For / dental-medical
Insurance verification automation for dental practices
Your front desk loses an hour per patient chasing eligibility on hold. I move that work to agents that read the clearinghouse and write back to your PMS.
Insurance verification automation is not a new PMS and not a new clearinghouse. It is a thin layer of agents that pull eligibility from claimconnect or eclaims, parse the response, and drop copay, deductible, and remaining benefits into the patient record before the appointment. You keep Dentrix or Open Dental. Nothing about your stack changes.
Systems retained
The systems you keep
I wire ai on top via legacy system modernization. Nothing about your stack changes.
Scope of work
What I build
- 01Pre-visit eligibility agent that pulls 270 or 271 responses from your clearinghouse 48 hours before each appointment and writes the result into the patient note
- 02Copay and deductible surfacing flow that posts the patient cost-of-visit into your booking confirmation so nobody is surprised at the front desk
- 03Rejected claim handler that catches denials in real time, classifies the reason code, and drops the claim into a recovery queue your biller actually works
- 04Morning huddle digest in slack or email that lists every patient with missing or expired coverage so the front desk fixes it before the chair turns over
- 05Weekly report on verification coverage, denial rate, and dollars stuck in claim limbo
- 06Handoff doc and a loom walkthrough so your office manager can run it on day one
Timeline
Scope and timeline
- Band
- Medium
- Timeline
- 3-4 weeks
This is a medium build. Timeline 3-4 weeks. Fixed fee, scoped on a 30-minute discovery call. It ends with a clean, documented handoff so a full-time developer can run it.
Questions
Faq
- What tools do you keep
- All of them. Dentrix, Eaglesoft, Open Dental, Curve, your clearinghouse, the eligibility spreadsheet your team pastes into every morning. I read from them and write tasks back. Nothing gets replaced.
- How long does this take
- First version live in week one. Full build in three to four weeks. That includes the eligibility agent, the copay surfacing flow, the rejected claim handler, and the weekly report.
- What does it cost
- Fixed fee. No per-verification charges, no per-seat pricing, no monthly retainer. I hand it off with the code and the prompts documented.
- Do we need to switch clearinghouses
- No. If you are on claimconnect, eclaims, change healthcare, or anything that returns a 270 or 271, I wire to it. If your clearinghouse changes tomorrow, I re-point the connector and keep going.
- What about HIPAA
- Agents run on your infrastructure or a private vps. Patient data and 271 responses stay inside your stack. I sign a baa when one is required and I keep phi out of any third-party llm call.
- What if the front desk does not adopt it
- I build the morning digest into the channel they already check, slack or email. No new app to log into. The eligibility result lands in the patient note inside Dentrix or Open Dental, where they already look.
Out of scope
When this is not worth automating
- 01You already have a full-time verification specialist who owns the workflow and the denial queue. The math does not work and you should put the budget into expansion instead.
- 02You are a cash-only practice with no clearinghouse integration. There is nothing to verify against.
- 03You are mid-migration to a new PMS or clearinghouse. Wait for the dust to settle so I wire to a stable schema.
- 04Your front desk has zero bandwidth to confirm a process for one week. Nothing autonomous works without a human on the other side of the handoff for the first sprint.
Related
Related for dental-medical
See all problems I solve for dental-medical on the dental-medical pillar.
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