Stop losing revenue to coding gaps.
ClaimPrism AI reads the chart, codes the encounter, and flags what a payer will fight, before the claim ever leaves the building. Every code is confirmed by a certified coder and checked against CMS, NCCI, and each payer's compliance rules.
CC: Laceration, left forearm, cut on glass. Wound 3.2 cm, single-layer simple repairCPT 12002; local anestheticCPT 90471. Tdap given. Problem-focused history & exam, separate E/MCPT 99213‑25 · often dropped. Assessment: laceration, left forearmICD‑10 S51.812A.
Representative industry benchmarks for AI medical-coding platforms, your results are measured against your own baseline, never assumed.
ClaimPrism AI didn’t just clean up our coding, it gave our billing team their afternoons back. We stopped re-working claims and started reviewing exceptions.
Every uncoded modifier is cash you already earned.
It rarely shows up as one big loss, it’s specificity risk, missing documentation, and preventable denials, repeated across thousands of encounters until it’s a number that matters. Generic RCM software wasn’t built for the pace of urgent and outpatient care, and manual coding doesn’t scale past a handful of centers.
Incorrect ICD-10 & CPT coding
70,000+ ICD-10 and 10,000+ CPT codes change yearly, creating constant specificity risk.
Documentation deficiencies
Missing or unclear documentation drives ~46% of denials (Experian, State of Claims 2025).
Revenue leakage
Under-coding and missed procedures cost the industry an estimated $36B in losses annually.
Compliance & audit exposure
CMS, OIG, and False Claims Act exposure, plus RAC/CERT/TPE audits and NCCI/MUE edits, raise the cost and risk of every miscoded claim.
Costly manual chart review
Traditional coding averages 15–20 minutes per encounter, unsustainable at scale.
Rising denial rates
41% of providers now report ≥10% claim denial rates, up year over year.
ClaimPrism AI is built to catch these before they become write-offs, rework, or audit exposure, every code confirmed by a certified coder.
Results your CFO can defend in a board meeting.
What ClaimPrism AI is built to deliver across revenue, speed, and compliance. Every figure is measured against your own baseline, before and after, never assumed.
Recover what you already earned
The E/M and modifiers your documentation supports but your current process misses, captured instead of written off.
Fixed before submission
Every claim checked against that payer's specific rules up front, so it's caught before it's denied, not appealed after.
No backlog to manage
Visits are coded and queued for review the same day, so charts don't pile up waiting on a coder.
Every claim, not a sample
No chart bills on AI judgment alone. A certified coder has eyes on the code before it goes to a payer.
Built across the care continuum, with urgent care at the core.
From independent urgent care centers to physician groups, hospital-owned clinics, RCM companies, billing orgs, and hospitals/health systems across the United States, anywhere documentation needs to become clean, defensible, compliant revenue.
- Independent operators, 1–10 locations. Enterprise-grade coding without an enterprise RCM department.
- Owners, medical directors, and billing managers who feel the leakage but don't have time to chase every chart.
- Teams on a major EHR/PM, ambulatory or hospital-based, who want coding to keep pace with care, not slow it down.
- Anyone tired of generalist RCM vendors who treat urgent care like a primary-care side case.
Single-site, limited billing bandwidth
One location and a small front-desk/billing team with no room to hire a coder, ClaimPrism AI adds coding depth without adding headcount.
Multi-location, inconsistent coding
Several centers coding differently, ClaimPrism AI makes coding consistent and defensible across every site.
Repeat denials & under-coded procedures
Lacerations, splints, X-rays, and the modifier-25 E/M slipping through, caught before claims go out.
Hospital ED & observation coding
ED E/M leveling, observation vs. inpatient status, and facility/professional split billing, coded to CMS rules and reviewed before submission.
Inpatient DRG integrity
ICD-10-CM/PCS sequencing and MCC/CC capture checked against MS-DRG logic, so the DRG reflects the documented severity, not less.
NCCI/MUE & medical-necessity denials
Bundling conflicts, unbundled procedures, and LCD/NCD medical-necessity mismatches flagged pre-bill, not discovered on remit.