A subset of your ESRD members are being reimbursed at the wrong CMS rate — up to $72,000 per member per year. We identify them, coordinate the missing CMS 2728 filings with their dialysis centers, and pursue the recovery through CMS.
Share your details and we'll schedule a brief call to understand your plan's ESRD enrollment profile. We'll tell you whether there's an opportunity before you commit to anything.
We'll review your information and reach out within one business day to schedule your free revenue recovery audit.
ESRD members trigger a dramatically higher CMS capitation rate — but only when their dialysis facility submits a CMS 2728 form to establish status. For many members, that submission never happens or never reaches CMS. The result: your plan is paid the standard rate instead of the ESRD rate, month after month, with nothing in your reporting to signal the gap.
See how the gap compounds →per member per year — for each gap category we screen:
The member is reimbursed at the wrong rate, every month.
Each uncaptured month adds to the recoverable total, up to the CMS window.
The longer a gap goes unaddressed, the more difficult and time-sensitive the recovery becomes.
Is the single biggest driver of how much you actually recover.
CMS allows retroactive recovery going back several years — but the opportunity erodes the longer a gap sits unaddressed. The plans that recover the most are the ones that move first.
Our process is fully managed and proprietary. You provide your data; we handle everything else — identifying the members, establishing what's owed, managing the correction end to end with the relevant parties, and tracking each dollar through to confirmed CMS recovery. Minimal internal lift required.
We ingest your data and surface the members who are being underpaid — using methods that go well beyond a standard reporting review.
We confirm each opportunity, establish the correct figures, and quantify what's recoverable within the CMS window.
We contact each member's dialysis center directly, confirm whether a CMS 2728 was ever submitted, and drive submission of any missing or corrected forms. This is the operational step that converts the gap into paid revenue — and the part most plans can't execute internally.
We close the loop with each dialysis center to confirm the 2728 has been filed. Once a submission is confirmed, the recovery is locked in — CMS handles payment from there.
You keep 88% of money you didn't know you were owed.
Recoverable amounts vary by plan size and how long each gap has persisted — frequently reaching six or seven figures. We'll size yours during the free audit.
Clear Capitation was founded by Hari Jayaraman. He spent five years at ZS advising top pharma and digital health companies on turning EHR and claims data into working clinical and commercial systems, after earlier stops in precision medicine strategy at DeciBio and financial reporting at BlackRock.
The pattern across that work is anomaly detection in complex data. ESRD capitation underpayment fits it exactly — unusual signals hiding in claims and membership data that internal reporting isn't built to surface. Our tools were built with insights from actuaries working with leading insurers.
Clear Capitation is early. We're taking on a small number of Medicare Advantage plans as design partners on contingency, with direct founder access and terms that reward the plans willing to move first.
→ LinkedIn: linkedin.com/in/hari-jayaraman-13e7
→ Email: contact@clearcapitation.com
Most internal reviews rely on the MMR at face value. Our analytics cross-reference claims data — dialysis procedures, session frequency, ESA utilization — against the ESRD flags on your MMR. Where claims show dialysis activity and the MMR shows no ESRD status, that's a recoverable gap. This type of cross-source detection is purpose-built and not something standard reporting surfaces.
We need your claims data and Monthly Membership Report (MMR) files. We handle all ingestion and parsing. The initial data pull is typically the only internal lift required — everything after that is fully managed on our side.
CMS allows retroactive corrections up to 84 months (7 years) back. This applies regardless of whether the member is still enrolled — recovery attaches to the months they were in ESRD status, not their current enrollment. The earlier you act, the more months fall within the window.
None. We charge 12% of recoverable revenue, billed once dialysis centers confirm 2728 submission, before CMS payment reaches your account. If we don't successfully drive submission, you pay nothing. There are no retainers, setup fees, or minimum commitments. The free audit itself carries zero obligation.
All data is transferred via AES-256 encryption. We operate under HIPAA-compliant protocols and offer a Business Associate Agreement (BAA) before any data changes hands. Access is restricted to authorized personnel only, and we maintain SOC 2-aligned controls for data handling and storage.
The initial audit and discovery phase completes within the first few weeks. Once a 2728 is submitted, CMS handles payment on its own timeline. We stay engaged through confirmation and see the process through to close.