AI Solutions for Healthcare

Codoxo Establishes Position as Healthcare Payment Integrity & Fraud, Waste, and Abuse Innovator, Leading AI Advancements in U.S. Healthcare


Codoxo Establishes Position as Healthcare Payment Integrity & Fraud, Waste, and Abuse Innovator, Leading AI Advancements in U.S. Healthcare

Codoxo Accelerates Strategic Growth Throughout 2022 with Industry Thought Leadership and Investments in AI

ATLANTA (January 5, 2023) – Codoxo, a trusted provider of healthcare artificial intelligence solutions for healthcare payers and agencies, announced significant growth and benchmarks achieved in customer growth and satisfaction, team expansion, continued investment in technology innovation, and earned recognition for 2022. The company’s momentum demonstrates the demand for its healthcare AI that is delivering ROI beyond industry expectations.

Awards and recognition: For the second year in a row, Codoxo was recognized by Aite Group in the “Aite Matrix: Payment Integrity in Healthcare” Report. Named a “mighty player,” Aite recognized Codoxo’s “AI prowess” as an industry differentiator. Additionally, Codoxo was awarded the 2022 Fierce Healthcare Innovation Award for the Data Analytics/Business Intelligence category for its Forensic AI Platform. Fierce Healthcare Innovation Awards recognized Codoxo for delivering “technology that uniquely blankets the payment system into one integrated platform.” Codoxo also was named the only “Highflier” vendor in CB Insights’ Fraud, Waste, & Abuse Analytics report, which refers to Codoxo’s leadership in providing innovative offerings that meet evolving customer needs. Lastly, Codoxo was also named one of the fastest-growing companies in Atlanta and received an Atlanta 2022 Pacesetter Award from the Atlanta Business Chronicle.

Revenue growth accelerates: In early 2022, Codoxo announced its $20 million Series B funding that helped to meet the rapidly growing demand for its technology, particularly among government agencies and healthcare payers. The company also used the investment to expand into the Pharmacy Benefits Management (PBM) market. The investments helped fuel a significant revenue increase in 2022, which included signing some of the company’s largest contracts during the year by focusing sales across Codoxo’s Unified Cost Containment Platform, including the products that comprise it: payment integrity, fraud, waste and abuse, audit case management and workflow, provider coding and billing education, prior authorization acceleration, network integrity and contract management, and outsourced virtual services.

Client growth and satisfaction: In 2022, Codoxo added a considerable number of new customers, while 40% of Codoxo’s existing clients decided to expand their work with the company. Expansion work included automating audit case management and workflow, targeted provider coding and billing accuracy education, and filling the need for Special Investigative Services support. Several of Codoxo’s current customers also signed three-year renewals and Codoxo customers realized more than $40 million in identified savings over the last 12 months.

Reflecting on Codoxo’s high client satisfaction, 100% of clients interviewed by KLAS Research analysts for their “Emerging Technology Spotlight” performance reported indicated they would buy Codoxo’s AI Platform again and recommend it to others based on its AI software abilities, useful reference information, and desire to preserve payment integrity and eliminate medical fraud, waste, and abuse (FWA). In the same report, it received an A+ grade for “Likely to Recommend” and an A for “Executive Involvement.”

Industry thought leadership: Codoxo led a variety of efforts to build awareness and education around AI and its ability to disrupt the U.S. healthcare system. In March, Codoxo brought together healthcare payer, agency, and PBM leaders for a Healthcare Executive Roundtable discussion focused on the impacts COVID-19 had on cost containment strategies and the need to re-envision plans in the year ahead. In October, Codoxo hosted its inaugural Customer Conference, a private, three-day virtual event spanning 14 sessions under the umbrella theme, “Changing the Cost of Containment Landscape through AI Innovation.” Additionally, the company’s monthly “Forensic AI Alerts” help healthcare organizations wade through the sea of updates, data mandates, coding changes, and trends through time-sensitive alerts. These alerts are designed to share opportunities to impact cost containment and uncover areas across FWA and payment integrity causing risk within healthcare organizations. In addition, Codoxo experts were quoted and published in a variety of articles and podcasts focused on advances in AI in healthcare and healthcare fraud, waste and abuse.

Conference education: Live events were back in 2022, and Codoxo led sessions with key customers and partners, including “Extracting Dental Resource Consumption from Your Medical Budget,” at the AHIP Conference; “ABA (Applied Behavioral Analysis) Therapy and Overlapping Services,” at the NAMPI 2022 Annual Conference; “Protect Your Network, Clients, & Your Bottom Line: An AI-Driven Journey to Proactive Payment Integrity” at the Pharmacy Benefit Management Institute (PBMI) 2022 Annual National Conference; and “Coordination is King: Use Case of Impossible Days” at the National Health Care Anti-Fraud Association (NHCAA). We were pleased to sponsor or co-present with several Codoxo customers including a Midwest Blues health plan, Pharmacy Data Management, Inc., MVP Health Care, as well as a Special Agent with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG).

Technology and innovation: Throughout the year, Codoxo made significant technology investments as a part of its strategic roadmap and in response to customer feedback and emerging industry needs. Highlights from the year include numerous innovations to the core Forensic AI Engine that powers the Codoxo solutions across the pre-submission to post-pay spectrum. Highlights include:

    • Provider Scope: Codoxo’s solution for provider coding and billing education, gained traction in 2022 through its ability to digitize the education process and methodically detect and execute education opportunities using AI. As the industry’s first fully automated solution for provider coding and billing education, Provider Scope incorporated AI-based detection of themes that present the best opportunities for provider behavior change and savings. The product’s fully automated outreach campaign module and provider portal helps improve billing practices, maximize coding accuracy, and reduce provider abrasion.
    • Audit Scope: Codoxo invested in new platform enhancements to the Audit Scope platform, including new AI and rules-driven audit detections, automation of provider outreach for medical records request management, and audit-related communications.
    • Fraud Scope: New features released for the Fraud Scope platform included new detections focused on emerging fraud, waste, abuse, and error, a new provider intelligence feature to identify signals for unusual provider behavior, and significant improvements to case management and reporting.
    • Data Management: Codoxo also launched significant innovation in data management. Using AI, the Codoxo Forensic AI Engine is now able to ensure high accuracy in provider specialty classification, resulting in more accurate peer group analysis and outlier detection.
    • HITRUST: Codoxo renewed its HITRUST Risk-based, 2-year (r2) Certified status for information security for its entire unified cost containment platform. Codoxo joins an elite group that has met key regulations and industry-defined requirements with its robust security infrastructure and has a high-quality information risk management and compliance program to protect sensitive customer information.

Strategic personnel hires: Codoxo continued to invest in hiring subject matter experts to build out its domain knowledge and the strategic leadership team. Codoxo grew domain experts across the data science, product engineering, product development, and customer success teams. A notable strategic leadership hire in 2022 was Mark Riendeau, Vice President of Sales, who has since built a highly proficient sales organization equipped to continue growth of partnerships throughout the industry.

“Codoxo has reached an inflection point for growth across key performance areas,” stated Musheer Ahmed, Codoxo’s Chief Executive Officer. “For healthcare payers, agencies, and PBMs, we’re leading the way with innovation and education, especially around how advanced AI can drive down costs and battle the fraud, waste, and abuse that is rampant in the U.S. healthcare system.”

To learn more about Codoxo, its Unified Cost Containment Platform, and how its team is advancing AI innovation in the healthcare payer industry, 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 and ensure payment integrity. The Codoxo Unified Cost Containment Platform 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 Engine, which uses 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

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Ronda Duncan