OpenBots AI Agent for Payment Posting

OpenBots Payment Posting AI Agent handles the back end of the revenue cycle once a payer (insurance company, Medicare/Medicaid, or patient) sends payment or an Explanation of Benefits (EOB)/Electronic Remittance Advice (ERA).

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OpenBots AI Agent makes Payment Posting Autonomous and Efficient

Core Functions

1

Ingesting Payments

Inputs:
Actions:
  • ERA (Electronic Remittance Advice, ANSI 835) from payers.
  • EOB PDFs or paper statements (scanned).
  • Patient payments from credit cards, checks, or portals.
Actions:
  • Reads, parses, and extracts payment details.
  • Uses LLMs for scanned EOBs.
  • Normalizes data into structured form.
2

Matching Payments to Claims

  • Matches claim IDs, patient identifiers, service dates, and amounts.
  • Identifies partial payments vs. full settlements.
  • Auto-applies contractual adjustments and disallowed amounts.
3

Handling Denials & Adjustments

  • Reads payer adjustment codes (CARC/RARC codes).
  • Categorizes them (e.g., medical necessity, coding error, prior auth missing).
  • Routes denial/underpayment cases to the appropriate OpenBots Denial Management AI Agent or work queue.
  • Suggests corrections or auto-generates appeal drafts for common denial reasons.
4

Updating the Patient Account

  • Posts correct payment and adjustment to patient’s ledger.
  • Calculates residual patient responsibility (copay, deductible, coinsurance).
  • Auto-generates patient statement or posts balance to portal.
5

Reconciliation & Reporting

  • Reconciles bank deposits with posted payments.
  • Flags mismatches (e.g., deposit doesn’t equal ERA total).
  • Produces dashboards on payer performance, denial trends, and collection efficiency.
  • Feeds metrics back to upstream processes to reduce future denials.

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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