Substrate ARC: Denials Resolution

Substrate ARC: Denials INTELLIGENCE

Recover the denied revenue your team never gets to.

The Substrate Denials Intelligence solution reviews eligibility, claim status, payer policies, lockboxes and eobs to find where revenue is leaking, understand why, and deploy agents to remediate through resolution.

Watch a Demo

Read Heading Health's story

Root cause analysis for every denial: opens every tab that a biller might, to research all context about a claim, payer, practice, or denial. Delivers tactical next steps to get paid, then executes on them.

Economical at any size, recovering small-dollar, complex, and aged denials alike, so winnable revenue stops slipping to write-off.

#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...

Recovers what you'd write off
Small-dollar and aged denials get abandoned because they're not worth a biller's hour. Substrate works them economically, so the revenue lands instead of leaking.

Grounded in the payer's own policy
‍The Policy agent reads the payer's medical-necessity rules, checks your documentation against them, and drafts an appeal that answers the actual denial reason.

Tracks every appeal to paid
Claim Status monitors each appeal through adjudication, so nothing stalls in a queue. Only true exceptions reach your team.

The problem

Most denied revenue isn't lost to hard cases. It's abandoned.

Denied

11.8%

of claims on first submission

Written off

2.8%

of claims, for good

Abandoned

up to 65%

of denied claims never reworked

Providers lost $38.6B to denials and uncollected balances in 2024, up 25% in 2025. Much of what gets written off was winnable, but never worked. Sources: Kodiak Solutions (2024), HFMA, Advisory Board. Rates shown are share of claims; illustrative, validate against your own data.

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 denied revenue you already earned, recovered.

Faster

Catch denials and pends earlier, and track them to paid.

Lower

Up to 70% lower cost per appeal.

Easy

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

Up to

50%

of denied dollars recovered

Up to

70%

lower cost per appeal

Across

3,500+

payers via EDI, API, and portal

About

3 pts

of EBITDA (illustrative, $100M NPR)

How Substrate ARC works the whole denial. Three agents, one resolved denial.

01

Claim Status

Catches the denial or pend, decodes the payer's CARC and RARC codes, and monitors the appeal through to adjudication.

02

Encounter Evaluation

Checks patient benefits, visit notes, and payer's own medical-necessity policy. Tells you the next steps to fix a denial.

03

Appeals / RFI

Retrieves the records, submits to the payer portal, and tracks the appeal to paid.

“We haven't had to manually touch most medical record denials or appeals in over a year.”

Simon Tankel, Founder & CEO, Heading Health

88% of appeals auto-submitted. 40% of denied dollars recovered. +2 pts net collection lift.

Read Heading Health's story

The payoff

Recover the denials you're writing off. Watch it land as EBITDA.

Denials cost you twice: the revenue you write off, and the days you wait to collect the rest. One denial rarely justifies a biller's time. Recovered at scale, small-dollar, complex, and high-value alike, they're about 3 points of EBITDA.

Illustrative, based on a $100M net patient revenue model. Actual impact varies; validate against your own data.

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 →

HIPAA

SOC2

See Substrate ARC recover your denials.

Talk to us and we'll show you policy-grounded appeals, submitted and tracked to paid, on your payers.

Talk to Us