Solutions · Clinics, practices, and health systems
Know the criteriabefore the request goes out.
Prisym gives clinical and authorization teams the payer's current policy for the patient in front of them, so submissions are complete the first time and denials stop being the way you learn the rules.
Most denials are decided at submission.Prisym decides them in your favor.
For providers
What providers teams use Prisym for.
- 01
Determination per case
Payer, therapy, and de-identified facts in; criteria met, gaps, and attachments out, before anything is sent.
- 02
Coverage for a therapy across your payer mix
See where a treatment is covered outright, covered with criteria, or excluded, for every plan you accept.
- 03
Change alerts on the payers you bill
Save the payers and therapies your service lines depend on and hear the day a policy moves.
20,000+
Policies searchable in one place
Day 1
When a revised policy reaches your team
1 view
Coverage for a therapy across every payer
In practice
A PSMA PET request for initial staging
- 1
Search the therapy: six payers, four with criteria, one revised this week.
- 2
Open the patient's payer: the policy language, four criteria, and the report most often missing in denials.
Attach the conventional imaging report and submit against the current version, with the policy citation in hand.
The platform underneath
Every solution runs on the same library.
One index of payer policies, versioned forever, feeds the matrix, the alerts, and every determination.
Ready to submit against the current policy?
Pick your most-denied service line. We will show you every payer's current criteria for it.