Less paperwork. Same compliance. Better patient throughput.
We automate the administrative layer of healthcare operations without touching clinical decisions. Prior auth processing, billing, scheduling, and intake get faster. Your clinical staff get more time for patients.
Prior authorization processing
Prior auth requests are extracted from payer portals, matched to clinical criteria, and routed for physician review only when medical judgment is required. Routine approvals move without touching clinical staff time.
Medical billing and claims management
Claims are assembled from encounter data, checked against payer rules before submission, and tracked through the remittance process. Denials trigger an automatic review workflow rather than sitting in a queue.
Patient scheduling and appointment management
Scheduling rules, provider availability, and patient preferences are combined to minimize gaps and no-shows. Automated reminders reduce no-show rates. Cancellations trigger waitlist fills without staff involvement.
Patient intake and eligibility verification
Intake forms are collected digitally, insurance eligibility is verified in real time at the point of scheduling, and patient records are updated before the patient arrives. Front-desk staff handle exceptions, not routine data entry.
Referral coordination and care transitions
Referrals are tracked from initiation to specialist acceptance. Missing information prompts are sent automatically. Care transition documentation follows the patient without manual faxing.
Compliance reporting and audit documentation
HIPAA access logs, incident reports, and regulatory submissions are generated from operational data rather than assembled manually. Audit readiness is continuous, not a sprint before an inspection.
Workflow and compliance audit
We map current administrative workflows alongside your HIPAA compliance posture. Output is a prioritized list of automation targets ranked by volume, time cost, and compliance risk.
Architecture and BAA
We design the integration architecture, establish Business Associate Agreements, and define data handling protocols. No data moves until the legal framework is in place.
Phased implementation
We start with the highest-volume administrative process and build in phases. Each phase runs in parallel with existing workflows for two weeks before handover.
Ongoing monitoring
All automated processes have audit logging active from day one. Monthly reviews cover throughput, error rates, and any regulatory changes that affect the automation.
01 Is Kwestra HIPAA compliant?
Yes. We sign Business Associate Agreements with all healthcare clients before any data integration work begins. Data handling in every engagement follows HIPAA Technical, Administrative, and Physical Safeguards. We have not had a PHI breach across any client engagement. Our security architecture is reviewed annually by an independent assessor. We can provide our most recent security attestation upon request during the evaluation process.
02 Do you work with clinical systems like Epic or Cerner?
Yes. We integrate with Epic, Cerner, Athenahealth, eClinicalWorks, Meditech, and several other EHR systems via their FHIR R4 APIs or HL7 v2 interfaces, depending on what each system supports. We do not modify clinical records. Our automation reads structured administrative data from the EHR and routes it to billing, scheduling, or prior authorization workflows. Clinical documentation stays in the EHR under clinical governance.
03 Can you automate prior authorization without clinical staff involvement?
For routine authorizations that meet clearly defined clinical criteria with no ambiguity, yes. The automation submits the request, tracks the payer response, and updates the workflow. For authorizations that fall outside standard criteria, require peer-to-peer review, or involve a payer denial, the case routes to the appropriate clinical or billing staff. The goal is to remove the administrative burden of routine cases, not to replace clinical judgment on complex ones.
04 How do you handle the POPIA requirements for South African healthcare clients?
POPIA requires data minimization, purpose limitation, defined retention periods, and breach notification within 72 hours of discovering a breach. We build all four requirements into every South African healthcare engagement: we collect only what is operationally necessary, document the retention schedule for each data category, build breach detection and notification procedures into the system design, and provide you with the notification templates required by the Information Regulator.
05 What is your approach to audit readiness?
Every automated process we build generates a full, structured audit log covering every action taken, the data accessed, the rule applied, the timestamp, and the outcome. Access to patient data is logged by user, role, timestamp, and documented purpose. We can produce a complete audit trail for any specific patient record, any date range, or any process instance within hours of a request. Audit readiness is a system design requirement on every engagement.
06 Do you support telehealth platforms?
Yes. We have integrated scheduling, consent management, pre-visit intake, and post-visit billing automation with telehealth platforms including Zoom for Healthcare, Teladoc, and several regional telehealth systems operating in South Africa and the US. The administrative workflow patterns are the same as in-person care: the patient data still needs to reach the billing system, the consent record still needs to be stored, and the prior authorization still needs to be tracked.