ClearPath Care

Built for Southeast Pain & Spine Care

Medicare RTM reimbursement, made audit-proof.

A platform architecturally incapable of surfacing a claim unless every condition of payment is satisfied and evidenced by a stored artifact. The patient app, the clinical console, and the compliance engine, in one guided tour.

Take the tourJump to the console
6
Charlotte clinics, one platform
15
console surfaces, audit-first
10
conditions of payment, evidenced
0
claims that bill without proof

The story

An independent practice, reclaiming its revenue

In December 2024, six double-board-certified physicians left a private-equity-backed group and rebuilt Southeast Pain & Spine Care as an independent practice across six Charlotte clinics. They had the clinical reputation. They had never built practice operations from scratch. ClearPath Care is how they take back their Medicare reimbursement, and their compliance, on their own terms.

Why this is hard

Two clocks, per patient

Device supply runs on rolling 30-day episodes; management runs on calendar months. Miss a day count or a threshold and the code is wrong.

A mandatory human call

No live phone or video contact in a month and the entire month forfeits, no matter how many minutes were captured.

Rules that bite

QMB patients can never be billed. Duplicate monitoring with another practice is a clawback. Time rounded up is a finding.

The audit, years later

When a contractor asks for proof, the answer has to be instant, complete, and tamper-evident, or the money comes back.

The design promise

The system is architecturally incapable of surfacing a claim unless every condition of payment is satisfied and evidenced by a stored artifact.
Compliance is a structural property of the software, not a checklist anyone has to remember.

How it works

One round trip, and the engine sits in the middle of it

The apps exist to feed the engine lawful inputs. The engine decides. The console proves it. Nothing bills until the loop is closed and evidenced.

Patient app

A daily check-in becomes a dated transmission day and monitoring data.

01

Reimbursement engine

Pure, deterministic, civil-date logic decides what is billable, and why.

02

Clinical console

Staff capture time and the live call, resolve holds, and close the month.

03

Medicare

A clean claim leaves with a frozen, hash-verified evidence bundle behind it.

04

Two independent clocks run per patient: a rolling 30-day device-supply episode and a calendar-month management period. Every month-close persists its full input, so any decision can be replayed or shadow-run against a new engine version, years later.

The patient app

A check-in a Medicare patient will actually do

A progressive web app built to WCAG 2.2 AA: front-desk activation, one question per screen, and an offline-first design that never loses a day of monitoring. Every word here is the real, shipped copy.

Activation

It starts at the front desk

No passwords, no email loops. The staff hands the patient a one-time QR code; the phone becomes a device-bound session. Re-activation happens at the desk. Nothing for a 78-year-old to remember.
9:41
ClearPath Care

Welcome to your check-in

To start, scan the activation code from the front desk with your phone camera, or open the link they gave you.

Your check-in keeps your care team informed between visits.

Front-desk activation. One-time, device-bound.

Home

One tap a day

The whole ask is a single daily check-in that keeps the care team informed between visits. Large type, one thumb, under a minute.
9:41
ClearPath Care

Your daily check-in

A quick update keeps your care team informed between visits.

Your tracking

11day streak

11 of 30 days this cycle

Days count when they reach us.

Check-in reminders

Turn on reminders and your phone will let you know when it is time for your daily check-in.

Try it

The daily check-in, for real

Pain, medication, exercise, red-flag symptoms, review, send. One question per screen. This is the actual flow, live in the frame. Tap through it.
9:41

How is your pain right now?

Tap the number that fits, from 0 to 10.

Offline

A missed signal never loses a day

Finish a check-in with no service and it is saved on the phone, then sent automatically when a signal returns. The words queue, sync, and error never appear. The patient is told, calmly, that there is nothing to do.
9:41
ClearPath Care

Your daily check-in

A quick update keeps your care team informed between visits.

One check-in is saved on your phone and waiting to send.

What does this mean?

Your tracking

11day streak

11 of 30 days this cycle

Days count when they reach us.

