Does this involve clinical AI or diagnostic decision support?

No. EdgeFirm builds AI for the administrative layer only: prior authorizations, billing, coding, revenue cycle intelligence, and internal knowledge management. We do not build clinical decision support tools, diagnostic AI, or anything that informs treatment decisions.

How do you handle HIPAA compliance for protected health information?

We execute a BAA before the project starts. HIPAA safeguards go into the architecture from week one with end-to-end PHI encryption, role-based access controls, and full audit logging meeting §164.312 requirements. PHI can stay within your AWS or Azure environment covered by their existing HIPAA BAAs.

Can this integrate with our Epic or Cerner EHR system?

Yes. We build integrations with Epic, Cerner, Meditech, and Athenahealth using HL7 FHIR APIs wherever they are available, and custom HL7 v2 integrations where FHIR is not supported. We also connect to practice management systems and revenue cycle platforms independently of the EHR. Integration scope is one of the first things we assess in discovery, and we will tell you upfront what is straightforward with your specific EHR version and what will take additional time to build properly. We do not recommend rebuilding your EHR workflow to fit our system. We build to fit your existing infrastructure.

What does prior authorization automation handle versus what still needs a human?

The AI handles documentation gathering, payer form completion, submission, status tracking, and follow-up queuing. What stays with your staff: reviewing the completed PA package before submission, handling payer appeals that require clinical escalation, and any request where clinical documentation is ambiguous or payer criteria do not clearly apply. The goal is not to remove humans from prior authorization. It is to remove the 8 to 9 hours of administrative gathering work so your staff can focus on the judgment and decision-making that actually requires them.

What does a healthcare administration AI project cost and how long does it take?

Four to five months to production. Most healthcare administration engagements run $70,000 to $160,000 depending on scope. A prior authorization automation system for a single-specialty group is toward the lower end. A full revenue cycle intelligence layer with EHR integration across multiple systems is toward the upper end. We quote a fixed price after the discovery call so you know the total investment before we write a line of code. A payback model is part of the discovery deliverable, built on your actual PA volume, denial rate, and current staff hours spent on the targeted process.

AI for healthcare admin
that cuts paperwork, not care

Health systems and medical groups use EdgeFirm to automate prior authorization, catch billing errors before they turn into denials, and give administrative and clinical staff a knowledge assistant that answers policy and payer questions in seconds. We stay in the administrative layer so your team gets results you can measure without the regulatory work that clinical AI needs.

Book Strategy Call See How We Build It

Prior authorization and claims work, measured against your baselineBAA signed before work startsProduction in 4 to 5 months

In production

What AI looks likein a health system's administrative operation

Every system below targets the administrative layer only. No clinical decision support. No FDA-regulated scope. Each ships in 4 to 5 months with HIPAA-aligned safeguards and complete code ownership at handoff.

Live operations,ranked in one view.

rcm.yourhealthsystem.org/queue

PayerRequestsTrendFirst-pass

BlueCross1,28494%

AetnaLive97291%

UnitedHealth61286%

Medicare39889%

Cigna24178%

Humana19883%

Medicaid15672%

Head-to-head,against your targets.

rcm.yourhealthsystem.org/queue

ClaimCPTDenial riskStatus

ENC-20481992140.06Clean

ENC-20486274470.62Fix coding

ENC-20490930000.09Clean

ENC-20493705530.41Needs auth

ENC-20497993960.03Clean

ENC-20502453780.12Clean

Every request,routed automatically.

rcm.yourhealthsystem.org/queue

Staff questionAnswered bySource

Payer policyKnowledge assistantPayer manual

Coding ruleKnowledge assistantCMS guidance

Scheduling gapSchedulerEHR

Discharge follow-upAI outreachSMS

PHI handlingKnowledge assistantCompliance SOP

What we build

Purpose-built forHealthcare Administration & Health Systems.

1From 3-Day Cycle to Same-Day Submission

Prior Authorization Automation

Clinical documentation gathered automatically from your EHR per payer criteria so staff are not manually locating and copying records for each request
Payer-specific form completion based on your formulary and current PA requirements, reducing the back and forth caused by missing information
Real-time status tracking with automatic follow-up queuing when payer responses are overdue
Denial pattern analysis that flags which request types are being denied and why so clinical teams can address the root causes

2Catch Errors Before They Become Denials

Medical Billing and Coding AI

Charge capture AI that cross-checks coded procedures against clinical documentation and flags discrepancies before the claim leaves the building
ICD-10 and CPT coding suggestions generated from clinical notes so coders review and approve rather than starting from a blank charge sheet
Pre-submission claim scrubbing for missing modifiers, coordination of benefits issues, and payer-specific formatting requirements
Denial prediction model trained on your own claim history that flags high-risk claims for coder review before submission

3Policies, Payer Requirements, and Protocols. Actually Searchable.

