Substrate ARC: Autonomous Revenue Cycle

Your team runs RCM. We do the hardest work.

Unlike outsourcing or software, Substrate ARC accelerates results in 48 hours, multiplies your team's output, and gets even smarter every time it runs.

Watch a DemoSee the customer results

Automation does the tasks. Substrate ARC does the work.

Most tools automate the routine. Substrate ARC works the hard parts too: the denials, appeals, and exceptions that still land on someone's desk. The agents run each within its defined scope, escalating only the true exceptions.

Substrate ARC works each part of the revenue cycle: Eligibility, Policy, Claim Status, and Credit Balance on the read-only research lane; Appeals/RFI, Posting, and Collections on the read/write action lane, recovering revenue.
The 6 levels of

Autonomous Revenue Cycle

A Substrate ARC framework, adapted from the SAE levels of driving automation.

L0No automation
Billing team

Bills by hand. Phones payers, works portals, posts payments manually.

System

Records what humans did. No active execution.

Manual operations
L1Single-task automation
Billing team

Owns the workflow. Software speeds up one step.

System

One slice automated: claim submission, real-time eligibility, auto-posting clean ERAs.

Single-task RCM software
L2Partial automation
Billing team

Reviews and approves every decision. A human stays at the wheel.

System

Scripted bots and RPA chain tasks. They break when portals change and need constant upkeep.

RPA and scripted automation
L3Conditional autonomy
Billing team

Handles true exceptions only. Trusts the agents for the rest, and redeploys to higher-value AR.

System

AI agents run their defined scope end-to-end, handsfree. They escalate outside that scope and on true edge cases, and learn from every outcome.

Substrate ARC todayAI agent platforms
L4High autonomy
Billing team

Strategic oversight only. Rare exceptions surfaced for review.

System

Multiple defined scopes run handsfree across the AR cycle. The system reasons through exceptions within its scopes and resolves them.

Substrate ARC ceilingAt scale, in production
L5Full autonomy
Billing team

Oversight only. The team focuses entirely on growth and strategy.

System

The entire revenue cycle, every specialty, payer, and edge case, handsfree.

Industry future stateNot a Substrate product
Outsourcing hires the driver. Software is cruise control. Substrate ARC is self-driving within its scope.
Adapted from the SAE J3016 levels of driving automation. Substrate ARC runs at L3 today; L4 is our ceiling. L5 is an industry future state that requires payer and regulatory change beyond any single vendor.

3 points of EBITDA. Almost all in denials.

+3.5 pts

of EBITDA margin, on a $100M-revenue practice

$2.5M

revenue recovered: net collection rate +2.6 pts

~22%

lower cost to collect, same team

Illustrative model on $100M net patient revenue; varies by specialty and payer mix. Built from NextGen RCM Services and Heading Health results; ARC recovery is a Substrate estimate, validated against client data.

The opportunity

Where the margin comes from

On a $100M net-patient-revenue practice, this is the path from billed revenue to EBITDA. Each column is the highlighted slice of the one before it, zoomed in.

$100MNet patient revenue
Underpaid$7M
Denied$11M
Paid clean$82M
↓
$18MAt-risk revenue
Lost$4M
Correctly written off$5M
Recovered today$9M
↓
$4MLost but winnable
Substrate ARC recovers$2.5M
Still lost$1.5M
↓
$3.5MTo EBITDA, +3.5 pts margin
Revenue recovered$2.5M
Cost reduction$1M

Same team, no new headcount. Substrate ARC clears denials and underpayments to resolution in hours, accelerating cash and lowering DSO. Illustrative model; varies by specialty and payer mix; ARC recovery is a Substrate estimate, validated against client data.

Why Substrate ARC

From cruise control to self-driving.

Proof

Hard outcomes, named clients

NextGen: 4x volume, 75% lower cost, 95% success on Claim Status.

Heading Health: 88% of appeals auto-submitted, 40% of denied revenue recovered.

Specialty: 8.5x placement productivity, 90% handsfree.

Pricing

Pay for the work, not the labor

No services bodies, nothing offshored.

No per-seat, no per-license, no implementation fee.

You pay for resolutions, placements, and dollars recovered.

A fraction of offshore or in-house labor cost.

Speed

Live in 48 hours

No developer, no EHR build, no SI engagement.

Doesn't compete with your EHR or PM roadmap.

Login credentials only (Claim Status needs 8 data fields).

Days, not quarters.

Capability

Built for the cases that break automation

Multi-route fallback: EDI to API to portal, learned per payer.

Reads each payer's medical-necessity policy and applies it.

Every claim makes the next one cheaper to resolve.

Learns your payers, your denials, and your rules, and gets even smarter every time it runs. Resolves the hard exceptions within its scope, not just routes them.

Service

Founder-level service, minutes not days

One business day is the floor; in practice, minutes.

Embed inside your workflow, not behind a ticket queue.

Measured on your outcomes: denials recovered, days in AR.

Founder-level escalation: the founder's cell is on the contract.

“Deploying the Substrate Claim Status AI agent enabled us to handle 4x the volume with the same team.”

Lance Merkley

VP RCMS Technical Services, NextGen RCM Services

See Substrate ARC run your revenue cycle.

Talk to us and we'll show you the agents taking the heaviest lifting on your denials, claim status, and posting off your team.

Talk to Us