Healthcare Workflow Automation Software

Healthcare workflow automation that ends the fax-and-phone tax on your clinical staff.

Healthcare organizations lose more revenue to administrative friction than most operators realize. Prior authorization requests that take three days and require a phone call. Insurance eligibility checks run manually before every appointment. Patient intake completed on paper and re-entered by a coordinator. Referral letters faxed and then followed up by phone to confirm they arrived.
At RaftLabs, we build healthcare admin automation software that removes the manual work from the workflows surrounding patient care, without disrupting clinical operations or creating compliance exposure. We've shipped healthcare technology products for clinics, hospital systems, and telehealth platforms. We know how HIPAA works in practice, not just in policy documents.

  • Appointment scheduling, reminders, and waitlist management automated end to end

  • Prior authorization and insurance eligibility workflows that run without staff intervention

  • Patient intake collected digitally before the appointment, not at the front desk

  • HIPAA-compliant architecture designed in from the start, not retrofitted

Recent outcomes

Healthcare AI · Remote patient monitoring platform

20% faster clinical decisions

Built a HIPAA-compliant AI RPM app that put 150+ patients under monitoring in 12 weeks.

4.9
on Clutch
See our work

The problem

Sound familiar?

  • Are your coordinators spending their day on phone calls and faxes that software should handle?

  • Do you know exactly how much revenue your practice loses each month to prior auth delays and eligibility errors?

Short answer

Healthcare workflow automation removes manual admin from the work surrounding patient care. RaftLabs builds HIPAA-compliant automation for clinics and health systems across the US, UK, Europe, Canada, and the UAE, covering prior authorization over EDI 278, insurance eligibility over EDI 270/271, claims, and patient intake, integrated with your EHR through HL7 FHIR. Shipping production healthcare software since 2015.

Key takeaways

  • Prior authorization automation assembles requests from EHR data, submits them electronically over EDI 278, and tracks status, removing the manual phone-and-fax work per request.
  • Prior authorization is typically the highest-return workflow to automate first, ahead of eligibility, intake, and billing.
  • A focused single-workflow automation (such as prior auth) typically costs $30,000 to $60,000; a broader system covering scheduling, eligibility, billing, and intake ranges from $80,000 to $180,000.
  • Most practices have their first automated workflow in production within 8 weeks.
  • All systems are built HIPAA-compliant from the start, with encrypted storage, role-based access controls, audit logging, and BAA templates for third-party integrations.
  • Integrations are supported for Epic, Cerner, Athenahealth, eClinicalWorks, Kareo, DrChrono, and most EHR systems that expose an HL7 FHIR or proprietary API.

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A prior auth that used to take three days and a phone call.

A coordinator starts the morning on hold with a payer, re-keying encounter data from the EHR into an auth portal, then faxing a referral and calling to confirm it arrived. Same script, dozens of times a day, before anyone gets to the patients waiting.

Now the request assembles itself from the EHR, submits electronically, and tracks its own status. Eligibility is checked before the patient books and again the day before they arrive. What reaches a coordinator is the handful of cases that genuinely need a human.

Healthcare admin runs on fax machines and phone calls. Both are expensive.

Healthcare workflow automation removes the manual admin that clinical staff never trained for. Days on hold with insurance companies. Data re-entered between systems. That is what the administrative layer costs when it runs by hand. The cost shows up as staff burnout, coordinator overtime, claim denial rates above 5%, and revenue cycle days that stretch past 45. Fixing it doesn't require replacing your EHR or retraining your clinical team. It requires building automation that handles the work that shouldn't be manual in the first place.

According to the AMA's 2025 Prior Authorization Physician Survey, physicians spend an average of 13 hours per week, nearly two full working days, on authorization requests. That figure covers physicians alone. Add coordinators and billing staff and the real organizational cost climbs higher, which is why prior auth automation delivers the fastest payback of any admin workflow we automate.

The waste is well documented. The 2024 CAQH Index estimates the medical industry could save around $20 billion a year by moving administrative transactions from manual to fully electronic. For prior authorization specifically, switching to the electronic standard saves staff about 14 minutes per request and the industry roughly $515 million annually (CAQH Index, 2024). Yet most prior auths still run on fax, phone, and payer portals.

RaftLabs has been shipping production software since 2015, with client relationships that include Vodafone, T-Mobile, Aldi, Nike, Cisco, and Lockheed Martin. We build HIPAA-compliant healthcare software for US clinics, telehealth platforms, and hospital systems, and we work with organizations across the US, UK, Europe, Canada, and the UAE. Most practices see their first automated workflow in production within 8 weeks. The team that scopes the workflow designs the HIPAA architecture, builds it, and stays on after launch.

