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Revenue

Every claim's status,
without the calls.

CIVIE agents pull claim status from EDI, clearinghouses and payer portals, normalize the answer and write the next action back to the claim, so your team only works the claims that need a person.

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Claim LSH-26-0924-55172

Paid

Read from the Lone Star Health provider portal (sample) by a CIVIE web bot in 17.3 s · sign-in code entered by a person

Billed$3,550.00
Allowed$1,284.60
Paid to provider$1,084.60
Patient responsibility$200.00
PaymentEFT 7302245519 on 10/08/2026
Next actionPost the payment, bill the patient's copay · PR-3 copay amountQueued

From a recorded run on a sample payer portal

The challenge

Hours on hold
for one answer.

  • Phone and portal checks

    Every unpaid claim means a payer call or a portal login to find out where it is.

  • Problems found late

    A claim stuck for missing information sits until someone happens to check it.

  • Answers in different formats

    Every payer and clearinghouse reports status differently, so nothing lines up.

How CIVIE helps

Retrieved, normalized,
acted on.

From an unpaid claim to the next action on it, with a person only where the work needs one.

  1. The richest status available

    Agents combine EDI 276/277, clearinghouse, API and payer portal data for each claim.

  2. Smart routing and retries

    Agents resolve payer and plan variations, retry with different inputs and use whichever source returns the most detail.

  3. Voice agents for the rest

    When only a call will do, a voice agent navigates the payer's phone menu and waits on hold.

    Payer call · claim status

    1. Pressed 2 · provider services
    2. Said the NPI and tax ID
    3. On hold 14:08
    4. Talking with a payer rep
    CIVIE Voice

  4. One format, on the claim

    Statuses and denial details are normalized and written back to the claim and your work queues.

    Claim status · enhanced

    EDI 277
    Finalized · no paymentReason: requested info not received
    Next actionRecords sent · follow-up in 14 daysQueued

  5. Learns what works

    Successful routing combinations are remembered, so status checks get faster over time.

Watch it work

Signed in, searched,
read back.

A real run of CIVIE's web bot on a sample payer portal, including the pause where a person enters the portal's text-message code. It follows a reviewed, read-only flow and returns the claim as structured fields.

Claim status, checked on a payer portal

Recorded run · synthetic patient data · Oct 11, 2026

Lone Star Health provider portal (sample)
Starting a fresh browser session…

Screenshots the bot took after each step. Fictional portal and data.

Claim LSH-26-0924-55172

  1. Open the payer's provider portal (pending)
  2. Sign in with the practice's stored credentials (pending)
  3. Pause for a person to enter the text-message code (pending)
  4. Search the claim number (pending)
  5. Read the claim into structured fields (pending)
Real output from CIVIE's web bot, running a reviewed claim-status flow, on invented patient data. The replay is paced for reading; the response times shown are the real ones. Not for clinical use.
What we changed in this recording
  • The payer portal is a fictional sample built for this recording. The bot, its steps, the screenshots and the extracted values are a real run against it.
  • After the code is entered, the bot submits it and waits for the next page in two helper steps. They're shown as part of the verification step, and the time the capture tooling spent waiting on them is cut from the replay and from the total time.
  • The capture script entered the text-message code 4 seconds after the bot asked, standing in for the person who enters it in CIVIE.

Solutions involved

What it runs on.

FAQ

Questions,
answered.

  • On CIVIE RCM it works natively. With other systems, statuses and next actions are written back through interfaces or automation.

Next steps

Let agents check.
Let people fix.

See claim status agents work your open receivables.

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