Codoxo, an artificial intelligence-powered payment integrity solutions company, announced Wednesday that it has received $35 million in Series C funding led by CVS Health Ventures.
Headquartered in Atlanta, Georgia, Codoxo focuses on identifying and preventing payment errors before a claim is submitted, the “zero point.” Its platform provides providers with insights to help them submit claims accurately the first time while avoiding denials, appeals and resubmissions. The company's services include provider education, data mining, clinical chart and medical record review, fraud detection and more.
It serves payers, pharmacy benefit managers, and state and federal agencies, covering the lives of more than 80 million people.
Justin Brock, partner at CVS Health Ventures, said, “Codoxo's ground zero approach and strong track record with national health plans make them uniquely positioned to improve how payers ensure payment accuracy at scale,” he said in a statement.
Other participants in Codoxo's Series C round include Echo Health Ventures, Sands Capital, 111 West Capital, Brewer Lane Ventures, Wipro Ventures, 450 Ventures (the venture capital arm of Blue Cross and Blue Shield of Alabama) and QED Investors. In total, Codoxo has raised more than $75 million.
Codoxo CEO and founder Musheer Ahmed said the financing will help the company expand the scope of its solutions.
“With this investment, we are accelerating the deployment of zero-point payment integrity solutions powered by generative artificial intelligence at scale,” Ahmed said in a statement. “We are proud to be the first intelligent, end-to-end payments integrity platform that thoughtfully determines which providers require intervention (whether at zero-point, prepay or postpay), ensuring smarter, more efficient outcomes across the entire claims process.”
The funding announcement comes as U.S. health care spending exceeds $5 trillion. Payers are under increased pressure to reduce administrative burden on providers, particularly around claim denials and payment errors. Claims are often denied due to missing or incorrect information. This is the healthcare problem Codoxo aims to solve.
“Healthcare payment integrity is reaching a tipping point. Payers and providers alike are beset by growing claim volumes, rising costs and administrative friction, and fixing problems after payment is no longer sustainable,” Ahmed said in an email. “This funding allows us to expand zero-point payment integrity, a radically different approach that intervenes before claims are created, prevents upstream errors, and enables payers and providers to work together in a smarter, more collaborative way.”
Codoxo isn't the only company focused on payments integrity. Others include Zelis and Cedar.
Photo: James Brey, Getty Images
