Substrate ARC: Appeals
Work every denial, not just the big ones.
Recover up to 50% of dollars tied up in RFI and medical-record requests, handsfree. Substrate's AI agents retrieve records from your EMR, evaluate medical necessity against the payer's own policy, submit the appeal, and monitor until adjudication.
Watch a Demo
Watch a Demo
Read the Heading Health story
Read the Heading Health story
AI-automated research and task execution. Pairs claim status with medical-necessity policy review, retrieves records, validates notes, submits to the payer portal.
Login-only deployment. Provide credentials like you would for a new hire. No IT or engineering bandwidth required.
#284719-1
CPT Paid
99214 CO-50
$0
90837 CO-50
$0
Billed
$1,847
Allowed
$1,564
Paid
$0
Denied
Appeals Agent
Analyzing denial reason...
Retrieving records from EHR...
Verifying patient data...
Building appeal package...
Filing appeal to payer...
Checking claim status...
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.

Pick Four

You don't have to pick two.

Most vendors make you pick two of these. With Substrate, you get all four.
More

Recover up to 50% of dollars tied up in RFI and record requests.

Faster

Hours from denial to appeal, not days or weeks.

Lower

Up to 70% less per claim vs labor-driven methods.

Easy

No integration project. Skip the IT, API, and EDI build.

Up to
88%
of appeals auto-submitted
Up to
40%
of denied dollars recovered
Across
3,500+
payers via EDI, API, and portal
Within
Hours
from denial to appeal, not days
How the appeals agent works. From a denied claim to recovered revenue.

01

Records retrieved

The agent logs into your EHR and downloads the documents the appeal needs: operative reports, visit notes, prior authorizations, imaging, and referrals.

02

Documents validated

Each document is matched to the right patient and date of service, checked for completeness, and verified against the authorization window.

03

Policy evaluated

The record is compared against the payer's coverage criteria, each rule answered yes or no with evidence pulled from the clinical notes.

04

Appeal packaged

A policy-grounded appeal letter cites the payer's criteria and points to the documentation that satisfies each one. No generic templates.

05

Filed and monitored

The agent files through the payer portal with a full screenshot and video audit trail, then monitors status through adjudication.

Over 3,500 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  →

Substrate ARC: Appeals

What is AI appeals software?

Denial management and appeals automation detects denials, retrieves EHR documentation, files appeals through payer portals, and monitors payment. Substrate AI, AKASA, Waystar, Cohere Health, FinThrive, Innovaccer, Infinx, and Adonis appear most often in this category. Substrate focuses on handsfree medical records and medical necessity appeals.

Updated August 2026. Compare vendors and ICP guides in the appeals and denials automation hub, or read the appeals automation FAQ.

Appeals and denials automation guidesAppeals automation FAQ
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  →
Contact Sales  →
Security first, from the ground-up
End-to-end encryption protects sensitive data in transit and at rest, ensuring complete confidentiality.
Zero-trust architecture verifies every request, reducing attack surfaces and preventing unauthorized access.
Regular security audits and compliance checks keep our infrastructure resilient against evolving threats.
Granular access controls allow precise permission management, securing data at every level of the system.
Trust & Security  →
Trust & Security  →
HIPAA
SOC2
FAQ
What types of denials does the agent handle today?
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Medical record denials and eligibility denials are fully autonomous. The agent identifies the denial, retrieves required documentation, validates it, files the appeal and monitors for payment. Prior authorization and credentialing denials are being added.
Which specialties and payers are supported?
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Currently live in urgent care, behavioral health and orthopedics across Aetna, UHC and several Blues plans. Expanding to additional specialties and payers on an ongoing basis.
How does the agent retrieve medical records?
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It securely logs into your EHR or PM system using automation, navigates to the correct encounter and downloads the specific documents needed for the appeal. This includes operative reports, visit notes, prior authorizations and imaging results.
How does the policy agent evaluate medical necessity?
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It ingests the payer's medical necessity policy, breaks it into scenarios and criteria, then compares each rule against what is documented in the medical record. The output is a structured evaluation with a yes/no for each criterion and the evidence that supports it.
Does a human review the appeal before it is submitted?
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The agent handles the full workflow autonomously. When it encounters uncertainty, such as an ambiguous document or a policy rule it cannot evaluate with confidence, it escalates to a human reviewer before proceeding.
How does the agent file the appeal?
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There is no electronic standard for filing most appeals. The agent uses browser automation to navigate the payer portal, upload documentation and submit the appeal. Every action is captured with screenshots and video recordings for audit purposes.
How do you monitor the appeal after filing?
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The agent periodically checks the claim status using a combination of EDI, portal lookups and EOB retrieval. When the claim is adjudicated, the result and recovered amount are logged and pushed back to your system.
What data do you need to get started?
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The same claim data used for claim status, plus access to your EHR for document retrieval and the relevant payer portal credentials. Most teams are live within days.
Watch a Demo
Watch a Demo

See Substrate ARC run your appeals.

Talk to us and we'll show you record retrieval, policy-grounded letters, and worklist write-back on your denials.

Talk to Us