Starting with the Initial and Crucial Bottlenecks of Oncology Care

Prior Authorization

With constant updates in payer guidelines and fragmented prior auth processes, it’s essential to have a tool that knows exactly what needs to be submitted, so your staff can focus on patients instead of spending hours on the phone with payers!

Ruchi Garg, MD

Chief Medical Officer @ Fairview Park Hospital
Gynecologic Oncologist

Current state of Prior Authorization in Oncology Treatments

69%

of cancer patients face care delays due to prior auth

1 Week

median delay in Prior Authorization approvals

42%

initial PA denial rate for proton therapy

3.2%

rise in mortality risk for early-stage cancers occurs with each week of treatment delay.

RISA’s intelligence streamlines the Prior Auth journey

Intelligent automation simplifies eligibility checks, guidelines, and submissions, reducing delays, speeding up approvals, and improving access to oncology treatments

Eligibility & Benefit Verification

Individual patient financial responsibility is calculated based on cost, co-pay and co-insurance for all HCPCS/CPT codes needing PA.

Medical Necessity Check

References payer-specific guidelines and NCCN guidelines to create a medical necessity checklist and attaches proof for each satisfied checklist item

Authorization Verification

Instantly ascertain the necessity for PA for a procedure or medication in real-time through dynamic rules engine.

Prior Auth Form Review & Submission

Auto-populates payer-specific forms, attaches required documents, and submits through a single interface via API, portals, or e-fax, streamlining the entire process.

Technology that powers precision

Leveraging AI-driven multi-agent system architecture and cutting-edge technology, we establish medical necessity while continuously feeding complex cases to improve the AI.

CoCo DNA: Strategic Alliances

Collaborations with top clearinghouses and payer portals like Availity and updated guidelines from MCG and Interqual.

RPA and Rules Engine: Streamlined Automation

RPA: Automates redundant tasks on web portals
Rules Engine: Comprehensive & expansive library of payer rules

Gen AI and LLMs: Precision in Medical Necessity

Reads EHR data to ensure medical necessity and issues alerts for missing documentation to avoid denials.

Human Experts: Precision Oversight

Specialists refine AI outputs and manage complex prior authorization cases.

One point solution for all Oncology Prior Authorization

Types of Prior Authorization

Chemotherapy and Targeted
Therapy (Oral and IVs)

Radiation
Therapy

Diagnostic Imaging
and Testing

Surgical
Procedures

Supportive Care and
Palliative Treatments

Genetic and
Precision Medicine

Pain
Management

Experimental
and Off-Label Use

Specialty
Pharmacy

Radiopharmaceuticals

Chemotherapy and Targeted
Therapy (Oral and IVs)

Radiation
Therapy

Diagnostic Imaging
and Testing

Surgical
Procedures

Supportive Care and
Palliative Treatments

Genetic and
Precision Medicine

Pain
Management

Experimental
and Off-Label Use

Specialty
Pharmacy

Radiopharmaceuticals

Oncology sub-specialities

Medical
Oncology

Surgical
Oncology

Radiation
Oncology

Hematology
Oncology

Urology
Oncology

Neuro
Oncology

Gynecology
Oncology

Rheumatology
Oncology

Surgical
Oncology

Radiation
Oncology

Medical
Oncology

Surgical
Oncology

Radiation
Oncology

Hematology
Oncology

Urology
Oncology

Neuro
Oncology

Gynecology
Oncology

Rheumatology
Oncology

Surgical
Oncology

Radiation
Oncology

Integration Capabilities

Normalized data ingestion workflows

across disparate EHRs, APIs, cloud vendors, payer source systems and digital health tools

Legacy standard transformations

for HL7®v2/DICOM®, X12, CDA/XML, and JSON into HL7®/ FHIR®

integrations across
90+ EHRs, 50+ HIEs & HINs

7.3k+

connected healthcare entities
from all corners of healthcare*

Clinical Operations
‍for Oncology

Prior Authorization

Current state of Prior Authorization in Oncology Treatments

RISA’s intelligence streamlines the Prior Auth journey

Technology that powers precision

One point solution for all Oncology Prior Authorization

Integration Capabilities

Compliance and Regulations

AI Agents for
Healthcare Automation

Clinical Operations‍for Oncology

Prior Authorization

Current state of Prior Authorization in Oncology Treatments

RISA’s intelligence streamlines the Prior Auth journey

Technology that powers precision

One point solution for all Oncology Prior Authorization

Integration Capabilities

Compliance and Regulations

AI Agents forHealthcare Automation

Clinical Operations
‍for Oncology

AI Agents for
Healthcare Automation