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
SIU Experts Share Pressing Challenges & Successes for Combating Fraud, Waste & Abuse
AI-based Provider Education Empowers Healthcare Payers to Shift Left on the Payment Cycle
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
Clinical ClaimPilot:
Streamlining Claim Validation with AI
Clinical ClaimPilot is transforming the process of claim verification for clinical audits by accelerating and simplifying it. Leveraging the power of generative AI, it enables the automated matching of submitted information and medical records against known patterns and simultaneously consults multiple data sources. This significant advancement minimizes the necessity for manual review, improving overall workflow and accuracy while decreasing processing time and costs. Achieving a 97% faster turnaround, Clinical ClaimPilot introduces an almost entirely automated approach to conducting clinical audits.
Clinical ClaimPilot:
Revolutionize Clinical Claim Audits
Discover the future of healthcare payment integrity with Clinical ClaimPilot, the groundbreaking generative AI solution revolutionizing claim validation processes. By automatically comparing submitted information against established patterns and cross-referencing data from multiple sources, ClaimPilot not only boosts accuracy but propels efficiency to unprecedented levels. The result? An 84% improvement in annual audits. Embrace the technology transforming payment integrity and provider satisfaction, learn more now!
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