PIMSY EHR Review (2026)

Overview

PIMSY (Practice Information Management System) is a cloud-based EHR and practice management platform purpose-built for behavioral health organizations. Developed by Smoky Mountain Information Systems, Inc. and founded in 2007 in Waynesville, North Carolina, PIMSY has grown to serve over 6,000 clinicians managing more than one million active patient records. The platform is designed from the ground up for behavioral health workflows, not adapted from a general medical EHR, which gives it a meaningful advantage in clinical relevance for agencies operating in substance use disorder treatment, IOP/PHP, residential care, medication-assisted treatment, and community mental health.

What sets PIMSY apart from simpler behavioral health platforms like TherapyNotes is its all-in-one ambition. Beyond clinical documentation, scheduling, and billing, PIMSY bundles HR management, payroll integration, telehealth, ePrescribing with EPCS, electronic medication administration records (eMAR), a patient portal, and an AI-powered documentation assistant called PAISLY into a single platform. This consolidation eliminates the need for multiple point solutions and reduces the administrative overhead that plagues many behavioral health agencies juggling disconnected systems.

The platform is hosted on Microsoft Azure infrastructure, providing enterprise-grade security, reliability, and scalability. PIMSY remains privately held by Smoky Mountain Information Systems with no private equity or venture capital involvement, a distinction worth noting in a market where PE-backed rollups have degraded product quality at several competing vendors. For a broader comparison of how PIMSY stacks up against other platforms in this space, see our behavioral health EHR comparison.

Key Features

PAISLY AI Documentation

PAISLY is PIMSY's AI-powered narrative documentation generator, and it is one of the platform's most distinctive capabilities. Using natural language processing, PAISLY converts discrete clinical data points entered during an encounter into complete progress note narratives. It supports multiple note formats including BIRP, DAIR, DAP, PIE, GIRP, and SOAP, giving clinicians flexibility to match their documentation style or payer requirements. PHI is de-identified during the generation process, addressing a common privacy concern with AI-assisted documentation tools.

What makes PAISLY particularly noteworthy is that it is included in PIMSY's base Prime tier at $99 per user per month. Most competing platforms either lack AI documentation entirely or charge premium prices for it. For documentation-heavy clinical environments where clinicians spend hours writing notes, PAISLY can deliver meaningful time savings. For more on how AI is reshaping clinical workflows, see our EHR selection process guide, which covers evaluating AI capabilities during vendor selection.

Wiley Treatment Planner

PIMSY includes a built-in integration with the Wiley Practice Planners library, providing clinicians with evidence-based treatment plan goals, objectives, and interventions that can be pulled directly from diagnoses. This integration helps standardize treatment planning across multi-clinician agencies and ensures documentation meets payer expectations for medical necessity. Like PAISLY, the Wiley Treatment Planner is available starting from the base Prime tier, which is unusual. TherapyNotes also offers Wiley integration, but PIMSY pairs it with significantly more administrative depth.

ePrescribing and eMAR

PIMSY integrates with DrFirst (via the H2h connector) for electronic prescribing, including EPCS (Electronic Prescribing for Controlled Substances) and PDMP (Prescription Drug Monitoring Program) connectivity. This is essential for psychiatric practices and medication-assisted treatment programs where prescribers need to verify patient prescription histories and prescribe controlled substances electronically. The platform also supports electronic medication administration records (eMAR), allowing residential and inpatient facilities to track medication dispensing and administration within the EHR rather than relying on paper MARs or separate systems.

Billing and Revenue Cycle Management

PIMSY provides a comprehensive billing and RCM suite that includes charge capture, claims scrubbing, electronic claim submission, 835 auto-posting, and real-time eligibility verification. The platform has processed over $2.1 billion in claims and reports a 96 percent net collection rate with a 26-day average days in accounts receivable (DSO). For IOP and PHP programs, PIMSY includes automated per diem billing scripts that handle the repetitive billing workflows specific to structured outpatient levels of care. Claims are submitted through integrated clearinghouse partnerships, and the system flags common coding errors before submission to reduce denial rates.

For organizations that prefer to outsource their revenue cycle entirely, PIMSY offers a full-service RCM option called PIMSY Billing, which handles claims management, denial follow-up, and collections on behalf of the practice.

