Powering 2–25 provider specialty practices across California and nationwide
Your billing team wins the appeal.Then the same claim gets denied next month.
PrismIQ closes that loop. One AI layer from intake to collections, where every downstream outcome rewrites the upstream rule — so the same mistake never costs you twice.
38% fewer denials in the first 90 days — across active specialty pilot practices in California, trailing 90 days
Percentage of recovered revenue — we only win when you collect · Connected to your EHR/PM system and running in under 30 days
Why RCM still breaks
Revenue cycle management has been automated in pieces. One vendor handles eligibility. Another handles prior auth. Another handles denials. They each do their job. None of them talk to each other.
A claim gets denied. Your billing team appeals it and wins. But the intake error that caused it never gets flagged — so it happens again next month, on the next patient, on the next claim.
US healthcare writes off over $260B a year in denied, delayed, and underpaid claims. Most of it is preventable.
Source: Premier Inc., 2024
That gap between the back office and the front desk is where the money disappears.
One system. Every phase. Closed loop.
PrismIQ is a single AI layer across the full revenue cycle — patient access, eligibility, prior authorization, coding, claims, denial management, remittance, and patient collections. Every downstream outcome feeds back into upstream rules automatically.
A denial doesn't just get resolved. It rewrites the rule that prevents the next one.
What PrismIQ does across the cycle
Stop the denial before it starts.
Referrals, faxes, and intake forms are read, structured, and validated at the front door — not after a claim bounces back 30 days later.
Real coverage details at the moment of scheduling — deductibles, co-insurance, procedure-specific pre-cert rules — not just an active/inactive flag.
PrismIQ reads the chart, matches it to the payer's clinical coverage policy, and files a complete authorization packet. No portal logins. No hold queues. No missed documents.
Get it right the first time.
Clinical documentation is cross-checked against charges before submission — catching under-coding, missed charges, and documentation gaps that trigger denials downstream.
Every claim is scrubbed against payer-specific edit rules and your own historical denial patterns. Fewer first-pass rejections. Faster cash.
Recover what you're owed.
PrismIQ reads the patient record, maps the clinical narrative to the payer's own published policy language, and drafts a complete appeal — chart citations, regulatory references, supporting documentation included.
Every 835 ERA file is parsed in real time. Underpayments, contract shortfalls, and silent zero-balance write-offs are flagged before they settle into an aging bucket.
Accurate patient estimates delivered up front. Automated balance follow-up after. Patient responsibility doesn't quietly become bad debt.
Referrals, faxes, and intake forms are read, structured, and validated at the front door — not after a claim bounces back 30 days later.
Real coverage details at the moment of scheduling — deductibles, co-insurance, procedure-specific pre-cert rules — not just an active/inactive flag.
PrismIQ reads the chart, matches it to the payer's clinical coverage policy, and files a complete authorization packet. No portal logins. No hold queues. No missed documents.
The part no one else does.
Every denial, underpayment, and rejection your back-end team resolves gets fed back to the front end automatically — updating intake validation, eligibility checks, and authorization rules across every practice location you manage.
Other tools fix problems. PrismIQ eliminates the pattern that created them.
Your staff does clinical work. PrismIQ does the rest.
Faster authorizations without the portal busywork. Documentation that matches payer criteria before the claim goes out. High-value surgical, imaging, and specialty revenue protected from end to end — not just at the denial stage.
Built for the specialties where one denied claim costs the most.
Orthopedics. Spine. Cardiology.
Complex CPT/ICD-10 pairings, implant documentation, unlisted codes, multi-level procedures — the cases where payer scrutiny is highest and manual pre-auth is slowest. That is where PrismIQ was built to operate first.
See what PrismIQ finds in your last 90 days of denials.
Send a de-identified remittance sample. We'll come back with the recurring root causes, what they cost you, and which ones are preventable upstream. About a week. No call required.