Codoxo Creates New "Point Zero" Category in Payment Integrity: Pre-Claim Provider Education Reduces Abrasion While Saving Payers $12-16 PMPY

Codoxo's Point Zero approach creates an entirely new space in payment integrity—before claims are ever created, before unnecessary costs are incurred, before providers experience delayed payments.

ATLANTA, May 20, 2025 /PRNewswire/ -- Codoxo, the trusted provider of AI-driven healthcare cost containment and payment integrity solutions, today announced the official launch of Point Zero Payment Integrity—a breakthrough strategic model that enables proactive intervention at the earliest possible stage in the healthcare payment lifecycle - pre-claim creation. By engaging providers before a claim is even created, Point Zero shifts the paradigm from traditional "prepay and postpay" focus to a new standard: prevent-and-partner.

This novel approach addresses core pain points that have long plagued healthcare payers and providers - namely, the administrative burden and costs associated with denied claims, reconsiderations, appeals, and resubmissions. These inefficiencies contribute to provider burnout and strain payer-provider relationships. Industry data* reveals that large healthcare payers incur an average of $250 per denied claim. With up to 13% of claims denied annually, the resulting financial toll ranges from $2.6 billion to $13 billion per year for a typical large payer*. These inefficiencies translate into significant burdens for patients, payers, and providers alike—resulting in higher premiums, claim denials, and provider abrasion.

"Point Zero Payment Integrity is a movement—we've created an entirely new space for payment integrity programs to intervene at point zero—before claims are created," said Musheer Ahmed, PhD, CEO and Founder of Codoxo. "Typically, healthcare payers manage claims in prepay or postpay. Point Zero Payment Integrity shifts this much earlier in the process—before a claim is created. By engaging providers at this earliest point while leveraging benchmark data from our platform, we're not just reducing errors and costs, we're enabling healthcare payers and providers to work in partnership, leading to fewer claim denials and appeals, faster payments, less administrative costs and significantly more savings."

How Point Zero Payment Integrity Works

Codoxo's advanced generative AI empowers providers with real-time guidance and insights at the "Point Zero"—the critical yet previously overlooked moment before claims are even created. Key solutions include:

• Concept Ideation & Policy Development – A no-code generative AI interface helps teams rapidly identify payment gaps, ideate payment integrity concepts, and create reimbursement policies to contain costs.
• Pre-Claim Policy Education – Targeted, personalized communication and education surrounding upcoming policy changes, helping providers sift through the noise of policy updates to focus on those that will impact them the most, while giving providers time to adjust coding practices before policies go live.
• Pre-Claim Provider Coding Accuracy Education – AI-driven identification and detection of inaccurate coding that feeds automated provider education programs through preferred channels, enabling both providers and payers to avoid costly and abrasive downstream payment integrity activities.

Pre-Claim education helps address previously overlooked payment gaps that could not be targeted through traditional approaches due to resource limitations and the risk of provider abrasion. These capabilities are seamlessly integrated with Codoxo's existing prepay and postpay solutions—including data mining, fraud detection, medical record reviews, provider contract compliance, and audit and case management—within a single unified platform.

Proven Results from Codoxo's Point Zero Solutions

Health plans using Codoxo's Point Zero model have reported:

• $12-16 Per Member Per Year (PMPY) in savings through provider education
• Up to 40% reduction in overpayments
• 20–30x efficiency gains for Payment Integrity, Provider Network, Clinical, and Special Investigation Units (SIU) teams

"Point Zero Payment Integrity rethinks how payment integrity should work," said Dr. Ahmed. "This new model shifts the traditional prepay and postpay approaches much further upstream. By doing so, we're not just preventing overpayments, we're reducing administrative burden and rebuilding trust between payers and providers. It's a smarter, more collaborative approach to cost containment that paves the way for a more sustainable healthcare system."

To learn more about Codoxo's Point Zero Payment Integrity solutions, visit: https://pointzeropaymentintegrity.codoxo.com.

*Becker's Hospital Review; MGMA Stat Report; AMA Payer Report Cards, CAQH Index, Change Healthcare Denials Index 2020

About Codoxo 
With a mission to make healthcare more affordable and effective for everyone, Codoxo is the leading provider of generative AI and advanced artificial intelligence-driven solutions that empower healthcare payers to proactively identify and resolve payment integrity issues at the earliest stages of the claim lifecycle—ranging from pre-claim to prepay and postpay. The Codoxo Unified Cost Containment Platform leverages generative AI to help payers drive savings through provider education, data mining, medical record reviews, fraud detection, medical policy and provider contract compliance, concept ideation, and audit and case management. 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 www.codoxo.com.

SOURCE Codoxo