CuraPatient® · CuraClaims
Get your book read

For health plans, integrated payers & SIU

Pay it right the first time.

End the battle of the bots. CuraClaims checks every claim against your contracts, your medical policies and the pricing method that governs, before the dollar goes out. Savings that hold up, because every finding arrives signed, cited and built to survive the provider's rebuttal.

Request a portfolio assessment See example cases
Prepayment in under 500 ms A person signs every determination Underpayments surfaced too Never auto-denies
The Inspector, payment integrity agent

The realization

You don't spend integrity dollars to win a fight. You spend them to be right.

Vendors that promise every flagged dollar is recoverable are the ones whose findings collapse when a provider pushes back. Cost to pursue climbs, abrasion climbs, net recovery falls. We show you the gray zones up front, so every dollar you pursue holds up.

where this fits 01 · the genome→ 03 · your door — you are here→ 04 · the dollar returns to care

Act 01 — The battle of the bots

Both sides automate the fight. Nobody wins it.

01 Deny, appeal, repeat

Every round adds cost, strains the network and catches members in the middle.

Today

Deny, appeal, repeat

  1. Round 1Denied by rule
  2. Round 2Appealed by bot
  3. Round 3Re-denied, new reason
  4. Round 4Appealed again
  5. Round 5Arbitration or write-off

Providers now automate appeals. Rules engines deny what they can't explain. Each round costs both sides money and goodwill, and the member waits in the middle. Illustrative.

With CuraClaims

One answer, before payment

Priced by the contract and the method that governs, checked against your medical policy, cited and signed. Both sides can see why, so the loop never starts.

  • Contract rate and governing pricing method applied
  • Medical policy and coding edits, current version
  • Only the claims that need a look are held

<500 msper prepayment decision, on your adjudication flow

Act 02 — What we do

"We don't need more flags. We need more staff."

02 Finished work, not flags

You're right. Flags don't file themselves.

A

Before the dollar moves

Prepayment review

Every claim scored on your adjudication flow, priced by the contract and the governing method, checked against medical policy. Prevention is the product; recovery is the apology.

Pay-and-chase, ended
B

After payment

Findings that survive rebuttal

Whole episodes of care, not line items. Every finding tiered by confidence, from near-certain rule violations to clinical-judgment calls, with the regulation it rests on.

You decide where to spend effort
C

For your SIU

Finished cases

Every flag arrives as a signed determination package: evidence, citations, the provider's best counter-argument and a recommendation. Medical records read for you, in any format.

Awaiting one thing: your signature

Act 03 — Use cases

Where the waste actually lives.

03 What we saw, what we found, what we recommended

Not the whales. The millions of small claims rules can't read.

Each example is a composite of patterns we see on payer books. All identifiers and amounts are placeholders; no member or client data appears on this site.

Trajectory · therapyExample

Therapy that never tapers

Provider X · physical therapy · xx weeks · $xx,xxx

  1. What the claims showedThe same visit intensity, week after week. Every claim, on its own, looked fine.
  2. What we foundRead as one episode, functional scores in the provider's own notes plateaued around week xx; your medical policy calls for step-down.
  3. What we recommendedEducation first, with the evidence shared with the provider; targeted review of the episode only if the pattern continues.
Educate · recover · referproportional, defensible
Prepayment · pricingExample

Priced off the chargemaster

Claim EX-xxxx · out-of-network · billed $xx,xxx

  1. What the claim showedAn out-of-network claim about to be paid as a percentage of billed charges.
  2. What we foundThe contract and the applicable law set a different pricing method. Repriced by the method that governs, with each source cited.
  3. What we recommendedPay the governed amount now, with the basis attached, so there is nothing for either side to fight about later.
Paid right, before paymentunder 500 ms
Both directions · underpaymentExample

The underpayment you'd rather find first

Provider group X · xxx claims · one fee schedule

  1. What the claims showedA quiet pattern of short payments to one provider group.
  2. What we foundThe claims system was still applying last year's fee schedule to xxx claims.
  3. What we recommendedCorrect it proactively, before the appeals arrive. Credibility you can bring to the next contract negotiation.
About a third runs this waya credibility asset
Cohort · force multiplierExample

One decision, hundreds of claims

Pattern X · xxx similar claims · one billing behavior

  1. What the claims showedThe same billing behavior repeated across hundreds of claims, too many to review one by one.
  2. What we foundA representative sample, reviewed in full, settled the pattern. High-dollar claims still got individual review.
  3. What we recommendedYour reviewer signs one determination; it propagates to every matching claim, each with its own citations.
One review, the whole cohort1:342 in production

Act 04 — The package

Both briefs on every claim. Then a person rules.

04 What your reviewer signs

A determination, not a risk score.

Both sides argued

Your case and the provider's strongest case, side by side.

Tiered by confidence

Near-certain violations apart from clinical-judgment calls.

Every line cited

Contract clause, medical policy, coding edit and chart, as of the date of service.

