AI Solutions for Healthcare

Innovation fuels Codoxo’s AI platform designed to accelerate insights and impact healthcare cost containment

By Rajesh Razdan, Vice President of Products for Codoxo

In the midst of an onslaught of fraud, waste and abuse, healthcare payers and agencies are facing mounting pressure when it comes to cost containment.

A combination of factors are at play: new telehealth regulations since the pandemic’s onset, deferral of care and elective procedures, and new technologies making it easier for fraudsters to operate. This adds up to a growing problem that costs the nation between $68 billion and $230 billion annually. Fraud significantly impacts insurers’ bottom lines and contributes to the unsustainable cost of healthcare. This must be curtailed.

Codoxo is at the forefront of a movement – a quest to impact cost containment faster and earlier. We’re leading a shift toward proactive versus reactive solutions. Core to our effort is our proprietary AI technology that’s fundamentally different from what exists in the market today. 

All AI technology is not the same

Our customers have choices in the marketplace, and many may still be entertaining a certain amount of fear, uncertainty and doubt (FUD) when it comes to moving beyond deterministic rules and incorporating predictive AI. From our point of view, it’s time to move beyond the FUD and focus on the movement to disrupt the status quo and change the future of healthcare. Today, we’re working closely with health plans and state agencies who are reimagining their cost containment strategy and embracing AI as part of the solution.

I can attest that Codoxo offers the most powerful, effective AI in the industry, able to spot existing and emerging problems among millions of claims and offer actionable insights before they impact the bottom line. Our sophisticated AI technology was built from the ground up using deep academic research. It combines both self-learning AI with rules-based techniques to truly meet a gap in healthcare AI fraud detection. This unique, proprietary AI is able to spot existing and emerging problems among millions of claims faster and more accurately than any other technology on the market today.

The Codoxo Forensic AI Platform can anticipate and identify fraud, waste and abuse schemes that traditional solutions cannot, delivering a potential ROI of 15:1. And because the old adage “time is money” is always true, the Codoxo solution can deliver actionable insights in weeks, not months.

Breaking down silos with an integrated platform approach

As important as the AI innovation that drives Codoxo is our ability to intelligently integrate all cost containment processes on a single platform. This eliminates silos – and costly delays – between different departments, including data analytics, special investigation units, network teams and program integrity departments. Instead, collaboration happens using a single repository and analytics for different claim types, with the ability to share insights and automate workflows spanning multiple teams. Insights from one group are easily shared with other groups, creating holistic cost containment with a super-efficient process.

Codoxo’s platform includes a Provider Scope module that payers use to turn payment integrity insights into effective provider education strategies and automated campaigns that reduce provider abrasion and embrace providers as part of the solution. 

What sets Codoxo apart

Codoxo’s proprietary AI technology paired with intuitive product modules focused on specific payment integrity workflows – complemented by our deep commitment to ongoing product innovation – is what sets us apart.

Don’t take our word. Multiple health payers have shared their own experience about improved outcomes when working with Codoxo. 

Seize the moment and join the movement. Together we’ll push boundaries of what’s possible to help create a better future in healthcare.

Interested in learning more? Watch the Codoxo overview video to see how we’re leading the movement.