Built for how specialty billing actually works
PrismIQ gives specialty billing teams a single command center — real-time denial intelligence, payer policy analysis, and appeal generation, all in one platform. Built for the practices where a single denied claim can mean $15,000–$40,000 in revenue that should never have left.
Your remittance, translated.
Upload or Connect
Drop in your 835 ERA file or connect your clearinghouse feed directly — Availity, Change Healthcare, Office Ally, and more. No new software. No IT project. You're live in minutes.
Every denial, decoded
Claim IQ reads every CARC and RARC code on your remittance and converts them into plain English — what the payer did, why they did it, and what it means for your revenue. No more guessing what CO-50 actually means at 4pm on a Friday.
Fight or fold — we tell you which
Not every denial is worth fighting. Claim IQ scores each one by appeal confidence and estimated recovery value — so your billing team spends time on the claims that will actually pay off, not the ones that won't.
Appeal letter, ready to send
For every appealable denial, Claim IQ generates a fully constructed appeal letter — citing the payer's own policy language, the specific procedure's clinical criteria, and the medical necessity documentation required. Not a template with blanks. A built argument.
Stop the denial before it starts.
Risk Check runs before you submit. Enter the payer, CPT code, ICD-10, and documentation you have on hand. PrismIQ returns a denial risk score, the top reasons this specific payer flags this specific procedure, and a documentation readiness checklist with severity ratings. A $24,000 Total Knee Arthroplasty to UnitedHealthcare gets a different analysis than a Cervical Fusion to Anthem. The payer policies are different. The documentation requirements are different. Risk Check knows the difference.
A clean claim submitted once is worth more than a perfect appeal submitted twice.
Try Risk Check →Designed for the payers that matter
We've architected Claim IQ around the payers handling 60% of US specialty claim volume.
UnitedHealthcare
US national, 49M members
Anthem Blue Cross
Multi-state, 42M members
Aetna
National, 23M members
Built for complexity
Specialty procedures have specialty denial patterns. We know them.
Orthopedics
Surgical implants & procedures
Spine Surgery
Fusion, decompression, fusion revision
Pain Management
Interventional procedures
Neurology
Diagnostic & therapeutic procedures
Cardiology
Coronary & structural interventions
Gastroenterology
Advanced therapeutic endoscopy