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Codoxo, an AI-powered fee integrity options firm, has secured $35 million in Collection C funding led by CVS Well being Ventures, the corporate introduced on Wednesday.
Atlanta, Georgia-based Codoxo is concentrated on figuring out and stopping fee errors earlier than claims are submitted, or in different phrases, at “Level Zero.” Its platform gives insights to suppliers to assist them submit claims precisely the primary time, whereas additionally avoiding denials, appeals and resubmissions. The corporate’s companies embody supplier training, knowledge mining, scientific chart and medical report critiques, fraud detection and extra.
It serves payers, pharmacy profit managers and state and federal businesses, and covers greater than 80 million lives.
In accordance with CVS Well being Ventures Associate Justin Brock, “Codoxo’s Level Zero strategy and confirmed observe report at nationwide well being plans place them uniquely to enhance how payers guarantee fee accuracy at scale,” he stated in a press release.
Further members in Codoxo’s Collection C spherical embody Echo Well being Ventures, Sands Capital, 111 West Capital, Brewer Lane Ventures, Wipro Ventures, 450 Ventures (enterprise arm of Blue Cross and Blue Protect of Alabama) and QED Buyers. In complete, Codoxo has raised greater than $75 million.
The financing will assist the corporate broaden the attain of its options, in response to Musheer Ahmed, CEO and founding father of Codoxo.
“With this funding, we’re accelerating the scaled deployment of our Level Zero Fee Integrity options, powered by generative AI,” Ahmed stated in a press release. “We’re proud to be the primary clever, end-to-end fee integrity platform that thoughtfully determines which suppliers require intervention—whether or not at Level Zero, prepay, or postpay—guaranteeing smarter, extra environment friendly outcomes throughout your entire claims course of.”
The funding announcement comes as U.S. healthcare spending exceeds $5 trillion. Payers are dealing with extra strain to cut back administrative burden for suppliers, particularly round claims denials and fee errors. And oftentimes claims are denied resulting from lacking or incorrect info. That is the difficulty in healthcare that Codoxo goals to unravel.
“Healthcare fee integrity is reaching a breaking level. Payers and suppliers are buried underneath rising declare volumes, rising prices, and administrative friction — and fixing issues after fee is not sustainable,” Ahmed stated in an e mail. “This funding permits us to scale Level Zero Fee Integrity, a basically completely different strategy that intervenes earlier than claims are ever created, stopping errors upstream and enabling payers and suppliers to work collectively in a wiser, extra collaborative manner.”
Codoxo isn’t the one firm targeted on fee integrity. Others embody Zelis and Cedar.
Photograph: JamesBrey, Getty Photos
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