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.

  • 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

  • Architecture designed around HIPAA requirements from the start, not retrofitted

See our work

Bring the problem, the current workflow, or the existing code. We reply with a practical next step within one business day.

Trusted by

Perceptional logoMusgrave GroupUrShipper logoBrux Dental SolutionsBella Skin Institute LogoEnergia RewardsDraftly logoTuneClub LogoSekou LMS logoLogo of food order management app gulaSnelwegDealsGrubly logoPSi logoInstantor Rewards logologo of Mobile app for events, membership clubs, and communitiesAldiFest retail campaign logoVidmattic logoEMS Connect logoWorx Squad logologo of Online Web App For Making Intrologo of Referral and Viral Marketing PlatformConcurrences logoGitano Perfumes logoBank of America logoNike logoMicrosoft logoCisco logoWells Fargo logoGE logoJimmy Choo logoT-Mobile logoIconmobile logoVodafone logoUniversity of Southern California (USC) logoTicketstop logo

The brief

Start with what is not working.

Good software decisions begin with the constraint, not a list of features or a preferred technology.

01

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

02

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

Plain answer

Healthcare workflow automation removes manual admin from the work surrounding patient care. RaftLabs builds automation designed around HIPAA requirements 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.

What to remember

  • 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 a common first workflow to automate, ahead of eligibility, intake, and billing.
  • Scope and price are locked in writing before development starts, after a discovery phase that maps the workflows and EHR integration points.
  • Discovery comes before any build commitment: no development starts without a signed-off scope.
  • All systems are designed around HIPAA requirements 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.

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, elevated claim denial rates, and stretched revenue cycle days. 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 shipped production software since 2015 for clients across the US, UK, Europe, Canada, and the UAE. We build healthcare software designed around HIPAA requirements for clinics, telehealth platforms, and hospital systems. The team that scopes the workflow designs the architecture, builds it, and stays on after launch.

Proof

shipping production software, including healthcare platforms designed around HIPAA requirements
Since 2015
RaftLabs delivery record
average client rating across delivered projects
4.9/5
Clutch, verified reviews

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

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

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

You want automation around clinical care, not a new EHR, and you can commit budget for a custom build.

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

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, and waitlist automation fills cancellations quickly.

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.

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 weeks later.

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.

Patient intake and digital forms

Digital patient intake completed on a secure portal designed around HIPAA requirements 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.

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 which workflow to automate first.

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. Step 01
    01

    Audit and discovery

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

  2. Step 02
    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. Step 03
    03

    Build, integrate, and QA

    Working software at a staging URL early in the build, with regular demos. EHR integration tested against your actual system, not a sandbox. QA runs in parallel with the build, not as a phase at the end.

  4. Step 04
    04

    Launch and post-launch support

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

Healthcare admin automation by area

Work with us

Tell us where the work is stuck.

Bring the rough workflow, half-built product, or messy brief. We will map the smallest useful first move, then send scope, timeline, and price in plain English.

  • 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.

Common questions

Prior authorization is a common starting point: manual requests eat staff time across submission, tracking, and denial follow-up. Automation that submits auth requests electronically, tracks status, and escalates denials removes most of that manual work. Insurance eligibility verification is close behind: manual checks before every appointment are expensive and error-prone, and automated checks run at scheduling and again 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 cut no-shows 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 can make or break a healthcare technology project. Automation that coordinators find confusing gets abandoned for the old workflow. 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 after launch to address friction in real-world use.

Cost depends on the scope and which workflows you are automating. A focused automation covers one workflow, such as prior authorization submission and tracking; a broader system covers scheduling, eligibility, billing, and intake. 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.

Timing depends on scope and EHR integration complexity. We run demos throughout the build so you see working software, not just at the end.

Clinicians do not want more screens: they are already overloaded. The system succeeds when it is invisible yet effective, removing back-office work without adding clinical burden. Start with high-volume, stable-rule work: insurance eligibility checks, claim status monitoring, payment posting, registration, and referral processing.

Agree the cohort and baseline before the build, then track volume, staff-touch time, response and exception rates, queue age, resolution path, failures, and downstream outcomes. Keep staff capacity separate from booked cash savings, and include implementation and recurring costs in ROI.

Many inbound documents are still faxes, and no tool turns a fax into a correct chart entry by itself. Most of the engineering effort sits in the pipeline around the OCR: document splitting, patient and MRN matching, validation, confidence scoring, human review, EHR write-back. Ask any vendor to show the pipeline, not the OCR demo. RPA is not automatically HIPAA compliant because it is used in healthcare: compliance depends on how the system is designed, configured, secured, operated, and governed.

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.