Codoxo

Codoxo is an AI-powered healthcare finance tool that helps companies identify and prevent fraud, waste, and abuse. It offers a Unified Cost Containment Platform to control costs and improve payment integrity.

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At a glance

Pricing

Likely Not Free

Free tier

API

Skill level

Technical

About

What is Codoxo?

Codoxo provides AI solutions for healthcare companies and agencies, focusing on cost containment and payment integrity. Their Unified Cost Containment Platform leverages generative AI and advanced automation to shift left in the payment cycle, enabling earlier intervention and proactive cost avoidance. Key features include Provider Scope for pre-claim provider education, Audit Scope for automating audit detection, Fraud Scope for identifying new fraud schemes, and Payment Scope for identifying claim accuracy issues before payment. Codoxo also offers Clinical ClaimPilot for automating medical record reviews, Compliance ClaimPilot for validating contracts and policies, and Concept ClaimPilot for accelerating new payment method development. The platform aims to reduce healthcare costs, improve provider relationships, and streamline workflows for payers, PBMs, and state/federal agencies.

Best used for

Ideal for healthcare payers, PBMs, and government agencies who need to proactively prevent fraud, waste, and abuse, reduce healthcare costs, and improve payment integrity. Especially valuable for shifting cost containment efforts to pre-claim stages and fostering stronger provider relationships through education.

Common actions

prevent healthcare fraud

reduce healthcare costs

automate payment integrity

streamline medical audits

improve provider education

Capabilities

Key features

Pre-claim provider education
Automated audit detection
Fraud scheme identification
Claim accuracy insights
Medical record review automation
Contract/policy validation
New payment method development

Target Audience

healthcare payerspharmacy benefit managers (pbms)state and federal healthcare agencieshealthcare fraud investigators

Integrations

Not yet documented

Pricing & Plans

Likely Not Free

Not publicly disclosed. Check codoxo.com for current pricing.

FAQs

How does Codoxo's platform achieve cost savings?

Codoxo's platform focuses on 'shifting left' by providing pre-claim provider education and identifying issues before claims are submitted. This proactive approach helps eliminate denials, appeals, and resubmissions, leading to significant cost savings and improved efficiency for healthcare organizations.

What types of organizations benefit most from Codoxo's solutions?

Codoxo's AI solutions are primarily designed for healthcare payers, Pharmacy Benefit Managers (PBMs), and state and federal agencies. These organizations leverage the platform to manage and reduce healthcare costs, ensure payment integrity, and combat fraud, waste, and abuse.

Can Codoxo help improve relationships with healthcare providers?

Yes, by intervening earlier with pre-claim provider education, Codoxo helps ensure claims accuracy from the start. This reduces the need for abrasive post-payment integrity activities like denials and appeals, fostering more collaborative and positive relationships between payers and providers.

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Data & Analytics › Business Intelligence Wellness & Lifestyle › Clinical & Healthcare Pro Data & Analytics › Predictive Analytics

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