Payer portal automation for medical billing companies
Your billers shouldn't spend
their day in payer portals.
I automate the payer portal work your team does by hand, eligibility checks, claim status, denial follow-up, and remit retrieval, and I run it as a managed service. Nothing to install, no IT project, and I fix it when a portal changes. Built on Microsoft's stack by one engineer who stays accountable for it.
The browser is already your integration layer.
You run an independent billing or RCM shop, and your team logs into 10 to 20 payer portals a day because that is where the work lives. For most of it, there is no API coming, so the clicks fall to people.
No API, and often none coming
Your payer and clearinghouse portals were never built to talk to anything. For regional plans, behavioral health carve-outs, workers' comp, and secondary claims, there is no usable electronic feed. Someone logs in and reads it by hand.
You think in cost per biller
Every portal task is somebody's minutes. The CAQH Index puts a single manual claim status check at about $11.37 and 24 minutes, and closer to 28 minutes on behavioral health. Multiply that by your daily volume and it is a full seat of pure clicking.
Nothing off the shelf fits your size
Enterprise RPA is priced for health systems. Zapier can't log into a portal. Offshore VAs put credentials and PHI in the wrong hands. This is not an Epic or Cerner integration project. You need someone who builds it and owns it.
The four workflows I start with.
Automation pays where the same portal steps repeat on every claim. These are the four where independent billing shops see the fastest return. Your team knows all of them by heart.
Eligibility & benefits verification
Pull eligibility and benefits from each payer portal before the visit, so your team stops checking members one at a time. This is where behavioral health carve-outs bite: the 271 comes back with nothing usable, so the real answer only lives in the portal. That is exactly the work software can read for you.
Claim status follow-up
Chase claim status across every payer without a biller sitting in a portal doing it one claim at a time. At about $11.37 and 24 minutes per manual inquiry (CAQH), this is usually the cheapest workflow to justify and the first one to pay for itself.
Denial worklist follow-up
Work the denial worklist the day denials land, not weeks later when timely filing is already at risk. The automation reads each denial, routes it by reason, and tees up the corrected claim, so your team acts on denials instead of just triaging them.
ERA / EOB retrieval
Pull ERAs and EOBs out of the portal-only payers that never send you an 835, so nobody is downloading PDFs and keying remits line by line into your billing system.
The prior-authorization API mandate arriving in 2027 (CMS-0057-F) will standardize some of this at the big national plans. It does nothing for the long tail your team actually fights: regional plans, behavioral health carve-outs, workers' comp, and secondary claims. That is the work with no API coming, and the work I build around.
Why the usual fixes don't fit a billing company.
Every alternative fails on the same two facts: payer portals have no API, and someone has to maintain the workaround when they change. Here is how each one breaks.
Priced for health systems. A ~$50K license is the entry ticket, then you need $100K+ certified developers to build it and a team to maintain it. 30 to 50% of RPA projects fail (EY). The right comparison is not my price against a license, it is my all-in service against license plus developers plus the maintenance nobody budgets for.
Built for apps that already have an API. They cannot log into a payer portal, clear an MFA prompt, or read a PDF remit. The moment the work lives behind a login, they are out of the picture.
You are sharing payer credentials and exposing PHI, then paying again through turnover, retraining, and error rates. Outsourced billing typically runs 6 to 10% of collections, and a single in-house biller seat is $45K to $55K loaded. The clicking never actually goes away.
A script someone wrote breaks the first time a portal changes its login or layout, fails silently, and there is no one whose job is to fix it. You find out when the denials pile up.
Not production-reliable for regulated work yet. On OpenAI's own OSWorld benchmark, agents complete only 24 to 38% of real computer tasks. You cannot run a claim on a coin flip.
I build it, I run it, and I fix it when the portal changes.
The reason every alternative fails is maintenance. A payer changes a login page and the automation stops. So maintenance is not an add-on here. It is the service.
I build it
I map the workflow with your team, build it in your environment, and launch it. Credentials and sessions stay in Azure Key Vault on dedicated service accounts, never on a staffer's laptop or in a shared spreadsheet.
I run it
It runs on a schedule, monitored, with retries when a step doesn't take the first time. Your billers get clean batches and flagged exceptions back, instead of a portal tab open all day.
I fix it when it breaks
When a portal changes and the automation stops, fixing it is included, not billed hourly. That upkeep is the whole point. A maintained service is worth far more than a script nobody owns.
Start with a $3,000 assessment, not a leap of faith.
The assessment is the low-risk first step. I look at your real portal volume and numbers and tell you what to automate first, and whether it pays at all. If we build, it is credited toward setup.
Assessment
A focused look at your portal workflows with your real numbers, and a straight recommendation on what to automate first, and whether it's worth doing at all.
Setup
I build, test, and launch the automation in your environment. Dedicated service accounts, credentials in Key Vault, nothing running off someone's desktop.
Managed
I run it, monitor it, and keep it alive as payer portals change, plus support and ongoing improvements. The maintenance is the service, not an add-on.
12-month minimum term, which keeps the build affordable up front. Weigh it against one biller seat at $45K to $55K loaded, or outsourced billing at 6 to 10% of collections. Figures are typical ranges, not a binding quote.
13 years building healthcare software. Now I point it at your portals.
Two production systems make the pattern concrete: one pulling data out of platforms that hoard it, one pushing data into sites that won't take it. The same pattern your payer portals need.
From manual googling to 47,000 facilities
Employees googled assisted-living facilities one at a time and guessed at emails. Impossible past a few hundred records. I built a pipeline that collects records from government sources, enriches each through Google APIs, and validates every email for deliverability. No human in the loop.
1,000× publishing output, zero hand-keying
Hourly staff hand-keyed fund performance data into 30 partner sites that had no API. Every typo was a credibility problem, and every departure meant retraining someone on all 30. I built a cloud pipeline that logs into each site and publishes through the browser, with retries and zero-downtime deploys.
HIPAA and portal terms, handled out loud.
The reason most developers won't touch payer-portal work is the same reason it's valuable. Here's how I handle the parts that matter.
Runs in a hardened environment
Credentials and sessions live in Azure Key Vault on dedicated service accounts, not on a biller's laptop, not in a shared spreadsheet.
PHI stays where it should
I work inside your HIPAA posture, not around it, scope every build to the minimum data it needs, and sign a BAA where one belongs.
Portal terms, on the table from day one
Some payer portals restrict automated access in their terms. I raise that before we build, not after. It's a decision we make together, not a risk I hide.
Let's find one workflow worth automating.
Fifteen minutes. Bring the portal task that eats the most biller time, and I'll tell you honestly whether automating it pays, before anyone commits to anything.
Founding clients (first three): setup fee waived in exchange for a documented case study and a reference call.
Primarily billing and RCM companies. I also take on portal work for title, escrow, and insurance back-office teams that live with the same no-API problem.