# PrismClaim

One canonical identity. Human page: https://www.insightits.com/products/prismclaim.html

| Field | Value |
|-------|-------|
| Slug | `prismclaim` |
| Status | published |
| Family | research |
| Infra category | — |
| Record type | product |
| Parent | — |
| JSON | https://www.insightits.com/catalog/prismclaim.json |
| Markdown | https://www.insightits.com/catalog/prismclaim.md |
| GitHub | — |
| PyPI | — |
| 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 | — |

## What it is

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.

## Alternatives

- **Clearinghouse edits only** — PrismClaim runs before submission with clinical note evidence and claim_hash audit — not post-adjudication scrubbing.
- **LLM claim coding copilots** — Those tools suggest codes. PrismClaim verifies proposed codes against note text with deterministic policy and no auto-correct on conflict.

## Features

- **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.

## 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.

## Use cases

- RCM vendors adding evidence gates before 837P release
- Agent loops calling MCP prismclaim_verify before billing actions

## Benchmarks

No published vendor benchmark for this product. Do not invent metrics.

### Disclosures

- No published vendor benchmark for this product. Do not invent metrics.



## GitHub

_No public GitHub repository for this identity._

## PyPI

_No PyPI package for this identity._

## Documentation

- [Verify API](https://www.insightits.com/docs/prismclaim-api.md)
- [API docs on the product page](https://www.insightits.com/products/prismclaim.html#api-docs)
- [Claim verification guide](https://www.insightits.com/guides/claim-verification.html)
- [MCP verify tool](https://www.insightits.com/mcp_tools/prismclaim_verify.json)
- [https://www.insightits.com/docs/prismclaim-openapi.yaml](https://www.insightits.com/docs/prismclaim-openapi.yaml)
- [https://www.insightits.com/docs/prismclaim-agent-guide.md](https://www.insightits.com/docs/prismclaim-agent-guide.md)
- [https://www.insightits.com/docs/prismclaim-implementation.md](https://www.insightits.com/docs/prismclaim-implementation.md)
- [https://www.insightits.com/catalog/prismclaim.json](https://www.insightits.com/catalog/prismclaim.json)
- [https://www.insightits.com/dashboard.html#prismclaim](https://www.insightits.com/dashboard.html#prismclaim)
- [https://www.insightits.com/mcp_tools/prismclaim_get_job.json](https://www.insightits.com/mcp_tools/prismclaim_get_job.json)
- [https://www.insightits.com/mcp_tools/prismclaim_batch_ingest.json](https://www.insightits.com/mcp_tools/prismclaim_batch_ingest.json)

## Is not

- 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

## Related products

- [prismguard](./prismguard.md)
- [vectorprism](./vectorprism.md)
- [prismmanifest](./prismmanifest.md)
- [prism-shield](./prism-shield.md)