Confidential — Prepared for Waystar Corp Dev

The Missing Layer
Before Your Platform

Same note. Same codes. Every time. Zero PHI exposure. The clinical extraction logic that doesn't exist anywhere you can buy it.

$1.1BWaystar FY25 Revenue
42%Adj. EBITDA Margin
5B+Annual Transactions
$15.5BDenial $ Prevented (AltitudeAI)

Projected VMC Impact on Waystar Platform

1%FPAR Improvement
50%Coder Efficiency Gain
30%EBITDA Flow-Through
1–2%Denial Rate Reduction
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The Problem

Where data quality breaks down

The note is the source of truth. Between the note and the claim, there's a gap. Everything downstream inherits it.

Step 1Patient Encounter
Step 2Doctor Writes Note

Iodine (yours) improves documentation during encounter

Iodine (yours)
Step 3Note → Codes

Manual coder, weak auto-suggest, or nothing.

The extraction gap
Step 4Coded Claim → Waystar

AltitudeAI catches format errors & payer rules — can’t fix wrong codes

AltitudeAI (yours)
Step 5Waystar Submits to Payer

Scrubbing + edits applied. Bad codes still pass through.

Step 6Payer Adjudicates

15% denied. $25–40 rework per denial.

Integration

Can I integrate this?

One API endpoint. No workflow changes. PHI never leaves your network.

Split-Pipeline Architecture

Stage 1 on-device (extraction, PHI containment). Stages 2–4 cloud via API. Your data stays in your network.

Single API Endpoint

POST PHI-free IR, receive structured claim-ready JSON. Built, tested, deployed on Google Cloud Run.

Any Input Source

Epic, Cerner, fax, OCR, dictation. No EHR dependency.

No Workflow Change

Parallel with existing pipeline. Compare output. Zero disruption.

Under 2 weeks to pilot. Thin client for Stage 1. Point at notes. Compare against current output.

Regulatory & Compliance

Can I defend this to regulators?

Every output is traceable, reproducible, evidence-backed. No black boxes. No hallucinated codes.

Deterministic & Reproducible

Same note, same codes, every time. SHA-256 hash verified. No model drift.

Zero PHI in Cloud

Three-layer fail-closed egress gate. Structural transformation, not redaction. Zero patient identifiers.

Full Decision Trace

Every code: supporting sentence, assertion proof, resolver path, suppression evidence, tier reason. Auditors trace any output to the note.

Engine-First, AI-Gated

90%+ deterministic rules. AI (~10%) can only propose. Engine validates before surfacing. AI never sees PHI.

“Run the same note 100 times. Get the same codes 100 times. No AI-first system can make that claim.”

Replacement Cost

How long to build this ourselves?

43 modules. 5 pipeline stages. 2+ years. The decision logic connecting CMS codes to SNOMED ontology doesn't exist anywhere you can buy it.

6–12 mo
574K-Concept Matching Engine

Semantic-tag gated SNOMED index, abbreviation expansion, section-aware matching, 6-signal candidate scoring

8–14 mo
50+ Family Resolver Tables

Multi-axis code resolution for every major ICD-10 family. Heart failure alone: 12 codes, 2 axes, HCC boundary guards. Pattern is simple once discovered — discovering it requires clinical coding + architecture expertise in the same person.

6–9 mo
PHI-Safe Semantic Rebuilder

Structural transformation preserving clinical meaning. Three-layer fail-closed egress gate

6–12 mo
Clinical Relationship Graph

4.4M SNOMED relationships, O(1) query API. 851 explained-by pairs, acuity variants, complication chains

6–9 mo
Evidence & Tier Architecture

Per-entity evidence annotation, 5-tier classification, entity dossier, assertion operator algebra

3–6 mo
Testing & Validation Suite

255 integration tests, 19 golden tests, blind eval, reproducibility verification, adversarial audit

2–3 years · 3–4 engineers + clinical informaticist

Clinical edge cases are discovered through thousands of test notes, not designed upfront.

Strategic Risk

What if a competitor gets this?

You own Iodine (during encounter) and claim lifecycle (AltitudeAI). The extraction layer between them is the one piece you don't control.

Layer 1: During EncounterYou own this

Iodine (Yours)CDI. Improves documentation while the doctor writes.

Layer 2: Post-Encounter ExtractionGap

VMC (The Gap)Turns finished note into claim-ready codes. Deterministic. Any input.

Layer 3: Claim LifecycleYou own this

Waystar Platform (Yours)Scrubbing, submission, denial management, appeals. 5B+ transactions/year.

If someone else acquires this

Instant 2–3 year leap

A competitor gets 43 production modules, 50+ family resolvers, PHI-safe AI architecture — deployed.

Shipped product, not just code

Electron app, cloud API, tested pipeline. They offer extraction to their clients in weeks, not years.

Clinical logic transfer

574K mappings, 851 suppression rules, 4.4M graph relationships. 2+ years of decision logic walks out.

They introduce a layer nobody knows exists

No one knows the extraction layer is solvable. A competitor embeds it — every garbage note produces better data. Their denials drop, first-pass rates climb. You’re still feeding AltitudeAI the same incomplete input.

If Waystar owns this

Close the stack

Iodine → VMC → Waystar. End-to-end, one platform.

Better data into AltitudeAI

Cleaner input → fewer denials, better charge integrity, stronger appeals.

30,000 clients, day one

Platform-level deployment. Better first-pass acceptance without a separate tool.

No competitor can replicate this

You own all three layers. Only company with CDI + extraction + claim lifecycle.

Financial Model

Modeled Impact — Waystar Platform

Conservative modeling. 50.0M annual notes — a fraction of 5B+ platform transactions. All inputs from public filings and industry benchmarks.

Model Assumptions
50.0M
Notes/Year
$180
Avg Reimb.
15%
Denial Rate
$30
Rework Cost
78%
Current FPAR
$0.75
VMC $/Note
First Pass Revenue
FPAR 78% → 79% — 500K claims
$90.0M
Coding Uplift
1% from specificity, HCC capture, OCR recovery
$90.0M
Recovered Denial Revenue
600K denials prevented
$108.0M
Rework Elimination
600K denials × $30 rework
$18.0M
Throughput Capacity
8% more per coder. No headcount reduction.
$720.0M
Downstream Services
0.5% from better data → referrals & RAF
$45.0M
VMC Annual Cost
50.0M × $0.75/note
$37.5M
Net Operational Impact
$1.0B
Gross minus VMC cost
Est. EBITDA Capture
$310.1M$413.4M
30–40% incremental margin
Enterprise Value Delta
$3.7B$5.0B
@ 12× fwd EV/EBITDA

Throughput = capacity expansion, not headcount reduction. Conservative modeling. Framework for diligence.

Validation

Pre-commercial. Production-validated.

0
critical false positives
100%
reproducible output
574K
concepts indexed
851
suppression rules
50+
family resolvers
~45s
per note incl. AI negotiation

The Ask

A 30-day parallel run on notes already flowing into your platform.
Our extraction alongside whatever you currently receive.
You see the delta. No commitment until you see data.

No workflow disruptionNo process changeUnder 2 weeks to integrate