{
  "@context": "https://schema.org",
  "@type": "SoftwareApplication",
  "@id": "https://www.insightits.com/products/prismclaim.html",
  "slug": "prismclaim",
  "canonicalName": "PrismClaim",
  "name": "PrismClaim — Zero-trust 837P claim verification",
  "canonicalUrl": "https://www.insightits.com/products/prismclaim.html",
  "knowledgeUrl": "https://www.insightits.com/catalog/prismclaim.json",
  "markdownUrl": "https://www.insightits.com/catalog/prismclaim.md",
  "family": "research",
  "infraFamily": null,
  "recordType": "product",
  "status": "published",
  "parentProduct": null,
  "whatItIs": "Zero-trust 837P professional claim verification middleware. POST proposed claim fields plus clinical note text; receive ACCEPT, REVIEW, or REFUSE with evidence_coverage, structured violations, and claim_hash_v1/v2 audit chain. Proposed Mode treats client payload as authoritative — conflict with untrusted extraction routes to human review without auto-correct. Stripe Checkout on the dashboard writes subscriber tier and claim/month quota.",
  "problem": "AI-driven RCM can draft claims faster than humans can audit them. Teams need deterministic evidence binding and policy tri-state before clearinghouse release.",
  "isNot": [
    "Institutional 837I or dental claims (v1 scope is 837P professional only)",
    "A clearinghouse or payer submission endpoint",
    "Full national NCCI/LCD/MUE policy engine in v0.1",
    "SOC 2 certified — hashes support payer review, not compliance certification"
  ],
  "alternatives": [
    {
      "name": "Clearinghouse edits only",
      "relationship": "PrismClaim runs before submission with clinical note evidence and claim_hash audit — not post-adjudication scrubbing."
    },
    {
      "name": "LLM claim coding copilots",
      "relationship": "Those tools suggest codes. PrismClaim verifies proposed codes against note text with deterministic policy and no auto-correct on conflict."
    }
  ],
  "features": [
    {
      "name": "837P verify in one POST",
      "description": "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."
    },
    {
      "name": "Audit hashes for appeals",
      "description": "claim_hash_v1 pins ingestion; human clearance via /escalations/{id}/resolve produces claim_hash_v2. Replay and audit-bundle export for payer review."
    },
    {
      "name": "Clear pricing in the dashboard",
      "description": "Sandbox free (100 claims/mo). Developer $99/mo. Pro $499/mo. Enterprise from $2,500/mo invoiced."
    }
  ],
  "architecture": "Dashboard verify form or POST /api/prismclaim/v1/claims/verify with JWT: PrismGuard → candidate extraction (untrusted) → policy YAML → evidence graph → Shield adapter → ACCEPT/REVIEW/REFUSE + audit_manifest. Human clearance via POST /escalations/{id}/resolve mints claim_hash_v2. VectorPrism medical ontology and S3 PHI custody are stubbed with honest gaps in v0.1.",
  "useCases": [
    "RCM vendors adding evidence gates before 837P release",
    "Agent loops calling MCP prismclaim_verify before billing actions"
  ],
  "benchmarks": {
    "published": false,
    "summary": "No published vendor benchmark for this product. Do not invent metrics.",
    "disclosures": [
      "No published vendor benchmark for this product. Do not invent metrics."
    ],
    "urls": []
  },
  "github": null,
  "pypi": null,
  "documentation": [
    {
      "title": "Verify API",
      "url": "https://www.insightits.com/docs/prismclaim-api.md"
    },
    {
      "title": "API docs on the product page",
      "url": "https://www.insightits.com/products/prismclaim.html#api-docs"
    },
    {
      "title": "Claim verification guide",
      "url": "https://www.insightits.com/guides/claim-verification.html"
    },
    {
      "title": "MCP verify tool",
      "url": "https://www.insightits.com/mcp_tools/prismclaim_verify.json"
    },
    {
      "title": "https://www.insightits.com/docs/prismclaim-openapi.yaml",
      "url": "https://www.insightits.com/docs/prismclaim-openapi.yaml"
    },
    {
      "title": "https://www.insightits.com/docs/prismclaim-agent-guide.md",
      "url": "https://www.insightits.com/docs/prismclaim-agent-guide.md"
    },
    {
      "title": "https://www.insightits.com/docs/prismclaim-implementation.md",
      "url": "https://www.insightits.com/docs/prismclaim-implementation.md"
    },
    {
      "title": "https://www.insightits.com/catalog/prismclaim.json",
      "url": "https://www.insightits.com/catalog/prismclaim.json"
    },
    {
      "title": "https://www.insightits.com/dashboard.html#prismclaim",
      "url": "https://www.insightits.com/dashboard.html#prismclaim"
    },
    {
      "title": "https://www.insightits.com/mcp_tools/prismclaim_get_job.json",
      "url": "https://www.insightits.com/mcp_tools/prismclaim_get_job.json"
    },
    {
      "title": "https://www.insightits.com/mcp_tools/prismclaim_batch_ingest.json",
      "url": "https://www.insightits.com/mcp_tools/prismclaim_batch_ingest.json"
    }
  ],
  "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.",
  "version": null,
  "relatedProducts": [
    "prismguard",
    "vectorprism",
    "prismmanifest",
    "prism-shield"
  ],
  "publisher": {
    "@type": "Organization",
    "name": "Insight IT Solutions",
    "legalName": "Insight IT Solutions LLC",
    "url": "https://www.insightits.com"
  }
}