Clarity Before Contract
Questions deserve operating answers.
Every organization has a different payer mix, service model, technology environment, workforce, and level of readiness. These responses explain PRISM’s baseline posture; final responsibilities are controlled by the executed agreement and statement of work.
Is PRISM only a claim-submission service?
No. Claim submission is one component. PRISM can also address clinical systems, provider readiness, authorization, documentation-to-claim alignment, denial management, payment posting, A/R, quality, reporting, training, and management services—depending on the signed scope.
Can PRISM work inside our existing EHR or billing platform?
Often, yes. The system is evaluated for security, payer connectivity, work queues, reporting, audit logs, role-based access, and whether it can support the required workflow. PRISM does not recommend changing software merely to automate a broken process.
How does PRISM handle incomplete or unsupported claims?
The claim is held and escalated under the agreed process. PRISM may identify deficiencies, request lawful clarification, support an appropriate late entry or amendment, and provide training. PRISM will not fabricate services, backdate records, or alter clinical meaning.
Does PRISM work with substance use disorder records?
Potentially. The client, program, record, consent, contract, access, communication, subcontractor, and incident-response requirements must be evaluated before access. When 42 CFR Part 2 applies, those controls must be built into the engagement.
How is pricing determined?
Pricing depends on service lines, number of locations, payer mix, claim volume, A/R age, denial condition, authorization burden, credentialing status, documentation risk, technology, implementation intensity, reporting, and the responsibilities retained by the client.
Does PRISM guarantee payer payment or collection amounts?
No responsible RCM company can guarantee payer adjudication or collection amounts. PRISM commits to defined processes, controls, follow-up, reporting, escalation, and measurable performance—not invented certainty.
Can PRISM provide ongoing behavioral health management?
Yes, when the scope, authority, deliverables, boundaries, meeting cadence, reporting, and reserved client responsibilities are defined in a written management-services statement of work.
What is the recommended starting point?
For most organizations, PRISM begins with discovery and a focused diagnostic. The diagnostic creates a current-state picture, identifies risks and priorities, and supports a responsible proposal for a pilot, build, stabilization, or ongoing management engagement.