Proof

Since 2015
shipping production software, including HIPAA-compliant healthcare platforms
RaftLabs delivery record
4.9/5
average client rating across delivered projects
Clutch, verified reviews
8 weeks
to the first automated admin workflow in production, HIPAA architecture built in
Typical healthcare-admin build

This pays off when manual admin is already costing you staff time and revenue.

Everything on the left should already be true for your practice. Even one thing on the right, and a discovery call comes before any build.

A fit
01

A US clinic, medical group, or health system with an EHR (Epic, Cerner, Athenahealth, eClinicalWorks, and similar) already in place.

02

High-volume manual admin: prior auth, eligibility checks, intake, or billing your coordinators run by hand every day.

03

You want automation around clinical care, not a new EHR, and you can commit budget for a build from $30,000.

Not a fit
  • You want to replace your EHR rather than automate the workflows around it.
  • Your admin volume is low enough that manual handling isn't costing staff time or revenue yet.
  • Your EHR exposes no HL7 FHIR or proprietary API to integrate against.

What we build

What we automate

  • 01
    Appointment scheduling and reminders
    Multi-channel scheduling with real-time availability across providers, locations, and appointment types, wired into Epic, Athenahealth, Kareo, and similar platforms. Patients book via web portal, app, or SMS, and the system writes to your scheduling platform without coordinator involvement for routine appointments. Automated reminders cut no-show rates by 25-40%, and waitlist automation fills cancellations within minutes.
  • 02
    Prior authorization workflows
    The full prior authorization workflow, automated: requests assemble from EHR encounter data, submit electronically over EDI 278, and track status with automatic follow-up. Supporting documentation is extracted from clinical notes with NLP to cut prep time, expiration tracking prevents a common denial source, and denied auths route to staff with appeal paperwork pre-assembled. As payers stand up FHIR-based prior authorization APIs under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F, effective for impacted payers in 2027), we build the integration to submit and track auths against those endpoints as they come online.
  • 03
    Insurance eligibility verification
    Eligibility verification runs at two checkpoints where it prevents problems: at scheduling, and again 24-48 hours before the appointment when a plan may have changed. Payer systems are queried in real time over EDI 270/271 through Availity, Change Healthcare, and similar clearinghouses, returning active coverage, deductibles, and copays. Gaps and inactive policies surface before the patient arrives, not as a denial 30-45 days later.
  • 04
    Medical billing and claims
    Claims generated directly from encounter documentation over EDI 837 and checked against payer-specific rules before submission, catching mismatched codes, missing modifiers, and absent authorization numbers. Denial tracking categorizes every denial by root cause, and payment posting is automated from ERA 835 remittances with variance flagging between expected and paid amounts.
  • 05
    Patient intake and digital forms
    Digital patient intake completed on a secure HIPAA-compliant portal before the appointment, eliminating the paper clipboard and the staff data entry that follows. Forms cover demographics, insurance with card photo upload, medical history, and consent, pre-populated for returning patients, and completed data flows directly into your EHR over HL7 FHIR or HL7 v2, cutting front-desk time per new patient by 10-15 minutes.
  • 06
    Referral management and credentialing
    Outbound referral letters generated from clinical note templates and transmitted over Direct Secure Messaging, with delivery confirmation, acknowledgment tracking, and automatic follow-up when a specialist hasn't confirmed receipt. Credentialing tracks license, DEA, and board certification expirations with reminders at 90, 60, and 30 days, plus automated primary source verification against the NPDB, so nothing lapses.

Which admin workflow is costing you the most?

Walk us through it. We'll tell you how automation would handle it, what it costs to build, and where the fastest payback sits.

How it works

From scope to shipped

Every project follows the same four phases. Scope is locked and price is fixed before development starts.

  1. Week 1
    01

    Audit and discovery

    We map your existing admin workflows, identify the highest-cost manual steps, and assess your EHR integration points. You leave week 1 with a written scope document and a fixed-price quote. No development starts without your sign-off.

  2. Weeks 2-3
    02

    Design and architecture

    We design the automation logic, data flows, and coordinator-facing interfaces before writing production code. HIPAA architecture is scoped here, not retrofitted later. The spec is locked before the build starts.

  3. Weeks 4-12
    03

    Build, integrate, and QA

    Working software at a staging URL by end of sprint one. Bi-weekly demos. EHR integration tested against your actual system, not a sandbox. QA runs in parallel with every sprint, not as a phase at the end.

  4. Weeks 12+
    04

    Launch and post-launch support

    Production deployment with monitoring activated on launch day. Staff training included. 8 weeks of post-launch support included in every project so adoption issues get fixed before they become habits.

What clients say

What our clients say

Three-year average engagement. Founders and operators describing the work in their own words. No marketing varnish.

Charles E.
Charles E.
USA flagUSA
Entrepreneur at Aggie Technologies

All of the sprints were completed on schedule and on budget. We highly recommend RaftLabs!

