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From 60-Day to 15-Day Average Reimbursement Cycles with Automated Dental Sleep Billing

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.

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About the Project

A California practice ran a 40% rejection rate and 60-day reimbursement cycles because staff were untrained in dental sleep cross-coding. The unified code engine suggests the right CDT/CPT/ICD set per visit, blocks non-compliant pairings, auto-generates claims, and OCRs EOBs to flag underpayments — cash cycle now 15 days.

Industry

Healthcare / Dental Sleep Medicine

Oral appliance therapy billing that crosses the dental-medical divide.

  • Dental Sleep Medicine
  • Oral Appliance Therapy
  • Medical Billing
Business Type

Mid-Size Practice

A California practice submitting 200+ claims a month with an audit-shy billing team.

  • 200+ Claims/Month
  • In-House Billing
  • Audit-Sensitive
Core Offering

Billing & Claims Automation

Auto-generated claims from clinical visit data with compliance validation built in.

  • Auto Claim Generation
  • Batch Submission
  • Denial Tracking
  • Appeal Workflow
Cross-Coding Engine

CDT, CPT and ICD-10 in one code library

AI suggestions pick the right combination and guardrails block non-compliant pairings.

  • CDT Codes
  • CPT Codes
  • ICD-10 Diagnosis
  • Compliance Guardrails
Reconciliation

EOB OCR with Underpayment Flagging

Scanned EOBs reconcile against submitted claims and flag every discrepancy.

  • EOB OCR Scanning
  • Auto-Reconciliation
  • Denial Categorization
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Talk to our experts

Scope your own claims automation build with our healthcare billing team.

  • Free Consultation

The Challenge: A 40% Claim Rejection Rate

Cross-coding errors drove a 40% claim rejection rate.

Cross-Coding
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.
40%
Staff untrained in cross-coding submitted incorrect claims, leading to a 40% rejection rate. Each rejected claim required manual rework, and the average reimbursement cycle stretched to 60 days.
25 min
The billing team spent 25 minutes per claim on manual code lookups, form population, and submission. With 200+ claims per month, this was a massive operational bottleneck.

Bill with confidence.
Get paid faster.
Eliminate coding errors.

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Our Solution

  • Unified Code Library & AI Suggestions

    Unified Code Library & AI Suggestions

    Unified Code Library & AI Suggestions

    • Unified CDT + CPT + ICD-10 code library for dental sleep medicine
    • AI-powered code suggestions based on diagnosis and procedure
    • Code compliance guardrails that prevent impossible combinations
  • Automated Claim Generation

    Automated Claim Generation

    Automated Claim Generation

    • Visit-level code assignment with compliance validation
    • Auto-populated claim forms from clinical visit data
    • Batch claim submission across multiple payers
  • Fee Schedule & Revenue Tracking

    Fee Schedule & Revenue Tracking

    Fee Schedule & Revenue Tracking

    • Fee schedule management per payer and location
    • Patient ledger with real-time balance updates
    • Denial tracking and structured appeal workflow
  • EOB Processing & Reconciliation

    EOB Processing & Reconciliation

    EOB Processing & Reconciliation

    • EOB OCR scanning with auto-reconciliation against submitted claims
    • Automatic flagging of underpayments and discrepancies
    • Denial reason categorization for root cause analysis
  • Payer Rule Updates & Compliance

    Payer Rule Updates & Compliance

    Payer Rule Updates & Compliance

    • Payer policy and code changes applied to the library on release
    • Pre-submission scrubbing against current payer edits
    • Audit-ready documentation behind every code and claim decision

Key Challenges We Solved

Hover a row to see what changed.

Why They Chose Us

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.

The Results

Every number below was measured in production after launch — not projected in a pitch deck.

15 days

Average Reimbursement Cycle — Down from 60 days

6%

Claim Rejection Rate — Down from 40%

98%

Coding Accuracy — Up from ~55%

$150K

Revenue Recovered from Denials — In the first year

Global presence

Three offices. One team.

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