Federal · VA · CMS · DoD
Pay first.
Verify always.
The pipeline routes every claim to its correct payment authority — it never denies through automation. Veterans always get paid; post-payment review catches and corrects without ever delaying care.
The non-negotiable
Never deny through automation.
When the evidence is in equipoise, the benefit of the doubt goes to the veteran. The system never denies on ambiguity — it routes to a human reviewer. AI assembles the case; a person decides.
Act 01 — The read
The right authority, from the claim itself.
01 Statutory authority, determined from the claim
The right authority, the right amount, the right speed — at national scale.
For VA community care, every claim must be assigned to the correct statute — authorized care, non-service-connected emergency, or service-connected emergency. We determine most of that directly from the claim and the data warehouse, without pulling clinical records for every episode — and route only the genuine edge cases to a nurse.
Five-determination framework — each independent, each cited
- Emergency — 837 fieldsauto
- Service connection — DX → ICD-10 → CDW ratingauto
- Layperson standard — 38 CFR §17.1002cited
- Point of stability — clinical recordsto nurse
Act 02 — The clearance
The authorizations are already in hand.
02 Deployable today
No procurement reset. Months, not years.
The authorizations are already in hand. We drop into the federal estate — VA, DoD, CMS — and run against the most complex health-record environment in the country, including VistA, Cerner, and Epic in production.
First deployment to a national Authority to Operate in under 18 months.
Act 03 — The doctrine
Integrity as shared infrastructure — not a weapon.
03 A policy posture, not just a product
Program integrity should be shared infrastructure — not a weapon.
In our response to the CMS CRUSH RFI, we proposed the standard for next-generation program integrity: surface underpayments alongside overpayments; require glass-box, per-claim explainability; keep humans as the deciding authority; mandate that systems measurably improve over time; lead with education; and build prevention from outcome-trained detection.
Read the principlesAct 04 — The terms
How we engage — risk shared.
04 The terms
We get paid
when you do.
No seats. No shelfware. No report that dies in a drawer. Results as a service — the agents do the work, your people approve it, and the risk is shared.
01 · inside your ATO
The Diagnostic
A scoped read on your own claims, inside your enclave — no procurement reset, results in weeks.
02 · observe-only
Shadow
The pre-payment engine runs in silence against live flow — scored, memorialized, measured before it touches anything.
03 · graduated
Earned autonomy
Shadow → recommend → automate, granted mode by mode on evidence. Never deny through automation.
pay first · verify always · benefit of the doubt to the veteran, by law
For federal program leaders
A briefing for your payment-operations team.
How claims-first authority determination works on your data — auditable, glass-box, zero access impact, and ready to deploy inside your existing ATO.