Codoxo, an AI-powered cost 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 cost 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, information mining, scientific chart and medical file opinions, fraud detection and extra.
It serves payers, pharmacy profit managers and state and federal businesses, and covers greater than 80 million lives.
“Codoxo’s Level Zero method and confirmed monitor file at nationwide well being plans place them uniquely to enhance how payers guarantee cost accuracy at scale,” CVS Well being Ventures Companion Justin Brock mentioned in an announcement.
Extra contributors 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 whole, Codoxo has raised greater than $75 million.
The financing will assist the corporate broaden the attain of its options, in accordance with Musheer Ahmed, CEO and founding father of Codoxo.
“With this funding, we’re accelerating the scaled deployment of our Level Zero Cost Integrity options, powered by generative AI,” Ahmed mentioned in an announcement. “We’re proud to be the primary clever, end-to-end cost 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 going through extra strain to cut back administrative burden for suppliers, particularly round claims denials and cost errors. And oftentimes claims are denied attributable to lacking or incorrect data. That is the problem in healthcare that Codoxo goals to resolve.
“Healthcare cost integrity is reaching a breaking level. Payers and suppliers are buried underneath rising declare volumes, rising prices, and administrative friction — and fixing issues after cost is now not sustainable,” Ahmed mentioned in an electronic mail. “This funding permits us to scale Level Zero Cost Integrity, a basically totally different method that intervenes earlier than claims are ever created, stopping errors upstream and enabling payers and suppliers to work collectively in a wiser, extra collaborative approach.”
Codoxo isn’t the one firm targeted on cost integrity. Others embody Zelis and Cedar.
Photograph: JamesBrey, Getty Pictures
