Codoxo

Founded by Dr. Mustaque Ahamad & Musheer Ahmed in 2015

Detect healthcare payment fraud and billing errors before claims are paid

Pricing model

Demo

Rating

★ People love it

Time to value

Requires Expertise

You can use Codoxo to identify fraudulent, wasteful, and abusive healthcare claims using AI. It covers the full payment integrity cycle — from educating providers before claims are submitted, to catching errors at prepay, to recovering overpayments postpay. Teams can automate claim audits, run fraud investigations, validate provider contracts, and conduct medical record reviews. It also helps Special Investigation Units manage case workflows and scale operations without adding headcount.

What Codoxo does

Detect fraudulent billing patterns across large claim datasetsSend automated education notices to providers before claims are filedRun prepay audits to flag claims for review before paymentReview medical records using generative AI for DRG and facility auditsBuild and manage SIU investigation case workflowsValidate provider contracts against submitted claim dataIdentify overpayments and initiate recovery workflowsMonitor for new fraud schemes using self-learning AI modelsSends provider education before claims are submitted to prevent errors upfrontAutomatically detects new and emerging fraud schemes using self-learning AIAutomates end-to-end audit detection and case workflow managementReviews medical records with generative AI to speed up and improve accuracyValidates provider contracts and medical policies to catch payment errorsIntegrates prepay and postpay processes in one unified systemProvides SIU teams with virtual service resources to scale investigationsReduces claim review turnaround from weeks to under 24 hours

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