Insurance operations · Open Dental practices · New England

Every patient verified before they walk in. Every claim chased until it’s paid.

Benefits verified two days ahead. Claims checked against them before they go out. Posting, follow-up, and appeals handled after.

Problems get caught before the claim leaves — not six weeks after it bounces.

Denials halved in 90 days, or we work free Open Dental only New England only HIPAA compliant, BAA signed first Month to month
THU 07/23  ·  18 APPOINTMENTS 17 verified · 1 flagged

MARTINEZ, ELENA

DELTA DENTAL PPO · GRP 4471190 · 07/23 10:40A
Verified 7/21
Maximums & coverage
Annual maximum$1,500$840 left
Deductible$50Met
Preventive / Basic / Major100 / 80 / 50%
Frequencies
Prophy D11102 / 12 moLAST 01/14/26
Bitewings D02741 / 12 moLAST 01/14/26
FMX D02101 / 36 moLAST 03/09/24
Perio maintenance D4910Flagged
Frequency history not returned by the payer. Called 7/21, callback requested — we'll confirm before the appointment.

ILLUSTRATIVE RECORD. NOT A REAL PATIENT.

01  ·  The problem

Insurance is five jobs, not one.

Verify the benefits. Build and send the claim. Post the payment when it comes, chase it when it doesn’t, and appeal it when they say no.

A large group staffs a billing office for all of this. In most practices it’s one person, working between phone calls.

So things slip. The quote is off by $400 and now it’s an awkward conversation. A crown pays $650 against a $720 contract and nobody has time to notice. It’s 4:40 and your coordinator is on hold with Delta of Massachusetts while a patient waits at the desk.

None of this is money you might have earned. It’s money you already earned — the crown is seated, the work is done — leaking out through five jobs nobody has time to do properly. It never arrives as one loss. It arrives as a hundred small ones, every month.

02  ·  What we do

We handle it all, from verification to paid.

Anything the payer won't confirm is marked, with the reason. Never a blank field, never a guess.

Your team’s part: check in patients and handle the few things we flag.

03  ·  What lands on your desk

The work is invisible when it’s working. These two aren’t.

Every morning, a brief you can read before your first patient. Every month, one page that says whether the number moved. Not a dashboard to log into.

MORNING BRIEF

THU 07/23 · 7:02A · IN YOUR INBOX
Every morning
Today’s schedule17 of 18 verified1 FLAGGED
Delta of MA callback 10:00 — Martinez perio historyWe’re on it
Posted yesterday$1,240
Underpayment caught — crown, $70 vs contractAppeal drafted
Needs you todayNothing

SCORECARD — JULY

ONE PAGE · FROM YOUR OPEN DENTAL DATA
Monthly
The guarantee number — eligibility denials
Baseline, from your audit6.4%
90-day target3.2%
This month3.1%Halved
Practice health
Days to payment19HEALTHY < 25
Claims aged past 60 days2LAST MONTH 11
Underpayments recovered$4126 CLAIMS

ILLUSTRATIVE NUMBERS. NOT A REAL PRACTICE.

04  ·  How it works

Software does the routine. People do the hard part.

What runs on software

Most verifications and status checks run electronically against the payer. Nothing is written to Open Dental that the payer didn’t confirm.

What needs a person

Some payers only answer phones, so a person sits on hold — ours, not yours. Appeals are written by someone who has read the chart.

What happens when we miss

We correct it the same day and trace what caused it — the payer or us. You’ll know because we’ll tell you: it’s in the Morning Brief too.

05  ·  Who it's for

Who this is for.

We only work with Open Dental practices in New England. That’s not a limitation we apologize for — it’s the reason the work is good.

A good fit
  • Running Open Dental
  • In New England — MA, NH, RI, VT, ME, or CT
  • PPO-heavy — most patients have insurance you have to chase
  • One to three doctors, insurance through one coordinator
Probably not
  • On any other practice management system — we'd rather say no than work in software we don't live in
  • Outside New England
  • Fee-for-service or membership plans — you don't have this problem
  • Anyone who wants software their team operates. This isn't that.

Not sure which side you're on? Email us the shape of your practice — we'll tell you if it isn't worth it.

06  ·  The free audit

Start here: what did the last 90 days cost you?

We pull your last 90 days of eligibility denials from your own Open Dental data — read-only, and you approve every step.

