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The pricing infrastructure for the $5.6 trillion healthcare economy
Haseeb Chaudhry  ·  Founder & CEO
$30,000,000,000
Medicare — the most sophisticated payer in the world, the entity that writes the rules — overpays and underpays by this amount every single year.

Not because the rules are unclear.
Because nobody built the machine that executes them.
CMS MEDICARE FEE-FOR-SERVICE IMPROPER PAYMENT RATE  ·  FY2025 CERT REPORT
The Problem
$5.6 trillion industry.
Nobody knows what anything costs.
The Provider
Submits a claim. Receives whatever the payer decides. Fights denials for months with no ground truth on what they were actually owed.
No Ground Truth
The Insurer
Runs 30-year-old adjudication engines. Pays billions in improper amounts — including CMS itself — then audits after the fact.
No Ground Truth
The Patient
Receives a bill weeks later with no way to verify if the amount is correct. Pays it anyway. Or doesn't.
No Ground Truth
$300B+
The revenue cycle management industry exists entirely to manage this information gap. It has never tried to close it. It profits from the chaos remaining unsolved.
Money flow in healthcare is like gravity — invisible, and yet it determines everything about how medicine is practiced.
The Secret
The industry is using
the wrong equation.
✗  Probabilistic Guessing — What Everyone Else Does
INPUT: 1,000,000,000 claims ↓ neural network ↓ pattern matching ↓ statistical inference OUTPUT: probability distribution
“87% confidence: $2,400 — $2,800”
Fatal flaw: if payers systematically underpay by $1,000, the model learns that's “normal.” It cannot find what it has been trained to expect.
✓  Deterministic Truth — What We Do
42 CFR §414.22
RVU × GPCI × CF
↓
$2,743.18
Citation: CMS MPFS Final Rule · No probability. One answer.
Medicare payment is not a pattern. It is federal law — a strict mathematical formula. You don't predict gravity. You calculate it.
Every other company is trying to predict the answer. We realized you just have to calculate it.
The Product
CAPE — Crescent Adjudication and Pricing Engine
Input — Raw 837P Claim
ISA*00* *00* *ZZ*1234567890 *ZZ*9876543210 *250315*1200*^*00501*000000001*0*P*:~ GS*HC*1234567890*9876543210*20250315*1200*1*X*005010X222A1~ ST*837*0001*005010X222A1~ NM1*41*2*ORTHO SPINE ASSOC*****XX*1234567890~ PER*IC*BILLING DEPT*TE*5551234567~ NM1*40*2*MEDICARE*****PI*00435~ HL*1**20*1~ NM1*85*2*ORTHO SPINE ASSOC*****XX*1234567890~ N3*123 MEDICAL PLAZA DR~ N4*HARTFORD*CT*06103~ REF*EI*987654321~ HL*2*1*22*0~ SBR*P*18*******MB~ NM1*IL*1*DOE*JOHN****MI*1EG4TE5MK72~ CLM*20250315-001*3847.22***11:B:1*Y*A*Y*I~ DTP*431*D8*20250312~ HI*ABK:M17.11*ABF:Z96.641~ LX*1~ SV1*HC:27447:50**3847.22*UN*1***1~ DTP*472*D8*20250315~
→
CAPE
Crescent Adjudication
& Pricing Engine
P0 · Intake & Normalize
P1 · Provider & Geo
P2 · Eligibility
P3 · Coverage / LCD
P4 · NCCI / MUE
P5 · Fee Schedule
P6 · Modifiers / MPPR
P7 · Financial Split
→
Output — Adjudication Decision
CPT 27447 — Total Knee Arthroplasty · Bilateral Mod 50
CAPE CORRECT PAYMENT$3,847.22
ACTUAL PAID$3,204.00
VARIANCE— $643.22
RULE VIOLATEDMPPR Ind. 2, Bilateral
CITATION42 CFR §414.22(d)
RECOVERY PROB.78%
112
Implemented Medicare rules
8
Adjudication phases
50K+
Lines of production code
Took 9 months of singular focus to build the only ground-truth oracle for Medicare payment that exists outside the US government itself.
Competitive Posture
Competition is
for losers.
Proprietary Technology
A 10× advantage that cannot be purchased
112 deterministic Medicare rules. Not marginally better than prediction models — categorically different. The complexity that made this hard to build makes it impossible to replicate quickly.
Network Effects
Every engagement compounds the moat
Every claim processed trains payer behavior models. More engagements → more variance data → smarter predictions → more accurate findings → more clients. The flywheel accelerates.
Economies of Scale
$0 marginal cost per adjudication
The first correct adjudication took 9 months of engineering. The next million will take seconds. RCM companies charge per-FTE. We charge per-insight. Unit economics only improve.
Barrier to Entry
A knowledge gap, not a feature gap
Big Tech won’t build this — too niche. Standard startups can’t — 100,000+ pages of federal policy implemented in strict deterministic code. The complexity is the moat. You cannot hire your way out of it.
“Every monopoly is unique, but they usually share some combination of these characteristics.” — Peter Thiel, Zero to One
Market
The largest unpriced
asset class in America.
$5.6T
Total annual US healthcare spend — every dollar a Medicare-denominated or Medicare-referenced asset with an objectively correct, calculable value that nobody computes
$300B
Outstanding healthcare accounts receivable at any given moment — all awaiting correct valuation before being collected, financed, or sold
$62B
Annual private equity physician group M&A volume — every deal conducted without ground truth on receivable quality or reimbursement accuracy
This market runs on 30-year-old infrastructure. The Change Healthcare cyberattack in 2024 paralyzed $1.5T in claims flow for months and exposed its catastrophic fragility. Cotiviti, Optum, TriZetto — built in the Clinton era, never rebuilt. The window to become the modern infrastructure layer is open. It will not stay open forever.
Go-to-Market Wedge
Start where the ROI is undeniable.
PE firms are buying Medicare-denominated cash flows. They currently do reimbursement diligence through manual sampling — 6–12 weeks, $150K–$500K per engagement, zero ground truth. CAPE delivers a deterministic line-by-line variance report in days.
CAPE finds in underpayments$1.5M
× EBITDA acquisition multiple10×
Instant enterprise value created
$15,000,000
Our fee
$75,000
200:1 ROI
FIRST ENGAGEMENT IN SIGNING · Q2 2026
01
Kill Score Analysis

