Claim Status Agent

Get up to speed on No-Response claims in minutes.

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.

Every channel. One agent.

Voice AI waits on hold. 276/277 stops at a status code. Substrate completes the claim.

How the Substrate Claim Status Agent compares to voice AI callers, EDI-only monitoring, and onshore/offshore teams across speed, cost, data depth, and revenue recovered.

Attribute	Substrate Claim Status Agent	Voice AI Callers	EDI-Only Monitoring (276/277)	Onshore/Offshore Teams
Speed / turnaround	Real time - 24/7/365, runs in parallel nights, weekends and holidays	Up to 45 mins per claim. Payer call centers open 9 to 5	Real-time / instant	~25–30 checks per FTE/day. Not available nights/weekends/holidays.
Cost per check	Usage-based; no per-minute phone cost, no FTE overhead	$5 to $10 per call, regardless of success rates	Cents per transaction	$15.96 per manual check (CAQH); plus hiring, QA, and management
Data depth / richness	Combines payor portal check with EDI, EOBs and Appeal Status	Only as rich as what a rep reads aloud	Often generic 277 codes ("see remittance advice"); no denial reason or check #	Dependent on the AR Team/biller's expertise
Cognitive load on your team	Low: autonomous; only true exceptions escalate	Medium: manage scripts, callbacks, failed calls	Medium-high: interpret vague codes, chase the rest manually	High: hire, train, QA, backfill attrition daily
Throughput / scalability	Highly scalable; more than 50k claims per day.	Limited by payer call center capacity	Highly scalable, but for supported payers only	Scales with headcount/FTEs
Payer coverage	3,500+ payers incl. portal-only Medicare/Medicaid	Any payer with a phone line; quality varies by IVR	~500 payers support 276/277	Any payer via phone or portal
Reliability / success rate	Documented over >70% success rates	Real-world completion commonly 30–50%	One mismatched input = no usable response	Variable; degrades with fatigue and turnover
Actionability	Drives next steps: appeals, rebills & corrected claims. Writes back to your PM	Reports status; some denial follow-up	Reports a code; no next action	Can act, but capacity-limited
Integration	Auto-writeback to PM/EHR/data lake; no code required	EHR writeback varies by vendor	Returns X12/JSON; posting often still manual	Manual data entry
Modes	EDI, APIs, Payor Portals. Voice coming soon	Voice	EDI	Voice + Portal
Ramp / time to value	Days; start from a spreadsheet; no migration	Days to weeks depending on integration	Days	Weeks-to-months to hire, train, reach productivity
Audit trail	Screenshots + video of every agent action	Call recordings and transcripts	Transaction logs	Manually entered notes

See what your claims actually say. Send a file and get a fully worked status report back within 24 hours.

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Cost and time benchmarks from the CAQH Index: a manual claim status inquiry costs providers $13.80 and takes 25 minutes, vs. $3.64 fully electronic. Denial rework benchmarks from MGMA. Substrate outcome figures are early-adopter results.

Pricing

Simple to start. Built to scale.

We believe you should try before you buy. Thats why we publish our price list online, and make it easy for anyone to try.

No minimums

Pay As You Go

Start monitoring your no response queues and appeals today. No contract, no setup fee, cancel anytime.
‍

As low as $0.50 / txn

Starts at $2.00 for your first 100 checks each month, then scales down automatically as volume grows.

1 – 100 / mo

$2.00

101 – 1,000 / mo

$1.25

1,001 – 10,000 / mo

$0.75

10,001+ / mo

$0.50

✓

Real-time checks

across 3,500+ payers

✓

Results

pushed to your PM / EHR automatically

✓

Screenshots & audit trail

on every check

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Custom

Enterprise

For health systems, hospitals, large physician groups and scaled outsourced billers with enterprise needs.

Custom

White glove engagement for large scale healthcare organizations with specialized RCM teams.

Custom

Priced to your committed volume

✓

Volume discounts

for teams with committed volume. Further discounts available as prepaid credits.

✓

SLAs

on turnaround time and uptime

✓

Custom data exports

, including raw payer data & audit trail of agent activity & reasoning.

✓

Additional sources

update claims with data from Lockbox, Correspondences and Clearinghouse Activity (eg rejected claims)

✓

Worklist integration

completion codes mapped to your existing queues

✓

SSO / SAML

for your team

✓

Custom Trends

purpose built analytics and reporting for your organization

Integration options

API

CSV

MCP

SFTP

Custom Feeds

Contact Sales

Pay As You Go pricing reflects the rate for your full monthly volume at the applicable tier. Enterprise pricing is available below $0.50 per check for qualifying committed monthly volume.

Is there a minimum commitment? No — Pay As You Go has no monthly minimum and no setup fee.

Do failed or empty checks get billed? No — you're only charged for checks that return a usable result.

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

Contact Sales →

FAQ

What data do you need to get started?

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?

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 3,500+ payers with the actual denial reason from the portal.

View Payers →

Do you support Medicare and Medicaid?

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?

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?

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?

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?

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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How does pay as you go pricing work?

Pay-as-you-go pricing enables you to try before you buy. You can get started with a really small amount (eg $10) and attempt to status 5 claims and see what quality of results you're able to get back before committing to larger volume.

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What are all the integration options?

Substrate supports several integration options:
- APIs: you can initiate claim status agents via API request (documentation available upon request)
- MCP: MCP wrapper with Oauth is coming soon
- CSV/SFTP/Custom Feeds: Enterprises with custom needs have many integration options available. We'll even connect directly to your data lake - our objective is to reduce the overhead required to integrate, and reduce the odds that going live with Substrate causes resource conflict with your team or roadmap.

Book a Demo

Voice AI waits on hold. 276/277 stops at a status code. Substrate completes the claim.

Simple to start. Built to scale.

Pay As You Go

Enterprise

Put your revenue cycle on Autopilot