Codoxo’s Forensic AI Platform Helps Highmark Inc. Financial Investigations and Provider Review Department Realize Millions in Savings

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AI-based payment integrity solutions lead the charge in protecting members and ensuring dollars are spent on high-quality care

Codoxo's AI software helps Highmark Inc. save millions.

“Codoxo’s Forensic AI Platform has accelerated Highmark’s ability to detect and prevent suspicious activity more quickly and stay attuned to the ever-changing schemes of bad actors,” said Kurt Spear, Highmark’s Vice President of Financial Investigations and Provider Review.

Codoxo, a trusted provider of healthcare artificial intelligence solutions for healthcare payers and agencies, has announced its healthcare AI software helped contribute to the $220 million in savings related to fraud, waste, and abuse for Highmark Inc. in 2020. In a March 16 press release, Highmark announced its Financial Investigations and Provider Review (FIPR) department had generated cumulative financial savings of nearly $1.1 billion in such activity since 2015.

Since 2019, Codoxo has worked with Kurt Spear, Highmark’s Vice President of Financial Investigations and Provider Review, as a part of Highmark’s healthcare payment integrity strategy to decrease fraud, waste, and abuse as schemes grow more prevalent and sophisticated. “Codoxo’s Forensic AI Platform has accelerated Highmark’s ability to detect and prevent suspicious activity more quickly and stay attuned to the ever-changing schemes of bad actors,” said Spear. Highmark recently expanded its partnership with Codoxo to include Special Investigations Unit and Payment Integrity services for further identification of fraud leads and to uncover billing and payment errors.

Codoxo’s Forensic AI Platform analyzes claims to detect entities that intentionally or unintentionally waste money and builds connections across various claim types to deliver actionable insights. Specifically, the Forensic AI Platform evaluates the holistic behavior of any entity (provider, facility, claim, or member) and accurately identifies suspicious activity.

“Codoxo’s AI and sophisticated machine learning algorithms are producing savings well beyond what healthcare payers are typically able to achieve,” stated Musheer Ahmed, Codoxo Chief Executive Officer. “Our ability to take a more holistic approach to the payer, provider, and patient data relationship allows health plans and healthcare agencies to identify sophisticated trends as well as anomalous activity to identify and ferret out specific schemes that cost the healthcare system billions of dollars.”

Codoxo’s Healthcare Integrity Suite, built on Codoxo’s Forensic AI Platform, has been used by healthcare payers and government agencies across the country to identify hundreds of millions of dollars in savings and reduce false positives in fraud detection by 93 percent. It is built on a HIPAA-compliant and HITRUST-certified environment.

About Codoxo
Codoxo is the premier provider of artificial intelligence-driven solutions that help healthcare payers and agencies quickly identify and act to reduce risks from fraud, waste, and abuse. Codoxo’s Healthcare Integrity Suite helps clients reduce risks and costs across network management, clinical care, provider education, payment integrity, and special investigation units. Our software-as-a-service applications are built on our Forensic AI Platform, which uses a patented algorithm to identify problems and suspicious behavior earlier than traditional techniques. Our solutions are HIPAA-compliant and operate in a HITRUST-certified environment. For additional information, visit https://www.codoxo.com.

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Michelle Smyth
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