AI Solutions for Healthcare

Resources

Protect your limited healthcare dollars with the most powerful, effective AI in the industry. 

Application Datasheets

ClaimPilot

Download and share an overview of everything the ClaimPilot generative AI platform can do for your organization.

Unified Cost Containment Platform

Download and share an overview of everything the Unified Cost Containment Platform can do for your organization.

Fraud Scope

Download and share an overview of everything the Fraud Scope product can do for your organization.

Provider Scope

Download and share an overview of everything the Provider Scope product can do for your organization.

Payment Scope

Download and share an overview of everything the Payment Scope product can do for your organization.

Insight Scope

Download and share an overview of everything the Insight Scope product can do for your organization.

Network Scope

Download and share an overview of everything the Network Scope product can do for your organization.

Clinical Scope

Download and share an overview of everything the Clinical Scope product can do for your organization.

Audit Scope

Download and share an overview of everything the Audit Scope product can do for your organization.

Virtual SIU Services

Download and share an overview of Codoxo’s Virtual SIU Services designed to help health plans and state agencies scale operations and meeting FWA compliance.

Infographics

11 Emerging Healthcare Fraud Schemes to Watch out for in 2023

5 Trends and Predictions for Healthcare Cost Containment in 2023

SIU Leaders Speak: Roadblocks to Productive and Effective Case Management & FWA Operations

Under the Hood of Healthcare Payer SIU

Top SIU & Payment Integrity Priorities & Challenges

Forensic AI Alerts: See What the Future of Cost Containment Looks Like Tomorrow…Today

AI-driven Fraud, Waste & Abuse Delivers Return

The Rise of Virtual Healthcare

6 Trends & Predictions for Healthcare Cost Containment in 2022

Faster Time to Value: 4 Tips to Replacing or Adopting Payment Integrity Systems

Top Fraud, Waste & Abuse
Cases in Healthcare

AI-driven Fraud, Waste & Abuse Delivers Return

Payment Integrity Market Trends:
What You Need To Know

Video and Podcasts

Healthcare NOW Radio

January 2024

HealthcareNOW is joined by Musheer Ahmed, PhD, founder & CEO of Codoxo, to discuss generative AI and its immediate and significant impact on the future of payment integrity in healthcare. Codoxo, its technology, and Musheer himself have won many awards and accolades for their expertise and impact.

Codoxo Customer Conference 2023 Overview

Codoxo’s 2023 Customer Conference brought together our community of FWA and payment integrity community of customers for over 19 educational sessions, networking events, peer-to-peer engagement, and chances for prizes!

View the conference recap video as we walk through the highlights of the 2023 Codoxo Customer Conference.

NCHAA Webinar: Revolutionizing Healthcare Payment Integrity with Generative AI as Your Co-Pilot

November 2023

By partnering with Generative AI as a co-pilot, healthcare organizations can benefit from its advanced predictive capabilities, including identifying patterns and anomalies in claims data and flagging potential issues before they become larger problems.  

Codoxo 2022 Reflection

Over the past 12 months, Codoxo’s growth, client satisfaction, industry recognition, and improved performance validate that our deep commitment to next-generation
healthcare cost containment is making a real difference to healthcare payers, agencies, and PBMs, along with the members and patients they serve.

Virtual Services

Codoxo’s Virtual Outsourced Services help health plans, agencies and PBMs offload compliance and scale operations through:

• Data Management & Implementation
• End-to-end Virtual SIU Services
• Client Reporting & Communication 

Audit Scope

Audit Scope provides seamless integration of detection, selection, audit creation, tracking and reporting of audits across all pre-pay and post-pay functions. When paired with Codoxo’s advanced AI detection technology such as that used in Codoxo’s Fraud Scope solution, healthcare organizations are able to create efficiencies and break down data silos to create a single view across all claims, audits, and departments. 

Provider Scope

Provider Scope compares each providers’ claims and coding practices to their peers, identifies outlier behavior, and proactively engages providers to improve claim integrity and bring down pre-claim costs with a provider self-monitoring and communication portal. Provider Scope allows payers and healthcare companies to efficiently reduce coding errors and influence healthcare costs prior to submission of claims while decreasing provider abrasion. 

Codoxo Customer Conference 2022 Overview

November 2022

The Codoxo Customer Conference facilitated education, training, and networking for our customer user community and allowed PI and FWA experts to join together to help support our mission to contain healthcare costs. View the conference recap video as we walk through the highlights of the 2022 Codoxo Customer Conference.  

Atlanta Business Radio

August 2022

Hear Musheer Ahmed share with Atlanta Business Radio the pressing need for the healthcare industry to address the rising cost curve, and the value AI is bringing to proactive cost containment for healthcare payers and organizations.

