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Just Healthcare

Policy intelligence

Prisym™

Know the patient's coverage criteria. Then use it to secure access.

Prisym™ helps your team find the right payer policy, understand the criteria, and apply those requirements to the patient in front of you.

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prisym.health/coverageLive

Search a therapy across every payer

Sources CommandsAll payers
PayerPolicyCoverageUpdated
DeterminationM. Okafor · UnitedHealthcare

Oncology Imaging · PSMA PET

Initial staging · CPT 78815

With criteria
Checking the chart0 of 4 criteria met
  • Unfavorable-intermediate risk or higher
  • PSA and Gleason documented
  • No prior PSMA PET for staging
  • Conventional imaging report attached
Send to Submission Copilot
Review queue
  • Anthem RAD.00072Revised
  • Cigna MM 0553Annual review
  • Aetna CPB 0964Codes added

What it solves

The policy is public. Finding and applying it is the hard part.

Coverage rules change by payer, plan, service, and patient. Prisym™ puts the applicable criteria where your team can use them, with 20,000+ payer policies and growing.

  • Find the right policy

    Search by payer, plan, service, or treatment without opening dozens of websites.

  • See what the policy requires

    Review coverage criteria, documentation needs, codes, and exclusions.

  • Use it across the suite

    Carry the criteria into a submission, peer-to-peer brief, or appeal.

20,000+ payer policies and growing.

The right policy for the patient in front of you.

Insights · Prisym™

How it works

From policy search to patient-specific action

Prisym™ makes the rule useful at the moment your team needs it.

  1. Step 01

    Start with the request

    Choose the payer, plan, and requested care.

    Payer · plan · service
  2. Step 02

    Open the policy

    See the current coverage rules and the source behind them.

    Policy · source
  3. Step 03

    Review the criteria

    Compare the requirements with the patient's record.

    Criteria · record
  4. Step 04

    Move the case forward

    Use the policy in Submission Co-Pilot™, P2P Co-Pilot™, or Responder™.

    Across the suite

What your team gets

Policy intelligence your team can use

The right coverage information, connected to the patient's case and ready for the next step.

  • 01

    Searchable policy library

    20,000+ commercial, Medicare Advantage, and Medicaid policies in one place, and growing.

  • 02

    Coverage criteria and documentation needs

    What the policy requires, what must be documented, and which codes and exclusions apply.

  • 03

    Policy-change review

    Know when a payer revises a policy and which of your cases it touches.

  • 04

    Connections to the Just Healthcare suite

    Carry the criteria into a submission, call brief, or appeal without re-entering them.

Keep exploring

See how the rest of the suite supports the work.

Where it fits

Other products

Start with the problem that hurts most

Show us where your team is losing time.

We will show you which product fits the work, what your team would see, and how the solution can support the way your organization operates today.

Request a demo