Claims & Denials

Claim Status, Denial Retrieval, and Appeals Automation

Pull claim status, retrieve denial detail, and file appeals through the payer portals where that work actually lives. The follow-up half of the revenue cycle, the part the EDI rails don’t carry, run as a browser agent instead of a queue of portal logins.

This workflowClearinghouse-style payer portal
StatusComing soon
AccessBrowser agent
AuthCustomer portal login

Step by step

What this workflow covers

After a claim is submitted, the work moves to follow-up: someone logs into the portal to check where the claim stands, pulls the denial reason and remittance detail when it doesn’t pay, and assembles and files the appeal. This workflow covers that loop on clearinghouse-style payer portals: status lookup with the payer’s exact wording, denial retrieval as structured data, and appeal submission with the documentation you provide.

  1. 01Sign in to the clearinghouse-style payer portal with your credentials, stored in an agent profile.
  2. 02Look up the claim and capture its status with the portal’s exact wording, the detail behind the status code your EDI feed already gave you.
  3. 03For a denied claim, retrieve the denial reason and remittance detail as one structured record instead of a screen someone transcribes.
  4. 04Where the portal supports appeal submission, assemble the appeal from the documentation provided and file it. Provided data only; nothing is invented to complete a form.
  5. 05A claim the portal can’t find, a member mismatch, or anything the portal disputes routes to a person with the portal’s wording attached.

The appeal argument itself stays human, deliberately: the agent retrieves, assembles, and files, but it never invents the clinical or contractual case for overturning a denial.

Denials age on the payer’s clock, not your staffing plan

Denial follow-up is the queue that loses to everything else, because it’s the most manual work in the revenue cycle: portal by portal, claim by claim, screen by screen. But appeal windows and filing deadlines run on the payer’s calendar whether or not anyone opened the queue this week, and a denial that ages out stops being a denial and becomes a write-off. Running status sweeps and denial retrieval as agents means the queue is worked on schedule, and what reaches your staff is the decision-shaped part: which denials to fight and with what argument.

At scale

What runs today

These claims agents are in the catalogue pipeline; the same portal discipline runs today one step upstream in the prior authorization submission workflows, reference numbers and statuses captured on every run. At queue scale, status sweeps run nightly across the payer mix and appeals file as fast as your team approves the argument; the queue layer above this loop is denial management, the economics are in the medical billing automation deep-dive, and if the denial queue is the current pain, scoping a build against your payer mix is the fastest path. Category view: the claims and denials workflow library.

Questions

Frequently asked questions

You get the status code. The portal carries what the code doesn’t: the denial’s stated reason, the remittance line detail, and the appeal submission path itself. That gap is why claim follow-up teams still log in by hand after the feed already answered; the API-gap breakdown covers why it persists.

Disclaimer

Third-party names, including government agencies and registries, are used only to identify systems commonly involved in healthcare operations workflows. Asteroid is not affiliated with, endorsed by, sponsored by, or certified by those third parties unless expressly stated. Workflow availability depends on customer authorization, account permissions, configuration, and applicable system terms.