Streamlined AI Integration
for Health Plans

Your Gateway to Simplified Prior Authorization
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Prior Auth Workflow Challenges
Hidden Cost Drain
While PA aims to control costs, complex PA processes actually inflate administrative costs for health plans.
Administrative Overload
Manual processing, repeated data entry and regulatory changes burden management, increasing delays and risk.
Compliance Dynamics
Ongoing healthcare regulation changes add layers of complexity, demanding constant adaptation and oversight.
Submission Disparities
Managing PAs across fax, mail, and digital portals complicates and slows approvals, increasing error rates.

Our Solution

Transforming your operational landscape with cutting-edge
automation and integration.

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Automating Prior Authorization Reviews

Cost Savings
Significantly reduce costs with RISA’s proactive  prevention.
High Accuracy
Deploy RISA’s AI precision to elevate the accuracy of prior authorizations and claims.
Reduced Burnout
RISA’s automated
workflows transform prior authorization.
Minimized Risk
Mitigate audit risks with RISA’s compliance-focused system.
Administrative Cost Savings and Enhanced Efficiency
Our MAS-driven PA verification engine automates 70% of prior auth reviews, with partial automation for the rest, cutting admin workload while enhancing efficiency and accuracy.
Focused Expertise on Complex Cases
Our PA prioritization engine, identifies and allocate complex cases for human intervention while providing comprehensive assistance with all the necessary data required

Streamlined Prior Authorisation
Workflow with RISA

Automated end-to-end for effortless scaling

API Infrastructure for Interoperobility

Comprehensive API Coverage: We build APIs that follow DaVinci Protocol, powered by FHIR standard, to transfer relevant health data across systems without the need for significant investment in developing and maintaining in-house infrastructure

Starting Jan 2026 (Complete implementation by Jan 2027), it is mandated to implement and maintain certain HL7 FHIR APIs, to improve the electronic exchange of healthcare data and streamline
Prior Authorization Process

Implement an HL7® FHIR® :

  • Patient Access API
  • Provider Access API
  • Payer Access API

Implement an FHIR-based, X12-based, or a combination of both for Prior Authorization API populated with:

  • Whether a PA is required for an item or service,
  • What requirements are needed to authorize the item or service,
  • Request and response flow for providers to submit PA requests to payers, and for payers to respond with decisions and status

Tech behind RISA

Multi-Agent System
RISA’s proprietary algorithm uses MAS(a pool of AI Agents) to automate multiple steps in PA workflow right from encoding payer policies to validating clinical documents for establishing medical necessity. This reduces administrative burden on payers while maintaining high accuracy.

Compliance and Regulations

Multi-Agent System enabled

Prior Authorisation

RISA’s Prior Authorisation solution condenses a multi-step process into digitally connected workflows. From automated patient registration and prior auth checks to case submission and status update – all without leaving the EHR.

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Seamless Integration, No New Dashboards.

Prior Authorization Workflow with RISA

With RISA’s support, prior authorizations receive higher approval rates, faster decisions and fewer downstream claim denials.

1. Patient Registration and In-take Forms

The current process of registration and in-take forms are full of inefficiencies like delays and data leakage, surged billing inaccuracies and inconsistent data collection format.

2. Insurance Eligibility and Coverage Verification

More than 27% of claim denials are attributed to inefficiencies in patient registration and insurance eligibility check. Their inefficiencies can be attributed to lack of standardized information.

3. Auth Verification & ADT Alerts

The current auth verification process is inefficient due to disconnected systems, delayed response cycles, higher manual intervention and lack of integrated alerts and tracking.

4. Adapting to Evolving Protocols

Due to rapid, erratic shifts in payer and plan guidelines and third-party rules overwhelm providers, making consistent compliance a daunting task.

5. Prior Authorization Management

The current prior authorization management is inefficient due to manual process and lack of standardization in PA application submission, status tracking, evidence gathering for resubmission and appeal management.

6. Chart Profiling & Auth Documentation

The existing workflow is cumbersome, involving several error-prone manual steps: scanning patient charts to confirm need, crafting checklists tailored to specialties according to payer requirements, sifting through a large document database, and compiling a PA document with necessary attachments. RISA streamlines this process with AI agents that enhance accuracy and flag any missing elements in the authorization paperwork.
Prior authorization Workflow with RISA

Seamless Integration, No New Dashboards.

With RISA’s support, prior authorizations receive higher approval rates, faster decisions and fewer downstream claim denials.

1. Patient Registration and In-take Forms

The current process of registration and in-take forms are full of inefficiencies like delays and data leakage, surged billing inaccuracies and inconsistent data collection format.

2. Insurance Eligibility and Coverage Verification

More than 27% of claim denials are attributed to inefficiencies in patient registration and insurance eligibility check.

3. Auth Verification & ADT Alerts

The current auth verification process is inefficient due to disconnected systems, delayed response cycles, higher manual intervention and lack of integrated alerts and tracking.

4. Adapting to Evolving Protocols

Rapid, erratic shifts in payer and plan guidelines and third-party rules overwhelm providers, making consistent compliance a daunting task.

5. Prior Authorization Management

The current prior authorization management is inefficient due to manual process and lack of standardization in PA application submission, status tracking, evidence gathering for resubmission and appeal management.

6. Chart Profiling & Auth Documentation

The existing workflow is cumbersome, involving several error-prone manual steps: scanning patient charts to confirm need, crafting checklists tailored to specialties according to payer requirements, sifting through a large document database, and compiling a Prior Authorization (PA) document with necessary attachments. RISA streamlines this process with AI agents that enhance accuracy and flag any missing elements in the authorization paperwork.

Unbeatable solution for all of your needs

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Unprecedented Prior Authorization Intelligence

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