Check-in reminders

Turn on reminders and your phone will let you know when it is time for your daily check-in.

Adherence

Streaks, never rewards

A gentle streak and a 30-day dot calendar. Completed days come from the server's truth; pending days are hope, not guilt. Nothing of value is ever offered, because inducement is a compliance problem.
9:41
ClearPath Care

Your daily check-in

Your tracking

11day streak

11 of 30 days this cycle

Days count when they reach us.

Great month of tracking.

Reminders

A nudge with no vendor and no PHI

Standards-based Web Push, sent by the practice server straight to the phone, with no third-party messaging company in the loop and no health information in the message. Turning it on is the opt-in.
9:41
ClearPath Care

Your daily check-in

Check-in reminders

Turn on reminders and your phone will let you know when it is time for your daily check-in.

Standards-based Web Push, delivered by the practice server with no third-party messaging vendor. The reminder carries no health information.

Safety

A red flag is calm, and it reaches a human

Report a red-flag symptom and the app never gives clinical advice. It thanks the patient, promises a call from the care team, and names 911 for an emergency. The alert surfaces to staff immediately, even offline.
9:41
ClearPath Care

Thank you for telling us

A member of your care team will contact you.

To reach the office, call 704 555 0142.

If this is an emergency, call 911.

The handoff

One tap on the phone, and the practice sees it happen

This is the whole product in a single moment. A patient finishes a check-in and sends it. The engine dates the transmission, counts it toward the 30-day episode, and the console updates on its own. No staff re-entry, no spreadsheet, no guesswork about what is billable.

9:41

Please review your check-in

Pain
6 / 10
Medication
Taken as prescribed
Exercises
Done
Symptoms
None
Console, Panel, live
Ada Lovelace15/30 days
Grace Hopper22/30 days
Alan Turing14/30 days

The moment above is illustrative and runs on synthetic data. In the product, a transmission day only counts once it actually reaches the server, which is exactly why the patient app says days count when they arrive, not when they are entered.

The clinical console

Where the practice does the work, and the money becomes provable

Capability-gated, server-authoritative, and audit-first. Fifteen surfaces; here are the ones that decide whether a claim is lawful. Every label and number is drawn from the real build on a synthetic panel.

Panel

The money is in the 14-to-15-day cohort

Every enrolled patient at a glance. The engine flags the patients one transmission day from 98977 and the ones a single minute or one live call short of a management code. Nobody hunts through a spreadsheet.

console.clearpathcare.app
All sites07:41 · Ada LovelaceNK

Panel

The staffer's panel at a glance. Rows one nudge from a billable code are flagged.

PatientLastDaysMinutesLive callFlagsNext action
Ada Lovelace2h ago15/30 *18 min yes0One more day reaches 16 unique days: unlocks 98977
Grace Hoppertoday22/3020 min okyes0Ready to close
Alan Turingtoday14/30 *12 min no0No live call yet this month
Katherine Johnson1d ago9/3020 min okyes1Red flag raised: review
Edsger Dijkstratoday27/3041 min okyes0Ready: 98980 + one 98981 block
Barbara Liskov3h ago5/306 min no0Early in cycle
Donald Knuthtoday16/3020 min okyes0Ready to close
Margaret Hamiltontoday15/30 *19 min yes0One more day, plus 1 minute to reach 20
Triage

A ranked queue that shows its reasons

Not a black box. Each item carries its tier and the plain reason it is there, deep-linked to the patient and the one action that resolves it. A red-flag with no outreach sits at the top.

console.clearpathcare.app
All sitesNK

Triage

A transparent rule cascade: ranked, with the reason shown, deep-linked to the patient.

