Frequently, claim statuses either via EDI, portals, or voice fail because there is something incorrect in the patient data. Either the name is misspelled, or you have a wrong birth date, or the member ID is wrong or formatted incorrectly.
With this change, the Substrate Claim Status Agent has a new tool to resolve claim statuses. It can independently run a real time eligibility call (270/271 EDI transaction + eligibility browser agents), troubleshoot discrepancies in patient demographics, fix them, and rerun the claim status request with the updated patient data to get a successful response.
This change means that even if there are demographic errors in your initial claim status request, the Claim Status Agent now has the ability to fix them using data returned from payers. We will also tell you what was incorrect and what we fixed. For example, if Buzz Lightyear's claim status had demographic errors, the fix might look like this:
This update is automatically included in the Substrate Claim Status Agent, so users should immediately start to experience some lift in success rates.
