State Medicaid · program integrity
We don't flag issues.
We fix them.
Your program-integrity shop isn't short on alerts — it's short on resolution. CuraClaims turns detection into finished, cited case files: recoupments that survive appeal, corrections that keep providers in your network, referrals your MFCU can run with.
The graduated response
Educate. Recoup. Refer.
Not every overpayment is fraud. Where it's error, lead with provider education. Where it's abuse, the recoupment is cited and built to hold. Where it's fraud, the file is MFCU-referral-ready under 42 CFR §455.23. A human picks the path — the package is ready either way.
Act 01 — The work
We don’t flag issues. We fix them.
01 From alert to action
A flag is an alert. This is a recovery package.
Every determination arrives as a finished case file: the pattern evidence, the cited exhibits, the adversarial review record, and the human sign-off. Your team submits it — they don't build it.
And because the engine surfaces underpayments too — fee-schedule lags, EPSDT services paid below the state plan — providers learn your system is accurate, not adversarial. That's what keeps them enrolled, and what makes the recoupments you do pursue stick.
Recovery package — personal care services (T1019), representative case
- Impossible-day analysis — 41 dates exceed 24 billable hrsconfirmed
- EVV cross-match — visit logs vs. units billeddocumented
- 42 CFR §455.23 — credible-allegation posturecited
- Claim roster + 835 reconciliation — 2,316 claimsattached
Act 02 — The clearance
Federal-grade, ready for your MMIS.
02 Deployable today
Sits on your MMIS. No rip-and-replace.
CuraClaims reads the 837s and 835s your systems already produce — pre-payment scoring in under 500ms per claim, or post-payment review across the full book. EVV-aware, EHR-integrated, and proven against the most complex record environments in the country.
First deployment to a national Authority to Operate in under 18 months. Every resolved claim is a ground-truth label — the engine gets sharper with each state it serves.
Act 03 — The proof
Where this has already worked.
03 Traction & track record
Proof, not adjectives.
In production across the Department of Veterans Affairs (national operations), a top-5 U.S. payer, and a 46-hospital health system — and engaged with CMS on the CRUSH program-integrity RFI, where we proposed the standard for next-generation program integrity: underpayments surfaced alongside overpayments, glass-box per-claim explainability, humans as the deciding authority, and education before recovery.
Act 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 · two weeks · fixed
The Read
Your Medicaid extract, sequenced — improper-payment surface by service family, EVV-aware, with provenance.
02 · contingency
Fix
Cited case files that survive appeal: educate, recoup, or refer — graduated by design, paid on results.
03 · MFCU-ready
Refer
When it is willful, the file is already court-grade — pattern evidence, citations, chain of custody.
keep Medicaid affordable · underpayments surfaced too — that’s what objective means
For state Medicaid agencies · presented at CHCS Virtual Demo Days, June 2026
Bring us a claims sample. We'll hand you the recovery packages.
A de-identified 837/835 extract is enough. We'll return cited determinations on your own data — underpayments included — in days, not quarters.