Dental revenue cycle management
Dental revenue leaks at verification and attachments - plans with maximums, frequencies and downgrades, and claims that reject without X-rays and narratives. AI agents get the whole cycle right before the claim leaves.
Dental practices juggle complex plan structures, frequent eligibility changes and attachment-hungry claims. AI agents verify benefits down to frequencies and downgrades, auto-attach the right documentation, code and appeal - and keep the hygiene schedule full.
Insurance verification & benefits
- Real-time eligibility & plan breakdown - Pulls annual maximums, frequencies, downgrades and waiting periods before the visit.
- Patient-responsibility estimation - Computes what the patient owes so the front desk quotes accurately.
- Coordination of benefits - Detects dual coverage and orders primary/secondary correctly.
- Frequency & history check - Confirms last cleaning, exam and X-ray dates against plan frequencies.
Claims & documentation
- Attachment automation - Auto-attaches X-rays, perio charts and narratives so claims don't reject.
- CDT coding assistance - Suggests CDT codes from the clinical note and flags likely downgrades (e.g., composite to amalgam).
- Narrative generation - Drafts medical-necessity narratives for scaling, crowns and extractions.
- Medical-dental cross-coding - Cross-codes eligible procedures to CPT for medical billing (e.g., surgical extractions, appliances).
- Predetermination submission & tracking - Submits and tracks predeterminations for major work.
Prior authorization
- Pre-treatment estimates for major work - Requests PAs/estimates for crowns, implants and perio.
- Ortho authorization & lifetime-max tracking - Handles ortho authorizations and tracks the orthodontic lifetime maximum.
Payments, denials & AR
- ERA/EOB auto-posting - Posts electronic remittances and write-offs automatically.
- Denial & downgrade appeals - Auto-generates appeals for common dental denials and downgrades.
- Underpayment vs. fee-schedule detection - Flags payments below the contracted fee schedule.
- AR follow-up worklist - Prioritizes aged claims by recoverable value and filing deadline.
Patient billing & collections
- Statements & reminders - Sends statements and balance reminders by text and email.
- Payment & membership-plan billing - Runs payment plans and in-house membership-plan billing.
- Treatment-plan financial presentation - Turns the treatment plan into a clear patient-cost breakdown at the desk.
Front office & scheduling
- Recall & hygiene reactivation - Automated 6-month recall and reactivation of lapsed patients.
- No-show & waitlist backfill - Fills cancellations from the waitlist automatically.
- 24/7 call answering & booking - Answers overflow calls and books into Dentrix, Eaglesoft or Open Dental.
- New-patient digital forms & insurance capture - Collects forms and captures the insurance card before arrival.
Analytics
- Production & unscheduled-treatment dashboards - Tracks production, collections and unscheduled treatment to recover.
What you get
- Verify every plan's maximums, frequencies and downgrades before the chair
- Cut claim rejections with automatic X-ray and narrative attachments
- Quote accurate patient responsibility up front
- Appeal downgrades and denials in a click
- Reactivate lapsed recall patients without manual chasing
- Fill cancelled slots from the waitlist automatically
Frequently asked questions
What are frequency limitations in dental insurance?
Plans limit how often a service is covered - for example two cleanings per year, or bitewings once per year. Verifying the patient's remaining frequency and service history before the appointment prevents the most common dental denial.
What is a downgrade or alternate benefit?
When a plan pays for a less expensive alternative than the treatment provided - for example paying a composite filling at the amalgam rate. The patient owes the difference, so the estimate has to account for downgrades or the practice absorbs the gap.
What is an annual maximum?
The most a dental plan will pay in a benefit year. Once it is exhausted, the patient is responsible for the balance, which is why the remaining maximum should be checked and communicated before treatment planning.
Why do dental claims need attachments?
Many procedures - crowns, periodontal treatment, endodontics - require radiographs, perio charting or narratives to prove medical necessity. Claims submitted without the right attachment are denied or pended, so attaching the correct documentation on the first submission is what keeps cash moving.