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.

Go-live in as little as 30 min·Browser agent·Customer portal login

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How Asteroid runs this workflow

The follow-up loop, worked on the payer's clock

A claim lands in the follow-up queue, Asteroid pulls its status and denial detail off the payer portal, assembles the appeal from the documentation your team provides, and files it. The argument for overturning a denial is never the agent's to make, so that judgment stops with your staff.

Clearinghouse-style payer portals

How it actually runs

1. 01 Sign in to the clearinghouse-style payer portal with your credentials, stored in an agent profile.
2. 02 Look 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. 03 For a denied claim, retrieve the denial reason and remittance detail as one structured record instead of a screen someone transcribes.
4. 04 Where 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. 05 A 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.

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.

Frequently asked questions

Our follow-up process has its own rules. What gets configured, and what does our team keep doing?

The loop is configured to your payer mix and follow-up SOP: which clearinghouse-style payer portals to work, how status sweeps are scheduled - nightly across the payer mix at queue scale - what the structured denial record must carry, and which documentation your team supplies for appeals. Your team keeps the part that is genuinely theirs: deciding which denials to fight and with what argument; appeals file as fast as your team approves. The agent takes the logins, lookups, and transcription.

What systems and credentials does this run on, and where does the output land?

The agent signs in to the clearinghouse-style payer portal with your credentials, stored in an agent profile so nobody handles them at run time - provisioned for the follow-up work only, and revocable by rotating the profile. Inputs are the claims to check plus the appeal documentation you provide; outputs are statuses in the portal's exact wording and denials as single structured records with reason and remittance detail, alongside your existing EDI feed rather than replacing it. An API integration is optional.

What happens when the portal can't find a claim or disputes what we submitted?

It stops and routes to a person. A claim the portal can't find, a member mismatch, or anything the portal disputes goes to your team with the portal's wording attached - the agent never forces a near-match or invents claim, member, or documentation data to complete a form; appeals use provided data only. Those are business exceptions from runs that completed their job. A technical failure - a portal that won't load or a broken sign-in - is reported as a failed run, and portal changes that block a step surface the same explicit way.

How do we control appeal submissions and audit what was filed?

Every status check captures the portal's exact wording, every denial becomes one structured record with the stated reason and remittance detail, and every appeal is assembled strictly from the documentation your team provided and filed only where the portal supports it - so the filing trail is reconstructible claim by claim. A denial retrieved cleanly is a successful run with a business finding, not a failure; the failure category is reserved for the portal not cooperating.

What does the payer portal give us that our EDI status feed doesn't?

The feed gives you the status code; the portal carries what the code doesn't: the denial's stated reason in the payer's own words, 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 has already answered - the decision-shaped information and the ability to act on it live behind the login. This workflow captures that detail as structured records and files through that path.

Where does appeal judgment stop and automated retrieval, assembly, and submission begin?

The line is deliberate and hard: the agent retrieves the denial and remittance detail, assembles the appeal from the documentation your team provides, and files it where the portal supports submission - but it never invents the clinical or contractual case for overturning a denial, and it never decides which denials to fight. Your team supplies the argument and the supporting documentation; the agent does the portal work on the payer's clock, which matters because appeal windows run whether or not anyone opened the queue this week. Provided data only, nothing invented to complete a form.