Most healthcare RPA pilots stall because the bot was built to move data, not handle the exceptions that show up the moment claims get denied, or a field comes back blank. We build bots with a human-in-the-loop layer from day one, so your claims, billing, and scheduling workflows run unattended until something genuinely needs a person.
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Claims teams that handle 200 denials a week can usually absorb the manual rework. At 2,000 a week, the same process buries staff in re-entry and the days in AR start climbing. Most healthcare organizations hit this wall not because their team is slow, but because the workflow was never designed to scale past a certain claim volume.
The gap shows up first in prior authorization, where payer portals, EHR fields, and fax-based documentation rarely talk to each other. Every manual handoff between those systems is a place where a clean claim turns into a denied one.
Each bot is scoped to one workflow first, tested against real claim and patient data, and expanded only once it's proven stable in production.
Bots extract CPT and ICD-10 codes from intake documents, validate them against payer rules before submission, and route denials to the right staff queue with the denial reason already classified. This shortens the reimbursement cycle instead of just digitizing the paperwork.
Bots pull patient history and policy rules from the EHR, populate PA forms, submit them through payer portals, and track approval status so staff stop refreshing portals manually, waiting on a decision.
Bots handle appointment booking, reminder sequencing, and intake form data entry into the EHR, reducing no-shows and freeing front-desk staff from repetitive scheduling calls.
Bots reconcile remittance data against billed amounts, flag mismatches before they become write-offs, and keep patient accounting systems updated without nightly batch delays.
We'll map your current process and tell you honestly whether RPA is the right fit before you spend on a build.
Book a 30-Minute Workflow ReviewOur bots integrate through HL7/FHIR-compliant interfaces and respect existing access control policies, so automation never becomes the weak point in your compliance posture.
Connects with Epic, Cerner, Athenahealth, and Oracle Health to read and write patient data without disrupting existing user workflows.
Syncs claim status, remittance data, and patient balances across billing software and payer portals in near real time.
Submits and tracks prior authorization and eligibility requests directly through payer-facing web portals using prior authorization workflows built for the CMS-0057-F API shift.
Pulls structured data from intake forms, faxes, and scanned referrals into downstream systems automatically.
Healthcare RPA builds typically range from $15,000 for a single-process pilot to $200,000 or more for enterprise-wide automation programs, depending on integration complexity and compliance scope. Share your workflow details and we'll give you a realistic estimate.
Bots that only move data still fail when the data is wrong. Ours are built to catch the failure before it becomes a denied claim.
Denial reasons are classified automatically, so rework starts with context instead of a blank investigation.
Missing-field detection happens before submission, not after a payer rejects the claim.
Every automated step writes to an audit trail, keeping denial-rate reporting accurate without manual logging.
Bots flag exceptions to staff instead of silently failing, so nothing disappears into a queue no one checks.
CMS's interoperability and prior authorization final rule now requires payer decisions to flow through standardized APIs rather than fax or portal-only submissions, which changes how PA bots need to be architected starting in 2026. We design prior auth automation around this API-first requirement instead of building on top of workflows that will need to be rebuilt within a year.
HIPAA-aligned encryption at rest and in transit for all automated data movement
Role-based access control scoped to each bot's specific task, not blanket system access
Full audit logging for every automated transaction, available for compliance review
CMS-0057-F-ready API integration paths for prior authorization and eligibility checks
We map your current workflow end-to-end, including the exceptions and edge cases your staff currently handle manually, before deciding whether RPA is the right tool. Some processes need a different fix entirely, and we'll tell you if that's the case rather than building a bot anyway.
We design the bot's logic around your actual EHR and billing setup, not a generic template, defining exactly which exceptions route to a human and which run unattended. Compliance requirements are mapped into the design before a single line of automation logic gets built.
Our team builds the bot using current RPA tooling paired with AI-based document understanding for unstructured inputs like scanned referrals or handwritten intake forms. Each bot is built to handle one or more connected tasks, never a single rigid script that breaks the moment a form layout changes.
We run the bot against historical claim and patient data before it ever touches a live system, validating accuracy against your actual denial patterns rather than a generic test set. Any gap gets fixed here, not after deployment.
We deploy with monitoring in place from day one and tune the bot's exception thresholds based on real production behavior over the following weeks. Most bots need two or three rounds of tuning before the exception rate settles where it should be.
Every bot is designed with HIPAA and audit-trail requirements built into the logic itself, not added as a compliance checklist after the build is finished.
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We design for the failure cases, not just the happy path, so denial classification and missing-field detection are part of the bot's core logic from day one.
Our teams have built directly against Epic, Cerner, and Athenahealth interfaces, so integration timelines reflect real experience instead of optimistic estimates.
You own the full bot logic and source code at delivery, with no dependency on us for future changes or scaling.
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More InfoA single-process pilot, such as claims intake or scheduling, typically takes 4-8 weeks from discovery to production. Department-wide rollouts run 3-4 months.
The bot routes the case to a human queue with the relevant context attached, rather than failing silently or stalling the workflow.
No. Bots integrate with your existing EHR, billing platform, and payer portals through whatever interface they expose, API or screen-level.
You do. Full source code and bot logic transfer to you at delivery, with no vendor lock-in.
We architect prior authorization bots around the API-first submission model CMS now requires, instead of building on fax or portal workflows that will need rework.
Single-process pilots typically run $15,000 to $60,000. Enterprise-wide programs with multiple connected workflows can reach $200,000 or more depending on integration complexity.
Yes. Bots paired with AI-based document understanding can extract data from scanned forms, faxes, and handwritten referrals, not just structured digital inputs.
RPA handles rule-based, repetitive steps. AI agents add judgment, like classifying a denial reason or deciding which exception queue a case belongs in. Most 2026 deployments combine both.
