Background

Eligibility responses can contain a lot of useful information, but it is often hard to read in the raw payer response. Billers need to know basic questions quickly:

- Is the service covered?

- How much deductible has been met?

- Is there a remaining stop-loss amount?

- Are there payer messages or validation issues that change what should happen next?

When those details are buried or formatted inconsistently, teams have to interpret the response manually before they can decide whether to submit, correct, appeal, or follow up.

What’s new

Substrate now makes eligibility benefit details easier to review directly in the dashboard, and in the results that stream into your PM.

Insurance plan pages now support CPT coverage lookup, so teams can check coverage for the procedure codes they are actually working. Eligibility displays also now show clearer deductible and stop-loss financials, service delivery information, time qualifiers, payer messages, and PDS details.

This means billers can move from “the eligibility check came back” to “here is what the payer is telling us and what we should do next” much faster, without digging through the raw eligibility response.

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Automatically available to users of the Substrate Claim Status Agent and the Substrate Eligibility Agent.