CVS Health Ventures–led round accelerates national adoption of Point Zero Payment Integrity, a cost prevention model that shifts intervention upstream before claims are created
DULUTH, Ga., Feb. 17, 2026 /PRNewswire/ — Codoxo, the leading provider of AI and generative AI-powered healthcare payment integrity solutions, today announced a year of record momentum marked by rapid customer expansion, national payer adoption of its Point Zero Payment Integrity solutions, and significant investment to support continued growth. As healthcare payers, government agencies, and pharmacy benefit managers (PBMs) face mounting administrative waste, rising claims volumes, and growing provider abrasion, Codoxo is the leader in prevention-first payment integrity.
By intervening earlier than any traditional prepay or postpay solution, Codoxo is gaining rapid traction as a more sustainable path to healthcare cost containment—one that reduces downstream denials, appeals, and administrative friction while strengthening payer-provider relationships.
Momentum Highlights from the Past 12 Months
Accelerated National Scale and Category Leadership through Series C Funding
Codoxo’s $35 million oversubscribed Series C investment reinforces the company’s position as a leader in pre-claim payment integrity—a category-defining approach that moves intervention to the earliest possible point in the healthcare payment lifecycle. Led by CVS Health Ventures, with participation from Echo Health Ventures and continued support from existing strategic and financial investors, the funding enables Codoxo to accelerate growth and its speed of innovation across its GenAI-powered payment integrity solutions.
Established New Category of Payment Integrity Intervention: Point Zero
Codoxo introduced a new healthcare payment model called Point Zero that fundamentally shifts how the industry approaches cost containment—intervening before claims exist through proactive, AI-driven provider education. By addressing payment accuracy at the earliest possible stage, Codoxo is helping payers realize $12–$16 PMPY in savings, reduce overpayments by up to 40%, and dramatically improve operational efficiency.
Continued Revenue Growth and Scaled Financial Impact
Over the past year, Codoxo achieved strong year-over-year revenue growth and expanded its customer base, with its Unified Cost Containment Platform now supporting payment integrity operations across more than 80 million covered lives. In 2025, the company achieved 100% customer retention and 125% net revenue retention, reflecting expanded adoption among existing customers. Customer implementations are delivering up to $66 PMPY in cost reduction across the payment spectrum—while reducing downstream denials, appeals, and provider friction.
Accelerated GenAI Category Leadership with Breakthrough Innovation and Enterprise-Grade Security
Codoxo expanded Point Zero Payment Integrity, its proactive, pre-claim intervention category designed to identify and address payment inaccuracies earlier in the claims lifecycle. The company also launched the Data Health Integrity (DHI) Agent, enabling payers to share high-fidelity claims data without costly delays or operational friction. Codoxo also unveiled a Policy-to-Code capability that uses generative AI to transform complex payer policy language into executable code, reducing configuration time and improving consistency across implementations. To combat rapidly evolving fraud threats, Codoxo also introduced Deepfake Detection to identify synthetic medical documents and manipulated images with AI-driven precision. These capabilities were delivered alongside continued enterprise-grade security, achieving NIST 800-53 Revision 5 compliance for the second consecutive year, maintaining HITRUST r2 certification, and advancing toward FedRAMP readiness.
Earning Industry Recognition and Expanding the Ecosystem
Codoxo’s impact was recognized with multiple industry honors, including:
- Inclusion on the 2025 Inc. National Fastest Growing Private Companies list for the third consecutive year
- Inclusion in Everest Group’s 2025 PEAK Matrix for Payment Integrity solutions
- Recognition by Black Book Research for AI-powered fraud and claims integrity solutions
- 2025 A.I. Awards finalist for Most Innovative AI Technology and Best Use of AI for Healthcare
The company also expanded strategic partnerships, including collaboration with HealthEdge to integrate advanced payment integrity capabilities directly into core payer platforms.
Strengthening Leadership and Industry Community Influence
To support continued growth, Codoxo welcomed several senior leaders, including Dr. Riccardo “Ric” Baron VP of AI and Jim Brady, VP of Growth.
Codoxo also expanded its leadership role in healthcare AI through industry education and community building. The company grew its AI for Payment Integrity (AI for PI) community and hosted its Second Annual AI for Payment Integrity Summit, convening payer leaders around early intervention and prevention-first cost containment strategies. Codoxo experts also shared insights at major industry forums, including NHCAA, NAMPI, and HPRI, and hosted its annual invite-only Xcelerate Conference for customers and innovators.
“This past year marked a defining moment for Codoxo, driven by the rapid adoption of Point Zero Payment Integrity,” said Musheer Ahmed, PhD, Founder and CEO of Codoxo. “Codoxo is at the forefront of reimagining healthcare cost containment by moving payment integrity to the earliest possible point in the payment lifecycle—before claims are ever created. By combining generative AI with proactive provider education, we’re proving that prevention-first payment integrity can deliver measurable savings while strengthening payer-provider relationships. This investment allows us to scale that impact nationally and build on the momentum we’ve created.”
For more information about Codoxo and its AI-powered payment integrity solutions, visit www.codoxo.com. To learn more about career opportunities supporting Codoxo’s continued growth, visit www.codoxo.com/careers.
About Codoxo
Codoxo empowers healthcare payers with its Generative AI-driven Unified Cost Containment Platform, delivering intelligent, end-to-end payment integrity and fraud, waste, and abuse (FWA) solutions—from pre-claim to prepay and postpay. At the earliest intervention point, Codoxo’s Point Zero Payment Integrity solutions identify and prevent payment errors before claims are even submitted, stopping issues at their source. The platform’s comprehensive AI capabilities span across provider education, data mining, clinical chart and medical record reviews, no-code concept ideation, fraud detection, audit workflow and case management and provider contract and medical policy compliance. These help payers achieve unmatched accuracy across the entire claim lifecycle. Codoxo’s platform transforms payment integrity by shifting payers from reactive detection to proactive prevention—reducing costs and improving provider relationships. Codoxo has been recognized with a Fierce Healthcare Innovation Award and named to the Inc. 5000 list for its rapid growth. All Codoxo solutions operate in a HITRUST-certified environment. For more information, visit www.codoxo.com.
View original content to download multimedia:https://www.prnewswire.com/news-releases/codoxo-caps-breakout-year-with-oversubscribed-35m-series-c-cementing-significant-market-momentum–leadership-in-pre-claim-payment-integrity-302689012.html
SOURCE Codoxo
