Codoxo
Codoxo provides an AI-driven unified payment integrity platform that detects fraud, waste, abuse, and claim errors for U.S. healthcare payers, PBMs, and state and federal agencies, covering more than 80 million lives across pre-claim, pre-pay, and post-pay workflows.
- Company typePrivate
- Founded2017
- HeadquartersDuluth, United States
- Headcount51–100
- GTM typeB2B
- OfferingSoftware
What Codoxo does
Codoxo is a private, Duluth, Georgia-based AI software company founded in 2017 (originally as FraudScope) that provides a unified generative-AI-driven payment integrity platform to U.S. healthcare payers, pharmacy benefit managers (PBMs), and state and federal agencies. Its patented Forensic AI Platform is a self-learning engine, originally developed from Georgia Tech PhD research, that analyzes healthcare claims data to detect fraud, waste, and abuse, identify claim accuracy issues, and surface emerging schemes without relying on predefined rules. The platform powers a portfolio of products spanning the full cost-containment lifecycle: Fraud Scope, Provider Scope, Payment Scope, and Audit Scope for detection and case management; the ClaimPilot family (Clinical, Concept, and Compliance) for generative AI-driven medical record review, data mining, and compliance; Point Zero Payment Integrity for pre-claim provider intervention; and Deepfake Detection for AI-generated medical documentation analysis.
The company sells primarily through direct enterprise sales to large health plans, PBMs, and government agencies on a SaaS subscription basis, complemented by professional services including outsourced Medical Record Reviews, Data Mining, and Virtual SIU operations. Named customers include Highmark and Pacific Blues Health Plan, with stated coverage of more than 80 million lives and reported outcomes of $60+ PMPY cost savings, $500M+ in identified savings, 100% customer retention, and 125% net revenue retention in 2025. Codoxo has raised over $75 million across four rounds, with the December 2025 $35 million Series C led by CVS Health Ventures representing both a capital and strategic distribution milestone. The company maintains HIPAA, HITRUST r2, and NIST 800-53 Rev. 5 compliance certifications, supporting its expansion into regulated government healthcare programs.
Codoxo firmographics
Firmographics- Name
- Codoxo
- Legal name
- Codoxo, Inc.
- Website
- https://www.codoxo.com
- Company type
- Private
- Founded year
- 2017
- Operating status
- Operating
- Headcount range
- 51–100 employees
- Short description
- Codoxo provides an AI-driven unified payment integrity platform that detects fraud, waste, abuse, and claim errors for U.S. healthcare payers, PBMs, and state and federal agencies, covering more than 80 million lives across pre-claim, pre-pay, and post-pay workflows.
- Ownership category
- akta.pro rank
Codoxo industry classification
Industry- Product category
- Healthcare Payment Integrity Software
- NAICS
- Software Publishers (513210)
- SIC
- Services-Prepackaged Software (7372)
- akta.pro primary industry
- RPM Reimbursement, Billing & Program Operations Platforms (HLACAFAN)
Keywords
Where Codoxo is headquartered
LocationHeadquarters
- HQ city
- Duluth
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Codoxo business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Personnel, Technology or R&D, Marketing or Sales, Operations, Infrastructure
Revenue model
- SaaS Subscriptions: Software-as-a-service subscription model for healthcare payers, agencies, and PBMs to access the unified cost containment platform. Pricing likely based on covered lives or transaction volume. Supporting payment integrity operations across more than 80 million covered lives.
- Professional Services: Additional revenue from services including Medical Record Reviews Services, Data Mining Services, and Virtual SIU Services for organizations requiring outsourced support.
Go-to-market motion1 record
Distribution channels1 record
Marketing channels6 records
Codoxo product offering
Product offeringCore offering
Codoxo sells a unified, generative AI-driven healthcare cost containment platform powered by its patented Forensic AI self-learning engine. The platform delivers pre-claim, pre-pay, and post-pay payment integrity capabilities—fraud/waste/abuse detection, provider education, claim accuracy, audit case management, and generative-AI medical record review—for U.S. healthcare payers, PBMs, and state/federal agencies. Complementary professional services (medical record reviews, data mining, virtual SIU) are offered alongside the SaaS platform.
Product overview
Codoxo offers a unified generative AI-driven healthcare cost containment platform that provides pre-claim, pre-pay, and post-pay solutions. The core Forensic AI Platform powers multiple integrated products including Fraud Scope (fraud detection), Payment Scope (claim accuracy), Provider Scope (provider education), Audit Scope (case management), and the ClaimPilot family (Clinical, Concept, and Compliance ClaimPilot). The platform also includes Deepfake Detection for AI-generated medical documentation analysis. Services include Medical Record Reviews, Data Mining, and Virtual SIU Services. All products leverage patented self-learning AI technology to identify fraud, waste, and abuse patterns earlier than traditional techniques.