You get a report, not a pitch: which denials were preventable, what each one cost, and what would have stopped it. The report is yours to keep whether or not we ever work together. And if we do, it becomes the baseline the guarantee is measured against — your numbers, from your system, visible to both sides.

We onboard two practices a month, so audit slots are limited.

07  ·  Pricing

One price, however complicated your payers make it.

Here’s the arithmetic that matters. A crown that pays $650 against a $720 contract is $70 nobody had time to notice. A denied claim that ages out is the whole fee, written off. A quote that’s $400 wrong is a discount you never meant to give. Per-verification services charge $4 to $12 a head — and stop at verification, leaving the other four jobs on your coordinator’s desk.

How much of the fee does that add up to in your practice? That’s exactly what the free audit counts — and if your number doesn’t make the case, don’t hire us.

TierSizeMonthly
Solo Usually one dentist $2,500PER MONTH
Practice Two to three dentists $4,000PER MONTH
Group Four or more, or multi-location Quoted

No setup fee, no per-claim charges, no rush fees. Month to month — no long-term contract, cancel anytime.

The audit comes first, and it’s free. You see exactly what your denials cost — from your own Open Dental data — before you pay for anything.

08  ·  The guarantee

Denials halved in 90 days, or we work free.

If eligibility-related denials haven’t dropped by half within 90 days, we keep working free until they have.

How it’s measured, in plain English: the free audit sets your baseline — your last 90 days of denials, from your own Open Dental data. Ninety days in, we count again, same method, same system. Both sides look at the same numbers, and the numbers are yours.

A guarantee is only as good as the incentive behind it, so here’s ours: we onboard two practices a month. Few enough that we cannot afford a single one where this doesn’t work.

Where you stand, at every point: ·  The free audit comes first — the report is yours to keep either way ·  BAA signed before we see a record ·  Month to month, cancel anytime ·  Denials halved in 90 days, or we work free
09  ·  Security and questions

Before you hand anyone your schedule.

How do you access our system?

Through Open Dental's own API — no screen-sharing, no borrowed logins. For the audit: read-only access to claims and denial history, and you approve every step. For the service: read access to the schedule, write access to patient records, nothing else. A BAA is signed before any of it.

Why only Open Dental? Why only New England?

Because depth is the product. We live in one system instead of being shallow in six, and we work one region's payers — Delta of Massachusetts, Northeast Delta Dental, and the Blue Cross plans your coordinator already knows. If you're on different software or outside New England, we're the wrong choice, and we'll tell you so.

We already have a biller.

Keep them — and give them their afternoons back. We take the hold music, the posting, and the appeals backlog. They keep the judgment calls, the patient conversations, and the parts of the job that need someone in the room. Practices with a good coordinator get more from this, not less: flags get handled the same hour.

Do we need new software?

No. Nothing to install, no logins for your team, no change to how anyone works. Results appear on the patient record you already open.

Is this HIPAA compliant?

Yes. A BAA is signed before any patient data moves. Encrypted in transit and at rest, access logged, minimum necessary data only — the schedule and the fields required to verify benefits.

Who actually does the work?

Eligibility runs electronically against the payer. Where a payer doesn't expose data electronically, we retrieve it by portal or phone, using automation for routine calls. Anything automation can't resolve goes to a person. Nothing gets written to your system that the payer didn't confirm.

What if you get something wrong?

We correct the record the same day it’s reported, and we trace what caused it — whether that was the payer or us. Every miss gets a root cause, not an excuse.

What if benefits change after you verify?

Verification reflects what the payer reported at the time. For appointments booked far out, we re-verify inside the window rather than relying on a stale check.

How is this different from a service that charges per verification?

Different scope. A per-verification rate usually buys an eligibility check, with your team still working the portals, frequencies and exceptions. This is the whole task, ending in your system.

Do you do billing and claims too?

Yes — that's the point. Every engagement starts with verification, because bad benefits data is where most denials begin. The rest of the cycle runs on the same system.

One email starts the audit.

Tell us your payer mix and roughly how many patients a day. If you're on Open Dental in New England, we'll set up your free 90-day denial audit — read-only, and the report is yours to keep either way. Every email is read and answered by a person, and if it isn't a fit, we'll say so and tell you why.

Get the free audit HELLO@CERTABILLING.COM