Out-of-network claims,
resolved with precision.
PRISM combines proprietary IDR software with white-glove consulting to maximize recovery under the No Surprises Act. We do the dispute math so you can focus on patient care.
Built for the entire IDR lifecycle.
From the moment a payer issues an underpayment to final IDRE determination, PRISM handles the legal mechanics, the math, and the documentation — without disrupting your revenue cycle workflow.
Forensic analysis of every Qualifying Payment Amount against geographic and specialty benchmarks before you file.
Federal-certified IDR entity selection, batching logic, and offer modeling tuned to your case mix.
Full HIPAA-aligned audit trail, deadline tracking, and NSA Open Negotiation documentation.
Real-time dashboards on payer behavior, win rates, dispute aging, and net recovery per claim.
Every dispute. Every dollar. One source of truth.
Our case management software ingests EOBs, validates QPAs, runs eligibility screens, drafts Open Negotiation letters, and tracks each dispute through the IDRE process — all from one workspace.
- Automated NSA eligibility screening
- QPA comparison vs. FAIR Health & geographic data
- Open Negotiation & IDR initiation generators
- IDRE batching & strategic offer modeling
- Full audit trail & PHI-safe document vault
"PRISM took our IDR backlog from chaos to a structured 92% win rate. The white-glove team understands NSA math better than the payers do."
