Codoxo Launches Generative AI for Healthcare Payment Integrity

Codoxo, a trusted provider of artificial intelligence solutions for healthcare payers, agencies and pharmacy benefits managers (PBMs),announced its new generative AI product, ClaimPilot, aimed at making healthcare cost containment and payment integrity programs exponentially more efficient while easing healthcare workforce constraints. Codoxo’s newest patent-pending AI innovation will initially focus on addressing health insurers’ most dire need: automating in-patient and facility claim audits. This significant technology milestone remains unachieved in the healthcare industry.

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“Codoxo is investing deeply in groundbreaking AI applications to create a more affordable and efficient healthcare system. Our generative AI tackles the industry’s most complex and relatively untouched frontier of healthcare claims, fueling a future where manual, resource intensive tasks are automated,” said Musheer Ahmed, CEO and Founder of Codoxo. “By freeing clinicians and administrators of tasks that AI can tackle more efficiently, they are empowered to work at the top of their licenses and focus on higher priority areas that further reduce the cost of U.S. healthcare.”

In-patient and facility claims account for a significant portion of costs in healthcare. Yet due to their complex nature, healthcare payers, third-party administrators, and government agencies typically focus most of their constrained resources on auditing professional claims. ClaimPilot aims to drive an exponential increase in audit turnaround times and clinician audits per day, while eliminating dollar thresholds that restrict claims analysis to higher dollar ranges. Codoxo plans to integrate ClaimPilot across its spectrum of healthcare AI products addressing the entire payment integrity lifecycle.

“Healthcare organizations can expect game-changing outcomes with generative AI applications such as ClaimPilot,” said Jesse Montgomery, Vice President of Analytics for Codoxo. “Today, it takes a clinician an average of 15 days to review a single in-patient or professional claim audit, from the time records are received to the time the audit is complete. With ClaimPilot, the turnaround time will be less than 24 hours. Automation will enable extreme efficiencies; the clinician average for audits per day will increase from two or three to more than 20. Thresholds will be a thing of the past, as there won’t be any limitations to the number of claims that a healthcare payer can review, audit or investigate.”

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Codoxo’s entrance into healthcare AI began in academia more than a decade ago when Dr. Musheer Ahmed earned his PhD at the Georgia Institute of Technology where his research focused on bringing differentiated AI technology into the payment integrity space. Since then, he has assembled a vanguard of healthcare and AI experts to build Codoxo’s award-winning Unified Cost Containment Platform. The integrated healthcare AI platform enables healthcare payer teams – Payment Integrity, Special Investigations Units (SIU) and other departments – to maximize savings across pre-claim submission, pre-pay and post-pay programs on all claim types​.

“ClaimPilot is a natural progression of our longstanding innovation in healthcare AI. And we’re here to help healthcare payers and agencies understand and navigate the generative AI evolution,” stated Ahmed. “In our pursuit to deliver greater transparency, automation, collaboration, and outcomes across the healthcare cost containment industry,

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