Visible to the provider

The same evidence, before the recoupment letter. Engagement goes up, not abrasion.

Claim to package in under 5 minutes

Signed by your reviewer. Never denied by automation.

curaclaims · determination · EX-xxxx EXAMPLE · SYNTHETIC

Determination · provider X · episode of care

Therapy past functional plateau

Tier 2 · clinical judgment

Paid

$xx,xxx

Supported

$xx,xxx

Recommended

Educate

Payer's case

Functional scores flat after week xx; policy calls for step-down; visit intensity unchanged.

Provider's best case

Documented flare in week xx; plan of care updated; partial gains in one measure.
Medical policy · therapy continuation criteria, current versionCITED
Chart · progress notes, weeks xx–xx, scores highlightedCITED
Contract · utilization review clause §xCITED
Ready for reviewer · built in under 5 minutesSign determination

Act 05 — How it works

Four stages. Two gates. Both gates human-grade.

05 What we built

Imagine the best claims attorney you know.*

Give them every contract, every statute, every medical policy, and have them review every claim, in real time, for your whole team. We built the attorney. You keep the signature.

* A figure of speech. CuraPatient is not a law firm, CuraClaims is not an attorney, and nothing it produces is legal advice or legal representation. Determinations are reviewed and signed by your team. For legal questions, consult your own counsel.

stage 01

Detection

55 learned pattern types find it: signatures, not written rules.

stage 02

Investigation

5-lens analysis builds the case: billing, clinical, systemic, statistical, historical.

gate 1 · the seal

Nothing uncited ships

Every citation checked and current. ~14% of our own work blocked※self-review gate · engineering telemetry before a person ever sees it.

stage 03

Adjudication

Advocate, Defender and Arbiter argue it: both briefs on every claim.

gate 2 · the signature

A person decides

Every determination signed by a human. Never deny through automation, ever.

stage 04

Resolution

Graduated response: educate, recover, refer. Proportional and defensible.

the part everyone asks about

The records request is where
most programs drown.

Anyone can request records. It's the 100,000 pages that come back, as faxes, scans, PDFs and portal exports, where staffing dies and provider relationships sour.

The ask is precise, driven by your data, this payer's patterns and this jurisdiction's rules. When the records return, the model reads them, mapping unstructured clinical text onto the claim until there's a single picture of the patient's care.

1

Precise ask

Only what decides the claim. Provider burden goes down.

100k

Pages return, every format

No analyst reads them. The model does, cited to the chart.

1

Patient journey

One coherent picture: the clinical strand your determination needs.

06 Proven on payer books at scale

Tens of millions of claim lines. The patterns rules never caught.

Working with a top-5 U.S. integrated payer covering nine million members, the engine read four years of claims and discovered 28 novel detection patterns across behavioral health, ABA, physical therapy, emergency care and home health that traditional edits don't see.

"I want to set the contract, monitor it, and let my members get the best access at the best quality, instead of spending hundreds of millions gaming with my providers."

— a major carrier CEO, in conversation
54M
Claim lines analyzed
single payer · 4 years
28
Novel patterns discovered
unsupervised, not hand-coded
$380M
Structural waste surfaced
a third ran the other way
1:342
One reviewed decision, propagated
force multiplier · production

07 The terms

We get paid
when you do.

No seats. No shelfware. No report that dies in a drawer. The agents do the work, your people approve it, and the risk is shared.

01 · two weeks · fixed

The Read

Your book, sequenced: exposure and underpayments by confidence tier, every number with its provenance.

02 · contingency

Recover

Findings that survive rebuttal, and the third that runs the other way, surfaced too. We fund the work and get paid on dollars that return.

03 · per claim

Prevent

Prepayment review on your adjudication flow, in under 500 ms per claim, priced on prevented loss.

08 Questions payment integrity leaders ask

Does CuraClaims ever deny a claim automatically?

No. Every determination is signed by a person on your team. The engine assembles the evidence, the citations and the provider's strongest counter-argument; a human decides.

Will this increase provider abrasion?

It is designed to lower it. Findings are tiered by confidence, the same evidence package is visible to the provider, and about a third of what the engine finds runs the other way as underpayments, which builds credibility with your network.

How does prepayment review fit our claims system?

CuraClaims scores each claim on your adjudication flow in under 500 milliseconds and holds only the claims that need a look, priced by the contract and the method that governs.

Does it replace our payment integrity vendor?

It can run alongside existing vendors or replace sample-based review. The difference is finished, signed work on every claim rather than flags, and findings that hold up on rebuttal.

Is CuraClaims a law firm?

No. "Claims attorney" is a figure of speech. CuraPatient does not provide legal advice or legal representation. Your team reviews and signs every determination.

From readout to recovery

A portfolio assessment on your own claims.

We run your book, return claim-level evidence packages with the provenance for every number, and stand up the first recovery sprints, in weeks, not quarters.

Request an assessment How the engine works