BENEFITS

Increase your denial rate

save costs

save costs and reduce payment of fraudulent claims

categorize

automatically categorize your risk scoring into low, medium and high risk claims

high-risk

process high-risk claims faster

manual work

reduce the manual labor

Automate your claims processing

processing

increase the efficiency in claims processing

goals

increase the accuracy in claims processing

reduce labor costs

reduce labor costs invested into processing claims

satisfaction

increase the satisfaction of your payers due to the increased denial rate of WAF claims

Increase your claim recovery rate

compare

evaluate and compare the effectiveness of your TPAs

network

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.

Continuous improvement

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.