End-to-End
Prior Authorization
for Providers

Through strategic integration of tech intelligence
Bring down denials →
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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Prior authorization costs health systems millions. The industry needs a prior authorization solution that automates the process — end to end.

Healthcare Critical Numbers

13%

of PA denials met Medicare coverage rules and should've been approved.

$17.5M

spent annually by a 20-hospital system for PA requirements.

24 FTEs

are required by a single 355-bed psychiatric facility to manage authorizations.

Streamlined Prior Authorisation Workflow

Expertly Automated at Every Step for Effortless Efficiency

Solution

From advanced PA optimization with RISA Co-pilot to the all-encompassing RISA 360, discover the perfect fit for your healthcare facility's Prior Authorization needs.

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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.

The RISA Benefit

Prior authorization doesn’t have to be a negative experience for providers and patients. With RISA the entire PA workflow is automated and always at the care team’s fingertips, reducing administrative overhead and smooth delivery of care.

Unbeatable solution for all of your needs

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Unprecedented Prior Authorization Intelligence

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