with coding practices that fall outside the norm of their peers. Detailed explanations for the provider integrity score are available with the Fraud Scope application.
gives everyone a high-level look at the various schemes that exist in your insurance plan. Detailed scheme explanations are available with the Fraud Scope application.
for problematic providers and facilities that may be involved in FWA activity as determined by the Codoxo Forensic AI platform and your existing teams.
providers and facilities that you do not want to analyze.
make it easy to share data and reports with others across your organization, accelerating research and resolution for everything from network and clinical questions to payment integrity and fraud issues.
Enrich insights with additional data
you have about each provider, network and plan.
Augment analysis with third party data
such as OIG or state exclusion lists.
all claim types
Codoxo can ingest and analyze all professional, facility, pharmaceutical, behavioral, dental, and workers comp claims.
Our patented AI technology has the ability to identify issues and opportunities that may arise from complex claims and codes in addition to the standard ones which helps discover a wider range of existing and emerging problems.
Insight Scope is built on our Forensic AI Platform and a part of the Codoxo Healthcare Integrity Suite
Our AI engine analyzes your claims data, detects providers and entities that intentionally or unintentionally waste money, and builds connections across your data to provide actionable insights.
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
"Codoxo's Forensic AI Platform is a game changer.
– Kurt Spear, Vice President Financial Investigations and Provider Review
Ready to get started?
Talk with a sales rep to get a demo of Codoxo and learn more.