Codoxo Launches Full Suite of AI-Powered Solutions for Healthcare Companies and Agencies

Codoxo (formerly FraudScope), a trusted partner in artificial intelligence-driven fraud detection and investigation for health plans and health agencies, announces a new name and brand along with an expanded suite of solutions that goes beyond the Special Investigations Unit (SIU) to help all teams within a health plan or agency. The decision to change the company name from FraudScope to Codoxo reflects the company’s expanded offerings for health plans and agencies and its broader mission to “make the healthcare system more affordable and effective for everyone,” according to Musheer Ahmed, Codoxo Chief Executive Officer.

“Having achieved success in fraud detection and investigation, we discovered that the insights and results from our AI technology were organically sought after by other departments,” said Ahmed. “Codoxo’s Healthcare Integrity Suite empowers every team across a health plan or agency with unique insights and solutions to identify risks and control costs across network management, clinical care, provider education, and payment integrity, in addition to special investigation units.”

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Built on Codoxo’s Forensic AI Platform, the Codoxo Healthcare Integrity Suite includes the following applications:

• Fraud Scope: Codoxo’s flagship application that automatically detects new and emerging fraud schemes, streamlines collection of evidence chains, and gives SIU teams integrated case workflow for investigations.
• Provider Scope: Compares 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.
• Insight Scope: Gives departments across health plans an easy way to research issues with self-service reporting and querying of claim, provider, facility, and member behavior.
• Network Scope: Gives payers and health agencies comparative data for each healthcare group, plan, hospital, pharmacy, dental practice and provider within a network so teams can go into every contract negotiation with the data needed to bring down long-term costs.
• Clinical Scope: Accelerates pre-authorization approvals for providers with strong integrity scores and flags requests that need a closer look based on recent provider behavior or emerging fraud, waste and abuse schemes.
• Payment Scope: Proactively flags problematic claims and gives analysts an easy way to follow up with post-pay and pre-pay intelligence with claim workflow and automated outreach.

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Codoxo’s Forensic AI Platform analyzes claims data, detects suspicious activity that intentionally or unintentionally wastes money, and builds connections across data to deliver actionable insights. It has been used by health plans across the country to identify over $500 million in savings and reduce false positives in fraud detection by 93 percent. It is built on a HIPAA-compliant and HITRUST-certified environment.

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