Clinical operations and auditing · Puerto Rico
We empower providers, reduce costs, and maximize results
PR Prima supports physician groups and practices serving Medicare Advantage patients in Puerto Rico. We take care of clinical documentation, the Comprehensive Assessment, strategic billing, and HEDIS/NCQA quality metrics, so physicians can devote their energy to their patients.
About
Letting physicians focus on what matters most: caring for their patients
At PR Prima we believe physicians should focus on what matters most: caring for their patients. That is why we position ourselves as their strategic partner, guiding them to reach their goals with confidence and without unnecessary complications.
What sets us apart is our ability to simplify complex processes, ensuring every physician operates under the highest standards, maximizing results for their practice and the well-being of their patients. We take care of the details so they can devote all their energy to what matters.
To provide a professional, efficient, and transparent path that helps physicians reach their full potential.
At PR Prima, we are here to turn challenges into opportunities and take your practice to the next level.
Evelia NaterFounder and Owner
Services
PR Prima's operational workflow
Tailored solutions to maximize clinical and financial impact. Each phase is designed to capture and reflect clinical information accurately and traceably, bringing together the physician, the auditor, and the administrative team.
- 01
Population analysis
We get to know the practice before we begin and determine its current level of optimization.
- We review a sample of the practice's patient population.
- We analyze trends and patterns: average RAF, prevalence, HCCs, and consistency in forms and encounters.
- We determine the current level of optimization.
- We issue an executive report indicating whether it is worthwhile to continue to the next phase.
- 02
Onboarding
We establish the foundation for a consistent, standardized clinical system.
- We look for gaps in clinical documentation, medical coding, billing, and administrative workflow.
- We standardize the electronic health record (EHR): problem-list cleanup, consistent coding, and uniformity across users.
- We reconcile information between the EHR and the health plan portal so diagnoses from other specialties are not lost.
- We train the entire staff (physician, secretary, PA, and biller) so the workflow stays intact and no data is missed.
- 03
Comprehensive Assessment
A clinical review of every eligible patient, validated with the physician.
- We perform the Comprehensive Assessment (CA) for every eligible patient.
- We review the complete EHR to identify active chronic conditions, missed diagnoses, and the clinical evidence that supports them.
- We validate the information with the physician: the provider confirms and approves every diagnosis.
- We run clinical queries when findings need clarification or confirmation.
- We update the electronic health record with the validated diagnoses and close any documentation gaps.
- We produce monthly reports with key performance indicators.
- 04
Billing + Stars
Evidence-based strategic billing and preventive follow-up to strengthen quality metrics.
Billing
Accurate, evidence-based billing aligned with what is documented in the patient's record.
- We integrate the physician-validated Comprehensive Assessment information so billing reflects what is documented.
- We reconcile every claim with the electronic health record (EHR) and with the health plan to ensure consistency between what is documented and what is billed.
- We manage denials and reconciliations with documented evidence.
- We deliver monthly reports with key metrics.
Stars
Strengthen quality and compliance metrics (Stars) through preventive patient follow-up.
- Coordination of preventive appointments and laboratory tests (HbA1c, blood pressure, screenings).
- Health and education campaigns designed to improve HEDIS and NCQA measures.
- Automated reminders and scheduling, ensuring ongoing compliance.
- Monthly reports on quality metrics and patient satisfaction.
Education
Educational services for health professionals
We develop and deliver educational activities for physicians and health professionals, focused on strengthening best practices in clinical documentation and coding based on documented evidence.
- Topics coordinated in advance with the organization, such as diabetes, cardiovascular conditions, and chronic kidney disease, among others.
- Activities of up to two hours covering the clinical and documentation concepts that apply to the selected topic.
- Practical examples of medical documentation scenarios and discussion of documentation and coding best practices.
- Time for questions and discussion with participants.
Our goal is to work with health organizations through practical, applicable education that strengthens clinical documentation, supports the quality of medical data, and promotes consistent coding processes.
Approach
Clinical evidence, physician approval, and standardized processes
Every phase brings together the physician, the auditor, and the administrative team so clinical information is captured accurately and traceably.
Clinical evidence and physician approval
All documentation rests on clinical evidence already in the record. We never add or change diagnoses on our own: the physician reviews, confirms, and approves every diagnosis.
Clinical queries
When a finding needs clarification or confirmation, we raise it with the physician through clinical queries.
Standardized processes
We standardize the EHR and train the entire staff so the workflow stays intact and no data is missed.
Monthly reports
We deliver monthly reports with key performance indicators and quality metrics.
The results we work toward
Accurate documentation and less administrative burden. Results depend on each practice; these are the goals of our work.
Standardized clinical processes
A clean EHR, a consistent workflow, and trained staff.
Complete, accurate documentation
Records that reflect the patient's actual condition, validated by the physician.
Fewer denials and less rework
Claims backed by clear documentation that reduce repeated administrative work.
Improved quality and compliance
Greater adherence to preventive metrics and patient satisfaction.
Contact
Let's talk about your practice
Write to us to arrange a conversation about your practice or about educational activities for your organization. We will reply by email or by phone.
- info@prprima.com
- Phone
- 939-904-0337
- Location
- Canóvanas, Puerto Rico
We optimize care, we maximize results.
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