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Dental Practice · Dental

Dental Eligibility and Claim Workflow Automation

Illustrative Revenue Cycle Automation Scenario. This scenario demonstrates how a healthcare organization could apply revenue-cycle automation. It is not presented as an actual customer result.

The Challenge

A dental practice struggled with dental insurance eligibility and claim complexity. Dental benefits have annual maximums, different coverage percentages for different procedure categories (preventive, basic, major), and waiting periods for major services. Manual eligibility verification did not capture these details, leading to inaccurate patient estimates and denied claims.

The Approach

Sarva automated dental eligibility verification including annual maximum remaining, coverage percentages by procedure category, and waiting period status.

Claim scrubbing was configured with dental-specific rules covering procedure category coding and benefit limitations.

Patient cost estimates were generated using verified benefits data, improving pre-treatment financial discussions.

Annual maximum tracking was automated with alerts when patients approached their limit.

Illustrative Outcomes

Dental claim denial rate

Illustrative reduction from 12% to under 4%

Patient estimate accuracy

Illustrative improvement to above 90%

Staff time on eligibility

Illustrative 80% reduction

Outcomes are illustrative and do not represent actual customer results.

Key Lessons

Dental benefits have unique structures (annual maximums, category percentages, waiting periods) that require specialized verification.
Accurate patient estimates from verified benefits data improve upfront collections.
Annual maximum tracking prevents treatment plan denials late in the benefit year.

See how this approach could work for your organization.

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