Provider-sponsored Health Plans
AI-powered analysis to bring down out-of-network costs and obtain insights into clinical care patterns
Whether you run a provider-sponsored health plan that maintains reserves, or a health system with a staff model, your teams work as a single integrated system to deliver outstanding patient care. And you have lots of data. You know everything about your providers and the care your patients receive within your health system.
But you don’t have this same level of insight and trust with providers outside of your network. And your internal teams can’t easily access the wealth of information you have about your members, providers, care plans and protocols.
That’s why we built the Codoxo Unified Cost Containment Platform. Codoxo gives commercial, state and provider-sponsored health plans an easier way to research issues and accelerate out-of-network authorizations with an AI-assisted clinical cost analysis solution.
Integrated Health Systems
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
Codoxo helps provider-sponsored health plan leaders control out-of-network costs and get unique insights into clinical patterns. Using our Forensic AI clinical cost analysis solutions provider-sponsored plans can accelerate out-of-network authorizations and give everyone access to behavior-based insights.
Forensic AI Engine analyzes your out-of-network claims data, identifies practices that intentionally or unintentionally waste money, and builds connections across your data to provide actionable insights.
AI analyzes all claim types and Codoxo can easily ingest all professional, facility, pharmaceutical, behavioral, dental, and workers comp claims.
Patented-AI analyzes all codes 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.
Automatically and accurately detect existing and emerging fraud schemes with an AI-assisted solution for provider-owned plans.
Easy-to-use reports and queries democratize access to claim, provider, facility and member insights and gives everyone across your teams’ behavior-based context.
Accelerate emergent decisions and out-of-network prior authorizations with AI-assisted reviews and integrity checks.
AI Solutions for Healthcare
The Codoxo Unified Cost Containment Platform gives you a powerful way to identify problems and take action to control costs with a full set of applications that help each team quickly research issues and get behavioral context to inform and accelerate the best next step.
– Kurt Spear, Vice President Financial Investigations and Provider Review
HIGHMARK
Ready for a better solution?
Request a demo to learn what we can do for you.