01 / 02

Where you land in that range depends on scope, not negotiation:

Single-workflow automation, $30,000-$60,000
A focused build covering one workflow such as prior authorization submission and tracking, with your first automated workflow in production within 8 weeks.
Full admin system, $80,000-$180,000
Scheduling, eligibility, billing, and intake automated together, typically shipped in 14 to 20 weeks depending on EHR integration complexity.

What it costs

Healthcare admin automation, starting at $30,000.

We provide a firm quote after the discovery phase, which takes one week. Every project includes a security architecture document and 8 weeks of post-launch support.

Starts at $30,000

First automated workflow in production within 8 weeks. Start with your highest-volume manual process, then expand into adjacent workflows once it's proven.

Most health systems start with one manual process, the one burning the most staff hours, and expand into adjacent workflows once the first automation is live and trusted.

No hourly billing

Once we scope your first workflow, that price is locked in writing, so there's no hourly billing and no surprise line items. A scope change is a priced change request, agreed before work begins.

Post-launch support

8 weeks of post-launch support included in every project, with monitoring activated on launch day, so adoption issues get fixed before they become habits.

Healthcare admin automation by area

Stay on topic

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Frequently asked questions

Prior authorization is the highest-impact starting point for most practices. A typical manual prior auth request takes 20 to 45 minutes of staff time and 1 to 3 business days to resolve. Automation that submits auth requests electronically, tracks status, and escalates denials removes most of that manual staff time and delivers same-day turnaround for routine cases. Insurance eligibility verification is close behind, running manual eligibility checks before every appointment is expensive and error-prone. Automated eligibility checks run at scheduling and again 24 hours before the appointment catch changes before they become claim denials. Appointment reminders and no-show management are also high-return targets: automated multi-channel reminders (text, email, voice) with a reschedule link recover 15 to 25 percent of appointments that would otherwise no-show, with no coordinator time spent.

HIPAA compliance is an architecture decision, not a checkbox. For every healthcare automation system we build, we default to encrypted data storage and transit, role-based access controls that match the clinical workflow, minimum necessary access principles, full audit logging, business associate agreement templates for any third-party integrations, and secure messaging channels that meet the technical safeguard requirements. We scope HIPAA requirements in the discovery phase and deliver a security architecture document as part of every healthcare project. For practices with specific EHR integration requirements, we assess PHI handling across the integration boundary before the build starts.

Yes, in most cases. We integrate with Epic, Cerner, Athenahealth, eClinicalWorks, Kareo, DrChrono, and most EHR systems that expose an HL7 FHIR or proprietary API. The automation layer sits between your EHR and your administrative workflows, it doesn't replace the EHR. Patient data flows into the EHR; admin tasks are handled by the automation system. If your EHR uses a non-standard integration approach, we assess feasibility and scope the integration approach during the discovery phase. We don't make integration promises before we've looked at the API documentation.

Staff adoption is the single biggest risk in healthcare technology projects. Automation that coordinators find confusing reverts to the old workflow within two weeks. We build coordinator-facing interfaces that match how the work actually happens: task queues, simple form submissions, status dashboards with no medical jargon. We run user acceptance testing with your actual staff before anything goes live, document the system in plain language, and stay engaged for 30 days post-launch to address friction in real-world use.

Cost depends on the scope and which workflows you are automating. A focused automation covering one workflow, such as prior authorization submission and tracking, typically runs between $30,000 and $60,000. A broader system covering scheduling, eligibility, billing, and intake ranges from $80,000 to $180,000. We lock the price in writing before development starts. A scope change is a change request with a separate price, never a surprise on the final invoice. We provide a fixed-price quote after the discovery phase, which takes one week.

Most practices have their first automated workflow in production within 8 weeks. A full-featured system covering scheduling, prior auth, eligibility, intake, and billing typically ships in 14 to 20 weeks depending on EHR integration complexity. We run bi-weekly demos from week 2 so you see working software throughout the build, not just at the end.

Yes. HEDIS quality measure reporting for payer value-based contracts and MIPS (Merit-based Incentive Payment System) performance data for CMS both follow the same pattern as the rest of your admin workload: structured data that currently gets assembled by hand under deadline pressure. We build extraction pipelines that pull the required measures from your EHR and claims data, validate against the measure specification, and assemble the submission format automatically on your reporting schedule, cutting the staff time per reporting period from days to hours.

Work with us

Tell us what you need. We'll tell you what it would take.

We scope Healthcare Admin Automation Software in 30 minutes. You walk away with a clear cost, timeline, and approach. No commitment required.

  • Scope and cost agreed before work starts. No surprises. No obligation.
  • Working prototype within 3 weeks of kickoff.
  • Pay by milestone. You see progress before each invoice.
  • 60-day post-launch warranty. Bug fixes, UI tweaks, and deployment support. No retainer.
  • All conversations are NDA-protected.