Staff Knowledge Assistant

RAG-based LLM trained on your internal policy documents, clinical protocols, payer contracts, and coding guidelines so staff ask in plain language and get answers
Every answer cites the specific document and section it came from so staff can verify rather than re-read an entire manual
Role-based access means billing staff, front desk teams, and care coordinators each see answers appropriate to their function
Updates automatically when policies change so staff see the current answer without waiting for a retraining session

4Real-Time Visibility Into Your Entire Revenue Pipeline

Revenue Cycle Intelligence

Unified data pipeline connecting your EHR, practice management system, and billing platform into a single queryable revenue layer updated in real time
Natural language interface so revenue cycle directors can ask "where are our biggest denial drivers this month?" and get a sourced answer in seconds rather than requesting a report
Automated daily briefings surfaced to department leads covering AR aging, denial trends, and payer performance side by side
Predictive cash flow modeling based on payer mix, claim submission timing, and historical payment patterns

Reporting

One clear view,ready for every stakeholder.

Live dashboards and pipelines turn scattered operational data into one picture your team can act on, exportable for leadership.

HIPAA-aligned safeguards with BAA signed before we start
Integrates with Epic, Cerner, Meditech, and Athenahealth
Administrative scope only with no FDA-regulated clinical AI
Fixed price scoped before we write a line of code

See How We Build It

rcm.yourhealthsystem.org/queue

PayerRequestsTrendFirst-pass

BlueCross1,28494%

AetnaLive97291%

UnitedHealth61286%

Medicare39889%

Cigna24178%

Humana19883%

Medicaid15672%

Production stack

Built on Production-Grade InfrastructureWith HIPAA-Aligned Safeguards

Every system we deliver runs on infrastructure your team can own and extend, no black boxes, no per-seat licensing.

Healthcare Systems

Epic and MyChart integration · Cerner and Oracle Health · Meditech Expanse · Athenahealth API · HL7 FHIR data standards

AI & Models

GPT-4 and Claude · LangChain and LlamaIndex · RAG over policy and billing docs · Claim denial prediction models · Custom fine-tuning where needed

Compliance and Security

HIPAA-aligned architecture · BAA signed before project start · End-to-end PHI encryption · Role-based access control · Full audit logging per §164.312

Infrastructure

Python and FastAPI · React and Next.js · AWS and Azure with HIPAA BAA · Docker and Kubernetes · Designed with SOC 2 guidance, hosted on AWS or Google Cloud

Observability & Ops

CI/CD pipelines · Logging & metrics · Error tracking · Uptime monitoring · Automated backups

Full production stack

The models, vector stores, data tooling and infra behind every build.

Common questions

Common Questions About AI for Healthcare Administration

: No. EdgeFirm builds AI for the administrative layer only: prior authorizations, billing, coding, revenue cycle intelligence, and internal knowledge management. We do not build clinical decision support tools, diagnostic AI, or anything that informs treatment decisions.
: We execute a BAA before the project starts. HIPAA safeguards go into the architecture from week one with end-to-end PHI encryption, role-based access controls, and full audit logging meeting §164.312 requirements. PHI can stay within your AWS or Azure environment covered by their existing HIPAA BAAs.
: Yes. We build integrations with Epic, Cerner, Meditech, and Athenahealth using HL7 FHIR APIs wherever they are available, and custom HL7 v2 integrations where FHIR is not supported. We also connect to practice management systems and revenue cycle platforms independently of the EHR. Integration scope is one of the first things we assess in discovery, and we will tell you upfront what is straightforward with your specific EHR version and what will take additional time to build properly. We do not recommend rebuilding your EHR workflow to fit our system. We build to fit your existing infrastructure.
: The AI handles documentation gathering, payer form completion, submission, status tracking, and follow-up queuing. What stays with your staff: reviewing the completed PA package before submission, handling payer appeals that require clinical escalation, and any request where clinical documentation is ambiguous or payer criteria do not clearly apply. The goal is not to remove humans from prior authorization. It is to remove the 8 to 9 hours of administrative gathering work so your staff can focus on the judgment and decision-making that actually requires them.
: Four to five months to production. Most healthcare administration engagements run $70,000 to $160,000 depending on scope. A prior authorization automation system for a single-specialty group is toward the lower end. A full revenue cycle intelligence layer with EHR integration across multiple systems is toward the upper end. We quote a fixed price after the discovery call so you know the total investment before we write a line of code. A payback model is part of the discovery deliverable, built on your actual PA volume, denial rate, and current staff hours spent on the targeted process.