FAQ

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.

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

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.

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.

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.

BAA agreements standard with all customers

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.

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.

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.

Results vary, but most customers see 70-80% reduction in manual AR work.

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.
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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

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.

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

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

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.