AI Solutions for Healthcare

Insight Scope

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:

Easy-to-use queries

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.

Self-service reports

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.

Location analysis

makes it easy to see where claims and providers are in relation to each other with a familiar ‘map view’.

Association graphs

based on user preference and filtering criteria to map connections between providers or entities.

Code utilization

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.

Scheme dashboard

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.

Watch lists

for problematic providers and facilities that may be involved in FWA activity as determined by the Codoxo Forensic AI platform and your existing teams.

Whitelist

providers and facilities that you do not want to analyze.

Collaborative workflows

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.

AI analyzes
all claim types

Codoxo can ingest and analyze all professional, facility, pharmaceutical, behavioral, dental, and workers comp claims.

AI analyzes
all CODES

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

Codoxo_ProductStackDiagram_InsightScope

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.

Codoxo_ProductStackDiagram_InsightScope

We invest heavily in our people and our technology to help us push the boundaries of what’s possible.
We have helped achieve savings at world-class payers and healthcare agencies including:

Highmark

6+ million members

State Medicaid Agency

1.5+ million recipients

Southeast Health Plan

3.5+ million members

Pacific Health Plan

700k+ members

Mid-State Health Plan

3.5+ million members

Midwest Plan

2.5+ million members

We invest heavily in our people and our technology to help us push the boundaries of what’s possible.

We have helped achieve savings at world-class payers and healthcare agencies including:

Highmark

6+ million members

State Medicaid Agency

1.5+ million recipients

Southeast Health Plan

3.5+ million members

Pacific Health Plan

700k+ members

Mid-State Health Plan

3.5+ million members

Midwest Plan

2.5+ million members

Ready for a better solution?

Request a demo to learn what we can do for you.

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 >