AI Solutions for Healthcare

When one of the Nation’s Largest Health Plans began noticing large dollar amounts for paid exposure and a significant number of high-risk scores on the Codoxo Fraud Scope dashboard, they reached out to us for further insight. The Codoxo team conducted an internal comparison to answer two questions: how many of these leads would have been identified if Fraud Scope was the only tool used? And, did Fraud Scope identify other tangible leads? 

The results of this study were impressive. Codoxo’s Fraud Scope Solution, as a standalone tool, detected nearly all the leads, capturing approximately 97% of exposures. Furthermore, Fraud Scope assigned a high-risk score of 40+ to every provider with $1 million or more in potential exposure, allowing the client to prioritize the highest exposures first – a critical step for payers to prioritize resources when struggling with the high false-positive rates of most AI-based FWA solutions. 

Our solution not only proved more effective as a standalone platform than a multitude of other tools in detecting high-potential leads, but also helped prioritize leads based on exposure. Fraud Scope is leading the way to a more secure future in healthcare.