The Claims Genomics Company

Every claim
has DNA.
We read it.

A claim carries two strands — the care that was given and the claim that was billed. We read both and resolve them into one number every side can defend — so the dollar stays in care.

72% appeals won · ind. 38%※production data · 2025 Enterprise-grade · top-5 payer · 46-hospital system
CO-16 · $421,000 CO-197 · $57,000 CO-50 · $242,110 PT · wk 16 · AM-PAC plateau episode · day 142 · step-down F32.9 · session 90837 plan · MA-HMO · COB plan · Medicaid MCO · EVV plan · commercial · PPO Mr. Claims, the CuraClaims guide, standing at the base of the claims genome

care strand × claims strand
episodes · plans · codes — read together

Chapter 01 — The fight

Two strands, pulled apart for fifty years.

01 The push and the pull

Providers push. Payers pull.
Patients and employers pay for the fight.

Every other vendor arms one side. We sit in the middle — sequence the evidence, argue both sides against ourselves, and land on the number that survives. That's what an objective broker is.

Dr. Render — clinical coding agent

The provider's case

pushes toward billed →

"The chart supports every line. The care was real, documented, and medically necessary. Pay it."

Built by CCPRA — the Provider Advocate. The strongest case the evidence supports. Confidence: 0.91.

Where the strands cross

$2,847.50

cited · final · fair

Cited to the contract, the code, the regulation, and the chart. A human signs it. And the patient behind claim SAMPLE-0001 never sees the fight — their care was never the question.

The Inspector — payment integrity agent

The payer's case

← pulls toward zero

"This claim lacks documentation. The pattern looks like up-coding. Why would I pay full?"

Built by CCPVA — the Payer Defender. Finds every legitimate reason not to pay. Confidence: 0.62.

adversarial by design — both briefs, every claim, then a human rules

A self-insured plan, read

Employees on the plan5,000
Plan cost per employee$15,000
Claims paid each year$75M
Every 1% paid wrong$750K

a year · illustrative arithmetic · try your own numbers →

The Director, CuraClaims review agent

Who pays for the fight

If you self-insure, the fight is on your bill.

About six in ten workers※KFF Employer Health Benefits Survey, 2024 · self-funded plans with job-based coverage are in a self-funded plan. Their employer pays every claim, and every round of the fight in between. CuraClaims reads every claim the plan pays, from both sides, and protects your employees along the way.

  • Every claim, every week. Not a sample every few years.
  • Employees' wrong bills and denials, fixed too.
  • No carrier change. A free screening in about two weeks.
Self-insured employers & benefits leadersFor employersYour plan, independently checked. Start with a free screening. Running benefits across a portfolio or coalition? One agreement covers every company →

Chapter 02 — The payoff

Why any of this matters.

02 The point of it all

From compliance
to care.

When integrity is real-time, gaming stops paying — and the dollar stays in care instead of the fight. The provider gets paid for the care they gave. The payer pays for the care that happened. The patient never sees the battle. Integrity stops being a police function and becomes the thing that keeps coverage affordable and doors open.

And when payment and outcomes finally share one record — the care strand and the claims strand, bound — value-based care stops being a pilot program and becomes how the system runs.

  1. Integrity goes real-time

    Every claim sequenced in 19µs※enterprise pre-payment engine · production telemetry — before the dollar moves, not eighteen months after.

  2. Gaming stops paying

    When the genome sees every pattern, exploiting the rules stops being a business model.

  3. The dollar stays in care

    Money that burned in audits, appeals, and abrasion returns to the bedside.

  4. Value-based care gets real

    One defensible record of care and cost — the substrate VBC has been waiting for.

every claim dollar yesterday — audits · appeals · abrasion with curaclaims — member care

03 Proven where the money moves

$250B

in annual medical claims — the only operator running payer and provider in production simultaneously.

A top-5 U.S. integrated payer · 9M members A 46-hospital health system · provider CMS · policy
72%
Appeals won — industry avg. 38%※production data · 2025
93,218
Denied claims sequenced, one engagement※recovery engagement · live
1:342
One reviewed decision propagates to hundreds※force multiplier 1:342 · production data
9
Payer specialist desks, briefed daily

Chapter 03 — The people

The humans who sign their names to it.

04 The bench behind the genome

Operators, physicians,
and public stewards.

People who have run the largest payer in America, the largest state health agency, and military health operations — now building the referee. Full bios →

Long Nguyen

Long Nguyen

Co-founder · CEO

C. Rockefeller

C. Rockefeller

Co-founder · capital

Dr. S. Mukherjee

Dr. S. Mukherjee

Co-founder · physician-scientist

Wallace Smith

Wallace Smith

Colonel (ret.), U.S. Army

Sam Pham

Sam Pham

VP, Engineering

Cesar Gonzalez Cuellar

Cesar Gonzalez

DevOps & security

Chapter 04 — Your door

The truth of a claim doesn't change by audience.

Sequence your book

Bring your 837s and 835s.
We'll show you the DNA.

The signature engagement: two weeks, your 837s + 835s in, the sequencing read out — the recoverable pool by path, every number with its provenance.