Codoxo has raised $35 million in an oversubscribed Series C round, reinforcing investor confidence and accelerating national adoption of its AI-driven healthcare payment integrity platform.

The funding round was led by CVS Health Ventures, with participation from Echo Health Ventures and continued backing from existing strategic and financial investors. The oversubscribed round signals strong market demand and positions Codoxo to expand its prevention-first approach to healthcare cost containment.

This investment comes at a time when healthcare payers, pharmacy benefit managers, and government agencies face rising claims volume and growing administrative inefficiencies. Codoxo’s model focuses on stopping payment errors before claims are even created, which reduces operational friction and improves financial accuracy across the healthcare system.

A New Approach to Preventing Payment Errors

Healthcare payment integrity has traditionally relied on reviewing claims after submission or payment. Codoxo takes a different path. Its Point Zero Payment Integrity model intervenes earlier, using AI to identify potential issues before claims are generated.

This upstream intervention helps healthcare payers prevent overpayments, reduce appeals, and improve relationships with providers. By addressing payment accuracy at its earliest stage, Codoxo reports savings of $12 to $16 per member per year, along with up to 40 percent reductions in overpayments.

“This past year marked a defining moment for Codoxo, driven by the rapid adoption of Point Zero Payment Integrity. 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.”

Musheer Ahmed, PhD, Founder and CEO of Codoxo.

Scaling Innovation and Expanding Platform Capabilities

The new funding will support product development, customer expansion, and continued innovation in generative AI applications for healthcare payments. Codoxo plans to accelerate deployment of its Unified Cost Containment Platform and strengthen its prevention-first model across national payer networks.

The company has already expanded its AI capabilities significantly. Recent developments include its Data Health Integrity Agent, which allows healthcare payers to share structured claims data efficiently. Codoxo also introduced Policy to Code functionality, using generative AI to convert payer policies into executable workflows. These tools reduce manual configuration time and improve consistency.

Security and fraud detection remain key priorities. Codoxo has implemented deepfake detection technology to identify synthetic medical records and altered documents. The company maintains HITRUST certification and continues advancing toward FedRAMP readiness to support government customers.

Rapid Growth and Strong Market Adoption

Codoxo’s growth over the past year reflects rising demand for prevention-focused payment integrity. The company’s platform now supports more than 80 million covered lives across healthcare systems and payer organizations nationwide.

Customer retention remains strong, with Codoxo reporting 100 percent customer retention and 125 percent net revenue retention. These figures indicate expanded usage among existing clients, as well as continued platform adoption.

Customer implementations have delivered measurable financial impact, including up to $66 per member per year in total cost reductions across the payment lifecycle. At the same time, the system reduces disputes, appeals, and administrative burden for both payers and providers.

Codoxo’s expansion has also included strategic partnerships, such as its integration with HealthEdge to embed payment integrity capabilities directly into payer platforms.

Company Foundation and Technology Focus

Founded to address inefficiencies in healthcare payments, Codoxo provides an AI-driven Unified Cost Containment Platform designed to prevent errors, fraud, and waste before claims are processed.

Its platform combines provider education, data analysis, fraud detection, and compliance monitoring into a single system. The goal is to identify and resolve payment risks early, reducing financial losses while improving operational efficiency.

The company has received multiple industry recognitions, including inclusion on the Inc. list of fastest-growing private companies and Everest Group’s PEAK Matrix for payment integrity solutions. Codoxo was also named a finalist in the 2025 A.I. Awards for healthcare innovation.

Leadership expansion has supported this growth, including the addition of Dr. Riccardo Baron as VP of AI and Jim Brady as VP of Growth.

Investors Continue Backing Codoxo’s Expansion

CVS Health Ventures led the Series C investment, joined by Echo Health Ventures and existing investors. Their continued participation reflects confidence in Codoxo’s strategy and the growing importance of proactive payment integrity solutions.

Healthcare costs continue to rise, and organizations are seeking more efficient ways to manage payments. Codoxo’s prevention-first model provides an alternative to reactive auditing, helping reduce financial leakage while improving operational clarity.

With strong investor backing, expanding customer adoption, and ongoing platform innovation, Codoxo is positioning itself as a key player in the future of healthcare payment integrity.

Origianl Creator: Paulo Palma
Original Link: https://justainews.com/companies/funding-news/codoxo-secures-35m-series-c-for-ai-payment-integrity/
Originally Posted: Tue, 17 Feb 2026 14:22:32 +0000