Healthcare RPA Services
Healthcare staff spend a significant portion of their day on administrative tasks that deliver no clinical value. Prior authorizations submitted manually to payer portals. Patient records reconciled between systems that don't talk to each other. Insurance claims prepared, checked, and filed by hand. Compliance reports assembled from data spread across multiple systems.
We build robotic process automation systems that handle these workflows automatically, claims processing, EHR data entry, prior auth submissions, and billing reconciliation, so clinical and administrative staff focus on patient care instead of paperwork.
Claims processing and prior authorization automation for payer portals
EHR data migration and cross-system patient record reconciliation
Billing and revenue cycle automation that reduces accounts receivable days
HIPAA-compliant automation architecture with full audit trails
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The problem
Prior auth submissions taking days of staff time per week across your practice?
Claims rejection rate driven by manual data entry errors your team has to resubmit?
Short answer
RaftLabs builds robotic process automation systems for healthcare organizations. We automate insurance claims submission and status checking, prior authorization requests to payer portals, EHR data entry and cross-system patient record reconciliation, revenue cycle tasks including eligibility verification and denial management, compliance reporting, and patient communication workflows. All systems are HIPAA-compliant with full audit trails. Claims processing automation typically reduces per-claim time from 8-12 minutes to under 60 seconds. A focused single-process automation runs $20,000-$50,000. Most projects deliver in 8-12 weeks.
Key takeaways
Trusted by
Every hour a nurse spends reconciling records is an hour not spent with patients. Every prior auth your billing team submits manually is a task that a bot can do faster and with fewer errors. The administrative overhead in healthcare isn't just a cost problem, it's a capacity problem.
RPA doesn't replace clinical judgment. It replaces the repetitive, rule-based work that surrounds it, the data entry, the portal submissions, the status checks, the report assembly, so your staff has more time for the work that requires a human.
According to research published in a 2024 PMC study drawing on CMS national health expenditure data, administrative costs account for approximately 25% of total US healthcare spending. For a mid-size hospital network, that translates directly into staff hours that could be reallocated to patient-facing work the moment repetitive workflows are automated.
Capabilities
Automated CMS-1500 and UB-04 claims preparation, EDI 837 submission, status monitoring, and rejection management. Processing that takes 8-12 minutes per claim manually runs in under 60 seconds with error rates dropping from 5-10% to under 1%, as bots extract ICD-10 and CPT codes from your EHR and submit via your clearinghouse or direct payer EDI. Rejected claims are categorized and routed with the denial reason in plain English.
Automated prior authorization submission across payer portals, a workflow that takes 20-40 minutes of staff time per request today. Bots pull demographics, diagnosis and procedure codes, and clinical justification from your EHR, then complete and submit the payer-specific form, with status checks on schedule, escalation when a payer misses its turnaround standard, and a pre-populated appeal workflow on denials.
Automated data entry from intake forms, referral documents, lab results, and external records into your EHR, eliminating manual transcription and its errors. HL7 and FHIR integration handles real-time exchange with labs, imaging, and pharmacy systems, OCR extraction reduces scanned documents to a 30-second verification step, and patient records are reconciled across your EHR, billing, and scheduling systems to catch duplicates.
Automation across the full revenue cycle from patient scheduling to payment posting, where manual steps at each stage compound into extended days in AR. Eligibility verification bots run payer checks 24-48 hours before each appointment, charge capture applies CPT and modifier coding rules before claim submission, denials are routed to the correct rework protocol, and payment posting identifies underpayments against contracted rates.
Automated assembly of compliance reports from clinical and administrative systems, eliminating the multi-day manual compilation that blocks compliance staff from higher-value analysis. CMS quality measure reporting (HEDIS, STARS, MIPS) pulls clinical data from your EHR, applies measure logic, and generates the submission file, while HIPAA monitoring logs PHI access and flags anomalous patterns for the Privacy Officer. Every report is timestamped, versioned, and logged for audit.
