Every claim verified before it settles. Every historical claim re-examined with court-ready evidence. The same 175 checks run whether the claim is in-flight or five years old. Sealed to CourtChain™, anchored by a 14-of-20 BFT validator quorum, and self-authenticating under FRE 902(14).
| Audience | MCOs, government payment agencies (CMS, state Medicaid), insurance carriers, ACH/RTP banks, government vendor offices. |
| Buyer | Chief Compliance Officer, General Counsel, VP Payment Integrity, RADV defense lead. |
| Economic Model | Per-attestation flat fee, volume-tiered. No contingency on recovery. Buyer authorizes Tier-2 substantiation per case. |
| Partners | Recovery Audit Contractors, MCO-side counsel, qui-tam firms (post-CREB™), regulators (FRE 902(14) admissible). |
837/835 EDI, FHIR R4, custom CSV. Idempotent dedup on natural key + content hash.
148 deterministic checks - sanctions, exclusions, premise/billing pattern, statutory eligibility, NCD/LCD, MUE/NCCI, beneficiary identity.
Agentic-AI groups Tier-1 findings, recommends Tier-2 plan, reasons over substantiation cost vs expected value.
BFT 14-of-20 validators across 13 jurisdictions sign each verdict. Anchor bytes hashed, signed, retained immutably.
Court-Ready Evidence Bundle: each finding with source URL + query timestamp + response hash + signing-officer attestation.
MCO ships 14,000 claims for the week ($4.2M total). Tier-1 fires 47 findings: 12 hospice-LOS outliers, 8 phantom-telehealth flags, 22 OIG-excluded reactivations, 5 premise-business mismatches. Ava groups by provider TIN and recommends Tier-2 (substantiate the 12 hospice flags first - highest dollar concentration, $1.8M). Customer approves $4,800 in Tier-2 fees. JIL pulls bank-deposit fingerprints from Plaid + CMS PECOS history. 9 of 12 confirmed. Tier-3 CREB™ built. MCO holds $1.5M, refers to qui-tam under FCA 60-Day Rule.
| Detection | 148 deterministic checks - sanctions, OIG, premise, billing-pattern, beneficiary, statutory eligibility |
| Substantiation | Plaid, ATTOM, Refinitiv, Etherscan, OpenCorporates, IRS IVES, customer-internal feeds |
| Reasoning | Ava (Bedrock) - finding clustering, Tier-2 cost optimization, statutory framing |
| Evidence | CourtChain™ - BFT 14-of-20, FRE 902(14) self-authenticating, re-verifiable from canonical bytes |
| Latency | <2s P95 pre-settlement; 12 min/M claims retroactive |
| Compliance | FCA 60-Day Rule, RADV, BSA/AML, OFAC, GDPR, HIPAA |