HR and Payroll

This is where PIMSY stands apart from virtually every other behavioral health EHR. The platform includes built-in HR management tools covering productivity tracking, credential management, and staff scheduling. Payroll is handled through a Paychex integration, allowing agencies to manage clinical operations and administrative functions from a single platform. Having HR and payroll within the EHR eliminates the need for separate systems and provides visibility into clinician productivity metrics alongside financial and clinical data. For mid-size agencies managing 20 or more staff members, this consolidation can represent meaningful cost and time savings.

Telehealth

PIMSY includes integrated HIPAA-compliant video telehealth. Sessions can be launched directly from the scheduling interface, and telehealth documentation is automatically linked to the clinical encounter. The platform supports standard one-on-one video sessions as well as group telehealth, which is important for IOP and PHP programs that conduct group therapy remotely. Combined with the ePrescribing integration, PIMSY supports fully remote care delivery, from clinical encounter through prescription, without leaving the platform.

Patient Portal

The patient-facing portal allows clients to schedule appointments, complete intake forms and clinical screening instruments (including PHQ-9 and GAD-7), make payments, communicate with providers via secure messaging, and access telehealth sessions. Online intake reduces front-desk administrative burden and ensures that demographic, insurance, and clinical screening data is captured before the first appointment.

Lab Integrations

PIMSY connects to over 500 diagnostic labs nationwide, supporting electronic lab ordering and results retrieval within the EHR. This is particularly valuable for SUD treatment programs that require regular drug screening and MAT clinics that monitor medication levels. Lab results flow back into the patient chart automatically, reducing manual data entry and the risk of transcription errors.

Outcomes Tracking

PIMSY includes measurement-based care tools built into the clinical workflow. Standardized screening instruments can be administered through the patient portal or during encounters, with automated scoring and trend visualization over time. This supports outcomes-driven treatment planning and provides data for quality reporting, payer audits, and program evaluation.

Pros

• Purpose-built for behavioral health. PIMSY was designed from the ground up for behavioral health agencies, not converted from a general medical EHR. Clinical workflows, documentation templates, and billing rules reflect the realities of behavioral health practice rather than being bolted on as an afterthought.
• Comprehensive all-in-one platform. Clinical documentation, billing/RCM, HR/payroll, telehealth, ePrescribing, eMAR, patient portal, and lab integrations in a single system. This level of consolidation is rare in the behavioral health EHR market and eliminates the need for multiple point solutions.
• PAISLY AI saves significant documentation time. AI-powered narrative generation is included at the base tier, converting discrete clinical data into complete note narratives across six standard formats. For clinicians spending hours on documentation, this is a meaningful productivity gain.
• Wiley Treatment Planner included in base tier. Evidence-based goals, objectives, and interventions from the Wiley Practice Planners library are available starting at $99 per user per month. This standardizes treatment planning and supports medical necessity documentation.
• 42 CFR Part 2 compliant for SUD programs. Robust redaction controls and confidentiality workflows meet the requirements of 42 CFR Part 2, making PIMSY suitable for substance use disorder treatment programs that handle sensitive patient records.
• ONC-certified (Platinum tier) with MIPS support. The platform meets ONC Health IT certification requirements and supports quality reporting for practices participating in MIPS or Promoting Interoperability programs.
• Strong RCM performance metrics. Over $2.1 billion in claims processed, 96 percent net collection rate, and 26-day average DSO. The full-service PIMSY Billing option provides an outsourced RCM alternative for agencies that lack billing staff.
• 500+ lab integrations. Electronic lab ordering and results retrieval across a broad network of diagnostic labs, which is essential for SUD treatment and MAT programs requiring regular drug screening.
• Full-service RCM outsourcing option. PIMSY Billing handles claims management, denial follow-up, and collections for organizations that prefer to outsource revenue cycle operations entirely.
• Responsive U.S.-based customer support. Consistently cited in user reviews as one of PIMSY's strongest attributes. The support team is knowledgeable about behavioral health workflows and accessible, which matters for a platform with this level of complexity.