Healthcare Executive Round Table

March 2022

During Codoxo’s Healthcare Executive Round Table, payment integrity leaders from Highmark, BlueCross BlueShield of South Carolina, and the former COO of Shared Services at United Healthcare discussed the impacts COVID-19 had on healthcare cost containment, including shifts to telehealth and adoption of new AI solutions.  

Codoxo’s Momentum Building Year

February 2022

2021 was a year of achieving key milestones and growth benchmarks that demonstrate our growing momentum in helping the healthcare industry battle fraud, waste and abuse and ensure payment integrity – while using the industry’s most advanced healthcare AI platform. 

NCHAA Webinar: Detecting the Undetected

January 2022

Codoxo’s leading fraud analyst and health payer special investigations unit present case study for using AI to Identify previously undetected FWA schemes.

Codoxo

Leading a Movement to Contain Healthcare Costs and Disrupt the Status Quo.  See why our mission to contain healthcare costs has sparked a movement.  A movement that includes collaborating with payers and agencies across the U.S. to deploy AI solutions that disrupt the status quo of unsustainable healthcare costs.  That’s seeing tomorrow, today.

AHIP Webinar: Innovative AI Delivers Unified Cost Containment Approach

June 2021

Speakers in this session will discuss best practices for creating an AI-driven, unified approach to cost containment

AHIP Webinar: Unified Cost Containment Approach and Next-level Outcomes Using AI

June 2021

Learn practical approaches to creating AI-driven unified approaches to cost containment for improved access, transparency, and outcomes

FNO: InsureTech Podcast

June 2021

Check out our recent podcast with FNO: InsureTech on how healthcare fraud, waste and abuse is tackled with tech.

Highmark NHCAA Session

November 2020

Learn how Highmark and Codoxo collaborate on psychotherapy analytics and savings in this recent NHCAA training session.

Whitepapers and Reports

Forensic AI Alerts eBook:
2023 Fraud, Waste, & Abuse Trends to Guide 2024 Healthcare Cost Containment Plans

The eBook is a compilation of Forensic AI Alerts the Codoxo team publishes throughout the year that highlight timely topics for the cost containment community.

Generative AI for Payment Integrity:
Harnessing AI Innovation
to Future-Proof Healthcare Payments

Learn practical tips and best practices for leveraging generative AI to boost payment strategies and drive transformative change in the healthcare industry.

The Quest for Modernized Healthcare Payment Integrity:
A Case for AI-Driven Provider Education

Learn how payment integrity, SIU, and provider teams are using AI-driven technology to seamlessly engage with providers to prevent claim errors before they start.

5 Trends & Predictions for Healthcare Cost Containment in 2023

Codoxo’s FWA and payment integrity experts shed light on the year ahead in healthcare cost containment and share their predictions for the most impactful trends to watch out for in 2023

Forensic AI Alerts eBook:
2022 FWA Trends to Inform 2023 Cost Containment Strategies

This eBook is a culmination of Forensic AI Alerts curated throughout the year by Codoxo’s team of payment integrity and FWA experts.

Codoxo’s Forensic AI Platform Named Fierce Healthcare Innovation Award Winner in the “Data Analytics/Business Intelligence” Category

Patented Self-learning Healthcare AI Recognized for Effectiveness, Technical Innovation, Competitive Advantage, and Financial Impact for Healthcare Payers, Agencies and PBMs

Codoxo Named “Highflier” in CB Insights’ ESP Matrix for Fraud, Waste & Abuse

In its October 2022 ESP Matrix for fraud, waste & abuse analytics providers, CB Insights positions Codoxo as the sole “Highflier” company among 9 vendors.

KLAS Research Emerging Technology Spotlight Report 2022

Codoxo Received an A+ Rating by KLAS Research in a Recent Emerging Technology Spotlight Report.

eBook: Re-envisioning Cost Containment in 2022 and Beyond

Ways in which healthcare organizations are adjusting their cost containment strategies in a post-pandemic world.

Fraud Schemes in a Telehealth Era:
What Healthcare Payers Should Know

New Study from Codoxo Reveals Up to 15% of Telehealth Claims are Non-Compliant with CMS Guidelines

 

Aite Matrix Payment Integrity in Healthcare Report

Codoxo Recognized as Leading Contender in Payment Integrity in Healthcare Aite Matrix

Using AI to Power Successful Unified Cost Containment Programs

5 best practices to using AI solutions for a holistic approach that breaks down silos while improving efficiency, transparency and insight, contributing to better healthcare.

COVID-19 FWA Schemes Report

30 page special report on emerging COVID-19 related FWA schemes

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

Audit Scope

For everyone across the health plan and PBM

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.