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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%
247
CFR rules encoded
50ms
Full Phase 0–7 latency
99.1%
Accuracy within $0.10
CMS publishes 100,000+ pages of payment policy. CAPE implements the complete Medicare Part B professional claims adjudication ruleset — every modifier, every reduction, every exception — in deterministic code. For the first time, any financial party can call an API and get the exact dollar Medicare owes, with the statutory citation proving it.
Competitive Posture
Competition is
for losers.
Proprietary Technology
A 10× advantage that cannot be purchased
247 deterministic CFR 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.
$1.2T
Annual US physician and professional services spend — every dollar flowing through the 837P claim format CAPE adjudicates. Every dollar governed by the rules CAPE has encoded.
$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 completely blind.
The incumbent standard: 12 weeks, $300K, and a 5% manual guess.
Crescent’s standard: 4 hours, 100% deterministic adjudication, and the exact EBITDA delta.
$ cape run --mode=acquisition-qoe
Practice:
Southeast Gastro Group · 80 providers
Period:
2024-01-01 → 2024-12-31
Claims:
148,470 · Loading...
Running Phase 0–7...
✓ complete in 4,287ms
Variance Report
billed_charges$42,918,400
payer_paid_eob$29,411,800
cape_true_allowed$31,140,370
variance_delta +$1.72M ↑ EBITDA +5.9%
Enterprise Value Created
$20,000,000 @ ~12× EBITDA
Top Variance Rules
42 CFR §414.22(b)(5) +$894,410 RVU adj
42 CFR §414.26(c) +$512,030 GPCI
42 CFR §414.40(a)(2) +$322,130 Multiple proc
Full engagement fee
$50K–$100K
200:1 ROI
PROOF OF CONCEPT DELIVERED · NORTHEAST PE FIRM
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.
$62B M&A VOLUME BOUGHT BLIND
STEP 02
MA Plans
Replace brittle payer infrastructure with deterministic adjudication at plan scale.
$500B+ IN MEDICARE ADVANTAGE SPEND
STEP 03
Smart Clearinghouse
Adjudicate claims in motion. Charge an API toll on the flow of healthcare itself.
5 BILLION+ CLAIMS ROUTED ANNUALLY
STEP 04 ★
CAPE Capital
Finance receivables with perfect underwriting intelligence and earn the risk spread. When a receivable has a mathematically verified expected value, it becomes a financeable asset. We advance the liquidity, package the risk, and capture the yield on an entirely new fixed-income market.
$1.2T IN NEWLY FINANCEABLE ASSETS
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 software. We become the Central Bank of the largest industry in the world.
Validation
The math checks out.
The government agrees. Wall Street is buying.
A trillion-dollar vision is just a hallucination if there's no validation.
// THE ECONOMIC MANDATE
$45B
Peter Orszag — CEO of Lazard, former Director of the U.S. Office of Management and Budget — published a formal policy brief estimating $45 billion in annual waste from the current claims adjudication failure. The paper, funded by Gates Ventures and published through Yale's Tobin Center, identifies real-time deterministic adjudication as the single highest-value intervention available in U.S. healthcare.
WE ARE BUILDING EXACTLY WHAT HE IDENTIFIED.
// THE FEDERAL MANDATE
CMS Agrees
CMS published a Statement of Objectives to replace their COBOL mainframe — the system processing $460B in Medicare claims annually. Their technical requirements for the replacement: sub-second adjudication, full CFR citation per claim, REST API output, 99%+ accuracy.

CAPE meets every specification. Commercially. Today.
CMS IS PROCURING WHAT WE ALREADY BUILT.
// THE TECHNICAL BENCHMARK
99.1%
Deterministic match rate against 500,000 historical Part B claims, verified against actual 835 remittances. CMS's own POC requirement for their mainframe replacement: median variance ≤ 0.5%. CAPE's measured accuracy exceeds it. The physics engine works at scale.
TOLERANCE: ±$0.10 (CMS STATUTORY STANDARD)
// THE COMMERCIAL REALITY
Live Deal
Successful proof of concept delivered to a Northeast Private Equity firm conducting an 8-figure orthopedic acquisition. CAPE identified material, line-level EBITDA leakage with exact CFR citations.
STATUS: ACTIVE NEGOTIATION FOR FULL QOE CONTRACT
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 in my family's medical practice — where 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.
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