AI does the work. People stay accountable.
PrismIQ runs autonomous agents across your revenue cycle — but every consequential action is reviewable, attributable, and bounded by human approval. Here is exactly who reviews the output, how your data is handled, and where the liability sits.
Where the human stays in the loop
Ingests clearinghouse 835 feeds, translates complex CARC/RARC codes, and categorizes denials by recovery confidence.
Biller reviews the flagged high-priority claim queue and selects claims for action.
RAG engine cross-references clinical charts against live payer policy manuals to identify missing documentation.
Clinical biller confirms extracted chart notes align with payer criteria.
Auto-drafts fully cited, policy-backed Level 1 & Level 2 appeal packages in under 60 seconds.
Billing specialist reviews, makes final edits, and approves the appeal package.
Scans pre-billed surgical claims for documentation gaps, unbundling risks, and missing medical-necessity rules.
Authorization manager reviews flagged high-risk claims before batch release.
Gathers clinical intraoperative notes and hemodynamics data for mid-procedure code escalations.
Practice manager verifies the clinical packet before submitting the retro-auth request.
Formats approved appeal packets into payer-ready PDF/Word documents or direct portal exports.
Staff submits the appeal directly via the payer portal or practice-management queue.
Your data is not our training data
Zero model training on customer PHI
PrismIQ operates under strict zero-retention and zero-training guarantees. Protected Health Information (PHI) and practice data are never used to train, fine-tune, or evaluate foundation models, proprietary LLMs, or third-party AI services.
Tenant isolation & security
All patient data and EDI 835 feeds are logically isolated in customer-dedicated infrastructure using enterprise-grade encryption — AES-256 at rest and TLS 1.3 in transit. Data processed during appeal generation resides strictly within ephemeral memory environments and is purged immediately upon task completion, according to HIPAA guidelines and custom data-retention schedules. All sub-processors are vetted under strict Business Associate Agreements (BAAs).
Every decision is logged and attributable
Immutable audit logging
PrismIQ maintains a complete, tamper-evident audit trail for every action taken across your claims. Every generated appeal, policy match, and pre-submission risk score is logged with an immutable timestamp, user ID, system model version, and exact input-prompt metadata.
Policy citation lineage
Never guess how a recommendation was formed. Every output includes deterministic lineage tracing back to the specific payer policy clause, clinical guideline, and underlying EHR chart note used. Audit logs are retained for 7 years in compliance with HIPAA requirements and can be exported on demand via customer administrative portals for internal compliance reviews.
Compliance posture
HIPAA Compliant
PHI is encrypted at rest and in transit. Access is scoped, logged, and least-privilege.
SOC 2 Type I complete, Type II in progress
Type I report available on request under NDA. Type II observation period underway.
BAA executed with all customers
A Business Associate Agreement is signed with every customer before any PHI is shared.
Model governance & error-correction process
How model behavior is reviewed, how errors are detected and corrected, and how changes are validated before release.
What onboarding looks like
Connect your EHR / practice-management system and clearinghouse via API and FHIR. No rip-and-replace.
PrismIQ learns from your historical denials — mapping your payers, your specialties, and your recurring root causes.
Agents go live across the revenue cycle with human approval gates in place from day one.
Connected to your EHR/PM system and running in under 30 days.
Placeholder for what happens to in-flight claims during cutover — how claims already in progress are handled, whether PrismIQ runs in parallel before taking over, and how continuity of cash flow is guaranteed. Switching risk is the dominant objection for a system that touches the customer's entire cash flow.
Bring your compliance officer. We'll answer every question.
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.