Automated appointment reminders, recall notifications, and follow-ups triggered by EHR events, reducing no-show rates by 25-40% and freeing front desk staff from 2-4 hours of daily outreach calls. Reminders fire by SMS, email, or voice per patient preference, confirmations update the EHR without staff involvement, recall notices include direct scheduling links, and refill reminders fire before chronic medications lapse.
Healthcare Software Development
Custom clinical and patient-facing platforms.
AI for Healthcare
AI clinical decision support, automation, and analytics.
Remote Patient Monitoring
RPM platforms for continuous patient data capture and alerts.
Patient Portal Development
Secure portals for patient records, scheduling, and messaging.
Process, volume, and current system. We'll design the automation and give you a fixed cost.
How it works
The same four steps on every engagement. A 6-week voice AI deployment runs the same shape as a 16-week enterprise project.
We spend the first week understanding the problem, not presenting a solution. Discovery session, interviews with the people closest to the work, workflow mapping, and a technical audit of what you already have. You leave knowing exactly what's broken and why previous attempts didn't fix it.
Low-fidelity wireframes before any code is written. You see the product before we build it. Scope, timeline, and fixed price locked at this stage. No surprises after work starts.
Bi-weekly agile sprints. Weekly progress calls. Direct access to the team and project management tools. Working software at the end of every sprint. Not a big-bang delivery at the finish line.
Production deployment, QA sign-off, load testing, and team handover. You own the full codebase from day one. We stay on for post-launch iteration and support, then our growth team takes it to market. Nothing gets thrown over the wall.
Tell us what's broken. Within one business day you get a straight take on cost, timeline, and the right first step. No deck, no pressure.
Stay on topic
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Read moreThe best RPA candidates in healthcare share three characteristics: they're high volume, rule-based, and currently done by people copying data between systems. Top candidates include: insurance claims submission and status checking (bots submit to payer portals, check status, and flag rejections), prior authorization requests (bots complete payer-specific forms using patient and clinical data), EHR data entry from intake forms or referral documents, patient scheduling and reminder workflows, pharmacy benefit verification, and compliance and regulatory reporting that requires data aggregated from multiple systems.
Healthcare RPA must be implemented with HIPAA compliance as a design requirement, not an afterthought. We build RPA systems with access controls that limit data exposure to only what each bot requires, encrypted credential management (no hardcoded passwords), full audit logs of every action a bot takes including what data it accessed and modified, and secure data handling in line with your existing HIPAA policies. The RPA system inherits the compliance posture of the systems it accesses, we document the data flows and help ensure the implementation meets your compliance requirements.
We integrate with EHR systems via three approaches depending on what your system exposes: UI automation (the bot interacts with the EHR interface as a user would, useful when no API exists), API integration (where the EHR exposes a FHIR or HL7 API, we use it directly for more reliable data access), and database integration (for on-premise EHR systems where direct database access is available and appropriate). Common EHR systems we've worked with or around: Epic, Cerner, eClinicalWorks, NextGen, and Athenahealth. The integration approach is determined during scoping based on what your specific EHR version exposes.
Claims submission automation typically reduces processing time from 8-12 minutes per claim (manual) to under 60 seconds (automated), with error rates dropping from 5-10% to under 1%. Prior authorization workflows that take 20-40 minutes of staff time per request are typically automated to under 5 minutes of bot-handled work with a human review step for exceptions. 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.
A focused healthcare RPA system, one process automated (e.g., claims submission to 3 payers), including bot development, testing in your environment, and deployment, typically runs $20,000--$50,000. Multi-process automation programs covering claims, prior auth, and EHR data entry run $50,000--$120,000. Cost depends on the number of processes, payer or system complexity, and integration requirements. We scope every project before pricing it.
Work with us
We scope RPA in Healthcare in 30 minutes. You walk away with a clear cost, timeline, and approach. No commitment required.