Trust, engineered in, not bolted on.
Revenue integrity can't come at the cost of trust. ClaimPrism AI is built to U.S. healthcare data-security standards, with a human accountable at every step.
HIPAA & HITECH
Built to HIPAA Privacy, Security, and Breach Notification Rule standards for PHI handling, with a BAA available for every customer.
Human in the loop
No autonomous code reaches a payer without AAPC/AHIMA-certified coder review and your approval.
Full audit trail
Every code links to the documentation that supports it, timestamped and defensible on review.
Least-privilege access
Role-based access and encryption in transit and at rest, scoped to the minimum PHI needed.
Minimum necessary retention
PHI is retained only as long as your workflow requires, with configurable purge schedules and de-identification for analytics.
Subcontractor & BAA chain
Every downstream subprocessor that touches PHI operates under its own signed BAA, flowed down and tracked.
Built around the rules that actually get claims denied, or audited.
Coding compliance isn't a checkbox, it's the specific edit logic, medical-necessity policy, and fraud-and-abuse law of the market you bill in, applied to every single line of every claim, before it's submitted.
NCCI edits & MUEs
Every claim is screened against National Correct Coding Initiative procedure-to-procedure edits and Medically Unlikely Edits before submission, so bundling conflicts and implausible unit counts are caught pre-bill, not on remit.
LCD / NCD medical necessity
Diagnosis-to-procedure medical-necessity checks against Local and National Coverage Determinations for the MAC and plan you're billing, so a service isn't denied for a diagnosis code the payer won't cover.
ICD-10-CM & CPT/HCPCS Level II specificity
Codes are matched to the highest specificity the documentation actually supports, laterality, encounter type, and 7th-character extensions included, not the vague default a rushed chart invites.
E/M leveling to 2021+ guidelines
Evaluation & Management levels are validated against CMS/AMA medical-decision-making or time-based criteria, coded to exactly what's documented, defensible under a payer audit either way.
Modifier logic
Modifier 25, 59, 76, and site-of-service (POS) modifiers are validated against payer-specific and NCCI modifier-indicator rules, so legitimate separate services aren't dropped, or misapplied.
Hospital inpatient & outpatient logic
ICD-10-PCS procedure coding, MCC/CC capture, and MS-DRG grouping for inpatient claims; APC assignment and OPPS packaging rules for hospital outpatient and ED claims.
Applies to claims billed under U.S. federal and commercial payer rules (CMS, AMA, and payer-specific policy).
DHA & DOH claim-submission rules
Coding is validated against the standard your facility submits under, Dubai Health Authority's eClaimLink coding guidelines (updated quarterly by the Dubai Medical Coding Task Force) or Department of Health – Abu Dhabi's Shafafiya claims and adjudication rules, so a claim isn't rejected for the wrong emirate's standard.
ICD-10-CM & CPT specificity
Both DHA and DOH build their claims rules around ICD-10-CM for diagnoses and CPT for procedures, the same code sets ClaimPrism AI already codes to for U.S. claims, matched to the specificity the documentation supports.
DoH Service Codes & Mandatory Tariff
Where a service isn't unambiguously represented in ICD-10-CM, CPT, or HCPCS, Abu Dhabi claims fall back to DoH-specific Service Codes defined in the Mandatory Tariff, applied per the current Shafafiya-published rule set rather than guessed at.
DRG-based hospital reimbursement
Both DHA and DOH reimburse hospital claims on a DRG basis, so inpatient coding is checked for the same grouping accuracy that determines the reimbursement rate, not just clinical correctness.
MOHAP alignment (Northern Emirates)
Facilities licensed under the Ministry of Health and Prevention follow comparable coding standards with their own facility-specific billing and submission rules, checked against the licensing category you actually bill under.
Retrospective audit exposure
UAE insurers commonly reserve the right to retrospective claim review for up to three years post-payment. Every code carries the documentation citation to defend it if that review happens.
Applies to claims billed under DHA (Dubai), DOH (Abu Dhabi), or MOHAP (Northern Emirates) rules. Confirm current emirate-specific circulars before publishing final pricing or claim-turnaround commitments — these are updated periodically by each authority.
Coded to survive an audit, not just to bill.
ClaimPrism AI's workflow is designed around the audit and compliance expectations of the market you bill in, so every claim carries the documentation and rationale to defend it.
OIG 7-element alignment
Written coding standards, ongoing auditing/monitoring, and corrective-action tracking map to the elements OIG looks for in an effective compliance program.
False Claims Act discipline
Never over-codes to capture revenue the documentation doesn't support. Compliance-first accuracy is the guardrail against knowing-or-reckless submission risk.
RAC / CERT / TPE-ready
Every code carries a documentation citation and audit trail, so responding to a Recovery Audit, CERT, or Targeted Probe-and-Educate request is a records pull, not a scramble.
Anti-Kickback & Stark awareness
Coding and revenue recommendations stay inside documented medical necessity, no volume-based incentives that could implicate referral-based fraud and abuse rules.
Credentialed coders
Human review performed by AAPC (CPC/CCS-P) or AHIMA (CCS) certified coders, with credentials verified and refreshed on your reporting dashboard.
CDI feedback loop
Documentation gaps get routed back to the provider as clinical documentation improvement (CDI) prompts, not silently corrected, so coding accuracy improves at the source.
DHA / DOH standards alignment
Written coding standards and ongoing internal monitoring map to the facility-licensing and clinical-governance standards each authority requires for license renewal.
Upcoding discipline
Never bills a higher CPT or DRG code than documentation supports, one of the most common findings in UAE insurer recovery audits, avoided at the source rather than caught after payment.
Retrospective-review ready
Every code carries a documentation citation and audit trail, so a 3-year retrospective claim review from an insurer is a records pull, not a scramble.
UAE PDPL alignment
Patient data handling is designed around the UAE's federal Personal Data Protection Law, the UAE's equivalent framework to HIPAA for patient-data confidentiality and use.
Credentialed coders
Human review performed by AAPC (CPC) certified coders, credentials recognized and commonly required by UAE healthcare employers alongside local regulatory training.
CDI feedback loop
Documentation gaps get routed back to the provider as clinical documentation improvement (CDI) prompts, so coding accuracy improves at the source rather than being silently corrected downstream.
ClaimPrism AI supports your compliance program, it doesn't replace your organization's designated compliance officer or legal counsel. Nothing here is legal advice.