AI-OCR data platform for a 40-location operator
- 20K+
- transactions extracted per day in real-world testing
- 40+
- locations synced on one offline-first platform
RPA in Healthcare: Claims & Prior Auth Automation
RPA in healthcare that gives clinical staff back the hours paperwork steals.
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
Bring the problem, the current workflow, or the existing code. We reply with a practical next step within one business day.
Trusted by
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
Prior auth submissions taking days of staff time per week across your practice?
02
Claims rejection rate driven by manual data entry errors your team has to resubmit?
Plain answer
RPA in healthcare automates the rule-based work around care: insurance claims, prior authorization, eligibility verification, EHR data entry, and compliance reporting. Administrative tasks consume roughly 25% of US healthcare spending (PMC/CMS, 2024). RaftLabs builds HIPAA-compliant automation with full audit trails. A first workflow starts around $20,000-$50,000; launch a validated v1 in 8-12 weeks, then expand.
What to remember
- Claims processing automation reduces per-claim time from 8-12 minutes to under 60 seconds with error rates dropping below 1%.
- A focused single-process automation (one workflow, one environment) starts around $20,000-$50,000 and launches as a validated v1 in 8-12 weeks, then expands.
- Multi-process programs covering claims, prior auth, and EHR data entry run $50,000-$120,000.
- Prior authorization workflows that take 20-40 minutes of staff time are automated to under 5 minutes of bot-handled work.
- Revenue cycle teams report 30-50% reduction in time spent on routine billing tasks.
- All automation systems are HIPAA-compliant with full audit trails and integrate with Epic, Cerner, eClinicalWorks, NextGen, and Athenahealth.
The payer portal your billing team opens forty times a day.
A billing coordinator opens the payer portal for the fortieth time today. Same patient demographics, same diagnosis and procedure codes, same clinical justification, retyped out of the EHR into a form that has not changed in years.
Now a bot pulls the demographics, the codes, and the justification from the EHR, completes the payer-specific form, submits it, and checks the status on schedule. What reaches the coordinator is the handful of cases a payer kicked back for real review.
The portal work was never clinical. It was never judgment. It was data moving from one system to another, by hand.
That is the work RPA takes off your team.
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. The team that scopes your automation is the team that builds it, tests it in your environment, and hands it over.
Proof
- Since 2015
- shipping production software across healthcare, fintech, hospitality, and logistics
- RaftLabs delivery record
- 4.9/5
- average client rating across delivered projects
- Clutch, verified reviews
- Week one
- HIPAA architecture scoped into the automation, tested in your environment before go-live
- Every healthcare RPA build
RPA pays off when the work is high volume and the rules are fixed.
Everything on the left should already be true for your organization. Even one thing on the right, and the workflow needs process work or a different approach before automation fits.
A fit
01
A high-volume, rule-based workflow your staff runs by copying data between systems: claims, prior auth, or EHR data entry.
02
An EHR your team works in daily (Epic, Cerner, eClinicalWorks, NextGen, or Athenahealth) that the automation can integrate with.
03
Manual data entry driving claim rejections or prior auth backlogs you currently absorb with more staff hours.
Not a fit
01
A workflow that turns on clinical judgment rather than repetitive data movement.
02
A one-off task that runs a handful of times a month, not at high volume.
03
No documented process yet, where the steps change every time and live only in someone's head.
What we build
Healthcare processes we automate
- 01Insurance claims processingAutomated 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%. Bots extract ICD-10 and CPT codes from your EHR (Epic, Cerner, or your current system) and submit via your clearinghouse or direct payer EDI. Rejected claims are categorized and routed with the denial reason in plain English.
- 02Prior authorization automationAutomated prior authorization submission across payer portals (BCBS, UnitedHealthcare, Aetna, Cigna), 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.
- 03EHR data entry and migrationAutomated 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.
- 04Revenue cycle automationAutomation 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.
- 05Compliance and regulatory reportingAutomated 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.
- 06Patient communication workflowsAutomated 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.
Tell us which administrative process costs your team the most time.
Process, volume, and current system. We'll design the automation and give you a fixed cost.
We have not published a healthcare RPA case study yet. The closest work we can point to is adjacent, not identical: the same discipline of high-volume document extraction and syncing clean data into an incumbent system your team already runs.
Proof
Adjacent proof: high-volume document extraction and sync
Where you land in that range depends on scope, not negotiation:
- Single-process automation, $20,000-$50,000
- One workflow automated end to end (e.g., claims submission to 3 payers), including bot development, testing in your environment, and deployment, in 8-12 weeks.
- Multi-process program, $50,000-$120,000
- Claims, prior auth, and EHR data entry automated together, scoped by process count, payer or system complexity, and integration requirements.
What it costs
HIPAA-compliant automation, starting at $20,000.
Claims processing that runs in under 60 seconds instead of 8-12 minutes, with error rates below 1%, and full audit trails on every bot action.
We scope every project before pricing it. Most health systems start with one bot on their highest-volume workflow, then expand the automation as it proves its return.
Starting investment
Starts at $20,000
Launch a validated v1 in 8-12 weeks. Start with your highest-volume claims workflow, then add bots for adjacent processes once the first one proves its return.
No hourly billing
Once we scope your first bot, that price is locked in writing, so there's no hourly billing and no invoice surprises. A scope change is a priced change request, agreed before work begins.
HIPAA by design
Every bot ships with access controls that limit data exposure, encrypted credential management with no hardcoded passwords, and full audit logs of every action it takes, in line with your existing HIPAA policies.
Useful next steps
More on workflow automation
Work with us
AI Workflow Automation Services
See the serviceTry it yourself
Try it yourself
Automation ROI Calculator
Find out what your manual processes cost, and what automation saves.
Open the free tool
Article
AI Workflow Automation Cost in 2026: What You'll Actually Pay
AI workflow automation costs $5,000 for simple off-the-shelf setups to $400,000 for enterprise-grade, multi-department systems. The spread comes down to workflow count, integration complexity, and compliance requirements.
Read more
Article
Intelligent Document Processing for Legal and Law Firms
Intelligent document processing for legal firms digitizes case files, extracts contract clauses, manages discovery documents, and automates billing records.
Read more
Article
HR Automation Software: What to Automate, What to Buy, and What to Build
HR teams spend 73% of their time on administrative tasks that software could handle. The question is not whether to automate. It is which workflows to buy off-the-shelf and which to build custom. Here is the decision guide.
Read more
Article
AI in procurement: what actually works in 2025
AI cuts procurement cycle times by 45% - but only when applied to the right tasks. Here's where the ROI is real and where it isn't.
Read moreFrequently asked questions
The 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
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.