Funding
Funding not disclosed
Founders
Product
Problem
Healthcare providers and billing teams spend extensive manual effort chasing claim statuses, preparing appeals, posting payments, and processing patient refunds, leading to delayed revenue, high labor costs, and frequent errors.
Solution
Substrate AI delivers an AI-native revenue cycle management platform that automates each step of the accounts receivable workflow. Specialized AI agents connect to existing practice management, EHR, and clearinghouse systems without data migration, ingest claim data, and learn payer-specific routing and response patterns. The Claim Status Agent aggregates EDI 276/277, portal logins, and direct APIs to provide real-time, normalized status and denial details for over 3,500 payers. The Appeals Agent retrieves required medical records, validates them against payer policies, generates tailored appeal letters, and files them through payer portals with full audit trails. Exception Posting agents parse ERA/EOB files, match payments to encounters, and automatically flag and route clawbacks, recoupments, and contract rate variances. Patient Credit Refund agents verify overpayments, reconcile offsets, and issue compliant refunds programmatically. All agents operate 24/7, continuously improving through learned strategies, and push results directly into the provider’s system of record.
Target Audience
Primary customers are hospitals, health systems, and independent physician practices that manage large volumes of claims and seek to reduce manual AR labor while improving cash capture.
Features
- AI agents integrate with practice management, EHR, and clearinghouse systems via APIs, EDI, and browser automation, requiring no migration
- Claim Status Agent combines EDI 276/277, portal scraping, and direct APIs to deliver unified, line‑item status and denial reasons for 3,500+ payers
- Appeals Agent automates record retrieval, policy validation, appeal letter generation, and portal submission with video‑recorded audit trails
- Exception Posting parses every ERA/EOB line, performs fuzzy matching to encounters, and auto‑detects clawbacks, recoupments, and rate mismatches
- Patient Credit Refund agent validates credit balances, reconciles offsets, enforces state‑specific compliance windows, and initiates refunds via card or check
- Continuous learning engine stores successful payer strategies and applies them to new claims, improving accuracy and speed over time
- System‑agnostic output pushes status updates, payment postings, and refund actions directly into any practice management or data warehouse without custom code