Build, Buy or Partner: AI for Claim Status, Payer Calls and Denials

Which AI billing work to build, which to buy, and why payer phone calls are a partner decision, with vendor pricing as published.

HBMA, the Healthcare Business Management Association, ran a three-session workshop in April 2026 called "Build or Buy: A Practical AI & RPA Playbook for the Modern RCM Owner/Operator" (HBMA Store, accessed Oct 2026). RPA is robotic process automation: software that clicks through screens the way a person would. The title names the question every billing-company owner is facing.

The honest answer is "some of each," plus a third option most owners skip: partner. Here is how to split the work.

Claim status: three routes, in order

Checking the status of unpaid claims is one of the biggest time sinks in a billing company. One vendor says a single claim-status inquiry can take a billing specialist "30 to 60 minutes," and commercial payer hold times "frequently exceed one hour" (SuperDial, Jul 2026, vendor figure). Another says US billing teams make "tens of millions" of insurer calls a week averaging 25 minutes (LunaBill launch, Nov 2025, vendor figure).

There are three ways to get a status answer, and you should try them in this order.

1. Electronic status through your clearinghouse

The standard electronic claim-status request and response (the X12 276/277 transaction pair) runs through most clearinghouses. It is the cheapest and cleanest route. Build your queue to read these responses first, and only send a claim to the next route when the electronic answer is missing or unhelpful.

2. Payer portals

Portals fill gaps, but they come with limits. Some payer contracts "discourage or prohibit portal scraping," and some payers have cut portal functions (SuperDial, Jul 2026, vendor source). Before anyone automates a portal, read that payer's terms. If the terms say no, the answer is no.

3. Phone calls

Phone calls remain necessary where payers have no electronic support, or where smaller third-party administrators skip real-time checks (same source). This is where AI voice vendors are selling hardest.

Buying AI phone calls: who sells it and how it is priced

Several companies sell AI agents that call payers. Pricing is mostly quote-only.

Vendor	What they say they do	Pricing (as published)
SuperDial	AI calls for claim status and more; targets revenue-cycle companies	Per completed call; demo required (SuperDial, Jul 2026)
LunaBill	AI voice callers for billing teams; says it works with three large enterprise billing companies	Not published (YC, Nov 2025)
Prosper AI	Benefits checks, prior auth, claim status, EOB retrieval, denial follow-up	Usage-based quote (Prosper, Oct 2026)
Infinitus	AI agents for payer calls	Annual platform and license fees plus usage, with monthly minimums (Agentman, Aug 2026)

All of the above are vendor statements. Two vendor claims worth knowing, and worth testing yourself: SuperDial says revenue-cycle company MBW RCM cut its average call operating costs in half, and LunaBill says billers using its callers went from about 25 to 300+ claim follow-ups a day. We did not find a published method for either.

For price anchors, one vendor article lists its own pricing at $10 per hour of call time or $1,500 per provider per month unlimited, and reports that another vendor quoted the author a $75,000 annual minimum (Agentman, Aug 2026, vendor article). Treat those as the shape of the market, not a quote.

Our view: do not build your own phone agent. The vendors above specialize in payer phone trees and call handling. Partner with one, and own the queue around it.

What to build yourself

Build the parts that depend on your own data and history, because no vendor has them:

The denial queue. Sorting by reason, payer, dollars and deadline, plus appeal drafts from your own winning appeals. See Denial triage and appeal drafts.
The work queue that ties routes together. Electronic status first, then portal where allowed, then the voice vendor, with results landing in one list your billers already use.
Client monthly summaries. A plain-language letter per practice: what was collected, what is stuck and why, what the practice needs to fix on its side. Your account manager edits and sends it.
Front-end flags. Before claims go out, flag ones that match denial patterns you have seen for that payer. It suggests; a biller fixes.
Your AI tool policy. See the BAA checklist.

What to buy

AI features already in your practice-management system or clearinghouse, if they are inside your existing BAA and do the job.
A voice vendor for payer calls, once electronic status is exhausted.
A HIPAA-eligible AI plan to run your own queues on.

What to skip

Building a phone bot from scratch.
Scraping portals whose terms forbid it.
Anything that changes codes or submits claims without a person.
Platforms that want your whole operation moved onto their system before you see results on one queue.

A quick decision table

Work	Build	Buy	Partner
Denial sort and appeal drafts	Yes, from your data	Only if your billing system does it well	—
Electronic claim status	Read it into your queue	Comes with the clearinghouse	—
Portal status checks	Only where terms allow	—	—
Payer phone calls	No	—	Voice vendor
Client monthly summary	Yes	—	—
Staff AI policy and training	Yes	—	—

Questions before signing a voice vendor

Will you sign a BAA, and what does it cover?
What is the pricing unit (per call, per minute, per provider) and is there a minimum?
Which of our top payers do you handle today?
How do results land in our queue: file, API or your screen?
What happens when a call fails or a payer rep asks something unexpected?
Who can listen to call recordings, and how long are they kept?
Can we pilot on one payer group and measure it against a baseline first?

That last question is the important one. Get a two-week baseline before any pilot, or the vendor's numbers become your only numbers. See Accounts per biller.

If you want help drawing the build-buy-partner line for your firm, Lunan offers a free conversation. We work for your firm, not for a vendor.