Increase your denial rate
save costs and reduce payment of fraudulent claims
automatically categorize your risk scoring into low, medium and high risk claims
process high-risk claims faster
reduce the manual labor
Automate your claims processing
increase the efficiency in claims processing
increase the accuracy in claims processing
reduce labor costs invested into processing claims
increase the satisfaction of your payers due to the increased denial rate of WAF claims
Increase your claim recovery rate
evaluate and compare the effectiveness of your TPAs
better provider and network risk management
Real time control
RiSIC is a real-time machine learning engine that analyses claims before decisions are made and flags up unexpected outcomes for human intervention – helping insurance providers clamp down on waste, fraud and abuse as they occur.
No investments needed
Not only does RiSIC connect with existing systems seamlessly without needing disruptive integration, but you also only pay when RiSIC starts saving you money. This means that you can start gaining control of your costs without up-front expenditure, and without risk.
Unlike static rules-based engines, RiSIC learns and improves all the time. Each doctor’s prognosis and claims processor decision makes the system more accurate – making it more efficient at streamlining your costs.
Beneficial for all stakeholders
RiSIC does not just help insurance providers. By stamping out waste, abuse and fraud, it helps lower insurance premiums to the benefit of patients and employers. It also helps hospitals and healthcare providers identify wasteful procedures to deliver more effective healthcare. On a population level, it supports the health system by contributing to the management of the medical inflation.
Trained for GCC medical case appraisal
We built RiSIC leveraging our decade long experience in analyzing healthcare claims and in collaboration with GCC based healthcare insurance company. Training the RiSIC engine with market specific claims data and decisions makes it incredibly well tuned and capable of detecting localized behavior.