AI Solutions for Healthcare

At-Home COVID-19 Testing Coverage Mandate Emphasizes Need for Advanced AI for Payment Integrity Teams and SIUs


At-Home COVID-19 Testing Coverage Mandate Emphasizes Need for Advanced AI for Payment Integrity Teams and SIUs

While new mandate leaves some health payers and agencies scrambling, Codoxo clients are well-positioned to tackle new detection demands

ATLANTA (January 18, 2022) – Codoxo, a trusted provider of healthcare artificial intelligence solutions, today reacted to the new federal mandate requiring healthcare insurers to cover a maximum of eight at-home, over-the-counter COVID-19 tests per covered individual, per month. The new mandate, effective as of January 15, 2022, potentially exposes the healthcare industry to hundreds of millions of dollars in new reimbursements and with that, the potential for errors, duplicate reimbursements, and even new fraud, waste, and abuse schemes.

Codoxo is urging health payers and agencies to act quickly by aligning with health technologies on the forefront of sophisticated artificial intelligence. Codoxo’s Forensic AI Platform can look across all claim types and across disparate claim systems to analyze claims at the member level regardless of codes. Codoxo’s patented Forensic AI platform allows for real-time identification and detection of new and emerging fraud and payment integrity schemes and complex claims irregularities to meet the new challenges presented by COVID-19 and the government actions and regulations that result.

“Because there is currently no procedure code for at-home tests, no requirement for a prescription, or any specific direction for benefits billing, healthcare payers anticipate quite a bit of confusion around COVID-19 at-home testing and the irregularities, complexities, and potential fraud that could result from reimbursement requests,” stated Musheer Ahmed, Codoxo’s Founder and Chief Executive Officer. “Codoxo has developed a sophisticated AI solution that quickly and easily helps healthcare payers pivot to analyze the types of claims challenges that could arise under this mandate, including duplicate claims, overlapping claims, and other patterns that might raise a red flag.”

Codoxo’sFraud Scope allows payers to detect overutilization and abuse of this benefit by a provider or member compared to their peers and detects patterns regardless of who submitted a claim, including pharmacies, DME providers, PCP, outpatient settings, and more.

For additional information about how Codoxo’s healthcare AI solutions can help healthcare payers quickly react to and manage claims arising from the new COVID-19 at-home testing coverage mandate, please visit

About Codoxo
Codoxo’s mission is to make healthcare more affordable and effective for everyone and serves as the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse. The Codoxo Healthcare Integrity Suite helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a-service applications are built on our proven Forensic AI Platform, which uses a patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques. Our solutions are HIPAA- compliant and operate in a HITRUST-certified environment. For additional information, visit