AI Solutions for Healthcare

Payment Scope

Identify claim accuracy issues before claims are paid with our patented Forensic AI engine for payment integrity

Payment Scope proactively flags problematic claims and helps analysts save costs pre-payment with unique claim insights, easy-to-use claim workflow, and automated provider outreach.

Our AI payment integrity AI solution is popular with pre-pay payment integrity teams at major healthcare companies and agencies in North America. It includes:

AI analyzes claims pre-payment

and assigns risk scores to claims along with detailed explanations that help identify problematic claims.

Gives analysts integrated workflows

to approve, deny or pend each claim with a reason code.

Significantly lower provider abrasion

with integrated approach to AI problem identification.

Customize results

using watchlists, whitelists, and claim amount thresholds.

Provider Integrity Score

flags providers associated with any new or existing fraud 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.

Claims dashboard

gives all users an at-a-glance overview of the current claims review workflow as well as a breakdown of claims by risk scores and potential savings.

Analyst dashboard and workflow screens

give each user an easy way to review each claim, understand the reason why a claim was flagged, request more information from a provider, update claim notes, and move the claim through your review workflow.

Automate claims reviews

with real-time integration to your claims system and automatically pend or deny payments for high-risk claims with suspicious activity.

Ensure contract payment accuracy

with integrated pre-pay and contract analysis.

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.

Payment 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_PaymentScope

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 >