Transforming Payment Integrity with Generative Artificial Intelligence (GenAI): HealthEdge® and Codoxo Announce Strategic Partnership

BURLINGTON, Mass. & DULUTH, Ga.--(BUSINESS WIRE)--HealthEdge® and Codoxo announce a strategic partnership to provide healthcare payers with the industry’s most cutting-edge solutions and services. This partnership will streamline and enhance their respective end-to-end payment integrity processes by leveraging HealthEdge Source™ in conjunction with Codoxo’s GenAI-driven Unified Cost Containment Platform. By joining forces to deliver an end-to-end payment integrity solution, healthcare payers will benefit from the ability to consolidate vendor solutions, improve data integrity, and accelerate time-to-value.

“Our strategic partnership with Codoxo aligns one HealthEdge managed data source, feeding two cutting-edge technology platforms, to empower health plans with the information they have always wanted to correct any process errors, further upstream than previously possible, before the claim is paid.”

HealthEdge Source is a preeminent prospective payment integrity solution, combining contract modeling and configuration, claim pricing, editing, and proactive business intelligence to fix chronic payment errors. Codoxo’s comprehensive Unified Cost Containment Platform consists of AI and GenAI-powered provider education, data mining, medical record & complex chart reviews, medical policy & provider contract compliance, fraud, waste & abuse, and audit & case management. These products collectively offer health plans increased savings and enhanced efficiencies via leading technology.

“A forward-looking approach to pre-pay payment integrity reduces the need for costly post-payment recoveries, minimizes provider abrasion, and improves the quality of our healthcare system,” said Ryan Mooney, Executive VP & General Manager of HealthEdge Source. “Our strategic partnership with Codoxo aligns one HealthEdge managed data source, feeding two cutting-edge technology platforms, to empower health plans with the information they have always wanted to correct any process errors, further upstream than previously possible, before the claim is paid.”

Today, health plans often leverage several different vendors to support their payment integrity processes, increasing operational costs through more administrative expenses and less transparency to address the root cause of payment inaccuracies. The HealthEdge-Codoxo collaboration delivers market-leading payment integrity solutions while reducing a health plan’s vendor footprint. The partnership will enable health plan customers’ payment integrity, clinical, network and special investigation unit teams to gain greater transparency, ensure payment accuracy, generate increased savings and detect more payment issues, all while reducing their overhead.

“Codoxo and HealthEdge are aligned in bringing innovation to drive increased savings through earlier interventions in the claim lifecycle to ensure claims are coded accurately by providers and paid correctly by payers the first time. Leveraging GenAI to deliver on these, sets a new standard for claims payment accuracy and efficiency in the industry,” stated Musheer Ahmed, Founder & CEO of Codoxo.

Through this partnership, HealthEdge and Codoxo are positioned to deliver expanded value to health plans, setting a new standard for efficiency, security, and innovation in payment integrity solutions. This will also benefit the healthcare industry – helping to make healthcare more affordable and effective, and furthering the development of a cohesive ecosystem that connects payers, providers, and patients.

About HealthEdge:

HealthEdge® is on a mission to drive digital transformation in healthcare. We connect health plans, providers, and members with end-to-end digital technology solutions to support rapid member growth, new business models, and improved health outcomes. As a recipient of both industry recognition and awards from Gartner, KLAS, and BlackBook, as well as one of the Best and Brightest Companies to Work For in the Nation, the company is committed to excellence. As a leader in digital transformation in healthcare, their integrated ecosystem includes advanced solutions for core administration (HealthRules® Payer), payment integrity (HealthEdge Source™), care management (GuidingCare®), and member experience (Wellframe™). HealthEdge solutions – deployed as standalone technologies or as a cohesive platform – help payers automate their core administrative and clinical care systems. Together with our customers and employees, HealthEdge is committed to innovating a world where healthcare can focus on people. Learn more at HealthEdge.com and follow us on LinkedIn.

About Codoxo:

With a mission to make healthcare more affordable and effective for everyone, Codoxo is the premier provider of generative AI and artificial intelligence-driven solutions and services that help healthcare payers proactively detect and eliminate payment issues earlier in the claim lifecycle. The Codoxo Unified Cost Containment Platform helps payers drive savings across payment integrity, provider education, special investigation unit (SIU), network management, and clinical teams. Our software-as-a-service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify payment issues far faster and earlier than traditional techniques. Codoxo is a Fierce Healthcare Innovation Award winner and has been recognized by the Inc. 5000 list for growth. Our solutions are HIPAA-compliant and operate in a HITRUST-certified environment. For additional information, visit https://www.codoxo.com/.