Considerations

• Onboarding is deeper than lightweight therapist tools. PIMSY's all-in-one model (clinical, billing, HR/payroll, and AI) delivers more operational depth, but teams should budget structured training time to fully leverage the platform.
• Desktop-first workflow. PIMSY is fully usable on mobile browsers, but it is optimized for desktop-heavy operational workflows. Organizations with high field-mobile usage should validate fit during trials.
• Advanced tiers are quote-based. Prime pricing is transparent at $99/user/month, while Professional and Platinum are custom quoted. Buyers should request detailed module-level pricing early in evaluation.
• ASAM support is configurable rather than a dedicated module. PIMSY supports ASAM-aligned workflows through configurable templates and documentation logic. Programs wanting a rigidly prebuilt ASAM module should compare this implementation style with alternatives like AZZLY Rize.

Pricing

PIMSY uses a tiered per-user pricing model. The Prime tier is transparent at $99 per user per month, while the Professional and Platinum tiers require custom quotes based on organization size, feature requirements, and implementation scope.

Tier	Price	Target
Prime	$99/user/month	Small practices; includes EHR, PM, telehealth, PAISLY AI, Wiley Treatment Planner, patient portal. Same-day onboarding.
Professional	Custom quote	Growing practices; adds advanced practice management, customizable notes, medication management, HR/payroll, labs, faxing.
Platinum	Custom quote	Large and multi-location organizations; adds multi-site management, 24/7 help desk, residential module, eMAR, ONC certification, CURES compliance.

All three tiers include PAISLY AI documentation and the Wiley Treatment Planner, which is a strong value proposition at the base level. No setup fees are publicly disclosed. However, most agencies will need the Professional or Platinum tier to access the administrative modules (HR/payroll, ePrescribing, eMAR) that make PIMSY distinctive. Prospective buyers should request detailed quotes for the tier that matches their operational requirements and verify exactly which features are included to avoid surprises.

Who Should Use PIMSY

PIMSY is a strong fit for:

• Behavioral health agencies that need clinical, billing, and HR in one platform. If you are tired of managing separate systems for clinical documentation, revenue cycle, and human resources, PIMSY consolidates all three under a single roof. This is its core value proposition.
• SUD treatment centers. 42 CFR Part 2 compliance, MAT support, ePrescribing with EPCS/PDMP, eMAR, and residential bed management make PIMSY a viable option for programs treating substance use disorders across multiple levels of care.
• IOP and PHP programs. Automated per diem billing scripts, group note support, and structured outpatient documentation workflows address the specific operational needs of intensive outpatient and partial hospitalization programs.
• Community mental health centers. The combination of ONC certification, outcomes tracking, measurement-based care tools, and comprehensive billing support makes PIMSY suitable for community mental health organizations with quality reporting requirements.
• Mid-size practices wanting to consolidate vendors. Agencies with 10 to 100 clinicians that are currently running multiple disconnected systems for clinical, billing, HR, and telehealth will find the most value in PIMSY's all-in-one approach.

Who Should Not Use PIMSY

PIMSY is not the right choice for:

• Solo therapists wanting minimal setup and lowest-cost tooling. PIMSY is feature-rich by design. Individual clinicians with very simple workflows may prefer lighter-weight options such as TherapyNotes or SimplePractice.
• Practices needing a highly responsive mobile experience. If your clinical workflow depends on documenting from a phone or tablet in the field, PIMSY's mobile experience is not yet competitive with platforms that have invested more heavily in mobile-first design.
• Organizations with limited onboarding bandwidth. PIMSY's breadth is a strength for scaling teams, but it benefits from structured implementation and training. Teams needing immediate minimal-configuration rollout may prefer a simpler platform profile.
• Practices that do not need HR and payroll. A significant portion of PIMSY's value comes from its administrative modules. If your organization already has HR and payroll systems that work well and you only need clinical and billing tools, you may be paying for capabilities you will not use.
• Residential SUD centers wanting more purpose-built addiction-specific workflows. While PIMSY supports SUD treatment well, organizations that want deeper, more native ASAM integration, dedicated bed management workflows, and SUD-specific clinical pathways should evaluate AZZLY Rize, which is built specifically for addiction treatment.

Implementation

PIMSY implementation timelines vary significantly by tier, reflecting the different levels of complexity and customization involved.

• Prime tier: Same-day onboarding is available. Setup is primarily self-service through online configuration, supported by video tutorials and the knowledge base. Most small practices using the Prime tier can be operational within one to three days.
• Professional and Platinum tiers: Custom implementation with a dedicated onboarding process. PIMSY's team works with the organization to configure workflows, note templates, billing rules, and administrative settings. Data migration from legacy systems is supported, including patient demographics, clinical history, and billing data. Personalized training is provided through a train-the-trainer model. Typical implementation takes four to six weeks depending on organization size and complexity.

