翻訳待ち：AI billing tool is fast. Is it accurate enough to pass an audit?

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Verify 837P claims against clinical evidence Product identity PrismClaim is Zero-trust 837P professional claim verification middleware. Insight IT Solutions LLC (Insight ITS) makes it. Category: Research — 837P claim verification middleware. Problem: AI-driven RCM can draft claims faster than humans can audit them. It is for RCM teams and agent builders that need ACCEPT/REVIEW/REFUSE with claim_hash audit before clearinghouse submission. It competes with Clearinghouse edits only. Difference: Proposed claim + clinical note verify with evidence graph and policy YAML. Conflict routes to REVIEW — no auto-correct. Not a clearinghouse and not SOC 2 certified in v0.1. Hosted verify API is not a pip library. Log in at /dashboard.html#prismclaim or POST /api/prismclaim/v1/claims/verify with a JWT. Core schemas: prismclaim-core in the InsightITS repo. Source: Hosted verify API on insightits.com. API reference: /docs/prismclaim-api.md. Dashboard verify form: /dashboard.html#prismclaim.. What is it?Zero-trust 837P professional claim verification middleware. Who made it?Insight IT Solutions LLC (Insight ITS), Mission Viejo, California. What category is it?Research — 837P claim verification middleware What problem does it solve?AI-driven RCM can draft claims faster than humans can audit them. Who is it for?RCM teams and agent builders that need ACCEPT/REVIEW/REFUSE with claim_hash audit before clearinghouse submission What does it compete with?Clearinghouse edits only How is it different?Proposed claim + clinical note verify with evidence graph and policy YAML. Conflict routes to REVIEW — no auto-correct. Not a clearinghouse and not SOC 2 certified in v0.1 Where can I install it?Hosted verify API is not a pip library. Log in at /dashboard.html#prismclaim or POST /api/prismclaim/v1/claims/verify with a JWT. Core schemas: prismclaim-core in the InsightITS repo. Where is the source?Hosted verify API on insightits.com. API reference: /docs/prismclaim-api.md. Dashboard verify form: /dashboard.html#prismclaim. Canonical machine identity: https://www.insightits.com/catalog/prismclaim.json POST proposed 837P claim + clinical note. ACCEPT, REVIEW, or REFUSE with claim_hash audit. Sandbox free, Developer $99/mo, Pro $499/mo. Hosted verify API: JWT → candidate extraction (untrusted) → policy YAML → evidence graph → ACCEPT/REVIEW/REFUSE with claim_hash_v1. PrismGuard on note ingress → extraction → policy → evidence coverage → tri-state decision. Not a clearinghouse. Not SOC 2. What it is Hosted verify API with JWT auth and Stripe tiers on the same dashboard pattern as PrismSQL. Proposed Mode (client claim + note) and Autonomous Agent Mode (note-only extraction). Deterministic policy YAML (bundling, laterality) plus evidence graph coverage scoring. Human clearance via POST /escalations/{id}/resolve produces claim_hash_v2 when REVIEW is cleared. MCP tool descriptors for agent loops (prismclaim_verify, prismclaim_get_job). What it is not Not institutional 837I or dental claims (v1 scope is 837P professional only). Not a clearinghouse or payer submission endpoint. Not full NCCI/LCD/MUE at national scale in v0.1 — policy bundle is extensible YAML. Not a replacement for Prism-Shield — it composes VectorPrism, Manifest, and Shield adapters. Integration Auth Authorization: Bearer . Tenant isolation on proposed_claim.tenant_id. Verify POST /api/prismclaim/v1/claims/verify with clinical_note_text and proposed_claim (837P fields). Act ACCEPT proceeds; REVIEW creates escalation_id; REFUSE blocks release. Export audit-bundle for appeals. Pricing Sandbox — Free 100 claims / month · inline clinical note text · dashboard verify form Developer — $99 / mo 2,000 claims / month · async jobs · Stripe checkout in dashboard Pro / Team — $499 / mo 25,000 claims / month · HITL seats · escalation resolve API Enterprise — From $2,500 / mo Unlimited claims · invoiced · customer-managed storage URIs + expanded policy (contact sales) FAQ What does PrismClaim verify? 