Prior authorisation requests taking hours of staff time per week across your practice?
Claims rejection rate driven by manual data entry errors that cost your revenue cycle team time to fix?
Automation for the administrative work that surrounds clinical care -- claims, prior auth, EHR data entry, patient communication, and compliance reporting -- built HIPAA-compliant with full audit trails.
Clinical staff focus on patients. The structured, rule-based administrative work runs automatically.
Claims submission and prior authorisation automation for major payer portals
EHR data entry automation from intake forms, referrals, and external records
Patient communication workflows for reminders, recalls, and follow-up
HIPAA-compliant architecture with complete audit trails on every automated action
RaftLabs builds healthcare workflow automation systems -- claims processing and submission, prior authorisation, EHR data entry from intake documents, patient communication workflows, and compliance reporting -- for hospitals, clinics, medical groups, and healthcare operators. All automation is built with HIPAA-compliant architecture and full audit trails. Most healthcare automation projects deliver in 8--12 weeks at a fixed cost, with full source code ownership.
Every hour a practice administrator spends on prior auth submissions is an hour not spent on patient-facing work. Every claim rejected due to a data entry error creates rework and delays payment that could be avoided. Every patient reminder sent manually is a task that runs automatically with the right system in place.
Healthcare automation doesn't replace clinical judgment -- it replaces the structured, rule-based administrative work that surrounds it. Claims processing, prior auth, EHR data entry, patient outreach, and compliance reporting follow consistent rules. Automation handles them reliably, at scale, with a complete audit trail.
Automated claims preparation, payer portal submission, status monitoring, and rejection handling. Bots extract patient and encounter data from your EHR, complete payer-specific claim forms, submit via portal or EDI, and track claim status on a defined schedule. Rejected claims are flagged with the rejection reason and routed to your billing team for review. The claims workflow that reduces days in AR and submission errors without adding billing headcount.
Automated prior auth request submission across payer portals. Bots pull patient demographics, diagnosis and procedure codes, and clinical justification from your EHR, complete payer-specific authorisation forms, and submit requests automatically. Status checking on a defined schedule with escalation to staff when authorisation is not received within expected timeframes. The workflow that takes prior auth from a 30-minute manual task to a 5-minute exception-review process.
Automated data entry from intake forms, referral letters, external records, and lab results into your EHR. Cross-system patient record reconciliation when data exists in multiple systems. Bulk data migration for practice acquisitions or EHR transitions. Bots that handle the structured, repetitive data entry that consumes medical admin time -- so staff focus on the unstructured and exception cases that require human judgment.
Automated appointment reminders, recall notifications, and follow-up communications triggered by EHR events. Prescription refill and lab result notifications. Post-visit follow-up sequences. Multi-channel delivery -- SMS, email, and patient portal -- based on patient preferences. The outreach that improves show rates and patient engagement without adding staff time per communication sent.
Automation across the revenue cycle -- eligibility verification at scheduling, co-pay and deductible lookup, claim submission, denial management, and payment posting. Bots verify patient insurance before appointments and flag issues for staff before the visit. Post-visit billing workflow runs automatically with exception routing for cases requiring review. The revenue cycle that reduces write-offs and shortens time from service to payment.
Automated assembly of compliance reports from clinical and administrative systems -- quality measure reporting, payer-specific data submissions, and regulatory filings. Audit trail documentation maintained automatically for every automated action. HIPAA compliance monitoring integrated into the automation architecture. The compliance reporting that keeps your organisation on the right side of regulatory requirements without requiring staff to spend days pulling data each reporting period.
Frequently asked questions
Healthcare automation must be designed with HIPAA compliance as a core requirement, not an add-on. We build automation systems with access controls that limit data exposure to only what each bot requires, encrypted credential management, full audit logs of every action a bot takes (including what data was accessed and modified), and secure data handling consistent with your existing HIPAA policies. Every automation project includes a data flow review and compliance documentation as part of the deliverable.
We integrate with EHR systems via API where available or UI automation where the system doesn't expose an API. Common systems: Epic, Cerner, eClinicalWorks, NextGen, Athenahealth, and Greenway Health. For systems with FHIR R4 APIs, we use the API directly for more reliable data access. For legacy EHR platforms, UI automation handles the integration. The integration approach is determined during scoping based on your specific EHR version and configuration.
Claims submission automation typically reduces processing time from 8--12 minutes per claim (manual) to under 60 seconds (automated), with error rates dropping significantly. Prior authorisation workflows that take 20--40 minutes of staff time per request are automated to under 5 minutes of bot-handled work with a human exception step. Revenue cycle teams report 30--50% reduction in time spent on routine billing tasks. The actual savings depend on your current process, claim volume, and payer mix -- we model these during scoping.
Every automation system we build has an exception path. Cases that don't meet the straight-through criteria -- complex clinical scenarios, unusual payer requirements, data quality issues -- are routed to a human review queue with context and suggested resolution. Reviewers handle exceptions efficiently because the bot has done the data gathering; they focus on the decision. Exception rates typically start at 15--25% and reduce over time as edge cases are incorporated into the automation rules.
Tell us the administrative process costing your team the most time. We'll tell you how we'd automate it and what it costs.