Audit Scope
Automates and streamlines end-to-end audit detection and workflow while ensuring compliance.
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, health plans, state agencies and Pharmacy Benefits Management (PBMs) organizations are able to create efficiencies and break down data silos to create a single view across all claims, audits, and departments.
Codoxo’s Audit Scope platform is used by PBMs and healthcare payers to automate and streamline end-to-end audit detection and workflow while ensuring compliance.
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.
Our Audit Scope solution is used across all functions of a PBM, state agency or Health Plan’s cost containment operations, including Compliance, Legal, Network, Clinical and Fraud, Waste, and Abuse teams. Audit Scope provides users and leaders with:
Rapid and accurate detection
of potential claims and/or providers for audits when paired with Codoxo’s Fraud Scope, AI-based fraud detection solution and rules-based algorithms
Deep insights into reasons for detection,
including peer-to-peer comparisons, provider performance, and claim level details
Easy and intuitive review and selection workflow,
allowing auditors to drill into each provider or claim and quickly identify and collect supporting claims to add to audit queues
Client/internal contract and government compliance
across state, federal and client-defined requirements
Flexibility
for audit team to create AI-detected, rules-based or manual audits
Seamless transition from pre-pay to post-pay
End-to-end case management module for managing all aspects of an audit case,
including notes, supporting documentation, provider communications, financials, recoveries and reporting
Integrated communication capabilities including HIPPA compliant
email, fax and postal mail
AI analyzes
all claim types
Codoxo can ingest and analyze all professional, facility, pharmaceutical, behavioral, dental, and workers comp claims.
AI analyzes
all CODES
Our patented AI technology has the ability to identify issues and opportunities that may arise from complex claims and codes in addition to the standard ones which helps discover a wider range of existing and emerging problems.
Audit Scope is built on our Forensic AI Platform and a part of the Codoxo Unified Cost Containment Platform
Our AI engine analyzes your claims data, detects practices that intentionally or unintentionally waste money, and builds connections across your data to provide actionable insights.
We invest heavily in our people and our technology to help us push the boundaries of what’s possible.
We have helped achieve savings at world-class payers and healthcare agencies including:
Highmark
6+ million members
State Medicaid Agency
1.5+ million recipients
Southeast Health Plan
3.5+ million members
Pacific Health Plan
700k+ members
Mid-State Health Plan
3.5+ million members
Midwest Plan
2.5+ million members
We invest heavily in our people and our technology to help us push the boundaries of what’s possible.
We have helped achieve savings at world-class payers and healthcare agencies including:
Highmark
6+ million members
State Medicaid Agency
1.5+ million recipients
Southeast Health Plan
3.5+ million members
Pacific Health Plan
700k+ members
Mid-State Health Plan
3.5+ million members
Midwest Plan
2.5+ million members
Ready for a better solution?
Request a demo to learn what we can do for you.