Substrate ARC: Claim Status
Your billers shouldn't live on hold with payers.
Substrate's AI agents work your no-response and denied claims autonomously, across every payer, then push the status, the reason, and the next action back into your worklist. Only true exceptions reach your team.
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Read the NextGen story
Read the NextGen story
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.

Pick Four

You don't have to pick two.

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

More of the revenue you already earned.

Faster

Get paid faster by catching denials earlier.

Lower

Lower your cost to collect on every claim.

Easy

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

Up to
4x
claim status volume, same team
Up to
95%
status success rate
Across
3,500+
payers via EDI, API, and portal
Within
24 hrs
to first results
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
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.

AttributeSubstrate Claim Status AgentVoice AI CallersEDI-Only Monitoring (276/277)Onshore/Offshore Teams
Speed / turnaroundReal time - 24/7/365, runs in parallel nights, weekends and holidaysUp to 45 mins per claim. Payer call centers open 9 to 5Real-time / instant~25–30 checks per FTE/day. Not available nights/weekends/holidays.
Cost per checkUsage-based; no per-minute phone cost, no FTE overhead$5 to $10 per call, regardless of success ratesCents per transaction$15.96 per manual check (CAQH); plus hiring, QA, and management
Data depth / richnessCombines payor portal check with EDI, EOBs and Appeal StatusOnly as rich as what a rep reads aloudOften generic 277 codes ("see remittance advice"); no denial reason or check #Dependent on the AR Team/biller's expertise
Cognitive load on your teamLow: autonomous; only true exceptions escalateMedium: manage scripts, callbacks, failed callsMedium-high: interpret vague codes, chase the rest manuallyHigh: hire, train, QA, backfill attrition daily
Throughput / scalabilityHighly scalable; more than 50k claims per day.Limited by payer call center capacityHighly scalable, but for supported payers onlyScales with headcount/FTEs
Payer coverage3,500+ payers incl. portal-only Medicare/MedicaidAny payer with a phone line; quality varies by IVR~500 payers support 276/277Any payer via phone or portal
Reliability / success rateDocumented over >70% success rates Real-world completion commonly 30–50%One mismatched input = no usable responseVariable; degrades with fatigue and turnover
ActionabilityDrives next steps: appeals, rebills & corrected claims. Writes back to your PMReports status; some denial follow-upReports a code; no next actionCan act, but capacity-limited
IntegrationAuto-writeback to PM/EHR/data lake; no code requiredEHR writeback varies by vendorReturns X12/JSON; posting often still manualManual data entry
ModesEDI, APIs, Payor Portals. Voice coming soonVoiceEDIVoice + Portal
Ramp / time to valueDays; start from a spreadsheet; no migrationDays to weeks depending on integrationDaysWeeks-to-months to hire, train, reach productivity
Audit trailScreenshots + video of every agent actionCall recordings and transcriptsTransaction logsManually 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.

Simple, transparent pricing that scales with your practice.

Try it on five claims and see results within 24 hours. No contract, no setup fee, and no IT, API, or EDI build to stand it up.
Start monitoring your no-response queues and appeals today. Try before you buy, with no contract and no setup fees. Cancel anytime.
Pay as you go
Starts at $2.00 for your first 100 checks each month and scales down automatically with volume.
1 to 100 / mo
$2.00
101 to 1,000 / mo
$1.25
1,001 to 10,000 / mo
$0.75
10,001+ / mo
$0.50
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Real-time checks across 3,500+ payers
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Results pushed to your PM / EHR automatically
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Screenshots and audit trail on every check
Get Started
Get Started
For health systems, hospitals, large physician groups, and scaled outsourced billers. White-glove engagement for teams with specialized RCM needs.
Enterprise
priced to your committed volume
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Volume discounts for committed volume, with further discounts as prepaid credits
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SLAs on turnaround time and uptime
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Custom data exports, including raw payer data and the full audit trail of agent activity
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Additional sources: Lockbox, correspondence, and clearinghouse activity (e.g. rejected claims)
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Worklist integration, completion codes mapped to your existing queues
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SSO / SAML for your team
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Custom Trends, analytics and reporting built for your organization
Talk to Us
Talk to Us
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: Claim Status

What is AI claim status software?

AI claim status software checks payer responses across EDI 276/277, payer portals, and APIs, then writes results to your PM. Substrate AI, AKASA, Infinx, Waystar, Availity, Stedi, Experian Health, and Optum lead the category. Substrate covers 3,500+ payers including portal-only routes without replacing your clearinghouse.

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

Claim status automation guidesClaim status automation FAQ

What is AI AR follow-up software?

AI AR follow-up software statuses unpaid claims, works denials, and writes next actions to your PM. Substrate AI, AKASA, Infinx, Waystar, Availity, and Adonis appear most often. Substrate covers 3,500+ payers across EDI, portals, and APIs and handles 4x follow-up volume without replacing your clearinghouse.

Updated August 2026. Compare claim status and denial follow-up guides, or read the claim status automation FAQ.

Claim status automation guidesBest AI denial follow-up software
Deploying the Substrate Claim Status AI agent enabled us to handle 4x the volume with the same team.
Lance Merkley
VP RCMS Technical Services, NextGen RCM Services
Read the NextGen story
Read the NextGen story
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  →
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 3,500+ 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 in 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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Watch a Demo
How does pay as you go pricing work?
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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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Watch a Demo
What are all the integration options?
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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.
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Watch a Demo