Substrate - AI Agents for Healthcare Revenue Cycle

AI Agents for Healthcare Revenue Cycle

Save time & money by autonomously completing mission critical tasks in claim status, appeals, policy reviews, payment posting, refunds and more.

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87%

Reduction in manual collections work

40%

Medical record appeals resolved handsfree

3,500+

Payers available via EDI, APIs & Portals

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Agents for every step in
the revenue cycle

From the moment a claim is submitted to final payment, our agents work intelligently to maximize recovery and minimize manual work.

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" }

Claim Status Agent

Combines 276/277 messages, browser agents, and direct payer APIs into a single unified response. Processing hundreds of thousands of encounters each month.

Analyzing denial reason...

Retrieving records from EHR...

Verifying patient data...

Building appeal package...

Filing appeal to payer...

Checking claim status...

Appeals Agent

Detects claims pended or denied for medical records, then retrieves, validates and submits them to payers. Recovers over 40% of dollars trapped in appeals.

Exception Posting Automation

Automatically posts exceptions including case rates, globals, payer recoups and more.

No outstanding claims

EOB verified

$23.06 offset applied

Reviewing...

Patient Credit Refunds

Validates credit balances, checks for offsetting claims and processes refunds within your limits. Tracks state compliance and maintains full audit trails autonomously.

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Put your Revenue Cycle on Autopilot

Here's how it works

Step 1

Connect your systems

Integrate with your PM, EHR and clearinghouse. No migration required. Most practices are live within 48 hours.

Step 2

Agents start learning

Our agents analyze your claims, map payer patterns and build specific strategies. Every success gets securely stored.

Step 3

Autonomous resolution

Claims are monitored, researched and resolved 24/7. Success rates compound over time as learned strategies accumulate.

Trusted by leading health professionals. See how we save teams hundreds of hours each month.

Case Studies →

Mental Health

Heading Health

Orthopaedics

MidJersey Orthopaedics

Mental Health

Compass Health

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Enterprise-grade AI that actually works and gets smarter at scale.

Full Audit Trail

Complete visibility into every agent action with screenshots and video recordings. Know exactly what happened, when and why.

Human-in-the-Loop

When our agent is uncertain, it escalates to your team for verification. These cases get logged and learned from, so they rarely happen twice.

Predictive Insights

Track payer trends, denial patterns and agent performance across your entire revenue cycle. Surface the signals that matter across your entire AR.

Intelligence behind every agent. The models and data that power every decision.

Eligibility Checks verify patient eligibility for claim routing, COB and eligibility denials in real-time.

Catch issues before they become denials

Verifies coverage prior to submission

Fills COB gaps automatically

Routes claims based on verified eligibility

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Payer Policy Review models and validates your medical records against specific coverage criteria.

Validates documentation before submission

Confirms medical necessity

Compares against payer-specific rules

Generates appeals that reference criteria

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Document Review classifies and extracts data from any medical document automatically.

Faster and more accurate than humans

Identifies & categorizes documents

Extracts billing details & auth windows

Validates patient & claim data

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Need tailored automation?

Our AI engineers embed with your team to build & automate pipelines

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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.

Periodic 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

Put your revenue cycle on Autopilot