Risk adjustment coding, compliance, and RADV readiness - built for results you can defend.
Prizm helps Health Plans and IPAs improve RAF accuracy and reduce audit exposure with decision-grade analytics, clean operational controls, and focused coding and documentation workflows.
Accuracy
Close documentation and coding gaps with practical workflows that scale.
Compliance
Strengthen controls, QA, and evidence standards to reduce audit risk.
Readiness
Improve defensibility and submission discipline ahead of RADV and related audits.
What we deliver
Modular deliverables that fit your current workflow. Start small, or run a full program assessment.
Coding and documentation improvement
Build consistent evidence standards and documentation habits that improve accuracy and defensibility.
- Documentation requirements by condition and setting
- Specialty-focused education and reinforcement
- Coder QA approach and escalation paths
Compliance controls and QA
Create a compliance-first operating system: clear guardrails, review logic, and auditable QA.
- Minimum-necessary data practices (no PHI requested here)
- Sampling strategy and QC checkpoints
- Provider query and documentation guidance
RADV audit proofing and readiness
Strengthen record defensibility and submission discipline using a CMS-aligned mindset.
- Pre-submission “proof” checks for documentation support
- Root cause themes and corrective action planning
- Audit response workflow recommendations
Program audit and remediation plan
A practical assessment of your current MRA program with a prioritized plan your team can execute.
- Workflow and handoff review
- Reporting that leaders can trust
- 90-day remediation roadmap
Executive dashboard and performance reporting
Decision-grade reporting that explains performance, pinpoints leakage, and supports action.
- Provider and clinic drilldowns
- Opportunity and recapture tracking
- Simple, repeatable KPI cadence
Staff enablement and operating rhythm
Training and workflows that stick. Clear roles, cadence, QA, and accountability.
- Role-based training for coders and leaders
- SOP templates and QA checklists
- Weekly and monthly operating rhythm
How we work
Simple and executive-friendly. You get clarity quickly, then we execute with your team.
Phase 1 - Diagnose
- Current-state review of workflow, reporting, and controls
- Priority areas by impact and feasibility
- Clear success metrics and cadence
Phase 2 - Execute and sustain
- Deliverables built into your existing rhythm
- Training, reinforcement, and QA checkpoints
- Leadership updates that stay out of the weeds
RADV readiness without panic
RADV and related audits reward disciplined documentation support, consistent review standards, and clean submission workflows. We help you build defensibility into your day-to-day process - not just during audit season.
What “proofing” means
A structured check that a diagnosis is supported by the medical record and meets documentation expectations, before it becomes part of your finalized submission story.
What you get
A repeatable checklist, evidence standards, QA sampling approach, and an audit response workflow that reduces chaos.
Common questions
Do you need PHI to do this work?
Can you support both Health Plans and IPAs?
What’s a good first step?
Want a clear plan in 2 weeks?
We’ll review your current approach and deliver an executive-ready action plan that your team can actually run.