Codoxo, an AI-powered healthcare payment integrity platform, announced an oversubscribed $35 million Series C round to accelerate national adoption of its pre-claim cost-prevention model and expand its generative AI capabilities.
The round was led by CVS Health Ventures, with participation from Echo Health Ventures and continued backing from existing strategic and financial investors. The funding strengthens Codoxo’s position in its category-defining approach to payment integrity by shifting intervention to the earliest possible point in the healthcare payment lifecycle.
The company said it is seeing accelerating demand from healthcare payers, government agencies, and pharmacy benefit managers seeking to reduce administrative waste, rising claims volumes, and provider friction. Codoxo’s Point Zero Payment Integrity model focuses on intervening before claims are created, using AI-driven provider education to prevent downstream denials, appeals, and overpayments.
Over the past year, Codoxo reported strong year-over-year revenue growth and customer expansion, with its Unified Cost Containment Platform now supporting payment-integrity operations for more than 80 million covered lives. In 2025, the company achieved 100% customer retention and 125% net revenue retention, reflecting expanded adoption among existing clients. Implementations are delivering up to $66 per member per year in cost reductions across the payment spectrum, according to the company, while reducing operational friction.
Codoxo also reported that its Point Zero model helps payers realize $12 to $16 per member per year in savings and reduce overpayments by up to 40% by improving payment accuracy before claims are submitted.
During the year, the company expanded its generative AI offerings, including enhancements to Point Zero Payment Integrity, the launch of its Data Health Integrity Agent to enable secure and streamlined claims data sharing, and a Policy-to-Code capability that converts complex payer policy language into executable code. It also introduced Deepfake Detection to identify synthetic medical documents and manipulated images.
Codoxo said it maintained enterprise-grade security standards, achieving NIST 800-53 Revision 5 compliance for the second consecutive year, maintaining HITRUST r2 certification, and progressing toward FedRAMP readiness.
The company earned multiple industry recognitions, including being named to 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, and finalist honors in the 2025 A.I. Awards.
Codoxo also expanded strategic partnerships, including a collaboration with HealthEdge to integrate advanced payment integrity capabilities into core payer platforms.
To support growth, Codoxo added senior leaders, including Dr. Riccardo “Ric” Baron as VP of AI and Jim Brady as VP of Growth. The company also grew its AI for Payment Integrity community, hosted its Second Annual AI for Payment Integrity Summit, and participated in major industry forum,s including NHCAA, NAMPI, and HPRI, along with hosting its annual Xcelerate Conference.
The Series C capital will be used to scale Codoxo’s national footprint and further develop its prevention-first payment integrity platform as payers seek more sustainable approaches to healthcare cost containment.
KEY QUOTE:
“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, Codoxo