Differentiator
Problem solved
Functional benefit
Products and services
- Forensic AI Platform Patented self-learning AI engine that analyzes healthcare claims data, detects fraud, waste, and abuse patterns, and builds connections across data to deliver actionable insights for healthcare payers, PBMs, and agencies.
- Fraud Scope Flagship application that automatically detects new and emerging fraud schemes, streamlines evidence chain collection, and provides integrated case workflow for Special Investigations Unit (SIU) investigations.
- Provider Scope Online provider self-monitoring portal that compares providers' claims and coding practices to peers, identifies outlier behavior, and enables proactive provider engagement to reduce costs pre-claim.
- Payment Scope Claims accuracy identification tool with unique claim insights, easy-to-use claim workflow, and automated provider outreach for pre-pay and post-pay payment integrity teams.
- Audit Scope AI-enabled audit case management and workflow solution that automates and streamlines end-to-end audit detection across pre-pay and post-pay functions for health plans and PBMs.
- ClaimPilot Generative AI-powered product family for healthcare claims processing, including Clinical ClaimPilot (medical record reviews), Concept ClaimPilot (data mining), and Compliance ClaimPilot (medical claims review).
- Deepfake Detection AI-powered tool that analyzes medical records, clinical notes, diagnostic images, and claim context to identify AI-generated or manipulated documentation submitted in support of fraudulent claims before payment.
- Unified Cost Containment Platform A single generative AI-driven platform that unites payment integrity, provider education, fraud/waste/abuse detection, and SIU teams into one unified system covering pre-claim, pre-pay, and post-pay cost containment.
- Medical Record Reviews Services Generative AI-driven outsourced services for in-patient, facility, and DRG audits that speed turnaround times and increase accuracy for medical record reviews.
- Data Mining Services AI-driven outsourced healthcare data mining services to uncover more overpayments with advanced analytics capabilities.
- Virtual SIU Services End-to-end virtual resources and services to offload SIU compliance requirements and scale operations for healthcare organizations.
Quantifiable outcome
- $60+ PMPY in cost savings
- +10 more outcomes
Companies that use Codoxo
Customer profileNamed customers2 records
Segments3 records
Ideal customer profiles3 records
Codoxo technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability7 records
Feature8 records
Codoxo partnerships and signals
Strategic signalPartnerships
One partnership is on record.
- HealthEdgestrategicStrategic partnership announced November 2024 to transform payment integrity with generative AI. Codoxo and HealthEdge collaborating to integrate AI capabilities into HealthEdge's payment integrity solutions.
Scale indicators11 records
Recent moves6 records
Expansion highlights6 records
Codoxo competitors and assessment
Company assessmentMarket position
Weaknesses4 records
Competitive moat5 records
Key highlights1 record
Customer concentration
Codoxo social profiles
Digital presenceCodoxo compliance and trust
Trust signalCompliance3 records
Codoxo financial estimates
Financial estimateRevenue estimate
Valuation estimate
Codoxo leadership team
Management profileNumber of profiles
Profiles9 records
Codoxo funding detail
Funding detailFunding overview
Funding rounds8 records
Investors16 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Codoxo M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Codoxo
What does Codoxo do?
Codoxo sells a unified, generative AI-driven healthcare cost containment platform powered by its patented Forensic AI self-learning engine. The platform delivers pre-claim, pre-pay, and post-pay payment integrity capabilities—fraud/waste/abuse detection, provider education, claim accuracy, audit case management, and generative-AI medical record review—for U.S. healthcare payers, PBMs, and state/federal agencies. Complementary professional services (medical record reviews, data mining, virtual SIU) are offered alongside the SaaS platform.
Is Codoxo a public or private company?
Codoxo is a private company. It is classified as venture growth investor backed and is currently operating.
When was Codoxo founded?
Codoxo was founded in 2017. It employs 51 to 100 people.
Where is Codoxo based?
Codoxo is headquartered in Duluth, United States, in the North America region.
How does Codoxo make money?
Two revenue lines are on record. SaaS Subscriptions are the primary driver. The others are professional Services.
Does Codoxo have an API?
No public API is recorded for Codoxo.
What industry is Codoxo in?
Codoxo's product category is Healthcare Payment Integrity Software. Its primary akta.pro industry code is HLACAFAN, RPM Reimbursement, Billing & Program Operations Platforms. Its NAICS code is 513210 and its SIC code is 7372.