Provider-sponsored Health Plans
AI-powered analysis to bring down out-of-network costs and obtain insights into clinical care patterns
Integrated Health Systems
Saving millions at world-class insurance companies and healthcare agencies including:
State Medicaid Agency
2+ million recipients
3+ million members
2.9 million members
Pacific Health Plan
Codoxo helps provider-sponsored health plan leaders control out-of-network costs and get unique insights into clinical patterns. Using our Forensic AI clinical cost analysis solutions provider-sponsored plans can accelerate out-of-network authorizations and give everyone access to behavior-based insights.
Forensic AI Engine analyzes your out-of-network claims data, identifies practices that intentionally or unintentionally waste money, and builds connections across your data to provide actionable insights.
AI analyzes all claim types and Codoxo can easily ingest all professional, facility, pharmaceutical, behavioral, dental, and workers comp claims.
Patented-AI analyzes all codes 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.
Automatically and accurately detect existing and emerging fraud schemes with an AI-assisted solution for provider-owned plans.
Easy-to-use reports and queries democratize access to claim, provider, facility and member insights and gives everyone across your teams’ behavior-based context.
Accelerate emergent decisions and out-of-network prior authorizations with AI-assisted reviews and integrity checks.
AI Solutions for Healthcare
The Codoxo Healthcare Integrity Suite gives you a powerful way to identify problems and take action to control costs with a full set of applications that help each team quickly research issues and get behavior-based context to inform and accelerate the best next step.
"Codoxo's Forensic AI Platform is a game changer.
– Kurt Spear, Vice President Financial Investigations and Provider Review
Ready to get started?
Request a demo or talk to our technical sales team to answer your questions.