AI Agent for Denials Management

OpenBots Denials AI Agent reviews denials, categorizes the root cause, and can automatically draft payer-specific appeal letters using medical records, policy language, and guidelines. It also predicts and prevents future denials and provide dashboards to track trends.

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Core Functions

Automatic Denial Analysis & Categorization

OpenBots Denials AI Agent analyzes claim denials, classifying them by root cause—like missing authorization, coding errors, or documentation gaps—and routes them accordingly. This automation replaces slow, manual triage.

Automated Appeals Generation

Once a denial is identified, the AI drafts appeal letters by pulling together relevant clinical documentation, insurance policy references, and payer-specific requirements.

Real-Time Insights & Denial Prevention

OpenBots AI agents provide dashboards and analytics that show denial patterns, enabling teams to address recurring issues. With agentic AI, they can predict and prevent denials before they happen by flagging potential issues during claim preparation.

OpenBots Integrated RCM AI Agents

OpenBots AI Agents are integrated with each other. The denials trends are analyzed and the insights are applied towards Prior Authorization and Claims submissions to reduce Denials pro-actively.

From a technical requirements and scoping perspective, it’s been excellent working with the team. I appreciate how detail-oriented they are and how clearly they define what they want to achieve. Overall, it’s been such a positive experience working with OpenBots!

Theresa Jackson Director of Technology, Complete Care Centers

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