Substrate AI, the leading provider of Agentic AI solutions for healthcare revenue cycle management, announced the general availability release of the Substrate Eligibility Agent, an AI agent built to increase collections from eligibility-related denials for healthcare practices, physician groups, and health systems. In Substrate’s network, the company has seen practices where eligibility-based denials represent up to 35% of denials by claim count and 60% by dollar value.

Eligibility errors are one of the largest sources of preventable denial work. They are often unrelated to care quality and are largely recoverable, but they still slow collections, increase cost to collect, and reduce net revenue when teams have to manually research coverage, demographics, payer routing, prior authorization, referrals, and coordination of benefits after a claim has already been denied.

"Most eligibility tools were built for the front desk. AR teams working denials need a different answer: why did this claim fail, what data is wrong, and what should happen next?” said Ayo Omojola, Founder and CEO of Substrate AI.

Traditional eligibility products confirm coverage and stop. Benefit verification, plan verification, cost share, coordination of benefits, and the gap between the payer you verify with and the payer you submit a claim to, fall to the front desk to chase, or go unaddressed until the claim is denied. The Substrate Eligibility Agent uses the same sources and strategy your AR team uses. These include multiple clearinghouses, API providers, and payer portals. It combines eligibility (270/271) with claim status (276/277), payer portal data (including from the Substrate Claim Status Agent), and EOBs, to diagnose denials, fix them, and write back into your system of record.

What it delivers

• Resolves the hard cases; coordination of benefits, carve-outs, referral and prior auth issues, demographic errors, and more
• Writes back to your system of record; researched claims automatically update your queues, moving claims to the next step in your worklist
• No rip-and-replace; works alongside your existing PM or workflow engine; no migration, no engineering lift

The Substrate Eligibility Agent is part of Substrate ARC, the company’s Autonomous Revenue Cycle platform for eligibility, policy review, claim status, appeals, payment posting, credit balances, and collections. The Substrate Eligibility Agent, along with the Substrate ARC platform helps practices accelerate collections, decrease cost to collect, and increase net revenue.