Automate Dental Billing and Save 20 Admin Hours a Week
A small dental clinic saves 15-20 hours per week in administrative time with AI-driven billing automation. This translates to recapturing payroll costs and reducing claim denial rates by over 50%.
A typical system ingests scanned insurance Explanations of Benefits (EOBs) and claim forms, extracts the necessary data, and posts payments and adjustments to your practice management software. The scope is defined by the number of unique insurance carriers and the integration method for your existing software. A clinic dealing with 10 major carriers is a more straightforward build than one processing forms from 50 different small group plans.
We built a system for a 2-dentist, 8-person clinic handling 400 insurance claims per month. Their office manager spent 3 hours daily on manual coding and submission. Our system now processes an entire day's claims in under 10 minutes, and the initial build was deployed in 4 weeks.
What Problem Does This Solve?
Most clinics rely on the billing module within their Practice Management Software (PMS) like Dentrix or Eaglesoft. These systems are great for generating claims but fail at processing the responses. They cannot automatically interpret unstructured PDF EOBs sent by smaller insurance carriers, forcing office staff to manually read each one and key the data back into the system.
A common workaround is trying to stitch together general-purpose tools. An office manager might use an OCR scanner connected to Zapier. This approach breaks down quickly. The OCR tool extracts text but cannot understand the context of a dental EOB; it might confuse a patient ID with a check number. Zapier's linear workflow cannot handle the conditional logic required: check the patient, match the date of service, find the correct CDT procedure code, and then post the correct amount. A single EOB could burn 15 Zapier tasks and still end up in a spreadsheet for manual review.
This workflow forces your most experienced administrative staff into low-value data entry. The process is slow, with a typical manual entry error rate of 5-8%, leading to costly resubmissions and payment delays of 30 days or more. It creates a bottleneck that prevents the clinic from growing without hiring more administrative staff.
How Does It Work?
We start by analyzing 50-100 sample EOBs from your top 10-15 insurance carriers. We use Python with the pdfplumber library to extract raw text and layout data, identifying the specific fields your PMS needs: patient name, service dates, CDT codes, and paid amounts.
The core of the system is an AWS Lambda function triggered when a new EOB is scanned to a specific folder. The function uses an OCR service for initial text extraction, then passes the text to the Claude API. The prompt instructs Claude to act as a dental billing specialist, identify the key fields, and structure the output as a JSON object. This entire process takes about 8 seconds per page, a 95% reduction from the 5-6 minutes of manual entry.
A FastAPI service validates the structured JSON from Claude. It connects to your PMS database to perform critical checks, matching patient name and date of birth against your records. It cross-references CDT codes like D2740 against the original claim to ensure accuracy. Validated transactions are queued for posting. We store a log of every processed document and its extracted data in a Supabase table, creating a 90-day auditable trail.
We build a simple web interface for handling exceptions. If the AI's confidence score on any field is below 98%, the EOB is flagged for human review. The interface shows the original PDF next to the extracted data, allowing for one-click correction and submission. This setup allows over 90% of documents to be processed with no human touch, and we've seen error rates on posted claims drop to under 1%.
What Are the Key Benefits?
Live in 4 Weeks, Not 4 Quarters
From document analysis to production deployment in 20 business days. Your staff can stop manual data entry next month, not after a year-long PMS migration.
Recapture Payroll, Not Add Subscriptions
A single, fixed-price build with optional flat monthly maintenance. You eliminate administrative overhead instead of adding another per-user SaaS bill.
You Own The System We Build
We deliver the full source code to your private GitHub repository. There is no vendor lock-in. You are free to modify or extend the system as your practice grows.
Alerts for Exceptions, Not for Everything
The system runs silently, flagging only the 5-10% of documents that require human review. Your office manager intervenes by choice, not by default.
Connects to Your Existing Practice Software
We build direct integrations with your current PMS, whether it's Dentrix, Eaglesoft, or Open Dental. Your team keeps their workflow, no new software to learn.
What Does the Process Look Like?
Week 1: Document & Systems Review
You provide 50-100 sample EOBs and read-only access to your PMS. We map the required data fields and define the exact logic for posting payments and adjustments.
Weeks 2-3: Core Pipeline Build
We build the document processing pipeline using AWS Lambda and the Claude API. You receive access to a development version to see extracted data from your samples.
Week 4: Integration & Validation
We connect the pipeline to a test instance of your PMS and process your sample documents end-to-end. Your office manager validates every transaction for accuracy.
Post-Launch: Monitoring & Handoff
We monitor the live system for 30 days to handle edge cases from new insurance forms. You receive the full source code, documentation, and a runbook for maintenance.
Frequently Asked Questions
- What factors determine the project's cost and timeline?
- The main factors are the number of distinct insurance carriers we need to support and the method of integration with your PMS. Supporting 10 carriers is faster than supporting 50. Integrating with a modern PMS via an API is simpler than connecting directly to an older on-premise database. We provide a fixed-price quote after our initial discovery call.
- What happens if the AI misreads an insurance form?
- The system is designed to fail safely. Each piece of extracted data is given a confidence score. If any score is below our 98% threshold, the entire document is flagged for manual review in a simple web interface. This ensures an expert human eye sees any ambiguous document before the data is posted to your PMS, preventing errors.
- How is this different from using a full-service dental billing company?
- Billing companies are an outsourced service you rent, typically for a percentage of your collections. We build an automated system that you own. It's a one-time capital expense that becomes an asset for your practice, rather than a perpetual operating expense. You retain full control over your billing process and patient relationships.
- How do you handle sensitive patient data (PHI)?
- We take PHI security very seriously. The entire system is deployed within your own secure cloud environment (e.g., your AWS account), not on our servers. All data is encrypted at rest and in transit. We sign a Business Associate Agreement (BAA) before any work begins, ensuring our processes are fully HIPAA compliant.
- Why not use a pre-built tool like Amazon Textract?
- Textract is a generic OCR engine. It's good at pulling text from a page but lacks the specialized knowledge to understand a dental EOB. Our solution uses the Claude API as an intelligence layer on top of OCR. This layer understands the difference between a procedure code and a patient ID, increasing accuracy on complex forms from around 70% to over 99%.
- Will this work with my specific Practice Management Software?
- Yes. We build the integration specific to your setup. If your PMS has a documented API, we use that. If it's an older, on-premise system, we can often connect directly to its underlying database (like SQL Server) or generate formatted files for batch import. We determine the best integration path during our first call.
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