Your payer denied it. We help you fight back — and win.
PrismIQ is built for specialty practices billing complex, high-value procedures — orthopedics, spine, neurology, pain management, and cardiology — where a single denied claim can mean $15,000–$40,000 walking out the door.
Payers are getting smarter. UnitedHealthcare and Anthem now routinely issue partial payments — reimbursing 60–70 cents on the dollar — knowing most practices won't audit the remittance closely enough to catch it. When a full denial does land, the Level 1 appeal window is typically 30–60 days. Billers know that. They also know their queue has forty other claims in it. The ones that don't get fought in time expire. That's not a billing failure — that's a structural one. Specialty practices billing complex, high-value procedures face denial rates of 12–18%, and the majority of those denials go unappealed — not because they aren't winnable, but because there isn't a fast enough way to build the argument.
From denied claim to appeal letter in three steps.
Connect your ERA/835 feed
Upload denied claims or connect your ERA/835 feed directly from your clearinghouse. PrismIQ accepts all major formats — Availity, Change Healthcare, Office Ally, and more. No new software to install.
Claim IQ™ translates the denial
Every CARC code is translated into plain English — what it means, why the payer used it, and whether it's worth appealing. PrismIQ flags the denial confidence level and estimated recovery value so your team prioritizes the right claims first.
We read their rulebook. Then we use it against them.
The AI cross-references your specific procedure, payer, and denial reason against live payer policy documents using retrieval-augmented generation. You get the exact policy clause the payer used — and the counter-argument, built from their own language, ready to deploy.
From remittance to appeal. From submission to certainty.
Purpose-built for specialty billing teams managing complex, high-value claims.
Claim IQ™
Your remittance, translated.
Drop in your 835 file. Claim IQ reads every line — what the payer paid, what they cut, and why — in plain English. Then it tells you which denials are worth fighting and writes the appeal argument, already citing the payer's own policy language.
Risk Check
Know before you submit.
Before a high-value claim goes out, run it through Risk Check. Enter the payer, CPT code, and documentation on hand. You'll get a denial probability score and a documentation readiness checklist — so the claim goes out clean the first time.
I work inside a hospital system where I see the full picture of how care gets reimbursed, and how often it doesn't. The complexity payers have built into the denial process is real, and most practices simply don't have the tools to match it. PrismIQ changes that equation. The intelligence it brings to appeal generation and pre-submission risk is exactly the kind of systematic thinking this problem has always needed.
Darina Stanyekeva, MD
Pilot practices identify an average of $40,000–$80,000 in recoverable denied revenue within their first 30 days.
Based on early access pilot data from specialty practices in California.
We're here to make sure practices get every dollar back.
Share a sample of denied claims. We'll return a policy-cited appeal for your hardest denial within 48 hours.
Request a Pilot →