Agentic AI for Claim Status

AI powered claim status with 3x better response rates than legacy solutions

  • Save an average of 4 minutes per claim
  • Get CARC, RARC, closure codes & remarks directly in your Practice Management system
  • No integration necessary
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Legacy claims monitoring products suck

100% EDI Based
EDI only claims monitoring tools come back with a limited, standard set of data. Even when you use these products, billers still have to log back into the payor portal to find out what's really happening.

Substrate AI Agents log into payor portals for you.
Limited Payer Coverage
Traditional claims monitoring products only work with a fixed set of payers.

Substrate AI Agents work with any payer portal.
Not Integrated into your EMR
Most EMRs don't have claims monitoring built in by default.

Substrate AI Agents work with any EMR or practice management system.

Join hundreds of healthcare practices using Substrate

Introducing AI powered claims monitoring:

Substrate automatically monitors claims according to your set rules. The Substrate AI agents will log into payor portals on your behalf to check if no-response claims have been updated. Substrate will also ingest correspondences and turn them into structured data for your billing team to use.
Easily see how frequently denial codes are occurring for specific payers, providers and procedures.
Verify allowed amounts vs. contracted rates
Substrate will extract your contracted rates from payers and automatically compare them to the allowed amounts in the payor portal and in your EOBs/ERAs
Stay up to date on denials
See all CARC & RARC codes as well as payor notes at a claim level and vs. every submitted CPT code.
Works with any EHR/PM System
Substrate's browser based AI agents push claims status updates directly into your EMR/PM system. No requirement for an IT team or a large integration lift.

Substrate is compatible with over 2 dozen EMR/PM systems

Real-time claims status(276/277) vs. AI Powered Claim Status

Substrate automatically monitors claims according to your set rules. The Substrate AI agents will log into payor portals on your behalf to check if no-response claims have been updated. Substrate will also ingest correspondences and turn them into structured data for your billing team to use.
Easily see how frequently denial codes are occurring for specific payers, providers and procedures.
Verify allowed amounts vs. contracted rates
Substrate will extract your contracted rates from payers and automatically compare them to the allowed amounts in the payor portal and in your EOBs/ERAs
Stay up to date on denials
See all CARC & RARC codes as well as payor notes at a claim level and vs. every submitted CPT code.
Works with any EHR/PM System
Substrate's browser based AI agents push claims status updates directly into your EMR/PM system. No requirement for an IT team or a large integration lift.

FAQ

What is Substrate?
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Substrate is an AI company helping healthcare providers get paid what they've earned. We use AI and AI agents to handle tasks that a biller would otherwise do.
How do Substrate's agents operate?
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Substrate's AI Agents securely log into your EMR, practice management system, and your payor portals to retrieve claims data on your behalf. Substrate works with several leading EMRs including AdvancedMD, Experity, Practicefusion and more
What is a no response claim?
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A "no response claim" refers to a situation where an insurance company or claims administrator fails to respond to a submitted claim within the required timeframe. No response claims can also happen when a payor has an update on a claim in the payor portal, or that they send via paper, but does not result in an EOB or ERA being sent electronically. No response claims are frustrating because they add delays to a provider getting paid or a biller working that denial.
Is Substrate suitable for any provider?
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Yes - Substrate can work with both outpatient and inpatient practices, including Spravato practices, urgent care, virtual and behavioral health, oncology, urology, dermatology and more. Substrate also works with outsourced billing/RCM vendors.
How does Substrate's claims monitoring work?
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Substrate's claims monitoring solution is very straightforward:
1. First, a practice will define which claims they want monitored. This can be set up as a report that runs daily or weekly, or provided on an ad hoc basis.
2. Next, Substrate maps each claim to the appropriate portal, logs in to the portal and looks for the claim
3. Third, Substrate pulls the latest status of each claim from the payor portal, and surfaces it in the Substrate dashboard.
4. Lastly, a practice can choose where to push the data; to the dashboard, to the practice management system, or even to a spreadsheet.
Can you sign a BAA with Substrate?
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BAA agreements standard with all customers

How is this different from legacy claims monitoring solutions?
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Legacy solutions give you basic claim status data from the 276/277 transaction with success rates at ~15%. Substrate consistently hits 60% success rates, & take action to matriculate the claims on your behalf, using AI.

Why not just use our clearinghouse for claim status?
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Clearinghouses only give you what payers send via EDI, which is limited and often delayed. Substrate does that, and goes directly to payer portals to get real-time, complete information including contract rates, check numbers, and detailed denial explanations. It’s the difference between a summary and the full story.

What makes this better than hiring more staff?
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Our bots work 24/7, never get sick, don’t have turnover, and get more accurate over time. A human can maybe check 20-30 claims per day; our system processes thousands. Plus there’s an institutional knowledge problem with human staff - when someone leaves, their expertise goes with them. With Substrate, your system retains all that knowledge.

What results do other customers see?
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Results vary, but most customers see 70-80% reduction in manual AR work.
How do you measure success?
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We track several metrics on behalf of clients:
- claim status coverage percentage,
- win rates for medical necessity denials and medical record appeals
- time to resolution
- staff time savings
- incremental collections.

We provide monthly reports showing exactly what our agents are doing, what we've recovered, and how much staff time we've saved.
What’s a realistic timeline to see results?
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You’ll see immediate time savings from automated claim status within the first week.

For appeals, you’ll start seeing recoveries within 30-45 days since that’s typical payer response time.

Full ROI usually becomes clear within 90 days

How do you handle data quality issues?
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We automatically validate data before processing - checking for formatting issues, missing fields, invalid dates, etc. Our system flags data quality problems and can often fix them automatically (like formatting NPIs or standardizing payer names). We also provide feedback reports to help improve your source data over time.

Can we control what gets automated vs manual review?
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Absolutely. We can set up human-in-the-loop workflows where certain types of claims or appeals get flagged for manual review before submission. You can customize rules based on dollar amounts, payer types, diagnosis codes, whatever criteria matter to your practice

Which payers do you support?
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We support over 500 payers via EDI, & an additional 200 payers via browser agent (including several Medicare MACs).

Do you work with Medicare/Medicaid?
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Yes, we have strong government payer coverage. Medicare through Novitasphere and Noridian, Medicaid through various state portals. Government payers are actually some of our best performers because they tend to have standardized processes and clear denial reason codes.

Ready to learn more?
Contact us to learn more about how our artificial intelligent agents can improve your revenue cycle operations
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