At Codoxo, we strive to be innovators on the cutting edge of the fight against healthcare fraud, waste, and abuse (FWA), so you can imagine our excitement when we learned about new recognition by
CB Insights, a New York-based market intelligence firm, who named Codoxo as the only “Highflier” out of a list of nine vendors. In addition, CB Insights also included us in its market map of
166 companies making healthcare payments faster and more accurate.
In its October 2022 evaluation,
ESP Matrix for fraud, waste & abuse analytics providers, CB Insights defines “Highfliers” as those with proven strength in execution and the most innovative offerings and resources to address evolving customer needs. This generous report wonderfully validates Codoxo’s passion for innovation and transforming the healthcare industry while helping to make healthcare more affordable and effective for everyone.
Why AI-based cost containment is key to transforming healthcare
The healthcare industry is in a crisis when it comes to payment and insurance claims integrity. In 2020, total expenditures on U.S. healthcare reached
$4.1 trillion or $12,530 per person, or 19.7% of the total Gross Domestic Product. What’s most disconcerting is that
3-10% of all U.S. healthcare spend is attributed to FWA. This not only leads to higher healthcare costs across the board, but to increased out-of-pocket consumer expenses. With millions of claims submitted annually to healthcare organizations, the risk of fraud has increased substantially in recent years.
CB Insights showcased key vendors helping to make healthcare payments faster and more accurate, with Codoxo landing on the list. Healthcare entities that have traditionally relied on legacy systems to review and surface outlier claims are frequently unable to accurately distinguish between appropriate care, a medical billing or coding mistake, and intentional fraud. The issue is further compounded as many healthcare companies struggle with data silos resulting from lack of proper data management tools and resources.
In Codoxo’s inaugural Customer Conference, held in October of this year, attendee survey data showed that
44% said staying ahead of fraud, waste, and abuse risk was top of mind. Another 40% of our customers indicated the importance of “managing FWA without contributing to provider abrasion.” More than anything, these trends indicate a growing desire among our own customers – and across the healthcare industry at large – for a holistic, unified AI solution to addressing healthcare cost containment.
What makes Codoxo different from the rest
Codoxo’s Forensic AI Platform sets itself apart in the healthcare analytics industry as the only market solution that allows self-learning AI to work with complex healthcare data to explain its decisions. Our unique approach not only helps to increase trust and adoption among healthcare customers, but proactively identifies new schemes significantly earlier than other AI and rules-based techniques – and with greater accuracy and lower cost.
“The use of artificial intelligence in the healthcare payment integrity space is truly in its infancy and Codoxo is leading the charge with some of the most advanced and sophisticated applications of AI that healthcare payers can deploy,” stated Dr. Musheer Ahmed, Codoxo’s Chief Executive Officer. “As the healthcare payer industry moves towards a more unified approach to cost containment, the use of AI has almost unimaginable upside potential for driving down costs not just for payers, but for the U.S. healthcare system as a whole.”
We love the idea of Codoxo as “highflying” across the healthcare market, bringing innovation not yet seen before. This quest to reduce healthcare costs overall and put money back in the pockets of healthcare payers –
and the consumers they serve – is fueled by our proven technology that captures 97% of fraud exposures, something that other solutions simply can’t do.
What’s more, Codoxo’s
shift-left approach to cost containment is supporting healthcare organizations’ quest to move closer to payment or pre-pay to avoid or limit exposure. And the fact that we’re doing so in a way that causes less friction for our customers, including with their providers, while lowering their overall costs is gaining attention. Overall, CB Insights’ FWA report is just another shout out to the value that customers see in our forensic AI engine.
Codoxo as Your Partner
As much as we’re grateful and excited about the significant progress made since our founding in 2017, Codoxo is really just getting started. The evolving payment integrity issues across healthcare are complex and multifaceted. But with our advanced “highflying” AI solution, we can transform the industry and provide peace of mind to healthcare payers, agencies, and PBMs that they have invested in the most innovative and effective AI engine to help them avoid FWA and ensure payment integrity.
We’d love for you to join us on this movement. To speak to a Codoxo team member about
Fraud Scope and Codoxo’s complete suite of healthcare cost containment solutions, please contact us at
info@codoxo.com.