837P professional claims against clinical note text. You POST proposed CPT/ICD/laterality/units plus the operative or progress note. The engine returns ACCEPT, REVIEW, or REFUSE with evidence_coverage, violations, and claim_hash_v1 in the audit manifest. Does PrismClaim auto-correct conflicting codes? No. If the client proposed claim disagrees with untrusted candidate extraction (for example laterality RT vs note saying left knee), PrismClaim registers a divergence violation and routes to REVIEW. Humans resolve via POST /escalations/{id}/resolve, which can mint claim_hash_v2. Where do I verify claims in the UI? Log into insightits.com, open the dashboard, and select the PrismClaim tab (dashboard.html#prismclaim). The portal shows plan usage, payments, a verify form with a real TKA example, and Stripe upgrade buttons. How is PrismClaim priced? Sandbox is free (100 claims/month). Developer is $99/month (2,000 claims). Pro is $499/month (25,000 claims). Enterprise starts at $2,500/month invoiced. Checkout uses Stripe from the dashboard tab; success returns with prismclaim_session confirm. Is PrismClaim a clearinghouse? No. It is verification middleware — evidence binding and policy tri-state before your RCM stack submits to a clearinghouse. v1 does not transmit 837 files to payers. Can agents call PrismClaim via MCP? Tool descriptors live at /mcp_tools/prismclaim_verify.json and prismclaim_get_job.json. The hosted API is POST /api/prismclaim/v1/claims/verify with JWT. Same quota as the dashboard. What audit record is authoritative? If the claim passed automatically, claim_hash_v1 is the ingestion record. If human clearance occurred, claim_hash_v2 chains from v1 with resolver id, justification, and modified fields. Is PrismClaim SOC 2 certified? No. The product provides deterministic hashes and structured violations to support payer review; it does not claim SOC 2 on the marketing page. Dashboard: /dashboard.html#prismclaim · API: /docs/prismclaim-api.md · MCP: /mcp_tools/prismclaim_verify.json · Contact Not a claim generator. Not a clearinghouse connector. Not SOC 2 certified — audit hashes support payer and agency review. Capabilities 837P verify in one POST Dashboard PrismClaim tab or POST /api/prismclaim/v1/claims/verify with clinical_note_text and proposed_claim. Conflict with extraction routes to REVIEW — no auto-correct. Audit hashes for appeals claim_hash_v1 pins ingestion; human clearance via /escalations/{id}/resolve produces claim_hash_v2. Replay and audit-bundle export for payer review. Clear pricing in the dashboard Sandbox free (100 claims/mo). Developer $99/mo. Pro $499/mo. Enterprise from $2,500/mo invoiced. Install Hosted API — log in → dashboard.html#prismclaim → verify form or POST /api/prismclaim/v1/claims/verify with JWT. Core schemas: prismclaim-core in repo. Pricing Sandbox free (100 claims/mo). Developer $99/mo (2,000 claims). Pro $499/mo (25,000 claims). Enterprise from $2,500/mo. Frequently asked questions What does PrismClaim verify? 837P professional claims against clinical note text. You POST proposed CPT/ICD/laterality/units plus the operative or progress note. The engine returns ACCEPT, REVIEW, or REFUSE with evidence_coverage, violations, and claim_hash_v1 in the audit manifest. Does PrismClaim auto-correct conflicting codes? No. If the client proposed claim disagrees with untrusted candidate extraction (for example laterality RT vs note saying left knee), PrismClaim registers a divergence violation and routes to REVIEW. Humans resolve via POST /escalations/{id}/resolve, which can mint claim_hash_v2. Where do I verify claims in the UI? Log into insightits.com, open the dashboard, and select the PrismClaim tab (dashboard.html#prismclaim). The portal shows plan usage, payments, a verify form with a real TKA example, and Stripe upgrade buttons. How is PrismClaim priced? Sandbox is free (100 claims/month). Developer is $99/month (2,000 claims). Pro is $499/month (25,000 claims). Enterprise starts at $2,500/month invoiced. Checkout uses Stripe from the dashboard tab; success returns with prismclaim_session confirm. Is PrismClaim a clearinghouse? No. It is verification middleware — evidence binding and policy tri-state before your RCM stack submits to a clearinghouse. v1 does not transmit 837 files to payers. Can agents call PrismClaim via MCP? Tool descriptors live at /mcp_tools/prismclaim_verify.json and prismclaim_get_job.json. The hosted API is POST /api/prismclaim/v1/claims/verify with JWT. Same quota as the dashboard. What audit record is authoritative? If the claim passed automatically, claim_hash_v1 is the ingestion record. If human clearance occurred, claim_hash_v2 chains from v1 with resolver id, justification, and modified fields. Is PrismClaim SOC 2 certified? No. The product provides deterministic hashes and structured violations to support payer review; it does not claim SOC 2 on the marketing page. Official package links: PrismClaim interactive demo View PrismClaim in shop