  1. T1

    Katherine Johnson

    Red-flag symptom reported 40 minutes ago, no outreach logged

  2. T1

    Ada Lovelace

    15 unique days, episode window closes in 2 days: one contact unlocks 98977

  3. T2

    Alan Turing

    18 management minutes, no live call this month: whole month forfeits without one

  4. T2

    Margaret Hamilton

    19 minutes captured: 1 minute of documented review reaches the 98980 floor

  5. T3

    Grace Hopper

    Ready to close, all conditions met

Close cockpit

Nothing is left on the table at month-close

A preflight worklist grouped by exactly what is missing: minutes short of twenty, a month with no live call, a fourteen-day episode still open. Practice-readiness signals sit on top.

console.clearpathcare.app
All sitesNK

Close preflight: June 2026

Roster fresh
2 eligibility profiles past reverify date
1 unresolved identity quarantine

Complete to 20 minutes (or accept 98979)

Margaret Hamilton

19 minutes captured. 1 minute of review reaches 98980 ($42.31 more than 98979).

No live call this month (whole month forfeits)

Alan Turing

18 management minutes, no live human call logged. $61.20 at risk.

14 to 15 data days, window still open

Ada Lovelace

15 unique days. One more transmission day unlocks 98977.

Blocked queue

Blocked is a work queue, with dollars attached

Every held claim, grouped by reason, with the revenue at stake. Items clear only when the engine re-runs and the condition is genuinely met, never by a manual override.

console.clearpathcare.app
All sitesNK

Blocked queue

BLOCKED is a work queue, not a dead end. Items clear only on the next engine run, never by hand.

$336.84 in claims currently held across 6 patient-months

Duplicate-practice denial (hold open)

3 blocked

$168.42

Eligibility pending (271 not returned)

2 blocked

$112.28

No artifact bundle finalized

1 blocked

$56.14
Coinsurance

One lawful lane per month, and the QMB wall

Every claim-month lands in exactly one lane with a machine-readable reason for any zero-collection. Qualified Medicare Beneficiaries are structurally un-billable: the scheduler cannot even select their rows.

console.clearpathcare.app
All sitesNK

Coinsurance operations

Every claim-month lands in exactly one lawful lane, with a machine-readable reason for any zero-collection month.

QMB protected61 patient-months
Secondary crossover44 patient-months
Hardship waived7 patient-months
Collection cycle19 patient-months

QMB hard block

61 QMB-protected months. The statement scheduler cannot select a single one of them. Attempting to bill a QMB patient is a SEV1 alarm, not a warning.

OIG self-screening

The audit the contractor would run, run first

Enrollment velocity, management-never-billed, duplicate-practice signals, and more, screened against the practice's own data every month with a twelve-month trend and a breach alarm.

console.clearpathcare.app
All sitesNK

OIG screening metrics

The platform runs the contractor's own screens against itself, every month.

Enrollment velocity

12/ 40 mo

Management never billed

3%/ 15%

Duplicate-practice signals

1/ 2

Multiple-device attempts

0/ 1

RPM prior relationship

N/A

Invoice report

The revenue event, with a ten-condition evidence trail

Every examined patient-month, each of the ten conditions of payment checked or not, and the first one that failed. The audit-ready count is precisely what ClearPath can invoice.

console.clearpathcare.app
All sitesNK

Audit-ready invoice report

Audit-ready this month

3

The count ClearPath can invoice: every condition of payment met and evidenced.

PatientEnrollmentConsentOrderWorkflowActivityTime + callNo holdPeriod closedArtifact bundleClaim readyReady
Grace Hopper✓✓✓✓✓✓✓✓✓✓yes
Edsger Dijkstra✓✓✓✓✓✓✓✓✓✓yes
Donald Knuth✓✓✓✓✓✓✓✓✓✓yes
Katherine Johnson✓✓✓✓✓✓✕···no
Alan Turing✓✓✓✓✓✕····no
Artifact browser

An audit answered in seconds, not weeks

Every finalized claim is a frozen, hash-verified bundle: the order, the consent, the engine run, the transmission ledger, the time entries with lineage. Recompute the hash and the verdict is VERIFIED or a tamper alarm fires.

console.clearpathcare.app
All sitesNK

Claim artifact: Grace Hopper, 98980, June 2026

VERIFIEDstored 9f2c…a71b · recomputed 9f2c…a71b

One frozen, tamper-evident bundle. Every condition of payment, in one place, for the audit that may come years later.

