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Codoxo Solutions for the Public Sector

Codoxo Unified Cost Containment Platform

All solutions within the Unified Cost Containment Platform are built on top of the Codoxo Forensic AI Platform. Our AI engine analyzes your existing claims data, detects practices that intentionally or unintentionally waste money and builds connections across your data to provide actionable insights.

 

  • Fraud Scope
    • Codoxo’s Fraud Scope is an end-to-end solution that uses advanced and proprietary AI technology to quickly and accurately detect fraud, waste, and abuse while providing SIU and PI teams with fully automated case and lead workflows. Fraud Scope helps health plans, healthcare agencies, and PBM teams stay ahead of evolving fraud threats by identifying and flagging emerging schemes for rapid review and intervention. Using AI, automatically detects new and emerging fraud schemes, streamlines collection of evidence chains and gives SIU teams integrated case workflow (includes Case Management) for the investigations you choose to pursue.

  • Provider Scope
    • Codoxo’s Provider Scope is the only platform that comprehensively and proactively identifies provider coding and billing concerns across all codes and transparently shares trends and insights with both payers and providers. Payers can create proactive, comprehensive, and automated provider education programs that deliver clear communication on coding and billing performance to their providers and providers can self-audit through an easy-to-use provider portal to improve coding accuracy, proactively monitor the largest number of codes automatically, and lower pre-claim submission costs. Provider Scope creates transparency between providers and payers to help reduce abrasion and equip both parties with performance insights for proactive intervention. Compares each provider's claims and coding practices to their peers, identifies outlier behavior and proactively engages providers to improve claim integrity and bring down pre-claim expenses.
  • Audit Scope
    • Codoxo’s Audit Scope provides seamless integration of detection, selection, audit creation, tracking, and reporting of audits across all post-pay functions. The advanced AI detection empowers health plans, state agencies, and Pharmacy Benefits Management (PBMs) organizations to break down data silos and automate workflow. Now your teams have a single view across all claims, audits, and departments, so you can create efficiencies and ensure compliance.Automates and streamlines end-to-end audit detection (including case management) and workflow while ensuring compliance.
  • Payment Scope
    • Codoxo’s Payment Scope uses our patented AI engine to automatically and accurately detect existing and emerging fraud, waste, and abuse schemes. Proactively flagging problematic claims allows you to stay ahead of issues and save costs pre-payment with unique claim insights. While easy-to-use claim workflows and automated provider outreach for medical records and other needed information optimize your operations.Using AI, proactively flags problematic claims and gives analysts an easy way to follow-up on claims with pre-pay intelligence, easy-to-use claim workflow and provider outreach automation.

  • ClaimPilot
    • ClaimPilot is healthcare’s first and only generative AI platform fueling zero-touch payment integrity. ClaimPilot delivers greater accuracy, extreme workflow automation, exponential resource efficiencies, and dramatic cost reductions across healthcare payment integrity processes that free healthcare workers systemwide to focus on their highest priorities. ClaimPilot empowers Payment Integrity and SIU teams to focus on what matters most – maximized savings and ROI through faster, more efficient and accurate validation of claims payments. As the newest enhancement to Codoxo’s award-winning Unified Cost Containment Platform, ClaimPilot will safely and securely integrate across Codoxo’s spectrum of payment integrity and fraud, waste, and abuse solutions to deliver extreme automation, exponential resource efficiencies, greater accuracy and best-in-class security. Using Generative AI, autonomously compares submitted information with established patterns and cross-referencing data from multiple sources. The system drastically reduces the need for manual review, increasing accuracy and efficiency, empowering clinicians with precise guidance on where to direct their focus. This translates to faster claim processing, lower costs, and improved overall workflow for healthcare providers.