Backed by Y Combinator

Know what you're owed.
Prove it.

Your payer contracts become executable logic that verifies every payment, explains every denial, and proves what you're owed.

For hospitals, health systems, payers, and plan sponsors.

CLM-8847
BCBS · DRG 470 · Knee replacement
Underpaid
Contract rate (2024)
§3.1
Escalator applied
3% CPI-U
Implant carve-out
§7.3
Payment vs contract
Remittance
Contract says you're owed
Underpayment found
$24,180.00
Contract rate with 2024 escalator
Payer paid
$23,462.00
Underpayment per claim$718.00
§3.1 CPI-U Escalator · Payer still on 2023 rate847 claims with same pattern
Revenue recovered
$608K
From this pattern alone
Denials overturned
43
Contract evidence attached

The gap between contract and outcome.

Denied. Underpaid. Rejected for missing info. None of it is random. Every pattern traces back to how contract logic was loaded, interpreted, or ignored.

Hospital contract
Rate escalator clause
Contract rate (2024)
$1,805
Payer still paying
$1,487
Escalator applied
No
Per-claim underpayment$318

Repeated across 847 CPT codes for 5+ months

Hospital contract
Modifier downcoding
Billed
99215
Paid as
99214
Contract supports 99215
Yes
Per-claim shortfall$42

Silent downcoding across 3,200+ E&M claims per quarter

Hospital claim
Preventable denial
Procedure
43239
Prior auth required
Yes
Auth # on claim
Missing
ResultDenied

Would have been caught pre-submission. Now facing timely filing risk on appeal.

Claim denied
Why, and what to do about it
Denial code
CO-50
Contract §6.3
Infusion carved in
Verdict
Appealable
Per claim$2,340

180+ claims with same pattern, appeal evidence ready

These aren't edge cases. They're systematic patterns that repeat until the underlying logic is checked.

Your contract is the rulebook.
Make it machine-readable.

Traditional workflows chase denials after the fact and miss underpayments entirely. Contract logic changes that. Predict denials before submission. Understand why they happen after. Verify every payment in between.

Traditional audit
Audit Report Q3
Claim
Day 0
Paid
Day 1
Months later
Error found
CLM-8847
Variance found
Settled$2,450.00
Contract rate$847.32
5%
sampled
60-90d
to detect
Timely filing
at risk
Contract-as-logic
Verification
Live
Claim
Received
Verify
Correct $
Pre-submitMissing auth flagged
Post-denialCO-50: contract says appeal
Post-paymentUnderpaid $42 vs §3.1 rate
Before
submission
During
adjudication
After
payment
Week 1
Time to first insights
All in scope
Transaction coverage
Traceable
Findings
No hallucinations. Deterministic logic.

Your contracts become executable logic.

Contract language becomes formal logic. Predict how claims will process. Verify every payment. Explain every denial. Traceable to the clause.

Contract

“Apply Modifier 59 when services are performed at distinct anatomical sites or during separate encounters

Executable Logic
when site primary
encounter = separate
then apply(modifier_59)
Deterministic
Same input, same output
Traceable
Every finding to a clause
Pre-submission
Know before you send
Sampling10%
BenchifyAll

Predict

Know how a claim will process before it settles. Flag missing info and likely denials pre-submission.

Post-pay auditMonths
Benchify<1 sec

Verify

Check every payment and determination against the contract. Catch underpayments and wrongful denials.

Contract §4.2.1source
Transaction #2024-847input
Modifier 59 appliedresult

Explain

Every finding traces to a contract clause. See why a claim was denied, underpaid, or flagged.

Any logic that determines payment.

From simple rate lookups to complex multi-step rules, we model the full decision tree and verify every path.

Eligibility Rules
Member active on date of service
SPD §2.1
Provider in network
Network Agreement
Service covered under plan
Benefits Schedule
Coordination of benefits applied
COB Rules §4.3
Every claim checked against member status, network, and coverage rules on the exact date of service.
Example: Coverage Gap Detection
MemberMBR-472918
Date of serviceMar 15, 2024
Coverage end dateMar 12, 2024
!
Flagged

Service date falls 3 days after coverage termination. Retroactive term from employer.

This pattern is invisible in aggregate reporting but shows up immediately in transaction-level verification.

These are examples. If your contracts define it, we can verify it.

Recover what you lost. Prevent what you haven't.

Look back at historical payments. Watch transactions in real time. Optimize your contract terms. Same verified logic, three ways to use it.

Start with any solution. One contract model powers all three.

What this means for your organization.

Contract errors compound silently. Verified contract logic protects revenue and cuts the operational burden of finding what went wrong.

Audit
Historical analysis

Recover what's already been lost

Surface underpayments, wrongful denials, and systematic errors sampling missed.

Complete
Analyzed
240K
Variances
3,840
Monitor
Live

Predict issues before they settle

Know how claims will process. Catch underpayments and explain denials in real time.

29881Knee arthroscopy
99214E&M visit
96413Infusion admin
Underpaid
J0881Infusion drug
Denied
Today
1,247 verified5 underpaid3 denied
Optimize
Contract renewal

Negotiate with real data

Model escalator structures, carve-outs, and stop-loss terms against actual claims.

CURRENT
Tier B PricingOver-broad
67%
PROPOSED
Refined CriteriaTargeted
31%
Predict
Pre-submission flags
Verify
Every payment checked
Explain
Every denial decoded
Traceable
To the contract clause

Built for healthcare data.

Claims data is sensitive. Our infrastructure, processes, and team are designed around that from day one.

Certifications

SOC 2 Type II

Independently audited controls for security, availability, and confidentiality. Reports available under NDA.

HIPAA Compliant

Full administrative, physical, and technical safeguards. BAA executed before any data is shared.

Security Controls
Active
AES-256 encryption at rest, TLS 1.2+ in transit
Role-based access with least-privilege defaults
Every data access logged and auditable
Annual third-party penetration testing
All controls passing4 / 4
Works alongside your revenue cycle stack

No EHR integration required to start. Ingest claims data via file upload or warehouse connection. Compatible with Epic, Cerner, MEDITECH, and any system that produces 837/835 files.

No integration project

See what your contracts
are actually doing.

Send us a contract and a sample of claims. Within a week, you see every underpayment, every denial explained, and what would get caught before submission.

Week 1 findings report
No integration required
Catch issues before timely filing expires
Findings Report
Week 1
Contract modeled
247 clauses extracted, 18 rate schedules loaded
Underpayment: rate escalator drift
§3.1 CPI-U Adjustment
1,247 claims$318/claim
Denial explained: CO-50 on infusion
Carve-out §6.3 covers this
184 claimsAppealable
Pre-submit: missing auth number
Payer requires prior auth for 43239
Caught before filingDenial prevented
Denial valid: auth expired 3d pre-service
Auth Policy v2.4
67 claimsProcess fix
Coverage
Underpayments, denials, pre-submit
Every finding traceable to
A specific contract clause