✓Claim
✓Engine run
✓Practitioner order
✓Consent
✓Duplicate-monitoring check
✓Education note
✓Benefit profile / eligibility
✓Transmission ledger
✓Time entries (with lineage)
✓Live calls

And the rest of the console

Fifteen surfaces, one discipline

Holds

The universal circuit breaker. System-opened holds need compliance plus step-up to resolve.

Users and access review

DB-authoritative roles, quarterly review, step-up re-auth on every admin action.

Data export

Right of access with a single-use, 15-minute download link and a 30-day clock.

Document registry

Every consent, order, and note, versioned and linked to the claims it evidences.

Roster intake

eCW CSV upload with hash dedup and an identity quarantine that never auto-merges.

Timeline and trends

One patient's clinical story, newest first; viewing the trend is itself an audited review.

The engine

Compliance is a property of the code, not a checklist

Underneath every screen is a pure, deterministic function. It takes a patient-month of facts and returns a billing decision with the reasons attached. It holds no state, reads no clock of its own, and given the same inputs it returns the same answer, this year or in an audit five years from now.

Setup98975

Billed once per episode of care

Order, consent, and a resolved duplicate check
present
An education note on file
present
Same episode of care, already billed
never again
A genuinely new episode
permitted

A new episode of care unlocks setup again. The same one never re-bills.

Device supply98977 xor 98985

One code, decided by qualifying days

Unique transmission days, 16 to 30
98977
Unique transmission days, 2 to 15
98985 (parity)
Fewer than 2 days
nothing
Two check-ins on one calendar day
counts once

Days are counted inside the rolling 30-day episode window, never across the sibling code in the same month.

Management98980 / 98981 / 98979

The live call comes first, then the minutes

No live human call this month
no code at all
Floored minutes, 10 to 19
98979
Floored minutes, 20 or more
98980
Each additional full 20 minutes
+98981

Automation and voicemail never satisfy the live-call gate, and rounded-up minutes never happen: seconds are floored once.

The guarantees the engine keeps

INV-1

The artifact gate

A claim is clean only when every condition of payment is met with its exact matching reason codes. Blocked is a work queue, not a dead end.

INV-2 / INV-3

Two ledgers that never merge

Human billable activity and AI or automation activity live in separate schemas with disjoint write credentials, enforced at the database role level, not by convention.

INV-4

Append-only money trail

UPDATE and DELETE are revoked on the ledgers. A correction is a new row that references the original, so history can never be quietly rewritten.

INV-5

One place for floor semantics

Minutes are floored from raw seconds in exactly one function. Time can never be rounded up, because there is no code path that could round it up.

INV-6

The live-call gate

No live human phone or video contact in a month means no management code that month, whatever the minute count. CMS's brightest line, encoded as a hard gate.

Fail toward protection

The safe default is not to bill

Unknown eligibility is eligibility-pending, never a guess. A QMB flag that cannot be confirmed blocks, and every ambiguous state resolves toward not billing.

Same inputs, same decision, forever.

Nineteen golden scenarios pin the CPT rules in place, property tests probe the edges, and every month-close stores its full engine run. Any month can be replayed, or shadow-run against a future engine version, and produce a byte-for-byte identical decision.

Trust and compliance

Built to survive the audit before it is ever requested

Security here is not a banner. It is a written HIPAA risk analysis, a set of core policies, and a threat model where each risk is answered by a control that is already in the code. A quarterly restore test rehearses recovery and, on purpose, tries and fails to delete a locked artifact.

Multi-tenancy that fails closed

Every table carries an org and enforces FORCE ROW LEVEL SECURITY. Patient identity is read from the session token, never a request parameter, and all access flows through one tenancy wrapper. An unset context returns zero rows, not everything.

Step-up re-authentication

User and role administration and patient data export demand a fresh authentication factor inside a short window, enforced on the server. A stolen session still cannot quietly widen its own access.

