New AI-native solution eliminates manual AR follow-up by combining EDI, payer portals, and direct APIs into a single unified response; reducing collections work by up to 75%
Early adopters report claim status retrieval in minutes instead of hours, with learned strategies that compound success rates over time
SAN FRANCISCO–(BUSINESS WIRE)–Substrate AI, a provider of Agentic AI solutions for healthcare revenue cycle management, today announced the general availability of the Substrate Claim Status Agent, the industry’s first AI-native solution that combines EDI 276/277 transactions, browser agents for payor portals, and direct APIs into a single unified response across more than 3,500 healthcare payers.
The new capability addresses one of the most time-intensive bottlenecks in healthcare revenue cycle operations: determining claim status. Today, billers spend anywhere from 3 minutes per claim logging into payer portals to 45 minutes on hold waiting for payer representatives. This work consumes thousands of hours annually and delays reimbursement for providers already operating on thin margins.
Substrate’s Claim Status Agent processes millions of encounters per year. Early adopters report a 75% cost savings in their claims status queues, and a 4x productivity boost for their claim status teams. Unlike traditional EDI-only approaches that cover only a subset of payers and often return incomplete results, Substrate’s Claim Status Agent automatically maps payer names, chooses the correct entity, fixes eligibility errors, and learns over time. It retrieves actual denial reasons from the source; whether that’s an EDI endpoint, clearinghouse, direct API, or payer portal.
“Every fee-for-service healthcare provider relies on someone to status their claims,” said Ayo Omojola, Founder and CEO of Substrate AI. “The 276/277 EDI transaction was designed decades ago, and most payers don’t even support it. The Substrate Claim Status Agent does what a great biller would do; tries multiple approaches, learns what works, and gets the richest data possible – except it does it 24/7 across millions of claims.”
Beyond Traditional Clearinghouse EDI
Traditional clearinghouse EDI covers approximately 500 payers and often returns vague responses such as “see remittance advice.” Substrate’s Claim Status Agent provides:
• Coverage across 3,500+ payers including portal-only payers like Medicare and Medicaid
• Actual denial reasons and adjudication details instead of acknowledgment-only responses
• Adaptive retry logic that interprets errors and adjusts inputs automatically
• Automatic detection of payer IDs, provider NPIs, Tax IDs, EINs and more
• Direct PM integration with no code or engineering resources required
To learn more about the Substrate Claim Status Agent or to schedule a demonstration, visit www.substrateai.com/claim-status or contact [email protected].
About Substrate AI
Substrate AI (YC S24) builds AI Agents for healthcare revenue cycle management. The company’s platform enables healthcare practices, billing companies, and EHR providers to automate mission-critical tasks including claim status, appeals, payment posting, and patient refunds across 3,500+ payers. Substrate’s AI Agents deliver up to 75% reduction in manual collections work and process millions of healthcare claims each year. The platform is trusted by healthcare organizations ranging from mental health practices to orthopaedic groups, and is compatible with over 20 EHRs. For more information, visit www.substrateai.com.
Contacts
Media Contact
Ayo Omojola
Substrate AI
[email protected]