Data migration from legacy systems is supported but can be complex depending on the source system's data export capabilities. Organizations should get specific migration timelines in writing before committing, particularly if migrating from a system with non-standard data formats. For a structured framework for managing the entire EHR evaluation and implementation lifecycle, see our EHR selection process guide.

Frequently Asked Questions

How much does PIMSY cost?

PIMSY starts at $99 per user per month for the Prime tier, which includes the EHR, practice management, telehealth, PAISLY AI documentation, Wiley Treatment Planner, and a patient portal. The Professional and Platinum tiers are custom-quoted and add features like advanced practice management, customizable progress notes, medication management, HR/payroll integration, residential modules, and eMAR. No setup fees are publicly disclosed.

What is PAISLY AI and how does it work?

PAISLY is PIMSY's AI-powered narrative documentation generator. It uses natural language processing to convert discrete clinical data points entered during an encounter into complete progress note narratives. PAISLY supports six standard note formats: BIRP, DAIR, DAP, PIE, GIRP, and SOAP. PHI is de-identified during the generation process to address privacy concerns. PAISLY is included in all PIMSY tiers starting with the $99 per user per month Prime plan, making PIMSY one of the few behavioral health EHRs to bundle AI documentation at its base price point.

Is PIMSY 42 CFR Part 2 compliant for SUD programs?

Yes. PIMSY is fully 42 CFR Part 2 compliant with robust redaction controls designed specifically for substance use disorder treatment programs. This means patient records related to SUD treatment are protected with the appropriate confidentiality safeguards required by federal regulation. The platform supports SUD-specific workflows across residential, IOP/PHP, and MAT levels of care.

How does PIMSY compare to Netsmart?

PIMSY and Netsmart both serve behavioral health organizations, but at different scales and price points. PIMSY is best suited for small to mid-size agencies (5 to 100 clinicians) and offers a more accessible entry point with PAISLY AI and Wiley Treatment Planner included at $99 per user per month. Netsmart targets larger enterprise organizations, community mental health centers, and state-funded agencies with more extensive interoperability, reporting, and care coordination capabilities. PIMSY is generally easier to implement and has stronger user satisfaction ratings for customer support, while Netsmart offers deeper integration with state reporting systems and more mature enterprise-scale infrastructure.

Is PIMSY ONC-certified?

Yes. PIMSY is ONC Health IT certified at the Platinum tier, HIPAA compliant, and supports MIPS quality reporting for practices participating in merit-based incentive programs. The platform is hosted on Microsoft Azure infrastructure and also supports CURES Act compliance requirements.

How long does PIMSY implementation take?

Implementation timelines depend on the tier. The Prime tier offers same-day onboarding with self-service online setup and video tutorials. Professional and Platinum tier implementations typically take four to six weeks and include custom configuration, data migration support from legacy systems, and personalized training. Data migration complexity depends on the source system, so organizations should request specific timelines in writing before committing.

Verdict

PIMSY delivers a strong all-in-one behavioral health EHR for agencies that want clinical documentation, billing and RCM, HR/payroll, and telehealth consolidated in a single platform. The combination of PAISLY AI documentation and the Wiley Treatment Planner included at the base $99 per user per month tier is a standout value proposition that few competitors match. For organizations that routinely struggle with documentation burden, these tools alone can justify the platform's cost.

The platform is best suited for mid-size behavioral health agencies, IOP and PHP programs, and community mental health centers that need comprehensive operational coverage without cobbling together multiple point solutions. SUD treatment centers will appreciate the 42 CFR Part 2 compliance, ePrescribing with EPCS, and eMAR capabilities, though the ASAM integration is workflow-based rather than a dedicated module.

The trade-offs are real: a steep learning curve, performance inconsistencies, a mobile experience that needs improvement, and limited pricing transparency on the upper tiers. Solo therapists and small outpatient practices that do not need the administrative depth should look at simpler, more affordable alternatives like TherapyNotes.

For dedicated SUD treatment centers that want deeper addiction-specific workflows, native ASAM integration, and purpose-built residential treatment features, AZZLY Rize is worth evaluating as an alternative. For a detailed side-by-side comparison of behavioral health EHR platforms, visit our behavioral health EHR comparison guide.