Background

Frequently claim status requests fail (or billers manually checking the claim status fails) because the claim has been rejected at the clearinghouse, rather than denied by the payer,and this data hasn’t made itself back to your work queues yet. Very often this is because your clearinghouse is only integrated into your EMR and PM for claim creation and submission, not the 277CA (the EDI transaction that payers use to confirm that they have received a claim). 

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In these cases, very few payers will actually tell you that they rejected a claim via the claim status transaction. You'll just get an unsuccessful attempt.

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What’s new

With this change, the Substrate Claim Status Agent can independently to

• Check your clearinghouse for claim rejections
• Detect if a claim was rejected by the payer and the rejection reason
• Return rejected claims to you for review
• Update your worklists so you can resubmit the claim, rebill or send a corrected claim

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Supports any clearinghouse billers log into.

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