Codoxo, an AI-powered payment integrity solutions company, has secured $35 million in Series C funding led by CVS Health Ventures, the company announced on Wednesday.
Atlanta, Georgia-based Codoxo is focused on identifying and preventing payment errors before claims are submitted, or in other words, at “Point Zero.” Its platform offers insights to providers to help them submit claims accurately the first time, while also avoiding denials, appeals and resubmissions. The company’s services include provider education, data mining, clinical chart and medical record reviews, fraud detection and more.
It serves payers, pharmacy benefit managers and state and federal agencies, and covers more than 80 million lives.
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“Codoxo’s Point Zero approach and proven track record at national health plans position them uniquely to improve how payers ensure payment accuracy at scale,” CVS Health Ventures Partner Justin Brock said in a statement.
Additional participants in Codoxo’s Series C round include Echo Health Ventures, Sands Capital, 111 West Capital, Brewer Lane Ventures, Wipro Ventures, 450 Ventures (venture arm of Blue Cross and Blue Shield of Alabama) and QED Investors. In total, Codoxo has raised more than $75 million.
The financing will help the company broaden the reach of its solutions, according to Musheer Ahmed, CEO and founder of Codoxo.
“With this investment, we’re accelerating the scaled deployment of our Point Zero Payment Integrity solutions, powered by generative AI,” Ahmed said in a statement. “We’re proud to be the first intelligent, end-to-end payment integrity platform that thoughtfully determines which providers require intervention—whether at Point Zero, prepay, or postpay—ensuring smarter, more efficient outcomes across the entire claims process.”
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The funding announcement comes as U.S. healthcare spending exceeds $5 trillion. Payers are facing more pressure to reduce administrative burden for providers, especially around claims denials and payment errors. And oftentimes claims are denied due to missing or incorrect information. This is the issue in healthcare that Codoxo aims to solve.
“Healthcare payment integrity is reaching a breaking point. Payers and providers are buried under 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 scale Point Zero Payment Integrity, a fundamentally different approach that intervenes before claims are ever created, preventing errors upstream and enabling payers and providers to work together in a smarter, more collaborative way.”
Codoxo isn’t the only company focused on payment integrity. Others include Zelis and Cedar.
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