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 01Before 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 02During 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 03After 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.