Crescent Intelligence provides the CAPE engine, a deterministic, cloud‑native platform that prices Medicare Part B claims to the cent by encoding the full CMS Physician Fee Schedule as executable mathematics. The API‑first service returns a complete decision object with exact rule citations in about 50 ms per claim, enabling real‑time, auditable financial analysis for payers and revenue‑cycle solutions.
Funding
Funding not disclosed
Founders
Product
Problem
Healthcare claim pricing relies on legacy adjudication systems that are slow, costly to implement, and provide opaque results without precise rule citations, making real‑time financial decisions and auditability difficult.
Solution
Crescent Intelligence offers the CAPE engine, a deterministic, cloud‑native adjudication platform that prices Medicare Part B claims to the cent against the full CMS Physician Fee Schedule. By encoding every CFR rule as executable mathematics, the engine delivers pricing accuracy within $0.10 and a full audit trail in approximately 50 ms per claim. The API‑first design integrates with existing workflows in days, replacing multi‑million‑dollar legacy mainframes and eliminating weeks‑long processing cycles. Clients receive a complete decision object—including billed amount, allowed amount, payment, and exact rule citations—enabling defensible, real‑time financial analysis and compliance reporting.
Target Audience
Primary customers are payer organizations, Medicare Advantage plans, private‑equity firms evaluating physician practice acquisitions, and clearinghouses building next‑generation revenue cycle management solutions that require precise, auditable claim pricing.
Features
- Deterministic pricing engine encoding all 247 CMS Physician Fee Schedule rules (42 CFR Part 414) as exact mathematical functions
- Full claim lifecycle processing (Phases 0–7) covering eligibility, coverage, coding edits, modifiers, and financial calculations
- Pricing accuracy benchmarked to within $0.10 per claim against 500,000 historical Part B claims
- Ultra‑low latency processing at ~50 ms per claim, reducing cycles from 14–30 days to milliseconds
- RESTful API with webhook support for rapid integration and real‑time adjudication
- Comprehensive audit trail with rule IDs and CFR section citations for each calculation
- Cloud‑native, zero‑legacy dependencies enabling scalable deployment and quarterly updates aligned with CMS final rules