Solutions · Authorization, billing, coding, and denials teams
Preempt the denial.Prove what applied.
Prisym keeps revenue cycle teams ahead of payer policy: alerts when a billing or payment rule changes, the exact version in effect on a date of service, and the criteria behind every prior authorization requirement.
A denial cites a policy.Prisym has the version it cited, and the one before it.
For revenue cycle
What revenue cycle teams use Prisym for.
- 01
Point-in-time policy retrieval
For any claim, the policy version in effect on the date of service, kept intact, with the redline against today's.
- 02
Payment and billing policy tracking
Reimbursement, modifier, bundling, and fee schedule changes across commercial, Medicare Advantage, and Medicaid plans.
- 03
Code-level coverage lookup
Enter a CPT or HCPCS code and see which payers require prior authorization and under which policy.
Every
Version kept; nothing overwritten
45
Policy types tracked, including fee schedules and manuals
Daily
Monitoring for fast-moving payers
In practice
A denial that cites a policy revised after the date of service
- 1
Pull the policy as of the date of service: the criterion the denial cites was added eleven days later.
- 2
Export the version that applied and the redline showing the change.
Send the appeal with the correct version attached and the payer's own change history as evidence.
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 stop learning policy from denials?
Bring a recent denial. We will show you the policy version that applied and everything that changed since.