Rising Medical Solutions

What Rising Medical Solutions does

Rising Medical Solutions is a Chicago-based, privately held medical cost containment and care management company serving the U.S. workers' compensation market, with adjacent capabilities in auto no-fault and disability management. Founded in 1999 and operating with 251–500 employees, the company sells three integrated service pillars — Medical Cost Reduction (medical bill review, hospital bill review, specialty bill review, provider negotiations, and provider networks), Medical Care Optimization (telephonic and field case management, utilization review, peer review, physician pharmacy review, and ancillary care services), and Analytics & Technology (advanced analytics, risk modeling, Rx Intelligence pharmacy analytics) — to insurance carriers, third-party administrators, self-insured employers, and government entities such as Cook County, Illinois.

The technology backbone is the proprietary VISION™ platform, which comprises a VISION Payer Portal, a VISION Digital Marketplace for ancillary care services, and a VISION Patient Portal for Medicare Set Aside administration, all delivered from a HITRUST r2-certified cloud infrastructure. AI-augmented bill review reportedly achieves 99.9% duplicate-bill detection (vs. an 85% industry average) and delivers $8–$78 in client savings per $1 in fees. Rising also operates state-certified provider networks including California MPN, Texas HCN, and the Rising Choice Network™, and licenses Rhode Island and Wisconsin workers' compensation fee schedule databases.

Revenue is generated primarily through transaction-based and professional-services fees invoiced on 30-day terms, supplemented by recurring subscription licensing of fee schedule data and managed mailroom/payment processing services bundled with bill review. The go-to-market is enterprise field sales targeting large payers, supplemented by the VISION platform for mid-market self-service. Notable strategic milestones include the April 2023 acquisition of Preferred Disability Management, the October 2025 hiring of David Dubrof as Chief Growth Officer, 2025 Inc. 5000 recognition, and HITRUST r2 certification in 2024 with recertification in March 2026.

Name

Rising Medical Solutions

Legal name

Rising Medical Solutions

Website

https://risingms.com

Company type

Private

Founded year

1999

Operating status

Operating

Headcount range

251–500 employees

Short description

Rising Medical Solutions is a Chicago-based, privately held provider of medical cost containment, care management, and analytics services for U.S. workers' compensation payers, insurance carriers, TPAs, and self-insured employers, delivered via its proprietary VISION™ platform.

Ownership category

akta.pro rank

Product category

Workers' Compensation Medical Cost Containment

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518)

SIC

Services-Health Services (8000), Hospital & Medical Service Plans (6324)

akta.pro primary industry

Care Management & Coordination Platforms (case/disease management workflows) (HLACAHAD)

akta.pro secondary industries

Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK), Healthcare Payouts (Payers-to-Providers, Patient Refunds) (FSAMAKAK)

Keywords

• Medical bill review
• Workers compensation management
• Medical cost containment
• Care management services
• Utilization review services

Headquarters

HQ city

Chicago

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Medical Cost Containment Services: Fee-for-service model for medical bill review, hospital bill review, specialty bill review, provider negotiations, and network services. Pricing is based on standard rates and fees invoiced by Rising, with payment due within 30 days.
2. Medical Care Management Services: Clinical services including utilization review, telephonic case management, field case management, peer review, and physician pharmacy review. Charged as professional service fees.
3. Data & Fee Schedule Licensing: Access to Rhode Island and Wisconsin workers' compensation fee schedule databases, offered through end-user license agreements.
4. Mailroom and Payment Processing: Outsourced mailroom and payment processing services bundled with medical bill review, consolidating bill workflow from intake through payment processing.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels6 records

Core offering

Rising Medical Solutions delivers medical cost containment, care management, and analytics services for workers' compensation payers, insurance carriers, self-insured employers, third-party administrators, and auto no-fault insurers. The company's offerings integrate medical bill review, hospital bill auditing, specialty and nurse audit reviews, provider negotiations, utilization and peer review, telephonic and field case management, pharmacy review, and Medicare compliance/settlement solutions. These services are delivered through the proprietary VISION™ cloud platform with AI-powered bill review, advanced analytics, and a digital marketplace for ancillary care coordination.

Product overview

Rising Medical Solutions offers an integrated platform approach combining three core service pillars: Medical Cost Reduction (bill review, hospital review, provider negotiations, and specialty networks), Medical Care Optimization (case management, utilization review, pharmacy review, and ancillary services), and Analytics & Technology (advanced analytics, risk modeling, and pharmacy intelligence). The VISION™ platform serves as the unified technology backbone, offering distinct modules including VISION Payer Portal, VISION Digital Marketplace, and VISION Patient Portal. The company also operates proprietary provider networks (Rising Choice Network™, California MPN, Texas HCN) and maintains state-specific fee schedule databases for Rhode Island and Wisconsin. The offering architecture is platform-plus-modules with the VISION enterprise system enabling all service delivery.

Differentiator

Problem solved

Functional benefit

Brands

• VISION™: Enterprise platform providing payer portal, digital marketplace, and patient portal services for medical claims management.
• Rising Choice Network™

Products and services

• Medical Bill Review

Quantifiable outcome

• $8 to $78 return per $1 in fees for standard bill review; additional $3 to $4 per $1 when enhanced with Specialty Bill Review
• +6 more outcomes

Named customers1 record

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature6 records

Scale indicators4 records

Recent moves5 records

Expansion highlights5 records

Direct peers

• Genex Services: Provider of managed-care and clinical solutions for workers' comp and disability markets. Overlaps with Rising on case management, utilization review, peer review, and medical cost containment services.
• Sedgwick: Largest independent tech-enabled claims and managed-care provider for workers' compensation. Directly competes with Rising across bill review, case management, utilization review, and integrated payer services.
• Apricus: Workers' compensation specialty services company offering utilization review, peer review, and medical cost containment. Closely overlaps with Rising's clinical and financial service lines.
• myMatrixx: Pharmacy benefit management and pharmacy analytics platform purpose-built for workers' compensation. Directly comparable to Rising's Rx Intelligence offering.
• IMCS Group: Independent medical cost containment and case management provider focused on workers' compensation. Comparable in size and product mix to Rising's bill review and care management services.
• One Call: Specialty network and care management provider serving workers' comp with diagnostics, PT, dental, and transportation services. Comparable to Rising in its ancillary-care marketplace model and payer focus.
• Mitchell International (Enlyte): Provider of P&C claims technology, bill review, and casualty solutions including pharmacy (myMatrixx). Direct competitor in medical bill review and pharmacy analytics.

Broad incumbents

• Optum (UnitedHealth Group): Diversified health services platform with workers' compensation, bill review, and care management capabilities. Competes broadly with Rising across payer services but as part of a much larger portfolio.
• Helmsman Management Services: Liberty Mutual subsidiary providing managed-care services for workers' compensation. Overlaps with Rising on bill review and network services but operates as part of a much larger carrier-owned platform.
• Coventry (CVS Health/Aetna): Workers' comp managed-care services business now operating within CVS Health. Provides bill review, networks, and clinical services at significantly larger scale than Rising.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/risingms
• YouTubeyoutube.com/user/RisingMedical
• Facebookfacebook.com/RisingMedicalSolutions
• LinkedInlinkedin.com/company/rising-medical-solutions

Revenue estimate

Valuation estimate

Number of profiles

Profiles7 records

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Rising Medical Solutions