Codoxo

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.

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