40% Claim Rejection Rate
Incorrect CDT/CPT/ICD-10 combinations were the primary cause of rejections. AI-powered code suggestions and compliance guardrails brought coding accuracy from ~55% to 98%.
Oral appliance therapy billing crosses the dental-medical divide. We built a unified code engine that suggests the right CDT/CPT/ICD combination, blocks non-compliant pairings, and auto-generates claims.
Get StartedA practice in California had a billing team that dreaded dental sleep claims. They had been burned by audits and lived in fear of incorrect coding. Staff untrained in cross-coding submitted incorrect claims, leading to a 40% rejection rate and 60-day average reimbursement cycles.
The unified code engine changed everything — it suggested the right CDT/CPT/ICD combination for each visit type, blocked non-compliant code pairings, and auto-generated claims from clinical visit data. When EOBs came back, the system OCR'd them and flagged every underpayment. Their 60-day cash cycle compressed to 15 days.
Oral appliance therapy billing crosses the dental-medical divide. Practices must navigate CDT codes (dental), CPT codes (medical), and ICD-10 codes (diagnosis) — often for the same procedure. The complexity is unique to dental sleep medicine and most billing staff have no training in it.
Staff untrained in cross-coding submitted incorrect claims, leading to a 40% rejection rate. Each rejected claim required manual rework — researching the denial reason, correcting the codes, resubmitting, and following up. The average reimbursement cycle stretched to 60 days.
The billing team spent 25 minutes per claim on manual code lookups, form population, and submission. With 200+ claims per month, this represented a massive operational bottleneck that directly impacted cash flow.
Incorrect CDT/CPT/ICD-10 combinations were the primary cause of rejections. AI-powered code suggestions and compliance guardrails brought coding accuracy from ~55% to 98%.
Manual claim generation, submission delays, and rework on denials stretched cash cycles to 60 days. Auto-generated claims and batch submission compressed this to 15 days.
Billing staff manually looked up codes, populated forms, and submitted each claim individually. Auto-population from clinical data reduced time per claim from 25 minutes to 5 minutes.
EOBs arrived by mail and were manually reviewed — underpayments were frequently missed. OCR scanning and auto-reconciliation flagged every discrepancy, recovering $150K in the first year.
The practice needed a billing solution that understood dental sleep medicine — not generic dental billing software that treated OAT like a filling. Our system was built from the ground up for the unique cross-coding requirements of sleep dentistry.
A curated library of CDT, CPT, and ICD-10 codes specific to dental sleep medicine — not a generic code database with thousands of irrelevant entries.
The system actively prevents non-compliant code pairings, protecting practices from audit risk and rejected claims.
OCR scanning of explanation of benefits documents with automatic reconciliation catches every underpayment that manual review would miss.
From code suggestion to claim generation to submission to reconciliation — the entire billing lifecycle is automated within a single workflow.