AI Solutions for Healthcare

Network Scope

Get unique insights into each group, plan and network and engage with them to bring down healthcare costs
Codoxo Network Scope

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.

Negotiation Playbooks

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.

Prescriptive insights

for contract negotiation based on usage.

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.

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.

Codoxo_ProductStackDiagram_NetworkScope

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

700K+ members

"Codoxo's Forensic AI Platform is a game changer.
AI is helping us identify, prevent, and stop potentially fraudulent activities earlier than ever.”
Highmark

– 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.

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 >