Read now   Digital Twin Ecosystem for Oncology Clinical Operations

Clinical Operations
for Oncology

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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 Auth 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 & Benefits Verification
Individual patient's 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 clearing houses 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®
9K
integrations across
90+ EHRs, 50+ HIEs & HINs
7.3k+
connected healthcare entities
from all corners of healthcare*

Compliance and Regulations

We are compliant and follows all industry-standard regulations, ensuring ethical and legal communication practices