The QMB wall

A Qualified Medicare Beneficiary can never be sent a statement. It is a hard domain block with a severity-one alarm, and the scheduler cannot even select their rows. Unconfirmed eligibility fails safe as pending, never a false not-QMB.

Deletion is structurally impossible

Finalized claim bundles enter an S3 Object Lock compliance-mode bucket with ten-year retention: immutable to ransomware and undeletable even by root. Each bundle is envelope-encrypted with its own KMS data key and hash-anchored.

Least privilege, end to end

Four purpose-built database roles, UPDATE and DELETE revoked on the ledgers, no long-lived cloud keys, and a two-account split between production PHI and developer tooling. Root carries MFA and holds no access keys.

PHI never lands on-prem

The on-prem environment is synthetic-only by rule. The first byte of real PHI lives in AWS under a signed business associate agreement, encrypted at rest and in transit, inside private no-egress subnets with thirty-five-day point-in-time recovery.

Eligibility is exchanged only with a business associate under a signed agreement, the raw response is kept for audit, and benefit profiles are versioned. Access control is enforced twice over, at the application guard and again at the database, so the two never drift apart.

The AI layer, Phase 2

AI that helps staff work faster, and cannot touch the money

Inference runs on an owner-operated GPU box reached over a private Tailscale link, not a cloud API. No business associate agreement is required, for two independent reasons: the box sits inside the practice's own trust boundary, and Tailscale is a conduit that moves end-to-end encrypted traffic it can never read.

It never touches a bill

The model writes only to the automation ledger, which is a separate schema with its own credentials. Its output can inform a human but can never become a billable minute or satisfy the live-call gate.

It leaves no PHI at rest

Prompts are processed in memory and never persisted. There is no request or output logging and no disk cache, so a stolen box holds nothing to recover. The system of record stays in AWS.

A person stays in the loop

Every AI suggestion is advisory. Staff accept, edit, or ignore it, and the deterministic engine, not the model, still decides what is billable.

It degrades to the rules

If inference is unavailable, nothing breaks. The product falls back to the same deterministic engine that governs every decision when AI is present.

Hardening on the inference box: full-disk encryption, deny-all network rules with a tagged identity that can be revoked instantly, no key-value cache on disk, and metadata-only audit. AI helps the practice move faster without ever leaving protected data at rest or crossing into a bill.

What is built

Nearly all of it is done, and waiting on one door to open

This is not a concept. The patient app, the console, the engine, the security posture, and the compliance documents exist and have passed quality review on a synthetic panel. What remains is provisioning, not product.

Shipped and QA-passed
  • Patient app: activation, the daily check-in, the offline outbox, adherence, Web Push
  • Clinical console: all fifteen surfaces, from Panel to the artifact browser
  • The reimbursement engine, deterministic, with nineteen golden scenarios and property tests
  • Step-up re-authentication, enforced server-side
  • HIPAA risk analysis and the core policy set
  • Staging identity provider and a synthetic six-site panel
Designed, pending infrastructure
  • AWS provisioning: Fargate, RDS, and the Object Lock bucket, via Terraform
  • Cognito patient and staff pools
  • Eligibility exchange, built and waiting behind a flag
  • The pre-launch security pass and first restore test
Phase 2
  • On-prem AI inference over Tailscale, non-billable and advisory
  • Staff-facing assistance that degrades cleanly to the deterministic rules

One thing stands between the build and a live pilot.

The AWS accounts and the signed business associate agreement that let the first byte of real PHI land. Everything above is built, tested, and ready the day that door opens.

One promise, kept in code

A platform architecturally incapable of surfacing a claim unless every condition of payment is satisfied and evidenced by a stored artifact.

That is the whole idea, and it is real today on a synthetic panel: the patient app, the clinical console, and the compliance engine, working as one.

Back to the topSee what is built

Built for Southeast Pain & Spine Care. Every name, number, and record shown in this tour is synthetic.