What It Does

Everything the revenue cycle needs, in one system.

PrismIQ runs the full cycle — patient access, eligibility, prior authorization, coding, claims, denial management, remittance, and patient collections. Here is what it does at each phase, and the outcome it moves.

Phase 01 — Before the Claim

Stop the denial before it starts.

Prior auth turnaround: 5 days → 14 hours
Intake

Referrals, faxes, and intake forms are read, structured, and validated at the front door — not after a claim bounces back 30 days later.

Eligibility

Real coverage details at the moment of scheduling — deductibles, co-insurance, procedure-specific pre-cert rules — not just an active/inactive flag.

Prior Authorization

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.

Phase 02 — During the Claim

Get it right the first time.

First-pass clean claim rate: 89% → 95%
Coding & Charge Capture

Clinical documentation is cross-checked against charges before submission — catching under-coding, missed charges, and documentation gaps that trigger denials downstream.

Claims Submission

Every claim is scrubbed against payer-specific edit rules and your own historical denial patterns. Fewer first-pass rejections. Faster cash.

Phase 03 — After the Claim

Recover what you're owed.

Days in A/R: 46 → 32
Denial Management & Appeals

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.

Remittance & Payment Posting

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.

Patient Collections

Accurate patient estimates delivered up front. Automated balance follow-up after. Patient responsibility doesn't quietly become bad debt.

Integrates directly with
Epic
athenahealth
NextGen
eClinicalWorks
via API & FHIR

See this running on your claims, not our slides.

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.