OpenBots Launches "MedFlow Total Eligibility" to Tackle Healthcare's #1 Cause of Claim Denials

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The healthcare industry's first platform to fully replace manual eligibility interpretation while automating insurance discovery, coordination of benefits, and patient financial responsibility to help providers reduce denials and lower cost-to-collect.

SUNRISE, FL / ACCESS Newswire / March 10, 2026 / Eligibility verification is widely considered a solved problem in healthcare. Yet nearly one in four claim denials still originate from eligibility errors.

Despite widespread adoption of eligibility verification systems across the industry, approximately 24% of claim denials stem from eligibility issues, and nearly 50% of those denials are caused by coordination of benefits (COB) errors, where the wrong payer is billed first.

These mistakes often originate from the manual interpretation of 271 eligibility responses, which vary widely across payers and require significant staff effort to review, validate, and reconcile. Even organizations using clearinghouses and standard eligibility tools still rely on teams to interpret responses, navigate payer portals, and confirm coverage details before claims are submitted.

Today, OpenBots announced the launch of MedFlow Total Eligibility, a new capability within its MedFlow revenue cycle automation platform designed to replace manual interpretation of the 271 response, eliminate eligibility-driven denials, and significantly reduce administrative workload.

The operational impact of eligibility errors extends far beyond the front desk. Incorrect coverage verification frequently leads to claim rejections, downstream denials, increased accounts receivable (A/R), delayed reimbursement, and significant staff time spent navigating payer portals or calling payers for clarification.

"Eligibility is often assumed to be automated in healthcare," said Gabe Skelton, Head of Sales at OpenBots. "But in reality, most systems only retrieve the eligibility response. Staff are still responsible for interpreting it, determining coordination of benefits, checking coverage status, and confirming patient responsibility. MedFlow Total Eligibility is designed to replace that manual interpretation entirely."

Eligibility operations are also frequently decentralized across registration teams, intake coordinators, and revenue cycle staff, making it difficult for organizations to measure accuracy, track performance, or identify the root cause of denials.

"You cannot improve what you do not track," said Karan Sehgal, Chief Customer Officer at OpenBots. "Eligibility work is often distributed across the organization, and leadership rarely has clear visibility into how much manual work is actually happening or where errors originate."

MedFlow Total Eligibility introduces a unified system designed to interpret eligibility responses automatically, identify coverage issues, and automatically make coverage decisions that previously required manual review.

"Healthcare has relied on standardized point solutions for eligibility for years," said Ashish Nangla, CTO & Co-Founder of OpenBots. "Those systems retrieve payer responses, but they do not solve the operational complexity around interpreting them. Our goal with MedFlow Total Eligibility was to remove that manual burden entirely."

According to Ranodeb Banerjee, Associate Director of Healthcare Automation at OpenBots, the platform also improves financial visibility before care is delivered.

"Providers need a reliable way to understand financial exposure before services are performed," Banerjee said. "By interpreting eligibility data and payer rules automatically, MedFlow Total Eligibility allows organizations to generate patient estimates and financial responsibility insights before the visit."

For Zia Bhutta, CEO & Founder of OpenBots, the launch reflects a broader shift in healthcare automation.

"For years, the industry has accepted eligibility denials as unavoidable," Bhutta said. "But when nearly a quarter of all denials originate from eligibility, it's clear the problem has not been solved. MedFlow Total Eligibility brings the intelligence needed to finally address that gap."

One OpenBots client, one of the largest non-profit behavioral health organizations in the United States, publicly discussed significant improvements after implementing the technology. The organization reported reducing eligibility-related denials from approximately 400 per month to just 50, while reducing manual eligibility review time by more than 95%. The automation also contributed to helping the organization reduce over $4 million in outstanding accounts receivable.

With MedFlow Total Eligibility in place, organizations no longer need to rely on manual processes to verify coverage. Staff no longer need to log into payer portals, question whether a green "verified" eligibility check is actually accurate, call payers to confirm coverage, admit patients without knowing financial responsibility, or submit claims that ultimately result in preventable denials.

By automating eligibility interpretation, payer sequencing, prior authorization triggers, and patient financial estimation, MedFlow Total Eligibility significantly reduces eligibility-driven denials while removing one of the largest administrative burdens from healthcare staff.

Differentiators of MedFlow Total Eligibility

Automated 271 Response Interpretation

Replaces manual review of complex payer eligibility responses and converts them into structured coverage insights.

Automated Estimates (Pre-Visit)

Generates patient financial responsibility estimates before appointments.

Coordination of Benefits (COB) Automation

Automatically identifies primary vs. secondary payer conflicts and correct payer sequencing.

EHR Writeback

Automatically returns verified eligibility data directly into the EHR, eliminating manual entry and reducing front-desk errors.

Eligibility Intelligence

Transforms eligibility data into actionable decisions across the revenue cycle.

Grace Period & Coverage Termination Detection

Flags inactive policies, non-payment grace periods, and pending coverage terminations.

Insurance Discovery

Identifies active insurance coverage and performs automated verification of benefits across payers.

Network Status, Benefit Limits & Deductible Tracking

Analyzes in-network status, deductible balances, coinsurance levels, and remaining benefit limits.

Prior Authorization Triggers

Automatically flags services requiring prior authorization based on payer rules and benefit structure.

The solution is part of the broader OpenBots MedFlow healthcare automation platform, which includes AI-driven solutions for:

• Fax Indexing & Referral Management

• Prior Authorization & Utilization Review

• Accounts Receivable Automation

• Claims, Denials & Payment Posting

• Credentialing

Takeaway

MedFlow Total Eligibility ultimately gives healthcare organizations something the industry has long lacked: a reliable way to eliminate eligibility-driven denials and operate with the lowest possible cost to collect.

About OpenBots

OpenBots is a healthcare agentic automation platform for both the front-end and back-end of revenue cycle management. Its MedFlow platform automates critical workflows across eligibility, prior authorization, referrals, claims, payments, denials, accounts receivable, and credentialing.

Media Contact

OpenBots, Inc.

505 Thornall Street

Edison, NJ 08837

www.openbots.ai

For media inquiries or to request a demonstration of MedFlow Total Eligibility, please contact:

[email protected]

SOURCE: OpenBots