Codoxo provides an AI-powered platform for health plan payers to identify fraud, waste, and abuse in medical claims, along with cost containment and provider network analytics. The system uses machine learning to detect anomalous billing patterns, improper coding, and coordinated fraud schemes. Customers include health plans and managed care organizations. It is fraud detection tuned to payment integrity, surfacing the billing patterns that feed an SIU referral on the health side.
Key features: Claims fraud and billing anomaly detection · Provider profiling and behavior analytics · Coordination of benefits and eligibility analytics · Cost containment opportunity identification · Investigative case management integration
Pros: Purpose-built for healthcare payer use cases · Combines pre-payment and post-payment analytics · Network analysis identifies coordinated fraud rings · Reduces false positives compared to rules-only systems
Cons: Focused solely on healthcare lines; not applicable to P&C or life · Enterprise implementation and data integration requirements · Pricing not publicly listed
Pricing: Quote-based, not publicly listed.
Best for: mid-large health carriers and payers
Audience: carrier
