Codoxo to Highlight Point Zero Payment Integrity Innovation at 2025 NAMPI Conference

Healthcare AI pioneer to co-present with CalOptima Health on transforming fraud detection through early intervention strategies

DULUTH, Ga., July 31, 2025 /PRNewswire/ -- Codoxo, a leading provider of artificial intelligence solutions for payment integrity in healthcare, will return as a Platinum Sponsor of the 2025 National Association for Medicaid Program Integrity (NAMPI) Annual Conference, held August 24–26 at the Marriott St. Louis Grand in St. Louis, Missouri.

Codoxo will co-present with CalOptima Health in a featured session titled: "AI-Powered Program Integrity: How CalOptima's SIU Transformed Fraud Detection Through Strategic AI Implementation." Scheduled for Monday, August 25, from 11:30 a.m. to 12:30 p.m., the session will feature Matt Smith, Healthcare Fraud Analyst at Codoxo, and Cynthia Valencia, Manager of Regulatory Affairs & Compliance at CalOptima Health. Together, they will share real-world cases of fraud uncovered through AI and the power of the industry's fastest and most accurate healthcare fraud detection for SIUs.

Leading the Shift to Pre-Claim Payment Integrity

As Congress considers cutting Medicaid funding by 10-15%, leaving states with impossible choices such as removing beneficiaries or cutting provider rates, Codoxo offers a third path forward through innovative pre-claim payment integrity solutions. Codoxo will showcase its Point Zero Payment Integrity framework—a pioneering approach that moves intervention before claims are created, preventing waste that traditional approaches miss entirely. While current market approaches are abrasive and costly, Point Zero focuses on provider education at the highest ROI point in the payment spectrum.

"With growing fiscal pressure on public health programs, traditional retrospective reviews are no longer enough," said Dr. Musheer Ahmed, CEO and Founder of Codoxo. "Our Point Zero approach enables early detection and provider education before a claim is even submitted—leading to better outcomes, reduced waste, and improved collaboration across stakeholders."

With $800 billion in Medicaid cuts on the horizon and recent legislative changes including a 10-year, 12% reduction in Medicaid funding, an urgent need is in front of us for innovative solutions that protect limited resources and streamline integrity efforts. Codoxo's platform helps government agencies, payers, and PBMs move from reactive postpay processes to strategic, data-driven interventions at the earliest stages of the claim lifecycle.

Real Impact Through Innovation

Codoxo's Point Zero Payment Integrity platform has demonstrated:

• Up to 40% reduction in overpayments
  
  
• $12–16 PMPY in total savings through pre-claim provider education
  
  
• 42% decrease in administrative costs
  
  
• 20–30X efficiency gains for integrity teams

By unifying data across professional, pharmacy, behavioral, and other claim types, Codoxo's AI platform facilitates real-time collaboration across SIU, clinical, and provider teams—helping payers contain costs and improve compliance from the ground up.

Visit Codoxo at Booth #16

As states face these unprecedented funding challenges, Codoxo's Point Zero approach offers a path forward that protects beneficiaries, supports providers, and maximizes limited resources through intelligent early intervention. Conference attendees are invited to experience interactive demos of Codoxo's Point Zero solutions—including provider education, fraud, waste, and abuse, data mining and more. Attendees can also schedule 1:1 meetings with Codoxo experts. To learn more or schedule a demo, visit https://info.codoxo.com/nampi2025 or www.codoxo.com.

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