Platform
Every payer's rules,read for the patient in front of you.
Prisym tracks, versions, and indexes the policies of 1,200+ payers and delegated entities, then turns them into a coverage matrix, a change feed, and a determination for each case.
Policy library
One library for every rule a payer sets.
Medical policies, prior authorization policies and lists, payment policies, pharmacy policies, provider manuals, fee schedules, forms, and bulletins, across commercial plans, state programs, government programs, and the delegated vendors plans lean on.
- Faceted search by organization, plan, state, line of business, policy type, status, code, and effective date.
- Six policy groups and 45 policy types, normalized across payers that each name them differently.
- Known gaps are first-class: when a payer does not maintain a policy type, the catalog says so.
- Payers
- 1,200+
- Policies
- 20,000+
- Policy types
- 45
- CPB 0964 · Proton beam therapyAetna · MedicalRev 08/2026
- MCP-243 · Genetic testingMolina · TX · Prior authRev 07/2026
- Oncology imaging guidelinesEvicore · DelegatedRev 09/2026
- Modifier 25 reimbursementUnitedHealthcare · PaymentRev 05/2026
- NCD 220.6 · PET scansMedicare · NCD · GovernmentRev 01/2026
Coverage matrix
One therapy, every payer, one view.
Name a therapy, procedure, or code and see covered, covered with criteria, or not covered for every payer you track. The governing policy and the exact criteria are one click behind each cell.
- Filter to the payers, states, and lines of business you actually bill.
- Cells update when the underlying policy changes; the change is flagged in place.
- Export or pull the matrix over the API for internal tools and decks.
- States
- Covered · Criteria · Not covered
- Behind each cell
- Policy · version · criteria
Change alerts
Hear about the revision before the denial.
Every stored version transition produces a redline diff. A model turns the diff into a structured summary with the old and new text as evidence, a confidence, and a materiality score. Material changes publish to the feed; minor edits stay attached to the policy.
- Save any library search as a subscription and receive alerts when a matching policy changes.
- Plain-language summary with exact before-and-after evidence, never a paraphrase without the policy text behind it.
- What's New feed across all payers, filterable by therapy, payer, and impact.
- Per change
- Diff · summary · score
- Delivery
- In-app · email · API
- Anthem RAD.00072Added unfavorable-intermediate risk to initial staging PSMA PET.Material · 0.91
- Cigna MM 0553Annual review; no criteria changes.Minor · 0.12
- Aetna CPB 0964Added CPT 77525 to covered codes list.Material · 0.78
Initial staging is considered medically necessary for high-risk unfavorable-intermediate-risk or higher prostate cancer when conventional imaging is negative or equivocal.
Rapid determination
The coverage answer before the request goes out.
Enter the payer, the therapy, and the de-identified clinical facts. Prisym lines the case up against the payer's stated criteria, shows which are met, and names what to attach so the request is complete the first time.
- Criterion-by-criterion view with the policy language each one comes from.
- Likelihood of approval and the documents most often cited in denials on that policy.
- Hands off to Submission Co-Pilot, P2P Co-Pilot, or Responder in the JustAppeals suite.
- Input
- Payer · therapy · facts
- Output
- Answer · gaps · attachments
- Unfavorable-intermediate risk or higher
- PSA and Gleason documented
- No prior PSMA PET for staging
- Conventional imaging report attached
Add before submitting
Attach the CT and bone-scan report. Cited in 68% of UHC denials on this policy.
Version history
What was in effect on the date of service.
Payers replace their own policies. Prisym never does. Every version is kept intact with its effective, revised, first-seen, and superseded dates, so the policy that governed a claim is always retrievable.
- Point-in-time queries: the version in effect on any date, for any payer.
- Redline diff between any two versions, text and codes.
- Retired policies stay queryable and are marked with the date they disappeared.
- Retention
- Every version, forever
- Diff
- Any two versions
- v7Effective 02/01/2026current
- v6Effective 07/01/2025 · superseded 02/01/2026
- v5Effective 01/01/2025 · superseded 07/01/2025
- v4Effective 03/15/2024 · superseded 01/01/2025in effect on 2024-09-02
API
Everything in the product, available to your systems.
Policies, versions, diffs, coverage by plan, hybrid keyword and semantic search, and a change feed since any timestamp, over a REST API with bearer-token authentication.
- Filter the catalog by payer, state, line of business, category, code, and as-of date.
- Full policy text for any version; structured criteria and codes alongside.
- Ask a question over the library and get an answer with the policy passages it rests on.
- Auth
- Bearer token
- Format
- JSON
{
"policy_id": "anthem-rad-00072",
"payer": "Anthem BCBS",
"policy_number": "RAD.00072",
"category": "medical",
"version": {
"version_id": "v7",
"effective_date": "2026-02-01",
"superseded_at": null,
"extraction": { "confidence": 0.94, "codes": ["78815", "A9595"] }
},
"coverage": "covered_with_criteria"
}Design principles
How the system stays trustworthy while running unattended.
- 01
Append-only
No policy version is ever overwritten or deleted.
- 02
Quarantine before commit
An anomalous run never mutates the live catalog. A reviewer or an automated repair resolves it first.
- 03
Policy text intact
The payer's own language is preserved unchanged. Extracted fields carry their confidence.
- 04
Human in the loop
Low-confidence extractions, ambiguous matches, and new payers all go through a review queue.
Ready to see coverage in full spectrum?
Name a therapy. We will show you its coverage across every payer we track, and the last policy that changed.