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 sequence both across $250B a year, and resolve them into one number every side can defend — so the dollar stays in care.
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
Payers pull. Providers push.
The patient pays 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.
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.
Where the strands cross
cited · final · fair
Cited to the contract, the code, the regulation, and the chart. A human signs it. And the veteran behind claim 600-K50F6XN never sees the fight — their care was never the question.
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.
Chapter 02 — The proof
Not a vision deck. Production.
02 Not a deck — the product in production
The recovery surface,
as our analysts see it.
One VA engagement: 93,218 denied claims※VA CPAC recovery engagement · live system sequenced into a $324.9M recoverable surface — every claim sorted by what it's waiting on and the exact artifact that recovers it.
The denied-claims recovery surface · pick a readiness lens, then a path to work
93,218 denied claims · $324.9M recoverable surface
VALIDATE → BUNDLE → REVIEW → FILE → LEARN · nothing auto-mails — a person always clicks Approve & file
03 A day in the seat
The Next button.
(our biggest invention)
Every customer asks for the same thing, in nearly the same words: "give my team something they can just click — with the confidence to focus only on what’s in front of them." This is that button. Mr. Claims narrates a Tuesday with it.
next/nɛkst/verb · CuraClaims
- To sign work that arrived finished — evidence gathered, citations checked, packet sealed — and receive the next case in exactly the same state.
- The unit of trust between a team and its engine: nothing reaches the button unchecked; nothing leaves it unsigned.
"My team just clicks Next — and trusts everything behind it."the ask we hear from every customer — payer and provider alike
8:01 a.m. · the queue
93,218 denied claims · $324.9M · sorted, priced, ready
S01 · CO-16 · SUBMISSION DEFECT — INFO MISSING
A***** F***** · 600-K50F6XN
99291 critical care · DOS 2025-02-12 · BCBS Federal Employee Program
READY
your dispute packet · preview · reconcile · file
Built while the page loaded
- ✓Fax cover — VA letterhead, signing official resolved
- ✓Corrected-claim letter — itemized bill + records
- ✓UB-04 (CMS-1450) — rebuilt from the 837I
- ✓835 ERA — reconciled · 7 consistency checks passed
- ▲1 item to double-check — the appeals address from this claim's EOB
S01 · CO-16
A***** F***** · 600-K50F6XN
packet complete · 6 sections · cited
4:52 p.m. · the shift
One analyst. One Tuesday.
1 / 5 · the book
This is the whole book — 93,218 denials · $324.9M, every dollar sorted by what it's waiting on. $133.3M needs nothing at all.
shown: the provider recovery seat · the payer determination seat runs the same loop — review · sign · next
Chapter 03 — The crew
Specialists with KPIs, not a model with vibes.
04 The team that reasons every claim
An org chart,
not a model.
"We don’t need more flags — we need more staff." Every payer SIU says it; they’re right. So we didn’t build a flagging tool — we built the staff. Think of it like HR — but for the bots. Every agent has a seat, a KPI it's measured on, and an incentive that keeps it honest. They draft and reason. A person always clicks Approve.
Mr. Claims
Your guide
Walks you through every surface — from the $324.9M pool to the single claim you're about to sign.
The Director
Revenue cycle lead
"One coherent, payer-tailored strategy — resolve the conflicts, own the go/no-go." Answers to the human approver.
The Coder
Coding & medical necessity
"Does the chart actually support the billed line?" Never says 'chart confirms' without a quote.
The Adjudicator
Denials & compliance
"Is this denial even adjudicable — and what's the cleanest legal posture?" Kills false claims before they exist.
The Tracer
Payer intelligence
Researches what each payer actually needs — jurisdiction- and date-specific, cited to source. Briefs all nine desks.
The Auditor
QA gate
"Every assertion has a citation; nothing finalizes with an open gap." Blocks ~14% of our own work※self-review gate · engineering telemetry before it ships.
You bring your claims.
We bring the experts.
Like TurboTax: you bring a W-2; it brings the entire tax code — federal, state, current — and hands you a finished 1040. You bring your 837s and 835s; we bring everything below — and hand you signed, filed determinations.
you bring · that’s the whole ask
your 837s · your 835s · your contracts. Software arrives empty — our agents arrive trained.
we bring · current, cited, already versed in your payers
the codebook
CPT · ICD-10 · CARC/RARC · NCCI · MUE
the law
38 U.S.C. §1729 · 42 CFR · FCA · OIG work plans
the contracts
fee schedules · timely-filing · appeal ladders
the behavior
payer pay-rates by code — learned from their own 835s
the clinic
treatment trajectories by disease type — BH, ABA, PT, SNF, HH
the outcomes
every filed packet returns as ground truth — the loop no one can fork
01 · find
The opportunities in your book — sequenced, priced, by readiness.
02 · ask
Precise asks tuned to your data, your payers, your jurisdictions — never generic.
03 · act
Packets and determinations filed and signed — finished work, not findings.
04 · learn
Every outcome retrains the read — your moat compounds with ours.
your W-2 in, your 1040 out — your claims in, signed determinations out
wall 01
The memory — payer behavior from 80M+ live claims. Not for sale anywhere.
wall 02
The clearance — FedRAMP High + national ATO. 18 months if you're flawless.
wall 03
The position — all three sides in production. One-sided vendors can't follow.
wall 04
The loop — every outcome retrains the genome. The gap widens daily.
Chapter 04 — The payoff
Why any of this matters.
05 The point of it all
From compliance
to care.
When integrity is real-time, gaming stops paying — and the dollar stays inside the member's care. Payment integrity stops being a police function and becomes the lever that keeps coverage affordable.
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.
Integrity goes real-time
Every claim sequenced in 19µs※VA pre-payment engine · production telemetry — before the dollar moves, not eighteen months after.
Gaming stops paying
When the genome sees every pattern, exploiting the rules stops being a business model.
The dollar stays in care
Money that burned in audits, appeals, and abrasion returns to the bedside.
Value-based care gets real
One defensible record of care and cost — the substrate VBC has been waiting for.
05 Proven where the money moves
in annual medical claims — the only operator running payer, provider, and federal in production simultaneously.
Chapter 05 — The people
The humans who sign their names to it.
06 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
Co-founder · CEO
C. Rockefeller
Co-founder · capital
Dr. S. Mukherjee
Co-founder · physician-scientist
Dr. Ed Ellison
Advisor · ex-co-CEO, Permanente
Dr. Mark Ghaly
Advisor · ex-Sec., CA HHS
Wallace Smith
Colonel (ret.), U.S. Army
Chapter 06 — Your door
The truth of a claim doesn't change by audience.
07 Pick your side — the truth doesn't change
One genome.
Four doors.
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.