Network Scope gives you AI-connected insights and comparative behavior analysis for each healthcare group, plan, hospital, pharmacy, dental practice, and provider in your network. With the unique Codoxo AI product insights your network teams will have the comparative coding behavior data you need in contract negotiations to bring down long-term costs.
Our network and group insights AI product is popular with Network teams and Chief Medical Officers at major healthcare companies and agencies in North America. It includes:
Codoxo Forensic AI Platform analyzes claims, claim lines, medical code usage and provider-level behavior
to give your network team insights into the collective behavior of providers and billing teams at each group, facility, pharmacy and dental practice.
Group-to-group comparative dashboards
make it easy to see how the treatment plans and billing practices are similar or different between groups.
are pre-populated with the provider-specific cost information and behavior, as well as group-level comparisons to their five most similar groups in your network.
AI-based risk scores
flag groups with higher-than-average costs and claim patterns than their peers.
Provider watchlist report
shows you the groups with providers associated with recent FWA schemes, 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.
Outlier provider reports
give you a list of providers within a group with lower Provider Integrity Scores than their peers so that network teams can work with the group to address the coding behavior of the individual provider(s).
Easy-to-use reports and queries
let anyone on your network team find and research issues across groups – without any help from IT.
Analyze risk-based contracts
Analyze risk-based contracts and understand how they are performing compared to their peers.
Streamline contract negotiations
with built-in workflow for the ongoing network contracting process.
for contract negotiation based on usage.
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.
Network 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 practices 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.