Claim Status Agent
Get up to speed on No-Response claims in minutes.
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Autonomous direct status retrieval that continuously reduces manual chase time, surfaces denial reasons earlier and feeds actionable responses into your billing workflow.
Real-time intelligence combines EDI 276/277, clearinghouse data, browser-based portal agents and direct APIs into a single unified response across thousands of payers.
#284719
BCBSIL
Patient
DOS
Status
Awaiting data...
Billed $1,663
Paid $0
Denied $1,663
EDI 277
ST*277*0001~ BHT*0085*08~ NM1*PR*2*BCBS~ STC*F0:1~ REF*1K*284719~ AMT*YU*1663~
Enhanced
{ "claimId": "284719-1", "status": "Finalized", "statusCode": "F4", "reasonCode": "X277", "reason": "Requested info not received", "billedAmt": 1663.00, "paidAmt": 0.00, "patResp": 0.00, "deniedAmt": 1663.00, "payer": "BCBSIL" }
Ends calls to payers
Most billing teams spend hours on the phone with payers. Substrate uses EDI, APIs, and logs into portals like a biller would, to get the richest data possible.
Resolves payer complexity
Payer name variations, NPI routing, sub-plan quirks — the agent resolves all of it automatically. You send us the claim, it figures out where to go and how to get a response.
Gets smarter with every claim
When a combination of inputs and routes works, the agent remembers it. Future claims start with proven strategies instead of guessing. This compounds across millions of claims.
AI Enhanced Claim Status
Transform acknowledgments into executable answers
Discover how legacy EDI compares to the new modern standard
EDI 276/277
Response Detail
Acknowledgment only
Data Sources
EDI Only
Payer Coverage
500 ~
Retry behavior
Silent or manual
Data Mapping
Precise configuration required
Intelligence
Static
Claim Status Agent
Response Detail
Reason + adjudication detail
Data Sources
EDI + APIs + Portals + Clearinghouses
Payer Coverage
4,000 +
Retry Behavior
Adaptive routing + learning
Data Mapping
Automatic payer normalization
Intelligence
Compounds over time
VS
Discover the difference
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How the claim status agent works. From a few data fields to an updated work-list.
Claim arrives
Agent ingests the claim with just a few data points
Payer mapped
AI resolves name variations & source mappings
Smart Retry
The agent adapts inputs & various combinations
Adaptive Routing
Agent picks whichever returns the richest data
Enhanced Status
Denial details are normalized into a single format
Push to PM
Statuses & actions append directly to your system
Monitoring
Claims matriculate to your work-lists
Intelligence
Learned strategies compound & improve results
Over 4,000 Payers Available
Covers all of the payers your team bills
EDI endpoints, direct APIs and browser-based portal agents across commercial, government and portal-only payers.
View Payers  →
View Payers  →
AI Agents that are designed & built for the way your claim status works.
Multi-route infrastructure uses EDI, clearinghouses, direct APIs and browser-based portal agents with automatic fallback for weak data.
Intelligent browser agents are onboarded similarly to a human biller with credentials then navigating  payer sites to find the claim.
Custom queue mapping connects payer denial codes and descriptions to your internal systems, notes and next actions based on your rules.
Payer routing lets the agent build profiles of each payer over time including required inputs, best routes, hours of operation and downtime patterns.
Deep integrations connect statuses, notes and next actions push directly into your PM or system of record with no manual data entry.
Immediate results with only eight data fields, no migration or engineering work on your end and get results back to your system instantly.
Need tailored automation?
Our AI engineers embed with your team to build & automate pipelines
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Contact Sales  →
FAQ
What data do you need to get started?
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A few fields per claim: date of service, NPI, date of birth, first name, last name and payer name. Most teams are returning results within 24 hours of sending us an initial file.
How is this different from my clearinghouse?
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Your clearinghouse uses EDI 276/277, which covers around 500 payers and often returns vague responses like "see remittance advice." Our agent also uses browser-based portal access and direct APIs, covering 4,000+ payers with the actual denial reason from the portal.
View Payers  →
View Payers  →
Do you support Medicare and Medicaid?
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Yes. Medicare and Medicaid are often portal-only, meaning there is no EDI claim status available for them at all. Our browser agents handle these along with hundreds of other portal-only and long-tail payers.
How does the agent handle MFA and portal logins?
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You onboard it the same way you would add a human biller. Give it portal credentials and it logs in, handles two-factor authentication, navigates pop-ups and finds claims the same way a person would. All securely stored an an encrypted vault.
What PM systems do you integrate with?
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We are agnostic to the system of record you use. Results push into your PM, data lake, or wherever you manage AR. No code or engineering resources required on your end.
What happens when a status check fails?
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The agent interprets the error, adjusts inputs and retries with a different combination. "Entity not found" might mean it needs a different NPI. "Unable to respond" means the payer is down and it should retry later. Every failure teaches the agent what to try next time.
What are learned strategies?
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When a specific payer ID, NPI and route combination succeeds, the agent stores it. Next time a similar claim arrives, it leads with the proven approach instead of trying combinations from scratch. This knowledge compounds over time across all claims.
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