We score every PE-backed orthopedic practice using CMS public data. Cold outreach contains a specific finding — not a pitch. We show them the problem.

02
Free Proof of Concept

One payer, one CPT family, 90 days of data. Takes 2 hours. Shows one real finding with one CMS citation. Converts at ~70%.

03
Full Engagement + Platform Contract

$75K engagement fee — fully refunded against a recurring 6–7 figure annual monitoring platform contract. We get paid to acquire long-term customers.

The Master Plan
Four steps. One endgame.
STEP 01
PE Diligence
Own reimbursement diligence. Become the required workflow in healthcare M&A.
$50M ARR
STEP 02
MA Plans
Replace brittle payer infrastructure with deterministic adjudication at plan scale.
$120M ARR
STEP 03
Smart Clearinghouse
Adjudicate claims in motion. Charge an API toll on the flow of healthcare itself.
$250M ARR
STEP 04 ★
Crescent Capital
Finance receivables with perfect underwriting intelligence and earn the risk spread.
$1B+ annual yield
1. PE DILIGENCE (The Wedge)$50M ARR[ 20 PE Platforms × 100 Docs × $2k/mo ]SaaS Seats
2. MA PLANS (Payer Infrastructure)$120M ARR[ 5M Covered Lives × $2 PMPM × 12 mos ]PMPM
3. SMART CLEARINGHOUSE (API Volume)$250M ARR[ 1 Billion Claims/yr × $0.25 API Toll ]API Toll
4. CRESCENT CAPITAL (The Endgame)$1B+ ANNUAL YIELD[ $50B Financed Receivables × 2% Risk Spread ]Interest Spread
Larry Fink built Aladdin — a risk analytics engine — then used Aladdin to justify managing the money. BlackRock today manages $10 trillion. We are building Aladdin for healthcare receivables. We don't just sell to the ecosystem. We become its Central Bank.
Founder-Market Fit
I didn't look for a startup idea.
The combination of skills required to build this is a statistical anomaly.
The Atoms
7 YEARS
of manual medical billing, starting at age 13. I learned exactly where the plumbing breaks by fighting insurance companies on the phone.
The Capital
$300M+
in healthcare M&A evaluated. I hunted for EBITDA leakage manually in the deal room, and built CAPE because I desperately needed it to do my job.
The Code
50,000
lines of deterministic Python. Built entirely by a dual BS/MD student who published first-author Yale research at age 17, won international awards for ML research at 16.
Remove any one of these three pillars, and this company does not exist.
10,000,000
Claims Ingested (Q3 2026 Target)
The critical mass of data required to train our payer behavior models—mapping the exact friction and denial patterns of every major insurance carrier.
Local Compute Hardware: High-performance silicon to host local LLMs and train our payer behavior models in a strictly air-gapped, HIPAA-compliant environment.
AWS Infrastructure: Scalable cloud storage and elastic compute to ingest, parse, and adjudicate raw healthcare claims at production volume.
Deal Execution Runway: Legal structuring, compliance, and sales operations to close our first PE engagement and publish the definitive case study that unlocks the market.
U.S. healthcare processes $5.6 trillion every year.
Every dollar is bound by a mathematical law.
The industry spent billions trying to guess the answer.
We built the calculator.
Crescent Intelligence