CombineHealth replaces payer portals with Stedi eligibility checks
CombineHealth builds AI agents for revenue cycle management (RCM): the workflows a provider needs to follow to get paid by an insurance payer.
Their agents cover those RCM workflows from end to end. Providers can use them to handle insurance verification, medical coding, claim submission, payment posting, reconciliation, denial management, and more.
CombineHealth works with several major providers, including Union Health, SignatureCare, and Kodiak Community Health Center. Their agents have an 85% claim automation rate with 64% fewer denials overall.
Challenge
Payer portals were one way CombineHealth agents verified a patient's insurance. The agent logged in to the portal, pulled coverage details, then surfaced them back to the provider.
The problem is that payer portals are built for humans, not agents. Think front desk staff who log in, search for a patient, and click through pages.
To get their agents the structured data they needed, CombineHealth's engineers found the request each portal makes when a person verifies insurance. They then had their agents call those requests directly.
But those requests depended on session cookies and headers that would eventually expire. When they did, someone would have to manually log back in to the portal.
Every request also returned a different response shape. That meant new work every time CombineHealth onboarded a provider with new payers.
"Every time we encountered a new portal, we had to understand their requests, learn their schema, and translate that into something our agents could understand," says Sourabh Agrawal, co-founder and CEO of CombineHealth. "It was taking too much engineering time. We want our engineers building AI agents, not maintaining portal integrations."
"Every time we encountered a new portal, we had to understand their requests, learn their schema, and translate that into something our agents could understand. It was taking too much engineering time."
To scale, CombineHealth's agents needed a programmatic way of verifying insurance that worked the same way for every payer.
Solution
CombineHealth replaced their portal-based insurance verification process with Stedi's Real-Time Eligibility API.
The API lets CombineHealth's agents run standardized eligibility checks that return the same structured response shape across payers. Most checks return results in 1-5 seconds.
And because it's an API, CombineHealth no longer needed to worry about expiring session cookies or headers. All they needed was a production API key.
"Stedi's eligibility checks consistently give us back all the information we need," says Mohit Goyal, senior AI engineer at CombineHealth. "The API is reliable and easy to work with. We're moving all of our eligibility work over to Stedi."
"Stedi's eligibility checks consistently give us back all the information we need. The API is reliable and easy to work with."
CombineHealth was also impressed with Stedi's real-time support. When an engineer had a question or needed help with migration, Stedi's support engineers were available to help over Slack.
"If I need anything, I know I can just reach out to Stedi on Slack. Stedi feels like part of our team," says Mohit.
"If I need anything, I know I can just reach out to Stedi on Slack. Stedi feels like part of our team."
Results
CombineHealth now runs thousands of eligibility checks a month through Stedi. A daily background job pulls appointments from the provider's system, runs Stedi eligibility checks for the patients, and then returns the results.
Those checks are powering real results for CombineHealth's providers. One hospital group verified insurance 80% faster and cut coverage-related denials by 8%.
Stedi's Real-Time Eligibility API has also allowed CombineHealth's engineering team to focus on expanding their product instead of maintaining portal integrations.
"Our engineers were spending hours every week patching portal integrations," says Sourabh. "Now we don't even have to think about our payer infrastructure. Stedi handles that for us."
"We don't even have to think about our payer infrastructure. Stedi handles that for us."
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