Numbers you can push back on.
Most coding work sits under BAA and NDA, so instead of named-client trophies, here’s the methodology and the kinds of revenue we recover, the things you can pressure-test on your own charts during a free revenue check.
The dropped modifier 25
The leak: an E/M and a minor procedure on the same visit, billed without modifier 25, so the office visit bundles into the procedure and goes unpaid.
What ClaimPrism AI does: flags the missing modifier before the claim goes out, so the separately identifiable E/M gets paid.
Representative scenario, not a specific client.The down-leveled visit
The leak: documentation supports a higher-level E/M, but the visit is coded down “to be safe”, leaving earned, defensible revenue on the table.
What ClaimPrism AI does: surfaces the documentation that supports the appropriate level, with a rationale a certified coder stands behind.
Representative scenario, not a specific client.The preventable denial
The leak: eligibility wasn’t confirmed and the claim trips a payer-specific edit, a denial that often costs more to rework than it earns.
What ClaimPrism AI does: verification up front plus payer-rule scrubbing pre-bill, so it lands clean the first time.
Representative scenario, not a specific client.The NCCI bundling conflict
The leak: two procedure codes billed together trip an NCCI procedure-to-procedure edit, and the claim denies for a bundling conflict no one caught before submission.
What ClaimPrism AI does: screens every code pair against current NCCI edits and applicable modifier indicators pre-bill, so the conflict is resolved, not discovered on the remit.
Representative scenario, not a specific client.The under-captured MCC on an inpatient stay
The leak: a documented major comorbidity isn’t coded, so the claim groups to a lower-weighted MS-DRG than the patient’s actual acuity supports.
What ClaimPrism AI does: flags the undocumented-but-supported ICD-10-CM code for CDI follow-up, so the DRG reflects the true severity, defensibly.
Representative scenario, not a specific client.The honest version of a case study is your own charts.
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